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Authors: Z. Zaman Asam, M. Ajmal, R. Saeed, H. Miraj, M. Muhammad Ahtisham, B. Hameed, A. -Sattar Nizami

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In Pakistan, environmental degradation and consequent human health deterioration has rapidly accelerated in the past decade due to solid waste mismanagement. As the situation worsens with time, establishment of proper waste management practices is urgently needed especially in semi urban and rural areas of Pakistan. This study uses a concept of Waste Bank, which involves a transfer station for collection of sorted waste fractions and its delivery to the targeted market such as recycling industries, biogas plants, composting facilities etc. The management efficiency and effectiveness of Waste Bank depend strongly on the proficient sorting and collection of solid waste fractions at household level. However, the social attitude towards such a solution in semi urban/rural areas of Pakistan demands certain prerequisites to make it workable. Considering these factors the objectives of this study are to: [A] Obtain reliable data about quantity and characteristics of generated waste to define feasibility of business and design factors, such as required storage area, retention time, transportation frequency of the system etc. [B] Analyze the effects of various social factors on waste generation to foresee future projections. [C] Quantify the improvement in waste sorting efficiency after awareness campaign. We selected Gujrat city of Central Punjab province of Pakistan as it is semi urban adjoined by rural areas. A total of 60 houses (20 from each of the three selected colonies), belonging to different social status were selected. Awareness sessions about waste segregation were given through brochures and individual lectures in each selected household. Sampling of waste, that households had attempted to sort, was then carried out in the three colored bags that were provided as part of the awareness campaign. Finally, refined waste sorting, weighing of various fractions and measurement of dry mass was performed in environmental laboratory using standard methods. It was calculated that sorting efficiency of waste improved from 0 to 52% as a result of the awareness campaign. The generation of waste (dry mass basis) on average from one household was 460 kg/year whereas per capita generation was 68 kg/year. Extrapolating these values for Gujrat Tehsil, the total waste generation per year is calculated to be 101921 tons dry mass (DM). Characteristics found in waste were (i) organic decomposable (29.2%, 29710 tons/year DM), (ii) recyclables (37.0%, 37726 tons/year DM) that included plastic, paper, metal and glass, and (iii) trash (33.8%, 34485 tons/year DM) that mainly comprised of polythene bags, medicine packaging, pampers and wrappers. Waste generation was more in colonies with comparatively higher income and better living standards. In future, data collection for all four seasons and improvements due to expansion of awareness campaign to educational institutes will be quantified. This waste management system can potentially fulfill vital sustainable development goals (e.g. clean water and sanitation), reduce the need to harvest fresh resources from the ecosystem, create business and job opportunities and consequently solve one of the most pressing environmental issues of the country.

Keywords: integrated solid waste management, waste segregation, waste bank, community development

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Authors: Abdullah S. Alghamdi, Khaled Alghamdi, Richard O. Jenkins, Parvez I. Haris

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Background: Unhealthy diet is one of the modifiable risk factors for developing type 2 diabetes mellitus (T2DM). Improvement in diet can be beneficial for countering diabetes. For example, HbA1c, an important biomarker for diabetes, can be reduced by 1.1% through only alteration in diet. Ramadan fasting has been reported to provide positive health benefits. However, optimal benefits are not achieved, often due to poor dietary habits and lifestyle. There is a need to better understand the dietary habits of people fasting during Ramadan, so that necessary improvements can be made to develop this form of fasting as a non-pharmacological strategy for management and prevention of T2DM. Aim: This study aimed to assess the dietary patterns of Saudi adult patients with T2DM over three different periods (before, during, and after Ramadan) and relate this to HbA1c levels. Methods: This study recruited 82 Saudi with T2DM, who chose to fast during Ramadan, from the Endocrine and Diabetic Centre of Al Iman General Hospital, Riyadh, Saudi Arabia. Ethical approvals for the study were obtained from De Montfort University and Saudi Ministry of Health. Dietary patterns were assessed by a self-administered questionnaire in each period. This assessment included the diet type and frequency. Blood samples were collected in each period for determination of HbA1c. Results: The number of meals per day for the participants significantly decreased during Ramadan (P < 0.001). The consumption of fruit and vegetables significantly increased during Ramadan (P = 0.017). However, the consumption of sugary drinks significantly increased during and after Ramadan (P = 0.005). Approximately 60% of the patients indicated that they ate sugary foods at least once per week. The consumption of bread and rice was reported to be at least two times per week. The consumption of rice significantly reduced during Ramadan (P = 0.002). The mean HbA1c significantly varied between periods (P = 0.001), with lowest level during Ramadan compared to before and after Ramadan. The increase in the consumption of fruits and vegetables had a medium effect size on the reduction in HbA1c during Ramadan. There was a variance of 7.7% in the mean difference in HbA1c levels between groups (who changed their fruit and vegetable consumption) which can be accounted for by the increase in the consumption of fruits and vegetables. Likewise, 9.3% of the variance in the mean HbA1c difference between the groups was accounted for by a decrease in the consumption of rice. Conclusion: The increase in the frequency of fruit and vegetables intake, and especially the reduction in the frequency of rice consumption, during Ramadan produce beneficial effects in reducing HbA1c level. Therefore, further improving the dietary habits of patients with T2DM, such as reducing their sugary drinks intake, may help them to obtain greater benefits from Ramadan fasting in the management of their diabetes. It is recommended that dietary guidance is provided to the public to maximise health benefits through Ramadan fasting.

Keywords: Diabetes, Diet, Fasting, HbA1c, Ramadan

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Authors: Mohsen Hababalahi, Morteza Bastami

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Buried pipeline damage correlations are critical part of loss estimation procedures applied to lifelines for future earthquakes. The vulnerability of buried pipelines against earthquake and liquefaction has been observed during some of previous earthquakes and there are a lot of comprehensive reports about this event. One of the main reasons for impairment of buried pipelines during earthquake is liquefaction. Necessary conditions for this phenomenon are loose sandy soil, saturation of soil layer and earthquake intensity. Because of this fact that pipelines structure are very different from other structures (being long and having light mass) by paying attention to the results of previous earthquakes and compare them with other structures, it is obvious that the danger of liquefaction for buried pipelines is not high risked, unless effective parameters like earthquake intensity and non-dense soil and other factors be high. Recent liquefaction researches for buried pipeline include experimental and theoretical ones as well as damage investigations during actual earthquakes. The damage investigations have revealed that a damage ratio of pipelines (Number/km ) has much larger values in liquefied grounds compared with one in shaking grounds without liquefaction according to damage statistics during past severe earthquakes, and that damages of joints and pipelines connected with manholes were remarkable. The purpose of this research is numerical study of buried pipelines under the effect of liquefaction by case study of the 2013 Dashti (Iran) earthquake. Water supply and electrical distribution systems of this township interrupted during earthquake and water transmission pipelines were damaged severely due to occurrence of liquefaction. The model consists of a polyethylene pipeline with 100 meters length and 0.8 meter diameter which is covered by light sandy soil and the depth of burial is 2.5 meters from surface. Since finite element method is used relatively successfully in order to solve geotechnical problems, we used this method for numerical analysis. For evaluating this case, some information like geotechnical information, classification of earthquakes levels, determining the effective parameters in probability of liquefaction, three dimensional numerical finite element modeling of interaction between soil and pipelines are necessary. The results of this study on buried pipelines indicate that the effect of liquefaction is function of pipe diameter, type of soil, and peak ground acceleration. There is a clear increase in percentage of damage with increasing the liquefaction severity. The results indicate that although in this form of the analysis, the damage is always associated to a certain pipe material, but the nominally defined “failures” include by failures of particular components (joints, connections, fire hydrant details, crossovers, laterals) rather than material failures. At the end, there are some retrofit suggestions in order to decrease the risk of liquefaction on buried pipelines.

Keywords: liquefaction, buried pipelines, lifelines, earthquake, finite element method

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Authors: S. Chowdhury, A. Corlett

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Large tsunamis strike the British Columbia coast every few hundred years. The Cascadia Subduction Zone, which extends along the Pacific coast from Vancouver Island to Northern California is one of the most seismically active regions in Canada. Significant earthquakes have occurred in this region, including the 1700 Cascade Earthquake with an estimated magnitude of 9.2. Based on geological records, experts have predicted a 'great earthquake' of a similar magnitude within this region may happen any time. This earthquake is expected to generate a large tsunami that could impact the coastal communities on Vancouver Island. Since many of these communities are in remote locations, they are more likely to be vulnerable, as the post-earthquake relief efforts would be impacted by the damage to critical road infrastructures. To assess the coastal vulnerability within these communities, a hydrodynamic model has been developed using MIKE-21 software. We have considered a 500 year probabilistic earthquake design criteria including the subsidence in this model. The bathymetry information was collected from Canadian Hydrographic Services (CHS), and National Oceanic Atmospheric and Administration (NOAA). The arial survey was conducted using a Cessna-172 aircraft for the communities, and then the information was converted to generate a topographic digital elevation map. Both survey information was incorporated into the model, and the domain size of the model was about 1000km x 1300km. This model was calibrated with the tsunami occurred off the west coast of Moresby Island on October 28, 2012. The water levels from the model were compared with two tide gauge stations close to the Vancouver Island and the output from the model indicates the satisfactory result. For this study, the design water level was considered as High Water Level plus the Sea Level Rise for 2100 year. The hourly wind speeds from eight directions were collected from different wind stations and used a 200-year return period wind speed in the model for storm events. The regional model was set for 12 hrs simulation period, which takes more than 16 hrs to complete one simulation using double Xeon-E7 CPU computer plus a K-80 GPU. The boundary information for the local model was generated from the regional model. The local model was developed using a high resolution mesh to estimate the coastal flooding for the communities. It was observed from this study that many communities will be effected by the Cascadia tsunami and the inundation maps were developed for the communities. The infrastructures inside the coastal inundation area were identified. Coastal vulnerability planning and resilient design solutions will be implemented to significantly reduce the risk.

Keywords: tsunami, coastal flooding, coastal vulnerable, earthquake, Vancouver, wave propagation

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Authors: Celeste E. van Rinsum, Sanne M. P. L. Gerards, Geert M. Rutten, Ien A. M. van de Goor, Stef P. J. Kremers

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Combined lifestyle interventions have shown to be effective in changing and maintaining behavioral lifestyle changes and reducing overweight and obesity. A lifestyle coach is expected to promote lifestyle changes in adults related to physical activity and diet. The present Coaching on Lifestyle (CooL) study examined participants’ physical activity level, dietary behavioral, and motivational changes immediately after the intervention and at 1.5 years after baseline. In CooL intervention a lifestyle coach coaches individuals from eighteen years and older with (a high risk of) obesity in group and individual sessions. In addition a process evaluation was conducted in order to examine the implementation process and to be able to interpret the changes within the participants. This action-oriented research has a pre-post design. Participants of the CooL intervention (N = 200) completed three questionnaires: at baseline, immediately after the intervention (on average after 44 weeks), and at 1.5 years after baseline. T-tests and linear regressions were conducted to test self-reported changes in physical activity (IPAQ), dietary behaviors, their quality of motivation for physical activity (BREQ-3) and for diet (REBS), body mass index (BMI), and quality of life (EQ-5D-3L). For the process evaluation, we used individual and group interviews, observations and document analyses to gain insight in the implementation process (e.g. the recruitment) and how the intervention was valued by the participants, lifestyle coaches, and referrers. The study is currently ongoing and therefore the results presented here are preliminary. On average, the participants that finished the intervention and those that have completed the long-term measurement improved their level of vigorous-intense physical activity, sedentary behavior, sugar-sweetened beverage consumption and BMI. Mixed results were observed in motivational regulation for physical activity and nutrition. Moreover, an improvement on the quality of life dimension anxiety/depression was found, also in the long-term. All the other constructs did not show significant change over time. The results of the process evaluation have shown that recruitment of clients was difficult. Participants evaluated the intervention positively and the lifestyle coaches have continuously adapted the structure and contents of the intervention throughout the study period, based on their experiences and feedback from research. Preliminary results indicate that the CooL-intervention may have beneficial effects on overweight and obese participants in terms of energy balance-related behaviors, weight reduction, and quality of life. Recruitment of participants and embedding the position of the lifestyle coach in traditional care structures is challenging.

Keywords: combined lifestyle intervention, effect evaluation, lifestyle coaching, process evaluation, overweight, the Netherlands

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Authors: Seyed Hamed Mousavi, Juha M. Hijmans, Reza Rajabi, Ron Diercks, Johannes Zwerver, Henk van der Worp

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Introduction: Running is one of the most popular sports activity among people. Improper sagittal plane ankle, knee and hip kinematics are considered to be associated with the increase of injury risk in runners. Motion assessing smart-phone applications are increasingly used to measure kinematics both in the field and laboratory setting, as they are cheaper, more portable, accessible, and easier to use relative to 3D motion analysis system. The aims of this study are 1) to compare the results of 3D gait analysis system and CE; 2) to evaluate the test-retest and intra-rater reliability of coach’s eye (CE) app for the sagittal plane hip, knee, and ankle angles in the touchdown and toe-off while running. Method: Twenty subjects participated in this study. Sixteen reflective markers and cluster markers were attached to the subject’s body. Subjects were asked to run at a self-selected speed on a treadmill. Twenty-five seconds of running were collected for analyzing kinematics of interest. To measure sagittal plane hip, knee and ankle joint angles at touchdown (TD) and toe off (TO), the mean of first ten acceptable consecutive strides was calculated for each angle. A smartphone (Samsung Note5, android) was placed on the right side of the subject so that whole body was simultaneously filmed with 3D gait system during running. All subjects repeated the task with the same running speed after a short interval of 5 minutes in between. The CE app, installed on the smartphone, was used to measure the sagittal plane hip, knee and ankle joint angles at touchdown and toe off the stance phase. Results: Intraclass correlation coefficient (ICC) was used to assess test-retest and intra-rater reliability. To analyze the agreement between 3D and 2D outcomes, the Bland and Altman plot was used. The values of ICC were for Ankle at TD (TRR=0.8,IRR=0.94), ankle at TO (TRR=0.9,IRR=0.97), knee at TD (TRR=0.78,IRR=0.98), knee at TO (TRR=0.9,IRR=0.96), hip at TD (TRR=0.75,IRR=0.97), hip at TO (TRR=0.87,IRR=0.98). The Bland and Altman plots displaying a mean difference (MD) and ±2 standard deviation of MD (2SDMD) of 3D and 2D outcomes were for Ankle at TD (MD=3.71,+2SDMD=8.19, -2SDMD=-0.77), ankle at TO (MD=-1.27, +2SDMD=6.22, -2SDMD=-8.76), knee at TD (MD=1.48, +2SDMD=8.21, -2SDMD=-5.25), knee at TO (MD=-6.63, +2SDMD=3.94, -2SDMD=-17.19), hip at TD (MD=1.51, +2SDMD=9.05, -2SDMD=-6.03), hip at TO (MD=-0.18, +2SDMD=12.22, -2SDMD=-12.59). Discussion: The ability that the measurements are accurately reproduced is valuable in the performance and clinical assessment of outcomes of joint angles. The results of this study showed that the intra-rater and test-retest reliability of CE app for all kinematics measured are excellent (ICC ≥ 0.75). The Bland and Altman plots display that there are high differences of values for ankle at TD and knee at TO. Measuring ankle at TD by 2D gait analysis depends on the plane of movement. Since ankle at TD mostly occurs in the none-sagittal plane, the measurements can be different as foot progression angle at TD increases during running. The difference in values of the knee at TD can depend on how 3D and the rater detect the TO during the stance phase of running.

Keywords: reliability, running, sagittal plane, two dimensional

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Authors: Malab Sana Balouch, Meenakshi Nayar

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Hemispatial Neglect is a common disorder primarily associated with right hemispheric stroke, in the acute phase of which it can occur up to 82% of the time. Such individuals fail to acknowledge or respond to people and objects in their left field of vision due to deficits in attention and awareness. Persistent hemispatial neglect significantly impedes post-stroke recovery, leading to longer hospital stays post-stroke, increased functional dependency, longer-term disability in ADLs and increased risk of falls. Recently, evidence has emerged for the use of dopamine agonist Rotigotine in neglect. The aim of our Quality Improvement Project (QIP) is to evaluate and better the current protocols and practice in assessment, documentation and management of neglect and rotigotine use at the Neurorehabilitation unit at Charing Cross Hospital (CNRU). In addition, it brings light to rotigotine use in the management of hemispatial neglect and paves the way for future research in the field. Our QIP was based in the CNRU. All patients admitted to the CNRU suffering from a right-sided stroke from 2nd of February 2018 to the 2nd of February 2021 were included in the project. Each patient’s multidisciplinary team report and hospital notes were searched for information, including bio-data, fulfilment of the inclusion criteria (having hemispatial neglect) and data related to rotigotine use. This includes whether or not the drug was administered, any contraindications to drug in patients that did not receive it, and any therapeutic benefits(subjective or objective improvement in neglect) in those that did receive the rotigotine. Data was simultaneously entered into excel sheet and further statistical analysis was done on SPSS 20.0. Out of 80 patients suffering from right sided strokes, 72.5% were infarcts and 27.5% were hemorrhagic strokes, with vast majority of both types of strokes were in the middle cerebral artery territory (MCA). A total of 31 (38.8%) of our patients were noted to have hemispatial neglect, with the highest number of cases being associated with MCA strokes. Almost half of our patients with MCA strokes suffered from neglect. Neglect was more common in male patients. Out of the 31 patients suffering from visuospatial neglect, only 16% actually received rotigotine and 80% of them were noted to have an objective improvement in their neglect tests and 20% revealed subjective improvement. After thoroughly going through neglect-associated documentation, the following recommendations/plans were put in place for the future. We plan to liaise with the occupational therapy team at our rehab unit to set a battery of tests that would be done on all patients presenting with neglect and recommend clear documentation of outcomes of each neglect screen under it. Also to create two proformas; one for the therapy team to aid in systematic documentation of neglect screens done prior to and after rotigotine administration and a second proforma for the medical team with clear documentation of rotigotine use, its benefits and any contraindications if not administered.

Keywords: hemispatial Neglect, right hemispheric stroke, rotigotine, neglect, dopamine agonist

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Authors: Miguel Angel Calvo Salve

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This qualitative and quantitative study will identify the impact of tourism pressure on the intangible cultural heritage of the pilgrim route of El Camino de Santiago (Saint James Way) and propose an approach to a sustainable touristic model for these Cultural Routes. Since 1993, the Spanish Section of the Pilgrim Route of El Camino de Santiago has been on the World Heritage List. In 1994, the International Committee on Cultural Routes (CIIC-ICOMOS) initiated its work with the goal of studying, preserving, and promoting the cultural routes and their significance as a whole. Another ICOMOS group, the Charter on Cultural Routes, pointed out in 2008 the importance of both tangible and intangible heritage and the need for a holistic vision in preserving these important cultural assets. Tangible elements provide a physical confirmation of the existence of these cultural routes, while the intangible elements serve to give sense and meaning to it as a whole. Intangible assets of a Cultural Route are key to understanding the route's significance and its associated heritage values. Like many pilgrim routes, the Route to Santiago, as the result of a long evolutionary process, exhibits and is supported by intangible assets, including hospitality, cultural and religious expressions, music, literature, and artisanal trade, among others. A large increase in pilgrims walking the route, with very different aims and tourism pressure, has shown how the dynamic links between the intangible cultural heritage and the local inhabitants along El Camino are fragile and vulnerable. Economic benefits for the communities and population along the cultural routes are commonly fundamental for the micro-economies of the people living there, substituting traditional productive activities, which, in fact, modifies and has an impact on the surrounding environment and the route itself. Consumption of heritage is one of the major issues of sustainable preservation promoted with the intention of revitalizing those sites and places. The adaptation of local communities to new conditions aimed at preserving and protecting existing heritage has had a significant impact on immaterial inheritance. Based on questionnaires to pilgrims, tourists and local communities along El Camino during the peak season of the year, and using official statistics from the Galician Pilgrim’s Office, this study will identify the risk and threats to El Camino de Santiago as a Cultural Route. The threats visible nowadays due to the impact of mass tourism include transformations of tangible heritage, consumerism of the intangible, changes of local activities, loss in the authenticity of symbols and spiritual significance, and pilgrimage transformed into a tourism ‘product’, among others. The study will also approach some measures and solutions to mitigate those impacts and better preserve this type of cultural heritage. Therefore, this study will help the Route services providers and policymakers to better preserve the Cultural Route as a whole to ultimately improve the satisfying experience of pilgrims.

Keywords: cultural routes, El Camino de Santiago, impact of tourism, intangible heritage

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Authors: Antoni Grau, Yolanda Bolea, Alberto Sanfeliu

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Mobile robots can be used in many different applications, including mapping, search, rescue, reconnaissance, hazard detection, and carpet cleaning, exploration, etc. However, they are limited due to their reliance on traditional energy sources such as electricity and oil which cannot always provide a convenient energy source in all situations. In an ever more eco-conscious world, solar energy offers the most environmentally clean option of all energy sources. Electricity presents threats of pollution resulting from its production process, and oil poses a huge threat to the environment. Not only does it pose harm by the toxic emissions (for instance CO2 emissions), it produces the combustion process necessary to produce energy, but there is the ever present risk of oil spillages and damages to ecosystems. Solar energy can help to mitigate carbon emissions by replacing more carbon intensive sources of heat and power. The challenge of this work is to propose the design and the implementation of electric battery recharge stations. Those recharge docks are based on the use of renewable energy such as solar energy (with photovoltaic panels) with the object to reduce the CO2 emissions. In this paper, a comparative study of the CO2 emission productions (from the use of different energy sources: natural gas, gas oil, fuel and solar panels) in the charging process of the Segway PT batteries is carried out. To make the study with solar energy, a photovoltaic panel, and a Buck-Boost DC/DC block has been used. Specifically, the STP005S-12/Db solar panel has been used to carry out our experiments. This module is a 5Wp-photovoltaic (PV) module, configured with 36 monocrystalline cells serially connected. With those elements, a battery recharge station is made to recharge the robot batteries. For the energy storage DC/DC block, a series of ultracapacitors have been used. Due to the variation of the PV panel with the temperature and irradiation, and the non-integer behavior of the ultracapacitors as well as the non-linearities of the whole system, authors have been used a fractional control method to achieve that solar panels supply the maximum allowed power to recharge the robots in the lesser time. Greenhouse gas emissions for production of electricity vary due to regional differences in source fuel. The impact of an energy technology on the climate can be characterised by its carbon emission intensity, a measure of the amount of CO2, or CO2 equivalent emitted by unit of energy generated. In our work, the coal is the fossil energy more hazardous, providing a 53% more of gas emissions than natural gas and a 30% more than fuel. Moreover, it is remarkable that existing fossil fuel technologies produce high carbon emission intensity through the combustion of carbon-rich fuels, whilst renewable technologies such as solar produce little or no emissions during operation, but may incur emissions during manufacture. The solar energy thus can help to mitigate carbon emissions.

Keywords: autonomous robots, CO2 emissions, DC/DC buck-boost, solar energy

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Authors: Ponshano Kaselekela, Simooya O. Oscar, Lunshano Boyd

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The Copperbelt University Health Services (CBUHS) was designated by the Zambia Medicines Regulatory Authority (ZAMRA), formally the Pharmaceutical Regulatory Authority (PRA) as a regional pharmacovigilance centre to carryout activities of drug safety monitoring in four provinces in Zambia. CBUHS’s mandate included stimulating the reporting of adverse drug reactions (ADRs), as well as collecting and collating ADR reports from health institutions in the four provinces. This report covers the researchers’ experiences from May 2008 to September, 2016. The main objectives are 1) to monitor ADRs in the Zambian population, 2) to disseminate information to all health professionals in the region advising that the CBU health was a centre for reporting ADRs in the region, 3) to monitor polypharmacy as well as the benefit-risk profile of medicines, 4) to generate independent, evidence based recommendations on the safety of medicines, 5) to support ZAMRA in formulating safety related regulatory decisions for medicines, and 6) to communicate findings with all key stakeholders. The methodology involved monthly visits, beginning in early May 2008 to September, 2016, by the CBUHS to health institutions in the programme areas. Activities included holding discussions with health workers, distribution of ADR forms and collection of ADRs reports. These reports, once collected, were documented and assessed at the CBUHS. A report was then prepared for ZAMRA on quarterly basis. At ZAMRA, serious ADRs were noted and recommendations made to the Ministry of Health of the Republic of Zambia. The results show that 2,600 ADRs reports were received at the pharmacovigilance regional centre. Most of the ADRs reports that received were due to antiretroviral drugs, as well as a few from anti-malarial drugs like Artemether/Lumefantrine – Coartem®. Three hundred and twelve ADRs were entered in the Uppsala Monitoring Centre WHO Vigiflow for further analysis. It was concluded that in general, 2008-16 were exciting years for the pharmacovigilance group at CBUHS. From a very tentative beginning, a lot of strides were made and contacts established with healthcare facilities in the region. The researchers were encouraged by the support received from the Copperbelt University management, the motivation provided by ZAMRA and most importantly the enthusiasm of health workers in all the health care facilities visited. As a centre for drug safety in Zambia, the results show it achieves its objectives for monitoring ADRs, Pharmacovigilance (drug safety monitoring), and activities of monitoring ADRs as well as preventing them. However, the centre faces critical challenges caused by erratic funding that prevents the smooth running of the programme.

Keywords: adverse drug reactions, drug safety, monitoring, pharmacovigilance

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Authors: Suman Som, Abhijit Maity, Sunil B. Daschakraborty, Sujit Chaudhuri, Manik Pradhan

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Background: Helicobacter pylori is a common and important human pathogen and the primary cause of peptic ulcer disease and gastric cancer. Currently H. pylori infection is detected by both invasive and non-invasive way but the diagnostic accuracy is not up to the mark. Aim: To set up an optimal diagnostic cut-off value of 13C-Urea Breath Test to detect H. pylori infection and evaluate a novel c-PDR methodology to overcome of inconclusive grey zone. Materials and Methods: All 83 subjects first underwent upper-gastrointestinal endoscopy followed by rapid urease test and histopathology and depending on these results; we classified 49 subjects as H. pylori positive and 34 negative. After an overnight, fast patients are taken 4 gm of citric acid in 200 ml water solution and 10 minute after ingestion of the test meal, a baseline exhaled breath sample was collected. Thereafter an oral dose of 75 mg 13C-Urea dissolved in 50 ml water was given and breath samples were collected upto 90 minute for 15 minute intervals and analysed by laser based high precisional cavity enhanced spectroscopy. Results: We studied the excretion kinetics of 13C isotope enrichment (expressed as δDOB13C ‰) of exhaled breath samples and found maximum enrichment around 30 minute of H. pylori positive patients, it is due to the acid mediated stimulated urease enzyme activity and maximum acidification happened within 30 minute but no such significant isotopic enrichment observed for H. pylori negative individuals. Using Receiver Operating Characteristic (ROC) curve an optimal diagnostic cut-off value, δDOB13C ‰ = 3.14 was determined at 30 minute exhibiting 89.16% accuracy. Now to overcome grey zone problem we explore percentage dose of 13C recovered per hour, i.e. 13C-PDR (%/hr) and cumulative percentage dose of 13C recovered, i.e. c-PDR (%) in exhaled breath samples for the present 13C-UBT. We further explored the diagnostic accuracy of 13C-UBT by constructing ROC curve using c-PDR (%) values and an optimal cut-off value was estimated to be c-PDR = 1.47 (%) at 60 minute, exhibiting 100 % diagnostic sensitivity , 100 % specificity and 100 % accuracy of 13C-UBT for detection of H. pylori infection. We also elucidate the gastric emptying process of present 13C-UBT for H. pylori positive patients. The maximal emptying rate found at 36 minute and half empting time of present 13C-UBT was found at 45 minute. Conclusions: The present study exhibiting the importance of c-PDR methodology to overcome of grey zone problem in 13C-UBT for accurate determination of infection without any risk of diagnostic errors and making it sufficiently robust and novel method for an accurate and fast non-invasive diagnosis of H. pylori infection for large scale screening purposes.

Keywords: 13C-Urea breath test, c-PDR methodology, grey zone, Helicobacter pylori

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Authors: Shofiayuningtyas Luftiani

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Some private schools in Indonesia started integrating the online program Gizmos in the teaching-learning process. Gizmos was developed to supplement the existing curriculum by integrating it into the instructional programs. The program has some features using an inquiry-based simulation, in which students conduct exploration by using a worksheet while teachers use the teacher guidelines to direct and assess students’ performance In this study, the discussion about Gizmos highlights its features as the assessment media of mathematics learning for secondary school students. The discussion is based on the case study and literature review from the Indonesian context. The purpose of applying Gizmos as an assessment media refers to the diagnostic assessment. As a part of the diagnostic assessment, the teachers review the student exploration sheet, analyze particularly in the students’ difficulties and consider findings in planning future learning process. This assessment becomes important since the teacher needs the data about students’ persistent weaknesses. Additionally, this program also helps to build student’ understanding by its interactive simulation. Currently, the assessment over-emphasizes the students’ answers in the worksheet based on the provided answer keys while students perform their skill in translating the question, doing the simulation and answering the question. Whereas, the assessment should involve the multiple perspectives and sources of students’ performance since teacher should adjust the instructional programs with the complexity of students’ learning needs and styles. Consequently, the approach to improving the assessment components is selected to challenge the current assessment. The purpose of this challenge is to involve not only the cognitive diagnosis but also the analysis of skills and error. Concerning the selected setting for this diagnostic assessment that develops the combination of cognitive diagnosis, skills analysis and error analysis, the teachers should create an assessment rubric. The rubric plays the important role as the guide to provide a set of criteria for the assessment. Without the precise rubric, the teacher potentially ineffectively documents and follows up the data about students at risk of failure. Furthermore, the teachers who employ the program of Gizmos as the diagnostic assessment might encounter some obstacles. Based on the condition of assessment in the selected setting, the obstacles involve the time constrain, the reluctance of higher teaching burden and the students’ behavior. Consequently, the teacher who chooses the Gizmos with those approaches has to plan, implement and evaluate the assessment. The main point of this assessment is not in the result of students’ worksheet. However, the diagnostic assessment has the two-stage process; the process to prompt and effectively follow-up both individual weaknesses and those of the learning process. Ultimately, the discussion of Gizmos as the media of the diagnostic assessment refers to the effort to improve the mathematical learning process.

Keywords: diagnostic assessment, error analysis, Gizmos online program, skills analysis

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Authors: Ed de Jong

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Avantium is a leading technology development company and a frontrunner in renewable chemistry. Avantium develops disruptive technologies that enable the production of sustainable high value products from renewable materials and actively seek out collaborations and partnerships with like-minded companies and academic institutions globally, to speed up introductions of chemical innovations in the marketplace. In addition, Avantium helps companies to accelerate their catalysis R&D to improve efficiencies and deliver increased sustainability, growth, and profits, by providing proprietary systems and services to this regard. Many chemical building blocks and materials can be produced from biomass, nowadays mainly from 1st generation based carbohydrates, but potential for competition with the human food chain leads brand-owners to look for strategies to transition from 1st to 2nd generation feedstock. The use of non-edible lignocellulosic feedstock is an equally attractive source to produce chemical intermediates and an important part of the solution addressing these global issues (Paris targets). Avantium’s Dawn Technology™ separates the glucose, mixed sugars, and lignin available in non-food agricultural and forestry residues such as wood chips, wheat straw, bagasse, empty fruit bunches or corn stover. The resulting very pure lignin is dense in energy and can be used for energy generation. However, such a material might preferably be deployed in higher added value applications. Bitumen, which is fossil based, are mostly used for paving applications. Traditional hot mix asphalt emits large quantities of the GHG’s CO₂, CH₄, and N₂O, which is unfavorable for obvious environmental reasons. Another challenge for the bitumen industry is that the petrochemical industry is becoming more and more efficient in breaking down higher chain hydrocarbons to lower chain hydrocarbons with higher added value than bitumen. This has a negative effect on the availability of bitumen. The asphalt market, as well as governments, are looking for alternatives with higher sustainability in terms of GHG emission. The usage of alternative sustainable binders, which can (partly) replace the bitumen, contributes to reduce GHG emissions and at the same time broadens the availability of binders. As lignin is a major component (around 25-30%) of lignocellulosic material, which includes terrestrial plants (e.g., trees, bushes, and grass) and agricultural residues (e.g., empty fruit bunches, corn stover, sugarcane bagasse, straw, etc.), it is globally highly available. The chemical structure shows resemblance with the structure of bitumen and could, therefore, be used as an alternative for bitumen in applications like roofing or asphalt. Applications such as the use of lignin in asphalt need both fundamental research as well as practical proof under relevant use conditions. From a fundamental point of view, rheological aspects, as well as mixing, are key criteria. From a practical point of view, behavior in real road conditions is key (how easy can the asphalt be prepared, how easy can it be applied on the road, what is the durability, etc.). The paper will discuss the fundamentals of the use of lignin as bitumen replacement as well as the status of the different demonstration projects in Europe using lignin as a partial bitumen replacement in asphalts and will especially present the results of using Dawn Technology™ lignin as partial replacement of bitumen.

Keywords: biorefinery, wood fractionation, lignin, asphalt, bitumen, sustainability

Procedia PDF Downloads 137

Authors: Zdzislaw Kaminski, Zbigniew Czyz, Krzysztof Skiba

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This paper discusses the CFD simulation of a flow around a rotor of a Vertical Axis Wind Turbine. Numerical simulation, unlike experiments, enables us to validate project assumptions when it is designed and avoid a costly preparation of a model or a prototype for a bench test. CFD simulation enables us to compare characteristics of aerodynamic forces acting on rotor working surfaces and define operational parameters like torque or power generated by a turbine assembly. This research focused on the rotor with the blades capable of modifying their working surfaces, i.e. absorbing wind kinetic energy. The operation of this rotor is based on adjusting angular aperture α of the top and bottom parts of the blades mounted on an axis. If this angular aperture α increases, the working surface which absorbs wind kinetic energy also increases. The operation of turbines is characterized by parameters like the angular aperture of blades, power, torque, speed for a given wind speed. These parameters have an impact on the efficiency of assemblies. The distribution of forces acting on the working surfaces in our turbine changes according to the angular velocity of the rotor. Moreover, the resultant force from the force acting on an advancing blade and retreating blade should be as high as possible. This paper is part of the research to improve an efficiency of a rotor assembly. Therefore, using simulation, the courses of the above parameters were studied in three full rotations individually for each of the blades for three angular apertures of blade working surfaces, i.e. 30 °, 60 °, 90 °, at three wind speeds, i.e. 4 m / s, 6 m / s, 8 m / s and rotor speeds ranging from 100 to 500 rpm. Finally, there were created the characteristics of torque coefficients and power as a function of time for each blade separately and for the entire rotor. Accordingly, the correlation between the turbine rotor power as a function of wind speed for varied values of rotor rotational speed. By processing this data, the correlation between the power of the turbine rotor and its rotational speed for each of the angular aperture of the working surfaces was specified. Finally, the optimal values, i.e. of the highest output power for given wind speeds were read. The research results in receiving the basic characteristics of turbine rotor power as a function of wind speed for the three angular apertures of the blades. Given the nature of rotor operation, the growth in the output turbine can be estimated if angular aperture of the blades increases. The controlled adjustment of angle α enables a smooth adjustment of power generated by a turbine rotor. If wind speed is significant, this type of adjustment enables this output power to remain at the same level (by reducing angle α) with no risk of damaging a construction. This work has been financed by the Polish Ministry of Science and Higher Education.

Keywords: computational fluid dynamics, numerical analysis, renewable energy, wind turbine

Procedia PDF Downloads 195

Authors: Pierre-Andre Mudry, Jean Decaix, Jeremy Schmid, Cesar Papilloud, Cecile Munch-Alligne

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In most of the Swiss Alpine regions, the availability of water resources is usually adequate even in times of drought, as evidenced by the 2003 and 2018 summers. Indeed, important natural stocks are for the moment available in the form of snow and ice, but the situation is likely to change in the future due to global and regional climate change. In addition, alpine mountain regions are areas where climate change will be felt very rapidly and with high intensity. For instance, the ice regime of these regions has already been affected in recent years with a modification of the monthly availability and extreme events of precipitations. The current research, focusing on the municipality of Val de Bagnes, located in the canton of Valais, Switzerland, is part of a project led by the Altis company and achieved in collaboration with WSL, BlueArk Entremont, and HES-SO Valais-Wallis. In this region, water occupies a key position notably for winter and summer tourism. Thus, multiple actors want to apprehend the future needs and availabilities of water, on both the 2050 and 2100 horizons, in order to plan the modifications to the water supply and distribution networks. For those changes to be salient and efficient, a good knowledge of the current water distribution networks is of most importance. In the current case, the water drinking network is well documented, but this is not the case for the irrigation one. Since the water consumption for irrigation is ten times higher than for drinking water, data acquisition on the irrigation network is a major point to determine future scenarios. This paper first presents the instrumentation and simulation of the irrigation network using custom-designed IoT devices, which are coupled with a digital clone simulated to reduce the number of measuring locations. The developed IoT ad-hoc devices are energy-autonomous and can measure flows and pressures using industrial sensors such as calorimetric water flow meters. Measurements are periodically transmitted using the LoRaWAN protocol over a dedicated infrastructure deployed in the municipality. The gathered values can then be visualized in real-time on a dashboard, which also provides historical data for analysis. In a second phase, a digital clone of the irrigation network was modeled using EPANET, a software for water distribution systems that performs extended-period simulations of flows and pressures in pressurized networks composed of reservoirs, pipes, junctions, and sinks. As a preliminary work, only a part of the irrigation network was modelled and validated by comparisons with the measurements. The simulations are carried out by imposing the consumption of water at several locations. The validation is performed by comparing the simulated pressures are different nodes with the measured ones. An accuracy of +/- 15% is observed on most of the nodes, which is acceptable for the operator of the network and demonstrates the validity of the approach. Future steps will focus on the deployment of the measurement devices on the whole network and the complete modelling of the network. Then, scenarios of future consumption will be investigated. Acknowledgment— The authors would like to thank the Swiss Federal Office for Environment (FOEN), the Swiss Federal Office for Agriculture (OFAG) for their financial supports, and ALTIS for the technical support, this project being part of the Swiss Pilot program 'Adaptation aux changements climatiques'.

Keywords: hydraulic digital clone, IoT water monitoring, LoRaWAN water measurements, EPANET, irrigation network

Procedia PDF Downloads 118

Authors: Elizabeth M. Seabrook, Nikki S. Rickard

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Examining time-dependent measures of emotion such as variability, instability, and inertia, provide critical and complementary insights into mental health status. Observing changes in the pattern of emotional expression over time could act as a tool to identify meaningful shifts between psychological well- and ill-being. From a practical standpoint, however, examining emotion dynamics day-to-day is likely to be burdensome and invasive. Utilizing social media data as a facet of lived experience can provide real-world, temporally specific access to emotional expression. Emotional language on social media may provide accurate and sensitive insights into individual and community mental health and well-being, particularly with focus placed on the within-person dynamics of online emotion expression. The objective of the current study was to examine the dynamics of emotional expression on the social network platform Facebook for active users and their relationship with psychological well- and ill-being. It was expected that greater positive and negative emotion variability, instability, and inertia would be associated with poorer psychological well-being and greater depression symptoms. Data were collected using a smartphone app, MoodPrism, which delivered demographic questionnaires, psychological inventories assessing depression symptoms and psychological well-being, and collected the Status Updates of consenting participants. MoodPrism also delivered an experience sampling methodology where participants completed items assessing positive affect, negative affect, and arousal, daily for a 30-day period. The number of positive and negative words in posts was extracted and automatically collated by MoodPrism. The relative proportion of positive and negative words from the total words written in posts was then calculated. Preliminary analyses have been conducted with the data of 9 participants. While these analyses are underpowered due to sample size, they have revealed trends that greater variability in the emotion valence expressed in posts is positively associated with greater depression symptoms (r(9) = .56, p = .12), as is greater instability in emotion valence (r(9) = .58, p = .099). Full data analysis utilizing time-series techniques to explore the Facebook data set will be presented at the conference. Identifying the features of emotion dynamics (variability, instability, inertia) that are relevant to mental health in social media emotional expression is a fundamental step in creating automated screening tools for mental health that are temporally sensitive, unobtrusive, and accurate. The current findings show how monitoring basic social network characteristics over time can provide greater depth in predicting risk and changes in depression and positive well-being.

Keywords: emotion, experience sampling methods, mental health, social media

Procedia PDF Downloads 225

Authors: Alan N. A. Heberle, Salatiel W. Da Silva, Valentin Perez-Herranz, Andrea M. Bernardes

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Contaminants of emerging concern are substances widely used, such as pharmaceutical products. These compounds represent risk for both wild and human life since they are not completely removed from wastewater by conventional wastewater treatment plants. In the environment, they can be harm even in low concentration (µ or ng/L), causing bacterial resistance, endocrine disruption, cancer, among other harmful effects. One of the most common taken medicine to treat cardiocirculatory diseases is the Atenolol (ATL), a β-Blocker, which is toxic to aquatic life. In this way, it is necessary to implement a methodology, which is capable to promote the degradation of the ATL, to avoid the environmental detriment. A very promising technology is the advanced electrochemical oxidation (AEO), which mechanisms are based on the electrogeneration of reactive radicals (mediated oxidation) and/or on the direct substance discharge by electron transfer from contaminant to electrode surface (direct oxidation). The hydroxyl (HO•) and sulfate (SO₄•⁻) radicals can be generated, depending on the reactional medium. Besides that, at some condition, the peroxydisulfate (S₂O₈²⁻) ion is also generated from the SO₄• reaction in pairs. Both radicals, ion, and the direct contaminant discharge can break down the molecule, resulting in the degradation and/or mineralization. However, ATL molecule and byproducts can still remain in the treated solution. On this wise, some efforts can be done to implement the AEO process, being one of them the use of a cationic membrane to separate the cathodic (reduction) from the anodic (oxidation) reactor compartment. The aim of this study is investigate the influence of the implementation of a cationic membrane (Nafion®-117) to separate both cathodic and anodic, AEO reactor compartments. The studied reactor was a filter-press, with bath recirculation mode, flow 60 L/h. The anode was an Nb/BDD2500 and the cathode a stainless steel, both bidimensional, geometric surface area 100 cm². The solution feeding the anodic compartment was prepared with ATL 100 mg/L using Na₂SO₄ 4 g/L as support electrolyte. In the cathodic compartment, it was used a solution containing Na₂SO₄ 71 g/L. Between both solutions was placed the membrane. The applied currents densities (iₐₚₚ) of 5, 20 and 40 mA/cm² were studied over 240 minutes treatment time. Besides that, the ATL decay was analyzed by ultraviolet spectroscopy (UV/Vis). The mineralization was determined performing total organic carbon (TOC) in TOC-L CPH Shimadzu. In the cases without membrane, the iₐₚₚ 5, 20 and 40 mA/cm² resulted in 55, 87 and 98 % ATL degradation at the end of treatment time, respectively. However, with membrane, the degradation, for the same iₐₚₚ, was 90, 100 and 100 %, spending 240, 120, 40 min for the maximum degradation, respectively. The mineralization, without membrane, for the same studied iₐₚₚ, was 40, 55 and 72 %, respectively at 240 min, but with membrane, all tested iₐₚₚ reached 80 % of mineralization, differing only in the time spent, 240, 150 and 120 min, for the maximum mineralization, respectively. The membrane increased the ATL oxidation, probably due to avoid oxidant ions (S₂O₈²⁻) reduction on the cathode surface.

Keywords: contaminants of emerging concern, advanced electrochemical oxidation, atenolol, cationic membrane, double compartment reactor

Procedia PDF Downloads 112

Authors: Edward Shizha, Edward Makwarimba

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This literature review explores current research on the educational strengths and barriers of newcomer and refugee youth in Canada. Canada’s shift in immigration policy in the past three decades, from Europe to Asian and African countries as source continents of recent immigrants to Canada, has tremendously increased the ethnic, linguistic, cultural and religious diversity of the population, including that of students in its education system. Over 18% of the country’s population was born in another country, of which 70% are visible minorities. There has been an increase in admitted immigrants and refugees, with a total of 226,203 between July 2020 and June 2021. Newcomer parents and their children in all major destination countries, including Canada, face tremendous challenges, including racism and discrimination, lack of English language skills, poverty, income inequality, unemployment, and underemployment. They face additional challenges, including discrimination against those who cannot speak the official languages, English or French. The severity of the challenges depends on several intersectional factors, including immigrant status (asylum seeker, refugee, or immigrant), age, gender, level of education and others. Through the lens of intersectionality as an explanatory perspective, this literature review examines the educational attainment and outcomes of newcomer and refugee youth in Canada in order to understand their educational needs, educational barriers and strengths. Newcomer youths’ experiences are shaped by numerous intersectional and interconnected sociocultural, sociopolitical, and socioeconomic factors—including gender, migration status, racialized status, ethnicity, socioeconomic class, sexual minority status, age, race—that produce and perpetuate their disadvantage. According to research, immigrants and refugees from visible minority ethnic backgrounds experience exclusions more than newcomers from other backgrounds and groups from the mainstream population. For many immigrant parents, migration provides financial and educational opportunities for their children. Yet, when attending school, newcomer and refugee youth face unique challenges related to racism and discrimination, negative attitudes and stereotypes from teachers and other school authorities, language learning and proficiency, differing levels of acculturation, and different cultural views of the role of parents in relation to teachers and school, and unfamiliarity with the social or school context in Canada. Recognizing discrepancies in educational attainment of newcomer and refugee youth based on their race and immigrant status, the paper develops insights into existing research and data gaps related to educational strengths and challenges for visible minority newcomer youth in Canada. The paper concludes that the educational successes or failures of the newcomer and refugee youth and their settlement and integration into the school system in Canada may depend on where their families settle, the attitudes of the host community and the school officials (teachers, guidance counsellors and school administrators) after-school support programs and their own set of coping mechanisms. Conceivably a unique approach to after-school programming should provide learning supports and opportunities that consider newcomer and refugee youth’s needs, experiences, backgrounds and circumstances. This support is likely to translate into significant academic and psychological well-being of newcomer students.

Keywords: deficit discourse, discrimination, educational outcomes, newcomer and refugee youth, racism, strength-based approach, whiteness

Procedia PDF Downloads 45

Authors: Anshu Gupta, Charu Gupta

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Background: Adolescence is the transitional period between puberty and adulthood. It is marked by immense turmoil in emotional and behavioral spheres. Adolescents are at risk of an array of behavioral and emotional problems, resulting in social, academic and vocational function impairments. Conflicts in the family and inability of the parents to cope with the changing demands of an adolescent have a negative impact on the overall development of the child. This augers ill for the individual’s future, resulting in depression, delinquency and suicides among other problems. Aim: The aim of the study was to compare the prevalence of behavioral and emotional problems in school going adolescents aged 13 to 15 years residing in Ludhiana city. Method: A total of 1380 school children in the age group of 13 to 15 years were assessed by the adolescent health screening questionnaire (FAPS) and Youth Self-Report (2001) questionnaire. Statistical significance was ascertained by t-test, chi-square test (x²) and ANOVA, as appropriate. Results: A considerably high prevalence of behavioral and emotional problems was found in school going adolescents (26.5%), more in girls (31.7%) than in boys (24.4%). In case of boys, the maximum problem was in the 13 year age group, i.e., 28.2%, followed by a significant decline by the age of 14 years, i.e., 24.2% and 15 years, i.e., 19.6%. In case of girls also, the maximum problem was in the 13 year age group, i.e., 32.4% followed by a marginal decline in the 14 years i.e., 31.8% and 15 year age group, i.e., 30.2%. Demographic factors were non contributory. Internalizing syndrome (22.4%) was the most common problem followed by the neither internalizing nor externalizing (17.6%) group. In internalizing group, most (26.5%) of the students were observed to be anxious/ depressed. Social problem was observed to be the most frequent (10.6%) among neither internalizing nor externalizing group. Aggressive behavior was the commonest (8.4%) among externalizing group. Internalizing problems, mainly anxiety and depression, were commoner in females (30.6%) than males (24.6%). More boys (16%) than girls (13.4%) were reported to suffer from externalizing disorders. A critical review of the data showed that most of the adolescents had poor knowledge about reproductive health. Almost 36% reported that the source of their information on sexual and reproductive health being friends and the electronic media. There was a high percentage of adolescents who reported being worried about sexual abuse (20.2%) with majority of them being girls (93.6%) reflecting poorly on the social setup in the country. About 41% of adolescents reported being concerned about body weight and most of them being girls (92.4%). Up to 14.5% reported having thoughts of using alcohol or drugs perhaps due to the easy availability of substances of abuse in this part of the country. 12.8% (mostly girls) reported suicidal thoughts. Summary/conclusion: There is a high prevalence of emotional and behavioral problems among school-going adolescents. Resolution of these problems during adolescence is essential for attaining a healthy adulthood. The need of the hour is to spread awareness among caregivers and formulation of effective management strategies including school mental health programme.

Keywords: adolescence, behavioral, emotional, internalizing problem

Procedia PDF Downloads 258

Authors: Lena Lapidot, Amir Amnon, Rita Nosenko, Veitsman Ella, Cohen-Ezra Oranit, Davidov Yana, Segev Shlomo, Koren Omry, Safran Michal, Ben-Ari Ziv

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Introduction: Hepatocellular carcinoma (HCC) is one of the leading causes of cancer related mortality worldwide. Liver Cirrhosis is the main predisposing risk factor for the development of HCC. The factor(s) influencing disease progression from Cirrhosis to HCC remain unknown. Gut microbiota has recently emerged as a major player in different liver diseases, however its association with HCC is still a mystery. Moreover, there might be an important association between the gut microbiota, nutrition, life style and the progression of Cirrhosis and HCC. The aim of our study was to characterize the gut microbial signature in association with life style and nutrition of patients with Cirrhosis, HCC-Cirrhosis and healthy controls. Design: Stool samples were collected from 95 individuals (30 patients with HCC, 38 patients with Cirrhosis and 27 age, gender and BMI-matched healthy volunteers). All participants answered lifestyle and Food Frequency Questionnaires. 16S rRNA sequencing of fecal DNA was performed (MiSeq Illumina). Results: There was a significant decrease in alpha diversity in patients with Cirrhosis (qvalue=0.033) and in patients with HCC-Cirrhosis (qvalue=0.032) compared to healthy controls. The microbiota of patients with HCC-cirrhosis compared to patients with Cirrhosis, was characterized by a significant overrepresentation of Clostridium (pvalue=0.024) and CF231 (pvalue=0.010) and lower expression of Alphaproteobacteria (pvalue=0.039) and Verrucomicrobia (pvalue=0.036) in several taxonomic levels: Verrucomicrobiae, Verrucomicrobiales, Verrucomicrobiaceae and the genus Akkermansia (pvalue=0.039). Furthermore, we performed an analysis of predicted metabolic pathways (Kegg level 2) that resulted in a significant decrease in the diversity of metabolic pathways in patients with HCC-Cirrhosis (qvalue=0.015) compared to controls, one of which was amino acid metabolism. Furthermore, investigating the life style and nutrition habits of patients with HCC-Cirrhosis, we found significant correlations between intake of artificial sweeteners and Verrucomicrobia (qvalue=0.12), High sugar intake and Synergistetes (qvalue=0.021) and High BMI and the pathogen Campylobacter (qvalue=0.066). Furthermore, overweight in patients with HCC-Cirrhosis modified bacterial diversity (qvalue=0.023) and composition (qvalue=0.033). Conclusions: To the best of the our knowledge, we present the first report of the gut microbial composition in patients with HCC-Cirrhosis, compared with Cirrhotic patients and healthy controls. We have demonstrated in our study that there are significant differences in the gut microbiome of patients with HCC-cirrhosis compared to Cirrhotic patients and healthy controls. Our findings are even more pronounced because the significantly increased bacteria Clostridium and CF231 in HCC-Cirrhosis weren't influenced by diet and lifestyle, implying this change is due to the development of HCC. Further studies are needed to confirm these findings and assess causality.

Keywords: Cirrhosis, Hepatocellular carcinoma, life style, liver disease, microbiome, nutrition

Procedia PDF Downloads 100

Authors: Amarasinghe Shashikala, Pramudika Hansini, Fernando Tajan, Rathnayake Piyumi

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This study investigates the prominence of the social entrepreneurship (SE) model over the sustainable entrepreneurship model among Sri Lankan exporters in the small and medium enterprise (SME) sector. The primary objective of this study is to explore how the unique socio-economic contextual nuances of the country influence this behavior. The study employs a multiple-case study approach, collecting data from thirteen SEs in the SME sector. The findings reveal a significant alignment between SE and the lifestyle of the people in Sri Lanka, attributed largely to its deep-rooted religious setting and cultural norms. A crucial factor driving the prominence of SE is the predominantly labor-intensive nature of production processes within the exporters of the SME sector. These processes inherently lend themselves to SE, providing employment opportunities and fostering community engagement. Further, SE initiatives substantially resonate with community-centric practices, making them more appealing and accessible to the local populace. In contrast, the findings highlight a dilemma between cost-effectiveness and sustainable entrepreneurship. Transitioning to sustainable export products and production processes is demanded by foreign buyers and acknowledged as essential for environmental stewardship, which often requires capital-intensive makeovers. This investment inevitably raises the overall cost of the export product, making it less competitive in the global market. Interestingly, the study notes a disparity between international demand for sustainable products and the willingness of buyers to pay a premium for them. Despite the growing global preference for eco-friendly options, the findings suggest that the additional costs associated with sustainable entrepreneurship are not adequately reflected in the purchasing behavior of international buyers. The abundance of natural resources coupled with a minimal occurrence of natural catastrophes renders exporters less environmentally sensitive. The absence of robust policy support for environmental preservation exacerbates this inclination. Consequently, exporters exhibit a diminished motivation to incorporate environmental sustainability into their business decisions. Instead, attention is redirected towards factors such as the local population's minimum standards of living, prevalent social issues, governmental corruption and inefficiency, and rural poverty. These elements impel exporters to prioritize social well-being when making business decisions. Notably, the emphasis on social impact, rather than environmental impact, appears to be a generational trend, perpetuating a focus on societal aspects in the realm of business. In conclusion, the manifestation of entrepreneurial behavior within developing nations is notably contingent upon contextual nuances. This investigation contributes to a deeper understanding of the dynamics shaping the prevalence of SE over sustainable entrepreneurship among Sri Lankan exporters in the SME sector. The insights generated have implications for policymakers, industry stakeholders, and academics seeking to navigate the delicate balance between socio-cultural values, economic feasibility, and environmental sustainability in the pursuit of responsible business practices within the export sector.

Keywords: small and medium enterprises, social entrepreneurship, Sri Lanka, sustainable entrepreneurship

Procedia PDF Downloads 48

Authors: Mustafa M. Donma, Orkide Donma

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Obesity is associated with cardiovascular disease risk factors and metabolic syndrome (MetS). In this study, associations between adipokines and adipokine as well as obesity indices were evaluated. Plasma adipokine levels may exhibit variations according to body adipose tissue mass. Besides, upon consideration of obesity as an inflammatory disease, adipokines may play some roles in this process. The ratios of proinflammatory adipokines to adiponectin may act as highly sensitive indicators of body adipokine status. The aim of the study is to present some adipokine indices, which are thought to be helpful for the evaluation of childhood obesity and also to determine the best discriminators in the diagnosis of MetS. 80 prepubertal children (aged between 6-9.5 years) included in the study were divided into three groups; 30 children with normal weight (NW), 25 morbid obese (MO) children and 25 MO children with MetS. Physical examinations were performed. Written informed consent forms were obtained from the parents. The study protocol was approved by Ethics Committee of Namik Kemal University Medical Faculty. Anthropometric measurements, such as weight, height, waist circumference (C), hip C, head C, neck C were recorded. Values for body mass index (BMI), diagnostic obesity notation model assessment Index-II (D2 index) as well as waist-to-hip, head-to-neck ratios were calculated. Adiponectin, resistin, leptin, chemerin, vaspin, progranulin assays were performed by ELISA. Adipokine-to-adiponectin ratios were obtained. SPSS Version 20 was used for the evaluation of data. p values ≤ 0.05 were accepted as statistically significant. Values of BMI and D2 index, waist-to-hip, head-to-neck ratios did not differ between MO and MetS groups (p ≥ 0.05). Except progranulin (p ≤ 0.01), similar patterns were observed for plasma levels of each adipokine. There was not any difference in vaspin as well as resistin levels between NW and MO groups. Significantly increased leptin-to-adiponectin, chemerin-to-adiponectin and vaspin-to-adiponectin values were noted in MO in comparison with those of NW. The most valuable adipokine index was progranulin-to-adiponectin (p ≤ 0.01). This index was strongly correlated with vaspin-to-adiponectin ratio in all groups (p ≤ 0.05). There was no correlation between vaspin-to-adiponectin and chemerin-to--adiponectin in NW group. However, a correlation existed in MO group (r = 0.486; p ≤ 0.05). Much stronger correlation (r = 0.609; p ≤ 0.01) was observed in MetS group between these two adipokine indices. No correlations were detected between vaspin and progranulin as well as vaspin and chemerin levels. Correlation analyses showed a unique profile confined to MetS children. Adiponectin was found to be correlated with waist-to-hip (r = -0.435; p ≤ 0.05) as well as head-to-neck (r = 0.541; p ≤ 0.05) ratios only in MetS children. In this study, it has been investigated if adipokine indices have priority over adipokine levels. In conclusion, vaspin-to-adiponectin, progranulin-to-adiponectin, chemerin-to-adiponectin along with waist-to-hip and head-to-neck ratios were the optimal combinations. Adiponectin, waist-to-hip, head-to-neck, vaspin-to-adiponectin, chemerin-to-adiponectin ratios had appropriate discriminatory capability for MetS children.

Keywords: adipokine indices, metabolic syndrome, obesity indices, pediatric obesity

Procedia PDF Downloads 187

Authors: H. E. Elzain, S. Y. Chung, V. Senapathi, Kye-Hun Park

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Groundwater is considered a significant source for drinking and irrigation purposes in Miryang city, and it is attributed to a limited number of a surface water reservoirs and high seasonal variations in precipitation. Population growth in addition to the expansion of agricultural land uses and industrial development may affect the quality and management of groundwater. This research utilized multidisciplinary approaches of geostatistics such as multivariate statistics, factor analysis, cluster analysis and kriging technique in order to identify the hydrogeochemical process and characterizing the control factors of the groundwater geochemistry distribution for developing risk maps, exploiting data obtained from chemical investigation of groundwater samples under the area of study. A total of 79 samples have been collected and analyzed using atomic absorption spectrometer (AAS) for major and trace elements. Chemical maps using 2-D spatial Geographic Information System (GIS) of groundwater provided a powerful tool for detecting the possible potential sites of groundwater that involve the threat of contamination. GIS computer based map exhibited that the higher rate of contamination observed in the central and southern area with relatively less extent in the northern and southwestern parts. It could be attributed to the effect of irrigation, residual saline water, municipal sewage and livestock wastes. At wells elevation over than 85m, the scatter diagram represents that the groundwater of the research area was mainly influenced by saline water and NO3. Level of pH measurement revealed low acidic condition due to dissolved atmospheric CO2 in the soil, while the saline water had a major impact on the higher values of TDS and EC. Based on the cluster analysis results, the groundwater has been categorized into three group includes the CaHCO3 type of the fresh water, NaHCO3 type slightly influenced by sea water and Ca-Cl, Na-Cl types which are heavily affected by saline water. The most predominant water type was CaHCO3 in the study area. Contamination sources and chemical characteristics were identified from factor analysis interrelationship and cluster analysis. The chemical elements that belong to factor 1 analysis were related to the effect of sea water while the elements of factor 2 associated with agricultural fertilizers. The degree level, distribution, and location of groundwater contamination have been generated by using Kriging methods. Thus, geostatistics model provided more accurate results for identifying the source of contamination and evaluating the groundwater quality. GIS was also a creative tool to visualize and analyze the issues affecting water quality in the Miryang city.

Keywords: groundwater characteristics, GIS chemical maps, factor analysis, cluster analysis, Kriging techniques

Procedia PDF Downloads 148

Authors: K. Karapetyan, F. Tkhruni, A. Aghajanyan, T. S. Balabekyan, L. Arstamyan

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Introduction: Globalization of the food supply has created the conditions favorable for the emergence and spread of food-borne and especially dangerous pathogens (EDP) in developing countries. The fresh-cut fruit and vegetable industry is searching for alternatives to replace chemical treatments with biopreservative approaches that ensure the safety of the processed foods product. Antimicrobial compounds of lactic acid bacteria (LAB) possess bactericidal or bacteriostatic activity against intestinal pathogens, spoilage organisms and food-borne pathogens such as Listeria monocytogenes, Staphylococcus aureus and Salmonella. Endemic strains of LAB were isolated. The strains, showing broad spectrum of antimicrobial activity against food spoiling microorganisms, were selected. The genotyping by 16S rRNA sequencing, GS-PCR, RAPD PCR methods showed that they were presented by Lactobacillus rhamnosus109, L.plantarum 65, L.plantarum 66 and Enterococcus faecium 64 species. LAB are deposited in "Microbial Depository Center" (MDC) SPC "Armbiotechnology". Methods: LAB strains were isolated from different dairy products from rural households from the highland regions of Armenia. Serially diluted samples were spread on MRS (Merck, Germany) and hydrolyzed milk agar (1,2 % w/v). Single colonies from each LAB were individually inoculated in liquid MRS medium and incubated at 37oC for 24 hours. Culture broth with biomass was centrifuged at 10,000 g during 20 min for obtaining of cell free culture broth (CFC). The antimicrobial substances from CFC broth were purified by the combination of adsorption-desorption and ion-exchange chromatography methods. Separation of bacteriocins was performed using a HPLC method on "Avex ODS" C18 column. Mass analysis of peptides recorded on the device API 4000 in the electron ionization mode. The spot-on-lawn method on the test culture plated in the solid medium was applied. The antimicrobial activity is expressed in arbitrary units (AU/ml). Results. Purification of CFC broth of LAB allowed to obtain partially purified antimicrobial preparations which contains bacteriocins with broad spectrum of antimicrobial activity. Investigation of their main biochemical properties shown, that inhibitory activity of preparations is partially reduced after treatment with proteinase K, trypsin, pepsin, suggesting a proteinaceous nature of bacteriocin-like substances containing in CFC broth. Preparations preserved their activity after heat treatment (50-121 oC, 20 min) and were stable in the pH range 3–8. The results of SDS PAAG electrophoresis show that L.plantarum 66 and Ent.faecium 64 strains have one bacteriocin (BCN) with maximal antimicrobial activity with approximate molecular weight 2.0-3.0 kDa. From L.rhamnosus 109 two BCNs were obtained. Mass spectral analysis indicates that these bacteriocins have peptide bonds and molecular weight of BCN 1 and BCN 2 are approximately 1.5 kDa and 700 Da. Discussion: Thus, our experimental data shown, that isolated endemic strains of LAB are able to produce bacteriocins with high and different inhibitory activity against broad spectrum of microorganisms of different taxonomic group, such as Salmonella sp., Esherichia coli, Bacillus sp., L.monocytogenes, Proteus mirabilis, Staph. aureus, Ps. aeruginosa. Obtained results proved the perspectives for use of endemic strains in the preservation of foodstuffs. Acknowledgments: This work was realized with financial support of the Project Global Initiatives for Preliferation Prevention (GIPP) T2- 298, ISTC A-1866.

Keywords: antimicrobial activity, bacteriocins, endemic strains, food safety

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Authors: Magdalena B. Kaziuk, Waldemar Kosiba, Marek J. Kuzniewski

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Introduction: Adipose tissue is a typical place for storage water-insoluble toxins in the body. It's connective tissue, where the intercellular substance consist of fat, which level in people with low physical activity should be 18-25% for women and 13-18% for men. Due to the fat distribution in the body we distinquish two types of obesity: android (visceral, abdominal) and gynoidal (gluteal-femoral, peripheral). Abdominal obesity increases the risk of complications of the cardiovascular system diseases, and impaired renal and liver function. Through the influence on disorders of metabolism, lipid metabolism, diabetes and hypertension, leading to emergence of the metabolic syndrome. So thus, obesity will especially overload kidney function in patients after transplantation. Aim: An attempt was made to estimate the impact of amount fat tissue on transplanted kidney function and excretory function of the liver in patients after Ktx. Material and Methods: The study included 108 patients (50 females, 58 male, age 46.5 +/- 12.9 years) with active kidney transplant after more than 3 months from the transplantation. An analysis of body composition was done by using electrical bioimpedance (BIA) and anthropometric measurements. Estimated basal metabolic rate (BMR), muscle mass, total body water content and the amount of body fat. Information about physical activity were obtained during clinical examination. Nutritional status, and type of obesity were determined by using indicators: Waist to Height Ratio (WHR) and Waist to Hip Ratio (WHR). Excretory functions of the transplanted kidney was rated by calculating the estimated renal glomerular filtration rate (eGFR) using the MDRD formula. Liver function was rated by total bilirubin and alanine aminotransferase levels ALT concentration in serum. In our patients haemolitic uremic syndrome (HUS) was excluded. Results: In 19.44% of patients had underweight, 22.37% of the respondents were with normal weight, 11.11% had overweight, and the rest were with obese (49.08%). People with android stature have a lower eGFR compared with those with the gynoidal stature (p = 0.004). All patients with obesity had higher amount of body fat from a few to several percent. The higher amount of body fat percentage, the lower eGFR had patients (p <0.001). Elevated ALT levels significantly correlated with a high fat content (p <0.02). Conclusion: Increased amount of body fat, particularly in the case of android obesity can be a predictor of kidney and liver damage. Due to that obese patients should have more frequent control of diagnostic functions of these organs and the intensive dietary proceedings, pharmacological and regular physical activity adapted to the current physical condition of patients after transplantation.

Keywords: obesity, body fat, kidney transplantation, glomerular filtration rate, liver function

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Authors: Kali Prasad Sarma, Sanghita Dutta

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Deepor Beel (DB), the lone Ramsar site and an important wetland of the Brahmaputra valley in the state of Assam. The local people from fourteen peripheral villages traditionally utilize the wetland for harvesting vegetables, flowers, aquatic seeds, medicinal plants, fish, molluscs, fodder for domestic cattle etc. Therefore, it is of great importance to understand the concentration and distribution of trace metals in water-sediment system of the beel in order to protect its ecological environment. DB lies between26°05′26′′N to 26°09′26′′N latitudes and 90°36′39′′E to 91°41′25′′E longitudes. Water samples from the surface layer of water up to 40cm deep and sediment samples from the top 5cm layer of surface sediments were collected. The trace metals in waters and sediments were analysed using ICP-OES. The organic Carbon was analysed using the TOC analyser. The different mineral present in the sediments were confirmed by X-ray diffraction method (XRD). SEM images were recorded for the samples using SEM, attached with energy dispersive X-ray unit, with an accelerating voltage of 20 kv. All the statistical analyses were performed using SPSS20.0 for windows. In the present research, distribution, source apportionment, temporal and spatial variability, extent of pollution and the ecological risk of eight toxic trace metals in sediments and water of DB were investigated. The average concentrations of chromium(Cr) (both the seasons), copper(Cu) and lead(Pb) (pre-monsoon) and zinc(Zn) and cadmium(Cd) (post-monsoon) in sediments were higher than the consensus based threshold concentration(TEC). The persistent exposure of toxic trace metals in sediments pose a potential threat, especially to sediment dwelling organisms. The degree of pollution in DB sediments for Pb, Cobalt (Co) Zn, Cd, Cr, Cu and arsenic (As) was assessed using Enrichment Factor (EF), Geo-accumulation index (Igeo) and Pollution Load Index (PLI). The results indicated that contamination of surface sediments in DB is dominated by Pb and Cd and to a lesser extent by Co, Fe, Cu, Cr, As and Zn. A significant positive correlation among the pairs of element Co/Fe, Zn/As in water, and Cr/Zn, Fe/As in sediments indicates similar source of origin of these metals. The effects of interaction among trace metals between water and sediments shows significant variations (F =94.02, P < 0.001), suggesting maximum mobility of trace metals in DB sediments and water. The source apportionment of the heavy metals was carried out using Principal Component Analysis (PCA). SEM-EDS detects the presence of Cd, Cu, Cr, Zn, Pb, As and Fe in the sediment sample. The average concentration of Cd, Zn, Pb and As in the bed sediments of DB are found to be higher than the crustal abundance. The EF values indicate that Cd and Pb are significantly enriched. From source apportionment studies of the eight metals using PCA revealed that Cd was anthropogenic in origin; Pb, As, Cr, and Zn had mixed sources; whereas Co, Cu and Fe were natural in origin.

Keywords: Deepor Beel, enrichment factor, principal component analysis, trace metals

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Authors: William Michael Short

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Semantic Web’ technologies such as the Unified Medical Language System Metathesaurus, SNOMED-CT, and MeSH have been touted as transformational for the way users access online medical and health information, enabling both the automated analysis of natural-language data and the integration of heterogeneous healthrelated resources distributed across the Internet through the use of standardized terminologies that capture concepts and relationships between concepts that are expressed differently across datasets. However, the approaches that have so far characterized ‘semantic bioinformatics’ have not yet fulfilled the promise of the Semantic Web for medical and health information retrieval applications. This paper argues within the perspective of cognitive linguistics and cognitive anthropology that four features of human meaning-making must be taken into account before the potential of semantic technologies can be realized for this domain. First, many semantic technologies operate exclusively at the level of the word. However, texts convey meanings in ways beyond lexical semantics. For example, transitivity patterns (distributions of active or passive voice) and modality patterns (configurations of modal constituents like may, might, could, would, should) convey experiential and epistemic meanings that are not captured by single words. Language users also naturally associate stretches of text with discrete meanings, so that whole sentences can be ascribed senses similar to the senses of words (so-called ‘discourse topics’). Second, natural language processing systems tend to operate according to the principle of ‘one token, one tag’. For instance, occurrences of the word sound must be disambiguated for part of speech: in context, is sound a noun or a verb or an adjective? In syntactic analysis, deterministic annotation methods may be acceptable. But because natural language utterances are typically characterized by polyvalency and ambiguities of all kinds (including intentional ambiguities), such methods leave the meanings of texts highly impoverished. Third, ontologies tend to be disconnected from everyday language use and so struggle in cases where single concepts are captured through complex lexicalizations that involve profile shifts or other embodied representations. More problematically, concept graphs tend to capture ‘expert’ technical models rather than ‘folk’ models of knowledge and so may not match users’ common-sense intuitions about the organization of concepts in prototypical structures rather than Aristotelian categories. Fourth, and finally, most ontologies do not recognize the pervasively figurative character of human language. However, since the time of Galen the widespread use of metaphor in the linguistic usage of both medical professionals and lay persons has been recognized. In particular, metaphor is a well-documented linguistic tool for communicating experiences of pain. Because semantic medical knowledge-bases are designed to help capture variations within technical vocabularies – rather than the kinds of conventionalized figurative semantics that practitioners as well as patients actually utilize in clinical description and diagnosis – they fail to capture this dimension of linguistic usage. The failure of semantic technologies in these respects degrades the efficiency and efficacy not only of medical research, where information retrieval inefficiencies can lead to direct financial costs to organizations, but also of care provision, especially in contexts of patients’ self-management of complex medical conditions.

Keywords: ambiguity, bioinformatics, language, meaning, metaphor, ontology, semantic web, semantics

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Authors: Sadie Namani, Lindita Ajazaj, Arjeta Zogaj, Vera Berisha, Bahrije Halili, Luljeta Hasani, Ajete Aliu

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Background: The outcome of bacterial meningitis is strongly related to the resistance of bacterial pathogens to the initial antimicrobial therapy. The objective of the study was to analyze the initial antimicrobial therapy, the resistance of meningeal pathogens and the outcome of adults bacterial meningitis cases. Materials/methods: This prospective study enrolled 46 adults older than 16 years of age, treated for bacterial meningitis during the years 2009 and 2010 at the infectious diseases clinic in Prishtinë. Patients are categorized into specific age groups: > 16-26 years of age (10 patients), > 26-60 years of age (25 patients) and > 60 years of age (11 patients). All p-values < 0.05 were considered statistically significant. Data were analyzed using Stata 7.1 and SPSS 13. Results: During the two year study period 46 patients (28 males) were treated for bacterial meningitis. 33 patients (72%) had a confirmed bacterial etiology; 13 meningococci, 11 pneumococci, 7 gram-negative bacilli (Ps. aeruginosa 2, Proteus sp. 2, Acinetobacter sp. 2 and Klebsiella sp. 1 case) and 2 staphylococci isolates were found. Neurological complications developed in 17 patients (37%) and the overall mortality rate was 13% (6 deaths). Neurological complications observed were: cerebral abscess (7/46; 15.2%), cerebral edema (4/46; 8.7%); haemiparesis (3/46; 6.5%); recurrent seizures (2/46; 4.3%), and single cases of thrombosis sinus cavernosus, facial nerve palsy and decerebration (1/46; 2.1%). The most common meningeal pathogens were meningococcus in the youngest age group, gram negative-bacilli in second age group and pneumococcus in eldery age group. Initial single-agent antibiotic therapy (ceftriaxone) was used in 17 patients (37%): in 60% of patients in the youngest age group and in 44% of cases in the second age group. 29 patients (63%) were treated with initial dual-agent antibiotic therapy; ceftriaxone in combination with vancomycin or ampicillin. Ceftriaxone and ampicillin were the most commonly used antibiotics for the initial empirical therapy in adults > 50 years of age. All adults > 60 years of age were treated with the initial dual-agent antibiotic therapy as in this age group was recorded the highest mortality rate (M=27%) and adverse outcome (64%). Resistance of pathogens to antimicrobics was recorded in cases caused by gram-negative bacilli and was associated with greater risk for developing neurological complications (p=0.09). None of the gram-negative bacilli were resistant to carbapenems; all were resistant to ampicillin while 5/7 isolates were resistant to cefalosporins. Resistance of meningococci and pneumococci to beta-lactams was not recorded. There were no statistical differences in the occurrence of neurological complications (p > 0.05), resistance of meningeal pathogens to antimicrobics (p > 0.05) and the inital antimicrobial therapy (one vs. two antibiotics) concerning group-ages in adults. Conclusions: The initial antibiotic therapy with ceftriaxone alone or in combination with vancomycin or ampicillin did not cover cases caused by gram-negative bacilli.

Keywords: adults, bacterial meningitis, outcomes, therapy

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Authors: Rebecca Johnson, Elizabeth Hoban

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Condom use among young men in Cambodia has declined between 2005 and 2014 which has public health implications such as increased risks of sexually transmitted infections, including HIV, and unplanned pregnancies. Conversations about sexual and reproductive health issues, including condom use, are not socially sanctioned in Cambodian society leaving young adults with limited knowledge of, and poor access to sexual and reproductive health services. Additionally, men play a dominant role in decision making regarding condom use within sexual partnerships. This study sought to fill a gap in knowledge by exploring young adult males’ attitudes, perceptions and behaviours regarding condom use. In February and March 2018, twenty young adult males, aged 18 to 24 years, were recruited from urban, peri urban and rural areas in Cambodia. The young adult males participated in a face-to-face semi structured interview that used an interview guide and photo elicitation method. The interview explored participants’ knowledge of sexual and reproductive health issues and efficacy, sexual behaviours, and use of condoms. Inductive thematic analysis was conducted and the following major themes emerged: understanding of reproduction, understanding of sexually transmitted infections, knowledge about condoms, condom use, access to condoms, and sexual behaviour. Participants’ knowledge of condoms and specific reasons for their use varied; most participants understood that condoms provide protection from sexually transmitted infections and prevent pregnancy. Stigma associated with condom access was consistently referred to as a problem and the main reason cited by young men for not using condoms during sexual intercourse. The perceived importance of condom use altered with partner type and relationship status, dependent upon the need for protection from sexually transmitted infections or pregnancy. Condoms were used for infection control in the context of multiple relationships, or as a contraceptive method for unmarried and some married couples. The majority of young men engaged in premarital sexual intercourse, of those men the many used condoms. The inconsistent use of condoms by young men in Cambodia is of public health concern because of the increased risk of sexually transmitted infections (including HIV), and unplanned pregnancy. Public health action is required in order to minimize long term health issues for individuals and the community. Health education is required to increase knowledge of condom use, sexually transmitted infections and HIV, and reduce the stigma associated with this topic. Sustainable health promotion programs are needed to increase ease of access to condoms for young people. Public health policy in Cambodia needs to be reviewed to improve sexual and reproductive health outcomes for young adults.

Keywords: Cambodia, condom use, sexual and reproductive health, young adult males

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Authors: Gagandeep Singh Digra, Pawan Kumar, Mandeep Kaur Sidhu

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INTRODUCTION: Chronic Progressive External Ophthalmoplegia (CPEO), also known as Progressive External Ophthalmoplegia (PEO), is a type of eye disorder characterized by a loss of the muscle functions involved in eye and eyelid movement. CPEO can be caused by mutations in mitochondrial DNA. It typically manifests in young adults with bilateral and progressive ptosis as the most common presentation but can also present with difficulty swallowing (dysphagia) and general weakness of the skeletal muscles (myopathy), particularly in the neck, arms, or legs. CASE PRESENTATION: This is a case discussion of 3 cousins who presented to our clinic. A 23-year-old male with past surgical history (PSH) of ptosis repair 2 years ago presented with a chief complaint of nasal intonation for 1.5 years associated with difficulty swallowing. The patient also complained of nasal regurgitation of liquids. He denied any headaches, fever, seizures, weakness of arms or legs, urinary complaints or changes in bowel habits. Physical Examination was positive for facial muscle weakness, including an inability to lift eyebrows (Frontalis), inability to close eyes tightly (Orbicularis Oculi), corneal reflex absent bilaterally, difficulty clenching jaw (Masseter muscle), difficulty smiling (Zygomaticus major), inability to elevate upper lip (Zygomaticus minor). Another cousin of the first patient, a 25-year-old male with no past medical history, presented with complaints of nasal intonation for 2 years associated with difficulty swallowing. He denied a history of nasal regurgitation, headaches, fever, seizures, weakness, urinary complaints or changes in bowel habits. Physical Examination showed facial muscle weakness of the Frontalis muscle, Orbicularis Oculi muscle, Masseter Muscle, Zygomaticus Major, Zygomaticus Minor and absent corneal reflexes. A 28-year-old male, a cousin of the first two patients, presented with chief complaints of ptosis and nasal intonation for the last 8 years. He also complained of difficulty swallowing and nasal regurgitation of liquids. His physical examination showed facial muscle weakness, including frontalis muscle (inability to lift eyebrows), Orbicularis Oculi (inability to close eyes tightly), absent corneal reflexes bilaterally, Zygomaticus Major (difficulty smiling), and Zygomaticus Minor (inability to elevate upper lip). MRI brain and visual field of all the patients were normal. Differential diagnoses, including Grave’s disease, Myasthenia Gravis and Glioma, were ruled out. Due to financial reasons, muscle biopsy could not be pursued. Pedigree analysis revealed only males were affected, likely due to maternal inheritance, so the clinical diagnosis of CPEO was made. The patients underwent symptomatic management, including ptosis surgical correction for the third patient. CONCLUSION: Chronic Progressive External Ophthalmoplegia (CPEO), a rare case entity, occurs in young adults as a manifestation of mitochondrial myopathy. There are three modes of transmission- maternal transmission associated with mitochondrial point mutations, autosomal recessive, and autosomal dominant. CPEO can sometimes be difficult to diagnose, especially in asymmetric presentation. Therefore, it is crucial to keep it in differential diagnosis to avoid delay in diagnosis.

Keywords: neurology, chronic, progressive, ophthalmoplegia

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