Search results for: case study one

Authors: Paras Agarwal

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Background: Initially believed to be rare, metastases to the eye are the most common ocular malignancy. The choroid’s high perfusion rate not only makes it the most susceptible ocular site for tumour seeding, but also promotes its growth. The cancers most frequently responsible for choroidal metastases originate from the breast and lung, although a significant proportion have unidentified primaries at the time of presentation. Case Presentation: This case report describes a 34 year old female presenting to the ophthalmology department with a one month history of painless distorted vision. On fundus examination, she was noted to have bilateral choroidal lesionsand subsequently underwent a comprehensive diagnostic work-up. The patient was diagnosed with metastatic pulmonary adenocarcinoma, despite lacking conventional risk factors. As she was found to have a mutation in EGFR, the patient was commenced on tyrosine-kinase inhibition with afatinib. The choroidal lesions regressed with a significant improvement in visual acuity and a dramatic anatomical reduction of the choroidal masses. Conclusions: Our case demonstrates the importance of considering metastases as a differential diagnosis for choroidal lesions. Appropriate and thorough history-taking, examination and investigations may be required in order to deduce the underlying cause. Our case is unusual in view of the choroidal lesion being the primary manifestation of metastatic lung cancer in a young patient with no known risk factors. Early recognition of choroidal metastases is important as it is often the first sign of tumour dissemination and will prompt earlier treatment with systemic medications such as chemotherapy, immunotherapy, targeted therapy or hormonal therapy. Our case report also demonstrates the efficacy of afatinib for the treatment of choroidal metastases, with morphological and functional improvements observed with regard to the choroidal metastatic tumour.

Keywords: choroidal neoplasm, choroidal naevus, pulmonary adenocarcinoma, metastases, lung cancer

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Authors: Viktória Sugár, Orsolya Frick, Gabriella Horváth, A. Bendegúz Vöröss, Péter Leczovics, Géza Baráth

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Urban greenery has multiple positive effects both on the city and its residents. Apart from the visual advantages, it changes the micro-climate by cooling and shading, also increasing vapor and oxygen, reducing dust and carbon-dioxide content at the same time. The above are all critical factors of livability of an urban fabric. Unfortunately, in a dense, historical district there are restricted possibilities to build green surfaces. The present study collects and systemizes the applicable green solutions in the case of a historical downtown district of Budapest. The study contains a GIS-based measurement of the eligible surfaces for greenery, and also calculates the potential of oxygen production, carbon-dioxide reduction and cooling effect of an increased green surface.  It can be concluded that increasing the green surface has measurable effects on a densely built urban fabric, including air quality, micro-climate and other environmental factors.

Keywords: urban greenery, green roof, green wall, green surface potential, sustainable city, oxygen production, carbon-dioxide reduction, geographical information system

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Authors: Daniel Gidey, Kunwar Siddarth Dadhwal, Tagel Wondimu

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There are numerous ways for ending conflict; hitherto, most conflicts are resolved either through negotiated or victor's peace, this article is about the former. Negotiations entail concessions, consensus-building, and mutual trust in order to transform a belligerent situation into a settlement. In such a context, regional and sub-regional organizations play a critical role in mediating conflicting parties so as to prevent, manage, and resolve conflicts between and among conflicting parties. This article is about the AU-led negotiated peace deal on the bloody conflict between the Tigray Peoples Liberation Front (TPLF) and the Federal Democratic Republic of Ethiopia (FDRE) by undertaking the Pretoria Peace Accord as a case study. In terms of research method, the article is based on a critical evaluation of the literature and content analysis on the very research topic. Findings of the study revealed that the AU, through Olusegun Obasanjo and other dignitaries, played a critical role in nurturing compromise and mutual trust between the TPLF and the Ethiopian federal government so as to take along the Pretoria peace deal. Through critical literature review and content analysis of the Peace deal, the article has concluded that negotiated peace is likely, at least, to achieve negative peace.

Keywords: regional organizations, peace promotion, African Union, negotiating conflicts, Northern Ethiopia, conflict resolution

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Authors: S. H. Park, D. W. You

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This study is about to the field survey and repair works in a marine approach-bride. In order to evaluate the stability of the ground and the structure, field surveys such as exterior inspection, non-destructive inspection, measurement, and geophysical exploration are carried out. Numerical analysis is conducted to investigate the cause of the abutment displacement at the same time. In addition, repair works are practiced to the region damaged with intent to sustain long-term safety.

Keywords: field survey, expansion joint, repair, maintenance

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Authors: Nadir Ali Mugheri, Shaukat Ali Lohar

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In a multilingual society like Pakistan, code switching is commonly observed in different contexts. Mostly people use L1 (Native Languages) and L2 for common communications and L3 (i.e. English, Urdu, Sindhi) in formal contexts and for academic writings. Such a frequent code switching does affect EFL learners' acquisition of grammar and lexis of the target language which in the long run result in different types of errors in their writings. The current study is to investigate and identify common elements of L1 and L2 (spoken by students of the Universities in Pakistan) which create hindrances for EFL learners. Case study method was used for this research. Formal writings of 400 EFL learners (as participants from various Universities of the country) were observed. Among 400 participants, 200 were female and 200 were male EFL learners having different academic backgrounds. Errors found were categorized into different types according to grammatical items, the difference in meanings, structure of sentences and identifiers of tenses of L1 or L2 in comparison with those of the target language. The findings showed that EFL learners in Pakistani varsities have serious problems in their writings and they committed serious errors related to the grammar and meanings of the target language. After analysis of the committed errors, the results were found in the affirmation of the hypothesis that L1 or L2 does affect EFL learners. The research suggests in the end to adopt natural ways in pedagogy like task-based learning or communicative methods using contextualized material so as to avoid impediments of L1 or L2 in acquisition the target language.

Keywords: multilingualism, L2 acquisition, code switching, language acquisition, communicative language teaching

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Authors: Soyhan Egitim

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This case study aims to investigate leadership practices in diversity management in the liberal arts department of a Japanese university. In 2013, the Japanese Ministry of Education, Sports, Science, and Technology (MEXT) revealed their English education reform plan in response to rapid globalization. Based on the new reform plan, Japanese universities would expand their international faculty in order to promote globalization through an increased number of intercultural communication and content-based language classes in English. The study employed a two-phased qualitative approach to gain a deeper understanding of the management strategies employed in diversity management, and the leadership practices influenced those management strategies. In the first phase, a closed-ended qualitative survey was conducted with ten adjunct faculty members from the liberal arts department. The results indicate that syllabus design, grading scheme, textbook choices, and class management policies are strictly regulated by the tenured Japanese faculty. In the second phase, semi-structured interviews were held with international faculty members to understand their personal experiences. Their responses revealed that top-down management approaches are counter-effective in the department’s efforts to promote diversity and thus, a new organizational culture needs to be nurtured to emphasize inclusion alongside diversity. In this regard, the study proposes collaborative leadership as an inclusive leadership practice to minimize power differences in the hierarchy and increase opportunities for inclusion in the rapidly diversifying workforce.

Keywords: collaborative leadership, diversity, inclusion, international faculty, top-down

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Authors: Yosef Ferede Bogale

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The purpose of this study was to evaluate the degree of customer satisfaction and the variables influencing it in the instance of the Bank of Abyssinia branches in the districts of Arada and Bole in Addis Ababa. The study was carried out utilizing a mixed research approach and a descriptive and explanatory research design in Addis Ababa, the capital city of Ethiopia. Both primary and secondary data were employed in this investigation. The study's target population consisted of 1000 of the bank's most prestigious clients. With a 93% response rate, 265 respondents from both genders in the active age group had higher levels of education and work experience and were in the active age group. Customers of the case bank under consideration comprised the study's target audience. The respondents, who belonged to both gender groups, were in the active age bracket with superior levels of education and work experience. As a result, this investigation discovered that the degree of client satisfaction was assigned a medium rating. Additionally given a middling rating were the company's image practices, employee competency, technology, and service quality. Further, the results also demonstrate that corporate image, employees’ competency, technology, and service quality all positively and significantly affect customer happiness. This study found that, to varying degrees, company image, technology, competence, and high-quality financial services will all improve consumer happiness. According to this report, banks should monitor customer satisfaction and service quality at least twice a year. This is because there is a growing movement among bank service providers for accountability, and measuring these factors is crucial. This study also recommends that banks make every effort to satisfy consumers' expectations to the highest level.

Keywords: customer satisfaction, corporate image, quality services risk, bank

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Authors: Yusuf Bala

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The last decades of the 20th Centaury witnessed renewed hope about the birth of democracy and development in Africa the interface between democracy and development in Africa has long engaged the sustained interest of scholars and researchers across Africa. The process was actively supported by all segment of society, labour students market women, rural dweller who saw in it, the prospects of reversing the trend of political despair and in disillusionment that hither to characterized political life in Africa. The political tyranny and dictatorship while having it own clientele and beneficiaries had negative and suffocating effect on the majority of the people. The democratic aspiration of the Africa people is not only confined to the Arena of political Democracy of election and granting of civil and political rights, but it involves the demand for economic empowerment better living standards of the people and adequate social welfare indeed, for the majority of the people democracy is meaningful only when it delivers socio-economic goods. However, democracy and development have generated enormous interest no conclusive evidence seems to be shared in Africa. In the course of this research emphasis shall be made on certain issues, such as issues of corruption in democracy in Africa, ethnic conflict and democracy in Africa contribution of women to democratic practice and women participation in political arena, is still very low, democratization process and industrial relation in Africa as factor that hinder the development of Democracy in Africa, a case study of Nigeria.

Keywords: democracy, development, dictatorship, conflict, ethnicity

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Authors: Ilham Benali, Nasser Hajji, Nawfal Acha

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Given the fact that the pharmaceutical industry is a commonly studied sector in the context of innovation, the majority of innovation research is devoted to the developed markets known by high research and development (R&D) assets and intensive innovation. In contrast, in developing countries where R&D assets are very low, there is relatively little research to mention in the area of pharmaceutical sector innovation, characterized mainly by two principal elements which are the presence of foreign-owned firms and licensed manufacturing agreements between local firms and multinationals. With the scarcity of research in this field, this paper attempts to study the effect of these two elements on the firms’ innovation tendencies. Other traditional factors that influence innovation, which are the age and the size of the firm, the R&D activities and the market structure, revealed in the literature review, will be included in the study in order to try to make this work more exhaustive. The study starts by examining innovation tendency in pharmaceutical firms located in developing countries before analyzing the effect of foreign-owned firms and licensed manufacturing agreements between local firms and multinationals on technological, organizational and marketing innovation. Based on the related work and on the theoretical framework developed, there is a probability that foreign-owned firms and licensed manufacturing agreements between local firms and multinationals have a negative influence on technological innovation. The opposite effect is possible in the case of organizational and marketing innovation.

Keywords: developing countries, foreign owned firms, innovation, licensed manufacturing agreements, pharmaceutical industry

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Authors: Ricardo Chaves, Carlos Vasconcelos

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Candidates to join the Naval Academy have to take a set of physical tests, which is crucial for a high level of physical fitness. Thus, the planning of physical exercises for candidates to the Naval School must take into account the improvement of their physical fitness. The aim of this study was to investigate the impact of a 6-month exercise program to improve the physical fitness of an individual who will apply for the Naval Academy. This was a non-experimental pre-post-evaluation study. The patient was male, had 18 years old, and a body mass index of 21.1 kg.m². The patient participated in a 6-month aerobic and strength exercise program (3 sessions per week, 75 minutes duration each session). Physical fitness tests were performed according to the physical fitness requirements for entry into the Naval academy (muscle strength [maximum number of lifts and maximum number of sit-ups for 1 minute]; aerobic fitness [2.4 km run and 200 m swimming test]) before (baseline) and after the exercise intervention (6 months). Regarding muscle strength, in the abdominal test, the improvements between the pre-test (39 abdominals.) and post-test (61 abdominals) were 56.4%. For elevations, there was an increase in its number by 150% between the pre-test (4 elevations) and post-test (10 elevations). With regard to aerobic fitness, in the 2.4 km race, there was an evolution of 32.0% between the pre-test (16.46 min.) and the post-test (12.42 min.). For the 200-meter swimming test, there was a negative variation of 2% between the pre-test (2.25 min.) and post-test (2.28 min). A 6-month aerobic and strength exercise program leads to a positive evolution in the muscular strength of the patient. Regarding aerobic fitness, opposite results were found, with a positive evolution in the 2.4 km running test and a negative evolution in the swimming test. In future exercise programs for the improvement of the physical fitness of candidates for the Naval Academy, more emphasis has to be done on specific swimming training.

Keywords: case study, exercise program, Naval Academy, physical fitness

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Authors: Pornpimol Chaiwuttisak, Honora Smith, Yue Wu

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Blood is a perishable product which suffers from physical deterioration with specific fixed shelf life. Although its value during the shelf life is constant, fresh blood is preferred for treatment. However, transportation costs are a major factor to be considered by administrators of Regional Blood Centres (RBCs) which act as blood collection and distribution centres. A trade-off must therefore be reached between transportation costs and short-term holding costs. In this paper we propose a number of algorithms for online allocation and routing of blood supplies, for use in conditions of variable and insufficient blood supply. A case study in northern Thailand provides an application of the allocation and routing policies tested. The plan proposed for daily allocation and distribution of blood supplies consists of two components: firstly, fixed routes are determined for the supply of hospitals which are far from an RBC. Over the planning period of one week, each hospital on the fixed routes is visited once. A robust allocation of blood is made to hospitals on the fixed routes that can be guaranteed on a suitably high percentage of days, despite variable supplies. Secondly, a variable daily route is employed for close-by hospitals, for which more than one visit per week may be needed to fulfil targets. The variable routing takes into account the amount of blood available for each day’s deliveries, which is only known on the morning of delivery. For hospitals on the variables routes, the day and amounts of deliveries cannot be guaranteed but are designed to attain targets over the six-day planning horizon. In the conditions of blood shortage encountered in Thailand, and commonly in other developing countries, it is often the case that hospitals request more blood than is needed, in the knowledge that only a proportion of all requests will be met. Our proposal is for blood supplies to be allocated and distributed to each hospital according to equitable targets based on historical demand data, calculated with regard to expected daily blood supplies. We suggest several policies that could be chosen by the decision makes for the daily distribution of blood. The different policies provide different trade-offs between transportation and holding costs. Variations in the costs of transportation, such as the price of petrol, could make different policies the most beneficial at different times. We present an application of the policies applied to a realistic case study in the RBC at Chiang Mai province which is located in Northern region of Thailand. The analysis includes a total of more than 110 hospitals, with 29 hospitals considered in the variable route. The study is expected to be a pilot for other regions of Thailand. Computational experiments are presented. Concluding remarks include the benefits gained by the online methods and future recommendations.

Keywords: online algorithm, blood distribution, developing country, insufficient blood supply

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Authors: A. K. Aswathy, Asha Manoharan, Arya Manoharan

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The purpose of this study are to define the nature of oral sensory issues in children with autism spectrum disorder (ASD), identify important components of the assessment and treatment of this issues specific to this population, and delineate specific therapeutic techniques designed to improve assessment and treatment within therapeutic settings. Literature review and case example is used to define the predominant nature of the oral sensory issues that are experienced by some children on the autism spectrum. Characteristics of this complex disorder that can have an impact on feeding skill and behavior are also identified. These factors are then integrated to create assessment and intervention techniques that can be used in conjunction with traditional feeding approaches to facilitate improvements in eating as well as reducing oral apraxic component in this unique population. The complex nature of ASD and its many influences on feeding skills and behavior create the need for modification to both assessment and treatment approaches. Additional research is needed to create therapeutic protocols that can be used by speech-language pathologists to effectively assess and treat feeding and oro motor apraxic difficulties that are commonly encountered in children with ASD.

Keywords: autism, assessment, feeding, intervention, oral sensory issues, oral apraxia

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Authors: Jubaida Gulshan Ara, Zebun Nasreen Ahmed

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Urban flood and drought has been a major problem of Dhaka city, particularly in recent years. Continuous increase of the city built up area, and limiting rainwater infiltration zone, are thought to be the main causes of the problem. Proper rainwater management, even at the individual plot level, might bring significant improvement in this regard. As residential use pattern occupies a significant portion of the city surface, the scope of rainwater harvesting (RWH) in residential buildings can be investigated. This paper reports on a research which explored the scope of rainwater harvesting in residential plots, with multifamily apartment buildings, in Dhaka city. The research investigated the basics of RWH, contextual information, i.e., hydro-geological, meteorological data of Dhaka city and the rules and legislations for residential building construction. The study also explored contemporary rainwater harvesting practices in the local and international contexts. On the basis of theoretical understanding, 21 sample case-studies, in different phases of construction, were selected from seven different categories of plot sizes, in different residential areas of Dhaka city. Primary data from the 21 case-study buildings were collected from a physical survey, from design drawings, accompanied by a questionnaire survey. All necessary secondary data were gathered from published and other relevant sources. Collected primary and secondary data were used to calculate and analyze the RWH needs for each case study, based on the theoretical understanding. The main findings have been compiled and compared, to observe residential development trends with regards to building rainwater harvesting system. The study has found that, in ‘Multifamily Apartment Building’ of Dhaka city, storage, and recharge structure size for rainwater harvesting, increases along with occupants’ number, and with the increasing size of the plot. Hence, demand vs. supply ratio remains almost the same for different sizes of plots, and consequently, the size of the storage structure increases significantly, in large-scale plots. It has been found that rainwater can meet only 12%-30% of the total restricted water demand of these residential buildings of Dhaka city. Therefore, artificial groundwater recharge might be the more suitable option for RWH, than storage. The study came up with this conclusion that, in multifamily residential apartments of Dhaka city, artificial groundwater recharge might be the more suitable option for RWH, than storing the rainwater on site.

Keywords: Dhaka city, rainwater harvesting, residential plots, urban flood

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Authors: Jerome D. Donovan

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The pandemic has resulted in a dramatic re-consideration of the reliance on international student fees to support university models in Australia. A key resulting initiative for the Australian Federal Government has been shifting the way universities consider their research model, emphasising the importance of commercialising research. This study specifically examines this shift from the perspective of a university spin-off, examining how university support structures and incubation models have assisted in the translation of fundamental research into a high-growth university spin-off. A focused case study approach is adopted in this study, using an auto-ethnographic research method to document the experiences and insights drawn from being a co-founder in a university spin-off in a time where research commercialisation has emerged as a central focus in Australian universities.

Keywords: research commercialisation, spin-offs, university incubation, entrepreneurship

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Authors: Marek Halenár, Eva Tvrdá, Tomáš Slanina, Ľubomír Ondruška, Eduard Kolesár, Peter Massányi, Adriana Kolesárová

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The present in vitro study was designed to reveal whether amygdalin (AMG) is able to cause changes to the motility, viability and mitochondrial activity of rabbit spermatozoa. New Zealand White rabbits (n = 10) aged four months were used in the study. Semen samples were collected from each animal and used for the in vitro incubation. The samples were divided into five equal parts and diluted with saline supplemented with 0, 0.5, 1, 2.5 and 5 mg/mL AMG. At times 0h, 3h and 5h spermatozoa motion parameters were assessed using the SpermVision™ computer-aided sperm analysis (CASA) system, cell viability was examined with the metabolic activity (MTT) assay, and the eosin-nigrosin staining technique was used to evaluate the viability of rabbit spermatozoa. All AMG concentrations exhibited stimulating effects on the spermatozoa activity, as shown by a significant preservation of the motility (P<0.05 with respect to 0.5 mg/mL and 1 mg/mL AMG; Time 5 h) and mitochondrial activity (P< 0.05 in case of 0.5 mg/mL AMG; P< 0.01 in case of 1 mg/mL AMG; P < 0.001 with respect to 2.5 mg/mL and 5 mg/mL AMG; Time 5 h). None of the AMG doses supplemented had any significant impact of the spermatozoa viability. In conclusion, the data revealed that short-term co-incubation of spermatozoa with AMG may result in a higher preservation of the sperm structural integrity and functional activity.

Keywords: amygdalin, CASA, mitochondrial activity, motility, rabbits, spermatozoa, viability

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Authors: Vehbi Gorgulu

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The primary objective of the current study is to explore how brand managers can employ Internet memes as a marketing tool. Internet memes are marked for their sarcastic and entertaining content and their amateur/DIY natures. The current study focuses on #TFWGucci, a collaborative marketing project enacted by Gucci, which is marked for being one of the first structured collaborative memetic marketing campaigns in the world. By embracing a qualitative approach, the study will explore production and meaning making processes of #TFWGucci campaign via analysis of sample campaign contents. The study will provide hints and insights for digital marketers on how to employ memetic marketing strategies in successful ways.

Keywords: meme, internet meme, online marketing, memetic marketing, #TFWGucci

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Authors: Jae Soo Do, Kyoung Seok Kim

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Korea baseball experts reckoned Samsung Lions as the best baseball team. It has the unparalleled records of winning first place in the pennant race for five straight years from 2011 to 2015 and winning the Korean series for four years in a row from 2011 to 2014. However, the team made an unbelievably miserable record of ninth place in the pennant race in 2016 and 2017. How come the strong competitive superiority has gone and what kind of slump made the team how it is now. This study investigates this organizational failure case of Samsung Lions, the professional baseball team in Korea. What factors have brought the organizational failure to Samsung Lions? Based on an in-depth examination on how a league-fore-runner drastically lost its competitive superiority, this verifies the necessity of risk management to which common corporations as well as sport teams can be subject at any time in these days.

Keywords: Samsung Lions, organizational failure, baseball, slump

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Authors: Fofie Kokea Ariane Darolle, Gouet Daniel Hervé, Koumetio Fidèle, Yemele David

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The electrical resistivity method is successfully used in this paper in order to have a clearer picture of the subsurface of the North-East ofFiguil in northern Cameroon. It is worth noting that this method is most often used when the objective of the study is to image the shallow subsoils by considering them as a set of stratified ground layers. The problem to be solved is very often environmental, and in this case, it is necessary to perform an inversion of the data in order to have a complete and accurate picture of the parameters of the said layers. In the case of this work, thirty-three (33) Schlumberger VES have been carried out on an irregular grid to investigate the subsurface of the study area. The 1D inversion applied as a preliminary modeling tool and in correlation with the mechanical drillings results indicates a complex subsurface lithology distribution mainly consisting of marbles and schists. Moreover, the quasi-3D inversion with lateral constraint shows that the misfit between the observed field data and the model response is quite good and acceptable with a value low than 10%. The method also reveals existence of two water bearing in the considered area. The first is the schist or weathering aquifer (unsuitable), and the other is the marble or the fracturing aquifer (suitable). The final quasi 3D inversion results and geological models indicate proper sites for groundwaters prospecting and for mining exploitation, thus allowing the economic development of the study area.

Keywords: electrical resistivity method, 1D inversion, quasi 3D inversion, groundwaters, mining

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Authors: Paul Saah, Charles Mbohwa, Nelson Sizwe Madonsela

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In the context of developing countries, this study explores a crucial component of economic development by examining the reasons behind the failure of small and medium-sized enterprises (SMEs). SMEs are acknowledged as essential drivers of economic expansion, job creation, and poverty alleviation in emerging countries. This research uses South Africa as a case study to evaluate the reasons why SMEs fail in developing nations. This study explores a quantitative research methodology to investigate the complex causes of SME failures using statistical tools and reliability tests. To ensure the viability of data collection, a sample size of 400 small business owners was chosen using a non-probability selection technique. A closed-ended questionnaire was the primary technique used to obtain detailed information from the participants. Data was analysed and interpreted using computer software packages such as the Statistical Package for the Social Sciences (SPSS). According to the findings, the main reasons why SMEs fail in developing nations are a lack of strategic business planning, a lack of funding, poor management, a lack of innovation, a lack of business research and a low level of education and training. The results of this study show that SMEs can be sustainable and successful as long as they comprehend and use the suggested small business success determining variables into their daily operations. This implies that the more SMEs in developing countries implement the proposed determinant factors of small business success in their business operations the more the businesses are likely to succeed and vice versa.

Keywords: failure, developing countries, SMEs, economic development, South Africa

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Authors: Birome Holo Ba, Christian Prins, Caroline Prodhon

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Optimization is an important aspect of logistics management. It can reduce significantly logistics costs and also be a good tool for decision support. In this paper, we address a planning problem specific to biomass supply chain. We propose a new mixed integer linear programming (MILP) model dealing with different feed stock production operations such as harvesting, packing, storage, pre-processing and transportation, with the objective of minimizing the total logistic cost of the system on a regional basis. It determines the optimal number of harvesting machine, the fleet size of trucks for transportation and the amount of each type of biomass harvested, stored and pre-processed in each period to satisfy demands of refineries in each period. We illustrate the effectiveness of the proposal model with a numerical example, a case study in Aube (France department), which gives preliminary and interesting, results on a small test case.

Keywords: biomass logistics, supply chain, modelling, optimization, bioenergy, biofuels

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Authors: Ammar Asma, Bouafia Nabiha, Ben Cheikh Asma, Ezzi Olfa, Mahjoub Mohamed, Sma Nesrine, Chouchène Imed, Boussarsar Hamadi, Njah Mansour

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Background: Ventilator-associated pneumonia (VAP) is currently recognized as one of the most relevant causes of morbidity and mortality among intensive care unit (ICU) patients worldwide. Identifying modifiable risk factors for VAP could be helpful for future controlled interventional studies aiming at improving prevention of VAP. The purposes of this study were to determine the incidence and risk factors for VAP in in a Tunisian medical ICU. Materials / Methods: A retrospective case-control study design based on the prospective database collected over a 14-month period from September 15th, 2015 through November 15th, 2016 in an 8-bed medical ICU. Patients under ventilation for over 48 h were included. The number of cases was estimated by Epi-info Software with the power of statistical test equal to 90 %. Each case patient was successfully matched to two controls according to the length of mechanical ventilation (MV) before VAP for cases and the total length of MV in controls. VAP in the ICU was defined according to American Thoracic Society; Infectious Diseases Society of America guidelines. Early onset or late-onset VAP were defined whether the infectious process occurred within or after 96 h of ICU admission. Patients’ risk factors, causes of admission, comorbidities and respiratory specimens collected were reviewed. Univariate and multivariate analyses were performed to determine variables associated with VAP with a p-value < 0.05. Results: During the period study, a total of 169 patients under mechanical ventilation were considered, 34 patients (20.11%) developed at least one episode of VAP in the ICU. The incidence rate for VAP was 14.88/1000 ventilation days. Among these cases, 9 (26.5 %) were early-onset VAP and 25 (73.5 %) were late-onset VAP. It was a certain diagnosis in 66.7% of cases. Tracheal aspiration was positive in 80% of cases. Multi-drug resistant Acinerobacter baumanii was the most common species detected in cases; 67.64% (n=23). The rate of mortality out of cases was 88.23% (n= 30). In univariate analysis, the patients with VAP were statistically more likely to suffer from cardiovascular diseases (p=0.035) and prolonged duration of sedation (p=0.009) and tracheostomy (p=0.001), they also had a higher number of re-intubation (p=0.017) and a longer total time of intubation (p=0.012). Multivariate analysis showed that cardiovascular diseases (OR= 4.44; 95% IC= [1.3 - 14]; p=0.016), tracheostomy (OR= 4.2; 95% IC= [1.16 -15.12]; p= 0.028) and prolonged duration of sedation (OR=1.21; 95% IC= [1.07, 1.36]; p=0.002) were independent risk factors for the development of VAP. Conclusion: VAP constitutes a therapeutic challenge in an ICU setting, therefore; strategies that effectively prevent VAP are needed. An infection control-training program intended to all professional heath care in this unit insisting on bundles and elaboration of procedures are planned to reduce effectively incidence rate of VAP.

Keywords: case control study, intensive care unit, risk factors, ventilator associated pneumonia

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Authors: Ruchi Sharma, Rajasekhar Balasubramanian

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Motor vehicles emit a number of air pollutants, among which fine particulate matter (PM₂.₅) is of major concern in cities with high population density due to its negative impacts on air quality and human health. Typically, people spend more than 80% of their time indoors. Consequently, human exposure to traffic-related PM₂.₅ in indoor environments has received considerable attention. Most of the public residential buildings in tropical countries are designed for natural ventilation where indoor air quality tends to be strongly affected by the migration of air pollutants of outdoor origin. However, most of the previously reported traffic-related PM₂.₅ exposure assessment studies relied on ambient PM₂.₅ concentrations and thus, the health impact of traffic-related PM₂.₅ on occupants in naturally ventilated buildings remains largely unknown. Therefore, a systematic field study was conducted to assess indoor human exposure to traffic-related PM₂.₅ with and without mitigation measures in a typical naturally ventilated residential apartment situated near a road carrying a large volume of traffic. Three PM₂.₅ exposure scenarios were simulated in this study, i.e., Case 1: keeping all windows open with a ceiling fan on as per the usual practice, Case 2: keeping all windows fully closed as a mitigation measure, and Case 3: keeping all windows fully closed with the operation of a portable indoor air cleaner as an additional mitigation measure. The indoor to outdoor (I/O) ratios for PM₂.₅ mass concentrations were assessed and the effectiveness of using the indoor air cleaner was quantified. Additionally, potential human health risk based on the bioavailable fraction of toxic trace elements was also estimated for the three cases in order to identify a suitable mitigation measure for reducing PM₂.₅ exposure indoors. Traffic-related PM₂.₅ levels indoors exceeded the air quality guidelines (12 µg/m³) in Case 1, i.e., under natural ventilation conditions due to advective flow of outdoor air into the indoor environment. However, while using the indoor air cleaner, a significant reduction (p < 0.05) in the PM₂.₅ exposure levels was noticed indoors. Specifically, the effectiveness of the air cleaner in terms of reducing indoor PM₂.₅ exposure was estimated to be about 74%. Moreover, potential human health risk assessment also indicated a substantial reduction in potential health risk while using the air cleaner. This is the first study of its kind that evaluated the indoor human exposure to traffic-related PM₂.₅ and identified a suitable exposure mitigation measure that can be implemented in densely populated cities to realize health benefits.

Keywords: fine particulate matter, indoor air cleaner, potential human health risk, vehicular emissions

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Authors: Isiya Salihu Shinkafi

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The focus of this paper is to elaborate on employment opportunities within the tourism sector and the solutions to youth unemployment in Africa and Nigeria in particular. Youth unemployment creates a monumental social problem to African continent, the world over and Nigeria in particular. The intelligence of this paper was collected from secondary sources using previews researches and analysis of scholars to gather empirical data. The findings revealed that unemployment in Africa and specifically Nigeria among youths were caused by certain factors which constitute a greater challenge to the economy and the existence of the continent. The tourism sector provides the enabling environment to address the different categories of unemployment among the youths. One of the unique characteristics of the tourism industry that makes it a prime sector from which employment can be engineered; especially in the case of the African countries, are its labour intensive characteristics of both experts, skilled, semi-skilled and unskilled labour.

Keywords: tourism industry, employment opportunities, youth employment

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Authors: Yael Cohen Azaria, Sara Zamir

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This study examined what motivated Israeli Arab students to choose to study for a degree in education and society and the influence of this academic choice on them while they were studying. The study follows the qualitative paradigm of data collection and analysis, in a case study of a homogeneous group of Arab students in a Jewish multicultural academic institution. 33 students underwent semi-structured in-depth interviews. Findings show that the choice stemmed from a desire to lead social change within their own society; to imitate an educational role-model and to realize a dream of higher education. Among the female students, this field suits the role of the woman in Arab society. The interviewees claimed that the influence of their studies was that they felt more openness towards others and those who are different; they felt pride and self-confidence in their abilities, and the women mentioned that they felt empowered.

Keywords: education, higher education, Israeli Arabs, minorities

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Authors: Adam J. Carinci

Abstract:

Background: The opioid epidemic is the most pressing healthcare crisis of our time. There is increasing recognition that opioids have limited long-term efficacy and are associated with hyperalgesia, addiction, and increased morbidity and mortality. Therefore, alternative strategies to combat chronic pain are paramount. We initiated a multicenter retrospective case series to review the efficacy of DRG stimulation in facilitating opioid tapering, opioid discontinuation and as a viable alternative to chronic opioid therapy. Purpose: The dorsal root ganglion (DRG) plays a key role in the development and maintenance of pain. Recent innovations in neuromodulation, specifically, dorsal root ganglion stimulation, offers an effective alternative to opioids in the treatment of chronic pain. This retrospective case series demonstrates preliminary evidence that DRG stimulation facilitates opioid tapering, opioid discontinuation and presents a viable alternative to chronic opioid therapy. Procedure: This small multicenter retrospective case series provides preliminary evidence that DRG stimulation facilitates opioid weaning, opioid tapering and is a viable option to opioid therapy in the treatment of chronic pain. A retrospective analysis was completed. Visual analog scale pain scores and pain medication usage were collected at the baseline visit and after four weeks, 3 months and 6 months of treatment. Ten consecutive patients across two study centers were included. The pain was rated 7.38 at baseline and decreased to 1.50 at the 4-week follow-up, a reduction of 79.5%. All patients significantly decreased their opioid pain medication use with an average > 30% reduction in morphine equivalents and four were able to discontinue their medications entirely. Conclusion: This Retrospective case series demonstrates preliminary evidence that DRG stimulation facilitates opioid tapering, opioid discontinuation and presents a viable alternative to chronic opioid therapy.

Keywords: dorsal root ganglion, neuromodulation, opioid sparing, stimulation

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Authors: Chengyuan Zhu, Zhu Wang

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With the strategy of Rural Rejuvenation proposed in China, the rural has become the focus of all works today. In addition to the support of industry and policy, the rural planning and construction which is the space dependence of Rural Rejuvenation are also very crucial. Based on an analysis of the case of Yangdun Village in Deqing County, this paper summarizes village existing resources and construction status quo. It tries to illuminate the micro-activated organic renewal strategies and methods, based on ecological landscape, history context, industry development and living life requirements. It takes advantage of industrial linkage and then asks for the coordination of both spatial and industrial planning, the revival and remodeling of the rural image can be achieved through shaping the of architectural and landscape nodes as well as the activation of street space.

Keywords: rural construction, rural human settlements, micro-activation, organic renewal

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Authors: Thakur Pushpawati, Singh Vinita, Agrawal Sarita, Mohapatra Eli

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Polycystic ovary syndrome (PCOS) is a disease of endocrine and frequently encountered in women in their reproductive period, and it is characterized by clinical features of anovulation, clinical and biochemical features of hyperandrogenism, and PCOS morphology on ultrasonographic examination. In Indian scenario, only a few studies are available on the correlation of serum 25-dihydroxy vitamin D3 level and insulin level. The present study is a prospective case-control study and aims to estimate the concentration of serum 25-dihydroxy vitamin D3 and insulin resistance and determine the association of serum 25-dihydroxy vitamin D3 with insulin resistance in PCOS women of 18-40 years age group. In this study, the primary objective is to estimate the concentration of 25-dihydroxy vitamin D3, insulin, glycaemic status, calcium and phosphorus levels in 18-40 year age women with polycystic ovary syndrome and to compare these parameters with age and BMI matched healthy control of same age group women. The secondary objective is to determine the association between 25-dihydroxy vitamin D3 concentration and insulin resistance among PCOS cases in 18-40 years age group women. This study was carried on at outpatient Department of Obstetrics & Gynaecology, Aiims Raipur. It took one year from the date of approval. In case, 32 women were diagnosed (Diagnosed PCOS cases as per Rotterdoms criteria among women of 18-40 years of age), as control group 32 women of 18-40 years of age were diagnosed As a result, serum insulin level was elevated among PCOS women along with 25-dihydroxy vitamin D3 deficiency.Conclude up, PCOS is more common in the age group of 20-40 years. There is a strong correlation between vitamin D deficiency and insulin resistance among PCOS patients.

Keywords: vitamin D, insulin resistance, PCOS, reproductive age group

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Authors: Samar Akef, Ahdab M. K. El-Morshedy, Mohamed M. Samy, Ahmed M. Emam

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This paper presents a safe and realistic design for the proposed high voltage direct current grounding grid for the converter station at Badr City in Egypt. The outcomes show that the estimated results for touch and step voltages are below the safe limits for humans in monopolar operation and fault conditions. The cross-section area of earthing conductor is computed using IEC TS 62344. The results show that touch voltage in monopolar and fault conditions are 46.6 V and 167.68 V, respectively. The optimum number of required earthing rods is obtained by an analytical method. The step voltages are 12.9 and 43 V in monopolar operation and fault conditions. In addition, this paper presents an experimental case study to verify the simulation work executed using CYMGrd software (finite element method based). The percentage error between the measured and simulated surface potential is below 15.9%.

Keywords: grounding, monopolar, fault conditions, step potential, touch potential, CYMGrd, finite element method, experimental case study

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Authors: Abdulwahab Alalyani, Mahbub Rashid

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Public Open Space (POS) availability and distribution among urban communities have a central role to promotes community health. However, growing health challenges in a city would raise attention to the planning quality of these community's assets. This research aims to measure the existing availability and distribution equity of POS in the context of Saudi Arabia using Riyadh city as a case study. The methodology for the POS availability was by calculating the total POS with respect to the population total (m²/inhabitant). All POS were mapped using geographical information systems (GIS), and the total area availability of POS was compared to global, regional, and local standards. To evaluate the significant differences in POS availability across low, medium, and high-income Riyadh neighborhoods, we used a One-way ANOVA analysis of covariance to test the differences. The results are as follows; POS availability was lower than global standers. Riyadh has only 1.40m² per capita of POS. Spatial equity of the availability were significantly different among Riyadh neighborhoods based on socioeconomic status. The future development of POS should be focused on increasing general POS availability and should be given priority to those low-income and unhealthy communities. Accessibility indicators of POS should be considered in future studies.

Keywords: open spaces availability, open spaces distribution, spatial equity, healthy city, Riyadh City

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Authors: Veronica Diaz Quezada

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The society of the 21st century requires training of engineers capable of solving routine and non-routine problems in applications of the limit of real functions, as part of the course Calculus I. For this purpose, research was conducted with a methodological design that combines quantitative and qualitative procedures and that aims, to identify and to characterize the types of problems according to their nature and context, through the application of a mathematics test; to know— through a questionnaire— the opinion of difficulties in their solution, previous and missing knowledge of some students of three engineering careers of a state university in Chile. This research is completed with three case studies. The results favor the performance of students in solving problems of a fantasist and realistic context, but these do not guarantee mathematical skills which are necessary to solve non-routine problems of limit applications. In conclusion, through this research, it became clear that the students of the three engineerings do not have all the necessary skills to solve problems of application of the limit of a function of the real variable.

Keywords: case studies, engineering program, limits, problem solving

Procedia PDF Downloads 116