Search results for: elderly households

Authors: Nolitha L. Skenjana, Bongani P. Kubheka, Maxwell A. Poswal

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The Eastern Cape Province of South Africa is characterized by subsistence farming, which is mostly distributed in the rural areas of the province. It is estimated that cereal crops such as maize and sorghum, and vegetables such as cabbage are grown in more than 400.000 rural households, with maize being the most dominant crop. However, compared to commercial agriculture, small-scale farmers receive minimal support from research and development, limited technology transfer on the latest production practices and systems and have poor production infrastructure and equipment. Similarly, there is limited farmers' appreciation on best practices in insect pest management and control. The paper presents findings from the primary literature and personal observations on insect pest management practices of small-scale farmers in the province. Inferences from literature and personal experiences in the production areas have led to a number of deductions regarding the level of exposure and extent of vulnerability. Farmers' pest management practices, which included not controlling at all though there is a pest problem, resulted in their crop stands to be more vulnerable to pest attacks. This became more evident with the recent brown locust, African armyworm, and Fall armyworm outbreaks, and with the incidences of opportunistic phytophagous insects previously collected on wild hosts only, found causing serious damages on crops. In most of these occurrences, damage to crops resulted in low or no yield. Improvements on farmers' reaction and response to pest problems were only observed in areas where focused awareness campaigns and trainings on specific pests and their management techniques were done. This then calls for a concerted effort from all role players in the sphere of small-scale crop production, to train and equip farmers with relevant skills, and provide them with information on affordable and climate-smart strategies and technologies in order to create a state of preparedness. This is necessary for the prevention of substantial crop losses that may exacerbate food insecurity in the province.

Keywords: Eastern Cape Province, small-scale farmers, insect pest management, vulnerability

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Authors: Kalina Alina Aidarovna, Khayrullina Yulia Sergeevna

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The question of forming quality housing and living environment remains a vexed problem in the current situation of high-rise apartment building in big cities of Russia. At this start up stage of the modern so-called "mass housing" market it needs to identify key quality characteristics on a different scale from apartments to the district. This paper describes the methodology of qualitative assessment of modern mass housing construction, made on the basis of the ITMO university in cooperation with the institute of spatial planning "Urbanika," based on the case study of St. Petersburg’s residential mass housing built in 2011-2014. The methodology of the study of housing and living environment goes back to the native and foreign urbanists of 60s - 80s, such Jane Jacobs, Jan Gehl, Oscar Newman, Krasheninnikov, as well as Sommer, Stools, Kohnen and Sherrod, Krasilnikova, Sychev, Zhdanov, Tinyaeva considering spatial features of living environment in a wide range of its characteristics (environmental control, territorial and personalization, privacy, etc.). Assessment is carrying out on the proposed system of criteria developed for each residential environment scale-district, quarter, courtyard, building surrounding grounds, houses, and flats. Thus the objects of study are planning unit of residential development areas (residential area, neighborhood, quarter) residential units areas (living artist, a house), and households (apartments) consisting of residential units. As a product of identified methodology, after the results of case studies of more than 700 residential complexes in St. Petersburg, we intend the creation of affordable online resource that would allow conducting a detailed qualitative evaluation or comparative characteristics of residential complexes for all participants of the construction market-developers, designers, realtors and buyers. Thereby the main objective of the rating may be achieved to improve knowledge, requirements, and demand for quality housing and living environment among the major stakeholders of the construction market.

Keywords: methodology of living environment, qualitative assessment of mass housing, scale-district, vexed problem

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Authors: Carolyn Cameron

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Stop Food Waste Australia is working with the industry to co-design sector action plans to prevent and reduce food waste across the supply chain. We are a public-private partnership, funded in 2021 by the Australian national government under the 2017 National Food Waste Strategy. Our partnership has representatives from all levels of government, industry associations from farm to fork, and food rescue groups. Like many countries, Australia has adopted the Sustainable Development Goal (SDG) target of 12.3 to halve food waste by 2030. A seminal 2021 study, the National Food Waste Feasibility Report, developed a robust national baseline, illustrating hotspots in commodities and across the supply chain. This research found that the consumption stages – households, food service, and institutions - account for over half of all food waste, and 22% of food produced never leaves the farm gate. Importantly the study found it is feasible for Australia to meet SDG 12.3, but it will require unprecedented action by governments, industry, and the community. Sector Action Plans (Plan) are one of the four main initiatives of Stop Food Waste Australia, including a voluntary commitment, a coordinated food waste communications hub, and robust monitoring and reporting framework. These plans provide a systems-based approach to reducing food loss and waste while realising multiple benefits for supply chain partners and other collaborators. Each plan is being co-designed with the key stakeholders most able to directly control or influence the root cause(s) of food waste hotspots and to take action to reduce or eliminate food waste in their value chain.  The initiatives in the Plans are fit-for-purpose, reflecting current knowledge and recognising priorities may refocus over time. To date, sector action plans have been developed with the Food Rescue, Cold Chain, Bread and Bakery, and Dairy Sectors. Work is currently underway on Meat and Horticulture, and we are also developing supply-chain stage plans for food services and institutions. The study will provide an overview of Australia’s food waste baseline and challenges, the important role of sector action plans in reducing food waste, and case studies of implementation outcomes.

Keywords: co-design, horticulture, sector action plans, voluntary

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Authors: Nuttapimon Bhirommuang, Kulapong Jayanama

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Background: Prevalence of malnutrition in hospitalized patient is higher than general population. As a result of the unawareness of consequence and the more concerning in the other aspects of care, many patients with high risk of malnutrition are unrecognized. Even if malnutrition has been identified as affecting in many patient outcomes, the impact may differ in each population and group of patients. Objectives: The aims of this study were to examine the association between the nutritional status and the length of stay and hospital costs in hospitalized patients, to investigate the factors related these outcomes and to determine the frequency of malnutrition in hospitals. Method: This retrospective cohort study enrolled all patients aged 15 years old or older and admitted in SDMC, Ramathibodi Hospital between 1st January 2016 and 30th September 2016. The nutritional status assessment by Nutrition Alert Form (NAF) was performed by well-trained nurses in all patients at admission. Baseline characteristics were recorded. Length of stay and hospital costs were collected during their hospitalization. Univariate analysis, nonparametric rank test, Kruskal-Wallis test were used to compare means in the case of nonnormally and noncontinuously distributed data. Chi-square used to analyze categorical variables, the nutritional status and the length of stay and hospital costs and identify possible confounding factors (data were analyzed using SPSS version 18.0). Result: Of the 2,906 patients, 3.9% were severe malnutrition (NAF-C score > 10) and 11.4% were moderate malnutrition (NAF-B score 6 - 10). Both length of stay and hospital costs were found significantly higher in more severe malnutrition group (p < 0.001), NAF = A: 3.21 days, 95% CI 3.06-3.35 and 111,544.25 THB, 95% CI 106,994.41 – 116,094.1; NAF = B: 7.54 days, 95% CI 6.32 – 8.76 and 162,302.4 THB, 95% CI 129,557.88 – 195,046.92; NAF =C: 14.77 days, 95% CI 11.34 – 18.2 and 323,572.11 THB, 95% CI 226,958.1 – 420,096.13 (1 THB = 0.03019 USD). Age of each nutritional status group had also significant increase from NAF A to NAF C (p < 0.001): 55.07, 67.03 and 73.88 years old, respectively. Conclusion: The prevalence of malnutrition in Ramathibodi hospital is voluminous. Severe malnutrition screening by NAF is significantly correlated with worse clinical outcome, especially higher length of stay and hospital costs. Elderly is also a significant factor which correlates with malnutrition. The results of this study could change the awareness of health personnel and the practice protocol. Moreover, the further study concerning nutritional support in high-risk group of malnutrition is ongoing to confirm this hypothesis.

Keywords: malnutrition, NAF, length of stay, hospital costs

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Authors: Wipakon Sonsnam, Kanya Napapongsa

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The quantitative aim of the study; 1) health conditions, to examine the state of health of the aging, 2) perceived of self-efficacy, self-care of aging ,3) perceived of social support of the aging, 4) to examine factors associated with self-efficacy in enhancing the health and self-care when illness. 100 samples selected from communities in Dusit, Bangkok, 2014 by random sampling. The questionnaires were used to collect data have 5-point rating scale, consisting of strongly agree, agree, undecided, disagree, and strongly disagree; approved content valid by 3 experts, reliability coefficients alpha was .784 for perceived of self-efficacy, self-care of aging and .827 for perceived of social support of the aging. ST-5, 2Q used for collect mental health. The ability to engage in a daily routine was collected by Barthel ADL index. Founding, the sample group were female (68%). (33%) of them were in the age of 60-65. Most of them were married and still live with their spouse (55%) and do not work (38%). The average annual income was less than 10,000 baht supported by child. Most people think that income was adequate (49.0%) and Satisfaction (61.0%). Most of aging caring them-self, followed by them spouse (26%). Welfare of the public had supported, living for the aging (100%), followed by Join and health volunteers in communities (23%). In terms of health, (53%) of the sample group feels health was fair, hypertension was the most common health condition among sample group (68%), following by diabetes (55%). About eyesight, (42%) have visual acuity. (59.0%) do not need hearing aids. 84% have more than 20 teeth remaining, and have no problem with chewing (61%). In terms of Ability to engage in a daily routine, most of people (84%) in sample group are in type 1. (91%) of the participants don’t have bladder incontinence. For mental condition, (82%) do not have insomnia. (87%) do not have anxiety. (96%) do not have depression. However, (77%) of the sample group is facing stress. In terms of environment in home, bathroom in the home (90.0%) and floor of bathroom was slippery (91.0%). (48%) of the sample group has the skills of how to look after themselves while being sick, and how to keep up healthy lifestyle. Besides, some other factors, such as gender, age and educational background are related to the health perception. The statistical significance was <0.05. Suggestion: The instruments available to national standards such as ST-5, 2Q and Barthel ADL index. Reliability coefficients alpha was .784 for perceived of self-efficacy, self-care of aging and .827 for perceived of social support of the aging. The instrument used to collect perceived of social support must be further developed to study level of influence of social support that affect the health of elderly.

Keywords: ้health status, perception of aging, self-efficacy, social support

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Authors: Mariia Khramova, Sergio Martinez, Duc Nguyen

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Modern electronic devices, particularly smartphones, are characterised by extremely high environmental footprint and short product lifecycle. Every year manufacturers release new models with even more superior performance, which pushes the customers towards new purchases. As a result, millions of devices are being accumulated in the urban mine. To tackle these challenges the concept of circular economy has been introduced to promote repair, reuse and recycle of electronics. In this case, electronic devices, that previously ended up in landfills or households, are getting the second life, therefore, reducing the demand for new raw materials. Smartphone reuse is gradually gaining wider adoption partly due to the price increase of flagship models, consequently, boosting circular economy implementation. However, along with reuse of communication device, circular economy approach needs to ensure the data of the previous user have not been 'reused' together with a device. This is especially important since modern smartphones are comparable with computers in terms of performance and amount of data stored. These data vary from pictures, videos, call logs to social security numbers, passport and credit card details, from personal information to corporate confidential data. To assess how well the data privacy requirements are followed on smartphones second-hand market, a sample of 100 Android smartphones has been purchased from IT Asset Disposition (ITAD) facilities responsible for data erasure and resell. Although devices should not have stored any user data by the time they leave ITAD, it has been possible to retrieve the data from 19% of the sample. Applied techniques varied from manual device inspection to sophisticated equipment and tools. These findings indicate significant barrier in implementation of circular economy and a limitation of smartphone reuse. Therefore, in order to motivate the users to donate or sell their old devices and make electronic use more sustainable, data privacy on second-hand smartphone market should be significantly improved. Presented research has been carried out in the framework of sustainablySMART project, which is part of Horizon 2020 EU Framework Programme for Research and Innovation.

Keywords: android, circular economy, data privacy, second-hand phones

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Authors: Joshua Russell, Omar Zubair, Reuben Ndegwa

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Introduction: Mesenteric ischemia is an uncommon condition that can be challenging to diagnose in the acute setting, with the potential for significant morbidity and mortality. Very rarely has acute acalculous cholecystitis been described in the setting of mesenteric ischemia. Case: This was the case in a 78-year-old male, who initially presented with clinical and radiological evidence of small bowel obstruction, thought likely secondary to malignancy. The patient had a 6-week history of anorexia, worsening lower abdominal pain, and ~30kg of unintentional weight loss over a 12-month period and a CT- scan demonstrated a transition point in the distal ileum. The patient became increasingly hemodynamically unstable and peritonitic, and an emergency laparotomy was performed. Intra-operatively, however, no obvious transition point was identified, and instead, the gallbladder was markedly gangrenous and oedematous, consistent with acalculous cholecystitis. An open total cholecystectomy was subsequently performed. The patient was admitted to the Intensive Care Unit post-operatively and continued to deteriorate over the proceeding 48 hours, with two re-look laparotomies demonstrating progressively worsening bowel ischemia, initially in the distribution of the superior mesenteric artery and then the coeliac trunk. On review, the patient was found to have an aberrant right hepatic artery arising from the superior mesenteric artery. The extent of ischemia was considered non-survivable, and the patient was palliated. Discussion: Multiple theories currently exist for the underlying pathophysiology of acalculous cholecystitis, including biliary stasis, sepsis, and ischemia. This case lends further support to ischemia as the underlying etiology of acalculous cholecystitis. This is particularly the case when considered in the context of the patient’s aberrant right hepatic artery arising from the superior mesenteric artery, which occurs in 11-14% of patients. Conclusion: This case report adds further insight to the debate surrounding the pathophysiology of acalculous cholecystitis. It also presents acalculous cholecystitis as a complication of mesenteric ischemia that should always be considered, especially in the elderly patient and in the context of relatively common anatomical variations. Furthermore, the case brings to attention the importance of maintaining dynamic working diagnoses in the setting of evolving pathophysiology and clinical presentations.

Keywords: acalculous cholecystitis, anatomical variation, general surgery, mesenteric ischemia

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Authors: Nashaat Mazrui, Oarabile Mogobe, Barbara Ngwenya, Ketlhatlogile Mosepele, Mangaliso Gondwe

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Over the last several decades, the world has seen a rapid increase in activities such as deforestation, agriculture, and energy use. Subsequently, trace elements are being deposited into our water bodies, where they can accumulate to toxic levels in aquatic organisms and can be transferred to humans through fish consumption. Thus, though fish is a good source of essential minerals and omega-3 fatty acids, it can also be a source of toxic elements. Monitoring trace elements in fish is important for the proper management of aquatic systems and the protection of human health. The aim of this study was to determine concentrations of trace elements in sediment and muscle tissues of Clarias gariepinus at Lake Ngami, in the Okavango Delta in northern Botswana, during low floods. The fish were bought from local fishermen, and samples of muscle tissue were acid-digested and analyzed for iron, zinc, copper, manganese, molybdenum, nickel, chromium, cadmium, lead, and arsenic using inductively coupled plasma optical emission spectroscopy (ICP-OES). Sediment samples were also collected and analyzed for the elements and for organic matter content. Results show that in all samples, iron was found in the greatest amount while cadmium was below the detection limit. Generally, the concentrations of elements in sediment were higher than in fish except for zinc and arsenic. While the concentration of zinc was similar in the two media, arsenic was almost 3 times higher in fish than sediment. To evaluate the risk to human health from fish consumption, the target hazard quotient (THQ) and cancer risk for an average adult in Botswana, sub-Saharan Africa, and riparian communities in the Okavango Delta was calculated for each element. All elements were found to be well below regulatory limits and do not pose a threat to human health except arsenic. The results suggest that other benthic feeding fish species could potentially have high arsenic levels too. This has serious implications for human health, especially riparian households to whom fish is a key component of food and nutrition security.

Keywords: Arsenic, African sharp tooth cat fish, Okavango delta, trace elements

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Authors: Mihretu Erjabo

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Halaba special district is characterized by drought, soil erosion, high population pressure, poor livestock production, lack of feed for livestock, very deep water table, very low productivity of crops and food insufficiency. In order to address these problems, the woreda agricultural development office along with other management practices such as soil physical conservation measures agroforestry was introduced decades ago as a means to alleviate the problem. However, the level of agroforestry adoption remains low. Objective of this study was to identify the factors that influence adoption of agroforestry technologies by farmers in the district. Random sampling was employed to select two kebele administrations and respondents. Data collection was conducted by rural household questionnaire survey, participatory rural appraisal, questionnaires for local and woreda extension staff, secondary data resources and field observation. A sample of 12 key informants, 6 extension staffs, and 182 households, were used in the data collection. Chi square test used to determine significant relationships between adoption of agroforestry and 15 selected variables. Out of which eleven were found to be significant to affect farmers’ adoptiveness. These were frequency of visits of farmers (13.39%), participation in training (11.49%), farmers’ attitude towards agroforestry practices (10.61%), frequency of visits of extensionists (10.38%), participation in extension meeting (10.34%), participation in field day (10.28%), land holding size (9.29%), level of literacy (8.78%), awareness about the importance of agroforestry technology packages (7.06%), time taken from their residence to nearest extension (5.04%) and gender of respondents (3.34%). This study also identified various factors that result in low adoption rates of agroforestry including fear of competition, seedling, rainfall and labour shortage, free grazing, financial problem, expecting trees as soil degrader and long span of trees and lack of need ranking. To improve farmers’ adoption, the factors identified should be well addressed by launching a series and recurrent outreach extension program appropriate and suitable to farmers need.

Keywords: farmers attitude, farmers participation, soil degradation, technology packages

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Authors: Amirreza Razzaghipour Sorkhab

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One of the most common disorders among humans is hearing impairment. This paper provides an evidence base that recovers understanding of Meniere’s disease and highlights the physical and mental health correlates of the disorder. Meniere's disease is more common in the elderly. The term idiopathic endolymphatic hydrops has been attributed to this disease by some in the previous. Meniere’s disease demonstrations a genetic tendency, and a family history is found in 10% of cases, with an autosomal dominant inheritance pattern. The COCH gene may be one of the hereditary factors contributing to Meniere’s disease, and the possibility of a COCH mutation should be considered in patients with Meniere’s disease symptoms. Should be considered Missense mutations in the COCH gene cause the autosomal dominant sensorineural hearing loss and vestibular disorder. Meniere’s disease is a complex, heterogeneous disorder of the inner ear and that is characterized by episodes of vertigo lasting from minutes to hours, fluctuating sensorineural hearing loss, tinnitus, and aural fullness. The existing evidence supports the suggestion that age and sleep disorder are risk factors for Meniere's disease. Many factors have been reported to precipitate the progress of Menier, including endolymphatic hydrops, immunology, viral infection, inheritance, vestibular migraine, and altered intra-labyrinthine fluid dynamics. Although there is currently no treatment that has a proven helpful effect on hearing levels or on the long-term evolution of the disease, however, in the primary stages, the hearing may improve among attacks, but a permanent hearing loss occurs in the majority of cases. Current publications have proposed a role for the intratympanic use of medicine, mostly aminoglycosides, for the control of vertigo. more than 85% of patients with Meniere's disease are helped by either changes in lifestyle and medical treatment or minimally aggressive surgical procedures such as intratympanic steroid therapy, intratympanic gentamicin therapy, and endolymphatic sac surgery. However, unilateral vestibular extirpation methods (intratympanic gentamicin, vestibular nerve section, or labyrinthectomy) are more predictable but invasive approaches to control the vertigo attacks. Medical therapy aimed at reducing endolymph volume, such as low-sodium diet, diuretic use, is the typical initial treatment.

Keywords: meniere's disease, endolymphatic hydrops, hearing loss, vertigo, tinnitus, COCH gene

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Authors: Salamatu Shaibu, Jan Hernning Sommer

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Integrating biodiversity conservation practices in mining landscapes ensures the continual provision of various ecosystem services to the dependent communities whilst serving as ecological insurance for corporate mining when purchasing reclamation security bonds. Climate hazards such as long dry seasons, erratic rainfall patterns, and extreme weather events contribute to biodiversity loss in addition to the impact due to mining. Both corporate mining and mine-fringe communities perceive the effect of climate on biodiversity from the context of the benefits they accrue, which motivate their conservation practices. In this study, pragmatic approaches including semi-structured interviews, field visual observation, and review were used to collect data on corporate mining employees and households of fringing communities in the southwestern mining hub. The perceived changes in the local climatic conditions and the consequences on environmental management practices that promote biodiversity conservation were examined. Using a thematic content analysis tool, the result shows that best practices such as concurrent land rehabilitation, reclamation ponds, artificial wetlands, land clearance, and topsoil management are directly affected by prolonging long dry seasons and erratic rainfall patterns. Excessive dust and noise generation directly affect both floral and faunal diversity coupled with excessive fire outbreaks in rehabilitated lands and nearby forest reserves. Proposed adaptive measures include engaging national conservation authorities to promote reforestation projects around forest reserves. National government to desist from using permit for mining concessions in forest reserves, engaging local communities through educational campaigns to control forest encroachment and burning, promoting community-based resource management to promote community ownership, and provision of stricter environmental legislation to compel corporate, artisanal, and small scale mining companies to promote biodiversity conservation.

Keywords: biodiversity conservation, climate hazards, corporate mining, mining landscapes

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Authors: Basma Yassa

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Evidence on cash transfers’ effectiveness in mitigating macro and idiosyncratic shocks’ impacts has been mixed and is mostly concentrated in Latin America, Sub-Saharan Africa, and South Asia with very limited evidence from the MENA region. Yet conditional cash transfers schemes have been continually used, especially in Egypt, as the main social protection tool in response to the recent socioeconomic crises and macro shocks. We use 2 panel datasets and 1 cross-sectional dataset to estimate the effectiveness of cash transfers as a shock-mitigative mechanism in the Egyptian context. In this paper, the results from the different models (Panel Fixed Effects model and the Regression Discontinuity Design (RDD) model) confirm that micro and macro shocks lead to significant decline in several household-level welfare outcomes and that Takaful cash transfers have a significant positive impact in mitigating the negative shock impacts, especially on households’ debt incidence, debt levels, and asset ownership, but not necessarily on food, and non-food expenditure levels. The results indicate large positive significant effects on decreasing household incidence of debt by up to 12.4 percent and lowered the debt size by approximately 18 percent among Takaful beneficiaries compared to non-beneficiaries’. Similar evidence is found on asset ownership levels, as the RDD model shows significant positive effects on total asset ownership and productive asset ownership, but the model failed to detect positive impacts on per capita food and non-food expenditures. Further extensions are still in progress to compare the models’ results with the DID model results when using a nationally representative ELMPS panel data (2018/2024) rounds. Finally, our initial analysis suggests that conditional cash transfers are effective in buffering the negative shock impacts on certain welfare indicators even after successive macro-economic shocks in 2022 and 2023 in the Egyptian Context.

Keywords: cash transfers, fixed effects, household welfare, household debt, micro shocks, regression discontinuity design

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Authors: Emielex M. Aguilar, Kristen Angela G. Cruz, Czarina Joie L. Rivera, Francis Dave C. Tan, Gavino Ivan N. Tanodra, Dianne Katrina G. Usana, Mary Grace T. Valentin, Nico Albert S. Vasquez, Edwin Monico C. Wee

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The risk of diabetes mellitus is increasing in the Philippines, with Metformin and Insulin as drugs commonly used for its management. The use of herbal medicines has grown increasingly, especially among the elderly population. Moringa oleifera or malunggay is one of the most common plants in the country, and several studies have shown the plant to exhibit a hypoglycemic property with its flavonoid content. This study aims to investigate the possible effects of concomitant use of Metformin and powdered M. oleifera leaves (PMOL) on blood glucose levels. Twenty male Sprague-Dawley rats were equally distributed into four groups. Fasting blood glucose levels of the rats were measured prior to experimentation. The following treatments were administered to the four groups, respectively: glucose only 2 g/kg; glucose 2 g/kg + Metformin 100 mg/kg; glucose 2 g/kg + PMOL 200 mg/kg; and glucose 2 g/kg + PMOL 200 mg/kg and Metformin 100 mg/kg. Blood glucose levels were determined on the 1st, 2nd, 3rd, and 4th hour post-treatment and compared between groups. Statistical analysis showed that the type of intervention did not show significance in the reduction of blood glucose levels when compared with the other groups (p=0.378), while the effect of time exhibited significance (p=0.000). The interaction between the type of intervention and time of blood glucose measurement was shown to be significant (p=0.024). Within each group, the control and PMOL-treated groups showed significant reduction in blood glucose levels over time with p-values of 0.000 and 0.000, respectively, while the Metformin-treated and the combination groups had p-values of 0.062 and 0.093, respectively, which are not significant. The descriptive data also showed that the mean total reduction of blood glucose levels of the Metformin and PMOL combination treatment group was lower than the PMOL-treated group alone, while the mean total reduction of blood glucose levels of the combination group was higher than the Metformin-treated group alone. Based on the results obtained, the combination of Metformin and PMOL did not significantly lower the blood glucose levels of the rats as compared to the other groups. However, the concomitant use of Metformin and PMOL may affect each other’s blood glucose lowering activity. Additionally, prolonged time of exposure and delay in the first blood glucose measurement after treatment could exhibit a significant effect in the blood glucose levels. Further studies are recommended regarding the effects of the concomitant use of the two agents on blood glucose levels.

Keywords: blood glucose levels, concomitant use, metformin, Moringa oleifera

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Authors: B. Rusyidi

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Since 2009, the Indonesian Ministry of Social Affairs has been implementing Program Kesejahteraan Sosial Anak (PKSA) (Child Welfare Program) a conditional cash transfer program that targets neglected children, children with disabilities, street children, children in conflict with the law, and children in need of special protection, all from poor households. PKSA integrates three elements: Transfer of cash, care and social services through social workers, and institutional childcare assistance. This qualitative study analyzed the roles and the challenges of social workers in implementing PKSA and lays out recommendations to inform policy changes. Data were collected in late 2014 from national and local government and non-government child welfare agencies, social workers, and childcare institution representatives through interviews and Focused Group Discussions (FGDs). Field work took place in six districts in the provinces of Jakarta, Central Java and South Sulawesi. The study found that the social workers’ role was significant in facilitating cash transfer, providing education and guidance, and linking children and families to basic social services. This improved utilization of basic social services enhanced children and families’ behaviors and contributed to the well being of the children. However, only a small number of childcare institutions have social workers, leaving many children and families without care and social service linkages, depriving them of rehabilitative components to help them regain their social functions. Some social workers reported their struggles with heavy workloads, lack of professional competencies and training, limited job security, and inadequate professional acknowledgment from other professions. Parts of those challenges were due to the centralized nature of the program and the lack of shared vision and commitment about the child protection system among related government agencies both at the national and local levels. The study highlights the necessity to implement an integrated child protection system, decentralize the PKSA program, and increase the number, competence, case management, and management and monitoring of social workers. The most recent progress of the program and its impacts on social workers are also discussed.

Keywords: child protection, conditional cash transfer, program decentralization, social worker, working conditions

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Authors: Md. Mustakimur Rahman

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On the one hand, while dealing with temporally distant international crimes (TDICs), prosecutors are likely to encounter many defendants suffering from severe physical or mental disorders. The concept of a defendant's "fitness," on the other hand, is based on the notion that an alleged perpetrator must be protected from a conviction resulting from a lack of participation or competence in making proper judgments. As a result, if a defendant is temporarily or permanently mentally ill, going through a formal criminal trial may be highly unlikely. TheExtraordinary Chambers in the Courts of Cambodia(ECCC), for example, arrested and tried IengThirth for crimes against humanity, grave breaches of the 1949 Geneva Conventions, and genocide. Still, the Trial Chamber found her incompetent to stand trial and released her in 2011. Although the prosecution had a lot of evidence against her, she was free from prosecution. It suggests that alleged war criminals may be granted immunity due to their unfitness, implying that unfitness is a hurdle to combating impunity. Given the absence of a formal criminal trial, international criminal law (ICL) should take steps to address this issue. ICL, according to Mark A. Drumbl, has yet to develop its penology; hence it borrows penological rationales from domestic criminal law. For example, international crimes tribunals such as the Nuremberg Tribunal and the Tokyo Tribunal, ad hoc tribunals have used retribution, utilitarianism, and rehabilitation as punishment justifications. On the other hand, like in the case of IengThirth, a criminal trial may not always be feasible. As a result, instead of allowing impunity, this paper proposes informal trials. This paper, for example, suggests two approaches to dealing with unfit defendants: 1) trial without punishment and 2) punishment without trial. Trial without punishment is a unique method of expressing condemnation without incarceration. "Expressivism has a broader basis than communication of punishment and sentencing," says Antony Duff. According to Drumbl, we can untangle our understanding of punishment from "the iconic preference for jailhouses" to include a larger spectrum of non-incarcerative measures like "recrimination, shame, consequence, and sanction." Non-incarcerative measures allow offenders to be punished without going through a formal criminal trial. This strategy denotes accountability for unlawful behavior. This research concludes that in many circumstances, prosecuting elderly war crimes suspects is difficult or unfeasible, but their age or illness should not be grounds for impunity. They should be accountable for their heinous activities through criminal trials or other mechanisms.

Keywords: international criminal law, international criminal punishment, international crimes tribunal, temporally distant international crimes

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Authors: Jamila Fakchich, Mostafa Jamila Lazaar Elachouri, Lakhder Fakchich, Fatna Ouali, Abd Errazzak Belkacem

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Diabetes is a chronic metabolic disease that has a significant impact on the health, quality of life, and life expectancy of patients as well as the health care system. By its nature diabetes, is a multisystem disease with wide-ranging complication that span nearly all region of the body. This epidemic problem, however, is not unique to the industrialized society, but has also hardly struck the developing countries. In Morocco, as developing country, there is an epidemic rise in diabetes, with ensuing concern about the management and control of this disease; it began a chronic burdensome disease of largely middle-aged and elderly people, with a long course and serious complications often resulting in high death-rate, the treatment of diabetes spent vast amount of resources including medicines, diets, physical training. Treatment of this disease is considered problematic due to the lack of effective and safe drugs capable of inducing sustained clinical, biochemical, and histological cure. In Moroccan society, the phytoremedies are some times the only affordable sources of healthcare, particularly for the people in remote areas. In this paper, we present a synthesis work obtained from the ethnobotanical data reported in different specialized journals. A Synthesis of four published ethnobotanical studies that have been carried out in different region of Morocco by different team seekers during the period from 1997 to 2015. Medicinal plants inventoried by different seekers in four Moroccan’s areas have been regrouped and codified, then, Factorial Analysis (FA) and Principal Components Analysis (PCA) are used to analyse the aggregated data from the four studies and plants are classified according to their frequency of use by population. Our work deals with an attempt to gather information on some traditional uses of medicinal plants from different regions of Morocco, also, it was designed to give a set of medicinal plants commonly used by Moroccan people in the treatment of diabetes; In this paper, we intended to provide a basic knowledge about plant species used by Moroccan society for treatment of diabetes. One of the most interesting aspects of this type of works is to assess the relative cultural importance of medicinal plants for specific illnesses and exploring its usefulness in the context of diabetes.

Keywords: Morocco, medicinal plants, ethnobotanical, diabetes, phytoremedies

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Authors: Godfrey Nsereko, Daniel Kadobera, Denis Okethwangu, Joyce Nguna, Alex Riolexus Ario

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Background: Malaria is a leading cause of morbidity and mortality in Uganda. In April 2018, malaria cases surged in Nwoya District, northern Uganda, exceeding the action thresholds. We investigated to assess the outbreak’s magnitude, identify transmission risk factors, and recommend evidence-based control measures. Methods: We defined a malaria case as onset of fever in a resident of Nwoya District with a positive Rapid Diagnostic Test or microscopy for malaria P. falciparum from 1 February to 22 May 2018. We reviewed medical records in all health facilities of affected sub-counties to find cases. In a case-control study, we compared exposure risk factors between 107 case-persons and 107 asymptomatic controls matched by age and village. We conducted entomological assessment on vector-density and behavior. Results: We identified 3,879 case-persons (attack rate [AR]=6.5%) and 2 deaths (case-fatality rate=5.2/10,000). Females (AR=8.1%) were more affected than males (AR=4.7%). Of all age groups, the 5-18 year age group (AR=8.4%) was most affected. Heavy rain started on 4 March; a propagated outbreak began during the week of 2 April. In the case-control study, 55% (59/107) of case-patients and 18% (19/107) of controls had stagnant water around households for several days following rainfall (ORM-H=5.6, 95%CI=3.0-11); 25% (27/107) of case-patients and 51% (55/107) of controls wore long-sleeve cloths during evening hours (ORM-H=0.30, 95%CI=0.20-0.60); 29% (31/107) of case-patients and 15% (16/107) of controls did not sleep under a long-lasting insecticide-treated net (LLIN) (ORM-H=2.3, 95%CI=1.1-4.9); 37% (40/107) of case-patients and 52% (56/107) of controls had ≥1 LLIN per 2 household members (ORM-H=0.54, 95%CI=0.30-0.97). Entomological assessment indicated active breeding sites; Anopheles gambiae sensu lato species were the predominant vector. Conclusion: Increased vector breeding sites after heavy rainfall, together with inadequate malaria preventive measures caused this outbreak. We recommended increasing coverage for LLINs and larviciding breeding sites.

Keywords: malaria outbreak, Plasmodium falciparum, global health security, Uganda

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Authors: Shantam Gupta

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The objective of this study is to address the critical need for automation in the domestic food processing sector and study its impact. Food is the one of the most basic physiological needs essential for the survival of a living being. Some of them have the capacity to prepare their own food (like most plants) and henceforth are designated as primary food producers; those who depend on these primary food producers for food form the primary consumers’ class (herbivores). Some of the organisms relying on the primary food are the secondary food consumers (carnivores). There is a third class of consumers called tertiary food consumers/apex food consumers that feed on both the primary and secondary food consumers. Humans form an essential part of the apex predators and are generally at the top of the food chain. But still further disintegration of the food habits of the modern human i.e. Homo sapiens, reveals that humans depend on other individuals for preparing their own food. The old notion of eating raw/brute food is long gone and food processing has become very trenchant in lives of modern human. This has led to an increase in dependence on other individuals for ‘processing’ the food before it can be actually consumed by the modern human. This has led to a further shift of humans in the classification of food chain of consumers. The effects of the shifts shall be systematically investigated in this paper. The processing of food has a direct impact on the economy of the individual (consumer). Also most individuals depend on other processing individuals for the preparation of food. This dependency leads to establishment of a vital link of dependency in the food web which when altered can adversely affect the food web and can have dire consequences on the health of the individual. This study investigates the challenges arising out due to this dependency and the impact of food processing on the economy of the individual. A comparison of Industrial food processing and processing at domestic platforms (households and restaurants) has been made to provide an idea about the present scenario of automation in the food processing sector. A lot of time and energy is also consumed while processing food at home for consumption. The high frequency of consumption of meals (greater than 2 times a day) makes it even more laborious. Through the medium of this study a pressing need for development of an automatic cooking machine is proposed with a mission to reduce the inter-dependency & human effort of individuals required for the preparation of food (by automation of the food preparation process) and make them more self-reliant The impact of development of this product has also further been profoundly discussed. Assumption used: The individuals those who process food also consume the food that they produce. (They are also termed as ‘independent’ or ‘self-reliant’ modern human beings.)

Keywords: automation, food processing, impact on economy, processing individual

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Authors: Zahra Mila Elmi, Mahsa Khanekheshi

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Almost half of the population and potential manpower in the country and rural areas are women. Manpower especially educated people, plays an important role in the production and economic growth. Also, the potential of rural areas to create employment should not be overlooked. In this research, the effects of socio-economic and demographic factors on women's economic participation in rural areas of Iran's provinces will be studied. Therefore, this study was performed by using the results of the rural households income and expenditure surveys -has been taken in 2016- in the framework of pseudo panel data. This study used the logit model and the maximum likelihood method to study the rural women's participation, with 28,265 observations. Results show the inverted U-shaped relationship between age and the probability of female participation; In other words, young women are more likely to participate in labor markets more than the other groups. Divorced and single woman has more chance of participation in comparison with who was being married. With increasing the divorce rate and singleness in Iran, economic policymakers must provide appropriate solutions for this challenge in the coming years. On the base of the results, being a student and the presence of an infant under the age of 6 in the household has a negative effect on the possibility of women's participation in the labor market. The women's education level has a U-shaped relationship with their participation rate. Illiteracy and high education have a strong positive effect on the economic participation of rural women. This shows the dual labor market for women in Iran. Illiterate women are attracted to service jobs, and educated woman are more attracted to education and health jobs. Increasing household income has a small but positive and significant effect on the probability of rural female participation. In the overlook, due to the frequency of the women population in the age group of 25 to 35 years, and more willingness of women in the age 35 to 44 years to participate in the labor market, and studying ofa significant portion of the rural women, the increase of rural female participation is expected in the years ahead. Thus, it is expected policy maker to create new job opportunities for the employment of educated women and take the necessary plan to improve the current situation for women.

Keywords: female participation rate, rural area, provincial data, pseudo-panel data method

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Authors: Piyush Hajela

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The significance of public spaces is on a rise in Indian cities as a strong interaction space across cultures and community. It is a pertinent gathering space for people across age and gender, where the face keeps changing with time. A public space is directly related to the social dimension, people, comfort, safety, and security, that, it proposes to provide, as inherent qualities. The presence of these and other dimensions of space, together with related equitable environments, impart certain quality to a public space. The higher the optimum contents of these dimensions, the better the quality of public space. Public is represented by PEOPLE through society and community, and space is created by dimensions. Society contains children, women and the elderly, community is composed of social, and religious groups. These behave differently in a different setting and call for varied quality of spaces, created and generated. Public spaces are spread across a city and have more or less established their existence and prominence in a social set up. While few of them are created others are discovered by the people themselves in their constant search for desirable interactive public spaces. These are the most sought after gathering spaces that have the quality of promoting social interaction, providing free accessibility, provide desirable scale etc. The emergence of public space dates back to the times when people started forming communities, display cultures and traditions publicly, gathered for religious observations and celebrations, and address the society. Traditional cities and societies in India were feudal and orthodox in their nature and yet had public spaces. When the gathering of people at one point in a city became more frequent the point became more accessible and occupied. Baras (large courts, Chowks (public squares) and Maidans (large grounds) became well-known gathering spaces in the towns and cities. As the population grew such points grew in number, each becoming a public space in itself and with a different and definite social character. The author aims at studying the various dimensions of public spaces with which a public space has power to hold people for a significant period of time. The human senses here are note referred to as taste, sight, hearing, touch or smell, but how human senses collectively respond to when stationed in a given public space. The collectives may reflect in dimensions like comfort, safety, environment, freedom etc. Various levels of similar other responses would be studied through interviews, observations and other scientific methods for both qualitative and quantitative analysis.

Keywords: society, interaction, people, accessibility, comfort, enclosure

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Authors: Vidya Yadav

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India’s youth bulge is now sharpest at the critical 15-24 age group, even as its youngest, and oldest age groups begin to narrow. As the ‘single year, age data’ for the 2011 Census releases the data on the number of people at each year of age in the population. The data shows that India’s working age population (15-64 years) is now 63.4 percent of the total, as against just short of 60 percent in 2001. The numbers also show that the ‘dependency ratio’ the ratio of children (0-14) and the elderly (65 above) to those in the working age has shrunk further to 0.55. “Even as the western world is in ageing situation, these new numbers show that India’s population is still very young”. As the fertility falls faster in urban areas, rural India is younger than urban India; while 51.73 percent of rural Indians are under the age of 24 and 45.9 percent of urban Indians are under 24. The percentage of the population under the age of 24 has dropped, but many demographers say that it should not be interpreted as a sign of the youth bulge is shrinking. Rather it is because of “declining fertility, the number of infants and children reduces first, and this is what we see with the number of under age 24. Indeed the figure shows that the proportion of children in the 0-4 and 5-9 age groups has fallen in 2011 compared to 2001. For the first time, the percentage of children in the 10-14 age group has also fallen, as the effect of families reducing the number of children they have begins to be felt. The present paper key issue is to examine that “whether this growing youth bulge has the right skills for the workforce or not”. The study seeks to examine the youth population structure and employment distribution among them in India during 2001-2011 in different industrial category. It also tries to analyze the workforce participation rate as main and marginal workers both for male and female workers in rural and urban India by utilizing an abundant source of census data from 2001-2011. Result shows that an unconscionable number of adolescents are working when they should study. In rural areas, large numbers of youths are working as an agricultural labourer. Study shows that most of the youths working are in the 15-19 age groups. In fact, this is the age of entry into higher education, but due to economic compulsion forces them to take up jobs, killing their dreams of higher skills or education. Youths are primarily engaged in low paying irregular jobs which are clearly revealed by census data on marginal workers. That is those who get work for less than six months in a year. Large proportions of youths are involved in the cultivation and household industries works.

Keywords: main, marginal, youth, work

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Authors: Takahiro Katayama, Hsueh-Sheng Chang

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Due to the global climate change, it has increased the extreme rainfall that led to serious floods around the world. In recent years, urbanization and population growth also tend to increase the number of impervious surfaces, resulting in significant loss of life and property during floods especially for the urban areas of Taiwan. In the past, the primary governmental response to floods was structural flood control and the only flood protection standards in use were the design standards. However, these design standards of flood control facilities are generally calculated based on current hydrological conditions. In the face of future extreme events, there is a high possibility to surpass existing design standards and cause damages directly and indirectly to the public. To cope with the frequent occurrence of floods in recent years, it has been pointed out that there is a need for a different standard called FPSR (Flood Protection Standard of Regions) in Taiwan. FPSR is mainly used for disaster reduction and used to ensure that hydraulic facilities draining regional flood immediately under specific return period. FPSR could convey a level of flood risk which is useful for land use planning and reflect the disaster situations that a region can bear. However, little has been reported on FPSR and its impacts to the public in Taiwan. Hence, this study proposes a quantity procedure to evaluate the FPSR. This study aimed to examine FPSR of the region and public perceptions of and knowledge about FPSR, as well as the public’s WTP (willingness to pay) for FPSR. The research is conducted via literature review and questionnaire method. Firstly, this study will review the domestic and international research on the FPSR, and provide the theoretical framework of FPSR. Secondly, CVM (Contingent Value Method) has been employed to conduct this survey and using double-bounded dichotomous choice, close-ended format elicits households WTP for raising the protection level to understand the social costs. The samplings of this study are citizens living in Taichung city, Taiwan and 700 samplings were chosen in this study. In the end, this research will continue working on surveys, finding out which factors determining WTP, and provide some recommendations for adaption policies for floods in the future.

Keywords: climate change, CVM (Contingent Value Method), FPSR (Flood Protection Standard of Regions), urban flooding

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Authors: E. C. Swart, E. Kunneke

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Background: Disparities in food security exist between communities and households across the country, reflecting continuing social and economic inequalities. The purpose of this study was to investigate the presence of food insecurity amongst UWC students. Method: Cross-sectional study recruited 200 students via email and cellphone from an ICS generated list of randomly selected students aged 18-25. Data collection took place during the first two weeks of term 3. Individual appointments were made with consenting participants and conducted in English by trained BSc Dietetics students. Data was analysed using SPSS. The hunger scale used by Stats SA (October 2010) was used. Dietary intake was assessed using a single 24hr recall. Results: Sixty-three percent of the students reported that they do experience some food insecurity whilst 14.5% reported to go hungry due to inadequate access to food. Coping mechanisms during periods of food insecurity include: Asking a friend, neighbour, family member (40%); Borrow (15%); Steal (none); Casual jobs (12%). Anthropometric status of students did not differ statistically significantly by food security status. A statistically significantly greater proportion of Xhosa speaking students reported inadequate money for food. Students residing in residences off campus appear to be least food secure in terms of money available and limiting food intake, whilst those residing at home are less food insecure. Similar proportions of students who receive bursaries or whose parents are paying reported going hungry whilst those who supports themselves never goes hungry. Mean nutrient intake during the previous 24 hours of students who reported inadequate resources to buy food, who eat less due to inadequate resources and who goes hungry only differed statistically significantly for Vitamin B (go hungry) and for fibre (money shortage). In general the nutrient intake is lower for those who reported to eat less and go hungry except for added sugar, vitamin A and folate (go hungry), and energy, fibre, iron, riboflavin and folate (eat less). For students who reported to have inadequate money to buy food, the mean nutrient intake was higher except for calcium and thiamin. The mean body mass index of this group of students was also higher even though the difference was not statistically significant. Conclusion: Hunger is present on campus however a single 24hr recall did not confirm statistically significant lower nutrient intakes for students who reported different levels of food insecurity.

Keywords: anthropometry, dietary intake, nutritional status, students

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Authors: Nivedita Paul

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The changing character of marriage be it arranged marriage, love marriage, polygamy, informal unions, all signify different gender relations in everyday lives. Marriages in India are part and parcel of the kinship and cultural practices. Arranged marriage is still the dominant form of marriage where spouse selection is the initiative and decision of the parents; but its form is changing, as women are now actively participating in spouse selection but with parental consent. Spouse selection related decision making is important because marriage as an institution brings social change and gender inequality; especially in a women’s life as marriages in India are mostly patrilocal. Moreover, the amount of say in spouse selection can affect a woman’s reproductive rights, domestic violence issues, household resource allocation, communication possibilities with the spouse/husband, marital life, etc. The present study uses data from Indian Human Development Survey II (2011-12) which is a nationally representative multitopic survey that covers 41,554 households. Currently, married women of age group 15-49 in their first marriage; whose year of marriage is from 1970s to 2000s have been taken for the study. Based on spouse selection experiences, the sample of women has been divided into three marriage categories-self, semi and family arranged. Women in self arranged or love marriage is the sole decision maker in choosing the partner, in semi arranged marriage or arranged marriage with consent both parents and women together take the decision, whereas in family arranged or arranged marriage without consent only parents take the decision. The main aim of the study is to find the relationship between spouse selection experiences and women’s autonomy in India. Decision making in economic matters, child and health related decision making, mobility and access to resources are taken to be proxies of autonomy. Method of ordinal regression has been used to find the relationship between spouse selection experiences and autonomy after marriage keeping other independent variables as control factors. Results show that women in semi arranged marriage have more decision making power regarding financial matters of the household, health related matters, mobility and accessibility to resources, when compared to women in family, arranged marriages. For freedom of movement and access to resources women in self arranged marriage have the highest say or exercise greatest power. Therefore, greater participation of women (even though not absolute control) in spouse selection may lead to greater autonomy after marriage.

Keywords: arranged marriage, autonomy, consent, spouse selection

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Authors: Sahar Elsaleh, Ghada Farhat, Shaikha Al-Derham, Fasih Alam

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Background: Cesarean section (CS) delivery is one of the major concerns both in developing and developed countries. The rate of CS deliveries are on the rise globally, and especially in Qatar. Many socio-economic, demographic, clinical and institutional factors play an important role for cesarean sections. This study aims to investigate factors affecting the prevalence of CS among women in Qatar using the UNICEF’s Multiple Indicator Cluster Survey (MICS) 2012 database. Methods: The study has focused on the women’s questionnaire of the MICS, which was successfully distributed to 5699 participants. Following study inclusion and exclusion criteria, a final sample of 761 women aged 19- 49 years who had at least one delivery of giving birth in their lifetime before the survey were included. A number of socio-economic, demographic, clinical and institutional factors, identified through literature review and available in the data, were considered for the analyses. Bivariate and multivariate logistic regression models, along with a multi-level modeling to investigate clustering effect, were undertaken to identify the factors that affect CS prevalence in Qatar. Results: From the bivariate analyses the study has shown that, a number of categorical factors are statistically significantly associated with the dependent variable (CS). When identifying the factors from a multivariate logistic regression, the study found that only three categorical factors -‘age of women’, ‘place at delivery’ and ‘baby weight’ appeared to be significantly affecting the CS among women in Qatar. Although the MICS dataset is based on a cluster survey, an exploratory multi-level analysis did not show any clustering effect, i.e. no significant variation in results at higher level (households), suggesting that all analyses at lower level (individual respondent) are valid without any significant bias in results. Conclusion: The study found a statistically significant association between the dependent variable (CS delivery) and age of women, frequency of TV watching, assistance at birth and place of birth. These results need to be interpreted cautiously; however, it can be used as evidence-base for further research on cesarean section delivery in Qatar.

Keywords: cesarean section, factors, multiple indicator cluster survey, MICS database, Qatar

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Authors: Minh Huynh, Aaron Heuser, Luke Patterson, Chris Zhang, Mason Miller, Daniel Wang, Sandeep Shetty, Mike Trinh, Abigail Miller, Adaeze Enekwechi, Tenille Daniels, Lu Huynh

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Machine learning and text analytics have been used to analyze child abuse, cyberbullying, domestic abuse and domestic violence, and hate speech. However, to the authors’ knowledge, no research to date has used these methods to study elder abuse in nursing homes or skilled nursing facilities from field inspection reports. We used machine learning and text analytics methods to analyze 356,000 inspection reports, which have been extracted from CMS Form-2567 field inspections of US nursing homes and skilled nursing facilities between 2016 and 2021. Our algorithm detected occurrences of the various types of abuse, including physical abuse, psychological abuse, verbal abuse, sexual abuse, and passive and active neglect. For example, to detect physical abuse, our algorithms search for combinations or phrases and words suggesting willful infliction of damage (hitting, pinching or burning, tethering, tying), or consciously ignoring an emergency. To detect occurrences of elder neglect, our algorithm looks for combinations or phrases and words suggesting both passive neglect (neglecting vital needs, allowing malnutrition and dehydration, allowing decubiti, deprivation of information, limitation of freedom, negligence toward safety precautions) and active neglect (intimidation and name-calling, tying the victim up to prevent falls without consent, consciously ignoring an emergency, not calling a physician in spite of indication, stopping important treatments, failure to provide essential care, deprivation of nourishment, leaving a person alone for an inappropriate amount of time, excessive demands in a situation of care). We further compare the prevalence of abuse before and after Covid-19 related restrictions on nursing home visits. We also identified the facilities with the most number of cases of abuse with no abuse facilities within a 25-mile radius as most likely candidates for additional inspections. We also built an interactive display to visualize the location of these facilities.

Keywords: machine learning, text analytics, elder abuse, elder neglect, nursing home abuse

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Authors: Michael Adebayo, Saheed Lawal

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The Comprehensive Geriatric Assessment (CGA) is the multidimensional tool used to assess elderly, frail patients either on admission to hospital care or at a community level in primary care. It is a tool designed with the aim of using a holistic approach to managing patients. A Cochrane review of CGA use in 2011 found that the likelihood of being alive and living in their own home rises by 30% post-discharge. RCTs have also discovered 10–15% reductions in readmission rates and reductions in institutionalization, and resource use and costs. Past audit cycles at King’s College Hospital, Denmark Hill had shown inconsistent evidence of CGA completion inpatient discharge summaries (less than 50%). Junior Doctors in the Health and Ageing (HAU) wards have struggled to sustain the efforts of past audit cycles due to the quick turnover in staff (four-month placements for trainees). This 7th cycle created a multi-faceted approach to solving this problem amongst staff and creating lasting change. Methods: 1. We adopted multidisciplinary team involvement to support Doctors. MDT staff e.g. Nurses, Physiotherapists, Occupational Therapists and Dieticians, were actively encouraged to fill in the CGA document. 2. We added a CGA Document Pro-forma to “Sunrise EPR” (Trust computer system). These CGAs were to automatically be included the discharge summary. 3. Prior to assessing uptake, we used a spot audit questionnaire to assess staff awareness/knowledge of what a CGA was. 4. We designed and placed posters highlighting domains of CGA and MDT roles suited to each domain on geriatric “Health and Ageing Wards” (HAU) in the hospital. 5. We performed an audit of % discharge summaries which include CGA and MDT role input. 6. We nominated ward champions on each ward from each multidisciplinary specialty to monitor and encourage colleagues to actively complete CGAs. 7. We initiated further education of ward staff on CGA's importance by discussion at board rounds and weekly multidisciplinary meetings. Outcomes: 1. The majority of respondents to our spot audit were aware of what a CGA was, but fewer had used the EPR document to complete one. 2. We found that CGAs were not being commenced for nearly 50% of patients discharged on HAU wards and the Frailty Assessment Unit.

Keywords: comprehensive geriatric assessment, CGA, multidisciplinary team, quality of life, mortality

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Authors: Xiaoyuan Chen

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Background: This study aimed to characterize the epidemiological and clinical features of five rare subtypes of hepatocellular carcinoma (HCC) and to create a competing risk nomogram for predicting cancer-specific survival. Methods: This study used the Surveillance, Epidemiology, and End Results database to analyze the clinicopathological data of 50,218 patients with classic HCC and five rare subtypes (ICD-O-3 Histology Code=8170/3-8175/3) between 2004 and 2018. The annual percent change (APC) was calculated using Joinpoint regression, and a nomogram was developed based on multivariable competing risk survival analyses. The prognostic performance of the nomogram was evaluated using the Akaike information criterion, Bayesian information criterion, C-index, calibration curve, and area under the receiver operating characteristic curve. Decision curve analysis was used to assess the clinical value of the models. Results: The incidence of scirrhous carcinoma showed a decreasing trend (APC=-6.8%, P=0.025), while the morbidity of other rare subtypes remained stable from 2004 to 2018. The incidence-based mortality plateau in all subtypes during the period. Clear cell carcinoma was the most common subtype (n=551, 1.1%), followed by fibrolamellar (n=241, 0.5%), scirrhous (n=82, 0.2%), spindle cell (n=61, 0.1%), and pleomorphic (n=17, ~0%) carcinomas. Patients with fibrolamellar carcinoma were younger and more likely to have non-cirrhotic liver and better prognoses. Scirrhous carcinoma shared almost the same macro clinical characteristics and outcomes as classic HCC. Clear cell carcinoma tended to occur in the Asia-Pacific elderly male population, and more than half of them were large HCC (Size>5cm). Sarcomatoid (including spindle cell and pleomorphic) carcinoma was associated with larger tumor size, poorer differentiation, and more dismal prognoses. The pathological subtype, T stage, M stage, surgery, alpha-fetoprotein, and cancer history were identified as independent predictors in patients with rare subtypes. The nomogram showed good calibration, discrimination, and net benefits in clinical practice. Conclusion: The rare subtypes of HCC had distinct clinicopathological features and biological behaviors compared with classic HCC. Our findings could provide a valuable reference for clinicians. The constructed nomogram could accurately predict prognoses, which is beneficial for individualized management.

Keywords: hepatocellular carcinoma, pathological subtype, fibrolamellar carcinoma, scirrhous carcinoma, clear cell carcinoma, spindle cell carcinoma, pleomorphic carcinoma

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Authors: Vuiswa Lucia Sethunya, Tonderayi Matambo, Diane Hildebrandt

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South African’s informal settlements produce tonnes of kitchen waste (KW) per year which is dumped into the landfill. These landfill sites are normally located in close proximity to the household of the poor communities; this is a problem in which the young children from those communities end up playing in these landfill sites which may result in some health hazards because of methane, carbon dioxide and sulphur gases which are produced. To reduce this large amount of organic materials being deposited into landfills and to provide a cleaner place for those within the community especially the children, an energy conversion process such as anaerobic digestion of the organic waste to produce biogas was implemented. In this study, the digestion of various kitchen waste was investigated in order to understand and develop a system that is suitable for household use to produce biogas for cooking. Three sets of waste of different nutritional compositions were digested as per acquired in the waste streams of a household at mesophilic temperature (35ᵒC). These sets of KW were co-digested with cow dung (CW) at different ratios to observe the microbial behaviour and the system’s stability in a laboratory scale system. The gas chromatography-flame ionization detector analyses have been performed to identify and quantify the presence of organic compounds in the liquid samples from co-digested and mono-digested food waste. Acetic acid, propionic acid, butyric acid and valeric acid are the fatty acids which were studied. Acetic acid (1.98 g/L), propionic acid (0.75 g/L) and butyric acid (2.16g/L) were the most prevailing fatty acids. The results obtained from organic acids analysis suggest that the KW can be an innovative substituent to animal manure for biogas production. The faster degradation period in which the microbes break down the organic compound to produce the fatty acids during the anaerobic process of KW also makes it a better feedstock during high energy demand periods. The C/N ratio analysis showed that from the three waste streams the first stream containing vegetables (55%), fruits (16%), meat (25%) and pap (4%) yielded more methane-based biogas of 317mL/g of volatile solids (VS) at C/N of 21.06. Generally, this shows that a household will require a heterogeneous composition of nutrient-based waste to be fed into the digester to acquire the best biogas yield to sustain a households cooking needs.

Keywords: anaerobic digestion, biogas, kitchen waste, household

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Authors: Vito Telesca, Giuseppina A. Giorgio, M. Ragosta

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The effects of extreme heat events are increasing in recent years. Humans are forced to adjust themselves to adverse climatic conditions. The impact of weather on human health has become public health significance, especially in light of climate change and rising frequency of devasting weather events (e.g., heat waves and floods). The interest of scientific community is widely known. In particular, the associations between temperature and mortality are well studied. Weather conditions are natural factors that affect the human organism. Recent works show that the temperature threshold at which an impact is seen varies by geographic area and season. These results suggest heat warning criteria should consider local thresholds to account for acclimation to local climatology as well as the seasonal timing of a forecasted heat wave. Therefore, it is very important the problem called ‘local warming’. This is preventable with adequate warning tools and effective emergency planning. Since climate change has the potential to increase the frequency of these types of events, improved heat warning systems are urgently needed. This would require a better knowledge of the full impact of extreme heat on morbidity and mortality. The majority of researchers who analyze the associations between human health and weather variables, investigate the effect of air temperature and bioclimatic indices. These indices combine air temperature, relative humidity, and wind speed and are very important to determine the human thermal comfort. Health impact studies of weather events showed that the prevention is an essential element to dramatically reduce the impact of heat waves. The summer Italian of 2012 was characterized with high average temperatures (con un +2.3°C in reference to the period 1971-2000), enough to be considered as the second hottest summer since 1800. Italy was the first among countries in Europe which adopted tools for to predict these phenomena with 72 hours in advance (Heat Health Watch Warning System - HHWWS). Furthermore, in Italy heat alert criteria relies on the different Indexes, for example Apparent temperature, Scharlau index, Thermohygrometric Index, etc. This study examines the importance of developing public health policies that protect the most vulnerable people (such as the elderly) to extreme temperatures, highlighting the factors that confer susceptibility.

Keywords: heat waves, Italy, local warming, temperature

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