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Authors: Marjan Moradi Fard, Hossein Rassi, Masoud Houshmand

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Aim: Breast cancer is one of the most common cancers affecting the morbidity and mortality of Iranian women. This disease is a result of collective alterations of oncogenes and tumor suppressor genes. Studies have produced conflicting results concerning the role of p53 codon 72 polymorphism (G>C) and miR-146a rs2910164 polymorphism (G>C) on the risk of several cancers; therefore, a research was performed to estimate the association between the p53 codon 72 polymorphism and miR-146a rs2910164 polymorphism in breast cancer. Methods and Materials: A total of 45 archival breast cancer samples from khatam hospital and 40 healthy samples were collected. Verification of each cancer reported in a relative was sought through the pathology reports of the hospital records. Then, DNA extracted from all samples by standard methods and p53 codon 72 polymorphism genotypes and miR-146a rs2910164 polymorphism genotypes were analyzed using multiplex PCR. The tubules, mitotic activity, necrosis, polymorphism and grade of breast cancer were staged by Nottingham histological grading and immunohistochemical staining of the sections from the paraffin wax embedded tissues for the expression of ER, PR and p53 was carried out using a standard method. Finally, data analysis was performed using the 7 version of the Epi Info(TM) 2012 software and test chi-square(x2) for trend. Results: Successful DNA extraction was assessed by PCR amplification of b-actin gene (99 bp). According to the results, p53 GG genotype and miR-146a rs2910164 CC genotype was significantly associated with increased risk of breast cancer in the study population. In this study, we established that tumors of p53 GG genotype and miR-146a rs2910164 CC genotype exhibited higher mitotic activity, higher polymorphism, lower necrosis, lower tubules, higher ER- and PR-negatives and lower TP53-positives than the other genotypes. Conclusion: The present study provided preliminary evidence that a p53 GG genotype may effect breast cancer risk in the study population, interacting synergistically with miR-146a rs2910164 CC genotype. Our results demonstrate that the testing of p53 codon 72 polymorphism genotypes and miR-146a rs2910164 polymorphism genotypes in combination with clinical parameters can serve as major risk factors in the early identification of breast cancers.

Keywords: breast cancer, p53 codon 72 polymorphism, miR-146a rs2910164 polymorphism, genotypes

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Authors: Elyce Cardonick, Shistri Dhar, Linsdey Seidman

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Background: When breast cancer is diagnosed during pregnancy, the prognosis is comparable to non-pregnant women matched for prognostic indicators when pregnant women receive treatment without delay. Chemotherapy, including taxanes, can be given during pregnancy with normal neonatal development in exposed fetuses. Methods: Cases of primary breast cancer were extracted from the Cancer and Pregnancy Registry and longitudinal study at Cooper Medical School, which collects cases of pregnant women diagnosed and treated for cancer into a single database. Obstetrical, oncology and pediatric records were reviewed, including annual neonatal developmental, behavioral and medical assessments. Results: 270 pregnant women were diagnosed with primary breast cancer at a mean gestational age of 14.7+9weeks. Mean maternal age at diagnosis 34.5+4.5 years. Receptor status is comparable to non-pregnant women of reproductive age. Forty-nine women were advised to terminate. Two hundred two women underwent surgery;244 women received chemotherapy in pregnancy after the first trimester; the majority of Doxorubucin/Cytoxan; 81 of the cases included a taxane. At a mean of 90 months, follow up obtained on 255 newborns.192/255 newborns are meeting developmental milestones. Respiratory illnesses, including asthma, and bronchiolitis, were reported in 64 newborns, the most common medical condition reported. Thirty-one children are undergoing treatment for GERD, 11 for urinary tract infections, and 7 are undergoing treatment for anemia. Twenty-six children with expressive or articulation language delays, 21/26 are mild. Eleven children with gross/ 7 with fine motor delays. Eight children are treated for ADHD, 4 for anxiety and 4 have social skill impairment. The majority of children with developmental, language or motor delays were born preterm. Conclusion: After chemotherapy exposure in utero for breast cancer, the majority of newborns are meeting developmental milestones and are medically healthy. The goal for treating pregnant women with breast cancer is to aim for delivery close to the term.

Keywords: breast cancer, pregnancy, chemotherapy, newborn

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Authors: Ching-Yuan Chen, Lung-Kwang Pan

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Objective: Back pain is a major health problem costing billions of health budgets annually in Taiwan. Thousands of back pain surgeries are performed annually with up to 40% of patients complaining of back pain at time of post-surgery causing failed back surgery syndrome (FBSS), although diagnosis in these patients may be complex. The aim of study is to assess the feasibility of using bone SPECT-CT imaging to localize the active lesions causing persistent, recurrent or new backache after spine surgery. Materials and Methods: Bone SPECT-CT imaging was performed after the intravenous injection of 20 mCi of 99mTc-MDP for all the patients with diagnosis of FBSS. Patients were evaluated using status of subjectively pain relief, functional improvement and degree of satisfaction by reviewing the medical records and questionnaires in a 2 more years’ follow-up. Results: We enrolled a total of 16 patients were surveyed in our hospital from Jan. 2015 to Dec. 2016. Four people on SPEC/CT imaging ensured significant lesions were undergone a revised surgery (surgical treatment group). The mean visual analogue scale (VAS) decreased 5.3 points and mean Oswestry disability index (ODI) improved 38 points in the surgical group. The remaining 12 on SPECT/CT imaging were diagnosed as no significant lesions then received drug treatment (medical treatment group). The mean VAS only decreased 2 .1 point and mean ODI improved 12.6 points in the medical treatment group. In the posttherapeutic evaluation, the pain of the surgical treatment group showed a satisfactory improvement. In the medical treatment group, 10 of the 12 were also satisfied with the symptom relief while the other 2 did not improve significantly. Conclusions: Findings on SPECT-CT imaging appears to be easily explained the patients' pain. We recommended that SPECT/CT imaging was a feasible and useful clinical tool to improve diagnostic confidence or specificity when evaluating patients with FBSS.

Keywords: failed back surgery syndrome, oswestry disability index, SPECT-CT imaging, 99mTc-MDP, visual analogue scale

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Authors: Susan Corby, Pete Burgess, Armin Hoeland, Helene Michel, Laurent Willemez

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In German 1st instance labour courts, lay judges always sit with a professional judge and in British and French 1st instance labour courts, lay judges sometimes sit with a professional judge. The lay judges’ main contribution is their workplace knowledge, but they act in a juridical setting where legal norms prevail. Accordingly, the research question is: does the professional judge dominate the lay judges? The research, funded by the Hans-Böckler-Stiftung, is based on over 200 qualitative interviews conducted in France, Germany and Great Britain in 2016-17 with lay and professional judges. Each interview lasted an hour on average, was audio-recorded, transcribed and then analysed using MaxQDA. Status theories, which argue that external sources of (perceived) status are imported into the court, and complementary notions of informational advantage suggest professional judges might exercise domination and control. Furthermore, previous empirical research on British and German labour courts, now some 30 years old, found that professional judges dominated. More recent research on lay judges and professional judges in criminal courts also found professional judge domination. Our findings, however, are more nuanced and distinguish between the hearing and deliberations, and also between the attitudes of judges in the three countries. First, in Germany and Great Britain the professional judge has specialist knowledge and expertise in labour law. In contrast, French professional judges do not study employment law and may only seldom adjudicate on employment law cases. Second, although the professional judge chairs and controls the hearing when he/she sits with lay judges in all three countries, exceptionally in Great Britain lay judges have some latent power as they have to take notes systematically due to the lack of recording technology. Such notes can be material if a party complains of bias, or if there is an appeal. Third, as to labour court deliberations: in France, the professional judge alone determines the outcome of the case, but only if the lay judges have been unable to agree at a previous hearing, which only occurs in 20% of cases. In Great Britain and Germany, although the two lay judges and the professional judge have equal votes, the contribution of British lay judges’ workplace knowledge is less important than that of their German counterparts. British lay judges essentially only sit on discrimination cases where the law, the purview of the professional judge, is complex. They do not sit routinely on unfair dismissal cases where workplace practices are often a key factor in the decision. Also, British professional judges are less reliant on their lay judges than German professional judges. Whereas the latter are career judges, the former only become professional judges after having had several years’ experience in the law and many know, albeit indirectly through their clients, about a wide range of workplace practices. In conclusion, whether or if the professional judge dominates lay judges in labour courts varies by country, although this is mediated by the attitudes of the interactionists.

Keywords: cross-national comparisons, labour courts, professional judges, lay judges

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Authors: Huixia Shi, Can Hu, Jun Zhu, Hongling Guo, Haiyan Li, Hongyan Du

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The identification of human body fluids during forensic investigations is a critical step to determine key details, and present strong evidence to testify criminal in a case. With the popularity of DNA and improved detection technology, the potential question must be revolved that whether the suspect’s DNA derived from saliva or semen, menstrual or peripheral blood, how to identify the red substance or aged blood traces on the spot is blood; How to determine who contribute the right one in mixed stains. In recent years, molecular approaches have been developing increasingly on mRNA, miRNA, DNA methylation and microbial markers, but appear expensive, time-consuming, and destructive disadvantages. Physicochemical methods are utilized frequently such us scanning electron microscopy/energy spectroscopy and X-ray fluorescence and so on, but results only showing one or two characteristics of body fluid itself and that out of working in unknown or mixed body fluid stains. This paper focuses on using chemistry methods Raman spectroscopy and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry to discriminate species of peripheral blood, menstrual blood, semen, saliva, vaginal secretions, urine or sweat. Firstly, non-destructive, confirmatory, convenient and fast Raman spectroscopy method combined with more accurate matrix-assisted laser desorption/ionization time-of-flight mass spectrometry method can totally distinguish one from other body fluids. Secondly, 11 spectral signatures and specific metabolic molecules have been obtained by analysis results after 70 samples detected. Thirdly, Raman results showed peripheral and menstrual blood, saliva and vaginal have highly similar spectroscopic features. Advanced statistical analysis of the multiple Raman spectra must be requested to classify one to another. On the other hand, it seems that the lactic acid can differentiate peripheral and menstrual blood detected by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, but that is not a specific metabolic molecule, more sensitivity ones will be analyzed in a forward study. These results demonstrate the great potential of the developed chemistry methods for forensic applications, although more work is needed for method validation.

Keywords: body fluids, identification, Raman spectroscopy, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry

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Authors: Shanza Akram, Samir Salah, Imran Saleem, Ashraf Alzaabi, Jassim Abdou

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Introduction: 300 million people worldwide are affected by asthma .In UAE, prevalence is around 10% (900,000 people).Patients with persistent symptoms despite using high dose ICS plus a second controller +/- OCS are considered to have severe asthma. Omalizumab (Xolaire) an IgE monoclonal antibody is approved as add on therapy for severe allergic asthma. Objective: To determine the efficacy of omalizumab based on clinical outcomes in our cohort of patient pre and post 52 weeks of treatment to assess safety and tolerability of treatment. Methods: Medical records of patients receiving omalizumab therapy for asthma at ZMH ,Abu Dhabi were retrospectively analyzed.Patients fulfilling the criteria of severe allergic asthma as per GINA guidelines were included. Asthma control over 12 months prior to and 12 months after commencement of omalizumab therapy was analysed by taking into account the number of exacerbations and hospitalizations in addition to maintenance of medication dosages, need for rescue reliever therapy and pulmonary function testing. Results: Total cohort of 21 patient (5 females), average age 41 years and av length of therapy 22 months were included. Seven patients (total 11/52%) managed to stop steroids on treatment while four were able to decrease the dosage. Mean exacerbation rate decreased from five/ year pre treatment to 1.36 while on treatment. Number of hospitalizations decreased from mean of two per year to 0.9 per year. Rescue reliever inhaler usage decreased from mean of 40 puffs to 15 puffs per week. 2 patients discontinued therapy, 1 due to lack of benefit (2 doses) and 2nd due to severe persistent side effects including local irritation, severe limb and joint pains after 6 months. Conclusion: Treatment with omalizumab showed effect in terms of reduced number of exacerbations, maintenance therapy and reliever medications. However, no improvement was seen in PFTs.There is room for improved documentation in terms of symptom recording and use of rescue medicationas as well as for better patient education and counselling in order to improve compliance.

Keywords: asthma, omalizumab, severe allergic asthma, UAE

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Authors: Simon Shibru, Karen Vancampenhout, Jozef Deckers, Herwig Leirs

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We investigated the population size of the endemic and endangered Swayne’s Hartebeest (Alcelaphus buselaphus swaynei) in Nech Sar National Park from 2012 to 2014 and document the major threats why the species is on the verge of local extinction. The park was once known for its abundant density of Swayne’s Hartebeest. We used direct total count methods for a census. We administered semi-structured interviews and open-ended questionnaires with senior scouts who are the member of the local communities. Historical records were obtained to evaluate the population trends of the animals since 1974. The density of the animal decreased from 65 in 1974 to 1 individual per 100 km2 in 2014 with a decline of 98.5% in the past 40 years. The respondents agreed that the conservation status of the park was in its worst condition ever now with only 2 Swayne’s Hartebeest left, with a rapid decline from 4 individuals in 2012 and 12 individuals in 2009. Mainly hunting and habitat loss, but also the unsuitable season of reproduction and shortage of forage as minor factors were identified as threats for a local extinction of the Swayne’s Hartebeests. On the other hand, predation, fire, disease, and ticks were not considered a cause for the declining trend. Hunting happens mostly out of some kind of revenge since the local community thought that they were pushed out from the land because of the presence of Swayne's Hartebeest in the area. Respondents agreed that the revenge action of the local communities was in response to their unwillingness to be displaced from the park in 1982/3. This conflict situation is resulting from the exclusionary wildlife management policy of the country. We conclude that the human interventions in general and illegal hunting, in particular, pushed the Swayne’s Hartebeest to a point of local extinction. Therefore, we recommend inclusive wildlife management approach for continuing existence of the park together with its natural resources so that sustainable use of the resources is in place.

Keywords: hunting, habitat destruction, local extinction, Nech Sar National Park, Swayne’s Hartebeest

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Authors: Israel B. Bitton

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“Memory” is associated with various phenomena, from physical to mental, personal to collective and historical to cultural. As part of a broader exploration of memory studies in philosophy and science (slated for academic publication October 2021), this specific study employs analytical methods of cognitive psychology and philosophy of memory to theorize that A) the primary human will (drive) is to significance, in that every human action and expression can be rooted in a most primal desire to be cosmically significant (however that is individually perceived); and B) that the will to significance manifests as the will to memorability, an innate desire to be remembered by others after death. In support of these broad claims, a review of various popular culture “touchpoints”—historic and contemporary records spanning literature, film and television, traditional news media, and social media—is presented to demonstrate how this very theory is repeatedly and commonly expressed (and has been for a long time) by many popular public figures as well as “everyday people.” Though developed before COVID, the crisis only increased the theory’s relevance: so many people were forced to die alone, leaving them and their loved ones to face even greater existential angst than what ordinarily accompanies death since the usual expectations for one’s “final moments” were shattered. To underscore this issue of, and response to, what can be considered a sociocultural “memory gap,” this study concludes with a summary of several projects launched by journalists at the height of the pandemic to document the memorable human stories behind COVID’s tragic warped speed death toll that, when analyzed through the lens of Viktor E. Frankl’s psychoanalytical perspective on “existential meaning,” shows how countless individuals were robbed of the last wills and testaments to their self-significance and memorability typically afforded to the dying and the aggrieved. The resulting insight ought to inform how government and public health officials determine what is truly “non-essential” to human health, physical and mental, at times of crisis.

Keywords: cognitive psychology, covid, neuroscience, philosophy of memory

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Authors: Arif Anwar Surani, Salman Ali, Asif Surani, Sohaib Zahid, Akbar Shoukat Ali, Zeeshan-Ul-Hassan Usmani, Joseph Varon, Salim Surani

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Objective: Terrorism and suicidal bomb blast attacks are commonplace in Karachi, Pakistan. During the years 2000 to 2007, there were over 60 bomb explosions resulting in more than 1500 casualties. These explosions produce a wide variety of external injuries. We undertook this study to evaluate pattern of external injury produced after bomb blast attacks and to compare injury profile resulting from explosions in open versus semi-confined blast environments. Method: A retrospective, cross-sectional, study was conducted to review injuries sustained after bomb blast attacks in Karachi, Pakistan, from January 2000 to October 2007. Emergency medical records and medico legal certificates of patients presented to three major public sector hospitals of Karachi were evaluated using self-design proforma. Results: Data of 481 victims meet inclusion criteria and were incorporated for final analysis. Of these, 63.6% were injured in open spaces and 36.4% were injured in semi-confined blast environments. Lacerations were commonly encountered as external injury (47.7%) followed by penetrating wounds (15.3%). Lower and upper extremities were most commonly affected (38.6% and 19% respectively). Open and semi-confined blast environments produced a specific injury pattern and profile (p=<0.001). Conclusions: Bomb blast attacks in Karachi produce an external injury pattern consistent with other studies, with exception of an increased frequency in penetrating wounds. Semi-confined blast environments were associated with severe injuries. Further studies are required to better classify injuries and their severity based on standardized scoring systems. Effective emergency response systems must be designed to cope with mass causalities following bomb explosions.

Keywords: bomb blast attacks, injury pattern, external injury, open space, semi-confined space, blast environment

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Authors: Hee-Young Song

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Background and objectives: In 2011, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations proposed a multidimensional assessment of patients’ conditions that included both functional parameters and patient-reported outcomes, with the aim to provide a comprehensive assessment of the disease, thus meeting both the needs of the patient and the role of the physician. However, few studies have evaluated patient-reported outcomes as well as objective functional assessments among individuals with chronic obstructive pulmonary disease (COPD) in clinical practice in Korea. This study was undertaken to explore the relationship between functional status assessed by the 6-minute walking distance (MWD) test and subjective health status reported by stable patients with COPD residing in community. Methods: A cross-sectional descriptive study was conducted with 118 stable COPD patients aged 69.4 years old and selected by a convenient sampling from an outpatient department of pulmonology in a tertiaryhospitals. The 6-MWD test was conducted according to standardized instructions. Participants also completed a constructed questionnaire including general characteristics, smoking history, dyspnea by modified medical research council (mMRC) scale, and health status by COPD assessment test (CAT). Anthropometric measurements were performed for body mass index (BMI). Medical records were reviewed to obtain disease-related characteristics including duration of the disease and forced expiratory volume in 1 second (FEV1). Data were analyzed using PASW statistics 20.0. Results: Mean FEV1% of participants was 63.51% and mean 6-MWD and CAT scores were 297.54m and 17.7, respectively. The 6-MWD and CAT showed significant negative correlations (r= -.280, p=.002); FEV1 and CAT did as well correlations (r= -.347, p < .001). Conclusions: Findings suggest that the better functional status an individual with COPD has, the better subjective health status is, and provide the support for using patient-reported outcomes along with functional parameters to facilitate comprehensive assessment of COPD patients in real clinical practices.

Keywords: chronic obstructive pulmonary disease, COPD assessment test, functional status, patient-reported outcomes

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Authors: Leszek Szpakowski, Daniel Celiński, Sławomir Pilip, Grzegorz Michalak

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The aim of the study was to analyse the usefulness of the 'E-rescuer' pilot project planned to be implemented in a chosen area of Eastern Poland in the cases of suspected sudden cardiac arrests in the extra-urban areas. Inventing an application allowing to dispatch simultaneously both Medical Emergency Teams and the E-rescuer to the place of the accident is the crucial assumption of the mentioned pilot project. The E-rescuer is defined to be the trained person able to take effective basic life support and to use automated external defibrillator. Having logged in using a smartphone, the E-rescuer's readiness is reported online to provide cardiopulmonary resuscitation exactly at the given location. Due to the accurately defined location of the E-rescuer, his arrival time is possible to be precisely fixed, and the substantive support through the displayed algorithms is capable of being provided as well. Having analysed the medical records in the years 2015-2016, cardiopulmonary resuscitation was considered to be effective when an early indication of circulation was provided, and the patient was taken to hospital. In the mentioned term, there were 2.291 cases of a sudden cardiac arrest. Cardiopulmonary resuscitation was taken in 621 patients in total including 205 people in the urban area and 416 in the extra-urban areas. The effectiveness of cardiopulmonary resuscitation in the extra-urban areas was much lower (33,8%) than in the urban (50,7%). The average ambulance arrival time was respectively longer in the extra-urban areas, and it was 12,3 minutes while in the urban area 3,3 minutes. There was no significant difference in the average age of studied patients - 62,5 and 64,8 years old. However, the average ambulance arrival time was 7,6 minutes for effective resuscitations and 10,5 minutes for ineffective ones. Hence, the ambulance arrival time is a crucial factor influencing on the effectiveness of cardiopulmonary resuscitation, especially in the extra-urban areas where it is much longer than in the urban. The key role of trained E-rescuers being nearby taking basic life support before the ambulance arrival can effectively support Emergency Medical Services System in Poland.

Keywords: basic life support, bystander, effectiveness, resuscitation

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Authors: S. V. Ukwungwu, A. J. Abbas, G. G. Nasr

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The increasing high price of natural gas and oil with attendant increase in energy demand on world markets in recent years has stimulated interest in recovering residual oil saturation across the globe. In order to meet the energy security, efforts have been made in developing new technologies of enhancing the recovery of oil and gas, utilizing techniques like CO2 flooding, water injection, hydraulic fracturing, surfactant flooding etc. Surfactant flooding however optimizes production but poses risk to the environment due to their toxic nature. Amongst proven records that have utilized other type of bacterial in producing biosurfactants for enhancing oil recovery, this research uses a technique to combine biosurfactants that will achieve a scale of EOR through lowering interfacial tension/contact angle. In this study, three biosurfactants were produced from three Bacillus species from freeze dried cultures using sucrose 3 % (w/v) as their carbon source. Two of these produced biosurfactants were screened with the TEMCO Pendant Drop Image Analysis for reduction in IFT and contact angle. Interfacial tension was greatly reduced from 56.95 mN.m-1 to 1.41 mN.m-1 when biosurfactants in cell-free culture (Bacillus licheniformis) were used compared to 4. 83mN.m-1 cell-free culture of Bacillus subtilis. As a result, cell-free culture of (Bacillus licheniformis) changes the wettability of the biosurfactant treatment for contact angle measurement to more water-wet as the angle decreased from 130.75o to 65.17o. The influence of microbial treatment on crushed rock samples was also observed by qualitative wettability experiments. Treated samples with biosurfactants remained in the aqueous phase, indicating a water-wet system. These results could prove that biosurfactants can effectively change the chemistry of the wetting conditions against diverse surfaces, providing a desirable condition for efficient oil transport in this way serving as a mechanism for EOR. The environmental friendly effect of biosurfactants applications for industrial purposes play important advantages over chemically synthesized surfactants, with various possible structures, low toxicity, eco-friendly and biodegradability.

Keywords: bacillus, biosurfactant, enhanced oil recovery, residual oil, wettability

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Authors: Seyran Naghdi

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Background: Orphan drug development is limited by very high costs attributed to the research and development and small size market. How health policymakers address this challenge to consider both supply and demand sides need to be explored for directing the policies and plans in the right way. The price is an important signal for pharmaceutical companies’ profitability and the patients’ accessibility as well. Objective: This study aims to find out the orphan drugs' price-setting patterns and approaches in health systems through a systematic review of the available evidence. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) approach was used. MedLine, Embase, and Web of Sciences were searched via appropriate search strategies. Through Medical Subject Headings (MeSH), the appropriate terms for pricing were 'cost and cost analysis', and it was 'orphan drug production', and 'orphan drug', for orphan drugs. The critical appraisal was performed by the Joanna-Briggs tool. A Cochrane data extraction form was used to obtain the data about the studies' characteristics, results, and conclusions. Results: Totally, 1,197 records were found. It included 640 hits from Embase, 327 from Web of Sciences, and 230 MedLine. After removing the duplicates, 1,056 studies remained. Of them, 924 studies were removed in the primary screening phase. Of them, 26 studies were included for data extraction. The majority of the studies (>75%) are from developed countries, among them, approximately 80% of the studies are from European countries. Approximately 85% of evidence has been produced in the recent decade. Conclusions: There is a huge variation of price-setting among countries, and this is related to the specific pharmacological market structure and the thresholds that governments want to intervene in the process of pricing. On the other hand, there is some evidence on the availability of spaces to reduce the very high costs of orphan drugs development through an early agreement between pharmacological firms and governments. Further studies need to focus on how the governments could incentivize the companies to agree on providing the drugs at lower prices.

Keywords: orphan drugs, orphan drug production, pricing, costs, cost analysis

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Authors: Cherif Y., Ghariani R., Derbal S., Farhati S., Ben Dahmen F., Abdallah M.

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Introduction: Tuberculosis (TBC) is a frequent infection and is still a major public health problem in Tunisia. The aim of this work is to focus on diagnostic and therapeutic characteristics of TBC in patients referred to our internal medicine department. Patients and Methods: The study was retrospective and descriptive of a cohort of consecutive cases treated from January 2016 to December 2019, collecting patients with latent or patent TBC. Twenty-eight medical records of adults diagnosed with TBC were reviewed. Results: Twenty-eight patients, including 18 women and 10 men, were diagnosed with TBC. Their mean age is 48 years (range: 22-78 years). Five patients have a medical history of diabetes mellitus, 1 patient was followed for systemic lupus erythematosus treated with corticosteroids and immunosuppressant drugs, and another was treated with corticosteroids for Mac Duffy syndrome. The TBC is latent in 12 cases and patent in 16 cases. The most common symptoms were fever and weight loss and were found in 10 cases, a cough in 2 cases, sputum in 3 cases, lymph nodes in 4 cases, erythema nodosum in 2 cases, and neurological signs in 3 cases. Lymphopenia is noticed in 3 cases and a biological inflammatory syndrome in 18 of the cases. The purified protein derivate reaction was positive in 17 cases, anergic in 3 cases, negative in 5 cases, and not done in 3 cases. The acid-fast bacilli stain culture was strongly positive in one patient. The histopathological study was conclusive in 11 patients and showed granulomatosis with caseous necrosis. TBC was pulmonary in 7 patients, lymph node in 7 cases, peritoneal in 7 cases, digestive in 1 case, neuromeningeal in 3 cases, and thyroïd in 1 case. Seven patients had multifocal TBC. All the patients received anti-tuberculosis treatment with a mean duration of 8 months with no failure or relapse with an average follow-up time of 10.58 months. Conclusion: Diagnosis and management of TBC remain essential to avoid serious complications. The survey is necessary to ensure timely detection and treatment of infected adults to decrease its incidence. The best treatment remains preventive through vaccination and improving social and economic conditions.

Keywords: tuberculosis, infection, autoimmune disease, granulomatosis

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Authors: Chineduum Okpala

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Nigeria, since her independence, has been engulfed in financial crimes of different forms. From embezzlement and conversion of public funds by public servants to stealing, contract inflation, and money laundering. Money laundering in Nigeria, particularly by political exposed persons, has been an issue of concern since independence. Corruption has been endemic, and Nigeria needs to integrate pro-active measures to show to the international community that it is ready to move against this vice. This paper discusses the negative effect of corruption and its effect on prosecutorial discretion. It also takes cognisance of the policy and aims of the anti-money laundering (AML) policy as enacted in Nigeria. It also takes as valid the assumption that the effective application of the rule of law will improve the efficacy of the Nigerian regime. In this regard, the perspective is internal to the Nigerian regime and its internal policy discourse which also reflect its policy discourse at international level. This paper takes notice of the typology of money laundering (ML) offences that most affect Nigeria, which hinges on corruption and abuse of office by a specific type of person, politically exposed persons (PEP). This typology of money laundering offence appears to be the most prevalent in developing nations like Nigeria. The application of essential principles of law provides an opportunity for the internalisation of the rule of law in the anti-money laundering regime in Nigeria, which could aid the successful prosecution of politically exposed persons on money laundering offences. The rule of law and how well the Nigerian legal system manages to deal with the interface between high level politics and the criminal justice system in Nigeria cannot be understood from internal sources but must be developed as a genuine but critical account informed by perspectives external to the Nigerian regime. If the efficacy of the regime is to be assessed in view of notorious failures of the regime, an external assessment is needed. Hence the paper discusses the need to integrate the essential principles of law in the application of prosecutorial discretion in the anti-money laundering regime in Nigeria, particularly with politically exposed persons. The paper highlights jurisdiction where prosecutorial discretion is integrated into the anti-money laundering regime in accordance to the rule of law which forms a basis for comparative analysis of the success of the anti-money laundering regime in Nigeria. This paper discusses why the application of prosecutorial discretion should not be used as a tool to extricate or avail the rich and powerful in the society from justice. The paper aims to argue that the successful prosecution of politically exposed persons, will raise the confidence of the citizens and the international community in the anti-money laundering regime in Nigeria.

Keywords: money laundering, politically exposed persons, corruption, Nigeria

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Authors: Samrawit Tamrat Gebretsadik

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Recurrent wheezing is a common respiratory symptom among children, often indicative of underlying airway inflammation and hyperreactivity. Understanding the prevalence and associated factors of recurrent wheezing in specific age groups is crucial for targeted interventions and improved respiratory health outcomes. This study aimed to investigate the prevalence and associated factors of recurrent wheezing among 6-year-old children attending Adama Comprehensive Specialized Hospital Medical College in Ethiopia. A cross-sectional study design was employed, involving structured interviews with parents/guardians, medical records review, and clinical examination of children. Data on demographic characteristics, environmental exposures, family history of respiratory diseases, and socioeconomic status were collected. Logistic regression analysis was used to identify factors associated with recurrent wheezing. The study included X 6-year-old children, with a prevalence of recurrent wheezing found to be Y%. Environmental exposures, including tobacco smoke exposure (OR = Z, 95% CI: X-Y), indoor air pollution (OR = Z, 95% CI: X-Y), and presence of pets at home (OR = Z, 95% CI: X-Y), were identified as significant risk factors for recurrent wheezing. Additionally, a family history of asthma or allergies (OR = Z, 95% CI: X-Y) and low socioeconomic status (OR = Z, 95% CI: X-Y) were associated with an increased likelihood of recurrent wheezing. The impact of recurrent wheezing on the quality of life of affected children and their families was also assessed. Children with recurrent wheezing experienced a higher frequency of respiratory symptoms, increased healthcare utilization, and decreased physical activity compared to their non-wheezing counterparts. In conclusion, recurrent wheezing among 6-year-old children attending Adama Comprehensive Specialized Hospital Medical College is associated with various environmental, genetic, and socioeconomic factors. These findings underscore the importance of targeted interventions aimed at reducing exposure to known triggers and improving respiratory health outcomes in this population. Future research should focus on longitudinal studies to further elucidate the causal relationships between risk factors and recurrent wheezing and evaluate the effectiveness of preventive strategies.

Keywords: wheezing, inflammation, respiratory, crucial

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Authors: Lilian Ijomah

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Restorative justice practices continue to gain recognition globally in the criminal and juvenile justice systems and schools. Despite considerable research, little is known about how juvenile detention center staff members’ knowledge, beliefs, and attitudes affect implementation. As with many interventions, effective implementation relies on the staff members who must do the daily work. This phenomenological study aimed to add to the existing literature by examining staff knowledge, beliefs, and attitudes on restorative justice practices, barriers to effective implementation, and potential differences in knowledge, beliefs, and attitudes between education staff and juvenile detention officers at the research site. The present study used semi-structured interviews and focus groups of both types of staff members who work with the youth in a juvenile justice facility to answer three research questions: (1) To what extent are staff members knowledgeable about the principles behind restorative approach to discipline and about how the approach should be carried out?; (2) What are staff member beliefs and attitudes toward the restorative justice program and its implementation in a juvenile justice setting?; and (3) What similarities and differences are there between (a) knowledge and (b) beliefs and attitudes of the educators and juvenile detention officers? A total of 28 staff members participated, nine educators, and 19 detention officers. The findings for the first research question indicated that both groups (educators and juvenile detention officers) were knowledgeable about two of the three principles of restorative justice: repairing the harm done by the offender and reducing risks for future occurrence; but did not show clear knowledge of one principle, active involvement from all stakeholders. For research question 2, staff beliefs and attitudes were categorized into two types, positive beliefs and attitudes (e.g., that restorative justice is more appropriate than the use of punitive measures) and negative beliefs and attitudes (e.g., that restorative justice is ‘just another program that creates extra work for staff’). When the two staff groups were compared to answer research question 3, both groups were found to have similar knowledge (showing knowledge of two of the three principles) and somewhat different beliefs and attitudes – both groups showed a mix of positive and negative, but the educators showed somewhat more on the positive side. Both groups also identified barriers to implementation such as the perception of restorative justice as ‘soft’, lack of knowledge and exposure to restorative justice, shortage of resources and staff, and difficulty sustaining the restorative justice approach. The findings of this study are largely consistent with current literature but also extend the literature by studying staff knowledge, attitudes, and beliefs in a juvenile detention center and comparing the two staff groups. Recommendations include assessing staff knowledge and attitudes toward restorative justice during the hiring process, ensuring adequate staff training, communicating clearly to build positive attitudes and beliefs, providing adequate staffing, and building a sense of community.

Keywords: juvenile justice, restorative justice, restorative practices, staff attitudes and beliefs

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Authors: Nicole M. Martino

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Reinforced concrete bridge deck condition assessments primarily use visual inspection methods, where an inspector looks for and records locations of cracks, potholes, efflorescence and other signs of probable deterioration. Sounding is another technique used to diagnose the condition of a bridge deck, however this method listens for damage within the subsurface as the surface is struck with a hammer or chain. Even though extensive procedures are in place for using these inspection techniques, neither one provides the inspector with a comprehensive understanding of the internal condition of a bridge deck – the location where damage originates from.  In order to make accurate estimates of repair locations and quantities, in addition to allocating the necessary funding, a total understanding of the deck’s deteriorated state is key. The research presented in this paper collected infrared thermography and ground penetrating radar data from reinforced concrete bridge decks without an asphalt overlay. These decks were of various ages and their condition varied from brand new, to in need of replacement. The goals of this work were to first verify that these nondestructive evaluation methods could identify similar areas of healthy and damaged concrete, and then to see if combining the results of both methods would provide a higher confidence than if the condition assessment was completed using only one method. The results from each method were presented as plan view color contour plots. The results from one of the decks assessed as a part of this research, including these plan view plots, are presented in this paper. Furthermore, in order to answer the interest of transportation agencies throughout the United States, this research developed a step-by-step guide which demonstrates how to collect and assess a bridge deck using these nondestructive evaluation methods. This guide addresses setup procedures on the deck during the day of data collection, system setups and settings for different bridge decks, data post-processing for each method, and data visualization and quantification.

Keywords: bridge deck deterioration, ground penetrating radar, infrared thermography, NDT of bridge decks

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Authors: Sandra Smart-Akande, Chaminda Hewage, Imtiaz Khan, Thanuja Mallikarachchi

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According to UK police-recorded data, there has been a substantial increase in knife-related crime and youth violence in the UK since 2014 particularly in the London boroughs. These crime rates are disproportionally distributed across London with the majority of these crimes occurring in the highly deprived areas of London and among young people aged 11 to 24 with large discrepancies across ethnicity, age, gender and borough of residence. Comprehensive studies and literature have identified risk factors associated with a knife carrying among youth to be Adverse Childhood Experience (ACEs), poor mental health, school or social exclusion, drug dealing, drug using, victim of violent crime, bullying, peer pressure or gang involvement, just to mention a few. ACEs are potentially traumatic events that occur in childhood, this can be experiences or stressful events in the early life of a child and can lead to an increased risk of damaging health or social outcomes in the latter life of the individual. Research has shown that children or youths involved in youth violence have had childhood experience characterised by disproportionate adverse childhood experiences and substantial literature link ACEs to be associated with criminal or delinquent behavior. ACEs are commonly grouped by researchers into: Abuse (Physical, Verbal, Sexual), Neglect (Physical, Emotional) and Household adversities (Mental Illness, Incarcerated relative, Domestic violence, Parental Separation or Bereavement). To the author's best knowledge, no study to date has investigated how household mental health (mental health of a parent or mental health of a child) and domestic violence (domestic violence on a parent or domestic violence on a child) is related to knife homicides across the local authorities areas of London. This study seeks to address the gap by examining a large sample of data from the London Metropolitan Police Force and Characteristics of Children in Need data from the UK Department for Education. The aim of this review is to identify and synthesise evidence from data and a range of literature to identify the relationship between adverse childhood experiences and youth violence in the UK. Understanding the link between ACEs and future outcomes can support preventative action.

Keywords: adverse childhood experiences, domestic violence, mental health, youth violence, prediction analysis, London knife crime

Procedia PDF Downloads 101

Authors: Dativa Maria Aliddeki, Fred Monje, Godfrey Nsereko, Benon Kwesiga, Daniel Kadobera, Alex Riolexus Ario

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Background: Cholera is a severe gastrointestinal disease caused by Vibrio cholera. It has caused several pandemics. On 26 February 2018, a suspected cholera outbreak, with one death, occurred in School X in Hoima Municipality, western Uganda. We investigated to identify the scope and mode of transmission of the outbreak, and recommend evidence-based control measures. Methods: We defined a suspected case as onset of diarrhea, vomiting, or abdominal pain in a student or staff of School X or their family members during 14 February–10 March. A confirmed case was a suspected case with V. cholerae cultured from stool. We reviewed medical records at Hoima Hospital and searched for cases at School X. We conducted descriptive epidemiologic analysis and hypothesis-generating interviews of 15 case-patients. In a retrospective cohort study, we compared attack rates between exposed and unexposed persons. Results: We identified 15 cases among 75 students and staff of School X and their family members (attack rate=20%), with onset from 25-28 February. One patient died (case-fatality rate=6.6%). The epidemic curve indicated a point-source exposure. On 24 February, a student brought fried fish from her home in a fishing village, where a cholera outbreak was ongoing. Of the 21 persons who ate the fish, 57% developed cholera, compared with 5.6% of 54 persons who did not eat (RR=10; 95% CI=3.2-33). None of 4 persons who recooked the fish before eating, compared with 71% of 17 who did not recook it, developed cholera (RR=0.0, 95%CIFisher exact=0.0-0.95). Of 12 stool specimens cultured, 6 yielded V. cholerae. Conclusion: This cholera outbreak was caused by eating fried fish, which might have been contaminated with V. cholerae in a village with an ongoing outbreak. Lack of thorough cooking of the fish might have facilitated the outbreak. We recommended thoroughly cooking fish before consumption.

Keywords: cholera, disease outbreak, foodborne, global health security, Uganda

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Authors: Michael Ward, Eliana Kalakouti, Andrew Alabi

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Aim: The handover process is recognized as a vulnerable step in the patient care pathway where errors are likely to occur. As such, it is a major preventable cause of patient harm due to human factors of poor communication and systematic error. The aim of this study was to audit the general surgery department’s weekend handover process compared to the recommended criteria for safe handover as set out by the Royal College of Surgeons (RCS). Method: A retrospective audit of the General Surgery department’s Friday patient lists and patient medical notes used for weekend handover in a London-based District General Hospital (DGH). Medical notes were analyzed against RCS's suggested criteria for handover. A standardized paper weekend handover proforma was then developed in accordance with guidelines and circulated in the department. A post-intervention audit was then conducted using the same methods for cycle 1. For cycle 2, we introduced an electronic weekend handover tool along with Electronic Patient Records (EPR). After a one-month period, a second post-intervention audit was conducted. Results: Following cycle 1, the paper weekend handover proforma was only used in 23% of patient notes. However, when it was used, 100% of them had a plan for the weekend, diagnosis and location but only 40% documented potential discharge status and 40% ceiling of care status. Qualitative feedback was that it was time-consuming to fill out. Better results were achieved following cycle 2, with 100% of patient notes having the electronic proforma. Results improved with every patient having documented ceiling of care, discharge status and location. Only 55% of patients had a past surgical history; however, this was still an increase when compared to paper proforma (45%). When comparing electronic versus paper proforma, there was an increase in documentation in every domain of the handover outlined by RCS with an average relative increase of 1.72 times (p<0.05). Qualitative feedback was that the autofill function made it easy to use and simple to view. Conclusion: These results demonstrate that the implementation of an electronic autofill handover proforma significantly improved handover compliance with RCS guidelines, thereby improving the transmission of information from week-day to weekend teams.

Keywords: surgery, handover, proforma, electronic handover, weekend, general surgery

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Authors: Ricky A. J. Syngkon, Santi Gopal Maji

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Decent work and inclusive economic growth, social development, environmental protection, eradication of poverty and hunger as well as clean water and sanitation are the rudiments of 2030 agenda of sustainable development goals of the United Nations. On the other hand, spirituality is deeply entwined in the fabric of daily lives that helps in shaping attitudes, opinions, and behaviors of common people and ensuring quality of lives and overall sustainable development through protection of environment and natural resources. Mawlynnong, a small village in North-Eastern part of India, is a vivid example of how spirituality influences the development of sense of community leading to upliftment of the economic conditions of the people. Mawlynnong as a small hamlet has been in existence for a couple of centuries and it was acknowledged as the cleanest village of Asia in 2004 by BBC and National Geographic and subsequently endorsed by UNESCO in 2006. Consequently, it has attracted large number of tourists over the years from India and other parts of the world. This paper tries to explore how spirituality leads to a sense of community and the economic benefits for the people. Further, this paper also tries to find out the answer whether such an informal collective effort is sustainable or not for achieving solidarity economy. The study is based on both primary and secondary data collected from the local people and the State Government records. The findings of the study indicate that over the last one and a half decade the tourist footfall has increased to a great extent in Mawlynnong and this has brought about a paradigm shift in the occupational structure of its inhabitants from plantation to service sector particularly tourism and tourism related activities. As a result, from the economic standpoint, it is observed that life is much better off now as compared to before. But from the socio-cultural standpoint, the study finds a drift in terms of the cohesiveness and community bonding which was the hallmark of this village. This drift puts a question mark about the sustainability of such practices and consequently the development of solidarity economy.

Keywords: spirituality, sense of community, economic welfare, solidarity economy, Mawlynnong village

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Authors: Iyad Jadalhaq, Mohammed El Hadi El Maknouzi

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The place of Islamic law in the legal system of the UAE is best understood by introducing a differentiation between its role as a formal source of law and its influence as a material source of law. What this differentiation helps clarify is that the corpus of Islamic law constitutes a much deeper influence on adjudication, law-making and the legal profession in the UAE, than it might appear at first sight, by considering its formal position in the division of labor between courts, or legislative lists of sources of law. This paper aims to examine the role of Shariah in the UAE private law system by determining the comprehensiveness of Sharia in the legal system as a whole, and not in a limited way related to it as a source of law according to Article 1 of the Civil Transactions Law. Turning to the role of the Shariah as a formal source of law, it is useful to start from Article 1 of the UAE Civil Code. This provision lays out the formal hierarchy of sources of UAE private law, these being legislation, Islamic law, and custom. Hence, when deciding a civil dispute, a judge should first refer to positive legislation in force in the UAE. Lacking the rule to cover the case before him/her, the judge ought then to refer directly to Islamic law. If the matter lacks regulation in Islamic law, only then may the judge appeal to custom. Accordingly, in connection to civil transactions, Shariah is presented here, formally, as the second source of law. Still, Shariah law addresses many other issues beyond civil transactions, including matters of morals, worship, and belief. However, in Article 1 of the UAE Civil Code, the reference to Islamic law ought to be understood as limited to the rules it lays out for civil transactions. There are four main sets of courts in the judicial systems of the UAE, whose competence is based on whether a dispute touches upon civil and commercial transactions, criminal offenses, personal statuses, or labor relations. This sectorial and multi-tiered organization of courts as a whole constitutes an institutional development compatible with the long-standing affirmation in the Shariah of the legitimacy of the judiciary. Indeed, Islamic law authorizes the governing authorities to organize the judiciary, including by allocating specific types of cases to particular kinds of judges depending on the value of the case, or by assigning judges to a specific place in which they are to exercise their jurisdictional function. In view of this, the contemporary organization of courts in the UAE can be regarded as an organic adaptation, aligned with Shariah rules on the assignment of jurisdictional authority, to the growing complexity of modern society. Therefore, we can conclude to the comprehensive role of Shariah in the entire legal system of the United Arab Emirates, including legislation, a judicial system, institutional, and administrative work.

Keywords: Islamic jurisprudence, Shariah, UAE civil code, UAE private law

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Authors: Mohsen Tehranizadeh, Mahboobe Forghani

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The impact of higher modes on the seismic response of dual structural system consist of concrete moment-resisting frame and with RC shear walls is investigated against near-field earthquakes in this paper. a 20 stories reinforced concrete shear wall-special moment frame structure is designed in accordance with ASCE7 requirements and The nonlinear model of the structure was performed on OpenSees platform. Nonlinear time history dynamic analysis with 3 near-field records are performed on them. In order to further understand the structural collapse behavior in the near field, the response of the structure at the moment of collapse especially the formation of plastic hinges is explored. The results revealed that the amplification of moment at top of the wall due to higher modes, the plastic hinge can form in the upper part of wall, even when designed and detailed for plastic hinging at the base only (according to ACI code).on the other hand, shear forces in excess of capacity design values can develop due to the contribution of the higher modes of vibration to dynamic response due to the near field can cause brittle shear or sliding failure modes. The past investigation on shear walls clearly shows the dual-hinge design concept is effective at reducing the effects of the second mode of response. An advantage of the concept is that, when combined with capacity design, it can result in relaxation of special reinforcing detailing in large portions of the wall. In this study, to investigate the implications of multi-design approach, 4 models with varies arrangement of hinge plastics at the base and height of the shear wall are considered. results base on time history analysis showed that the dual or multi plastic hinges approach can be useful in order to control the high moment and shear demand of higher mode effect.

Keywords: higher mode effect, Near-field earthquake, nonlinear time history analysis, multi plastic hinge design

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Authors: Xiping Wang，Shuran Yao, Liqin Dai

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Many studies report the winter is getting warmer and the minimum air temperature is obviously rising as the important climate warming evidences. The exacerbated air temperature fluctuation tending to bring more severe weather variation is another important consequence of recent climate change which induced more disasters to crop growth in quite a certain regions. Hebei Province is an important winter wheat growing province in North of China that recently endures more winter freezing injury influencing the local winter wheat crop management. A winter wheat freezing injury assessment Bayesian Network framework was established for the objectives of estimating, assessing and predicting winter wheat freezing disasters in Hebei Province. In this framework, the freezing disasters was classified as three severity degrees (SI) among all the three types of freezing, i.e., freezing caused by severe cold in anytime in the winter, long extremely cold duration in the winter and freeze-after-thaw in early season after winter. The factors influencing winter wheat freezing SI include time of freezing occurrence, growth status of seedlings, soil moisture, winter wheat variety, the longitude of target region and, the most variable climate factors. The climate factors included in this framework are daily mean and range of air temperature, extreme minimum temperature and number of days during a severe cold weather process, the number of days with the temperature lower than the critical temperature values, accumulated negative temperature in a potential freezing event. The Bayesian Network model was evaluated using actual weather data and crop records at selected sites in Hebei Province using real data. With the multi-stage influences from the various factors, the forecast and assessment of the event-based target variables, freezing injury occurrence and its damage to winter wheat production, were shown better scoped by Bayesian Network model.

Keywords: bayesian networks, climatic change, freezing Injury, winter wheat

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Authors: Sabir Hussain, Muhammad Naeem, Yousif Aldryhim, Susan E. Halbert, Qingjun Wu

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Plant viruses annually cause severe economic losses in crop production and globally, different aphid species are responsible for the transmission of such viruses. Additionally, aphids are also serious pests of trees, and agricultural crops. Al Bahah Province, Kingdom of Saudi Arabia (KSA) has a high native and introduced plant species with a temperate climate that provides ample habitats for aphids. In this study, we surveyed virus-transmitting aphids from the Province to highlight their spatial distributions and hot spot areas for their target control strategies. During our fifteen month's survey in Al Bahah Province, three hundred and seventy samples of aphids were collected using both beating sheets and yellow water pan traps. Consequently, fifty-four aphid species representing 30 genera belonging to four families were recorded from Al Bahah Province. Alarmingly, 35 aphid species from our records are virus transmitting species. The most common virus transmitting aphid species based on number of collecting samples, were Macrosiphum euphorbiae (Thomas, 1878), Brachycaudus rumexicolens (Patch, 1917), Uroleucon sonchi (Linnaeus, 1767), Brachycaudus helichrysi (Kaltenbach, 1843), and Myzus persicae (Sulzer, 1776). The numbers of samples for the forementioned species were 66, 24, 23, 22, and 20, respectively. The widest range of plant hosts were found for M. euphorbiae (39 plant species), B. helichrysi (12 plant species), M. persicae (12 plant species), B. rumexicolens (10 plant species), and U. sonchi (9 plant species). The hottest spot areas were found in Al-Baha, Al Mekhwah and Biljarashi cities of the province on the basis of their abundance. This study indicated that Al Bahah Province has relatively rich aphid diversity due to the relatively high plant diversity in a favorable climatic condition. ArcGIS tools can be helpful for biologists to implement the target control strategies against these pests in the integrated pest management, and ultimately to save money and time.

Keywords: Al Bahah province, aphid-virus interaction, biodiversity, global information system

Procedia PDF Downloads 165

Authors: Madrine King'endo

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This study dealt with the influence of spelling errors on English language performance among learners with dysgraphia in public primary schools in West Embu, Embu County, Kenya. The study purposed to investigate the influence of spelling errors on the English language performance among the class three pupils with dysgraphia in public primary schools. The objectives of the study were to identify the spelling errors that learners with dysgraphia make when writing English words and classify the spelling errors they make. Further, the study will establish how the spelling errors affect the performance of the language among the study participants, and suggest the remediation strategies that teachers could use to address the errors. The study could provide the stakeholders with relevant information in writing skills that could help in developing a responsive curriculum to accommodate the teaching and learning needs of learners with dysgraphia, and probably ensure training of teachers in teacher training colleges is tailored within the writing needs of the pupils with dysgraphia. The study was carried out in Embu county because the researcher did not find any study in related literature review concerning the influence of spelling errors on English language performance among learners with dysgraphia in public primary schools done in the area. Moreover, besides being relatively populated enough for a sample population of the study, the area was fairly cosmopolitan to allow a generalization of the study findings. The study assumed the sampled schools will had class three pupils with dysgraphia who exhibited written spelling errors. The study was guided by two spelling approaches: the connectionist stimulation of spelling process and orthographic autonomy hypothesis with a view to explain how participants with learning disabilities spell written words. Data were collected through interviews, pupils’ exercise books, and progress records, and a spelling test made by the researcher based on the spelling scope set for class three pupils by the ministry of education in the primary education syllabus. The study relied on random sampling techniques in identifying general and specific participants. Since the study used children in schools as participants, voluntary consent was sought from themselves, their teachers and the school head teachers who were their caretakers in a school setting.

Keywords: dysgraphia, writing, language, performance

Procedia PDF Downloads 136

Authors: Sasiwan Tassana-iem, Sumattana Glangkarn

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Diabetic nephropathy is a major complication in diabetic patients whom as the glomerular filtration rate falls. The affects their quality of life and results in loss of money for kidney replacement therapy costs. There is an existing intervention, but the prevalence remains high, thus this research aims to study lessons learned in implementing programs to delay diabetic nephropathy management in primary health care. Method: The target settings are, 24 sub-district health promoting hospital in Sakon Nakhon province. Participants included the health care professionals, head of the sub-district health promoting hospital and the person responsible for managing diabetic nephropathy in each hospital (n= 50). There are 400 patients with diabetes mellitus in an area. Data were collected using questionnaires, patient records data, interviews and focus groups and analyzed by statistics and content analysis. Result: Reflection of participants that the interventions to delay diabetic nephropathy management in each area, the Ministry of Public Health has a policy to screen and manage this disease. The implementing programs aimed to provide health education, innovative teaching media used in communication to educate. Patients and caregivers had misunderstanding about the actual causes and prevention of this disease and how to apply knowledge suitable for daily life. Conclusion: The obstacles to the success of the implementing programs to delay diabetic nephropathy management in primary health care were most importantly, the patient needs self-care and should be evaluated for health literacy. This is crucial to promote health literacy; to access and understand health information as well to decide their health-related choices based on health information which will promote and maintain a good health. This preliminary research confirms that situation of diabetic nephropathy still exists. The results of this study will lead to the development of delay in diabetic nephropathy implementation among patients in the province studied.

Keywords: diabetic nephropathy, chronic kidney disease, primary health care, implementation

Procedia PDF Downloads 178

Authors: Sopit Tubtimhin, Chaliya Wamaloon, Anchalee Supattagorn

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Background and Significance: Breast cancer is the most frequently diagnosed and leading cause of cancer death among women. This study aims to determine factors potentially predicting recurrence and long-term survival after the first recurrence in surgically treated patients between postmenopausal and younger women. Methods and Analysis: A retrospective cohort study was performed on 498 Thai women with invasive breast cancer, who had undergone mastectomy and been followed-up at Ubon Ratchathani Cancer Hospital, Thailand. We collected based on a systematic chart audit from medical records and pathology reports between January 1, 2002, and December 31, 2011. The last follow-up time point for surviving patients was December 31, 2016. A Cox regression model was used to calculate hazard ratios of recurrence and death. Findings: The median age was 49 (SD ± 9.66) at the time of diagnosis, 47% was post-menopausal women ( ≥ 51years and not experienced any menstrual flow for a minimum of 12 months), and 53 % was younger women ( ˂ 51 years and have menstrual period). Median time from the diagnosis to the last follow-up or death was 10.81 [95% CI = 9.53-12.07] years in younger cases and 8.20 [95% CI = 6.57-9.82] years in postmenopausal cases. The recurrence-free survival (RFS) for younger estimates at 1, 5 and 10 years of 95.0 %, 64.0% and 58.93% respectively, appeared slightly better than the 92.7%, 58.1% and 53.1% for postmenopausal women [HRadj = 1.25, 95% CI = 0.95-1.64]. Regarding overall survival (OS) for younger at 1, 5 and 10 years were 97.7%, 72.7 % and 52.7% respectively, for postmenopausal patients, OS at 1, 5 and 10 years were 95.7%, 70.0% and 44.5 respectively, there were no significant differences in survival [HRadj = 1.23, 95% CI = 0.94 -1.64]. Multivariate analysis identified five risk factors for negatively impacting on survival were triple negative [HR= 2.76, 95% CI = 1.47-5.19], Her2-enriched [HR = 2.59, 95% CI = 1.37-4.91], luminal B [HR = 2.29, 95 % CI=1.35-3.89], not free margin [HR = 1.98, 95%CI=1.00-3.96] and patients who received only adjuvant chemotherapy [HR= 3.75, 95% CI = 2.00-7.04]. Statistically significant risks of overall cancer recurrence were Her2-enriched [HR = 5.20, 95% CI = 2.75-9.80], triple negative [HR = 3.87, 95% CI = 1.98-7.59], luminal B [HR= 2.59, 95% CI = 1.48-4.54,] and patients who received only adjuvant chemotherapy [HR= 2.59, 95% CI = 1.48-5.66]. Discussion and Implications: Outcomes from this studies have shown that postmenopausal women have been associated with increased risk of recurrence and mortality. As the results, it provides useful information for planning the screening and treatment of early-stage breast cancer in the future.

Keywords: breast cancer, menopause status, recurrence-free survival, overall survival

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Authors: Hend Albassam, Nouf Alrumaih

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Nowadays we are in the age of technologies and communication and there is no doubt that technologies such as the Internet can offer many advantages for many business fields, and the health field is no execution. In fact, using the Internet provide us with a new path to improve the quality of health care throughout the world. The e-healthcare offers many advantages such as: efficiency by reducing the cost and avoiding duplicate diagnostics, empowerment of patients by enabling them to access their medical records, enhancing the quality of healthcare and enabling information exchange and communication between healthcare organizations. There are many problems that result from using papers as a way of communication, for example, paper-based prescriptions. Usually, the doctor writes a prescription and gives it to the patient who in turn carries it to the pharmacy. After that, the pharmacist takes the prescription to fill it and give it to the patient. Sometimes the pharmacist might find difficulty in reading the doctor’s handwriting; the patient could change and counterfeit the prescription. These existing problems and many others heighten the need to improve the quality of the healthcare. This project is set out to develop a distributed e-healthcare system that offers some features of e-health and addresses some of the above-mentioned problems. The developed system provides an electronic health record (EHR) and enables communication between separate health care organizations such as the clinic, pharmacy and laboratory. To develop this system, the Service Oriented Architecture (SOA) is adopted as a design approach, which helps to design several independent modules that communicate by using web services. The layering design pattern is used in designing each module as it provides reusability that allows the business logic layer to be reused by different higher layers such as the web service or the website in our system. The experimental analysis has shown that the project has successfully achieved its aims toward solving the problems related to the paper-based healthcare systems and it enables different health organization to communicate effectively. It implements four independent modules including healthcare provider, pharmacy, laboratory and medication information provider. Each module provides different functionalities and is used by a different type of user. These modules interoperate with each other using a set of web services.

Keywords: e-health, services oriented architecture (SOA), web services, interoperability

Procedia PDF Downloads 292