Search results for: meso scale parameters

Authors: Anshu Tyagi

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Zeolitic imidazolate frameworks (ZIFs), a subclass of metal-organic frameworks (MOFs) with structures resembling aluminosilicate zeolites, are gaining significant attention due to their unique properties. ZIF-8, in particular, has shown high surface area and enhanced hydrophobicity, making it a promising candidate for catalytic applications. In this study, ZIF-8 was synthesized in an aqueous medium by mixing 2-methylimidazole (mIm) with zinc nitrate hexahydrate (Zn) in deionized water. To improve the basicity and catalytic performance of ZIF-8, a series of K-loaded ZIF-8 catalysts (K/ZIF-8) were prepared by varying the KOH content from 5 to 10 wt%. Characterization of the synthesized catalysts was conducted using powder X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), high-resolution transmission electron microscopy (HRTEM), and temperature-programmed desorption (TPD) techniques. The ZIF-8 and K/ZIF-8 catalysts were applied in the transesterification of glycerol (GL) and dimethyl carbonate (DMC) to form glycerol carbonate (GLC). Various reaction parameters, including DMC/GL molar ratio, KOH loading, catalyst amount, and reaction temperature, were systematically studied to optimize the GLC yield. Under optimized conditions, the 10 wt% KOH-loaded ZIF-8 catalyst (10-K/ZIF-8) demonstrated excellent catalytic activity, achieving up to 95% GLC yield at a DMC/GL molar ratio of 3:1 within 0.5 hours. Remarkably, despite the hygroscopic nature of potassium, the catalyst exhibited significant water resistance, maintaining performance with up to 5 wt% water in relation to GL. Furthermore, the catalyst retained its activity after three recycling cycles without any notable loss in catalytic efficiency. This study highlights the potential of K/ZIF-8 as an efficient, water-tolerant catalyst for the transesterification of GL with DMC, offering high GLC yields and recyclability.

Keywords: metal-organic frameworks (MOFs), zeolitic imidazolate frameworks (ZIFs), transesterification, sustainable catalytic

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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: M. K. Mzuza, W. Zhang, L. S. Chapola, M. Tembo

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Shire River is the largest and longest river in Malawi emptying its water into the Zambezi River in Mozambique. Siltation is now a major problem in the Shire River due to catchment degradation. This study analysed soil samples from tributaries of the Shire River to determine sources of sediments that cause siltation using the mineral magnetic approach. Bulk sediments and separated particle size fractions of representative samples were collected from tributaries on the western and eastern sides of the Shire River, and Nkula Dam. Eastern tributaries showed relatively higher ferrimagnetic mineral contents and ferrimagnetic to anti ferromagnetic ratios than western tributaries. Sediments from both sides of the Shire River were distinguished by χARM, SIRM versus χlf and S-100 versus SIRM. Findings in this study showed that most of the sediments originated from the western part of the Shire River. Tributaries on the eastern side of the Shire River had higher values for concentration related parameters (χlf, χfd, χARM, SIRM, HIRM, S-100, and χARM/SIRM) than tributaries on the western side. Bulky and detailed magnetic measurements carried out on particle size fractions provided additional confirmation of magnetic contrasts between the two sides of the river suggesting differences in lithology, topography, climate and weather regimes in the catchments. This study demonstrated that the magnetic approach can provide a reliable means of understanding major sediment sources of Nkula Dam and similar situations. It can also help to assess future variations in sediment composition resulting from catchment changes

Keywords: ferrimagnetic minerals, Shire River, tributaries rivers, particle size , topography

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Authors: Kamel Abd Elaziz Mohamed

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Introduction: Drug related problems (DRPs) are of major concern, affecting patients of both sex. They impose considerable economic burden on the society and the health-care systems. Aim of the work: The aim of this work was to identify and categorize drug-related problems in adult intensive care unit. Patients and methods: The study was a prospective, observational study as eighty six patients were included. They were consecutively admitted to ICU through the emergency room or transferred from the general ward due to DRPs. Parameters included in the study as length of stay in ICU, need for cardiovascular support or mechanical ventilation, dialysis, as well as APACHE II score were recorded. Results: Drug related problems represent 3.6% of the total ICU admission. The median (range) of APACHE II score for 86 patients included in the study was 17 (10-23), and length of ICU stay was 2.4 (1.5-4.2) days. In 45 patients (52%), DRP was drug over dose (group 1), while other DRP was present in the other 41 patients (48%, group 11). Patients in group 1 were older (39 years versus 32 years in group 11), with significant impaired renal function. The need of inotropic drugs and mechanical ventilation as well as the length of stay (LOS) in ICU was significantly higher in group 1. There were no significant difference in GCS between both groups, however APACHE II score was significantly higher in group 1. Only four patients (4.6%) were admitted by suicidal attempt as well as three patients (3.4%) due to trauma drug-related admissions, all were in (group 1). Nineteen percent of the patients had drug related problem due to hypoglycaemic medication followed by tranquilizer (15%). Adverse drug effect followed by failure to receive medication were the most causes of drug problem in (group11).The total mortality rate was 4.6%, all of them were eventually non preventable. Conclusion: The critically ill patients admitted due to drug related problems represented a small proportion (3.6%) of admissions to the ICU. Hypoglycaemic medication was one of the most common causes of admission by drug related problems.

Keywords: drug related problems, ICU, cost, safety

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Authors: Ratnakumar V. Kappagantula, Gordon D. Ingram, Hari B. Vuthaluru

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This paper analyzes a three reactor chemical looping process for hydrogen production from natural gas, allowing for carbon dioxide capture through chemical looping technology. An oxygen carrier is circulated to separate carbon dioxide, to reduce steam for hydrogen production and to supply oxygen for combustion. In this study, the emphasis is placed on the steam conversion in the steam reactor by investigating the hydrogen efficiencies of the complete system at steam conversions of 15.8% and 50%. An Aspen Plus model was developed for a Three Reactor Chemical Looping process to study the effects of operational parameters on hydrogen production is investigated. Maximum hydrogen production was observed under stoichiometric conditions. Different conversions in the steam reactor, which was modelled as a Gibbs reactor, were found when Gibbs-identified products and user identified products were chosen. Simulations were performed for different oxygen carriers, which consist of an active metal oxide on an inert support material. For the same metal oxide mass flowrate, the fuel reactor temperature decreased for different support materials in the order: aluminum oxide (Al2O3) > magnesium aluminate (MgAl2O4) > zirconia (ZrO2). To achieve the same fuel reactor temperature for the same oxide mass flow rate, the inert mass fraction was found to be 0.825 for ZrO2, 0.7 for MgAl2O4 and 0.6 for Al2O3. The effect of poisoning of the oxygen carrier was also analyzed. With 3000 ppm sulfur-based impurities in the feed gas, the hydrogen product energy rate of the process were found to decrease by 0.4%.

Keywords: aspen plus, chemical looping combustion, inert support balls, oxygen carrier

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Authors: Chloe Richards, Adrian Delgado Ollero, Yan Delaure, Fiona Regan

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Growing concern about the natural environment has accelerated the search for non-toxic, but at the same time, economically reasonable, antifouling materials. Bioinspired surfaces, due to their nano and micro topographical antifouling capabilities, provide a hopeful approach to the design of novel antifouling surfaces. Biological organisms are known to have highly evolved and complex topographies, demonstrating antifouling potential, i.e. shark skin. Previous studies have examined the antifouling ability of topographic patterns, textures and roughness scales found on natural organisms. One of the mechanisms used to explain the adhesion of cells to a substrate is called attachment point theory. Here, the fouling organism experiences increased attachment where there are multiple attachment points and reduced attachment, where the number of attachment points are decreased. In this study, an attempt to characterize the microtopography of the common brill fish, Scophthalmus rhombus, was undertaken. Scophthalmus rhombus is a small flatfish of the family Scophthalmidae, inhabiting regions from Norway to the Mediterranean and the Black Sea. They reside in shallow sandy and muddy coastal areas at depths of around 70 – 80 meters. Six engineered surfaces (inspired by the Brill fish scale) produced by a 2-photon polymerization (2PP) process were evaluated for their potential as an antifouling solution for incorporation onto tidal energy blades. The micro-textures were analyzed for their AF potential under both static and dynamic laboratory conditions using two laboratory grown diatom species, Amphora coffeaeformis and Nitzschia ovalis. The incorporation of a surface topography was observed to cause a disruption in the growth of A. coffeaeformis and N. ovalis cells on the surface in comparison to control surfaces. This work has demonstrated the importance of understanding cell-surface interaction, in particular, topography for the design of novel antifouling technology. The study concluded that biofouling can be controlled by physical modification, and has contributed significant knowledge to the use of a successful novel bioinspired AF technology, based on Brill, for the first time.

Keywords: attachment point theory, biofouling, Scophthalmus rhombus, topography

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Authors: Johnson C. Y. Pang, Bo Peng, Kara K. L. Reeves, Allan C. L. Fud

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Objective: Dry needling (DN) has long been used as a treatment method for various musculoskeletal pain conditions. However, the evidence level of the studies was low due to the limitations of the methodology. Lack of randomization and inappropriate blinding is potentially the main sources of bias. A method that can differentiate clinical results due to the targeted experimental procedure from its placebo effect is needed to enhance the validity of the trial. Therefore, this study aimed to validate the method as a placebo ultrasound(US)-guided DN for patients with knee osteoarthritis (KOA). Design: This is a randomized controlled trial (RCT). Ninety subjects (25 males and 65 females) aged between 51 and 80 (61.26 ± 5.57) with radiological KOA were recruited and randomly assigned into three groups with a computer program. Group 1 (G1) received real US-guided DN, Group 2 (G2) received placebo US-guided DN, and Group 3 (G3) was the control group. Both G1 and G2 subjects received the same procedure of US-guided DN, except the US monitor was turned off in G2, blinding the G2 subjects to the incorporation of faux US guidance. This arrangement created the placebo effect intended to permit comparison of their results to those who received actual US-guided DN. Outcome measures, including the visual analog scale (VAS) and Knee injury and Osteoarthritis Outcome Score (KOOS) subscales of pain, symptoms, and quality of life (QOL), were analyzed by repeated measures analysis of covariance (ANCOVA) for time effects and group effects. The data regarding the perception of receiving real US-guided DN or placebo US-guided DN were analyzed by the chi-squared test. The missing data were analyzed with the intention-to-treat (ITT) approach if more than 5% of the data were missing. Results: The placebo US-guided DN (G2) subjects had the same perceptions as the use of real US guidance in the advancement of DN (p<0.128). G1 had significantly higher pain reduction (VAS and KOOS-pain) than G2 and G3 at 8 weeks (both p<0.05) only. There was no significant difference between G2 and G3 at 8 weeks (both p>0.05). Conclusion: The method with the US monitor turned off during the application of DN is credible for blinding the participants and allowing researchers to incorporate faux US guidance. The validated placebo US-guided DN technique can aid in investigations of the effects of US-guided DN with short-term effects of pain reduction for patients with KOA. Acknowledgment: This work was supported by the Caritas Institute of Higher Education [grant number IDG200101].

Keywords: ultrasound-guided dry needling, dry needling, knee osteoarthritis, physiotheraphy

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Authors: Massimiliano Condotta, Paolo Ruggeri, Chiara Scanagatta, Giovanni Borga

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Architects and urban planners, when designing and renewing cities, have to face a complex set of problems, including the issues of noise and air pollution which are considered as hot topics (i.e., the Clean Air Act of London and the Soundscape definition). It is usually taken for granted that these problems go by together because the noise pollution present in cities is often linked to traffic and industries, and these produce air pollutants as well. Traffic congestion can create both noise pollution and air pollution, because NO₂ is mostly created from the oxidation of NO, and these two are notoriously produced by processes of combustion at high temperatures (i.e., car engines or thermal power stations). We can see the same process for industrial plants as well. What have to be investigated – and is the topic of this paper – is whether or not there really is a correlation between noise pollution and air pollution (taking into account NO₂) in urban areas. To evaluate if there is a correlation, some low-cost methodologies will be used. For noise measurements, the OpeNoise App will be installed on an Android phone. The smartphone will be positioned inside a waterproof box, to stay outdoor, with an external battery to allow it to collect data continuously. The box will have a small hole to install an external microphone, connected to the smartphone, which will be calibrated to collect the most accurate data. For air, pollution measurements will be used the AirMonitor device, an Arduino board to which the sensors, and all the other components, are plugged. After assembling the sensors, they will be coupled (one noise and one air sensor) and placed in different critical locations in the area of Mestre (Venice) to map the existing situation. The sensors will collect data for a fixed period of time to have an input for both week and weekend days, in this way it will be possible to see the changes of the situation during the week. The novelty is that data will be compared to check if there is a correlation between the two pollutants using graphs that should show the percentage of pollution instead of the values obtained with the sensors. To do so, the data will be converted to fit on a scale that goes up to 100% and will be shown thru a mapping of the measurement using GIS methods. Another relevant aspect is that this comparison can help to choose which are the right mitigation solutions to be applied in the area of the analysis because it will make it possible to solve both the noise and the air pollution problem making only one intervention. The mitigation solutions must consider not only the health aspect but also how to create a more livable space for citizens. The paper will describe in detail the methodology and the technical solution adopted for the realization of the sensors, the data collection, noise and pollution mapping and analysis.

Keywords: air quality, data analysis, data collection, NO₂, noise mapping, noise pollution, particulate matter

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Authors: Abbas Sheikhtaheri, Nasim Hashemi

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Health information systems have great benefits for clinical and managerial processes of health care organizations. However, identifying and removing constraints and barriers of implementing and using health information systems before any implementation is essential. Physicians are one of the main users of health information systems, therefore, identifying the causes of their resistance and concerns about the barriers of the implementation of these systems is very important. So the purpose of this study was to determine the barriers of the development and implementation of health information systems in terms of the Iranian physicians’ perspectives. In this study conducted in 8 selected hospitals affiliated to Tehran and Iran Universities of Medical Sciences, Tehran, Iran in 2014, physicians (GPs, residents, interns, specialists) in these hospitals were surveyed. In order to collect data, a research made questionnaire was used (Cronbach’s α = 0.95). The instrument included 25 about organizational (9), personal (4), moral and legal (3) and technical barriers (9). Participants were asked to answer the questions using 5 point scale Likert (completely disagree=1 to completely agree=5). By using a simple random sampling method, 200 physicians (from 600) were invited to study that eventually 163 questionnaires were returned. We used mean score and t-test and ANOVA to analyze the data using SPSS software version 17. 52.1% of respondents were female. The mean age was 30.18 ± 7.29. The work experience years for most of them were between 1 to 5 years (80.4 percent). The most important barriers were organizational ones (3.4 ± 0.89), followed by ethical (3.18 ± 0.98), technical (3.06 ± 0.8) and personal (3.04 ± 1.2). Lack of easy access to a fast Internet (3.67±1.91) and the lack of exchanging information (3.61±1.2) were the most important technical barriers. Among organizational barriers, the lack of efficient planning for the development and implementation systems (3.56±1.32) and was the most important ones. Lack of awareness and knowledge of health care providers about the health information systems features (3.33±1.28) and the lack of physician participation in planning phase (3.27±1.2) as well as concerns regarding the security and confidentiality of health information (3.15 ± 1.31) were the most important personal and ethical barriers, respectively. Women (P = 0.02) and those with less experience (P = 0.002) were more concerned about personal barriers. GPs also were more concerned about technical barriers (P = 0.02). According to the study, technical and ethics barriers were considered as the most important barriers however, lack of awareness in target population is also considered as one of the main barriers. Ignoring issues such as personal and ethical barriers, even if the necessary infrastructure and technical requirements were provided, may result in failure. Therefore, along with the creating infrastructure and resolving organizational barriers, special attention to education and awareness of physicians and providing solution for ethics concerns are necessary.

Keywords: barriers, development health information systems, implementation, physicians

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Authors: Lu Song Ma Li Zhi

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With the rapid advancement of artificial intelligence technology, large language models (LLMs) have become a milestone in the field of natural language processing, demonstrating remarkable capabilities in semantic understanding, intelligent question answering, and text generation. These models are gradually penetrating various industries, particularly showcasing significant application potential in the data analysis domain. However, retraining or fine-tuning these models requires substantial computational resources and ample downstream task datasets, which poses a significant challenge for many enterprises and research institutions. Without modifying the internal parameters of the large models, prompt engineering techniques can rapidly adapt these models to new domains. This paper proposes a prompt design strategy aimed at leveraging the capabilities of large language models to automate the generation of data analysis code. By carefully designing prompts, data analysis requirements can be described in natural language, which the large language model can then understand and convert into executable data analysis code, thereby greatly enhancing the efficiency and convenience of data analysis. This strategy not only lowers the threshold for using large models but also significantly improves the accuracy and efficiency of data analysis. Our approach includes requirements for the precision of natural language descriptions, coverage of diverse data analysis needs, and mechanisms for immediate feedback and adjustment. Experimental results show that with this prompt design strategy, large language models perform exceptionally well in multiple data analysis tasks, generating high-quality code and significantly shortening the data analysis cycle. This method provides an efficient and convenient tool for the data analysis field and demonstrates the enormous potential of large language models in practical applications.

Keywords: large language models, prompt design, data analysis, code generation

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Authors: Jin-Hee Kim

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The way that globalization distinguishes itself from the previous changes is scope and intensity of changes, which together affect many parts of a nation’s system. In this way, globalization has its relation with the concept of ‘internationalization’ in that a nation state formulates a set of strategies in many areas of its governance to actively react to it. In short, globalization is a ‘catalyst,’ and internationalization is a ‘response’. In this regard, the field of higher education is one of the representative cases that globalization has several consequences that change the terrain of national policy-making. Started and been dominated mainly by the Western world, it has now been expanded to the ‘late movers,’ such as Asia-Pacific countries. The case of internationalization of Korean higher education is, therefore, located in a unique place in this arena. Yet Korea still is one of the major countries of sending its students to the so-called, ‘first world.’ On the other hand, it has started its effort to recruit international students from the world to its higher education system. After new Millennium, particularly, internationalization of higher education has been launched in its full-scale and gradually been one of the important global policy agenda, striving in both ways by opening its turf to foreign educational service providers and recruiting prospective students from other countries. Particularly the latter, recruiting international students, has been highlighted under the government project named ‘Study Korea,’ launched in 2004. Not only global, but also local issues and motivations were based to launch this nationwide project. Bringing international students means various desirable economic outcomes such as reducing educational deficit as well as utilizing them in Korean industry after the completion of their study, to name a few. In addition, in a similar vein, Korea's higher education institutes have started to have a new comers of adult learners. When it comes to the questions regarding the quality and access of this new learning agency, the answer is quite tricky. This study will investigate the different dimension of education provision and learning process to empower diverse group regardless of nationality, race, class and gender in Korea. Listening to the voices of international students and adult learning as non-traditional participants in a changing Korean higher educational space not only benefit students themselves, but Korean stakeholders who should try to accommodate more comprehensive and fair educational provisions for more and more diversifying groups of learners.

Keywords: education equity, access, globalisation, international students, adult learning, learning support

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Authors: F. Clara Fang, Hernan Castaneda

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The Connecticut Department of Transportation (ConnDOT) has constructed four roundabouts in the State of Connecticut within the past ten years. VISSIM traffic simulation software was utilized to analyze these roundabouts during their design phase. The queue length and level of service observed in the field appear to be better than predicted by the VISSIM model. The objectives of this project are to: identify VISSIM input variables most critical to accurate modeling; recommend VISSIM calibration factors; and, provide other recommendations for roundabout traffic operations modeling. Traffic data were collected at these roundabouts using Miovision Technologies. Cameras were set up to capture vehicle circulating activity and entry behavior for two weekdays. A large sample size of filed data was analyzed to achieve accurate and statistically significant results. The data extracted from the videos include: vehicle circulating speed; critical gap estimated by Maximum Likelihood Method; peak hour volume; follow-up headway; travel time; and, vehicle queue length. A VISSIM simulation of existing roundabouts was built to compare both queue length and travel time predicted from simulation with measured in the field. The research investigated a variety of simulation parameters as calibration factors for describing driver behaviors at roundabouts. Among them, critical gap is the most effective calibration variable in roundabout simulation. It has a significant impact to queue length, particularly when the volume is higher. The results will improve the design of future roundabouts in Connecticut and provide decision makers with insights on the relationship between various choices and future performance.

Keywords: driver critical gap, roundabout analysis, simulation, VISSIM modeling

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Authors: Santosh Kumar Yadav, Shobha Keswani, Nishat Quddus, Sohrab Ahmad Khan, Zuheb Ahmad Shiddiqui, Varsha Chorsiya

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Introduction: Early onset diabetes is more aggressive than the late onset diabetes. Diabetic individual has a greater spectrum of life period to suffer from its damage, complications, and long-term disability. This study aimed at assessing knee joint muscle performance under various durations of diabetes. Method and Materials: A total of 30 diabetic subjects (18 male and 12 females) without diabetic neuropathy were included for the study. They were divided into three groups with 5 years, 10 years and 15 years of duration of disease each. Muscle performance was evaluated through strength and flexibility. Peak torque for quadriceps muscle was measured using isokinetic dynamometer. Flexibility for quadriceps and hamstring muscles were measured through Ducan’s Elys test and 90/90 test. Results: The result showed significant difference in muscle strength (p<0.05), flexibility (p≤0.05) between groups. Discussion: Optimal muscle strength and flexibility are vital for musculoskeletal health and functional independence. Conclusion: The reduced muscle performance and functional impairment in nonneuropathic diabetic patients suggest that other mechanism besides neuropathy that contribute to altered biomechanics. These findings of this study project early management of these altered parameters through disease-specific physical therapy and assessment-based intervention. Clinical Relevance: Managing disability is more costly than managing disease. Prompt and timely identification and management strategy can dramatically reduce the cost of care for diabetic patients.

Keywords: muscle flexibility, muscle performance, muscle torque, type 2 diabetes

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Authors: Mediha B. Sılaydın Aydın, Emine D. Kahraman

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One of the important impacts of climate change is the sea level rise. Turkey is a peninsula, so the coastal areas of the country are threatened by the problem of sea level rise. Therefore, the urbanized coastal areas are highly vulnerable to climate change. At the aim of enhancing spatial resilience of urbanized areas, this question arises: What should be the priority intervention subject in the urban planning process for a given city. To answer this question, by focusing on the problem of sea level rise, this study aims to determine spatial vulnerability typologies and levels of Turkey coastal cities based on morphological, physical and social characteristics. As a method, spatial vulnerability of coastal cities is determined by two steps as level and type. Firstly, physical structure, morphological structure and social structure were examined in determining spatial vulnerability levels. By determining these levels, most vulnerable areas were revealed as a priority in adaptation studies. Secondly, all parameters are also used to determine spatial typologies. Typologies are determined for coastal cities in order to use as a base for urban planning studies. Adaptation to climate change is crucial for developing countries like Turkey so, this methodology and created typologies could be a guide for urban planners as spatial directors and an example for other developing countries in the context of adaptation to climate change. The results demonstrate that the urban settlements located on the coasts of the Marmara Sea, the Aegean Sea and the Mediterranean respectively, are more vulnerable than the cities located on the Black Sea’s coasts to sea level rise.

Keywords: climate change, coastal cities, vulnerability, urban land use planning

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Authors: Shivani Thakur, Jasmin Dominguez Cervantes, Ahmed Zabiba, Fatima Zabiba, Sandhini Agarwal, Kamalpreet Kaur, Hussein Maatouk, Shae Chand, Omar Madriz, Tiffany Huang, Saloni Bansal

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The prevalence of lymphedema in women in rural communities highlights the importance of developing effective treatment and prevention methods. Subjects with secondary lymphedema in California’s Central Valley were surveyed at 6 surgical clinics to assess demographics and symptoms of lymphedema. Additionally, subjects on semaglutide treatment for obesity and/or T2DM were monitored for their diabetes management, weight loss progress, and lymphedema symptoms compared to subjects who were not treated with semaglutide. The subjects were followed for 12 months. Subjects who were treated with semaglutide completed pre-treatment questionnaires and follow-up post-treatment questionnaires at 3, 6, 9, 12 months, along with medical assessment. The untreated subjects completed similar questionnaires. The questionnaires investigated subjective feelings regarding lymphedema symptoms and management using a Likert-scale; quantitative leg measurements were collected, and blood work reviewed at these appointments. Paired difference t-tests, chi-squared tests, and independent sample t-tests were performed. 50 subjects, aged 18-75 years, completed the surveys evaluating secondary lymphedema: 90% female, 69% Hispanic, 45% Spanish speaking, 42% disabled, 57 % employed, 54% income range below 30 thousand dollars, and average BMI of 40. Both treatment and non-treatment groups noted the most common symptoms were leg swelling (x̄=3.2, ▁d= 1.3), leg pain (x̄=3.2, ▁d=1.6 ), loss of daily function (x̄=3, ▁d=1.4 ), and negative body image (x̄=4.4, ▁d=0.54). Subjects in the semaglutide treatment group >3 months of treatment compared to the untreated group demonstrated: 55% subject in the treated group had a 10% weight loss vs 3% in the untreated group (average BMI reduction by 11% vs untreated by 2.5%, p<0.05) and improved subjective feelings about their lymphedema symptoms: leg swelling (x̄=2.4, ▁d=0.45 vs x̄=3.2, ▁d=1.3, p<0.05), leg pain (x̄=2.2, ▁d=0.45 vs x̄= 3.2, ▁d= 1.6, p<0.05), and heaviness (x̄=2.2, ▁d=0.45 vs x̄=3, ▁d=1.56, p<0.05). Improvement in diabetes management was demonstrated by an average of 0.9 % decrease in A1C values compared to untreated 0.1 %, p<0.05. In comparison to untreated subjects, treatment subjects on semaglutide noted 6 cm decrease in the circumference of the leg, knee, calf, and ankle compared to 2 cm in untreated subjects, p<0.05. Semaglutide was shown to significantly improve weight loss, T2DM management, leg circumference, and secondary lymphedema functional, physical and psychosocial symptoms.

Keywords: diabetes, secondary lymphedema, semaglutide, obesity

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Authors: Brindha Senthil Kumar, Payel Chakraborty, Senthil Kumar Nachimuthu, Arindam Maitra, Prem Nath

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Gastric cancer is predominantly caused by demographic and diet factors as compared to other cancer types. The aim of the study is to predict Early Gastric Cancer (ECG) from diet and lifestyle factors using supervised machine learning algorithms. For this study, 160 healthy individual and 80 cases were selected who had been followed for 3 years (2016-2019), at Civil Hospital, Aizawl, Mizoram. A dataset containing 11 features that are core risk factors for the gastric cancer were extracted. Supervised machine algorithms: Logistic Regression, Naive Bayes, Support Vector Machine (SVM), Multilayer perceptron, and Random Forest were used to analyze the dataset using Python Jupyter Notebook Version 3. The obtained classified results had been evaluated using metrics parameters: minimum_false_positives, brier_score, accuracy, precision, recall, F1_score, and Receiver Operating Characteristics (ROC) curve. Data analysis results showed Naive Bayes - 88, 0.11; Random Forest - 83, 0.16; SVM - 77, 0.22; Logistic Regression - 75, 0.25 and Multilayer perceptron - 72, 0.27 with respect to accuracy and brier_score in percent. Naive Bayes algorithm out performs with very low false positive rates as well as brier_score and good accuracy. Naive Bayes algorithm classification results in predicting ECG showed very satisfactory results using only diet cum lifestyle factors which will be very helpful for the physicians to educate the patients and public, thereby mortality of gastric cancer can be reduced/avoided with this knowledge mining work.

Keywords: Early Gastric cancer, Machine Learning, Diet, Lifestyle Characteristics

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Authors: Richard Roberts, Anna Kravtcova

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Introduction: The realisation that personality can change over the course of a lifetime has led to a new companion model to the Big Five, the behavioural, emotional, and social skills approach (BESSA). BESSA hypothesizes that this set of skills represents how the individual is thinking, feeling, and behaving when the situation calls for it, as opposed to traits, which represent how someone tends to think, feel, and behave averaged across situations. The five major skill domains share parallels with the Big Five Factor (BFF) model creativity and innovation (openness), self-management (conscientiousness), social engagement (extraversion), cooperation (agreeableness), and emotional resilience (emotional stability) skills. We point to noteworthy limitations in the current operationalisation of BESSA skills (i.e., via Likert-type items) and offer up a different measurement approach: forced choice. Method: In this forced-choice paradigm, individuals were given three skill items (e.g., managing my time) and asked to select one response they believed they were “worst at” and “best at”. The Thurstonian IRT models allow these to be placed on a normative scale. Two multivariate studies (N = 1178) were conducted with a 22-item forced-choice version of the BESSA, a published measure of the BFF, and various criteria. Findings: Confirmatory factor analysis of the forced-choice assessment showed acceptable model fit (RMSEA<0.06), while reliability estimates were reasonable (around 0.70 for each construct). Convergent validity evidence was as predicted (correlations between 0.40 and 0.60 for corresponding BFF and BESSA constructs). Notable was the extent the forced-choice BESSA assessment improved upon test-criterion relationships over and above the BFF. For example, typical regression models find BFF personality accounting for 25% of the variance in life satisfaction scores; both studies showed incremental gains over the BFF exceeding 6% (i.e., BFF and BESSA together accounted for over 31% of the variance in both studies). Discussion: Forced-choice measurement models offer up the promise of creating equated test forms that may unequivocally measure skill gains and are less prone to fakability and reference bias effects. Implications for practitioners are discussed, especially those interested in selection, succession planning, and training and development. We also discuss how the forced choice method can be applied to other constructs like emotional immunity, cross-cultural competence, and self-estimates of cognitive ability.

Keywords: Big Five, forced-choice method, BFF, methods of measurements

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Authors: Abeer Hashem, Khalid F. Almutairi, Ulkar Ibrahimova, Elsayed Fathi Abdallah

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Salinity poses a significant challenge to wheat production, necessitating the exploration of strategies to mitigate its adverse effects. The present investigation aims to study the impact of arbuscular mycorrhizal fungi (AMF) application to improve plant tolerance in terms of growth, carbohydrate, photosynthetic characteristics, and antioxidant enzyme activities under salt stress conditions. So, a randomized complete block design with five replications was employed comprising various treatments of AMF application under salinity stress (200mM), and control samples were used for each treatment. The obtained results demonstrated significantly that AMF used in this study showed beneficial impacts in all parameters used as sensitive monitor for relation of plant-salt microbe interaction. The root colonization by AMF showed the highest plant growth criteria, relative water content, soluble sugar, starch, and total non-structural carbohydrates under both control and salinity stress conditions. Moreover, the application of AMF-treated plants showed the highest soluble protein concentration and activity in leaves and antioxidant enzymes (catalase, superoxide dismutase, guaiacol peroxidase). These findings highlight the potential impact of AMF application as a biologically based strategy to manage the mitigation of salt stress on wheat, which increases the availability of many salt marsh habitats for sustainable agriculture of such strategy crops.

Keywords: arbuscular mycorrhizal fungi, salt stress, plant growth criteria, soluble protein, antioxidant enzymes, wheat plant

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Authors: Buchh Aqsa, Inayat Umar

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Background- Clonidine, α 2 agonist, possesses several properties to make it valuable adjuvant for spinal anesthesia. The study was aimed to evaluate the clinical effects of oral clonidine premedication for laparoscopic gynecological procedures under subarachnoid block. Patients and method- Sixtyfour adult female patients of ASA physical status I and II, aged 25 to 45 years and scheduled for laparoscopic gynecological procedures under the subarachnoid block, were randomized into two comparable equal groups of 32 patients each to received either oral clonidine, 100 µg (Group I) or placebo (Group II), 90 minutes before the procedure. Subarachnoid block was established with of 3.5 ml of 0.5% hyperbaric bupivacaine in all patients. Onset and duration of sensory and motor block, maximum cephalad level, and the regression time to reach S1 sensory level were assessed as primary end points. Sedation, hemodynamic variability, and respiratory depression or any other side effects were evaluated as secondary outcomes. Results- The demographic profile was comparable. The intraoperative hemodynamic parameters showed significant differences between groups. Oral clonidine was accelerated the onset time of sensory and motor blockade and extended the duration of sensory block (216.4 ± 23.3 min versus 165 ± 37.2 min, P <0.05). The duration of motor block showed no significant difference. The sedation score was more than 2 in the clonidine group as compared to the control group. Conclusion- Oral clonidine premedication has extended the duration of sensory analgesia with arousable sedation. It also prevented the post spinal shivering of the subarachnoid block.

Keywords: oral clonidine, subarachnoid block, sensory analgesia, laparoscopic gynaecological

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Authors: Carlos V. Gonzalez

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Background: Providers of in-home and community based services strive for the elimination of preventable harm to the people under their care as well as to the employees who support them. Traditional models of safety and protection from harm have assumed that the absence of incidents of harm is a good indicator of safe practices. However, this model creates an illusion of safety that is easily shaken by sudden and inadvertent harmful events. As an alternative, we have developed and implemented an evidence-based resilient model of safety known as C.O.P.E. (Caring, Observing, Predicting and Evaluating). Within this model, safety is not defined by the absence of harmful incidents, but by the presence of continuous monitoring, anticipation, learning, and rapid response to events that may lead to harm. Objective: The objective was to evaluate the effectiveness of the C.O.P.E. model for the reduction of harm to individuals with mental disabilities who receive home and community based services. Methods: Over the course of 2 years we counted the number of incidents of harm and near misses. We trained employees on strategies to eliminate incidents before they fully escalated. We trained employees to track different levels of patient status within a scale from 0 to 10. Additionally, we provided direct support professionals and supervisors with customized smart phone applications to track and notify the team of changes in that status every 30 minutes. Finally, the information that we collected was saved in a private computer network that analyzes and graphs the outcome of each incident. Result and conclusions: The use of the COPE model resulted in: A reduction in incidents of harm. A reduction the use of restraints and other physical interventions. An increase in Direct Support Professional’s ability to detect and respond to health problems. Improvement in employee alertness by decreasing sleeping on duty. Improvement in caring and positive interaction between Direct Support Professionals and the person who is supported. Developing a method to globally measure and assess the effectiveness of prevention from harm plans. Future applications of the COPE model for the reduction of harm to people who receive home and community based services are discussed.

Keywords: harm, patients, resilience, safety, mental illness, disability

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Authors: Soufiane Fal, Abderahim Aasfar, Ali Ouhssain, Hasnae Choukri, Abelaziz Smouni, Hicham El Arroussi

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Heavy metals contamination is a major environmental concern around the world. It has a harmful impact on plant productivity and poses a serious risk to humans and animals health. In the present study, the effect of Microalgae Crude Extract (MCE) on tomato growth and nutrients uptake exposed to 2 mM Pb2+ and Cd2+ was investigated. In results, 2 mM Pb2+ and Cd2+ showed a significant reduction of tomatobiomass and perturbation in nutrients absorption. Moreover, MCE application in tomato plant exposed to Pb2+ and Cd2+ showed a significant enhancement of biomass compared to tomato plants under Pb2+ and Cd2+. On the other hand, MCE application favoured heavy metals accumulation in root and inhibited their translocation to shoot as phytostabilisation mechanism. Tomato plants showed biochemical responses to Pb2+ and Cd2+ stress with elevation of scavenging enzymes and molecules such as POD, CAT, SOD, Proline, and polyphenols, etc. In addition, the treatment by MCE showed a significant reduction level of the majority of these parameters. Furthermore, the metabolomic analysis revealed a significant change in important metabolites. Pb2+ and Cd2+ showed decrease in SFA and increase of UFA, VLFA, alkanes, alkenes, sterols, which known accumulated as tolerance and resistance mechanism to heavy metal (H.M) stress. However, MCE treatment showed the inverse of these response to return tomato plants to normal state and enhanced tolerance and resistance to heavy metal stress. In the present study, we emphasized that MCE can alleviate H.M stress, enhance tomato plant growth nutrients absorption and improve biochemical responses.

Keywords: microalgae crude extract, heavy metal stress, nutrient uptake, metabolomic analysis, solanum lycopersicum (Tomato), phytostabilisation

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Authors: Morlu Stevens, Bareki Batlokwa

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The use of treated wastewater is widely employed to compensate for the scarcity of safe and uncontaminated freshwater. However, the existence of toxic heavy metal ions in the wastewater pose a health hazard to animals and the environment, hence, the importance for an effective technique to tackle the challenge. A multi-templated ion imprinted sorbent (Fe,Ni,Cu-IIP) for the simultaneous removal of heavy metal ions from waste water was synthesised employing molecular imprinting technology (MIT) via thermal free radical bulk polymerization technique. Methacrylic acid (MAA) was employed as the functional monomer, and ethylene glycol dimethylacrylate (EGDMA) as cross-linking agent, azobisisobutyronitrile (AIBN) as the initiator, Fe, Ni, Cu ions as template ions, and 1,10-phenanthroline as the complexing agent. The template ions were exhaustively washed off the synthesized polymer by solvent extraction in several washing steps, while periodically increasing solvent (HCl) concentration from 1.0 M to 10.0 M. The physical and chemical properties of the sorbents were investigated using Fourier Transform Infrared Spectroscopy (FT-IR), X-ray Diffraction (XRD) and Atomic Force Microscopy (AFM) were employed. Optimization of operational parameters such as time, pH and sorbent dosage to evaluate the effectiveness of sorbents were investigated and found to be 15 min, 7.5 and 666.7 mg/L respectively. Selectivity of ion-imprinted polymers and competitive sorption studies between the template and similar ions were carried out and showed good selectivity towards the targeted metal ion by removing 90% - 98% of the templated ions as compared to 58% - 62% of similar ions. The sorbents were further applied for the selective removal of Fe, Ni and Cu from real wastewater samples and recoveries of 92.14 ± 0.16% - 106.09 ± 0.17% and linearities of R2 = 0.9993 - R2 = 0.9997 were achieved.

Keywords: ion imprinting, ion imprinted polymers, heavy metals, wastewater

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Authors: S. A. N. Danushka, T. A. Weerasinghe

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The diverse necessities of instruction could be addressed effectively with the support of new dimensions of ICT integrated learning such as blended learning –which is a combination of face-to-face and online instruction which ensures greater flexibility in student learning and congruity of course delivery. As blended learning has been the ‘new normality' in education, many experimental and quasi-experimental research studies provide ample of evidence on its successful implementation in many fields of studies, but it is hard to justify whether blended learning could work similarly in the delivery of technology-teacher development programmes (TTDPs). The present study is bound with the particular research uncertainty, and having considered existing research approaches, the study methodology was set to decide the efficient instructional strategies for flipped classroom learning in TTDPs. In a quasi-experimental pre-test and post-test design with a mix-method research approach, the major study objective was tested with two heterogeneous samples (N=135) identified in a virtual learning environment in a Sri Lankan university. Non-randomized informal ‘before-and-after without control group’ design was employed, and two data collection methods, identical pre-test and post-test and Likert-scale questionnaires were used in the study. Selected two instructional strategies, self-directed learning (SDL) and self-regulated learning (SRL), were tested in an appropriate instructional framework with two heterogeneous samples (pre-service and in-service teachers). Data were statistically analyzed, and an efficient instructional strategy was decided via t-test, ANOVA, ANCOVA. The effectiveness of the two instructional strategy implementation models was decided via multiple linear regression analysis. ANOVA (p < 0.05) shows that age, prior-educational qualifications, gender, and work-experiences do not impact on learning achievements of the two diverse groups of learners through the instructional strategy is changed. ANCOVA (p < 0.05) analysis shows that SDL is efficient for two diverse groups of technology-teachers than SRL. Multiple linear regression (p < 0.05) analysis shows that the staged self-directed learning (SSDL) model and four-phased model of motivated self-regulated learning (COPES Model) are efficient in the delivery of course content in flipped classroom learning.

Keywords: COPES model, flipped classroom learning, self-directed learning, self-regulated learning, SSDL model

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Authors: Nedal N. Marei, Nashaat Nassar

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Many treatment techniques have been used to remove the soluble pollutants from wastewater as; dyes and metal ions which could be found in rich amount in the used water of the textile and tanneries industry. The effluents from these industries are complex, containing a wide variety of dyes and other contaminants, such as dispersants, acids, bases, salts, detergents, humectants, oxidants, and others. These techniques can be divided into physical, chemical, and biological methods. Adsorption has been developed as an efficient method for the removal of heavy metals from contaminated water and soil. It is now recognized as an effective method for the removal of both organic and inorganic pollutants from wastewaters. Nanosize materials are new functional materials, which offer high surface area and have come up as effective adsorbents. Nano alumina is one of the most important ceramic materials widely used as an electrical insulator, presenting exceptionally high resistance to chemical agents, as well as giving excellent performance as a catalyst for many chemical reactions, in microelectronic, membrane applications, and water and wastewater treatment. In this study, methylene blue (MB) dye has been used as model dye of textile wastewater in order to synthesize a synthetic MB wastewater. NiO nanoparticles were added in small percentage in the sand packed bed adsorption columns to remove the MB from the synthetic textile wastewater. Moreover, different parameters have been evaluated; flow of the synthetic wastewater, pH, height of the bed, percentage of the NiO to the sand in the packed material. Different mathematical models where employed to find the proper model which describe the experimental data and help to analyze the mechanism of the MB adsorption. This study will provide good understanding of the dyes adsorption using metal oxide nanoparticles in the classical sand bed.

Keywords: adsorption, column, nanoparticles, methylene

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Authors: Shireen Bhatti, M. Asif Shaikh, Atif Khan

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Sexually abusive behavior is seen as a social phenomenon across different societies and different territories. An institution of sport has its own uniqueness. It is different from other workplaces and academia. The challenges in sports raised are different, which require a call to action for specific sexual harassment policies and practices. Many sportswomen who are members of team games or individual games experience sexually abusive behavior from their male counterparts, including trainers, coaches, and lower staff. The power of the coach over the athlete is massive due to the coach’s position. The power can be disguised for possible abuse, whether physical or emotional. Female athletes are victims in most offensive situations that occur in collegiate settings by male coaches. The objective of the study is to identify the relationship between the sexually abusive behavior of male coaches and the motivation of female athletes at public sector universities in Sindh, Pakistan. The descriptive approach was used, whereas The cross-sectional survey design was used to support the study. Intercollegiate, intervarsity, provincial, and national level female athletes of public sector universities of Sindh province were the subject of this study. The tool of research was a self-developed scale that encompassed the relationship between the sexually abusive behaviors of coaches and the motivation of female athletes. Frequency, percentage, and mean and Pearson Correlation, chi square, and ANOVA were used. The results indicate that there is a strong negative relationship between the sexually abusive behavior of male coaches and female athletes’ sports motivation. The Pearson correlation shows that there is a strong negative relation between the sexually abusive behavior of male athletes and female athletes’ sports motivation. The significant level is (r = -.741); however, The findings confirmed that the coach’s power, authority, decision-making position, the threat of rejection on the refusal of sexual cooperation, the ready availability of inexperienced female athletes, and lack of implication of policies regarding sexual misconducts in public sector universities decline motivation of female athletes witnessed. Based on the findings, the study recommended that the family background, career history, and participation record of coaches should be investigated to ensure that they have ever been involved in any criminal activity or sexual misconduct during their career or participation.

Keywords: abusive, athlete, coach, motivation

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Authors: Arjun G. Koppad

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The study was conducted in Joida taluk of Uttara Kannada district, Karnataka, India, to assess the land use land cover (LULC) and forest aboveground biomass using L band SAR data. The study area covered has dense, moderately dense, and sparse forests. The sampled area was 0.01 percent of the forest area with 30 sampling plots which were selected randomly. The point center quadrate (PCQ) method was used to select the tree and collected the tree growth parameters viz., tree height, diameter at breast height (DBH), and diameter at the tree base. The tree crown density was measured with a densitometer. Each sample plot biomass was estimated using the standard formula. In this study, the LULC classification was done using Freeman-Durden, Yamaghuchi and Pauli polarimetric decompositions. It was observed that the Freeman-Durden decomposition showed better LULC classification with an accuracy of 88 percent. An attempt was made to estimate the aboveground biomass using SAR backscatter. The ALOS-2 PALSAR-2 L-band data (HH, HV, VV &VH) fully polarimetric quad-pol SAR data was used. SAR backscatter-based regression model was implemented to retrieve forest aboveground biomass of the study area. Cross-polarization (HV) has shown a good correlation with forest above-ground biomass. The Multi Linear Regression analysis was done to estimate aboveground biomass of the natural forest areas of the Joida taluk. The different polarizations (HH &HV, VV &HH, HV & VH, VV&VH) combination of HH and HV polarization shows a good correlation with field and predicted biomass. The RMSE and value for HH & HV and HH & VV were 78 t/ha and 0.861, 81 t/ha and 0.853, respectively. Hence the model can be recommended for estimating AGB for the dense, moderately dense, and sparse forest.

Keywords: forest, biomass, LULC, back scatter, SAR, regression

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Authors: Mohamed Ahmed Fouad

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Background: Stroke is the most leading cause to functional disability and gait problems. Objectives: The purpose of this study was to determine the effect of rhythmic auditory stimulation combined with treadmill training on selected gait kinematics in stroke patients. Methods: Thirty male stroke patients participated in this study. The patients were assigned randomly into two equal groups, (study and control). Patients in the study group received treadmill training combined with rhythmic auditory stimulation in addition to selected physical therapy program for hemiparetic patients. Patients in the control group received treadmill training in addition to the same selected physical therapy program including strengthening, stretching, weight bearing, balance exercises and gait training. Biodex gait trainer 2 TM was used to assess selected gait kinematics (step length, step cycle, walking speed, time on each foot and ambulation index) before and after six weeks training period (end of treatment) for both groups. Results: There was a statistically significant increase in walking speed, step cycle, step length, percent of the time on each foot and ambulation index in both groups post-treatment. The improvement in gait parameters post-treatment was significantly higher in the study group compared to the control. Conclusion: Rhythmic auditory stimulation combined with treadmill training is effective in improving selected gait kinematics in stroke patients when added to the selected physical therapy program.

Keywords: stroke, rhythmic auditory stimulation, treadmill training, gait kinematics

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Authors: Olalekan Sunday Alabi, Titus Adeyemi Alonge, Olumuyiwa Idowu Ojo

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Agricultural land suitability analysis and mapping play an imperative role for sustainable utilization of scarce physical land resources. The objective of this study was to prepare spatial database of physical land resources for irrigated agriculture and to assess land suitability for irrigation and developing suitable area map of the study area. The study was conducted at Kampe-Omi irrigation scheme located at Yagba West Local Government Area of Kogi State, Nigeria. Temperature and rainfall data of the study area were collected for 10 consecutive years (2005-2014). Geographic Information System (GIS) techniques were used to develop irrigation land suitability map of the study area. Attribute parameters such as the slope, soil properties, topography of the study area were used for the analysis. The available data were arranged, proximity analysis of Arc-GIS was made, and this resulted into five mapping units. The final agricultural land suitability map of the study area was derived after overlay analysis. Based on soil composition, slope, soil properties and topography, it was concluded that; Kampe-Omi has rich sandy loam soil, which is viable for agricultural purpose, the soil composition is made up of 60% sand and 40% loam. The land-use pattern map of Kampe-Omi has vegetal area and water-bodies covering 55.6% and 19.3% of the total assessed area respectively. The landform of Kampe-Omi is made up of 41.2% lowlands, 37.5% normal lands and 21.3% highlands. Kampe-Omi is adequately suitable for agricultural purpose while an extra of 20.2% of the area is highly suitable for agricultural purpose making 72.6% while 18.7% of the area is slightly suitable.

Keywords: remote sensing, GIS, Kampe–Omi, land suitability, mapping

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Authors: Prasad Urvashi, Wynn Yezarni, Williams Shehan, Ravindran Arun

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Introduction: Primary health services are often the first point of contact that patients with mental illness have with the healthcare system. A number of tools have been developed to increase detection of depression in the context of primary care. However, one challenge amongst many includes utilizing these tools within the limited primary care consultation timeframe. Therefore, short questionnaires that screen for depression that are just as effective as more comprehensive diagnostic tools may be beneficial in improving detection rates of patients visiting a primary care setting. Objective: To develop and determine the sensitivity and specificity of a 2-Question Questionnaire (2-QQ) to screen for depression in in a suburban primary care clinic in Ragama, Sri Lanka. The purpose is to develop a short screening tool for depression that is culturally adapted in order to increase the detection of depression in the Sri Lankan patient population. Methods: This was a cross-sectional study involving two steps. Step one: verbal administration of 2-QQ to patients by their primary care physician. Step two: completion of the Peradeniya Depression Scale, a validated diagnostic tool for depression, the patient after their consultation with the primary care physician. The results from the PDS were then correlated to the results from the 2-QQ for each patient to determine sensitivity and specificity of the 2-QQ. Results: A score of 1/+ on the 2-QQ was most sensitive but least specific. Thus, setting the threshold at this level is effective for correctly identifying depressed patients, but also inaccurately captures patients who are not depressed. A score of 6 on the 2-QQ was most specific but least sensitive. Setting the threshold at this level is effective for correctly identifying patients without depression, but not very effective at capturing patients with depression. Discussion: In the context of primary care, it may be worthwhile setting the 2-QQ screen at a lower threshold for positivity (such as a score of 1 or above). This would generate a high test sensitivity and thus capture the majority of patients that have depression. On the other hand, by setting a low threshold for positivity, patients who do not have depression but score higher than 1 on the 2-QQ will also be falsely identified as testing positive for depression. However, the benefits of identifying patients who present with depression may outweigh the harms of falsely identifying a non-depressed patient. It is our hope that the 2-QQ will serve as a quick primary screen for depression in the primary care setting and serve as a catalyst to identify and treat individuals with depression.

Keywords: depression, primary care, screening tool, Sri Lanka

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Authors: Tracey Lion-Cachet

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Eating disorders typically manifest in adolescence and are notoriously difficult to treat. There are two notable reasons for this. Firstly, research consistently demonstrates that early intervention is a critical mediator of prognosis, with early intervention leading to a better prognosis. However, because eating disorders do not originate as full-syndrome diagnoses but rather as prodromal cases, they often go undetected; by the time symptoms meet diagnostic criteria, they have become recalcitrant. Another interrelated issue is motivation to change. Research demonstrates that in the early stages of an eating disorder, adolescents are highly resistant to change, and motivation increases only once symptoms have shifted from egosyntonic to egodystonic in nature. The purpose of this project was to design a prevention model based on the social psychology paradigm of Entertainment-Education, which embeds messages within the genre of film as a means of affecting change. The resulting project was a narrative screenplay targeting teenagers/young adults from diverse backgrounds. The goals of the project were to create a film script that, if ultimately made into a film, could serve to: 1) interrupt symptom progression and improve prognosis through early intervention; 2) incorporate techniques from third-wave cognitive behavioral treatment models, acceptance and commitment therapy (ACT) and rational recovery (RR), with a focus on the effects of mindfulness as a means of informing recovery; 3) target issues to do with motivation to change by shifting the perception of eating disorders from culturally specific psychiatric illnesses to habit-based brain wiring issues. Nine licensed clinicians were asked to evaluate two excerpts taken from the final script. They subsequently provided feedback on a Likert-scale, which assessed whether the script had achieved its goals. Overall, evaluators agreed that the project’s etiological and intervention models have the potential to inspire change and serve as an effective means of prevention and treatment of eating disorders. However, one-third of the evaluators did not find the content developmentally appropriate. This is a notable limitation to the study and will need to be addressed in the larger script before the final project can potentially be targeted to a teenage and young adult audience.

Keywords: adolescents, eating disorders, pediatrics, entertainment-education, mindfulness-based intervention, prevention

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