Search results for: clinical quality and safety

Authors: João Pedro Zanella, Michel J. O. Fagundes

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Introduction: Drug use has been practised by humans universally for millennia, not excluding any population from these habits, however, the rampant drug use is a global concern due to the harm that affects the health of the world population. In this sense, it is observed the reduction of lasting and effective public policies for the resolution, increasing the demand for treatment services. With this comes ibogaine, an alkaloid derived from the root of an African bush (Tabernanthe Iboga), found mostly in Gabon and used widely by the native Bwiti population in rituals, and also other social groups, which demonstrates efficacy against chemical dependence, psychic and emotional disorders, opioid withdrawal was first confirmed by a study in rats done by Michailo Dzoljic and associates in 1988 and again in 1994. Methods: A brief description of the plant, its neurohumoral potential and the effects caused by ingested doses, in a simplified and objective way, will be discussed in the course of this abstract. Results: Ibogaine is not registered or passed by Anvisa, regarding safety and efficacy, and cannot be sold in Brazil. Its illegal trade reaches R$ 5 thousand for a session with the proceeds of the root, and its effect can last up to 72 hours, attributing Iboga's psychoactive effects to the alkaloid called ibogaine. The shrub where Ibogaine is located has pink and yellow flowers, and its fruit produced does not have psychoactive substances, but its root bark contains 6 to 7% indolic alkaloids. Besides extraction from the iboga plant, ibogaine hydrochloride can be semisynthesized from voacangine, another plant alkaloid that acts as a precursor. Its potential has the ability to perform multiple interactions with the neurotransmitter system, which are closely associated with addiction, including nicotinic, opioid and serotoninergic systems. Studies carried out by Edwards found that the doses administered of Iboga should be determined by a health professional when its purpose is to treat individuals for dependence on other drugs. Its use in small doses may cause an increase in sensibility, impaired vision and motor alterations; in moderate quantities, hallucinations, motor and neurological alterations and impaired vision; in high quantities it may cause hallucinations with personal events at a deeper level lasting up to 24 hours or more, followed by motor and visual alterations. Conclusion: The product extracted from the Iboga plant is of great importance in controlling addiction, reducing the need for the use of narcotics by patients, thus gaining a space of extreme importance in the treatment of users of psychoactive substances. It is remarkable the progress of the latest’s research about the usefulness of Ibogaine, and its benefits for certain treatments, even with the restriction of its sale in Brazil. Besides this, Ibogaine has an additional benefit of helping the patient to gain self-control over their destructive behaviours.

Keywords: alkaloids, dependence, Gabon, ibogaine

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Authors: Samar Alharbi, Yota Dimitriadi

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With the exponential growth of information and communication technologies in higher education, new online teaching strategies have become increasingly important for student engagement and learning. In particular, some institutions depend solely on asynchronous e-learning to provide courses for their students. The major challenge facing these institutions is how to improve the quality of teaching and learning in their asynchronous tools. One of the most important methods that can help e-learner to enhance their social learning and social presence in asynchronous learning setting is immediacy. This study explores tutors perceptions of their instructional immediacy practices as part of their communication actions in online learning environments. It was used a mixed-methods design under the umbrella of pragmatic philosophical assumption. The participants included tutors at an educational institution in a Saudi university. The participants were selected with a purposive sampling approach and chose an institution that offered fully online courses to students. The findings of the quantitative data show the importance of teachers’ immediacy practices in an online text-based learning environment. The qualitative data contained three main themes: the tutors’ encouragement of student interaction; their promotion of class participation; and their addressing of the needs of the students. The findings from these mixed methods can provide teachers with insights into instructional designs and strategies that they can adopt in order to use e-immediacy in effective ways, thus improving their students’ online learning experiences.

Keywords: asynchronous e-learning, higher education, immediacy, tutor

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Authors: G. S. Sumanasekara, W. M. P. B. Weerasingheg

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The major problem associated with concentrate feeds used for feeding cattle is declining quality by contamination with Aflatoxins. Objective: The aim of the study was to detect levels of Aflatoxin M1(AFM1) in cow milk , AFM1 levels present in milk related to different feed types and to identify the relationship between feed type and Aflatoxin M1 in milk. Design: cross sectional study design. Milk samples from each farm assessed for presence of AFM1 using High Performance Liquid Chromatographic method. Setting: Ten dairy farms located in Nuwara-Eliya district were randomly selected.AFM1 analysis was done using High Performance Liquid Chromatography(HPLC). Results: The results indicated that AFM1 was present in 50% of samples. Coconut poonac shown the most significant relationship among individual feeds having a correlation of 0.65 and P value of 0.042 . Among feed combinations, coconut poonac and beer pulp combination showed the highest correlation of 0.77 and P value of 0.05. Grasses had shown a very poor relationship with the AFM1 occurrence in milk (r=0.053, P=0.885). Relationship between overall concentrate feeds in the study and AFM1 in milk, it was clear that they had a significant relationship having correlation of 0.65 and P value of 0.042. Majority of samples lied between 0-10 ng L-1 of AFM1 and one sample exceeded above 30 ng L-1. Two samples had AFM1 concentrations between 22-32 ng L-1. One sample lied between 32-42ng L-1, did not exceed the EU recommended level of 50 ng L-1. The presence of AFM1 in milk under various management and feeding conditions is yet to be investigated in Sri Lanka.

Keywords: aflatoxin M1, aspergillus, cattle feed, concentrates, cow milk, high perforamance liquid chromatography

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Authors: Abhijit Trailokya

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Background: Cardiovascular diseases (CVD’s) are the major cause of morbidity and mortality in both developed and developing countries. Many clinical trials have demonstrated that low-density lipoprotein cholesterol (LDL-C) lowering, reduces the incidence of coronary and cerebrovascular events across a broad spectrum of patients at risk. Guidelines for the management of patients at risk have been established in Europe and North America. The guidelines have advocated progressively lower LDL-C targets and more aggressive use of statin therapy. In Indian patients, comprehensive data on dyslipidemia management and its treatment outcomes are inadequate. There is lack of information on existing treatment patterns, the patient’s profile being treated, and factors that determine treatment success or failure in achieving desired goals. Purpose: The present study was planned to determine the lipid control status in high-risk dyslipidemic patients treated with lipid-lowering therapy in India. Methods: This cross-sectional, non-interventional, single visit program was conducted across 483 sites in India where male and female patients with high-risk dyslipidemia aged 18 to 65 years who had visited for a routine health check-up to their respective physician at hospital or a healthcare center. Percentage of high-risk dyslipidemic patients achieving adequate LDL-C level (< 70 mg/dL) on lipid-lowering therapy and the association of lipid parameters with patient characteristics, comorbid conditions, and lipid lowering drugs were analysed. Results: 3089 patients were enrolled in the study; of which 64% were males. LDL-C data was available for 95.2% of the patients; only 7.7% of these patients achieved LDL-C levels < 70 mg/dL on lipid-lowering therapy, which may be due to inability to follow therapeutic plans, poor compliance, or inadequate counselling by physician. The physician’s lack of awareness about recent treatment guidelines also might contribute to patients’ poor adherence, not explaining adequately the benefit and risks of a medication, not giving consideration to the patient’s life style and the cost of medication. Statin was the most commonly used anti-dyslipidemic drug across population. The higher proportion of patients had the comorbid condition of CVD and diabetes mellitus across all dyslipidemic patients. Conclusion: As per the European Society of Cardiology guidelines the ideal LDL-C levels in high risk dyslipidemic patients should be less than 70%. In the present study, 7.7% of the patients achieved LDL-C levels < 70 mg/dL on lipid lowering therapy which is very less. Most of high risk dyslipidemic patients in India are on suboptimal dosage of statin. So more aggressive and high dosage statin therapy may be required to achieve target LDLC levels in high risk Indian dyslipidemic patients.

Keywords: cardiovascular disease, diabetes mellitus, dyslipidemia, LDL-C, lipid lowering drug, statins

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Authors: Novia Liza Rahmawaty, Wilson Novarino, Muhammad Nazri Janra

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Indonesian people love to keep songbird in cage to be competed, such as White-rumped Shama (Copsychus malabaricus). Each individual White-rumped Shama will be pitted their song and try to imitate the rhythm of the enemy with its songs. This study was conducted to see the natural song characters of White-rumped Shama and song character from birds that had been trained and comparison in three different places in West Sumatra. Individuals were recorded totaling 30 individuals in three areas in West Sumatra namely Padang, Solok and Pariaman and sound recordings of White-rumped Shama in nature were taken in HBW and Xenocanto website. Research has done conducted from June to October 2016 at place group practice of birdsongs and recorded at 16:00 to 18:00 pm. These voices were analyzed by Avisoft SAS-Lab Lite inform of oscillogram and sonogram. Measured parameters included: the length of voice, repertoire size, number of syllable type, syllable repertoire, and song repertoire. The results showed that repertoire composition of White-rumped Shama in nature less than the sound which was trained and has repeat songs composed by the same type of repertoire composition. Comparison of song character White-rumped Shama in three different places in West Sumatra, those birds in Solok had the best quality of voice or song than Padang and Pariaman. It showed by higher repertoire composition in Solok.

Keywords: repertoire composition, song characters, songbird, white-rumped shama

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Authors: Yousuf Nasser Al Khamisi

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Purpose: This paper presents a Knowledge Transfer (KT) Framework in healthcare sectors by applying a systematic literature review process to the healthcare organizations domain to identify enablers and barriers of KT in Healthcare. Methods: The paper conducted a systematic literature search of peer-reviewed papers that described key elements of KT using four databases (Medline, Cinahl, Scopus, and Proquest) for a 10-year period (1/1/2008–16/10/2017). The results of the literature review were used to build a conceptual framework of KT in healthcare organizations. The author used a systematic review of the literature, as described by Barbara Kitchenham in Procedures for Performing Systematic Reviews. Findings: The paper highlighted the impacts of using Knowledge Management (KM) concept at a healthcare organization in controlling infectious diseases in hospitals, improving family medicine performance and enhancing quality improvement practices. Moreover, it found that good-coding performance is analytically linked with a knowledge sharing network structure rich in brokerage and hierarchy rather than in density. The unavailability or ignored of the latest evidence on more cost-effective or more efficient delivery approaches leads to increase the healthcare costs and may lead to unintended results. Originality: Search procedure produced 12,093 results, of which 3523 were general articles about KM and KT. The titles and abstracts of these articles had been screened to segregate what is related and what is not. 94 articles identified by the researchers for full-text assessment. The total number of eligible articles after removing un-related articles was 22 articles.

Keywords: healthcare organisation, knowledge management, knowledge transfer, KT framework

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Authors: Mustafa M. Donma, Orkide Donma

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Metabolic syndrome (MetS) is a severe health problem which is common among obese individuals. The components of MetS are rather stable in adults compared to the components discussed for children. Due to the ambiguity in this group of the population, how to diagnose MetS in morbid obese (MO) children still constitutes a matter of discussion. For this purpose, a formula, which facilitates the diagnosis of MetS in MO children, was investigated. The aim of this study was to develop a formula which was capable of discriminating MO children with and without MetS findings. Study population comprised MO children. Age and sex-dependent body mass index (BMI) percentiles of the children were above 99. Metabolic syndrome components were also determined. Elevated systolic and diastolic blood pressures (SBP and DBP), elevated fasting blood glucose (FBG), elevated triglycerides (TRG), and/or depressed high density lipoprotein cholesterol (HDL-C) in addition to central obesity were listed as MetS components for each child. Presence of at least two of these components confirmed that the case was MetS. Two groups were constituted. In the first group, there were forty-two MO children without MetS components. Second group was composed of forty-four MO children with at least two MetS components. Anthropometric measurements, including weight, height, waist, and hip circumferences, were performed following physical examination. Body mass index and homeostatic model assessment of insulin resistance values were calculated. Informed consent forms were obtained from the parents of the children. Institutional Non-Interventional Ethics Committee approved the study design. Blood pressure values were recorded. Routine biochemical analysis, including FBG, insulin (INS), TRG, HDL-C were performed. The performance and the clinical utility of the Diagnostic Obesity Notation Model Assessment Metabolic Syndrome Index (DONMA MetS index) [(INS/FBG)/(HDL-C/TRG)*100] was tested. Appropriate statistical tests were applied to the study data. p value smaller than 0.05 was defined as significant. Metabolic syndrome index values were 41.6±5.1 in MO group and 104.4±12.8 in MetS group. Corresponding values for HDL-C values were 54.5±13.2 mg/dl and 44.2±11.5 mg/dl. There were statistically significant differences between the groups (p<0.001). Upon evaluation of the correlations between MetS index and HDL-C values, a much stronger negative correlation was found in MetS group (r=-0.515; p=0.001) in comparison with the correlation detected in MO group (r=-0.371; p=0.016). From these findings, it was concluded that the statistical significance degree of the difference between MO and MetS groups was highly acceptable for this recently introduced MetS index as expected. This was due to the involvement of all of the biochemically defined MetS components into the index. This is particularly important because each of these four parameters used in the formula is cardiac risk factor. Aside from discriminating MO children with and without MetS findings, MetS index introduced in this study is important from the cardiovascular risk point of view in MetS group of children.

Keywords: children, fasting blood glucose, high density lipoprotein cholesterol, index, insulin, metabolic syndrome, morbid obesity, triglycerides.

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Authors: T. Poyai, P. Painmanakul, N. Chawaloesphonsiya, P. Dhanasin, C. Getwech, P. Wattana

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Drilling is a key activity in oil and gas exploration and production. Drilling always requires the use of drilling mud for lubricating the drill bit and controlling the subsurface pressure. As drilling proceeds, a considerable amount of cuttings or rock fragments is generated. In general, water or Water Based Mud (WBM) serves as drilling fluid for the top hole section. The cuttings generated from this section is non-hazardous and normally applied as fill materials. On the other hand, drilling the bottom hole to reservoir section uses Synthetic Based Mud (SBM) of which synthetic oils are composed. The bottom-hole cuttings, SBM cuttings, is regarded as a hazardous waste, in accordance with the government regulations, due to the presence of hydrocarbons. Currently, the SBM cuttings are disposed of as an alternative fuel and raw material in cement kiln. Instead of burning, this work aims to propose an alternative for drill cuttings management under two ultimate goals: (1) reduction of hazardous waste volume; and (2) making use of the cleaned cuttings. Soil washing was selected as the major treatment process. The physiochemical properties of drill cuttings were analyzed, such as size fraction, pH, moisture content, and hydrocarbons. The particle size of cuttings was analyzed via light scattering method. Oil present in cuttings was quantified in terms of total petroleum hydrocarbon (TPH) through gas chromatography equipped with flame ionization detector (GC-FID). Other components were measured by the standard methods for soil analysis. Effects of different washing agents, liquid-to-solid (L/S) ratio, washing time, mixing speed, rinse-to-solid (R/S) ratio, and rinsing time were also evaluated. It was found that drill cuttings held the electrical conductivity of 3.84 dS/m, pH of 9.1, and moisture content of 7.5%. The TPH in cuttings existed in the diesel range with the concentration ranging from 20,000 to 30,000 mg/kg dry cuttings. A majority of cuttings particles held a mean diameter of 50 µm, which represented silt fraction. The results also suggested that a green solvent was considered most promising for cuttings treatment regarding occupational health, safety, and environmental benefits. The optimal washing conditions were obtained at L/S of 5, washing time of 15 min, mixing speed of 60 rpm, R/S of 10, and rinsing time of 1 min. After washing process, three fractions including clean cuttings, spent solvent, and wastewater were considered and provided with recommendations. The residual TPH less than 5,000 mg/kg was detected in clean cuttings. The treated cuttings can be then used for various purposes. The spent solvent held the calorific value of higher than 3,000 cal/g, which can be used as an alternative fuel. Otherwise, the recovery of the used solvent can be conducted using distillation or chromatography techniques. Finally, the generated wastewater can be combined with the produced water and simultaneously managed by re-injection into the reservoir.

Keywords: drill cuttings, green solvent, soil washing, total petroleum hydrocarbon (TPH)

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Authors: M. Javahar, H. B. Dong

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Single crystal components manufactured using Ni-base Superalloys are routinely used in the hot sections of aero engines and industrial gas turbines due to their outstanding high temperature strength, toughness and resistance to degradation in corrosive and oxidative environments. To control the quality of the single crystal turbine blades, particular attention has been paid to grain selection, which is used to obtain the single crystal morphology from a plethora of columnar grains. For this purpose, different designs of grain selectors are employed and the most common type is the spiral grain selector. A typical spiral grain selector includes a starter block and a spiral (helix) located above. It has been found that the grains with orientation well aligned to the thermal gradient survive in the starter block by competitive grain growth while the selection of the single crystal grain occurs in the spiral part. In the present study, 2D spiral selectors with different geometries were designed and produced using a state-of-the-art Bridgeman Directional Solidification casting furnace to investigate the competitive growth during grain selection in 2d grain selectors. The principal advantage of using a 2-D selector is to facilitate the wax injection process in investment casting by enabling significant degree of automation. The automation within the process can be derived by producing 2D grain selector wax patterns parts using a split die (metal mold model) coupled with wax injection stage. This will not only produce the part with high accuracy but also at an acceptable production rate.

Keywords: grain selector, single crystal, directional solidification, CMSX-4 superalloys, investment casting

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Authors: Mona Shawky, Khaled M. Elsheikh, Heba M. Darwish, Eman Abd El Elsamea

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Seams are the basic component in the structure of any apparel. The seam quality of the garment is a term that indicates both the aesthetic and functional performance of the garment. Seam slippage is one of the important properties that determine garment performance. Lightweight fabrics are preferred for their aesthetic properties. Since seam slippage is one of the most occurable faults for woven garments, in this study, a design of experiment of the following sewing parameters (three levels of needle size, three levels of stitch density, three levels of the seam allowance, two levels of sewing thread count, and two fabric types) was used to obtain the effect of the interaction between different sewing parameters on-seam slippage force. Two lightweight polyester woven fabrics with different constructions were used with lock stitch 301 to perform this study. Regression equations which can predict seam slippage force in both warp and weft directions were concluded. It was found that fabric type has a significant positive effect on seam slippage force in the warp direction, while it has a significant negative effect on seam slippage force on weft direction. Also, the interaction between needle size and stitch density has a significant positive effect on seam slippage force on warp direction, while the interaction between stitch density and seam allowance has a negative effect on seam slippage force in the weft direction.

Keywords: needle size, regression equation, seam allowance, seam slippage, stitch density

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Authors: Fazal Said, Mian Inayatullah

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Various insect visitors in common and honeybees in particular are considered to be accountable for 80-85% of pollination services for numerous crops worldwide. Pollinators not only increase crop yield but also improve quality of produce as well. The present investigation is therefore, an endeavor to assess the visitation pattern of honeybees, Apis florea (Hymenopterae: Apidae) in sunflower (Helianthus annuus L.). The current research trial was carried out at New Developmental Farm (NDF), The University of Agriculture Peshawar, (34.01° N, 71.53° E) Khyber Pakhtunkhwa-Pakistan during 2012 and 2013. Different observations on the foraging behavior of A. florea’s individuals were made from 0800 hr in the morning and continued until 1800 hr in the evening. Hence, total duration of foraging activity of A. florea individuals was comprised of 10 hours. It was found that two peaks of visitation/foraging occurred between 1400 to 1600 hr of the day. First peak of foraging was recorded at 1600hr, where 15 individuals of honeybees/3 m2 were counted to be engaged in foraging sunflower blooms. Second peak visitation was recorded with a total of 12 bees/3 m2 at 1400 hrs of the day. Visitations of A. florea were observed to its minimum intensity of only 07 individuals during late hours of the day as evening approached after 1800 hrs. Similarly, due to more number of pollens and nectars on flowers, high frequency of A. florea were found engaged in foraging during 20th and 25th day after initiation of blooms on sunflower. Minimum numbers of honeybees were recorded during initial and very last days of flowering due to less number of plants with blooms and less availability of pollen and nectar on flowers.

Keywords: apis florea, days after flowering, daily hours, sunflower, visitation pattern

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Authors: Malihe Ahmadi

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Nowadays, stress, tension and neural problems are among the most important concerns of the present age. The environment plays key role on improving mental health and reducing stress of citizens. Establishing balance and appropriate relationship between city and natural environment is of the most important approaches of present century. Type of approach and logical planning for urban green spaces as one of the basic sections of integration with nature, not only plays key role on quality and efficiency of comprehensive urban planning; but also it increases the system of distributing social activities and happiness and lively property of urban environments that leads to permanent urban development. The main purpose of recovering urban identity is considering culture, history and human life style in past. This is a documentary-library research that evaluates the historical properties of Iranian gardens in compliance with climate condition. Results of this research reveal that in addition to following Iranian gardens from common principles of land lot, structure of flowers and plants, water, specific buildings during different ages, the role of climate at different urban areas is among the basics of determining method of designing green spaces and different buildings located at diverse areas i.e. Iranian gardens are a space for merging natural and artificial elements that has inseparable connection with semantic principles and guarantees different functions. Some of the necessities of designing present urban gardens are including: recognition and recreation.

Keywords: historical gardens, climate, properties of Iranian gardens, Iran

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Authors: Yuri Laevsky, Tatyana Nosova

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The phenomenon of filtration gas combustion (FGC) had been discovered experimentally at the beginning of 80’s of the previous century. It has a number of important applications in such areas as chemical technologies, fire-explosion safety, energy-saving technologies, oil production. From the physical point of view, FGC may be defined as the propagation of region of gaseous exothermic reaction in chemically inert porous medium, as the gaseous reactants seep into the region of chemical transformation. The movement of the combustion front has different modes, and this investigation is focused on the low-velocity regime. The main characteristic of the process is the velocity of the combustion front propagation. Computation of this characteristic encounters substantial difficulties because of the strong heterogeneity of the process. The mathematical model of FGC is formed by the energy conservation laws for the temperature of the porous medium and the temperature of gas and the mass conservation law for the relative concentration of the reacting component of the gas mixture. In this case the homogenization of the model is performed with the use of the two-temperature approach when at each point of the continuous medium we specify the solid and gas phases with a Newtonian heat exchange between them. The construction of a computational scheme is based on the principles of mixed finite element method with the usage of a regular mesh. The approximation in time is performed by an explicit–implicit difference scheme. Special attention was given to determination of the combustion front propagation velocity. Straight computation of the velocity as grid derivative leads to extremely unstable algorithm. It is worth to note that the term ‘front propagation velocity’ makes sense for settled motion when some analytical formulae linking velocity and equilibrium temperature are correct. The numerical implementation of one of such formulae leading to the stable computation of instantaneous front velocity has been proposed. The algorithm obtained has been applied in subsequent numerical investigation of the FGC process. This way the dependence of the main characteristics of the process on various physical parameters has been studied. In particular, the influence of the combustible gas mixture consumption on the front propagation velocity has been investigated. It also has been reaffirmed numerically that there is an interval of critical values of the interfacial heat transfer coefficient at which a sort of a breakdown occurs from a slow combustion front propagation to a rapid one. Approximate boundaries of such an interval have been calculated for some specific parameters. All the results obtained are in full agreement with both experimental and theoretical data, confirming the adequacy of the model and the algorithm constructed. The presence of stable techniques to calculate the instantaneous velocity of the combustion wave allows considering the semi-Lagrangian approach to the solution of the problem.

Keywords: filtration gas combustion, low-velocity regime, mixed finite element method, numerical simulation

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Authors: Lady Salvador Purganan, Jojo M. Villamin, Noel L. Lansang

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Tourism is a multifaceted but interdependent industry. This industry is composed of four major players, the public sector, the private sector, the local community, and the tourists. Each player has a vital role in the success of delivering high-quality tourism products and activities. There are various manifestations of positive economic outcomes that benefit the local community. Pro-poor tourism development approach has a great potential to serve as an avenue for capacity building leading to economic independence since natural attractions and cultural resources are assets that can be capitalized on, especially by the poor, because it is more accessible to them compared to financial resources. In the National Tourism Development Plan 2016-2022, specific mechanisms are not reflected to combat and lower poverty incidence through tourism. The researcher used the multidimensional poverty theory and sustainable tourism theory to formulate indicators in the research instrument and social exchange theory. The expected output of the study is to unlock opportunities, specifically in Brgy. Sta. Lucia, Guimba, Nueva Ecija, by crafting policies taking into utmost consideration local community involvement and participation in the process of tourism development which is essential in attaining inclusive growth and sustainability. This study will apply the sequential explanatory design mixed-method approach.

Keywords: pro-poor tourism, poverty alleviation, livelihood opportunities, tourism development plan

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Authors: Kiranmay Sarma

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Recent decades have witnessed rapid increase in urbanization, for which, rural-urban migration is stated to be the principal reason. Urban growth throughout the world has already outstripped the capacities of most of the cities to provide basic amenities to the citizens, including clean drinking water and consequently, they are struggling to get fresh and clean water to meet water demands. Delhi, the capital of India, is one of the rapid fast growing metropolitan cities of the country. As a result, there has been large influx of population during the last few decades and pressure exerted to the limited available water resources, mainly on groundwater. Considering this important aspect, the present research has been designed to study the effects of urbanization on the green cover and groundwater and their relationships of Delhi. For the purpose, four different land uses of the study area have been considered, viz., protected forest area, trees outside forest, maintained park and settlement area. Samples for groundwater and vegetation were collected seasonally in post-monsoon (October), winter (February) and summer (June) at each study site for two years during 2012 and 2014. The results were integrated into GIS platform. The spatial distribution of groundwater showed that the concentration of most of the ions is decreasing from northern to southern parts of Delhi, thus groundwater shows an improving trend from north to south. The depth was found to be improving from south to north Delhi, i.e., opposite to the water quality. The study concludes the groundwater properties in Delhi vary spatially with depending on the types of land cover.

Keywords: groundwater, urbanization, GIS, green cover, Delhi

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

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

Keywords: reliability, running, sagittal plane, two dimensional

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Authors: Sebastian Kohlstädt, Michael Vynnycky, Stephan Goeke, Jan Jäckel, Andreas Gebauer-Teichmann

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This paper summarizes the progress in the latest computational fluid dynamics research towards the modeling in of lost core viability in high-pressure die casting. High-pressure die casting is a process that is widely employed in the automotive and neighboring industries due to its advantages in casting quality and cost efficiency. The degrees of freedom are however somewhat limited as it has been so far difficult to use lost cores in the process. This is right now changing and the deployment of lost cores is considered a future growth potential for high-pressure die casting companies. The use of this technology itself is difficult though. The strength of the core material, as chiefly salt is used, is limited and experiments have shown that the cores will not hold under all circumstances and process designs. For this purpose, the publicly available CFD library foam-extend (OpenFOAM) is used, and two additional fluid models for incompressible and compressible two-phase flow are implemented as fluid solver models into the FSI library. For this purpose, the volume-of-fluid (VOF) methodology is used. The necessity for the fluid-structure interaction (FSI) approach is shown by a simple CFD model geometry. The model is benchmarked against analytical models and experimental data. Sufficient agreement is found with the analytical models and good agreement with the experimental data. An outlook on future developments concludes the paper.

Keywords: CFD, fluid-structure interaction, high-pressure die casting, multiphase flow

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Authors: Funmilayo L. Amao, Amos O. Amao

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It has been observed that majority of the people are living in poor housing quality or totally homeless in urban center despite all governmental policies to provide housing to the public. On the supply side, various government policies in the past have been formulated towards overcoming the huge shortage through several Housing Reform Programmes. Despite these past efforts, housing continues to be a mirage to ordinary Nigerian. Currently, there are various mass housing delivery programmes such as the affordable housing scheme that utilize the Public Private Partnership effort and several Private Finance Initiative models could only provide for about 3% of the required stock. This suggests the need for a holistic solution in approaching the problem. The aim of this research is to find out the problems hindering the delivery of housing in Nigeria and its effects on housing affordability. The specific objectives are to identify the causes of housing delivery problems, to examine different housing policies over years and to suggest a way out for sustainable housing delivery. This paper also reviews the past and current housing delivery programmes in Nigeria and analyses the demand and supply side issues. It identifies the various housing delivery mechanisms in current practice. The objective of this paper, therefore, is to give you an insight into the delivery option for the sustainability of housing in Nigeria, given the existing delivery structures and the framework specified in the New National Housing Policy. The secondary data were obtained from books, journals and seminar papers. The conclusion is that we cannot copy models from other nations, but should rather evolve workable models based on our socio-cultural background to address the huge housing shortage in Nigeria. Recommendations are made in this regard.

Keywords: housing, sustainability, housing delivery, housing policy, housing affordability

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Authors: Ammar Aljabri, Alhussain Halawani, Alaa Ashqar, Omar Alageely

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Objective: mild Traumatic Brain Injury (mTBI) or concussion is a common yet undermanaged and underreported condition. This systematic review and meta-analysis aim to determine the efficacy of VRT as a treatment option for mTBI. Method: This review and meta-analysis was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and included RCTs and pre-VRT/post-VRT retrospective chart reviews. Records meeting the inclusion criteria were extracted from the following databases: Medline, Embase, and Cochrane Register of Controlled Trials (CENTRAL). Results: Eight articles met the inclusion criteria, and six RCTs were included in the meta-analysis. VRT demonstrated significant improvement in decreasing perceived dizziness at the end of the intervention program, as shown by DHI scores (SMD= -0.33, 95% CI -0.62 to -0.03, p=0.03, I2= 0%). However, no significant reduction in DHI was evident after two months of follow-up (SMD= 0.15, 95% CI -0.23 to 0.52, p=0.44, I2=0%). Quantitative analysis also depicts significant reduction in both VOMS (SMD=-0.40, 95% CI -0.60 to -0.20, p<0.0001, I2=0%) and PCSS (SMD= -0.39, 95% CI -0.71 to -0.07, p=0.02, I2=0%) following the intervention. Lastly, there was no significant difference between intervention groups on BESS scores (SMD= -31, 95% CI -0.71 to 0.10, p=0.14, I2=0%) and return to sport/function (95% CI 0.32 to 30.80, p=0.32, I2=82%). Conclusions: Current evidence on the efficacy of VRT for mTBI is limited. This review and analysis provide evidence that supports the role of VRT in improving perceived symptoms following concussion. There is still a need for high-quality trials evaluating the benefit of VRT using a standardized approach.

Keywords: concussion, traumatic brain injury, vestibular rehabilitation, neurorehabilitation

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Authors: Djordjevic J. Sladjana, Djordjevic-Milošević B. Suzana, Milošević M. Slobodan

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The potential of biomass as a renewable energy source leads Serbia to be the top of European countries by the amount of available but unused biomass. Technologies for its use are available and ecologically acceptable. Moreover, they are not expensive high-tech solutions even for the poor investment environment of Serbia, while other options seem to be less achievable. From the other point of view, Serbia has a huge percentage of unused agriculture land. Agricultural production in Serbia languishes: a large share of agricultural land therefore remains untreated, and there is a significant proportion of degraded land. From all the above, biomass intended for energy production is becoming an increasingly important factor in the stabilization of agricultural activities. Orientation towards the growing bioenergy crops versus conventional crop cultivation becomes an interesting option. The aim of this paper is to point out the possibility of growing energy crops in accordance with the conditions and cultural practice in rural areas of Serbia. First of all, the cultivation of energy crops on lower quality land is being discussed, in order to revitalize the rural areas of crops through their inclusion into potential energy sector. Next is the theme of throwing more light on the increase in the area under this competitive agricultural production to correct land use in terms of climate change in Serbia. The goal of this paper is to point out the contribution of the share of biomass in energy production and consumption, and the effect of reducing the negative environmental impact.

Keywords: agro-energy crops, conditions for plantation, revitalization of rural areas, degraded and unused soils

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Authors: Vanessa Bennemann, Gabriela Laste, Márcia Inês Goettert

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The gestational period is a phase in which the pregnant woman undergoes constant physiological and hormonal changes, which are part of the woman’s biological cycle, the development of the fetus, childbirth, and lactation. These are factors of response to the immunological adaptation of the human reproductive process that is directly related to the pregnancy’s well-being and development. Although most pregnancies occur without complications, about 15% of pregnant women will develop potentially fatal complications, implying maternal and fetal risk. Therefore, requiring specialized care for high-risk pregnant women (HRPW) with obstetric interventions for the survival of the mother and/or fetus. Among the risk factors that characterize HRPW are the women's age, gestational diabetes mellitus (GDM), autoimmune diseases, infectious diseases such as syphilis and HIV, hypertension (SAH), preeclampsia, eclampsia, HELLP syndrome, uterine contraction abnormalities, and premature placental detachment (PPD), thyroid disorders, among others. Thus, pregnancy has an impact on the thyroid gland causing changes in the functioning of the mother's thyroid gland, altering the thyroid hormone (TH) profiles and production as pregnancy progresses. Considering, throughout the gestational period, the interpretation of the results of the tests to evaluate the thyroid functioning depends on the stage in which the pregnancy is. Thyroid disorders are directly related to adverse obstetric outcomes and in child development. Therefore, the adequate release of TH is important for a pregnancy without complications and optimal fetal growth and development. Objective: Investigate the physiological effects caused by thyroid disorders in the gestational period. Methods: A search for articles indexed in PubMed, Scielo, and MDPI databases, was performed using the term “AND”, with the descriptors: Pregnancy, Thyroid. With several combinations that included: Melatonin, Thyroidopathy, Inflammatory processes, Cytokines, Anti-inflammatory, Antioxidant, High-risk pregnancy. Subsequently, the screening was performed through the analysis of titles and/or abstracts. The criteria were: including clinical studies in general, randomized or not, in the period of 10 years prior to the research, in the English literature; excluded: experimental studies, case reports, research in the development phase. Results: In the preliminary results, a total of studies (n=183) were found, (n=57) excluded, such as studies of cancer, diabetes, obesity, and skin diseases. Conclusion: To date, it has been identified that thyroid diseases can impair the fetus’s brain development. Further research is suggested on this matter to identify new substances that may have a potential therapeutic effect to aid the gestational period with thyroid diseases.

Keywords: pregnancy, thyroid, melatonin, high-risk pregnancy

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Authors: A. M. Ferrari, L. Volpi, M. Pini, C. Siligardi, F. E. Garcia Muina, D. Settembre Blundo

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A long tradition in the ceramic manufacturing since the 18th century, primarily due to the availability of raw materials and an efficient transport system, let to the birth and development of the Italian ceramic tiles district that nowadays represents a reference point for this sector even at global level. This economic growth has been coupled to attention towards environmental sustainability issues throughout various initiatives undertaken over the years at the level of the production sector, such as certification activities and sustainability policies. In this way, starting from an evaluation of the sustainability in all its aspects, the present work aims to develop a benchmarking helping both producers and consumers. In the present study, throughout the Life Cycle Sustainability Assessment (LCSA) framework, the sustainability has been assessed in all its dimensions: environmental with the Life Cycle Assessment (LCA), economic with the Life Cycle Costing (LCC) and social with the Social Life Cycle Assessment (S-LCA). The annual district production of stoneware tiles during the 2016 reference year has been taken as reference flow for all the three assessments, and the system boundaries cover the entire life cycle of the tiles, except for the LCC for which only the production costs have been considered at the moment. In addition, a preliminary method for the evaluation of local and indoor emissions has been introduced in order to assess the impact due to atmospheric emissions on both people living in the area surrounding the factories and workers. The Life Cycle Assessment results, obtained from IMPACT 2002+ modified assessment method, highlight that the manufacturing process is responsible for the main impact, especially because of atmospheric emissions at a local scale, followed by the distribution to end users, the installation and the ordinary maintenance of the tiles. With regard to the economic evaluation, both the internal and external costs have been considered. For the LCC, primary data from the analysis of the financial statements of Italian ceramic companies show that the higher cost items refer to expenses for goods and services and costs of human resources. The analysis of externalities with the EPS 2015dx method attributes the main damages to the distribution and installation of the tiles. The social dimension has been investigated with a preliminary approach by using the Social Hotspots Database, and the results indicate that the most affected damage categories are health and safety and labor rights and decent work. This study shows the potential of the LCSA framework applied to an industrial sector; in particular, it can be a useful tool for building a comprehensive benchmark for the sustainability of the ceramic industry, and it can help companies to actively integrate sustainability principles into their business models.

Keywords: benchmarking, Italian ceramic industry, life cycle sustainability assessment, porcelain stoneware tiles

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Authors: Constance Kirker

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This paper examines examples of the shared use of mango references as a culinary metaphor powerful in maintaining immigrant identity in the works of diaspora authors from a variety of regions of the world, including South Asia, the Caribbean, and Africa, and across a variety of genres, including novels, culinary memoirs, and children’s books. There has been past criticism of so-called sari-mango literature, suggesting that use of the image of mango is a cliché, even “lazy,” attempt to “exoticize” and sentimentalize South Asia in particular. A broader review across national boundaries reveals that diaspora authors, including those beyond South Asia, write nostalgically about mango as much about the messy “full body” tactile experience of eating a mango as about the “exotic” quality of mango representing the “otherness” of their home country. Many of the narratives detail universal childhood food experiences that are more shared than exotic, such as a desire to subvert the adult societal rules of neatness and get very messy, or memories of small but memorable childhood transgressions such as stealing mangoes from a neighbor’s tree. In recent years, food technology has evolved, and mangoes have become more familiar and readily available in Europe and America, from smoothies and baby food to dried fruit snacks. The meaning associated with the imagery of mangoes for both writers and readers in diaspora literature evolves as well, and authors do not have to heed Salman Rushdie’s command, “There must be no tropical fruits in the title. No mangoes.”

Keywords: identity, immigrant diaspora, culinary metaphor, food studies

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Authors: Jennifer E Simpson

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Background and purpose: The ubiquitous use of the Internet and social media by children and young people has had a dual effect. The first is to open a world of possibilities and promise that is characterized by the ability to consume and create content, connect with friends, explore and experiment. The second relates to risks such as unsolicited requests, sexual exploitation, cyberbullying and commercial exploitation. This duality poses significant difficulties for a generation of foster carers and social workers who have no childhood experience to draw on in terms of growing up using the Internet, social media and digital devices. This presentation is concerned with the findings of a small qualitative study about the use of digital devices and the Internet by care-experienced young people to stay in touch with their families and the way this was managed by foster carers and social workers using specific parental mediation strategies. The findings highlight that restrictive strategies were used by foster carers and endorsed by social workers. An argument is made for an approach that develops a series of balanced solutions that move foster carers from such restrictive approaches to those that are grounded in co-use and are interpretive in nature. Methods: Using a purposive sampling strategy, 12 triads consisting of care-experienced young people (aged 13-18 years), their foster carers and allocated social workers were recruited. All respondents undertook a semi-structured interview, with the young people detailing what social media apps and other devices they used to contact their families via an Ecomap. The foster carers and social workers shared details of the methods and approaches they used to manage digital devices and the Internet in general. Data analysis was performed using a Framework analytic method to explore the various attitudes, as well as complementary and contradictory perspectives of the young people, their foster carers and allocated social workers. Findings: The majority of foster carers made use of parental mediation strategies that erred on the side of typologies that included setting rules and regulations (restrictive), ad-hoc checking of a young person’s behavior and device (monitoring), and software used to limit or block access to inappropriate websites (technical). It was noted that minimal use was made by foster carers of parental mediation strategies that included talking about content (active/interpretive) or sharing Internet activities (co-use). Amongst the majority of the social workers, they also had a strong preference for restrictive approaches. Conclusions and implications: Trepidations on the part of both foster carers and social workers about the use of digital devices and the Internet meant that the parental strategies used were weighted more towards restriction, with little use made of approaches such as co-use and interpretative. This lack of balance calls for solutions that are grounded in co-use and an interpretive approach, both of which can be achieved through training and support, as well as wider policy change.

Keywords: parental mediation strategies, risk, children in state care, online safety

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Authors: Hector Liu, Chih-Ming Tsai

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Consumer behaviors in the subscription of over-the-top (OTT) media services have substantially changed because of the COVID-19 pandemic; hence, this study aims to determine the factors affecting subscription intentions. The increased usage of OTT media, particularly in the lockdowns during the COVID-19 pandemic, has intensified the competition between both global and local streaming providers. While studies have discussed antecedents accounting for this change, they have paid limited attention to the psychological factors that shape consumer behavior in using OTT services. Given the changes in consumers’ psychological states during the pandemic, this study seeks to fill the research gap by integrating the expectancy-value model to provide insights into the key gratifications that consumers seek and obtain and that have affected their subscription to OTT services. This study proposes a theoretical model and assesses this framework on data collected from 1,068 OTT service users in Taiwan. The results strengthen the literature by indicating a clear growth in the popularity and subscription of OTT services because of the COVID-19 lockdowns as well as factors such as perceived quality and satisfaction, which influence behavioral intentions for OTT services. Most crucially, however, OTT viewers who acquired a sense of belonging, a sense of being accompanied, and a sense of reduction in anxiety due to being quarantined and in lockdown show a higher tendency to continue their subscriptions to their OTT services of choice during the pandemic. With consumer behavior trends forever changed by the COVID-19 pandemic, the implications from this study provide OTT service platforms with an opportunity to capitalize on their current and potential customers’ changing desires, demands, and factors for a continued subscription.

Keywords: consumer behavior, COVID-19, expectancy-value model, OTT media services

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Authors: Francesca Nardi, Kashish Aneja, Katherine Ginsbach

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The COVID-19 pandemic has demonstrated both a need for evidence-based and rights-based public health policy and how challenging it can be to make effective decisions with limited information, evidence, and data. The O’Neill Institute, in conjunction with several partners, has been working since the beginning of the pandemic to collect, analyze, and distribute critical data on public health policies enacted in response to COVID-19 around the world in the COVID-19 Law Lab. Well-designed laws and policies can help build strong health systems, implement necessary measures to combat viral transmission, enforce actions that promote public health and safety for everyone, and on the individual level have a direct impact on health outcomes. Poorly designed laws and policies, on the other hand, can fail to achieve the intended results and/or obstruct the realization of fundamental human rights, further disease spread, or cause unintended collateral harms. When done properly, laws can provide the foundation that brings clarity to complexity, embrace nuance, and identifies gaps of uncertainty. However, laws can also shape the societal factors that make disease possible. Law is inseparable from the rest of society, and COVID-19 has exposed just how much laws and policies intersects all facets of society. In the COVID-19 context, evidence-based and well-informed law and policy decisions—made at the right time and in the right place—can and have meant the difference between life or death for many. Having a solid evidentiary base of legal information can promote the understanding of what works well and where, and it can drive resources and action to where they are needed most. We know that legal mechanisms can enable nations to reduce inequities and prepare for emerging threats, like novel pathogens that result in deadly disease outbreaks or antibiotic resistance. The collection and analysis of data on these legal mechanisms is a critical step towards ensuring that legal interventions and legal landscapes are effectively incorporated into more traditional kinds of health science data analyses. The COVID-19 Law Labs see a unique opportunity to collect and analyze this kind of non-traditional data to inform policy using laws and policies from across the globe and across diseases. This global view is critical to assessing the efficacy of policies in a wide range of cultural, economic, and demographic circumstances. The COVID-19 Law Lab is not just a collection of legal texts relating to COVID-19; it is a dataset of concise and actionable legal information that can be used by health researchers, social scientists, academics, human rights advocates, law and policymakers, government decision-makers, and others for cross-disciplinary quantitative and qualitative analysis to identify best practices from this outbreak, and previous ones, to be better prepared for potential future public health events.

Keywords: public health law, surveillance, policy, legal, data

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Authors: Shabeer Khan

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The main objective of Islamic Finance is to promote social justice thorough financial inclusion and redistribution of economic resources between rich and poor. The approach of Islamic finance is more comprehensive in nature and covers both formal and informal sectors of the economy, first, through reducing the gap between both sectors, and second by using specific Islamic values to reallocate the wealth between formal and informal sectors. Applying Generalized Method of Movements (GMM) to the annual data spanning from 1995-2015 for 141 countries, this study explores the determinants of informal business sector in Organization of Islamic Cooperation (OIC) countries and then compares with Non-OIC countries. Economic freedom and institutions variables as well as economic growth and money supply are found to reduce informal business sector in both OIC and Non-OIC nations while government expenditure are found to increase informal business sector in both group of nations. Informal Business sector remain the same in both types of countries but still the majority Muslim population in OIC economies create main difference between both groups of nations and justify the potential role of Islamic Finance in informal business sector in OIC nations. The study suggests that institutions quality should be improved and entrepreneurs’ friendly business environment must be provided. This study refines the main features of informal business sector and discuss their implications on policy designing and implementation, particularly in the context of Islamic finance fight against poverty, inequality and improving living standards of informal sector participants in OIC countries.

Keywords: Islamic finance, informal Business Sector, Generalized Method of Movements (GMM) and OIC

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Authors: Esther Liyanage, Indrajith Liyanage, A. A. J. Rajaratne

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During the 30 year civil war in Sri Lanka, a large number of individuals were injured and disabled. These disabilities have reduced their daily physical activities which may cause reduction in flexibility of upper limb, shoulder girdle, lower back and lower limb. Muscle flexibility is important for a healthy lifestyle. The main objective of the study was to assess the upper limb, shoulder girdle and lower back, hamstring flexibility of the intact lower limb in disabled individuals in the North and Eastern parts of Sri Lanka. Back saver sits and reach test and shoulder scratch test described in FITNESS GRAM was used in the study. A total of 125 disabled soldiers with lower limb disabilities were recruited for the study. Flexibility of the lower back and hamstring muscles of uninjured lower limb was measured using back saver sit and reach test described by Wells and Dillon (1952). Upper limb and shoulder girdle flexibility was assessed using shoulder stretch test. Score 0-3 was given according to the ability to reach Superior medial angle of the opposite scapula, top of the head or the mouth. The results indicate that 31 (24.8%) disabled soldiers have lower limb flexibility less than 8, 2 (1.6 % ) have flexibility of 8, 2 (1.6 %) have flexibility of 8.5, 11 ( 8.8% ) have flexibility of 9, 14 (11.2 %) have flexibility of 9.5, 23 (18.4 %) have flexibility of 10, 17 (13.6 %) have 10.5 flexibility, 13 (10.4%) have 11 flexibility, 2 (1.6%) have 11.5 flexibility, 10 (8 %) have flexibility of 12 and 3 (2.34 %) have flexibility of 12.5. Six disabled soldiers (4.8%) have upper limb flexibility of 2 and remaining 95.2% have normal upper limb flexibility (score 3). A reduction in the flexibility of muscles in lower body and lower limbs was seen in 25% disabled soldiers which could be due to reduction in their daily physical activities.

Keywords: disability, flexibility, rehabilitation, quality of life

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Authors: Emily Purdom, Rachel Robinson

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As the number of students worldwide requiring speech-language therapy, occupational therapy and mental health services during their school day increases, innovation is becoming progressively more important to meet the demand. Telepractice can be used to reach a greater number of students requiring specialized therapy while maintaining the highest quality of care. It can be provided in a way that is not only effective but ultimately more convenient for student, teacher and therapist without the added burden of travel. Teletherapy eradicates many hurdles to traditional on-site service delivery and helps to solve the pervasive shortage of certified professionals. Because location is no longer a barrier to specialized education plans for students with disabilities when teletherapy is conducted, there are many advantages that can be deployed. Increased frequency of engagement is possible along with students receiving specialized care from a clinician that may not be in their direct area. Educational teams, including parents, can work together more easily and engage in face-to-face, student-centered collaboration through videoconference. Practical strategies will be provided for connecting students with qualified therapists without the typical in-person dynamic. In most cases, better therapy outcomes are going to be achieved when treatment is most convenient for the student and educator. This workshop will promote discussion in the field of education to increase advocacy for remote service delivery. It will serve as a resource for those wanting to expand their knowledge of options for students with special needs afforded through innovation.

Keywords: education technology, innovation, student support services, telepractice

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

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

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

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