Search results for: ISO/IEC 17025:2017

Authors: Kangujam Monika, Kiranbala Devi Thokchom, Soibam Sandhyarani Devi

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Earthquake is a major natural hazard in India. Manipur, located in the North-Eastern Region of India, is one of the most affected location in the region prone to earthquakes since it lies in an area where Indian and Eurasian tectonic plates meet and is in seismic Zone V which is the most severe intensity zone, according to IS Code. Some recent earthquakes recorded in Manipur are M 6.7 epicenter at Tamenglong (January 4, 2016), M 5.2 epicenter at Churachandpur (February 24, 2017) and most recent M 4.4 epicenter at Thoubal (June 19, 2017). In these recent earthquakes, some houses and buildings were damaged, landslides were also occurred. A field study was carried out. An overview of the various causal factors involved in triggering of earthquake in Manipur has been discussed. It is found that improper planning, poor design, negligence, structural irregularities, poor quality materials, construction of foundation without proper site soil investigation and non-implementation of remedial measures, etc., are possibly the main causal factors for damage in Manipur during earthquake. The study also suggests, though the proper design of structure and foundation along with soil investigation, ground improvement methods, use of modern techniques of construction, counseling with engineer, mass awareness, etc., might be effective solution to control the hazard in many locations. An overview on the analysis pertaining to earthquake in Manipur together with on-going detailed site specific geotechnical investigation were presented.

Keywords: Manipur, earthquake, hazard, structure, soil

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Authors: Xuechen Chen

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The EU-ASEAN relations which can be dated back to 1972 represents one of the oldest group-to-group relationship in international politics. Despite a longstanding dialogue partnership, the EU and ASEAN have long been reluctant to forge deeper and substantial cooperation in political and security domains. However, the year of 2012 witnessed a salient shift in EU-ASEAN relations, with the EU significantly elevating ASEAN's profile in its external relations. Given the limited scholarly attention that has been devoted to this change in ASEAN-EU relations, this article explores why there has been a greater level of engagement and approximation between the EU and ASEAN. In particular, it asks why the EU, which had long been reluctant to recognize ASEAN as a strategic partner, has changed its policy towards ASEAN. Drawing on social constructivism, this article argues that the EU’s and ASEAN’s evolving identity-formation processes have played a significant role in reshaping their mutual perceptions, which subsequently leads to the modification of the interregional policies of both actors. The methodology of this study is based on content analysis of a wide range of official documents and policy papers from the EU and ASEAN, as well as more than 20 in-depth elite interviews with diplomats and experts working on the EU-ASEAN relationship from both organisations. Departing from the existing works which mainly adopt a Eurocentric perspective when analysing the EU-ASEAN interregionalism, this study suggests that the approximation of the EU-ASEAN relationship between 2012 and 2017 is driven by both actors’ adjustment of international identities, together with the internal dynamics and systematic changes within both regions.

Keywords: Association of Southeast Asia Nations, European Union, EU foreign policy, interregionalism

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Authors: Melissa Angus Baboun

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Utilizing a Critical Discourse Analysis (CDA) methodology and a theoretical framework based on disability studies, how Jamaican and Trinidadian newspapers discussed issues relating to the Deaf community were examined. The term deaf was inputted into the search engine tool of the online website for the Jamaica Observer and the Trinidad & Tobago Guardian. All 27 articles that contained the term deaf in its content and were written between August 1, 2017 and November 15, 2017 were chosen for the study. The data analysis was divided into three steps: (1) listing and analysis instances of metaphorical deafness (e.g. fall on deaf ears), (2) categorization of the content of the articles into the models of disability discourse (the medical, socio-cultural, and superscrip models of disability narratives), and (3) the analysis of any additional data found. A total of 42% of the articles pulled for this study did not deal with the Deaf community in any capacity, but rather instances of the use of idiomatic expressions that use deafness as a metaphor for a non-physical, undesirable trait. The most common idiomatic expression found was fall on deaf ears. Regarding the models of disability discourse, eight articles were found to follow the socio-cultural model, two were found to follow the medical model, and two were found to follow the superscrip model. The additional data found in these articles include two instances of the term deaf and mute, an overwhelming use of lower case d for the term deaf, and the misuse of the term translator (to mean interpreter).

Keywords: deafness, disability, news coverage, Caribbean newspapers

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Authors: Asamaporn Puetpaiboon, Sunisa Chatmongkolchart, Nalinee Kovitwanawong, Osaree Akaraborworn

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Traumatic patients with massive bleeding require intensive resuscitation. The actual cost of anesthesia per case has never been clarified, so our study aimed to quantify the direct cost, and cost-to-charge ratio of anesthetic care in traumatic patients with intraoperative massive bleeding. This study was a prospective, observational, cost analysis study, conducted in Prince of Songkla University hospital, Thailand, with traumatic patients, of any mechanisms being recruited. Massive bleeding was defined as estimated blood loss of at least one blood volume in 24 hours, or a half of blood volume in 3 hours. The cost components were identified by the micro-costing method, and valued by the bottom-up approach. The direct cost was divided into 4 categories: the labor cost, the capital cost, the material cost and the cost of drugs. From September 2017 to August 2018, 10 patients with multiple injuries were included. Seven patients had motorcycle accidents, two patients fell from a height and another one was in a minibus accident. Two patients died on the operating table, and another two died within 48 hours. The median Sequential Organ Failure Assessment (SOFA) score was 8. The median intraoperative blood loss was 3,500 ml. The median direct cost, per case, was 250 United States Dollars (2017 exchange rate), and the cost-to-charge ratio was 0.53. In summary, the direct cost was nearly half of the hospital charge, for these traumatic patients with massive bleeding. However, our study did not analyze the indirect cost.

Keywords: cost, cost-to-charge ratio, micro-costing, trauma

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Authors: Esra Danaci, Tugba Kavalali Erdogan, Sevil Masat, Selin Keskin Kiziltepe, Tugba Cinarli, Zeliha Koc

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This study was conducted in a descriptive and cross-sectional manner to determine that factors that influence the self-efficacy and self-sufficiency levels among oncology patients. The research was conducted between January 24, 2017 and September 24, 2017 in the oncology and hematology departments of a university hospital in Turkey with 179 voluntary inpatients. The data were collected through the Self-Sufficiency/Self-Efficacy Scale and a 29-question survey, which was prepared in order to determine the sociodemographic and clinical properties of the patients. The Self-Sufficiency/Self-Efficacy Scale is a Likert-type scale with 23 articles. The scale scores range between 23 and 115. A high final score indicates a good self-sufficiency/self-efficacy perception for the individual. The data were analyzed using percentage analysis, one-way ANOVA, Mann Whitney U-test, Kruskal Wallis test and Tukey test. The demographic data of the subjects were as follows: 57.5% were male and 42.5% were female, 82.7% were married, 46.4% were primary school graduate, 36.3% were housewives, 19% were employed, 93.3% had social security, 52.5% had matching expenses and incomes, 49.2% lived in the center of the city. The mean age was 57.1±14.6. It was determined that 22.3% of the patients had lung cancer, 19.6% had leukemia, and 43.6% had a good overall condition. The mean self-sufficiency/self-efficacy score was 83,00 (41-115). It was determined that the patients' self-sufficiency/self-efficacy scores were influenced by some of their socio-demographic and clinical properties. This study has found that the patients had high self-sufficiency/self-efficacy scores. It is recommended that the nursing care plans should be developed to improve their self-sufficiency/self-efficacy levels in the light of the patients' sociodemographic and clinical properties.

Keywords: oncology, patient, self-efficacy, self-sufficiency

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Authors: Bansal Ashwani

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Cartographic depiction and visualization of wetland changes is an important tool to map spatial-temporal information about the wetland dynamics effectively and to comprehend the response of these water bodies in maintaining the groundwater and surrounding ecosystem. This is true for the states of North Western India, i.e., J&K, Himachal, Punjab, and Haryana that are bestowed upon with several natural wetlands in the flood plains or on the courses of its rivers. Thus, the present study documents, analyses and reconstructs the lost wetlands, which existed in the flood plains of the major river basins of these states, i.e., Chenab, Jhelum, Satluj, Beas, Ravi, and Ghagar, in the beginning of the 20th century. To achieve the objective, the study has used multi-temporal datasets since the 1960s using high to medium resolution satellite datasets, e.g., Corona (1960s/70s), Landsat (1990s-2017) and Sentinel (2017). The Sentinel (2017) satellite image has been used for making the wetland inventory owing to its comparatively higher spatial resolution with multi-spectral bands. In addition, historical records, repeated photographs, historical maps, field observations including geomorphological evidence were also used. The water index techniques, i.e., band rationing, normalized difference water index (NDWI), modified NDWI (MNDWI) have been compared and used to map the wetlands. The wetland types found in the north-western states have been categorized under 19 classes suggested by Space Application Centre, India. These enable the researcher to provide with the wetlands inventory and a series of cartographic representation that includes overlaying multiple temporal wetlands extent vectors. A preliminary result shows the general state of wetland shrinkage since the 1960s with varying area shrinkage rate from one wetland to another. In addition, it is observed that majority of wetlands have not been documented so far and even do not have names. Moreover, the purpose is to emphasize their elimination in addition to establishing a baseline dataset that can be a tool for wetland planning and management. Finally, the applicability of cartographic depiction and visualization, historical map sources, repeated photographs and remote sensing data for reconstruction of long term wetlands fluctuations, especially in the northern part of India, will be addressed.

Keywords: cartographic depiction and visualization, wetland changes, NDWI/MDWI, geomorphological evidence and remote sensing

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Authors: Abiodun M. Adeola, Hannes Rautenbach, Gbenga J. Abiodun, Thabo E. Makgoale, Joel O. Botai, Omolola M. Adisa, Christina M. Botai

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There was a surge in malaria morbidity as well as mortality in 2016/2017 malaria season in malaria-endemic regions of South Africa. Rainfall is a major climatic driver of malaria transmission and has potential use for predicting malaria. Annual and seasonal trends and cross-correlation analyses were performed on time series of monthly total rainfall (derived from interpolated weather station data) and monthly malaria cases in five districts of Limpopo Province for the period of 1998 to 2017. The time series analysis indicated that an average of 629.5mm of rainfall was received over the period of study. The rainfall has an annual variation of about 0.46%. Rainfall amount varies among the five districts, with the north-eastern part receiving more rainfall. Spearman’s correlation analysis indicated that total monthly rainfall with one to two months lagged effect is significant in malaria transmission in all the five districts. The strongest correlation is noticed in Mopani (r=0.54; p-value = < 0.001), Vhembe (r=0.53; p-value = < 0.001), Waterberg (r=0.40; p-value = < 0.001), Capricorn (r=0.37; p-value = < 0.001) and lowest in Sekhukhune (r=0.36; p-value = < 0.001). More particularly, malaria morbidity showed a strong relationship with an episode of rainfall above 5-year running means of rainfall of 400 mm. Both annual and seasonal analyses showed that the effect of rainfall on malaria varied across the districts and it is seasonally dependent. Adequate understanding of climatic variables dynamics annually and seasonally is imperative in seeking answers to malaria morbidity among other factors, particularly in the wake of the sudden spike of the disease in the province.

Keywords: correlation, malaria, rainfall, seasonal, trends

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Authors: Adejoke Omowumi Adediran

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The commitment of African states to liberalise civil aviation in Africa through the implementation of the Yamoussoukro Decision of 1999 was reiterated in 2015 at the African Union Assembly meeting. A declaration was made by African Heads of government at the meeting to ensure the immediate implementation of the decision towards the establishment of a Single African Air Transport Market (SAATM) by 2017. A SAATM will imply among others, a removal of all commercial restrictions for African airlines in Africa; access to any route in Africa by African airlines without any required permit or authorisation; and a common set of regulations for airlines in African member states. As the envisioned 2017 date for launching the SAATM could not be met, a new date of January 2018 has been set. The lack of political will by African States, however, remains a prominent challenge to the realisation of the SAATM. As at June 2017, only twenty-one states had signed the commitment to actualise the decision creating the SAATM. In actualisation of the SAATM, a regulatory framework has been established to efficiently manage the new African airline industry, and regulatory texts have been adopted as part of the legal regime. This legal regime is to regulate both interstate and domestic operations. Airlines in Nigeria are currently faced with certain challenges which ultimately affect their effectiveness and passengers as well do not enjoy utmost customer satisfaction with services rendered by the airlines. Although Nigeria has demonstrated support for the SAATM since 2015, as Nigeria alongside ten other states, signed the initial commitment, whether or not SAATM will eventually be beneficial to airlines and passengers has become an issue in the light of the challenges of the Nigerian airline industry. Remarkably, the benefit of the SAATM is to a large extent ultimately determined by its legal framework. Using doctrinal research, this paper examines the legal implications of the SAATM on airlines and passengers in Nigeria. This paper analyses the legal framework of SAATM and juxtaposes this with the particular issues affecting airlines and passengers in Nigeria such as financial difficulties on the part of airlines and consumer protection as regards passengers. Among others, it can be asserted that the legal regime affords an opportunity for business expansion and creates a fair environment for competition. This is beneficial not only to the airlines but to passengers as well. In addition, in the interest of passengers, consumer rights are prescribed, and the regulations also cater for situations where airlines interrupt their services, as losses arising from these situations will be mitigated. There is indeed no doubt that the SAATM will be of great utility to both airlines and passengers in Nigeria.

Keywords: airlines, civil aviation, competition, consumer protection, passengers, single African air transport market, yamoussoukro decision

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Authors: M. Gerasimou, S. Mantzoukis, P. Christodoulou, N. Varsamis, G. Kolliopoulou, N. Zotos

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Purpose: Microbial infection of the blood is a serious condition where bacteria invade the bloodstream and cause systemic disease. In such cases, blood cultures are performed. Blood cultures are a key diagnostic test for intensive care unit (ICU) patients. Material and method: The BacT/Alert system, which measures the production of carbon dioxide with metabolic organisms, is used. The positive result in the BacT/Alert system is followed by culture in the following selective media: Blood, Mac Conkey No 2, Chocolate, Mueller Hinton, Chapman and Sabaureaud agar. Gram staining method was used to differentiate bacterial species. The microorganisms were identified by biochemical techniques in the automated Microscan (Siemens) system and followed by a sensitivity test on the same system using the minimum inhibitory concentration MIC technique. The sensitivity test is verified by a Kirby Bauer-based test. Results: In 2017 the Laboratory of Microbiology received 3347 blood cultures. Of these, 170 came from the ICU. 116 found positive. Of these S. epidermidis was identified in 42, A. baumannii in 27, K. pneumoniae in 12 (4 of these KPC ‘Klebsiella pneumoniae carbapenemase’), S. hominis in 8, E. faecium in 7, E. faecalis in 5, P. aeruginosa in 3, C. albicans in 3, S. capitis in 2, K. oxytoca in 2, P. mirabilis in 2, E. coli in 1, S. intermidius in 1 and S. lugdunensis in 1. Conclusions: The study of epidemiological data and microbial resistance phenotypes is essential for the choice of therapeutic regimen for the early treatment and limitation of multivalent strains, while it is a crucial factor to solve diagnostic problems.

Keywords: blood culture, bloodstream, infection, intensive care unit

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Authors: Lucy Ampaw-Asiedu, Terri R. Norton

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In the wake of recent disasters happening around the world such as earthquake in Italy (January, 2017); hurricanes in the United States (US) (September 2016 and September 2017); and compounding disasters in Haiti (September 2010 and September 2016); to our best knowledge, never has the world seen the need to work on preemptive rather than reactionary measures to salvage this situation than now. Tornadoes are natural hazards that mostly affect mid-western and central states in the US. Tornadoes, like all natural hazards such as hurricanes, earthquakes, floods and others, are very destructive and result in massive destruction to homes, cause billions of dollars in damage and claims many lives. Healthcare facilities in general are vulnerable to disasters, and therefore, the safety of patients, health workers and those who come in to seek shelter should be a priority. The focus of this study is to assess disaster management measures instituted by healthcare facilities. Thus, the sole aim of the study is to examine the vulnerabilities and the design of safe spaces in healthcare facilities in Central US. Objectives that guide the study are to primarily identify the impacts of tornadoes in hospitals and to assess the structural design or specifications of safe spaces. St. John’s Regional Medical Center, now Mercy Hospital in Joplin, is used as a case study. Preliminary results show that the lateral base shear of the proposed design to be 684.24 ton (1508.49kip) for the safe space. Findings from this work will be used to make recommendations about the design of safe spaces for health care facilities in Central US.

Keywords: disaster management, safe spaces, structural design, tornado, vulnerability

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Authors: Hutomo Abdurrohman, Muhammad Latief, Waridatun Nida, Ranta Dwi Irawati

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Yogyakarta Kembali Monument (Monjali) is one of the most popular tourist attraction in Yogyakarta. Yogyakarta is known as ‘Student City’, and Monjali is a right place to learn and explore more about Yogyakarta, especially for students in elementary and junior high school to do the study tour. Monjali is located in North Ringroad, Jongkang, Sariharjo village, Ngaglik Subdistrict, Sleman Regency, Yogyakarta. Monjali offers many historical replicas, and also the story behind them. That is about the war between Indonesia's fighter, called TNI (Indonesian national army) and the colonizer of Netherlands in Yogyakarta, on March, 1st 1949. That event could open the eyes of the whole of Indonesia, because at that time the TNI was placed by the invaders. This research is an effort to evaluate the visitor's interest in Monjali as a special tourist attraction. The substance that we use in this research is the Monjali's visitors whom up to 17 years old by taking a respondent in every 15 persons who visit Monjali, and we need 200 respondents to know the condition and facilities of Monjali. This research has been collected since January 2017 until October 2017. We do the interview and spread the questionnaire which has been tested all of its validity and reliability. This data analysis is descriptive statistic analysis by using the qualitative data, which is converted into the quantitative data, use the Linkert Scale. The result of this research shows that the interest of Monjali's visitors is higher 75,6%. Based on the result, we know that Monjali is being an attractiveness for people which always experience its improvements and the development. Monjali is the success to be a place which combines the entertainment with its education as a vision of Yogyakarta as a Student City.

Keywords: descriptive statistical analysis, Jogja Kembali monument, Linkert scale, sensation

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Authors: Linh Tong

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This paper aims to contribute to the understanding of key education reforms in Vietnam from 1945 to 2017, which reflects an evolution of socio-political needs of the Socialist Republic of Vietnam throughout this period. It explores the contextual conditions, motivations and ambitions influencing the formation of the education reforms in Vietnam. It also looks, from an applied practical perspective, at the influence of politics on education policy-making. The research methodology includes a content analysis of curriculum designs proposed by the Ministry of Education and Training, relevant resolutions and executive orders passed by the National Assembly and the Prime Minister, as well as interviews with experts and key stakeholders. The results point to a particular configuration of factors which have been inspiring the shape and substance of these reforms and which have most certainly influenced their implementation. This configuration evolves from the immediate needs to erase illiteracy and cultivate socialist economic model at the beginning of Vietnam’s independence in 1945-1975, to a renewed urge to adopt market-oriented economy in 1986 and cautiously communicate with the outside world until 2000s, and to currently a demonstrated desire to fully integrate into the global economy and tackle with rising concerns about national security (the South China Sea Dispute), environmental sustainability, construction of a knowledge economy, and a rule-of-law society. Overall, the paper attempts to map Vietnam’s socio-political needs with the changing sets of goals and expected outcomes in teaching and learning methodologies and practices as introduced in Vietnamese key education reforms.

Keywords: curriculum development, knowledge society, national security, politics of education policy-making, Vietnam's education reforms

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Authors: Iyanujesu Adereti, Tajudeen Basiru, Ayodamola Olanipekun

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Background: Substance abuse among adolescents is of public health concern globally. Despite being the most abused by adolescents, there are limited studies on the prevalence of alcohol use and cigarette smoking among adolescents in Mauritius. Objectives: To determine the prevalence of cigarette smoking, alcohol use and associated correlates among school-going adolescents in Mauritius. Methodology: Data obtained from 2017 WHO Global School-based Student Health Survey (GSHS) survey of 3,012 school-going adolescents in Mauritius was analyzed using STATA. Descriptive statistics were used to obtain prevalence. Bivariate and multivariate logistic regression analysis was used to evaluate predictors of cigarette smoking and alcohol use. Results: Prevalence of alcohol consumption and cigarette smoking were 26.0% and 17.1%, respectively. Smoking and alcohol use was more prevalent among males, younger adolescents, and those in higher school grades (p-value <.000). In multivariable logistic regression, male gender was associated with a higher risk of cigarette smoking (adjusted Odds Ratio (aOR) [95%Confidence Interval (CI)]= 1.51[1.06-2.14]) but lower risk of alcohol use (aOR[95%CI]= 0.69[0.53-0.90]) while older age (mid and late adolescence) and parental smoking were found to be associated with increased risk of alcohol use (aOR[95%CI]= 1.94[1.34-2.99] and 1.36[1.05-1.78] respectively). Marijuana use, truancy, being in a fight and suicide ideation were associated with increased odds of alcohol use (aOR[95%CI]= 3.82[3.39-6.09]; 2.15[1.62-2.87]; 1.83[1.34-2.49] and 1.93[1.38-2.69] respectively) and cigarette smoking (aOR[95%CI]= 17.28[10.4 - 28.51]; 1.73[1.21-2. 49]; 1.67[1.14-2.45] and 2.17[1.43-3.28] respectively) while involvement in sexual activity was associated with reduced risk of alcohol use (aOR[95%CI]= 0.50[0.37-0.68]) and cigarette smoking (aOR[95%CI]= 0.47[0.33-0.69]). Parental support and parental monitoring were uniquely associated with lower risk of cigarette smoking (aOR[95%CI]= 0.69[0.47-0.99] and 0.62[0.43-0.91] respectively). Conclusion: The high prevalence of alcohol use and cigarette smoking in this study shows the need for the government of Mauritius to enhance policies that will help address this issue putting into accounts the various risk and protective factors.

Keywords: adolescent health, alcohol use, cigarette smoking, global school-based student health survey

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Authors: Valmir Baloshi, Fran Gjoka, Nehat Çollaku, Elvin Toromani

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As a sediment production mechanism, soil erosion is the main environmental threat to the Bovilla watershed, including the decline of water quality of the Bovilla reservoir that provides drinking water to Tirana city (the capital of Albania). Therefore, an experiment with 25 erosion plots for soil erosion monitoring has been set up since June 2017. The aim was to determine the soil loss on plot and watershed scale in Bovilla watershed (Tirana region) for implementation of soil and water protection measures or payments for ecosystem services (PES) programs. The results of erosion monitoring for the period June 2017 - May 2018 showed that the highest values of surface runoff were noted in bare land of 38829.91 liters on slope of 74% and the lowest values in forest land of 12840.6 liters on slope of 64% while the highest values of soil loss were found in bare land of 595.15 t/ha on slope of 62% and lowest values in forest land of 18.99 t/ha on slope of 64%. These values are much higher than the average rate of soil loss in the European Union (2.46 ton/ha/year). In the same sloping class, the soil loss was reduced from orchard or bare land to the forest land, and in the same category of land use, the soil loss increased with increasing land slope. It is necessary to conduct chemical analyses of sediments to determine the amount of chemical elements leached out of the soil and end up in the reservoir of Bovilla. It is concluded that PES programs should be implemented for rehabilitation of sub-watersheds Ranxe, Vilez and Zall-Bastar of the Bovilla watershed with valuable conservation practices.

Keywords: ANOVA, Bovilla, land cover, slope, soil loss, watershed management

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Authors: Sun-Hee Lee, Amanda Kraley

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The “MeToo” movement is a social movement against sexual abuse and harassment. Though the hashtag went viral in 2017 following different cultural flashpoints in different countries, the initial response was quiet in South Korea. This radically changed in January 2018, when a high-ranking senior prosecutor, Seo Ji-hyun, gave a televised interview discussing being sexually assaulted by a colleague. Acknowledging public anger, particularly among women, on the long-existing problems of sexual harassment and abuse, the South Korean media have focused on several high-profile cases. Analyzing the media representation of these cases is a window into the evolving South Korean discourse around “MeToo.” This study presents a linguistic analysis of “MeToo” discourse in South Korea by utilizing a corpus-based approach. The term corpus (pl. corpora) is used to refer to electronic language data, that is, any collection of recorded instances of spoken or written language. A “MeToo” corpus has been collected by extracting newspaper articles containing the keyword “MeToo” from BIGKinds, big data analysis, and service and Nexis Uni, an online academic database search engine, to conduct this language analysis. The corpus analysis explores how Korean media represent accusers and the accused, victims and perpetrators. The extracted data includes 5,885 articles from four broadsheet newspapers (Chosun, JoongAng, Hangyore, and Kyunghyang) and 88 articles from two Korea-based English newspapers (Korea Times and Korea Herald) between January 2017 and November 2020. The information includes basic data analysis with respect to keyword frequency and network analysis and adds refined examinations of select corpus samples through naming strategies, semantic relations, and pragmatic properties. Along with the exponential increase of the number of articles containing the keyword “MeToo” from 104 articles in 2017 to 3,546 articles in 2018, the network and keyword analysis highlights ‘US,’ ‘Harvey Weinstein’, and ‘Hollywood,’ as keywords for 2017, with articles in 2018 highlighting ‘Seo Ji-Hyun, ‘politics,’ ‘President Moon,’ ‘An Ui-Jeong, ‘Lee Yoon-taek’ (the names of perpetrators), and ‘(Korean) society.’ This outcome demonstrates the shift of media focus from international affairs to domestic cases. Another crucial finding is that word ‘defamation’ is widely distributed in the “MeToo” corpus. This relates to the South Korean legal system, in which a person who defames another by publicly alleging information detrimental to their reputation—factual or fabricated—is punishable by law (Article 307 of the Criminal Act of Korea). If the defamation occurs on the internet, it is subject to aggravated punishment under the Act on Promotion of Information and Communications Network Utilization and Information Protection. These laws, in particular, have been used against accusers who have publicly come forward in the wake of “MeToo” in South Korea, adding an extra dimension of risk. This corpus analysis of “MeToo” newspaper articles contributes to the analysis of the media representation of the “MeToo” movement and sheds light on the shifting landscape of gender relations in the public sphere in South Korea.

Keywords: corpus linguistics, MeToo, newspapers, South Korea

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Authors: Paula Lazarim

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As global mobility thrives, researchers emphasize the urgency of global literacy through training qualified counselors to serve internationally in a culturally competent manner. However, the focus thus far has been on how counselors’ preparation to approach international populations fuses with study abroad experiential learning short-term immersions. Looking for better solutions for cultural competency and skills learning related to international counseling, the author of this manuscript examines international counseling's current status, learning scope and goals, and educational opportunities. A guiding framework grounded on relational pedagogy (Reeves & Le Mare, 2017), relational cultural theory (Jordan, 2017), and intercultural education (Nastasi et al., 2020) is applied with four long-term educational modality projects designed to benefit cultural competence, attitude, relational skills development, and learning an intercultural counseling approach. Suggestions that encourage innovative instruction in counselor education and counseling programs at master and doctoral levels, stimulate self-learning, and educate in intercultural relational competence are linked to strategies for engaging in international counseling based on findings of a literature review and training-projects implementation. Ultimately, the author highlights theoretical and practical implications of suitable training to improve counselors' performance and discusses long-term teaching-learning opportunities that positively impact the international counseling community by sending out internationally culturally competent counselors.

Keywords: international counseling, counselor education, counseling, relational pedagogy, intercultural education, counselors’ training

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Authors: Yudo Prasetyo, Hana Sugiastu Firdaus, Diyanah Diyanah

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The phenomenon of the lack of clean water supply in several big cities in Indonesia is a major problem in the development of urban areas. Moreover, in the city of Semarang, the population density and growth of physical development is very high. Continuous and large amounts of underground water (aquifer) exposure can result in a drastically aquifer supply declining in year by year. Especially, the intensity of aquifer use in the fulfilment of household needs and industrial activities. This is worsening by the land subsidence phenomenon in some areas in the Semarang city. Therefore, special research is needed to know the spatial correlation of the impact of decreasing aquifer capacity on the land subsidence phenomenon. This is necessary to give approve that the occurrence of land subsidence can be caused by loss of balance of pressure on below the land surface. One method to observe the correlation pattern between the two phenomena is the application of remote sensing technology based on radar and optical satellites. Implementation of Differential Interferometric Synthetic Aperture Radar (DINSAR) or Small Baseline Area Subset (SBAS) method in SENTINEL-1A satellite image acquisition in 2014-2017 period will give a proper pattern of land subsidence. These results will be spatially correlated with the aquifer-declining pattern in the same time period. Utilization of survey results to 8 monitoring wells with depth in above 100 m to observe the multi-temporal pattern of aquifer change capacity. In addition, the pattern of aquifer capacity will be validated with 2 underground water cavity maps from observation of ministries of energy and natural resources (ESDM) in Semarang city. Spatial correlation studies will be conducted on the pattern of land subsidence and aquifer capacity using overlapping and statistical methods. The results of this correlation will show how big the correlation of decrease in underground water capacity in influencing the distribution and intensity of land subsidence in Semarang city. In addition, the results of this study will also be analyzed based on geological aspects related to hydrogeological parameters, soil types, aquifer species and geological structures. The results of this study will be a correlation map of the aquifer capacity on the decrease in the face of the land in the city of Semarang within the period 2014-2017. So hopefully the results can help the authorities in spatial planning and the city of Semarang in the future.

Keywords: aquifer, differential interferometric synthetic aperture radar (DINSAR), land subsidence, small baseline area subset (SBAS)

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Authors: Bruna Goncalves, Jennifer Henck, Romulo Uliana, Eliana Kamimura, Carlos Oliveira, Carlos Corassin

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Studies have shown evidence of human exposure to aflatoxin M1 due to the consumption of contaminated milk and dairy products (mainly cheeses). This poses a great risk to public health, since milk and milk products are frequently consumed by a portion of the population considered immunosuppressed, children and the elderly. Knowledge of the negative impacts of aflatoxins on health and economics has led to investigations of strategies to prevent their formation in food, as well as to eliminate, inactivate or reduce the bioavailability of these toxins in contaminated products This study evaluated the effect of microbiological methods using lactic acid bacteria on aflatoxin M1 (AFM1) reduction in Minas Frescal cheese (typical Brazilian product, being among the most consumed cheeses in Brazil) spiked with 1 µg/L AFM1. Inactivated lactic acid bacteria (0,5%, v/v de L. rhamnosus e L. lactis) were added during the cheese production process. Nine cheeses were produced, divided into three treatments: negative controls (without AFM1 or lactic acid bacteria), positive controls (AFM1 only), and lactic acid bacteria + AFM1. Samples of cheese were collected on days 2, 10, 20 and 30 after the date of production and submitted to composition analyses and determination of AFM1 by high-performance liquid chromatography. The reductions of AFM1 in cheese by lactic acid bacteria at the end of the trial indicate a potential application of inactivated lactic acid bacteria in reducing the bioavailability of AFM1 in Minas frescal cheese without physical-chemical and microbiological modifications during the 30-day experimental period. The authors would like to thank São Paulo Research Foundation – FAPESP (grants #2017/20081-6 and #2017/19683-1).

Keywords: aflatoxin, milk, minas frescal cheese, decontamination

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Authors: Parvin Berenjkar, Qiuyan Yuan, Richard Sparling, Stan Lozecznik

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Landfills highly contribute to anthropological global warming through CH₄ emissions. Landfills are usually capped by a conventional soil cover to control the migration of gases. Methane is consumed by CH₄-oxidizing microorganisms known as methanotrophs that naturally exist in the landfill soil cover. The growth of methanotrophs can be optimized in a bio-cover that typically consists of a gas distribution layer (GDL) to homogenize landfill gas fluxes and an overlying oxidation layer composed of suitable materials that support methanotrophic populations. Materials such as mature yard waste composts can provide an inexpensive and favourable porous support for the growth and activity of methanotrophs. In areas with seasonal cold climates, it is valuable to know if methanotrophs in a bio-cover can survive in winter until the next spring, and how deep they are active in the bio-cover to mitigate CH₄. In this study, a pilot bio-cover was constructed in a closed landfill cell in Winnipeg that has a very cold climate in Canada. The bio-cover has a surface area of 2.5 m x 3.5 m and 1.5 m of depth, filled with 50 cm of gravel as a GDL and 70 cm of biosolids compost amended with yard and leaf waste compost. The observed in situ potential of methanotrophs for CH₄ oxidation was investigated at a specific period of time from December 2016 to April 2017 as well as November 2017 to April 2018, when the transition to surface frost and thawing happens in the bio-cover. Compost samples taken from different depths of the bio-cover were incubated in the laboratory under standardized conditions; an optimal air: methane atmosphere, at 22ºC, but at in situ moisture content. Results showed that the methanotrophs were alive oxidizing methane without a lag, indicating that there was the potential for methanotrophic activity at some depths of the bio-cover.

Keywords: bio-cover, global warming, landfill, methanotrophic activity

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Authors: Khatia Tavidashvili, Nino Jamrishvili, Valerian Omsarashvili

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Studies of the vertical distribution of the air temperature in the atmosphere have great value for the solution of different problems of meteorology and climatology (meteorological forecast of showers, thunderstorms, and hail, weather modification, estimation of climate change, etc.). From the end of May 2015 in Kakheti after 25-year interruption, the work of anti-hail service was restored. Therefore, in connection with climate change, the need for the detailed study of the contemporary regime of the vertical distribution of the air temperature above this territory arose. In particular, the indicated information is necessary for the optimum selection of rocket means with the works on the weather modification (fight with the hail, the regulation of atmospheric precipitations, etc.). Construction of the detailed maps of the potential damage distribution of agricultural crops from the hail, etc. taking into account the dimensions of hailstones in the clouds according to the data of radar measurements and height of locality are the most important factors. For now, in Georgia, there is no aerological probing of atmosphere. To solve given problem we processed information about air temperature profiles above Telavi, at 27 km above earth's surface. Information was gathered during four observation time (4, 10, 16, 22 hours with local time. After research, we found vertical distribution of the average monthly values of the air temperature above Kakheti in ‎2012-2017 from January to December. Research was conducted from 0.543 to 27 km above sea level during four periods of research. In particular, it is obtained: -during January the monthly average air temperature linearly diminishes with 2.6 °C on the earth's surface to -57.1 °C at the height of 10 km, then little it changes up to the height of 26 km; the gradient of the air temperature in the layer of the atmosphere from 0.543 to 8 km - 6.3 °C/km; height of zero isotherm - is 1.33 km. -during July the air temperature linearly diminishes with 23.5 °C to -64.7 °C at the height of 17 km, then it grows to -47.5 °C at the height of 27 km; the gradient of the air temperature of - 6.1 °C/km; height of zero isotherm - is 4.39 km, which on 0.16 km is higher than in the sixties of past century.

Keywords: hail, Kakheti, meteorology, vertical distribution of the air temperature

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Authors: Nkatow Mafany Christian

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No other period in human history has offered such great opportunities for grievances not only to last long but also to be manifested across international boundaries. This state of affairs is likely a common feature of the advent of social media. The Anglophone Question in Cameroon has been a problem of poor constitutional arrangements that can be traced to 1961 when the former French Cameroon reunified with former British Southern Cameroons following a plebiscite in which the latter overwhelmingly voted to reunify with the former. Though Southern/Anglophone Cameroons complained of perceived marginalization and an attempt by the majority French section to assimilate them, the manifestation was subtle and took place only through protests, petitions, strikes movements and demonstrations. However, with the advent of social media, a new cream of leaders emerged in the diaspora, including the US, Canada, Europe, Asia and the Middle East, to champion the manifestations leading to violence and conflicts that have bedeviled the region since 2017. The feeling of political subjugation, economic exploitation, social suppression and cultural assimilation among Anglophone Cameroonians united them under diaspora leaders against the government of Cameroon, calling for the creation of a separate state for Anglophones. This paper draws from this lead-up to analyze the current Anglophone Crisis in Cameroon in the light of the Grievance Theory and Transnationalism. The paper makes an appeal to field experience, interviews, official sources, documentation, and the internet to succor its central thesis. From the fertility of its sources, the paper submits that social media is a potent source of conflicts and makes nonsense of the principle of sovereignty and territorial integrity by its capacity to promote the transnational manifestation of grievances.

Keywords: grievance, transnationalism, anglophone crisis, Cameroon, crisis and social media

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Authors: Tugba Sevinc Gamsiz, Emine Koroglu, Ozcan Keskin

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Aim: Nonalcoholic fatty liver disease (NAFLD) is considered the most common chronic liver disease in the general population. The higher mortality and morbidity among NAFLD patients and lack of symptoms makes early detection and management important. In our study, we aimed to evaluate the relationship between noninvasive imaging and biochemical markers in diabetic and nondiabetic patients diagnosed with NAFLD. Materials and Methods: The study was conducted from (September 2017) to (December 2017) on adults admitted to Internal Medicine and Gastroenterology outpatient clinics with hepatic steatosis reported on ultrasound or transient elastography within the last six months that exclude patients with other liver diseases or alcohol abuse. The data were collected and analyzed retrospectively. Number cruncher statistical system (NCSS) 2007 program was used for statistical analysis. Results: 116 patients were included in this study. Diabetic patients compared to nondiabetics had significantly higher Controlled Attenuation Parameter (CAP), Liver Stiffness Measurement (LSM) and fibrosis values. Also, hypertension, hepatomegaly, high BMI, hypertriglyceridemia, hyperglycemia, high A1c, and hyperuricemia were found to be risk factors for NAFLD progression to fibrosis. Advanced fibrosis (F3, F4) was present in 18,6 % of all our patients; 35,8 % of diabetic and 5,7 % of nondiabetic patients diagnosed with hepatic steatosis. Conclusion: Transient elastography is now used in daily clinical practice as an accurate noninvasive tool during follow-up of patients with fatty liver. Early diagnosis of the stage of liver fibrosis improves the monitoring and management of patients, especially in those with metabolic syndrome criteria.

Keywords: diabetes, elastography, fatty liver, fibrosis, metabolic syndrome

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Authors: Dana R. Thomson, Catherine Linard, Sabine Vanhuysse, Jessica E. Steele, Michal Shimoni, Jose Siri, Waleska Caiaffa, Megumi Rosenberg, Eleonore Wolff, Tais Grippa, Stefanos Georganos, Helen Elsey

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The Sustainable Development Goals (SDGs) and Urban Health Equity Assessment and Response Tool (Urban HEART) identify dozens of key indicators to help local decision-makers prioritize and track inequalities in health outcomes. However, presentations and discussions at the International Conference on Urban Health (ICUH) 2017 suggested that additional indicators are needed to make decisions and policies. A local decision-maker may realize that malaria or road accidents are a top priority. However, s/he needs additional health determinant indicators, for example about standing water or traffic, to address the priority and reduce inequalities. Health determinants reflect the physical and social environments that influence health outcomes often at community- and societal-levels and include such indicators as access to quality health facilities, access to safe parks, traffic density, location of slum areas, air pollution, social exclusion, and social networks. Indicator identification and disaggregation are necessarily constrained by available datasets – typically collected about households and individuals in surveys, censuses, and administrative records. Continued advancements in earth observation, data storage, computing and mobile technologies mean that new sources of health determinants indicators derived from 'big data' are becoming available at fine geographic scale. Big data includes high-resolution satellite imagery and aggregated, anonymized mobile phone data. While big data are themselves not representative of the population (e.g., satellite images depict the physical environment), they can provide information about population density, wealth, mobility, and social environments with tremendous detail and accuracy when combined with population-representative survey, census, administrative and health system data. The aim of this paper is to (1) flag to data scientists important indicators needed by health decision-makers at the city and sub-city scale - ideally free and publicly available, and (2) summarize for local decision-makers new datasets that can be generated from big data, with layperson descriptions of difficulties in generating them. We include SDGs and Urban HEART indicators, as well as indicators mentioned by decision-makers attending ICUH 2017.

Keywords: health determinant, health outcome, mobile phone, remote sensing, satellite imagery, SDG, urban HEART

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Authors: Abdullah Almulhim

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The International Accounting Standards Board (IASB) was established in 2001 to develop International Financial Reporting Standards (IFRS) that bring transparency, accountability, and efficiency to financial markets around the world. In addition, the IFRS provide a unified accounting language, which is especially important in the era of globalization. However, the establishment of a single set of high-quality international accounting standards is a matter of growing importance, as participants in the increasingly integrated world capital market demand comparability and transparency of financial reporting worldwide. Saudi Arabia became the 149th member of the World Trade Organization (WTO) on 11 December 2005, which has increased the need to convert to IFRS. Currently, the Saudi Arabian Monetary Authority (SAMA) requires banks and insurance companies in Saudi Arabia to report under IFRS Standards. However, until the end of 2016, SOCPA standards were applied to all other companies, listed and unlisted. From 2017, listed Saudi companies would be required to report under IFRS Standards as adopted by SOCPA effective 2017. This paper is to investigate the expected benefits gained and highlight the challenges faced by adopting IFRS by the listed companies in the Saudi Stock Exchange. Questionnaires were used as the main method of data collection. They were distributed to listed companies in the Saudi Capital Market. Data obtained through the questionnaires have been imported into SPSS statistical software for analysis. The expected results of this study will show the benefits of adopting IFRS by Saudi Listed Companies. However, this study will investigate the challenges faced by adopting IFRS by the listed companies in the Saudi Arabian Stock Market. Findings will be discussed later upon completion of initial analysis.

Keywords: challenges, IAS, IFRS, opportunities, Saudi, SOCPA

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Authors: Elron Fouten

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Recently, debates surrounding the social relevance of psychology in South Africa have focussed on how the growing neoliberal rationality within academia has again resulted in the discipline catering to the needs of powerful social groupings to protect its own economic interests, rather than producing socially relevant knowledge. Consequently, this study aimed to conduct a content analysis of the recent research output of psychology masters students, to establish whether it has produced research that addresses local and national psychosocial issues and as such deemed socially relevant knowledge. The study sampled clinical, counselling, and research psychology masters theses from 16 South African universities submitted between 1998 and 2017. Overall, 2001 theses were sampled, which were analysed using qualitative content analysis predominantly based on the descriptive categories identified in similar studies using published journal articles. Results indicated that empirical qualitative theses, using systems-oriented theory and post-modern frameworks were most prevalent. Further, traditional topics within psychology had relatively more weighting compared to more social topics. Although a significant number of theses recruited participants from working-class or poor backgrounds, there was an overreliance on participants from urban areas located in some of the country’s wealthiest provinces. Despite a strong adult-centric focus, trends regarding participants’ race and gender roughly resembled current population demographics. Overall, the results indicate that psychology in South Africa, at least at university-level, is to some extent trying to engage with national psychosocial concerns. However, there are still several key areas which need to be addressed to ensure the continued social relevance of the discipline.

Keywords: adult-centric, content analysis, relevance, psychosocial

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Authors: G. C. Joshi, M. Paul, B. K. Kalita, V. Ranga, J. S. Rawat, P. S. Rawat

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Being a habitat of the global village, every place has established connection through the strength and power of social media piercing through the political boundaries. Social media is a digital platform, where people across the world can interact as it has advantages of being universal, anonymous, easily accessible, indirect interaction, gathering and sharing information. The power of social media lies in the intensity of sharing extreme opinions or feelings, in contrast to the personal interactions which can be easily mapped in the form of Sentiment Mapping. The easy access to social networking sites such as Facebook, Twitter and blogs made unprecedented opportunities for citizens to voice their opinions loaded with dynamics of emotions. These further influence human thoughts where social media plays a very active role. A recent incident of public importance was selected as a case study to map the sentiments of people through Twitter. Understanding those dynamics through the eye of an ordinary people can be challenging. With the help of R-programming language and by the aid of GIS techniques sentiment maps has been produced. The emotions flowing worldwide in the form of tweets were extracted and analyzed. The number of tweets had diminished by 91 % from 25/08/2017 to 31/08/2017. A boom of sentiments emerged near the origin of the case, i.e., Delhi, Haryana and Punjab and the capital showed maximum influence resulting in spillover effect near Delhi. The trend of sentiments was prevailing more as neutral (45.37%), negative (28.6%) and positive (21.6%) after calculating the sentiment scores of the tweets. The result can be used to know the spatial distribution of digital penetration in India, where highest concentration lies in Mumbai and lowest in North East India and Jammu and Kashmir.

Keywords: sentiment mapping, digital literacy, GIS, R statistical language, spatio-temporal

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Authors: Rene Jimenez, Sonia E. Ruiz, Miguel A. Orellana

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On 09/19/2017, a Mw = 7.1 intraslab earthquake occurred in Mexico causing the collapse of about 40 buildings. Many of these were 5- or 6-story buildings with soft first story; so, it is desirable to perform a structural fragility analysis of typical structures representative of those buildings and to propose a reliable structural solution. Here, a typical 5-story building constituted by regular R/C moment-resisting frames in the first story and confined masonry walls in the upper levels, similar to the collapsed structures on the 09/19/2017 Mexico earthquake, is analyzed. Three different structural solutions of the 5-story building are considered: S1) it is designed in accordance with the Mexico City Building Code-2004; S2) then, the column dimensions of the first story corresponding to S1 are reduced, and S3) viscous dampers are added at the first story of solution S2. A number of dynamic incremental analyses are performed for each structural solution, using a 3D structural model. The hysteretic behavior model of the masonry was calibrated with experiments performed at the Laboratory of Structures at UNAM. Ten seismic ground motions are used to excite the structures; they correspond to ground motions recorded in intermediate soil of Mexico City with a dominant period around 1s, where the structures are located. The fragility curves of the buildings are obtained for different values of the maximum inter-story drift demands. Results show that solutions S1 and S3 give place to similar probabilities of exceedance of a given value of inter-story drift for the same seismic intensity, and that solution S2 presents a higher probability of exceedance for the same seismic intensity and inter-story drift demand. Therefore, it is concluded that solution S3 (which corresponds to the building with soft first story and energy dissipation devices) can be a reliable solution from the structural point of view.

Keywords: demand hazard analysis, fragility curves, incremental dynamic analyzes, soft-first story, structural capacity

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Authors: Deginet Aklilu, Tianqi Wang, Endwoke Amsalu, Wei Feng, Zhiwei Li, Xia Li, Lixin Tao, Yanxia Luo, Moning Guo, Xiangtong Liu, Xiuhua Guo

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Extreme temperature-related cardiovascular diseases (CVDs) have become a growing public health concern. However, the impact of temperature on the cause of specific CVDs has not been well studied in the study area. The objective of this study was to assess the impact of temperature on cause-specific cardiovascular hospital admissions in Beijing, China. We obtained data from 172 large general hospitals from the Beijing Public Health Information Center Cardiovascular Case Database and China. Meteorological Administration covering 16 districts in Beijing from 2013 to 2017. We used a time-stratified case crossover design with a distributed lag nonlinear model (DLNM) to derive the impact of temperature on CVD in hospitals back to 27 days on CVD admissions. The temperature data were stratified as cold (extreme and moderate ) and hot (moderate and extreme ). Within five years (January 2013-December 2017), a total of 460,938 (male 54.9% and female 45.1%) CVD admission cases were reported. The exposure-response relationship for hospitalization was described by a "J" shape for the total and cause-specific. An increase in the six-day moving average temperature from moderate hot (30.2 °C) to extreme hot (36.9 °C) resulted in a significant increase in CVD admissions of 16.1%(95% CI = 12.8%-28.9%). However, the effect of cold temperature exposure on CVD admissions over a lag time of 0-27 days was found to be non significant, with a relative risk of 0.45 (95% CI = 0.378-0.55) for extreme cold (-8.5 °C)and 0.53 (95% CI = 0.47-0.60) for moderate cold (-5.6 °C). The results of this study indicate that exposure to extremely high temperatures is highly associated with an increase in cause-specific CVD admissions. These finding may guide to create and raise awareness of the general population, government and private sectors regarding on the effects of current weather conditions on CVD.

Keywords: admission, Beijing, cardiovascular diseases, distributed lag non linear model, temperature

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Authors: Warda Jabeen, Romaisa Shamim Khan, Osama Shakeel, Ahmed Faraz Bhatti, Raza Hussain

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Background: The worldwide incidence of cutaneous melanoma (CM) has been on the rise over the past few decades. Primary prevention and early treatment remain the focus of management to reduce the burden of disease. This entails identification of risk factors to prompt early diagnosis. In Pakistan, there is a scarcity of clinico-pathological data relating to cutaneous malignant melanoma. Objective: The purpose of this study was to analyze the epidemiological and clinical characteristics of patients presenting with cutaneous malignant melanoma in Pakistan, and to compare the results with other studies. Method: Shaukat Khanum Memorial Cancer Hospital and Research Centre is currently the only dedicated cancer hospital in the country, accepting patients from all over Pakistan. Majority of the patients, however, belong to the northern half of the country. From the recorded data of the hospital, all cutaneous melanoma cases were identified and evaluated. Results: Between 1997 and 2017, a total of 169 cutaneous melanoma patients were registered at Shaukat Khanum. Mean age was 47.5 years. The highest incidence of melanoma was seen in the age group 40-59 years (n=69, 40.8%). Most commonly reported clinical subtype was unspecified melanoma (n=154, 91%). Amongst those in which T stage was reported, the most frequently observed T-stage at presentation was T4 (n=23, 13.6%). With regards to body distribution, in our study CM was seen most commonly in the lower limb including the hip. The yearly incidence of melanoma has increased/remained stable from 2007 to 2017. Conclusion: cutaneous malignant melanoma is a fairly common disease in Pakistan. Patients tend to present at a more advanced stage as compared to patients in developed countries. Identification of risk factors and tumor characteristics is therefore of paramount importance to deal with these patients.

Keywords: epidemiology of cutaneous malignant melanoma, cutaneous malignant melanoma, Pakistan, skin cancer

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Authors: Nurunnahar Akter, Elena Kulinskaya, Nicholas Steel, Ilyas Bakbergenuly

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Although Hormone Replacement Therapy (HRT) is an effective treatment in ameliorating menopausal symptoms, it has mixed effects on different health outcomes, increasing, for instance, the risk of breast cancer. Because of this, many symptomatic women are left untreated. Untreated menopausal symptoms may result in other health issues, which eventually put an extra burden and costs to the health care system. All-cause mortality analysis may explain the net benefits and risks of the HRT therapy. However, it received far less attention in HRT studies. This study investigated the impact of HRT on all-cause mortality using electronically recorded primary care data from The Health Improvement Network (THIN) that broadly represents the female population in the United Kingdom (UK). The study entry date for this study was the record of the first HRT prescription from 1984, and patients were followed up until death or transfer to another GP practice or study end date, which was January 2017. 112,354 HRT users (cases) were matched with 245,320 non-users by age at HRT initiation and general practice (GP). The hazards of all-cause mortality associated with HRT were estimated by a parametric Weibull-Cox model adjusting for a wide range of important medical, lifestyle, and socio-demographic factors. The multilevel multiple imputation techniques were used to deal with missing data. This study found that during 32 years of follow-up, combined HRT reduced the hazard ratio (HR) of all-cause mortality by 9% (HR: 0.91; 95% Confidence Interval, 0.88-0.94) in women of age between 46 to 65 at first treatment compared to the non-users of the same age. Age-specific mortality analyses found that combined HRT decreased mortality by 13% (HR: 0.87; 95% CI, 0.82-0.92), 12% (HR: 0.88; 95% CI, 0.82-0.93), and 8% (HR: 0.92; 95% CI, 0.85-0.98), in 51 to 55, 56 to 60, and 61 to 65 age group at first treatment, respectively. There was no association between estrogen-only HRT and women’s all-cause mortality. The findings from this study may help to inform the choices of women at menopause and to further educate the clinicians and resource planners.

Keywords: hormone replacement therapy, multiple imputations, primary care data, the health improvement network (THIN)

Procedia PDF Downloads 148