Search results for: maternal outcome

Authors: Yaxian Chen, Yeonhee Park

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Driven by evolving FDA recommendations, modern clinical trials demand innovative designs that strike a balance between statistical rigor and ethical considerations. Covariate-adjusted response-adaptive (CARA) designs bridge this gap by utilizing patient attributes and responses to skew treatment allocation in favor of the treatment that is best for an individual patient’s profile. However, existing CARA designs for survival outcomes often hinge on specific parametric models, constraining their applicability in clinical practice. In this article, we address this limitation by introducing a CARA design for survival outcomes (CARAS) based on the Cox model and a variance estimator. This method addresses issues of model misspecification and enhances the flexibility of the design. We also propose a group sequential overlapweighted log-rank test to preserve type I error rate in the context of group sequential trials using extensive simulation studies to demonstrate the clinical benefit, statistical efficiency, and robustness to model misspecification of the proposed method compared to traditional randomized controlled trial designs and response-adaptive randomization designs.

Keywords: cox model, log-rank test, optimal allocation ratio, overlap weight, survival outcome

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Authors: Akiode Ayobami, Akiode Akinsewa, Odeku Mojisola, Salako Busola, Odutolu Omobola, Nuhu Khadija

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Purpose: Evidence exists that family planning use can contribute to reduction in infant and maternal mortality in any country. Despite these benefits, contraceptive use in Nigeria still remains very low, only 10% among married women. Understanding factors that predict contraceptive use is very important in order to improve the situation. In this paper, we analysed data from the 2013 Nigerian Demographic and Health Survey (NDHS) to better understand predictors of contraceptive use in Nigeria. The use of logistics regression and other traditional models in this type of situation is not appropriate as they do not account for social structure influence brought about by the hierarchical nature of the data on response variable. We therefore used multilevel modelling to explore the determinants of contraceptive use in order to account for the significant variation in modern contraceptive use by socio-demographic, and other proximate variables across the different Nigerian states. Method: This data has a two-level hierarchical structure. We considered the data of 26, 403 married women of reproductive age at level 1 and nested them within the 36 states and the Federal Capital Territory, Abuja at level 2. We modelled use of modern contraceptive against demographic variables, being told about FP at health facility, heard of FP on TV, Magazine or radio, husband desire for more children nested within the state. Results: Our results showed that the independent variables in the model were significant predictors of modern contraceptive use. The estimated variance component for the null model, random intercept, and random slope models were significant (p=0.00), indicating that the variation in contraceptive use across the Nigerian states is significant, and needs to be accounted for in order to accurately determine the predictors of contraceptive use, hence the data is best fitted by the multilevel model. Only being told about family planning at the health facility and religion have a significant random effect, implying that their predictability of contraceptive use varies across the states. Conclusion and Recommendation: Results showed that providing FP information at the health facility and religion needs to be considered when programming to improve contraceptive use at the state levels.

Keywords: multilevel modelling, family planning, predictors, Nigeria

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Authors: Ziara Carmelli G. Tan, Irene Carmelle S. Tan

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Background: Trichotillomania (TTM) and Major Depressive Disorder (MDD) are two psychiatric conditions that frequently co-occur, presenting a significant challenge for treatment due to their complex interplay. TTM involves repetitive hair-pulling, leading to noticeable hair loss and distress, while MDD is characterized by persistent low mood and loss of interest or pleasure, leading to dysfunctionality. This case report examines the intricate relationship between TTM and MDD in a young adult female, emphasizing the need for a comprehensive, multifaceted therapeutic approach to address both disorders effectively. Case Presentation: The patient is a 21-year-old female college student and youth church leader who presented with chronic hair-pulling and depressive symptoms. Her premorbid personality was marked by low self-esteem and a strong need for external validation. Despite her academic and social responsibilities and achievements, she struggled with managing her emotional distress, which was exacerbated by her family dynamics and her role within her church community. Her hair-pulling and mood symptoms were particularly triggered by self-esteem threats and feelings of inadequacy. She was diagnosed with Trichotillomania, Scalp and Major Depressive Disorder. Intervention/Management: The patient’s treatment plan was comprehensive, incorporating both pharmacological and non-pharmacological interventions. Initial pharmacologic management was Fluoxetine 20mg/day up, titrated to 40mg/day with no improvement; hence, shifted to Escitalopram 20mg/day and started with N-acetylcysteine 600mg/day with noted significant improvement in symptoms. Psychotherapeutic strategies played a crucial role in her treatment. These included supportive-expressive psychodynamic psychotherapy, which helped her explore and understand underlying emotional conflicts. Cognitive-behavioral techniques were employed to modify her maladaptive thoughts and behaviors. Grief processing was integrated to help her cope with significant losses. Family therapy was done to address conflicts and collaborate with the treatment process. Psychoeducation was provided to enhance her understanding of her condition and to empower her in her treatment journey. A suicide safety plan was developed to ensure her safety during critical periods. An interprofessional approach, which involved coordination with the Dermatology service for co-management, was also a key component of her treatment. Outcome: Over the course of 15 therapy sessions, the patient demonstrated significant improvement in both her depressive symptoms and hair-pulling behavior. Her active engagement in therapy, combined with pharmacological support, facilitated better emotional regulation and a more cohesive sense of self. Her adherence to the treatment plan, along with the collaborative efforts of the interprofessional team, contributed to her positive outcomes. Discussion: This case underscores the significance of addressing both TTM and its comorbid conditions to achieve effective treatment outcomes. The intricate interplay between TTM and MDD in the patient’s case highlights the importance of a comprehensive treatment plan that includes both pharmacological and psychotherapeutic approaches. Supportive-expressive psychodynamic psychotherapy, Cognitive-behavioral techniques, and Family therapy were particularly beneficial in addressing the complex emotional and behavioral aspects of her condition. The involvement of an interprofessional team, including dermatology co-management, was crucial in providing holistic care. Future practice should consider the benefits of such a multidisciplinary approach to managing complex cases like this, ensuring that both the psychological and physiological aspects of the disorders are adequately addressed.

Keywords: cognitive-behavioral therapy, interprofessional approach, major depressive disorder, psychodynamic psychotherapy, trichotillomania

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Authors: T. Nakkeran, C. Dhamodharan, Win Myint Soe , Ramasamy Deverajan, M. Ganesh Babu

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This manuscript presents the results of an experimental investigation performed to study the material and mechanical properties of two weld joints fabricated within close proximity. The experiment was designed using welded S355 D Z35 with distances between two parallel adjacent weld toes at 8 mm. These distances were less than the distance that has normally been recommended in standards, codes, and specifications. The main idea of the analysis is to determine any significant effects when welding the joints with the close proximity of 8mm using the SAW welding process of the one joint with high heat put and one joint welded with the FCAW welding process and evaluating the destructing and nondestructive testing between the welded joints. Further, we have evaluated the joints with Mechanical Testing for evaluating by performing Tensile test, bend testing, Macrostructure, Microstructure, Hardness test, and Impact testing. After evaluating the final outcome of the result, no significant changes were observed for welding the close proximity of weld of 8mm distance between the joints as compared to the specification minimum distance between the weldments of any design should be 50mm.

Keywords: S355 carbon steel, weld proximity, SAW process, FCAW process, heat input, bend test, tensile test, hardness test, impact test, macro and microscopic examinations

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Authors: Yi Tse Wang, Che Hsiu Chen, Zih Jian Huang, Hon Wen Cheng

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Stretching treatments enhanced flexibility. On the other hand, decreases in hamstrings strength have been reported after stretching, especially with static stretching or passive stretching. Stretching has been shown to be more effective than static stretching to improve muscle performance, but a clear consensus for the effect of dynamic stretching on muscle performance has not been achieved. The purpose of this study was to compare the acute effect of a dynamic stretching, static stretching and eccentric exercise protocol on hamstrings stiffness, flexibility and muscle strength. Forty-five healthy active men (height 179.9 cm; weight 71.5 kg; age 22.5 years) were participated in 3 randomly ordered testing sessions: dynamic stretching (DS), active static stretching (ASS), and passive static stretching (PSS). All the stretch were performed 30 seconds and repeated 6 times. There was a 30-second interval between repetitions. The outcome measures were isokinetic concentric contraction (60°/s), eccentric contraction (30°/s) peak torque, muscle flexibility after stretching. The results showed that the muscle flexibility (3.6%, 3.9% and 1.59%, respectively) increased significantly after DS, PSS and ASS. Hamstring isokinetic concentric peak torque (-6.4%, -8.0% and -5.8%, respectively) and eccentric peak torque (-5.8%, -4.5% and -5.4%, respectively) decreased significantly after DS, PSS and ASS. Hence, although the stretching protocols improve hamstrings flexibility immediately, reduced hamstring muscle eccentric and concentric peak torque.

Keywords: hamstrings injury, warm-up, muscle performance, muscle stretching

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Authors: Pimploi Tirastittam, Phutthiwat Waiyawuththanapoom, Manop Tirastittam

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Traceability system is one of the tools which can ensure the product’s confident of the consumer as it can trace the product back to its origin and can reduce the operation cost of recall. Nowadays, there are so many technologies which can be applied to the traceability system and also able to increase the efficiency of the system such as QR Code, barcode, GS1 and GTIN. As the result, this research is aimed to study and design the information technology pattern that suits for the traceability of Thailand’s orchid because Thailand’s orchid is the popular export product for Japan, USA, China, Netherlands and Italy. This study will enhance the value of Thailand’s orchid and able to prevent the unexpected event of the defects or damaged product. The traceability pattern was received IOC test from 12 experts from 4 fields of study which are traceability field, information technology field, information communication technology field and orchid export field. The result of the in-depth interview and questionnaire showed that the technology which most compatibility with the traceability system is the QR code. The mean of the score was 4.25 and the standard deviation was 0.5 as the QR code is the new technology and user-friendly. The traceability system should start from the farm to the consumer in the consuming country as the traceability system will enhance the quality level of the product and increase the value of its as well. The other outcome from this research is the supply chain model of Thailand’s Orchid along with the system architecture and working system diagram.

Keywords: exporting, information technology pattern, orchid, traceability

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Authors: Yaser Meeralam, Walaa Alharthi, Hadeel Ashi, Alaa Bakhsh, Kholood Aljabri, Ebtihal Bin Salim

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Background:Basidiobolusranrum causes one of the rare fungal diseases that infects mainly immunocompetent individuals. Gastrointestinal Basidiobolomycosis (GIB) is a rare and uncommon form of this fungal infection. It’s still ambiguous how this fungus is reaching the gastrointestinal tract leading to Gastrointestinal Basidiobolomycosis. Objective: To summarize the clinical features, imaging, and histopathological of patients diagnosed with GIB in our institution. Patients and methods: A series of five cases of patients who diagnosed by basidiobolomycosis in King Abdullah Medical City, Makkah, Saudi Arabia, which reviewed by latest literature related to diagnosis and treatment. Results: Most of the patients were externally evaluated and were initially misdiagnosed. Some of them were suspected of colonic malignancy, other presumed to have hepatic hemangioma and fistulizing crohn’s disease. The definitive diagnosis is often based on histopathological examination and fungal culture of the surgically resected mass. An optimum standardized treatment of basidiobolomycosis has not yet been established. Conclusion: Deeper knowledge of clinical characteristics, diagnosis, and treatment of basidiobolomycosis will allow early initiating of treatment with a subsequent positive impact on the patients’ outcome. More studies are needed to establish a definite treatment.

Keywords: gastrointestinal infection, crohn's mimics, malignancy mimics, fungal infection

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Authors: Humeyra Bolakar Tosun

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The transport sector has an undisputed place in human life. People need transport access to continuous increase day by day with growing population. The number of rail network, urban transport planning, infrastructure improvements, transportation management and other related areas is a key factor affecting our country made it quite necessary to improve the work of transportation. In this context, it plays an important role in domestic rail freight demand planning. Alternatives that the increase in the transportation field and has made it mandatory requirements such as the demand for improving transport quality. In this study generally is known and used in studies by the definition, rail freight transport, railway line length, population, energy consumption. In this study, Iron Road Load Net Demand was modeled by multiple regression and ANN methods. In this study, model dependent variable (Output) is Iron Road Load Net demand and 6 entries variable was determined. These outcome values extracted from the model using ANN and regression model results. In the regression model, some parameters are considered as determinative parameters, and the coefficients of the determinants give meaningful results. As a result, ANN model has been shown to be more successful than traditional regression model.

Keywords: railway load carrying, neural network, modelling transport, transportation

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Authors: Mohd Faridz Ahmad, Muhammad Amir Asyraf Rosli

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Aerobic dance has becoming a popular mode of exercise especially among women due to its fun nature. With a catchy music background and joyful dance steps, aerobic dancers would be able to have fun while sweating out. Depending on its level of aggressiveness, aerobic may also improve and maintain cardiorespiratory fitness other than being a great tool for weight loss. This study intends to prove that aerobic dance activity can bring the same, if not better impacts on health than other types of cardiovascular exercise such as jogging and cycling. The objective of this study was to evaluate and identify the effect of six weeks aerobic dance on cardiovascular fitness and weight loss among women. This study, which was held in Seremban Fit Challenge, used a quasi-experimental design. The subjects selected include a total of 14 women (n = 14) with age (32.4 years old ± 9.1), weight (65.93 kg ± 11.24) and height (165.36 ± 3.46) who joined the Seremban Fit Challenge Season 13. The subjects were asked to join an aerobic dance class with duration of one hour for six weeks in a row. As for the outcome, cardiovascular fitness was measured with a 1-mile run test while any changes on weight was measured using the weighing scale. The result showed that there was a significant difference between pre and post-test for cardiovascular fitness when p = 0.02 < 0.05 and weight loss when p = 0.00 < 0.05. In conclusion, a six-week long aerobic dance program would have a positive effect on cardiovascular fitness and weight. Therefore, aerobic dance may be used as an alternative tool for people who wish to lead a healthy lifestyle in a fun way.

Keywords: aerobic dance, cardiovascular fitness, weight loss, 1-mile run test

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Authors: Gouda K. Helal, Marwa I. Shabayek, Heba A. El-Ramly, Heba A. Awida

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The adverse effects of Clindamycin (Clind.) / Ibuprofen (Ibu.) combination on liver, kidney, blood elements and the significances of antioxidants (N-acetylcysteine and Zinc) against these effects were evaluated. The study includes: Group I; control n=30, Group II; patients on Clind.300mg/Ibu.400mg twice daily for a week n=30, Group III; patients on Clind.300mg/Ibu.400mg+N-acetylcysteine 200mg twice daily for a week n=15 and Group IV; patients on Clind.300mg/Ibu.400mg+Zinc50mg twice daily for a week n=15. Serum malondialdehyde (MDA), alanine transferase (ALT), aspartate transferase (AST), γ glutamyl transferase (GGT), creatinine, blood urea nitrogen (BUN) were measured. Applying one way ANOVA followed by Tuckey Kramer post test, Group II showed significant increase in ALT, AST, GGT, BUN and decrease in Hb, RBCs, platelets than Group I. Group III showed significant decrease in ALT, AST, GGT, BUN than Group II. Moreover, Group IV showed significant decrease in ALT, AST, GGT and increase in Hb, RBCs, and platelets than Group II. Conclusively, Adding Zinc or N-acetylcysteine buffer the oxidative stress and improve the therapeutic outcome of Clindamycin/Ibuprofen combination.

Keywords: clindamycin, ibuprofen, adverse effects, antioxidant, zinc, N-acetylcysteine

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Authors: Phomid Techi, L. N. Padmasini, Mohan Mathew

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Objective: To evaluate the effectiveness of co-parent support on the duration of exclusive breastfeeding by a randomized control trial. Introduction: The current rates of exclusive breastfeeding for 6 months in India is 46% (NFHS3 2008.). The purpose of the study is to evaluate the effectiveness of co-parenting support on duration of exclusive breastfeeding in primi mothers. Design: RCT: Willing parents of healthy TAGA babies born in our hospital were explained about the study purpose and randomly assigned to either trial or control group. The control group was given the usual care. The intervention group received usual care and in addition the trial intervention. Follow-up data was collected at the end of 6 mon. Intervention: Face to face 30-minute discussion in post partum unit on breast feeding benefits, techniques, and problem-solving information followed up by phone calls to mother every 4 weeks to answer questions/concerns. Outcome measures: Duration of exclusive breastfeeding Baseline demographic variables were measured. Results: After obtaining IEC approval a total of 100 couples were recruited, 100 is each group. In the intervention group, the rate of exclusive breastfeeding was 97.2% while in the control group it was 64% (p-value 0.00). Conclusion: Co-parenting support has an important role in promoting exclusive breastfeeding.

Keywords: co-parenting, exclusive breastfeeding, developing nation, randomised control trial

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Authors: Mona Nikidehaghani, Freda Hui

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In Australia, one-third of mental health carers provide 40 hours or more of unpaid care per week. These hidden workers contribute significantly to the Australian mental health workforce by providing unpaid services both direct and indirect to people in their care. However, carers are often neglected in the healthcare system because Government services focus on those with a mental health condition rather than those supporting them. The aim of this study is to evaluate the perceptions of mental health carers on the effectiveness of community services designed for carers and how these services could be improved. We collaborated with One Door Mental Health, a community organisation that supports mental health carers. Through semi-structured interviews with 27 mental health carers residing in the Illawarra region (NSW), we documented their daily challenges and evaluated outcomes of the current programs for carers. Our findings demonstrate that services such as education programs enable capacity building and improve the social life and mental health of carers. Drawing on the perceptions of mental health carers, this study maps pathways for making meaningful changes in the lives of carers and proposes an outcome framework to evaluate the impact of a community organisation on the lives of their clients. The framework prepared by this project would be replicable, allowing other community organisations to measure the outcomes and improve their services.

Keywords: capacity building, community development, community service, mental health carers

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Authors: Amir Farouk Ahmed Ali Hussin

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Social media, such as Facebook, LinkedIn and Ex-Twitter have experienced exponential growth and a remarkable adoption rate in recent years. They give fantastic means of online social interactions and communications with family, friends, and colleagues from around the corner or across the globe, and they have become an important part of daily digital interactions for more than one and a half billion users around the world. The personal information sharing practices that social network providers encourage have led to their success as innovative social interaction platforms. Moreover, these practices have outcome in concerns with respect to privacy and security from different stakeholders. Guiding these privacy and security concerns in social networks is a must for these networks to be sustainable. Real security and privacy tools may not be enough to address existing concerns. Some points should be followed to protect users from the existing risks. In this research, we have checked the various privacy and security issues and concerns pertaining to social media. However, we have classified these privacy and security issues and presented a thorough discussion of the effects of these issues and concerns on the future of the social networks. In addition, we have presented a set of points as precaution measures that users can consider to address these issues.

Keywords: international legal, consultation mix, legal research, small and medium-sized enterprises, strategic International law, strategy alignment, house of laws, deployment, production strategy, legal strategy, business strategy

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Authors: Gulseren Mutlu, Gurupdesh Pandher

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This paper studies the strategic interplay between innovation, incentives, expropriation threat and disputes arising from expropriation from an intra-organization perspective. We present a simple principal-agent model with hidden actions and hidden information in which two employees can choose how much (innovative) effort to exert, whether to expropriate the innovation of the other employee and whether to dispute if innovation is expropriated. The organization maximizes its expected payoff by choosing the optimal reward scheme for both employees as well as whether to encourage or discourage disputes. We analyze two mechanisms under which innovative ideas are not expropriated. First, we show that under a non-contestable mechanism (in which the organization discourages disputes among employees), the organization has to offer a “rent” to the potential expropriator. However, under a contestable mechanism (in which the organization encourages disputes), there is no need for such rent. If the cost of resolving the dispute is negligible, the organization’s expected payoff is higher under a contestable mechanism. Second, we develop a comparable team mechanism in which innovation takes place as a result of the joint efforts of employees and innovation payments are made based on the team outcome. We show that if the innovation value is low and employees have similar productivity, then the organization is better off under a contestable mechanism. On the other hand, if the innovation value is high, the organization is better off under a team mechanism. Our results have important practical implications for the design of innovation reward system for employees, hiring policy and governance for different companies.

Keywords: innovation, incentives, expropriation threat, dispute resolution

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Authors: Ehsan Kaviani, Azin Golmoradizade

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Introduction: Traditionally, tendons are considered to only contain tenocytes that are responsible for the maintenance, repair, and remodeling of tendons. Stem cells, which are termed tendon-derived stem cells, so this study we investigate the effect of transcranial direct current stimulation combined with swallowing training on post-stroke dysphagia. Methods: This review article is about effects of transcranial direct current stimulation (tDCS) on post-stroke dysphagia that were extracted from Science Direct, Pro quest, and Pub med Data Bases. 15 articles had been selected according to inclusion criteria from 2014 to 2019, and 6 of them had been deleted by exclusion criteria. Results: The results of our systematic review suggest that tDCS may represent a promising novel treatment for post-stroke dysphagia. However, to date, little is known about the optimal parameters of tDCS for relieving post-stroke dysphagia. Further studies are warranted to refine this promising intervention by exploring the optimal parameters of tDCS. Conclusion: anodal tDCS over the affected hemisphere may be as effective as cathodal tDCS on the unaffected hemisphere to enhance recovery after subacute ischemic stroke and anodal tdcs applied over the affected pharyngeal motor cortex can enhance the outcome of swallowing training in post-stroke dysphagia.

Keywords: dysphagia, stroke, cortical stimulation, transcranial direct current stimulation

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Authors: Dong Jin Kang

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Application of single board microcontrollers is an important skill even for non-electronic engineering major students. Arduino board is widely utilized in engineering classes of the Yeungnam University of South Korea. In those classes, students are subjected to learn how to use various sensor components related to motion, sound, light, and so on as well as physical quantities. Students are grouped into several teams, and each team consists of 4~5 students. Many students are not motivated enough to learn those skills. An extracurricular program was planned to improve this problem. The extracurricular program was held as an international boot camp where students from three different countries were invited to participate. 10 students groups were formed, and each team was consisted of students having different nationality. The camp was 4 days long and wrapped up with competitions. During the camp, every student was assigned to design and make a two wheel robot. The competition was carried out in two different areas; individual and group performances. As most skills dealt in the class are used to build the robot, students are much motivated to review the whole subjects of the class. All students were surveyed after the program. The survey shows that the skills studied in the class are greatly improved, and practically understood. Staying at the dormitory and teaming with international students are help students improve communication skills. Competition at the camp was found as a key element to inspire and attract students for voluntary participation.

Keywords: extracurricular program, robot, Arduino board, international camp, competition

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Authors: Ahmad Mansoor Stanikzai, Yoshitaka Kajita

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This research is a very essential towards transportation planning of Kabul New City. In this research, the travel demand of Kabul metropolitan area (Existing and Kabul New City) are evaluated for three different target years (2015, current, 2025, mid-term, 2040, long-term). The outcome of this study indicates that, though currently the vehicle volume is less the capacity of existing road networks, Kabul city is suffering from daily traffic congestions. This is mainly due to lack of transportation management, the absence of proper policies, improper public transportation system and violation of traffic rules and regulations by inhabitants. On the other hand, the observed result indicates that the current vehicle to capacity ratio (VCR) which is the most used index to judge traffic status in the city is around 0.79. This indicates the inappropriate traffic condition of the city. Moreover, by the growth of population in mid-term (2025) and long-term (2040) and in the case of no development in the road network and transportation system, the VCR value will dramatically increase to 1.40 (2025) and 2.5 (2040). This can be a critical situation for an urban area from an urban transportation perspective. Thus, by introducing high-capacity public transportation system and the development of road network in Kabul New City and integrating these links with the existing city road network, significant improvements were observed in the value of VCR.

Keywords: Afghanistan, Kabul new city, planning, policy, urban transportation

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Authors: Inayatullah Khan, Afzal Khan, Hamzullah Khan, Afzal Khan

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Objectives: The objective of this study was to compare different statistical variables for vaccinated and unvaccinated children in measles cases. Material and Methods: This cross sectional comparative study was conducted at Isolation ward, Department of Paediatrics, Lady Reading Hospital (LRH), Peshawar, from April 2012 to March 2013. A total of 566 admitted cases of measles were enrolled. Data regarding age, sex, address, vaccination status, measles contact, hospital stay and outcome was collected and recorded on a proforma. History of measles vaccination was ascertained either by checking the vaccination cards or on parental recall. Result: In 566 cases of measles, 211(39%) were vaccinated and 345 (61%) were unvaccinated. Three hundred and ten (54.80%) patients were males and 256 (45.20%) were females with a male to female ratio of 1.2:1.The age range was from 1 year to 14 years with mean age with SD of 3.2 +2 years. Majority (371, 65.5%) of the patients were 1-3 years old. Mean hospital stay was 3.08 days with a range of 1-10 days and a standard deviation of ± 1.15. History of measles contact was present in 393 (69.4%) cases. Fourty eight patients were expired with a mortality rate of 8.5%. Conclusion: Majority of the children in Khyber Pukhtunkhwa are unvaccinated and unprotected against measles. Among vaccinated children, 39% of children attracted measles which indicate measles vaccine failure. This figure is clearly higher than that accepted for measles vaccine (2-10%).

Keywords: measles, vaccination, immunity, population

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Authors: Benard Omogo

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The Kenyan Constitution 2010 introduced various commissions to devolve the powers that were previously centralized through the imperial Presidency. One of the commissions that directly determine the levels of remuneration and terms of service of Kenyan workers is the Salary and Remuneration Commission (SRC). Article 230 of the Kenyan Constitution 2010 mandates this commission to regularly review the remuneration and benefits of all the state officers and to advise the national and county governments on the remuneration and benefits of all other public officers. At the same time, article 54 of the Kenyan Labor Relations Act 2007 provides for the recognition of trade unions and collective bargaining agreements. The emerging challenges, therefore, originate from the conflicts of the mandate of the Salary and Remuneration Commission, whose advice is almost adopted as the order and this undermines the outcome of the Collective Bargaining Agreements. This has seen so many trade unions in Kenya being rendered irrelevant. This research paper is therefore going to sample the various trade unions of Kenya to assess the challenges that result from the position of the Salary and Remuneration Commission. We will also extend it by purposively sampling several trade unions in Africa to determine how they handle such challenges. The results from this paper will be useful to the Kenyan Lawmakers and Africa at large and may inform them to consider reviewing the laws and acts that relate to the trade unions for prosperity.

Keywords: salary, remuneration, collective, bargaining, labor laws

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Authors: Jafar Mortadha, Imran Qureshi

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This research explains and compares the modern techniques used for measuring the flow angles of a flowing fluid with the traditional technique of using multi-hole pressure probes. In particular, the focus of the study is on four-hole probes, which offer great reliability and benefits in several applications where the use of modern measurement techniques is either inconvenient or impractical. Due to modern advancements in manufacturing, small multi-hole pressure probes can be made with high precision, which eliminates the need for calibrating every manufactured probe. This study aims to improve the range of calibration maps for a four-hole probe to allow high flow angles to be measured accurately. The research methodology comprises a literature review of the successful calibration definitions that have been implemented on five-hole probes. These definitions are then adapted and applied on a four-hole probe using a set of raw pressures data. A comparison of the different definitions will be carried out in Matlab and the results will be analyzed to determine the best calibration definition. Taking simplicity of implementation into account as well as the reliability of flow angles estimation, an adapted technique from a research paper written in 2002 offered the most promising outcome. Consequently, the method is seen as a good enhancement for four-hole probes and it can substitute for the existing calibration definitions that offer less accuracy.

Keywords: calibration definitions, calibration maps, flow measurement techniques, four-hole probes, multi-hole pressure probes

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Authors: K. P. v. R. de Silva, R. W. Senevirathna, M. M. A. J. Kumara, J. P. M. Kumarasinghe, R. L. Gunawardana, S. M. Uluwitiya, G. C. P. Jayawickrama, W. K. T. I. Madushani

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Introduction: The limited literature supporting the utilization of mechanical bowel preparation (MBP) for patients undergoing laparoscopic anterior resection (LAR) remains a notable issue. This study was conducted to examine the clinical consequences of anastomosis in colorectal surgery with MBP compared to cases where MBP was not utilized (no-MBP) in the context of LAR. Methods: This was a retrospective comparative study conducted in the professorial surgical wards of the teaching hospital karapitiya (THK). Colorectal cancer patients(n=306) participated in the study, including 151 MBP patients and 155 no-MBP patients, where the postoperative complications and mortality rates were compared. Results: The anastomotic leakage rate was 2.6%(n=4) in the no-MBP group and 6.0%(n=9) in the MBP group (p=0.143). The postoperative paralytic ileus rate was 18.5%(n=28) and 5.8%(n=9) in the MBP group and no-MBP group, respectively, displaying a statistically significant difference (p=0.001). Wound infection, pneumonia, urinary tract infection, and cardiac complication rates also were higher in the MBP group. The overall mortality rate was 1.3%(n=3) in the no-MBP group and 2.0%(n=2) in the MBP group. Conclusions: The evidence concludes that MBP increases post-operative complications. Therefore, prophylactic MBP in LAR has not been proven to benefit patients. However, further research is necessary to understand the comparative effects of MBP versus no preparation comprehensively.

Keywords: MBP, anastomosis, LAR, paralytic ileus

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Authors: Masuma Novak, Daniel Novak

Abstract:

Background: Sweden along with other Nordic countries has the highest incidence of type 1 diabetes mellitus (T1DM) worldwide. The trend is increasing globally. The diagnosis is often given at the emergency clinic when children arrive with cardinal symptom of T1DM. Children with T1DM are known to have an increased risk of microvascular- and macrovascular complications. A family history of cardiovascular complications may further increase their risk. Clinically evident diabetes-related vascular complications are however rarely visible in childhood and adolescence, whereby an intensive diabetes treatment and normoglycemic control is a goal for every child. This study is a risk evaluation of children with T1DM based on their family’s cardiovascular history. Method: Since 2005 the Better Diabetes Diagnosis (BDD) study is a nationwide Swedish prospective cohort study that recruits new-onset T1DM who are less than 18 years old at time of diagnosis. For each newly diagnosed child, blood samples are collected for specific HLA genotyping and islet autoantibody assays and their family’s cardiovascular history is evaluated. As part of the BDD study, during the years 2010-2013 all children diagnosed with T1DM at the Queen Silvia’s Children’s Hospital in Sweden were asked about their family’s cardiovascular history. Questions regarded maternal and paternal high blood pressure, stroke, and myocardial infarction before the age of 55 years, and hyperlipidemia were answered. A maximum risk score of eight was possible. All children are clinically observed prospectively for early functional and structural abnormalities such as protein uremia, blood pressure, and retinopathy. Results: A total of 275 children aged 0 to 18 years were diagnosed with T1DM at the Queen Silvia’s Children’s Hospital emergency clinic during this four year period. The participation rate was 99.7%. 26.4% of the children had no hereditary cardiovascular risk factors. 22.7 % had one risk factor and 18.8% had two risk factors. 14.8% had three risk factors. 9.7% had four risk factors and 7.5% had five risk factors or more. Conclusion: Among children with T1DM in Sweden there is a difference in hereditary cardiovascular risk factors. These results indicate that children with T1DM who also have increased hereditary cardiovascular risk factors should be monitored closely with early screening for functional and structural cardiovascular abnormalities. This is a very preliminary and ongoing study which will be complemented with the cardiovascular risk analysis among children without T1DM.

Keywords: children, type I diabetes, emergency clinic, CVD risk

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Authors: Siti Fatimah Kader Maideen, Abdul Rashid, Nur Indah Ahmad

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Introduction: Indigenous people have an increased risk of contracting zoonotic infections due to their practices. Similarly, the aborigines in Peninsular Malaysia, the Orang Asli, have a higher risk too. This study aimed to empower the Jahai children on the prevention of zoonotic infections by implementing a health promotion intervention program. Methods: A non-experimental pre and post-test interventional study was conducted among the indigenous primary school children aged between nine and 12 years in Perak, Malaysia. A structured questionnaire was used to assess the pre-and post-knowledge and attitudes towards zoonotic infections and hand hygiene practice. This is followed by three sessions of the health promotion program. Ethical approval was obtained prior to the data collection. Data were analysed using SPSS software. Results: The knowledge on whether diseases can spread from animals to humans, transmission via saliva and faeces, types of organisms that can infect, and signs and symptoms increased significantly between pre and post. Significant improvements were observed in the attitude and practices too. Conclusion: The intervention program demonstrated improvement in the knowledge, attitude, and practice among the children. The continuous program needs to be conducted for a sustainable outcome.

Keywords: health promotion, zoonotic infections, aborigines, knowledge, practice

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Authors: Yu-Chih Wang, Chia-Yu Lai, Hsiao-Tien Liu, Yi-Ju Chen, Shao-Bin Cheng

Abstract:

Liver transplant has been one of the curative treatment options for hepatocellular carcinomaunder certain oncological conditions. Two of the most validated criteria are from Milan in1996 and USCF in 2001, suggesting number and size limits of tumor without vascularinvasion or distant metastasis. We performed a retrospective cohort study of hepatocellular carcinoma patients undergoing livertransplant between August 2003 and December 2020 in our institute. Clinical andpathological characteristic, survival outcome, and recurrent pattern were analysed.UCSF criteria was applied for living donor transplantation, and Milan criteria was applied for deceased donor transplantation. Of 180 total patients, 52 cases(28.8%) with diagnosis of hepatocellular carcinoma, including26 living donor(LD) and 26 deceased donor(DD) liver transplant. Complete pathologicalremission was significantly more in the DD group(p=0.009). Pathological reports showed that30.8% of DD group exceeded Milan criteria, and 19.2% of LD group exceeded UCSFcriteria.After a median follow-up of 52.2 months, the 1-year, 3-year and 5-year overall survival was 87.6%, 74.1%, and 71.8%, respectively.Meanwhile, progression-free survival was 93.1%, 85.7%, and 81.6% for 1, 3, and 5-year, respectively, similar to that in Mazzaferro et al, 1996. We concluded that Liver transplant could be applied cautiously in expanded criteria for patent withhepatocellular carcinoma.

Keywords: liver transplant, milan criteria, UCSF criteria, living donor transplantation, deceased donor transplantation

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Authors: Pradeep Kumar, Shibashish Chakraborty, Sasadhar Bera

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In the anticipation of demand fluctuations, services cannot be inventoried and hence it creates a difficult problem in marketing of services. The inability to meet customers (patients) requirements in healthcare context has more serious consequences than other service sectors. In order to meet patient requirements in the current uncertain environment, healthcare organizations are seeking ways for improved service delivery. Flexibility provides a mechanism for reducing variability in service encounters and improved performance. Flexibility is defined as the ability of the organization to cope with changing circumstances or instability caused by the environment. Patient satisfaction is an important performance outcome of healthcare organizations. However, the paucity of information exists in healthcare delivery context to examine the impact of flexibility on patient satisfaction and behavioral intention. The present study is an attempt to develop a conceptual foundation for investigating overall impact of flexibility on patient satisfaction and behavioral intention. Several dimensions of flexibility in healthcare context are examined and proposed to have a significant impact on patient satisfaction and intention. Furthermore, the study involves a critical examination of determinants of patient satisfaction and development of a comprehensive view the relationship between flexibility, patient satisfaction and behavioral intention. Finally, theoretical contributions and implications for healthcare professionals are suggested from flexibility perspective.

Keywords: healthcare, flexibility, patient satisfaction, behavioral intention

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Authors: Olusegun Akinsiku, Olukayode Oyediran, Koleola Odusami

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A construction project is usually made up of a variety of stakeholders whose interests may positively or negatively impact on the outcome of the project execution. The variability of project stakeholders is apparent in their cultural differences, professional background and ethics, and differences in ideas. The need for the effectiveness of construction teams has been investigated as this is an important aspect to meeting client’s expectations in the construction industry. This study adopts a cross-sectional descriptive survey with the purpose of identifying the critical success factors (CSFs) associated with the team effectiveness of construction projects stakeholders, their relationship and the effects on construction project performance. The instrument for data collection was a designed questionnaire which was administered to construction professionals in the construction industry in Lagos State, Nigeria using proportionate stratified sampling. The highest ranked identified CSFs include “team trust”, “esprit de corps among members” and “team cohesiveness”. Using factor analysis and considering the effects of team cohesiveness on project performance, the identified CSFs were categorized into three groups namely cognitive attributes, behavior and processes attributes and affective attributes. All the three groups were observed to have a strong correlation with project performance. The findings of this study are useful in helping construction stakeholders benchmark the team effectiveness factors that will guarantee project success.

Keywords: construction, critical success factors, performance, stakeholders, team effectiveness

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Authors: Sutan Emir Hidayat, Latifa Hassan Al-Qassab

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The purpose of this study is to examine depositors’ awareness on the pursuit of corporate social responsibilities (CSR) conducted by Islamic retail banks in the Kingdom of Bahrain according to the Accounting and Auditing Organization for Islamic Financial Institutions (AAOIFI) standards. The outcome of the paper is the extent to which the depositors knew about the banks’ CSR activities in promoting the welfare of the society beyond their business objectives. The study covered all Islamic retail banks in the Kingdom of Bahrain where a survey questionnaire was distributed to a total of 200 Islamic banks' depositors. The results of the survey show that the level of depositors’ awareness is limited on the pursuit of corporate social responsibilities by the banks as indicated by the small number of statements in the survey questionnaire which the respondents agreed to or of which they had satisfactory knowledge. The significant statistical difference in the respondents' answers to the survey questionnaire when they are grouped according to their respective banks prove that the level of depositors’ awareness on the pursuit of corporate social responsibilities varies considerably among the six Islamic retail banks in the kingdom. The findings of the study might be used to assist the policy makers in the field of CSR of Islamic financial institutions in formulation of better CSR activities and in delivering better services for the public welfare. The study also might help Islamic banks in the kingdom to set up strategy in order to increase the level of depositors’ awareness on their CSR activities.

Keywords: corporate social responsibilities, awareness, Islamic banks, Bahrain

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Authors: Muhammad Mustaqeem, Musa Kaleem Baloch, Irfan Ullah, Ammarah Luqman, Afshan Ahmad

Abstract:

Flurbiprofen is one of the most potent nonsteroidal anti-inflammatory drugs. It is widely used for relief of pain in patients suffering from rheumatic diseases, migraine, sore throat and primary dysmenorrhea. However, its aqueous solubility is very low and hinders the skin permeation. Thus, it is imperative to develop such a drug delivery systems which can improve its aqueous solubility and hence improve the skin permeation and therapeutic compliance. Microemulsions have been also proven to increase the cutaneous absorption of lipophilic drugs as compared to conventional vehicles. Micro-emulsion is thermodynamically stable emulsion that has the capacity to ‘hide/solubilize’ water-insoluble molecules within a continuous oil phase. Therefore, flurbiprofen was converted to Easters through chemical reactions with alcohols such as methanol, ethanol, propanol and butanol. The product was further treated with hydrazine to get hydrazide. The solubility of the parent drug Flurbiprofen and the products were solubilized in microemulsions formed using various surfactants like ionic, non-ionic and zwitterions. It has been concluded that the product was more soluble than the parent compound. The biological activities of these were also investigated. The outcome was very promising and the product was more active than the parent compound. It, therefore, concluded that in this way, we can not only enhance the solubility of the drug and increase its bioactivity, but also reduce the risk of stomach cancer.

Keywords: Flurbiprofen, microemulsion, surfactants, hyrazides

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Authors: Abdullah I. Alkraiji, Thomas W. Jackson, Ian Murray

Abstract:

The proliferation of health data standards today is somewhat overlapping and conflicting, resulting in market confusion and leading to increasing proprietary interests. The government role and support in standardization for health data are thought to be crucial in order to establish credible standards for the next decade, to maximize interoperability across the health sector, and to decrease the risks associated with the implementation of non-standard systems. The normative literature missed out the exploration of the different steps required to be undertaken by the government towards the development of national health data standards. Based on the lessons learned from a qualitative study investigating the different issues to the adoption of health data standards in the major tertiary hospitals in Saudi Arabia and the opinions and feedback from different experts in the areas of data exchange and standards and medical informatics in Saudi Arabia and UK, a list of steps required towards the development of national health data standards was constructed. Main steps are the existence of: a national formal reference for health data standards, an agreed national strategic direction for medical data exchange, a national medical information management plan and a national accreditation body, and more important is the change management at the national and organizational level. The outcome of this study can be used by academics and practitioners to develop the planning of health data standards, and in particular those in developing countries.

Keywords: interoperabilty, medical data exchange, health data standards, case study, Saudi Arabia

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Authors: Mária Hudáková, Mária Lusková

Abstract:

This report is focused on widening the theoretical knowledge as well as controlling practical application from the risk management point of view, regarding to dynamic business changes that have occurred in Slovakia which recently has been considered to be an environment full of risk and uncertainty. The idea of the report is the proposal of the controlling operation model in the course of risk management process in an enterprise operating in Slovakia, by which the controller is able to identify early risk factors in suggested major areas of the business management upon appropriate business information integration, consecutive control and prognoses and to prepare in time full-value documents in order to suggest measures for reduction thereof. Dealing with risk factors, that can quickly limit the growth potential of the enterprise, is an essential part of managerial activities on each level. This is the reason why mutual unofficial, ergo collegial cooperation of individual departments is necessary for controlling application from the business risk management point of view. An important part of the report is elaborated survey of the most important risk factors existing in major management areas of enterprises operating in Slovakia. The outcome of the performed survey is a catalogue of the most important enterprise risk factors. The catalogue serves for better understanding risk factors affecting the Slovak enterprises, their importance and evaluation.

Keywords: controlling, information, risks, risk factor, crisis

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