Search results for: environmental cases

Authors: Christopher Leung, Guillermo Becerril-Martinez

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Amyloidosis is a rare systemic disease where abnormal proteins invade various organs and impede their function. Occasionally, they can manifest in a solidary organ such as the heart, lung, and nervous systems; rarely do they manifest in the gallbladder. Diagnosis often requires biopsy of the affected area and histopathology shows deposition of abnormally folded globular proteins called amyloid proteins. This case presents a 69-year-old male with a 3-month history of RUQ pain, diarrhea and non-specific symptoms of tiredness, etc. On imaging, both his US and CT abdomen showed gallbladder wall thickening and pericholecystic fluid, which may represent acute cholecystitis with hypodense lesions around the gallbladder, possibly representing liver abscesses. Given his symptoms of abdominal pain and imaging findings, this gentleman eventually had a laparoscopic cholecystectomy showing a gangrenous gallbladder with a mass on the liver bed. On histopathology, it showed amorphous hyaline eosinophilic material, which Congo-stained confirmed amyloidosis. Amyloidosis explained his non-specific symptoms, he avoided further biopsy, and he was commenced immediately on Lenalidomide. Involvement of the gallbladder is extremely rare, with less than 30 cases around the world. Half of the cases are reported as primary amyloidosis. This case adds to the current literature regarding primary gallbladder amyloidosis. Importantly, this case highlights how laparoscopic cholecystectomy can help with the diagnosis of gallbladder amyloidosis.

Keywords: amyloidosis, cholecystitis, gangrenous cholecystitis, gallbladder, systemic amyloidosis

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Authors: Seiyaboh E. I.

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Water Hyacinth (Eichhornia crassipes) was introduced into many parts of the world, including Africa, as an ornamental garden pond plant because of its beauty. However, it is considered a dangerous pest today because when not controlled, water hyacinth will cover rivers, lakes and ponds entirely; this dramatically impacts water flow, blocks sunlight from reaching native aquatic plants, and starves the water of oxygen, often killing fish and other aquatic organisms. In the Niger Delta region, water hyacinth is considered a nuisance because of its very obvious devastating environmental impacts in the region. However, water hyacinth (Eichhornia crassipes) constitutes a very important part of an aquatic ecosystem. It possesses specialized growth habits, physiological characteristics and reproductive strategies that allow for rapid growth and spread in freshwater environments and this explains its very rapid spread in the Niger Delta freshwater ecosystem. This paper therefore focuses on the environmental consequences of the proliferation of water hyacinth (Eichhornia crassipes) in the Niger Delta freshwater ecosystem, extent of impact, and options available for its ecological utilization which will help mitigate proliferation, restore effective freshwater ecosystem utilization and balance. It concludes by recommending sustainable practices outlining the beneficial uses of water hyacinth (Eichhornia crassipes) rather than control.

Keywords: environmental impacts, ecological utilization, Niger Delta, water hyacinth, Eichhornia crassipes

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Authors: Radah Yousuf, Ashraf Shebl

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Suicide is a tragic event with strong emotional repercussions for its survivors and for families of its victims. There were thousands of cases all over the world. There are many risk factors include mental disorders such as depression, and substance abuse, including alcoholism and use of benzodiazepines. Other suicides are impulsive acts due to stress such as from financial difficulties, troubles with relationships, or from bullying. The aim of work in this study is making a survey from archives of the suicidal cases, which had a medicolegal examination, in forensic medicine center in Al Madinah Almunawarah-KSA, for ten years in the period between 1428-1438h. In each case, some data are collected such as age, sex, time and place of an act, method of suicide, the presence of the witness, medical history. This study demonstrates that suicide is more common in male than female, and the 4th decade was the most period of age. The most common method of suicide was hanging followed by falling from the height. These results indicated that cultural and religious beliefs that discourage suicide and support self-preservation instinct, and suicide education programs provide information to students in high school, builds awareness, one of the most important issues in solving that problem. From the forensic view, circumstantial evidence of every forensic case must take and record, full history about the social, medical and psychological problems, attend the scene of death is a very important, complete medicolegal investigation for every case, and full autopsy with very skilled techniques and facilities can help in diagnosing what type of crimes.

Keywords: suicide, age, sex, hanging

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Authors: Jason Chen, Jennifer Chen, Shiyu Li

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We examine whether managerial ability (MA), the passing of Sarbanes-Oxley in 2002 (SOX), and corporate operational complexity affect the accuracy of environmental capital expenditure projections of the environmentally sensitive industries (ESI). Prior studies found that firms in the ESI manipulated their projected environmental capital expenditures as a tool to achieve corporate legitimation and suggested that human factors must be examined to determine whether they are part of the determinants. We use MA to proxy for the latent human factors to examine whether MA affects the accuracy of financial disclosures in the ESI. To expand Chen and Chen (2020), we further investigate whether (1) SOX and (2) firms with complex operations and financial reporting in conjunction with MA affect firms’ projection accuracy. We find, overall, that MA is positively correlated with firm’s projection accuracy in the annual 10-Ks. Furthermore, results suggest that SOX has a positive, yet temporary, effect on MA, and that leads to better accuracy. Finally, MA matters for firms with more complex operations and financial reporting to make less projection errors than their less-complex counterparts. These results suggest that MA is a determinant that affects the accuracy of environmental capital expenditure projections for the firms in the ESI.

Keywords: managerial ability, environmentally sensitive industries, sox, corporate operational complexity

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Authors: Binh Thanh Ta, Elizabeth Sturgiss

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Central to patient-centered care is the idea of treating a patient as a person and understanding their perspectives regarding their health conditions and care preferences. Surprisingly, little is known about how GPs can understand their patients’ perspectives. This paper addresses the challenge of understanding patient perspectives in behavior change consultations by adopting Conversation Analysis (CA), which is an empirical research approach that allows both researchers and the audience to examine patients’ perspectives as displayed in GP-patient interaction. To understand people’s perspectives, CA researchers do not rely on what they say but instead on how they demonstrate their endogenous orientations to social norms when they interact with each other. Underlying CA is the notion that social interaction is orderly by all means. (It is important to note that social orders should not be treated as exogenous sets of rules that predetermine human behaviors. Rather social orders are constructed and oriented by social members through their interactional practices. Also, note that these interactional practices are the resources shared by all social members). As CA offers tools to uncover the orderliness of interactional practices, it not only allows us to understand the perspective of a particular patient in a particular medical encounter but, more importantly, enables us to recognise the shared interactional practice for signifying a particular perspective. Drawing on the 10 video-recorded consultations on behavior change in primary care, we have discovered the orderliness of patient laughter when reporting health behaviors, which signifies their orientation to the problematic nature of the reported behaviors. Among 24 cases where patients reported their health behaviors, we found 19 cases in which they laughed while speaking. In the five cases where patients did not laugh, we found that they explicitly framed their behavior as unproblematic. This finding echoes the CA body research on laughter, which suggests that laughter produced by first speakers (as opposed to laughing in response to what has been said earlier) normally indicates some sort of problems oriented to the self (e.g. self-tease, self-depreciation, etc.). This finding points to the significance of understanding when and why patients laugh; such understanding would assist GPs to recognise whether patients treat their behavior as problematic or not, thereby producing responses sensitive to patient perspectives.

Keywords: patient centered care, laughter, conversation analysis, primary care, behaviour change consultations

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Authors: Shahul Hamid Khan, S. Santhosh, Abhinav Kumar Sharma

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Environmental performance along with social performance is becoming vital factors for industries to achieve global standards. With a good environmental policy global industries are differentiating them from their competitors. This paper concentrates on multi stage, multi product and multi period manufacturing network. Bi-objective mathematical models for total cost and total emission for the entire forward supply chain are considered. Here five different problems are considered by varying the number of suppliers, manufacturers, and environmental levels, for illustrating the taken mathematical model. GA, and Random search are used for finding the optimal solution. The input parameters of the optimal solution are used to find the tradeoff between the initial investment by the industry and the long term benefit of the environment.

Keywords: closed loop supply chain, genetic algorithm, random search, green supply chain

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Authors: Begum Rokeya, Rahelee Zinnat, Fatema Jebunnesa, Israt Ara Hossain, A. Rahman

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Background and Aims: Arsenic in drinking water is a global environmental health problem, and the exposure may increase dyslipidemia and cerebrovascular diseases mortalities, most likely through causing atherosclerosis. However, the mechanism of lipid metabolism, atherosclerosis formation, arsenic exposure and impact in pregnancy is still unclear. Recent epidemiological evidences indicate close association between inorganic arsenic exposure via drinking water and Dyslipidemia. However, the exact mechanism of this arsenic-mediated increase in atherosclerosis risk factors remains enigmatic. We explore the association of the effect of arsenic on serum lipid profile in pregnant subjects. Methods: A total 200 pregnant mother screened in this study from arsenic exposed area. Our study group included 100 exposed subjects were cases and 100 Non exposed healthy pregnant were controls requited by a cross-sectional study. Clinical and anthropometric measurements were done by standard techniques. Lipidemic status was assessed by enzymatic endpoint method. Urinary As was measured by inductively coupled plasma-mass spectrometry and adjusted with specific gravity and Arsenic exposure was assessed by the level of urinary arsenic level > 100 μg/L was categorized as arsenic exposed and < 100 μg/L were categorized as non-exposed. Multivariate logistic regression and Student’s t - test was used for statistical analysis. Results: Systolic and diastolic blood pressure both were significantly higher in the Arsenic exposed pregnant subjects compared to the Non-exposed group (p<0.001). Arsenic exposed subjects had 2 times higher chance of developing hypertensive pregnancy (Odds Ratio 2.2). In parallel to the findings in Ar exposed subjects showed significantly higher proportion of triglyceride and total cholesterol and low density of lipo protein when compare to non- arsenic exposed pregnant subjects. Significant correlation of urinary arsenic level was also found with SBP, DBP, TG, T chol and serum LDL-Cholesterol. On multivariate logistic regression showed urinary arsenic had a positive association with DBP, SBP, Triglyceride and LDL-c. Conclusion: In conclusion, arsenic exposure may induce dyslipidemia like atherosclerosis through modifying reverse cholesterol transport in cholesterol metabolism. For decreasing atherosclerosis related mortality associated with arsenic, preventing exposure from environmental sources in early life is an important element.

Keywords: Arsenic Exposure, Dyslipidemia, Gestational Diabetes Mellitus, Serum lipid profile

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Authors: Thea Freese, Michael Gille, Andrew Hursthouse, John Struthers

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Ship operators on the North and Baltic Sea have been experiencing increased political interest in marine environmental protection and cleaner vessel operations. Stricter legislation on SO2 and NOx emissions, ballast water management and other measures of protection are currently being phased in or will come into force in the coming years. These measures benefit the health of the marine environment, while increasing company’s operational costs. In times of excess shipping capacity and linked consolidation in the industry non-compliance with environmental rules is one way companies might hope to stay competitive with both intra- and inter-modal trade. Around 5-15% of industry participants are believed to neglect laws on vessel-source pollution willingly or unwillingly. Exploratory in-depth interviews conducted with 12 experts from various stakeholder groups informed the researchers about variables influencing compliance levels, including awareness and apprehension, willingness to comply, ability to comply and effectiveness of controls. Semi-structured expert interviews were evaluated using qualitative content analysis. A model of determinants of compliance was developed and is presented here. While most vessel operators endeavour to achieve full compliance with environmental rules, a lack of availability of technical solutions, expediency of implementation and operation and economic feasibility might prove a hindrance. Ineffective control systems on the other hand foster willing non-compliance. With respect to motivations, lacking time, lacking financials and the absence of commercial advantages decrease compliance levels. These and other variables were inductively developed from qualitative data and integrated into a model on environmental compliance. The outcomes presented here form part of a wider research project on economic effects of maritime environmental legislation. Research on determinants of compliance might inform policy-makers about actual behavioural effects of shipping companies and might further the development of a comprehensive legal system for environmental protection.

Keywords: compliance, marine environmental protection, exploratory qualitative research study, clean vessel operations, North and Baltic Sea area

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Authors: Aamna Tufail, Catherine Anyanwu

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Introduction/Aims: Neurosensory deficits following third molar removal affect the quality of life markedly. The purpose of this audit was to evaluate the incidence of IDN and LN damage and to compare departmental rates to an established standard. A secondary objective was to provide a descriptive summary of identified cases for clinical learning. Materials and Methods: A retrospective audit was conducted by a telephone survey of 101 patients who had third molar extractions performed under LA, IVS, or GA from January 2019 to June 2020 at a District General Hospital. The results were compared to a clinical standard identified as Cheng et al1. Data collection included mode of surgery, mode of anaesthesia, grade of clinician, assessment of difficulty, severity, and duration of symptoms. Results/Statistics: A total of 101 patients had 136 third molars extracted. Age range was 18-84 years. 44% extractions were under LA, 52% under GA, and 4% under IV sedation. 30% were simple extractions, 68% were surgical removals, 2% were unspecified. 89% extractions were performed by an Associate Specialist, 5% by a consultant, and 6% by unspecified grade of clinician. The rate of IDN injuries was 2.9% (n=4), higher than standard (0.3%). The rate of LN injuries was 0.7% (n=1), same as standard (0.7%). The 5 cases of neurosensory deficits are discussed in detail. Conclusions/Clinical Relevance: The rate of ID nerve injuries was higher than the standard. The rate of LN complications was lower than the standard.

Keywords: inferior dental nerve, lingual nerve, nerve injuries, third molars

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Authors: Fernanda M. Assef, Maria Teresinha A. Steiner, David Gabriel F. Barros

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Review researches are useful in terms of analysis of research problems. Between the types of review documents, we commonly find bibliometric studies. This type of application often helps the global visualization of a research problem and helps academics worldwide to understand the context of a research area better. In this document, a bibliometric view surrounding clustering techniques and sustainability problems is presented. The authors aimed at which issues mostly use clustering techniques, and, even which sustainability issue would be more impactful on today’s moment of research. During the bibliometric analysis, we found ten different groups of research in clustering applications for sustainability issues: Energy; Environmental; Non-urban planning; Sustainable Development; Sustainable Supply Chain; Transport; Urban Planning; Water; Waste Disposal; and, Others. And, by analyzing the citations of each group, we discovered that the Environmental group could be classified as the most impactful research cluster in the area mentioned. Now, after the content analysis of each paper classified in the environmental group, we found that the k-means technique is preferred for solving sustainability problems with clustering methods since it appeared the most amongst the documents. The authors finally conclude that a bibliometric assessment could help indicate a gap of researches on waste disposal – which was the group with the least amount of publications – and the most impactful research on environmental problems.

Keywords: bibliometric assessment, clustering, sustainability, territorial partitioning

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Authors: Taha Almarayhe

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This study addresses the gap in understanding the effect of environmental, social, and governance (ESG) practices on firm performance within the Middle East and North Africa (MENA) region. Using a sample of 340 publicly traded firms across ten MENA countries (2007–2017) and employing ordinary least squares (OLS) regression, the study evaluates how ESG ratings impact both accounting-based performance measures—such as return on assets (ROA), return on equity (ROE), and earnings per share (EPS)—and market-based measures like Tobin’s Q and dividend yield. Results reveal that ESG ratings positively and significantly influence financial performance, particularly in countries with strong regulatory environments. This research contributes empirical insights to the literature on ESG’s financial impact, particularly by comparing cross-country data within the MENA region. It provides valuable guidance for investors and managers aiming to enhance financial outcomes through sustainable business practices.

Keywords: ESG ratings, financial performance, MENA countries, environmental disclosures

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Authors: Kherbache Radhwane

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We currently live in the world pressed by technological developments necessary for the construction, where the concept of sustainable development is truly rooted in recent years. Construction or demolitions of buildings necessarily generate environmental pollution, both inside and outside the site. Depending on the size and nature of work and the context surrounding these problems can be more or less important as is the case here in Algeria. They may affect the smooth running of the site. Moreover, there are regulations exist or are under development and should be taken into account by the various players in the act of building. This is, for example, the case of new obligations in terms of sorting and recycling of construction waste. Given this situation, it appears increasingly necessary to integrate the building sites in an effort to better respect the environment and its regulation. Several operations were performed according to this principle. The success of a project is that respects its environment through the involvement of each actor of the operation of the site with a low nuisance. As such, the client assisted by his driver and its operating contractor and the company plays a central role as an initiator of the process. It must ensure the establishment of appropriate means of organizational plans and contract.

Keywords: evolution, sustainable development, construction, demolition, building, nuisance, environmental, tailings, construction, regulations

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Authors: Maryamsadat Habibi

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Objective: pharmaceutical errors are avoidable occurrences that can result in inappropriate pharmaceutical use, patient harm, treatment failure, increased hospital costs and length of stay, and other outcomes that affect both the individual receiving treatment and the healthcare provider. This study aimed to perform a reconciliation of medications in the cardiovascular ward of Imam Reza Hospital in Mashhad, Iran, and evaluate the prevalence of medication discrepancies between the best medication list created for the patient by the pharmacist and the medication order of the treating physician there. Materials & Methods: The 97 patients in the cardiovascular ward of the Imam Reza Hospital in Mashhad were the subject of a cross-sectional study from June to September of 2021. After giving their informed consent and being admitted to the ward, all patients with at least one underlying condition and at least two medications being taken at home were included in the study. A medical reconciliation form was used to record patient demographics and medical histories during the first 24 hours of admission, and the information was contrasted with the doctors' orders. The doctor then discovered medication inconsistencies between the two lists and double-checked them to separate the intentional from the accidental anomalies. Finally, using SPSS software version 22, it was determined how common medical discrepancies are and how different sorts of discrepancies relate to various variables. Results: The average age of the participants in this study was 57.6915.84 years, with 57.7% of men and 42.3% of women. 95.9% of the patients among these people encountered at least one medication discrepancy, and 58.9% of them suffered at least one unintentional drug cessation. Out of the 659 medications registered in the study, 399 cases (60.54%) had inconsistencies, of which 161 cases (40.35%) involved the intentional stopping of a medication, 123 cases (30.82%) involved the stopping of a medication unintentionally, and 115 cases (28.82%) involved the continued use of a medication by adjusting the dose. Additionally, the category of cardiovascular pharmaceuticals and the category of gastrointestinal medications were found to have the highest medical inconsistencies in the current study. Furthermore, there was no correlation between the frequency of medical discrepancies and the following variables: age, ward, date of visit, type, and number of underlying diseases (P=0.13), P=0.61, P=0.72, P=0.82, P=0.44, and so forth. On the other hand, there was a statistically significant correlation between the number of medications taken at home (P=0.037) and the prevalence of medical discrepancies with gender (P=0.029). The results of this study revealed that 96% of patients admitted to the cardiovascular unit at Imam Reza Hospital had at least one medication error, which was typically an intentional drug discontinuance. According to the study's findings, patients admitted to Imam Reza Hospital's cardiovascular ward have a great potential for identifying and correcting various medication discrepancies as well as for avoiding prescription errors when the medication reconciliation method is used. As a result, it is essential to carry out a precise assessment to achieve the best treatment outcomes and avoid unintended medication discontinuation, unwanted drug-related events, and drug interactions between the patient's home medications and those prescribed in the hospital.

Keywords: drug combination, drug side effects, drug incompatibility, cardiovascular department

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Authors: Monica Anumula

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Nowadays human beings attain comfort zone artificially for heating, cooling and lighting the spaces they live, and their main importance is given to aesthetics of building and they are not designed to protect themselves from climate. They depend on artificial sources of energy resulting in energy wastage. In order to reduce the amount of energy being spent in the construction industry and Energy Package goals by 2020, new ways of constructing houses is required. The larger part of energy consumption of a building is directly related to architectural aspects hence nature has to be integrated into the building design to attain comfort zone and reduce the dependency on artificial source of energy. The research is to develop bioclimatic design strategies and techniques for the walls and roofs of Vijayawada houses. Study and analysis of design strategies and techniques of various cases like Kerala, Mangalore etc. for similar kind of climate is examined in this paper. Understanding the vernacular architecture and modern techniques of that various cases and implementing in the housing of Vijayawada not only decreases energy consumption but also enhances socio cultural values of Vijayawada. This study focuses on the comparison of vernacular techniques and modern building bio climatic strategies to attain thermal comfort and energy reduction in hot and humid climate. This research provides further thinking of new strategies which include both vernacular and modern bioclimatic techniques.

Keywords: bioclimatic design, energy consumption, hot and humid climates, thermal comfort

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Authors: Luljeta Gashi, Naser Ramadani, Zana Deva, Dafina Gexha-Bunjaku

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The official HIV/AIDS data in Kosovo are based on HIV case reporting from health-care services, the blood transfusion system and Voluntary Counselling and Testing centres. Between 1986 and 2014, are reported 95 HIV and AIDS cases, of which 49 were AIDS, 46 HIV and 40 deaths. The majority (69%) of cases were men, age group 25 to 34 (37%) and route of transmission is: heterosexual (90%), MSM (7%), vertical transmission (2%) and IDU (1%). Based on existing data and the UNAIDS classification system, Kosovo is currently still categorised as having a low-level HIV epidemic. Even though with a low HIV prevalence, Kosovo faces a number of threatening factors, including increased number of drug users, a stigmatized and discriminated MSM community, high percentage of youth among general population (57% of the population under the age of 25), with changing social norms and especially the sexual ones. Methods: Data collection was done using self administered structured questionnaires amongst 249 high school students. Data were analysed using the Statistical Package for Social Sciences (SPSS). Results: The findings revealed that 68% of students know that HIV transmission can be reduced by having sex with only one uninfected partner who has no other partners, 94% know that the risk of getting HIV can be reduced by using a condom every time they have sex, 68% know that a person cannot get HIV from mosquito bites, 81% know that they cannot get HIV by sharing food with someone who is infected and 46% know that a healthy looking person can have HIV. Conclusions: Seventy one percent of high school students correctly identify ways of preventing the sexual transmission of HIV and who reject the major misconceptions about HIV transmission. The findings of the study indicate a need for more health education and promotion.

Keywords: Kosovo, KPAR, HIV, high school

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Authors: Bharat Rawat, Shekhar Rajbhandari, Yadav Bhatta, Jay Prakash Jaiswal, Shivaji Bikram Silwal, Rajiv Shrestha, Shova Sunuwar

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Introduction: The honey produced by the bees fed on Rhobdodendron species containing grayanotoxin is known as mad honey. Grayanotoxin is found in honey obtained from the nectar of Rhododendron species growing on the mountains of the Black Sea region of Turkey and also in Japan, Nepal, Brazil, parts of North America, and Europe. Although the incidence of grayanotoxin poisoning is rare, there is concern that the number of cases per year will rise with the increasing demand for organic products. Mad honey intoxication might present with mild symptoms of cardiovascular, gastrointestinal and neurological systems or might also present with a life-threatening form with AV block and cardiovascular collapse. In this article, we describe the summary of five cases, which came to our hospital with mad honey related cardiac complications. Findings: In last one year, five cases presented in the emergency department with sudden onset of Loss of consciousness, dizziness, shortness of breath. They felt difficulty after the consumption of 1-3 teaspoonful of wild honey. The honey was brought from most of the rural parts of Nepal like khotang. Some of them also came with vomiting, dizziness, and loose stool. On examination, most of them had severe bradycardia and low blood pressure. No abnormalities were detected on systemic examinations. In one patient, ECG and cardiac enzymes showed features of the acute coronary syndrome, but his treadmill test done few days later was normal. All patients were managed with inj. Atropine, I/V normal saline, and other supportive measures and discharged in a stable condition within one or two days. Conclusions: Rhododendrons is the national flower of Nepal. The specific species of rhododendron found in Nepal which contains the toxin is not known. Bees feeding on these rhododendrons are known to transfer the grayanotoxin to the honey they produce. Most symptoms are mild and resolve themselves without medical intervention. Signs and symptoms of grayanotoxin poisoning rarely last more than 24 hours and are usually not fatal. Some signs of mad honey poisoning include Bradycardia, Cardiac arrhythmia, Hypotension, Nausea and Vomiting. They respond to close monitoring and appropriate supportive treatment. Normally, patients recover completely with no residual damage to the heart or its conduction system.

Keywords: rhobdodendron, honey, grayanotoxin, bradycardia

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Authors: Kalyan Kumar Moulick

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In this paper the author studied the possibilities of using Rice Husk Ash (RHA) available in India; to produce concrete. The effect of RHA on concrete discussed. Traditional uses of Rice Husk in India pointed out and the advantages of using RHA in making concrete highlighted. Suggestion provided regarding prospective application of RHA concrete in India which in turn will definitely reduce the cost of concrete and environmental friendly due to utilization of waste and replacement of Cement.

Keywords: cement replacement, concrete, environmental friendly, rice husk ash

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Authors: H. Ozbasaran

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Lateral torsional buckling is a global stability loss which should be considered in the design of slender structural members under flexure about their strong axis. It is possible to compute the load which causes lateral torsional buckling of a beam by finite element analysis, however, closed form equations are needed in engineering practice. Such equations can be obtained by using energy method. Unfortunately, this method has a vital drawback. In lateral torsional buckling applications of energy method, a proper function for the critical lateral torsional buckling mode should be chosen which can be thought as the variation of twisting angle along the buckled beam. The accuracy of the results depends on how close is the chosen function to the exact mode. Since critical lateral torsional buckling mode of the cantilever I-beams varies due to material properties, section properties, and loading case, the hardest step is to determine a proper mode function. This paper presents an approximate function for critical lateral torsional buckling mode of doubly symmetric cantilever I-beams. Coefficient matrices are calculated for the concentrated load at the free end, uniformly distributed load and constant moment along the beam cases. Critical lateral torsional buckling modes obtained by presented function and exact solutions are compared. It is found that the modes obtained by presented function coincide with differential equation solutions for considered loading cases.

Keywords: buckling mode, cantilever, lateral-torsional buckling, I-beam

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Authors: Aadil Khan, Yasser Chomayil, P. P. Venugopalan

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Background: Budd-Chiari syndrome is caused by thrombosis of the hepatic veins and/or the thrombosis of the intrahepatic or suprahepatic IVC. The etiology remains idiopathic in 16% -35% of cases. Malignancy, rheumatological disorder, myeloproliferative disease, inheritable coagulopathy, infection or hyperestrogen state can be identified in many cases. Methodology: Review of case records of the patient presented to Aster Medcity, Emergency Department, Cochin. Introduction:17 years old female was presented to ED with fever, jaundice and abdominal distention since 1 week. O/E: Pallor+, icterus+. Abdomen- gross distension+, shifting dullness+, generalized anasarca+. USG abdomen showed hepatomegaly with mild coarse echotexture and moderate to gross ascites. CT abdomen and chest showed hepatomegaly with thrombosis of all three hepatic vein and moderate ascites suggestive of Budd-Chiari syndrome. Patient was taken for catheter vein thrombolysis. Venogram done the next day revealed almost > 50% opening of the right hepatic vein. Concurrent doppler showed colour and doppler signals in middle hepatic veins. She gradually improved and was discharged home on anticoagulant and adviced regular follow up. Conclusion: Being a rare disease in this young population, high suspicion is required when evaluating young patients with abdominal pain and jaundice.

Keywords: Budd-Chiari syndrome, rare disease, abdominal pain, India

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Authors: Julie A. Baldwin, Robert T. Trotter, Mark Remiker, C. Loren Buck, Amanda Aguirre, Trudie Milner, Emma Torres, Frank A. von Hippel

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Introduction: In the past, there have been concerns about contaminants in the water sources in Yuma, Arizona, including the Colorado River. Prolonged exposure to contaminants, such as perchlorate and heavy metals, can lead to deleterious health effects in humans. This project examined the association between the concentration of environmental contaminants and patient health outcomes in Yuma residents, using a community-engaged approach to data collection. Methods: A community-engaged design allowed community partners and researchers to establish joint research goals, recruit participants, collect data, and formulate strategies for dissemination of findings. Key informant interviews were conducted to evaluate adherence to models of community-based research. Results: The training needs, roles, and expectations of community partners varied based on available resources, prior research experience, and perceived research challenges and ways to address them. Conclusions: Leveraging community-engaged approaches for studies of environmental contamination in marginalized communities can expedite recruitment efforts and stimulate action that can lead to improved community health.

Keywords: community engaged research, environmental contaminants, underserved populations, health equity

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Authors: Farrin Nayebzadeh, Mohammadreza Eslami Amirabadi

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According to technological progress and urban development, the cities of the world are growing to become metropolitans, living in which can be enthusiastic, entertaining and accessibility to the facilities like education, economic factors, hygiene and welfare is high. On the other hand, there are some problems that have been ignored in planning for such high quality of life, most important of which, is human health. Two aspects of human health are physical health and mental health, that are closely associated. Human mental health depends on two important factors: Biological factor and environmental factor. Air pollution is one of the most important environmental risk factors that affects mental health. Psychological and toxic effects of air pollution can lead to psychiatric symptoms, including anxiety and changes in mood, cognition, and behavior, depression and also children's mental disorders like hyperactivity, aggression and agitation. Increased levels of some air pollutants are accompanied by an increase in psychiatric admissions and emergency calls and, in some studies, by changes in behavior and a reduction in psychological well-being. Numerous toxic pollutants interfere with the development and adult functioning of the nervous system. Psychosocial stress can cause symptoms similar to those of organic mental disorders. These factors can cause resonance of psychiatric disorders. So, in cities of developing countries, people challenge with mental health problems due to environmental factors especially air pollution that have not been forecasted in urban planning.

Keywords: air pollution, environmental factors, mental health, psychiatric disorder

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Authors: Babak Nematshahrbabaki, Fallahi Arezoo

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Objective: The aim of this study was to describe teenagers’ decisions to undergo orthodontic treatment through a qualitative study. Materials and methods: Twenty-three patients (12 girls), aged 12–18 years, at a dental clinic in Sanandaj the western part of Iran participated. Face-to-face and semi-structured interviews and two focus group discussions were held to gather data. Data analyzed by the grounded theory method. Results: ‘Decision-making’ was the core category. During the data analysis four main themes were developed: ‘being like everyone else’, ‘being diagnosed’, ‘maintaining the mouth’ and ‘cultural-social and environmental factors’. Conclusions: cultural- social and environmental factors have crucial role in decision-making to undergo orthodontic treatment. The teenagers were not fully conscious of these external influences. They thought their decision to undergo orthodontic treatment is independent while it is related to cultural- social and environmental factors.

Keywords: decision-making, qualitative study, teenager, orthodontic treatment

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Authors: Shruti Malviya, Chris Bowler

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Environmental processes acting at multiple spatial scales control marine diatom community structure. However, the contribution of local factors (e.g., temperature, salinity, etc.) in these highly complex systems is poorly understood. We, therefore, investigated the diatom community organization as a function of environmental predictors and determined the relative contribution of various environmental factors on the structure of marine diatoms assemblages in the world’s ocean. The dataset for this study was derived from the Tara Oceans expedition, constituting 46 sampling stations from diverse oceanic provinces. The V9 hypervariable region of 18s rDNA was organized into assemblages based on their distributional co-occurrence. Using Ward’s hierarchical clustering, nine clusters were defined. The number of ribotypes and reads varied within each cluster-three clusters (II, VIII and IX) contained only a few reads whereas two of them (I and IV) were highly abundant. Of the nine clusters, seven can be divided into two categories defined by a positive correlation with phosphate and nitrate and a negative correlation with longitude and, the other by a negative correlation with salinity, temperature, latitude and positive correlation with Lyapunov exponent. All the clusters were found to be remarkably dominant in South Pacific Ocean and can be placed into three classes, namely Southern Ocean-South Pacific Ocean clusters (I, II, V, VIII, IX), South Pacific Ocean clusters (IV and VII), and cosmopolitan clusters (III and VI). Our findings showed that co-occurring ribotypes can be significantly associated into recognizable clusters which exhibit a distinct response to environmental variables. This study, thus, demonstrated distinct behavior of each recognized assemblage displaying a taxonomic and environmental signature.

Keywords: assemblage, diatoms, hierarchical clustering, Tara Oceans

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Authors: Alicja Kot-Niewiadomska

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Securing sustainable access to raw materials is vital for the growth of the European economy and for the goals laid down in Strategy Europe 2020. One of the most important sources of mineral raw materials are primary deposits. The efficient management of them, including extraction, will ensure competitiveness of the European economy. A critical element of this approach is mineral deposits safeguarding and the most important tool - spatial planning. The safeguarding of deposits should be understood as safeguarding of land access, and safeguarding of area against development, which may (potential) prevent the use of the deposit and the necessary mining activities. Many European Union countries successfully integrated their mineral policy and spatial policy, which has ensured the proper place of mineral deposits in their spatial planning systems. These, in turn, are widely recognized as the most important mineral deposit safeguarding tool, the essence of which is to ensure long-term access to its resources. The examples of Austria, Portugal, Slovakia, Czech Republic, Sweden, and the United Kingdom, discussed in the paper, are often mentioned as examples of good practices in this area. Although none of these countries managed to avoid cases of social and environmental conflicts related to mining activities, the solutions they implement certainly deserve special attention. And for many countries, including Poland, they can be a potential source of solutions aimed at improving the protection of mineral deposits.

Keywords: mineral deposits, land use planning, mineral deposit safeguarding, European practices

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Authors: Madhusudana S. N., Reeta Mani, Ashwini S. Satishchandra P., Netravati, Udhani V., Fiaz A., Karande S.

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Rabies is an acute encephalitis which is considered 100% fatal despite occasional reports of survivors. However, in recent times more cases of human rabies survivors are being reported. In the last 5 years, there are six laboratories confirmed human rabies survivors in India alone. All cases were children below 15 years and all contracted the disease by dog bites. All of them also had received the full or partial course of rabies vaccination and 4 out of 6 had also received rabies immunoglobulin. All cases were treated in intensive care units in hospitals at Bangalore, Mumbai, Chandigarh, Lucknow and Goa. We report here the results of immunological and virological studies conducted at our laboratory on these patients. The clinical samples that were obtained from these patients were Serum, CSF, nuchal skin biopsy and saliva. Serum and CSF samples were subjected to standard RFFIT for estimation of rabies neutralizing antibodies. Skin biopsy, CSF and saliva were processed by TaqMan real-time PCR for detection of viral RNA. CSF, saliva and skin homogenates were also processed for virus isolation by inoculation of suckling mice. The PBMCs isolated from fresh blood was subjected to ELISPOT assay to determine the type of immune response (Th1/Th2). Both CSF and serum were also investigated for selected cytokines by Luminex assay. The level of antibodies to virus G protein and N protein were determined by ELISA. All survivors had very high titers of RVNA in serum and CSF 100 fold higher than non-survivors and vaccine controls. A five-fold rise in titer could be demonstrated in 4 out of 6 patients. All survivors had a significant increase in antibodies to G protein in both CSF and serum when compared to non-survivors. There was a profound and robust Th1 response in all survivors indicating that interferon gamma could play an important factor in virus clearance. We could isolate viral RNA in only one patient four years after he had developed symptoms. The partial N gene sequencing revealed 99% homology to species I strain prevalent in India. Levels of selected cytokines in CSF and serum did not reveal any difference between survivors and non-survivors. To conclude, survival from rabies is mediated by virus-specific immune responses of the host and clearance of rabies virus from CNS may involve the participation of both Th2 and Th1 immune responses.

Keywords: rabies, rabies treatment, rabies survivors, immune reponse in rabies encephalitis

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Authors: Leila H. Khiabani, Mohammadreza Vafaee, Farshad Hashemzadeh

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Industrial waste management regulates different stages of production, storage, transfer, recycling and waste disposal. There are several common practices for industrial waste management. However, due to various local health, economic, social, environmental and aesthetic considerations, the most optimal principles and measures often vary at each specific industrial zone. In addition, waste management strategies are heavily impacted by local administrative, legal, and financial regulations. In this study, a hybrid qualitative and quantitative research methodology has been designed for waste management planning in an industrial city. Firstly, following a qualitative research methodology, the most relevant waste management strategies for the specific industrial city were identified through interviews with environmental planning and waste management experts. Forty experts participated in this study. Alborz industrial city in Iran, which hosts more than one thousand industrial units in nine hundred acres, was chosen as the sample industrial city in this study. The findings from the expert interviews at the first phase were then used to design a quantitative questionnaire for the second phase of the study. The aim of the questionnaire was to quantify the relative impact of different waste management strategies in the sample industrial city. Eight waste management strategies and three implementation policies were included in the questionnaire. The experts were asked to rank the relative effectiveness of each strategy for environmental planning of the sample industrial city. They were also asked to rank the relative effectiveness of each planning policy on each of the waste management strategies. In the end, the weighted average of all the responses was calculated to identify the most effective waste management strategy and planning policies for the sample industrial city. The results suggested that among the eight suggested waste management strategies, industrial composting is the most effective (31%) strategy based on the collective evaluation of the local expert. Additionally, the results suggested that the most effective policy (58%) in the city’s environmental planning is to reduce waste generation by prolonging the effective life of industrial products using higher quality and recyclable materials. These findings can provide useful expert guidelines for prioritization between different waste management strategies in the city’s overall environmental planning roadmap. The findings may also be applicable to similar industrial cities. In addition, a similar methodology can be utilized in the environmental planning of other industrial cities.

Keywords: environmental planning, industrial city, quantitative research, waste management

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Authors: Ghada A. Gamea, Nabila A. Yaseen, Ahmed A. Othman, Ahmed S. Tawfik

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Infection with Toxoplasma gondii can cause serious complications in pregnant women, leading to abortion, stillbirth, and congenital anomalies in the fetus. Definitive diagnosis of T. gondii acute infection is therefore critical for the clinical management of a mother and her fetus. This study was conducted on 250 pregnant females in the first trimester who were inpatients or outpatients at Obstetrics and Gynaecology Department at Tanta University Hospital. Screening of the selected females was done for the detection of immunoglobulin (IgG and IgM), and all subjects were submitted to history taking through a questionnaire including personal data, risk factors for Toxoplasma, complaint and history of the present illness. Thirty-eight samples, including 18 IgM +ve and 20 IgM-ve cases were further investigated by the avidity and IgE ELISA tests. The seroprevalence of toxoplasmosis in pregnant women was (42.8%) based on the presence of IgG antibodies in their sera. Contact with cats and consumption of raw or undercooked meat are important risk factors that were associated with toxoplasmosis in pregnant women. By serology, it could be observed that in the IgM +ve group, only one case (5.6%) showed an acute pattern by using the avidity test, though 10 (55.6%) cases were found to be acute by the IgE assay. On the other hand, in the IgM –ve group, 3 (15%) showed low avidity, but none of them was positive by using the IgE assay. In conclusion, there is no single serological test that can be used to confirm whether T. gondii infection is recent or was acquired in the distant past. A panel of tests for detection of toxoplasmosis will certainly have higher discriminatory power than any test alone.

Keywords: diagnosis, serology, seroprevalence, toxoplasmosis

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Authors: Adel Fathy Sadek Abdalla

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The issue of respect for human rights in Southeast Asia has become a major concern and is attracting the attention of the international community. Basically, the Association of Southeast Asian Nations (ASEAN) made human rights one of its main issues and in the ASEAN Charter in 2008. Subsequently, the Intergovernmental Commission on Human Rights ASEAN Human Rights (AICHR) was established. AICHR is the Southeast Asia Human Rights Enforcement Commission charged with the responsibilities, functions and powers to promote and protect human rights. However, at the end of 2016, the protective function assigned to the AICHR was not yet fulfilled. This is shown by several cases of human rights violations that are still ongoing and have not yet been solved. One case that has recently come to light is human rights violations against the Rohingya people in Myanmar. Using a legal-normative approach, the study examines the urgency of establishing a human rights tribunal in Southeast Asia capable of making a decision binding on ASEAN members or guilty parties. Data shows ASEAN needs regional courts to deal with human rights abuses in the ASEAN region. In addition, the study also highlights three important factors that ASEAN should consider when establishing a human rights tribunal, namely: Volume. a significant difference in terms of democracy and human rights development among the members, a consistent implementation of the principle of non-interference and the financial issue of the continuation of the court.

Keywords: sustainable development, human rights, the right to development, the human rights-based approach to development, environmental rights, economic development, social sustainability human rights protection, human rights violations, workers’ rights, justice, security.

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Authors: Adebomi M. Oyewumi, Sunday Amaize

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The study was designed to examine the barriers to marital expectations among unmarried persons with hearing impairment in Oyo State, Nigeria. Descriptive survey research design was adopted. Purposive sampling technique was used to select one hundred participants made up forty-four (44) males and fifty-six (56) females, all with varying degrees of hearing impairment. Eight research questions were raised and answered. The instrument used was Marital Expectations Scale with reliability coefficient of 0.86. Data was analyzed using descriptive statistics tools of frequency count and simple percentage as well as inferential statistics tools of T-TEST and ANOVA. The findings revealed that there was a significant relationship existing among the main identified barriers (environmental barrier, communication barrier, hearing loss, unemployment and poor sexuality education) to the marital expectations of unmarried persons with hearing impairment. The joint contribution of the independent variables (identified barriers) to the dependent variable (marital expectations) was significant, F = 5.842, P < 0.05, accounting for about 89% of the variance. The relative contribution of the identified barriers to marital expectations of unmarried persons with hearing impairment is as follows: environmental barrier (β = 0.808, t = 5.176, P < 0.05), communication barrier (β = 0.533, t = 3.305, P < 0.05), hearing loss (β = 0.550, t = 2.233, P < 0.05), unemployment (β = 0.431, t = 2.102, P < 0.05), poor sexuality education (β = 0.361, t = 1.985, P < 0.05). Environmental barrier proved to be the most potent contributor to the poor marital expectations among unmarried persons with hearing impairment. Therefore, it is recommended that society dismantles the nagging environmental barrier through positive identification with individuals suffering from hearing impairment. In this connection, members of society should change their negative attitudes and do away with all the wrong notions about the marital ability of individuals with hearing impairment.

Keywords: environmental barrier, hearing impairment, marriage, marital expectations

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Authors: Chang Liu, Hanwen Zhang, Vikash Sharma, Don Eliseo Lucerno-Prisno III, Emmanuel Yujuico, Maulik Chokshi, Prashanthi Krishnakumar, Bach Xuan Tran, Giang Thu Vu, Kamilla Anna Pinter, Shenglan Tang

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Background and Aims: Globally, many health systems focus on hospital-based healthcare models targeting acute care and disease treatment, which are not effective in addressing the challenges of ageing populations, chronic conditions, multi-morbidities, and increasingly unhealthy lifestyles. Recently, integrated care programs on chronic diseases have been developed, piloted, and implemented to meet such challenges. However, integrated care programs in the Asia-Pacific region vary in the levels of integration from linkage to coordination to full integration. This study aims to identify and analyze existing cases of integrated care in the Asia-Pacific region and identify the facilitators and barriers in order to improve existing cases and inform future cases. Methods: The study is a comparative study, with a combination approach of desk-based research and key informant interviews. The selected countries included in this study represent a good mix of lower-middle income countries (the Philippines, India, Vietnam, and Fiji), upper-middle income country (China), and high-income country (Singapore) in the Asia-Pacific region. Existing integrated care programs were identified through the scoping review approach. Trigger, history, general design, beneficiaries, and objectors were summarized with barriers and facilitators of integrated care based on key informant interviews. Representative case(s) in each country were selected and comprehensively analyzed through deep-dive case studies. Results: A total of 87 existing integrated care programs on chronic diseases were found in all countries, with 44 in China, 21 in Singapore, 12 in India, 5 in Vietnam, 4 in the Philippines, and 1 in Fiji. 9 representative cases of integrated care were selected for in-depth description and analysis, with 2 in China, the Philippines, and Vietnam, and 1 in Singapore, India, and Fiji. Population aging and the rising chronic disease burden have been identified as key drivers for almost all the six countries. Among the six countries, Singapore has the longest history of integrated care, followed by Fiji, the Philippines, and China, while India and Vietnam have a shorter history of integrated care. Incentives, technologies, education, and performance evaluation would be crucial for developing strategies for implementing future programs and improve already existing programs. Conclusion: Integrated care is important for addressing challenges surrounding the delivery of long-term care. To date, there is an increasing trend of integrated care programs on chronic diseases in the Asia-Pacific region, and all six countries in our study set integrated care as a direction for their health systems transformation.

Keywords: integrated healthcare, integrated care delivery, chronic diseases, Asia-Pacific region

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