Search results for: ethical guidelines

Authors: Naif A. Haddad

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Greek, Hellenistic and Roman theatre heritage are exposed to multiple risks at varied times or simultaneously. There is no single reason why a theatre building becomes ‘at risk’, as each case has different circumstances which have led to the theatre building decay. There are complicated processes of destruction and distress that show divergence in theatre building materials' decay. Theatre modern use for cultural performances causes much of the risks concerning the physical structure and authenticity of theatre sites. In addition, there are some deterioration and deformations due to previous poor quality restorations and interventions through related excavation and conservation programmes as also risks to authenticity due to new additions. For preventive conservation, theatre natural and anthropogenic risks management can provide a framework for decision making. These risks to ancient theatre heritage may stem from exposure to one or more risk or synergy of many factors. We, therefore, need to link the theatre natural risks to the risks that come from anthropogenic factors associated with social and economic development. However, this requires a holistic approach, and systematic methodology for understanding these risks from various sources while incorporating specific actions, planning and strategies for each specific risk. Elaborating on recent relevant studies, and ERATO and ATHENA EU projects for ancient theaters and odea and general surveys, this paper attempts to discuss the main aspects of the ancient Greek, Hellenistic and Roman theatres risk related issues. Relevant case studies shall also be discussed and investigated to examine frameworks for risk mitigation, and related guidelines and recommendations that provide a systematic approach for sustainable management and planning in relation mainly to ‘compatible use’ of theatre sites.

Keywords: cultural heritage management, European ancient theatres projects, Anthropogenic risks mitigation, sustainable management and planning, preventive conservation, modern use, compatible use

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Authors: Yung Yau

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'Little people' are those who have extremely short stature as they suffer from rare bone diseases. They are commonly known as 'dwarves' or 'people with dwarfism'. Dwarfism is generally regarded as a type of rare disease for its extremely small odds (~1 in 15,000). On account of its rarity, dwarfism, unlike other types of disability, has attracted relatively little attention from the general public and in various academic fields (e.g. architecture, psychology and sociology) except medical science. In view of the extant research gaps, this study aims to investigate the physical barriers facing the little people in the built environment in Hong Kong. Between November 2017 and July 2018, ten little people or their family members participated in in-depth interviews. Responses of the interviewees were transcribed (i.e., speech being converted to text word for word). Interview data were then analyzed using the interpretative phenomenological analysis methodology developed by J. Smith and others in 2009. The findings of the project reveal that although Hong Kong's built environment has been designed barrier-free pursuant to the prevailing building standards, those standards do not cater to the special anthropometric characteristics of little people. As a result, little people face a lot of challenges when using built facilities. For example, most water closets, urinals, and wash hand basins are not fit for little people's use. As indicated by the project findings, we are still far away from providing a discrimination-free and barrier-free living environment for the little people in Hong Kong. To make Hong Kong society more inclusive to the little people, there is a need for further tailored building design. A set of building design principles for better inclusion of the little people in our society are highlighted. These principles include 'the building design should accommodate individuals with different heights' and 'the building design should allow individuals to use comfortably and efficiently with a minimum of fatigue'. At the end of the paper, the author also calls for an agenda for further studies. For instance, we need an anthropometric study on little people for developing practical building design guidelines.

Keywords: dwarfism, little people, inclusive buildings, people with disabilities, social sustainability

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Authors: Changdong Oh

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With the arrival of post-industrial society, social scientists have been giving attention to issues of which factors shape cleavage of political parties. Especially, there is a heated controversy over whether and how social and cultural values influence the identities of parties and voting behavior. Drawing from Moral Foundations Theory (MFT), which approached similar issues by considering the effect of five moral foundations on political decision-making of people, this study investigates the role of moral rhetoric in the evolution of Korean political parties. Researcher collected official announcements released by the major two parties (Democratic Party of Korea, Saenuri Party) from 2007 to 2016, and analyzed the data by using Word2Vec algorithm and Moral Foundations Dictionary. Five moral decision modules of MFT, composed of care, fairness (individualistic morality), loyalty, authority and sanctity (group-based, Durkheimian morality), can be represented in vector spaces consisted of party announcements data. By comparing the party vector and the five morality vectors, researcher can see how the political parties have actively used each of the five moral foundations to express themselves and the opposition. Results report that the conservative party tends to actively draw on collective morality such as loyalty, authority, purity to differentiate itself. Notably, such moral differentiation strategy is prevalent when they criticize an opposition party. In contrast, the liberal party tends to concern with individualistic morality such as fairness. This result indicates that moral cleavage does exist between parties in South Korea. Furthermore, individualistic moral gaps of the two political parties are eased over time, which seems to be due to the discussion of economic democratization of conservative party that emerged after 2012, but the community-related moral gaps widened. These results imply that past political cleavages related to economic interests are diminishing and replaced by cultural and social values associated with communitarian morality. However, since the conservative party’s differentiation strategy is largely related to negative campaigns, it is doubtful whether such moral differentiation among political parties can contribute to the long-term party identification of the voters, thus further research is needed to determine it is sustainable. Despite the limitations, this study makes it possible to track and identify the moral changes of party system through automated text analysis. More generally, this study could contribute to the analysis of various texts associated with the moral foundation and finding a distributed representation of moral, ethical values.

Keywords: moral foundations theory, moral politics, party system, Word2Vec

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Authors: Ying-Lun Tseng Chiu-Ying Chen

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Taiwan's Mental Health Act was amended at the end of 2022; they added regulations regarding refusing compulsory treatment by patients with mental illnesses. In addition, not only by an examination committee, the judge must also assess the patient's need for compulsory treatment. Additionally, the maximum of compulsory hospitalization has been reduced from an unlimited period to a maximum of 60 days. They aim to promote the healthcare autonomy of individuals with mental illnesses in Taiwan and prevent their silenced voice in medical decision-making while they still possess rationality. Furthermore, they plan to use community support and social care networks to replace the current practice of compulsory treatment in Taiwan. This study uses qualitative research methodology, utilizing interview guidelines to inquire about the experiences of Taiwanese who have undergone compulsory hospitalization, compulsory community treatment, and compulsory medical care. The interviews aimed to explore their feelings when they were subjected to compulsory medical intervention, the inside of their illness, their opinions after treatments, and whether alternative medical interventions proposed by them were considered. Additionally, participants also asked about their personal life history and their support networks in their lives. We collected 12 Taiwanese who had experienced compulsory medical interventions and were interviewed 14 times. The findings indicated that participants still possessed rationality during the onset of their illness. However, when they have other treatments to replace compulsory medical, they sometimes diverge from those of the doctors and their families. Finally, doctors prefer their professional judgment and patients' families' option. Therefore, Taiwanese mental health patients' power of decision-making still needs to improve. Because this research uses qualitative research, so difficult to find participants, and the sample size rate was smaller than Taiwan's population, it may have biases in the analysis. So, Taiwan still has significant progress in enhancing the decision-making rights of participants in the study.

Keywords: medical decision making, compulsory treatment, medical ethics, mental health act

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Authors: Friman Hen, Banner Ifaa, Shalom-Tuchin Bosmat, Einav Yulia

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The action learning course is an academic course which involves academic learning and social activities. The courses deal with processes and social challenges, reveal different ideologies, and develop critical thinking and pragmatic ideas. Students receive course credits and a grade for being part of such courses. Participating students enroll in courses that involve action and activities to engage in the experiential learning process, thereby creating a dialogue and cross-fertilization between being taught in the classroom and experiencing the reality in the real world. A learning experience includes meeting with social organizations, institutions, and state authorities and carrying out practical work with diverse populations. Through experience, students strengthen their academic skills, formulate ethical attitudes toward reality, develop professional and civilian perspectives, and realize how they can influence their surrounding in the present and the hereafter. Under the guidance and supervision of Dr. Hen Friman, H.I.T. has built an innovative course that combines action and activities to increase the awareness and accessibility of the community in an experiential way. The end goal is to create Green Ambassadors—children with a high level of environmental awareness. This course is divided into two parts. The first part, focused on frontal teaching, delivers knowledge from extensive environmental fields to students. These areas include introduction to ecology, the process of electricity generation, air pollution, renewable energy, water economy, waste and recycling, and energy efficiency (first stage). In addition to the professional content in the environment field, students learn the method of effective and experiential teaching to younger learners (4 to 8 years old). With the attainment of knowledge, students are divided into operating groups. The second part of the course shows how the theory becomes practical and concrete. At this stage, students are asked to introduce to the first- and second-graders of ‘Revivim’ School in Holon a lesson of 90 minutes focused on presenting the issues and their importance during the course (second stage). This course is the beginning of a paradigm shift regarding energy usage in the modern society in Israel. The objective of the course is to expand worldwide and train the first and second-graders, and even pre-schoolers, in a wide scope to increase population awareness rate, both in Israel and all over the world, for a green future.

Keywords: air pollution, green ambassador, recycling, renewable energy

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Authors: Jaya Bishnu Pradhan

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Weaving mat is one of the common activities performed in different community generally in the rural part of Nepal. Mat weavers’ practice mathematical ideas and concepts implicitly in order to perform their job. This study is intended to uncover the mathematical ideas embedded in mat weaving that can help teachers and students for the teaching and learning of school geometry. The ethnographic methodology was used to uncover and describe the beliefs, values, understanding, perceptions, and attitudes of the mat weavers towards mathematical ideas and concepts in the process of mat weaving. A total of 4 mat weavers, two mathematics teachers and 12 students from grade level 6-8, who are used to participate in weaving, were selected for the study. The whole process of the mat weaving was observed in a natural setting. The classroom observation and in-depth interview were taken with the participants with the help of interview guidelines and observation checklist. The data obtained from the field were categorized according to the themes regarding mathematical ideas embedded in the weaving activities, and its possibilities in teaching learning of school geometry. In this study, the mathematical activities in different sectors of their lives, their ways of understanding the natural phenomena, and their ethnomathematical knowledge were analyzed with the notions of pluralism. From the field data, it was found that the mat weaver exhibited sophisticated geometrical ideas in the process of construction of frame of mat. They used x-test method for confirming if the mat is rectangular. Mat also provides a good opportunity to understand the space geometry. A rectangular form of mat may be rolled up when it is not in use and can be converted to a cylindrical form, which usually can be used as larder so as to reserve food grains. From the observation of the situations, this cultural experience enables students to calculate volume, curved surface area and total surface area of the cylinder. The possibilities of incorporation of these cultural activities and its pedagogical use were observed in mathematics classroom. It is argued that it is possible to use mat weaving activities in the teaching and learning of school geometry.

Keywords: ethnography, ethnomathematics, geometry, mat weaving, school pedagogy

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Authors: Mohammad Karam, Abdulmalik Alsaif, Abdulrahman Al-Naseem, Amrit Hayre, Abdurrahman Al Jabbouri, Ahmad Aldubaikhi, Narvair Kahlar, Salem Al-Mutairi

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Purpose: To compare the outcomes of mycophenolate mofetil (MMF) versus methotrexate (MTX) in non-infectious ocular inflammatory disease (NIOID). Methods: A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines and an electronic search was conducted to identify all comparative studies of MMF versus MTX in NIOID. Treatment results and side effects were primary outcome measures. Secondary outcome measures included visual acuity and resolution of macular oedema. Fixed and random-effects models were used for the analysis. Results: Four studies enrolling 905 patients were identified. There was no significant difference between MMF and MTX groups in overall treatment success (Odds Ratio [OR] = 0.97, P = 0.96) and failure (OR = 0.86, P = 0.85) of NIOID. Although treatment success of uveitis showed no significant difference for anterior and intermediate uveitis cases (OR = 2.33, P = 0.14), MTX showed a significantly improved effect in cases involving posterior uveitis and panuveitis (OR = 0.41, P = 0.003). However, the median dose required for treatment success was lower for MTX whereas MMF was associated with a faster median time to treatment success. Further to this, MMF showed a reduced rate of side effects when compared to MTX, but MTX failed to reach statistical significance, most notably for liver enzyme elevation (OR = 0.65, P = 0.16), fatigue (OR = 0.84, P = 0.49) and headache (OR = 0.81, P = 0.37). For secondary outcomes, no significant difference was noted in visual acuity and resolution of macular edema. Conclusions: MMF is comparable to MTX in the treatment of NIOID as there was no significant difference in the outcome of treatment success and side effect profiles.

Keywords: Mycophenolate mofetil, methotrexate, non-infectious ocular inflammation, uveitis, scleritis

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Authors: Nithra Kitreerawutiwong, Sunsanee Mekrungrongwong, Artitaya Wongwonsin, Chakkraphan Phetphoom, Buaploy Phromjang

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Background: Thailand has implemented a district health system based on the concept of primary health care. Since 2014, Family Care Team (FCT) was launched to improve the quality of care through a multidisciplinary team include not only the health sector but also social sector work together. FCT classified into 3 levels: district, sub-district, and community. This system now consists of 66,353 teams, including 3,890 teams at district level, 12,237 teams at the sub-district level, and 50,326 teams at the community level. There is a report regarding assessment the situation and perception on FCT, however, relatively few examined the operationality of this policy. This study aimed to explore the perception of district manager on the process of the implementation of FCT policy and the factors associating to implement FCT in the district health system. Methods/Results: Forty in-depth interviews were performed: 5 of primary care manager at the provincial medical health office, 5 of community hospital director, 5 of district administrative health office, 10 of sub-district health promoting hospital, and 10 of local organization. Semi-structure interview guidelines were used in the discussions. The data was analyzed by thematic analysis. This policy was formulated based on the demographic change and epidemiology transition to serve a long term care for elderly. Facilitator factors are social capital in district health systems such as family health leader and multidisciplinary team. Barrier factors are communication to the frontline provider and local organization. The output of this policy in relation to the structure of FCT is well-defined. Unanticipated effects include training of FCT in community level. Conclusion: Early feedback from healthcare manager is valuable information for the improvement of FCT to function optimally. Moreover, in the long term, health outcome need to be evaluated.

Keywords: family care team, district health system, primary care, qualitative study

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Authors: Windy Rakhmawati, Suryani Suryani, Sri Hendrawati, Nenden Nur Asriyani Maryam

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Tuberculosis (TB) is one of the leading causes of death in the world. Fear of COVID-19 has made people reluctant to visit health facilities, leading to disruptions to childhood TB control programs, which may increase household transmission and delay diagnosis and treatment. This study aimed to describe parents' knowledge, attitudes, and health-seeking behaviour towards childhood TB during the COVID-19 pandemic. This cross-sectional study was performed on 392 parents with TB children in three provinces with the highest proportion of TB cases in Indonesia. This study was conducted from February to December 2022. The inclusion criteria of respondents were parents with a child aged 0-14 years old with TB diagnosis who live with their parents. Data were collected using the Knowledge, Attitude, and Practice (KAP) survey guidelines from the World Health Organization and analyzed descriptively, as well as Spearman’s correlation. Overall, 392 parents of children with TB had poor knowledge (51.8%) including about causes, risk factors, transmission, symptoms, treatment, and prevention, which about 52.3%, 55.1%, 61.2%, 69.6%, 100%, 59.2%, respectively. Parents' health service-seeking behaviour towards Child TB was not normally distributed (P < 0.05) with knowledge test results (.000) and Seeking Health Services (.000). Health-seeking behaviour of parents in pediatric TB care was self-medication or self-treatment (86.2%), Traditional health seeking behaviour (4.8%), and modern health seeking behaviour (8.9%). The correlation between knowledge and seeking health services (Sig= .609) means there is no correlation between knowledge about TB and parents' health-seeking behaviour. Furthermore, 60.2% of the respondents would be shocked if their child had TB. More than half of the families in this study have poor knowledge and did self-medication or self-treatment regarding health-seeking behaviour for TB disease. Therefore, health workers, especially nurses, must provide TB-related education and health promotion and emphasize the importance of early detection. Health workers can also optimize their role in caring for and providing care to patients by increasing their trust in health workers, which will impact health-seeking behaviour in the future.

Keywords: attitude, child, health seeking behaviour, knowledge, tuberculosis

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Authors: Ivan Gunass Govender, Andrea Giampiccoli

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A developmental state should use community engagement to facilitate socio-economic development for disadvantaged groups and individual members of society through empowerment, social justice, sustainability, and self-reliance. In this regard, community-based tourism (CBT) as a growing market should be an indigenous effort aided by external facilitation. Since this form of tourism presents its own preconditions, characteristics, and challenges, it could be guided by higher education institutions engagement. In particular, the facilitation should not only serve to assist the community members to reach their own goals; but rather also focus on learning through knowledge creation and sharing with the engagement of higher education institutions. While the increased relevance of CBT has produced various CBT manuals (or handbooks/guidelines) documents aimed to ‘teach’ and assist various entities in CBT development, this research aims to analyse the current monitoring & evaluation (M&E) manuals and thereafter, propose an M&E model for CBT. It is important to mention that all too often effective monitoring is seldom carried out thus risking the long-term sustainability and improvement of the CBT ventures. Therefore, the proposed model will also consider some inputs external to the tourism field, but in relation to local economic development (LED) matters from the previously proposed development monitoring and evaluation system framework. M&E should be seen as fundamental components of any CBT initiative, and the whole CBT intervention should be evaluated. In this context, M&E in CBT should go beyond strict ‘numerical’ economic matters and should be understood in a holistic development. In addition, M&E in CBT should not consider issues in various ‘compartments’ such as tourists, tourism attractions, CBT owners/participants, and stakeholder engagement but as interdependent components of a macro-ecosystem. Finally, the external facilitation process should be structured in a way to promote community self-reliance in both the intervention and the M&E process. The research will attempt to propose an M&E model for CBT so as to enhance the CBT possibilities of long-term growth and success through effective collaborations with key stakeholders.

Keywords: community-based tourism, community-engagement, monitoring and evaluation, stakeholders

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Authors: Elena V. Lysenko

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Motivating as the leading function of a modern Human Resources Management involves issues of increasing the effectiveness of the organization in a broader context. During the formation of motivational systems, the top-management of organization should pay equal attention to both external motivation (incentive system) and internal (self-motivation). The balance of internal and external motivation harmonizes the relations between employers and employees, increases the level of job satisfaction by the organization staff, which in turn leads the organization to success and ensures the organization`s profitability and competitiveness in the market environment. The article is devoted to the study of personnel motivation system in the small metal trade company, which is located in Yekaterinburg, Russian Federation. The study took place during November-December, 2016 ordered by the Company Director to analyze the motivational potential of work (managerial aspect of motivation) and motivation of personnel (personnel aspect of motivation) with the purpose to construct a system of employees’ motivation. The research tools included 6 specially selected tests of motivation, which are: “Motivation profile of your job”, “Constructive motivational attitudes”, Tests about Motivation of achievements (1st variant: Test by А.Mehrabian by the theory of D.С.McClelland and 2nd variant: Test about leading needs according with the theory of D.С.MacClelland), Tests by T.Elers (1st variant: “Determination of the motivation towards success or to avoid failure” and 2nd variant: “Trends to achieve results or to avoid failure”). The results of the study showed only one, but fundamental problem of the whole organization: high level of both motivational potential in work and self-motivation, especially in terms of achievement motivation, but serious lack of productivity. According the results which study showed this problem is derived from insufficient staff competence. The research suggests basic guidelines in order to build the new personnel motivation system for this Company, which is planned to be developed in the nearest future.

Keywords: incentive system, motivation of achievements, motivation system, self-motivation

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Authors: Samuel Gary Beckton

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Ever since the Scottish Independence Referendum in 2014, there has been a threat of a second referendum. However, if there was another referendum and the majority favoured independence, it is highly likely to be by a small majority. In this paper, it will look into the hypothetical situation of what could have happened if Scotland had voted in favour of independence in 2014. If this occurred, there would be many Unionists within Scotland, including devoted supporters of the Better Together campaign. There was a possibility of some Scottish Unionists not willing to accept the result of the Referendum unchallenged and use their right of self-determination through the UN Charter for their region to remain within the United Kingdom. The Shetland and Orkney Islands contemplated of opting out of an independent Scotland in 2013. This caught the attention of some politicians and the media, via confirming the possibility of some form of partition in Scotland and could have gained extra attention if partition quickly became a matter of ‘need’ instead of ‘want’. Whilst some Unionists may have used petitions and formed pressure groups to voice their claims, others may have used more hard-line tactics to achieve their political objectives, including possible protest marches and acts of civil unrest. This could have possibly spread sectarian violence between Scottish Unionists and Nationalists. Glasgow has a serious issue of this kind of sectarianism, which has escalated in recent years. This is due to the number communities that have been established from Irish Immigrants, which maintain links with Northern Irish loyalists and republicans. Some Scottish Unionists not only have sympathy towards Northern Irish loyalists but actively participate with the paramilitary groups and gave support. Scottish loyalists could use these contacts to create their own paramilitary group(s), with aid from remaining UK (RUK) benefactors. Therefore, this could have resulted in the RUK facing a serious security dilemma, with political and ethical consequences to consider. The RUK would have the moral obligation to protect Scottish Unionists from persecution and recognise their right of self-determination, whilst ensuring the security and well-being of British citizens within and outside of Scotland. This work takes into consideration the lessons learned from the ‘Troubles’ in Northern Ireland. As an era of ‘Troubles’ could occur in Scotland, extending into England and Northern Ireland. This is due to proximity, the high number of political, communal and family links in Scotland to the RUK, and the delicate peace process within Northern Ireland which shares a similar issue. This paper will use British and Scottish Government documents prior to the Scottish referendum to argue why partition might happen and use cartography of maps of a potential partition plan for Scotland. Reports from the UK National Statistics, National Rail, and Ministry of Defence shall also be utilised, and use of journal articles that were covering the referendum.

Keywords: identity, nationalism, Scotland, unionism

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Authors: Ruzanna Muradyan

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Medical data mining is a crucial field in contemporary healthcare that offers cutting-edge tactics with enormous potential to transform patient care. This abstract examines how sophisticated data mining techniques could transform the healthcare industry, with a special focus on how they might improve patient outcomes. Healthcare data repositories have dynamically evolved, producing a rich tapestry of different, multi-dimensional information that includes genetic profiles, lifestyle markers, electronic health records, and more. By utilizing data mining techniques inside this vast library, a variety of prospects for precision medicine, predictive analytics, and insight production become visible. Predictive modeling for illness prediction, risk stratification, and therapy efficacy evaluations are important points of focus. Healthcare providers may use this abundance of data to tailor treatment plans, identify high-risk patient populations, and forecast disease trajectories by applying machine learning algorithms and predictive analytics. Better patient outcomes, more efficient use of resources, and early treatments are made possible by this proactive strategy. Furthermore, data mining techniques act as catalysts to reveal complex relationships between apparently unrelated data pieces, providing enhanced insights into the cause of disease, genetic susceptibilities, and environmental factors. Healthcare practitioners can get practical insights that guide disease prevention, customized patient counseling, and focused therapies by analyzing these associations. The abstract explores the problems and ethical issues that come with using data mining techniques in the healthcare industry. In order to properly use these approaches, it is essential to find a balance between data privacy, security issues, and the interpretability of complex models. Finally, this abstract demonstrates the revolutionary power of modern data mining methodologies in transforming the healthcare sector. Healthcare practitioners and researchers can uncover unique insights, enhance clinical decision-making, and ultimately elevate patient care to unprecedented levels of precision and efficacy by employing cutting-edge methodologies.

Keywords: data mining, healthcare, patient care, predictive analytics, precision medicine, electronic health records, machine learning, predictive modeling, disease prognosis, risk stratification, treatment efficacy, genetic profiles, precision health

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Authors: Tara Hunter, Kristine Concepcion, Wendy Cheng, Brianna Pike, Jane Estoesta, Anne Stuart

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In 2015, Family Planning NSW was contracted by the NSW Ministry of Health to design and deliver Sexual Safety Policy training (SSPT) to mental health professionals across NSW. The training was based on their current guidelines and developed in consultation with an expert reference group. From October 2015 to April 2017 it was delivered to over 2,400 mental health professionals with a view to supporting implementation of consistent prevention and intervention related to sexual safety in the mental health setting. An evaluation was undertaken to determine the knowledge and confidence of participants related to sexual safety before and after the training, and whether any improvements were translated into changes in practice. Participants were invited to complete a survey prior to the training, upon completion and three to six months thereafter. Telephone interviews were conducted among service managers and mental health champions six months post-training. Prior to training, the majority of mental health professionals reported being slightly to moderately confident in identifying a sexual safety incident. When asked on their understanding of sexual safety, gender sensitive practice and trauma informed care, they reported no confidence, slight confidence and moderate confidence. Immediately after the training, 54.5% reported being very confident and 10.9% extremely confident in identifying a sexual safety incident. More than half felt very confident or extremely confident in their understanding of sexual safety principles. The impact survey (six months later) found that the majority of participants (91%) were highly confident in identifying a sexual safety incident. Telephone interviewees reported a change in workplace culture and increased awareness after the training. Mental health professionals experienced increased knowledge and confidence about sexual safety principles following the training and were able to implement positive changes and concrete actions to better address sexual safety issues in their workplace.

Keywords: sexual safety, mental health professionals, trauma informed care, policy training

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Authors: Siddarth Kannan

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Objectives: Deep Brain Stimulation (DBS) and Motor Cortex stimulation (MCS) are innovative interventions in order to treat various neuropathic pain disorders such as post-stroke pain. While each treatment has a varying degree of success in managing pain, comparative analysis has not yet been performed, and the success rates of these techniques using validated, objective pain scores have not been synthesised. The aim of this study was to compare the effect of pain relief offered by MCS and DBS on patients with post-stroke pain and to assess if either of these procedures offered better results. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines (PROSPEROID CRD42021277542). Three databases were searched, and articles published from 2000 to June 2023 were included (last search date 25 June 2023). Meta-analysis was performed using random effects models. We evaluated the performance of DBS or MCS by assessing studies that reported pain relief using the Visual Analogue Scale (VAS). Data analysis of descriptive statistics was performed using SPSS (Version 27; IBM; Armonk; NY; USA). R statistics (Rstudio Version 4.0.1) was used to perform meta-analysis. Results: Of the 478 articles identified, 27 were included in the analysis (232 patients- 117 DBS & 115 MCS). The pooled number of patients who improved after DBS was 0.68 (95% CI, 0.57-0.77, I2=36%). The pooled number of patients who improved after MCS was 0.72 (95% CI, 0.62-0.80, I2=59%). Further sensitivity analysis was done to include only studies with a minimum of 5 patients in order to assess if there was any impact on the overall results. Nine studies each for DBS and MCS met these criteria. There seemed to be no significant difference in results. Conclusions: The use of surgical interventions such as DBS and MCS is an upcoming field for the treatment of post-stroke pain, with limited studies exploring and comparing these two techniques. While our study shows that MCS might be a slightly better treatment option, further research would need to be done in order to determine the appropriate surgical intervention for post-stroke pain.

Keywords: post-stroke pain, deep brain stimulation, motor cortex stimulation, pain relief

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Authors: Christos Lampropoulos, Maria Konsta, Vicky Dradaki, Irini Dri, Konstantina Panouria, Tamta Sirbilatze, Ifigenia Apostolou, Vaggelis Lambas, Christina Kordali, Georgios Mavras

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Objectives: Malnutrition in hospitalized patients is related to increased morbidity and mortality. The purpose of our study was to compare various nutritional scores in order to detect the most suitable one for assessing the nutritional status of elderly, hospitalized patients and correlate them with mortality and extension of admission duration, due to patients’ critical condition. Methods: Sample population included 150 patients (78 men, 72 women, mean age 80±8.2). Nutritional status was assessed by Mini Nutritional Assessment (MNA full, short-form), Malnutrition Universal Screening Tool (MUST) and short Nutritional Appetite Questionnaire (sNAQ). Sensitivity, specificity, positive and negative predictive values and ROC curves were assessed after adjustment for the cause of current admission, a known prognostic factor according to previously applied multivariate models. Primary endpoints were mortality (from admission until 6 months afterwards) and duration of hospitalization, compared to national guidelines for closed consolidated medical expenses. Results: Concerning mortality, MNA (short-form and full) and SNAQ had similar, low sensitivity (25.8%, 25.8% and 35.5% respectively) while MUST had higher sensitivity (48.4%). In contrast, all the questionnaires had high specificity (94%-97.5%). Short-form MNA and sNAQ had the best positive predictive value (72.7% and 78.6% respectively) whereas all the questionnaires had similar negative predictive value (83.2%-87.5%). MUST had the highest ROC curve (0.83) in contrast to the rest questionnaires (0.73-0.77). With regard to extension of admission duration, all four scores had relatively low sensitivity (48.7%-56.7%), specificity (68.4%-77.6%), positive predictive value (63.1%-69.6%), negative predictive value (61%-63%) and ROC curve (0.67-0.69). Conclusion: MUST questionnaire is more advantageous in predicting mortality due to its higher sensitivity and ROC curve. None of the nutritional scores is suitable for prediction of extended hospitalization.

Keywords: duration of admission, malnutrition, nutritional assessment scores, prognostic factors for mortality

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Authors: Ellis Kofi Akwaa-Sekyi, Jordi Moreno Gené

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Managerial actions which negatively profile banks and impair corporate reputation are addressed through effective internal control systems. Disregard for acceptable standards and procedures for granting credit have affected bank loan portfolios and could be cited for the crises in some European countries. The study intends to determine the effectiveness of internal control systems, investigate whether perceived agency problems exist on the part of board members and to establish the relationship between internal controls and credit risk among listed banks in the European Union. Drawing theoretical support from the behavioural compliance and agency theories, about seventeen internal control variables (drawn from the revised COSO framework), bank-specific, country, stock market and macro-economic variables will be involved in the study. A purely quantitative approach will be employed to model internal control variables covering the control environment, risk management, control activities, information and communication and monitoring. Panel data from 2005-2014 on listed banks from 28 European Union countries will be used for the study. Hypotheses will be tested and the Generalized Least Squares (GLS) regression will be run to establish the relationship between dependent and independent variables. The Hausman test will be used to select whether random or fixed effect model will be used. It is expected that listed banks will have sound internal control systems but their effectiveness cannot be confirmed. A perceived agency problem on the part of the board of directors is expected to be confirmed. The study expects significant effect of internal controls on credit risk. The study will uncover another perspective of internal controls as not only an operational risk issue but credit risk too. Banks will be cautious that observing effective internal control systems is an ethical and socially responsible act since the collapse (crisis) of financial institutions as a result of excessive default is a major contagion. This study deviates from the usual primary data approach to measuring internal control variables and rather models internal control variables in a quantitative approach for the panel data. Thus a grey area in approaching the revised COSO framework for internal controls is opened for further research. Most bank failures and crises could be averted if effective internal control systems are religiously adhered to.

Keywords: agency theory, credit risk, internal controls, revised COSO framework

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Authors: Anne N. Heirman, Song Duimel, Rob van Son, Lisette van der Molen, Richard Dirven, Gyorgi B. Halmos, Julia van Weert, Michiel W.M. van den Brekel

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Objectives: Treatments for head-neck cancer are drastic and often significantly impact the quality of life and appearance of patients. Shared decision-making (SDM) beholds a collaboration between patient and doctor in which the most suitable treatment can be chosen by integrating patient preferences, values, and medical information. SDM has a lot of advantages that would be useful in making difficult treatment choices. The objective of this study was to determine the current level of SDM among patients and head-and-neck surgeons. Methods: Consultations of patients with a non-cutaneous head-and-neck malignancy facing a treatment decision were selected and included. If given informed consent, the consultation was recorded with an audio recorder, and the patient and surgeon filled in a questionnaire immediately after the consultation. The SDM level of the consultation was scored objectively by independent observers who judged audio recordings of the consultation using the OPTION5-scale, ranging from 0% (no SDM) to 100% (optimum SDM), as well as subjectively by patients (using the SDM-Q-9 and Control preference scale) and clinicians (SDM-Q-Doc, modified control preference scale) percentages. Preliminary results: Five head-neck surgeons have each at least seven recorded conversations with different patients. One of them was trained in SDM. The other four had no experience with SDM. Most patients were male (74%), and oropharyngeal carcinoma was the most common diagnosis (41%), followed by oral cancer (33%). Five patients received palliative treatment of which two patients were not treated recording guidelines. At this moment, all recordings are scored by the two independent observers. Analysis of the results will follow soon. Conclusion: The current study will determine to what extent there is a discrepancy between the objective and subjective level of shared decision-making (SDM) during a doctor-patient consultation in Head-and-Neck surgery. The results of the analysis will follow shortly.

Keywords: head-and-neck oncology, patient involvement, physician-patient relations, shared decision making

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Authors: Marwa A. A. Ragab, Hadir M. Maher, Eman I. El-Kimary

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Co-administration of methotrexate (MTX) and aspirin (ASP) can cause a pharmacokinetic interaction and a subsequent increase in blood MTX concentrations which may increase the risk of MTX toxicity. Therefore, it is important to develop a sensitive, selective, accurate and precise method for their simultaneous determination in urine. A new hybrid chemometric method has been applied to the emission response data of the two drugs. Spectrofluorimetric method for determination of MTX through measurement of its acid-degradation product, 4-amino-4-deoxy-10-methylpteroic acid (4-AMP), was developed. Moreover, the acid-catalyzed degradation reaction enables the spectrofluorimetric determination of ASP through the formation of its active metabolite salicylic acid (SA). The proposed chemometric method deals with convolution of emission data using 8-points sin xi polynomials (discrete Fourier functions) after the derivative treatment of these emission data. The first and second derivative curves (D1 & D2) were obtained first then convolution of these curves was done to obtain first and second derivative under Fourier functions curves (D1/FF) and (D2/FF). This new application was used for the resolution of the overlapped emission bands of the degradation products of both drugs to allow their simultaneous indirect determination in human urine. Not only this chemometric approach was applied to the emission data but also the obtained data were subjected to non-parametric linear regression analysis (Theil’s method). The proposed method was fully validated according to the ICH guidelines and it yielded linearity ranges as follows: 0.05-0.75 and 0.5-2.5 µg mL-1 for MTX and ASP respectively. It was found that the non-parametric method was superior over the parametric one in the simultaneous determination of MTX and ASP after the chemometric treatment of the emission spectra of their degradation products. The work combines the advantages of derivative and convolution using discrete Fourier function together with the reliability and efficacy of the non-parametric analysis of data. The achieved sensitivity along with the low values of LOD (0.01 and 0.06 µg mL-1) and LOQ (0.04 and 0.2 µg mL-1) for MTX and ASP respectively, by the second derivative under Fourier functions (D2/FF) were promising and guarantee its application for monitoring the two drugs in patients’ urine samples.

Keywords: chemometrics, emission curves, derivative, convolution, Fourier transform, human urine, non-parametric regression, Theil’s method

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Authors: Ahmed El Naggar, Homyan Saleh

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Dams are crucial for flood control, water supply, and the creation of hydroelectric power. Every dam has a water conveyance system, such as a spillway, providing the safe discharge of catastrophic floods when necessary. Spillway design has historically been investigated in laboratory research owing to the absence of suitable full-scale flow monitoring equipment and safety problems. Prototype measurements of aerated flows are urgently needed to quantify projected scale effects and provide missing validation data for design guidelines and numerical simulations. In this work, an image-based investigation of free-surface flows on a tiered spillway was undertaken at the laboratory (fixed camera installation) and prototype size (drone video) (drone footage) (drone footage). The drone videos were generated using data from citizen science. Analyses permitted the measurement of the free-surface aeration inception point, air-water surface velocities, fluctuations, and residual energy at the chute's downstream end from a remote site. The prototype observations offered full-scale proof of concept, while laboratory results were efficiently confirmed against invasive phase-detection probe data. This paper stresses the efficacy of image-based analyses at prototype spillways. It highlights how citizen science data may enable academics better understand real-world air-water flow dynamics and offers a framework for a small collection of long-missing prototype data.

Keywords: remote sensing, aerated flows, large dams, proof of concept, dam spillways, air-water flows, prototype operation, remote sensing, inception point, optical flow, turbulence, residual energy

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Authors: Rohit Kamal, Devaki Perumal Rajaram, Rajam Krishna, Sai Kumar Pindagiri, Silas Danielraj

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Introduction: According to WHO, Global health observatory at least 2.8 million people die each year because of obesity and overweight. This is mainly because of the adverse metabolic effects of obesity and overweight on blood pressure, lipid profile especially cholesterol and insulin resistance. To achieve optimum health WHO has set the BMI in the range of 18.5 to 24.9 kg/m2. Due to modernization of life style, physical exercise in the form of work is no longer a possibility and hence an effective way to burn out calories to achieve the optimum BMI is the need of the hour. Studies have shown that exercising for more than 60 minutes /day helps to maintain the weight and to reduce the weight exercise should be done for 90 minutes a day. Moderate exercise for about 30 min is essential for burning up of calories. People with low endurance fail to perform even the low intensity exercise for minimal time. Hence, it is necessary to find out some effective method to increase the endurance time. Methodology: This study was approved by the Institutional Ethical committee of our college. After getting written informed consent, 25 apparently healthy males between the age group 18-20 years were selected. Subjects are with muscular disorder, subjects who are Hypertensive, Diabetes, Smokers, Alcoholics, taking drugs affecting the muscle strength. To determine the endurance time: Maximum voluntary contraction (MVC) was measured by asking the participants to squeeze the hand grip dynamometer as hard as possible and hold it for 3 seconds. This procedure was repeated thrice and the average of the three reading was taken as the maximum voluntary contraction. The participant was then asked to squeeze the dynamometer and hold it at 70% of the maximum voluntary contraction while hearing fast tempo music which was played for about ten minutes then the participant was asked to relax for ten minutes and was made to hold the hand grip dynamometer at 70% of the maximum voluntary contraction while hearing slow tempo music. To avoid the bias of getting habituated to the procedure the order of hearing for the fast and slow tempo music was changed. The time for which they can hold it at 70% of MVC was determined by using a stop watch and that was taken as the endurance time. Results: The mean value of the endurance time during fast and slow tempo music was compared in all the subjects. The mean MVC was 34.92 N. The mean endurance time was 21.8 (16.3) seconds with slow tempo music which was more then with fast tempo music with which the mean endurance time was 20.6 (11.7) seconds. The preference was more for slow tempo music then for fast tempo music. Conclusion: Music when played during exercise by some unknown mechanism helps to increase the endurance time by alleviating the symptoms of lactic acid accumulation.

Keywords: endurance time, fast tempo music, maximum voluntary contraction, slow tempo music

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Authors: Ratneev Kaur, Tajinder Kaur, Anupam Kaur

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Introduction: Polycystic Ovary Syndrome (PCOS) is a heterogenous disorder of endocrine system among women of reproductive age. PCOS is characterized by hyperandrogenism, anovulation, polycystic ovaries, hirsutism, obesity, and hyperinsulinemia. Several pathways are implicated in its etiology including the metabolic pathway of steroid hormone synthesis regulatory pathways. PCOS is an androgen excess disorder, genes operating in steroidogenesis may alter pathogenesis of PCOS. The cytochrome P450scc is a cholesterol side chain cleavage enzyme coded by CYP11A1 gene and catalyzes conversion of cholesterol to pregnenolone, the initial and rate-limiting step in steroid hormone synthesis. It is postulated that polymorphisms in this gene may play an important role in the regulation of CYP11A1 expression and leading to increased or decreased androgen production. The present study will be the first study from north India to best of our knowledge, to analyse the association of CYP11A1 (rs11632698) polymorphism in women suffering from PCOS. Methodology: The present study was approved by ethical committee of Guru Nanak Dev University in consistent with declaration of Helsinki. A total of 300 samples (150 PCOS cases and 150 controls) were recruited from Hartej hospital, for the present study. Venous blood sample (3ml) was withdrawn from women diagnosed with PCOS by doctor, according to Rotterdam 2003 criteria and from healthy age matched controls only after informed consent and detailed filled proforma. For molecular genetics analysis, blood was stored in EDTA vials. After DNA isolation by organic method, PCR-RFLP approach was used for genotyping and association analysis of rs11632698 polymorphism. Statistical analysis was done to check for significance of selected polymorphism with PCOS. Results: In 150 PCOS cases, the frequency of AA, AG and GG genotype was found to be 48%, 35%, and 13% compared to 62%, 27% and 8% in 150 controls. The major allele (A) and minor allele (G) frequency was 68% and 32% in cases and 78% and 22% in controls. Minor allele frequency was higher in cases as compared to controls, as well as the distribution of genotype was observed to be statistically significant (ᵡ²=6.525, p=0.038). Odds ratio in dominant, co-dominant and recessive models observed was 1.81 (p=0.013), 1.54 (p=0.012) and 1.77 (p=0.132) respectively. Conclusion: The present study showed statistically significant association of rs11632698 with PCOS (p=0.038) in North Indian women.

Keywords: polycystic ovary syndrome, CYP11A1, rs11632698, hyperandrogenism

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Authors: Junaid Mahmood Alam

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Revalidating and harmonizing clinical chemistry analytical principles and optimizing methods through quality control programs and assessments is the preeminent means to attain optimal outcome within the clinical laboratory services. Present study reports revalidation of our existing IFCC regularized analytical methods, particularly hepatic and thyroid function tests, by optimization of precision analyses and processing through external and internal quality assessments and regression determination. Parametric components of hepatic (Bilirubin ALT, γGT, ALP), cardiac (LDH, AST, Trop I) and thyroid/pituitary (T3, T4, TSH, FT3, FT4) function tests were used to validate analytical techniques on automated chemistry and immunological analyzers namely Hitachi 912, Cobas 6000 e601, Cobas c501, Cobas e411 with UV kinetic, colorimetric dry chemistry principles and Electro-Chemiluminescence immunoassay (ECLi) techniques. Process of validation and revalidation was completed with evaluating and assessing the precision analyzed Preci-control data of various instruments plotting against each other with regression analyses R2. Results showed that: Revalidation and optimization of respective parameters that were accredited through CAP, CLSI and NEQAPP assessments depicted 99.0% to 99.8% optimization, in addition to the methodology and instruments used for analyses. Regression R2 analysis of BilT was 0.996, whereas that of ALT, ALP, γGT, LDH, AST, Trop I, T3, T4, TSH, FT3, and FT4 exhibited R2 0.998, 0.997, 0.993, 0.967, 0.970, 0.980, 0.976, 0.996, 0.997, 0.997, and R2 0.990, respectively. This confirmed marked harmonization of analytical methods and instrumentations thus revalidating optimized precision standardization as per IFCC recommended guidelines. It is concluded that practices of revalidating and harmonizing the existing or any new services should be followed by all clinical laboratories, especially those associated with tertiary care hospital. This is will ensure deliverance of standardized, proficiency tested, optimized services for prompt and better patient care that will guarantee maximum patients’ confidence.

Keywords: revalidation, standardized, IFCC, CAP, harmonized

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Authors: Romel Cordova Shedan

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The traditional seismic design is the methodology of Forced Based Design (FBD). The Displacement Based Design (DBD) is a seismic design that considers structural damage to achieve a failure mechanism of the structure before the collapse. It is easier to quantify damage of a structure with displacements rather than forces. Therefore, a structure to achieve an inelastic displacement design with good ductility, it is necessary to be damaged. The first part of this investigation is about differences between the methodologies of DBD and FBD with some DBD advantages. In the second part, there is a study case about a dual building 5-story, which is regular in plan and elevation. The building is located in a seismic zone, which acceleration in firm soil is 45% of the acceleration of gravity. Then it is applied both methodologies into the study case to compare its displacements, shear forces and overturning moments. In the third part, the Dynamic Time History Analysis (DTHA) is done, to compare displacements with DBD and FBD methodologies. Three accelerograms were used and the magnitude of the acceleration scaled to be spectrum compatible with design spectrum. Then, using ASCE 41-13 guidelines, the hinge plastics were assigned to structure. Finally, both methodologies results about study case are compared. It is important to take into account that the seismic performance level of the building for DBD is greater than FBD method. This is due to drifts of DBD are in the order of 2.0% and 2.5% comparing with FBD drifts of 0.7%. Therefore, displacements of DBD is greater than the FBD method. Shear forces of DBD result greater than FBD methodology. These strengths of DBD method ensures that structure achieves design inelastic displacements, because those strengths were obtained due to a displacement spectrum reduction factor which depends on damping and ductility of the dual system. Also, the displacements for the study case for DBD results to be greater than FBD and DTHA. In that way, it proves that the seismic performance level of the building for DBD is greater than FBD method. Due to drifts of DBD which are in the order of 2.0% and 2.5% compared with little FBD drifts of 0.7%.

Keywords: displacement-based design, displacement spectrum reduction factor, dynamic time history analysis, forced based design

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Authors: Randa M. Ali, Naguiba F. Loutfy, Osama M. Awad

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Background: Leishmaniasis is a worldwide disease, affecting 88 countries, it is estimated that about 350 million people are at risk of leishmaniasis. Overall prevalence is 12 million people with annual mortality of about 60,000. Annual incidence is 1,500,000 cases of cutaneous leishmaniasis (CL) worldwide and half million cases of visceral Leishmaniasis (VL). Objectives: The objective of this study was to assess primary health care physicians knowledge (PHP) and attitude about leishmaniasis and to assess awareness of local inhabitants about the disease and its vector in four areas in west Alexandria, Egypt. Methods: This study was a cross sectional survey that was conducted in four PHC units in west Alexandria. All physicians currently working in these units during the study period were invited to participate in the study, only 20 PHP completed the questionnaire. 60 local inhabitant were selected randomly from the four areas of the study, 15 from each area; Data was collected through two different specially designed questionnaires. Results: 11(55%) percent of the physicians had satisfactory knowledge, they answered more than 9 (60%) questions out of a total 14 questions about leishmaniasis and sandfly. The second part of the questionnaire is concerned with attitude of the primary health care physicians about leishmaniasis, 17 (85%) had good attitude and 3 (15%) had poor attitude. The second questionnaire showed that the awareness of local inhabitants about leishmaniasis and sandly as a vector of the disease is poor and needs to be corrected. Most of the respondents (90%) had not heard about leishmaniasis, Only 3 (5%) of the interviewed inhabitants said they know sandfly and its role in transmission of leishmaniasis. Conclusions: knowledge and attitudes of physicians are acceptable. However, there is, room for improvement and could be done through formal training courses and distribution of guidelines. In addition to raising the awareness of primary health care physicians about the importance of early detection and notification of cases of lesihmaniasis. Moreover, health education for raising awareness of the public regarding the vector and the disease is necessary because related studies have demonstrated that if the inhabitants do not perceive mosquitoes to be responsible for diseases such as malaria they do not take enough measures to protect themselves against the vector.

Keywords: leishmaniasis, PHP, knowledge, attitude, local inhabitants

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Authors: R. Zhankina, U. Zhanbyrbekuly, A. Tamadon, M. Askarov, R. Sherkhanov, D. Akhmetov, D. Saipiyeva, N. Keulimzhaev

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Male infertility affects about 15% of couples of reproductive age. Approximately 10–15% have azoospermia who have previously been diagnosed with male infertility. Azoospermia is regarded as the absence of spermatozoa in the ejaculate and is found in 10-15% of infertile men. Non-obstructive azoospermia is considered a cause of male infertility that is not amenable to drug therapy. Patients with non-obstructive azoospermia are unable to have their "own" children and have only options for adoption or use of donor sperm. Advances in assisted reproductive technologies such as intracytoplasmic sperm injection in vitro fertilization have significantly changed the management of patients with non-obstructive azoospermia. Advances in biotechnology have increased the options for treating patients with non-obstructive azoospermia. Mesenchymal stem cell therapy has been recognized as a new option for infertility treatment. Material and methods of the study: After obtaining informed consent, 5 patients diagnosed with non-obstructive azoospermia were included in an open, non-randomized study. The age of the patients ranged from 24 to 35 years. The examination was carried out before the start of treatment, which included biochemical blood tests, hormonal profile levels (luteinizing hormone, follicle-stimulating hormone, testosterone, prolactin, inhibin B); tests for tumor markers; genetic research. All studies were carried out in compliance with the requirements of Protocol No. 8 dated 06/09/20, approved by the Local Ethical Commission of NJSC "Astana Medical University". The control examination of patients was carried out after 6 months, by re-taking the program and hormonal profile (testosterone, luteinizing hormone, follicle-stimulating hormone, prolactin, inhibin B). Before micro-TESE of the testis, all 5 patients underwent myeloexfusion in the operating room. During the micro-TESE, autotransplantation of mesenchymal stem cells into the testicular network, previously cultured in a cell technology laboratory for 2 weeks, was performed. Results of the study: in all patients, the levels of total testosterone increased, the level of follicle-stimulating hormone decreased, the levels of luteinizing hormone returned to normal, the level of inhibin B increased. IVF with a positive result; another patient (20%) had spermatogenesis cells. Non-obstructive azoospermia and mesenchymal stem cells Conclusions: The positive results of this work serve as the basis for the application of a new cellular therapeutic approach for the treatment of non-obstructive azoospermia using mesenchymal stem cells.

Keywords: cell therapy, regenerative medicine, male infertility, mesenchymal stem cells

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Authors: Tony Jehi, Sujatha Rajaram, Nader majzoub, Joan Sabate

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Aging significantly increases the incidence of various cardiometabolic diseases, including cardiovascular disease (CVD). To combat CVD and its associated risk factors, it is imperative to adopt a healthy dietary pattern that is rife with beneficial nutrient and non-nutrient compounds. Unsaturated fats, specifically n-3 polyunsaturated fatty acids (n-3 PUFA), have cardio-protective effects; the opposite is true for saturated fatty acids. What role, if any, does the biomarker of fatty acid intake (specific fatty acids in the erythrocyte) play in predicting cardiometabolic risk among the elderly, a population highly susceptible to increased mortality and morbidity from CVD risk factors, remains unclear. This was a secondary analysis of the Walnuts and Healthy Aging Study. Briefly, elderly (n=192, mean age 69 y) participants followed their usual diet and were randomized into two groups to either eat walnuts daily or abstain from eating walnuts for a period of 2 years. The purpose was to identify potential associations between erythrocyte membrane fatty acids and cardiometabolic risk factors (body weight, blood pressure, blood lipids, and fasting glucose). Erythrocyte n-3 PUFA were inversely associated with total cholesterol (ß = -3.83; p= 0.02), triglycerides (ß = -7.66; p= <0.01), and fasting glucose (ß = -0.19; p=0.03). Specifically, erythrocyte ALA (ß= -1.59; P = 0.04) and DPA (ß= -0.62; P=0.04) were inversely associated with diastolic blood pressure and fasting glucose, respectively. N-6 PUFAs were positively associated with systolic blood pressure (ß=1.10; P=0.02). Mono-unsaturated fatty acids were positively associated with TAG (ß = 4.16; P=0.03). Total saturated fatty acids were not associated with any cardiometabolic risk factors. No association was found between any erythrocyte fatty acid and body weight. In conclusion, erythrocyte n-3 PUFA may be used as a biomarker to predict the cardiometabolic risk among healthy elders, providing support for the American Heart Association guidelines for including n-3 PUFA for preventing CVD.

Keywords: cardiometabolic diseases, erythrocyte fatty acids, elderly, n-3 PUFA

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Authors: Suhathai Tosangwarn, Philip Clissett, Holly Blake

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Background: High prevalence of depression has been reported among older adults living in care homes in Thailand, associated with physical impairment, low social support, low self-esteem and particularly stigma associated with living in a care home. However, little is understood about how such stigma is experienced among Thai care home residents. This study examines residents’ perceptions of stigma and their strategies for coping with stigma. Method/Design: Case study research was used to gain an in-depth view about the stigma of residents’ perspectives and experiences from two care homes in the northeast of Thailand by conducting an in-depth interview and non-participant observation. Qualitative interviews were conducted with 30 older residents (aged >60 years), purposively sampled from both care homes. Non-participant observation was conducted in various public spaces of the care homes, including the dining room, corridors, and activities areas for approximately one to two hours per day at different times; morning and afternoon including weekdays and weekend in both care homes for one month. Thematic analysis was used to analyse the data. Results: The study identified three major themes related to the causes of stigma, the reactions towards stigma and the mitigating factors. Negative beliefs about care homes, negative attitudes, and stereotypes toward the elderly and perceptions of unequal power relations between staff and residents were the main factors precipitating stigma. Consequently, residents exhibited negative emotions and behaviours, including depressive symptoms, while living in care homes. Residents reported the use of particular coping strategies, including accessing support from the public and staff and engaging in care home activities which these helped them to cope with their perception of stigma. Conclusion: Improved understanding of the underlying factors behind perceived stigma in care home residents may help to prevent depression and reduce perceptions of stigma associated with living in a care home, by informing strategy, supportive intervention and guidelines for appropriate care for older Thai residents.

Keywords: care home, depression, older adult, stigma, Thailand

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Authors: Binaya Tamang, Buddhi R. Pokharel, Narayan Gautam, Puspa R. Dhakal, Yuresh Twayana

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Background and Objective: Microalbuminuria is often regarded as a sign of end-organ damage due to hypertension, with an increased risk for renal diseases. The present study was designed to find the prevalence of microalbuminuria in hypertensive patients by determining albumin creatinine ratio (ACR) and the association of ACR and microalbuminuria status with different stages and duration of hypertension (HTN). Also, to establish the correlation of systolic and diastolic blood pressure (SBP and DBP) with various parameters viz; ACR, urinary microalbumin (UMA), estimated glomerular filtration rate (eGFR), urinary creatinine (Ucreat), serum creatinine (Screat), and find out their significance among HTN and ACR status. Materials and Methods: A hospital-based cross-sectional study was conducted in the Department of Biochemistry in collaboration with the Department of Internal Medicine, UCMS, Bhairahawa, Nepal from April 2019 to September 2019 after obtaining ethical approval from institutional review committee (IRC), UCMS. A total of 120 hypertensive patients were enrolled whose blood, and spot urine samples were taken. eGFR was calculated by using Cockcroft-Gault formula after determining Screat while ACR was calculated after measuring Ucreat and UMA from the spot urine sample. Creatinine was estimated from modified jaffes’ reaction, whereas urinary micro albumin was done by Mispa i3 analyzer. Data were analyzed by using SPSS. 20 using p-value ≤ 0.05 as statistically significant. Results: In our study, the highest enrolled were grade II HTN (36.7%) followed by normal (33.3%), grade I (20.8%) and grade III (9.2%). Evaluating the ACR status, 19.2% were microalbuminuria, and the rest were normal. Though the ACR status (normal and microalbuminuria) was not statistically significant with HTN status (P=0.860) and the duration of HTN status (P=0.165), 5 (45.5%) out of 11 grade III HTN were microalbuminuria and the prevalence was also higher for longer duration .i.e., more than 10 years. In microalbuminuria, both the SBP (p=0.023, r=0.471) and DBP (P=0.034, r= 0.444) were strongly and positively correlated with Screat, in contrast to eGFR, which was negatively but weakly correlated. With the significant difference between the HTN group, the mean ACR (P=0.047) and UMA (P=0.02) were found to be highest among grade III patients, i.e., 84.3 ± 113.3 mg/gm. and 88.4 ± 83.9 mg/l respectively. The mean eGFR (64.2 ± 24.8 vs 77.2 ± 18.1 ml/min) was considerably lower in microalbuminuria ( p=0.026) than the normal in contrast to the SBP (160 ± 33.7 vs. 146.6 ± 19.5 mm of Hg) which was significantly higher (P=0.008). Among the different BMI category, the mean ACR was found to be significantly different (P= 0.01) with the highest value in underweight (115.2 ± 51.5 mg/gm.) and lowest in overweight (31.8 ± 4.3 mg/gm.). Conclusion: The study recommends that the microalbuminuria can be a very useful and imperative predictor of deranged kidney functions in hypertensive patients. The high value of ACR and UMA in hypertensive patients along with significant increased Screat, SBP whereas decreased eGFR in microalbuminuria patients explicitly supports the above statement.

Keywords: albumin creatinine ratio, hypertension, microalbuminuria, renal disease

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Authors: Ana Mafalda Silva, Rebeca Fontes, Ana Paula Vaz, Carla Carreira, Ana Corte-Real

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Decades of research on the topic of interpersonal violence against minors highlight five main conclusions: 1) it causes harmful effects on children's development and health; 2) it is prevalent; 3) it violates children's rights; 4) it can be prevented and 5) parents are the main aggressors. The child abuse scenario is identified through clinical observation, administrative data and self-reports. The most used instruments are self-reports; however, there are no valid and reliable self-report instruments for minors, which consist of a retrospective interpretation of the situation by the victim already in her adult phase and/or by her parents. Clinical observation and collection of information, namely from the orofacial region, are essential in the early identification of these situations. The management of medical data, such as personal data, must comply with the General Data Protection Regulation (GDPR), in Europe, and with the General Law of Data Protection (LGPD), in Brazil. This review aims to answer the question: In a situation of medical assistance to minors, in the suspicion of interpersonal violence, due to mistreatment, is it necessary for the guardians to provide consent in the registration and sharing of personal data, namely medical ones. A scoping review was carried out based on a search by the Web of Science and Pubmed search engines. Four papers and two documents from the grey literature were selected. As found, the process of identifying and signaling child abuse by the health professional, and the necessary early intervention in defense of the minor as a victim of abuse, comply with the guidelines expressed in the GDPR and LGPD. This way, the notification in maltreatment scenarios by health professionals should be a priority and there shouldn’t be the fear or anxiety of legal repercussions that stands in the way of collecting and treating the data necessary for the signaling procedure that safeguards and promotes the welfare of children living with abuse.

Keywords: child abuse, disease notifications, ethics, healthcare assistance

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