Search results for: cardio-metabolic risk factors

Authors: Osama Shakeel

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The objective of the paper is to study the clinic-pathological factors, survival analyses, recurrence rate, metastatic rate, risk factors and the management of cutaneous malignant melanoma at Shaukat Khanum Memorial Cancer Hospital and Research Center. Methodology: From 2014 to 2017, all patients with a diagnosis of cutaneous malignant melanoma (CMM) were included in the study. Demographic variables were collected. Short and long term oncological outcomes were recorded. All data were entered and analyzed in SPSS version 21. Results: A total of 28 patients were included in the study. Median age was 46.5 +/-15.9 years. There were 16 male and 12 female patients. The family history of melanoma was present in 7.1% (n=2) of the patients. All patients had a mean survival of 13.43+/- 9.09 months. Lower limb was the commonest site among all which constitutes 46.4%(n=13). On histopathological analyses, ulceration was seen in 53.6% (n=15) patients. Unclassified tumor type was present in 75%(n=21) of the patients followed by nodular 21.4% (n=6) and superficial spreading 3.5%(n=1). Clark level IV was the commonest presentation constituting 46.4%(n=13). Metastases were seen in 50%(n=14) of the patients. Local recurrence was observed in 60.7%(n=17). 64.3%(n=18) lived after one year of treatment. Conclusion: CMM is a fatal disease. Although its disease of fair skin individuals, however, the incidence of CMM is also rising in this part of the world. Management includes early diagnoses and prompt management. However, mortality associated with this disease is still not favorable.

Keywords: malignant cancer of skin, cutaneous malignant melanoma, skin cancer, survival analyses

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Authors: Maggie Hui

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Risk management is not a new concept; however, it is an uncharted area as applied to the translation process and translator training. Serving as one of the self-discovery activities in their practicum course, a two-cycle experiment was carried out with a class of 13 MA translation students with an attempt to explore their risk management while translating in a simulated setting that involves translator-client relations. To test the effects of the main variable of translators’ interaction with the simulated clients, the researcher employed control-group translators and two experiment groups (with Group A being the translator in Cycle 1 and the client in Cycle 2, and Group B on the client position in Cycle 1 and the translator position in Cycle 2). Experiment cycle 1 aims to explore if there would be any behavioral difference in risk management between translators with interaction with the simulated clients, i.e. experiment group A, and their counterparts without such interaction, i.e. control group. Design of Cycle 2 concerns the order of playing different roles of the translator and client in the experiment, and provides information to compare behavior of translators of the two experiment groups. Since this is process-oriented research, it is necessary to hypothesize what was happening in the translators’ minds. The researcher made use of a user-friendly screen-voice recording freeware to record subjects’ screen activities, including every word the translator typed and every change they made to the rendition, the websites they browsed and the reference tools they used, in addition to the verbalization of their thoughts throughout the process. The research observes the translation procedures subjects considered and finally adopted, and looks into the justifications for their procedures, in order to interpret their risk management. The qualitative and quantitative results of this study have some implications for translator training: (a) the experience of being a client seems to reinforce the translator’s risk aversion; (b) the use of role-playing simulation can empower students’ learning by enhancing their attitudinal or psycho-physiological competence, interpersonal competence and strategic competence; and (c) the screen-voice recordings serve as a helpful tool for learners to reflect on their rendition processes, i.e. what they performed satisfactorily and unsatisfactorily while translating and what they could do for improvement in future translation tasks.

Keywords: risk management, screen-voice recordings, simulated translator-client relations, translation pedagogy, translation process-oriented research

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Authors: Ehsan Ahmed Yahia

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Introduction: The nursing role in nutrition screening and assessing hospitalized patients is important. Malnutrition is a common and costly problem, particularly among hospitalized patients, and can have an adverse effect on the healing process. The study's goal is to assess the prevalence of malnutrition among adult hospitalized orthopedic patients and to detect the barriers to the nutrition screening process. Aim of the study: This study aimed to (a) assess the prevalence of malnutrition in hospitalized orthopedic patients and (b) evaluate the relationship between malnutrition and selected clinical outcomes. Material and Methods: This prospective field study was conducted for three months between 03/2022 and 06/2022 in the selected orthopedic departments in a teaching hospital affiliated withCairo University, Egypt. with a total number of one hundred twenty (120) patients. Patients' assessment included checking for malnutrition using the Nutritional Risk Screening Questionnaire. Patients at risk for malnourishment were defined as NRS score ≥ 3. Clinical outcomes under consideration included 1) length of hospitalization, 2) mobilization after surgery and conservative treatment, and 3) rate of adverse events. Results: This study found that malnutrition is a significant problem among patients hospitalized in an orthopedic ward. The prevalence of malnutrition was the highest in patients with lumbar spine and pelvis fractures, followed by the proximal femur and proximal humerus fractures. Patients at risk for malnutrition had significantly prolonged hospitalization, delayed postoperative mobilization, and increased incidence of adverse events.27.8% of the study sample were at risk for malnutrition. The highest prevalence of malnourishment was found in Septic Surgery with 32%, followed by Traumatology with 19.6% and Arthroplasty with 15.3%. A higher prevalence of malnutrition was detected among patients with typical fractures, such as lumbar spine and pelvis (46.7%), proximal femur (34.4%), and proximal humeral (23.7%) fractures. Additionally, patients at risk for malnutrition showed prolonged hospitalization (14.7 ± 11.1 vs. 21.2 ± 11.7 days), delayed postoperative mobilization (2.3 ± 2.9 vs. 4.1 ± 4.9 days), and delayed to mobilize after conservative treatment (1.1 ± 2.7 vs. 1.8 ± 1.9 days). A significant statistical correlation of NRS with individual parameters (Spearman's rank correlation, p < 0.05) was observed. The rate of adverse incidents in patients at risk for malnutrition was significantly higher than that of patients with a regular nutritional status (37.2% vs. 21.1%, p < 0.001). Conclusions: Our results indicate that the prevalence of malnutrition in surgical patients is significant. The nutritional status of patients with typical fractures is especially at risk. Prolonged hospitalization, delayed postoperative mobilization, and delayed mobilization after conservative treatment is significantly associated with malnutrition. In addition, the incidence of adverse events in patients at risk for malnutrition is significantly higher.

Keywords: malnutrition, nutritional risk screening, surgery, nursing, orthopedic nurse

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Authors: Anocha Rojanapanich

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This research aimed to identify important factors that effect customer satisfaction in boutique hotels and the important factors effecting customer loyalty in returning to boutique hotels. Furthermore, this study also aimed to study demographics, which effect variable factors. Four hundred questionnaires were completed by customers of the boutique hotels. The descriptive statistics used in this paper were percentages, means, and standard deviation (S.D.), while hypothesis testing was done using T-test, Anova, Correlation and Regression to analyze the relationship among those factors. In terms of the purpose in staying, it was found that the largest respondent was for ‘leisure purposes’. While the frequency indicated that most of the customers who stayed ‘once’in the last two years in the hotels had less concern in the hotel’s image than other groups. For customer’s perceived value and income levels had an influence on customer perceived values in both functional value price and emotional value.

Keywords: boutique hotels, customer attitude, customer satisfaction, customer loyalty

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Authors: Fatemeh Kourkinejad Gharaei, Tahereh Safari, Zahra Saebinasab

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Metabolic syndrome (MetS) is a set of risk factors associated with cardiovascular diseases, atherosclerosis, and type 2 diabetes. Nonalcoholic fatty liver disease (NAFLD) is the most important liver disorder in metabolic syndrome. High fructose consumption increases the risk of NAFLD. Eugenol shows anti-thrombotic, insulin-sensitive, fat-reducing effects. This study was designed to investigate the protective role of eugenol in NAFLD caused by metabolic syndrome. Methods: Thirty male Wistar rats were randomly divided into five groups; group 1, drinking water intake animals; group 2, fructose, group 3, fructose+eugenol solvent; group 4, fructose+ eugenol 50mg/kg and group 5, fructose+ eugenol 100mg/kg. At the end of the experiment, after 12 hours of fasting and under anesthesia, blood samples were taken for measurement of fast blood glucose (FBS), SGOT, AGPT, LDL, HDL, cholesterol, triglyceride. Results: FBG significantly increased in group 2 compared to group 1 (p < 0.001); however, it significantly decreased in groups 4 and 5 compared to group 2 (p < 0.05). SGOT and SGPT levels significantly increased in group 2 compared to drinking water alone (p < 0.001). However, SGOT and SGPT levels significantly decreased in groups 4 and 5. MDA and LTDS significantly increased in group 2 compared with drinking water alone (p < 0.01), while MDA and LTDS decreased in 4 and 5 groups compared to group 2 (p < 0.05), which confirms the pathology results related to the liver damage. Conclusion: Eugenol has protective effects on the liver and fat accumulation in liver cells.

Keywords: eugenol, fructose, metabolic syndrome, nonalcoholic fatty liver disease

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Authors: Haoyu Zhao, Qianshu Ma, Min Xie, Yunqi Huang, Yunjia Liu, Huan Song, Hongsheng Gui, Mingli Li, Qiang Wang

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Rationale: Bipolar disorder (BD) and major depressive disorder (MDD), as severe chronic illnesses that restrict patients’ psychosocial functioning and reduce their quality of life, are both categorized into mood disorders. Emerging evidence has suggested that the reliability of self-rated health (SRH) was wellvalidated and that the risk of various health outcomes, including mortality and health care costs, could be predicted by SRH. Compared with other lengthy multi-item patient-reported outcomes (PRO) measures, SRH was proven to have a comparable predictive ability to predict mortality and healthcare utilization. However, to our knowledge, no study has been conducted to assess the association between SRH and hospitalization among people with mental disorders. Therefore, our study aims to determine the association between SRH and subsequent all-cause hospitalizations in patients with BD and MDD. Methods: We conducted a prospective cohort study on people with BD or MDD in the UK from 2006 to 2010 using UK Biobank touchscreen questionnaire data and linked administrative health databases. The association between SRH and 2-year all-cause hospitalizations was assessed using proportional hazard regression after adjustment for sociodemographics, lifestyle behaviors, previous hospitalization use, the Elixhauser comorbidity index, and environmental factors. Results: A total of 29,966 participants were identified, experiencing 10,279 hospitalization events. Among the cohort, the average age was 55.88 (SD 8.01) years, 64.02% were female, and 3,029 (10.11%), 15,972 (53.30%), 8,313 (27.74%), and 2,652 (8.85%) reported excellent, good, fair, and poor SRH, respectively. Among patients reporting poor SRH, 54.19% had a hospitalization event within 2 years compared with 22.65% for those having excellent SRH. In the adjusted analysis, patients with good, fair, and poor SRH had 1.31 (95% CI 1.21-1.42), 1.82 (95% CI 1.68-1.98), and 2.45 (95% CI 2.22, 2.70) higher hazards of hospitalization, respectively, than those with excellent SRH. Conclusion: SRH was independently associated with subsequent all-cause hospitalizations in patients with BD or MDD. This large study facilitates rapid interpretation of SRH values and underscores the need for proactive SRH screening in this population, which might inform resource allocation and enhance high-risk population detection.

Keywords: severe mental illnesses, hospitalization, risk prediction, patient-reported outcomes

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Authors: Neena Kanojia, R. K. Kanojia

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Background: Osteoarthritis OA of the knee is one of the leading causes of disability characterized by degeneration of hyaline cartilage combined with reparative processes. Its strong association with metabolic syndrome is postulated to be due to both mechanical and biochemical factors. Our study aims to study differential effect of metabolic risk factors on cartilage degeneration and regeneration at biomarker level. Design: After screening 281 patients presenting with knee pain, 41 patients who met the selection criteria were included and were divided into metabolic MetS OA and non-metabolic Non-MetS OA phenotypes using National Cholesterol Education Programme-Adult Treatment Panel-III NCEP ATP III criteria for metabolic syndrome. Serum Cartilage Oligomeric Matrix Protein COMP and Procollagen type IIA N terminal Propeptide PIIANP levels were used as tools to assess cartilage degeneration and regeneration, respectively. Results: 22 among 41 patients 53.66% had metabolic syndrome. Covariates like age, gender, Kellgren Lawrence KL grades were comparable in both groups. MetS OA group showed significant increase in serum COMP levels (p 0.03 with no significant effect on serum PIIANP levels (p 0.46. Hypertriglyceridemia showed independent association with both cartilage anabolism (p 0.03 and catabolism (p 0.03. Conclusion: Metabolic syndrome, though has no effect on cartilage regeneration tends to shift cartilage homeostasis towards degeneration with hypertriglyceridemia showing significant independent effect on cartilage metabolism.

Keywords: metabolic, syndrome, cartilage, degernation

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Authors: Hadeel Abdulatif, Maha Alkhaffaf

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E-government is the use of Information and Communication Technology to enrich the access to and delivery of government services to citizens, business partners and employees, Policy makers and regulatory bodies have to be cognizant of the degree of readiness of a populace in order to design and implement efficient e-government programs. This paper aims to provide a transparent situation analyses for the case of e-government official website in Jordan, it focuses on assessing e-government in Jordan; web site assessment by using international criteria for assessing e-government websites, However, the study analyses the environmental factor consisting of cultural and business environment factors. By reviewing the literature the researchers found that government's efforts towards e-government may vary according to the country's readiness and other key implementation factors which will lead to diverse e-government experience; thus, there is a need to study the impact of key factors to implement e-government in Jordan.

Keywords: e-government, environmental factors, website assessment, readiness

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Authors: Anandita Mitro, Archana Srivastava, Bidisha Banerjee

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The present paper attempts to analyze the hierarchy and interconnection of factors responsible for the uptake of BCG vaccination in India. The study uses National Family Health Survey (NFHS-5) data which was conducted during 2019-21. The univariate logistic regression method is used to understand the univariate effects while the interconnection effects have been studied using the Categorical Inference Tree (CIT) which is a non-parametric Machine Learning (ML) model. The hierarchy of the factors is further established using Conditional Inference Forest which is an extension of the CIT approach. The results suggest that BCG vaccination coverage was influenced more by system-level factors and awareness than education or socio-economic status. Factors such as place of delivery, antenatal care, and postnatal care were crucial, with variations based on delivery location. Region-specific differences were also observed which could be explained by the factors. Awareness of the disease was less impactful along with the factor of wealth and urban or rural residence, although awareness did appear to substitute for inadequate ANC. Thus, from the policy point of view, it is revealed that certain subpopulations have less prevalence of vaccination which implies that there is a need for population-specific policy action to achieve a hundred percent coverage.

Keywords: vaccination, NFHS, machine learning, public health

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Authors: Hyun Chul Cho, Hyunkyoung Oh, Hyun Yoon, Jooyeon Jin, Jae Won Lee

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Identifying, structuring, and racking the most important factors related to improving athletes’ performances could pave the way for improve training system. The purpose of this study was to identify the relative importance factors to improve performance of the of judo athletes with visual impairments, including blindness by using the Analytic Hierarchy Process (AHP). After reviewing the literature, the relative importance of factors affecting performance of the blind judo was selected. A group of expert reviewed the first draft of the questionnaires, and then finally selected performance factors were classified into the major categories of techniques, physical fitness, and psychological categories. Later, a pre-selected experts group was asked to review the final version of questionnaire and confirm the priories of performance factors. The order of priority was determined by performing pairwise comparisons using Expert Choice 2000. Results indicated that “grappling” (.303) and “throwing” (.234) were the most important lower hierarchy factors for blind judo skills. In addition, the most important physical factors affecting performance were “muscular strength and endurance” (.238). Further, among other psychological factors “competitive anxiety” (.393) was important factor that affects performance. It is important to offer psychological skills training to reduce anxiety of judo athletes with visual impairments and blindness, so they can compete in their optimal states. These findings offer insights into what should be considered when determining factors to improve performance of judo athletes with visual impairments and blindness.

Keywords: analytic hierarchy process, blind athlete, judo, sport performance

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Authors: Chia-Chun Wu, Yu-Hsien Sung

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This study aims to examine the consistency between students’ predictions and their actual observations on the bullying prevalence rate among different types of high-risk victims, thereby clarifying the reliability of students’ reports on the identification of bullying. A total of 1,732 Taiwanese students (734 males and 998 females) participated in this study. A Rasch model was adopted for data analysis. The results showed that students with “personality or behavioral issues” are more likely to be bullied in schools, based on both students’ predictions and actual observations. Moreover, the results differed significantly between genders and between various educational levels in students’ predictions and their actual observations on the bullying prevalence rate of different types of high-risk victims. To summarize, this study not only suggests that students’ reports on the identification of bullying are accurate and could be a valuable reference in terms of recognizing a bullying incident, but it also argues that more attention should be paid to students’ gender and educational level when taking their perspectives into consideration when it comes to identifying bullying behaviors.

Keywords: school bullying, student, bullying recognition, high-risk victims

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Authors: Chloé Kernaléguen, Laura Kundun, Tessie Lery, Ryan Laleg, Zhangyun Tan

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This study explores global disparities in respiratory syncytial virus (RSV) bronchiolitis incidence among children aged 0-2 years, focusing on the human development index (HDI) as a key determinant. RSV bronchiolitis poses a significant health risk to young children, influenced by factors, including socio-economic conditions captured by the HDI. Through a comprehensive systematic review and dataset selection (Switzerland, Brazil, United States of America), we formulated an HDI-SEIRS numerical model within the SEIRS framework. Results show variations in RSV bronchiolitis dynamics across countries, emphasizing the influence of HDI. Modelling reveals a correlation between higher HDI and increased bronchiolitis spread, notably in the USA and Switzerland. The ratios HDIcountry over HDImax strengthen this association, while climate disparities contribute to variations, especially in colder climates like the USA and Switzerland. The study raises the hypothesis of an indirect link between higher HDI and more frequent bronchiolitis, underlining the need for nuanced understanding. Factors like improved healthcare access, population density, mobility, and social behaviors in higher HDI countries might contribute to unexpected trends. Limitations include dataset quality and restricted RSV bronchiolitis data. Future research should encompass diverse HDI datasets to refine HDI's role in bronchiolitis dynamics. In conclusion, HDI-SEIRS models offer insights into factors influencing RSV bronchiolitis spread. While HDI is a significant indicator, its impact is indirect, necessitating a holistic approach to effective public health policies. This analysis sets the stage for further investigations into multifaceted interactions shaping bronchiolitis dynamics in diverse socio-economic contexts.

Keywords: bronchiolitis propagation, HDI influence, respiratory syncytial virus, SEIRS model

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Authors: Tolga Barisik, Ali Fuat Guneri, K. Dastan

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Major industrial facilities have a high potential for fire risk. In particular, the indices used for the detection of hidden fire are used very effectively in order to prevent the fire from becoming dangerous in the initial stage. These indices provide the opportunity to prevent or intervene early by determining the stage of the fire, the potential for hazard, and the type of the combustion agent with the percentage values of the ambient air components. In this system, artificial neural network will be modeled with the input data determined using the Levenberg-Marquardt algorithm, which is a multi-layer sensor (CAA) (teacher-learning) type, before modeling the modeling methods in the literature. The actual values produced by the indices will be compared with the outputs produced by the network. Using the neural network and the curves to be created from the resulting values, the feasibility of performance determination will be investigated.

Keywords: artifical neural networks, fire, Graham Index, levenberg-marquardt algoritm, oxygen decrease percentage index, risk assessment, Trickett Index

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Authors: Orathai Srithongtham, Ubonsri Thabuddha

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The youth with HIV positive is not difference from the general youth in term of sexual needs. Sexual health is crucial the most to support the youth with HIV positive to be sexual well-being. This study aims to elucidate the sexual health on protection from STDs (Sexual Transmitted Diseases) and HIV transmission and to explain sexual risk behavior of the youth with HIV positive. The target group was the youth with HIV positive about 23 cases from two provinces in northeastern part of Thailand. Qualitative method was applied for collecting data by in-depth interview. Content analysis was use for data analysis. The youth with HIV positive was protection from STDs and HIV transmission by using the condom during sexual activity. The reason to deny the condom use were ashamed, condom is not a part of life, no have fit size, and the youth fear to stigmatized as a mental disorder and fear to stigmatized as going to fuck someone. The youth who trust with nurse in clinic was dare to request the condom by face. Sexual activity without condom use is sexual risk behavior. The major causes were couple trust and the sexual enjoyment first and sexual active competition with friend without condom use. The concern on HIV was the boyfriend or girlfriend not accepts the HIV positive people, worry about the HIV transmutation, and finally not compliance to ARV drug. The youth with HIV positive was lacking of the knowledge on sexual health on the issues of access to condom and the concern to keep on relationship with the boyfriend or girlfriend. This concern issues was led to the non-adherence of ARV drug and HIV distribution. To provide the sexual health service is more essential to the youth with HIV positive.

Keywords: sexual health, sexual risk behavior, youth, HIV

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Authors: Chua Bee Seok, Getrude Cosmas, Jasmine Adela Mutang, Shazia Iqbal Hashmi

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The aims of this study were to determine the factor structure and psychometric properties (i.e., reliability and convergent validity) of the employees trust scale, a newly created instrument by the researchers. The employees trust scale initially contained 82 items to measure employee’s trust toward their supervisors. A sample of 818 (343 females, 449 males) employees were selected randomly from public and private organization sectors in Kota Kinabalu, Sabah, Malaysia. Their ages ranged from 19 to 67 years old with the mean of 34.55 years old. Their average tenure with their current employer was 11.2 years (s.d. = 7.5 years). The respondents were asked to complete the employees trust scale, as well as a managerial trust questionnaire from Mishra. The exploratory factor analysis on employee’s trust toward their supervisor’s extracted three factors, labeled 'trustworthiness' (32 items), 'position status' (11 items) and 'relationship' (6 items) which accounted for 62.49% of the total variance. Trustworthiness factors were re-categorized into three sub factors: competency (11 items), benevolence (8 items) and integrity (13 items). All factors and sub factors of the scales demonstrated clear reliability with internal consistency of Cronbach’s Alpha above 0.85. The convergent validity of the Scale was supported by an expected pattern of correlations (positive and significant correlation) between the score of all factors and sub factors of the scale and the score on the managerial trust questionnaire which measured the same construct. The convergent validity of employees trust scale was further supported by the significant and positive inter correlation between the factors and sub factors of the scale. The results suggest that the employees trust scale is a reliable and valid measure. However, further studies need to be carried out in other groups of sample as to further validate the Scale.

Keywords: employees trust scale, psychometric properties, trustworthiness, position status, relationship

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Authors: Tin Thongthammachart, Wanida Jinsart

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Atmospheric particulate matter particles with a diameter less than 10 microns (PM₁₀) and less than 2.5 microns (PM₂.₅) have adverse health effect. The impact from PM was studied from both health and regulatory perspective. Ambient PM data was collected over ten years in Bangkok and vicinity areas of Thailand from 2007 to 2017. Statistical models were used to forecast PM concentrations from 2018 to 2020. Monitoring monthly data averaged concentration of PM₁₀ and PM₂.₅ were used as input to forecast the monthly average concentration of PM. The forecasting results were validated by root means square error (RMSE). The predicted results were used to determine hazard risk for the carcinogenic disease. The health risk values were interpolated with GIS with ordinary kriging technique to create hazard maps in Bangkok and vicinity area. GIS-based maps illustrated the variability of PM distribution and high-risk locations. These evaluated results could support national policy for the sake of human health.

Keywords: PM₁₀, PM₂.₅, statistical models, atmospheric particulate matter

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Authors: Youmen Chaaban, Maha Ellili-Cherif

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The purpose of this study was to examine the effects of teachers’ individual characteristics and perceptions of environmental factors that impact their technology integration into their EFL (English as a Foreign Language) classrooms. To this end, a national survey examining EFL teachers’ perceptions was conducted at Qatari Independent schools. 263 EFL teachers responded to the survey which investigated several factors known to impact technology integration. These factors included technology availability and support, EFL teachers’ perceptions of importance, obstacles facing technology integration, competency with technology use, and formal technology preparation. The impact of these factors on teachers’ and students’ educational technology use was further measured. The analysis of the data included descriptive statistics and a chi-square analysis test in order to examine the relationship between these factors. The results revealed important cultural factors that impact teachers’ practices and attitudes towards technology in the Qatari context. EFL teachers were found to integrate technology most prominently for instructional delivery and preparation. The use of technology as a learning tool received less emphasis. Teachers further revealed consistent perceptions about obstacles to integration, high levels of confidence in using technology, and consistent beliefs about the importance of using technology as a learning tool. Further analyses of the factors impacting technology integration can assist with Qatar’s technology advancement and development efforts by indicating the areas of strength and areas where additional efforts are needed. The results will lay the foundation for conducting context-specific professional development suitable for the needs of EFL teachers in Qatari Independent Schools.

Keywords: educational technology integration, Qatar, EFL, independent schools, ICT

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Authors: Nahla Elsherbiny, Ahmed Ahmed, Hamada Mohammed, Mohamed Ali

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Background: The enterococci may be considered as opportunistic agents particularly in immunocompromised patients. It is one of the top three pathogens causing many healthcare associated infections (HAIs). Resistance to several commonly used antimicrobial agents is a remarkable characteristic of most species which may carry various genes contributing to virulence. Objectives: to determine the prevalence of enterococci species in different intensive care units (ICUs) causing health care-associated infections (HAIs), intestinal carriage and environmental contamination. Also, to study the antimicrobial susceptibility pattern of the isolates with special reference to vancomycin resistance. In addition to phenotypic and genotypic detection of gelatinase, cytolysin and biofilm formation among isolates. Patients and Methods: This study was carried out in the infection control laboratory at Assiut University Hospitals over a period of one year. Clinical samples were collected from 285 patients with various (HAIs) acquired after admission to different ICUs. Rectal swabs were taken from 14 cases for detection of enterococci carriage. In addition, 1377 environmental samples were collected from the surroundings of the patients. Identification was done by conventional bacteriological methods and confirmed by analytical profile index (API). Antimicrobial sensitivity testing was performed by Kirby Bauer disc diffusion method and detection of vancomycin resistance was done by agar screen method. For the isolates, phenotypic detection of cytolysin, gelatinase production and detection of biofilm by tube method, Congo red method and microtiter plate. We performed polymerase chain reaction (PCR) for detection of some virulence genes (gelE, cylA, vanA, vanB and esp). Results: Enterococci caused 10.5% of the HAIs. Respiratory tract infection was the predominant type (86.7%). The commonest species were E.gallinarum (36.7%), E.casseliflavus (30%), E.faecalis (30%), and E.durans (3.4 %). Vancomycin resistance was detected in a total of 40% (12/30) of those isolates. The risk factors associated with acquiring vancomycin resistant enterococci (VRE) were immune suppression (P= 0.031) and artificial feeding (P= 0.008). For the rectal swabs, enterococci species were detected in 71.4% of samples with the predominance of E. casseliflavus (50%). Most of the isolates were vancomycin resistant (70%). Out of a total 1377 environmental samples, 577 (42%) samples were contaminated with different microorganisms. Enterococci were detected in 1.7% (10/577) of total contaminated samples, 50% of which were vancomycin resistant. All isolates were resistant to penicillin, ampicillin, oxacillin, ciprofloxacin, amikacin, erythromycin, clindamycin and trimethoprim-sulfamethaxazole. For the remaining antibiotics, variable percentages of resistance were reported. Cytolysin and gelatinase were detected phenotypically in 16% and 48 % of the isolates respectively. The microtiter plate method showed the highest percentages of detection of biofilm among all isolated species (100%). The studied virulence genes gelE, esp, vanA and vanB were detected in 62%, 12%, 2% and 12% respectively, while cylA gene was not detected in any isolates. Conclusions: A significant percentage of enterococci was isolated from patients and environments in the ICUs. Many virulence factors were detected phenotypically and genotypically among isolates. The high percentage of resistance, coupled with the risk of cross transmission to other patients make enterococci infections a significant infection control issue in hospitals.

Keywords: antimicrobial resistance, enterococci, ICUs, virulence factors

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Authors: Nael Y. Zabel, Maged E. Georgy, Moheeb E. Ibrahim

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A knowledge-based expert system with the acronym RASPE is developed as an application tool to help decision makers in construction companies make informed decisions about managing risks in pipeline construction projects. Choosing to use expert systems from all available artificial intelligence techniques is due to the fact that an expert system is more suited to representing a domain’s knowledge and the reasoning behind domain-specific decisions. The knowledge-based expert system can capture the knowledge in the form of conditional rules which represent various project scenarios and potential risk mitigation/response actions. The built knowledge in RASPE is utilized through the underlying inference engine that allows the firing of rules relevant to a project scenario into consideration. This paper provides an overview of the knowledge acquisition process and goes about describing the knowledge structure which is divided up into four major modules. The paper shows one module in full detail for illustration purposes and concludes with insightful remarks.

Keywords: expert system, knowledge management, pipeline projects, risk mismanagement

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Authors: Yelin Zhao, Xinxiu Li, Martin Smelik, Oleg Sysoev, Firoj Mahmud, Dina Mansour Aly, Mikael Benson

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Background: Early diagnosis of pancreatic cancer is clinically challenging due to vague, or no symptoms, and lack of biomarkers. Polygenic risk score (PRS) scores may provide a valuable tool to assess increased or decreased risk of PC. This study aimed to develop such PRS by filtering genetic variants identified by GWAS using transcriptional programs identified by single-cell RNA sequencing (scRNA-seq). Methods: ScRNA-seq data from 24 pancreatic ductal adenocarcinoma (PDAC) tumor samples and 11 normal pancreases were analyzed to identify differentially expressed genes (DEGs) in in tumor and microenvironment cell types compared to healthy tissues. Pathway analysis showed that the DEGs were enriched for hundreds of significant pathways. These were clustered into 40 “programs” based on gene similarity, using the Jaccard index. Published genetic variants associated with PDAC were mapped to each program to generate program PRSs (pPRSs). These pPRSs, along with five previously published PRSs (PGS000083, PGS000725, PGS000663, PGS000159, and PGS002264), were evaluated in a European-origin population from the UK Biobank, consisting of 1,310 PDAC participants and 407,473 non-pancreatic cancer participants. Stepwise Cox regression analysis was performed to determine associations between pPRSs with the development of PC, with adjustments of sex and principal components of genetic ancestry. Results: The PDAC genetic variants were mapped to 23 programs and were used to generate pPRSs for these programs. Four distinct pPRSs (P1, P6, P11, and P16) and two published PRSs (PGS000663 and PGS002264) were significantly associated with an increased risk of developing PC. Among these, P6 exhibited the greatest hazard ratio (adjusted HR[95% CI] = 1.67[1.14-2.45], p = 0.008). In contrast, P10 and P4 were associated with lower risk of developing PC (adjusted HR[95% CI] = 0.58[0.42-0.81], p = 0.001, and adjusted HR[95% CI] = 0.75[0.59-0.96], p = 0.019). By comparison, two of the five published PRS exhibited an association with PDAC onset with HR (PGS000663: adjusted HR[95% CI] = 1.24[1.14-1.35], p < 0.001 and PGS002264: adjusted HR[95% CI] = 1.14[1.07-1.22], p < 0.001). Conclusion: Compared to published PRSs, scRNA-seq-based pPRSs may be used not only to assess increased but also decreased risk of PDAC.

Keywords: cox regression, pancreatic cancer, polygenic risk score, scRNA-seq, UK biobank

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Authors: Tu Shuyang, Zhang Xu, Zhou Xiang

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The objective of this paper is to investigate the effect of short-term heat exchange decay of ground heat exchanger (GHE) on the ground source heat pump (GSHP) energy efficiency and capacity. A resistance-capacitance (RC) model was developed and adopted to simulate the transient characteristics of the ground thermal condition and heat exchange. The capacity change of the GSHP was linked to the inlet and outlet water temperature by polynomial fitting according to measured parameters given by heat pump manufacturers. Thus, the model, which combined the heat exchange decay with the capacity change, reflected the energy efficiency decay of the whole system. A case of GSHP system was analyzed by the model, and the result showed that there was risk that the GSHP might not meet the load demand because of the efficiency decay in a short-term operation. The conclusion would provide some guidances for GSHP system design to overcome the risk.

Keywords: capacity, energy efficiency, GSHP, heat exchange

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Authors: Vladimir A. Todiras

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Spatio-temporal models provide new possibilities for real-time action in pest risk analysis. It should be noted that estimation of the possibility and probability of introduction of a pest and of its economic consequences involves many uncertainties. We present a new mapping technique that assesses pest invasion risk using online BioClass software. BioClass is a GIS tool designed to solve multiple-criteria classification and optimization problems based on fuzzy logic and level set methods. This research describes a method for predicting the potential establishment and spread of a plant pest into new areas using a case study: corn rootworm (Diabrotica spp.), tomato leaf miner (Tuta absoluta) and plum fruit moth (Grapholita funebrana). Our study demonstrated that in BioClass we can combine fuzzy logic and geographic information systems with knowledge of pest biology and environmental data to derive new information for decision making. Pests are sensitive to a warming climate, as temperature greatly affects their survival and reproductive rate and capacity. Changes have been observed in the distribution, frequency and severity of outbreaks of Helicoverpa armigera on tomato. BioClass has demonstrated to be a powerful tool for applying dynamic models and map the potential future distribution of a species, enable resource to make decisions about dangerous and invasive species management and control.

Keywords: classification, model, pest, risk

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Authors: Simon Mensah Ofosu

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Illicit surface mining activities pollutes agricultural lands and water bodies and results in accumulation of heavy metals in vegetables cultivated in such areas. Heavy metal (HM) accumulation in vegetables is a serious food safety issues due to the adverse effects of metal toxicities, hence the need to investigate the levels of these metals in cultivated vegetables in the eastern region. Cocoyam leaves, cabbage and cucumber were sampled from selected farms in mining areas (Atiwa District) and non -mining areas (Yilo Krobo and East Akim District) of the region for the study. Levels of Cadmium, Lead, Mercury and Arsenic were investigated in the vegetables with Atomic Absorption Spectrometer, and the results statistically analyzed with Microsoft Office Excel (2013) Spread Sheet and ANOVA. Cadmium (Cd) and arsenic (As) were the highest and least concentrated HM in the vegetables sampled, respectively. The mean concentrations of Cd and Pb in cabbage (0.564 mg/kg, 0.470 mg/kg), cucumber (0.389 mg/kg, 0.190 mg/kg), cocoyam leaves (0.410 mg/kg, 0.256 mg/kg) respectively from the mining areas exceeded the permissible limits set by Joint FAO/WHO. The mean concentrations of the metals in vegetables from the mining and non-mining areas varied significantly (P<0.05). The Target Hazard Quotient (THQ) was used to assess the health risk posed to the human population via vegetable consumption. The THQ values of cadmium, mercury, and lead in adults and children through vegetable consumption in the mining areas were greater than 1 (THQ >1). This indicates the potential health risk that the children and adults may be facing. The THQ values of adults and children in the non-mining areas were less than the safe limit of 1 (THQ<1), hence no significant health risk posed to the population from such areas.

Keywords: food safety, risk assessment, illicit mining, public health, contaminated vegetables

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Authors: Chaiyaporn Yuksen

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Backgroud: Supraventricular tachycardia (SVT) is an abnormally fast atrial tachycardia characterized by narrow (≤ 120 ms) and constant QRS. Adenosine was the drug of choice; the first dose was 6 mg. It can be repeated with the second and third doses of 12 mg, with greater than 90% success. The study found that patients observed at 4 hours after normal sinus rhythm was no recurrence within 24 hours. The objective of this study was to investigate the factors that influence the recurrence of SVT after adenosine in the emergency department (ED). Method: The study was conducted retrospectively exploratory model, prognostic study at the Emergency Department (ED) in Faculty of Medicine, Ramathibodi Hospital, a university-affiliated super tertiary care hospital in Bangkok, Thailand. The study was conducted for ten years period between 2010 and 2020. The inclusion criteria were age > 15 years, visiting the ED with SVT, and treating with adenosine. Those patients were recorded with the recurrence SVT in ED. The multivariable logistic regression model developed the predictive model and prediction score for recurrence PSVT. Result: 264 patients met the study criteria. Of those, 24 patients (10%) had recurrence PSVT. Five independent factors were predictive of recurrence PSVT. There was age>65 years, heart rate (after adenosine) > 100 per min, structural heart disease, and dose of adenosine. The clinical risk score to predict recurrence PSVT is developed accuracy 74.41%. The score of >6 had the likelihood ratio of recurrence PSVT by 5.71 times Conclusion: The clinical predictive score of > 6 was associated with recurrence PSVT in ED.

Keywords: clinical prediction score, SVT, recurrence, emergency department

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Authors: Adam Chlapecka, Anna Kagstrom, Pavla Cermakova

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Background: Increasing educational attainment (EA) could decrease the occurrence of depression. We investigated the relationship between EA and depressive symptoms in older individuals across four European regions. Methods: We studied 108 315 Europeans (54 % women, median age 63 years old) from the Survey on Health, Ageing and Retirement in Europe assessing EA (7 educational levels based on ISCED classification); and depressive symptoms (≥ 4 points on EURO-D scale). Logistic regression estimated the association between EA and depressive symptoms, adjusting for sociodemographic and health-related factors; testing for sex/age/region and education interactions. Results: Higher EA was associated with lower odds of depressive symptoms, independent of sociodemographic and health-related factors. A threshold of the lowest odds of depressive symptoms was detected at the first stage of tertiary education (OR 0.60; 95% CI 0.55-0.65; p<0.001; relative to no education). Central and Eastern Europe showed the strongest association (OR for high vs. low education 0.37; 95% CI 0.33-0.40; p<0.001) and Scandinavia the weakest (OR for high vs. low education 0.69; 95% CI 0.60-0.80; p<0.001). The association was strongest amongst younger individuals. There was a sex and education interaction only within Central and Eastern Europe. Conclusion: The level of EA is reflected in later-life depressive symptoms, suggesting that supporting individuals in achieving EA, and considering those with lower EA at increased risk for depression, could lead to the decreased burden of depression across the life course. Further educational support in Central and Eastern Europe may decrease the higher burden of depressive symptoms in women.

Keywords: depression, education, epidemiology, Europe

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Authors: Nada Souissi, Mourad Mroua

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The main purpose of this study is to examine the interaction between financial asset volatility, economic factors and investor's behavioral indicators related to both the company's and the markets stocks for the period from January 2000 to January2020. Using multiple linear regression and Bayesian Networks modeling, results show a positive and negative relationship between investor's psychology index, economic factors and predicted stock market return. We reveal that the application of the Bayesian Discrete Network contributes to identify the different cause and effect relationships between all economic, financial variables and psychology index.

Keywords: Financial asset return predictability, Economic factors, Investor's psychology index, Bayesian approach, Probabilistic networks, Parametric learning

Procedia PDF Downloads 151

Authors: Shosh Shahrabani, Sharon Teitler-Regev, Helena Desivilya Syna, Fotini Voulgaris, Evangelos Tsoukatos, Vitor Ambrosio, Sandra M. Correia Loureiro

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International crises that affect tourism, such as terror attacks, political unrest, and economic crises have become more frequent, and their influence has become broader. The influence of such extreme events depends on their salience in the tourists' awareness. Hence, it is important to understand the mechanisms underlying tourists' selection of travel destinations, especially their perceptions of crisis-related events and the impact of the sociopolitical and economic context in their countries of origin. The current study examined how the socio-political and economic context in the home countries of potential young tourists affected their selection of travel destinations. The objective was to elucidate how the salience of various crises (economic and political) in the tourists' perceptions, due to their experiences at home, color their construal of destinations affected by similar hazards and influence their travel intentions. The study focused on student tourists from Israel, Greece, and Portugal. Today about a fifth of international tourism is based on young people, especially students. These countries were chosen since Greece and Portugal are in the midst of economic crises. In addition, Greece and Portugal have experienced political instability, while Israel has security-related problems (including terrorist incidents). In 2013, a total of 648 students, responded to a questionnaire that included questions concerning attitudes and risk perceptions regarding travel to destinations with various risk hazards as well as socio-demographic details. The results indicate that over half of the Israelis intend to visit Greece or Portugal. The majority of the Portuguese intend to visit Greece, while less than a third of them intend to visit Israel. About half of the Greeks intend to visit Portugal, and most of them do not intend to visit Israel. The results indicate that greater perceived importance of economic crises mitigates the intention to travel to destinations with economic crises for tourists from origin countries that are also marked by economic crises, such as Greece and Portugal. However, for tourists from Israel, a country with a relatively stable economy, issues related to the economy barely affect their intention to travel to the other two countries. The findings also suggest that Greeks and Portuguese who are highly concerned about political unrest are unlikely to select Israel as a tourist destination. In addition, strong apprehension regarding terrorism impedes the intention to travel to destinations marked by terrorist incidents, such as Israel. The current research contributes to the existing literature by highlighting the impact of travelers' personal previous experience with crisis on their risk perceptions and in turn on their intentions to travel to countries with similar risks. Therefore, in a world where such incidents are on the rise, understanding tourists' risk perceptions and behavior and the factors influencing their destination-related decisions are crucial for countries that wish to increase the numbers of incoming tourists.

Keywords: economic crises, political instability, risk perception, young tourists

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Authors: Vanphanom Sychareun, Viengnakhone Vongxay, Kongmany Chaleunvong, Pascale Hancart Petitet

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Background: Lao PDR still has challenges in preventing and managing health against risk of emerging and re-emerging diseases, particularly HIV/AIDS, tuberculosis and malaria among pregnant women. Community-based intervention for mothers requires more evidences on awareness of such diseases and access to rapid diagnostic tests. The study aims to determine the awareness of pregnant women regarding HIV, TB and Malaria, the access to rapid diagnostic test of such diseases among pregnant women of local community and their factors related. Method: This is a cross sectional study using quantitative approach to explore the awareness of pregnant women on HIV/AIDS/TB and Malaria in Savannakhet province, Lao PDR in three remote districts (Phin, Thapangthong and Atsaphone) of Savannakhet province. The study targeted group was pregnant women at the community level. Sample size for primary data collection of pregnant women was 189. Face-to-face administered questionnaires were applied. Descriptive and inferential statistics were applied to determine the associated factors with awareness of pregnant women on HIV/AIDS/TB and Malaria. This study is under the HEALTH project/ Expertise France. Result: Most of our participants were pregnant at 28 – 42 weeks (50.3%); ranged 4 – 38 weeks. Mean age of pregnant women was 24.3 years old (range: 14 - 48 years old); 15.9% of whom were at age below 19 years. Around 94.2% of respondents works were farming, 54.5% were illiterate, 74.0% were Mon-Kmer ethnic, and 60% had income lower than average. Only 56.6% that have access to ANC, 39.1% started the access to ANC during the first trimester and only 19.6% had visited the ANC for at least four times. Almost pregnant women (and 92.1% and 93.1%) had low to moderate knowledge of HIV and TB respectively, while three-fourth of pregnant women (74.6%) had low to moderate knowledge of malaria. Slightly higher than half of participants (53.4% and 52.9%) had easy access to HIV and TB respectively ; while 72.5% had easy access to malaria. Majority of participants knew where to get tested for malaria (73.5%) and TB (54.5%), but 73.5% did not know where to get tested for HIV. Very few pregnant women (1.6%, 2.1% and 8.5%) experienced having tested for HIV/TB/malaria. respectively. Factors associated with awareness on HIV were occupation as staff, business (OR:5.9; 95% CI:1.2-28.1), upper secondary education (OR: 14.6; 95% CI:3.1-69.2); Mone-Khmer ethnic (OR: 0.4, 95% CI: 0.2-0.8); and attending ANC more than 4 times (OR:4.1, 95%:1.7-9.7). Factors associated with awareness on TB were occupation as staff, business (OR:2.4; 95% CI: 0.7-8.0), upper secondary education (OR: 6.2; 95% CI: 1.9-20.5); Mone-Khmer ethnic (OR: 0.5, 95% CI:0.3-0.9); attending ANC more than 4 times (OR:2.8, 95%:1.2-6.4). Factors associated with awareness on malaria were upper secondary education (OR: 18.1; 95% CI: 2.3-142.9); Mone-Khmer ethnic (OR: 0.2, 95% CI:0.1-0.4); attending ANC more than 4 times (OR:3.6, 95%:1.5-8.8). Conclusion: A very low awareness on HIV, TB and malaria among pregnant women in rural community of Savannakhet triggers the requirement of comprehensive public health intervention on awareness and access to prevention against emerging diseases for all pregnant women. Future intervention should focus on providing more knowledge to pregnant women during ANC and encouraging them to attend ANC more than 4 times.

Keywords: pregnant women, HIV, tuberculosis, malaria, awareness, Laos

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Authors: Mónika Ditta Tóth, Ádám Fritz, Balázs Hankó, György Purebl

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Communication training about depression and suicide prevention for pharmacists – A Hungarian pilot study Mónika Ditta Tóth1, Ádám Fritz2, Balázs Hankó2, György Purebl1 1: Semmelweis University, Institute of Behavioural Sciences 2: Semmelweis University, University Pharmacy Department of Pharmacy Administration Background: Suicide rates in Hungary have been one of the highest in the European Union. Depression is one of the main risk factors for suicide and recognizing and treating depression is an effective way to prevent suicidal behaviour. In their daily practice, pharmacists meet patients with high risk of mental health problems. Therefore they have a key role in the prevention of depression and suicide. Aim: The main aim of this study is to raise pharmacists’ awareness about depression and suicide to enable better recognation of verbal and non-verbal signs of these deseases. Another important objective is to reduce their stigma about depression and increase their confidence in communication with depressed and/or suicidal patients. Methods: A 3-hour communication workshop has been delivered in this pilot study about the reasons, trigger factors, verbal and non-verbal signs of depression and suicide. The training includes communication techniques which have been developed to patients needs, as well as role-playing scenarios. Depression Stigma and Morris Confidence Scales were applied before, after and 6 weeks following the training. The results of the training group are then compared with two of the following pharmacist groups: 1. written material only (N=15), 2. no material (N=15). Results: One-way ANOVA revealed significant differences in the training group regarding the level of confidence in treating and communicating with patients with depression and/or suicide following the training, and after 6 weeks (F(2, 24)= 7,135, p=,004; baseline: 20,37, after training: 30,00, follow up: 27,66). After the 3-hour workshop the personal stigma about depression decreased (baselin: 19,75 after training: 17,00, p=0,075) in the training group (N=9), whilst the perceived stigma did not change (before: 33.54, after: 33,44, p=NS). Trainees assessed the workshop as ‘useful’ and ‘gap filling’. No significant differences was found in the group of pharmacisists who got written material only. Conclusions: Despite the high rates of depression and suicide in Hungary, pharmacists do not receive lectures or seminars about mental health during their university studies. Such half-day workshops could fill this gap and give practical help to recognize and communicate with depressed and/or suicidal patients in a more effective way. This way pharmacists, as community gate-keepers, could contribute to a more effective suicide prevention program in Hungary.

Keywords: communication training, pharmacists, depression, suicide

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Authors: Sofia Baldelli, Aman More

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Milk curd obstruction is commonly reported as being misdiagnosed for NEC, and they predominantly mimic each other in clinical presentation, including abdominal distension, vomiting, constipation, feeding intolerance and frank or occult blood PR. Using the case of a pre-term neonate misdiagnosed with necrotising enterocolitis when in fact, they had milk curd obstruction, we compare the two diagnoses and why they are hard to differentiate, the risk factors for clinicians to consider and the different management options. The main diagnostic tool for these conditions remains the plain radiograph and here we present the original radiograph of the neonate and discuss the classical radiological features of both diagnoses. We conclude that further imaging techniques such as ultrasound might be used to improve diagnosis when X-ray is inconclusive.

Keywords: milk curd obstruction, Necrotising Enterocolitis, radiology, pediatric surgery

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