Search results for: majority

Authors: Shamim Akhtar

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The purpose of the present research was to analyse the performance level of district administrators and school heads teachers at secondary school level. The sample of the study was head teachers and teachers of secondary schools. In survey three scales were used, two scales were for the head teachers, one five point scale was for analysing the working efficiency of educational administrators and other seven points scale was for head teachers for analysing their own performance and one another seven point rating scale similar to head teacher was for the teachers for analysing the working performance of their head teachers. The results of the head teachers’ responses revealed that the performance of their District Educational Administrators was average and for the performance efficiency of the head teachers, researcher constructed the rating scales on seven parameters of management likely academic management, personnel management, financial management, infra-structure management, linkage and interface, student’s services, and managerial excellence. Results of percentages, means, and graphical presentation on different parameters of management showed that there was an obvious difference in head teachers and teachers’ responses and head teachers probably were overestimating their efficiency; but teachers evaluated that they were performing averagely on majority statements. Results of t-test showed that there was no significance difference in the responses of rural and urban teachers but significant difference in male and female teachers’ responses showed that female head teachers were performing their responsibilities better than male head teachers in public sector schools. When efficiency of the head teachers on different parameters of management were analysed it was concluded that their efficiency on academic and personnel management was average and on financial management and on managerial excellence was highly above of average level but on others parameters like infra-structure management, linkage and interface and on students services was above of average level on most statements but highly above of average on some statements. Hence there is need to improve the working efficiency in academic management and personnel management.

Keywords: educational administration, educational management, parameters of management, education

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Authors: Hasn Perera, Is Almeida, Hnk Perera, Mzf Mohammed, Ade Silva, H. Wijesinghe, Ajal Fernando

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Introduction: Dengue is a major Public Health burden of two clinical entities, Dengue Fever & Dengue Haemorrhagic Fever (DHF). The vast majority of dengue deaths occur in DHF patients, where the diagnosis hinges on the presence of fluid leakage. Limited Ultrasound Scans (USS) of chest and abdomen are used widely at Centre for Clinical Management of Dengue & Dengue Haemorrhagic Fever (CCMDDHF), as the primary method for detecting fluid leaking in DHF. This study analyses the relationship between haematological and USS findings at the onset of leaking and to further determine the usefulness of ultrasound in diagnosing DHF. Methods: A prospective analysis of 80 serologically confirmed dengue patients initially admitted to a General Medical and Paediatric wards who were subsequently transferred to the CCMDDHF from March to September 2017 were analysed. In addition to repeated blood counts and capillary haematocrits’, serial USS were done to detect the onset fluid leaking by three competent and experienced doctors at CCMDDHF. Results: 80 patients (male: female: 38:42) with a mean age of 20 years (SD ±16.8, range 3-74) were evaluated. Dropping of platelet counts below 100,000 and haematocrit rise towards 20% started 4±1.3 day of fever with a mean platelet value of 69x103(range17-98x103). Gallbladder wall thickening was the commonest (98.7%) USS finding followed by fluid in hepato-renal pouch (95%), pelvic fluid (58.7%), right-sided pleural effusion (35%), bilateral effusions (7.5%). USS evidence of plasma leakage was detected in 11.25 %( n=9) of DHF cases from 1 day before significant haematocrit rise was noted. 35 (43.7%) patients with lowering platelets and haematocrit rise showed no objective evidence of plasma leaking on ultrasound scan. Conclusion: This outbreak underscores the importance of USS as a useful, sensitive and cost-effective tool for early diagnosis of suspected DHF cases, facilitating the tracking of progress of leaking and management of epidemics.

Keywords: dengue, ultrasound, plasma leaking, South Asia

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Authors: Elida Cena

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Return migration is receiving increased attention as the phenomenon challenges assumptions of natural ‘homecomings’. This talk outlines preliminary findings from an ongoing PhD study which explores return migration of Albanian migrants (aged 30-50 years) and their children (aged 7-18 years). Participants (n=51) were purposively recruited from two Albanian cities with divergent social and economic conditions, and the majority had returned from Greece following the recent economic downturn in that country. Qualitative data were collected through in-depth interviews with respondents aged 13 years and above, and were augmented with focus groups and family case studies. Data collection for case studies was aided by photo elicitation, interviews and participatory techniques (drawing) were employed for children aged 7-12 years. Through a multidisciplinary perspective, findings will uncover experiences of migrants and children upon return, the quest to identify with the originating country and create a sense of belongingness. Narrative analysis reveals that the abrupt return was associated with ambivalent feelings and disillusionment about their (re)settlement for both younger and older participants. Faced with unexpected realities and lack of opportunities, particularly for the children of migrants, Albania is viewed as a ‘transit country’, a temporary solution to escape the crisis in the destination country and move to a more developed western country. Adult return migrants articulate lack of employment and insecurity for the future. Apart from school difficulties, children experience isolation and social exclusion, marked by stigmatized labelling from other peers which exacerbates their belonging. Such mobilities have had deeper effects in complicating family relationships as influenced by many disintegration factors. Feelings of alienation and being emigrant for the second time were common in participants' accounts. Findings concerning the difficulties of individuals (re)connecting with their ethnic background and the impact on their identities are discussed in relation to the literature on return migration and identification.

Keywords: return migration, belonging, identity, disintegration, integration

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Authors: Benedicta Asante, Catherine Trask, Brenna Bath

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Background: Waste Collection Workers’ (WCWs) activities contribute greatly to the recycling sector and are an important component of the waste management industry. As the recycling sector evolves, there is the increase in reports of injuries, particularly for common and debilitating musculoskeletal disorders such as low back disorder (LBD). WCWs are likely exposed to diverse work-related hazards that could contribute to LBD. However, there is currently no summary of the state of knowledge on the prevalence and risk factors of LBD within this workforce. Method: A comprehensive search was conducted in Ovid Medline, EMBASE, and Global Health e-publications with search term categories ‘low back disorder’ and ‘waste collection workers’. Two reviewers screened articles at title, abstract, and full-text stages. Data were extracted on study design, sampling strategy, socio-demographics, geographical region, and exposure definition, the definition of LBD, response rate, statistical techniques, LBD prevalence and risk factors. The risk of bias was assessed with a standardized tool. Results: The search of three databases generated 79 studies. Thirty-two studies met the study inclusion criteria for both title and abstract; only thirteen full-text articles met the study criteria and underwent data extraction. The majority of articles reported a 12-month prevalence of LBD between 16-74%. Although none of the included studies quantified relationships between risk factors and LBD, the suggested risk factors for LBD among WCWs included: awkward posture; lifting; pulling; pushing; repetitive motions; work duration; and physical loads. Conclusion: LBD is a major occupational health issue among WCWs. In light of these risks and future growth in this industry, further research should focus on the investigation of risk factors, with more focus on ergonomic exposure assessment, and LBD prevention efforts.

Keywords: low back pain, scavenger, waste pickers, waste collection workers

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Authors: Toby Gibbs, Glen Craigie, Suwaree Yordchim

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Using the Speexx Online Language Training Program with Thai students has allowed us to evaluate their learning comprehension and track their progression through the English language program. Speexx sets the standard for excellence and innovation in web-based language training and online coaching services. The program is designed to improve the business communication skills of language learners for Thai students. Speexx consists of English lessons, exercises, tests, web boards, and supplementary lessons to help students practice English. The sample groups are 191 Thai sophomores studying Business English with the department of Humanities and Social Science. The data was received by standard deviation (S.D.) value from questionnaires and samples provided from the Speexx training program. The results found that most Thai sophomores fail the Speexx training program due to their learning comprehension of the English language is below average. With persisted efforts on new training methods, the success of the Speexx Language Training Program can break through the cultural barriers and help future students adopt English as a second language. The Speexx results revealed four main factors affecting the success as follows: 1) Future English training should be pursued in applied Speexx development. 2) Thai students didn’t see the benefit of having an Online Language Training Program. 3) There is a great need to educate the next generation of learners on the benefits of Speexx within the community. 4) A great majority of Thai Sophomores didn't know what Speexx was. A guideline for self-reliance planning consisted of four aspects: 1) Development planning: by arranging groups to further improve English abilities with the Speexx Language Training program and encourage using Speexx every day. Local communities need to develop awareness of the usefulness of Speexx and share the value of using the program among family and friends. 2) Humanities and Social Science staff should develop skills using this Online Language Training Program to expand on the benefits of Speexx within their departments. 3) Further research should be pursued on the Thai Students progression with Speexx and how it helps them improve their language skills with Business English. 4) University’s and Language centers should focus on using Speexx to encourage learning for any language, not just English.

Keywords: ability, comprehension, sophomore, speexx

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Authors: Azzi Mohammed Amin

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Summary: This note aims to demonstrate the impact that comes out of electronic commerce to improve the quality of banking services and to answer the questions raised in the problem; it also aims to find out the methods applied in the banks to improve the quality of banking. And it identified a conceptual framework for electronic commerce and electronic banking. In addition, the inclusion of case study includes the Algerian Popular Credit Bank to measure the impact of electronic commerce on the quality of banking services. Has been focusing on electronic banking services as a field of modern knowledge, including fields characterized by high module in content and content, where banking management concluded that the service and style of electronic submission is the only area to compete and improve their quality. After studying the exploration of some of the banks operating in Algeria, and concluded that the majority relies sites, especially on the Internet, to introduce themselves and their affiliates as well as the definition of customer coverage for traditional and electronic, which are still at the beginning of the road where only some plastic cards, e-Banking, Bank of cellular, ATM and fast transfers. The establishment of an electronic network that requires the use of an effective banking system overall settlement of all economic sectors also requires the Algerian banks to be ready to receive this technology through the modernization of management and modernization of services (expand the use of credit cards, electronic money, and expansion of the Internet). As well as the development of the banking media to contribute to the dissemination of electronic banking culture in the community. Has been reached that the use of the communications revolution has made e-banking services inevitable impose itself in determining the future of banks and development, has also been reached that there is the impact of electronic commerce on the improvement of banking services through the provision of the information base and extensive refresher on-site research and development, and apply strategies Marketing, all of which help banks to increase the performance of its services, despite the presence of some of the risks of the means of providing electronic service and not the nature of the service itself and clear impact also by changing the shape or location of service from traditional to electronic which works to reduce and the costs of providing high-quality service and thus access to the largest segment.

Keywords: e-commerce, e-banking, impact e-commerce, B2C

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Authors: Fredrick Olatunji Ajegbomogun, Bello Modinat Morenikeji, Okorie Nancy Chituru

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Electronic information resources are highly relevant to students' academic and research needs but are grossly underutilized, despite the institutional commitment to making them available. The under-utilisation of these resources could be attributed to a low level of study behaviour coupled with a low level of computer self-efficacy. This study assessed computer self-efficacy, study behaviour, and the use of electronic information resources by students in selected polytechnics in Ogun State. A simple random sampling technique using Krejcie and Morgan's (1970) Table was used to select 370 respondents for the study. A structured questionnaire was used to collect data on respondents. Data were analysed using frequency counts, percentages, mean, standard deviation, Pearson Product Moment Correlation (PPMC) and multiple regression analysis. Results reveal that the internet (= 1.94), YouTube (= 1.74), and search engines (= 1.72) were the common information resources available to the students, while the Internet (= 4.22) is the most utilized resource. Major reasons for using electronic information resources were to source materials and information (= 3.30), for research (= 3.25), and to augment class notes (= 2.90). The majority (91.0%) of the respondents have a high level of computer self-efficacy in the use of electronic information resources through selecting from screen menus (= 3.12), using data files ( = 3.10), and efficient use of computers (= 3.06). Good preparation for tests (= 3.27), examinations (= 3.26), and organization of tutorials (= 3.11) are the common study behaviours of the respondents. Overall, 93.8% have good study behaviour. Inadequate computer facilities to access information (= 3.23), and poor internet access (= 2.87) were the major challenges confronting students’ use of electronic information resources. According to the PPMC results, study behavior (r = 0.280) and computer self-efficacy (r = 0.304) have significant (p 0.05) relationships with the use of electronic information resources. Regression results reveal that self-efficacy (=0.214) and study behavior (=0.122) positively (p 0.05) influenced students' use of electronic information resources. The study concluded that students' use of electronic information resources depends on the purpose, their computer self-efficacy, and their study behaviour. Therefore, the study recommended that the management should encourage the students to improve their study habits and computer skills, as this will enhance their continuous and more effective utilization of electronic information resources.

Keywords: computer self-efficacy, study behaviour, electronic information resources, polytechnics, Nigeria

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Authors: Md Y. Reja, Samuel D. Brody, Wesley E. Highfield, Galen D. Newman

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Historically, wetlands in the United States have been lost due to agriculture, anthropogenic activities, and rapid urbanization along the coast. Such losses of wetlands have resulted in high flooding risk for coastal communities over the period of time. In addition, alteration of wetlands via the Section 404 Clean Water Act permits can increase the flooding risk to future hurricane events, as the cumulative impact of this program is poorly understood and under-accounted. Further, recovery after hurricane events is acting as an encouragement for new development and reconstruction activities by converting wetlands under the wetland alteration permitting program. This study investigates the degree to which hurricane recovery activities in coastal communities are undermining the ability of these places to absorb the impacts of future storm events. Specifically, this work explores how and to what extent wetlands are being affected by the federal permitting program post-Hurricane Ike in 2008. Wetland alteration patterns are examined across three counties (Harris, Galveston, and Chambers County) along the Texas Gulf Coast over a 10-year time period, from 2004-2013 (five years before and after Hurricane Ike) by conducting descriptive spatial analyses. Results indicate that after Hurricane Ike, the number of permits substantially increased in Harris and Chambers County. The vast majority of individual and nationwide type permits were issued within the 100-year floodplain, storm surge zones, and areas damaged by Ike flooding, suggesting that recovery after the hurricane is compromising the ecological resiliency on which coastal communities depend. The authors expect that the findings of this study can increase awareness to policy makers and hazard mitigation planners regarding how to manage wetlands during a long-term recovery process to maintain their natural functions for future flood mitigation.

Keywords: ecological resiliency, Hurricane Ike, recovery, Section 404 Permitting, wetland alteration

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Authors: T. Frawley, G. O'Kelly

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The UCD School of Nursing, Midwifery and Health Systems Higher Diploma in Mental Health (HDMH) nursing programme commenced in January 2017. Forty students successfully completed the programme. Programme evaluation was conducted from the outset. Research ethics approval was granted by the UCD Human Research Ethics Committee – Sciences in November 2016 (LS-E-16-163). Plan for Sustainability: Each iteration of the programme continues to be evaluated and adjusted accordingly. Aims: The ultimate purpose of the HDMH programme is to prepare registered nurses (registered children’s nurse (RCN), registered nurse in intellectual disability (RNID) and registered general nurse (RGN)) to function as effective registered psychiatric nurses in all settings which provide care and treatment for people experiencing mental health difficulties. Curriculum evaluation is essential to ensure that the programme achieves its purpose, that aims and expected outcomes are met and that required changes are highlighted for the programme’s continuing positive development. Methods: Both quantitative and qualitative methods were used in the evaluation. A series of questionnaires were used (the majority pre and post programme) to determine student perceptions of the programme, behaviour and attitudinal change from commencement to completion. These included the student assessment of learning gains (SALG); mental health knowledge schedule (MAKS); mental health clinician attitudes scale (MICA); reported and intended behaviour scale (RIBS); and community attitudes towards the mentally ill (CAMI). In addition, student and staff focus groups were conducted. Evaluation methods also incorporated module feedback. Outcome/Results: The evaluation highlighted a very positive response in relation to the achievement of programme outcomes and preparation for future work as registered psychiatric nursing. Some areas were highlighted for further development, which have been taken cognisance of in the 2019 iteration of the programme.

Keywords: learning gains, mental health, nursing, stigma

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Authors: Dimuthu Manage

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Introduction: The prevalence of obesity and obesity-related non-communicable diseases are becoming a massive health concern in the whole world. Physical activity is recognized as an effective solution for this matter. The published data on the effectiveness of High-Intensity Interval Training (HIIT) in improving health parameters in overweight and obese individuals in Sri Lanka is sparse. Hence this study is conducted. Methodology: This is a quasi-experimental study that was conducted at the Sports medicine clinic, General Hospital, Kalutara. Participants have engaged in a programme of HIIT three times per week for six weeks. Data collection was based on precise measurements by using structured and validated methods. Ethical clearance was obtained. Results: Registered number for the study was 48, and only 52% have completed the study. The mean age was 32 (SD=6.397) years, with 64% males. All the anthropometric measurements which were assessed (i.e. waist circumference(P<0.001), weight(P<0.001) and BMI(P<0.001)), body fat percentage(P<0.001), VO2 max(P<0.001), and lipid profile (ie. HDL(P=0.016), LDL(P<0.001), cholesterol(P<0.001), triglycerides(P<0.010) and LDL: HDL(P<0.001)) had shown statistically significant improvement after the intervention with the HIIT programme. Conclusions: This study confirms HIIT as a time-saving and effective exercise method, which helps in preventing obesity as well as non-communicable diseases. HIIT ameliorates body anthropometry, fat percentage, cardiopulmonary status, and lipid profile in overweight and obese individuals markedly. As with the majority of studies, the design of the current study is subject to some limitations. The first is the study focused on a correlational study. If it is a comparative study, comparing it with other methods of training programs would have given more validity. Although the validated tools used to measure variables and the same tools used in pre and post-exercise occasions with the available facilities, it would have been better to measure some of them using gold-standard methods. However, this evidence should be further assessed in larger-scale trials using comparative groups to generalize the efficacy of the HIIT exercise program.

Keywords: HIIT, lipid profile, BMI, VO2 max

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Authors: Genziana Lay

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A wide majority of older children and adolescents who enter the juvenile court system present with an array of problematic symptoms and behaviors including anxiety, depression, aggressive acting out, detachment, and substance abuse. Attachment theory offers a framework for understanding normative and pathological functioning, which during development is influenced by emotional, social and cognitive elements. There is clear evidence that children and adolescents with the highest risk of developing adaptation problems present an insecure attachment profile. Most offending minors have experienced dysfunctional family relationships as well as social and/or economic deprivation. Their maladaptive attachment develops not only through their relationship with caregivers but with the environment at large. Activation of their faulty attachment system leads them to feel emotionally overwhelmed and engage in destructive behaviors and decision-making. A psycho-social intervention with this population conceptualized as attachment therapy is a multi-faceted, practical approach that has shown excellent results in terms of increased psychological well-being and drastically reduced rates of re-offense/ destructive behavior. Through several; components including psychotherapy, monitoring, volunteering, meditation and socialization, the program focuses on seven dimensions: self-efficacy, responsibility, empathy/reparation, autonomy/security, containment/structure, insight building, and relational health. This paper presents the program and illustrates how the framework of attachment theory practically applied to psycho-social intervention has great therapeutic and social reparation potential. Preliminary evidence drawn from the Sassari Juvenile Court is very promising; this paper will illustrate these results and propose an even more comprehensive, applicable approach to psycho-social reparative intervention that leads to greater psychological health and reduced recidivism in the child and adolescent population.

Keywords: attachment, child, adolescent, crime, juvenile, psychosocial

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Authors: Liz van Acker, Linda Colley

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Political processes are shaped by the gendered culture of parliaments. This paper examines how the institution of parliament has been affected by the changing number of women in politics. In order to understand how and why gender change occurs, the paper employs a feminist historical institutionalism approach. It argues that while it is difficult to change the gendered nature of political institutions, it is possible, from a gender perspective, to understand the processes of change both formally and informally. Increasing women’s representation has been a slow process which has not occurred without political struggles. A broadly defined ‘feminist historical institutionalism’ has critiqued existing approaches to institutions and combined historical institutional analysis with tools of gender to enhance our understanding of institutional processes and change. The paper examines the gendered rules, norms, and practices that influence institutional design choices and processes. Institutions such as Parliament often are able to adjust to women’s entry and absorb them without too much interruption. Exploring the hidden aspects to informal institutions involves identifying unspoken and accepted norms that may guide decision-making – exposing and questioning the gender status quo. This paper examines the representation of women in the Queensland Parliament, Australia. It places the Queensland experience in historical context, as well as in the national and international context. The study is interesting, given that its gender representation has rocketed from one of the worst performing states in 2012 to one of the best performing in 2015 with further improvements in 2017. The state currently has a re-elected female Premier, a female Deputy Premier and a female-dominated cabinet – in fact, Queensland was the first ministry in Australia to have a majority of women in its Cabinet. However, it is unnecessary to dig far below these headlines to see that this is uncharacteristic of its history: progress towards this current position has been slow and patchy. The paper finds that matters such as the glass ceiling and the use of quotas explain women’s recent success in Queensland politics.

Keywords: feminist historical institutional approach, glass ceiling, quotas, women’s participation in politics

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Authors: F. Abdelhamid

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Algeria is a multilingual speech community where individuals constantly mix between codes in spoken discourse. Code is used as a cover term to refer to the existing languages and language varieties which include, among others, the mother tongue of the majority Algerian Arabic, the official language Modern Standard Arabic and the foreign languages French and English. The present study explores whether Algerians mix between these codes in online communication as well. Facebook is the selected platform from which data is collected because it is the preferred social media site for most Algerians and it is the most used one. Adopting the notion of translanguaging, this study attempts explaining how users of Facebook use multilingual messages to communicate meaning. Accordingly, multilingual interactions are not approached from a pejorative perspective but rather as a creative linguistic behavior that multilingual utilize to achieve intended meanings. The study is intended as a contribution to the research on multilingualism online because although an extensive literature has investigated multilingualism in spoken discourse, limited research investigated it in the online one. Its aim is two-fold. First, it aims at ensuring that the selected platform for analysis, namely Facebook, could be a source for multilingual data to enable the qualitative analysis. This is done by measuring frequency rates of multilingual instances. Second, when enough multilingual instances are encountered, it aims at describing and interpreting some selected ones. 120 posts and 16335 comments were collected from two Facebook pages. Analysis revealed that third of the collected data are multilingual messages. Users of Facebook mixed between the four mentioned codes in writing their messages. The most frequent cases are mixing between Algerian Arabic and French and between Algerian Arabic and Modern Standard Arabic. A focused qualitative analysis followed where some examples are interpreted and explained. It seems that Algerians mix between codes when communicating online despite the fact that it is a conscious type of communication. This suggests that such behavior is not a random and corrupted way of communicating but rather an intentional and natural one.

Keywords: Algerian speech community, computer mediated communication, languages in contact, multilingualism, translanguaging

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Authors: Adebusoye Michael, Anthony Gloria, Fasan Temitope, Jacob Anayo

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Background: The culture of fast food consumption has gradually become a common lifestyle in Nigeria especially among young people in urban areas, in spite of the associated adverse health consequences. The adolescent pattern of fast foods consumption and their perception of this practice, as a risk factor for Non-Communicable Diseases (NCDs), have not been fully explored. This study was designed to assess fast food consumption pattern and the perception of it as a risk factor for NCDs among undergraduates of Federal Polytechnic, Bauchi. Methodology: The study was descriptive cross-sectional in design. One hundred and eighty-five students were recruited using systematic random sampling method from the two halls of residence. A structured questionnaire was used to assess the consumption pattern of fast foods. Data collected from the questionnaires were analysed using statistical package for the social sciences (SPSS) version 16. Simple descriptive statistics, such as frequency counts and percentages were used to interpret the data. Results: The age range of respondents was 18-34 years, 58.4% were males, 93.5% singles and 51.4% of their parents were employed. The majority (100%) were aware of fast foods and (75%) agreed to its implications as NCD. Fast foods consumption distribution included meat pie (4.9%), beef roll/ sausage (2.7%), egg roll (13.5%), doughnut (16.2%), noodles(18%) and carbonated drinks (3.8%). 30.3% consumed thrice in a week and 71% attached workload to high consumption of fast food. Conclusion: It was revealed that a higher social pressure from peers, time constraints, class pressure and school programme had the strong influence on high percentages of higher institutions’ students consume fast foods and therefore nutrition educational campaigns for campus food outlets or vendors and behavioural change communication on healthy nutrition and lifestyles among young people are hereby advocated.

Keywords: fast food consumption, Nigerian polytechnic, risk factors, undergraduate

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Authors: Chueh Chang, Chia-jung Hsieh, Fu-yu Yu, Yu-Hwa Lin

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Background:The majority of women diagnosed with breast cancer undergo treatment involving surgery and radiotherapy or chemotherapy, or both. With these major advances in breast cancer management, many patients still have to deal with short or long-term side effects and psychological distress related to the disease and treatment, which have a substantial impact on their quality of life. The Laughing Qigong Program (LQP) is an interactive laughter program that combines the physical and physiological benefits of laughter with the mental benefits of Chinese qigong. Purpose: In order to improve the quality of life for breast cancer women in the community as well as echoing the WHO 2004 “Promoting Mental Health” for every one. This study focused on how to promote the positive mental health for women of breast cancer through the “laughter program” in Taiwan. During the presentation, how to practice Laughing Qigong will be demonstrated. Method: Using nonequivalent pretest-posttest design, ix-one breast cancer patients were volunteered to enroll in this study from the Taiwan Breast Cancer Alliance (TBCA). Thirty patients were assigned to the experimental group and the other 31 patients were assigned to the control group. The women who were assigned to the experimental group received laughter program one hour per session, once a week, totally 12 sessions. All subjects were tested before and after the intervention on the following: Self-Esteem scale (RSE), Face Scale (FS), Anxiety and pain experience were measured as psychological markers; saliva cortisol (CS) as an immunological marker; blood pressure (BP), heart rate (HR),and heart rate variability (HRV) as physiological markers of the body’s response to stress. Results: After comparing the experimental and control groups, the results revealed that those breast cancer women with “laughing program” their sense of humor were improved, less uncomfortable on self report physical conditions, more positive attitudes toward stress management by using laughter, and had emotional improvement according to the face scale.

Keywords: mental health promotion, breast cancer, laughing Qigong, women

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Authors: Muhadam Labolo, Mughny Ibtisyam Mukhlis, Zulkarnaen, Safira Maulida Rahman Soulisa

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This research is motivated by one of the functions of government is a regulatory function. Aceh Province, especially in Banda Aceh City has special autonomy, one of them is in the application of Islamic law, but when the law implemented to the citizen, there are many problems happens. One of the problems faced by the Government and people of Banda Aceh was Seclusion. Seclusion/nasty silent act between two people mukallafor more of the opposite sex who is not mahram or without marriage. This study aims to determine and analyze how the effectiveness of the policy as well as enabling and inhibiting factors of Qanun Number 14 of 2003 On Khalwat (nasty) in sharia Islam Islamic law in the city of Banda Aceh. This type of research is qualitative research method is a descriptive and inductive approach. The source of data used is People, Problem, Phenomenon, and programs, while the data collection through field studies and literature such as interviews, observation, and documentation. The results of this study were analyzed by using data reduction, display data, conclusions, and verification. The results showed that the Qanun Number 14 of 2003 on Khalwat (nasty) in the establishment of Islamic law in Banda Aceh is still not effective. It is seen from the high number of violations seclusion committed by Banda Aceh citizen, especially among teenagers, lack of socialization, as well as a lack of budgetary support for the implementation of Islamic Law in Banda Aceh. The supporting factors are 1) Coordination and communication among agencies had been walking steadily. 2) Facilities and infrastructure Syar'iah Court of Banda Aceh and the Office of Sharia Islam Banda Aceh that very good. 3) The Cultural majority of the people of Banda Aceh that support. Inhibiting factors: 1) There are no written duties of each institution for the prosecution case Seclusion. 2) The lack of socialization programs. 3) Lack of facilities and infrastructure Municipal Police Unit and the WH less. 4) Lack of control by the family. 5) The absence of training for officials Municipal Police Units and the Wilayatul Hisbah Banda Aceh.

Keywords: effectiveness, Islamic Sharia, Khalwat, Qanun

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Authors: Naziha Mokadem, Rainier Dennis, Ingrid Dennis

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In South Africa, Karst aquifers are receiving greater attention since they provide large supplies of water which is used for domestic and agricultural purposes as well as for industry. Accordingly, a better insight into the origin of water mineralization and the geochemical processes controlling the recharge of the aquifer is crucial. Analyses of geochemical and environmental isotopes could lead to relevant information regarding karstification and infiltration processes, groundwater chemistry and isotopy. A study was conducted in a typical karst landscape of Wonderfonteinspruit catchment, also known as Wonderfonteinspruit Valley in North-western -South Africa. Furthermore, fifty-two samples were collected from (35 boreholes, 5 surface waters, 4 Dams, 4 springs, 1 canal, 2 pipelines, 1 cave) within the study area for hydrochemistry and 2H and 18O analysis. The determination of the anions (Cl-, SO42-, NO2, NO3-) were performed using Metrohm ion chromatography, model: 761 compact IC, with a precision of ± 0.001 mg/l. While, the cations (Na+, Mg2+, K+, Ca2+) were determined using Metrohm ion chromatography, Model: ICP-MS 7500 series. The alkalinity (Alk) was determined by pH meter with volumetric titration using HCL to pH 4.5; 4.2; and 8.2. In addition, 18O and 2H relative to the Vienna-Standard Mean Ocean Water (RVSMOW), were determined by picarro L2130-I Isotopic H2O (Cavity Ringdown laser spectrometer, Picarro Ltd). The hydrochemical analysis of Wonderfonteinspruit groundwater showed a dominance of the cations Ca-Mg and the anion HCO3. Piper diagram shows that the groundwater sample of study area is characterized by four hydrochemical facies: Two main groups: (1) Ca–Mg–Cl–SO4; (2) Ca–Mg–HCO3 and two minor groups: (3) Ca–Mg–Cl; (4) Na–K–HCO3. The majority of boreholes of Malmani (Transvaal Supergroup) aquifer are plotted in Ca–Mg–HCO3.Oxygen-18 (18O‰SMOW) and deuterium (D‰SMOW) isotopic data indicate that the aquifer’s recharge is influenced by two phenomena; precipitation rates for most of the samples and river flow (Wonderfonteinspruit, Middelvieinspruit, Renfonteinspruit) for some samples.

Keywords: South Africa, Wonderfonteinspruit Valley, isotopic, hydrochemical, carbonate aquifers

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Authors: Rajlakshmi Banerjee, Sujoy Banerjee

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The prevalence of malnutrition, as the most common cause of morbidity and mortality increases with old age, especially in developing countries like India, because of many factors out of which dentate status is one. It affects diet, nutritional status and general health due to reduced chewing ability and poor food choices. Aim and Objective: This study aimed to evaluate the effect of nutritional status, dietary intake on the Oral Health-related Quality of life (OHRQoL) of elderly edentulous complete denture wearing patients and to know whether they are at a higher risk of malnutrition. The objective was to assess the need to include dietary and nutritional counselling during Prosthodontic rehabilitation of elderly edentulous patients. Materials and method: A cross-sectional study was conducted among 200 elderly denture wearing patients above 60 yrs of age from Nagpur, Maharashtra. The majority of study subjects (60%) were between the age group 60 and 75 years. Mini-Nutritional Assessment (MNA) Questionnaire was used to assess nutritional status and General Oral Health Assessment Index (GOHAI) questionnaire was used to determine the Oral health related Quality of life of these patients.Descriptive statistics was used to analyze data using SPSS version 21. Results: Among the assessed subjects, nearly 80% of them had total scores of GOHAI between 12 and 57 which require ‘needed dental care.’ As per MNA, 10.5% had adequate nutrition, 70 % were at risk of malnutrition, and remaining 19.5 % of subjects were malnourished. There was a significant correlation between GOHAI and MNA scores. A strong association was found between mean GOHAI and MNA scores and thereby nutritional status and OHRQOL.Conclusion: The use of conventional dentures increases the risk of malnutrition in the elderly due to inability to eat and chew food properly and therefore severely affecting the quality of life. Dietary analysis and counselling should be strictly incorporated into geriatric treatment planning during Prosthetic rehabilitation.

Keywords: general oral health assessment index, General Oral Health Assessment Index (GOHAI), nutritional assessment, mini-nutritional assessment, Mini-Nutritional Assessment (MNA), quality of life

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Authors: Nazish Badar

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Background: To investigate the epidemic resurgent wave of influenza A (H1N1) pdm09 infections during 2015-16 Influenza season(Nov,15 –Feb,16) we compared epidemiological features of influenza A (H1N1) pdm09 associated hospitalizations and deaths during this period in Pakistan. Methods: Respiratory samples were tested using CDC Real-Time RT-PCR protocols. Demographic and epidemiological data was analyzed using SPSS. Risk ratio was calculated between age groups to compare patients that were hospitalized and died due to influenza A (H1N1) pdm09 during this period. Results: A total of 1970 specimens were analyzed; influenza virus was detected in 494(25%) samples, including 458(93%) Influenza type A and 36(7%) influenza type B viruses. Amongst influenza A viruses, 351(77%) A(H1N1) pdm09 and 107(23%) were A/H3N2. Influenza A(H1N1)pdm09 peaked in January 2016 when 250(54%) of tested patients were positive. The resurgent waves increased hospitalizations due to pdmH1N1 as compared to the rest part of the year. Overall 267(76%) A(H1N1) pdm09 cases were hospitalized. Adults ≥18 years showed the highest relative risk of hospitalization (1.2). Median interval of hospitalization and symptom onset was five days for all age groups. During this period, a total of 34 laboratory-confirmed deaths associated with pandemic influenza A (H1N1) were reported out of 1970 cases, the case fatality rate was 1.72%. the male to female ratio was 2:1in reported deaths. The majority of the deaths during that period occurred in adults ≥18 years of age. Overall median age of the death cases was 42.8 years with underlying medical conditions. The median number of days between symptom onset was two days. The diagnosis upon admission in influenza-associated fatal cases was pneumonia (53%). Acute Respiratory Distress Syndrome 9 (26%), eight out of which (88%) required mechanical ventilation. Conclusions: The present resurgence of pandemic virus cannot be attributed to a single factor. The prolong cold and dry weather, possibility of drift in virus and absence of annual flu vaccination may have played an integrated role in resurfacing of pandemic virus.

Keywords: influenza A (H1N1)pdm 09, resurgence, epidemiology, Pakistan

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Authors: Michael N. O'Sullivan, Con Sheahan

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Mass customization is the idea of offering custom products or services to satisfy the needs of each individual customer while maintaining the efficiency of mass production. Technologies like 3D printing and artificial intelligence have many start-ups hoping to capitalize on this dream of creating personalized products at an affordable price, and well established companies scrambling to innovate and maintain their market share. However, the majority of them are failing as they struggle to understand one key question – where does customization make sense? Customization and personalization only make sense where the value of the perceived benefit outweighs the cost to implement it. In other words, will people pay for it? Looking at the Kano Model makes it clear that it depends on the product. In products where customization is an inherent need, like prosthetics, mass customization technologies can be highly beneficial. However, for products that already sell as a standard, like headphones, offering customization is likely only an added bonus, and so the product development team must figure out if the customers’ perception of the added value of this feature will outweigh its premium price tag. This can be done through the use of a ‘serious game,’ whereby potential customers are given a limited budget to collaboratively buy and bid on potential features of the product before it is developed. If the group choose to buy customization over other features, then the product development team should implement it into their design. If not, the team should prioritize the features on which the customers have spent their budget. The level of customization purchased can also be translated to an appropriate production method, for example, the most expensive type of customization would likely be free-form design and could be achieved through digital fabrication, while a lower level could be achieved through short batch production. Twenty-five teams of final year students from design, engineering, construction and technology tested this methodology when bringing a product from concept through to production specification, and found that it allowed them to confidently decide what level of customization, if any, would be worth offering for their product, and what would be the best method of producing it. They also found that the discussion and negotiations between players during the game led to invaluable insights, and often decided to play a second game where they offered customers the option to buy the various customization ideas that had been discussed during the first game.

Keywords: Kano model, mass customization, new product development, serious game

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Authors: Alison Ryan, Himani Chhabra, Mohammed Dungarwalla, Judith Jones

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Background: Impacted and ectopic teeth present in 1-2% of orthodontic patients and often require joint surgical and orthodontic management. The authors present two patients undergoing orthodontic treatment, where the impacted teeth, in a hopeless position, spontaneously erupted during the period of cessation of general anaesthetic lists during the COVID-19 pandemic. Patient information: A healthy 11-year-old boy was referred to the Department of Oral and Maxillofacial Surgery for the management of a mesioangular impacted LR7. The patient was seen by the joint oral surgery/orthodontic team, who planned for the removal of the LR7 under general anaesthetic. A healthy 13-year-old boy was referred to the same Department and team for surgical extraction of unerupted and buccally impacted UL3 and UR3 under general anaesthetic. Management and outcome: The majority of elective dental-alveolar work ceased as a result of the global pandemic. On resumption of activity, the first patient was reviewed in July 2021. The LR7 had spontaneously erupted in a favourable position, and following MDT review, a decision was made to forgo any further surgical intervention. The second patient was reviewed in July 2021. The UL3 had clinically erupted, and there was radiographic evidence of favourable movement of UR3. Due to the nature of the patient’s malocclusion, the decision was made to proceed with the extractions as previously planned. Key Learning Points: Severely impacted teeth do have a prospect of spontaneous eruption or alignment without clinical intervention, and current literature states the initial location, axial inclination, degree of root formation, and relation of the impacted tooth to adjacent teeth roots may influence spontaneous eruption. There is potential to introduce a period of observation to account for this possibility in the developing dentition, with the aim of reducing the unnecessary need for surgical intervention. This could help prevent episodes of general anaesthetic and allocate theatre space more appropriately.

Keywords: spontaneous eruption, impaction, observation, hopeless position, surgical, orthodontic, change in treatment plan

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Authors: Ahmed E. Hodaib, Muhammed A. Hashem

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High-speed transportation has become a growing concern. To increase high-speed efficiencies and minimize power consumption of a vehicle, we need to eliminate the friction with the ground and minimize the aerodynamic drag acting on the vehicle. Due to the complexity and high power requirements of electromagnetic levitation, we make use of the air in front of the capsule, that produces the majority of the drag, to compress it in two phases and inject a proportion of it through small nozzles to make a high-pressure air cushion to levitate the capsule. The tube is partially-evacuated so that the air pressure is optimized for maximum compressor effectiveness, optimum tube size, and minimum vacuum pump power consumption. The total relative mass flow rate of the tube air is divided into two fractions. One is by-passed to flow over the capsule body, ensuring that no chocked flow takes place. The other fraction is sucked by the compressor where it is diffused to decrease the Mach number (around 0.8) to be suitable for the compressor inlet. The air is then compressed and intercooled, then split. One fraction is expanded through a tail nozzle to contribute to generating thrust. The other is compressed again. Bleed from the two compressors is used to maintain a constant air pressure in an air tank. The air tank is used to supply air for levitation. Dividing the total mass flow rate increases the achievable speed (Kantrowitz limit), and compressing it decreases the blockage of the capsule. As a result, the aerodynamic drag on the capsule decreases. As the tube pressure decreases, the drag decreases and the capsule power requirements decrease, however, the vacuum pump consumes more power. That’s why Design optimization techniques are to be used to get the optimum values for all the design variables given specific design inputs. Aerodynamic shape optimization, Capsule and tube sizing, compressor design, diffuser and nozzle expander design and the effect of the air bearing on the aerodynamics of the capsule are to be considered. The variations of the variables are to be studied for the change of the capsule velocity and air pressure.

Keywords: tube-capsule, hyperloop, aerodynamic design optimization, air compressor, air bearing

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Authors: Seyran Naghdi

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Background: Orphan drug development is limited by very high costs attributed to the research and development and small size market. How health policymakers address this challenge to consider both supply and demand sides need to be explored for directing the policies and plans in the right way. The price is an important signal for pharmaceutical companies’ profitability and the patients’ accessibility as well. Objective: This study aims to find out the orphan drugs' price-setting patterns and approaches in health systems through a systematic review of the available evidence. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) approach was used. MedLine, Embase, and Web of Sciences were searched via appropriate search strategies. Through Medical Subject Headings (MeSH), the appropriate terms for pricing were 'cost and cost analysis', and it was 'orphan drug production', and 'orphan drug', for orphan drugs. The critical appraisal was performed by the Joanna-Briggs tool. A Cochrane data extraction form was used to obtain the data about the studies' characteristics, results, and conclusions. Results: Totally, 1,197 records were found. It included 640 hits from Embase, 327 from Web of Sciences, and 230 MedLine. After removing the duplicates, 1,056 studies remained. Of them, 924 studies were removed in the primary screening phase. Of them, 26 studies were included for data extraction. The majority of the studies (>75%) are from developed countries, among them, approximately 80% of the studies are from European countries. Approximately 85% of evidence has been produced in the recent decade. Conclusions: There is a huge variation of price-setting among countries, and this is related to the specific pharmacological market structure and the thresholds that governments want to intervene in the process of pricing. On the other hand, there is some evidence on the availability of spaces to reduce the very high costs of orphan drugs development through an early agreement between pharmacological firms and governments. Further studies need to focus on how the governments could incentivize the companies to agree on providing the drugs at lower prices.

Keywords: orphan drugs, orphan drug production, pricing, costs, cost analysis

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Authors: Jared Abuga, Wesley Too

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Medical error is the third leading cause of death in US, with approximately 98,000 deaths occurring every year as a result of medical errors. The world financial burden of medication errors is roughly USD 42 billion. Medication errors may lead to at least one death daily and injure roughly 1.3 million people every year. Medical error reporting is essential in creating a culture of accountability in our healthcare system. Studies have shown that attitudes and practice of healthcare workers in reporting medical errors showed that the major factors in under-reporting of errors included work stress and fear of medico-legal consequences due to the disclosure of error. Further, the majority believed that increase in reporting medical errors would contribute to a better system. Most hospitals depend on nurses to discover medication errors because they are considered to be the sources of these errors, as contributors or mere observers, consequently, the nurse’s perception of medication errors and what needs to be done is a vital feature to reducing incidences of medication errors. We sought to explore knowledge among nurses on medical errors and factors affecting or hindering reporting of medical errors among nurses working at the emergency unit, KNH. Critical care nurses are faced with many barriers to completing incident reports on medication errors. One of these barriers which contribute to underreporting is a lack of education and/or knowledge regarding medication errors and the reporting process. This study, therefore, sought to determine the availability and the use of reporting systems for medical errors in critical care unity. It also sought to establish nurses’ perception regarding medical errors and reporting and document factors facilitating timely identification and reporting of medical errors in critical care settings. Methods: The study used cross-section study design to collect data from 76 critical care nurses from Kenyatta Teaching & Research National Referral Hospital, Kenya. Data analysis and results is ongoing. By October 2022, we will have analysis, results, discussions, and recommendations of the study for purposes of the conference in 2023

Keywords: errors, medical, kenya, nurses, safety

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Authors: Nyimas Annissa Mutiara Andini

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There are 325,000 children younger than age 15 in the U.S. have epilepsy. In Indonesia, 40% of 3,5 millions cases of epilepsy happens in children. The most common type of epilepsy, which affects 6 out of 10 people with the disorder, is called idiopathic epilepsy and which has no identifiable cause. One of the most commonly used medications in the treatment of this childhood epilepsy is sodium valproate. Administration of sodium valproat in children has a problem to fail. Nearly 60% of pediatric patients known were mildly, moderately, or severely non-adherent with therapy during the first six months of treatment. Many parents or caregiver took far less medication than prescribed, and the treatment-adherence pattern for the majority of patients was established during the first month of treatment. 42% of the patients were almost always given their medications as prescribed but 13% had very poor adherence even in the early weeks and months of treatment. About 7% of patients initially gave the medication correctly 90% of the time, but adherence dropped to around 20% within six months of starting treatment. Over the six months of observation, the total missing of administration is about four out of 14 doses in any given week. This fail can cause the epilepsy to relapse. Whereas, current reported epilepsy disorder were significantly more likely than those never diagnosed to experience depression (8% vs 2%), anxiety (17% vs 3%), attention-deficit/hyperactivity disorder (23% vs 6%), developmental delay (51% vs 3%), autism/autism spectrum disorder (16% vs 1%), and headaches (14% vs 5%) (all P< 0.05). They had a greater risk of limitation in the ability to do things (relative risk: 9.22; 95% CI: 7.56–11.24), repeating a school grade (relative risk: 2.59; CI: 1.52–4.40), and potentially having unmet medical and mental health needs. In the other side, technology can help to make our life easier. One of the technology, that we can use is a mobile application. A mobile app is a software program we can download and access directly using our phone. Indonesians are highly mobile centric. They use, on average, 6.7 applications over a 30 day period. This paper is aimed to describe an application that could help to control a sodium valproat administration in children; we call it as D-Epi app. D-Epi app is a downloadable application that can help parents or caregiver alert by a timer-related application to warn whether it is the time to administer the sodium valproat. It works not only as a standard alarm, but also inform important information about the drug and emergency stuffs to do to children with epilepsy. This application could help parents and caregiver to take care a child with epilepsy in Indonesia.

Keywords: application, children, D-Epi, epilepsy

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Authors: Lavrentiadou S. N., Angelou V., Chatzimisios K., Papazoglou L.

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The aim of this study was the isolation and culture of keratinocytes and fibroblasts from feline skin to ultimately create an artificial engineered skin (including dermis and epidermis) useful for the effective treatment of large cutaneous deficits in cats. Epidermal keratinocytes and dermal fibroblasts were freshly isolated from skin biopsies using an 8 mm biopsy punch obtained from 8 healthy cats that had undergone ovariohysterectomy. The owner’s consent was obtained. All cats had a complete blood count and a serum biochemical analysis and were screened for feline leukemia virus (FeLV) and feline immunodeficiency virus (FIV) preoperatively. The samples were cut into small pieces and incubated with collagenase (2 mg/ml) for 5-6 hours. Following digestion, cutaneous cells were filtered through a 100 μm cell strainer, washed with DMEM, and grown in DMEM supplemented with 10% FBS. The undigested epidermis was washed with DMEM and incubated with 0.05% Trypsin/0.02% EDTA (TE) solution. Keratinocytes recovered in the TE solution were filtered through a 100 μm and a 40 μm cell strainer and, following washing, were grown on a collagen type I matrix in DMEM: F12 (3:1) medium supplemented with 10% FΒS, 1 μm hydrocortisone, 1 μm isoproterenol and 0.1 μm insulin. Both fibroblasts and keratinocytes were grown in a humidified atmosphere with 5% CO2 at 37oC. The medium was changed twice a week and cells were cultured up to passage 4. Cells were grown to 70-85% confluency, at which point they were trypsinized and subcultured in a 1:4 dilution. The majority of the cells in each passage were transferred to a freezing medium and stored at -80oC. Fibroblasts were frozen in DMEM supplemented with 30% FBS and 10% DMSO, whereas keratinocytes were frozen in a complete keratinocyte growth medium supplemented with 10% DMSO. Both cell types were thawed and successfully grown as described above. Therefore, we can create a bank of fibroblasts and keratinocytes, from which we can recover cells for further culture and use for the generation of skin equivalent in vitro. In conclusion, cutaneous cell isolation and cell culture and expansion were successfully developed. To the authors’ best knowledge, this is the first study reporting isolation and culture of keratinocytes and fibroblasts from feline skin. However, these are preliminary results and thus, the development of autologous-engineered feline skin is still in process.

Keywords: cat, fibroblasts, keratinocytes, skin equivalent, wound

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Authors: Liying Li, Han Guo

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Considering the environmental issues generated by the building sector for its energy consumption, solid waste generation, water use, land use, and global greenhouse gas (GHG) emissions, this review pointed out to LCA as a decision-support tool to substantially improve the sustainability in the building and construction industry. The comprehensiveness and simplicity of LCA make it one of the most promising decision support tools for the sustainable design and construction of future buildings. This paper contains a comprehensive review of existing studies related to LCAs with a focus on their advantages and limitations when applied in the building sector. The aim of this paper is to enhance the understanding of a building life-cycle analysis, thus promoting its application for effective, sustainable building design and construction in the future. Comparisons and discussions are carried out between four categories of LCA methods: building material and component combinations (BMCC) vs. the whole process of construction (WPC) LCA，attributional vs. consequential LCA, process-based LCA vs. input-output (I-O) LCA, traditional vs. hybrid LCA. Classical case studies are presented, which illustrate the effectiveness of LCA as a tool to support the decisions of practitioners in the design and construction of sustainable buildings. (i) BMCC and WPC categories of LCA researches tend to overlap with each other, as majority WPC LCAs are actually developed based on a bottom-up approach BMCC LCAs use. (ii) When considering the influence of social and economic factors outside the proposed system by research, a consequential LCA could provide a more reliable result than an attributional LCA. (iii) I-O LCA is complementary to process-based LCA in order to address the social and economic problems generated by building projects. (iv) Hybrid LCA provides a more superior dynamic perspective than a traditional LCA that is criticized for its static view of the changing processes within the building’s life cycle. LCAs are still being developed to overcome their limitations and data shortage (especially data on the developing world), and the unification of LCA methods and data can make the results of building LCA more comparable and consistent across different studies or even countries.

Keywords: decision support tool, life-cycle analysis, LCA tools and data, sustainable building design

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Authors: Danielle A. Walker, Kyle L. Johnson, Tara B. Thomas, Sandor Dorgo, Jacen S. Moore

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Approximately 37 million people worldwide are infected with the Human Immunodeficiency Virus (HIV), with the majority located in sub-Saharan Africa. The relationship existing between HIV incidence and socioeconomic inequity confirms the critical need for programs promoting HIV education, prevention and treatment access. This literature review analyzed 36 sources with a specific focus on the Democratic Republic of Congo, whose critically low socioeconomic status and education rate have resulted in a drastically high HIV rates. Relationships between HIV testing and treatment and barriers to care were explored. Cultural and religious considerations were found to be vital when creating and implementing HIV education and testing programs. Partnerships encouraging active support from community-based spiritual leaders to implement HIV educational programs were also key mechanisms to reach communities and individuals. Gender roles were highlighted as a key component for implementation of effective community trust-building and successful HIV education programs. The efficacy of added support by hospitals and clinics in rural areas to facilitate access to HIV testing and care for people living with HIV/AIDS (PLWHA) was discussed. This review highlighted the need for healthcare providers to provide a network of continued education for PLWHA in clinical settings during disclosure and throughout the course of treatment to increase retention in care and promote medication adherence for viral load suppression. Implementation of culturally sensitive models that rely on community familiarity with HIV educators such as ‘train-the-trainer’ were also proposed as efficacious tools for educating rural communities about HIV. Further research is needed to promote community partnerships for HIV education, understand the cultural context of gender roles as barriers to care, and empower local health care providers to be successful within the HIV Continuum of Care.

Keywords: cultural sensitivity, Democratic Republic of the Congo, education, HIV

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Authors: Teresa Isabel Lozano Pérez, Sandra Soca Lozano

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In Cuba, the childcare is one of the programs prioritized by the Ministry of Public Health and the birth of a child becomes a desired and rewarding event for the family, which is prepared for the reception of a healthy child. When this does not happen and after the first months of the child's birth begin to appear developmental deviations that indicate the presence of a disorder, the event becomes a live event potentially negative and generates disruptions in the family health. A quantitative, descriptive, and cross-sectional research methodology was conducted to describe the impact on family health of diagnosis of autism in a sample of 25 families of children diagnosed with infantile autism at the University Pediatric Hospital Juan Manuel Marquez Havana, Cuba; in the period between January 2014 and May 2015. The sample was non probabilistic and intentional from the inclusion criteria selected. As instruments, we used a survey to identify the structure of the family, life events inventory and an instrument to assess the relative impact, adaptive resources of family and social support perceived (IRFA) to identify the diagnosis of autism as life event. The main results indicated that the majority of families studied were nuclear, small and medium and in the formation stage. All households surveyed identified the diagnosis of autism in a child as an event of great importance and negative significance for the family, taking in most of the families studied a high impact on the four areas of family health and impact enhancer of involvement in family health. All the studied families do not have sufficient adaptive resources to face this situation, sensing that they received social support frequently, mainly in information and emotional areas. We conclude that the diagnosis of autism one of the members of the families studied is valued as a life event highly significant with unfavorably way causing an enhancer impact of involvement in family health especially in the areas ‘health’ and ‘socio-psychological’. Among the social support networks health institutions, partners and friends are highlighted. We recommend developing intervention strategies in families of these children to support them in the process of adapting the diagnosis.

Keywords: family, family health, infantile autism, life event

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Authors: Ian Campbell, Gillian Mitchell, Paul James, Na Li, Ella Thompson

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The genetic cause of the majority of multiple-case breast cancer families remains unresolved. Next generation sequencing has emerged as an efficient strategy for identifying predisposing mutations in individuals with inherited cancer. We are conducting whole exome sequence analysis of germ line DNA from multiple affected relatives from breast cancer families, with the aim of identifying rare protein truncating and non-synonymous variants that are likely to include novel cancer predisposing mutations. Data from more than 200 exomes show that on average each individual carries 30-50 protein truncating mutations and 300-400 rare non-synonymous variants. Heterogeneity among our exome data strongly suggest that numerous moderate penetrance genes remain to be discovered, with each gene individually accounting for only a small fraction of families (~0.5%). This scenario marks validation of candidate breast cancer predisposing genes in large case-control studies as the rate-limiting step in resolving the missing heritability of breast cancer. The aim of this study is to screen genes that are recurrently mutated among our exome data in a larger cohort of cases and controls to assess the prevalence of inactivating mutations that may be associated with breast cancer risk. We are using the Agilent HaloPlex Target Enrichment System to screen the coding regions of 168 genes in 1,000 BRCA1/2 mutation-negative familial breast cancer cases and 1,000 cancer-naive controls. To date, our interim analysis has identified 21 genes which carry an excess of truncating mutations in multiple breast cancer families versus controls. Established breast cancer susceptibility gene PALB2 is the most frequently mutated gene (13/998 cases versus 0/1009 controls), but other interesting candidates include NPSR1, GSN, POLD2, and TOX3. These and other genes are being validated in a second cohort of 1,000 cases and controls. Our experience demonstrates that beyond PALB2, the prevalence of mutations in the remaining breast cancer predisposition genes is likely to be very low making definitive validation exceptionally challenging.

Keywords: predisposition, familial, exome sequencing, breast cancer

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