Search results for: alternative and complementary healthcare

Authors: Dawit Thomas

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Feeding and weaning practices vary from culture to culture and depend on different child-rearing values. The socio-cultural dimensions that influence the acceptable infant feeding practices are varied and complex. Understanding cultural differences in beliefs and practices relating to infant feeding is important to enhance designing programs for delivering successful psychological, social, physiological and economic well-being of mothers and infants. The main purpose of this study was exploring mothers infant feeding practices in the context of Hadiyya culture. After purposively selecting Harche Huyaya Uyaya Kebele eight infant feeding mothers were selected using snowball sampling technique. The study employed interviews and focus group discussion. The study found out early initiation and prolonged breastfeeding and early complementary feeding in some instances immediately after birth. In addition, infants were not forced to wean unless the mothers encounter pressing issues like pregnancy and health related problems. Furthermore, the main weaning techniques were putting unpleasant materials on the tip of nipples and sending infants to grandparents home. The study also found out gender difference in weaning, i.e., early initiation of weaning for girls. This can be indicative of gender-based bias on weaning practice. Finally, health extension workers, office of women and children affairs and Hadiyya Zone Tourism office should organize awareness raising programs to preserve vital infant feeding practices like prolonged breastfeeding and length of weaning. In addition, the offices should raise awareness among communities on negative side effects of sending infant to grandparents home that may weaken infant-mothers attachment and create favorable ground for the development of phobia.

Keywords: feeding, infant, practices, weaning

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Authors: Cameron Wilson, Megan Hanrahan, Katie Brittain, Riona McArdle, Alison Keogh, Lynn Rochester

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Background: The loss of mobility and functional dependence is a significant marker in the progression of neurodegenerative diseases such as Parkinson’s Disease (PD). Pharmacological, surgical, and therapeutic treatments are available that can help in the management and amelioration of PD symptoms; however, these only prolong more severe symptoms. Accordingly, ensuring people with PD can maintain independence and a healthy wellbeing are essential in establishing an effective treatment option for those afflicted. Existing literature reviews have examined experiences in engaging with PD treatment options and the impact of PD on independence and wellbeing. Although, the literature fails to explore the influence of treatment options on independence and wellbeing and therefore misses what people value in their treatment. This review is the first that synthesises the impact of mobility-related treatments on independence and wellbeing in people with PD and their carers, offering recommendations to clinical practice and provides a conceptual framework (in development) for future research and practice. Objectives: To explore the impact of mobility-related treatment (both pharmacological and non-pharmacological) on the independence and wellbeing of people with PD and their carers. To propose a conceptual framework to patients, carers and clinicians which captures the qualities people with PD value as part of their treatment. Methods: We performed a critical interpretive synthesis of qualitative evidence, searching six databases for reports that explored the impact of mobility-related treatments (both drug and non-pharmacological) on independence and wellbeing in Parkinson’s Disease. The types of treatments included medication (Levodopa and Amantadine), dance classes, Deep-Brain Stimulation, aquatic therapies, physical rehabilitation, balance training and foetal transplantation. Data was extracted, and quality was assessed using an adapted version of the NICE Quality Appraisal Tool Appendix H before being synthesised according to the critical interpretive synthesis framework and meta-ethnography process. Results: From 2301 records, 28 were eligible. Experiences and impact of treatment pathway on independence and wellbeing was similar across all types of treatments and are described by five inter-related themes: (i) desire to maintain independence, (ii) treatment as a social experience during and after, (iii) medication to strengthen emotional health, (iv) recognising physical capacity and (v) emphasising the personal journey of Parkinson’s treatments. Conclusion: There is a complex and inter-related experience and effect of PD treatments common across all types of treatment. The proposed conceptual framework (in development) provides patients, carers, and clinicians recommendations to personalise the delivery of PD treatment, thereby potentially improving adherence and effectiveness. This work is vital to disseminate as PD treatment transitions from subjective and clinically captured assessments to a more personalised process supplemented using wearable technology.

Keywords: parkinson's disease, medication, treatment, dance, review, healthcare, delivery, levodopa, social, emotional, psychological, personalised healthcare

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Authors: X. Vecino, J. M. Cruz, A. Moldes

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The disposal and the treatment of sewage sludge is an expensive and environmentally complex problem. In this work, a lipopeptide biosurfactant extracted from corn steep liquor was used as ecofriendly and cost-competitive alternative for the mobilization and bioremediation of fluorene in sewage sludge. Results have demonstrated that this biosurfactant has the capability to mobilize fluorene to the aqueous phase, reducing the amount of fluorene in the sewage sludge from 484.4 mg/Kg up to 413.7 mg/Kg and 196.0 mg/Kg after 1 and 27 days respectively. Furthemore, once the fluorene was extracted the lipopeptide biosurfactant contained in the aqueous phase allowed the bio-degradation, up to 40.5 % of the initial concentration of this polycyclic aromatic hydrocarbon.

Keywords: fluorene, lipopeptide biosurfactant, mobilization, sewage sludge

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Authors: Roger-Claude Liwanga

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This article reflects on the normative aspects of the jurisprudence on the protection of human rights in times of war that the International Court of Justice (ICJ) developed in 2005 in the Case Concerning Armed Activities on the Territory of the Congo (Democratic Republic of Congo v. Uganda). The article focuses on theories raised in connection with the Democratic Republic of Congo (DRC)'s claim of the violation of human rights of its populations by Uganda as opposed to the violation of its territorial integrity claims. The article begins with a re-visitation of the doctrine of state extraterritorial responsibility for violations of human rights by suggesting that a state's accountability for the breach of its international obligations is not territorially confined but rather transcends the State's national borders. The article highlights the criteria of assessing the State's extraterritorial responsibility, including the circumstances: (1) where the concerned State has effective control over the territory of another State in the context of belligerent occupation, and (2) when the unlawful actions committed by the State's organs on the occupied territory can be attributable to that State. The article also analyzes the ICJ's opinions articulated in DRC v. Uganda with reference to the relationship between human rights law and humanitarian law, and it contends that the ICJ had revised the traditional interaction between these two bodies of law to the extent that human rights law can no longer be excluded from applying in times of war as both branches are complementary rather than exclusive. The article correspondingly looks at the issue of reparations for victims of human rights violations. It posits that reparations for victims of human rights violations should be integral (including restitution, compensation, rehabilitation, satisfaction, and guarantees of non-repetition). Yet, the article concludes by emphasizing that reparations for victims were not integral in DRC v. Uganda because: (1) the ICJ failed to set a reasonable timeframe for the negotiations between the DRC and Uganda on the amount of compensation, resulting in Uganda paying no financial reparation to the DRC since 2005; and (2) the ICJ did not request Uganda to domestically prosecute the perpetrators of human rights abuses.

Keywords: human rights law, humanitarian law, civilian protection, extraterritorial responsibility

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Authors: Zeenat Rupawalla, Nicole Robinson, Susanne Schmidt, Sijie Li, Selina Carruthers, Elodie Buisset, John Roles, Ben Hankamer, Juliane Wolf

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Agriculture has radically changed the global biogeochemical cycle of nitrogen (N). Fossil fuel-enabled synthetic N-fertiliser is a foundation of modern agriculture but applied to soil crops only use about half of it. To address N-pollution from cropping and the large carbon and energy footprint of N-fertiliser synthesis, new technologies delivering enhanced energy efficiency, decarbonisation, and a circular nutrient economy are needed. We characterised algae fertiliser (AF) as an alternative to synthetic N-fertiliser (SF) using empirical and modelling approaches. We cultivated microalgae in nutrient solution and modelled up-scaled production in nutrient-rich wastewater. Over four weeks, AF released 63.5% of N as ammonium and nitrate, and 25% of phosphorous (P) as phosphate to the growth substrate, while SF released 100% N and 20% P. To maximise crop N-use and minimise N-leaching, we explored AF and SF dose-response-curves with spinach in glasshouse conditions. AF-grown spinach produced 36% less biomass than SF-grown plants due to AF’s slower and linear N-release, while SF resulted in 5-times higher N-leaching loss than AF. Optimised blends of AF and SF boosted crop yield and minimised N-loss due to greater synchrony of N-release and crop uptake. Additional benefits of AF included greener leaves, lower leaf nitrate concentration, and higher microbial diversity and water holding capacity in the growth substrate. Life-cycle-analysis showed that replacing the most effective SF dosage with AF lowered the carbon footprint of fertiliser production from 2.02 g CO₂ (C-producing) to -4.62 g CO₂ (C-sequestering), with a further 12% reduction when AF is produced on wastewater. Embodied energy was lowest for AF-SF blends and could be reduced by 32% when cultivating algae on wastewater. We conclude that (i) microalgae offer a sustainable alternative to synthetic N-fertiliser in spinach production and potentially other crop systems, and (ii) microalgae biofertilisers support the circular nutrient economy and several sustainable development goals.

Keywords: bioeconomy, decarbonisation, energy footprint, microalgae

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Authors: Naira Sahakyan, Margarit Petrosyan, Armen Trchounian

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One of the tasks in contemporary biotechnology, pharmacology and other fields of human activities is to obtain biologically active substances from plants. They are very essential in the treatment of many diseases due to their actually high therapeutic value without visible side effects. However, sometimes the possibility of obtaining the metabolites is limited due to the reduction of wild-growing plants. That is why the plant cell cultures are of great interest as alternative sources of biologically active substances. Besides, during the monitored cultivation, it is possible to obtain substances that are not synthesized by plants in nature. Isolated culture of Ajuga genevensis with high growth activity and ability of regeneration was obtained using MS nutrient medium. The agar-diffusion method showed that aqueous extracts of callus culture revealed high antimicrobial activity towards various gram-positive (Bacillus subtilis A1WT; B. mesentericus WDCM 1873; Staphylococcus aureus WDCM 5233; Staph. citreus WT) and gram-negative (Escherichia coli WKPM M-17; Salmonella typhimurium TA 100) microorganisms. The broth dilution method revealed that the minimal and half maximal inhibitory concentration values against E. coli corresponded to the 70 μg/mL and 140 μg/mL concentration of the extract respectively. According to the photochemiluminescent analysis, callus tissue extracts of leaf and root origin showed higher antioxidant activity than the same quantity of A. genevensis intact plant extract. A. genevensis intact plant and callus culture extracts showed no cytotoxic effect on K-562 suspension cell line of human chronic myeloid leukemia. The GC-MS analysis showed deep differences between the qualitative and quantitative composition of callus culture and intact plant extracts. Hexacosane (11.17%); n-hexadecanoic acid (9.33%); and 2-methoxy-4-vinylphenol (4.28%) were the main components of intact plant extracts. 10-Methylnonadecane (57.0%); methoxyacetic acid, 2-tetradecyl ester (17.75%) and 1-Bromopentadecane (14.55%) were the main components of A. genevensis callus culture extracts. Obtained data indicate that callus culture of A. genevensis can be used as an alternative source of biologically active substances.

Keywords: Ajuga genevensis, antibacterial activity, antioxidant activity, callus cultures

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Authors: K. J. Sannapapamma, H. Malligawad Lokanath, Sakeena Naikwadi

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Eco-friendly textiles are gaining importance among the consumers and textile manufacturers in the healthcare sector due to increased environmental pollution which leads to several health and environmental hazards. Hence, the research was designed to cultivate and develop the organic cotton knit, to prepare and characterize the Vetiver oil microcapsules for textile finishing and to access the wash durability of finished knits. The cotton SAHANA variety grown under organic production systems was processed and spun into 30 single yarn dyed with four natural colorants (Arecanut slurry, Eucalyptus leaves, Pomegranate rind and Indigo) and eco dyed yarn was further used for development of single jersy knitted fabric. Vetiveria zizanioides is an aromatic grass which is being traditionally used in medicine and perfumery. Vetiver essential oil was used for preparation of microcapsules by interfacial polymerization technique subjected to Gas Chromatography Mass Spectrometry (GCMS), Fourier Transform Infrared Spectroscopy (FTIR), Thermo Gravimetric Analyzer (TGA) and Scanning Electron Microscope (SEM) for characterization of microcapsules. The knitted fabric was finished with vetiver oil microcapsules by exhaust and pad dry cure methods. The finished organic knit was assessed for laundering on antimicrobial efficiency and aroma intensity. GCMS spectral analysis showed that, diethyl phthalate (28%) was the major compound found in vetiver oil followed by isoaromadendrene epoxide (7.72%), beta-vetivenene (6.92%), solavetivone (5.58%), aromadenderene, azulene and khusimol. Bioassay explained that, the vetiver oil and diluted vetiver oil possessed greater zone of inhibition against S. aureus and E. coli than the coconut oil. FTRI spectra of vetiver oil and microcapsules possessed similar peaks viz., C-H, C=C & C꞊O stretching and additionally oil microcapsules possessed the peak of 3331.24 cm^-1 at 91.14 transmittance was attributed to N-H stretches. TGA of oil microcapsules revealed that, there was a minimum weight loss (5.835%) recorded at 467.09°C compared to vetiver oil i.e., -3.026% at the temperature of 396.24°C. The shape of the microcapsules was regular and round, some were spherical in shape and few were rounded by small aggregates. Irrespective of methods of application, organic cotton knits finished with microcapsules by pad dry cure method showed maximum zone of inhibition compared to knits finished by exhaust method against S. aureus and E. coli. The antimicrobial activity of the finished samples was subjected to multiple washing which indicated that knits finished with pad dry cure method showed a zone of inhibition even after 20^th wash and better aroma retention compared to knits finished with the exhaust method of application. Further, the group of respondents rated that the 5^th washed samples had the greater aroma intensity in both the methods than the other samples. Thus, the vetiver microencapsulated organic cotton knits are free from hazardous chemicals and have multi-functional properties that can be suitable for medical and healthcare textiles.

Keywords: exhaust and pad dry cure finishing, interfacial polymerization, organic cotton knits, vetiver oil microcapsules

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Authors: Jun-Ho Chung, Sung-Hyun Yoo, In-Hwan Choi, Hyun-Kook Lee, Moon-Kyu Song, Choon-Ki Ahn

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The extended finite impulse response (EFIR) filter is addressed to optimize membership functions (MFs) of the fuzzy model that has strong nonlinearity. MFs are important parts of the fuzzy logic system (FLS) and, thus optimizing MFs of FLS is one of approaches to improve the performance of output. We employ the EFIR as an alternative optimization option to nonlinear fuzzy model. The performance of EFIR is demonstrated on a fuzzy cruise control via a numerical example.

Keywords: fuzzy logic system, optimization, membership function, extended FIR filter

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Authors: Shuqi Zhang

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Federated learning allows users to participate in collaborative model training without sending data to third-party servers, reducing the risk of user data privacy leakage, and is widely used in smart finance and smart healthcare. However, the distributed architecture design of federation learning itself and the existence of secure aggregation protocols make it inherently vulnerable to backdoor attacks. To solve this problem, the federated learning backdoor defense framework FLEX based on group aggregation, cluster analysis, and neuron pruning is proposed, and inter-compatibility with secure aggregation protocols is achieved. The good performance of FLEX is verified by building a horizontal federated learning framework on the CIFAR-10 dataset for experiments, which achieves 98% success rate of backdoor detection and reduces the success rate of backdoor tasks to 0% ~ 10%.

Keywords: federated learning, secure aggregation, backdoor attack, cluster analysis, neuron pruning

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Authors: Rogelio Portillo Vélez, Eduardo Vázquez-Santacruz, Mariano Gamboa-Zúñiga

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In this paper a new mechanical architecture design of a multi functional robot bed, is presented. The importance of this design relies on the fact that in next years the need of assistive devices development will increase in such way that elderly patients will use this kind of devices. This mechanical design implies following specific mechanisms which attend Mexican hospital requirements. This design is the base of next step of this kind of development given that it shows all technical details of the mechanical systems which are needed in order to construct the bed. This is first hospital bed design which could responds to the Latin America hospital requirements. We have obtained these hospital requirements using our diagnosis methodology [14]. From these results we have designed the mechanical system. This is the mechanical base of the hospital robotic bed which is being developed in our robotics laboratory. It will be useful in different hospital environments for elderly and disabled patients.

Keywords: assistive robotics, methodology, feasibility analysis, robotics, operational feasibility, assistive technology, viability analysis matrix, social impact

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Authors: Natina Roberts, Hanhee Lee

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The existing and emerging refugee research reports unfavorable resettlement outcomes in multiple domains. The proposed paper highlights trends in refugee research in which empirical studies investigate resettlement of former refugees from individual and culturally homogeneous perspectives. The proposed paper then aims to examine the reality of the lived experience of resettlement from family and cross-cultural viewpoints. Proponents for this focus include the United Nations High Commissioner for Refugees (UNHCR). The UNHCR is responsible for leading resettlement efforts for refugees through the durable solutions of repatriation, local integration and resettlement. Life experiences with refugee families, and a report of literary findings on former refugee resettlement from various cultural backgrounds – that highlight similarities and differences among various ethnic groups, will be discussed. The proposed paper is expected to frame underrepresented refugee perspectives, and review policy implications in healthcare, education, and public support systems.

Keywords: refugee, cross-cultural, families, resettlement policy

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Authors: Sharon Waichman, Shahaf Froim, Ido Zukerman, Shmuel Barzilai, Shmual Hayun, Avi Raveh

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Boron carbide is a ceramic material with superior properties such as high chemical and thermal stability, high hardness and high wear resistance. Moreover, it has a big cross section for neutron absorption and therefore can be employed in nuclear based applications. However, an efficient attachment of boron carbide to a metal such as aluminum can be very challenging, mainly because of the formation of aluminum-carbon bonds that are unstable in humid environment, the affinity of oxygen to the metal and the different thermal expansion coefficients of the two materials that may cause internal stresses and a subsequent failure of the bond. Here, we aimed to achieving a strong and a durable attachment between the boron carbide coating and the aluminum substrate. For this purpose, we applied Ti as a thin intermediate layer that provides a gradual change in the thermal expansion coefficients of the configured layers. This layer is continuous and therefore prevents the formation of aluminum-carbon bonds. Boron carbide coatings with a thickness of 1-5 µm were deposited on the aluminum substrate by pulse-DC magnetron sputtering. Prior to the deposition of the boron carbide layer, the surface was pretreated by energetic ion plasma followed by deposition of the Ti intermediate adhesive layer in a continuous process. The properties of the Ti intermediate layer were adjusted by the bias applied to the substrate. The boron carbide/aluminum bond was evaluated by various methods and complementary techniques, such as SEM/EDS, XRD, XPS, FTIR spectroscopy and Glow Discharge Spectroscopy (GDS), in order to explore the structure, composition and the properties of the layers and to study the adherence mechanism of the boron carbide/aluminum contact. Based on the interfacial bond characteristics, we propose a desirable solution for improved adhesion of boron carbide to aluminum using a highly efficient intermediate adhesive layer.

Keywords: adhesion, boron carbide coatings, ceramic/metal bond, intermediate layer, pulsed-DC magnetron sputtering

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Authors: S. Al-Khalasi, O. Mahgoub, H. Yaakub

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This study evaluated the use of raw or processed Prosopis juliflora (Meskit) pods as a major ingredient in a formulated ration to provide an alternative non-conventional concentrate for livestock feeding in Oman. Dry Meskit pods were reduced to lengths of 0.5- 1.0 cm to ensure thorough mixing into three diets. Meskit pods were subjected to two types of treatments; roasting and soaking. They were roasted at 150оC for 30 minutes using a locally-made roasting device (40 kg barrel container rotated by electric motor and heated by flame gas cooker). Chopped pods were soaked in tap water for 24 hours and dried for 2 days under the sun with frequent turning. The Meskit-pod-based diets (MPBD) were formulated and pelleted from 500 g/kg ground Meskit pods, 240 g/kg wheat bran, 200 g/kg barley grain, 50 g/kg local dried sardines and 10 g/kg of salt. Twenty four 10 months-old intact Omani male lambs with average body weight of 27.3 kg (± 0.5 kg) were used in a feeding trial for 84 days. They were divided (on body weight basis) and allocated to four diet combination groups. These were: Rhodes grass hay (RGH) plus a general ruminant concentrate (GRC); RGH plus raw Meskit pods (RMP) based concentrate; RGH plus roasted Meskit pods (ROMP) based concentrate; RGH plus soaked Meskit pods (SMP) based concentrate Daily feed intakes and bi-weekly body weights were recorded. MPBD had higher contents of crude protein (CP), acid detergent fibre (ADF) and neutral detergent fibre (NDF) than the GRC. Animals fed various types of MPBD did not show signs of ill health. There was a significant effect of feeding ROMP on the performance of Omani sheep compared to RMP and SMP. The ROMP fed animals had similar performance to those fed the GRC in terms of feed intake, body weight gain and feed conversion ratio (FCR).This study indicated that roasted Meskit pods based diet may be used instead of the commercial concentrate for feeding Omani sheep without adverse effects on performance. It offers a cheap alternative source of protein and energy for feeding Omani sheep. Also, it might help in solving the spread impact of Meskit trees, maintain the ecosystem and helping in preserving the local tree species.

Keywords: growth, Meskit, Omani sheep, Prosopis juliflora

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Authors: Shuofen Hsu, Ya-Yi Chao, Chao-Wei Li

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This paper investigates the relationship between voluntary audit (hereafter, VA) of semi-annual consolidated financial statements decision and accounting conservatism. In general, there are four kinds of auditors' assurance services, which include audit, review, agreed-upon procedure and compliance engagements base on degree of assurance. The VA work by auditors may not only have the higher audit quality but an important signal of more reliable information than the review work. In Taiwan, The listed companies must prepare the semi-annual consolidated financial statements and with auditors' review before 2012, but some of the listed companies choose the assurance work from review to audit voluntarily. Due to the adoption of International Financial Reporting Standards, the listed companies were required to prepare the second quarterly consolidated financial statements which should be reviewed by auditors since 2013. This rule will change some of the assurance work from audit to review by auditors, and the information asymmetry maybe increased. To control the selection bias, we use two-stage model to test the relationship between VA decision and accounting conservatism. Our empirical results indicate that the VA decision and accounting conservatism have a significant positive relationship in firms with family-controlled. That is, firms with family-controlled are more likely to do VA and to prepare more conservative consolidated financial statements to reduce the information asymmetry, meaning that there is a complementary effect between VA and accounting conservatism for firms with more information asymmetry. But on the contrary, we find that the VA decision and accounting conservatism have a significant negative relationship in firms with professional managers-controlled, meaning that there is a substitution effect between VA and accounting conservatism for firms with less information asymmetry. Finally, the accounting conservatism of consolidated financial statements decrease after the adoption of IFRSs (International Financial Reporting Standards) in Taiwan. It means that the disclosure and transparency of consolidated financial statements had be improved.

Keywords: voluntary audit, accounting conservatism, audit quality, information asymmetry

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Authors: Chander Shekhar, Jeetendra Yadav, Shaziya Allarakha

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Hypertension has been described as an 'iceberg disease' as those who suffered are ignored and hence usually seek healthcare services at a very late stage. It is estimated that more than 2 million Indians are suffering from hypertensive heart disease that contributed to above 0.13 million deaths in 2016. The paper study aims to know the prevalence of Hypertension in India and its variation by socioeconomic backgrounds and to find out risk factors discriminating hypertension with special emphasis on consumption of tobacco and alcohol among men aged 15-54 years in India. The paper uses NFHS (2015-16) data. The paper used binary logistic regression and discriminant analysis to find significant predictors and discriminants of interest. The prevalence of hypertension was 16.5% in the study population. The results suggest that consumption of alcohol and tobacco are significant discriminant characteristics in carrying hypertension irrespective of what socioeconomic background characteristic he possesses.

Keywords: hypertention, alcohol, tobacco, discriminant

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Authors: Elmo Thiago Lins Cöuras Ford, Valentina Alessandra Carvalho do Vale

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Given the unquestionable need of environmental preservation, the natural fibers have been seen as a salutary alternative for production of composites in substitution to the synthetic fibers, vitreous and metallic. In this work, the behavior of a composite was analyzed done with fiber of the peel of the coconut as reinforcement and latex as head office, when submitted the source of heat. The temperature profiles were verified in the internal surfaces and it expresses of the composite as well as the temperature gradient in the same. It was also analyzed the behavior of this composite when submitted to a cold source. As consequence, in function of the answers of the system, conclusions were reached.

Keywords: natural fiber, composite, temperature, latex, gradient

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Authors: Maureen Kamau, Gulnaz Mohamoud, Adelaide Lusambili, Njeri Nyanja

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Life expectancy has increased over the last century amongst older individuals, and in particular, those 60 years and over. The World Health Organization estimates that the world's population of persons over 60 years will rise to 22 per cent by the year 2050. Ageing is associated with increasing disability, multiple chronic conditions, and an increase in the use of health services. These multiple chronic conditions are managed with polypharmacy. Polypharmacy has numerous adverse effects including non-adherence, poor compliance to the various medications, reduced appetite, and risk of fall. Studies on polypharmacy and ageing are few and poorly understood especially in low and middle - income countries. The aim of this study was to explore the knowledge, attitudes and beliefs of older people towards polypharmacy. A qualitative study of 15 patients aged 60 years and above, taking more than five medications per day were conducted at the Aga Khan University using Semi-structured in-depth interviews. Three interviews were pilot interviews, and data analysis was performed on 12 interviews. Data were analyzed using NVIVO 12 software. A thematic qualitative analysis was carried out guided by Braun and Clarke (2006) framework. Themes identified; - knowledge of their co-morbidities and of the medication that older persons take, sources of information about medicines, and storage of the medication, experiences and attitudes of older patients towards polypharmacy both positive and negative, older peoples beliefs and their coping mechanisms with polypharmacy. The study participants had good knowledge on their multiple co-morbidities, and on the medication they took. The patients had positive attitudes towards medication as it enhanced their health and well-being, and enabled them to perform their activities of daily living. There was a strong belief among older patients that the medications were necessary for their health. All these factors enhanced compliance to the multiple medication. However, some older patients had negative attitudes due to the pill burden, side effects of the medication, and stigma associated with being ill. Cost of healthcare was a concern, with most of the patients interviewed relying on insurance to cover the cost of their medication. Older patients had accepted that the medication they were prescribed were necessary for their health, as it enabled them to complete their activities of daily living. Some concerns about the side effects of the medication arose, and brought about the need for patient education that would ensure that the patients are aware of the medications they take, and potential side effects. The effect that the COVID 19 pandemic had in the healthcare of the older patients was evident by the number of the older patients avoided coming to the hospital during the period of the pandemic. The relationship with the primary care physician and the older patients is an important one, especially in LMICs such as Kenya, as many of the older patients trusted the doctors wholeheartedly to make the best decision about their health and about their medication. Prescription review is important to avoid the use of potentially inappropriate medication.

Keywords: polypharmacy, older patients, multiple chronic conditions, Kenya, Africa, qualitative study, indepth interviews, primary care

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Authors: Maria Luiza Fulga, Georgeta Truca, Mihaela Alexandru, Andriescu Mariana, Crin Marcean

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The significance of nursing as a subject in the post-secondary healthcare curriculum is a major. We aimed to enable our students to assess the patient's risk, to establish prevention measures and to adapt to a specific learning context, in order to acquire the skills and abilities necessary for the nursing profession. In order to achieve these objectives, during the three years of study, teachers put an emphasis on acquiring communication skills, because in our country after the first cycle of hospital accreditation concluded in 2016, the National Authority for Quality of Health Management has introduced the criteria for the implementation and application of the nursing process according to the accreditation standards. According to these requirements, the nurse has to carry out the nursing assessment, based on communication as a distinct component, so that they can identify nursing diagnoses and implement the nursing plan. In this respect, we, the teachers, have refocused, by approaching various teaching strategies and preparing students for the real context of learning and applying what they learn. In the educational process, the tutors in the hospitals have an important role to play in acquiring professional skills. Students perform their activity in the hospital in accordance with the curriculum, in order to verify the practical applicability of the theoretical knowledge acquired in the school classes and also have the opportunity to acquire their skills in a real learning context. In clinical education, the student nurse learns in the middle of a guidance team which includes a practice tutor, who is a nurse that takes responsibility for the practical/clinical learning of the students in their field of activity. In achieving this objective, the tutor's abilities involve pedagogical knowledge, knowledge for the good of the individual and nursing theory, in order to be able to guide clinical practice in accordance with current requirements. The aim of this study is to find out the students’ confidence level in practice tutors in hospitals, the students’ degree of satisfaction in the pedagogical skills of the tutors and the practical applicability of the theoretical knowledge. In this study, we used as a method of investigation a student satisfaction questionnaire regarding the clinical practice in the hospital and the sample of the survey consisted of 100 students aged between 20 and 50 years, from the first, second and third year groups, with the General Nurse specialty (nurses responsible for general care), from 'Fundeni' Healthcare Post-Secondary School, Bucharest, Romania. Following the analysis of the data provided, we arrived the conclusion that the hospital tutor needs to improve his/her pedagogical skills, the knowledge of nursing diagnostics, and the implementation of the nursing plan, so that the applicability of the theoretical notions would be increased. Future plans include the pedagogical training of the medical staff, as well as updating the knowledge needed to implement the nursing process in order to meet current requirements.

Keywords: clinical training, nursing process, pedagogical skills, tutor

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Authors: Nihayatul Munaa, Nyoman A. Damayanti

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This study seeks to understand what factors might influence a patient’s perception of health care under national health insurance in early implementation. In Indonesia, National Health Insurance was first implemented in 2014 and planned to achieve universal health coverage by 2019. However, the little understanding of this new policy lead to increase of complaint in hospital as a health care provider. This is a observational descriptive study with cross sectional design method. Data was collected through in-depth interview with 96 patient from Jemursari Islamic Hospital of Surabaya (Rumah Sakit Islam Jemursari Surabaya) who participate in National Health Insurance. Subject was selected by simple random sampling. The findings demonstrated that from five categories, 82,3% patient was satisfied in reliability aspect and 85,4% in assurance aspect, while in tangible, responsiveness and empathy aspect > 90% patient was satisfied. Meanwhile, in Indonesia, the minimum service standard of healthcare of patient satisfaction is 90%.

Keywords: patient’s satisfaction, national health insurance, hospital, complaint

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Authors: Doran C. Kalmin

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The descending genicular artery (DGA) perforator free flap provides an alternative to free flap reconstruction based on a review of the literature detailing both anatomical and clinical studies. The descending genicular artery (DGA) supplies skin, muscle, tendon, and bone located around the medial aspect of the knee that has been used in several pioneering reports in reconstructing defects located in various areas throughout the body. After the success of the medial femoral condyle flap in early studies, a small number of studies have been published detailing the use of the DGA in free flap reconstruction. Despite early success in the use of the DGA flap, acceptance within the Plastic and Reconstructive Surgical community has been limited due primarily to anatomical variations of the pedicle. This literature review is aimed at detailing the progression of the DGA perforator free flap and its variations as an alternative and reliable free flap for reconstruction of composite defects with an exploration into both anatomical and clinical studies. A literature review was undertaken, and the progression of the DGA flap is explored from the early review by Acland et al. pioneering the saphenous free flap to exploring modern changes and studies of the anatomy of the DGA. An extensive review of the literature was undertaken that details the anatomy and its variations, approaches to harvesting the flap, the advantages, and disadvantages of the DGA perforator free flap as well as flap outcomes. There are 15 published clinical series of DGA perforator free flaps that incorporate cutaneous, osteoperiosteal, cartilage, osteocutaneous, osteoperiosteal and muscle, osteoperiosteal and subcutaneous and tendocutatenous. The commonest indication for using a DGA free flap was for non-union of bone, particularly that of the scaphoid whereby the medial femoral condyle could be used. In the case series, a success rate of over 90% was established, showing that these early studies have had good success with a wide range of tissue transfers. The greatest limitation is the anatomical variation of the DGA and therefore, the challenges associated with raising the flap. Despite the variation in anatomy and around 10-15% absence of the DGA, the saphenous artery can be used as well as the superior medial genicular artery if the vascular bone is required as part of the flap. Despite only a handful of anatomical and clinical studies describing the DGA perforator free flap, it ultimately provides a reliable flap that can include a variety of composite structure used for reconstruction in almost any area throughout the body. Although it has limitations, it provides a reliable option for free flap reconstruction that can routinely be performed as a single-stage procedure.

Keywords: anatomical study, clinical study, descending genicular artery, literature review, perforator free flap reconstruction

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Authors: Olaifa Temitope Abimbola

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The spate of the occurrence of Ethnic Conflict in Nigeria and indeed Africa is sporadic and to say the least alarming. To scholars of Ethnic Conflict in Africa, it has defied all logical approaches to its resolution. Based on this fact international organisations have begun to look for alternative means of approaching these conflicts. Not a few have agreed that wars are better and cheaper prevented than resolved or transformed. In the light of this, this paper had set out to look at the concept of Preventive Diplomacy, Ethnic Conflict, Women and the role they play in mitigating conflict by researching into activities of women in pre and post-conflict situations in selected African conflict and has been able to establish the peculiar capacity of women in dousing tension both at domestic and communal levels.

Keywords: preventive diplomacy, gender, peacebuilding, low

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Authors: Gracious Tendai Matayaya

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The world is facing problems in finding alternative resources to offset the decline in global petroleum reserves. The use of fossil fuels has prompted biofuel development, particularly in the transportation sector. In these circumstances, looking for alternative renewable energy sources makes sense. Petroleum-based fuels also result in a lot of carbon dioxide being released into the environment causing global warming. Replacing petroleum and fossil fuel-based fuels with biofuels has the advantage of reducing undesirable aspects of these fuels, which are mostly the production of greenhouse gas and dependence on unstable foreign suppliers. Algae refer to a group of aquatic microorganisms that produce a lot of lipids up to 60% of their total weight. This project aims to exploit the large amounts of oil produced by these microorganisms in the Soxhlet extraction to make biodiesel. Experiments were conducted to establish the cultivability of algae, harvesting methods, the oil extraction process, and the transesterification process. Although there are various methods for producing algal oil, the Soxhlet extraction method was employed for this particular research. After extraction, the oil was characterized before being used in the transesterification process that used methanol and hydrochloric acid as the process reactants. The properties of the resulting biodiesel were then determined. Because there is a requirement to dry wet algae, the experimental findings showed that Soxhlet extraction was the optimum way to produce a higher yield of microalgal oil. Upon cultivating algae, Compound D fertilizer was added as a source of nutrients (Phosphorous and Nitrogen), and the highest growth of algae was observed at 6 days (using 2 g of fertilizer), after which it started to decrease. Butanol, hexane, heptane and acetone have been experimented with as solvents, and heptane gave the highest amount of oil (89ml of oil) when 300 ml of solvent was used. This was compared to 73.21ml produced by butanol, 81.90 produced by hexane and 69.57ml produced by acetone, and as a result, heptane was used for the rest of the experiments, which included a variation of the mass of dried algae and time of extraction. This meant that the oil composition of algae was higher than other oil sources like peanuts, soybean etc. Algal oil was heated at 150℃ for 150 minutes in the presence of methanol (reactant) and hydrochloric acid (HCl), which was used as a catalyst. A temperature of 200℃ produced 93.64%, and a temperature of 250℃ produced 92.13 of biodiesel at 150 minutes.

Keywords: microalgae, algal oil, biodiesel, soxhlet extraction

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Authors: Mazoun Nasser Rashid Al Kharusi, Nada Al Siyabi

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Objectives: The main aim of this study is to Find the rate of susceptibility of ESBL E. coli causing UTI to oral antibiotics. Secondary objectives: Prevalence of ESBL E. coli from community urine samples, identify the best empirical oral antibiotics with the least resistance rate for UTI and identify alternative oral antibiotics for testing and utilization. Methods: This study is a retrospective descriptive study of the last three years in five major hospitals in Oman (Khowla Hospital, AN’Nahdha Hospital, Rustaq Hospital, Nizwa Hospital, and Ibri Hospital) equipped with a microbiologist. Inclusion criteria include all eligible outpatient urine culture isolates, excluding isolates from admitted patients with hospital-acquired urinary tract infections. Data was collected through the MOH database. The MOH hospitals are using different types of testing, automated methods like Vitek2 and manual methods. Vitek2 machine uses the principle of the fluorogenic method for organism identification and a turbidimetric method for susceptibility testing. The manual method is done by double disc diffusion for identifying ESBL and the disc diffusion method is for antibiotic susceptibility. All laboratories follow the clinical laboratory science institute (CLSI) guidelines. Analysis was done by SPSS statistical package. Results: Total urine cultures were (23048). E. coli grew in (11637) 49.6% of the urine, whereas (2199) 18.8% of those were confirmed as ESBL. As expected, the resistance rate to amoxicillin and cefuroxime is 100%. Moreover, the susceptibility of those ESBL-producing E. coli to nitrofurantoin, trimethoprim+sulfamethoxazole, ciprofloxacin and amoxicillin-clavulanate is progressing over the years; however, still low. ESBL E. coli was predominating in the female gender and those aged 66-74 years old throughout all the years. Other oral antibiotic options need to be explored and tested so that we add to the pool of oral antibiotics for ESBL E. coli causing UTI in the community. Conclusion: High rate of ESBL E. coli in urine from the community. The high resistance rates to oral antibiotics highlight the need for alternative treatment options for UTIs caused by these bacteria. Further research is needed to identify new and effective treatments for UTIs caused by ESBL-E. Coli.

Keywords: UTI, ESBL, oral antibiotics, E. coli, susceptibility

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Authors: A. Coetzee, C. F. Kelly, E. Even-Zahav

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Dominant approaches to livestock production are harmful to the environment, human health and animal welfare, yet global meat consumption is rising. Sustainable alternative production approaches are therefore urgently required, and ‘free range’ is the main alternative for chicken meat offered in South Africa (and globally). Although the South African Poultry Association provides non-binding guidelines, there is a lack of formal definition and regulation of free range chicken production, meaning it is unclear what this alternative entails and if it is consistently practised (a trend observed globally). The objective of this exploratory qualitative case study is therefore to investigate who and what determines free range chicken. The case study, conducted from a social constructivist worldview, uses semi-structured interviews, photographs and document analysis to collect data. Interviews are conducted with those involved with bringing free range chicken to the market - farmers, chefs, retailers, and regulators. Data is analysed using thematic analysis to establish dominant patterns in the data. The five major themes identified (based on prevalence in data and on achieving the research objective) are: 1) free range means a bird reared with good animal welfare in mind, 2) free range means quality meat, 3) free range means a profitable business, 4) free range is determined by decision makers or by access to markets, and 5) free range is coupled with concerns about the lack of regulation. Unpacking the findings in the context of the literature reveals who and what determines free range. The research uncovers wide-ranging interpretations of ‘free range’, driven by the absence of formal regulation for free range chicken practices and the lack of independent private certification. This means that the term ‘free range’ is socially constructed, thus varied and complex. The case study also shows that whether chicken meat is free range is generally determined by those who have access to markets. Large retailers claim adherence to the internationally recognised Five Freedoms, also include in the South African Poultry Association Code of Good Practice, which others in the sector say are too broad to be meaningful. Producers describe animal welfare concerns as the main driver for how they practice/view free range production, yet these interpretations vary. An additional driver is a focus on human health, which participants achieve mainly through the use of antibiotic-free feed, resulting in what participants regard as higher quality meat. The participants are also strongly driven by business imperatives, with most stating that free range chicken should carry a higher price than conventionally-reared chicken due to increased production costs. Recommendations from this study focus on, inter alia, a need to understand consumers’ perspectives on free range chicken, given that those in the sector claim they are responding to consumer demand, and conducting environmental research such as life cycle assessment studies to establish the true (environmental) sustainability of free range production. At present, it seems the sector mostly responds to social sustainability: human health and animal welfare.

Keywords: chicken meat production, free range, socially constructed, sustainability

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Authors: Muuz Abraha Meshesha

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Illegal Migration, specifically Trafficking in person is one of the primary issues of the day affecting all states of the world with variation on the extent of the root causes and consequences that led people to migrate irregularly and the consequences it is costing on humanity. This paper intends to investigate the root causes and consequences of illegal migration in Ethiopia’s Tigray Regional state and come up with alternative intervening strategy. To come up with pertinent and robust research finding, this study employed mixed research approach involving qualitative and quantitative data in line with purposive and snow ball sampling selection technique. The study revealed that, though poverty is the most commonly sensed pushing factor for people to illegally migrate, the issue of psycho-social orientation and attitudinal immersion of the local community for illegal migration, both in thinking and action is the most pressing problem that urges serious intervention. Trafficking in persons and Illegal migration in general, is becoming the norm of the day in the study area that overtly reveal illegal migration is an issue beyond livelihood securing demand in practice. Basically, parties engaged in illegal migration and the accomplice with human traffickers these days in the study area are found to be more than urgency for food security and a need to escape from livelihood impoverishment. Therefore, this study come up with a new paradigm insight indicating that illegal migration is believed by the local community members as an optional path way of doing business in illegal way while the attitude of the community and officials authorized to regulate is being part of the channel or to the least tolerant of this grave global danger. The study also found that the effect of illegal migration is significantly manifested in long run than in short term periods. Therefore, a need for critical consideration on attitudinal based intervention and youth oriented and enforceable legal and policy framework accountability framework is required to face and control illegal migration by international, national, local stakeholders. Besides this, economy based development interventions that could engage and reorient the youth, as primary victims of trafficking, and expansion of large scale projects that can employ large number of youths at a time.

Keywords: human traficking, illegal migration, migration, tigray region

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Authors: Arslan Murtaza

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RFID (Radio Frequency Identification) and WSN (Wireless sensor network) are two significant wireless technologies that have extensive diversity of applications and provide limitless forthcoming potentials. RFID is used to identify existence and location of objects whereas WSN is used to intellect and monitor the environment. Incorporating RFID with WSN not only provides identity and location of an object but also provides information regarding the condition of the object carrying the sensors enabled RFID tag. It can be widely used in stock management, asset tracking, asset counting, security, military, environmental monitoring and forecasting, healthcare, intelligent home, intelligent transport vehicles, warehouse management, and precision agriculture. This assessment presents a brief introduction of RFID, WSN, and integration of WSN and RFID, and then applications related to both RFID and WSN. This assessment also deliberates status of the projects on RFID technology carried out in different computing group projects to be taken on WSN and RFID technology.

Keywords: wireless sensor network, RFID, embedded sensor, Wi-Fi, Bluetooth, integration, time saving, cost efficient

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Authors: Roseliza Mat Alipiah, David Raffaelli, J. C. R. Smart

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This research is a new approach as it integrates information from both environmental and social sciences to inform effective management of the wetlands. A three-stage research framework was developed for modelling the drivers and pressures imposed on the wetlands and their impacts to the ecosystem and the local communities. Firstly, a Bayesian Belief Network (BBN) was used to predict the probability of anthropogenic activities affecting the delivery of different key wetland ecosystem services under different management scenarios. Secondly, Choice Experiments (CEs) were used to quantify the relative preferences which key wetland stakeholder group (aquaculturists) held for delivery of different levels of these key ecosystem services. Thirdly, a Multi-Criteria Decision Analysis (MCDA) was applied to produce an ordinal ranking of the alternative management scenarios accounting for their impacts upon ecosystem service delivery as perceived through the preferences of the aquaculturists. This integrated ecosystem management approach was applied to a wetland ecosystem in Setiu, Terengganu, Malaysia which currently supports a significant level of aquaculture activities. This research has produced clear guidelines to inform policy makers considering alternative wetland management scenarios: Intensive Aquaculture, Conservation or Ecotourism, in addition to the Status Quo. The findings of this research are as follows: The BBN revealed that current aquaculture activity is likely to have significant impacts on water column nutrient enrichment, but trivial impacts on caged fish biomass, especially under the Intensive Aquaculture scenario. Secondly, the best fitting CE models identified several stakeholder sub-groups for aquaculturists, each with distinct sets of preferences for the delivery of key ecosystem services. Thirdly, the MCDA identified Conservation as the most desirable scenario overall based on ordinal ranking in the eyes of most of the stakeholder sub-groups. Ecotourism and Status Quo scenarios were the next most preferred and Intensive Aquaculture was the least desirable scenario. The methodologies developed through this research provide an opportunity for improving planning and decision making processes that aim to deliver sustainable management of wetland ecosystems in Malaysia.

Keywords: Bayesian belief network (BBN), choice experiments (CE), multi-criteria decision analysis (MCDA), aquaculture

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Authors: Kesi Widjajanti

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To develop the growth of small and medium enterprises (SMEs), it is important to unlock potential resources that can improve their performance. Business Partnerships (BP) are currently an interesting topic of strategy to use to expand markets and maximize financial and marketing performance. However, many business partnerships have not quite a role among small and medium companies in the creative industry in the Batik Craft sector in Indonesia. This study is rooted in the Resource Advantage Theory of Competition ( RAToC), which emphasizes that the advantage of company resources can be sourced from organizational and relational resources. With the basis of this theory, SMEs can optimize the allocation of relational resources and organizational goals, improve operational efficiency, and gain a strategic advantage in the market. Companies that are able to actualize organizational and relational resources better than other market players can be used for the process of increasing their superior performance. This study explores key elements from the RAToC perspective and shows how Business Partnerships have the potential to drive SMEs' growth. By aligning visions, and organizational resources, sharing knowledge and leveraging complementary relational resources, SMEs can increase their competitiveness, enter new markets, and achieve superior performance. The theoretical contribution of RAToC in small companies is due to the role of Pro-Grow Business Partnership strength as an important antecedent for improving SMEs' performance. The benefits (scenarios) of a Business Partnership to grow together are directed at optimizing resources that can create additional value for customers so that they can outperform competitors. Furthermore, managerial implications for SMEs who wish to unlock their resource potential can encourage the role of Pro-Grow Business Partnerships, which have specific characteristics, can absorb experience/knowledge capacity and utilize this knowledge for the development of "together" business ventures.

Keywords: pro grow business partnership, performance, SMEs, resources advantage theory of competition, industry kreatif batik handycraft indonesia

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Authors: Nesreen M. Alqaissi

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Little is known about the lived experiences of breast cancer among Arab Muslim women. The researcher used a qualitative interpretive phenomenological research design to explore the lived experiences of breast cancer as described by Jordanian Muslim women. A purposive sample of 20 women with breast cancer was recruited. Data were collected utilizing individual semi-structured interviews, and analyzed using Heideggerian Hermeneutical methodology. Results: Five related themes and one constitutive pattern: (a) breast cancer means death; (b) matriarchal family members as important source of support; (c) spirituality as a way to live and survive breast cancer; (d) concealing cancer experiences to protect self and families; (e) physicians as protectors and treatment decision makers; (f) the constitutive pattern: culture influencing Jordanian women experiences with breast cancer. In conclusion, researchers and healthcare providers should consider the influence of culture, spirituality, and families, when caring for women with breast cancer from Jordan.

Keywords: breast cancer, Arab Muslim, Jordan, lived experiences, spirituality, culture

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Authors: Hasneet K. Kalsi, Julie K. Kilgariff

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Introduction: Within dentistry, the process for gaining informed consent has become more complex. To consent for treatment, patients must understand all reasonable treatment options and associated risks and benefits. Consenting is therefore deeply embedded in health literacy. Patients attending for dental consultation are often presented with an array of information and choices, yet studies show patients recall less than half of the information provided immediately after. Appropriate and comprehensible patient information leaflets (PILs) may be useful aid memories. In 2016 the World Health Organisation set improving health literacy as a global priority. Soon after, Scotland’s 2017-2025 Making it Easier: A Health Literacy Action Plan followed. This project involved the review of Restorative PILs used within Dundee Dental Hospital to assess the Content and Readability. Method: The current PIL on Root Canal Treatment (RCT) was created in 2011. This predates the Montgomery vs. NHS Lanarkshire case, a ruling which significantly impacted dental consenting processes, as well as General Dental Council’s (GDC’s) Standards for the Dental Team and Faculty of General Dental Practice’s Good Practice Guidance on Clinical Examination and Record-Keeping. Current evidence-based guidance, including that stipulated by the GDC, was reviewed. A 20-point Essential Content Checklist was designed to conform to best practice guidance for valid consenting processes. The RCT leaflet was scored against this to ascertain if the content was satisfactory. Having ensured the content satisfied medicolegal requirements, health literacy considerations were reviewed regarding readability. This was assessed using McLaughlin’s Simple Measure of Gobbledygook (SMOG) formula, which identifies school stages that would have to be achieved to comprehend the PIL. The sensitivity of the results to alternative readability methods were assessed. Results: The PIL was not sufficient for modern consenting processes and reflected a suboptimal level of health literacy. Evaluation of the leaflet revealed key content was missing, including information pertaining to risks and benefits. Only five points out of the 20-point checklist were present. The readability score was 16, equivalent to a level 2 in National Adult Literacy Standards/Scottish Credit and Qualification Framework Level 5; 62% of Scottish adults are able to read to this standard. Discussion: Assessment of the leaflet showed it was no longer fit for purpose. Reasons include a lack of pertinent information, a text-heavy leaflet lacking flow, and content errors. The SMOG score indicates a high level of comprehension is required to understand this PIL, which many patients may not possess. A new PIL, compliant with medicolegal and health literacy guidance, was designed with patient-driven checklists, notes spaces for annotations/ questions and areas for clinicians to highlight important case-specific information. It has been tested using the SMOG formula. Conclusion: PILs can be extremely useful. Studies show that interactive use can enhance their effectiveness. PILs should reflect best practice guidance and be understood by patients. The 2020 leaflet designed and implemented aims to fulfill the needs of a modern healthcare system and its service users. It embraces and embeds Scotland’s Health Literacy Action Plan within the consenting process. A review of further leaflets using this model is ongoing.

Keywords: consent, health literacy, patient information leaflet, restorative dentistry

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