Search results for: epidemic risk

Authors: Aishvarya Gupta, Keerthana Anand, Sasirekha Rengaraj, Latha Chathurvedula

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Introduction: Advances in assisted reproductive technology and increase in the proportion of infertile couples have both contributed to the steep increase in the incidence of twin pregnancies in past decades. Maternal and perinatal complications are higher in twins than in singleton pregnancies. Studies comparing the maternal and perinatal outcomes of ART twin pregnancies versus spontaneously conceived twin pregnancies report heterogeneous results making it unclear whether the complications are due to twin gestation per se or because of assisted reproductive techniques. The present study aims to compare both maternal and perinatal outcomes in twin pregnancies which are spontaneously conceived and after assisted conception methods, so that targeted steps can be undertaken in order to improve maternal and perinatal outcome of twins. Objectives: To study perinatal and maternal outcome in twin pregnancies conceived spontaneously as well as with assisted methods and compare the outcomes between the two groups. Setting: Women delivering at JIPMER (tertiary care institute), Pondicherry. Population: 380 women with twin pregnancies who delivered in JIPMER between June 2015 and March 2017 were included in the study. Methods: The study population was divided into two cohorts – one conceived by spontaneous conception and other by assisted reproductive methods. Association of various maternal and perinatal outcomes with the method of conception was assessed using chi square test or Student's t test as appropriate. Multiple logistic regression analysis was done to assess the independent association of assisted conception with maternal outcomes after adjusting for age, parity and BMI. Multiple logistic regression analysis was done to assess the independent association of assisted conception with perinatal outcomes after adjusting for age, parity, BMI, chorionicity, gestational age at delivery and presence of hypertension or gestational diabetes in the mother. A p value of < 0.05 was considered as significant. Result: There was increased proportion of women with GDM (21% v/s 4.29%) and premature rupture of membranes (35% v/s 22.85%) in the assisted conception group and more anemic women in the spontaneous group (71.27% v/s 55.1%). However assisted conception per se increased the incidence of GDM among twin gestations (OR 3.39, 95% CI 1.34 – 8.61) and did not influence any of the other maternal outcomes. Among the perinatal outcomes, assisted conception per se increased the risk of having very preterm (<32 weeks) neonates (OR 3.013, 95% CI 1.432 – 6.337). The mean birth weight did not significantly differ between the two groups (p = 0.429). Though there were higher proportion of babies admitted to NICU in the assisted conception group (48.48% v/s 36.43%), assisted conception per se did not increase the risk of admission to NICU (OR 1.23, 95% CI 0.76 – 1.98). There was no significant difference in perinatal mortality rates between the two groups (p = 0.829). Conclusion: Assisted conception per se increases the risk of developing GDM in women with twin gestation and increases the risk of delivering very preterm babies. Hence measures should be taken to ensure appropriate screening methods for GDM and suitable neonatal care in such pregnancies.

Keywords: assisted conception, maternal outcomes, perinatal outcomes, twin gestation

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Authors: Jayanta Pokharel, Gokarna Aryal, Netra Kanaal, Chris Tsokos

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Investment in stocks and shares aims to seek potential gains while weighing the risk of future needs, such as retirement, children's education etc. Analysis of the behavior of the stock market returns and making prediction is important for investors to mitigate risk on investment. Historically, the normal variance models have been used to describe the behavior of stock market returns. However, the returns of the financial assets are actually skewed with higher kurtosis, heavier tails, and a higher center than the normal distribution. The Laplace distribution and its family are natural candidates for modeling stock returns. The Variance-Gamma (VG) distribution is the most sought-after distributions for modeling asset returns and has been extensively discussed in financial literatures. In this paper, it explore the other Laplace family, such as Asymmetric Laplace, Skewed Laplace, Kumaraswamy Laplace (KS) together with Variance-Gamma to model the weekly returns of the S&P 500 Index and it's eleven business sector indices. The method of maximum likelihood is employed to estimate the parameters of the distributions and our empirical inquiry shows that the Kumaraswamy Laplace distribution performs much better for stock returns modeling among the choice of distributions used in this study and in practice, KS can be used as a strong alternative to VG distribution.

Keywords: stock returns, variance-gamma, kumaraswamy laplace, maximum likelihood

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Authors: Salima Taleb, Kafila Boulaba, Ahlem Yousfi, Nada Taleb, Difallah Basma

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Introduction: Obesity is recognized as a cardiovascular risk factor. It is associated with cardio-metabolic diseases. Its prevalence is increasing significantly in both rich and poor countries. However, there are obese people who have no metabolic disturbance. So we think obesity is not always a risk factor for an abnormal metabolic profile that increases the risk of cardiometabolic problems. However, there is no definition that allows us to identify the individual group Metabolically Healthy but Obese (MHO). Objective: The objective of this study is to evaluate the relationship between MHO and some factors associated with it. Methods: A longitudinal study is a prospective cohort study of 600 participants aged ≥18 years. Metabolic status was assessed by the following parameters: blood pressure, fasting glucose, total cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides. Body Mass Index (BMI) was calculated as weight (in kg) divided by height (m2), BMI = Weight/(Height)². According to the BMI value, our population was divided into four groups: underweight subjects with BMI <18.5 kg/m2, normal weight subjects with BMI = 18.5–24.9 kg/m², overweight subjects with BMI=25–29.9 kg/m², and obese subjects who have (BMI ≥ 30 kg/m²). A value of P < 0.05 was considered significant. Statistical processing was done using the SPSS 25 software. Results: During this study, 194 (32.33%) were identified as MHO among 416 (37%) obese individuals. The prevalence of the metabolically unhealthy phenotype among normal-weight individuals was (13.83%) vs. (37%) in obese individuals. Compared with metabolically healthy normal-weight individuals (10.93%), the prevalence of diabetes was (30.60%) in MHO, (20.59%) in metabolically unhealthy normal weight, and (52.29%) for metabolically unhealthy obese (p = 0.032). Blood pressure was significantly higher in MHO individuals than in metabolically healthy normal-weight individuals and in metabolically unhealthy obese than in metabolically unhealthy normal weight (P < 0.0001). Familial coronary artery disease does not appear to have an effect on the metabolic status of obese and normal-weight patients (P = 0.544). However, waist circumference appears to have an effect on the metabolic status of individuals (P < 0.0001). Conclusion: This study showed a high prevalence of metabolic profile disruption in normal-weight subjects and a high rate of overweight and/or obese people who are metabolically healthy. To understand the physiological mechanism related to these metabolic statuses, a thorough study is needed.

Keywords: metabolically health, obesity, factors associated, cardiovascular diseases

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Authors: Amani Ashari, Julia Omar, Arif Hashim, Shahrul Hamid

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Apolipoprotein E (APOE) gene polymorphism has influence on serum lipids which relates to cardiovascular risk. The purpose of this study was to determine the frequency distribution of APOE alleles among Malaysian Type 2 Diabetes Mellitus (DM) patients with and without coronary artery disease (CAD) and their association with serum lipid profiles. A total of 115 patients were recruited in which 78 patients had Type 2 DM without CAD and 37 patients had Type 2 DM with CAD. The APOE polymorphism was detected by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The APOE ɛ3 allele was the most common one in both groups. There was no significant association between the APOE genotypes and the CAD status in Type 2 DM using Pearson χ² test. Further analysis indicated there were no significant differences in all lipid parameters between E2, E3 and E4 subgroups in both groups. The study showed that the E4 allele carriers of Type 2 DM with CAD patients had higher LDL-C level and lower HDL-C level compared to the other allele carriers. However, analyses showed these levels were not statistically different. The study also showed that the Type 2 DM with CAD group with E2 allele had higher triglyceride (TG). In conclusion, further study with larger sample size is needed to confirm role of E4 as a marker of CAD among Type 2 DM patients in Malaysian population.

Keywords: Apolipoprotein E, diabetes mellitus, cardiovascular disease, lipids

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Authors: Sukhvinder Kaur, Jayanta Bora, Ashok Agarwal, Sangeeta Kaul

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Background: HIV and STI transmission can be prevented if condoms are used properly, but condom tear may lead to infections even if are used consistently. Studies reveal high rates of condom breakage among Female Sex Workers (FSWs). USAID PHFI-PIPPSE is piloting a prevention model among high risk groups at Thane district of Maharashtra, India by implementing prevention and advocacy efforts for such risk behaviors. The current analysis highlights the correlates of condom breakage among FSWs from Thane. Method: A Behavioral Tracking Survey was conducted in 2014-15 among 503 FSWs through probability-based two stage random sampling from 3,660 FSWs at 100 hotspots, to understand levels of high risk behaviors, awareness and exposure to prevention programs. Bi-variate and multivariate-logistic regression methods used to assess the association of condom breakage while having sex with age, STI occurrence, anal sex with clients and alcohol consumption. Only self-reported STIs (Genital sore/ulcer, yellowish/ greenish discharge from vagina with/without foul smell, lower abdominal pain without diarrhea/dysentery or menses) were considered. Major Findings: Results depicted FSWs who reported condom breakage while having sex with any type of partner (paying clients, non-paying partners and other than main partner husband/boyfriend) had significantly high number of STIs (42.3% vs 16.9 %, P, 0.000) and had started sexual relationship in <16 years of age (31.0% vs 16.4 %, P, 0.000). Multivariate analysis after controlling the age at sex, knowledge about HIV and literacy, highlighted significantly higher odds of condom breakage among FSWs who have reported currently suffering with STI [AOR 2.91, 95% CI 1.75 - 4.83; P, 0.000]; who had anal sex with their paying client [AOR 2.59, 95% CI 1.59 - 4.19; P, 0.000]; and who consumed alcohol in the last 12 months [AOR 1.89, 95% CI 1.01 - 3.53; P, 0.047]. Conclusion: Risky behavior like anal sex with paying clients and impact of alcohol while having sex are main factors for condom breakage among young sex workers; and condom breakage leads to STIs. Hence, program interventions should address measures for prevention of condom breakage for HIV/STI prevention.

Keywords: female sex workers, condom breakage, anal sex, young sex workers

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Authors: Ferdi Afian, Inne Yuliawati

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Background: The change in causes of death from infectious diseases to non-communicable diseases also occurs in the aviation community in Indonesia. Non-communicable diseases are influenced by several internal risk factors, such as age, lifestyle changes and the presence of other diseases. These risk factors will increase the incidence of heart diseases resulting in the incapacity of Indonesian aviators which will disrupt flight safety. Method: The study was conducted by collecting secondary data. The retrieval of primary data was obtained from medical records at the Indonesian Aviation Health Center in 2016-2017. The subjects in this study were all cases of incapacity in Indonesian aviators medical conditions. Results: In this study, there were 15 cases of aviators in Indonesia who experienced incapacity of medical conditions related to heart and lung diseases in 2016-2017. Based on the secondary data contained in the flight medical records at the Aviation Health Center Aviation, it was found that several factors related to aviators incapacity causing its inability to carried out flight duties. Conclusion: Incapacity of Indonesian aviators medical conditions are most affected by the high value of Body Mass Index (86%) and less affected by high of Uric Acid in the blood (26%) and Hyperglycemia (26%).

Keywords: incapacity, aviators, flight, Indonesia

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Authors: Meryem Saban Guler, Saniye Bilici

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Malnutrition is a problem that significantly affects patients with cancer throughout the course of their illness, and it may be present from the moment of diagnosis until the end of treatment. We searched electronic databases using key terms such as ‘malnutrition in cancer patients’ or ‘nutritional status in cancer’ or ‘nutritional screening tools’ etc. Decline in nutritional status and continuing weight loss are associated with an increase in number and severity of complications, impaired quality of life and decreased survival rate. Nutrition is an important factor in the treatment and progression of cancer. Cancer patients are particularly susceptible to nutritional depletion due to the combined effects of the malignant disease and its treatment. With increasing incidence of cancer, identification and management of nutritional deficiencies are needed. Early identification of malnutrition, is substantial to minimize or prevent undesirable outcomes throughout clinical course. In determining the nutritional status; food consumption status, anthropometric methods, laboratory tests, clinical symptoms, psychosocial data are used. First-line strategies must include routine screening and identification of inpatients or outpatients at nutritional risk with the use of a simple and standardized screening tool. There is agreement among international nutrition organizations and accredited health care organizations that routine nutritional screening should be a standard procedure for every patient admitted to a hospital. There are f management of all cancer patients therefore routine nutritional screening with validated tools can identify cancer patients at risk.

Keywords: cancer, malnutrition, nutrition, nutritional screening

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Authors: Pampita Chakraborty, Sukumar Mukherjee

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This study was done to determine the bacteriological profile and antibiotic resistance of the isolates and to find out the potential risk factors for infection with multidrug-resistant organisms. Diabetic foot ulcer is a major medical, social, economic problem and a leading cause of morbidity and mortality, especially in the developing countries like India. 25 percent of all diabetic patients develop a foot ulcer at some point in their lives which is highly susceptible to infections and that spreads rapidly, leading to overwhelming tissue destruction and subsequent amputation. Infection with multidrug resistant organisms (MDRO) may increase the cost of management and may cause additional morbidity and mortality. Proper management of these infections requires appropriate antibiotic selection based on culture and antimicrobial susceptibility testing. Early diagnosis of microbial infections is aimed to institute the appropriate antibacterial therapy initiative to avoid further complications. A total of 200 Type 2 Diabetic Mellitus patients with infection were admitted at GD Hospital and Diabetes Institute, Kolkata. 60 of them who developed ulcer during the year 2013 were included in this study. A detailed clinical history and physical examination were carried out for every subject. Specimens for microbiological studies were obtained from ulcer region. Gram-negative bacilli were tested for extended spectrum Beta-lactamase (ESBL) production by double disc diffusion method. Staphylococcal isolates were tested for susceptibility to oxacillin by screen agar method and disc diffusion. Potential risk factors for MDRO-positive samples were explored. Gram-negative aerobes were most frequently isolated, followed by gram-positive aerobes. Males were predominant in the study and majority of the patients were in the age group of 41-60 years. The presence of neuropathy was observed in 80% cases followed by peripheral vascular disease (73%). Proteus spp. (22) was the most common pathogen isolated, followed by E.coli (17). Staphylococcus aureus was predominant amongst the gram-positive isolates. S.aureus showed a high rate of resistance to antibiotic tested (63.6%). Other gram-positive isolates were found to be highly resistant to erythromycin, tetracycline and ciprofloxacin, 40% each. All isolates were found to be sensitive to Vancomycin and Linezolid. ESBL production was noted in Proteus spp and E.coli. Approximately 70 % of the patients were positive for MDRO. MDRO-infected patients had poor glycemic control (HbA1c 11± 2). Infection with MDROs is common in diabetic foot ulcers and is associated with risk factors like inadequate glycemic control, the presence of neuropathy, osteomyelitis, ulcer size and increased the requirement for surgical treatment. There is a need for continuous surveillance of resistant bacteria to provide the basis for empirical therapy and reduce the risk of complications.

Keywords: diabetic foot ulcer, bacterial infection, multidrug-resistant organism, extended spectrum beta-lactamase

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Authors: N. Hachemi, I. Benmehdi, O. Hasnaoui

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The air like water is an essential element for living beings. Each day, a man breathes about 20m3 of air. It originally consists of a set of gas whose presence and concentrations correspond to the needs of life. This study focuses on air pollution by smoke and dust emitted from the chimney of the cement works of Beni Saf, pathological and their impact on the environment. Dust of the cement plant are harmless to permissible levels for living organisms, but the two combined phenomena namely the release of dust and aridity of the climate, which severely marked area of Beni Saf; have contributed adverse effects in on human health and the degradation of vegetation cover and species especially weakened by environmental stress. The most visible impact is certainly the deposition of dust on the surrounding areas of the cement factory, and seriously affecting the aesthetics of the landscape. Health problems are more important inside and outside the factory. Among the diseases notable caused by the cement works are: deafness, heart disease, asthma and mental. The dust of the cement works is mainly composed of fine particles of limestone, clay, free lime, silicates and also loaded of the gases such as carbon dioxide gas CO2. The accumulation of this gas in the atmosphere is directly involved in the phenomenon of increasing of greenhouse effect. Some gases, for example, are directly toxic. They can change the climate, changing precipitation types and become a greater source of stress by drought, etc. The environment also suffers from air pollution indirectly; it is more precisely the acid rain. They are produced by the combustion of non-metals in air. Acid rain has consequences for contaminating the soil, weakening the flora, fauna and acidifies lakes. Finally, the pollution problems are multiple and specific dust. It can worsen and change, it has reached epidemic proportions quantitatively and qualitatively disturbing and unpredictable.

Keywords: atmospheric pollution, cement, dust, environment

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Authors: Bishnupriya Sahoo, Prasad K. Bhaskaran

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Tropical cyclone is one among the worst natural hazards that results in a trail of destruction causing enormous damage to life, property, and coastal infrastructures. In a global perspective, the Indian Ocean is considered as one of the cyclone prone basins in the world. Specifically, the frequency of cyclogenesis in the Bay of Bengal is higher compared to the Arabian Sea. Out of the four maritime states in the East coast of India, Odisha is highly susceptible to tropical cyclone landfall. Historical records clearly decipher the fact that the frequency of cyclones have reduced in this basin. However, in the recent decades, the intensity and size of tropical cyclones have increased. This is a matter of concern as the risk and vulnerability level of Odisha coast exposed to high wind speed and gusts during cyclone landfall have increased. In this context, there is a need to assess and evaluate the severity of coastal risk, area of exposure under risk, and associated vulnerability with a higher dimension in a multi-risk perspective. Changing climate can result in the emergence of a new hazard and vulnerability over a region with differential spatial and socio-economic impact. Hence there is a need to have coastal vulnerability projections in a changing climate scenario. With this motivation, the present study attempts to estimate the destructiveness of tropical cyclones based on Power Dissipation Index (PDI) for those cyclones that made landfall along Odisha coast that exhibits an increasing trend based on historical data. The study also covers the futuristic scenarios of integral coastal vulnerability based on the trends in PDI for the Odisha coast. This study considers 11 essential and important parameters; the cyclone intensity, storm surge, onshore inundation, mean tidal range, continental shelf slope, topo-graphic elevation onshore, rate of shoreline change, maximum wave height, relative sea level rise, rainfall distribution, and coastal geomorphology. The study signifies that over a decadal scale, the coastal vulnerability index (CVI) depends largely on the incremental change in variables such as cyclone intensity, storm surge, and associated inundation. In addition, the study also performs a critical analysis on the modulation of PDI on storm surge and inundation characteristics for the entire coastal belt of Odisha State. Interestingly, the study brings to light that a linear correlation exists between the storm-tide with PDI. The trend analysis of PDI and its projection for coastal Odisha have direct practical applications in effective coastal zone management and vulnerability assessment.

Keywords: Bay of Bengal, coastal vulnerability index, power dissipation index, tropical cyclone

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Authors: Sina Mahdavi

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Background and Objective: Multiple sclerosis (MS) is the most common inflammatory autoimmune disease of the central nervous system (CNS) that affects the myelination process in the CNS. Complex interactions of various "environmental or infectious" factors may act as triggers in autoimmunity and disease progression. The association between viral infections, especially the John Cunningham virus (JCV) and MS is one potential cause that is not well understood. This study aims to summarize the available data on JCV infection in MS disease progression. Materials and Methods: For this study, the keywords "Multiple sclerosis", " John Cunningham virus ", and "central nervous system" in the databases PubMed, Google Scholar, Sid, and MagIran between 2019 and 2022 were searched, and 12 articles were chosen, studied, and analyzed. Results: MS patients are candidates for natalizumab therapy, which inhibits lymphocyte migration and increases the risk of progressive multifocal leukoencephalopathy (PML), a rare lytic infection of glial cells caused by JCV. Oligodendrocytes may be the target of JCV infection in the central nervous system (CNS). Conclusion: There is a high expression of JCV during the natalizumab treatment period for MS patients, suggesting that the virus may play a role in the development of MS by inducing an inflammatory state. Therefore, it is necessary to evaluate anti-JCV antibody serum as an important risk factor for the development of PML before deciding on the treatment course for these patients.

Keywords: multiple sclerosis, John Cunningham virus, central nervous system, autoimmunity

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Authors: S. Silva

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Some professions had an increased risk for occupational stress and less quality of working life. Among several professions this risk is particularly preoccupant in teachers, namely high school teachers. This study aims to characterize the work stress in teachers and understand how the work stress influences their quality of working life. One hundred teachers, 60 women and 40 men with mean age of 43,2 years (SD=7,8), from North Portugal teaching in several high schools filled in the following questionnaires: Social-Demographic Questionnaire, Teacher Stress Questionnaire and the Survey of Professional Life, during January to March 2015. The results of our study show that high school teachers have several occupational stressors (M=5) and poor perceived quality of working life. They are unsatisfied with their current job and they refer to a considerable job frustration. 33% referred to no expectations about a better future in these profession and 40% have no career development. There is a strong negative correlation between stress and teacher quality of working life (r=-.775). Moderate levels of stress are related to more favorable quality of working life (r=.632). Stress, frequent in teachers, is a significant predictor of poor quality of working life. There are several stressors affecting the teachers’ performance. Career development is not considered among this professional class and it seems related to current job frustration. Considering the role of high school teacher in the development and learning of students, these results should be taken in consideration when planning the graduation and interventions with teachers.

Keywords: career, quality of working life, stress, teachers

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Authors: Edward Pol

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All companies are confronted with the need to innovate in order to meet market demands. In so doing they are challenged with the dilemma of whether to aim to be first into the market with a new innovative product or to deliberately wait and learn from a pioneers’ mistakes; potentially avoiding higher risks. It is therefore important to critically understand from a first-mover advantage and disadvantage perspective the decision-making implications of defence industry transformation onset by an innovative paradigm shift. This paper will argue that the type of industry characteristics matter, especially when considering what role the clients play in the innovation process and what is their level of influence. Through investigation of qualitative case study research, this inquiry will focus on first mover advantages and first mover disadvantages with a view to establish practical and value-added academic findings by focusing on specific industries where the clients play an active role in cooperation with the supplier innovation. The resulting findings will help managers to mitigate risk in innovative technology introduction. A selection from several defense industry innovations is specifically chosen because of the client-supplier relationship typically differing from traditional first-mover research. In this instance, case studies will be used referencing vertical-takeoff-and-landing defence equipment innovations.

Keywords: innovation, pioneer, first-mover advantage, first-mover disadvantage, risk

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Authors: R. Domínguez, A. Castro, N. Fernandez, F. Hidalgo, F. Ortiz

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Aims: Study musculoskeletal disorders produced by excess physical exertion in marines Introduction: Musculoskeletal injuries during military training are an important medical problem faced by military organizations throughout the world. Military occupations are physically demanding, which represents a high risk of injury "and subsequent disability, these injuries represent important risk factors for hospitalization, disability, and discharge Methodology: This is a causal correlational study in which data were collected in order to find a cause-effect relationship between the physical effort in marines during their career in the Chilean Navy and the musculoskeletal disorders that occur in some from them. Results:100% had experienced musculoskeletal pain in some part of the body and 73.52% of the respondents had experienced limitations in the ability to work, as a consequence forced to change jobs due to musculoskeletal pain. The neck, shoulders and the lumbar dorsal region were the regions with the highest prevalence of pain, as well as pain that limit the ability to work. Conclusion: Musculoskeletal injuries and illnesses related to injuries are common in marines, both in those who operate in campus Charles, as in another operational unit due to the nature of the work. Many of these injuries occur during physical training and sports and various studies have dealt with the descriptive epidemiology of musculoskeletal injuries in military personnel.

Keywords: physical effort, marines, musculoskeletal disorders produced (MSD), training

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Authors: Souhila Terfi, Fatma Hassaine-Sadi

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In the present study, wet digestion with HCl and HNO3 mixture was used to extract the heavy metals (copper (Cu), chromium (Cr), zinc (Zn), lead (Pb) and cadmium (Cd)) from the leaves, the stems and the roots of Malva sylvestris L., which were subsequently analyzed by AAS. The samples (soil and parts of species) were collected from different sites: the industrial area (IA) (Rouiba), the rubbish dump area (RDA) (Boudouaou), the residential area (RA) with large open fields and construction activities (Blida), the Montaigne area (MA) (Chrea) and the high plateau area (HPA) (Berouaguia). The study showed differences in metal concentrations according to the analysed parts and the different sampling locations. In the contaminated site of the industrial area (IA), high content of the toxic heavy metals (Cd: 3.18 µg/g DW and Pb: 34.48 µg/g DW) were found in the leaves of Malva sylvestris L. This finding suggests that the consumers of this species could be exposed to a risk associated with this higher level of these toxic metals. It was found that Malva sylvestris L. is rich by Zn and Cu in some sites, which are considered to be the essential elements for the human health. The obtained results with the control site (Montaigne area) suggest that this species can be applicable in both the health and food, feasible alternatives as medicinal plant without any risk.

Keywords: Malva sylvestris L., toxic heavy metal, medicinal plant, impact on human health

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Authors: Timmis W., Simms M., Thomas C.

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This case discusses the management of two floors of mouth (FOM) Squamous Cell Carcinomas (SCC) not identified upon initial biopsy. A 51 year-old male presented with right FOM erythroleukoplakia. Relevant medical history included alcoholic dependence syndrome and alcoholic liver disease. Relevant drug therapy encompassed acamprosate, folic acid, hydroxocobalamin and thiamine. The patient had a 55.5 pack-year smoking history and alcohol dependence from age 14, drinking 16 units/day. FOM incisional biopsy and histopathological analysis diagnosed Carcinoma in situ. Treatment involved wide local excision. Specimen analysis revealed two separate foci of pT1 moderately differentiated SCCs. Carcinoma staging scans revealed no pathological lymphadenopathy, no local invasion or metastasis. SCCs had been excised in completion with narrow margins. MDT discussion concluded that in view of the field changes it would be difficult to identify specific areas needing further excision, although techniques such as Lugol’s Iodine were considered. Further surgical resection, surgical neck management and sentinel lymph node biopsy was offered. The patient declined intervention, primary management involved close monitoring alongside alcohol and smoking cessation referral. Narrow excisional margins can increase carcinoma recurrence risk. Biopsy failed to identify SCCs, despite sampling an area of clinical concern. For gross field change multiple incisional biopsies should be considered to increase chance of accurate diagnosis and appropriate treatment. Coupling of tobacco and alcohol has a synergistic effect, exponentially increasing the relative risk of oral carcinoma development. Tobacco and alcoholic control is fundamental in reducing treatment‑related side effects, recurrence risk and second primary cancer development.

Keywords: alcohol dependence, biopsy, oral carcinoma, tobacco

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Authors: Stefano Scippo, Damiana Luzzi, Stefano Cuomo, Maria Ranieri

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Background: In response to the rise in natural disasters linked to climate change, numerous studies on Disaster Risk Reduction Education (DRRE) have emerged since the '90s, mainly using a didactic transmission-based approach. Effective DRRE should align with an interactive, experiential, and participatory educational model, which can be costly and risky. A potential solution is using simulations facilitated by eXtended Reality (XR). Research Question: This study aims to conduct a scoping review to explore educational methodologies that use XR to enhance knowledge among teachers, students, and citizens about environmental risks, natural disasters (including climate-related ones), and their management. Method: A search string of 66 keywords was formulated, spanning three domains: 1) education and target audience, 2) environment and natural hazards, and 3) technologies. On June 21st, 2023, the search string was used across five databases: EBSCOhost, IEEE Xplore, PubMed, Scopus, and Web of Science. After deduplication and removing papers without abstracts, 2,152 abstracts (published between 2013 and 2023) were analyzed and 2,062 papers were excluded, followed by the exclusion of 56 papers after full-text scrutiny. Excluded studies focused on unrelated technologies, non-environmental risks, and lacked educational outcomes or accessible texts. Main Results: The 34 reviewed papers were analyzed for context, risk type, research methodology, learning objectives, XR technology use, outcomes, and educational affordances of XR. Notably, since 2016, there has been a rise in scientific publications, focusing mainly on seismic events (12 studies) and floods (9), with a significant contribution from Asia (18 publications), particularly Japan (7 studies). Methodologically, the studies were categorized into empirical (26) and non-empirical (8). Empirical studies involved user or expert validation of XR tools, while non-empirical studies included systematic reviews and theoretical proposals without experimental validation. Empirical studies were further classified into quantitative, qualitative, or mixed-method approaches. Six qualitative studies involved small groups of users or experts, while 20 quantitative or mixed-method studies used seven different research designs, with most (17) employing a quasi-experimental, one-group post-test design, focusing on XR technology usability over educational effectiveness. Non-experimental studies had methodological limitations, making their results hypothetical and in need of further empirical validation. Educationally, the learning objectives centered on knowledge and skills for surviving natural disaster emergencies. All studies recommended XR technologies for simulations or serious games but did not develop comprehensive educational frameworks around these tools. XR-based tools showed potential superiority over traditional methods in teaching risk and emergency management skills. However, conclusions were more valid in studies with experimental designs; otherwise, they remained hypothetical without empirical evidence. The educational affordances of XR, mainly user engagement, were confirmed by the studies. Authors’ Conclusions: The analyzed literature lacks specific educational frameworks for XR in DRRE, focusing mainly on survival knowledge and skills. There is a need to expand educational approaches to include uncertainty education, developing competencies that encompass knowledge, skills, and attitudes like risk perception.

Keywords: disaster risk reduction education, educational technologies, scoping review, XR technologies

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Authors: Tim Nedyalkov

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A business decision to move to the cloud brings fundamental changes in how an organization develops and delivers its Information Technology solutions. The accelerated pace of digital transformation across businesses and government agencies increases the reliance on cloud-based services. They are collecting, managing, and retaining large amounts of data in cloud environments makes information security and data privacy protection essential. It becomes even more important to understand what key factors drive successful cloud adoption following the commencement of the Privacy Amendment Notifiable Data Breaches (NDB) Act 2017 in Australia as the regulatory changes impact many organizations and industries. This quantitative correlational research investigated the governance, risk management, and compliance factors contributing to cloud security success. The factors influence the adoption of cloud computing within an organizational context after the commencement of the NDB scheme. The results and findings demonstrated that corporate information security policies, data storage location, management understanding of data governance responsibilities, and regular compliance assessments are the factors influencing cloud computing adoption. The research has implications for organizations, future researchers, practitioners, policymakers, and cloud computing providers to meet the rapidly changing regulatory and compliance requirements.

Keywords: cloud compliance, cloud security, data governance, privacy protection

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Authors: Nina N. Serdar, Jelena R. Pejović

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This paper presents seismic risk assessment of two bridge structure, based on the probabilistic performance-based seismic assessment methodology. Both investigated bridges are tree span continuous RC curved bridges with the difference in column shapes. First bridge (type A) has a wall-type pier and second (type B) has a two-column bent with circular columns. Bridges are designed according to European standards: EN 1991-2, EN1992-1-1 and EN 1998-2. Aim of the performed analysis is to compare seismic behavior of these two structures and to detect the influence of column shapes on the seismic response. Seismic risk assessment is carried out by obtaining demand fragility curves. Non-linear model was constructed and time-history analysis was performed using thirty five pairs of horizontal ground motions selected to match site specific hazard. In performance based analysis, peak column drift ratio (CDR) was selected as engineering demand parameter (EDP). For seismic intensity measure (IM) spectral displacement was selected. Demand fragility curves that give probability of exceedance of certain value for chosen EDP were constructed and based on them conclusions were made.

Keywords: RC curved bridge, demand fragility curve, wall type column, nonlinear time-history analysis, circular column

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Authors: Magdi Elmessiry, Adel Elmessiry

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The fashion industry represents a significant portion of the global gross domestic product, however, it is plagued by cheap imitators that infringe on the trademarks which destroys the fashion industry's hard work and investment. While eventually the copycats would be found and stopped, the damage has already been done, sales are missed and direct and indirect jobs are lost. The infringer thrives on two main facts: the time it takes to discover them and the lack of tracking technologies that can help the consumer distinguish them. Blockchain technology is a new emerging technology that provides a distributed encrypted immutable and fault resistant ledger. Blockchain presents a ripe technology to resolve the infringement epidemic facing the fashion industry. The significance of the study is that a new approach leveraging the state of the art blockchain technology coupled with artificial intelligence is used to create a framework addressing the fashion infringement problem. It transforms the current focus on legal enforcement, which is difficult at best, to consumer awareness that is far more effective. The framework, Crypto CopyCat, creates an immutable digital asset representing the actual product to empower the customer with a near real time query system. This combination emphasizes the consumer's awareness and appreciation of the product's authenticity, while provides real time feedback to the producer regarding the fake replicas. The main findings of this study are that implementing this approach can delay the fake product penetration of the original product market, thus allowing the original product the time to take advantage of the market. The shift in the fake adoption results in reduced returns, which impedes the copycat market and moves the emphasis to the original product innovation.

Keywords: fashion, infringement, blockchain, artificial intelligence, textiles supply chain

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Authors: Hassan S. Naeini

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Nowadays a lot of people are working in several sorts of industrial sectors in which there are some risk factors which threaten human being especially in developing countries. One of the main problems which effect on workers’ health refers to Ergonomics. Ergonomics as multidisciplinary science concerns workers’ health and safety in terms of somatic and mental concepts. Surely ergonomics interventions and improvement make a better condition for workers and change the quality of working life to better condition. In this study, one of the factories in Iran which is producing some kinds of small and medium size of refrigerators was chosen as the sample. The preliminary ergonomics observation of the mentioned factory showed that there are some risk factors in terms of ergonomics aspects, so an ergonomic intervention was defined, then some ergonomic assessment methods such as NMQ,OWAS, and Environmental Ergonomic Assessment were used. Also Anthropometric measurement was done. This study shows that there are some workstations and plants which suffer some degrees of ergonomic problems. Considering with the gathered data, illumination, noise control and workstation design in metal workstation are known as the priority actions. Some parts of the mentioned interventions are ongoing actions. it seems that the mentioned intervention and workstations design make a better condition for workers, because ergonomics make a safer and more sustainable environments for human being.

Keywords: anthropometry, ergonomics, health, NMQ, OWAS

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Authors: Monika Yadav

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The incorporation of a healthy lifestyle significantly contributes to the advancement of economic development. Urbanization, industrialization, and economic growth have enhanced living conditions, promoting sedentary behaviours among individuals with elevated socio-economic statuses. The prevalence of overweight and obesity has increased globally, along with the rise in living standards, posing a growing health risk. Overweight and obesity are known to be precursors to a range of modifiable and metabolic risk factors, contributing to the increase in lifestyle diseases. Unhealthy dietary choices and lifestyle practices primarily drive these diseases. Lifestyle diseases refer to chronic and non-communicable illnesses, encompassing conditions such as hypertension, heart disease, kidney disorders, infertility, polycystic ovary syndrome (PCOD), diabetes, respiratory diseases, and certain forms of cancer. This study examines the prevalence of lifestyle diseases among urban Indian women, explicitly differentiating between individuals with normal weight and those classified as obese. The main aim of this study is to investigate whether there is a correlation between a higher body mass index (BMI) in women and an increased vulnerability to lifestyle diseases when compared to women with a normal BMI. This research provides insights into the intricate relationship between lifestyle, health, and economic development within urban areas.

Keywords: urbanization, economic development, BMI, NCDs, urban, women, lifestyle practices

Procedia PDF Downloads 57

Authors: Mark White

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The best practices for owners and urban planners to manage tsunami risk have evolved during the last fifty years, and related technical advances have created opportunities for them to obtain better performance than in earlier cataclysmic tsunami inundations. This basic pattern is illustrated at Hilo Bay, the waterfront area of Hilo, Hawaii, an urban seaport which faces the most severe tsunami hazard of the Hawaiian archipelago. Since April 1, 1946, Hilo Bay has endured tsunami waves with a maximum water height exceeding 2.5 meters following four severe earthquakes: Unimak Island (Mw 8.6, 6.1 m) in 1946; Valdiva (Mw 9.5, the largest earthquake of the 20th century, 10.6 m) in 1960; William Prince Sound (Mw 9.2, 3.8 m) in 1964; and Kalapana (Mw 7.7, the largest earthquake in Hawaii since 1868, 2.6 m) in 1975. Ignoring numerous smaller tsunamis during the same time frame, these four cataclysmic tsunamis have caused property losses in Hilo to exceed $1.25 billion and more than 150 deaths. It is reasonable to foresee another cataclysmic tsunami inundating the urban core of Hilo in the next 50 years, which, if unchecked, could cause additional deaths and losses in the hundreds of millions of dollars. Urban planners and individual owners are now in a position to reduce these losses in the next foreseeable tsunami that generates maximum water heights between 2.5 and 10 meters in Hilo Bay. Since 1946, Hilo planners and individual owners have already created buffer zones between the shoreline and its historic downtown area. As these stakeholders make inevitable improvements to the built environment along and adjacent to the shoreline, they should incorporate new methods for better managing the obvious tsunami risk at Hilo. At the planning level, new manmade land forms, such as tsunami parks and inundation reservoirs, should be developed. Individual owners should require their design professionals to include sacrificial seismic and tsunami fuses that will perform well in foreseeable severe events and that can be easily repaired in the immediate aftermath. These investments before the next cataclysmic tsunami at Hilo will yield substantial reductions in property losses and fatalities.

Keywords: hilo, tsunami parks, reservoirs, fuse systems, risk managment

Procedia PDF Downloads 159

Authors: Todd Jackson

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In this randomized control trial, we tested the effectiveness of a peer-facilitated version of the Body Project (BP) intervention among body-dissatisfied young women in China. Participants were randomly assigned to a peer-facilitator BP condition (N = 94) versus an educational video minimal intervention control condition (N = 89). Questionnaire measures of two primary outcomes (i.e., disordered eating and body dissatisfaction) and six secondary outcomes (thin-ideal internalization, pressure to be thin, negative affect, body surveillance, body shame, body appreciation and interest in cosmetic surgery) were administered at a pre-treatment baseline, a post-treatment assessment, and at a 12-month follow-up. A series of 2 (Group) x 2 (Time) analyses of variance indicated women in the peer-facilitated BP condition reported significant improvements in primary outcome measures of disordered eating and body dissatisfaction compared to women in the educational video control condition following treatment and at the 12-month follow-up. Furthermore, women in the peer-facilitated BP condition reported significant improvements in measures of body surveillance, body shame and body appreciation) compared to educational video controls that extended to the 12-month follow-up. Finally, although women in the peer-facilitated BP condition showed significant post-treatment improvements in thin-ideal internalization, negative affect, perceived pressure to be thin, and interest in cosmetic surgery compared to video controls, these differences were no longer statistically significant at the 12-month follow-up. In conclusion, findings supported the overall effectiveness of a peer-facilitated group version of the BP as an intervention for reducing disordered eating and several associated risk factors among at-risk young women in China.

Keywords: body project, disordered eating, body dissatisfaction, risk factors, prevention, China

Procedia PDF Downloads 50

Authors: Melese Wondatir

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Flooding ranks among the most destructive natural disasters, impacting millions of individuals globally and resulting in substantial economic, social, and environmental repercussions. This study's objective was to create a comprehensive model that assesses the Nile River basin's susceptibility to flood damage and improves existing flood risk management strategies. Authorities responsible for enacting policies and implementing measures may benefit from this research to acquire essential information about the flood, including its scope and susceptible areas. The identification of severe flood damage locations and efficient mitigation techniques were made possible by the use of geospatial data. Slope, elevation, distance from the river, drainage density, topographic witness index, rainfall intensity, distance from road, NDVI, soil type, and land use type were all used throughout the study to determine the vulnerability of flood damage. Ranking elements according to their significance in predicting flood damage risk was done using the Analytic Hierarchy Process (AHP) and geospatial approaches. The analysis finds that the most important parameters determining the region's vulnerability are distance from the river, topographic witness index, rainfall, and elevation, respectively. The consistency ratio (CR) value obtained in this case is 0.000866 (<0.1), which signifies the acceptance of the derived weights. Furthermore, 10.84m2, 83331.14m2, 476987.15m2, 24247.29m2, and 15.83m2 of the region show varying degrees of vulnerability to flooding—very low, low, medium, high, and very high, respectively. Due to their close proximity to the river, the northern-western regions of the Nile River basin—especially those that are close to Sudanese cities like Khartoum—are more vulnerable to flood damage, according to the research findings. Furthermore, the AUC ROC curve demonstrates that the categorized vulnerability map achieves an accuracy rate of 91.0% based on 117 sample points. By putting into practice strategies to address the topographic witness index, rainfall patterns, elevation fluctuations, and distance from the river, vulnerable settlements in the area can be protected, and the impact of future flood occurrences can be greatly reduced. Furthermore, the research findings highlight the urgent requirement for infrastructure development and effective flood management strategies in the northern and western regions of the Nile River basin, particularly in proximity to major towns such as Khartoum. Overall, the study recommends prioritizing high-risk locations and developing a complete flood risk management plan based on the vulnerability map.

Keywords: analytic hierarchy process, Blue Nile Basin, geospatial techniques, flood vulnerability, multi-criteria decision making

Procedia PDF Downloads 58

Authors: Elizabeth Behrens, Anne Timmermann, Alexander Yerkan, Joshua Thomas, Deborah Katz, Agne Paner, Melissa Larson, Shivi Jain, Seo-Hyun Kim, Celalettin Ustun, Ankur Varma, Parameswaran Venugopal, Jamile Shammo

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Coronavirus Disease-2019 (COVID-19) causes persistent concern for poor outcomes in vulnerable populations. Patients with hematologic malignancies (HM) have been found to have higher COVID-19 case fatality rates compared to those without malignancy. While cytopenias are common in patients with HM, especially in those undergoing chemotherapy treatment, hemoglobin (Hgb) and platelet count have not yet been studied, to our best knowledge, as potential prognostic indicators for patients with HM and COVID-19. The goal of this study is to identify factors that may increase the risk of mortality in patients with HM and COVID-19. In this single-center, retrospective, observational study, 65 patients with HM and laboratory confirmed COVID-19 were identified between March 2020 and January 2021. Information on demographics, laboratory data the day of COVID-19 diagnosis, and prognosis was extracted from the electronic medical record (EMR), chart reviewed, and analyzed using the statistical software SAS version 9.4. Chi-square testing was used for categorical variable analyses. Risk factors associated with mortality were established by logistic regression models. Non-Hodgkin lymphoma (37%), chronic lymphocytic leukemia (20%), and plasma cell dyscrasia (15%) were the most common HM. Higher Hgb level upon COVID-19 diagnosis was related to decreased mortality, odd ratio=0.704 (95% confidence interval [CI]: 0.511-0.969; P = .0263). Platelet count the day of COVID-19 diagnosis was lower in patients who ultimately died (mean 127 ± 72K/uL, n=10) compared to patients who survived (mean 197 ±92K/uL, n=55) (P=.0258). Female sex was related to decreased mortality, odd ratio=0.143 (95% confidence interval [CI]: 0.026-0.785; P = .0353). There was no mortality difference between the patients who were on treatment for HM the day of COVID-19 diagnosis compared to those who were not (P=1.000). Lower Hgb and male sex are independent risk factors associated with increased mortality of HM patients with COVID-19. Clinicians should be especially attentive to patients with HM and COVID-19 who present with cytopenias. Larger multi-center studies are urgently needed to further investigate the impact of anemia, thrombocytopenia, and demographics on outcomes of patients with hematologic malignancies diagnosed with COVID-19.

Keywords: anemia, COVID-19, hematologic malignancy, prognosis

Procedia PDF Downloads 141

Authors: Musa Sekamatte

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Background: Zoonotic diseases continue to be a public health burden in countries around the world. Uganda is especially vulnerable due to its location, biodiversity, and population. Given these concerns, the Ugandan government in collaboration with the Global Health Security Agenda conducted a zoonotic disease prioritization workshop to identify zoonotic diseases of concern to multiple Ugandan ministries. Materials and Methods: The One Health Zoonotic Disease Prioritization tool, developed by the U.S. Centers for Disease Control and Prevention (CDC), was used for prioritization of zoonotic diseases in Uganda. Workshop participants included voting members representing human, animal, and environmental health ministries as well as key partners who observed the workshop. Over 100 articles describing characteristics of these zoonotic diseases were reviewed for the workshop. During the workshop, criteria for prioritization were selected, and questions and weights relevant to each criterion were determined. Next steps for multi-sectoral engagement for the prioritized zoonoses were then discussed. Results: 48 zoonotic diseases were considered during the workshop. Criteria selected to prioritize zoonotic diseases in order of importance were (1) severity of disease in humans in Uganda, (2) availability of effective control strategies, (3) potential to cause an epidemic or pandemic in humans or animals, (4) social and economic impacts, and (5) bioterrorism potential. Seven zoonotic diseases were identified as priorities for Uganda: anthrax, zoonotic influenza viruses, viral hemorrhagic fevers, brucellosis, African trypanosomiasis, plague, and rabies. Discussion: One Health approaches and multi-sectoral collaborations are crucial in the surveillance, prevention, and control strategies for zoonotic diseases. Uganda used such an approach to identify zoonotic diseases of national concern. Identifying these priority diseases enables the National One Health Platform and the Zoonotic Disease Coordinating Office to address the diseases in the future.

Keywords: national one health platform, zoonotic diseases, multi-sectoral, severity

Procedia PDF Downloads 179

Authors: Haftay Abraha Tadesse, Dawit Gebreegziabiher Hagos, Atsebaha Gebrekidan Kahsay, Mahumd Abdulkader

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Background: Salmonella species and Escherichia coli (E. coli) are important foodborne pathogens affecting humans and animals. They are among the most important causes of infection that are associated with the consumption of contaminated food. This study was aimed to determine the prevalence, antimicrobial susceptibility patterns and associated risk factors for Salmonella species and E. coli in raw meat from butchery houses of Mekelle, Northern Ethiopia. Method: A cross-sectional study was conducted from January to December 2019. Socio-demographic data and risk factors were collected using a predesigned questionnaire. Meat samples were collected aseptically from the butchery houses and transported using icebox to Mekelle University, College of Veterinary Sciences for the isolation and identification of Salmonella species and E. coli. Antimicrobial susceptibility patterns were determined using Kirby disc diffusion method. Data obtained were cleaned and entered into Statistical Package for the Social Sciences version 22 and logistic regression models with odds ratio were calculated. P-value < 0.05 was considered as statistically significant. Results: A total of 153 out of 384 (39.8%) of the meat specimens were found to be contaminated. The contamination of Salmonella species and E. coli were 15.6% (n=60) and 20.8%) (n=80), respectively. Mixed contamination (Salmonella species and E. coli) was observed in 13 (3.4 %) of the analyzed. Poor washing hands regularly (AOR = 8.37; 95% CI: 2.75-25.50) and not using gloves during meat handling (AOR=11. 28; 95% CI:(4.69 27.10) were associated with overall bacterial contamination. About 100% of the tested isolates were sensitive to ciprofloxacin, gentamicin, Co trimoxazole , sulphamethoxazole, ceftriaxone, and trimethoprim and ciprofloxacin, gentamicin, and norfloxacine of E. coli and Salmonella species, respectively, while the resistance of amoxyclav_amoxicillin and erythromycin were both isolated bacteria species. The overall multidrug resistance pattern for Salmonella and E. coli were 51.4% (n=19) and 31.8% (14), respectively. Conclusion: Of the 153 (153/384) contaminated raw meat, 60 (15.6%) and 80 (20.8%) were contaminated by Salmonella species and E. coli, respectively. Poor handwashing practice and not using glove during meat handling showed a significant association with bacterial contamination. Multidrug-resistant showed in Salmonella species, and E. coli were 19 (51.4%) and 14 (31.8%), respectively.

Keywords: antimicrobial susceptibility test, butchery houses, E. coli, raw meat, salmonella species

Procedia PDF Downloads 158

Authors: Ella Abaev, Shany Segal, Miri Gabay

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Background: Choking is a blockage of airways that prevents efficient breathing and air flow to the lungs. Choking may be partial or full and is an emergency situation. Complete or prolonged choking leads to apnea, lack of oxygen in the tissues of the body and brain, and can cause death. There are three mechanisms of choking: obstruction of internal respiratory tracts by food or object aspiration, any material that blocks or covers external air passages, external pressure on the neck or trapping between objects. Children's airways are narrower than that of adults and therefore the risk of choking is greater, due to the aspiration of food and other foreign bodies into the lungs. In the Child Development Center at Safra Children’s Hospital, Tel Hashomer in Israel are treated infants, toddlers, and children aged 0-18 years with various developmental disabilities. Due to the increase in reports of ‘almost an event’ of choking in the past year and the serious consequences of choking event, it was decided to give an emphasis to the issue. Incidence and methods: The number of reports of ‘almost an event’ or a choking event was examined at the center during the years 2013-2018 and a thorough research work was conducted on the subject in order to build a prevention program. Findings: Between 2013 and 2018 the center reported about ten cases of ‘almost choking events’. In the middle of 2018 alone three cases of ‘almost an event’ were reported. Objective: Providing knowledge leads to awareness raise, change of perception, change in behavior and prevention. The center employs more than 130 staff members from various sectors so that it is the work of multi-professional teams to promote the quality and safety of the treatment. The familiarity of the staff with risk factors, prevention guidelines, identification of choking signs, and treatment are most important and significant in determining the outcome of a choking event. Conclusions and recommendations: After in-depth research work was carried out in cooperation with the Risk Management Unit on the subject of choking, which include a description of the definitions, mechanisms, risk factors, treatment methods and extensive recommendations for prevention (e.g. using treatment and stimulation accessories with standards association stamps and adjustment of the type of food and the way it is served to match to the child's age and the ability to swallow). The expected stages of development and emphasis on the population of children with special needs were taken into account. The research findings will be published by the staff and parents of the patients, professional publications, and lectures and there is an expectation to decrease the number of choking events in the next years.

Keywords: children with special needs, choking, educational system, prevention guidelines

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Authors: Mohsin Sadaqat, Hilal Anwar Butt

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Following the stock selection guidelines provided by the Sharia Board (SB), we segregate the firms listed at Pakistan Stock Exchange (PSX) into Sharia Compliant (SC) and Non-Sharia Compliant (NSC) stocks. Subsequently, we form portfolios within each group based on market capitalization and volatility. The purpose is to analyze and compare the performance of these two groups as the SC stocks have lesser diversification opportunities due to SB restrictions. Using data ranging from January 2004 until June 2016, our results indicate that in most of the cases the risk-adjusted returns (alphas) for the returns differential between SC and NCS firms are positive. In addition, the SC firms in comparison to their counterparts in PSX provides excess returns that are hedged against the market, size, and value-based systematic risks factors. Overall, these results reconcile with one prevailing notion that the SC stocks that have lower financial leverage and higher investment in real assets are lesser exposed to market-based risks. Further, the SC firms that are more capitalized and less volatile, perform better than lower capitalized and higher volatile SC and NSC firms. To sum up our results, we do not find any substantial evidence for opportunity loss due to limited diversification opportunities in case of SC firms. To optimally utilize scarce resources, investors should consider SC firms as a candidate in portfolio construction.

Keywords: diversification, performance, sharia compliant stocks, risk adjusted returns

Procedia PDF Downloads 191