Search results for: service improvement

Authors: Kailas Bhandarkar, Talib Dar, Laura Karia, Manasvi Upadhyaya

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Introduction: Frenotomy for tongue tie is commonly performed in breastfed infants who experience difficulty in latching after failed conservative management for tongue tie. However, there is no consensus for the routine use of massage following frenotomy. Our aim was to assess the efficacy of massage in preventing recurrence following frenotomy. Methods: The tongue tie service in our tertiary referral hospital consists of 5 consultants and a breastfeeding (BF) midwife. 3 consultants routinely advice massage post procedure. Babies are assessed by the midwife after the procedure and a follow-up consultation after a week. After due ethical approval, data were collected by two staff members who were independent of TT service on a standardized questionnaire to avoid bias. Fischer exact test was employed (p < 0.05 considered significant). Results: Six hundred and thirty-two babies attended the clinic from January 2018 to December 2018. Thirty-three of these were excluded as the procedure was not needed. Parents were contacted at a median of six months post-procedure (range 2-10 months). 282/599 were advised massage. 92/282 could be contacted. 40/ 92 adhered to massage regimen. None of these had a recurrence. 52/92 (54%), although advised, did not perform massage. Reasons cited for lack of adherence to massage included difficulty in performing massaging and conflicting advice given by other health care professionals involved in patient care like paediatricians and group practice and lack of information on the internet). Overall, 4/599 (0.66%) had recurrences, and this difference was not statistically significant. Conclusion: In our experience, the rate of recurrence after frenotomy is low enough for us to conclude that there is no significant benefit of massage after frenotomy for tongue tie. We could also conclude that among parents who were advised massage more than half failed to adhere to the advice.

Keywords: tongue tie, frenotomy, massage, recurrence

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Authors: Abdollah Sobhani, Hossein Vaseghi-Dodaran

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Proteomics is defined as the study of the component of a cell, tissue and biological fluid. This technique has the potential to identify protein biomarkers of a disease states. In this study which was performed on bovine ovarian follicular cysts (BOFC), eight proteins are over expressed in BOFC that these proteins could be useful biomarkers for BOFC. The difference between serum proteome pattern cows affected by postpartum endometritis with healthy cows revealed that concentrations orosomucoid was decreased in endometritis. The comparison proteome of brucella abortus between laboratory adapted strains and clinical isolates could be useful to better understand this disease and vaccine development. Proteomics experiments identified new proteins and pathways that may be important in future hypothesis-driven studies of glucocorticoid-induced immunosuppression. Understanding the molecular mechanisms of effective parameters on male fertility is essential for obtaining high reproductive efficiency by decreasing cost and time. The investigations on proteome of high fertility spermatozoa indicated that expression of some proteins such as casein kinase 2 (CKII) prime poly peptide and tyrosine kinase in high fertility spermatozoa was higher compared to low fertility spermatozoa. Also, some evidence has indicated that variation in protein types and amounts in seminal fluid regulates fertility indexes in dairy bull. In conclusion, proteomics is a useful technique for discovering drugs, vaccine development, and diagnosis disease by biomarkers and improvement of reproduction efficiency.

Keywords: proteomics, reproduction, biomarker, immunity

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Authors: Essam Amerian

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The aim of this study was to investigate the effects of improving waist-to-hip ratio (WHR) and visceral fat components on the health of shift workers in an offshore petrochemical company. A total of 100 male shift workers participated in the study, with an average age of 40.5 years and an average BMI of 28.2 kg/m². The study employed a randomized controlled trial design, with participants assigned to either an intervention group or a control group. The intervention group received a 12-week program that included dietary counseling, physical activity recommendations, and stress management techniques. The control group received no intervention. The outcomes measured were changes in WHR, visceral fat components, blood pressure, and lipid profile. The results showed that the intervention group had a statistically significant improvement in WHR (p<0.001) and visceral fat components (p<0.001) compared to the control group. Furthermore, there were statistically significant improvements in systolic blood pressure (p=0.015) and total cholesterol (p=0.034) in the intervention group compared to the control group. These findings suggest that implementing a 12-week program that includes dietary counseling, physical activity recommendations, and stress management techniques can effectively improve WHR, visceral fat components, and cardiovascular health among shift workers in an offshore petrochemical company.

Keywords: body composition, waist-hip-ratio, visceral fat, shift worker, work efficiency

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Authors: Josephine R. Migalbin

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Halal is an Arabic word meaning "lawful" or "permitted". When it comes to food and consumables, Halal is the dietary standard of Muslims. The Autonomous Region in Muslim Mindanao (ARMM) has a comparative advantage when it comes to Halal Industry because it is the only Muslim region in the Philippines and the natural starting point for the establishment of a halal industry in the country. The region has identified goat production not only for domestic consumption but for export market. Goat production is one of its strengths due to cultural compatibility. There is a high demand for goats during Ramadhan and Eid ul-Adha. The study aimed to provide an overview of the ARMM Halal Goat Industry; to map out the specific supply chain of halal goat, and to analyze the performance of the halal goat supply chain in terms of efficiency, flexibility, and overall responsiveness. It also aimed to identify areas for improvement in the supply chain such as behavioural, institutional, and process to provide recommendations for improvement in the supply chain towards efficient and effective production and marketing of halal goats, subsequently improving the plight of the actors in the supply chain. Generally, the raising of goats is characterized by backyard production (92.02%). There are four interrelated factors affecting significantly the production of goats which are breeding prolificacy, prevalence of diseases, feed abundance and pre-weaning mortality rate. The institutional buyers are mostly traders, restaurants/eateries, supermarkets, and meat shops, among others. The municipalities of Midsayap and Pikit in another region and Parang are the major goat sources and the municipalities in ARMM among others. In addition to the major supply centers, Siquijor, an island province in the Visayas is becoming a key source of goats. Goats are usually gathered by traders/middlemen and brought to the public markets. Meat vendors purchase them directly from raisers, slaughtered and sold fresh in wet markets. It was observed that there is increased demand at 2%/year and that supply is not enough to meet the demand. Farm gate price is 2.04 USD to 2.11 USD/kg liveweight. Industry information is shared by three key participants - raisers, traders and buyers. All respondents reported that information is through personal built-upon past experiences and that there is no full disclosure of information among the key participants in the chain. The information flow in the industry is fragmented in nature such that no total industry picture exists. In the last five years, numerous local and foreign agencies had undertaken several initiatives for the development of the halal goat industry in ARMM. The major issues include productivity which is the greatest challenge, difficulties in accessing technical support channels and lack of market linkage and consolidation. To address the various issues and concerns of the various industry players, there is a need to intensify appropriate technology transfer through extension activities, improve marketing channels by grouping producers, strengthen veterinary services and provide capital windows to improve facilities and reduce logistics and transaction costs in the entire supply chain.

Keywords: autonomous region in Muslim Mindanao, halal, halal goat industry, supply chain improvement

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Authors: Kareem Adedokun

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Official secrecy is one of the colonial vestiges which upholds non – disclosure of essential information for public consumption. Information, though an indispensable tool in tax administration, is not to be divulged by any person in an official duty of the revenue agency. As a matter o fact, the Federal Inland Revenue Service (Establishment) Act, 2007 emphasizes secrecy and confidentiality in dealing with tax payer’s document, information, returns and assessment in a manner reminiscent of protecting tax payer’s privacy in all situations. It is so serious that any violation attracts criminal sanction. However, Nigeria, being a democratic and egalitarian state recently enacted Freedom of Information Act which heralded in openness in governance and takes away the confidentialities associated with official secrets Laws. Official secrecy no doubts contradicts the philosophy of freedom of information but maintaining a proper balance between protected rights of tax payers and public interest which revenue agency upholds is an uphill task. Adopting the Doctrinal method, therefore, the author of this paper probes into the real nature of the relationship between taxpayers and Revenue Agencies. It also interfaces official secrecy with the doctrine of Freedom of Information and consequently queries the retention of non – disclosure clause under Federal Inland Revenue Service (Establishment) Act (FIRSEA) 2007. The paper finds among others that non – disclosure provision in tax statutes particularly as provided for in FIRSEA is not absolute; so also is the constitutional rights and freedom of information and unless the non – disclosure clause finds justification under any recognized exemption provided under the Freedom of Information Act, its retention is antithesis to democratic ethos and beliefs as it may hinder public interest and public order.

Keywords: confidentiality, information, official secrecy, tax administration

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Authors: Pauline Calleja, Brooke Alexander

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In 2010 the College of Emergency Nursing Australasia (CENA) undertook sole administration of the Trauma Nursing Program (TNP) across Australia. The original TNP was developed from recommendations by the Review of Trauma and Emergency Services-Victoria. While participant and faculty feedback about the program was positive, issues were identified that were common for industry training programs in Australia. These issues included didactic approaches, with many lectures and little interaction/activity for participants. Participants were not necessarily encouraged to undertake deep learning due to the teaching and learning principles underpinning the course, and thus participants described having to learn by rote, and only gain a surface understanding of principles that were not always applied to their working context. In Australia, a trauma or emergency nurse may work in variable contexts that impact on practice, especially where resources influence scope and capacity of hospitals to provide trauma care. In 2011, a program review was undertaken resulting in major changes to the curriculum, teaching, learning and assessment approaches. The aim was to improve learning including a greater emphasis on pre-program preparation for participants, the learning environment and clinically applicable contextualized outcomes participants experienced. Previously if participants wished to undertake assessment, they were given a take home examination. The assessment had poor uptake and return, and provided no rigor since assessment was not invigilated. A new assessment structure was enacted with an invigilated examination during course hours. These changes were implemented in early 2012 with great improvement in both faculty and participant satisfaction. This presentation reports on a comparison of participant evaluations collected from courses post implementation in 2012 and in 2015 to evaluate if positive changes were sustained. Methods: Descriptive statistics were applied in analyzing evaluations. Since all questions had more than 20% of cells with a count of <5, Fisher’s Exact Test was used to identify significance (p = <0.05) between groups. Results: A total of fourteen group evaluations were included in this analysis, seven CENA TNP groups from 2012 and seven from 2015 (randomly chosen). A total of 173 participant evaluations were collated (n = 81 from 2012 and 92 from 2015). All course evaluations were anonymous, and nine of the original 14 questions were applicable for this evaluation. All questions were rated by participants on a five-point Likert scale. While all items showed improvement from 2012 to 2015, significant improvement was noted in two items. These were in regard to the content being delivered in a way that met participant learning needs and satisfaction with the length and pace of the program. Evaluation of written comments supports these results. Discussion: The aim of redeveloping the CENA TNP was to improve learning and satisfaction for participants. These results demonstrate that initial improvements in 2012 were able to be maintained and in two essential areas significantly improved. Changes that increased participant engagement, support and contextualization of course materials were essential for CENA TNP evolution.

Keywords: emergency nursing education, industry training programs, teaching and learning, trauma education

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Authors: Mohammad Javaherian, Siamak Bashardoust Tajali, Monavvar Hadizadeh

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Objective: This systematic review study was conducted to evaluate the effects of Pulsed Electromagnetic (PEMF) and Static Magnetic Fields (SMG) on pain relief and functional improvement in patients with musculoskeletal Low Back Pain (LBP). Methods: Seven electronic databases were searched by two researchers independently to identify the published Randomized Controlled Trials (RCTs) on the efficacy of pulsed electromagnetic, static magnetic, and therapeutic nuclear magnetic fields. The identified databases for systematic search were Ovid Medline®, Ovid Cochrane RCTs and Reviews, PubMed, Web of Science, Cochrane Library, CINAHL, and EMBASE from 1968 to February 2016. The relevant keywords were selected by Mesh. After initial search and finding relevant manuscripts, all references in selected studies were searched to identify second hand possible manuscripts. The published RCTs in English would be included to the study if they reported changes on pain and/or functional disability following application of magnetic fields on chronic musculoskeletal low back pain. All studies with surgical patients, patients with pelvic pain, and combination of other treatment techniques such as acupuncture or diathermy were excluded. The identified studies were critically appraised and the data were extracted independently by two raters (M.J and S.B.T). Probable disagreements were resolved through discussion between raters. Results: In total, 1505 abstracts were found following the initial electronic search. The abstracts were reviewed to identify potentially relevant manuscripts. Seventeen possibly appropriate studies were retrieved in full-text of which 48 were excluded after reviewing their full-texts. Ten selected articles were categorized into three subgroups: PEMF (6 articles), SMF (3 articles), and therapeutic nuclear magnetic fields (tNMF) (1 article). Since one study evaluated tNMF, we had to exclude it. In the PEMF group, one study of acute LBP did not show significant positive results and the majority of the other five studies on Chronic Low Back Pain (CLBP) indicated its efficacy on pain relief and functional improvement, but one study with the lowest sessions (6 sessions during 2 weeks) did not report a significant difference between treatment and control groups. In the SMF subgroup, two articles reported near significant pain reduction without any functional improvement although more studies are needed. Conclusion: The PEMFs with a strength of 5 to 150 G or 0.1 to 0.3 G and a frequency of 5 to 64 Hz or sweep 7 to 7KHz can be considered as an effective modality in pain relief and functional improvement in patients with chronic low back pain, but there is not enough evidence to confirm their effectiveness in acute low back pain. To achieve the appropriate effectiveness, it is suggested to perform this treatment modality 20 minutes per day for at least 9 sessions. SMFs have not been reported to be substantially effective in decreasing pain or improving the function in chronic low back pain. More studies are necessary to achieve more reliable results.

Keywords: pulsed electromagnetic field, static magnetic field, magnetotherapy, low back pain

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Authors: S. Odabasi Cimer, A. Cimer

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Recently, the poor quality of education, low achieving students, low international exam performances and little or no effect of the education reforms on the teaching in the classrooms are the main problems of education discussed in Turkey. Research showed that the quality of an education system can not exceed the quality of its teachers and teaching. Therefore, in-service training (INSET) courses are important to improve teacher quality, thereby, the quality of education. However, according to the research conducted on the evaluation of the INSET courses in Turkey, they are not effective in improving the quality of teaching in the classroom. The main reason for this result is because INSET courses are conducted and delivered in limited time and presented theoretically, which does not meet the needs of teachers and as a result, the knowledge and skills taught are not used in the classrooms. Recently, developed countries have been using Critical Friends Groups (CFGs) successfully for the purpose of school-based training of teachers. CFGs are the learning groups which contain 6-10 teachers aimed at fostering their capacities to undertake instructional and personal improvement and schoolwide reform. CFGs have been recognized as a critical feature in school reform, improving teaching practice and improving student achievement. In addition, in the USA, teachers have named CFGs one of the most powerful professional development activities in which they have ever participated. Whereas, in Turkey, the concept is new. This study aimed to investigate the implications of application, evaluation, and promotion of CFGs which has the potential to contribute to teacher development and student learning in schools in Turkey. For this purpose, the study employed a qualitative approach and case study methodology to implement the model in high schools. The research was conducted in two schools and 13 teachers working in these schools participated. The study lasted two years and the data were collected through various data collection tools including interviews, meeting transcripts, questionnaires, portfolios, and diaries. The results of the study showed that CFGs contributed professional development of teachers and their students’ learning. It also contributed to a culture of collaborative work in schools. A number of barriers and challenges which prevent effective implementation were also determined.

Keywords: critical friends group, education reform, science learning, teacher education

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Authors: A. Ascenso, C. Silveira, B. Augusto, S. Rafael, S. Coelho, J. Ferreira, A. Monteiro, P. Roebeling, A. I. Miranda

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Innovative nature-based solutions (NBSs) can provide answers to the challenges that urban areas are currently facing due to urban densification and extreme weather conditions. The effects of NBSs are recognized and include improved quality of life, mental and physical health and improvement of air quality, among others. Part of the work developed in the scope of the UNaLab project, which aims to guide cities in developing and implementing their own co-creative NBSs, intends to assess the impacts of NBSs on air quality, using Eindhoven city as a case study. The state-of-the-art online air quality modelling system WRF-CHEM was applied to simulate meteorological and concentration fields over the study area with a spatial resolution of 1 km2 for the year 2015. The baseline simulation (without NBSs) was validated by comparing the model results with monitored data retrieved from the Eindhoven air quality database, showing an adequate model performance. In addition, land use changes were applied in a set of simulations to assess the effects of different types of NBSs. Finally, these simulations were compared with the baseline scenario and the impacts of the NBSs were assessed. Reductions on pollutant concentrations, namely for NOx and PM, were found after the application of the NBSs in the Eindhoven study area. The present work is particularly important to support public planners and decision makers in understanding the effects of their actions and planning more sustainable cities for the future.

Keywords: air quality, modelling approach, nature based solutions, urban area

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Authors: Alireza Nikravanshallmani, Jamshid Dehmeshki, Mojtaba Ahmadi

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Modeling of business processes, based on BPMN (Business Process Modeling Notation), helps analysts and managers to understand business processes, and, identify their shortages. These models provide a context to make rational decision of organizing business processes activities in an understandable manner. The purpose of this paper is to provide a framework for better understanding of business processes and their problems by reducing the cognitive load of displayed information for their audience at different managerial levels while keeping the essential information which are needed by them. For this reason, we integrate business process diagrams across the different managerial levels to develop a framework to improve the performance of business process management (BPM) projects. The proposed framework is entitled ‘Business process improvement framework based on managerial levels (BPIML)’. This framework, determine a certain type of business process diagrams (BPD) based on BPMN with respect to the objectives and tasks of the various managerial levels of organizations and their roles in BPM projects. This framework will make us able to provide the necessary support for making decisions about business processes. The framework is evaluated with a case study in a real business process improvement project, to demonstrate its superiority over the conventional method. A questionnaire consisted of 10 questions using Likert scale was designed and given to the participants (managers of Bank Refah Kargaran three managerial levels). By examining the results of the questionnaire, it can be said that the proposed framework provide support for correct and timely decisions by increasing the clarity and transparency of the business processes which led to success in BPM projects.

Keywords: business process management (BPM), business process modeling, business process reengineering (BPR), business process optimizing, BPMN

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Authors: Guanglin Song

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(Objective) Situated within the context of China's tiered medical treatment system, this study aims to analyze spatial causes of urban healthcare access difficulties from the perspective of the configuration of healthcare facilities. (Methods) A social network analysis approach is employed to construct a healthcare demand and supply flow network between major residential clusters and various tiers of hospitals in the city.(Conclusion) The findings reveal that:1.there exists overall maldistribution and over-concentration of healthcare resources in Study Area, characterized by structural imbalance; 2.the low rate of primary care utilization in Study Area is a key factor contributing to congestion at higher-tier hospitals, as excessive reliance on these institutions by neighboring communities exacerbates the problem; 3.gradual optimization of the healthcare facility layout in Study Area, encompassing holistic, local, and individual institutional levels, can enhance systemic efficiency and resource balance.(Prospects) This research proposes a method for evaluating urban healthcare resource distribution structures based on service flows within hierarchical networks. It offers spatially targeted optimization suggestions for promoting the implementation of the tiered healthcare system and alleviating challenges related to accessibility and congestion in seeking medical care. Provide some new ideas for researchers and healthcare managers in countries, cities, and healthcare management around the world with similar challenges.

Keywords: flow of public services, urban networks, healthcare facilities, spatial planning, urban networks

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Authors: Zhu Weimin, Allegorico Carmine, Ruggiero Gionata

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During decades of Baker Hughes (BH) iCenter experience, it is demonstrated that in addition to conventional insights on equipment steady operation conditions, insights on transient conditions can add significant and exclusive value for anomaly detection, downtime saving, and predictive maintenance. Our work shows examples from the BH iCenter experience to introduce the advantages and features of using transient condition analytics: (i) Operation under critical engine conditions: e.g., high level or high change rate of temperature, pressure, flow, vibration, etc., that would not be reachable in normal operation, (ii) Management of dedicated sub-systems or components, many of which are often bottlenecks for reliability and maintenance, (iii) Indirect detection of anomalies in the absence of instrumentation, (iv) Repetitive sequences: if data is properly processed, the engineering features of transients provide not only anomaly detection but also problem characterization and prognostic indicators for predictive maintenance, (v) Engine variables accounting for fatigue analysis. iCenter has been developing and deploying a series of analytics based on transient conditions. They are contributing to exclusive value adding in the following areas: (i) Reliability improvement, (ii) Startup reliability improvement, (iii) Predictive maintenance, (iv) Repair/overhaul cost down. Illustrative examples for each of the above areas are presented in our study, focusing on challenges and adopted techniques ranging from purely statistical approaches to the implementation of machine learning algorithms. The obtained results demonstrate how the value is obtained using transient condition analytics in the BH iCenter experience.

Keywords: analytics, diagnostics, monitoring, turbomachinery

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Authors: Jonathan Kissi, Baozhen Dai, Wisdom W. K. Pomegbe, Abdul-Basit Kassim

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Protecting patient’s digital information is a growing concern for healthcare institutions as people nowadays perpetually live their lives through telemedicine services. These telemedicine services have been confronted with several determinants that hinder their successful implementations, especially in developing countries. Identifying such determinants that influence the acceptance of telemedicine services is also a problem for healthcare professionals. Despite the tremendous increase in telemedicine services, its adoption, and use has been quite slow in some healthcare settings. Generally, it is accepted in today’s globalizing world that the success of telemedicine services relies on users’ satisfaction. Satisfying health professionals and patients are one of the crucial objectives of telemedicine success. This study seeks to investigate the determinants that influence health professionals’ intention to utilize telemedicine services in clinical activities in a sub-Saharan African country in West Africa (Ghana). A hybridized model comprising of health adoption models, including technology acceptance theory, diffusion of innovation theory, and protection of motivation theory, were used to investigate these quandaries. The study was carried out in four government health institutions that apply and regulate telemedicine services in their clinical activities. A structured questionnaire was developed and used for data collection. Purposive and convenience sampling methods were used in the selection of healthcare professionals from different medical fields for the study. The collected data were analyzed based on structural equation modeling (SEM) approach. All selected constructs showed a significant relationship with health professional’s behavioral intention in the direction expected from prior literature including perceived usefulness, perceived ease of use, management strategies, financial sustainability, communication channels, patients security threat, patients privacy risk, self efficacy, actual service use, user satisfaction, and telemedicine services systems securities threat. Surprisingly, user characteristics and response efficacy of health professionals were not significant in the hybridized model. The findings and insights from this research show that health professionals are pragmatic when making choices for technology applications and also their willingness to use telemedicine services. They are, however, anxious about its threats and coping appraisals. The identified significant constructs in the study may help to increase efficiency, quality of services, quality patient care delivery, and satisfactory user satisfaction among healthcare professionals. The implantation and effective utilization of telemedicine services in the selected hospitals will aid as a strategy to eradicate hardships in healthcare services delivery. The service will help attain universal health access coverage to all populace. This study contributes to empirical knowledge by identifying the vital factors influencing health professionals’ behavioral intentions to adopt telemedicine services. The study will also help stakeholders of healthcare to formulate better policies towards telemedicine service usage.

Keywords: telemedicine service, perceived usefulness, perceived ease of use, management strategies, security threats

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Authors: M. Klimova, O. Semyachkina-Glushkovskaya, J. Kurts, E. Zinchenko, N. Navolokin, A. Shirokov, A. Dubrovsky, A. Abdurashitov, A. Terskov, A. Mamedova, I. Agranovich, T. Antonova, I. Blokhina

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The direction for research of Alzheimer's disease is to find an effective non-invasive and non-pharmacological way of treatment. Here we tested our hypothesis that the opening of the blood-brain barrier (BBB) induces activation of lymphatic drainage and clearing functions that can be used as a method for non-invasive stimulation of clearance of beta-amyloid and therapy of Alzheimer’s disease (AD). To test our hypothesis, in this study on healthy male mice we analyzed the interaction between BBB opening by repeated loud music (100-10000 Hz, 100 dB, duration 2 h: 60 sec – sound; 60 sec - pause) and functional changes in the meningeal lymphatic vessels (MLVs). We demonstrate clearance of dextran 70 kDa (i.v. injection), fluorescent beta-amyloid (intrahippocampal injection) and gold nanorods (intracortical injection) via MLV that significantly increased after the opening of BBB. Our studies also demonstrate that the BBB opening was associated with the improvement of neurocognitive status in mice with AD. Thus, we uncover therapeutic effects of BBB opening by loud music, such as non-invasive stimulation of lymphatic clearance of beta-amyloid in mice with AD, accompanied by improvement of their neurocognitive status. Our data are consistent with other results suggesting the therapeutic effect of BBB opening by focused ultrasound without drugs for patients with AD. This research was supported by a grant from RSF 18-75-10033

Keywords: Alzheimer's disease, beta-amyloid, blood-brain barrier, meningeal lymphatic vessels, repeated loud music

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Authors: Nuha Alamro

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Besides achieving of weight loss, Bariatric surgery (BS) shown metabolic improvement including reduction of cardiovascular disease, insulin resistance and diabetes. This study aimed to measure BS effects on Framingham Risk Score (FRS) and metabolic syndrome (MetS) among patients who underwent BS. Additionally, to determine the effect of BS on TSH among euthyroid obese patients. A Retrospective follow-up study was conducted in King Abdullah Medical City. A total of 160 participants who underwent BS and completed one year of follow ups. Medical history, biochemical, anthropometric, and hormonal parameters were evaluated at baseline and 3-12 months after BS. International Diabetes Federation (IDF) criteria were used to diagnose MetS pre and postoperative. The mean age of participants was 41.9 ± 10.6 with Body Mass Index (BMI) of 48.8 ± 7.3. After 3 months, Systolic, Diastolic blood pressure (SBP, DBP), glycated haemoglobin (HBA1C), Low-density lipoprotein (LDL), cholesterol, triglycerides and Thyroid stimulating hormone (TSH) were significantly decrease (P < 0.001). Significant decrease was seen in Mets, BMI, FRS, SBP, DBP, HBA1C, LDL, triglycerides, cholesterol, liver enzyme, with significant increase in high-density lipoprotein (HDL) level 12 months post-op (P < 0.001). After 1 year, the prevalence of MetS, DM, HTN, FRS were significantly decrease from 72.5%, 43.1%, 78.1%, 11.4 to 16.3%, 9.4%, 22.5% and 5.4, respectively. Besides achieving substantial weight loss, MetS resolution was linked to improvement in cardiovascular risk profile.

Keywords: bariatric surgery, cardiovascular disease, metabolic syndrome, thyroid stimulating hormone

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Authors: Esam El Gohary

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— The companies’ ability to survive and compete in the fierce competition is determined by its competitiveness level. With the spread of information technology use and appearance of online shopping, it became crucial for companies to adopt e-commerce system to increase its competitiveness. This paper was conducted with the purpose of determine how increasing the service value through e-commerce factors (competitive strategy, ICT infrastructures, logistics, security, human resources and innovation) can enhance companies' competitiveness. The problem of this paper is summarized in the absence of the thorough awareness of e-commerce benefits for business owners and customers, as well as how to reduce the intangibility attributes of e-commerce. For this purpose this paper describes the e-commerce in Egypt and its success factors (infrastructures, legal and regulatory environment, human resources and innovation), as well as displays the barriers of such factor, to investigate the significant of these factors on increasing service value and enhance companies' competitiveness. This paper revealed that e-commerce companies have many opportunities to enhance its competitiveness in Egypt, which is enhanced by several factors. The most important factors are “strong ICT infrastructure, qualified and skilled human resources, in addition to the distinctive logistics that distinguish Egypt due to its location, strong legal and regulatory environment and Innovation, as well as the competitive strategy. As well as, companies encounter several threats such as; the lack of infrastructures and logistics in rural areas, the absence of the inclusive understanding and awareness of e-commerce, fear from e-payment transactions and fraud, the ambiguity and burdensome of customs. Through the research findings several recommendations were introduced to both government and companies to overcome threats and exploit opportunities to improve performance and enhance companies' competitiveness.

Keywords: e-commerce competitiveness, e-commerce factors, e-commerce in Egypt, information technology

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Authors: Sobhy El-Sohaimy, Abduvali Toshev, Hanem Mansour

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(1) Objective: The main objective of the current study was to evaluate in an In Vitro and In Vivo, the potential activity of olive leaves extract (OLE) in the treatment and/or preventing the diabetes mellitus type II and related implications; (2) Methodology: Five groups of male rats were used in the current study: group (1)- negative control (normal); group (2)- positive control, streptozotocin (STZ) induced rats; group (3)-diabetic rats treated with metformin (200 mg/kg) plus OLE (200 mg/kg); group 4- diabetic rats treated with metformin (200 mg/kg); group 5- diabetic rats treated with OLE (200 mg/kg). A four-week regime of oral treatment was administered once daily; (3) Results: Diabetic rats treated with metformin + OLE clearly showed normal blood glucose level (121.67 ± 5.49 mg/dl), and glycated hemoglobin (HbA1c) (3.70 ± 0.10%). The combination of metformin + OLE obviously showed a superior improvement in the lipid profile (TG, TC, HDL and LDL) compared to both metformin and OLE individually. The histological examination revealed that the combination of metformin + Olive leaves extract successfully repaired of the liver, kidneys, and pancreatic tissues in diabetic rats to be near to the normal status; (4) Conclusion: Finally, it can be concluded that, the combination of metformin and OLE exhibited a superior improvement than metformin and OLE individually which emphasized the promising adjuvant role of the OLE in the treatment protocol of diabetes mellitus type II.

Keywords: olive (olea europaea) leaves extracts, hypoglycemic agents, cytotoxicity, nitic oxide scavenging activity, α-glucose oxidase inhibitor

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Authors: Ahmad Ghanem, Mohamad Yasin, Mona Abdel Rehim, Fabrice Gouanve, Eliane Espuche

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Biodegradable polymers are of great interest, especially for biomedical and packaging applications. Current research efforts are focused on the development of biopolymers with the purpose of reducing the plastic pollution induced by the widely used in biodegradable polyolefins. The main challenge is focused on the elaboration of biopolymers having properties competitive to those of polyolefins. On the other hand, graphene oxide (GO), a graphene derivative, is characterized by the presence of several functional groups on the surface such as carboxylic, hydroxyl and epoxide. This feature enables modification of GO surface with different modifiers to obtain versatile surface properties and overcome the problem of graphene sheets aggregations during inclusion in a polymer matrix. In this context, poly (butylene succinate) (PBS) as promising biopolyester is modified through blending with different ratios of functionalized (GO) to improve its barrier properties. Modification of GO has been carried out using different hyperbranched polymeric structures in order to increase miscibility of the nanosheets in the hosting polymeric matrix. Films have been prepared from the modified PBS and their mechanical, thermal and gas barrier properties were investigated. The results reveal enhancement in the thermal and mechanical properties beside observed improvement of the barrier properties for the films prepared from the modified PBS. This improvement is related to the strong dependence on tortuosity effects of dispersion, exfoliation levels of fillers into the polymer matrix and interactions between the fillers and the polymer matrix.

Keywords: gas barrier properties, graphene oxide, food packaging, transport properties

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Authors: Eric Granholm, Christophe Delay, Jason Holden, Peter Link

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Negative symptoms are an important unmet treatment needed for schizophrenia. We conducted an open trial of a novel blended intervention called mobile-assisted cognitive behavior therapy for negative symptoms (mCBTn). mCBTn is a weekly group therapy intervention combining in-person and smartphone-based CBT (CBT2go app) to improve experiential negative symptoms in people with schizophrenia. Both the therapy group and CBT2go app included recovery goal setting, thought challenging, scheduling of pleasurable activities and social interactions, and pleasure savoring interventions to modify defeatist attitudes, a target mechanism associated with negative symptoms, and improve experiential negative symptoms. We tested whether participants with schizophrenia or schizoaffective disorder (N=31) who met prospective criteria for persistent negative symptoms showed improvement in experiential negative symptoms. Retention was excellent (87% at 18 weeks) and severity of defeatist attitudes and motivation and pleasure negative symptoms declined significantly in mCBTn with large effect sizes. We also tested whether pupillary responses, a measure of cognitive effort, predicted improvement in negative symptoms mCBTn. Pupillary responses were recorded at baseline using a Tobii pupillometer during the digit span task with 3-, 6- and 9-digit spans. Mixed models showed that greater dilation during the task at baseline significantly predicted a greater reduction in experiential negative symptoms. Pupillary responses may provide a much-needed prognostic biomarker of which patients are most likely to benefit from CBT. Greater pupil dilation during a cognitive task predicted greater improvement in experiential negative symptoms. Pupil dilation has been linked to motivation and engagement of executive control, so these factors may contribute to benefits in interventions that train cognitive skills to manage negative thoughts and emotions. The findings suggest mCBTn is a feasible and effective treatment for experiential negative symptoms and justify a larger randomized controlled clinical trial. The findings also provide support for the defeatist attitude model of experiential negative symptoms and suggest that mobile-assisted interventions like mCBTn can strengthen and shorten intensive psychosocial interventions for schizophrenia.

Keywords: cognitive-behavioral therapy, mobile interventions, negative symptoms, pupillometry schizophrenia

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Authors: Laleh Boroumand, Muhammad Shiraz, Abdullah Gani, Rashid Hafeez Khokhar

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Cloud computing being the use of hardware and software that are delivered as a service over a network has its application in the area of health care. Due to the emergency cases reported in most of the medical centers, prompt for an efficient scheme to make health data available with less response time. To this end, we propose a mobile global healthcare village (MGHV) model that combines the components of three deployment model which include country, continent and global health cloud to help in solving the problem mentioned above. In the creation of continent model, two (2) data centers are created of which one is local and the other is global. The local replay the request of residence within the continent, whereas the global replay the requirements of others. With the methods adopted, there is an assurance of the availability of relevant medical data to patients, specialists, and emergency staffs regardless of locations and time. From our intensive experiment using the simulation approach, it was observed that, broker policy scheme with respect to optimized response time, yields a very good performance in terms of reduction in response time. Though, our results are comparable to others when there is an increase in the number of virtual machines (80-640 virtual machines). The proportionality in increase of response time is within 9%. The results gotten from our simulation experiments shows that utilizing MGHV leads to the reduction of health care expenditures and helps in solving the problems of unqualified medical staffs faced by both developed and developing countries.

Keywords: cloud computing (MCC), e-healthcare, availability, response time, service broker policy

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Authors: Vishwanath Pethri Kamath, Jayantha Gowda Sarapanahalli, Vishal Mishra, Siddhesh Balwant Bandgar

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Recognition of emotional information is essential in any form of communication. Growing HCI (Human-Computer Interaction) in recent times indicates the importance of understanding of emotions expressed and becomes crucial for improving the system or the interaction itself. In this research work, textual data for emotion recognition is used. The text being the least expressive amongst the multimodal resources poses various challenges such as contextual information and also sequential nature of the language construction. In this research work, the proposal is made for a neural architecture to resolve not less than 8 emotions from textual data sources derived from multiple datasets using google pre-trained word2vec word embeddings and a Multi-head attention-based bidirectional LSTM model with a one-vs-all Multi-Level Classification. The emotions targeted in this research are Anger, Disgust, Fear, Guilt, Joy, Sadness, Shame, and Surprise. Textual data from multiple datasets were used for this research work such as ISEAR, Go Emotions, Affect datasets for creating the emotions’ dataset. Data samples overlap or conflicts were considered with careful preprocessing. Our results show a significant improvement with the modeling architecture and as good as 10 points improvement in recognizing some emotions.

Keywords: text emotion recognition, bidirectional LSTM, multi-head attention, multi-level classification, google word2vec word embeddings

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Authors: Maria Cherepanova, Svetlana Maximova

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Background And Aims: Suicide is among ten most common causes of death of the working-age population in the world. According to the WHO forecasts, by 2025 suicide will be the third leading cause of death, after cardiovascular diseases and cancer. In 2019, the global suicide rate in the world was 10,5 per 100,000 people. In Russia, the average figure was 11.6. However, in some depressed regions of Russia, such as Buryatia and Altai, it reaches 35.3. The aim of this study was to develop models based on the regional factors of social well-being deprivation that provoke the suicidal risk of various age groups of Russian population. We also investigated suicidal risk prevention in modern Russia, analyzed its efficacy, and developed recommendations for suicidal risk prevention improvement. Methods: In this study, we analyzed the data from sociological surveys from six regions of Russia. Totally we interviewed 4200 people, the age of the respondents was from 16 to 70 years. The results were subjected to factorial and regression analyzes. Results: The results of our study indicate that young people are especially socially vulnerable, which result in ineffective patterns of self-preservation behavior and increase the risk of suicide. That is due to lack of anti-suicidal barriers formation; low importance of vital values; the difficulty or impossibility to achieve basic needs; low satisfaction with family and professional life; and decrease in personal unconditional significance. The suicidal risk of the middle-aged population is due to a decrease in social well-being in the main aspects of life, which determines low satisfaction, decrease in ontological security, and the prevalence of auto-aggressive deviations. The suicidal risk of the elderly population is due to increased factors of social exclusion which result in narrowing the social space and limiting the richness of life. Conclusions: The existing system for lowering suicide risk in modern Russia is predominantly oriented to a medical treatment, which provides only intervention to people who already committed suicide, that significantly limits its preventive effectiveness and social control of this deviation. The national strategy for suicide risk reduction in modern Russian society should combine medical and social activities, designed to minimize possible situations resulting to suicide. The strategy for elimination of suicidal risk should include a systematic and significant improvement of the social well-being of the population and aim at overcoming the basic aspects of social disadvantages such as poverty, unemployment as well as implementing innovative mental health improvement, developing life-saving behavior that will help to counter suicides in Russia.

Keywords: social factors, suicide, prevention, Russia

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Authors: William Albeiro Alvarez, Gloria Patricia Jaramillo, Ivan Reinaldo Sarmiento

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Understanding the behavior of individuals and the different human factors that influence the choice when faced with a complex system such as transportation is one of the most complicated aspects of measuring in the components that constitute the modeling of route choice due to that various behaviors and driving mode directly or indirectly affect the choice. During the last two decades, with the development of information and communications technologies, new data collection techniques have emerged such as GPS, geolocation with mobile phones, apps for choosing the route between origin and destination, individual service transport applications among others, where an interest has been generated to improve discrete choice models when considering the incorporation of these developments as well as psychological factors that affect decision making. This paper implements a discrete choice model that proposes and estimates a hybrid model that integrates route choice models and latent variables based on the observation on the route of a sample of public taxi drivers from the city of Medellín, Colombia in relation to its behavior, personality, socioeconomic characteristics, and driving mode. The set of choice options includes the routes generated by the individual service transport applications versus the driver's choice. The hybrid model consists of measurement equations that relate latent variables with measurement indicators and utilities with choice indicators along with structural equations that link the observable characteristics of drivers with latent variables and explanatory variables with utilities.

Keywords: behavior choice model, human factors, hybrid model, real time data

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Authors: R. S. Quintal, J. L. Tesch Santos, M. D. Davis, E. C. de Santana, M. de F. Bandeira dos Santos

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The objective is to identify the contributions from the introduction of the computerized system deal within the Accounting Department of Brazilian Navy Financial Directorship and its possible effects on the budgetary and financial harvest of Brazilian Navy. The relevance lies in the fact that the management process is responsible for the continuous improvement of organizational performance through higher levels of quality in their activities. Improvements in organizational processes have direct effects on crops cost, quality, reliability, flexibility and speed. The method of study of this research is the case study. The choice of case study attended, among other demands, a need for greater flexibility to study processes related to a computerized system. The sources of evidence were used literature, documentary and direct observation. Direct observation was made by monitoring the implementation of the computerized system in the Division of Management Analysis. The main findings of the study point to the fact that the computerized system may contribute significantly to the standardization of information. There was improvement of internal processes in the division of management analysis, made possible the consolidation of a standard management and performance analysis that contribute to global homogeneity in the treatment of information essential to the process of decision making. This study has limitations related to the fact the search result be subject exclusively to the case studied, and it is impossible to generalize to other organs of government.

Keywords: process management, management control, business intelligence, Brazilian Navy

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Authors: Bambang Heliyanto, Rully Dyah Purwati, Hasnam, Fadjry Djufry

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Jatropha curcas L., a drought tolerant and monoecious perennial shrub, has received attention worldwide during the past decade. Realizing the facts, the Indonesian government has decided to option for Jatropha and palm oil for in country biofuel production. To support the program development of high yielding jatropha varieties is necessary. This paper reviews Jatropha improvement program in Indonesia using mass selection and hybrid development. To start with, at the end of 2005, in-country germplasm collection was mobilized to Lampung and Nusa Tenggara Barat (NTB) provinces and successfully collected 15 provenances/sub-provenances which serves as a base population for selection. A significant improvement has been achieved through a simple recurrent breeding selection during 2006 to 2007. Seed yield productivity increased more than double, from 0.36 to 0.97 ton dry seed per hectare during the first selection cycle (IP-1), and then increased to 2.2 ton per hectare during the second cycles (IP-2) in Lampung provenance. Similar result was also observed in NTB provenance. Seed yield productivity increased from 0.43 ton to 1 ton dry seed per hectare in the first cycle (IP-1), and then 1.9 ton in the second cycle (IP-2). In 2008, the population IP-3 resulted from the third cycle of selection have been identified which were capable of producing 2.2 to 2.4 ton seed yield per hectare. To improve the seed yield per hectare, jatropha hybrid varieties was developed involving superior provenances. As a result a Jatropha Energy Terbarukan (JET) variety-2 was released in 2017 with seed yield potential of 2.6 ton per hectare. The use of this high yielding genotypes for biofuel is discussed.

Keywords: Jatropha curcas, provenance, biofuel, improve population, hybrid

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Authors: Alanoud Moraya Aldalan, Abdulaziz Almaleh

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A crucial component of maintaining a customer-oriented business as in the telecom industry is understanding the reasons and factors that lead to customer churn. Competition between telecom companies has greatly increased in recent years. It has become more important to understand customers’ needs in this strong market of telecom industries, especially for those who are looking to turn over their service providers. So, predictive churn is now a mandatory requirement for retaining those customers. Machine learning can be utilized to accomplish this. Churn Prediction has become a very important topic in terms of machine learning classification in the telecommunications industry. Understanding the factors of customer churn and how they behave is very important to building an effective churn prediction model. This paper aims to predict churn and identify factors of customers’ churn based on their past service usage history. Aiming at this objective, the study makes use of feature selection, normalization, and feature engineering. Then, this study compared the performance of four different machine learning algorithms on the Orange dataset: Logistic Regression, Random Forest, Decision Tree, and Gradient Boosting. Evaluation of the performance was conducted by using the F1 score and ROC-AUC. Comparing the results of this study with existing models has proven to produce better results. The results showed the Gradients Boosting with feature selection technique outperformed in this study by achieving a 99% F1-score and 99% AUC, and all other experiments achieved good results as well.

Keywords: machine learning, gradient boosting, logistic regression, churn, random forest, decision tree, ROC, AUC, F1-score

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Authors: Óscar Muñoz Garrigós, José Manuel Bernabeu Aubán

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Time-sensitive services are the base of the cloud services industry. Keeping low service saturation is essential for controlling response time. All auto-scalable services make use of reactive auto-scaling. However, reactive auto-scaling has few in-depth studies. This presentation shows a model for reactive auto-scaling methodologies with a MAPE-k architecture. Queuing theory can compute different properties of static services but lacks some parameters related to the transition between models. Our model uses queuing theory parameters to relate the transition between models. It associates MAPE-k related times, the sampling frequency, the cooldown period, the number of requests that an instance can handle per unit of time, the number of incoming requests at a time instant, and a function that describes the acceleration in the service's ability to handle more requests. This model is later used as a solution to horizontally auto-scale time-sensitive services composed of microservices, reevaluating the model’s parameters periodically to allocate resources. The solution requires limiting the acceleration of the growth in the number of incoming requests to keep a constrained response time. Business benefits determine such limits. The solution can add a dynamic number of instances and remains valid under different system sizes. The study includes performance recommendations to improve results according to the incoming load shape and business benefits. The exposed methodology is tested in a simulation. The simulator contains a load generator and a service composed of two microservices, where the frontend microservice depends on a backend microservice with a 1:1 request relation ratio. A common request takes 2.3 seconds to be computed by the service and is discarded if it takes more than 7 seconds. Both microservices contain a load balancer that assigns requests to the less loaded instance and preemptively discards requests if they are not finished in time to prevent resource saturation. When load decreases, instances with lower load are kept in the backlog where no more requests are assigned. If the load grows and an instance in the backlog is required, it returns to the running state, but if it finishes the computation of all requests and is no longer required, it is permanently deallocated. A few load patterns are required to represent the worst-case scenario for reactive systems: the following scenarios test response times, resource consumption and business costs. The first scenario is a burst-load scenario. All methodologies will discard requests if the rapidness of the burst is high enough. This scenario focuses on the number of discarded requests and the variance of the response time. The second scenario contains sudden load drops followed by bursts to observe how the methodology behaves when releasing resources that are lately required. The third scenario contains diverse growth accelerations in the number of incoming requests to observe how approaches that add a different number of instances can handle the load with less business cost. The exposed methodology is compared against a multiple threshold CPU methodology allocating/deallocating 10 or 20 instances, outperforming the competitor in all studied metrics.

Keywords: reactive auto-scaling, auto-scaling, microservices, cloud computing

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Authors: Ambeck Celyne Tebid, Harry S. Rampa

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The South African Education system recognises the need for all learners including those experiencing learning difficulties, to have access to a single unified system of education. For teachers to be pedagogically responsive to an increasingly diverse learner population without appropriate support has been proven to be unrealistic. As such, this has considerably hampered interest amongst teachers, especially those at the foundation phase to work within an Inclusive Education (IE) and training system. This qualitative study aimed at investigating foundation phase teachers’ experiences of school-based support teams (SBSTs) in two Full-Service (inclusive schools) and one Mainstream public primary school in the Gauteng province of South Africa; with particular emphasis on finding ways to supporting them, since teachers claimed they were not empowered in their initial training to teach learners experiencing learning difficulties. Hence, SBSTs were created at school levels to fill this gap thereby, supporting teaching and learning by identifying and addressing learners’, teachers’ and schools’ needs. With the notion that IE may be failing because of systemic reasons, this study uses Bronfenbrenner’s (1979) ecosystemic as well as Piaget’s (1980) maturational theory to examine the nature of support and experiences amongst teachers taking individual and systemic factors into consideration. Data was collected using in-depth, face-to-face interviews, document analysis and observation with 6 foundation phase teachers drawn from 3 different schools, 3 SBST coordinators, and 3 school principals. Data was analysed using the phenomenological data analysis method. Amongst the findings of the study is that South African full- service and mainstream schools have functional SBSTs which render formal and informal support to the teachers; this support varies in quality depending on the socio-economic status of the relevant community where the schools are situated. This paper, however, argues that what foundation phase teachers settled for as ‘support’ is flawed; as well as how they perceive the SBST and its role is problematic. The paper conclude by recommending that, the SBST should consider other approaches at foundation phase teacher support such as, empowering teachers with continuous practical experiences on how to deal with real classroom scenarios, as well as ensuring that all support, be it on academic or non-academic issues should be provided within a learning community framework where the teacher, family, SBST and where necessary, community organisations should harness their skills towards a common goal.

Keywords: foundation phase, full- service schools, inclusive education, learning difficulties, school-based support teams, teacher support

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Authors: Nourhan Elshenawi

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Net Neutrality (NN) is the principle of treating all online data the same without any prioritization of some over others. A research gap in current scholarship about “violations of NN” and the subsequent ethical concerns paves the way for the following research question: To what extent violations of NN entail ethical concerns and implications for Internet stakeholders? To answer this question, NR is examined using the two major action-based ethical theories, Kantian and Utilitarian, across the relevant Internet stakeholders. First some necessary IT background is provided that shapes how the Internet works and who the key stakeholders are. Following the IT background, the relationship between the stakeholders, users, Internet Service Providers (ISPs) and content providers is discussed and illustrated. Then some violations of NN that are currently occurring is covered, without attracting any attention from the general public from an ethical perspective, as a new term Net Regularity (NR). Afterwards, the current scholarship on NN and its violations are discussed, that are mainly from an economic and sociopolitical perspectives to highlight the lack of ethical discussions on the issue. Before moving on to the ethical analysis however, websites are presented as digital entities that are affected by NR and their happiness is measured using functionalism. The analysis concludes that NR is prone to an unethical treatment of Internet stakeholders in the perspective of both theories. Finally, the current Digital Divide in the world is presented to be able to better illustrate the implications of NR. The implications present the new Internet divide that will take place between individuals within society. Through answering the research question using ethical analysis, it attempts to shed some light on the issue of NR and what kind of society it would lead to. NR would not just lead to a divided society, but divided individuals that are separated by something greater than distance, the Internet.

Keywords: digital divide, digital entities, digital ontology, internet ethics, internet law, net neutrality, internet service providers, websites as beings

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Authors: Lista Andriyati, Nurpudji A Taslim

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The human immunodeficiency virus (HIV) patients have potential nutritional and metabolic problems. HIV is a virus that attacks cells T helper and impairs the function of immune cells. Infected individuals gradually become immunodeficient, results in increased susceptibility to a wide range of infections such as tuberculosis (TB). Malnutrition has destructive effects on the immune system and host defense mechanisms. Effective and proper nutritional therapies are important to improve medical outcomes and quality of life, which is associated with functional improvement. A case of 38-years old man admitted to hospital with loss of consciousness and was diagnosed HIV infection and relapse lung TB with severe malnutrition, fever, oral candidiasis, anemia (6.3 g/dL), severe hypoalbuminemia (1.9 g/dL), severe hypokalemia (2.2 mmol/L), immune depletion (1085 /µL) and elevated liver enzyme (ALT 1198/AST 375 U/L). Nutritional intervention by giving 2300 kcal of energy, protein 2 g/IBW/day, carbohydrate 350 g, fat 104 g through enteral and parenteral nutrition. Supplementations administered are zinc, vitamin A, vitamin B1, vitamin B6, vitamin B12, vitamin C, vitamin D, and snakehead fish extract high content of protein albumin (Pujimin®). After 46 days, there are clinical and metabolic improvement in Hb (6.3 to 11.2 g/dL), potassium (2.2 to 3.4 mmol/L), albumin (1.9 to 2.3 g/dL), ALT 1198 to 47/AST 375 to 68 U/L) and improved awareness. In conclusion, nutritional therapy in HIV infection with adequate macronutrients and micronutrients fulfillment and immunonutrition is very important to avoid cachexia and to improve nutritional status and immune disfunction.

Keywords: HIV, hypoalbuminemia, malnutrition, tuberculosis

Procedia PDF Downloads 124