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Authors: Ozge Gurcanli

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Recent studies in active-learning focus on how student experience varies based on the content (e.g. STEM versus Humanities) and the medium (e.g. in-class exercises versus off-campus activities) of experiential learning. However, little is known whether the variation in classroom time and space within the same active learning context affects student experience. This study manipulated the use of classroom time for the active learning component of a developmental psychology course that is offered at a four-year university in the South-West Region of United States. The course uses a blended model: traditional and active learning. In the traditional learning component of the course, students do weekly readings, listen to lectures, and take midterms. In the active learning component, students make a documentary on a developmental topic as a final project. Students used the classroom time and space for the documentary in two ways: regular classroom time slots that were dedicated to the making of the documentary outside without the supervision of the professor (Classroom-time Outside) and lectures that offered basic instructions about how to make a documentary (Documentary Lectures). The study used the public teaching evaluations that are administered by the Office of Registrar’s. A total of two hundred and seven student evaluations were available across six semesters. Because the Office of Registrar’s presented the data separately without personal identifiers, One-Way ANOVA with four groups (Traditional, Experiential-Heavy: 19% Classroom-time Outside, 12% for Documentary Lectures, Experiential-Moderate: 5-7% for Classroom-time Outside, 16-19% for Documentary Lectures, Experiential Light: 4-7% for Classroom-time Outside, 7% for Documentary Lectures) was conducted on five key features (Organization, Quality, Assignments Contribution, Intellectual Curiosity, Teaching Effectiveness). Each measure used a five-point reverse-coded scale (1-Outstanding, 5-Poor). For all experiential conditions, the documentary counted towards 30% of the final grade. Organization (‘The instructors preparation for class was’), Quality (’Overall, I would rate the quality of this course as’) and Assignment Contribution (’The contribution of the graded work that made to the learning experience was’) did not yield any significant differences across four course types (F (3, 202)=1.72, p > .05, F(3, 200)=.32, p > .05, F(3, 203)=.43, p > .05, respectively). Intellectual Curiosity (’The instructor’s ability to stimulate intellectual curiosity was’) yielded a marginal effect (F (3, 201)=2.61, p = .053). Tukey’s HSD (p < .05) indicated that the Experiential-Heavy (M = 1.94, SD = .82) condition was significantly different than all other three conditions (M =1.57, 1.51, 1.58; SD = .68, .66, .77, respectively) showing that heavily active class-time did not elicit intellectual curiosity as much as others. Finally, Teaching Effectiveness (’Overall, I feel that the instructor’s effectiveness as a teacher was’) was significant (F (3, 198)=3.32, p <.05). Tukey’s HSD (p <.05) showed that students found the courses with moderate (M=1.49, SD=.62) to light (M=1.52, SD=.70) active class-time more effective than heavily active class-time (M=1.93, SD=.69). Overall, the findings of this study suggest that within the same active learning context, the time and the space dedicated to active learning results in different outcomes in intellectual curiosity and teaching effectiveness.

Keywords: active learning, learning outcomes, student experience, learning context

Procedia PDF Downloads 183

Authors: James Gallagher, Phillip Benachour

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As location aware mobile technologies become ever more omnipresent, the prospect of exploiting their context awareness to enforce learning approaches thrives. Utilizing the growing acceptance of ubiquitous computing, and the steady progress both in accuracy and battery usage of pervasive devices, we present a case study of remote location viewing, how the application can be utilized to support mobile learning in situ using an existing scenario. Through the case study we introduce a new innovative application: Mobipeek based around a request/response protocol for the viewing of a remote location and explore how this can apply both as part of a teacher lead activity and informal learning situations. The system developed allows a user to select a point on a map, and send a request. Users can attach messages alongside time and distance constraints. Users within the bounds of the request can respond with an image, and accompanying message, providing context to the response. This application can be used alongside a structured learning activity such as the use of mobile phone cameras outdoors as part of an interactive lesson. An example of a learning activity would be to collect photos in the wild about plants, vegetation, and foliage as part of a geography or environmental science lesson. Another example could be to take photos of architectural buildings and monuments as part of an architecture course. These images can be uploaded then displayed back in the classroom for students to share their experiences and compare their findings with their peers. This can help to fosters students’ active participation while helping students to understand lessons in a more interesting and effective way. Mobipeek could augment the student learning experience by providing further interaction with other peers in a remote location. The activity can be part of a wider study between schools in different areas of the country enabling the sharing and interaction between more participants. Remote location viewing can be used to access images in a specific location. The choice of location will depend on the activity and lesson. For example architectural buildings of a specific period can be shared between two or more cities. The augmentation of the learning experience can be manifested in the different contextual and cultural influences as well as the sharing of images from different locations. In addition to the implementation of Mobipeek, we strive to analyse this application, and a subset of other possible and further solutions targeted towards making learning more engaging. Consideration is given to the benefits of such a system, privacy concerns, and feasibility of widespread usage. We also propose elements of “gamification”, in an attempt to further the engagement derived from such a tool and encourage usage. We conclude by identifying limitations, both from a technical, and a mobile learning perspective.

Keywords: context aware, location aware, mobile learning, remote viewing

Procedia PDF Downloads 284

Authors: Liaqat Ali, Ehsan, Muhammad Shahzad, Nasir Orakzai

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Introduction: Internal optical urethrotomy is the main stay treatment modality in management of urethral stricture. Being minimal invasive with less morbidity, it is commonly performed and favored procedure by urologists across the globe. Although short-term success rate of optical urethrotomy is promising but long-term efficacy of IOU is questionable with high recurrence rate in different studies. Numerous techniques had been adopted to reduce the recurrence after IOU like prolong catheterization and self-clean intermittent catheterization with varying success. Mitomycin C has anti-fibroblast and anti-collagen properties and has been used in trabeculectomy, myringotomy and after keloid scar excision in contemporary surgical practice. Present study according to the best of our knowledge is a pioneer pilot study in Pakistan to determine the efficacy of Mitomycin C in preventing recurrence of urethral stricture after internal optical urethrotomy. Objective: To determine the efficacy of Mitomycin C in reducing the recurrence of anterior urethral stricture after internal optical urethrotomy. Methods: It is a randomized control trial conducted in department of urology, Institute of Kidney Diseases Hayatabad Medical Complex Peshawar from March 2011 till December 2013. After approval of hospital ethical committee, we included maximum of 2 cm anterior urethral stricture irrespective of etiology. Total of 140 patients were equally divided into two groups by lottery method. Group A (Case) comprising of 70 patients in whom Mitomycin C 0.1% was injected sub mucosal in stricture area at 1,11,6 and 12 O clock position using straight working channel paediatric cystoscope after conventional optical urethrotomy. Group B (Control) 70 patients in whom only optical urethrotomy was performed. SCIC was not offered in both the groups. All the patients were regularly followed on a monthly basis for 3 months then three monthly for remaining 9 months. Recurrence was diagnosed by using diagnostic tools of retrograde urethrogram and flexible urethroscopy in selected cased. Data was collected on structured Proforma and was analyzed on SPSS. Result: The mean age in Group A was 33 ±1.5 years and Group B was 35 years. External trauma was leading cause of urethral stricture in both groups 46 (65%) Group A and 50 (71.4%) Group B. In Group A. Iatrogenic urethral trauma was 2nd etiological factor in both groups. 18(25%) Group A while 15( 21.4%) in Group B. At the end of 1 year, At the end of one year, recurrence of urethral stricture was recorded in 11 (15.71%) patient in Mitomycin C Group A and it was recorded in 27 (38.5 %) patients in group B. Significant difference p=0.001 was found in favour of group A Mitomycin group. Conclusion: Recurrence of urethral stricture is high after optical urethrotomy. Mitomycin C is found highly effective in preventing recurrence of urethral stricture after IOU.

Keywords: urethral stricture, mitomycine, internal optical urethrotomy, medical and health sciences

Procedia PDF Downloads 379

Authors: Kuheli Chakrabarty, Animesh Ghosh, Atanu Roy, Gourab Kanti Das

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Aldol reaction is an important class of carbon-carbon bond forming reactions. One of the popular ways to impose asymmetry in aldol reaction is the introduction of chiral auxiliary that binds the approaching reactants and create dissymmetry in the reaction environment, which finally evolves to enantiomeric excess in the aldol products. The last decade witnesses the usage of natural amino acids as chiral auxiliary to control the stereoselectivity in various carbon-carbon bond forming processes. In this context, L-proline was found to be an effective organocatalyst in asymmetric aldol additions. In last few decades the use of water as solvent or co-solvent in asymmetric organocatalytic reaction is increased sharply. Simple amino acids like L-proline does not catalyze asymmetric aldol reaction in aqueous medium not only that, In organic solvent medium high catalytic loading (~30 mol%) is required to achieve moderate to high asymmetric induction. In this context, huge efforts have been made to modify L-proline and 4-hydroxy-L-proline to prepare organocatalyst for aqueous medium asymmetric aldol reaction. Here, we report the result of our DFT calculations on asymmetric aldol reaction of benzaldehyde, p-NO2 benzaldehyde and t-butyraldehyde with a number of ketones using L-proline hydrazide as organocatalyst in wet solvent free condition. Gaussian 09 program package and Gauss View program were used for the present work. Geometry optimizations were performed using B3LYP hybrid functional and 6-31G(d,p) basis set. Transition structures were confirmed by hessian calculation and IRC calculation. As the reactions were carried out in solvent free condition, No solvent effect were studied theoretically. Present study has revealed for the first time, the direct involvement of two water molecules in the aldol transition structures. In the TS, the enamine and the aldehyde is connected through hydrogen bonding by the assistance of two intervening water molecules forming a supramolecular network. Formation of this type of supramolecular assembly is possible due to the presence of protonated -NH2 group in the L-proline hydrazide moiety, which is responsible for the favorable entropy contribution to the aldol reaction. It is also revealed from the present study that, water assisted TS is energetically more favorable than the TS without involving any water molecule. It can be concluded from this study that, insertion of polar group capable of hydrogen bond formation in the L-proline skeleton can lead to a favorable aldol reaction with significantly high enantiomeric excess in wet solvent free condition by reducing the activation barrier of this reaction.

Keywords: aldol reaction, DFT, organocatalysis, transition structure

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Authors: Maria Lazari, Lorenzo Sanavia

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Mechanics of unsaturated soils has been an active field of research in the last decades. Efficient constitutive models that take into account the partial saturation of soil are necessary to solve a number of engineering problems e.g. instability of slopes and cuts due to heavy rainfalls. A large number of constitutive models can now be found in the literature that considers fundamental issues associated with the unsaturated soil behaviour, like the volume change and shear strength behaviour with suction or saturation changes. Partially saturated soils may either expand or collapse upon wetting depending on the stress level, and it is also possible that a soil might experience a reversal in the volumetric behaviour during wetting. Shear strength of soils also changes dramatically with changes in the degree of saturation, and a related engineering problem is slope failures caused by rainfall. There are several states of the art reviews over the last years for studying the topic, usually providing a thorough discussion of the stress state, the advantages, and disadvantages of specific constitutive models as well as the latest developments in the area of unsaturated soil modelling. However, only a few studies focused on the coupling between partial saturation states and time effects on the behaviour of geomaterials. Rate dependency is experimentally observed in the mechanical response of granular materials, and a viscoplastic constitutive model is capable of reproducing creep and relaxation processes. Therefore, in this work an elasto-viscoplastic constitutive model for unsaturated soils is proposed and validated on the basis of experimental data. The model constitutes an extension of an existing elastoplastic strain-hardening constitutive model capable of capturing the behaviour of variably saturated soils, based on energy conjugated stress variables in the framework of superposed continua. The purpose was to develop a model able to deal with possible mechanical instabilities within a consistent energy framework. The model shares the same conceptual structure of the elastoplastic laws proposed to deal with bonded geomaterials subject to weathering or diagenesis and is capable of modelling several kinds of instabilities induced by the loss of hydraulic bonding contributions. The novelty of the proposed formulation is enhanced with the incorporation of density dependent stiffness and hardening coefficients in order to allow the modeling of the pycnotropy behaviour of granular materials with a single set of material constants. The model has been implemented in the commercial FE platform PLAXIS, widely used in Europe for advanced geotechnical design. The algorithmic strategies adopted for the stress-point algorithm had to be revised to take into account the different approach adopted by PLAXIS developers in the solution of the discrete non-linear equilibrium equations. An extensive comparison between models with a series of experimental data reported by different authors is presented to validate the model and illustrate the capability of the newly developed model. After the validation, the effectiveness of the viscoplastic model is displayed by numerical simulations of a partially saturated slope failure of the laboratory scale and the effect of viscosity and degree of saturation on slope’s stability is discussed.

Keywords: PLAXIS software, slope, unsaturated soils, Viscoplasticity

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Authors: Maja Martinovic, Valentina Zarkovic, Hrvoje Maljak

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Europe is one of the most popular tourist destinations in the world, in which tourism occupies a significant place among the most relevant economic activities, and this applies to the Republic of Croatia as well. Based on this study, the authors intended to encourage and support the creation of an effective tourism policy in Croatia that would be based on the profiling of certain target groups. Another objective was to compare the results obtained from the customer analysis with the market analysis of the tourism industry in Croatia. The objective is to adapt the current tourist offer according to the identified needs and expectations of a particular tourist group in order to increase the attractiveness of Croatia as a tourist destination and motivate greater attendance of the targeted tourist groups. The current research was oriented towards the Russian market as the target group. Therefore, the authors wanted to encourage a discussion on how to attract more Russian guests. Consequently, the intention of the research was a detailed analysis of Russian tourists, in order to gain a better understanding of their travelling motives and tendencies. Furthermore, attention was paid to the expectations of Russian customers and to compare them with the Croatian tourist offer, and to determine whether there is a possibility for an overlap. The method used to obtain the information required was a survey conducted among Russian citizens about their travelling habits. The research was carried out on the basis of 166 participants of different age, gender, profession and income group. The sampling and distribution of the survey took place between May and July 2016. The results provided from the research indicate that Croatian tourism has certain unrealized potential considering the popularization of Croatia as a tourist destination, and there is a capacity for increasing the revenues within the group of Russian tourists. Such a conclusion is based on the fact that the Croatian tourist offer and the preferences of the Russian guests are compatible, i.e. they overlap in many aspects. The results demonstrate that beautiful nature, cultural and historical heritage as well as the sun and sea, play a leading role in attracting more Russian tourists. It is precisely these elements that form the three pillars of the Croatian tourist offer. On the other hand, the profiling revealed that the most desirable destinations for the Russian guests are Italy and Spain, both of which provide the same main tourist attractions as Croatia. Therefore, the focus of the strategic ideas given in the paper shifted to other tourism segments, such as type of accommodation, sales channels, travel motives, additional offer and seasonality etc., in order to gain advantage in the Russian market, the Mediterranean region and tourism in general. The purpose of the research is to serve as a foundation for analysing the attractiveness of the other tourist destinations in the Russian market, as well as to be a general basis for a more detailed profiling of the various specific target groups of the Russian and other tourist groups.

Keywords: Croatia, Russian market, target groups, tourism, tourist destination

Procedia PDF Downloads 318

Authors: Raed Fawzi Mohammed Ameen, Haider I. Alyasari, Maryam Altaweel

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Due to rapid urbanization, developing countries faced significant urban challenges that accompanied the population growth such as the inability to provide adequate housing; sustain human and community's health and wellbeing; ensure the safety in urban areas; the prevalence corruption; lack of jobs; and a shortage of investment. The destruction, degradation, and lack of planning are acute in countries such as Iraq that have suffered for more than four decades because of war and international sanctions, resulting in severe damages to the ecology sector, social utilities, housing, infrastructure, as well as the disruption of the economic sector. Many of significant urban development, housing, and regeneration projects are currently underway in different regions in Iraq, labelled as a means to reform the environmental, social, and economic sectors. However, most often with absence of public participation. Hence, there is an urgent need for understanding public perception, especially of urban socio-economic challenges, which represents a crucial concern for many planners, designers, and policy-makers in order to develop effective policies in addition to increasing their participation. The aim of this study is to investigate stakeholder perceptions of the socio-economic challenges of urban development and their priorities in the all Iraqi provinces. A nationwide questionnaire has been conducted (N = 643) across Iraq, using 19- item structured questionnaire where the stakeholder’s perspectives were collected on a 5-point Likert-type scale. The indicators were identified through deep investigation in previous studies. Principal component analysis (PCA) and statistical tests were utilized to the collected responses in order to investigate the linkage between the perceptions of socio- economic challenges and demographic factors. A high value of internal consistency and reliability of the instrument has been achieved (Cronbach’s alpha= 0.867). Five principal components have been identified, namely: economic, cultural aspects, design context, employment, security and housing demands. The item ‘safety of public places' was ranked as the most important, followed by the items 'minimize unplanned housing', and ‘provision of affordable housing’, respectively. Promote high-rise housing from the housing demands group, was ranked the lowest component between all indicators. 'Using sustainable local materials in construction' item had the second lowest mean score. The results also illustrate a link between deficiencies in the social and economic infrastructure because of the destruction and degradation caused by political instability in Iraq in the last few decades.

Keywords: public participation in development, socio-economic challenges, urban development, urban sustainability

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Authors: Erica Cochran Hameen, Bobuchi Ken-Opurum, Mounica Guturu

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The United Stated (U.S.) populous spends the majority of their time indoors in spaces where building codes and voluntary sustainability standards provide clear Indoor Environmental Quality (IEQ) metrics. The existing sustainable building standards and codes are aimed towards improving IEQ, health of occupants, and reducing the negative impacts of buildings on the environment. While they address the post-occupancy stage of buildings, there are fewer standards on the pre-occupancy stage thereby placing a large labor population in environments much less regulated. Construction personnel are often exposed to a variety of uncomfortable and unhealthy elements while on construction sites, primarily thermal, visual, acoustic, and air quality related. Construction site power generators, equipment, and machinery generate on average 9 decibels (dBA) above the U.S. OSHA regulations, creating uncomfortable noise levels. Research has shown that frequent exposure to high noise levels leads to chronic physiological issues and increases noise induced stress, yet beyond OSHA no other metric focuses directly on the impacts of noise on contractors’ well-being. Research has also associated natural light with higher productivity and attention span, and lower cases of fatigue in construction workers. However, daylight is not always available as construction workers often perform tasks in cramped spaces, dark areas, or at nighttime. In these instances, the use of artificial light is necessary, yet lighting standards for use during lengthy tasks and arduous activities is not specified. Additionally, ambient air, contaminants, and material off-gassing expelled at construction sites are one of the causes of serious health effects in construction workers. Coupled with extreme hot and cold temperatures for different climate zones, health and productivity can be seriously compromised. This research evaluates the impact of existing green building metrics on construction and risk management, by analyzing two codes and nine standards including LEED, WELL, and BREAM. These metrics were chosen based on the relevance to the U.S. construction industry. This research determined that less than 20% of the sustainability context within the standards and codes (texts) are related to the pre-occupancy building sector. The research also investigated the impact of construction personnel’s health and well-being on construction management through two surveys of project managers and on-site contractors’ perception of their work environment on productivity. To fully understand the risks of limited Environmental and Health Quality metrics for contractors (EHQ) this research evaluated the connection between EHQ factors such as inefficient lighting, on construction workers and investigated the correlation between various site coping strategies for comfort and productivity. Outcomes from this research are three-pronged. The first includes fostering a discussion about the existing conditions of EQH elements, i.e. thermal, lighting, ergonomic, acoustic, and air quality on the construction labor force. The second identifies gaps in sustainability standards and codes during the pre-occupancy stage of building construction from ground-breaking to substantial completion. The third identifies opportunities for improvements and mitigation strategies to improve EQH such as increased monitoring of effects on productivity and health of contractors and increased inclusion of the pre-occupancy stage in green building standards.

Keywords: construction contractors, health and well-being, environmental quality, risk management

Procedia PDF Downloads 128

Authors: Vivienne Cameron

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Background: Between 2010 and 2017, teachers in a suburban public school district struggled to get students to consistently produce adequate writing samples as measured by the Pennsylvania state writing rubric for measuring focus, content, organization, style, and conventions. A common thread in all of the data was the need to develop stamina in the student writers. Method: All of the teachers used the traditional writing process model (prewrite, draft, revise, edit, final copy) during writing instruction. One teacher taught the writing process using word processing and incentivizing with publication instead of the traditional pencil/paper/grading method. Students did not have instruction in typing/keyboarding. The teacher submitted resulting student work to real-life contests, magazines, and publishers. Results: Students in the test group increased both the quantity and quality of their writing over a seven month period as measured by the Pennsylvania state writing rubric. Reluctant writers, as well as students with autism spectrum disorder, benefited from this approach. This outcome was repeated consistently over a five-year period. Interpretation: Removing the burden of pencil and paper allowed students to participate in the writing process more fully. Writing with pencil and paper is physically tiring. Students are discouraged when they submit a draft and are instructed to use the Add, Remove, Move, Substitute (ARMS) method to revise their papers. Each successive version becomes shorter. Allowing students to type their papers frees them to quickly and easily make changes. The result is longer writing pieces in shorter time frames, allowing the teacher to spend more time working on individual needs. With this additional time, the teacher can concentrate on teaching focus, content, organization, style, conventions, and audience. S/he also has a larger body of works from which to work on whole group instruction such as developing effective leads. The teacher submitted the resulting student work to contests, magazines, and publishers. Although time-consuming, the submission process was an invaluable lesson for teaching about audience and tone. All students in the test sample had work accepted for publication. Students became highly motivated to succeed when their work was accepted for publication. This motivation applied to special needs students, regular education students, and gifted students.

Keywords: elementary-age students, reluctant writers, teaching strategies, writing process

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Authors: Majid Farsadrouh Rashti, Amir Shafiee Kisomi, Parisa Jahani

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The direct ethanol fuel cells (DEFCs) are contemplated as a promising energy source because, In addition to being used in portable electronic devices, it is also used for electric vehicles. The synthesis of bimetallic nanostructures due to their novel optical, catalytic and electronic characteristic which is precisely in contrast to their monometallic counterparts is attracting extensive attention. Galvanic replacement (sometimes is named to as cementation or immersion plating) is an uncomplicated and effective technique for making nanostructures (such as core-shell) of different metals, semiconductors, and their application in DEFCs. The replacement of galvanic does not need any external power supply compared to electrodeposition. In addition, it is different from electroless deposition because there is no need for a reducing agent to replace galvanizing. In this paper, a fast method for the palladium (Pd) wire nanostructures synthesis with the great surface area through galvanic replacement reaction utilizing copper nanowires (CuNWS) as a template by the assistance of ultrasound under room temperature condition is proposed. To evaluate the morphology and composition of Pd@ Copper nanowires/MultiWalled Carbon nanotubes-Chitosan, emission scanning electron microscopy, energy dispersive X-ray spectroscopy were applied. In order to measure the phase structure of the electrocatalysts were performed via room temperature X-ray powder diffraction (XRD) applying an X-ray diffractometer. Various electrochemical techniques including chronoamperometry and cyclic voltammetry were utilized for the electrocatalytic activity of ethanol electrooxidation and durability in basic solution. Pd@ Copper nanowires/MultiWalled Carbon nanotubes-Chitosan catalyst demonstrated substantially enhanced performance and long-term stability for ethanol electrooxidation in the basic solution in comparison to commercial Pd/C that demonstrated the potential in utilizing Pd@ Copper nanowires/MultiWalled Carbon nanotubes-Chitosan as efficient catalysts towards ethanol oxidation. Noticeably, the Pd@ Copper nanowires/MultiWalled Carbon nanotubes-Chitosan presented excellent catalytic activities with a peak current density of 320.73 mAcm² which was 9.5 times more than in comparison to Pd/C (34.2133 mAcm²). Additionally, activation energy thermodynamic and kinetic evaluations revealed that the Pd@ Copper nanowires/MultiWalled Carbon nanotubes-Chitosan catalyst has lower compared to Pd/C which leads to a lower energy barrier and an excellent charge transfer rate towards ethanol oxidation.

Keywords: core-shell structure, electrocatalyst, ethanol oxidation, galvanic replacement reaction

Procedia PDF Downloads 139

Authors: Kadhim Alabady

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Background: Autism poses a particularly large public health challenge and an inspiring lifelong challenge for many families; it is a lifelong challenge of a different kind. Purpose: Therefore, it is important to understand what the key challenges are and how to improve the lives of children who are affected with autism in Dubai. Method: In order to carry out this research we have used a qualitative methodology. We performed structured in–depth interviews and focus groups with mental health professionals working at: Al Jalila hospital (AJH), Dubai Autism Centre (DAC), Dubai Rehabilitation Centre for Disabilities, Latifa hospital, Private Sector Healthcare (PSH). In addition to that, we conducted quantitative approach to estimate ASD prevalence or incidence data due to lack of registry. ASD estimates are based on research from national and international documents. This approach was applied to increase the validity of the findings by using a variety of data collection techniques in order to explore issues that might not be highlighted through one method alone. Key findings: Autism is the most common of the Pervasive Developmental Disorders. Dubai Autism Center estimates it affects 1 in 146 births (0.68%). If we apply these estimates to the total number of births in Dubai for 2014, it is predicted there would be approximately 199 children (of which 58 were Nationals and 141 were Non–Nationals) suffering from autism at some stage. 16.4% of children (through their families) seek help for ASD assessment between the age group 6–18+. It is critical to understand and address factors for seeking late–stage diagnosis, as ASD can be diagnosed much earlier and how many of these later presenters are actually diagnosed with ASD. Autism spectrum disorder (ASD) is a public health concern in Dubai. Families do not consult GPs for early diagnosis for a variety of reasons including cultural reasons. Recommendations: Effective school health strategies is needed and implemented by nurses who are qualified and experienced in identifying children with ASD. There is a need for the DAC to identify and develop a closer link with neurologists specializing in Autism, to work alongside and for referrals. Autism can be attributed to many factors, some of those are neurological. Currently, when families need their child to see a neurologist they have to go independently and search through the many that are available in Dubai and who are not necessarily specialists in Autism. Training of GP’s to aid early diagnosis of Autism and increase awareness. Since not all GP’s are trained to make such assessments increasing awareness about where to send families for a complete assessment and the necessary support. There is an urgent need for an adult autism center for when the children leave the safe environment of the school at 18 years. These individuals require a day center or suitable job training/placements where appropriate. There is a need for further studies to cover the needs of people with an Autism Spectrum Disorder (ASD).

Keywords: autism spectrum disorder, autism, pervasive developmental disorders, incidence

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Authors: Şeyda Kaya

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The aim of this study is to examine the relationship between corporate social responsibility perception and organizational commitment among Turkish cabin crew. At the same time, the social responsibility perception and organizational commitment scores of the participants were compared according to their gender, age, education level, title, and work experience. In the globalizing world, businesses have developed some innovative marketing methods in order to survive and strengthen their place in the market. Nowadays, consumers who are connected to the brand with an emotional bond rather than being just consumers. Corporate Social Responsibility Projects, on the one hand, provide social benefit, on the other hand, increase the brand awareness of businesses by providing credibility in the eyes of consumers. The rapid increase of competition, requires businesses to use their human resources, which is the most important resource to sustain their existence, in the most effective and efficient way. For this reason, the concept of ‘Organizational Commitment’ has become an important research topic for business and academics. Although there are studies in the literature to determine the effect of the perception of corporate social Responsibility on Organizational Commitment in Banking and Finance and Tourism sectors, there are no studies conducted specifically for the Turkish aviation sector to our best knowledge. Personal information form, CSR scale, Importance of CSR scale, Organizational commitment scale were used as data collection tools in the research. CSR Scale created by Türker (2006). was used to find out how employees felt about CSR. Importance of CSR Scale through a subscale of the Perceived Role of Ethics and Social Responsibility (PRESOR) that Etheredge (1999) converted into a two-factor framework, the significance of social responsibility for employees was assessed. Organizational Commitment Scale, Mowday, Steers, and Porter (1979) created the OCQ, which uses 15 measures to evaluate global commitment to the organization. As a result of the study, there is a significant positive relationship between the participants' CSR scale sub-dimensions, CSR to Employees, CSR to Customers, CSR to Society, CSR to Government, CSR to Natural Environment, CSR to Next Generation, CSR to Governmental Organizations, Importance of CSR, and Organizational Commitment scores. As a result; as the participants' Corporate Social Responsibility scores increase, their organizational commitment increases. To summarize the findings of our study, the scores obtained from the CSR scale and the scores obtained from the Organizational Commitment scale were found to have a positive and significant relationship. In other words, if the participants value the corporate social responsibility projects of the institution they work for and think that they spare time and effort, the importance they attach to the corporate social responsibility projects and their organizational commitment to the institution they work for, increase. Similarly, the scores obtained from the Importance of CSR and the scores obtained from the Organizational Commitment scale also have a positive and significant relationship. As the importance given to corporate social responsibility projects by the participants increases, their organizational commitment to the institution they work for also increases.

Keywords: corporate social responsibility, organizational commitment, Turkish cabin crew, aviation

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Authors: Tramuta Clara, Masotti Chiara, Pitti Monica, Adriano Daniela, Battistini Roberta, Serraca Laura, Decastelli Lucia

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Oysters are considered filter organisms, and their raw consumption may increase health risks for consumers: it is often associated with outbreaks of gastroenteritis or enteric illnesses. Most of these foodborne diseases are caused by Vibrio strains, enteric pathogens also involved in the diffusion of genetic determinants of antibiotic resistance and their entrance along the food chain. The European Food Safety Authority (EFSA), during the European Union report on antimicrobial resistance in 2017, focused the attention about the role of food as a possible carrier of antibiotic-resistant bacteria or antibiotic-resistance genes that determine health risks for humans. This study wants to determine antibiotic resistance and antibiotic-resistance genes in Vibrio spp. isolated from Crassostrea gigas oysters collected in the Golfo della Spezia (Liguria, Italy). A total of 47 Vibrio spp. strains were isolated (ISO21872-2:2017) during the summer of 2021 from oysters of Crassostrea gigas. The strains were identified by MALDI-TOF (Bruker, Germany) mass spectrometry and tested for antibiotic susceptibility using a broth microdiluition method (ISO20776-1:2019) using Sensititre EUVSEC plates (Thermo-Fisher Scientific) to obtain the Minimum Inhibitory Concentration (MIC). The strains were tested with PCR-based biomolecular methods, according to previous works, to define the presence of 23 resistance genes of the main classes of antibiotics used in human and veterinary medicine: tet (B), tet (C), tet (D), tet (A), tet (E), tet (G ), tet (K), tet (L), tet (M), tet (O), tet (S) (tetracycline resistance); blaCTX-M, blaTEM, blaOXA, blaSHV (β-lactam resistance); mcr-1 and mcr-2 (colistin resistance); qnrA, qnrB, and qnrS (quinolone resistance); sul1, sul2 and sul3 (sulfonamide resistance). Six different species have been identified: V. alginolyticus 34% (n=16), V. harveyi 28% (n=13), V. fortis 15% (n=7), V. pelagius 8% (n=4), V. parahaemolyticus 11% (n=5) e V. chagasii 4% (n=2). The PCR assays showed the presence of the blaTEM gene on 40% of the strains (n=19). All the other genes were not detected, except for a V. alginolyticus positive for anrS gene. The broth microdiluition method results showed an high level of resistance for ciprofloxacin (62%; n=29), ampicillin (47%; n=22), and colistin (49%; n=23). Furthermore, 32% (n=15) of strains can be considered multiresistant bacteria for the simultaneous presence of resistance for three different antibiotic classes. Susceptibility towards meropenem, azithromycin, gentamicin, ceftazidime, cefotaxime, chloramphenicol, tetracycline and sulphamethoxazole reached 100%. The Vibrio species identified in this study are widespread in marine environments and can cause gastrointerstinal infections after the ingestion of raw fish products and bivalve molluscs. The level of resistance to antibiotics such as ampicillin, ciprofloxacin and colistin can be connected to anthropic factors (industrial, agricultural and domestic wastes) that promote the spread of resistance to these antibiotics. It can be also observed a strong correlation between phenotypic (resistant MIC) and genotypic (positive blaTEM gene) resistance for ampicillin on the same strains, probably due to the transfer of genetic material between bacterial strains. Consumption of raw bivalve molluscs can represent a risk for consumers heath due to the potentially presence of foodborne pathogens, highly resistant to different antibiotics and source of transferable antibiotic-resistant genes.

Keywords: vibrio species, blaTEM genes, antimicrobial resistance, PCR

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Authors: Tomás Sobrino, Lara García-Varela, Marta Aramburu-Núñez, Mónica Castro, Noemí Gómez-Lado, Mariña Rodríguez-Arrizabalaga, Antía Custodia, Juan Manuel Pías-Peleteiro, José Manuel Aldrey, Daniel Romaus-Sanjurjo, Ángeles Almeida, Pablo Aguiar, Alberto Ouro

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Introduction: Alzheimer’s disease (AD) and other tauopathies are primary causes of dementia, causing progressive cognitive deterioration that entails serious repercussions for the patients' performance of daily tasks. Currently, there is no effective approach for the early diagnosis and treatment of AD and tauopathies. This study suggests a theragnostic approach based on the importance of phosphorylated tau protein (p-Tau) in the early pathophysiological processes of AD. We have developed a novel theragnostic monoclonal antibody (mAb) to provide both diagnostic and therapeutic effects. Methods/Results: We have developed a p-Tau mAb, which was doped with deferoxamine for radiolabeling with Zirconium-89 (89Zr) for PET imaging, as well as fluorescence dies for immunofluorescence assays. The p-Tau mAb was evaluated in vitro for toxicity by MTT assay, LDH activity, propidium iodide/Annexin V assay, caspase-3, and mitochondrial membrane potential (MMP) assay in both mouse endothelial cell line (bEnd.3) and cortical primary neurons cell cultures. Importantly, non-toxic effects (up to concentrations of p-Tau mAb greater than 100 ug/mL) were detected. In vivo experiments in the tauopathy model mice (PS19) show that the 89Zr-pTau-mAb and 89Zr-Fragments-pTau-mAb are stable in circulation for up to 10 days without toxic effects. However, only less than 0.2% reached the brain, so further strategies have to be designed for crossing the Brain-Blood-Barrier (BBB). Moreover, an intraparenchymal treatment strategy was carried out. The PS19 mice were operated to implement osmotic pumps (Alzet 1004) at two different times, at 4 and 7 months, to stimulate the controlled release for one month each of the B6 antibody or the IgG1 control antibody. We demonstrated that B6-treated mice maintained their motor and memory abilities significantly compared with IgG1 treatment. In addition, we observed a significant reduction in p-Tau deposits in the brain. Conclusions /Discussion: A theragnostic pTau-mAb was developed. Moreover, we demonstrated that our p-Tau mAb recognizes very-early pathology forms of p-Tau by non-invasive techniques, such as PET. In addition, p-Tau mAb has non-toxic effects, both in vitro and in vivo. Although the p-Tau mAb is stable in circulation, only 0.2% achieve the brain. However, direct intraventricular treatment significantly reduces cognitive impairment in Alzheimer's animal models, as well as the accumulation of toxic p-Tau species.

Keywords: alzheimer's disease, theragnosis, tau, PET, immunotherapy, tauopathies

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Authors: Fouzia Arif, Arif S. Mohammad, Hifsa Altaf, Lubna Raees

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Introduction: The term "disability", refers to any condition that impedes the completion of daily tasks using traditional methods. In developing countries like Pakistan, disable population is usually excluded from the mainstream. In squatter settlements the situation is more critical. Sultanabad is one of the squatter settlements of Karachi. Purpose of case study is to improve the health of disabled children’s, and create awareness among the parents and community. Through a household visit, Shiraz, a young disabled boy of 15.5 years old was identified. Her mother articulated that her son was living normally and happily with his parents two years back. When he was 13 years old and student of class 8th, both his legs were traumatized in a Railway Train Accident while playing cricket. He got both femoral shaft fractured severely. He was taken to Jinnah Post Graduate Medical Centre (JPMC) where his left leg was amputated at above knee level and right leg was opened & fixed by reduction internally, luckily bone healed moderately with the passage of time. Methods: In Squatter settlements of Karachi Sultanabad, a survey was conducted in two sectors. Disability screening questionnaire was developed, collaboration with community through household visits, outreach sessions 23cases of disabled were identified who were socialized through sports, Musical program and get-together was organized with stockholder for creating awareness among community and parent’s. Collaboration was established with different NGOs, Government, stakeholders and community support for establishment of Physiotherapy Center. During home visit it was identified that Shiraz was on bed since last 1 year, his family could not afforded cost of physiotherapist and medical consultation due to poverty. Parents counseling was done mentioning that Shiraz needed to take treatment. After motivation his parents agreed for treatment. He was consulted by an orthopedic surgeon in AKUH, Who referred to DMC University of Health Science for rehabilitation service. There he was assessed and referred for Community Based Physiotherapy Centre Sultanabad. Physiotherapist visited home along with Coordinator for Special children and assessed him regularly, planned Physiotherapy treatment for abdominal, high muscles strutting exercise foot muscles strengthening exercise, knee mobilization weight bearing from partial to full weight gradually, also strengthen exercise were given for residual limb as the boy was dependent on it. He was also provided by an artificial leg and training was done. Result: Shiraz is now fully mobile, he can walk independently even out of home, functional ability progress improved and dependency factors reduced. It was difficult but not impossible. We all have sympathy but if we have empathy then we can rehabilitate the community in a better way. His parents are very happy and also the community is surprised to see him in such better condition. Conclusion: Combined efforts of physiotherapist, Coordinator of special children, community and parents made a drastic change in Shiraz’s case by continuously motivating him for better outcome. He is going to school regularly without support. Since he belongs to a poor family he faces financial constraints for education and clinical follow ups regularly.

Keywords: femoral shaft fracture, trauma, orthopedic surgeon, physiotherapy treatment

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Authors: C. Soffritti, A. Fortini, E. Baroni, M. Merlin, G. L. Garagnani

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Aluminum alloys are widely used in many engineering applications due to their advantages such ashigh electrical and thermal conductivities, low density, high strength to weight ratio, and good corrosion resistance. However, their low hardness and poor tribological properties still limit their use in industrial fields requiring sliding contacts. Hard anodizing is one of the most common solution for overcoming issues concerning the insufficient friction resistance of aluminum alloys. In this work, the tribological behavior ofhard-anodized AW-4006 aluminum alloys in dry and lubricated conditions was evaluated. Three different hard-anodizing treatments were selected: a conventional one (HA) and two innovative golden hard-anodizing treatments (named G and GP, respectively), which involve the sealing of the porosity of anodic aluminum oxides (AAO) with silver ions at different temperatures. Before wear tests, all AAO layers were characterized by scanning electron microscopy (VPSEM/EDS), X-ray diffractometry, roughness (Ra and Rz), microhardness (HV0.01), nanoindentation, and scratch tests. Wear tests were carried out according to the ASTM G99-17 standard using a ball-on-disc tribometer. The tests were performed in triplicate under a 2 Hz constant frequency oscillatory motion, a maximum linear speed of 0.1 m/s, normal loads of 5, 10, and 15 N, and a sliding distance of 200 m. A 100Cr6 steel ball10 mm in diameter was used as counterpart material. All tests were conducted at room temperature, in dry and lubricated conditions. Considering the more recent regulations about the environmental hazard, four bio-lubricants were considered after assessing their chemical composition (in terms of Unsaturation Number, UN) and viscosity: olive, peanut, sunflower, and soybean oils. The friction coefficient was provided by the equipment. The wear rate of anodized surfaces was evaluated by measuring the cross-section area of the wear track with a non-contact 3D profilometer. Each area value, obtained as an average of four measurements of cross-section areas along the track, was used to determine the wear volume. The worn surfaces were analyzed by VPSEM/EDS. Finally, in agreement with DoE methodology, a statistical analysis was carried out to identify the most influencing factors on the friction coefficients and wear rates. In all conditions, results show that the friction coefficient increased with raising the normal load. Considering the wear tests in dry sliding conditions, irrespective of the type of anodizing treatments, metal transfer between the mating materials was observed over the anodic aluminum oxides. During sliding at higher loads, the detachment of the metallic film also caused the delamination of some regions of the wear track. For the wear tests in lubricated conditions, the natural oils with high percentages of oleic acid (i.e., olive and peanut oils) maintained high friction coefficients and low wear rates. Irrespective of the type of oil, smallmicrocraks were visible over the AAO layers. Based on the statistical analysis, the type of anodizing treatment and magnitude of applied load were the main factors of influence on the friction coefficient and wear rate values. Nevertheless, an interaction between bio-lubricants and load magnitude could occur during the tests.

Keywords: hard anodizing treatment, silver ions, bio-lubricants, sliding wear, statistical analysis

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Authors: Luciano Tarantino

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Gas gangrene is a rare, severe infection with a very high mortality rate caused by Clostridium species. The infection causes a non-suppurative localized producing gas lesion from which harmful toxins that impair the inflammatory response cause vessel damage and multiple organ failure. Gas gangrene of the liver is very rare and develops suddenly, often as a complication of abdominal surgery and liver transplantation. The present paper deals with a case of gas gangrene of the liver that occurred after percutaneous MW ablation of hepatocellular carcinoma, resulting in progressive liver necrosis and multi-organ failure in spite of specific antibiotics administration. The patient was successfully treated with percutaneous Radiofrequency ablation. Case report: Female, 76 years old, Child A class cirrhosis, treated with synchronous insertion of 3 MW antennae for large HCC (5.5 cm) in the VIII segment. 24 hours after treatment, the patient was asymptomatic and left the hospital . 2 days later, she complained of fever, weakness, abdominal swelling, and pain. Abdominal US detected a 2.3 cm in size gas-containing area, eccentric within the large (7 cm) ablated area. The patient was promptly hospitalized with the diagnosis of anaerobic liver abscess and started antibiotic therapy with Imipenem/cilastatine+metronidazole+teicoplanine. On the fourth day, the patient was moved to the ICU because of dyspnea, congestive heart failure, atrial fibrillation, right pleural effusion, ascites, and renal failure. Blood tests demonstrated severe leukopenia and neutropenia, anemia, increased creatinine and blood nitrogen, high-level FDP, and high INR. Blood cultures were negative. At US, unenhanced CT, and CEUS, a progressive enlargement of the infected liver lesion was observed. Percutaneous drainage was attempted, but only drops of non-suppurative brownish material could be obtained. Pleural and peritoneal drainages gave serosanguineous muddy fluid. The Surgeon and the Anesthesiologist excluded any indication of surgical resection because of the high perioperative mortality risk. Therefore, we asked for the informed consent of the patient and her relatives to treat the gangrenous liver lesion by percutaneous Ablation. Under conscious sedation, percutaneous RFA of GG was performed by double insertion of 3 cool-tip needles (Covidien LDT, USA ) into the infected area. The procedure was well tolerated by the patient. A dramatic improvement in the patient's condition was observed in the subsequent 24 hours and thereafter. Fever and dyspnea disappeared. Normalization of blood tests, including creatinine, was observed within 4 days. Heart performance improved, 10 days after the RFA the patient left the hospital and was followed-up with weekly as an outpatient for 2 months and every two months thereafter. At 18 months follow-up, the patient is well compensated (Child-Pugh class B7), without any peritoneal or pleural effusion and without any HCC recurrence at imaging (US every 3 months, CT every 6 months). Percutaneous RFA could be a valuable therapy of focal GG of the liver in patients non-responder to antibiotics and when surgery and liver transplantation are not feasible. A fast and early indication is needed in case of rapid worsening of patient's conditions.

Keywords: liver tumor ablation, interventional ultrasound, liver infection, gas gangrene, radiofrequency ablation

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Authors: Maria E. V. Amarante, Carolina L. Cerdeira, Julia V. Cortes, Fiorita G. L. Mundim

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Basal cell carcinoma (BCC) is the most prevalent type of skin cancer in humans. It arises from the basal cells of the epidermis and cutaneous appendages. The role of sunlight exposure as a risk factor for BCC is very well defined due to its power to influence genetic mutations, in addition to having a suppressor effect on the skin immune system. Despite showing low metastasis and mortality rates, the tumor is locally infiltrative, aggressive, and destructive. Considering the high prevalence rate of this carcinoma and the importance of early detection, a retrospective study was carried out in order to correlate the clinical data available on BBC, characterize it epidemiologically, and thus enable effective prevention measures for the population. Data on the period from January 2015 to December 2019 were collected from the medical records of patients registered at one pathology service located in the southeast region of Brazil, known as SVO, which delivers skin biopsy results. The study was aimed at correlating the variables, sex, age, and subtypes found. Data analysis was performed using the chi-square test at a nominal significance level of 5% in order to verify the independence between the variables of interest. Fisher's exact test was applied in cases where the absolute frequency in the cells of the contingency table was less than or equal to five. The statistical analysis was performed using the R® software. Ninety-three basal cell carcinoma were analyzed, and its frequency in the 31-to 45-year-old age group was 5.8 times higher in men than in women, whereas, from 46 to 59 years, the frequency was found 2.4 times higher in women than in men. Between the ages of 46 to 59 years, it should be noted that the sclerodermiform subtype appears more than the solid one, with a difference of 7.26 percentage points. Reversely, the solid form appears more frequently in individuals aged 60 years or more, with a difference of 8.57 percentage points. Among women, the frequency of the solid subtype was 9.93 percentage points higher than the sclerodermiform frequency. In males, the same percentage difference is observed, but sclerodermiform is the most prevalent subtype. It is concluded in this study that, in general, there is a predominance of basal cell carcinoma in females and in individuals aged 60 years and over, which demonstrates the tendency of this tumor. However, when rarely found in younger individuals, the male gender prevailed. The most prevalent subtype was the solid one. It is worth mentioning that the sclerodermiform subtype, which is more aggressive, was seen more frequently in males and in the 46-to 59-year-old range.

Keywords: basal cell carcinoma, epidemiology, sclerodermiform basal cell carcinoma, skin cancer, solar radiation, solid basal cell carcinoma

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Authors: Ana Violante, Jodie Maccarrone, Maria Fimiani

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In the United States, over 30 million people are hospitalized annually for conditions that require acute, 24-hour, supervised care. The experience of hospitalization can be traumatic, exposing the patient to loss of control, autonomy, and productivity. Furthermore, 40% of patients admitted to hospitals for general medical illness have a comorbid psychiatric diagnosis. Research suggests individuals admitted with psychiatric comorbidities experience poorer health outcomes, higher utilization rates and increased overall cost of care. Empirical work suggests hospital settings that include a consultation liaison (CL) service report reduced length of stay, lower costs per patient, improved medical staff and patient satisfaction and reduced readmission after 180 days. Despite the overall positive impact CL services can have on patient care, it is estimated that only 1% - 2.8% of hospital admits receive these services, and most research has been conducted by the field of psychiatry. Health psychologists could play an important role in increasing access to this valuable service, though the extent to which health psychologists participate in CL settings is not well known. Objective: Outline the preliminary findings from an empirical study to understand how many APPIC internship training programs offer adult consultation liaison rotations within inpatient hospital settings nationally, as well as describe the specific nature of these training experiences. Research Method/Design: Data was exported into Excel from the 2022-2023 APPIC Directory categorized as “health psychology” sites. It initially returned a total of 537 health training programs out 1518 total programs (35% of all APPIC programs). A full review included a quantitative and qualitative comprehensive review of the APPIC program summary, the site website, and program brochures. The quantitative review extracted the number of training positions; amount of stipend; location or state of program, patient, population, and rotation. The qualitative review examined the nature of the training experience. Results: 29 (5%) of all APPIC health psychology internship training programs (2%) respectively of all APPIC training internship programs offering internship CL training were identified. Of the 29 internship training programs, 16 were exclusively within a pediatric setting (55%), 11 were exclusively within an adult setting (38%), and two were a mix of pediatric and adult settings (7%). CL training sites were located to 19 states, offering a total of 153 positions nationally, with Florida containing the largest number of programs (4). Only six programs offered 12-month training opportunities while the rest offered CL as a major (6 month) to minor (3-4 month) rotation. The program’s stipend for CL training positions ranged from $25,000 to $62,400, with an average of $32,056. Conclusions: These preliminary findings suggest CL training and services are currently limited. Training opportunities that do exist are mostly limited to minor, short rotations and governed by psychiatry. Health psychologists are well-positioned to better define the role of psychology in consultation liaison services and enhance and formalize existing training protocols. Future research should explore in more detail empirical outcomes of CL services that employ psychology and delineate the contributions of psychology from psychiatry and other disciplines within an inpatient hospital setting.

Keywords: consultation liaison, health psychology, hospital setting, training

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Authors: Bryana Woodard, Monica Mitchell, Kasey Harry, Ebony Washington, Megan Harris, Marcia Boyd, Regina Lynch, Daphene Baines, Surbi Bankar

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Introduction: African Americans experience mental health illnesses (i.e., depression, anxiety, etc.) at higher rates than their white counterparts. Despite this, they utilize mental health resources less and have lower mental health literacy, perhaps due to cultural barriers- including but not limited to mistrust. Research acknowledges African Americans’ close ties to community networks, identifying these linkages as key to establishing comfort and trust. Similarly, the church has historically been a space that creates unity and community among African Americans. Studies show that longstanding academic-community partnerships with organizations, such as churches and faith-based entities, have the capability to effectively address health and mental health barriers and needs in African Americans. The importance of implementing faith-based approaches is supported in the literature, however few empirical studies exist. This project describes the First Ladies for Health and Cincinnati Children's Hospital Medical Center (CCHMC) Partnership (FLFH-CCHMC Partnership) and the implementation and assessment of an annual Mental Health Symposium, the overall aim of which was to increase mental health awareness and decrease stigma in African American communities. Methods: The specific goals of the FLFH Mental Health Symposium were to (1) Collaborate with trusted partners to build trust with community participants; (2) Increase mental health literacy and decrease mental health stigma; (3) Understand the barriers to improving mental health and improving trust; (4) Assess the short-term outcomes two months following the symposium. Data were collected through post-event and follow-up surveys using a mixed methods approach. Results: More than 100 participants attended each year with over 350 total participants over three years. 98.7% of participants were African American, 86.67% female, 11.6% male, and 11.6% LGBTQ+/non-binary; 10.5% of participants were teens, with the remainder aged 20 to 80 plus. The event was successful in achieving its goals: (1a) Eleven different speakers from 8 community and church organizations presented; (1b) 93% of participants rated the overall symposium as very good or excellent (2a) Mental health literacy significantly increased each year with over 90% of participants reporting improvement in their “understanding” and “awareness of mental health (2b) Participants 'personal stigma surrounding mental health illness decreased each year with 92.3% of participants reporting changes in their “willingness to talk about and share” mental health challenges; (3) Barriers to mental health care were identified and included social stigma, lack of trust, and the cost of care. Data were used to develop priorities and an action plan for the FLFH-CCHMC Mental Health Partnership; (4) Follow-up data showed that participants sustained benefits of the FLFH Symposium and took actionable steps (e.g., meditation, referrals, etc.). Additional quantitative and qualitative data will be shared. Conclusions: Lower rates of mental health literacy and higher rates of stigma among participants in this initiative demonstrate the importance of mental health providers building trust and partnerships in communities. Working with faith-based entities provides an opportunity to mitigate and address mental health equity in African American communities.

Keywords: community psychology, faith-based, african-american, culturally competent care, mental health equity

Procedia PDF Downloads 27

Authors: Maria Lucia G. Lourenco, Keylla H. N. P. Pereira, Vivane Y. Hibaru, Fabiana F. Souza, Joao C. P. Ferreira, Simone B. Chiacchio, Luiz H. A. Machado

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Neonatal sepsis is a systemic response to the acute generalized infection caused by one or more bacterial agents, representing the main infectious cause of neonatal mortality in dogs during the first three weeks of life. This study aims to describe the incidence of sepsis in neonate dogs, as well as the main clinical signs and mortality rates. The study included 735 neonates admitted to the Sao Paulo State University (UNESP) Veterinary Hospital, Botucatu, Sao Paulo, Brazil, between January 2018 and November 2019. Seven hundred thirty-five neonates, 14% (98/703) presented neonatal sepsis. The main sources of infection for the neonates were intrauterine (72.5%, 71/98), lactogenic (13.2%, 13/98), umbilical (5.1%, 5/98) and unidentified sources (9.2%, 9/98). The main non-specific clinical signs observed in the newborns were weakness, depression, impaired or absent reflexes, hypothermia, hypoglycemia, dehydration, reduced muscle tonus and diarrhea. The newborns also manifested clinical signs of severe infection, such as hyperemia in the abdominal and anal regions, omphalitis, hematuria, abdomen and extremities with purplish-blue coloration necrosing injuries in the pads, bradycardia, dyspnea, epistaxis, hypotension and evolution to septic shock. Infections acquired during intrauterine life led to the onset of the clinical signs at the time of birth, with fast evolution during the first hours of life. On the other hand, infections acquired via milk or umbilical cord presented clinical signs later. The total mortality rate was 5.4% (38/703) and the mortality rate among the neonates with sepsis was 38.7% (38/98). The early mortality rate (0 to 2 days) accounted for 86.9% (33/38) and the late mortality rate (3 to 30 days) for 13.1% (5/38) of the deaths among the newborns with sepsis. The main bacterial agents observed were Staphylococcus spp., Streptococcus spp., Proteus spp. Mannheimia spp. and Escherichia coli. Neonatal sepsis evolves quickly and may lead to high mortality in a litter. The prognosis is usually favorable if the diagnosis is reached early and the antibiotic therapy instituted as soon as possible, even before the results of blood cultures and antibiograms. The therapeutic recommendations should meet the special physiological conditions of a neonate in terms of metabolism and excretion of medication. Therefore, it is of utmost importance that the veterinarian is knowledgeable regarding neonatology to provide effective intervention and improve the survival rates of these patients.

Keywords: Neonatal infection , bacteria, puppies, newborn

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Authors: Ananya Pal, Neelakshi Sarkar, Debraj Saha, Dipanwita Das, Subhashish Kamal Guha, Bibhuti Saha, Runu Chakravarty

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Presently, tenofovir disoproxil fumurate (TDF) is the most effective anti-viral agent for the treatment of hepatitis B virus (HBV) in individuals co-infected with HIV and HBV as TDF has activity to suppress both wild-type and lamivudine (3TC)-resistant HBV. However, suboptimal response to TDF was reported in HIV-HBV co-infected individuals with prior 3TC therapy from different countries recently. The incidence of 3TC-resistant HBV strains is quite high in HIV-HBV co-infected patients experiencing long-term anti-retroviral therapy (ART) in eastern India. In spite of this risk, most of the patients with long-term 3TC treatment are continued with the same anti-viral agent in this country. Only a few have received TDF in addition to 3TC in the ART regimen since TDF has been available in India for the treatment of HIV-infected patients in 2012. In this preliminary study, we investigated the virologic and biochemical parameters among HIV-HBV co-infected patients who are non-responders to 3TC treatment during the continuation of 3TC or TDF add-on to 3TC in their ART regimen. Fifteen HIV-HBV co-infected patients who experienced long-term 3TC (mean duration months 36.87 ± 24.08 months) were identified with high HBV viremia ( > 20,000 IU/ml) or harbouring 3TC-resistant HBV. These patients receiving ART from School of Tropical Medicine Kolkata, the main ART centre in eastern India were followed-up semi-annually for next three visits. Different virologic parameters including quantification of plasma HBV load by real-time PCR, detection of hepatitis B e antigen (HBeAg) by commercial ELISA and anti-viral resistant mutations by sequencing were studied. During three follow-up among study subjects, 86%, 47%, and 43% had 3TC-mono-therapy (mean treatment-duration 41.54±18.84, 49.67±11.67, 54.17±12.37 months respectively) whereas 14%, 53%, and 57% experienced TDF in addition to 3TC (mean treatment duration 4.5±2.12, 16.56±11.06, and 23±4.07 months respectively). Mean CD4 cell-count in patients receiving 3TC was tended to be lower during third follow-up as compared to the first and the second [520.67±380.30 (1st), 454.8±196.90 (2nd), and 397.5±189.24 (3rd) cells/mm3) and similar trend was seen in patients experiencing TDF in addition to 3TC [334.5±330.218 (1st), 476.5±194.25 (2nd), and 461.17±269.89 (3rd) cells/mm3]. Serum HBV load was increased during successive follow-up of patients with 3TC-mono-therapy. Initiation of TDF lowered serum HBV-load among 3TC-non-responders at the time of second visit ( < 2,000 IU/ml), interestingly during third follow-up, mean HBV viremia increased >1 log IU/ml (mean 3.56±2.84 log IU/ml). Persistence of 3TC-resistant double and triple mutations was also observed in both the treatment regimens. Mean serum alanine aminotransferase remained elevated in these patients during this follow-up study. Persistence of high HBV viraemia and 3TC-resistant mutation in HBV during the continuation of 3TC might lead to major public health threat in India. The inclusion of TDF in the ART regimen of 3TC non-responder HIV-HBV co-infected patients showed adverse treatment response in terms of virologic and biochemical parameters. Therefore, serious attention is necessary for proper management of long-term 3TC experienced HIV-HBV co-infected patients with high HBV viraemia or 3TC-resistant HBV mutants in India.

Keywords: HBV, HIV, TDF, 3TC-resistant

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Authors: Christiane Paulus

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Post-Islamism assumes that the Quran should not be viewed in terms of what Lyotard identifies as a ‘meta-narrative'. However, its socio-ethical content can be viewed as critical of power discourse (Foucault). Practicing religion seems to be limited to rites and individual spirituality, taqwa. Alternatively, can we build on Muhammad Abduh's classic-modern reform and develop it through a postmodernist frame? This is the main question of this study. Through his general and vague remarks on the context of the Quran, Abduh was the first to refer to the historical and cultural distance of the text as an obstacle for interpretation. His application, however, corresponded to the modern absolute idea of authentic sharia. He was followed by Amin al-Khuli, who hermeneutically linked the content of the Quran to the theory of evolution. Fazlur Rahman and Nasr Hamid abu Zeid remain reluctant to go beyond the general level in terms of context. The hermeneutic circle, therefore, persists in challenging, how to get out to overcome one’s own assumptions. The insight into and the acceptance of the lasting ambivalence of understanding can be grasped as a postmodern approach; it is documented in Derrida's discovery of the shift in text meanings, difference, also in Lyotard's theory of différend. The resulting mixture of meanings (Wolfgang Welsch) can be read together with the classic ambiguity of the premodern interpreters of the Quran (Thomas Bauer). Confronting hermeneutic difficulties in general, Niklas Luhmann proves every description an attribution, tautology, i.e., remaining in the circle. ‘De-tautologization’ is possible, namely by analyzing the distinctions in the sense of objective, temporal and social information that every text contains. This could be expanded with the Kantian aesthetic dimension of reason (critique of pure judgment) corresponding to the iʽgaz of the Coran. Luhmann asks, ‘What distinction does the observer/author make?’ Quran as a speech from God to the first listeners could be seen as a discourse responding to the problems of everyday life of that time, which can be viewed as the general goal of the entire Qoran. Through reconstructing koranic Lifeworlds (Alfred Schütz) in detail, the social structure crystallizes the socio-economic differences, the enormous poverty. The koranic instruction to provide the basic needs for the neglected groups, which often intersect (old, poor, slaves, women, children), can be seen immediately in the text. First, the references to lifeworlds/social problems and discourses in longer koranic passages should be hypothesized. Subsequently, information from the classic commentaries could be extracted, the classical Tafseer, in particular, contains rich narrative material for reconstructing. By selecting and assigning suitable, specific context information, the meaning of the description becomes condensed (Clifford Geertz). In this manner, the text gets necessarily an alienation and is newly accessible. The socio-ethical implications can thus be grasped from the difference of the original problem and the revealed/improved order/procedure; this small step can be materialized as such, not as an absolute solution but as offering plausible patterns for today’s challenges as the Agenda 2030.

Keywords: postmodern hermeneutics, condensed description, sociological approach, small steps of reform

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Authors: Evgenia Iakovleva, Juha Koivisto, Pasi Karppinen, J. Inkinen, Mikko Alava

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Preventing the spread of infectious diseases throughout the worldwide is one of the most important tasks of modern health care. Infectious diseases not only account for one fifth of the deaths in the world, but also cause many pathological complications for the human health. Touch surfaces pose an important vector for the spread of infections by varying microorganisms, including antimicrobial resistant organisms. Further, antimicrobial resistance is reply of bacteria to the overused or inappropriate used of antibiotics everywhere. The biggest challenges in bacterial detection by existing methods are non-direct determination, long time of analysis, the sample preparation, use of chemicals and expensive equipment, and availability of qualified specialists. Therefore, a high-performance, rapid, real-time detection is demanded in rapid practical bacterial detection and to control the epidemiological hazard. Among the known methods for determining bacteria on the surfaces, Hyperspectral methods can be used as direct and rapid methods for microorganism detection on different kind of surfaces based on fluorescence without sampling, sample preparation and chemicals. The aim of this study was to assess the relevance of such systems to remote sensing of surfaces for microorganisms detection to prevent a global spread of infectious diseases. Bacillus subtilis and Escherichia coli with different concentrations (from 0 to 10x8 cell/100µL) were detected with hyperspectral camera using different filters as visible visualization of bacteria and background spots on the steel plate. A method of internal standards was applied for monitoring the correctness of the analysis results. Distances from sample to hyperspectral camera and light source are 25 cm and 40 cm, respectively. Each sample is optically imaged from the surface by hyperspectral imaging system, utilizing a JAI CM-140GE-UV camera. Light source is BeamZ FLATPAR DMX Tri-light, 3W tri-colour LEDs (red, blue and green). Light colors are changed through DMX USB Pro interface. The developed system was calibrated following a standard procedure of setting exposure and focused for light with λ=525 nm. The filter is ThorLabs KuriousTM hyperspectral filter controller with wavelengths from 420 to 720 nm. All data collection, pro-processing and multivariate analysis was performed using LabVIEW and Python software. The studied human eye visible and invisible bacterial stains clustered apart from a reference steel material by clustering analysis using different light sources and filter wavelengths. The calculation of random and systematic errors of the analysis results proved the applicability of the method in real conditions. Validation experiments have been carried out with photometry and ATP swab-test. The lower detection limit of developed method is several orders of magnitude lower than for both validation methods. All parameters of the experiments were the same, except for the light. Hyperspectral imaging method allows to separate not only bacteria and surfaces, but also different types of bacteria, such as Gram-negative Escherichia coli and Gram-positive Bacillus subtilis. Developed method allows skipping the sample preparation and the use of chemicals, unlike all other microbiological methods. The time of analysis with novel hyperspectral system is a few seconds, which is innovative in the field of microbiological tests.

Keywords: Escherichia coli, Bacillus subtilis, hyperspectral imaging, microorganisms detection

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Authors: Adeline Meriaux, Claire Gaiani, Jennifer Burgain, Frantz Fournier, Lionel Muniglia, Jérémy Petit

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Spray-drying process is widely used for the production of dairy powders for food and pharmaceuticals industries. It involves the atomization of a liquid feed into fine droplets, which are subsequently dried through contact with a hot air flow. The resulting powders permit transportation cost reduction and shelf life increase but can also exhibit various interesting functionalities (flowability, solubility, protein modification or acid gelation), depending on operating conditions and milk composition. Indeed, particles porosity, surface composition, lactose crystallization, protein denaturation, protein association or crust formation may change. Links between spray-drying conditions and physicochemical and functional properties of powders were investigated by a design of experiment methodology and analyzed by principal component analysis. Quadratic models were developed, and multicriteria optimization was carried out by the use of genetic algorithm. At the time of abstract submission, verification spray-drying trials are ongoing. To perform experiments, milk from dairy farm was collected, skimmed, froze and spray-dried at different air pressure (between 1 and 3 bars) and outlet temperature (between 75 and 95 °C). Dry matter, minerals content and proteins content were determined by standard method. Solubility index, absorption index and hygroscopicity were determined by method found in literature. Particle size distribution were obtained by laser diffraction granulometry. Location of the powder color in the Cielab color space and water activity were characterized by a colorimeter and an aw-value meter, respectively. Flow properties were characterized with FT4 powder rheometer; in particular, compressibility and shearing test were performed. Air pressure and outlet temperature are key factors that directly impact the drying kinetics and powder characteristics during spray-drying process. It was shown that the air pressure affects the particle size distribution by impacting the size of droplet exiting the nozzle. Moreover, small particles lead to more cohesive powder and less saturated color of powders. Higher outlet temperature results in lower moisture level particles which are less sticky and can explain a spray-drying yield increase and the higher cohesiveness; it also leads to particle with low water activity because of the intense evaporation rate. However, it induces a high hygroscopicity, thus, powders tend to get wet rapidly if they are not well stored. On the other hand, high temperature provokes a decrease of native serum proteins, which is positively correlated to gelation properties (gel point and firmness). Partial denaturation of serum proteins can improve functional properties of powder. The control of air pressure and outlet temperature during the spray-drying process significantly affects the physicochemical and functional properties of powder. This study permitted to better understand the links between physicochemical and functional properties of powder to identify correlations between air pressure and outlet temperature. Therefore, mathematical models have been developed, and the use of genetic algorithm will allow the optimization of powder functionalities.

Keywords: dairy powders, spray-drying, powders functionalities, design of experiment

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Authors: Chu-Tzu Chen, Angela S. Huang, Yu-Min Chou, Chin-Hui Yang

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Dengue is a major public health concern throughout tropical and sub-tropical regions. Taiwan is located in the Pacific Ocean and overlying the tropical and subtropical zones. The island remains humid throughout the year and receives abundant rainfall, and the temperature is very hot in summer at southern Taiwan. It is ideal for the growth of dengue vectors and would be increasing the risk on dengue outbreaks. During the first half of the 20th century, there were three island-wide dengue outbreaks (1915, 1931, and 1942). After almost forty years of dormancy, a DEN-2 outbreak occurred in Liuchiu Township, Pingtung County in 1981. Thereafter, more dengue outbreaks occurred with different scales in southern Taiwan. However, there were more than ten thousands of dengue cases in 2014 and in 2015. It did not only affect human health, but also caused widespread social disruption and economic losses. The study would like to reveal the epidemiology of dengue on Taiwan, especially the severe outbreak in 2015, and try to find the effective interventions in dengue control including dengue vaccine development for the elderly. Methods: The study applied the Notifiable Diseases Surveillance System database of the Taiwan Centers for Disease Control as data source. All cases were reported with the uniform case definition and confirmed by NS1 rapid diagnosis/laboratory diagnosis. Results: In 2014, Taiwan experienced a serious DEN-1 outbreak with 15,492 locally-acquired cases, including 136 cases of dengue hemorrhagic fever (DHF) which caused 21 deaths. However, a more serious DEN-2 outbreak occurred with 43,419 locally-acquired cases in 2015. The epidemic occurred mainly at Tainan City (22,760 cases) and Kaohsiung City (19,723 cases) in southern Taiwan. The age distribution for the cases were mainly adults. There were 228 deaths due to dengue infection, and the case fatality rate was 5.25 ‰. The average age of them was 73.66 years (range 29-96) and 86.84% of them were older than 60 years. Most of them were comorbidities. To review the clinical manifestations of the 228 death cases, 38.16% (N=87) of them were reported with warning signs, while 51.75% (N=118) were reported without warning signs. Among the 87 death cases reported to dengue with warning signs, 89.53% were diagnosed sever dengue and 84% needed the intensive care. Conclusion: The year 2015 was characterized by large dengue outbreaks worldwide. The risk of serious dengue outbreak may increase significantly in the future, and the elderly is the vulnerable group in Taiwan. However, a dengue vaccine has been licensed for use in people 9-45 years of age living in endemic settings at the end of 2015. In addition to carry out the research to find out new interventions in dengue control, developing the dengue vaccine for the elderly is very important to prevent severe dengue and deaths.

Keywords: case fatality rate, dengue, dengue vaccine, the elderly

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Authors: Mona Ghafouri-Azar, Sara Diamond, Jeremy Bowes, Grace Yuan, Aimee Burnett, Michelle Wyndham-West, Sara Wagner, Anand Pariyarath

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Transportation is the fastest growing source of greenhouse gas emissions worldwide. In Canada, it is responsible for 23% of total CO2emissions from fuel combustion, and emissions from the transportation sector are the second largest source of emissions after the oil and gas sector. Currently, most Canadian public transportation systems rely on buses that operateon fossil fuels.Canada is currently investing billions of dollars to replacediesel buses with electric busesas this isperceived to have a significant impact on climate mitigation. This paper focuses on the possible impacts of zero emission buses (ZEB) on sustainable development, considering three dimensions of sustainability; environmental quality, economic growth, and social development.A sustainable transportation system is one that is safe, affordable, accessible, efficient, and resilient and that contributes minimal emissions of carbon and other pollutants.To enable implementation of these goals, relevant indicators were selected and defined that measure progress towards a sustainable transportation system. These were drawn from Canadian and international examples. Studies compare different European cities in terms of development, sustainability, and infrastructures, by using transport performance indicators. A Normalized Transport Sustainability index measures and compares policies in different urban areas and allows fine-tuning of policies. Analysts use a number ofmethods for sustainable analysis, like cost-benefit analysis (CBA) toassess economic benefit, life-cycle assessment (LCA) to assess social, economic, and environment factors and goals, and multi-criteria decision making (MCDM) analysis which can comparediffering stakeholder preferences.A multi criteria decision making approach is an appropriate methodology to plan and evaluate sustainable transit development and to provide insights and meaningful information for decision makers and transit agencies. It is essential to develop a system thataggregates specific discrete indices to assess the sustainability of transportation systems.Theseprioritize indicators appropriate for the differentCanadian transit system agencies and theirpreferences and requirements. This studywill develop an integrating index that alliesexistingdiscrete indexes to supporta reliable comparison between the current transportation system (diesel buses) and the new ZEB system emerging in Canada. As a first step, theindexes for each category are selected, and the index matrix constructed. Second, the selected indicators arenormalized to remove anyinconsistency between them. Next, the normalized matrix isweighted based on the relative importance of each index to the main domains of sustainability using the analytical hierarchy process (AHP) method. This is accomplished through expert judgement around the relative importance of different attributes with respect to the goals through apairwise comparison matrix. The considerationof multiple environmental, economic, and social factors (including equity and health) is integrated intoa sustainable transit planning index (STPI) which supportsrealistic ZEB implementation in Canada and beyond and is useful to different stakeholders, agencies, and ministries.

Keywords: zero emission buses, sustainability, sustainable transit, transportation, analytical hierarchy process, environment, economy, social

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Authors: Demelash Kassaye

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The Ethiopia case study reveals a unique model of community policing that has developed from a particular political context in which there is a history of violent political transition, a political structure characterized by ethnic federalism and a political ideology that straddles liberal capitalism and democracy on the one hand, and state-led development and centralized control on the other. The police see community policing as a way to reduce crime. Communities speak about community policing as an opportunity to take on policing responsibilities themselves. Both of these objectives are brought together in an overarching rhetoric of community policing as a way of ‘mobilizing for development’ – whereby the community cooperate with the police to reduce crime, which otherwise inhibits development progress. Community policing in Amhara has primarily involved the placement of Community Police Officers at the kebele level across the State. In addition, a number of structures have also been established in the community, including Advisory Councils, Conflict Resolving Committees, family police and the use of shoe shiner’s and other trade associations as police informants. In addition to these newly created structures, community policing also draws upon pre-existing customary actors, such as militia and elders. Conflict Resolving Committees, Community Police Officers and elders were reported as the most common first ports of call when community members experience a crime. The analysis highlights that the model of community policing in Amhara increased communities’ access to policing services, although this is not always attended by increased access to justice. Community members also indicate that public perceptions of the police have improved since the introduction of community policing, in part due to individual Community Police Officers who have, with limited resources, innovated some impressive strategies to improve safety in their neighborhoods. However, more broadly, community policing has provided the state with more effective surveillance of the population – a potentially oppressive function in the current political context. Ultimately, community policing in Amhara is anything but straightforward. It has been a process of attempting to demonstrate the benefits of newfound (and controversial) ‘democracy’ following years of dictatorship, drawing on generations of customary dispute resolution, providing both improved access to security for communities and an enhanced surveillance capacity for the state. For external actors looking to engage in community policing, this case study reveals the importance of close analysis in assessing potential merits, risks and entry points of programming. Factors found to be central in shaping the nature of community policing in the Amhara case include the structure of the political system, state-society relations, cultures dispute resolution and political ideology.

Keywords: community policing, community, militias, ethiopia

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Authors: Juan A. Arzate, Funda C. Ertem, M. Nicolas Cruz-Bournazou, Peter Neubauer, Stefan Junne

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— One of the biggest challenges the world faces today is global warming that is caused by greenhouse gases (GHGs) coming from the combustion of fossil fuels for energy generation. In order to mitigate climate change, the European Union has committed to reducing GHG emissions to 80–95% below the level of the 1990s by the year 2050. Renewable technologies are vital to diminish energy-related GHG emissions. Since water and biomass are limited resources, the largest contributions to renewable energy (RE) systems will have to come from wind and solar power. Nevertheless, high proportions of fluctuating RE will present a number of challenges, especially regarding the need to balance the variable energy demand with the weather dependent fluctuation of energy supply. Therefore, biogas plants in this content would play an important role, since they are easily adaptable. Feedstock availability varies locally or seasonally; however there is a lack of knowledge in how biogas plants should be operated in a stable manner by local feedstock. This problem may be prevented through suitable control strategies. Such strategies require the development of convenient mathematical models, which fairly describe the main processes. Modelling allows us to predict the system behavior of biogas plants when different feedstocks are used with different loading rates. Life cycle assessment (LCA) is a technique for analyzing several sides from evolution of a product till its disposal in an environmental point of view. It is highly recommend to use as a decision making tool. In order to achieve suitable strategies, the combination of a flexible energy generation provided by biogas plants, a secure production process and the maximization of the environmental benefits can be obtained by the combination of process modelling and LCA approaches. For this reason, this study focuses on the biogas plant which flexibly generates required energy from the co-digestion of maize, grass and cattle manure, while emitting the lowest amount of GHG´s. To achieve this goal AMOCO model was combined with LCA. The program was structured in Matlab to simulate any biogas process based on the AMOCO model and combined with the equations necessary to obtain climate change, acidification and eutrophication potentials of the whole production system based on ReCiPe midpoint v.1.06 methodology. Developed simulation was optimized based on real data from operating biogas plants and existing literature research. The results prove that AMOCO model can successfully imitate the system behavior of biogas plants and the necessary time required for the process to adapt in order to generate demanded energy from available feedstock. Combination with LCA approach provided opportunity to keep the resulting emissions from operation at the lowest possible level. This would allow for a prediction of the process, when the feedstock utilization supports the establishment of closed material circles within a smart bio-production grid – under the constraint of minimal drawbacks for the environment and maximal sustainability.

Keywords: AMOCO model, GHG emissions, life cycle assessment, modelling

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Authors: Takaaki Nemoto

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Case presentation: A 69-year-old Japanese man presented with a low-grade fever and fatigue that had persisted for one month. The patient had an aortic dissection on the aortic arch 13 years prior, an abdominal aortic aneurysm seven years prior, and an aortic dissection on the distal aortic arch one year prior, which were all treated with artificial blood-vessel replacement surgery. Laboratory tests revealed an inflammatory response (CRP 7.61 mg/dl), high serum creatinine (Cr 1.4 mg/dL), and elevated transaminase (AST 47 IU/L, ALT 45 IU/L). The patient was admitted to our hospital on suspicion of prosthetic vascular graft infection. Following further workups on the inflammatory response, an enhanced chest computed tomography (CT) and a non-enhanced chest DWI (MRI) were performed. The patient was diagnosed with a pulmonary fistula and a prosthetic vascular graft infection on the distal aortic arch. After admission, the patient was administered Ceftriaxion and Vancomycine for 10 days, but his fever and inflammatory response did not improve. On day 13 of hospitalization, a lung fistula repair surgery and an omental filling operation were performed, and Meropenem and Vancomycine were administered. The fever and inflammatory response continued, and therefore we took repeated blood cultures. M. fortuitum was detected in a blood culture on day 16 of hospitalization. As a result, we changed the treatment regimen to Amikacin (400 mg/day), Meropenem (2 g/day), and Cefmetazole (4 g/day), and the fever and inflammatory response began to decrease gradually. We performed a test of sensitivity for Mycobacterium fortuitum, and found that the MIC was low for fluoroquinolone antibacterial agent. The clinical course was good, and the patient was discharged after a total of 8 weeks of intravenous drug administration. At discharge, we changed the treatment regimen to Levofloxacin (500 mg/day) and Clarithromycin (800 mg/day), and prescribed these two drugs as a long life suppressive therapy. Discussion: There are few cases of prosthetic vascular graft infection caused by mycobacteria, and a standard therapy remains to be established. For prosthetic vascular graft infections, it is ideal to provide surgical and medical treatment in parallel, but in this case, surgical treatment was difficult and, therefore, a conservative treatment was chosen. We attempted to increase the treatment success rate of this refractory disease by conducting a susceptibility test for mycobacteria and treating with different combinations of antimicrobial agents, which was ultimately effective. With our treatment approach, a good clinical course was obtained and continues at the present stage. Conclusion: Although prosthetic vascular graft infection resulting from mycobacteria is a refractory infectious disease, it may be curative to administer appropriate antibiotics based on the susceptibility test in addition to surgical treatment.

Keywords: prosthetic vascular graft infection, lung fistula, Mycobacterium fortuitum, conservative treatment

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