Search results for: birth outcome

Authors: Hosam Alzahrani, Martin Mackey, Emmanuel Stamatakis, Marina B. Pinheiro, Manuela Wicks, Debra Shirley

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Objective: To investigate the effectiveness of incidental (non-structured) physical activity interventions compared with other commonly prescribed interventions for the management of people with low back pain (LBP). Methods: We performed a systematic review with meta-analyses of eligible randomized controlled trials obtained by searching Medline, Scopus, CINAHL, EMBASE, and CENTRAL. This review considered trials investigating the effect of incidental physical activity interventions compared to other interventions in people aged 18 years or over, diagnosed with non-specific LBP. Analyses were conducted separately for short-term (≤3 months), intermediate-term (> 3 and < 12 months), and long-term (≥ 12 months), for each outcome. The analyses were conducted using the weighted mean difference (WMD). The overall quality of evidence was assessed using the GRADE system. Meta-analyses were only performed for pain and disability outcomes as there was insufficient data on the other outcomes. Results: For pain, the pooled results did not show any significant effects between the incidental physical activity intervention and other interventions at any time point. For disability, incidental physical activity was not statistically more effective than other interventions at short-term; however, the pooled results favored incidental physical activity at intermediate-term (WMD= -6.05, 95% CI: -10.39 to -1.71, p=0.006) and long-term (WMD= -6.40 95% CI: -11.68 to -1.12, p=0.02) follow-ups among participants with chronic LBP. The overall quality of evidence was rated “moderate quality” based on the GRADE system. Conclusion: The incidental physical activity intervention provided intermediate and long disability relief for people with chronic LBP, although this improvement was small and not likely to be clinically important.

Keywords: physical activity, incidental, low back pain, systematic review, meta-analysis

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Authors: Nour Mohamad Fayad

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Complex and extensively researched, the impact of corruption on economic growth seems to be intricate. Many experts believe that corruption reduces economic development. However, counterarguments have suggested that corruption either promotes growth and development or has no significant impact on economic performance. Clearly, there is no consensus in the economics literature regarding the possible relationship between corruption and economic development. Corruption's complex and clandestine nature, which makes it difficult to define and measure, is one of the obstacles that must be overcome when investigating its effect on an economy. In an attempt to contribute to the ongoing debate, this study examines the impact of corruption on economic growth in the Middle East and North Africa (MENA) region between 2000 and 2021 using a Customized Corruption Index-CCI and panel data on MENA countries. These countries were selected because they are understudied in the economic literature, and despite the World Bank's recent emphasis on corruption in the developing world, the MENA countries have received little attention. The researcher used Cobb-Douglas functional form to test corruption in MENA using a customized index known as Customized Corruption Index-CCI to track corruption over almost 20 years, then used the dynamic panel data. The findings indicate that there is a positive correlation between corruption and economic growth, but this is not consistent across all MENA nations. First, the relatively recent lack of data from MENA nations. This issue is related to the inaccessibility of data for many MENA countries, particularly regarding the returns on resources, private malfeasance, and other variables in Gulf countries. In addition, the researcher encountered several restrictions, such as electricity and internet outages, due to the fact that he is from Lebanon, a country whose citizens have endured difficult living conditions since the Lebanese crisis began in 2019. Demonstrating a customized index known as Customized Corruption Index-CCI that suits the characteristics of MENA countries to peculiarly measure corruption in this region, the outcome of the Customized Corruption Index-CCI is then compared to the Corruption Perception Index-CPI and Control of Corruption from World Governance Indicator-CC from WGI.

Keywords: corruption, economic growth, corruption measurements, empirical review, impact of corruption

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Authors: Shalu Jain, Anju Bansal, Anup Kumar, Sunita Saxena

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Objectives: The novel TMPRSS2:ERG gene fusion is a common somatic event in prostate cancer that in some studies is linked with a more aggressive disease phenotype. Thus, this study aims to determine whether clinical variables are associated with the presence of TMPRSS2:ERG-fusion gene transcript in Indian patients of prostate cancer. Methods: We evaluated the clinical variables with presence and absence of TMPRSS2:ERG gene fusion in prostate cancer and BPH association of clinical patients. Patients referred for prostate biopsy because of abnormal DRE or/and elevated sPSA were enrolled for this prospective clinical study. TMPRSS2:ERG mRNA copies in samples were quantified using a Taqman chemistry by real time PCR assay in prostate biopsy samples (N=42). The T2:ERG assay detects the gene fusion mRNA isoform TMPRSS2 exon1 to ERG exon4. Results: Histopathology report has confirmed 25 cases as prostate cancer adenocarcinoma (PCa) and 17 patients as benign prostate hyperplasia (BPH). Out of 25 PCa cases, 16 (64%) were T2: ERG fusion positive. All 17 BPH controls were fusion negative. The T2:ERG fusion transcript was exclusively specific for prostate cancer as no case of BPH was detected having T2:ERG fusion, showing 100% specificity. The positive predictive value of fusion marker for prostate cancer is thus 100% and the negative predictive value is 65.3%. The T2:ERG fusion marker is significantly associated with clinical variables like no. of positive cores in prostate biopsy, Gleason score, serum PSA, perineural invasion, perivascular invasion and periprostatic fat involvement. Conclusions: Prostate cancer is a heterogeneous disease that may be defined by molecular subtypes such as the TMPRSS2:ERG fusion. In the present prospective study, the T2:ERG quantitative assay demonstrated high specificity for predicting biopsy outcome; sensitivity was similar to the prevalence of T2:ERG gene fusions in prostate tumors. These data suggest that further improvement in diagnostic accuracy could be achieved using a nomogram that combines T2:ERG with other markers and risk factors for prostate cancer.

Keywords: prostate cancer, genetic rearrangement, TMPRSS2:ERG fusion, clinical variables

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Authors: Shu-Lien Chou, Chung-Feng Liu

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Self-health management of chronic illnesses plays an important part in chronic illness treatments. However, various kinds of health information (health education materials) which government or healthcare institutions provide for patients may not achieve the expected outcome. One of the critical reasons affecting patients’ use intention could be patients’ perceived Information overload regarding the health information. This study proposed an extended model of Theory of Planned Behavior, which integrating perceived information overload as another construct to explore patients’ use intention of the health information for self-health management. The independent variables are attitude, subject norm, perceived behavior control and perceived information overload while the dependent variable is behavior intention to use the health information. The cross-sectional study used a structured questionnaire for data collection, focusing on the chronic patients with coronary artery disease (CAD), who are the potential users of the health information, in a medical center in Taiwan. Data were analyzed using descriptive statistics of the basic information distribution of the questionnaire respondents, and the Partial Least Squares (PLS) structural equation model to study the reliability and construct validity for testing our hypotheses. A total of 110 patients were enrolled in this study and 106 valid questionnaires were collected. The PLS analysis result indicates that the patients’ perceived information overload of health information contributes the most critical factor influencing the behavioral intention. Subjective norm and perceived behavioral control of TPB constructs had significant effects on patients’ intentions to use health information also, whereas the attitude construct did not. This study demonstrated a comprehensive framework, which extending perceived information overload into TPB model to predict patients’ behavioral intention of using heath information. We expect that the results of this study will provide useful insights for studying health information from the perspectives of academia, governments, and healthcare providers.

Keywords: chronic patients, health information, information overload, theory of planned behavior

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Authors: Cath Grimley, Debra Bick, Sarah Hillman, Louise Clarke, Helen Atherton, Jo Parsons

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The problem: Women in the UK are offered influenza (flu), pertussis (whooping cough) and COVID-19 vaccinations during their pregnancy but uptake of all three vaccines is below the desired rate. These vaccines are offered during pregnancy as pregnant women are at an increased risk of hospitalisation, morbidity, and mortality from these illnesses. Exposure to these diseases during pregnancy can also have a negative impact on the unborn baby with an increased risk of serious complications both while in utero and following birth. The research aims to explore perceptions about the vaccinations offered in pregnancy both from the perspectives of pregnant women and midwives. To determine factors that influence pregnant women’s decisions about whether or not to accept the vaccines following the Covid-19 pandemic and to explore midwives’ experiences of recommending and delivering vaccines. The approach: This research follows a qualitative design involving semi-structured interviews with pregnant women and midwives in the UK. Interviews with midwives explored vaccination discussions they routinely have with pregnant women and identified some of the barriers to vaccination that pregnant women discuss with them. Interviews with pregnant women explored their views since the COVID-19 pandemic about vaccinations offered during pregnancy, and whether the pandemic has influenced perceptions of vulnerability to illness in pregnant women. Midwives were recruited via participating hospitals and midwife specific social media groups. Pregnant women were recruited via participating hospitals and community groups. All interviews were conducted remotely (using telephone or Microsoft Teams) and analysed using thematic analysis. Findings: 43 pregnant women and 16 midwives were recruited and interviewed. The findings presented here will focus on data from midwives. Topics identified included three key themes for midwives. These were 1) Delivery of vaccinations which includes the convenience of offering vaccinations while attending standard antenatal appointments and practical barriers faced in delivering these vaccinations at hospital. 2) Messages and guidance included the importance of up-to-date informational needs for midwives to deliver vaccines and that uncertainty and conflicting messages about the COVID-19 vaccine during pregnancy were a barrier to delivery. 3) Recommendations to have vaccines look at all aspects of recommendations such as how recommendations are communicated, the contents of the recommendation, the importance of the vaccine and the impact of those recommendations on whether women accept the vaccine. Implications: Findings highlight the importance for midwives to receive clear and consistent information so they can feel confident in relaying this information while recommending and delivering vaccines to pregnant women. Emphasising why vaccines are important when recommending vaccinations to pregnant women in addition to standard information on the availability and timing will add to the strength and impact of that recommendation in helping women to make informed decisions about accepting vaccines. The findings of this study will inform the development of an intervention to increase vaccination uptake amongst pregnant women.

Keywords: vaccination, pregnancy, qualitative, interviews, Covid-19, midwives

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Authors: O.F. Akinmoladun, F.N. Fon, C.T. Mpendulo, O. Okoh

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The sustainability of livestock production is under threat as a result of water scarcity, fluctuating precipitation, and high environmental temperature. These combined stressors have impacted negatively on general animal production and welfare, necessitating a very reliable and cost-effective management practices, especially in arid and water-limited regions of the world. Instead of the above, this study was designed to investigate the growth performance and physiological response of water-restricted Xhosa ear-lobe goats fed diets supplemented with single or multiple vitamin C (VC) during summer. The total forty-eight goats used for the experiment were balanced for body weight and randomly assigned to the seven treatment groups (seven goats/treatment): GI (W100%); GII (W70%); GIII (W50%); GIV (W70%+3g/day VC); GV ((W50% +3g/day VC); GVI (W70%+3g/d VC+extra 5g on every eight-day); GVII (W50%+3g/d VC+extra 5g on every eight-day). The design was a complete randomized design and VC was administered per os. At the end of the 75-day feeding trial, GIII (W50%) animals were the most affected (P<0.05) and the effect was more pronounced in their body condition scores (BCs). Weight loss and depression in feed intake due to water restriction (P<0.05) were attenuated by VC treated groups (GIV-GVII). Changes in body thermal gradient (BTG) and rectal temperature (RcT) were similar (P>0.05) across the various experimental groups. The attenuation effect of VC was significant in responses to respiratory rate (RR) and cortisol. Supplementation of VC (either single or multiple) did not significantly (P>0.05) improve water restriction effect on body condition scores (BCs) and FAMACHA©. The current study found out that Xhosa ear lobe goats can adapt to the prevailing bioclimatic changes and limited water intake. However, supplementation of vitamin C can be beneficial at modulating these stressful stimuli. Continuous consistencies in the outcome of vitamin C on water-stressed animals can help validate recommendations especially to farmers in the arid and water-limited regions across the globe.

Keywords: vitamin C, Xhosa ear-lobe, thermotolerance, water stress

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Authors: Tan Lay Cheng (Cheryl), Low Huiqi

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Background: All children learn at different pace. Individualized learning is an approach that tailors to the individual learning needs of each child. When implementing this approach, educators have to base their lessons on the understanding that all students learn differently and that what works for one student may not work for another. In the current early childhood environment, individualized learning is for children with diverse needs. However, a typical developing child is also able to benefit from individualized learning. This research abstract explores the concept of utilizing DNA-MILE, a patented (in Singapore) DNA-based assessment tool that can be used to measure a variety of factors that can impact learning. The assessment report includes the dominant intelligence of the user or, in this case, the child. From the result, a personalized learning plan that is tailored to each individual student's needs. Methods: A study will be conducted to investigate the effectiveness of DNA-MILE in supporting individualized learning. The study will involve a group of 20 preschoolers who were randomly assigned to either a DNA-MILE-assessed group (experimental group) or a control group. 10 children in each group. The experimental group will receive DNA Mile assessments and personalized learning plans, while the control group will not. The children in the experimental group will be taught using the dominant intelligence (as shown in the DNA-MILE report) to enhance their learning in other domains. The children in the control group will be taught using the curriculum and lesson plan set by their teacher for the whole class. Parents’ and teachers’ interviews will be conducted to provide information about the children before the study and after the study. Results: The results of the study will show the difference in the outcome of the learning, which received DNA Mile assessments and personalized learning plans, significantly outperformed the control group on a variety of measures, including standardized tests, grades, and motivation. Conclusion: The results of this study suggest that DNA Mile can be an effective tool for supporting individualized learning. By providing personalized learning plans, DNA Mile can help to improve learning outcomes for all students.

Keywords: individualized, DNA-MILE, learning, preschool, DNA, multiple intelligence

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Authors: Ahmad Zulfahmi Mohd Kamaruzaman, Mohd Ismail Ibrahim, Ariffin Marzuki Mokhtar, Maizun Mohd Zain, Saiful Nazri Satiman, Mohd Najib Majdi Yaacob

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Background: Aftermath any patient safety incidents, the involved healthcare providers possibly sustained second victim-related distress (second victim distress and reduced their professional efficacy), with subsequent negative work-related outcomes or vice versa cultivating resilience. This study aimed to investigate the factors affecting negative work-related outcomes and resilience, with the triad of support; colleague, supervisor, and institutional support as the hypothetical mediators. Methods: This was a cross sectional study recruiting a total of 733 healthcare providers from three tertiary care in Kelantan, Malaysia. Three steps of hierarchical linear regression were developed for each outcome; negative work-related outcomes and resilience. Then, four multiple mediator models of support triad were analyzed. Results: Second victim distress, professional efficacy, and the support triad contributed significantly for each regression model. In the pathway of professional efficacy on each negative work-related outcomes and resilience, colleague support partially mediated the relationship. As for second victim distress on negative work related outcomes, colleague and supervisor support were the partial mediator, and on resilience; all support triad also produced a similar effect. Conclusion: Second victim distress, professional efficacy, and the support triad influenced the relationship with the negative work-related outcomes and resilience. Support triad as the mediators ameliorated the effect in between and explained the urgency of having good support for recovery post encountering patient safety incidents.

Keywords: second victims, patient safety incidents, hierarchical linear regression, mediation, support

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Authors: Quentin Lobbe, David Chavalarias, Alexandre Delanoe

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The ICT revolution has given birth to an unprecedented world of digital traces and has impacted a wide number of knowledge-driven domains such as science, education or policy making. Nowadays, we are daily fueled by unlimited flows of articles, blogs, messages, tweets, etc. The internet itself can thus be considered as an unsteady hyper-textual environment where websites emerge and expand every day. But there are structures inside knowledge. A given text can always be studied in relation to others or in light of a specific socio-cultural context. By way of their textual traces, human beings are calling each other out: hypertext citations, retweets, vocabulary similarity, etc. We are in fact the architects of a giant web of elements of knowledge whose structures and shapes convey their own information. The global shapes of these digital traces represent a source of collective knowledge and the question of their visualization remains an opened challenge. How can we explore, browse and interact with such shapes? In order to navigate across these growing constellations of words and texts, interdisciplinary innovations are emerging at the crossroad between fields of social and computational sciences. In particular, complex systems approaches make it now possible to reconstruct the hidden structures of textual knowledge by means of multi-scale objects of research such as semantic maps and phylomemies. The phylomemy reconstruction is a generic method related to the co-word analysis framework. Phylomemies aim to reveal the temporal dynamics of large corpora of textual contents by performing inter-temporal matching on extracted knowledge domains in order to identify their conceptual lineages. This study aims to address the question of visualizing the global shapes of online political discussions related to the French presidential and legislative elections of 2017. We aim to build phylomemies on top of a dedicated collection of thousands of French political tweets enriched with archived contemporary news web articles. Our goal is to reconstruct the temporal evolution of online debates fueled by each political community during the elections. To that end, we want to introduce an iterative data exploration methodology implemented and tested within the free software Gargantext. There we combine synchronic and diachronic axis of visualization to reveal the dynamics of our corpora of tweets and web pages as well as their inner syntagmatic and paradigmatic relationships. In doing so, we aim to provide researchers with innovative methodological means to explore online semantic landscapes in a collaborative and reflective way.

Keywords: online political debate, French election, hyper-text, phylomemy

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Authors: Aynura Valiyeva, Basil John Thomas

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Intra-firm communication is critical for building synergy amongst internal business units of a firm, where employees from various functional departments and ranks incorporate their decision-making, understanding of organizational objectives, as well as common norms and culture for better organizational effectiveness. This study builds on and assesses a framework of the causes and consequences of effective communication in business interactions between customer and supplier firms, and the path for efficient communication within a firm. The proposed study’s structural equation modeling (SEM) analysis based on 352 sample responses collected from firm representatives at different job positions ranging from marketing to logistics operations, reveals that, in the frame of reference of intra-organizational communication, organization characteristics and shared values, top management support and style of leadership, as well as information technology, are all significantly related to communication effectiveness. Furthermore, the frequency and variety of interactions enhance the outcome of communication, that improves a company’s performance. The results reveal that cultural factors are significantly related to communication effectiveness, as well as the shared beliefs and goals. In terms of organizational factors, leadership style, top management support and information technology are significant determinants of effective communication. Among the contextual factors, interaction frequency and diversity are found to be priority factors. This study also tests the relationship between supplier and supplier firm performance in the context of communication effectiveness, and finds that they are closely related, when trust and commitment is built between business partners. When firms do business in other multicultural contexts, language and shared values with destination country must be considered significant elements of communication process.

Keywords: business performance, intra-firm communication, inter-firm communication, structural equation modeling

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Authors: Shilpa Kumari, Ramakumar Jayachandran

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Machining of aluminium extrusion profiles in the automotive industry has gained much interest in the last decade, particularly due to the higher utilization of aluminum profiles and the weight reduction benefits it brings. Milling is the most common material removal process, where the rotary milling cutter is moved against a workpiece. The physical contact of the milling cutter to the workpiece increases the friction between them, thereby affecting the longevity of the milling tool and also the surface finish of the workpiece. To minimise this issue, the milling process uses cutting fluids or emulsions; however, the use of emulsion in the process has a negative impact on the environment ( such as consumption of water, oils and the used emulsion needs to be treated before disposal) and also on the personal ( may cause respiratory problems, exposure to microbial toxins generated by bacteria in the emulsions on prolonged use) working close to the process. Furthermore, the workpiece also needs to be cleaned after the milling process, which is not adding value to the process, and the cleaning also disperses mist of emulsion in the working environment. Hydro Extrusion is committed to improving the performance of sustainability from its operations, and with the negative impact of using emulsion in the milling process, a new innovative process- Dry Milling was developed to minimise the impact the cutting fluid brings. In this paper, the authors present one application of dry milling in the machining of tensile specimens in the laboratory. Dry milling is an innovative milling process without the use of any cooling/lubrication and has several advantages. Several million tensile tests are carried out in extrusion laboratories worldwide with the wet milling process. The machining of tensile specimens has a significant impact on the reliability of test results. The paper presents the results for different 6xxx alloys with different wall thicknesses of the specimens, which were machined by both dry and wet milling processes. For both different 6xxx alloys and different wall thicknesses, mechanical properties were similar for samples milled using dry and wet milling. Several tensile specimens were prepared using both dry and wet milling to compare the results, and the outcome showed the dry milling process does not affect the reliability of tensile test results.

Keywords: dry milling, tensile testing, wet milling, 6xxx alloy

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Authors: B. Vijay Antony Raj, Umarani Gunasekaran, R. Thiru Kumara Raja Vallaban

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Fibrous autoclaved aerated concrete (FAAC) is concrete containing fibrous material in it which helps to increase its structural integrity when compared to that of convention autoclaved aerated concrete (CAAC). These short discrete fibers are uniformly distributed and randomly oriented, which enhances the bond strength within the aerated concrete matrix. Conventional red-clay bricks create larger impact to the environment due to red soil depletion and it also consumes large amount to time for construction. Whereas, AAC are larger in size, lighter in weight and it is environmentally friendly in nature and hence it is a viable replacement for red-clay bricks. Internal micro cracks and corner cracks are the only disadvantages of conventional autoclaved aerated concrete, to resolve this particular issue it is preferable to make use of fibers in it.These fibers are bonded together within the matrix and they induce the aerated concrete to withstand considerable stresses, especially during the post cracking stage. Hence, FAAC has the capability of enhancing the mechanical properties and energy absorption capacity of CAAC. In this research work, individual fibers like glass, nylon, polyester and polypropylene are used they generally reduce the brittle fracture of AAC.To study the fibre’s surface topography and composition, SEM analysis is performed and then to determine the composition of a specimen as a whole as well as the composition of individual components EDAX mapping is carried out and then an experimental approach was performed to determine the effect of hybrid (multiple) fibres at various dosage (0.5%, 1%, 1.5%) and curing temperature of 180-2000 C is maintained to determine the mechanical properties of autoclaved aerated concrete. As an analytical part, the outcome experimental results is compared with fuzzy logic using MATLAB.

Keywords: fiberous AAC, crack control, energy absorption, mechanical properies, SEM, EDAX, MATLAB

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Authors: Tahar Tayachi, Ahlam Alrehaili

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Purpose: The purpose of this paper is to investigate the relationship between the corporate board characteristics and the dividend policy among firms on the Saudi Stock Exchange. Design/Methodology/Approach: This paper uses a sample of 103 nonfinancial firms over a time period of 4 years from 2015 to 2018. To investigate how corporate governance mechanisms such as board independence, the board size, frequency of meetings, and free cash flow impact dividends, the study uses Logit and Tobit models. Findings: This paper finds that board size, board independence, and frequency of board meetings have no influence on a firm’s decision to pay dividends, while board size has a significantly positive impact on the levels of cash dividends paid to investors. This study also finds that the level of free cash flows has a positively significant influence on both the decision to pay dividends and the magnitude of dividend payouts. Research Limitations/Implications: This paper attempts to study the effectiveness of dividend policy among some firms on the Saudi Stock Exchange. Practical Implications: The findings reveal that board characteristics, which represent one of the crucial mechanisms of corporate governance, were found to be complementary to corporate laws and regulations imposed on the Saudi market in 2015. The findings also imply that capital market authorities should revise their corporate regulations and ensure that protection laws are adequate and strong enough to protect the interests of all shareholders. Originality/Value: This paper is among the few studies focusing on dividend policy in Saudi Arabia. Finally, these findings suggest that the improvements in corporate laws in Saudi Arabia led to such an outcome, and it has become prevalent in dividend policy decisions and behaviors of Saudi firms.

Keywords: agency theory, Tobit, corporate governance, dividend payout, Logit

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Authors: Gustavo Naranjo Maroto, Dolores Fernandez Martinez

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Context has always been essential to understand any reaction from every human being, and words, whether written or spoken, are definitely a powerful representative sample of human reaction. This study starts with an accurate breakdown of the context in which the current president of the US, Mr. Donald J. Trump is conveying his discourses in order to be able to judge them from a critical discourse analysis point of view. The present world’s scenario with a pandemic disease in form of Covid-19 that is threatening the world and certainly putting at risk the so called 'Welfare State', the role of the United States as the first superpower on earth nowadays, the very peculiar profile of President Trump not only as a politician but as a persona, and the fact of being on the verge of a very controversial presidential elections are without doubt a great and undeniable opportunity for the implementation of the critical discourse analysis methodology. Hence, this research will primarily analyze in detail some of the most interesting discourses delivered by Trump in different media since the very beginning of the outbreak of the coronavirus pandemic in the United States of America (February, 2020), sadly very often downplayed by President Trump, until the final result of the upcoming presidential election scheduled for Tuesday, November 3, 2020, where the political discourse has been dramatically downgraded to a very dangerous state, putting in jeopardy the fundamentals of the political fair play in terms of speech. Finally, the study will hopefully conclude with the final outcome of the data analyzed, allowing to picture how significant the context can be concerning linguistics on the one hand, in terms of shaping or altering the message that the issuer thought to convey in the first place, and on the other hand, generously assessing to what extend the recipients of the message are influenced by the message in terms of receptiveness.

Keywords: Covid-19, critical discourse analysis, Donald J. Trump, political discourse

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Authors: Luc de Brabandere

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Searchers in various disciplines have long tried to understand how a human being thinks. Most of them seem to agree that the brain works in two very different modes. For us, the first phase of thought imagines, diverges, and unlocks the field of possibilities. The second phase, judges converge and choose. But if we were to stop there, that would give the impression that thought is essentially an individual effort that seldom depends on context. This is, however, not the case. Whether we be a champion in creativity, so primarily in induction, or a master in logic where we are confronted with reality, the ideas we layout are indeed destined to be presented to third parties. They should therefore be exposed, defended, communicated, negotiated, or even sold. Regardless of the quality of the concepts we craft (creative thinking) and the interferences we build (logical thinking) we will take one day, or another, be confronted by people whose beliefs, opinions and ideas differ from ours (critical thinking). Logic and critique: The shared characteristics of logical and critical thoughts include a three-level structure of reasoning invented by the Greeks. For the first time in history, Aristotle tried to model thought deployable in three stages: the concept, the statement, and the reasoning. The three levels can be assessed according to different criteria. A concept is more or less useful, a statement is true or false, and reasoning is right or wrong. This three-level structure allows us to differentiate logic and critique, where the intention and words used are not the same. Logic only deals with the structure of reasoning and exhausts the problem. It regards premises as acquired and excludes the debate. Logic is in all certainty and pursues the truth. Critique is most probably searching for the plausible. Logic and creativity: Many known models present the brain as a two-stroke engine (divergence vs convergence, fast vs. slow, left-brain vs right-brain, Yin vs Yang, etc.). But that’s not the only thing. “Why didn’t we think of that before?” How often have we heard that sentence? A creative idea is the outcome of logic, but you can only understand it afterward! Through the use of exercises, we will witness how logic and creativity work together. A third theme is hidden behind the two main themes of the conference: logical thought, which the author can shed some light on.

Keywords: creativity, logic, critique, digital

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Authors: Marine Hascoet, Valentina Giaconi, Ludivine Jamain

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The aim of our study is to examine if the family socio-economic status (SES) has an influence on students’ academic achievement. We first make the hypothesis that the more their families have financial and social resources, the more students succeed at school. We second make the hypothesis that this family SES has also an impact on parents’ expectations about their children educational outcomes. Moreover, we want to study if that parents’ expectations play the role of mediator between parents’ socio-economic status and the student’ self-concept and academic outcome. We test this model with a longitudinal design thanks to the census-based assessment from the System of Measurement of the Quality of Education (SIMCE). The SIMCE tests aim to assess all the students attending to regular education in a defined level. The sample used in this study came from the SIMCE assessments done three times: in 4th, 8th and 11th grade during the years 2007, 2011 and 2014 respectively. It includes 156.619 students (75.084 boys and 81.535 girls) that had valid responses for the three years. The family socio-economic status was measured at the first assessment (in 4th grade). The parents’ educational expectations and the students’ self-concept were measured at the second assessment (in 8th grade). The achievement score was measured twice; once when children were in 4th grade and a second time when they were in 11th grade. To test our hypothesis, we have defined a structural equation model. We found that our model fit well the data (CFI = 0.96, TLI = 0.95, RMSEA = 0.05, SRMR = 0.05). Both family SES and prior achievements predict parents’ educational expectations and effect of SES is important in comparison to the other coefficients. These expectations predict students’ achievement three years later (with prior achievement controlled) but not their self-concept. Our model explains 51.9% of the achievement in the 11th grade. Our results confirm the importance of the parents’ expectations and the significant role of socio-economic status in students’ academic achievement in Chile.

Keywords: Chilean context, parent’s expectations, school achievement, self-concept, socio-economic status

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Authors: Rosario Carmona

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This article aims to discuss the importance of indigenous people participation in climate change mitigation and adaptation. Specifically, it analyses different understandings of climate vulnerability among diverse actors involved in climate change policies in Chile: indigenous people, state officials, and academics. These data were collected through participant observation and interviews conducted during October 2017 and January 2019 in Chile. Following Karen O’Brien, there are two types of vulnerability, outcome vulnerability and contextual vulnerability. How vulnerability to climate change is understood determines the approach, which actors are involved and which knowledge is considered to address it. Because climate change is a very complex phenomenon, it is necessary to transform the institutions and their responses. To do so, it is fundamental to consider these two perspectives and different types of knowledge, particularly those of the most vulnerable, such as indigenous people. For centuries and thanks to a long coexistence with the environment, indigenous societies have elaborated coping strategies, and some of them are already adapting to climate change. Indigenous people from Chile are not an exception. But, indigenous people tend to be excluded from decision-making processes. And indigenous knowledge is frequently seen as subjective and arbitrary in relation to science. Nevertheless, last years indigenous knowledge has gained particular relevance in the academic world, and indigenous actors are getting prominence in international negotiations. There are some mechanisms that promote their participation (e.g., Cancun safeguards, World Bank operational policies, REDD+), which are not absent from difficulties. And since 2016 parties are working on a Local Communities and Indigenous Peoples Platform. This paper also explores the incidence of this process in Chile. Although there is progress in the participation of indigenous people, this participation responds to the operational policies of the funding agencies and not to a real commitment of the state with this sector. The State of Chile omits a review of the structure that promotes inequality and the exclusion of indigenous people. In this way, climate change policies could be configured as a new mechanism of coloniality that validates a single type of knowledge and leads to new territorial control strategies, which increases vulnerability.

Keywords: indigenous knowledge, climate change, vulnerability, Chile

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Authors: Julia Gontar, Natalia Buderatskaya, Igor Ilyin, Olga Parnitskaya, Sergey Lavrynenko, Eduard Kapustin, Ekaterina Ilyina, Yana Lakhno

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Introduction: It is well known that oocytes obtained from older reproductive women have accumulated mitochondrial DNA mutations, which negatively affects the morphology of a developing embryo and may lead to the birth of a child with mitochondrial disease. Special techniques have been developed to allow a donor oocyte cytoplasmic transfer with the parents’ biological nuclear DNA retention. At the same time, it is important to understand whether the procedure affects the future embryonic chromosome sets as the nuclear DNA is the transfer subject in this new complex procedure. Material and Methods: From July 2015 to July 2016, the investigation was carried out in the Medical Centre IGR. 34 donor oocytes (group A) were used for the manipulation with the aim of donating cytoplasm: 21 oocytes were used for zygotes pronuclear transfer and oocytes 13 – for the spindle transfer. The mean age of the oocyte donors was 28.4±2.9 years. The procedure was performed using Nikon Ti Eclipse inverted microscope equipped with the micromanipulators Narishige system (Japan), Saturn 3 laser console (UK), Oosight imaging systems (USA). For the preimplantation genetic screening (PGS) blastocyst biopsy was performed, trophectoderm samples were diagnosed using fluorescent in situ hybridization on chromosomes 9, 13, 15, 16, 17, 18, 21, 22, X, Y. For comparison of morphological characteristics and euploidy, was chosen a group of embryos (group B) with the amount of 121 blastocysts obtained from 213 oocytes, which were gotten from the donor programs of assisted reproductive technologies (ART). Group B was not subjected to donor oocyte cytoplasmic transfer procedure and studied on the above mentioned chromosomes. Statistical analysis was carried out using the criteria t, x^2 at a significance levels p<0.05, p<0.01, p<0.001. Results: After the donor cytoplasm transfer process the amount of the third day developing embryos was 27 (79.4%). In this stage, the group B consisted of 189 (88.7%) developing embryos, and there was no statistically significant difference (SSD) between the two groups (p>0.05). After a comparative analysis of the morphological characteristics of the embryos on the fifth day, we also found no SSD among the studied groups (p>0.05): from 34 oocytes exposed to manipulation, 14 (41.2%) blastocysts was obtained, while the group B blastocyst yield was 56.8% (n=121) from 213 oocytes. The following results were obtained after PGS performing: in group A euploidy in studied chromosomes were 28.6%(n=4) blastocysts, whereas in group B this rate was 40.5%(n=49), 28.6%(n=4) and 21.5%(n=26) of mosaic embryos and 42.8%(n=6) and 38.0%(n=46) aneuploid blastocysts respectively were identified. None of these specified parameters had an SSD (p>0.05). But attention was drawn by the blastocysts in group A with identified mosaicism, which was chaotic without any cell having euploid chromosomal set, in contrast to the mosaic embryos in group B where identified chaotic mosaicism was only 2.5%(n=3). Conclusions: According to the obtained results, there is no direct procedural effect on the chromosome in embryos obtained following donor oocyte cytoplasmic transfer. Thus, the technology introduction will enhance the infertility treating effectiveness as well as avoiding having a child with mitochondrial disease.

Keywords: donor oocyte cytoplasmic transfer, embryos’ chromosome set, oocyte spindle transfer, pronuclear transfer

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Authors: Aboli Gore, Aritra Das, Sunil Sonthalia, Tanmay Mahapatra, Sridhar Srikantiah, Hemant Shah

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AMANAT is an initiative, taken in collaboration with the Government of Bihar, aimed at improving the Quality of Maternal and Neonatal care services at Bihar’s public health facilities – those offering either the Basic Emergency Obstetric and Neonatal care (BEmONC) or Comprehensive Emergency Obstetric and Neonatal care (CEmONC) services. The effectiveness of this program is evaluated by conducting cross-sectional assessments at the concerned facilities prior to (baseline) and following completion (endline) of intervention. Direct Observation of Delivery (DOD) methodology is employed for carrying out the baseline and endline assessments – through which key obstetric and neonatal care practices among the Health Care Providers (especially the nurses) are assessed quantitatively by specially trained nursing professionals. Assessment of vitals prior to delivery improved during all three phases of BEmONC and all four phases of CEmONC training with statistically significant improvement noted in: i) pulse measurement in BEmONC phase 2 (9% to 68%), 3 (4% to 57%) & 4 (14% to 59%) and CEmONC phase 2 (7% to 72%) and 3 (0% to 64%); ii) blood pressure measurement in BEmONC phase 2 (27% to 84%), 3 (21% to 76%) & 4 (36% to 71%) and CEmONC phase 2 (23% to 76%) and 3 (2% to 70%); iii) fetal heart rate measurement in BEmONC phase 2 (10% to 72%), 3 (11% to 77%) & 4 (13% to 64%) and CEmONC phase 1 (24% to 38%), 2 (14% to 82%) and 3 (1% to 73%); and iv) abdominal examination in BEmONC phase 2 (14% to 59%), 3 (3% to 59%) & 4 (6% to 56%) and CEmONC phase 1 (0% to 24%), 2 (7% to 62%) & 3 (0% to 62%). Regarding infection control, wearing of apron, mask and cap by the delivery conductors improved significantly in all BEmONC phases. Similarly, the practice of handwashing improved in all BEmONC and CEmONC phases. Even on disaggregation, the handwashing showed significant improvement in all phases but CEmONC phase-4. Not only the positive practices related to handwashing improved but also negative practices such as turning off the tap with bare hands declined significantly in the aforementioned phases. Significant decline was also noted in negative maternal care practices such as application of fundal pressure for hastening the delivery process and administration of oxytocin prior to delivery. One of the notable achievement of AMANAT is an improvement in active management of the third stage of labor (AMTSL). The overall AMTSL (including administration of oxytocin or other uterotonics uterotonic in proper dose, route and time along with controlled cord traction and uterine massage) improved in all phases of BEmONC and CEmONC mentoring. Another key area of improvement, across phases, was in proper cutting/clamping of the umbilical cord. AMANAT mentoring also led to improvement in important immediate newborn care practices such as initiation of skin-to-skin care and timely initiation of breastfeeding. The next phase of the mentoring program seeks to institutionalize mentoring across the state that could potentially perpetuate improvement with minimal external intervention.

Keywords: capacity building, nurse-mentoring, quality of care, pregnancy, newborn care

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Authors: Marah El-Beeli, Abdullah Balkhair, Zakaryia Al Muharmi, Samir Al Adawi, Mansoor Al-Jabri, Abdullah Al Rawahi, Hazaa Al Yahyae, Eman Al Balushi, Yahya M. Al-Farsi

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The health care service and the anticancer chemotherapeutics has changed the natural history of cancer into manageable chronic disease and improve the cancer patient’s lifestyle and increase the survival time. Despite that, still, infection is the major dilemma opposing the cancer patient either because of the clinical presentation of the cancer type and impaired immune system or as a consequence of anticancer therapy. This study has been conducted to1) track changes in the epidemiology of hospital-acquired bloodstream infections among patients with malignancies in the last five years. 2) To explore the causative pathogens and 3) the outcome of HA-BSIs in patients with a different types of malignancies. An ampi-directional study (retrospective and prospective follow up) of patients with malignancies admitted at Sultan Qaboos University hospital (570-bed tertiary hospital) during the study period (from January 2015 to December 2019). The cumulative frequency and prevalence rates of HA-BSIs by patients and isolates were calculated. In addition, the cumulative frequency of participants with single versus mixed infections and types of causative micro-organisms of HA-BSIs were obtained. A total of 1246 event of HA-BSIs has occurred during the study period. Nearly the third (30.25%) of the HA-BSI events was identified among 288 patients with malignancies. About 20% of cases were mixed infections (more than one isolate). Staphylococcus spp were the predominant isolated pathogen (24.7%), followed by Klebsiella spp (15.8%), Escherichia spp (13%), and Pseudomonas spp (9.3%). About half (51%) of cases died in the same year, and (64%) of the deaths occur within two weeks after the infection. According to the observations, no changes in the trends of epidemiology, causative pathogens, morbidity, and mortality rates in the last five years.

Keywords: epidemiology, haematological malignancies, hospital acquired bloodstream infections, solid malignancies

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Authors: Jonathan J. Burson

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With the rise of virtually costless, mobile-based trading platforms, stock market trading activity has increased significantly over the past decade, particularly for the millennial generation. This increased stock market attention, combined with the recent market turmoil due to the economic upset caused by COVID-19, make the topics of market-timing and forecasting particularly relevant. While the overall stock market saw an unprecedented, historically-long bull market from March 2009 to February 2020, the end of that bull market reignited a search by investors for a way to reduce risk and increase return. Similar searches for outperformance occurred in the early, and late 2000’s as the Dotcom bubble burst and the Great Recession led to years of negative returns for mean-variance, index investors. Extensive research has been conducted on fundamental analysis, technical analysis, macroeconomic indicators, microeconomic indicators, and other techniques—all using different methodologies and investment periods—in pursuit of higher returns with lower risk. The enormous variety of timeframes, data, and methodologies used by the diverse forecasting methods makes it difficult to compare the outcome of each method directly to other methods. This paper establishes a process to evaluate the market-timing methods in an apples-to-apples manner based on simplicity, performance, and feasibility. Preliminary findings show that certain technical analysis models provide a higher return with lower risk when compared to the buy-and-hold method and to other market-timing strategies. Furthermore, technical analysis models tend to be easier for individual investors both in terms of acquiring the data and in analyzing it, making technical analysis-based market-timing methods the preferred choice for retail investors.

Keywords: buy-and-hold, forecast, market-timing, probit, technical analysis

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Authors: Ika Jorum

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The aim of this collaborative project was to develop library support that contributes in a long-term way to a technical university’s work on increased equality in education. The background was an assessment made by the Higher Education Authority that showed the need for improvement regarding equality in several programs at the university. The university’s Vice President for equality and Vice President for sustainability announced funds for projects that supported the improvement of equality in education. The library was granted funding for a one-year project that aimed both to support teachers in order to embed equality in education and to support the library staff and improve the organization’s own work. The part of the project that was directed to teachers was performed as activities in different areas and forms, such as acquisition and collections, teaching, exhibitions and book discussions. Besides the activities and support that was offered to teachers, the education team had journal clubs in order to develop and embed equality in their own teaching. The part that was directed to library staff and management was performed as workshops in collaboration with Equality Office in order to identify areas where the library could make improvements on work with equality and inclusion. The expectation was that the activities would be well attended since the project team had got indications that the content would be relevant. The outcome of this project was that some activities turned out to be more attended than others and what is expected to be found relevant, for example, a workshop on information searching from a gender and equality perspective for teachers, might still not attract participants. On the other hand, Ph.D. students and students participated in the book discussions and wanted them to continue after the project had ended. Results will be shared both on what was successful and what was challenging. Some reflections will be given on what can be done to attract participants to activities in the area of gender equality that is most likely relevant for the expected attendants and how results from a project on gender equality can be integrated into an organization’s daily work.

Keywords: equality, higher education, critical information literacy, collaboration

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Authors: Heba Salem

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This paper aims to share the researcher’s experience of using e-Portfolios as an assessment tool to follow up on students’ learning experiences and performance throughout the semester. It also aims at highlighting the importance of students’ self-reflection in the process of language learning. The paper begins by introducing the advanced media course, with its focus on listening and speaking skills, and introduces the students’ profiles. Then it explains the students’ role in the e-portfolio process as they are given the option to choose a listening text they studied throughout the semester and to choose a recorded oral production of their collection of artifacts throughout the semester. Students showcase and reflect on their progress in both listening comprehension and speaking. According to the research, re-listening to work given to them and to their production is a means of reflecting on both their progress and achievement. And choosing the work students want to showcase is a means to promote independent learning as well as self-expression. Students are encouraged to go back to the class learning outcomes in the process of choosing the work. In their reflections, students express how they met the specific learning outcome. While giving their presentations, students expressed how useful the experience of returning and going over what they covered to select one and going over their production as well. They also expressed how beneficial it was to listen to themselves and literally see their progress in both listening comprehension and speaking. Students also reported that they grasped more details from the texts than they did when first having it as an assignment, which coincided with one of the class learning outcomes. They also expressed the fact that they had more confidence speaking as well as they were able to use a variety of vocabulary and idiomatic expressions that students have accumulated. For illustration, this paper includes practical samples of students’ tasks and instructions as well as samples of their reflections. The results of students’ reflections coincide with what the research confirms about the effectiveness of the e-portfolios as a means of assessment. The employment of e-Portfolios has two-folded benefits; students are able to measure the achievement of the targeted learning outcomes, and teachers receive constructive feedback on their teaching methods.

Keywords: e-portfolios, assessment, self assessment, listening and speaking progress, foreign language, reflection, learning out comes, sharing experience

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Authors: Rakesh Mishra

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India’s Demography has always amazed the world because of its unprecedented outcomes in the presence of multifaceted socioeconomic and geographical characteristics. Being the first one to implement family panning in 1952, it occupies 2nd largest population of the world, with some of its state like Uttar Pradesh contributing 5th largest population to the world population surpassing Brazil. Being the one with higher in number it is more prone to the demographic disparity persisting into its territories brought upon by the inequalities in availability, accessibility and attainability of socioeconomic and various other resources. Fifth goal of Millennium Development Goal emphasis to improve maternal and child health across the world as Children’s development is very important for the overall development of society and the best way to develop national human resources is to take care of children. The target is to reduce the infant deaths by three quarters between 1990 and 2015. Child health status depends on the care and delivery by trained personnel, particularly through institutional facilities which is further associated with the status of the mother. However, delivery in institutional facilities and delivery by skilled personnel are rising slowly in India. The main objective of the present study is to measure the child health status on based on the educational and occupational background of the women in India. Study indicates that women education plays a very crucial role in deciding the health of the new born care and access to family planning, but the women autonomy indicates to have mixed results in different states of India. It is observed that rural women are 1.61 times more likely to exclusive breastfed their children compared to urban women. With respect to Hindu category, women belonging to other religious community were 21 percent less likely to exclusive breastfed their child. Taking scheduled caste as reference category, the odds of exclusive breastfeeding is found to be decreasing in comparison to other castes, and it is found to be significant among general category. Women of high education status have higher odds of using family planning methods in most of the southern states of India. By and large, girls and boys are about equally undernourished. Under nutrition is generally lower for first births than for subsequent births and consistently increases with increasing birth order for all measures of nutritional status. It is to be noted that at age 12-23 months, when many children are being weaned from breast milk, 30 percent of children are severely stunted and around 21 percent are severely underweight. So, this paper presents the evidence on the patterns of prevailing child health status in India and its states with reference to the mother socioeconomics and biological characteristics and examines trends in these, and discusses plausible explanations.

Keywords: immunization, exclusive breastfeeding, under five mortality, binary logistic regression, ordinal regression and life table

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Authors: Saheed Shittu, Lolwa Alansari, Fahed Nattouf, Tawa Olukade, Naji Abdallah, Tamara Alshdafat, Sarra Amdouni

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Cesarean sections (CS), a highly regarded surgical intervention for improving fetal-maternal outcomes and serving as an integral part of emergency obstetric services, are not without complications. Although CS has many advantages, it poses significant risks to both mother and child and increases healthcare expenditures in the long run. The escalating global prevalence of CS, coupled with variations in rates among immigrant populations, has prompted an inquiry into the correlation between CS rates and the nationalities of women undergoing deliveries at Al-Wakra Hospital (AWH), Qatar's second-largest public maternity hospital. This inquiry is motivated by the notable CS rate of 36%, deemed high in comparison to the 34% recorded across other Hamad Medical Corporation (HMC) maternity divisions This is Qatar's first comprehensive investigation of Caesarean section rates and nationalities. A retrospective cross-sectional study was conducted, and data for all births delivered in 2019 were retrieved from the hospital's electronic medical records. The CS rate, the crude rate, and adjusted risks of Caesarean delivery for mothers from each nationality were determined. The common indications for CS were analysed based on nationality. The association between nationality and Caesarean rates was examined using binomial logistic regression analysis considering Qatari women as a standard reference group. The correlation between the CS rate in the country of nationality and the observed CS rate in Qatar was also examined using Pearson's correlation. This study included 4,816 births from 69 different nationalities. CS was performed in 1767 women, equating to 36.5%. The nationalities with the highest CS rates were Egyptian (49.6%), Lebanese (45.5%), Filipino and Indian (both 42.2%). Qatari women recorded a CS rate of 33.4%. The major indication for elective CS was previous multiple CS (39.9%) and one prior CS, where the patient declined vaginal birth after the cesarean (VBAC) option (26.8%). A distinct pattern was noticed: elective CS was predominantly performed on Arab women, whereas emergency CS was common among women of Asian and Sub-Saharan African nationalities. Moreover, a significant correlation was found between the CS rates in Qatar and the women's countries of origin. Also, a high CS rate was linked to instances of previous CS. As a result of these insights, strategic interventions were successfully implemented at the facility to mitigate unwarranted CS, resulting in a notable reduction in CS rate from 36.5% in 2019 to 34% in 2022. This proves the efficacy of the meticulously researched approach. The focus has now shifted to reducing primary CS rates and facilitating well-informed decisions regarding childbirth methods.

Keywords: maternal nationality, caesarean section rate variation, migrants, high-income country

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Authors: Min-Feng Hsieh

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Nowadays, we are facing a highly competitive environment in which the situation for survival has come even more critical than ever before. The challenge we will be confronted with is no longer can be dealt with the single system of knowledge. The abilities we urgently need to acquire is something that can lead us to cross over the boundaries between different disciplines and take us to a neutral ground that gathers and integrates powers and intelligence that surrounds us. This paper aims at discussing how a trans-disciplinary design course organized by the College of Design at Chaoyang University can react to this modern challenge. By orchestrating an experimental course format and by developing a series of coaching strategies, a trans-disciplinary learning environment has been created and practiced in which students selected from five different departments, including Architecture, Interior Design, Visual Design, Industrial Design, Landscape and Urban Design, are encouraged to think outside their familiar knowledge pool and to learn with/from each other. In the course of implementing this program, a parallel research has been conducted alongside by adopting the theory and principles of Action Research which is a research methodology that can provide the course organizer emergent, responsive, action-oriented, participative and critically reflective insights for the immediate changes and amendments in order to improve the effect of teaching and learning experience. In the conclusion, how the learning and teaching experience of this trans-disciplinary design studio can offer us some observation that can help us reflect upon the constraints and division caused by the subject base curriculum will be pointed out. A series of concepts for course design and teaching strategies developed and implemented in this trans-disciplinary course are to be introduced as a way to promote learners’ self-motivated, collaborative, cross-disciplinary and student-centered learning skills. The outcome of this experimental course can exemplify an alternative approach that we could adopt in pursuing a remedy for dealing with the problematic issues of the current educational practice.

Keywords: course design, coaching strategy, subject base curriculum, trans-disciplinary

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Authors: Jamal Alasiri, Naif Hakeem, Saoud Almaslmani

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Background: Patients with humeral shaft fractures have two different treatment options. Surgical therapy has lesser risks of non-union, mal-union, and re-intervention than non-surgical therapy. These positive clinical outcomes of the surgical approach make it a preferable treatment option despite the risks of radial nerve palsy and additional surgery-related risk. We aimed to evaluate patients’ outcomes and return to work after surgical vs. non-surgical management of shaft humeral fracture. Methods: We used databases, including PubMed, Medline, and Cochrane Register of Controlled Trials, from 2010 to January 2022 to search for potential randomised controlled trials (RCTs) and cohort studies comparing the patients’ related outcome measures and return to work between surgical and non-surgical management of humerus fracture. Results: After carefully evaluating 1352 articles, we included three RCTs (232 patients) and one cohort study (39 patients). The surgical intervention used plate/nail fixation, while the non-surgical intervention used a splint or brace procedure to manage shaft humeral fracture. The pooled DASH effects of all three RCTs at six (M.D: -7.5 [-13.20, -1.89], P: 0.009) I2:44%) and 12 months (M.D: -1.32 [-3.82, 1.17], p:0.29, I2: 0%) were higher in patients treated surgically than in non-surgical procedures. The pooled constant Murley score at six (M.D: 7.945[2.77,13.10], P: 0.003) I2: 0%) and 12 months (M.D: 1.78 [-1.52, 5.09], P: 0.29, I2: 0%) were higher in patients who received non-surgical than surgical therapy. However, pooled analysis for patients returning to work for both groups remained inconclusive. Conclusion: Altogether, we found no significant evidence supporting the clinical benefits of surgical over non-surgical therapy. Thus, the non-surgical approach remains the preferred therapeutic choice for managing shaft humeral fractures due to its lesser side effects.

Keywords: shaft humeral fracture, surgical treatment, Patient-related outcomes, return to work, DASH

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Authors: Laura Çami (Vorpsi), Xhon Skënderi

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In today's rapidly evolving technological landscape, the traditional principles of contract law are facing significant challenges. The emergence of new technologies, such as electronic signatures, smart contracts, and online dispute resolution mechanisms, is transforming the way contracts are formed, interpreted, and enforced. This paper examines the implications of these technological advancements on the constitutional principles of contract law. One of the fundamental principles of contract law is freedom of contract, which ensures that parties have the autonomy to negotiate and enter into contracts as they see fit. However, the use of technology in the contracting process has the potential to disrupt this principle. For example, online platforms and marketplaces often offer standard-form contracts, which may not reflect the specific needs or interests of individual parties. This raises questions about the equality of bargaining power between parties and the extent to which parties are truly free to negotiate the terms of their contracts. Another important principle of contract law is the requirement of consideration, which requires that each party receives something of value in exchange for their promise. The use of digital assets, such as cryptocurrencies, has created new challenges in determining what constitutes valuable consideration in a contract. Due to the ambiguity in this area, disagreements about the legality and enforceability of such contracts may arise. Furthermore, the use of technology in dispute resolution mechanisms, such as online arbitration and mediation, may raise concerns about due process and access to justice. The use of algorithms and artificial intelligence to determine the outcome of disputes may also raise questions about the impartiality and fairness of the process. Finally, it should be noted that there are many different and complex effects of technical improvements on the fundamental constitutional foundations of contract law. As technology continues to evolve, it will be important for policymakers and legal practitioners to consider the potential impacts on contract law and to ensure that the principles of fairness, equality, and access to justice are preserved in the contracting process.

Keywords: technological advancements, constitutional principles, contract law, smart contracts, online dispute resolution, freedom of contract

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Authors: Praveen Adusumilli, Meher Lakshmi Konatam, Sadashivudu Gundeti, Stalin Bala

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The invention of trastuzumab has changed the treatment of breast cancer and lives of many patients all over the world. Despite many patients getting benefitted from the drug, it is out of reach for most of the patients. There is very limited real world data regarding the epidemiology and clinical outcome of Her2neu positive breast cancer patients. Materials and Methods: This is a retrospective analysis of breast cancer patients presenting to a tertiary care cancer centre in Southern India from 2007 to2013. All early and locally advanced breast cancer patients, who were Her2neu 3+ on IHC are included in the study and evaluated in terms of epidemiology, 3-year disease free survival (DFS)and 5-year overall survival(OS). Chemotherapy regimens used were-FAC 6 cycles or AC 4 cycles followed by 12 cycles of weekly paclitaxel . Trastuzumab was given after 6 cycles of FAC or weekly with paclitaxel followed by 3weekly maintenance until 1 year. Results: Over the period of this study there were 885 newly diagnosed cases of carcinoma breast, of which 242 (27%) were Her2neu positive, 360(40%) were hormone receptor positive, and 212(24%) were triple negative. A total of 71(8%) were Her2neu equivocal of which only 10 patients got FISH test done. Of the 212 newly diagnosed patients, only 74 (29%) opted to have standard of care therapy with trastuzumab at our centre, out of which 52(24%), 8(3%), received under insurance, paying basis respectively. 14(9%) patients received the care as part of clinical trial program (ALTTO trial). 7 (9.72%) patients developed decrease of ejection fraction by greater than 10%, requiring stoppage of trastuzumab out of which 5 were restarted in 2 months. Patients receiving trastuzumab along with chemotherapy had longer 3year DFS 92% vs. 60% (p value<0.0001) when compared to chemotherapy alone. 5 year OS was 87% vs 44% (p-value <0.0001) compared to chemotherapy alone. Conclusion: Trastuzumab with chemotherapy improves the DFS and OS in Her2neu positive patients. The biggest constraint is the cost of the treatment and absence of universal health security net to treat all patients with this diagnosis.

Keywords: breast cancer, Her 2 neu positive, real world data, Trastuzumab

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Authors: Margaret Elaine J. Villamayor, Lobert A. Padua, Neil S. Bacaltos, Virgilio P. Bañez

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Significance: This study aimed to determine the prevalence of Hepatobiliary Tuberculosis (HBTB) with biliary obstruction and to compare the outcomes of ERCP versus PTBD in these patients. Methodology: This is a cross-sectional study involving patients from PGH who underwent biliary drainage from HBTB from January 2009 to June 2014. HBTB was defined as having evidence of TB (culture, smear, PCR, histology) or clinical diagnosis with the triad of jaundice, fever, and calcifications on imaging with other causes of jaundice excluded. The primary outcome was successful drainage and secondary outcomes were mean hospital stay and complications. Simple logistic regression was used to identify factors associated with success of drainage, z-test for two proportions to compare outcomes of ERCP versus PTBD and t-test to compare mean hospital stay post-procedure. Results: There were 441 patients who underwent ERCP and PTBD, 19 fulfilled the inclusion criteria. 11 underwent ERCP while 8 had PTBD. There were more successful cases in PTBD versus ERCP but this was not statistically significant (p-value 0.3615). Factors such as age, gender, location and nature of obstruction, vices, coexisting pulmonary or other extrapulmonary TB and presence of portal hypertension did not affect success rates in these patients. The PTBD group had longer mean hospital stay but this was not significant (p-value 0.1880). There were no complications reported in both groups. Conclusion: HBTB comprises 4.3% of the patients undergoing biliary drainage in PGH. Both ERCP and PTBD are equally safe and effective in the management of biliary obstruction from HBTB.

Keywords: cross-sectional, hepatobiliary tuberculosis, obstructive jaundice, endoscopic retrograde cholangiopancreatography, percutaneous transhepatic biliary drainage

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