Search results for: residual power series methods

Authors: Constantinos Adamides, Petros Petrikkos

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In the era of growing hybrid threats, small states find themselves in need to re-evaluate existing foreign and defense policies. The pressure to establishing or maintain a status of a reliable partner in the community in which they belong to, vis-à-vis their multilateral relations with other organisations and entities, small states may need to shift their policies in the field to accommodate security needs that are not only pertinent to their security, but also to that of the organisations (bloc) in which they interact. Unlike potential shortcomings in a small state’s mainstream security and defence framework where the threat would be limited to the state itself, in more contemporary times with dominating hybrid threats, the small states’ security shortcomings may also become a security problem for the bloc in which these states belong to. An indicative example is small states like Cyprus and Malta, which belong and 'interact' in the European Union. As a result, the nature of hybrid threats can be utilised to hurt bigger states in a bloc by exploiting the small states’ vulnerabilities and security gaps. Inevitably, both the defensive and foreign policy collaborations of small states with bigger states have been and are constantly re-evaluated to tackle and prevent such problems. In essence, the goal of this ‘re-evaluation’ aims to achieve a twofold goal: The first is the small states’ quest to appear as a reliable partner within the bloc, while the second is to avoid being the weakest security link in the bloc’s defence against hybrid threats. Indeed, the hybrid arena is a security area where they can excel in the bloc, despite the potential and expected conventional military deficiencies. This new environment prompts us to think security from the perspective of small states differently and in relation to their role as members or big organisations. The paper focuses on the case of Cyprus following its accession to the European Union and examines how a country that has had a very focused security orientation –not least due to its ongoing security problems– altered its foreign and defence policies within the European Union to ensure compliance with the rest of the bloc, while at the same time maximizing its role as a security player. Specifically, it examines the methods through which the country shifted its policies as well as the challenges and opportunities that emerged from these security shifts.

Keywords: Cyprus, defence, foreign policy, hybrid threats, ontological security, small states

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Authors: Elyce Cardonick, Shistri Dhar, Linsdey Seidman

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Background: When breast cancer is diagnosed during pregnancy, the prognosis is comparable to non-pregnant women matched for prognostic indicators when pregnant women receive treatment without delay. Chemotherapy, including taxanes, can be given during pregnancy with normal neonatal development in exposed fetuses. Methods: Cases of primary breast cancer were extracted from the Cancer and Pregnancy Registry and longitudinal study at Cooper Medical School, which collects cases of pregnant women diagnosed and treated for cancer into a single database. Obstetrical, oncology and pediatric records were reviewed, including annual neonatal developmental, behavioral and medical assessments. Results: 270 pregnant women were diagnosed with primary breast cancer at a mean gestational age of 14.7+9weeks. Mean maternal age at diagnosis 34.5+4.5 years. Receptor status is comparable to non-pregnant women of reproductive age. Forty-nine women were advised to terminate. Two hundred two women underwent surgery;244 women received chemotherapy in pregnancy after the first trimester; the majority of Doxorubucin/Cytoxan; 81 of the cases included a taxane. At a mean of 90 months, follow up obtained on 255 newborns.192/255 newborns are meeting developmental milestones. Respiratory illnesses, including asthma, and bronchiolitis, were reported in 64 newborns, the most common medical condition reported. Thirty-one children are undergoing treatment for GERD, 11 for urinary tract infections, and 7 are undergoing treatment for anemia. Twenty-six children with expressive or articulation language delays, 21/26 are mild. Eleven children with gross/ 7 with fine motor delays. Eight children are treated for ADHD, 4 for anxiety and 4 have social skill impairment. The majority of children with developmental, language or motor delays were born preterm. Conclusion: After chemotherapy exposure in utero for breast cancer, the majority of newborns are meeting developmental milestones and are medically healthy. The goal for treating pregnant women with breast cancer is to aim for delivery close to the term.

Keywords: breast cancer, pregnancy, chemotherapy, newborn

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Authors: Nibedita Priyadarsini

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It is said that Ethics has a wide range of application which mainly deals with human life and human behavior. All ethical decisions are ultimately concerned with life and death. Both life and death must be considered dignified. Medical ethics with its different topics mostly deals with life and death concepts among which euthanasia is one. Various types of debates continue over Euthanasia long since. The question of putting an end to someone’s life has aroused controversial in legal sphere as well as in moral sphere. To permit or not to permit has remained an enigma the world over. Modern medicine is in the stage of transcending limits that cannot be set aside. The morality of allowing people to die without treatment has become more important as methods of treatment have become more sophisticated. Allowing someone to die states an essential recognition that there is some point in any terminal illness when further curative treatment has no purpose and the patient in such situation should allow dying a natural death in comfort, peace, and dignity, without any interference from medical science and technology. But taking a human life is in general sense is illogical in itself. It can be said that when we kill someone, we cause the death; whereas if we merely let someone die, then we will not be responsible for anyone’s death. This point is often made in connection with the euthanasia cases and which is often debatable. Euthanasia in the pediatric age group involves some important issues that are different from those of adult issues. The main distinction that occurs is that the infants and newborns and young children are not able to decide about their future as the adult does. In certain cases, where the child born with some serious deformities with no hope of recovery, in that cases doctor decide not to perform surgery in order to remove the blockage, and let the baby die. Our aim in this paper is to examine, whether it is ethically justified to withhold or to apply euthanasia on the part of the defective infant. What to do with severely defective infants from earliest time if got to know that they are not going to survive at all? Here, it will deal mostly with the ethics in deciding the relevant ethical concerns in the practice of euthanasia with the defective newborns issues. Some cases in relation to disabled infants and newborn baby will be taken in order to show what to do in a critical condition, that the patient and family members undergoes and under which condition those could be eradicated, if not all but some. The final choice must be with the benefit of the patient.

Keywords: ethics, medical ethics, euthanasia, defective newborns

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Authors: Didem Ildırar, Serap Fındık

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Baker’s yeast industry uses molasses as a raw material. Molasses wastewater contains high molecular weight polymers called melanoidins. Melanoidins are obtained after the reactions between the amino acids and carbonyl groups in molasses. The molasses wastewater has high biochemical and chemical oxygen demand and dark brown color. If it is discharged to receiving bodies without any treatment, it prevents light penetration and dissolved oxygen level of the surface water decreases. Melanoidin compounds are toxic effect to the microorganism in water and there is a resistance to microbial degradation. Before discharging molasses wastewater, adequate treatment is necessary. In addition to changing environmental regulations, properties of treated wastewater must be improved. Advanced oxidation processes can be used to improve existing properties of wastewater. Sonochemical oxidation is one of the alternative methods. Sonochemical oxidation employs the use of ultrasound resulting in cavitation phenomena. In this study, decolorization and chemical oxygen demand removal (COD) of baker’s yeast effluent was investigated by using ultrasound. Baker’s yeast effluent was supplied from a factory which is located in the north of Turkey. An ultrasonic homogenizator was used for this study. Its operating frequency is 20kHz. SnO2/TiO2 catalyst has been used as sonocatalyst. The effects of the composite preparation method, mixing time while composite prepared, the molar ratio of SnO2/TiO2, the calcination temperature, and time, the catalyst amount were investigated on the treatment of baker’s yeast effluent. . According to the results, the prepared composite SnO2/TiO2 by using ultrasonic probe gave a better result than prepared composite by using an ultrasonic bath. Prepared composite by using an ultrasonic probe with a 4:1 molar ratio treated at 800°C for 60min gave a better result. By using this composite, optimum catalyst amount was 0.2g/l. At these conditions 26.6% decolorization was obtained. There was no COD removal at the studied conditions.

Keywords: baker’s yeast effluent, COD, decolorization, sonocatalyst, ultrasonic irradiation

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Authors: Yueying Chen

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A city can be developed through memory, and memory is one of the most important elements for urban contexts. Collective memory is a collection of personal memories that can be preserved with objects, places, and events of heritage, expressing culture through spatial changes. These preserved forms can evoke a sense of community and certain emotions. Collective memory in cities reflects urban spatial alterations and historical developments. It can be preserved and reflected by revitalisation projects. A major current focus in collective memory research is how to identify and preserve memory in an intangible way. The influential elements within the preservation of collective memory mainly include institutions and objects. However, current research lacks the assessment of the collective memory after alterations of urban heritage. The assessment of urban heritage lacks visualization and qualitative methods. The emergence of the application of space syntax can fill in this gap. Hengshan Mansions was a new project in 2015. The original residential area has been replaced with a comprehensive commercial area integrating boutique shopping, upscale restaurants, and creative offices. Hengshan Mansions is located in the largest historic area in Shanghai, and its development is the epitome of the traditional culture in Shanghai. Its alteration is the newest project in this area and presents the new concept of revitalisation of urban heritage. For its physical parts, modern vitality is created, and historical information is preserved at the same time. However, most of the local people are moved away, and its functions are altered a lot. The preservation of its collective memory needs to discuss furtherly. Thus, the article builds a framework to assess the collective memory of urban heritage, including spatial configuration, spatial interaction, and cultural cognition. Then, it selects Hengshan Mansions in Shanghai as a case to analyse the assessed framework. Space syntax can be applied to visualize the assessment. Based on the analysis, the article will explore the influential reasons for the collective memory after alterations and proposes relevant advice for the preservation of the collective memory of urban heritage.

Keywords: collective memory, alternation of urban heritage, space syntax, Hengshan Mansions

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Authors: S. F. Kanaan, Fatima Al-Kadi, H. Khrais

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Background: Fibromyalgia is a chronic condition that is characterized by chronic pain that limits physical and functional activities. To our best knowledge, there is currently no key physiotherapy approach recommended to reduce pain and improve function. In addition, there are scarce studies that investigated the effect of manual therapy in the management of Fibromyalgia, and no study investigated the efficacy of Mulligan´s mobilization with movement (MWM) in particular. Methods: A 51-year-old female diagnosed with Fibromyalgia for more than a year. The patient was complaining of generalized pain including neck, lower back, shoulders, elbows, hips, and knees. In addition, the patient reported severe limitation in activities and inability to complete her work as a lawyer. The Intervention provided for the patient consisted of 4 sessions (in two weeks) of MWM for neck, lower back, shoulders, elbows, sacroiliac joint, hips, and knees. The Visual Analogue Scale of pain (VAS), Range of Motion (ROM), 10-minute walk test, Roland Morris Low Back Pain and Disability Questionnaire (RMQ), Disability of the Arm, Shoulder and Hand Score (DASH) were collected at the baseline and at the end of treatment. Results: Average improvement of ROM in the neck, lower back, shoulder, elbows, hips, and knees was 45%. VAS scale changed from pre-treatment to post-treatment as the following: neck pain (9 to 0), lower back pain (8 to 1), shoulders pain (8 to 2), elbows pain (7 to 1), and knees pain (9 to 0). The patient demonstrated improvement in all functional scale from pre-intervention to post-intervention: 10-meter walk test (9.8 to 4.5 seconds), RMQ (21 to 11/24), and DASH (88.7% to 40.5%). The patient did not report any side effect of using this approach. Conclusion: Fibromyalgia can cause joint 'faulty position' leading to pain and dysfunction, which can be reversed by using MWM. MWM showed to have clinically significant improvement in ROM, pain, and ability to walk and a clinically significant reduction in disability in only 4 sessions. This work can be expanded in a larger sample.

Keywords: mobilization, fibromyalgia, dysfunction, manual therapy

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Authors: Priyanka Yadav, Rajkumar Ghosh, Alok Saini

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Human civilization cannot exist and thrive in the absence of adequate water. As a result, even in smart cities, water plays an important role in human existence. The key causes of this catastrophic water scarcity crisis are lifestyle changes, over-exploitation of groundwater, water over usage, rapid urbanization, and uncontrolled population growth. Furthermore, salty water seeps into deeper aquifers, causing land subsidence. The purpose of this study on artificial groundwater recharge is to address the water shortage in Gomti Nagar, Lucknow. Submersibles are the most common methods of collecting freshwater from groundwater in Gomti Nagar neighbourhood of Lucknow. Gomti Nagar area has a groundwater depletion rate of 1968 m3/day/km2 and is categorized as Zone-A (very high levels) based on the existing groundwater abstraction pattern - A to D. Harvesting rainwater using roof top rainwater harvesting systems (RTRWHs) is an effective method for reducing aquifer depletion in a sustainable water management system. Rainwater collecting using roof top rainwater harvesting systems (RTRWHs) is an effective method for reducing aquifer depletion in a sustainable water conservation system. Due to a water imbalance of 24519 ML/yr, the Gomti Nagar region is facing severe groundwater depletion. According to the Lucknow Development Authority (LDA), the impact of installed RTRWHs (plot area 300 sq. m.) is 0.04 percent of rainfall collected through RTRWHs in Gomti Nagar region of Lucknow. When RTRWHs are deployed in all buildings, their influence will be greater. Bye-laws in India have mandated the installation of RTRWHs on plots greater than 300 sq.m. A better India without any water problem is a pipe dream that may be realized by installing residential and commercial rooftop rainwater collecting systems in every structure. According to the current study, RTRWHs should be used as an alternate source of water to bridge the gap between groundwater recharge and extraction in smart city viz. Gomti Nagar, Lucknow, India.

Keywords: groundwater recharge, RTRWHs, harvested rainwater, rainfall, water extraction

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Authors: Sarah Saad Alamer, Shujon Mohammed Alazzam, Amjad Khater Alanazi, Mohamed Ahmed Sankari, Jana Sameer Sendy, Saleh Al-Khaldi, Khaled Allam, Amani Badawi

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Background: Self-medication is defined as the selection of medicines by individuals to treat self-diagnosed. There are a lot of concerns about the safety of long-term use of nonprescription ophthalmic drugs, which may lead to a variety of serious ocular complications. Topical steroids can produce severe eye-threatening complications, including the elevation of intraocular pressure (IOP) with possible development of glaucoma and infrequent optic nerve damage. In recent times, many OTC ophthalmic preparations have been possible without a prescription. Objective: In our study, we aimed to determine the prevalence of self-medication ocular topical steroid practice and associated factors among adult ophthalmic patients attending King Saud medical city. Methods: This study was conducted as a cross-sectional study, targeting participants aged 18 years old or above who had used topical steroids eye drops to determine the prevalence of self-medication ocular topical steroid practice and associated factors among adult patients attending ophthalmology clinic in King Saud Medical City (KSMC) in the central region. Results: A total of 308 responses, 92(29.8%) were using ocular topical, 58(18.8%) with prescription, 5(1.6%) without prescription, 29(9.4%) with and without prescription while 216(70.1%) did not use it. The frequency of using ocular topical steroids without a prescription among participants was 11(12%) once and 33 (35%) many times. 26(28.3%) were having complication, mostly 11(12.4%) eye infection, 8(9%) Glaucoma, 6 (6.7%) Cataracts. Reasons for self-medication ocular topical steroid practice among participants were 14 (15.2%) repeated symptoms, 11(15.2%) had heard an advice from a friend, 11 (15.2%) thought they had enough knowledge. Conclusion: Our study reveals that, even though detecting a high level of knowledge and acceptable practices and attitudes among participants, the incidence of self-medication with steroid eye drops was observed. This practice is mainly due to participants having repeated symptoms and thinking they have enough knowledge. Increasing the education level of patients on self-medication steroid eye drops practice and it is associated complications would help reduce the incidence of self-medication steroid eye drops practice.

Keywords: self-medication, ophthalmic medicine, steroid eye drop, over the counter

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Authors: Julie Mariam Abraham, G. J. Melendez-Torres

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Background. Maternal mortality is disproportionately higher in low- and middle- income countries (LMICs) compared to other parts of the world. At the current pace of progress, the Sustainable Development Goals for maternal mortality rate will not be achieved by 2030. A variety of factors influence the increased risk of maternal complications in LMICs. These are exacerbated by socio-economic and political factors, including poverty, illiteracy, and gender inequality. This paper aims to use realist synthesis to identify the contexts, mechanisms, and outcomes (CMOs) of maternal health interventions conducted in LMICs to inform evidence-based practice for future maternal health interventions. Methods. In May 2022, we searched four electronic databases for systematic reviews of maternal health interventions in LMICs published in the last five years. We used open and axial coding of CMOs to develop an explanatory framework for intervention effectiveness. Results. After eligibility screening and full-text analysis, 44 papers were included. The intervention strategies and measured outcomes varied within reviews. Healthcare system level contextual factors were the most frequently reported, and infrastructural capacity was the most reported context. The most prevalent mechanism was increased knowledge and awareness. Discussion. Health system infrastructure must be considered in interventions to ensure effective implementation and sustainability. Healthcare-seeking behaviours are embedded within social and cultural norms, environmental conditions, family influences, and provider attitudes. Therefore, effective engagement with communities and families is important to create new norms surrounding pregnancy and delivery. Future research should explore community mobilisation and involvement to enable tailored interventions with optimal contextual fit.

Keywords: maternal mortality, service delivery and organisation, realist synthesis, sustainable development goals, overview of reviews

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Authors: Claire Baudry, Jessica Pearson, Laura-Emilie Savage, George Tarbulsy

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Introduction: Over the last decade, researchers have implemented attachment-based interventions to promote parental interactive sensitivity and child development among vulnerable families. In the context of the present study, these interventions have been shown to be effective to enhance cognitive development when child outcome was measured shortly after the intervention. Objectives: The goal of the study was to investigate the effects of an attachment-based intervention on child cognitive development one year post-intervention. Methods: Thirty-five mother-child dyads referred by Child Protective Services in the province of Québec, Canada, were included in this study: 21 dyads who received 6 to 8 intervention sessions and 14 dyads not exposed to the intervention and matched for the following variables: duration of child protective services, reason for involvement with child protection, age, sex and family status. Child cognitive development was measured using the WPPSI-IV, 12 months after the end of the intervention when the average age of children was 54 months old. Findings: An independent-samples t-test was conducted to compare the scores obtained on the WPPSI-IV for the two groups. In general, no differences were observed between the two groups. There was a significant difference on the fluid reasoning scale between children exposed to the intervention (M = 95,13, SD = 16,67) and children not exposed (M = 81, SD = 9,90). T (23) = -2,657; p= .014 (IC :-25.13;3.12). This difference was found only for children aged between 48 and 92 months old. Other results did not show any significant difference between the two groups (Global IQ or subscales). Conclusions: This first set of analyses suggest that relatively little effects of attachment-based intervention remain on the level of cognitive functioning 12-months post-intervention. It is possible that the significant findings concerning fluid reasoning may be pertinent in that fluid reasoning is linked to the capacity to analyse, to solve problems, and remember information, which may be important for promoting school readiness. As the study is completed and as more information is gained from other assessments of cognitive and socioemotional outcome, a clearer picture of the potential moderate-term impact of attachment-based intervention will emerge.

Keywords: attachment-based intervention, child development, child protective services, cognitive development

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Authors: A. Hira Masood, B. Umer Hameed, C. Ezza Nasir

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Contemporary studies support the strong co-relation between psychology and design. This study elaborates how different psychological personality test can help a fashion designer to judge the needs of their clients with respect to have products which will satisfy the client's request concerning costumised clothing. This study will also help the designer to improve the lacking in the personality and will enable him to put his effort in required areas for grooming the customer, control and direct organization regarding quality maintenance. The use of psychology test to support the choice of certain design strategies that how the right clothing can make client a better intellectual with enhanced self-esteem and confidence. Different projective personality test are being used to suggest to evaluate personality traits. The Rorschach Inkblot Test is projective mental comprising of 10 ink-blots synonymous with the clinical brain research. Lüsher Color Diagnostics measures a person’s psycho physical state, his or her ability to withstand stress to perform and communicate. HTP is a projective responsibility test measuring self-perception, attitudes. The TAT test intend to evaluate a person’s patterns of thoughts, attitudes, observation, capacity and emotional response to this ambiguous test materials. No doubt designers are already crucially redesigning the individuals by their attires, but to expose the behavioral mechanism of the customer, designers should be able to recognize the hidden complexity behind his client by using the above mentioned methods. The study positively finds the design and psychology need to become substantially contacted in order to create a new regime of norms to groom a personality under the concentration and services of a fashion designer in terms of clothing, This interactive activity altimately upgrade design team to help customers to find the suited way to satisfy their needs and wishes, offer client relible relationship and quality management services, and to become more disereable.

Keywords: projective personality tests, customized clothing, Rorschach Inkblot test, TAT, HTP, Lüsher color diagnostics, quality management services

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Authors: Bidisha Chatterjee, Sonal Grover, Rekha Gurung

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Postpartum dissection of the internal carotid artery is a relatively rare condition and is considered as an underlying aetiology in 5% to 25% of strokes under the age of 30 to 45 years. However, 86% of these cases recover completely and 14% have mild focal neurological symptoms. Prognosis is generally good with early intervention. The risk quoted for a repeat carotid artery dissection in subsequent pregnancies is less than 2%. 36-year Caucasian primipara presented on postnatal day one of forceps delivery with tachycardia. In the intrapartum period she had a history of prolonged rupture of membranes and developed intrapartum sepsis and was treated with antibiotics. Postpartum ECG showed septal inferior T wave inversion and a troponin level of 19. Subsequently Echocardiogram ruled out post-partum cardiomyopathy. Repeat ECG showed improvement of the previous changes and in the absence of symptoms no intervention was warranted. On day 4 post-delivery, she had developed symptoms of droopy right eyelid, pain around the right eye and itching in the right ear. On examination, she had developed right sided ptosis, unequal pupils (Rt miotic pupil). Cranial nerve examination, reflexes, sensory examination and muscle power was normal. Apart from migraine, there was no medical or family history of note. In view of Horner’s on the right, she had a CT Angiogram and subsequently MR/MRA and was diagnosed with dissection of the cervical portion of the right internal carotid artery. She was discharged on a course of Aspirin 75mg. By 6 week post-natal follow up patient had recovered significantly with occasional episodes of unequal pupils and tingling of right toes which resolved spontaneously. Cervical artery dissection, including VAD and carotid artery dissection, are rare complications of pregnancy with an estimated annual incidence of 2.6–3 per 100,000 pregnancy hospitalizations. Aetiology remains unclear though trauma during straining at labour, underlying arterial disease and preeclampsia have been implicated. Hypercoagulable state during pregnancy and puerperium could also be an important factor. 60-90% cases present with severe headache and neck pain and generally precede neurological symptoms like ipsilateral Horner’s syndrome, retroorbital pain, tinnitus and cranial nerve palsy. Although rare, the consequences of delayed diagnosis and management can lead to severe and permanent neurological deficits. Patients with a strong index of suspicion should undergo an MRI or MRA of head and neck. Antithrombotic and antiplatelet therapy forms the mainstay of therapy with selected cases needing endovascular stenting. Long term prognosis is favourable with either complete resolution or minimal deficit if treatment is prompt. Patients should be counselled about the recurrence risk and possibility of stroke in future pregnancy. Coronary artery dissection is rare and treatable but needs early diagnosis and treatment. Post-partum headache and neck pain with neurological symptoms should prompt urgent imaging followed by antithrombotic and /or antiplatelet therapy. Most cases resolve completely or with minimal sequelae.

Keywords: postpartum, dissection of internal carotid artery, magnetic resonance angiogram, magnetic resonance imaging, antiplatelet, antithrombotic

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Authors: Isabel Lopez-Oliva, Akshay Paropkari, Shweta Saraswat, Stefan Serban, Paola de Pablo, Karim Raza, Andrew Filer, Iain Chapple, Thomas Dietrich, Melissa Grant, Purnima Kumar

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Objective: We aimed to explicate the role of the subgingival microbiome in the causal link between rheumatoid arthritis (RA) and periodontitis (PD). Methods: Subjects with/without RA and with/without PD were randomized for treatment with scaling and root planing (SRP) or oral hygiene instructions. Subgingival biofilm, gingival crevicular fluid, and serum were collected at baseline and at 3- and 6-months post-operatively. Correlations were generated between 72 million 16S rDNA sequences, immuno-inflammatory mediators, circulating antibodies to oral microbial antigens, serum inflammatory molecules, and clinical metrics of RA. The dynamics of inter-microbial and host-microbial interactions were modeled using differential network analysis. Results: RA superseded periodontitis as a determinant of microbial composition, and DAS28 score superseded the severity of periodontitis as a driver of microbial assemblages (p=0.001, ANOSIM). RA subjects evidenced higher serum anti-PPAD (p=0.0013), anti-Pg-enolase (p=0.0031), anti-RPP3, anti- Pg-OMP and anti- Pi-OMP (p=0.001) antibodies than non-RA controls (with and without periodontitis). Following SRP, bacterial networks anchored by IL-1b, IL-4, IL-6, IL-10, IL-13, MIP-1b, and PDGF-b underwent ≥5-fold higher rewiring; and serum antibodies to microbial antigens decreased significantly. Conclusions: Our data suggest a circular relationship between RA and PD, beginning with an RA-influenced dysbiosis within the healthy subgingival microbiome that leads to exaggerated local inflammation in periodontitis and circulating antibodies to periodontal pathogens and positive correlation between severity of periodontitis and RA activity. Periodontal therapy restores host-microbial homeostasis, reduces local inflammation, and decreases circulating microbial antigens. Our data highlights the importance of integrating periodontal care into the management of RA patients.

Keywords: rheumatoid arthritis, periodontal, subgingival, DNA sequence analysis, oral microbiome

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Authors: Hamza A. Pantami, Khozizah Shaari, Intan S. Ismail, Chong C. Min

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Introduction: Tilapia is the second-highest harvested freshwater fish species in Malaysia, available in almost all fish farms and markets. Unfortunately, tilapia culture in Malaysia is highly affected by Aeromonas hydrophila and Streptococcus agalactiae, which affect the production rate and consequently pose a direct negative economic impact. Reliance on drugs to control or reduce bacterial infections has been led to contamination of water bodies and development of drug resistance, as well as gave rise to toxicity issues in downstream fish products. Resorting to vaccines have helped curb the problem to a certain extent, but a more effective solution is still required. Using microalgae-based feed to enhance the fish immunity against bacterial infection offers a promising alternative. Objectives: This study aims to evaluate the efficacy of Chlorella vulgaris at lower percentage incorporation in feeds for an immune boost of tilapia in a shorter time. Methods: The study was in two phases. The safety concentration studies at 500 mg/kg-1 and the administration of cultured C. vulgaris biomass via incorporation into fish feed for five different groups in three weeks. Group 1 was the control (0% incorporation), whereas group 2, 3, 4 and 5 received 0.625%, 1.25%, 2.5% and 5% incorporation respectively. The parameters evaluated were the blood profile, serum lysozyme activity (SLA), serum bactericidal activity (SBA), phagocytosis activity (PA), respiratory burst activity (RBA), and lymphoproliferation activity (LPA). The data were analyzed via ANOVA using SPSS (version 16). Further testing was done using Tukey’s test. All tests were performed at the 95% confidence interval (p < 0.05). Results: There were no toxic signs in tilapia fish at 500 mg/kg-1. Treated groups showed significantly better immune parameters compared to the control group (p < 0.05). Conclusions: C. vulgaris crude biomass in a fish meal at a lower incorporation level of 5% can increase specific and non-specific immunity in tilapia fish in a shorter time duration.

Keywords: Chlorella vulgaris, hematology profile, immune boost, lymphoproliferation

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Authors: Giancarlo La Marca, Engy Shokry, Fabio Villanelli

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Epilepsy is one of the most common neurological disorders, with an estimated prevalence of 50 million people worldwide. Twenty five percent of the epilepsy population is represented in children under the age of 15 years. For antiepileptic drugs (AED), there is a poor correlation between plasma concentration and dose especially in children. This was attributed to greater pharmacokinetic variability than adults. Hence, therapeutic drug monitoring (TDM) is recommended in controlling toxicity while drug exposure is maintained. Carbamazepine (CBZ) is a first-line AED and the drug of first choice in trigeminal neuralgia. CBZ is metabolised in the liver into carbamazepine-10,11-epoxide (CBZE), its major metabolite which is equipotent. This develops the need for an assay able to monitor the levels of both CBZ and CBZE. The aim of the present study was to develop and validate a LC-MS/MS method for simultaneous quantification of CBZ and CBZE in dried blood spots (DBS). DBS technique overcomes many logistical problems, ethical issues and technical challenges faced by classical plasma sampling. LC-MS/MS has been regarded as superior technique over immunoassays and HPLC/UV methods owing to its better specificity and sensitivity, lack of interference or matrix effects. Our method combines advantages of DBS technique and LC-MS/MS in clinical practice. The extraction process was done using methanol-water-formic acid (80:20:0.1, v/v/v). The chromatographic elution was achieved by using a linear gradient with a mobile phase consisting of acetonitrile-water-0.1% formic acid at a flow rate of 0.50 mL/min. The method was linear over the range 1-40 mg/L and 0.25-20 mg/L for CBZ and CBZE respectively. The limit of quantification was 1.00 mg/L and 0.25 mg/L for CBZ and CBZE, respectively. Intra-day and inter-day assay precisions were found to be less than 6.5% and 11.8%. An evaluation of DBS technique was performed, including effect of extraction solvent, spot homogeneity and stability in DBS. Results from a comparison with the plasma assay are also presented. The novelty of the present work lies in being the first to quantify CBZ and its metabolite from only one 3.2 mm DBS disc finger-prick sample (3.3-3.4 µl blood) by LC-MS/MS in a 10 min. chromatographic run.

Keywords: carbamazepine, carbamazepine-10, 11-epoxide, dried blood spots, LC-MS/MS, therapeutic drug monitoring

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Authors: Eric Beyegue, Boris Azantza, Judith Laure Ngondi, Julius E. Oben

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Background: Insulin resistance (IR) and oxidative stress are associated with obesity, diabetes mellitus, and other cardio metabolic disorders. The aim of this study was to investigate the effect of Coula edulis extracts (CEE) on insulin resistance and oxidative stress markers in high-fat/high sucrose diet-induced insulin resistance in rats. Materials and Methods: Thirty male rats were divided into 6 groups of 5 rats each fed, received daily oral administration of CE extracts for 8 weeks as follows: Group 1 or negative control group, fed with standard diet (SD); Group 2 fed with high-fat/high sucrose diet (HFHS) only; Group3 fed with HFHS + CEAq 200; Group 4 fed with HFHS + CEAq 400; Group 5 fed with HFHS + CEEt 200; Group 6 fed with HFHS + CEEt 400. At the end of the experiment (8 weeks), animals were sacrificed plasma lipid profile, glucose, insulin, oxidative marker and digestive enzyme activities were measured. The homeostasis model assessment for insulin resistance (HOMA-IR) was determined. Results: Feedings with HFHS significantly (p < 0.01) induced plasma hyperglycaemia, hyperinsulinaemia, increased triglyceride, total cholesterol, and low-density lipoprotein levels, decreased high-density lipoprotein levels, alterations of α amylase, and glucose-6-phosphatase activities, and oxidative stress. Daily oral administration with CEE for eight weeks after insulin resistance induction had a hypolipidaemic action, antioxidative activities and modulated metabolic markers. Ethanolic extract at the higher dose had the best effect on body weight gain and insulin resistance, whereas aqueous extract showed the better activity on hyperlipidemia. Conclusion: These results suggest that CEAq and CEEt at 400mg/kg are promising complementary supplements that can be used to protect better from metabolic disorders associated with HFHS.

Keywords: Coula edulis Baill, high-fat / high sucrose diet, insulin resistance, oxidative stress

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Authors: Lotfollah Rezagholizadeh

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Background and Aim: Diabetes mellitus is related to high mortality and morbidity caused by the early development of atherosclerosis correlated to diabetic macroangiopathy. The endothelium-derived vasodilator, nitric oxide (NO) has been implicated in the development of vascular complications via the regulation of blood flow, and various antiatherosclerotic actions. Patients with type 2 diabetes (T2D) have a decreased level of endothelial nitric oxide release. In this study we aimed to examine the effect of aquatic seed extract of Cichorium intybus L. (chicory) and metformin (a known prescription drug for diabetes) on NO levels in T2D rats. Methods: Five groups of adult male Wistar rats were used (n=6): Non-diabetic controls without extract treatment (Control), Non-diabetic controls with extract treatment (Chicory-control), T2D rats without extract treatment (NIA/STZ), T2D rats treated with the extract (Chicory-NIA/STZ), and T2D groups that received metformin (100 mg/kg) but no extract (Metformin-NIA/STZ). T2D was induced with intraperitoneal (i.p) injection of niacinamide (NIA, 200 mg/kg), 15 min after an i.p administration of streptozotocin (STZ, 55 mg/kg). Lyophilized chicory extract (125 mg/kg) was dissolved in 0.2 ml normal saline and administered one dose a day. The experiments lasted for 3 weeks after the diabetes induction. NO analysis was performed by assay based on the Griess reaction. Data were reported as the mean ± SD and statistical analysis was performed by ANOVA. Results: Serum nitric oxide levels decreased significantly in NIA/STZ group compared with Control and Chicory-control. Treatment with chicory extract caused a significant increase in serum levels of NO in Chicory-NIA/STZ group compare to NIA/STZ group (p<05). Metformin-NIA/STZ group did not show considerable difference when compared with NIA/STZ, with respect to NO levels. In a group of rats made diabetic by STZ alone (type 1 diabetic rats, T1D), chicory did not have a significant ameliorating effect. Conclusion: In this study, we clearly showed a relationship between low serum nitric oxide levels and diabetes mellitus in rats. The increase in serum nitric oxide by chicory extract is an indication of antiatherogenic effect of this plant. Chicory seed extract was more efficient than metformin in improving the NO levels in NO-deficient T2D diabetic rats.

Keywords: type 2 diabetes mellitus, nitric oxide, chicory, metformin

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Authors: Mohammad-Javad Eslami, Mahtab Zargham, Farshad Gholipour, Mohammadreza Hajian, Katayoun Bakhtiari, Sakineh Hajebrahimi, Melina Eghbal, Ziba Farajzadegan

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Introduction: To study the mid-term safety and functional outcomes of transvaginal anterior vaginal wall prolapse repair using polyvinylidene fluoride (PVDF) mesh (DynaMesh®-PR4) by the double trans-obturator technique (TOT). Methods: Between 2015 and 2020, we prospectively included women with symptomatic high-stage anterior vaginal wall prolapse with or without uterine prolapse or stress urinary incontinence (SUI) in the study. The patients underwent transvaginal repair of the prolapse using PVDF mesh in two medical centers. We followed all patients for at least 12 months. We recorded the characteristics of vaginal and sexual symptoms, urinary incontinence, and prolapse stage pre- and postoperatively using International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS), International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF), and Pelvic Organ Prolapse Quantification (POP-Q) system, respectively. Results: One hundred eight women were included in the final analysis with a mean follow-up time of 34.5 ± 18.6 months. The anatomical success was achieved in 103 (95.4%) patients. There was a significant improvement in patients’ vaginal symptoms, urinary incontinence, and quality of life scores postoperatively (p < 0.0001). Only six patients (5.5%) had mesh extrusion, five of whom were managed successfully. The total rates of complications and de novo urinary symptoms were 21.3% and 7.4%, respectively. Significant pain was reported in 17 cases (15.7%). Conclusion: Our findings show that using PVDF mesh in the double TOT technique for anterior vaginal wall prolapse repair is a safe procedure with high anatomic and functional success rates and acceptable complication rates in mid-term follow-up.

Keywords: stress urinary incontinence (SU, incontinence questionnaire-vaginal symptoms (ICIQ-VS), polyvinylidene fluoride (PVDF) mes, double trans-obturator technique (TOT)

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Authors: Brigita Mieziene, Arunas Emeljanovas, Vida Cesnaitiene, Ingunn Fjortoft, Lise Kjonniksen

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Background. Health-related physical fitness refers to the favorable health status, i.e. ability to perform daily activities with vigor, as well as capacities that are associated with a low risk for development of chronic diseases and premature death. However, in school-aged children it is constantly declining, while some aspects of fitness declined as much as 50 percent during the last two decades, which prognosticates increasingly earlier onset of health problems, decreasing the quality of life of the population and financial burden for the society. Therefore, the goal of the current study was to indicate nationally representative age- and gender-specific reference values of anthropometric measures, musculoskeletal, motor and cardiorespiratory fitness in Lithuanian primary school children from 6 to 10 years. Methods. The study included 3556 students in total, from 73 randomly selected schools. Ethics approval for research by the Kaunas Regional Ethics Committee (No. BE-2-42) was obtained. Physical fitness was measured by the 9-item test battery, developed by Fjørtoft and colleagues. Height and weight were measured and body mass index calculated. Smoothed centile charts were derived using the LMS method. Results. The numerical age- and gender-specific percentile values (3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentile) for anthropometric measures, musculoskeletal, motor and cardiorespiratory fitness were provided. The equivalent smoothed LMS curves were performed. The study indicated 12.5 percent of overweight and 5 percent of obese children in accordance with international gender and age specific norms of body mass index. This data could be used in clinical and educational settings in order to identify the level of individual physical fitness within its different components.

Keywords: fitness, overweight, primary school children, reference values, smoothed percentile curves

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Authors: Sylvie Michel, Sylvie Gerbaix, Marc Bidan

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Artificial intelligence (AI) can be held accountable for its detrimental impacts. This question gains heightened relevance given AI's pervasive reach across various domains, magnifying its power and potential. The expanding influence of AI raises fundamental ethical inquiries, primarily centering on biases, responsibility, and transparency. This encompasses discriminatory biases arising from algorithmic criteria or data, accidents attributed to autonomous vehicles or other systems, and the imperative of transparent decision-making. This article aims to stimulate reflection on AI accountability, denoting the necessity to elucidate the effects it generates. Accountability comprises two integral aspects: adherence to legal and ethical standards and the imperative to elucidate the underlying operational rationale. The objective is to initiate a reflection on the obstacles to this "accountability," facing the challenges of the complexity of artificial intelligence's system and its effects. Then, this article proposes to mobilize Edgar Morin's complex thought to encompass and face the challenges of this complexity. The first contribution is to point out the challenges posed by the complexity of A.I., with fractional accountability between a myriad of human and non-human actors, such as software and equipment, which ultimately contribute to the decisions taken and are multiplied in the case of AI. Accountability faces three challenges resulting from the complexity of the ethical issues combined with the complexity of AI. The challenge of the non-neutrality of algorithmic systems as fully ethically non-neutral actors is put forward by a revealing ethics approach that calls for assigning responsibilities to these systems. The challenge of the dilution of responsibility is induced by the multiplicity and distancing between the actors. Thus, a dilution of responsibility is induced by a split in decision-making between developers, who feel they fulfill their duty by strictly respecting the requests they receive, and management, which does not consider itself responsible for technology-related flaws. Accountability is confronted with the challenge of transparency of complex and scalable algorithmic systems, non-human actors self-learning via big data. A second contribution involves leveraging E. Morin's principles, providing a framework to grasp the multifaceted ethical dilemmas and subsequently paving the way for establishing accountability in AI. When addressing the ethical challenge of biases, the "hologrammatic" principle underscores the imperative of acknowledging the non-ethical neutrality of algorithmic systems inherently imbued with the values and biases of their creators and society. The "dialogic" principle advocates for the responsible consideration of ethical dilemmas, encouraging the integration of complementary and contradictory elements in solutions from the very inception of the design phase. Aligning with the principle of organizing recursiveness, akin to the "transparency" of the system, it promotes a systemic analysis to account for the induced effects and guides the incorporation of modifications into the system to rectify deviations and reintroduce modifications into the system to rectify its drifts. In conclusion, this contribution serves as an inception for contemplating the accountability of "artificial intelligence" systems despite the evident ethical implications and potential deviations. Edgar Morin's principles, providing a lens to contemplate this complexity, offer valuable perspectives to address these challenges concerning accountability.

Keywords: accountability, artificial intelligence, complexity, ethics, explainability, transparency, Edgar Morin

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Authors: Annette Louise Dupont

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Background and Introduction: Broadly defined, hybridity is a condition of racial and cultural ‘cross-pollination’ which arises as a result of contact between colonized and colonizer. It remains a highly contested concept in postcolonial studies as it is implicitly underpinned by colonial notions of ‘racial purity.’ While some postcolonial scholars argue that individuals exercise significant agency in the construction of their hybrid subjectivities, others underscore associated experiences of exclusion, marginalization, and alienation. Kuwait and the Philippines are among the most disparate of contemporary postcolonial states. While oil resources transformed the former British Mandate of Kuwait into one of the world’s richest countries, enduring poverty in the former US colony of the Philippines drives a global diaspora which produces multiple Filipino hybridities. Although more Filipinos work in the Arabian Gulf than in any other region of the world, scholarly and literary accounts of their experiences of hybridization in this region are relatively scarce when compared to those set in North America, Australia, Asia, and Europe. Study Aims and Significance: This paper aims to address this existing lacuna by investigating hybridity and other postcolonial themes in a novel by a Kuwaiti author which vividly portrays the lives of immigrants and citizens in Kuwait and which gives a rare voice and insight into the struggles of an Arab-Filipino and European-Filipina. Specifically, this paper explores the relationships between colonial discourses of ‘black’ and ‘white’ and postcolonial discourses pertaining to ‘brown’ Filipinos and ‘brown’ Arabs, in order to assess their impacts on the protagonists’ hybrid subjectivities. Methodology: Foucault’s notions of discourse not only provide a conceptual basis for analyzing the colonial ideology of Orientalism, but his theories related to the social exclusion of the ‘mad’ also elucidate the mechanisms by which power can operate to marginalize, alienate and subjectify the Other, therefore a Foucauldian lens is applied to the analysis of postcolonial themes and hybrid subjectivities portrayed in the novel. Findings: The study finds that Kuwaiti and Filipino discursive practices mirror those of former white colonialists and colonized black laborers and that these discursive practices combine with a former British colonial system of foreign labor sponsorship to create a form of governmentality in Kuwait which is based on exclusion and control. The novel’s rich social description and the reflections of the key protagonist and narrator suggest that such fiction has a significant role to play in highlighting the historical and cultural specificities of experiences of postcolonial hybridity in under-researched geographic, economic, social, and political settings. Whereas hybridity can appear abstract in scholarly accounts, the significance of literary accounts in which the lived experiences of hybrid protagonists are anchored to specific historical periods, places and discourses, is that contextual particularities are neither obscured nor dehistoricized. Conclusions: The application of Foucauldian theorizations of discourse, disciplinary, and biopower to the analysis of this Kuwaiti literary text serves to extend an understanding of the effects of contextually-specific discourses on hybrid Filipino subjectivities, as well as a knowledge of prevailing social dynamics in a little-researched postcolonial Arabian Gulf state.

Keywords: Filipino, Foucault, hybridity, Kuwait

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Authors: S. M. C. Kelly, M. Goulden

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Introduction: Chronic Pancreatitis is an increasing problem worldwide. Pain is the main symptom and the main reason for hospital readmission following diagnosis, despite the use of strong analgesics including opioids. Ketamine infusions reduce pain in complex regional pain syndrome and other neuropathic pain conditions. Our centre has trialed the use of ketamine infusions in patients with chronic pancreatitis. We have evaluated this service to assess whether ketamine reduces emergency department admissions and analgesia requirements. Methods: This study collected retrospective data from 2010 in all patients who received a ketamine infusion for chronic pain secondary to a diagnosis of chronic pancreatitis. The day-case ketamine infusions were initiated in theatre by an anaesthetist, with standard monitoring and the assistance of an anaesthetic practitioner. A bolus dose of 0.5milligrams/kilogram was given in theatre. The infusion of 0.5 milligrams/kilogram per hour was then administered over a 6 hour period in the theatre recovery area. A study proforma detailed the medical history, analgesic use and admissions to hospital. Patients received a telephone follow up consultation. Results: Over the last eight years, a total of 30 patients have received intravenous ketamine infusions, with a total of 92 ketamine infusions being administered. 53% of the patients were male with the average age of 47. A total of 27 patients participated with the telephone consultation. A third of patients reported a reduction in hospital admissions with pain following the ketamine infusion. Analgesia requirements were reduced by an average of 48.3% (range 0-100%) for an average duration of 69.6 days (range 0-180 days.) Discussion: This service evaluation illustrates that ketamine infusions can reduce analgesic requirements and the number of hospital admissions in patients with chronic pancreatitis. In the light of increasing pressures on Emergency departments and the increasing evidence of the dangers of long-term opioid use, this is clearly a useful finding. We are now performing a prospective study to assess the long-term effectiveness of ketamine infusions in reducing analgesia requirements and improving patient’s quality of life.

Keywords: acute-on-chronic pain, intravenous analgesia infusion, ketamine, pancreatitis

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Authors: Stephen Grant Atkins

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Radical use of project-based learning (PBL) in a small New Zealand business school provides an opportunity to longitudinally examine its effects over a decade of pre-Covid data. Prior to this business school’s implementation of PBL, starting in 2012, the business pedagogy literature presented just one example of PBL replacing an entire core-set of courses. In that instance, a British business school merged four of its ‘degree Year 3’ accounting courses into one PBL semester. As radical as that would have seemed, to students aged 20-to-22, the PBL experiment conducted in a New Zealand business school was notably more extreme: 41 nationally-approved Learning Outcomes (L.O.s), these deriving from 8 separate core courses, were aggregated into one grand set of L.O.s, and then treated as a ‘full-year’/‘full-time’ single course. The 8 courses in question were all components of this business school’s compulsory ‘degree Year 1’ curriculum. Thus, the students involved were notably younger (…ages 17-to-19…), and no ‘part-time’ enrolments were allowed. Of interest are this PBL experiment’s effects on subsequent performance outcomes in ‘degree Years 2 & 3’ (….which continued to operate in their traditional ways). Of special interest is the quality of ‘group project’ outcomes. This is because traditionally, ‘degree Year 1’ course assessments are only minimally based on group work. This PBL experiment altered that practice radically, such that PBL ‘degree Year 1’ alumni entered their remaining two years of business coursework with far more ‘project group’ experience. Timeline-wise, thus of interest here, firstly, is ‘degree Year 2’ performance outcomes data from years 2010-2012 + 2016-2018, and likewise ‘degree Year 3’ data for years 2011-2013 + 2017-2019. Those years provide a pre-&-post comparative baseline for performance outcomes in students never exposed to this school’s radical PBL experiment. That baseline is then compared to PBL alumni outcomes (2013-2016….including’Student Evaluation of Course Quality’ outcomes…) to clarify ‘radical PBL’ effects.

Keywords: project-based learning, longitudinal mixed-methods, students criticism, effects-on-learning

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Authors: Reena Aggarwal

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Wall art is a manifestation of the human mind and an absorbing form of cultural expression. Solapur wall hanging making art reflects cultural values, regional sensibilities, beliefs, and identity and helps to preserve the many different communities. The tango of warp and weft in many ways than one tells the story of civilization itself. Solapur wall hanging is a poem in multicolor, written with the warp and weft having long, rich, and complex history with indigenous design vocabularies made by the Padmasali communities. The wall-hanging weaving of Solapur has remained unaltered for years, from being very basic and monochrome having landscapes and portraits catering only to the local market, thereby becoming a potential family income generation tool. The study focuses on the need for contemporization of the Solapur wall hanging and also deliberates on the fact that wherever the culture of native people has been aided by intervention, in nearly every case, the quality of their craft has began to be enhanced. The study also found the underlying reason for diminishing sales to a declining market, low sales, lack of innovation in design, and product development. Keeping in mind that the artisans of Solapur have heroically always hold on to their ancient beliefs and practices, which give them strength and identity, and a sense of pride, an intervention program was developed with an objective of widening the market and help artisans have a sustaining income which include urban consumers and create designs suitable for the urban market. The process of defining and measuring the advantages of design intervention was achieved by using qualitative research methods. An ethnographic research methodology was adopted, which includes six months of close interface with artisans from ten families engaged in making of wall hanging in Solapur. Design solutions were proposed in terms of product diversification and design extensions of the existing product line for increased variety. A collection of contemporary wall arts (wall decor) and room dividers were designed and developed.

Keywords: wall hanging, Solapur, contemporization, traditional, sustainable

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Authors: Rahmi Kopar

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Legitimate expectations principle is considered one of the most dominant elements of the Fair and Equitable Treatment Standard which is today’s most relied upon treaty standard. Since its utilization by arbitral tribunals is relatively new, the contours of the legitimate expectations concept under investment treaty law have not been precisely defined yet. There are various fragmented views arising both from arbitral tribunals and scholarly writings with respect to its limits and use even though the principle is ‘firmly rooted in arbitral practice.’ International energy investments, due to their characteristics, are more prone to certain types of risks, especially the political risks. Thus, there are several mechanisms to protect an energy investment against those risks. Stabilisation is one of these investment protection methods. Stability provisions can be found under domestic legislations, as a contractual clause, or as a separate legal stability agreement. This paper will start by examining the roots of the contentious concept of legitimate expectations with reference to its application in domestic legal systems from where the doctrine under investment treaty law context was transplanted. Then the paper will turn to the investment treaty law and analyse the main contours of the doctrine as understood and applied by arbitral tribunals. 'What gives rise to the investor’s legitimate expectations?' question is answered mainly by three categories of sources: the general legal framework prevalent in a host state, the representations made by the officials or organs of a host state, and the contractual commitments. However, there is no unanimity among the arbitral tribunals and the scholars with respect to the form these sources should take. At this point, the study will discuss the sources of a stability provision and the effect of these stability provisions found in various legal sources in creating a legitimate expectation for the investor. The main questions to be discussed in this paper are as follows: a) Do the stability provisions found under different legal sources create a legitimate expectation on the investor side? b) If yes, what levels of legitimate expectations do they create? These questions will be answered mainly by reference to investment treaty jurisprudence.

Keywords: fair and equitable treatment standard, international energy investments, investment protection, legitimate expectations, stabilization

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Authors: Iva Buchberger, Vesna Kovač

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Global education policy trends and recommendations underline the importance of (distributive) school leadership as a school effectiveness key factor. In this context, the broader aim of this research (supported by the Croatian Science Foundation) is to identify school leadership characteristics in Croatian schools and to examine the correlation between school leadership and school effectiveness. The aim of the proposed conference paper is to focus on the school leadership characteristics which are additionally explained with school leadership facilitators that contribute to (distributive) school leadership development. The aforementioned school leadership characteristics include the following dimensions: (a) participation in the process of making different types of decisions, (b) influence in the decision making process, (c) social interactions between different stakeholders in the decision making process in schools. Further, the school leadership facilitators are categorized as follows: (a) principal’s activities (such as providing support to different stakeholders and developing mutual trust among them), (b) stakeholders’ characteristics (such as developed stakeholders’ interest and competence to participate in decision-making process), (c) organizational and material resources (such as school material conditions, the necessary information and time as resources for making decisions). The data were collected by a constructed and validated questionnaire for examining the school leadership characteristics and facilitators from teachers’ perspective. The main population in this study consists of all primary schools in Croatia while the sample is comprised of 100 primary schools, selected by random sampling. Furthermore, the sample of teachers was selected by an additional procedure taking into consideration the independent variables of sex, work experience, etc. Data processing was performed by standard statistical methods of descriptive and inferential statistics. Statistical program IBM SPSS 20.0 was used for data processing. The results of this study show that there is a (positive) correlation between school leadership characteristics and school leadership facilitators. Specifically, it is noteworthy to mention that all the dimensions of school leadership characteristics are in positive correlation with the categories of school leadership facilitators. These results are indicative for the education policy creators who should ensure positive and supportive environment for the school leadership development including the development of school leadership characteristics and school leadership facilitators.

Keywords: distributive school leadership, school effectiveness , school leadership characteristics, school leadership facilitators

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Authors: Amirul Adlan, Motaz AlAqeel, Scott Evans, Vaiyapuri sumathi, Mark Davies, Rajesh Botchu

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Background & Objectives: Osteoid osteoma (OO) is a benign tumor of the bone commonly found in childhood and adolescence, causing bone pain, especially during the night. CT-guided radiofrequency ablation (RFA) is currently the mainstay treatment for OO. There is currently no literature reporting the outcomes of OO following RFA based on the histological presence of a nidus seen on a biopsy taken at the time of RFA. The primary aim of this study was to compare the clinical outcomes of OO between the group of patients with the presence of nidus on biopsy samples from RFA with those without nidus. Secondly, we aimed to examine other factors that may affect the outcomes of OO, reflecting our experience as a tertiary orthopedic oncology center. Methods: We retrospectively reviewed 88 consecutive patients diagnosed with osteoid osteoma treated with RFA between November 2005 and March 2015, consisting of 63 males (72%) and 25 females (28%). Sixty-six patients (75%) had nidus present in their biopsy samples. Patients’ mean age was 17.6 years (4-53). The median duration of follow-up was 12.5 months (6-20.8). Lesions were located in the appendicular skeleton in seventy-nine patients (90%), while nine patients (10%) had an OO in the axial skeleton. Outcomes assessed were based on patients’ pain alleviation (partial, complete, or no pain improvement) and the need for further interventions. Results: Pain improvement in the patient group with nidus in the histology sample was significantly better than in the group without nidus (OR 7.4, CI 1.35-41.4, p=0.021). The patient group with nidus on biopsy demonstrated less likelihood of having a repeat procedure compared to the group without nidus(OR 0.092, CI 0.016-0.542, p=0.008). Our study showed significantly better outcomes in pain improvement in appendicular lesions compared to the axially located lesions (p = 0.005). Patients with spinal lesions tend to have relatively poor pain relief than those with appendicular or pelvic lesions (p=0.007). Conclusions: Patients with nidus on histology had better pain alleviation compared to patients without nidus. The histological presence of nidus significantly reduces the chance of repeat interventions. The pain alleviation of osteoid osteoma following RFA is better in patients with appendicular lesions than spinal or axially located lesions.

Keywords: osteoid osteoma, benign tumour, radiofrequency ablation, oncology

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Authors: Tong-Hsien Chow

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Background: Plantar pressure measurement is an effective method for assessing plantar loading and can be applied to evaluating movement performance of the foot. The purpose of this study is to explore the sprint athletes’ plantar loading characteristics and pain profiles in static standing. Methods: Experiments were undertaken on 80 first-division college sprint athletes and 85 healthy non-sprinters. ‘JC Mat’, the optical plantar pressure measurement was applied to examining the differences between both groups in the arch index (AI), three regional and six distinct sub-regional plantar pressure distributions (PPD), and footprint characteristics. Pain assessment and self-reported health status in sprint athletes were examined for evaluating their common pain areas. Results: Findings from the control group, the males’ AI fell into the normal range. Yet, the females’ AI was classified as the high-arch type. AI values of the sprint group were found to be significantly lower than the control group. PPD were higher at the medial metatarsal bone of both feet and the lateral heel of the right foot in the sprint group, the males in particular, whereas lower at the medial and lateral longitudinal arches of both feet. Footprint characteristics tended to support the results of the AI and PPD, and this reflected the corresponding pressure profiles. For the sprint athletes, the lateral knee joint and biceps femoris were the most common musculoskeletal pains. Conclusions: The sprint athletes’ AI were generally classified as high arches, and that their PPD were categorized between the features of runners and high-arched runners. These findings also correspond to the profiles of patellofemoral pain syndrome (PFPS)-related plantar pressure. The pain profiles appeared to correspond to the symptoms of high-arched runners and PFPS. The findings reflected upon the possible link between high arches and PFPS. The correlation between high-arched runners and PFPS development is worth further studies.

Keywords: sprint athletes, arch index, plantar pressure distributions, high arches, patellofemoral pain syndrome

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Authors: Junqi Zou

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As one of the world’s most tech-ready countries, Singapore has initiated the Smart Nation plan to harness the full power and potential of digital technologies to transform the way people live and work, through the more efficient government and business processes, to make the economy more productive. The key evolutions of digital technology transformation in healthcare and the increasing deployment of Internet of Things (IoTs), Big Data, AI/cognitive, Robotic Process Automation (RPA), Electronic Health Record Systems (EHR), Electronic Medical Record Systems (EMR), Warehouse Management System (WMS in the most recent decade have significantly stepped up the move towards an information-driven healthcare ecosystem. The advances in information technology not only bring benefits to patients but also act as a key force in changing management accounting in healthcare sector. The aim of this study is to investigate the impacts of digital technology transformation on Singapore’s healthcare sector from a management accounting perspective. Adopting a Balanced Scorecard (BSC) analysis approach, this paper conducted an exploratory case study of a newly launched Singapore public hospital, which has been recognized as amongst the most digitally advanced healthcare facilities in Asia-Pacific region. Specifically, this study gains insights on how the new technology is changing healthcare organizations’ management accounting from four perspectives under the Balanced Scorecard approach, 1) Financial Perspective, 2) Customer (Patient) Perspective, 3) Internal Processes Perspective, and 4) Learning and Growth Perspective. Based on a thorough review of archival records from the government and public, and the interview reports with the hospital’s CIO, this study finds the improvements from all the four perspectives under the Balanced Scorecard framework as follows: 1) Learning and Growth Perspective: The Government (Ministry of Health) works with the hospital to open up multiple training pathways to health professionals that upgrade and develops new IT skills among the healthcare workforce to support the transformation of healthcare services. 2) Internal Process Perspective: The hospital achieved digital transformation through Project OneCare to integrate clinical, operational, and administrative information systems (e.g., EHR, EMR, WMS, EPIB, RTLS) that enable the seamless flow of data and the implementation of JIT system to help the hospital operate more effectively and efficiently. 3) Customer Perspective: The fully integrated EMR suite enhances the patient’s experiences by achieving the 5 Rights (Right Patient, Right Data, Right Device, Right Entry and Right Time). 4) Financial Perspective: Cost savings are achieved from improved inventory management and effective supply chain management. The use of process automation also results in a reduction of manpower costs and logistics cost. To summarize, these improvements identified under the Balanced Scorecard framework confirm the success of utilizing the integration of advanced ICT to enhance healthcare organization’s customer service, productivity efficiency, and cost savings. Moreover, the Big Data generated from this integrated EMR system can be particularly useful in aiding management control system to optimize decision making and strategic planning. To conclude, the new digital technology transformation has moved the usefulness of management accounting to both financial and non-financial dimensions with new heights in the area of healthcare management.

Keywords: balanced scorecard, digital technology transformation, healthcare ecosystem, integrated information system

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Authors: Ashan Wijekoon, Abi Beane, Subashini Jayawardana

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Background: Civil war in Sri Lanka ended a decade ago, leaving thousands of army veterans permanently disabled following lower-limb amputations. Quantifying long-term functional health and psychological wellbeing will inform the development of tailored home-based rehabilitation intervention. Objectives: To assess the long-term health and quality of life of Sri Lankan soldiers with traumatic lower-limb amputation.Methods and Materials: A comparative cross-sectional study was conducted in five districts of Sri Lanka. Using stratified random sample technique, two groups of 85 participants were selected; group 1, community re-integrated male army veterans with unilateral lower-limb amputation, and group 2, age and sex matched normal healthy individuals. Long-term health and quality of life (QoL) outcomes were assessed and compared between the two groups using self-administered Short-Form Health Survey-36 questionnaire (SF-36) previously validated for use in Sri Lanka. Results: Group 1 were active prosthetic users who had undergone amputation > ten years ago (Mean±SD: 21.7±5.9). The most prevalent comorbidities for group 1 and 2 were hypertension and diabetes (22.4% and 30.6% and 9.4% and 9.8%, respectively). In group 1, injury-associated long-term health outcomes included knee osteoarthritis (18.8%), knee pain (20.0%), and back pain (69.4%). Scores of physical health and psychological wellbeing were 53.1 (IQR 64.4- 43.8) and 63.5 (IQR 73.3- 51.4) for each group, respectively. Scores revealed the highest QoL related to social functioning (75 (IQR 87.5- 62.5)) and the poorest aspects of QoL related to general health (40 (IQR 50- 35)). Prevalence of comorbidities was significantly higher, and QoL outcomes were significantly lower among soldiers compared to normal healthy individuals (p<0.05).Conclusion: Higher prevalence of comorbidities, poor physical health, and lower QoL outcomes were more prevalent in soldiers with lower-limb amputation when compared to healthy counterparts.

Keywords: community-based, disability, health outcomes, quality of life, soldiers

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