Search results for: anxiety attachment style

Authors: Divya SY. Ang, Mark B. Tan, Nicholas EM. Yeo, Siti RB. Sudirman, Khong Yik Chew

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Introduction: The importance of the amalgamation of technological and engineering advances with surgical principles of reconstruction cannot be overemphasized. With earlier detection of cancer, consequences of high-speed living and neglect, like traumatic injuries and infection, resulting in increasingly younger patients with bone defects. This may result in malformations and suboptimal function that is more noticeable and palpable in the younger, active demographic. Our team proposes a technique that encapsulates a mesh of multidisciplinary effort, tissue engineering and reconstructive principles. Methods/Materials: Our patient was a young competitive footballer in his early 30s who was diagnosed with submandibular adenoid cystic carcinoma with bony involvement. He was thus counselled for a right hemi mandibulectomy, the floor of mouth resection, right selective neck dissection, tracheostomy, and free fibular flap reconstruction of his mandible and required post-operative radiotherapy. Being young and in his prime sportsman years, he was unable to accept the morbidities associated with using his fibula to reconstruct his mandible despite it being the gold standard reconstructive option. The fibula is an ideal vascularized bone flap because it’s reliable and easily shaped with relatively minimal impact on functional outcomes. The fibula contributes to 30% of weightbearing and is the attachment for the lateral compartment muscles; it is stronger in footballers concerning lateral bending. When harvesting the fibula, the distal 6-8cm and up to 10% of the total length is preserved to maintain the ankle’s stability, thus, minimizing the impact on daily activities. There are studies that have noted gait variability post-operatively. Therefore, returning to a premorbid competitive level may be doubtful. To improve his functional outcomes, the decision was made to try and restore the fibula's form and function. Using the concept of Fused Deposition Modelling (FDM), our team comprising of Plastics, Otolaryngology, Orthopedics and Radiology, worked with Osteopore to design a 3D bioresorbable implant to regenerate the fibula defect (14.5cm). Bone marrow was harvested via reaming the contralateral hip prior to the wide resection. 30mls of his blood was obtained for extracting platelet rich plasma. These were packed into the Osteopore 3D-printed bone scaffold. This was then secured into the fibula defect with titanium plates and screws. The flexor hallucis longus and soleus were anchored along the construct and intraosseous membrane, done in a single setting. Results: He was reviewed closely as an outpatient over 10 months post operatively. He reported no discernable loss or difference in ankle function. He is satisfied and back in training and our team has video and photographs that substantiate his progress. Conclusion: FDM allows regeneration of long bone defects. However, we aimed to also restore his eversion and inversion that is imperative for footballers and hence reattached his previously dissected muscles along the length of the Osteopore implant. We believe that the reattachment of the muscle stabilizes not only the construct but allows optimum muscle tensioning when moving his ankle. This is a simple but effective technique in restoring complete function and form in a young patient whose minute muscle control is imperative to life.

Keywords: fused deposition modelling, functional reconstruction, lower limb bony defects, regenerative surgery, 3D printing, tissue engineering

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Authors: Pratap Chandra Pati, Prabina Rajib, Parama Barai

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The traditional finance theory neglects the role of sentiment factor in asset pricing. However, the behavioral approach to asset-pricing based on noise trader model and limit to arbitrage includes investor sentiment as a priced risk factor in the assist pricing model. Investor sentiment affects stock more that are vulnerable to speculation, hard to value and risky to arbitrage. It includes small stocks, high volatility stocks, growth stocks, distressed stocks, young stocks and non-dividend-paying stocks. Since the introduction of Chicago Board Options Exchange (CBOE) volatility index (VIX) in 1993, it is used as a measure of future volatility in the stock market and also as a measure of investor sentiment. CBOE VIX index, in particular, is often referred to as the ‘investors’ fear gauge’ by public media and prior literature. The upward spikes in the volatility index are associated with bouts of market turmoil and uncertainty. High levels of the volatility index indicate fear, anxiety and pessimistic expectations of investors about the stock market. On the contrary, low levels of the volatility index reflect confident and optimistic attitude of investors. Based on the above discussions, we investigate whether market-wide fear levels measured volatility index is priced factor in the standard asset pricing model for the Indian stock market. First, we investigate the performance and validity of Fama and French three-factor model and Carhart four-factor model in the Indian stock market. Second, we explore whether India volatility index as a proxy for fearful market-based sentiment indicators affect the cross section of stock returns after controlling for well-established risk factors such as market excess return, size, book-to-market, and momentum. Asset pricing tests are performed using monthly data on CNX 500 index constituent stocks listed on the National stock exchange of India Limited (NSE) over the sample period that extends from January 2008 to March 2017. To examine whether India volatility index, as an indicator of fear sentiment, is a priced risk factor, changes in India VIX is included as an explanatory variable in the Fama-French three-factor model as well as Carhart four-factor model. For the empirical testing, we use three different sets of test portfolios used as the dependent variable in the in asset pricing regressions. The first portfolio set is the 4x4 sorts on the size and B/M ratio. The second portfolio set is the 4x4 sort on the size and sensitivity beta of change in IVIX. The third portfolio set is the 2x3x2 independent triple-sorting on size, B/M and sensitivity beta of change in IVIX. We find evidence that size, value and momentum factors continue to exist in Indian stock market. However, VIX index does not constitute a priced risk factor in the cross-section of returns. The inseparability of volatility and jump risk in the VIX is a possible explanation of the current findings in the study.

Keywords: India VIX, Fama-French model, Carhart four-factor model, asset pricing

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Authors: Lucia Liu, Matthew Koziol

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Obsessive-compulsive disorder (OCD), a long-lasting anxiety disorder involving recurrent, intrusive thoughts, affects over 2 million adults in the United States. Transcranial magnetic stimulation (TMS) stands out as a noninvasive, cutting-edge therapy that has been shown to reduce symptoms in patients with treatment-resistant OCD. The Food and Drug Administration (FDA) approved protocol pairs TMS sessions with individualized symptom provocation, aiming to improve the susceptibility of brain circuits to stimulation. However, limited standardization or guidance exists on how to conduct symptom provocation and which methods are most effective. This study aims to compare the effect of internal versus external techniques to induce obsessional stress in a clinical setting during TMS therapy. Two symptom provocation methods, (i) Asking patients thought-provoking questions about their obsessions (internal) and (ii) Requesting patients to perform obsession-related tasks (external), were employed in a crossover design with repeated measurement. Thirty-six treatments of NeuroStar TMS were administered to each of two patients over 8 weeks in an outpatient clinic. Patient One received 18 sessions of internal provocation followed by 18 sessions of external provocation, while Patient Two received 18 sessions of external provocation followed by 18 sessions of internal provocation. The primary outcome was the level of self-reported obsessional stress on a visual analog scale from 1 to 10. The secondary outcome was self-reported OCD severity, collected biweekly in a four-level Likert-scale (1 to 4) of bad, fair, good and excellent. Outcomes were compared and tested between provocation arms through repeated measures ANOVA, accounting for intra-patient correlations. Ages were 42 for Patient One (male, White) and 57 for Patient Two (male, White). Both patients had similar moderate symptoms at baseline, as determined through the Yale-Brown Obsessive Compulsive Scale (YBOCS). When comparing obsessional stress induced across the two arms of internal and external provocation methods, the mean (SD) was 6.03 (1.18) for internal and 4.01 (1.28) for external strategies (P=0.0019); ranges were 3 to 8 for internal and 2 to 8 for external strategies. Internal provocation yielded 5 (31.25%) bad, 6 (33.33%) fair, 3 (18.75%) good, and 2 (12.5%) excellent responses for OCD status, while external provocation yielded 5 (31.25%) bad, 9 (56.25%) fair, 1 (6.25%) good, and 1 (6.25%) excellent responses (P=0.58). Internal symptom provocation tactics had a significantly stronger impact on inducing obsessional stress and led to better OCD status (non-significant). This could be attributed to the fact that answering questions may prompt patients to reflect more on their lived experiences and struggles with OCD. In the future, clinical trials with larger sample sizes are warranted to validate this finding. Results support the increased integration of internal methods into structured provocation protocols, potentially reducing the time required for provocation and achieving greater treatment response to TMS.

Keywords: obsessive-compulsive disorder, transcranial magnetic stimulation, mental health, symptom provocation

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Authors: Azzah Aldeghather, Sara Alkhodair

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In the modern urban planning and architecture landscape, with western ideologies and styles becoming the mainstay of experience and definitions globally, the Islamic world requires a methodology that defines its expression, which transcends cultural, societal, and national styles. This paper will propose a methodology as an objective system to define, evaluate and apply traditional Islamic knowledge to Islamic urban planning and architecture, providing the Islamic world with a system to manifest its approach to design. The methodology is expressed as Four Pillars which are based on traditional meanings of Arab words roughly translated as Pillar One: The Principles (Al Mabade’), Pillar Two: The Foundations (Al Asas), Pillar Three: The Purpose (Al Ghaya), Pillar Four: Presence (Al Hadara). Pillar One: (The Principles) expresses the unification (Tawheed) pillar of Islam: “There is no God but God” and is comprised of seven principles listed as: 1. Human values (Qiyam Al Insan), 2. Universal language as sacred geometry, 3. Fortitude© and Benefitability©, 4. Balance and Integration: conjoining the opposites, 5. Man, time, and place, 6. Body, mind, spirit, and essence, 7. Unity of design expression to achieve unity, harmony, and security in design. Pillar Two: The Foundations is based on two foundations: “Muhammad is the Prophet of God” and his relationship to the renaming of Medina City as a prototypical city or place, which defines a center space for collection conjoined by an analysis of the Medina Charter as a base for the humanistic design. Pillar Three: The Purpose (Al Ghaya) is comprised of four criteria: The naming of the design as a title, the intention of the design as an end goal, the reasoning behind the design, and the priorities of expression. Pillar Four: Presence (Al Hadara) is usually translated as a civilization; in Arabic, the root of Hadara is to be present. This has five primary definitions utilized to express the act of design: Wisdom (Hikma) as a philosophical concept, Identity (Hawiya) of the form, and Dialogue (Hiwar), which are the requirements of the project vis-a-vis what the designer wishes to convey, Expression (Al Ta’abeer) the designer wishes to apply, and Resources (Mawarid) available. The Proposal will provide examples, where applicable, of past and present designs that exemplify the manifestation of the Pillars. The proposed methodology endeavors to return Islamic urban planning and architecture design to its a priori position as a leading design expression adaptable to any place, time, and cultural expression while providing a base for analysis that transcends the concept of style and external form as a definition and expresses the singularity of the esoteric “Spiritual” aspects in a rational, principled, and logical manner clearly addressed in Islam’s essence.

Keywords: Islamic architecture, Islamic design, Islamic urban planning, principles of Islamic design

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Authors: Julia A. Ermakova

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In today's multicultural societies, dialogue, self-respect, and cultural etiquette play a vital role in fostering mutual respect and understanding. Whether viewed from an Islamic or secular perspective, the importance of these values cannot be overstated. Firstly, dialogue is essential in multicultural societies as it allows individuals from different cultural backgrounds to exchange ideas, opinions, and experiences. To engage in dialogue, one must be open and willing to listen, understand, and respect the views of others. This requires a level of self-awareness, where individuals must know themselves and their interlocutors to create a productive and respectful conversation. Secondly, self-respect is crucial for individuals living in multicultural societies (McLarney). One must have adequately high self-esteem and self-confidence to interact with others positively. By valuing oneself, individuals can create healthy relationships and foster mutual respect, which is essential in diverse communities. Thirdly, cultural etiquette is a way of demonstrating the beauty of one's culture by exhibiting good temperament (Al-Ghazali). Adab, a concept that encompasses good manners, praiseworthy words and deeds, and the pursuit of what is considered good, is highly valued in Islamic teachings. By adhering to Adab, individuals can guard against making mistakes and demonstrate respect for others. Islamic teachings provide etiquette for every situation in life, making up the way of life for Muslims. In the Islamic view, an elegant Muslim woman has several essential qualities, including cultural speech and erudition, speaking style, awareness of how to greet, the ability to receive compliments, lack of desire to argue, polite behavior, avoiding personal insults, and having good intentions (Al-Ghazali). The Quran highlights the inclination of people towards arguing, bickering, and disputes (Qur'an, 4:114). Therefore, it is imperative to avoid useless arguments and disputes, for they are poison that poisons our lives. The Prophet Muhammad, peace and blessings be upon him, warned that the most hateful person to Allah is an irreconcilable disputant (Al-Ghazali). By refraining from such behavior, individuals can foster respect and understanding in multicultural societies. From a secular perspective, respecting the views of others is crucial to engage in productive dialogue. The rule of argument emphasizes the importance of showing respect for the other person's views, allowing for the possibility of error on one's part, and avoiding telling someone they are wrong (Atamali). By exhibiting polite behavior and having respect for everyone, individuals can create a welcoming environment and avoid conflict. In conclusion, the importance of dialogue, self-respect, and cultural etiquette in multicultural societies cannot be overstated. By engaging in dialogue, respecting oneself and others, and adhering to cultural etiquette, individuals can foster mutual respect and understanding in diverse communities. Whether viewed from an Islamic or secular perspective, these values are essential for creating harmonious societies.

Keywords: multiculturalism, self-respect, cultural etiquette, adab, ethics, secular perspective

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Authors: Gyan Kashyap, Shri Kant Singh

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Improved mental health can be articulated as a good physical health and quality of life. Mental health plays an important role in survival of any one’s life. In today’s time people living with stress in life due to their personal matters, health problems, unemployment, work environment, living environment, substance use, life style and many more important reasons. Many studies confirmed that the significant proportion of mental health people increasing in India. This study is focused on mental well-being of male leather tannery workers in Kanpur city, India. Environment at work place as well as living environment plays an important health risk factors among leather tannery workers. Leather tannery workers are more susceptible to many chemicals and physical hazards, just because they are liable to be affected by their exposure to lots of hazardous materials and processes during tanning work in very hazardous work environment. The aim of this study to determine the level of mental health disorder and quality of life among male leather tannery and non-tannery workers in Kanpur city, India. This study utilized the primary data from the cross- sectional household study which was conducted from January to June, 2015 on tannery and non-tannery workers as a part of PhD program from the Jajmau area of Kanpur city, India. The sample of 286 tannery and 295 non-tannery workers has been collected from the study area. We have collected information from the workers of age group 15-70 those who were working at the time of survey for at least one year. This study utilized the general health questionnaire (GHQ-12) and work related stress scale to test the mental wellbeing of male tannery and non-tannery workers. By using GHQ-12 and work related stress scale, Polychoric factor analysis method has been used for best threshold and scoring. Some of important question like ‘How would you rate your overall quality of life’ on Likert scale to measure the quality of life, their earnings, education, family size, living condition, household assets, media exposure, health expenditure, treatment seeking behavior and food habits etc. Results from the study revealed that around one third of tannery workers had severe mental health problems then non-tannery workers. Mental health problem shown the statistically significant association with wealth quintile, 56 percent tannery workers had severe mental health problem those belong to medium wealth quintile. And 42 percent tannery workers had moderate mental health problem among those from the low wealth quintile. Work related stress scale found the statistically significant results for tannery workers. Large proportion of tannery and non-tannery workers reported they are unable to meet their basic needs from their earnings and living in worst condition. Important result from the study, tannery workers who were involved in beam house work in tannery (58%) had severe mental health problem. This study found the statistically significant association with tannery work and mental health problem among tannery workers.

Keywords: GHQ-12, mental well-being, factor analysis, quality of life, tannery workers

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Authors: Tamrat Girma Biru

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Multidrug-resistant tuberculosis (MDR-TB) is defined as resistant to at least Refampicin and Isoniazed: the most two power full TB drugs. It is a leading cause of high rates of morbidity and mortality, and increasing psychosocial challenges to patients, especially when co-infected with Human Immunodeficiency Virus (HIV). Ethiopia faces the highest rates of MDR-TB infection in the world. Objectives: The main objective of this study was to identify the psychosocial challenges of MDR-TB patients, to investigate the extent of the psychosocial challenges on (self-esteem, depression, and stigma) that MDR-TB patients encounter, to examine whether there is a sex difference in experiencing psychosocial challenges and assess the counseling needs of MDR-TB patients. Methodology: A cross-sectional study was conducted at St. Peter TB Specialized Hospital, Addis Ababa on 40 patients (25 males and 15 females) who are hospitalized for treatment. The patients were identified by using purposive sampling and made fill a questionnaire measuring their level of self-esteem, depression and stigma. Besides, data were collected from 16 participants, 28 care providers and 8 guardians, using semi-structured interview. The obtained data were analyzed using SPSS statistical program, descriptive statistics, independent t-test, and qualitative description. Results and Discussion: The results of the study showed that the majority (80%) of the respondents had suffered psychological challenges and social discriminations. Thus, the significance of MDR-TB and its association with HIV/AIDS problems is considered. Besides the psychosocial challenges, various aggravating factors such as length of treatment, drug burden and insecurity in economy together highly challenges the life of patients. In addition, 60% of participants showed low level of self-esteem. The patients also reported that they experienced high self-stigma and stigma by other members of the society. The majority of the participants (75%) showed moderate and severe level of depression. In terms of sex there is no difference between the mean scores of males and females in the level of depression and stigmatization by others and by themselves. But females showed lower level of self-esteem than males. The analysis of the t-test also shows that there were no statistically significant sex difference on the level of depression and stigma. Based on the qualitative data MDR-TB patients face various challenges in their life sphere such as: Psychological (depression, low self value, lowliness, anxiety), social (stigma, isolation from social relations, self-stigmatization,) and medical (drug side effect, drug toxicity, drug burden, treatment length, hospital stays). Recommendations: Based on the findings of this study possible recommendations were forwarded: develop and extend MDR-TB disease awareness creation through by media (printing and electronic), school net TB clubs, and door to door community education. Strengthen psychological wellbeing and social relationship of MDR-TB patients using proper and consistent psychosocial support and counseling. Responsible bodies like Ministry of Health (MOH) and its stakeholders and Non Governmental Organizations (NGOs) need to assess the challenges of patients and take measures on this pressing issue.

Keywords: psychosocial challenges, counseling, multi-drug resistant tuberculosis (MDR-TB), tuberculosis therapy

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Authors: Kavitha Puthanveedu, Kasi Sekar, Preeti Jacob, Kavita Jangam

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In India, The Juvenile Justice (Care and Protection of Children) Act, 2015, the law related to children alleged and found to be in conflict with law, proposes to address to the rehabilitation of children in conflict with law by catering to the basic rights by providing care and protection, development, treatment, and social re-integration. A major concern in addressing the issues of children in conflict with law in Kerala the southernmost state in India identified were: 1. Lack of psychological assessment for children in conflict with law, 2. Poor psychosocial intervention for children in conflict with law on bail, 3. Lack of psychosocial intervention or proper care and protection of CCL residing at observation and special home, 4. Lack convergence with systems related with mental health care. Aim: To develop individual care plan for children in conflict with law. Methodology: NIMHANS a premier Institute of Mental Health and Neurosciences, collaborated with Social Justice Department, Govt. of Kerala to address this issue by developing a participatory methodology to implement psychosocial care in the existing services by integrating the activities through multidisciplinary and multisectoral approach as per the Sec. 18 of JJAct 2015. Developing individual care plan: Key informant interviews, focus group discussion with multiple stakeholders consisting of legal officers, police, child protection officials, counselors, and home staff were conducted. Case studies were conducted among children in conflict with law. A checklist on 80 psychosocial problems among children in conflict with law was prepared with eight major issues identified through the quantitative process such as family and parental characteristic, family interactions and relationships, stressful life event, social and environmental factors, child’s individual characteristics, education, child labour and high-risk behavior. Standardised scales were used to identify the anxiety, caseness, suicidality and substance use among the children. This provided a background data understand the psychosocial problems experienced by children in conflict with law. In the second stage, a detailed plan of action was developed involving multiple stakeholders that include Special juvenile police unit, DCPO, JJB, and NGOs. The individual care plan was reviewed by a panel of 4 experts working in the area of children, followed by the review by multiple stakeholders in juvenile justice system such as Magistrates, JJB members, legal cum probation officers, district child protection officers, social workers and counselors. Necessary changes were made in the individual care plan in each stage which was pilot tested with 45 children for a period of one month and standardized for administering among children in conflict with law. Result: The individual care plan developed through scientific process was standardized and currently administered among children in conflict with law in the state of Kerala in the 3 districts that will be further implemented in other 14 districts. The program was successful in developing a systematic approach for the psychosocial intervention of children in conflict with law that can be a forerunner for other states in India.

Keywords: psychosocial care, individual care plan, multidisciplinary, multisectoral

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Authors: Taha Anjamrooz, Sareh Rajabi, Ayman Alzaatreh

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Smart cities are playing important roles in real life. Integration and automation between different features of modern cities and information technologies improve smart city efficiency, energy management, human and equipment resource management, life quality and better utilization of resources for the customers. One of difficulties in this path, is use, interface and link between software, hardware, and other IT technologies to develop and optimize processes in various business fields such as construction, supply chain management and transportation in parallel to cost-effective and resource reduction impacts. Also, Smart cities are certainly intended to demonstrate a vital role in offering a sustainable and efficient model for smart houses while mitigating environmental and ecological matters. Energy management is one of the most important matters within smart houses in the smart cities and communities, because of the sensitivity of energy systems, reduction in energy wastage and maximization in utilizing the required energy. Specially, the consumption of energy in the smart houses is important and considerable in the economic balance and energy management in smart city as it causes significant increment in energy-saving and energy-wastage reduction. This research paper develops features and concept of smart city in term of overall efficiency through various effective variables. The selected variables and observations are analyzed through data analysis processes to demonstrate the efficiency of smart city and compare the effectiveness of each variable. There are ten chosen variables in this study to improve overall efficiency of smart city through increasing effectiveness of smart houses using an automated solar photovoltaic system, RFID System, smart meter and other major elements by interfacing between software and hardware devices as well as IT technologies. Secondly to enhance aspect of energy management by energy-saving within smart house through efficient variables. The main objective of smart city and smart houses is to reproduce energy and increase its efficiency through selected variables with a comfortable and harmless atmosphere for the customers within a smart city in combination of control over the energy consumption in smart house using developed IT technologies. Initially the comparison between traditional housing and smart city samples is conducted to indicate more efficient system. Moreover, the main variables involved in measuring overall efficiency of system are analyzed through various processes to identify and prioritize the variables in accordance to their influence over the model. The result analysis of this model can be used as comparison and benchmarking with traditional life style to demonstrate the privileges of smart cities. Furthermore, due to expensive and expected shortage of natural resources in near future, insufficient and developed research study in the region, and available potential due to climate and governmental vision, the result and analysis of this study can be used as key indicator to select most effective variables or devices during construction phase and design

Keywords: smart city, traditional housing, RFID, photovoltaic system, energy efficiency, energy saving

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Authors: Elisabetta Ceretti, Silvia Bonizzoni, Alberto Bonetti, Milena Villarini, Marco Verani, Maria Antonella De Donno, Sara Bonetta, Umberto Gelatti

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Introduction: Air pollution is a global problem. In 2013, the International Agency for Research on Cancer (IARC) classified air pollution and particulate matter as carcinogenic to human. The study of the health effects of air pollution in children is very important because they are a high-risk group in terms of the health effects of air pollution and early exposure during childhood can increase the risk of developing chronic diseases in adulthood. The MAPEC_LIFE (Monitoring Air Pollution Effects on Children for supporting public health policy) is a project founded by EU Life+ Programme which intends to evaluate the associations between air pollution and early biological effects in children and to propose a model for estimating the global risk of early biological effects due to air pollutants and other factors in children. Methods: The study was carried out on 6-8-year-old children living in five Italian towns in two different seasons. Two biomarkers of early biological effects, primary DNA damage detected with the comet assay and frequency of micronuclei, were investigated in buccal cells of children. Details of children diseases, socio-economic status, exposures to other pollutants and life-style were collected using a questionnaire administered to children’s parents. Child exposure to urban air pollution was assessed by analysing PM0.5 samples collected in the school areas for PAHs and nitro-PAHs concentration, lung toxicity and in vitro genotoxicity on bacterial and human cells. Data on the chemical features of the urban air during the study period were obtained from the Regional Agency for Environmental Protection. The project created also the opportunity to approach the issue of air pollution with the children, trying to raise their awareness on air quality, its health effects and some healthy behaviors by means of an educational intervention in the schools. Results: 1315 children were recruited for the study and participate in the first sampling campaign in the five towns. The second campaign, on the same children, is still ongoing. The preliminary results of the tests on buccal mucosa cells of children will be presented during the conference as well as the preliminary data about the chemical composition and the toxicity and genotoxicity features of PM0.5 samples. The educational package was tested on 250 children of the primary school and showed to be very useful, improving children knowledge about air pollution and its effects and stimulating their interest. Conclusions: The associations between levels of air pollutants, air mutagenicity and biomarkers of early effects will be investigated. A tentative model to calculate the global absolute risk of having early biological effects for air pollution and other variables together will be proposed and may be useful to support policy-making and community interventions to protect children from possible health effects of air pollutants.

Keywords: air pollution exposure, biomarkers of early effects, children, public health policy

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Authors: Saleem Abu Jaber

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Born into a Sufi family, in which his father and other relatives, as well as additional community members, were particularly rooted in scholarly and cultural inquiry, Muḥammad ʾAbū al-Surūr al-Bikriyy al-Ṣidīqiyy (1562–1598 CE) was a prominent scholar of his time. Despite his relative youth, he became influential in his writings, which included Quranic exegeses and works on Hadith, Arabic grammar, jurisprudence, and Sufism. He was also a practicing physician and was the first person to be named Mufti of the Sultanate in Egypt. He was active in the political arena, having been close to the Ottoman sultans, providing them his support and counsel. He strived for their empowerment and victory and often influenced their political convictions and actions. Al-Ṣidīqiyy enjoyed the patronage of his contemporary Ottoman Caliphate sultans. In general, these sultans always promoted studies in the Islamic sciences and were keen to support scholars and gain their trust. This paper addresses al-Ṣidīqiyy’s legacy as a Quranic commentator, focusing on his exegesis (tafsīr) of Sūrat al-Fatḥ (48), written in 1589. It appears in a manuscript found at the Süleymaniye Library in Istanbul, consisting of one volume of 144 pages. It is believed that no other manuscript containing the text of this exegesis is to be found in any other library or institute for Arabic manuscripts. According to al-Ṣabbāġ (1995), al-Ṣidīqiyy had written a complete commentary of the Quran, but efforts to recover it have only unearthed the current commentary, as well as that of Sūrat al-Kahf (18), Sūrat al-ʾAnʿām (6), and ʾĀyat al-Kursī (2:255). The only critical edition published to date is that of Sūrat al-Kahf. The other two are currently being prepared for publication as well. The paucity of scholarly studies on the works of al-Ṣidīqiyy renders the current study particularly significant, as it provides introduction to al-Ṣidīqiyy’s exegesis, a synopsis of the biographical and cultural background of its author and his family, and a critical evaluation of his scholarly contribution. It will introduce the manuscript on which this study is based and elaborate on the structure and rationale of the exegesis, on its very attribution to al-Ṣidīqiyy, and subsequently evaluate its overall significance to the understanding of Sufi approaches to Quranic interpretation in 16th century Ottoman Egypt. An analysis of al-Ṣidīqiyy’s approach to interpreting the Quran leads to the definitive conclusion that it indeed reflects Sufi principles. For instance, when citing other Sufi commentators, including his own ancestors, he uses the epithets mawlāna ‘our elder, our patron,’ al-ʾustāḏ ‘the master,’ unique to Sufi parlance. Crucially, his interpretation, is written in a realistic, uncomplicated, fetching style, as was customary among Sufi scholars of his time, whose leaning was one of clarity, based on their perception of themselves as being closest to Muḥammad and his family, and by extension to the sunna, as reflected in the traditional narrative of the Prophet’s biography and teachings.

Keywords: Quran’ sufiism, manuscript, exegesis, surah, Al-fath, sultanate, sunna

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Authors: Tamar Bikashvili, Tamar Lordkipanidze, Ilia Lazrishvili

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Heavy metals remain one of serious environmental problems due to their toxic effects. The effect of arsenic and manganese compounds on rat behavior and neuromorphology was studied. Wistar rats were assigned to four groups: rats in control group were given regular water, while rats in other groups drank water with final manganese concentration of 10 mg/L (group A), 20 mg/L (group B) and final arsenic concentration 68 mg/L (group C), respectively, for a month. To study exploratory and anxiety behavior and also to evaluate aggressive performance in “home cage” rats were tested in “Open Field” and to estimate learning and memory status multi-branched maze was used. Statistically significant increase of motor and oriental-searching activity in experimental groups was revealed by an open field test, which was expressed in increase of number of lines crossed, rearing and hole reflexes. Obtained results indicated the suppression of fear in rats exposed to manganese. Specifically, this was estimated by the frequency of getting to the central part of the open field. Experiments revealed that 30-day exposure to 10 mg/ml manganese did not stimulate aggressive behavior in rats, while exposure to the higher dose (20 mg/ml), 37% of initially non-aggressive animals manifested aggressive behavior. Furthermore, 25% of rats were extremely aggressive. Obtained data support the hypothesis that excess manganese in the body is one of the immediate causes of enhancement of interspecific predatory aggressive and violent behavior in rats. It was also discovered that manganese intoxication produces non-reversible severe learning disability and insignificant, reversible memory disturbances. Studies of rodents exposed to arsenic also revealed changes in the learning process. As it is known, the distribution of metal ions differs in various brain regions. The principle manganese accumulation was observed in the hippocampus and in the neocortex, while arsenic was predominantly accumulated in nucleus accumbens, striatum, and cortex. These brain regions play an important role in the regulation of emotional state and motor activity. Histopathological analyzes of brain sections illustrated two morphologically distinct altered phenotypes of neurons: (1) shrunk cells with indications of apoptosis - nucleus and cytoplasm were very difficult to be distinguished, the integrity of neuronal cytoplasm was not disturbed; and (2) swollen cells - with indications of necrosis. Pyknotic nucleus, plasma membrane disruption and cytoplasmic vacuoles were observed in swollen neurons and they were surrounded by activated gliocytes. It’s worth to mention that in the cortex the majority of damaged neurons were apoptotic while in subcortical nuclei –neurons were mainly necrotic. Ultrastructural analyses demonstrated that all cell types in the cortex and the nucleus caudatus represent destructed mitochondria, widened neurons’ vacuolar system profiles, increased number of lysosomes and degeneration of axonal endings.

Keywords: arsenic, manganese, behavior, learning, neuron

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Authors: Nuray Baltaci, Kursat Cagiltay

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University rankings which can be seen as nouveau topic are at the center of focus and followed closely by different parties. Students are interested in university rankings in order to make informed decisions about the selection of their candidate future universities. University administrators and academicians can utilize them to see and evaluate their universities’ relative performance compared to other institutions in terms of including but not limited to academic, economic, and international outlook issues. Local institutions may use those ranking systems, as TUBITAK (The Scientific and Technological Research Council of Turkey) and YOK (Council of Higher Education) do in Turkey, to support students and give scholarships when they want to apply for undergraduate and graduate studies abroad. When it is considered that the ranking systems are concerned by this many different parties, the importance of having clear, easy to use and well-designed websites by ranking institutions will be apprehended. In this paper, a usability study for the websites of four different global university ranking institutions, namely Academic Ranking of World Universities (ARWU), Times Higher Education, QS and University Ranking by Academic Performance (URAP), was conducted. User-based approach was adopted and usability tests were conducted with 10 graduate students at Middle East Technical University in Ankara, Turkey. Before performing the formal usability tests, a pilot study had been completed to reflect the necessary changes to the settings of the study. Participants’ demographics, task completion times, paths traced to complete tasks, and their satisfaction levels on each task and website were collected. According to the analyses of the collected data, those ranking websites were compared in terms of efficiency, effectiveness and satisfaction dimensions of usability as pointed in ISO 9241-11. Results showed that none of the selected ranking websites is superior to other ones in terms of overall effectiveness and efficiency of the website. However the only remarkable result was that the highest average task completion times for two of the designed tasks belong to the Times Higher Education Rankings website. Evaluation of the user satisfaction on each task and each website produced slightly different but rather similar results. When the satisfaction levels of the participants on each task are examined, it was seen that the highest scores belong to ARWU and URAP websites. The overall satisfaction levels of the participants for each website showed that the URAP website has highest score followed by ARWU website. In addition, design problems and powerful design features of those websites reported by the participants are presented in the paper. Since the study mainly tackles about the design problems of the URAP website, the focus is on this website. Participants reported 3 main design problems about the website which are unaesthetic and unprofessional design style of the website, improper map location on ranking pages, and improper listing of the field names on field ranking page.

Keywords: university ranking, user-based approach, website usability, design

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Authors: Sarah Lister, Pauline Palmer

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Research findings presented within this paper form part of a larger scale collaboration between academics at Manchester Metropolitan University and a technology company. The overarching aims of this project focus on developing a series of game-based resources to promote the teaching of aspects of mathematics through a second language (L2) in primary schools. This study explores the potential of game-based learning (GBL) as a dynamic way to engage and motivate learners, making learning fun and purposeful. The research examines the capacity of GBL resources to provide a meaningful and purposeful context for CLIL. GBL is a powerful learning environment and acts as an effective vehicle to promote the learning of mathematics through an L2. The fun element of GBL can minimise stress and anxiety associated with mathematics and L2 learning that can create barriers. GBL provides one of the few safe domains where it is acceptable for learners to fail. Games can provide a life-enhancing experience for learners, revolutionizing the routinized ways of learning through fusing learning and play. This study argues that playing games requires learners to think creatively to solve mathematical problems, using the L2 in order to progress, which can be associated with the development of higher-order thinking skills and independent learning. GBL requires learners to engage appropriate cognitive processes with increased speed of processing, sensitivity to environmental inputs, or flexibility in allocating cognitive and perceptual resources. At surface level, GBL resources provide opportunities for learners to learn to do things. Games that fuse subject content and appropriate learning objectives have the potential to make learning academic subjects more learner-centered, promote learner autonomy, easier, more enjoyable, more stimulating and engaging and therefore, more effective. Data includes observations of the children playing the games and follow up group interviews. Given that learning as a cognitive event cannot be directly observed or measured. A Cognitive Discourse Functions (CDF) construct was used to frame the research, to map the development of learners’ conceptual understanding in an L2 context and as a framework to observe the discursive interactions that occur learner to learner and between learner and teacher. Cognitively, the children were required to engage with mathematical content, concepts and language to make decisions quickly, to engage with the gameplay to reason, solve and overcome problems and learn through experimentation. The visual elements of the games supported the learning of new concepts. Children recognised the value of the games to consolidate their mathematical thinking and develop their understanding of new ideas. The games afforded them time to think and reflect. The teachers affirmed that the games provided meaningful opportunities for the learners to practise the language. The findings of this research support the view that using the game-based resources supported children’s grasp of mathematical ideas and their confidence and ability to use the L2. Engaging with the content and language through the games led to deeper learning.

Keywords: CLIL, gaming, language, mathematics

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Authors: Cassandra Branham, Danielle Farrar

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As writing instructors and writing center administrators at a large research university with a significant population of English language learners (ELLs), we are interested in how peer feedback pedagogy can be effectively translated for writing center purposes, as well as how various modes of peer feedback can enrich the learning experiences of L1 and L2 writers in these spaces. Although peer feedback is widely used in classrooms and centers, instructor, student, and researcher opinions vary in respect to its effectiveness. We argue that peer feedback - traditional and digital, synchronous and asynchronous - is an indispensable element for both classrooms and centers and emphasize that it should occur with both L1 and L2 students to further develop an array of reading and writing skills. We also believe that further understanding of the best practices of peer feedback in such cross-cultural spaces, like the classroom and center, can optimize the benefits of peer feedback. After a critical review of the literature, we implemented an embedded tutoring program in our university’s writing center in collaboration with its First-Year Composition (FYC) program and Language Institute. The embedded tutoring program matches a graduate writing consultant with L1 and L2 writers enrolled in controlled-matriculation composition courses where ELLs make up at least 50% of each class. Furthermore, this program is informed by what we argue to be some best practices of peer feedback for both classroom and center purposes, including expectation-based training through rubrics, modeling effective feedback, hybridizing traditional and digital modes of feedback, recognizing the significance the body in composition (what we call writer embodiment), and maximizing digital technologies to exploit extended cognition. After conducting surveys and follow-up interviews with students, instructors, and writing consultants in the embedded tutoring program, we found that not only did students see an increased value in peer feedback, but also instructors saw an improvement in both writing style and critical thinking skills. Our L2 participants noted improvements in language acquisition while our L1 students recognized a broadening of their worldviews. We believe that both L1 and L2 students developed self-efficacy and agency in their identities as writers because they gained confidence in their abilities to offer feedback, as well as in the legitimacy of feedback they received from peers. We also argue that these best practices situate novice writers as experts, as writers become a valued and integral part of the revision process with their own and their peers’ papers. Finally, the use of iPads in embedded tutoring recovered the importance of the body and its senses in writing; the highly sensory feedback from these multi-modal sessions that offer audio and visual input underscores the significant role both the body and mind play in compositional practices. After beginning with a brief review of the literature that sparked this research, this paper will discuss the embedded tutoring program in detail, report on the results of the pilot program, and will conclude with a discussion of the pedagogical implications that arise from this research for both classroom and center.

Keywords: English language learners, peer feedback, writing center, writing classroom

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Authors: Dan Luo

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With the climate change can exacerbate exposure of cultural heritage to climatic stressors, scholars pin their hope on digital technology can help the site avoid surprises. Virtual museum has been regarded as a highly effective technology that enables people to gain enjoyable visiting experience and immersive information about cultural heritage. The technology clearly reproduces the images of the tangible cultural heritage, and the aesthetic experience created by new media helps consumers escape from the realistic environment full of uncertainty. The new cultural anchor has appeared outside the cultural sites. This article synthesizes the international literature on the virtual museum by developing diagrams of Citespace focusing on the tangible cultural heritage and the alarmingly situation has emerged in the process of resolving climate change: (1) Digital collections are the different cultural assets for public. (2) The media ecology change people ways of thinking and meeting style of cultural heritage. (3) Cultural heritage may live forever in the digital world. This article provides a typical practice information to manage cultural heritage in a changing climate—the Dunhuang Mogao Grottoes in the far northwest of China, which is a worldwide cultural heritage site famous for its remarkable and sumptuous murals. This monument is a typical synthesis of art containing 735 Buddhist temples, which was listed by UNESCO as one of the World Cultural Heritage sites. The caves contain some extraordinary examples of Buddhist art spanning a period of 1,000 years - the architectural form, the sculptures in the caves, and the murals on the walls, all together constitute a wonderful aesthetic experience. Unfortunately, this magnificent treasure cave has been threatened by increasingly frequent dust storms and precipitation. The Dunhuang Academy has been using digital technology since the last century to preserve these immovable cultural heritages, especially the murals in the caves. And then, Dunhuang culture has become a new media culture after introduce the art to the world audience through exhibitions, VR, video, etc. The paper chooses qualitative research method that used Nvivo software to encode the collected material to answer this question. The author paid close attention to the survey in Dunhuang City, including participated in 10 exhibition and 20 salons that are Dunhuang-themed on network. What’s more, 308 visitors were interviewed who are fans of the art and have experienced Dunhuang culture online(6-75 years).These interviewees have been exposed to Dunhuang culture through different media, and they are acutely aware of the threat to this cultural heritage. The conclusion is that the unique halo of the cultural heritage was always emphasized, and digital media breeds twin brothers of cultural heritage. In addition, the digital media make it possible for cultural heritage to reintegrate into the daily life of the masses. Visitors gain the opportunity to imitate the mural figures through enlarged or emphasized images but also lose the perspective of understanding the whole cultural life. New media construct a new life aesthetics apart from the Authorized heritage discourse.

Keywords: cultural ecology, digital twins, life aesthetics, media

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Authors: Charlotte Bach, Albrecht Jahn, Mahnaz Motamedi, Maryam Karimi-Ghahfarokhi

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Background: Maternal and infant deaths are most prevalent in the first month after birth, emphasizing the critical need for quality healthcare services during this period. Immigrant women, who are more susceptible to adverse pregnancy outcomes, often face neglect in accessing proper healthcare. The lack of adequate postpartum care significantly contributes to mortality rates. Therefore, utilizing maternal health care services and implementing postpartum care is crucial in reducing maternal and child mortality. Aims: This study aims to evaluate the assessment of pre- and postnatal care among women with and without migration background. In addition, the study explores the impact of COVID-19 procedures on women's experiences during pregnancy, birth, and the postpartum period. Methods: This research employs a cross-sectional Mixed-Method design. Data collection was facilitated through structured questionnaires administered to participants, alongside the utilization of patient bases, including Maternity and child medical records. Following the assumption that the investigator aimed to gain comprehensive insights, qualitative sampling focused on individuals with substantial experiences related to COVID-19, regarded as rich cases. Results: our study highlighted the influence of educational level, marital status, and consensual partnerships on the likelihood of Cesarean deliveries. Regarding breastfeeding practices, migrant women exhibited higher rates of breastfeeding initiation and continuation. Contraception utilization revealed interesting patterns, with non-migrants displaying higher odds of contraceptive use. The qualitative component of our research adds depth to the exploration of women's experiences during the COVID-19 pandemic, revealing nuanced challenges related to anxiety, hospital restrictions, breastfeeding support, and postnatal ward routines. Conclusion: Dissimilarity among studies toward cesarean rate between migrants and non-migrants underscores the importance of targeted interventions considering the diverse needs of distinct population groups. It also acknowledges potential cultural, contextual, and healthcare system influences on the association between mode of delivery and infant feeding practices. Studies acknowledge the influence of contextual variables on contraceptive preferences among migrants and non-migrants, emphasizing the need for tailored healthcare policies. The findings contribute to existing research, highlighting the need for a nuanced understanding of the impact of birth preparation courses on maternal and infant outcomes. Furthermore, they emphasize the universality of certain maternity care experiences, regardless of pandemic contexts, reinforcing the importance of patient-centred approaches in healthcare delivery.

Keywords: migration background, pregnancy outcome, covid-19, postpartum

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Authors: Daniel Gredig, Annabelle Bartelsen-Raemy

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Social work services offered to people living with diabetes tend to be moulded by the prevailing understanding that social work is to support people living with diabetes in their adherence to medical prescription and/or life style changes. As diabetes has been conceived as a condition facing no stigma, discrimination of people living with diabetes has not been considered. However, there is growing evidence of stigma. To our knowledge, nevertheless, there have been no comprehensive, in-depth studies of stigma and its impact. Against this background and challenging the present layout of services for people living with diabetes, the present study aimed to establish whether: -people living with diabetes in Switzerland experience stigma, and if so, in what context and to what extent; -experiencing stigma impacts the quality of life of those affected. It was hypothesized that stigma would impact on their quality of life. It was further hypothesized that low self-esteem, psychological distress, depression, and a lack of social support would be mediating factors. For data collection an anonymous paper-and-pencil self-administered questionnaire was used which drew on a qualitative elicitation study. Data were analysed using descriptive statistics and structural equation modelling. To generate a large and diverse convenience sample the questionnaire was distributed to the readers of journal destined to diabetics living in Switzerland issued in German and French. The sample included 3347 people with type 1 and 2 diabetes, aged 16–96, living in diverse living conditions in the German- and French-speaking areas of Switzerland. Respondents reported experiences of discrimination in various contexts and stereotyping based on the belief that diabetics have a low work performance; are inefficient in the workplace; inferior; weak-willed in their ability to manage health-related issues; take advantage of their condition and are viewed as pitiful or sick people. Respondents who reported higher levels of perceived stigma reported higher levels of psychological distress (β = .37), more pronounced depressive symptoms (β=.33), and less social support (β = -.22). Higher psychological distress (β = -.29) and more pronounced depressive symptoms (β = -.28), in turn, predicted lower quality of life. These research findings challenge the prevailing understanding of social work services for people living with diabetes in Switzerland and beyond. They call for a less individualistic approach, the consideration of the social context service users are placed in their everyday life, and addressing stigma. So, social work could partner with people living with diabetes in order to fight against discrimination and stereotypes. This could include identifying and designing educational and public awareness strategies. In direct social work with people living with diabetes, this could include broaching experiences of stigma and modes of coping with. This study was carried out in collaboration with the Swiss Diabetes Association. The association accepted the challenging conclusions from this study. It connected to the results and is currently discussing the priorities and courses of action to be taken.

Keywords: diabetes, discrimination, quality of life, services, stigma

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Authors: Ilona Buchem, Carolin Gellner

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The call for the support of senior learners in the development of digital literacy has become prevalent in recent years, especially in view of the aging societies paired with advances in digitalization in all spheres of life, including e-health. The goal has been to create opportunities for learning that incorporate the use of context in a reflective and dialogical way. Contextual learning has focused on developing skills through the application of authentic problems. While major research efforts in supporting senior learners in developing digital literacy have been invested so far in e-learning, focusing on knowledge acquisition and cognitive tasks, little research exists in reflective mentoring and coaching with the help of pedagogical agents and addressing the contextual dimensions of learning. This paper describes an approach to creating opportunities for senior learners to improve their digital literacy in the authentic context of the electronic health record (EHR) with the support of an intelligent virtual learning coach. The paper focuses on the design of the virtual coach as part of an e-learning system, which was developed in the EPA-Coach project founded by the German Ministry of Education and Research. The paper starts with the theoretical underpinnings of contextual learning and the related design considerations for a virtual learning coach based on previous studies. Since previous research in the area was mostly designed to cater to the needs of younger audiences, the results had to be adapted to the specific needs of senior learners. Next, the paper outlines the stages in the design of the virtual coach, which included the adaptation of the design requirements, the iterative development of the prototypes, the results of the two evaluation studies and how these results were used to improve the design of the virtual coach. The paper then presents the four prototypes of a senior-friendly virtual learning coach, which were designed to represent different preferences related to the visual appearance, the communication and social interaction styles, and the pedagogical roles. The first evaluation of the virtual coach design was an exploratory, qualitative study, which was carried out in October 2020 with eight seniors aged 64 to 78 and included a range of questions about the preferences of senior learners related to the visual design, gender, age, communication and role. Based on the results of the first evaluation, the design was adapted to the preferences of the senior learners and the new versions of prototypes were created to represent two male and two female options of the virtual coach. The second evaluation followed a quantitative approach with an online questionnaire and was conducted in May 2021 with 41 seniors aged 66 to 93 years. Following three research questions, the survey asked about (1) the intention to use, (2) the perceived characteristics, and (3) the preferred communication/interaction style of the virtual coach, i. e. task-oriented, relationship-oriented, or a mix. This paper follows with the discussion of the results of the design process and ends with conclusions and next steps in the development of the virtual coach including recommendations for further research.

Keywords: virtual learning coach, virtual mentor, pedagogical agent, senior learners, digital literacy, electronic health records

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Authors: Gift Udoh, Diane S. Rohlman, Benjamin Sindt

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BACKGROUND: There is concern regarding the widespread use of pesticides and impacts on public health. Farmers in Nigeria frequently apply pesticides, including organophosphate pesticides which are known neurotoxicants. They receive little guidance on how much to apply or information about safe handling practices. Pesticide poisoning is one of the major hazards that farmers face in Nigeria. Farmers continue to use highly neurotoxic pesticides for agricultural activities. Because farmers receive little or no information on safe handling and how much to apply, they continue to develop severe and mild illnesses caused by high exposures to pesticides. The project aimed to reduce pesticide exposure among rural farmers in Nigeria by identifying hazards associated with pesticide use and developing and pilot testing training to reduce exposures to pesticides utilizing the hierarchy of controls system. METHODS: Information on pesticide knowledge, behaviors, barriers to safety, and prevention methods was collected from farmers in Nigeria through workplace observations, questionnaires, and interviews. Pre and post-surveys were used to measure farmer’s knowledge before and after the delivery of pesticide safety training. Training topics included the benefits and risks of using pesticides, routes of exposure and health effects, pesticide label activity, use and selection of PPE, ways to prevent exposure and information on local resources. The training was evaluated among farmers and changes in knowledge, attitudes and behaviors were collected prior to and following the training. RESULTS: The training was administered to 60 farmers, a mean age of 35, with a range of farming experience (<1 year to > 50 years). There was an overall increase in knowledge after the training. In addition, farmers perceived a greater immediate risk from exposure to pesticides and their perception of their personal risk increased. For example, farmers believed that pesticide risk is greater to children than to adults, recognized that just because a pesticide is put on the market doesn’t mean it is safe, and they were more confident that they could get advice about handling pesticides. Also, there was greater awareness about behaviors that can increase their exposure (mixing pesticides with bare hands, eating food in the field, not washing hands before eating after applying pesticides, walking in fields recently sprayed, splashing pesticides on their clothes, pesticide storage). CONCLUSION: These results build on existing evidence from a 2022 article highlighting the need for pesticide safety training in Nigeria which suggested that pesticide safety educational programs should focus on community-based, grassroots-style, and involve a family-oriented approach. Educating farmers on agricultural safety while letting them share their experiences with their peers is an effective way of creating awareness on the dangers associated with handling pesticides. Also, for rural communities, especially in Nigeria, pesticide safety pieces of training may not be able to reach some locations, so intentional scouting of rural farming communities and delivering pesticide safety training will improve knowledge of pesticide hazards. There is a need for pesticide information centers to be situated in rural farming communities or agro supply stores, which gives rural farmers information.

Keywords: pesticide exposure, pesticide safety, nigeria, rural farming, pesticide education

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Authors: Alan Walsh, Peter Walker

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Differences in commercial, professional and personal cultural traditions between western consultants and project sponsors in the Gulf Cooperation Council (GCC) region are potentially significant in the workplace, and this can impact on project outcomes. These cultural differences can, for example, result in conflict amongst senior managers, which can negatively impact the megaproject. New entrants to the GCC often experience ‘culture shock’ as they attempt to integrate into their unfamiliar environments. Megaprojects are unique ventures with individual project characteristics, which need to be considered when managing their associated risks. Megaproject research to date has mostly ignored the significance of the absence of cultural congruence in the GCC, which is surprising considering that there are large volumes of megaprojects in various stages of construction in the GCC. An initial step to dealing with cultural issues is to acknowledge culture as a significant risk factor (SRF). This paper seeks to understand the criticality for western consultants to address these risks. It considers the cultural barriers that exist between GCC sponsors and western consultants and examines the cultural distance between the key actors. Initial findings suggest the presence to a certain extent of ethnocentricity. Other cultural clashes arise out of a lack of appreciation of the customs, practices and traditions of ‘the Other’, such as the need for avoiding public humiliation and the hierarchal significance rankings. The concept and significance of cultural shock as part of the integration process for new arrivals are considered. Culture shock describes the state of anxiety and frustration resulting from the immersion in a culture distinctly different from one's own. There are potentially substantial project risks associated with underestimating the process of cultural integration. This paper examines two distinct but intertwined issues: the societal and professional culture differences associated with expatriate assignments. A case study examines the cultural congruences between GCC sponsors and American, British and German consultants, over a ten-year cycle. This provides indicators as to which nationalities encountered the most profound cultural issues and the nature of these. GCC megaprojects are typically intensive fast track demanding ventures, where consultant turnover is high. The study finds that building trust-filled relationships is key to successful project team integration and therefore, to successful megaproject execution. Findings indicate that both professional and social inclusion processes have steep learning curves. Traditional risk management practice is to approach any uncertainty in a structured way to mitigate the potential impact on project outcomes. This research highlights cultural risk as a significant factor in the management of GCC megaprojects. These risks arising from high staff turnover typically include loss of project knowledge, delays to the project, cost and disruption in replacing staff. This paper calls for cultural risk to be recognised as an SRF, as the first step to developing risk management strategies, and to reduce staff turnover for western consultants in GCC megaprojects.

Keywords: western consultants in megaprojects, national culture impacts on GCC megaprojects, significant risk factors in megaprojects, professional culture in megaprojects

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Authors: Kaveri Dutta, Ratna Sharma

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Indian traditional textile is a synthesis of various cultures. Art and crafts of a country showcases the rich cultural and artistic history of that nation. Prehistorically Indian handicrafts were basically made for day to day use; the yearning for aesthetic application soon saw the development of flooding designs and motifs. Similarly, Bagh print a traditional hand block Print with natural colours an Indian handicraft practiced in Bagh, Madhya Pradesh(India). Bagh print has its roots in Sindh, which is now a part of Pakistan. The present form of Bagh printing actually started in 1962 when the craftsmen migrated from Manavar to the neighboring town of Bagh situated in Madhya Pradesh and hence Bagh has always been associated with this printing style. Bagh printing basically involved blocks that are carved onto motifs that represent flora such as Jasmine, Mushroom leheriya and so on. There are some prints that were inspired by the jaali work that embellished the Taj Mahal and various other forts. Inspiration is also drawn from the landscapes and geometrical figures. The motifs evoke various moods in the serenity of the prints and that is the catchy element of Bagh prints. The development in this traditional textile is as essential as in another field. Nowadays fashion trends are fragile and innovative changes over existing fashion field in the short span is the demand of times. We must make efforts to preserve this cultural heritage of arts and crafts and this is done either by documenting the various ancient traditions or by making a blend of it. Since this craft is well known over the world, but the need is to document the original motif, fabric, technology and colors used in contemporary fashion. Hence keeping above points in mind this study on bagh print textiles of Madhya Pradesh work has been formulated. The information incorporated in the paper was based on secondary data taken from relevant books, journals, museum visit and articles. Besides for the demographic details and working profile of the artisans dealt with printing, an interview schedule was carried out in three regions of Madhya Pradesh. This work of art was expressed in Cotton fabric. For this study selected traditional motifs for Bang printing was used. Some of the popular traditional Bagh motifs are Jasmine, Mushroom leheriya, geometrical figures and jaali work. The Bagh printed cotton fabrics were developed into a range of men’s ethic wear in combination with embroideries from Rajasthan. Products developed were bandhgala jackets, kurtas, serwani and dupattas. From the present study, it can be observed that the embellished traditional Bang printed range of ethnic men’s wear resulted in the fresh and colourful pattern. The embroidered Bagh printed cotton fabric also created a huge change in a positive way among artisans of the three regions.

Keywords: art and craft of Madhya Pradesh, evolution of printing in India, history of Bagh printing, sources of inspiration

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Authors: Flavia Oliveira de A. M. Cruz, Edison Tostes Faria, Paula Elaine D. Reis

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When the breast is submitted to radiation therapy (RT), the most common effects are pain, skin changes, mobility restrictions, local sensory alteration, and fatigue. These effects, if not managed properly, may reduce the quality of life of cancer patients and may lead to the treatment discontinuation. Therefore, promoting knowledge and guidelines for symptom management remain a high priority for patients and a challenge for health professionals, due to the need to handle side effects in a population with a life-threatening disease. Printed materials are important strategies for supporting educative activities since they help the individual to assimilate and understand the amount of information transmitted. Nurses' behavior can be systematized through the use of an educative manual, which may be effective in promoting information regarding the treatment, self-care and how to control the effects of RT at home. In view of the importance of guaranteeing the validity of the material before its use, the objective of this research was to validate the content and appearance of an educative manual for breast cancer patients undergoing RT. The Theory of Psychometrics was used for the validation process in this descriptive methodological research. A minimum agreement rate (AR) of 80% was considered to guarantee the validity of the material. The data were collected from October to December 2017, by means of two assessments tools, constructed in the form of a Likert scale, with five levels of understanding. These instruments addressed different aspects of the evaluation, in view of two different groups of participants; 17 experts in the theme area of the educative manual, and 12 women that received RT previously to treat breast cancer. The manual was titled 'Orientation Manual: radiation therapy in breast', and was focused on breast cancer patients attended at the Department of Oncology of the Brasília University Hospital (UNACON/HUB). The research project was submitted to the Research Ethics Committee at the School of Health Sciences of the University of Brasília (CAAE: 24592213.1.0000.0030). Only two items of the assessment tool for the experts, one related to the manual's ability to promote behavioral and attitude changes and the other related to the extent of its use for other health services, obtained AR < 80% and were reformulated based on the participants' suggestions and in the literature. All other items were considered appropriate and/or complete appropriate in the three blocks proposed for the experts: objectives - 89%, structure and form - 93%, and relevance - 93%; and good and/or very good in the five blocks of analysis proposed for patients: objectives - 100%, organization - 100%, writing style - 100%, appearance - 100%, and motivation. The appearance and content validation of the educative manual proposed were attended to. The educative manual was considered relevant and pertinent and may contribute to the understanding of the therapeutic process by breast cancer patients during RT, as well as support clinical practice through the nursing consultation.

Keywords: oncology nursing, nursing care, validation studies, educational technology

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Authors: Sandra Hartl, Meena Chavan

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This paper presents the outcome of a four year Ph.D. research on cross-cultural conflict management in transnational business relationships. An important and complex problem about managing conflicts that arise across cultures in business relationships is investigated, and conflict resolution strategies are identified. This paper particularly focuses on transnational relationships within a Chinese, German and Middle Eastern framework. Unlike many papers on this issue which have been built on experiments with international MBA students, this research provides real-life cases of cross-cultural conflicts which are not easy to capture. Its uniqueness is underpinned as the real case data was gathered by interviewing top executives at management positions in large multinational corporations through a qualitative case study method approach. This paper makes a valuable contribution to the theory of cross-cultural conflicts, and despite the sensitivity, this research primarily presents real-time business data about breaches of contracts between two counterparties engaged in transnational operating organizations. The overarching aim of this research is to identify the degree of significance for the cultural factors and the communication factors embedded in cross-cultural business conflicts. It questions from a cultural perspective what factors lead to the conflicts in each of the cases, what the causes are and the role of culture in identifying effective strategies for resolving international disputes in an increasingly globalized business world. The results of 20 face to face interviews are outlined, which were conducted, recorded, transcribed and then analyzed using the NVIVO qualitative data analysis system. The outcomes make evident that the factors leading to conflicts are broadly organized under seven themes, which are communication, cultural difference, environmental issues, work structures, knowledge and skills, cultural anxiety and personal characteristics. When evaluating the causes of the conflict it is to notice that these are rather multidimensional. Irrespective of the conflict types (relationship or task-based conflict or due to individual personal differences), relationships are almost always an element of all conflicts. Cultural differences, which are a critical factor for conflicts, result from different cultures placing different levels of importance on relationships. Communication issues which are another cause of conflict also reflect different relationships styles favored by different cultures. In identifying effective strategies for solving cross-cultural business conflicts this research identifies that solutions need to consider the national cultures (country specific characteristics), organizational cultures and individual culture, of the persons engaged in the conflict and how these are interlinked to each other. Outcomes identify practical dispute resolution strategies to resolve cross-cultural business conflicts in reference to communication, empathy and training to improve cultural understanding and cultural competence, through the use of mediation. To conclude, the findings of this research will not only add value to academic knowledge of cross-cultural conflict management across transnational businesses but will also add value to numerous cross-border business relationships worldwide. Above all it identifies the influence of cultures and communication and cross-cultural competence in reducing cross-cultural business conflicts in transnational business.

Keywords: business conflict, conflict management, cross-cultural communication, dispute resolution

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Authors: Peter Heimerl, Alexander Plaikner, Mike Peters

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Background and Significance of the Study: Family-run businesses are a decisive economic factor in the Alpine tourism and leisure industry. Within the next years, it is expected that a large number of family-run small and medium-sized businesses will transfer ownership due to demographic developments. Four stages of succession processes can be identified by several empirical studies: (1) the preparation phase, (2) the succession planning phase, (3) the development of the succession concept, (4) and the implementation of the business transfer. Family business research underlines the importance of individual's and family’s values: Especially leadership values address mainly the first phase, which strongly determines the following stages. Aim of the Study: The study aims at answering the following research question: Which leadership values are dominating during succession processes in family-run businesses in Austrian Alpine tourism industry? Methodology: Twenty-two problem-centred individual interviews with 11 transferors and their 11 transferees were conducted. Data analysis was carried out using the software program MAXQDA following an inductive approach to data coding. Major Findings: Data analysis shows that nine values particularly influence succession processes, especially during the vulnerable preparation phase. Participation is the most-dominant value (162 references). It covers a style of cooperation, communication, and controlling. Discipline (142) is especially prevailing from the transferor's perspective. It addresses entrepreneurial honesty and customer orientation. Development (138) is seen as an important value, but it can be distinguished between transferors and transferees. These are mainly focused on strategic positioning and new technologies. Trust (105) is interpreted as a basic prerequisite to run the family firm smoothly. Interviewees underline the importance to be able to take a break from family-business management; however, this is only possible when openness and honesty constitute trust within the family firm. Loyalty (102): Almost all interviewees perceive that they can influence the loyalty of the employees through their own role models. A good work-life balance (90) is very important to most of the transferors, especially for their employees. Despite the communicated importance of a good work-life-balance, but however, mostly the commitment to the company is prioritised. Considerations of regionality (82) and regional responsibility are also frequently raised. Appreciation (75) is of great importance to both the handover and the takeover generation -as appreciation towards the employees in the company and especially in connection with the family. Familiarity (66) and the blurring of the boundaries between private and professional life are very common, especially in family businesses. Familial contact and open communication with employees which is mentioned in almost all handing over. Conclusions: In the preparation phase of succession, successors and incumbents have to consider and discuss their leadership and family values of family-business management. Quite often, assistance is needed to commonly and openly discuss these values in the early stages of succession processes. A large majority of handovers fail because of these values. Implications can be drawn to support family businesses, e.g., consulting initiatives at chambers of commerce and business consultancies must address this problem.

Keywords: leadership values, family business, succession processes, succession phases

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Authors: Ayesha Mushtaq

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Asthma is a pulmonary disease in which blockade of the airway takes place due to inflammation as a response to certain allergens. Breathing troubles, cough, and dyspnea are one of the few symptoms. Several studies have indicated a significant effect on asthma due to changes in dietary routines. Certain food items, such as oily foods and other materials, are known to cause an increase in the symptoms of asthma. Low dietary intake of fruits and vegetables may be important in relation to asthma prevalence. The objective of this study is to assess and compare the nutritional status of asthmatic and non-asthmatic patients. The significance of this study lies in the factor that it will help nutritionists to arrange a feasible dietary routine for asthmatic patients. This research was conducted at the Pulmonology Department of the Pakistan Institute of Medical Science Islamabad. About thirty hundred thirty-four million people are affected by asthma worldwide. Pakistan is on the verge of being an uplifted urban population and asthma cases are increasingly high these days. Several studies suggest an increase in the Asthmatic patient population due to improper diet. This is a cross-sectional study aimed at assessing the nutritious standing of Asthmatic and non-asthmatic patients. This research took place at the Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan. The research included asthmatic and non-asthmatic patients coming to the pulmonology department clinic at the Pakistan Institute of Medical Sciences (PIMS). These patients were aged between 20-60 years. A questionnaire was developed for these patients to estimate their dietary plans in these patients. The methodology included four sections. The first section was the Socio-Demographic profile, which included age, gender, monthly income and occupation. The next section was anthropometric measurements which included the weight, height and body mass index (BMI) of an individual. The next section, section three, was about the biochemical attributes, such as for biochemical profiling, pulmonary function testing (PFT) was performed. In the next section, Dietary habits were assessed by a food frequency questionnaire (FFQ) through food habits and consumption pattern was assessed. The next section life style data, in which the person's level of physical activity, sleep and smoking habits were assessed. The next section was statistical analysis. All the data obtained from the study were statistically analyzed and assessed. Most of the asthma Patients were females, with weight more than normal or even obese. Body Mass Index (BMI) was higher in asthma Patients than those in non-Asthmatic ones. When the nutritional Values were assessed, we came to know that these patients were low on certain nutrients and their diet included more junk and oily food than healthy vegetables and fruits. Beverages intake was also included in the same assessment. It is evident from this study that nutritional status has a contributory effect on asthma. So, patients on the verge of developing asthma or those who have developed asthma should focus on their diet, maintain good eating habits and take healthy diets, including fruits and vegetables rather than oily foods. Proper sleep may also contribute to the control of asthma.

Keywords: BMI, nutrition, PAL, diet

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Authors: Laura E. Hall, Joel Monárrez-Espino, Luz María Tejada Tayabas

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College students are at risk of weight gain and poor dietary habits, and health behaviours established during this period have been shown to track into midlife. They may therefore be an important target group for health promotion strategies, yet there is a lack of literature regarding dietary intakes and associated factors in this group, particularly in middle-income countries such as Mexico. The aim of this exploratory research was to describe and compare reported dietary intakes among nursing and nutrition college students at two public universities in Mexico, and to explore the relationship between demographic, behavioural and other health-related factors and the risk of low diet quality. Mexican college students (n=444) majoring in nutrition or nursing at two urban universities completed questionnaires regarding dietary and health-related behaviours and risks. Dietary intake was assessed via 24-hour recall. Weight, height and abdominal circumference were measured. Descriptive statistics were reported and nutrient intakes were compared between colleges and study tracks using Student’s t tests, odds ratios and Pearson chi square tests. Two dietary quality scores were constructed to explore the relationship between demographic, behavioural and other health-related factors and the diet quality scores using binary logistic regression. Analysis was performed using SPSS statistics, with differences considered statistically significant at p<0.05. The response rate to the survey was 91%. When macronutrients were considered as a percentage of total energy, the majority of students had protein intakes within recommended ranges, however one quarter of students had carbohydrate and fat intakes exceeding recommended levels. Three quarters had fibre intakes that were below recommendations. More than half of the students reported intakes of magnesium, zinc, vitamin A, folate and vitamin E that were below estimated average requirements. Students studying nutrition reported macronutrient and micronutrient intakes that were more compliant with recommendations compared to nursing students, and students studying in central-north Mexico were more compliant than those studying in southeast Mexico. Breakfast skipping (Adjusted Odds Ratio (OR) = 5.3; 95% Confidence Interval (CI) = 1.2-22.7), risk of anxiety (OR = 2.3; CI = 1.3-4.4), and university location (OR = 1.6; CI = 1.03-2.6) were associated with a greater risk of having a low macronutrient score. Caloric intakes <1800kcal (OR = 5.8; CI = 3.5-9.7), breakfast skipping (OR = 3.7; CI = 1.4-10.3), vigorous exercise ≤1h/week (OR = 2.6; CI = 1.3-5.2), soda consumption >250mls/day (OR = 2.0; CI = 1.2-3.3), unhealthy diet perception (OR = 1.9; CI = 1.2-3.0), and university location (OR = 1.8; CI = 1.1-2.8) were significantly associated with greater odds of having a low micronutrient score. College students studying nursing and nutrition did not report ideal diets, and these students should not be overlooked in public health interventions. Differences in dietary intakes between universities and study tracks were evident, with more favourable profiles evident in nutrition compared to nursing, and North-central compared to Southeast students. Further, demographic, behavioural and other health-related factors were associated with diet quality scores, warranting further research.

Keywords: college student, diet quality, nutrient intake, young adult

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Authors: M. Attavanich, H. Kobayashi

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Moklen is a sub-group of ethnic minority in Thailand. In the past, they were vagabonds of the sea. Their livelihood relied on the sea but they built temporary shelters to avoid strong wind and waves during monsoon season. Recently, they have permanently settled on land along coastal area and mangrove forest in Phang Nga and Phuket Province, Southern Thailand. Moklen people have their own housing culture: the Moklen ethnic house was built from local natural materials, indicating a unique structure and design. Its wooden structure is joined by rattan ropes. The construction process is very unique because of using body-based unit of measurement for design and construction. However, there are several threats for those unique structures. One of the most important threats on Moklen ethnic house is tsunami. Especially the 2004 Indian Ocean Tsunami caused widely damage to Southern Thailand and Phang Nga province was the most affected area. In that time, Moklen villages which are located along the coastal area also affected calamitously. In order to recover the damage in affected villages, mostly new modern style houses were provided by aid agencies. This process has caused a significant impact on Moklen housing culture. Not only tsunami, but also modernization has an influence on the changing appearance of the Moklen houses and the effect of modernization has been started to experience before the tsunami. As a result, local construction knowledge is very limited nowadays because the number of elderly people in Moklen has been decreasing drastically. Last but not the least, restrictions of construction materials which are originally provided from accessible mangroves, create limitations in building a Moklen house. In particular, after the Reserved Forest Act, wood chopping without any permission has become illegal. These are some of the most important reasons for Moklen ethnic houses to disappear. Nevertheless, according to the results of field surveys done in 2013 in Phang Nga province, it is found out that some Moklen ethnic houses are still available in Tubpla Village, but only a few. Next survey in the same area in 2014 showed that number of Moklen houses in the village has been started to increase significantly. That proves that there is a high potential to conserve Moklen houses. Also the project of our research team in February 2014 contributed to continuation of Moklen ethnic house. With the cooperation of the village leader and our team, it was aimed to construct a Moklen house with the help of local participants. For the project, villagers revealed the building knowledge and techniques, and in the end, project helped community to understand the value of their houses. Also, it was a good opportunity for Moklen children to learn about their culture. In addition, NGOs recently have started to support ecotourism projects in the village. It not only helps to preserve a way of life, but also contributes to preserve indigenous knowledge and techniques of Moklen ethnic house. This kind of supporting activities are important for the conservation of Moklen ethnic houses.

Keywords: conservation, construction project, Moklen Ethnic House, 2004 Indian Ocean tsunami

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Authors: Samar Saadeldin Abdelmotalab Omer, Ikram Mohamed Eltayeb Elsiddig, Saad Mohammed Hussein Ayoub

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A variety of herbal medicinal plants are known to confer beneficial effects in regards to modification of cardiovascular ri’=sk factors. The anti-hypercholesterolaemic and antioxidant activities of the crude ethanolic extracts of Citrus reticulate fruit peel, Zingiber officinale rhizome and Sesamum indicum seed extracts have been demonstrated. These plants are assumed to possess biologically active principles, which impart their pharmacologic activities. GC-MS analysis of the ethanolic extracts was carried out to identify the active principles and their percentages of occurrence in the analytes. Analysis of the extracts was carried out using (GS-MS QP) type Schimadzu 2010 equipped with a capillary column RTX-50 (restec), (length 30mm, diameter 0.25mm, and thickness 0.25mm). Helium was used as a carrier gas, the temperature was programmed at 200°C for 5 minutes at a rate of 15ml/minute, and the extracts were injected using split injection mode. The identification of different components was achieved from their Mass Spectra and Retention time, compared with those in the NIST library. The results revealed the presence of 80 compounds in Sudanese locally grown C. reticulata fruit peel extract, most of which were monoterpenoid compounds including Limonene (3.03%), Alpha & Gamma - terpinenes (2.61%), Linalool (1.38%), Citral (1.72%) which are known to have profound antioxidant effects. The Sesquiterpenoids Humulene (0.26%) and Caryophyllene (1.97%) were also identified, the latter known to have profound anti-anxiety and anti-depressant activity in addition to the beneficiary effects in lipid regulation. The analysis of the locally grown S. indicum oily and water soluble portions of seed extract revealed the presence of a total of 64 compounds with considerably high percentage of the mono-unsaturated fatty acid ester methyl oleate (66.99%) in addition to methyl stearate (9.35%) and palmitate (15.71%) of oil portion, whereas, plant sterols including Gamma-sitosterol (13.5%), fucosterol (2.11%) and stigmasterol (1.95%) in addition to gamma-tocopherol (1.16%) were detected in extract water-soluble portion. The latter indicate various principles known to have valuable pharmacological benefits including antioxidant activities and beneficiary effects on intestinal cholesterol absorption and regulation of serum cholesterol levels. Z. officinale rhizome extract analysis revealed the presence of 93 compounds, the most abundant were alpha-zingeberine (16.5%), gingerol (9.25%), alpha-sesquiphellandrene (8.3%), zingerone (6.78%), beta-bisabolene (4.19%), alpha-farnesene (3.56%), ar-curcumene (3.29%), gamma-elemene (1.25%) and a variety of other compounds. The presence of these active principles reflected on the activity of the extract. Activity could be assigned to a single or a combination of two or more extract components. GC-MS analysis concluded the occurrence of compounds known to possess antioxidant activity and lipid profile effects.

Keywords: gas chromatography, indicum, officinale, reticulata

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Authors: Lucile Rapin, Cynthia El Hage, Rihab Gamaoun, Maria-Fernanda Arboleda, Erin Prosk

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Introduction: Sante Cannabis (SC), a Canadian group of clinics dedicated to medical cannabis, based in Montreal and in the province of Quebec, has served more than 8000 patients seeking cannabis-based treatment over the past five years. As randomized clinical trials with natural medical cannabis are scarce, real-world evidence offers the opportunity to fill research gaps between scientific evidence and clinical practice. Data on the use of medical cannabis products from SC patients were prospectively collected, leading to a large real-world database on the use of medical cannabis. The aim of this study was to report information on the profiles of both patients and prescribed medical cannabis products at SC clinics, and to assess the safety of medical cannabis among Canadian patients. Methods: This is an observational retrospective study of 1342 adult patients who were authorized with medical cannabis products between October 2017 and September 2019. Information regarding demographic characteristics, therapeutic indications for medical cannabis use, patterns in dosing and dosage form of medical cannabis and adverse effects over one-year follow-up (initial and 4 follow-up (FUP) visits) were collected. Results: 59% of SC patients were female, with a mean age of 56.7 (SD= 15.6, range= (19-97)). Cannabis products were authorized mainly for patients with a diagnosis of chronic pain (68.8% of patients), cancer (6.7%), neurological disorders (5.6%), and mood disorders (5.4 %). At initial visit, a large majority (70%) of patients were authorized exclusively medical cannabis products, 27% were authorized a combination of pharmaceutical cannabinoids and medical cannabis and 3% were prescribed only pharmaceutical cannabinoids. This pattern was recurrent over the one-year follow-up. Overall, oil was the preferred formulation (average over visits 72.5%) followed by a combination of oil and dry (average 19%), other routes of administration accounted for less than 4%. Patients were predominantly prescribed products with a balanced THC:CBD ratio (59%-75% across visits). 28% of patients reported at least one adverse effect (AE) at the 3-month follow-up visit and 12% at the six-month FUP visit. 84.8% of total AEs were mild and transient. No serious AE was reported. Overall, the most common side effects reported were dizziness (11.95% of total AEs), drowsiness (11.4%), dry mouth (5.5%), nausea (4.8%), headaches (4.6%), cough (4.4%), anxiety (4.1%) and euphoria (3.5%). Other adverse effects accounted for less than 3% of total AE. Conclusion: Our results confirm that the primary area of clinical use for medical cannabis is in pain management. Patients in this cohort are largely utilizing plant-based cannabis oil products with a balanced ratio of THC:CBD. Reported adverse effects were mild and included dizziness and drowsiness. This real-world data confirms the tolerable safety profile of medical cannabis and suggests medical indications not yet validated in controlled clinical trials. Such data offers an important opportunity for the investigation of the long-term effects of cannabinoid exposure in real-life conditions. Real-world evidence can be used to direct clinical trial research efforts on specific indications and dosing patterns for product development.

Keywords: medical cannabis, safety, real-world data, Canada

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