Search results for: Downside Risk

Authors: Ahmad Haidar

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The rapid adoption of Artificial Intelligence (AI) technology holds unforeseen risks like privacy violation, unemployment, and algorithmic bias, triggering research institutions, governments, and companies to develop principles of AI ethics. The extensive and diverse literature on AI lacks an analysis of the evolution of principles developed in recent years. There are two fundamental purposes of this paper. The first is to provide insights into how the principles of AI ethics have been changed recently, including concepts like risk management and public participation. In doing so, a NOISE (Needs, Opportunities, Improvements, Strengths, & Exceptions) analysis will be presented. Second, offering a framework for building Ethical AI linked to sustainability. This research adopts an explorative approach, more specifically, an inductive approach to address the theoretical gap. Consequently, this paper tracks the different efforts to have “trustworthy AI” and “ethical AI,” concluding a list of 12 documents released from 2017 to 2022. The analysis of this list unifies the different approaches toward trustworthy AI in two steps. First, splitting the principles into two categories, technical and net benefit, and second, testing the frequency of each principle, providing the different technical principles that may be useful for stakeholders considering the lifecycle of AI, or what is known as sustainable AI. Sustainable AI is the third wave of AI ethics and a movement to drive change throughout the entire lifecycle of AI products (i.e., idea generation, training, re-tuning, implementation, and governance) in the direction of greater ecological integrity and social fairness. In this vein, results suggest transparency, privacy, fairness, safety, autonomy, and accountability as recommended technical principles to include in the lifecycle of AI. Another contribution is to capture the different basis that aid the process of AI for sustainability (e.g., towards sustainable development goals). The results indicate data governance, do no harm, human well-being, and risk management as crucial AI for sustainability principles. This study’s last contribution clarifies how the principles evolved. To illustrate, in 2018, the Montreal declaration mentioned eight principles well-being, autonomy, privacy, solidarity, democratic participation, equity, and diversity. In 2021, notions emerged from the European Commission proposal, including public trust, public participation, scientific integrity, risk assessment, flexibility, benefit and cost, and interagency coordination. The study design will strengthen the validity of previous studies. Yet, we advance knowledge in trustworthy AI by considering recent documents, linking principles with sustainable AI and AI for sustainability, and shedding light on the evolution of guidelines over time.

Keywords: artificial intelligence, AI for sustainability, declarations, framework, regulations, risks, sustainable AI

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Authors: Pedro Batista, André Vinha, Filipe Castelo, Bárbara Costa, Ricardo Sousa, Raquel Ricardo, André Pinto

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Background: Septic arthritis is a diagnosis that must be considered in any patient presenting with acute joint swelling and fever. Among the several risk factors for septic arthritis, such as age, rheumatoid arthritis, recent surgery, or skin infection, diabetes mellitus can sometimes be the main risk factor. Staphylococcus aureus is the most common pathogen isolated in septic arthritis; however, it is uncommon in monomicrobial necrotizing fasciitis. Objectives: A case report of concomitant septic arthritis and necrotizing fasciitis in a patient with undiagnosed diabetes based on clinical history. Study Design & Methods: We report a case of a 58-year-old Portuguese previously healthy man who presented to the emergency department with fever and left knee swelling and pain for two days. The blood work revealed ketonemia of 6.7 mmol/L and glycemia of 496 mg/dL. The vital signs were significant for a temperature of 38.5 ºC and 123 bpm of heart rate. The left knee had edema and inflammatory signs. Computed tomography of the left knee showed diffuse edema of the subcutaneous cellular tissue and soft tissue air bubbles. A diagnosis of septic arthritis and necrotising fasciitis was made. He was taken to the operating room for surgical debridement. The samples collected intraoperatively were sent for microbiological analysis, revealing infection by multi-sensitive Staphylococcus aureus. Given this result, the empiric flucloxacillin (500 mg IV) and clindamycin (1000 mg IV) were maintained for 3 weeks. On the seventh day of hospitalization, there was a significant improvement in subcutaneous and musculoskeletal tissues. After two weeks of hospitalization, there was no purulent content and partial closure of the wounds was possible. After 3 weeks, he was switched to oral antibiotics (flucloxacillin 500 mg). A week later, a urinary infection by Pseudomonas aeruginosa was diagnosed and ciprofloxacin 500 mg was administered for 7 days without complications. After 30 days of hospital admission, the patient was discharged home and recovered. Results: The final diagnosis of concomitant septic arthritis and necrotizing fasciitis was made based on the imaging findings, surgical exploration and microbiological tests results. Conclusions: Early antibiotic administration and surgical debridement are key in the management of septic arthritis and necrotizing fasciitis. Furthermore, risk factors control (euglycemic blood glucose levels) must always be taken into account given the crucial role in the patient's recovery.

Keywords: septic arthritis, Necrotizing fasciitis, diabetes, Staphylococcus Aureus

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Authors: Joy Winston James, Abdul Kadher Jilani

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This review article provides a comprehensive overview of social engineering attacks, specifically those executed through the Kali Linux operating system. It aims to present an in-depth analysis of the background and importance of social engineering in cybersecurity, the tools, and techniques used in these attacks, real-world case studies that demonstrate their effectiveness, and ethical considerations that need to be taken into account while using them. The article highlights the Kali Linux tools that are commonly used in social engineering attacks, including SET, Metasploit, and BeEF, and discusses techniques such as phishing, pretexting, and baiting that are crucial in conducting successful social engineering attacks. It further explores real-world case studies that demonstrate the effectiveness of these techniques, emphasizing the importance of implementing effective countermeasures to reduce the risk of successful social engineering attacks. Moreover, the article sheds light on ethical considerations that need to be taken into account while using social engineering tools, emphasizing the importance of using them ethically and legally. Finally, the article provides potential countermeasures such as two-factor authentication, strong password policies, and regular security audits to help individuals and organizations better protect themselves against this growing threat. By understanding the tools and techniques used in social engineering attacks and implementing appropriate countermeasures, individuals and organizations can minimize the risk of successful social engineering attacks and improve their cybersecurity posture. To illustrate the effectiveness of social engineering attacks, we present real-world case studies that demonstrate how easily individuals and organizations can fall prey to these attacks. We also discuss ethical considerations that must be taken into account while using social engineering tools, emphasizing the need for responsible and legal use of these tools.

Keywords: pen testing, hacking, Kali Linux, social engineering

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Authors: Mehmet Akif Aslan, Mehmet Simsek, Eyup Sensoy

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Big Data stands for today’s cutting-edge technology. As the technology becomes widespread, so does Data. Utilizing massive data sets enable companies to get competitive advantages over their adversaries. Out of many area of Big Data usage, logistics has significance role in both commercial sector and military. This paper lays out what big data is and how it is used in both military and commercial logistics.

Keywords: big data, logistics, operational efficiency, risk management

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Authors: Shervin Rashidinia, Sara Shahmoradi, Seyyed Shahin Eftekhari, Mohsen Talebizadeh, Mohammad Saleh Sadeghi

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Background: Beta-thalassemia Major (BTM) is a kind of hereditary hemolytic anemia which depended on regular monthly blood transfusion. However, iron deposition into the organs leads to multi-organ damage. The present study is the first study which aimed to evaluate the average of five-years serum ferritin level and compared by the prevalence of short stature and hypocalcemia. Materials/Methods: A cross-sectional retrospective study which a total of 140 patients with beta-thalassemia who were referred to Qom Thalassemia Clinic between February 2011 and July 2016 were enrolled to be reviewed. The exclusion criteria were consisting of incomplete medical records, diagnosis less than 2-years-ago and the blood transfusion less than every 4 weeks. The data including age, gender, weight, height, age of initial blood transfusion, age of initial chelation therapy, ferritin, and calcium were collected and analysis by SPSS version 24. Results: A total of 140 patients were enrolled. Of them, 75 (53.4%) were female. The mean age of the patients was 13.4±4.6 years.The mean age of initial diagnosis was 20.2±7.4 months. Hypocalcemia and short stature were occurred in 41 (29.3%) and 37 (26.4%) patients, respectively. The mean five-years serum ferritin level was significantly higher in the patients with short stature and hypocalcemia (P<0.0001). However, rise in serum ferritin level significantly increases the risk of short-stature and hypocalcemia (1.0004- and 1.0029 fold, respectively). Conclusion: We demonstrated that prevalence of short stature and hypocalcemia were significantly higher in the BTM.However, ferritin significantly increases the risk of short stature and hypocalcemia.

Keywords: beta-thalassemia, ferritin, growth retardation, hypocalcemia

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Authors: Iulian Clain

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In contemporary public administration, the demand for greater accountability, transparency, and efficient governance has intensified, particularly in the face of increasing public scrutiny and fiscal constraints. Internal auditing has emerged as a vital tool in strengthening governance structures, enhancing the effectiveness of public sector institutions, and ensuring compliance with regulatory frameworks. This paper examines the evolving role of internal auditing within public administration, with an emphasis on risk management, regulatory compliance, and fraud prevention. Building on institutional theory and risk management frameworks, this study explores how internal audits contribute to identifying operational inefficiencies, minimizing financial irregularities, and promoting ethical governance practices. Through case studies and comparative analysis of auditing practices across OECD nations, this research provides insights into how strategic internal audits can be harnessed to reinforce public sector governance, thereby improving the delivery of public services. The paper argues that the integration of internal audit findings into decision-making processes enhances not only financial accountability but also policy outcomes, fostering greater public trust in government institutions. Key recommendations are presented on how public institutions can further integrate internal auditing processes to enhance governance outcomes, focusing on best practices for institutionalizing audit functions within public sector governance frameworks. These findings are particularly relevant for policymakers, audit professionals, and public administration leaders striving to achieve better governance, operational efficiency, and integrity in the public sector.

Keywords: internal auditing role, public administration sciences, public administration audit, internal auditing in universities

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Authors: M. Keršič, M. Lužnik, J. Lužnik

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Cervical dilatation and membrane herniation before 26th week of gestation poses very high risk for extremely and very premature childbirth. Cerclage with mesh cap (mesh cerclage, MC) can greatly diminish this risk and provide additional positive effects. Between 2005 and 2014, MC has been performed in 9 patients with singleton pregnancies who had prolapsed membranes beyond external cervical/uterine os before 25th week of pregnancy (one in 29th). With patients in general anaesthesia, lithotomy and Trendelenburg position (about 25°) prolapsed membranes were repositioned in the uterine cavity, using tampon soaked in antiseptic solution (Skinsept mucosa). A circular, a type of purse-string suture (main band) with double string Ethilon 1 was applied at about 1 to 1.5 cm from the border of the external uterine os - 6 to 8 stitches were placed, so the whole external uterine os was encircled (modified McDonald). In the next step additional Ethilon 0 sutures were placed around all exposed parts of the main double circular suture and loosely tightened. On those sutures, round tailored (diameter around 6 cm) mesh (Prolene® or Gynemesh* PS) was attached. In all 9 cases, gestation was prolonged on average for 9 weeks and 4 days (67 days). In four cases maturity was achieved. Mesh was removed in 37th–38th week of pregnancy or if spontaneous labour began. In two cases, a caesarean section was performed because of breech presentation. In the first week after birth in 22nd week one new born died because of immaturity (premature birth was threatening in 18th week and then MC was placed). Ten years after first MC, 8 of 9 women with singleton pregnancy and MC performed have 8 healthy children from these pregnancies. Mesh cerclage successfully closed the opened cervical canal or uterine orifice and prevented further membrane herniation and membrane rupture. MC also provides a similar effect as with occluding the external os with suturing but without interrupting the way for excretion of abundant cervical mucus. The mesh also pulls the main circular band outwards and thus lowers the chance of suture cutting through the remaining cervix. MC prolonged gestation very successfully (mean for 9 weeks and 4 days) and thus increased possibility for survival and diminished the risk for complications in very early preterm delivered survivors in cases with cervical dilatation and membrane herniation before 26th week of gestation. Without action possibility to achieve at least 28th or 32nd week of gestation would be poor.

Keywords: cervical insufficiency, mesh cerclage, membrane protrusion, premature birth prevention, physical exam-indicated cerclage, rescue cerclage

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Authors: Ya-Yi Yen

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The operating room is a medical environment full of high-risk, high-complexity and high-cost. In addition to assuring patient safety, the operating room should effort on the efficient and safe medical quality for the surgical patients of high risk, elders, and children. If the nursing staffs of operation room carry on the pre-operative visiting prior to surgery, the patient's anxiety and complications are expected to be alleviated, and the hospitalization days may also be shortened. Purpose: Applying the information system to enhance pre-operative visiting, case tracking, and effectiveness recording Method: (I) Application the information system to screen cases by integrating the operation scheduling, and linking the severe surgery codes, for to shorten the time to track cases of operative visiting. Through the improvement, the time required decreased to 1.5 minutes per day from 20 minutes per day, and nursing staffs’ satisfaction with satisfaction for tracking and visiting procedure of case increased to 86% from 54%. (II)The electronic establishment of the operative visiting record enhanced the integrity of the operative visiting record. The integrity rate was rise to 92% from 66%, while nursing staffs’ satisfaction with the visiting record increased to 82% from 61.3%. Since information technology continues evolving, the application of information technology is helpful to the integration of nursing information, simplification of processes, and saving of man-hours. This article introduces the application of information systems to simplify the processes and improve the effectiveness of operation visiting and tracking, including the saving of time, improving the integrity rate of record, and improving the satisfaction of nursing staffs.

Keywords: effectiveness, information system, perioperative nursing, pre-operative visiting

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Authors: Joulié Aurélien, Isabelle Desjardins, Elsa Jourdain, Sophie Pradier, Dufour Philippe, Elodie Rousset, Agnès Leblond

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Q fever is a worldwide zoonosis caused by the bacterium Coxiella burnetii. It may infect a broad range of host species, including horses. Although the role of horses in C. burnetii infections remains unknown, their use as sentinel species may be interesting to better assess the human risk exposure. Thus, we aimed to assess the C. burnetii horse exposition in a French endemic area by describing the antibody dynamics detected in serum; investigating the pathogen circulation in the horse environment, and exploring potential links with unexplained syndromes. Blood samples were collected in 2015 and 2016 on 338 and 294 horses, respectively and analyzed by ELISA. Ticks collected on horses were identified, and C. burnetii DNA detection was performed by qPCR targeting the IS1111 gene. Blood sample analyses revealed a significant increase of the seroprevalence in horses between both years, from 11% [7.67; 14.43] to 25% [20.06; 29.94]. On 36 seropositive horses in 2015 and 73 in 2016, 5 and four respectively showed clinical signs compatible with a C. burnetii infection (i.e., chronic fever or respiratory disorders, unfitness and unexplained weight loss). DNA was detected in almost 40% of ticks (n=59/148 in 2015 and n=103/305 in 2016) and exceptionally in dust samples (n=2/46 in 2015 and n=1/14 in 2016) every year. The C. burnetti detection in both the serum and the environment of horses confirm their exposure to the bacterium. Therefore, consideration should be given to target a relevant sentinel species to better assess the Q fever surveillance depending on the epidemiological context.

Keywords: ELISA, Q fever, qPCR, syndromic surveillance

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Authors: Theresa Ukamaka Nwagha, Angela Ogechukwu Ugwu, Martins Nweke

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Background and Objectives: Blood transfusion is an effective and proven treatment for some severe complications of sickle cell disease. Recurrent transfusions have put patients with sickle cell disease at risk of developing antibodies against the various antigens they were exposed to. This study aims to investigate the frequency of red blood cell alloimmunization in patients with sickle disease in Africa. Materials and Methods: This is a systematic review of peer-reviewed literature published in English. The review was conducted consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Data sources for the review include MEDLINE, PubMed, CINAHL, and Academic Search Complete. Included in this review are articles that reported the frequency/prevalence of red blood cell alloimmunization in sickle cell disease patients in Africa. Eligible studies were subjected to independent full-text screening and data extraction. Risk of bias assessment was conducted with the aid of the mixed method appraisal tool. We employed a random-effects model of meta-analysis to estimate the pooled prevalence. We computed Cochrane’s Q statistics and I2 and prediction interval to quantify heterogeneity in effect size. Results: The prevalence estimates range from 2.6% to 29%. Pooled prevalence was estimated to be 10.4% (CI 7.7.–13.8); PI = 3.0 – 34.0%), with significant heterogeneity (I2 = 84.62; PI = 2.0-32.0%) and publication bias (Egger’s t-test = 1.744, p = 0.0965). Conclusion: The frequency of red cell alloantibody varies considerably in Africa. The alloantibodies appeared frequent in this order: the Rhesus, Kell, Lewis, Duffy, MNS, and Lutheran

Keywords: frequency, red blood cell, alloimmunization, sickle cell disease, Africa

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Authors: Zahraa Al Ali, Ammar Abulibdeh, Talal Al-Awadhi, Midhun Mohan, Mohammed Al-Barwani, Mohammed Al-Barwani, Sara Al Nabbi, Meshal Abdullah

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This study aims to evaluate the performance and effectiveness of six spectral water indices - derived from Multispectral sentinel-2 data - to detect soil moisture and inundated area in arid regions to be used as an indicator of mudflow phenomena to predict high-risk areas. Herein, the validation of the performance of spectral indices was conducted using threshold method, spectral curve performance, and soil-line method. These indirect validation techniques play a key role in saving time, effort, and cost, particularly for large-scale and inaccessible areas. It was observed that the Normalized Difference Water Index (NDWI), Modified Normalized Difference Water Index (mNDWI), and RSWIR indices have the potential to detect soil moisture and inundated areas in arid regions. According to the temporal spectral curve performance, the spectral characteristics of water and soil moisture were distinct in the Near infrared (NIR), Short-wave Infrared (SWIR1,2) bands. However, the rate and degree differed between these bands, depending on the amount of water in the soil. Furthermore, the soil line method supported the appropriate selection of threshold values to detect soil moisture. However, the threshold values varied with location, time, season, and between indices. We concluded that considering the factors influencing the behavior of water and soil reflectivity could support decision-makers in identifying high-risk mudflow locations.

Keywords: spectral reflectance curve, soil-line method, spectral indices, Shaheen cyclone

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Authors: Sulemana Saibu, Moses Ikpeme

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Background: The severity of the COVID-19 pandemic, brought on by the SARS-CoV-2 coronavirus, has been unprecedented since the 1918 influenza pandemic. SARS-CoV-2 cases of CNS and peripheral nervous system disease, including neurodegenerative disorders and chronic immune-mediated diseases, may be anticipated based on knowledge of past coronaviruses, particularly those that caused the severe acute respiratory syndrome and Middle East respiratory syndrome outbreaks. Although respiratory symptoms are the most common clinical presentation, neurological symptoms are becoming increasingly recognized, raising concerns about their potential role in causing Parkinson's disease, Multiple sclerosis, and Narcolepsy. This systematic review aims to summarize the current evidence by exploring the association between COVID-19 infection and how it may overlap with etiological mechanisms resulting in Narcolepsy, Parkinson's disease, and Multiple sclerosis. Methods: A systematic search was conducted using electronic databases ((PubMed/MedLine, Embase, PsycINFO, ScieLO, Web of Science, ProQuest (Biotechnology, Virology, and AIDS), Scopus, and CINAHL)) to identify studies published between January 2020 and December 2022 that investigated the association between COVID-19 and Parkinson's disease, multiple sclerosis, and Narcolepsy. Per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the review was performed and reported. Study quality was assessed using the Critical Appraisal Skills Programme Checklist and the Joanna Briggs Institute Critical appraisal tools. Results: A total of 21 studies out of 1025 met the inclusion criteria, including 8 studies reporting Parkinson's disease, 11 on multiple sclerosis, and 2 on Narcolepsy. In COVID-19 individuals compared to the general population, Narcolepsy, Parkinson's disease, and multiple sclerosis were shown to have a higher incidence. The findings imply that COVID-19 may worsen the signs or induce multiple sclerosis and Parkinson's disease and may raise the risk of developing Narcolepsy. Further research is required to confirm these connections because the available data is insufficient. Conclusion: According to the existing data, COVID-19 may raise the risk of Narcolepsy and have a causative relationship with Parkinson's disease, multiple sclerosis, and other diseases. More study is required to confirm these correlations and pinpoint probable mechanisms behind these interactions. Clinicians should be aware of how COVID-19 may affect various neurological illnesses and should treat patients who are affected accordingly.

Keywords: COVID-19, parkinson’s disease, multiple sclerosis, narcolepsy, neurological disorders, sars-cov-2, neurodegenerative disorders, chronic immune-mediated diseases

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Authors: Stephen Oduro

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With a quantitative research design, this study seeks to analyze how, an intangible resource, Organisational Unlearning shapes the relationship between Entrepreneurial Orientation (EO) and Innovation Outcomes among social entrepreneurship organizations in Ghana. The Resource-Based View (RBV) of the firm and EO-Performance Contingency framework was adopted as the underpinning theories of the study. Entrepreneurial Orientation dimensions, namely Innovativeness, Autonomy, Risk-Taking, Proactiveness, and Competitive aggressiveness were examined to determine its significant, direct influence on the Innovation Outcomes of the social enterprises in Ghana. Organizational Unlearning dimensions, specifically examination of lens fitting, the consolidation of emergent understandings, and framework for changing individual habits were explored to determine whether they strengthen or weaken the direct nexus between Entrepreneurial Orientation dimensions and Innovation Outcomes. A self-administered questionnaire was administered to 556 targeted social enterprises across Africa through online questionnaire platform and the data generated and proposed hypotheses were analyzed and tested using Structural Equation Model-Partial Least Square (SEM-PLS 3) statistical tool. The findings revealed that EO dimensions, specifically proactiveness, autonomy, innovativeness, and risk-taking are positively related to IO, but we found no significant support for competitive aggressiveness. The findings, moreover, divulged that the positive, direct relationship between EO and IO is highly strengthened by OU. It is concluded that OU fully moderates the direct link between EO and IO. The present study contributes to the our understanding of the interrelationship among Entrepreneurial Orientation, Organizational Unlearning, and Innovation Outcomes in the social entrepreneurship context.

Keywords: entrepreneurial orientation, innovation outcomes, organizational unlearning, RBV, SEM-PLS, social enterprise, Africa

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Authors: Katherine Maurer

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Background and purpose: Violence that occurs within families is a global social problem. Children who are victims or witness to family violence are at risk for many negative effects both proximally and distally. One of the most disconcerting long-term effects occurs when child victims become adult perpetrators: the intergenerational transmission of family violence (ITFV). Early identification of those children most at risk for ITFV is needed to inform interventions to prevent future family violence perpetration and victimization. Only about 25-30% of child family violence victims become perpetrators of adult family violence (either child abuse, partner abuse, or both). Prior research has primarily been conducted using dichotomous measures of exposure (yes; no) to predict ITFV, given the low incidence rate in community samples. It is often assumed that exposure to greater amounts of violence predicts greater risk of ITFV. However, no previous longitudinal study with a community sample has tested a dose-response model of exposure to physical child abuse and parental physical intimate partner violence (IPV) using count data of frequency and severity of violence to predict adult ITFV. The current study used advanced statistical methods to test if increased childhood exposure would predict greater risk of ITFV. Methods: The study utilized 3 panels of prospective data from a cohort of 15 year olds (N=338) from the Project on Human Development in Chicago Neighborhoods longitudinal study. The data were comprised of a stratified probability sample of seven ethnic/racial categories and three socio-economic status levels. Structural equation modeling was employed to test a hurdle regression model of dose-response to predict ITFV. A version of the Conflict Tactics Scale was used to measure physical violence victimization, witnessing parental IPV and young adult IPV perpetration and victimization. Results: Consistent with previous findings, past 12 months incidence rates severity and frequency of interpersonal violence were highly skewed. While rates of parental and young adult IPV were about 40%, an unusually high rate of physical child abuse (57%) was reported. The vast majority of a number of acts of violence, whether minor or severe, were in the 1-3 range in the past 12 months. Reported frequencies of more than 5 times in the past year were rare, with less than 10% of those reporting more than six acts of minor or severe physical violence. As expected, minor acts of violence were much more common than acts of severe violence. Overall, regression analyses were not significant for the dose-response model of ITFV. Conclusions and implications: The results of the dose-response model were not significant due to a lack of power in the final sample (N=338). Nonetheless, the value of the approach was confirmed for the future research given the bi-modal nature of the distributions which suggest that in the context of both child physical abuse and physical IPV, there are at least two classes when frequency of acts is considered. Taking frequency into account in predictive models may help to better understand the relationship of exposure to ITFV outcomes. Further testing using hurdle regression models is suggested.

Keywords: intergenerational transmission of family violence, physical child abuse, intimate partner violence, structural equation modeling

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Authors: Claire Norman-Maillet

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Insider fraud, including its various synonyms such as occupational, employee or internal fraud, is a major financial crime threat whereby an employee defrauds (or attempts to defraud) their current, prospective, or past employer. ‘Employee’ covers anyone employed by the company, including contractors, directors, and part time staff; they may be a solo bad actor or working in collusion with others, whether internal or external. Insider fraud is even more of a concern given the impacts of the Coronavirus pandemic, which has generated multiple opportunities to commit insider fraud. Insider fraud is something that is not necessarily thought of as a significant financial crime threat; the focus of most academics and practitioners has historically been on that of ‘external fraud’ against businesses or entities where an individual or group has no professional ties. Without the face-to-face, ‘over the shoulder’ capabilities of staff being able to keep an eye on their employees, there is a heightened reliance on trust and transparency. With this, naturally, comes an increased risk of insider fraud perpetration. The objective of the research is to better understand how companies are impacted by insider fraud, and therefore how to stop it. This research will make both an original contribution and stimulate debate within the financial crime field. The financial crime landscape is never static – criminals are always creating new ways to perpetrate financial crime, and new legislation and regulations are implemented as attempts to strengthen controls, in addition to businesses doing what they can internally to detect and prevent it. By focusing on insider fraud specifically, the research will be more specific and will be of greater use to those in the field. To achieve the aims of the research, semi-structured interviews were conducted with 22 individuals who either work in financial services and deal with insider fraud or work within insider fraud perpetration in a recruitment or advisory capacity. This was to enable the sourcing of information from a wide range of individuals in a setting where they were able to elaborate on their answers. The principal recruitment strategy was engaging with the researcher’s network on LinkedIn. The interviews were then transcribed and analysed thematically. Main findings in the research suggest that insider fraud has been ignored owing to the denial of accepting the possibility that colleagues would defraud their employer. Whilst Coronavirus has led to a significant rise in insider fraud, this type of crime has been a major risk to businesses since their inception, however have never been given the financial or strategic backing required to be mitigated, until it's too late. Furthermore, Coronavirus should have led to companies tightening their access rights, controls and policies to mitigate the insider fraud risk. However, in most cases this has not happened. The research concludes that insider fraud needs to be given a platform upon which to be recognised as a threat to any company and given the same level of weighting and attention by Executive Committees and Boards as other types of economic crime.

Keywords: fraud, insider fraud, economic crime, coronavirus, Covid-19

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Authors: Kebret Kebede, Anthony Scinta

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Obesity is the most prevalent global problem that continues to rise at alarming rates both in the industrialized and developing countries. Adipose tissue is an endocrine tissue that secretes numerous chemical signals, hormones, lipids, cytokines and coagulation factors as well as prompting insulin resistance which is a primary contributor to Type II Diabetes- one of its most common adverse effects on health. Other hormones whose levels are linked to obesity and nutritional state are leptin, IGF-1, and adiponectin. Several studies indicate that obesity is the leading cause of high levels of cholesterol that leads to fatty liver disease, gallstones, hypertension, increased risk for cancer and degenerative joint disease that primarily affects the weight bearing joints of the lower extremities. The activation of inflammatory pathways promotes synovial pathology that results in accelerated degeneration of the joints. The study examines the prevalence of obesity in the US female population in comparison to that of the developing world and its emergence as a significant and potentially modifiable risk factor in degenerative disease of the hip and knee joints that has resulted in staggering healthcare cost. Studies have shown that as the prevalence of obesity rises, we continue to see a rise in degenerative joint disease. The percentage of arthritis cases linked directly to obesity has risen from 3 percent in 1971 to 18 percent in 2002. A person with obesity is around 60 percent more likely to develop arthritis than someone of normal body weight. In women, obesity is associated with increased mortality from breast, cervical, endometrial and ovarian cancer that may accompany debilitating joint diseases and restricted mobility.

Keywords: obesity, endocrine, degenerative, mortality, joint diseases, cancer, debilitating, mobility

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Authors: Amare Nigatu, Mågne Bratveit, Bente E. Moen

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Background: Pesticide exposure is an important public health concern in Ethiopia, but there is limited information on pesticide intoxications. Residents may have an increased risk of pesticide exposure through proximity of their homes to farms using pesticides. Also the pesticide exposure might be related to employment at these farms. This study investigated the prevalence of acute pesticide intoxications (API) by residence proximity to a nearby flower farm and assessed if intoxications are related to working there or not. Methods: A cross-sectional survey involving 516 persons was conducted. Participants were grouped according to their residence proximity from a large flower farm; living within 5 kilometers and 5-12 kilometers away, respectively. In a structured interview, participants were asked if they had health symptoms within 48 hours of pesticide exposure in the past year. Those, who had experienced this and reported two or more typical pesticide intoxication symptoms, were considered as having had API. Chi-square and independent t-tests were used to compare categorical and continuous variables, respectively. Confounding variables were adjusted by using binomial regression model. Results: The prevalence of API in the past year among the residents in the study area was 26%, and it was higher in the population living close to the flower farm (42%) compared to those living far away (11%), prevalence ratio (PR) = 3.2, 95% CI: 2.2-4.8, adjusted for age, gender & education. A subgroup living close to the farm & working there had significantly more API (56%) than those living close & did not work there (16%), adjusted PR = 3.0, 95% CI: 1.8-4.9. Flower farm workers reported more API (56%) than those not working there (13%,), adjusted PR = 4.0, 95% CI: 2.9-5.6. Conclusion: The residents living closer than 5 kilometers to the flower farm reported significantly higher prevalence of API than those living 5-12 kilometers away. This increased risk of API was associated with work at the flower farm.

Keywords: acute pesticide intoxications, self-reported symptoms, flower farm workers, living proximity

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Authors: Jing Niu, Jun X. Wang

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Arterial stiffness predicts mortality and morbidity, independently of other cardiovascular risk factors. And it is a major risk factor for age-related morbidity and mortality. The non-invasive industry gold standard measurement system of arterial stiffness utilizes pulse wave velocity method. However, the desktop device is expensive and requires trained professional to operate. The main objective of this research is the proof of concept of the proposed non-invasive method which uses measurement of magnetic flux disturbance and electrocardiogram (ECG) signal for measuring arterial stiffness. The method could enable accurate and easy self-assessment of arterial stiffness at home, and to help doctors in research, diagnostic and prescription in hospitals and clinics. A platform for assessing arterial stiffness through acquisition and analysis of radial artery pulse waveform and ECG signal has been developed based on the proposed method. Radial artery pulse waveform is acquired using the magnetic based sensing technology, while ECG signal is acquired using two dry contact single arm ECG electrodes. The measurement only requires the participant to wear a wrist strap and an arm band. Participants were recruited for data collection using both the developed platform and the industry gold standard system. The results from both systems underwent correlation assessment analysis. A strong positive correlation between the results of the two systems is observed. This study presents the possibility of developing an accurate, easy to use and affordable measurement device for arterial stiffness assessment.

Keywords: arterial stiffness, electrocardiogram, pulse wave velocity, Magnetic Flux Disturbance

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Authors: Ahmed Ghachem, Johann Colomba, Denis Prud'homme, Martin Brochu

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Background: Inactive obese postmenopausal women, are at greater risk for metabolic complications. On the other hand, high levels of cardiorespiratory fitness (CRF) are associated with a lower risk of metabolic complications. Objective: To compare inactive obese postmenopausal women displaying ‘lower’ vs ‘higher’ levels of CRF for body composition, metabolic profile, inflammatory profile and measures of energy expenditure. Methods: 132 women (age: 57.6 ± 4.8 yrs; BMI: 32.3 ± 4.6 kg/m2; Peak VO2: 17.81 ± 3.02 ml O2•kg-1•min-1) were studied. They were first divided into tertiles based on their CRF. Then, women in the first (< 16.51 ml O2•min-1•kg-1) and second tertiles (16.51 to 19.22 ml O2•min-1•kg-1) were combined (N= 88), and compared with those in the third tertile (> 19.22 ml O2•min-1•kg-1) (N= 44). Variables of interest were: Peak VO2 (stationary bike), body composition (DXA), body fat distribution (CT scan), glucose homeostasis (fasting state and euglycemic/ hyperinsulinemic clamp), fasting lipids, resting blood pressure, inflammatory profile and energy expenditure (DLW). Results: Both CRF groups (lower= 16.0 ± 2.0 ml O2•kg-1•min-1 vs higher= 21.2 ± 1.7 ml O2•kg-1•min-1; p < 0.001) were similar for age. Significant differences were observed between groups for body composition; with lower values for body weight, BMI, fat mass and visceral fat in women with higher CRF (p between 0.001 and 0.005). Also, women with higher CRF had lower values for fasting insulin (13.4 ± 4.5 vs 15.6 ± 6.6 μU/ml; p = 0.03) and CRP levels (2.31 ± 1.97 vs 3.83 ± 3.24 mg/liter; p = 0.001); and higher values for glucose disposal (6.71 ± 1.78 vs 5.92 ± 1.67 mg/kg/min; p = 0.01). However, these differences were no longer significant after controlling for visceral adipose tissue accumulations. Finally, no significant difference was observed between groups for the other variables of interest. Conclusion: Our results suggest that, among inactive overweight/obese postmenopausal women, those with higher CRF levels have a better metabolic profile; which is caused by lower visceral fat accumulations.

Keywords: cardiorespiratory fitness, metabolic profile, menopause, obesity

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Authors: Pascal Rey, Anaïs Weber

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Many mining projects are being developed in Africa the last decades. Due to the economic opportunities they offer, these projects result in a massive and rapid influx of migrants to the surrounding area. In areas where central government representation is low and local administration lack financial resources, urban development is often anarchical, beyond all public control. It leads to socio-spatial segregation, insecurity and the risk of social conflicts rising. Aware that their economic development is very correlated with local situation, mining companies get more and more involved in regional planning in setting up tools and Strategic Directions document. One of the commonly used tools in this regard is the “Influx Management Plan”. It consists in looking at the region’s absorption capacities in order to ensure its coherent development and by developing several urban centers than one macrocephalic city. It includes many other measures such as urban governance support, skills transfer, creation of strategic guidelines, financial support (local taxes, mining taxes, development funds etc.) local development projects. Through various examples of mining projects in Guinea, A country that is host to many large mining projects, we will look at the implications of regional and urban planning of which mining companies are key playor as well as public authorities. While their investment capacity offers advantages and accelerates development, their actions raise questions of the unilaterality of interests and local governance. By interfering in public affairs are mining companies not increasing the risk of central and local government shirking their responsibilities in terms of regional development, or even calling their legitimacy into question? Is such public-private collaboration really sustainable for the region as a whole and for all stakeholders?

Keywords: Africa, guinea, mine, urban planning

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Authors: Levente Kovács, Fruzsina Luca Kézér, Ottó Szenci

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Prediction of the onset of calving and recognizing difficulties at calving has great importance in decreasing neonatal losses and reducing the risk of health problems in the early postpartum period. In this study, changes of rumination time, reticuloruminal pH and temperature were investigated in eutocic (EUT, n = 10) and dystocic (DYS, n = 8) dairy cows around parturition. Rumination time was continuously recorded using an acoustic biotelemetry system, whereas reticuloruminal pH and temperature were recorded using an indwelling and wireless data transmitting system. The recording period lasted from 3 d before calving until 7 days in milk. For the comparison of rumination time and reticuloruminal characteristics between groups, time to return to baseline (the time interval required to return to baseline from the delivery of the calf) and area under the curve (AUC, both for prepartum and postpartum periods) were calculated for each parameter. Rumination time decreased from baseline 28 h before calving both for EUT and DYS cows (P = 0.023 and P = 0.017, respectively). After 20 h before calving, it decreased onwards to reach 32.4 ± 2.3 and 13.2 ± 2.0 min/4 h between 8 and 4 h before delivery in EUT and DYS cows, respectively, and then it decreased below 10 and 5 min during the last 4 h before calving (P = 0.003 and P = 0.008, respectively). Until 12 h after delivery rumination time reached 42.6 ± 2.7 and 51.0 ± 3.1 min/4 h in DYS and EUT dams, respectively, however, AUC and time to return to baseline suggested lower rumination activity in DYS cows than in EUT dams for the 168-h postpartum observational period (P = 0.012 and P = 0.002, respectively). Reticuloruminal pH decreased from baseline 56 h before calving both for EUT and DYS cows (P = 0.012 and P = 0.016, respectively), but did not differ between groups before delivery. In DYS cows, reticuloruminal temperature decreased from baseline 32 h before calving by 0.23 ± 0.02 °C (P = 0.012), whereas in EUT cows such a decrease was found only 20 h before delivery (0.48 ± 0.05 °C, P < 0.01). AUC of reticuloruminal temperature calculated for the prepartum period was greater in EUT cows than in DYS cows (P = 0.042). During the first 4 h after calving, it decreased from 39.7 ± 0.1 to 39.00 ± 0.1 °C and from 39.8 ± 0.1 to 38.8 ± 0.1 °C in EUT and DYS cows, respectively (P < 0.01 for both groups) and reached baseline levels after 35.4 ± 3.4 and 37.8 ± 4.2 h after calving in EUT and DYS cows, respectively. Based on our results, continuous monitoring of changes in rumination time and reticuloruminal temperature seems to be promising in the early detection of cows with a higher risk of dystocia. Depressed postpartum rumination time of DYS cows highlights the importance of the monitoring of cows experiencing difficulties at calving.

Keywords: reticuloruminal pH, reticuloruminal temperature, rumination time, dairy cows, dystocia

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Authors: Melkamu A. Zeru, Aweke A. Mitiku, Endashaw Amuka

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Background: Under-five mortality is the likelihood that a baby will pass away before turning exactly 5 years old, represented as a percentage per 1,000 live births. Exploring the spatial distribution and identifying the temporal pattern is important to reducing under-five child mortality globally, including in Ethiopia. Thus, this study aimed to identify the risk factors of under-five mortality and the spatiotemporal variation in Ethiopian administrative zones. Method: This study used the 2000-2016 Ethiopian Demographic and Health Survey (EDHS) data, which were collected using a two-stage sampling method. A total of 43,029 (10,873 in 2000, 9,861 in 2005, 11,654 in 2011, and 10,641 in 2016) weighted sample under-five child mortality was used. The space-time dynamic model was employed to account for spatial and time effects in 65 administrative zones in Ethiopia. Results: From the result of a general nesting spatial-temporal dynamic model, there was a significant space-time interaction effect [γ = -0.1444, 95 % CI (-0.6680, -0.1355)] for under-five mortality. The increase in the percentages of mothers illiteracy [𝛽 = 0.4501, 95% CI (0.2442, 0.6559)], not vaccinated[𝛽= 0.7681, 95% CI (0.5683, 0.9678)], unimproved water[𝛽= 0.5801, CI (0.3793, 0.7808)] were increased death rates for under five children while increased percentage of contraceptive use [𝛽= -0.6609, 95% CI (-0.8636, -0.4582)] and ANC visit > 4 times [𝛽= -0.1585, 95% CI(-0.1812, -0.1357)] were contributed to the decreased under-five mortality rate at the zone in Ethiopia. Conclusions: Even though the mortality rate for children under five has decreased over time, still there is still higher in different zones of Ethiopia. There exists spatial and temporal variation in under-five mortality among zones. Therefore, it is very important to consider spatial neighbourhoods and temporal context when aiming to avoid under-five mortality.

Keywords: under-five children mortality, space-time dynamic, spatiotemporal, Ethiopia

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Authors: Magdalena Barbara Kaziuk, Waldemar Kosiba

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Background: Obesity, particularly abdominal type, lead to accelerated progress of atherosclerosis and thus affects the functioning of various human organs. Non-HDL cholesterol includes residual risk of the cardiovascular diseases which persists in patients after achieved recommended level of LDL cholesterol. The maintenance of normal body mass index plays a particularly important role in both the prevention and treatment of chronic diseases. Materials and Methods: The study covered 96 patients (55 females, 42 males, age 66,9 +/-10,2 years). The nutritional status was determined with the Waist to Height Ratio (WHtR) and the Waist to Hip Ratio (WHR). A function of the kidney was evaluated by calculating the estimated glomerular filtration rate (eGFR) using the MDRD formula. Non-high-density lipoprotein cholesterol (non-HDL) is simply the difference between the total cholesterol concentration and the HDL cholesterol concentration. Results: The higher was level of non-HDL cholesterol, the lower eGFR had studied subjects (p<0.001). Significant correlation was found between higher WHtR and lower the eGFR (p=0.002). Also underweight (30% of patient) led to obtaining lower values of eGFR in subjects over 65 years old. The poorer nutrition the lower was glomerular filtration rate. Conclusions: Nutritional statuses of patients have a significant impact on the level of kidney function. Not only accumulated excess fat in the abdominal area, but also its deficiency affects the deterioration in renal filtration. Higher level of non-HDL not only raises the residual risk of the heart disease but also influences on kidney by worsening eGFR. Proper diet in connection with physical activity should lead to achieving good nutrition in these patients and protect their kidney function.

Keywords: nutrition, non-HDL cholesterol, glomerular filtration rate, lifestyle

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Authors: Sadaf Ambreen, Ayesha Bibi, Sara Rafiq

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Hypertension is a medical condition in which blood pressure in the arteries is elevated than the normal, having systolic blood pressure more than 120mmHg and diastolic blood pressure more than 80 mmHg. It leads to health complications and increase the risk of diseases such as stroke, heart failure, heart attack, and even death. The aim of the current study was to evaluate nutritional status and activity level among hypertensive early adults in District Mardan Data was collected from the subjects of Public Hospital, Mardan Medical Complex, through questionnaire. A complete information about individual sociodemographic, anthropometry and health status were collected, and physical activity was assessed by using IPAQ questionnaire. A total of 150 individuals were included in the study, in which 90% were females, and 10% were males. Data was analyzed through SPSS Version 22. Majority of the study subjects, 88%, were married, 70% having nuclear living system, 43% were having elementary education, and 43% were working as laborer. Body mass index and waist circumference in female counterpart were found to be positively associated with hypertension and was found statistically significant P=<0.01. Results showed that majority of females were fall in hypertension crisis category with mild activity, and males were having hypertension stage 1 with moderate activity. Our study concluded that non-optimal nutritional status and physical inactivity resulted in elevated blood pressure in females, therefore, lifestyle change such as optimal nutritional status and physical activity may play key role in reducing risk of hypertension.

Keywords: obesity/overwight, body mass index, waist circumference, early adulthood

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Authors: Sara Ataei, Maryam Taghizadeh-Ghehi, Amir Sarayani, Asieh Ashouri, Amirhossein Moslehi, Molouk Hadjibabaie, Kheirollah Gholami

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Background: Acute kidney injury (AKI) is common in hematopoietic stem cell transplantation (HSCT) patients with an incidence of 21–73%. Prevention and early diagnosis reduces the frequency and severity of this complication. Predictive biomarkers are of major importance to timely diagnosis. Neutrophil gelatinase associated lipocalin (NGAL) is a widely investigated novel biomarker for early diagnosis of AKI. However, no study assessed NGAL for AKI diagnosis in HSCT patients. Methods: We performed further analyses on gathered data from our recent trial to evaluate the performance of urine NGAL (uNGAL) as an indicator of AKI in 72 allogeneic HSCT patients. AKI diagnosis and severity were assessed using Risk–Injury–Failure–Loss–End-stage renal disease and AKI Network criteria. We assessed uNGAL on days -6, -3, +3, +9 and +15. Results: Time-dependent Cox regression analysis revealed a statistically significant relationship between uNGAL and AKI occurrence. (HR=1.04 (1.008-1.07), P=0.01). There was a relation between uNGAL day +9 to baseline ratio and incidence of AKI (unadjusted HR=.1.047(1.012-1.083), P<0.01). The area under the receiver-operating characteristic curve for day +9 to baseline ratio was 0.86 (0.74-0.99, P<0.01) and a cut-off value of 2.62 was 85% sensitive and 83% specific in predicting AKI. Conclusions: Our results indicated that increase in uNGAL augmented the risk of AKI and the changes of day +9 uNGAL concentrations from baseline could be of value for predicting AKI in HSCT patients. Additionally uNGAL changes preceded serum creatinine rises by nearly 2 days.

Keywords: acute kidney injury, hemtopoietic stem cell transplantation, neutrophil gelatinase-associated lipocalin, Receiver-operating characteristic curve

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Authors: Zubair Ahmad

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The aim of this study is to analyze the risks factors and issues with waste management in developing nations as barriers. Depending on their content and categorization, wastes are managed differently. Waste management strategies differ for liquid, solid, and organic wastes. The final stage of trash disposal entails procedures like burning, interment, recycling, and treatment. Due to the rising creation of solid waste, the growing urban population has a magnified impact on the environment and public health. All regions, but especially informal urban neighborhoods, tribal villages, and official rural settlements have a protracted backlog in waste services. Another significant impediment seen in the developing world is a lack of education and awareness of effective waste-management practices. Unauthorized dumpsites pose a serious risk to the environment since they could contain dangerous elements like radioactive, infectious, and toxic waste. Wealthier individuals are more inclined to think that their actions will have an impact on environmental problems and to act to address them. Waste managers need to take action to make sure the public is given information that is consistent with what they currently know. The results of the data analysis conducted with the aid of the various methodologies discussed in the preceding chapter are presented in this chapter by the researcher. Descriptive analysis has been used in research to determine whether or not there are relationships between variables and to determine the importance of the variables. According to a survey, there are no efforts being made to lessen the odor that garbage dump sites emit (in terms of treating or recycling the material placed at dumpsite) This might be the case since respondents only commented on the waste management conditions in their immediate surroundings and may not have fully understood the steps taken to resolve this issue.

Keywords: risk factor of waste material, lack of awareness, developing countries struggles, waste management

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Authors: Mehwish Azam, Muhammad Imran, Humaira Jabeen, Sumreen Begum, Rashida Qasim

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Background: Metabolic syndrome is a cluster of metabolic risk factors including obesity, glucose intolerance, insulin resistance, dyslipidemia and hypertension. Metabolic syndrome in obese and type 2 diabetic subjects increases the risk of cardiovascular diseases (CVD). Globally, the prevalence of metabolic syndrome ranges from 10%-50% and in Pakistan ranges from 18%-46%. The objective of the present study is to estimate the prevalence of metabolic syndrome (MS) in obese type 2 diabetic subjects by using International Diabetes Federation (IDF) and National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) definitions. Methods: Obese type 2 diabetic subjects and normal healthy subjects of both genders were selected from diabetic clinics and hospitals of various localities of Karachi, Pakistan. The frequency of metabolic syndrome was estimated by the proposed definitions of IDF and NCEP-ATP III. Results: The prevalence of metabolic syndrome using International Diabetes Federation (IDF) definition in obese type 2 diabetic subjects was 85.7%. It is significantly higher (p<0.05) in females (47.1%) as compared to males (38.6%). While, using National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) definition the overall prevalence of metabolic syndrome in obese type 2 diabetic subjects was 75.7%, the prevalence is significantly higher (p<0.05) in females (45.7%) than males (30.0%). Conclusion: It is concluded that, the overall prevalence of metabolic syndrome is increasing significantly in obese type 2 diabetic subjects by using IDF and NCEP–ATP III definitions. Therefore, it is need to initiate the preventive measures by arranging public awareness programmes to highlight the significance of a healthy lifestyle and emphasis should be given to reduce weight, increase physical activity, and increase intake of healthy low-glycemic-index foods.

Keywords: metabolic syndrome, diabetes mellitus, obesity, IDF, NCEP-ATP III

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Authors: Adane Kassa Shikur

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Today’s supply chains (SC) have become vulnerable to unexpected and ever-intensifying disruptions from myriad sources. Consequently, the concept of supply chain resilience (SCRes) has become crucial to complement the conventional risk management paradigm, which has failed to cope with unexpected SC disruptions, resulting in severe consequences affecting SC performances and making business continuity questionable. Advancements in cutting-edge technologies like artificial intelligence (AI) and their potential to enhance SCRes by improving critical antecedents in the different phases have attracted the attention of scholars and practitioners. The research from academia and the practical interest of the industry have yielded significant publications at the nexus of AI and SCRes during the last two decades. However, the applications and examinations have been primarily conducted independently, and the extant literature is dispersed into research streams despite the complex nature of SCRes. To close this research gap, this study conducts a systematic literature review of 106 peer-reviewed articles by curating, synthesizing, and consolidating up-to-date literature and presents the state-of-the-art development from 2010 to 2022. Bayesian networks are the most topical ones among the 13 AI techniques evaluated. Concerning the critical antecedents, visibility is the first ranking to be realized by the techniques. The study revealed that AI techniques support only the first 3 phases of SCRes (readiness, response, and recovery), and readiness is the most popular one, while no evidence has been found for the growth phase. The study proposed an AI-SCRes framework to inform research and practice to approach SCRes holistically. It also provided implications for practice, policy, and theory as well as gaps for impactful future research.

Keywords: ANNs, risk, Bauesian networks, vulnerability, resilience

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Authors: Dimitra V. Peristeri, Hussameldin M. Nour, Amiya Ahsan, Sameh Abogabal, Krishna K. Singh, Muhammad Shafique Sajid

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Introduction: The use of optimal skin antiseptic agents for the prevention of surgical site infection (SSI) is of critical importance, especially during abdominal surgical procedures. Alcohol-based chlorhexidine gluconate (CHG) and aqueous-based povidone-iodine (PVI) are the two most common skin antiseptics used nowadays. The objective of this article is to evaluate the effectiveness of alcohol-based CHG versus aqueous-based PVI used for skin preparation before abdominal surgery to reduce SSIs. Methods: Standard medical databases such as MEDLINE, Embase, Pubmed, and Cochrane Library were searched to find randomised, controlled trials (RCTs) comparing alcohol-based CHG skin preparation versus aqueous-based PVI in patients undergoing abdominal surgery. The combined outcomes of SSIs were calculated using an odds ratio (OR) with 95% confidence intervals (95% CI). All data were analysed using Review Manager (RevMan) Software 5.4, and the meta-analysis was performed with a random effect model analysis. Results: A total of 11 studies, all RCTs, were included (n= 12072 participants), recruiting adult patients undergoing abdominal surgery. In the random effect model analysis, the use of alcohol-based CHG in patients undergoing abdominal surgery was associated with a reduced risk of SSI compared to aqueous-based PVI (OR: 0.84; 95% CI [0.74, 0.96], z= 2.61, p= 0.009). Conclusion: Alcohol-based CHG may be more effective for preventing the risk of SSI compared to aqueous-based PVI agents in abdominal surgery. The conclusion of this meta-analysis may add a guiding value to reinforce current clinical practice guidelines.

Keywords: skin preparation, surgical site infection, chlorhexidine, skin antiseptics

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Authors: Wadsana Sarakarn, Pimonpan Charoensri, Baliya Chaiyara

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Objectives: To study the outcomes of the developed nursing model to prevent early postpartum hemorrhage (PPH). Materials and Methods: The analytical study was conducted in Sunpasitthiprasong Hospital during October 1st, 2015, until May 31st, 2017. After review the prevalence, risk factors, and outcomes of postpartum hemorrhage of the parturient who gave birth in Sunpasitthiprasong Hospital, the nursing model was developed under research regulation of Kemmis&McTaggart using 4 steps of operating procedures: 1) analyzing problem situation and gathering 2) creating the plan 3) noticing and performing 4) reflecting the result of the operation. The nursing model consisted of the screening tools for risk factors associated with PPH, the clinical nursing practice guideline (CNPG), and the collecting bag for measuring postpartum blood loss. Primary outcome was early postpartum hemorrhage. Secondary outcomes were postpartum hysterectomy, maternal mortality, personnel’s practice, knowledge, and satisfaction of the nursing model. The data were analyzed by using content analysis for qualitative data and descriptive statistics for quantitative data. Results: Before using the nursing model, the prevalence of early postpartum hemorrhage was under estimated (2.97%). There were 5 cases of postpartum hysterectomy and 2 cases of maternal death due to postpartum hemorrhage. During the study period, there was 22.7% prevalence of postpartum hemorrhage among 220 pregnant women who were vaginally delivered at Sunpasitthiprasong Hospital. No maternal death or postpartum hysterectomy was reported after using the nursing model. Among 16 registered nurses at the delivery room who evaluated using of the nursing model, they reported the high level of practice, knowledge, and satisfaction Conclusion: The nursing model for the prevention of early PPH is effective to decrease early PPH and other serious complications.

Keywords: the development of a nursing model, prevention of postpartum hemorrhage, pregnant women, postpartum hemorrhage

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