Search results for: hard care

Authors: Bonnie R. Brammall, Rhonda M. Garad, Helena J. Teede, Cheryce L. Harrison

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Introduction: Reproductive aged women are at high-risk for accelerated weight gain and obesity development, with pregnancy recognised as a critical contributory life phase. Healthy lifestyle interventions during the preconception and antenatal period improve maternal and infant health outcomes. Yet, interventions from preconception through to postpartum and translation and implementation into real-world healthcare settings remain limited. OptimalMe is a randomised, hybrid implementation effectiveness study of evidence-based healthy lifestyle intervention. Here, we report engagement, acceptability of the intervention during preconception, and self-reported behaviour change outcomes as a result of the preconception phase of the intervention. Methods: Reproductive aged women who upgraded their private health insurance to include pregnancy and birth cover, signalling a pregnancy intention, were invited to participate. Women received access to an online portal with preconception health and lifestyle modules, goal-setting and behaviour change tools, monthly SMS messages, and two coaching sessions (randomised to video or phone) prior to pregnancy. Results: Overall n=527 expressed interest in participating. Of these, n=33 did not meet inclusion criteria, n=8 were not contactable for eligibility screening, and n=177 failed to engage after the screening, leaving n=309 who were enrolled in OptimalMe and randomised to intervention delivery method. Engagement with coaching sessions dropped by 25% for session two, with no difference between intervention groups. Women had a mean (SD) age of 31.7 (4.3) years and, at baseline, a self-reported mean BMI of 25.7 (6.1) kg/m², with 55.8% (n=172) of a healthy BMI. Behaviour was sub-optimal with infrequent self-weighing (38.1%), alcohol consumption prevalent (57.1%), sub-optimal pre-pregnancy supplementation (61.5%), and incomplete medical screening. Post-intervention 73.2% of women reported engagement with a GP for preconception care and improved lifestyle behaviour (85.5%), since starting OptimalMe. Direct pre-and-post comparison of individual participant data showed that of 322 points of potential change (up-to-date cervical screening, elimination of high-risk behaviours [alcohol, drugs, smoking], uptake of preconception supplements and improved weighing habits) 158 (49.1%) points of change were achieved. Health coaching sessions were found to improve accountability and confidence, yet further personalisation and support were desired. Engagement with video and phone sessions was comparable, having similar impacts on behaviour change, and both methods were well accepted and increased women's accountability. Conclusion: A low-intensity digital health and lifestyle program with embedded health coaching can improve the uptake of preconception care and lead to self-reported behaviour change. This is the first program of its kind to reach an otherwise healthy population of women planning a pregnancy. Women who were otherwise healthy showed divergence from preconception health and lifestyle objectives and benefited from the intervention. OptimalMe shows promising results for population-based behaviour change interventions that can improve preconception lifestyle habits and increase engagement with clinical health care for pregnancy preparation.

Keywords: preconception, pregnancy, preventative health, weight gain prevention, self-management, behaviour change, digital health, telehealth, intervention, women's health

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Authors: Noemia Gomes de Mattos de Mesquita, José Eduardo Ferreira de Oliveira, Arimatea Quaresma Ferraz

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Stops to exchange cutting tool, to set up again the tool in a turning operation with CNC or to measure the workpiece dimensions have a direct influence on production. The premature removal of the cutting tool results in high cost of machining since the parcel relating to the cost of the cutting tool increases. On the other hand, the late exchange of cutting tool also increases the cost of production because getting parts out of the preset tolerances may require rework for its use when it does not cause bigger problems such as breaking of cutting tools or the loss of the part. Therefore, the right time to exchange the tool should be well defined when wanted to minimize production costs. When the flank wear is the limiting tool life, the time predetermination that a cutting tool must be used for the machining occurs within the limits of tolerance can be done without difficulty. This paper aims to show how the life of the cutting tool can be calculated taking into account the cutting parameters (cutting speed, feed and depth of cut), workpiece material, power of the machine, the dimensional tolerance of the part, the finishing surface, the geometry of the cutting tool and operating conditions of the machine tool, once known the parameters of Taylor algebraic structure. These parameters were raised for the ABNT 1038 steel machined with cutting tools of hard metal.

Keywords: machining, productions, cutting condition, design, manufacturing, measurement

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Authors: Mark E. Lokanan, Liz Lee

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This paper aims to examine the role of accountants as gatekeepers in anti-money laundering compliance in real estate transactions. The paper seeks to answer questions on ways in which accountants are involved in real estate transactions and mandatory compliance with regulatory authorities in Canada. The data for the study came from semi-structured interviews with accountants, lawyers, and government officials. Preliminary results reveal that there is a conflict between accountants’ obligation to disclose and loyalty to their clients. Accountants often do not see why they are obligated to disclose their clients' information to government agencies. The importance of the client in terms of the amount of revenue contributed to the accounting firm also plays a significant role in accountants' reporting decision-making process. Although the involvement of accountants in real estate purchase and sale transactions is limited to lawyers or notaries, they are often involved in designing financing schemes, which may involve money laundering activities. The paper is of wider public policy interests to both accountants and regulators. It is hard not to see Chartered Professional Accountant (CPA) Canada and government regulators using the findings to better understand the decision-making processes of accountants in their reporting practices to regulatory authorities.

Keywords: money laundering, real estate, disclosure, legislation, compliance

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Authors: S. MacDonald, A. Manuel, R. Law, N. Bandruak, A. Dubrowski, V. Curran, J. Smith-Young, K. Simmons, A. Warren

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High fidelity human patient simulation has been used for many years by health sciences education programs to foster critical thinking, engage learners, improve confidence, improve communication, and enhance psychomotor skills. Unfortunately, there is a paucity of research on the use of high fidelity human patient simulation to foster teamwork among nursing, medicine and pharmacy undergraduate students. This study compared the impact of high fidelity and low fidelity simulation education on teamwork among nursing, medicine and pharmacy students. For the purpose of this study, two innovative teaching scenarios were developed based on the care of an adult patient experiencing acute anaphylaxis: one high fidelity using a human patient simulator and one low fidelity using case based discussions. A within subjects, pretest-posttest, repeated measures design was used with two-treatment levels and random assignment of individual subjects to teams of two or more professions. A convenience sample of twenty-four (n=24) undergraduate students participated, including: nursing (n=11), medicine (n=9), and pharmacy (n=4). The Interprofessional Teamwork Questionnaire was used to assess for changes in students’ perception of their functionality within the team, importance of interprofessional collaboration, comprehension of roles, and confidence in communication and collaboration. Student satisfaction was also assessed. Students reported significant improvements in their understanding of the importance of interprofessional teamwork and of the roles of nursing and medicine on the team after participation in both the high fidelity and the low fidelity simulation. However, only participants in the high fidelity simulation reported a significant improvement in their ability to function effectively as a member of the team. All students reported that both simulations were a meaningful learning experience and all students would recommend both experiences to other students. These findings suggest there is merit in both high fidelity and low fidelity simulation as a teaching and learning approach to foster teamwork among undergraduate nursing, medicine and pharmacy students. However, participation in high fidelity simulation may provide a more realistic opportunity to practice and function as an effective member of the interprofessional health care team.

Keywords: acute anaphylaxis, high fidelity human patient simulation, low fidelity simulation, interprofessional education

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Authors: Aniket Ganvir, Ritarani Sahu, Suchismita Chinara

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The rapid digitization of various aspects of life is leading to the creation of smart IoT ecosystems, where interconnected devices generate significant amounts of valuable data. However, these IoT devices face constraints such as limited computational resources and bandwidth. Cloud computing emerges as a solution by offering ample resources for offloading tasks efficiently despite introducing latency issues, especially for time-sensitive applications like fog computing. Fog computing (FC) addresses latency concerns by bringing computation and storage closer to the network edge, minimizing data travel distance, and enhancing efficiency. Offloading tasks to fog nodes or the cloud can conserve energy and extend IoT device lifespan. The offloading process is intricate, with tasks categorized as full or partial, and its optimization presents an NP-hard problem. Traditional greedy search methods struggle to address the complexity of task offloading efficiently. To overcome this, the efficient crow search algorithm (ECSA) has been proposed as a meta-heuristic optimization algorithm. ECSA aims to effectively optimize computation offloading, providing solutions to this challenging problem.

Keywords: IoT, fog computing, task offloading, efficient crow search algorithm

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Authors: Quiza Pearl Senilla, Hannah Mercado, Francis Angelo Erosa

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Underdog narratives not only provides viewers with models of determination and hard work but that inducing hope may increase the likelihood that viewers will pursue their own goals in life. Although it has been proven that underdog narratives not only create a positive motivational state to the viewers but can also induce hope, little attention has been given to know if this underdog narrative affect the health outcomes or the subjective well-being of the viewers and if their hopefulness mediates on it. To address this gap, using underdog narratives as a predictor and hope as mediator, this study determined the effect of underdog narratives to the subjective well-being of the respondents, the relationship of hope and subjective well-being and last is the mediating effect of hopefulness. This study is an experimental research that uses a between subject design. Purposeful random sampling was used wherein the respondents must meet the following criteria to be part of the study. One hundred and twenty (N=120) Local State University students were assigned to different treatment conditions— underdog narrative, comedy, nature scenes—and a no exposure control group. Results show that there is a minimal difference on the subjective well-being of the respondents when exposed to different treatment condition although it is not significant. A moderate positive correlation between hope and subjective well-being also reveals in this study. And last the result also shows that there is no mediating effect of hopefulness to the subjective well-being of the subjects through exposure to underdog narrative.

Keywords: hope, hope theory, subjective well-being, underdog narratives

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Authors: Lin Dong-Yih, Yang S. M., Huang B. W., Lian J. A.

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Super duplex stainless steel has excellent mechanical properties and corrosion resistance. It becomes important structural material as its application has been extended to the fields such as renewable energy and the chemical industry because of its excellent properties. As examples are offshore wind power, solar cell machinery, and pipes in the chemical industry. The mechanical properties and corrosion resistance of super duplex stainless steel can be eliminated by welding due to the precipitation of the hard and brittle σ phase, which is rich of chromium, and molybdenum elements. This paper studies the influence of carbon element on the phase transformation of -ferrite and σ phase in 2507 super duplex stainless steel. The 2507 will be under argon gas protection welded with 316 and 316L extra low carbon stainless steel separately. The microstructural phases of stainless steels before and after welding, in fusion, heat affected zones, and base material will be studied via X-ray, OM, SEM, EPMA i.e. their quantity, size, distribution, and morphology. The influences of diffusion by carbon element will be compared according to the microstructures, hardness, and corrosion tests.

Keywords: complex stainless steel, welding, phase formation, carbon element, sigma phase, delta ferrite

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Authors: Catherine Kuforiji, Michel Nganbe

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The abrasive wear of composite materials is a major challenge in highly demanding wear applications. Therefore, this study focuses on fabricating, testing and assessing the properties of 50wt% SS316L stainless steel–50wt% Al2O3 particle composites. Composite samples were fabricated using the powder metallurgy route. The effects of the powder metallurgy processing parameters and hard particle reinforcement were studied. The microstructure, density, hardness and toughness were characterized. The wear behaviour was studied using pin-on-disc testing under dry sliding conditions. The highest hardness of 1085.2 HV, the highest theoretical density of 94.7% and the lowest wear rate of 0.00397 mm3/m were obtained at a milling speed of 720 rpm, a compaction pressure of 794.4 MPa and sintering at 1400 °C in an argon atmosphere. Compared to commercial SS316 and fabricated SS316L, the composites had 7.4 times and 11 times lower wear rate, respectively. However, the commercial 90WC-10Co showed 2.2 times lower wear rate compared to the fabricated SS316L-Al2O3 composites primarily due to the higher ceramic content of 90 wt.% in the reference WC-Co. However, eliminating the relatively high porosity of about 5 vol% using processes such as HIP and hot pressing can be expected to lead to further substantial improvements of the composites wear resistance.

Keywords: SS316L, Al2O3, powder metallurgy, wear characterization

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Authors: Mahla Azimi

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Introduction: Post-bladder catheter infection is a common and significant healthcare-associated infection that affects individuals with indwelling urinary catheters. These infections can lead to various complications, including urinary tract infections (UTIs), bacteremia, sepsis, and increased morbidity and mortality rates. This article aims to provide a comprehensive review of post-bladder catheter infections, including their causes, risk factors, clinical presentation, diagnosis, treatment options, and preventive measures. Causes and Risk Factors: Post-bladder catheter infections primarily occur due to the colonization of microorganisms on the surface of the urinary catheter. The most common pathogens involved are Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Enterococcus species. Several risk factors contribute to the development of these infections, such as prolonged catheterization duration, improper insertion technique, poor hygiene practices during catheter care, compromised immune system function in patients with underlying conditions or immunosuppressive therapy. Clinical Presentation: Patients with post-bladder catheter infections may present with symptoms such as fever, chills, malaise, suprapubic pain or tenderness, and cloudy or foul-smelling urine. In severe cases or when left untreated for an extended period of time, patients may develop more severe symptoms like hematuria or signs of systemic infection. Diagnosis: The diagnosis of post-bladder catheter infection involves a combination of clinical evaluation and laboratory investigations. Urinalysis is crucial in identifying pyuria (presence of white blood cells) and bacteriuria (presence of bacteria). A urine culture is performed to identify the causative organism(s) and determine its antibiotic susceptibility profile. Treatment Options: Prompt initiation of appropriate antibiotic therapy is essential in managing post-bladder catheter infections. Empirical treatment should cover common pathogens until culture results are available. The choice of antibiotics should be guided by local antibiogram data to ensure optimal therapy. In some cases, catheter removal may be necessary, especially if the infection is recurrent or associated with severe complications. Preventive Measures: Prevention plays a vital role in reducing the incidence of post-bladder catheter infections. Strategies include proper hand hygiene, aseptic technique during catheter insertion and care, regular catheter maintenance, and timely removal of unnecessary catheters. Healthcare professionals should also promote patient education regarding self-care practices and signs of infection. Conclusion: Post-bladder catheter infections are a significant healthcare concern that can lead to severe complications and increased healthcare costs. Early recognition, appropriate diagnosis, and prompt treatment are crucial in managing these infections effectively. Implementing preventive measures can significantly reduce the incidence of post-bladder catheter infections and improve patient outcomes. Further research is needed to explore novel strategies for prevention and management in this field.

Keywords: post-bladder catheter infection, urinary tract infection, bacteriuria, indwelling urinary catheters, prevention

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Authors: Monika Nuffer, Wesley Nuffer

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The problem of obesity is one that continues to be faced in the United States health care system and across the developing world. Prescription medications are available, but are often very expensive with minimal insurance coverage. The over-the-counter diet aid industry is a robust one, selling billions of dollars in products every year. It is important for clinicians to understand the myriad of different nutritional supplements marketed for obesity, and to weigh the evidence behind these products. This manuscript outlines the most commonly used nutritional supplements currently marketed for weight loss, reviewing the evidence with a focus on the efficacy and safety of these products.

Keywords: obesity, weight loss, herbal products, nutritional supplements

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Authors: Wei-Kuang Liu, Ya-Hsu Chiang

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In the coming of an aging society, the issues of living quality, health care, and social security for the elderly have been gradually taken seriously. In order to maintain favorable living condition, urban societies are also facing the challenge of disasters caused by extreme climate change. However, in the practice of disaster prevention, elderly people are always weak due to their physiological conditions. That is to say, in the planning of resilient urbanism, the aging society is relatively in need of more care. Thus, this research aims to map areas where have high-density elderly population and fragile environmental condition in Taiwan, and to understand the actual situation of disaster prevention management in these areas, so as to provide suggestions for the development of intellectual resilient urban management. The research takes the cities of Taoyuan and Taichung as examples for explorations. According to GIS mapping of areas with high aging index, high-density population and high flooding potential, the communities of Sihai and Fuyuan in Taoyuan and the communities of Taichang and Nanshih in Taichung are highlighted. In these communities, it can be found that there are more elderly population and less labor population with high-density living condition. In addition, they are located in the areas where they have experienced severe flooding in the recent past. Based on a series of interviews with community organizations, there is only one community out of the four using flood information mobile app and Line messages for the management of disaster prevention, and the others still rely on the traditional approaches that manage the works of disaster prevention by their community security patrol teams and community volunteers. The interview outcome shows that most elderly people are not interested in learning the use of intellectual devices. Therefore, this research suggests to keep doing the GIS mapping of areas with high aging index, high-density population and high flooding potential for grasping the high-risk communities and to help develop smart monitor and forecast systems for disaster prevention practice in these areas. Based on case-study explorations, the research also advises that it is important to develop easy-to-use bottom-up and two-way immediate communication mechanism for the management of aging society’s disaster prevention.

Keywords: aging society, disaster prevention, GIS, resilient, Taiwan

Procedia PDF Downloads 117

Authors: Sameer A. Pathan, Biswadev Mitra, Salman Mirza, Umais Momin, Zahoor Ahmed, Lubna G. Andraous, Dharmesh Shukla, Mohammed Y. Shariff, Magid M. Makki, Tinsy T. George, Saad S. Khan, Stephen H. Thomas, Peter A. Cameron

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Study objective: Emergency physician’s (EP) ability to identify hydronephrosis on point-of-care ultrasound (POCUS) has been assessed in the past using CT scan as the reference standard. We aimed to assess EP interpretation of POCUS to identify and grade the hydronephrosis in a direct comparison with the consensus-interpretation of POCUS by radiologists, and also to compare the EP and radiologist performance using CT scan as the criterion standard. Methods: Using data from a POCUS databank, a prospective interpretation study was conducted at an urban academic emergency department. All POCUS exams were performed on patients presenting with renal colic to the ED. Institutional approval was obtained for conducting this study. All the analyses were performed using Stata MP 14.0 (Stata Corp, College Station, Texas). Results: A total of 651 patients were included, with paired sets of renal POCUS video clips and the CT scan performed at the same ED visit. Hydronephrosis was reported in 69.6% of POCUS exams by radiologists and 72.7% of CT scans (p=0.22). The κ for consensus interpretation of POCUS between the radiologists to detect hydronephrosis was 0.77 (0.72 to 0.82) and weighted κ for grading the hydronephrosis was 0.82 (0.72 to 0.90), interpreted as good to very good. Using CT scan findings as the criterion standard, Eps had an overall sensitivity of 81.1% (95% CI: 79.6% to 82.5%), specificity of 59.4% (95% CI: 56.4% to 62.5%), PPV of 84.3% (95% CI: 82.9% to 85.7%), and NPV of 53.8% (95% CI: 50.8% to 56.7%); compared to radiologist sensitivity of 85.0% (95% CI: 82.5% to 87.2%), specificity of 79.7% (95% CI: 75.1% to 83.7%), PPV of 91.8% (95% CI: 89.8% to 93.5%), and NPV of 66.5% (95% CI: 61.8% to 71.0%). Testing for a report of moderate or high degree of hydronephrosis, specificity of EP was 94.6% (95% CI: 93.7% to 95.4%) and to 99.2% (95% CI: 98.9% to 99.5%) for identifying severe hydronephrosis alone. Conclusion: EP POCUS interpretations were comparable to the radiologists for identifying moderate to severe hydronephrosis using CT scan results as the criterion standard. Among patients with moderate or high pre-test probability of ureteric calculi, as calculated by the STONE-score, the presence of moderate to severe (+LR 6.3 and –LR 0.69) or severe hydronephrosis (+LR 54.4 and –LR 0.57) was highly diagnostic of the stone disease. Low dose CT is indicated in such patients for evaluation of stone size and location.

Keywords: renal colic, point-of-care, ultrasound, bedside, emergency physician

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Authors: Abdullah Karaman, Kursad Sayin

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In this research, which information technologies are used in small hotel businesses, and the information technologies-performance perception of the managers are pointed out. During the research, the questionnaire was prepared and the small scale hotel managers were interviewed face to face and they filled out the questionnaire and the answers acquired were evaluated. As the result of the research, it was obtained that the managers do not care much about the information technologies usage in practice even though they accepted that the information technologies are important in terms of performance.

Keywords: information technologies, managers, performance, small hotels

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Authors: Anand Prakash Dwivedi, Sounak Kumar Choudhury

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Electric Discharge Machining (EDM) is a well-established and one of the most primitive unconventional manufacturing processes, that is used world-wide for the machining of geometrically complex or hard and electrically conductive materials which are extremely difficult to cut by any other conventional machining process. One of the major flaws, over all its advantages, is its very slow Material Removal Rate (MRR). In order to eradicate this slow machining rate, various researchers have proposed various methods like; providing rotational motion to the tool or work-piece or to both, mixing of conducting additives (such as SiC, Cr, Al, graphite etc) powders in the dielectric, providing vibrations to the tool or work-piece or to both etc. Present work is a comparative study of Rotational and Stationary Tool EDM, which deals with providing rotational motion to the copper tool for the machining of AISI D3 Tool Steel and the results have been compared with stationary tool EDM. It has been found that the tool rotation substantially increases the MRR up to 28%. The average surface finish increases around 9-10% by using the rotational tool EDM. The average tool wear increment is observed to be around 19% due to the tool rotation. Apart from this, the present work also focusses on the recast layer analysis, which are being re-deposited on the work-piece surface during the operation. The recast layer thickness is less in case of Rotational EDM and more for Stationary Tool EDM. Moreover, the cracking on the re-casted surface is also more for stationary tool EDM as compared with the rotational EDM.

Keywords: EDM, MRR, Ra, TWR

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Authors: Li-Ching Lin, Yu-Tzu Dai

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Recurrent foot ulcers or foot amputation have a major impact on patients with diabetes mellitus (DM), medical professionals, and society. A critical procedure for foot care is foot self-monitoring. Medical professionals’ understanding of patients’ foot self-monitoring knowledge, attitude, and practice is beneficial for raising patients’ disease awareness. This study investigated these and related factors among patients with DM through a descriptive study of the correlations. A scale for measuring the foot self-monitoring knowledge, attitude, and practice of patients with DM was used. Purposive sampling was adopted, and 100 samples were collected from the respondents’ self-reports or from interviews. The statistical methods employed were an independent-sample t-test, one-way analysis of variance, Pearson correlation coefficient, and multivariate regression analysis. The findings were as follows: the respondents scored an average of 12.97 on foot self-monitoring knowledge, and the correct answer rate was 68.26%. The respondents performed relatively lower in foot health screenings and recording, and awareness of neuropathy in the foot. The respondents held a positive attitude toward self-monitoring their feet and a negative attitude toward having others check the soles of their feet. The respondents scored an average of 12.64 on foot self-monitoring practice. Their scores were lower in their frequency of self-monitoring their feet, recording their self-monitoring results, checking their pedal pulse, and examining if their soles were red immediately after taking off their shoes. Significant positive correlations were observed among foot self-monitoring knowledge, attitude, and practice. The correlation coefficient between self-monitoring knowledge and self-monitoring practice was 0.20, and that between self-monitoring attitude and self-monitoring practice was 0.44. Stepwise regression analysis revealed that the main predictive factors of the foot self-monitoring practice in patients with DM were foot self-monitoring attitude, prior experience in foot care, and an educational attainment of college or higher. These factors predicted 33% of the variance. This study concludes that patients with DM lacked foot self-monitoring practice and advises that the patients’ self-monitoring abilities be evaluated first, including whether patients have poor eyesight, difficulties in bending forward due to obesity, and people who can assist them in self-monitoring. In addition, patient education should emphasize self-monitoring knowledge and practice, such as perceptions regarding the symptoms of foot neurovascular lesions, pulse monitoring methods, and new foot self-monitoring equipment. By doing so, new or recurring ulcers may be discovered in their early stages.

Keywords: diabetic foot, foot self-monitoring attitude, foot self-monitoring knowledge, foot self-monitoring practice

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Authors: Nkechi V. Enwuru, Bullum Nkeki, Elizabeth A. Adekoya, Olumide A. Adebesin, Rebecca F. Peters, Victoria A. Aikhomu, Mendie E. U.

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Background: Probiotics are live microbial feed supplement beneficial for host. Probiotics and their postbiotic products have been used to prevent or treat various health conditions. However, the products cell viability is often low due to harsh conditions subjected during processing, handling, storage, and gastrointestinal transit. These strongly influence probiotics’ benefits; thus, viability is essential for probiotics to produce health benefits for the host. Microencapsulation is a promising technique with considerable effects on probiotic survival. The study is aimed to formulate a microencapsulated probiotic and evaluate its viability, antimicrobial efficacy, and cytotoxic activity of its postbiotic on the MCF-7 breast cancer cell line. Method: Human and animal raw milk were sampled for lactic acid bacteria. The isolated bacteria were identified using conventional and VITEK 2 systems. The identified lactic acid bacterium was encapsulated using spray-dried and extrusion methods. The free, encapsulated, and chitosan-coated encapsulated probiotics were tested for viability in simulated-gastric intestinal (SGI) fluid and different storage conditions at refrigerated (4oC) and room (25oC) temperatures. The disintegration time and weight uniformity of the spray-dried hard gelatin capsules were tested. The antimicrobial property of free and encapsulated probiotics was tested against enteric pathogenic isolates from antiretroviral therapy (ART) treated HIV-positive patients. The postbiotic of the free cells was extracted, and its cytotoxic effect on the MCF-7 breast cancer cell line was tested through an MTT assay. Result: The Lactobacillus plantarum was isolated from animal raw milk. Zero-size hard gelatin L. plantarum capsules with granules within a size range of 0.71–1.00 mm diameter was formulated. The disintegration time ranges from 2.14±0.045 to 2.91±0.293 minutes, while the average weight is 502.1mg. Simulated gastric solution significantly affected viability of both free and microcapsules. However, the encapsulated cells were more protected and viable due to impermeability in the microcapsules. Furthermore, the viability of free cells stored at 4oC and 25oC were less than 4 log CFU/g and 6 log CFU/g respectively after 12 weeks. However, the microcapsules stored at 4oC achieved the highest viability among the free and microcapsules stored at 25oC and the free cells stored at 4oC. Encapsulated cells were released in the simulated gastric fluid, viable and effective against the enteric pathogens tested. However, chitosan-coated calcium alginate encapsulated probiotics significantly inhibited Shigella flexneri, Candida albicans, and Escherichia coli. The Postbiotic Metabolites (PM) of L. plantarum produced a cytotoxic effect on the MCF-7 breast cancer cell line. The postbiotic showed significant cytotoxic activity similar to 5FU, a standard antineoplastic agent. The inhibition concentration of 50% growth (IC50) of postbiotic metabolite K3 is low and consistent with the IC50 of the positive control (Cisplatin). Conclusions: Lactobacillus plantarum postbiotic exhibited a cytotoxic effect on the MCF-7 breast cancer cell line and could be used as combined adjuvant therapy in breast cancer management. The microencapsulation technique protects the probiotics, improving their viability and delivery to the gastrointestinal tract. Chitosan enhances antibacterial efficacy; thus, chitosan-coated microencapsulated L. plantarum probiotics could be more effective and used as a combined therapy in HIV management of opportunistic enteric infection.

Keywords: probiotics, encapsulation, gastrointestinal conditions, antimicrobial effect, postbiotic, cytotoxicity effect

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Authors: Azreen Jihan Che Mohd Hashim, Rosidah Musa

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Although 'Spiritual Intelligence' (SI) is hard to measure, it is impossible without a noble value that may affect the attitude in purchasing behavior process, so this paper aims to report on a pilot study analysis results in order to evaluate the degree of SI towards consumers’ attitude in purchasing halal cosmetics and, in turn, to reaffirm intention to purchase by using Theory Planned Behaviour (TPB). It is a descriptive cross-sectional study among the Muslim women as the subjects, working and staying in Klang valley area in Malaysia. The purpose of the study is to develop a new measurement scale to unravel and decompose the underlying dimensions of SI from the perspective of the Muslim deemed imperative. About 200 respondents of users and non-users of halal cosmetics are selected. The structure equation modeling (SEM) was conducted to examine the relationships among god, society and self, which are the dimensions of SI. A finding indicates that, in influencing attitude, those who obligate high spiritual intelligence have a good relationship with god, society and self which may influence them to purchase halal cosmetic product. This study offers important findings and implications for future research as it presents a framework on the importance of SI.

Keywords: spiritual intelligence, god, society, self, young adult Muslim female

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Authors: Boumesbah Asma, Chergui Mohamed El-amine

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Since it has been shown that the multi-objective minimum spanning tree problem (MOST) is NP-hard even with two criteria, we propose in this study a hybrid NSGA-II algorithm with an exact mutation operator, which is only used with low probability, to find an approximation to the Pareto front of the problem. In a connected graph G, a spanning tree T of G being a connected and cycle-free graph, if k edges of G\T are added to T, we obtain a partial graph H of G inducing a reduced size multi-objective spanning tree problem compared to the initial one. With a weak probability for the mutation operator, an exact method for solving the reduced MOST problem considering the graph H is then used to give birth to several mutated solutions from a spanning tree T. Then, the selection operator of NSGA-II is activated to obtain the Pareto front approximation. Finally, an adaptation of the VNS metaheuristic is called for further improvements on this front. It allows finding good individuals to counterbalance the diversification and the intensification during the optimization search process. Experimental comparison studies with an exact method show promising results and indicate that the proposed algorithm is efficient.

Keywords: minimum spanning tree, multiple objective linear optimization, combinatorial optimization, non-sorting genetic algorithm, variable neighborhood search

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Authors: Chaoren Lu

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Public policy is playing as one driving force that influencing service innovation implementation in public sector. However, public policy implications cannot be automatically derived from the analyses of innovation issues, and there lacks of researches about the influences of public policy onto innovation. Moreover, innovation in service system is hard to predictable and whether policy encourages or hidden innovation is still lack of study. Especially, by given the context that multiple actors are active involving within the service delivery process in public transport sector, the complex driving forces and challenges are emerged towards the service operation. This study is aim to analysis the service innovation practices within service operating organizations to understand the drivers and challenges of service operation based on policy requirements, and where the innovation idea generating from. The case studies of Changzhou Transit Group and Nanjing Jiangnan Public Transit Group will be launched. This paper reveals the ambidexterity between top-down and bottom-up demands within the public transport service operating organizations contribute to the innovation ideas. Meanwhile, it contributes to the understanding of fundamental elements of service innovation is the new relationship creation and new way of sharing knowledge. The policy contributes to the trigger of creation of such relationship. The research question is: what are the sources of service innovation practices in local public transport system in China in in facing the policy implementation?

Keywords: public value, service innovation, public transport service, China

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Authors: Vidhu Mitha Goutham, Ruma Mukherjee

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The low availability of well-trained, unlimited, dynamic-access models for specific languages makes it hard for corporate users to adopt quick translation techniques and incorporate them into product solutions. As translation tasks increasingly require a dynamic sequence learning curve; stable, cost-free opensource models are scarce. We survey and compare current translation techniques and propose a modified sequence to sequence model repurposed with attention techniques. Sequence learning using an encoder-decoder model is now paving the path for higher precision levels in translation. Using a Convolutional Neural Network (CNN) encoder and a Recurrent Neural Network (RNN) decoder background, we use Fairseq tools to produce an end-to-end bilingually trained Spanish-English machine translation model including source language detection. We acquire competitive results using a duo-lingo-corpus trained model to provide for prospective, ready-made plug-in use for compound sentences and document translations. Our model serves a decent system for large, organizational data translation needs. While acknowledging its shortcomings and future scope, it also identifies itself as a well-optimized deep neural network model and solution.

Keywords: attention, encoder-decoder, Fairseq, Seq2Seq, Spanish, translation

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Authors: Joachim Monkelbaan, Marcia Hale

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Now that global frameworks for sustainability governance (e.g. the Sustainable Development Goals, Paris Climate Agreement and Sendai Framework for Disaster Risk Reduction) are in place, the question is how these aspirations that represent major transitions can be put into practice. Water ‘infrasystems’ can play an especially significant role in strengthening regional sustainability. Infrasystems include both hard and soft infrastructure, such as pipes and technology for delivering water, as well as the institutions and governance models that direct its delivery. As such, an integrated infrasystems view is crucial for Integrative Water Management (IWM). Due to frequently contested ownership of and responsibility for water resources, these infrasystems can also play an important role in facilitating conflict and catalysing community empowerment, especially through participatory approaches to governance. In this paper, we analyze the water infrasystem of the Los Angeles region through the lens of global frameworks for sustainability governance. By complementing a solid overview of governance theories with empirical data from interviews with water actors in the LA metropolitan region (including NGOs, water managers, scientists and elected officials), this paper elucidates ways for this infrasystem to be better aligned with global sustainability frameworks. In addition, it opens up the opportunity to scrutinize the appropriateness of global frameworks when it comes to fostering sustainability action at the local level.

Keywords: governance, transitions, global frameworks, infrasystems

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Authors: Marie-Helena Docherty, Sion Edryd Williams

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The prevalence of diabetes mellitus is increasing worldwide. In Sub-Saharan Africa, type 2 diabetes represents over 90% of all types of diabetes with the number of diabetic patients expected to rise. This represents a huge economic burden in an area already contending with high rates of other significant diseases, including the highest worldwide prevalence of HIV. Diabetic complications considerably impact on morbidity and mortality. The epidemiological data for the region quotes high rates of retinopathy (7-63%), neuropathy (27-66%) and microalbuminuria (10-83%). It is therefore imperative that diabetic screening programmes are established. It is recognised that in many parts of the developing world the implementation and management of such programmes is limited by a lack of available resources. The International Diabetes Federation produced guidelines in 2012 taking these limitations into account suggesting that all diabetic patients should have access to basic screening. These guidelines are consistent with the national diabetic guidelines produced by the Lesotho Medical Council. However, diabetic care in Lesotho is delivered at the local level, with variable levels of quality. A cross sectional study was performed in the outpatient department of Maluti Hospital in Mapoteng, Lesotho, a busy rural hospital in the Berea district. Demographic data on gender, age and modality of treatment were collected over a six-week time period. Information regarding 3 basic screening parameters was obtained. These parameters included eye screening (defined as a documented ophthalmology review within the last 12 months), foot screening (defined as a documented foot health assessment by any health care professional within the last 12 months) and secondary prevention (defined as a documented blood pressure and lipid profile reading within the last 12 months). These parameters were selected on the basis of the absolute minimum level of resources in Maluti Hospital. Renal screening was excluded, as the hospital does not have access to reliable renal profile checks or urinalysis. There is however a fully functioning on-site ophthalmology department run by a senior ophthalmologist with the ability to provide retinal photography, retinal surgery and photocoagulation therapy. Data was collected on 183 type 2 diabetics. 112 patients were male and 71 were female. The average age was 43 years. 4 patients were diet controlled, 140 patients were on oral hypoglycaemic agents (metformin and/or glibenclamide), and 39 patients were on a combination of insulin and oral hypoglycaemics. In the preceding 12 months, 5 patients had undergone eye screening (3%), 24 patients had undergone foot screening (13%), and 31 patients had lipid profile testing (17%). All patients had a documented blood pressure reading (100%). Our results show that screening is poorly performed in the basic indicators suggested by the IDF and the Lesotho Medical Council. On the basis of these results, a screening programme was developed using the mnemonic SaFE; secondary prevention, foot and eye care. This is simple, memorable and transferable between healthcare professionals. In the future, the expectation would be to expand upon this current programme to include renal screening, and to further develop screening pertaining to secondary prevention.

Keywords: Africa, complications, rural, screening

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Authors: Pronab Ganguly, Ahmed A. Moustafa

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Holistic management of schizophrenia involves mainstream pharmacological intervention, complimentary medicine intervention, therapeutic intervention and other psychosocial factors such as accommodation, education, job training, employment, relationship, friendship, exercise, overall well-being, smoking, substance abuse, suicide prevention, stigmatisation, recreation, entertainment, violent behaviour, arrangement of public trusteeship and guardianship, day-day-living skill, integration with community, and management of overweight due to medications and other health complications related to medications amongst others. Our review shows that there is no integrated survey by combining all these factors. An international web-based survey was conducted to evaluate the significance of all these factors and present them in a unified manner. It is believed this investigation will contribute positively towards holistic management of schizophrenia. There will be two surveys. In the pharmacological intervention survey, five popular drugs for schizophrenia will be chosen and their efficacy as well as harmful side effects will be evaluated on a scale of 0 -10. This survey will be done by psychiatrists. In the second survey, each element of therapeutic intervention and psychosocial factors will be evaluated according to their significance on a scale of 0 - 10. This survey will be done by care givers, psychologists, case managers and case workers. For the first survey, professional bodies of psychiatrists in English speaking countries will be contacted to request them to ask their members to participate in the survey. For the second survey, professional bodies of clinical psychologist and care givers in English speaking countries will be contacted to request them to ask their members to participate in the survey. Additionally, for both the surveys, relevant professionals will be contacted through personal contact networks. For both the surveys, mean, mode, median, standard deviation and net promoter score will be calculated for each factor and then presented in a statistically significant manner. Subsequently each factor will be ranked according to their statistical significance. Additionally, country specific variation will be highlighted to identify the variation pattern. The results of these surveys will identify the relative significance of each type of pharmacological intervention, each type of therapeutic intervention and each type of psychosocial factor. The determination of this relative importance will definitely contribute to the improvement in quality of life for individuals with schizophrenia.

Keywords: schizophrenia, holistic management, antipsychotics, quality of life

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Authors: Ricardo Hugo Gonzalez, Amanda Figueiredo Vasconcelos, Francisco Loureiro Neto Monteiro, Yara Luiza Freitas Silva, Ana Cristina Lindsay, Márcia Maria Tavares Machado

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The use of sport as an integration mean is a very important tool regarding the social involvement of children and teenagers in a vulnerability situation. This study aims to report the experiences of a multidisciplinary program that intends to improve the quality of life of children and teenagers in Fortaleza, in the Northeast of Brazil. More than 400 children and teenagers aging 11 and 16 years participated in this study. Poor communities experience many particular difficulties in the urban centers such as violence, poor housing conditions, unemployment, lack in health care and deficient physical education in school. Physical education, physiotherapy, odontology, medicine and pharmacy students are responsible for the activities in the project supervised by a general coordinator and a counselor teacher of each academic unit. There are classes about team sports like basketball and soccer. Lectures about sexual behavior and sexually transmitted diseases are ministered beside the ones about oral health education, basic life support education, first aids, use and care with pharmaceuticals and orientations about healthy nutrition. In order to get the children’s family closer, monthly informative lectures are ministered. There is also the concern about reflecting the actions and producing academic paperwork such as graduation final projects and books. The number of participants has oscillated lately, and one of the causes is the lack of practicing physical activities and sports regularly. However, 250 teenagers have participated regularly for at least two years. These teenagers have shown a healthier lifestyle and a better physical fitness profile. The resources for maintaining the project come from the Pro-Reitoria of Extension, Federal University of Ceara, as well as from the PROEXT/MEC, Federal Government. Actions of this nature need to be done thinking for long periods so the effects results can become effective. Public and private investments are needed due to low socioeconomic families who are most vulnerable and have fewer opportunities to enhance to health prevention services.

Keywords: children and teenagers, health, multidisciplinary program, quality of life

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Authors: Rebecca Heron, Steal Adcock, Karen Parsonson

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Non-offending pedophiles are an under- researched, hard to reach population. This group of individuals are often hesitant to come forward and fail to seek help ongoing stigma experienced in society.In order to better understand non-offending pedophiles experiences of their identity and the stigma they face, semi-structured qualitative interviews were conducted with 10 non-offending pedophiles, who were recruited through online support groups for individuals who have sexual attractions towards children. Participants were interviewed over skype, and the data was analysed using interpretative phenomenological analysis (IPA) approach, anda number of themes were generated from the rich data set produced. Four main themes emerged, providing insight into how non-offending pedophiles experience stigma. The themes included ‘stigma in relation to themselves’, ‘others’, ‘the media portrayal’and ‘impact of the stigma of MAP’s seeking treatment’. Findings are discussed in relation to existing literature, and practical recommendations are proposed to hopefully allow this population to feel more comfortable sharing their sexual interests, which will allow them to seek help resulting in them not offending and, ultimately, the prevention of sexual abuse. This study fills the void in terms of lack of research with this population, especially when it comes to qualitative in depth studies, including not just male minor attracted persons but female minor attracted persons as well.

Keywords: pedophillia, stigma, non-offending pedophiles, minor attracted persons, prevention

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Authors: Knol Hester, Müller Swantje, Danchenko Natalya

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Objective: Falls in older people cause an autonomy loss and result in an economic burden. LCare is an AI-based application to manage fall risks. The study's aim was to assess the effect of LCare use on patient outcomes in nursing homes in Germany. Methods: LCare identifies and monitors fall risks through a 3D-gait analysis and a digital questionnaire, resulting in tailored recommendations on fall prevention. A study was conducted with AOK Baden-Württemberg (01.09.2019- 31.05.2021) in 16 care facilities. Assessments at baseline and follow-up included: a fall risk score; falls (baseline: fall history in the past 12 months; follow-up: a fall record since the last analysis); fall-related injuries and hospitalizations; gait speed; fear of falling; psychological stress; nurses experience on app use. Results: 94 seniors were aged 65-99 years at the initial analysis (average 84±7 years); 566 mobility analyses were carried out in total. On average, the fall risk was reduced by 17.8 % as compared to the baseline (p<0.05). The risk of falling decreased across all subgroups, including a trend in dementia patients (p=0.06), constituting 43% of analyzed patients, and patients with walking aids (p<0.05), constituting 76% of analyzed patients. There was a trend (p<0.1) towards fewer falls and fall-related injuries and hospitalizations (baseline: 23 seniors who fell, 13 injury consequences, 9 hospitalizations; follow-up: 14 seniors who fell, 2 injury consequences, 0 hospitalizations). There was a 16% improvement in gait speed (p<0.05). Residents reported less fear of falling and psychological stress by 38% in both outcomes (p<0.05). 81% of nurses found LCare effective. Conclusions: In the presented study, the use of LCare app was associated with a reduction of fall risk among nursing home residents, improvement of health-related outcomes, and a trend toward reduction in injuries and hospitalizations. LCare may help to improve senior resident care and save healthcare costs.

Keywords: falls, digital healthcare, falls prevention, nursing homes, seniors, AI, digital assessment

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Authors: Jean Paul M. Milambo

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Purpose: Aromatase inhibitors (AIs) are indicated in the treatment of hormone-receptive breast cancer in postmenopausal women in various settings. Studies have shown cardiovascular events in some developed countries. To date the data is sparce for evidence-based recommendations in African clinical settings due to lack of cancer registries, capacity building and surveillance systems. Therefore, this study was conducted to assess the feasibility of HyBeacon® probe genotyping adjunctive to standard care for timely prediction and diagnosis of Aromatase inhibitors (AIs) associated adverse events in breast cancer survivors in Africa. Methods: Cross sectional study was conducted to assess the knowledge of POCT among six African countries using online survey and telephonically contacted. Incremental cost effectiveness ratio (ICER) was calculated, using diagnostic accuracy study. This was based on mathematical modeling. Results: One hundred twenty-six participants were considered for analysis (mean age = 61 years; SD = 7.11 years; 95%CI: 60-62 years). Comparison of genotyping from HyBeacon® probe technology to Sanger sequencing showed that sensitivity was reported at 99% (95% CI: 94.55% to 99.97%), specificity at 89.44% (95% CI: 87.25 to 91.38%), PPV at 51% (95%: 43.77 to 58.26%), and NPV at 99.88% (95% CI: 99.31 to 100.00%). Based on the mathematical model, the assumptions revealed that ICER was R7 044.55. Conclusion: POCT using HyBeacon® probe genotyping for AI-associated adverse events maybe cost effective in many African clinical settings. Integration of preventive measures for early detection and prevention guided by different subtype of breast cancer diagnosis with specific clinical, biomedical and genetic screenings may improve cancer survivorship. Feasibility of POCT was demonstrated but the implementation could be achieved by improving the integration of POCT within primary health cares, referral cancer hospitals with capacity building activities at different level of health systems. This finding is pertinent for a future envisioned implementation and global scale-up of POCT-based initiative as part of risk communication strategies with clear management pathways.

Keywords: breast cancer, diagnosis, point of care, South Africa, aromatase inhibitors

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Authors: Awole Seid, Yosef Zenebe, Hadgu Gerensea, Kebede Haile Misgina

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Background: Clinical competence is one of the ultimate goals of nursing education. Clinical skills are more than successfully performing tasks; it incorporates client assessment, identification of deficits and the ability to critically think to provide solutions. Assessment of clinical competence, particularly identifying gaps that need improvement and determining the educational needs of nursing students have great importance in nursing education. Thus this study aims determining clinical self-efficacy of final year school of nursing students in three universities of Tigray Region. Methods: A cross-sectional study was conducted on 224 final year school of nursing students from department of nursing, psychiatric nursing, and midwifery on three universities of Tigray region. Anonymous self-administered questionnaire was administered to generate data collected on June, 2017. The data were analyzed using SPSS version 20. The result is described using tables and charts as required. Logistic regression was employed to test associations. Result: The mean age of students was 22.94 + 1.44. Generally, 21% of students have been graduated in the department in which they are not interested. The study demonstrated 28.6% had poor and 71.4% had good perceived clinical self-efficacy. Beside this, 43.8% of psychiatric nursing and 32.6% of comprehensive nursing students have poor clinical self-efficacy. Among the four domains, 39.3% and 37.9% have poor clinical self- efficacy with regard to ‘Professional development’ and ‘Management of care’. Place of the institution [AOR=3.480 (1.333 - 9.088), p=0.011], interest during department selection [AOR=2.202 (1.045 - 4.642), p=.038], and theory-practice gap [AOR=0.224 (0.110 - 0.457), p=0.000] were significantly associated with perceived clinical self-efficacy. Conclusion: The magnitude of students with poor clinically self efficacy was high. Place of institution, theory-practice gap, students interest to the discipline were the significant predictors of clinical self-efficacy. Students from youngest universities have good clinical self-efficacy. During department selection, student’s interest should be respected. The universities and other stakeholders should improve the capacity of surrounding affiliate teaching hospitals to set and improve care standards in order to narrow the theory-practice gap. School faculties should provide trainings to hospital staffs and monitor standards of clinical procedures.

Keywords: clinical self-efficacy, nursing students, Tigray, northern Ethiopia

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Authors: Redha M. Elhuni

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This paper presents an analysis of the essential characteristics of the TQM philosophy by comparing the work of five notable authors in the field. A framework is produced which gather the identified TQM enablers under the well-known operations management dimensions of process, business and people. These enablers are linked with sustainable development via balance scorecard type economic and non-economic measures. In order to capture a picture of Libyan Company’s efforts to implement the TQM, a questionnaire survey is designed and implemented. Results of the survey are presented showing the main differentiating factors between the sample companies, and a way of assessing the difference between the theoretical underpinning and the practitioners’ undertakings. Survey results indicate that companies are experiencing much difficulty in translating TQM theory into practice. Only a few companies have successfully adopted a holistic approach to TQM philosophy, and most of these put relatively high emphasis on hard elements compared with soft issues of TQM. However, where companies can realize the economic outputs, non- economic benefits such as workflow management, skills development and team learning are not realized. In addition, overall, non-economic measures have secured low weightings compared with the economic measures. We believe that the framework presented in this paper can help a company to concentrate its TQM implementation efforts in terms of process, system and people management dimensions.

Keywords: TQM, balance scorecard, EFQM excellence model, oil sector, Libya

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Authors: Nahla Elsherbiny, Ahmed Ahmed, Hamada Mohammed, Mohamed Ali

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Background: The enterococci may be considered as opportunistic agents particularly in immunocompromised patients. It is one of the top three pathogens causing many healthcare associated infections (HAIs). Resistance to several commonly used antimicrobial agents is a remarkable characteristic of most species which may carry various genes contributing to virulence. Objectives: to determine the prevalence of enterococci species in different intensive care units (ICUs) causing health care-associated infections (HAIs), intestinal carriage and environmental contamination. Also, to study the antimicrobial susceptibility pattern of the isolates with special reference to vancomycin resistance. In addition to phenotypic and genotypic detection of gelatinase, cytolysin and biofilm formation among isolates. Patients and Methods: This study was carried out in the infection control laboratory at Assiut University Hospitals over a period of one year. Clinical samples were collected from 285 patients with various (HAIs) acquired after admission to different ICUs. Rectal swabs were taken from 14 cases for detection of enterococci carriage. In addition, 1377 environmental samples were collected from the surroundings of the patients. Identification was done by conventional bacteriological methods and confirmed by analytical profile index (API). Antimicrobial sensitivity testing was performed by Kirby Bauer disc diffusion method and detection of vancomycin resistance was done by agar screen method. For the isolates, phenotypic detection of cytolysin, gelatinase production and detection of biofilm by tube method, Congo red method and microtiter plate. We performed polymerase chain reaction (PCR) for detection of some virulence genes (gelE, cylA, vanA, vanB and esp). Results: Enterococci caused 10.5% of the HAIs. Respiratory tract infection was the predominant type (86.7%). The commonest species were E.gallinarum (36.7%), E.casseliflavus (30%), E.faecalis (30%), and E.durans (3.4 %). Vancomycin resistance was detected in a total of 40% (12/30) of those isolates. The risk factors associated with acquiring vancomycin resistant enterococci (VRE) were immune suppression (P= 0.031) and artificial feeding (P= 0.008). For the rectal swabs, enterococci species were detected in 71.4% of samples with the predominance of E. casseliflavus (50%). Most of the isolates were vancomycin resistant (70%). Out of a total 1377 environmental samples, 577 (42%) samples were contaminated with different microorganisms. Enterococci were detected in 1.7% (10/577) of total contaminated samples, 50% of which were vancomycin resistant. All isolates were resistant to penicillin, ampicillin, oxacillin, ciprofloxacin, amikacin, erythromycin, clindamycin and trimethoprim-sulfamethaxazole. For the remaining antibiotics, variable percentages of resistance were reported. Cytolysin and gelatinase were detected phenotypically in 16% and 48 % of the isolates respectively. The microtiter plate method showed the highest percentages of detection of biofilm among all isolated species (100%). The studied virulence genes gelE, esp, vanA and vanB were detected in 62%, 12%, 2% and 12% respectively, while cylA gene was not detected in any isolates. Conclusions: A significant percentage of enterococci was isolated from patients and environments in the ICUs. Many virulence factors were detected phenotypically and genotypically among isolates. The high percentage of resistance, coupled with the risk of cross transmission to other patients make enterococci infections a significant infection control issue in hospitals.

Keywords: antimicrobial resistance, enterococci, ICUs, virulence factors

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