Search results for: population density

Authors: Renee Monchalin

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Métis peoples, while comprising over a third of the total Indigenous population in Canada, experience major gaps in health services that accommodate their cultural identities. This is problematic given Métis peoples experience severe disparities in health determinants and outcomes compared to the non-Indigenous Canadian population. At the same time, Métis are unlikely to engage in health services that do not value their cultural identities, often utilizing mainstream options. Given these contexts, this research aims to fill the culturally-safe health care gap for Métis peoples in Canada. It does this by engaging 56 urban Métis women who participated in a longitudinal cohort study, Our Health Counts (OHC) Toronto. Traditionally, Métis women were central to the health and well-being of their communities. However, due to decades of colonial legislation and forced land displacement, female narratives have been silenced, and Métis identities have been fractured. This has resulted in having direct implications on Métis people’s current health and access to health services. Solutions to filling the Métis health service gap may lie in the all too often unacknowledged or missing voices of Métis women. Through a conversational method, this research will explore urban Métis women’s perspectives on identity and their experiences with health services in Toronto. The goal of this research is to learn from urban Métis women on steps towards filling the health service gap. This research is currently in the data collection stage. Preliminary findings from the conversations will be disseminated. Policy recommendations for health service providers will be provided to better accommodate Métis people.

Keywords: indigenous health, Metis health, urban, health service access, identity

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Authors: Luljeta Gashi, Naser Ramadani, Zana Deva, Dafina Gexha-Bunjaku

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The official HIV/AIDS data in Kosovo are based on HIV case reporting from health-care services, the blood transfusion system and Voluntary Counselling and Testing centres. Between 1986 and 2014, are reported 95 HIV and AIDS cases, of which 49 were AIDS, 46 HIV and 40 deaths. The majority (69%) of cases were men, age group 25 to 34 (37%) and route of transmission is: heterosexual (90%), MSM (7%), vertical transmission (2%) and IDU (1%). Based on existing data and the UNAIDS classification system, Kosovo is currently still categorised as having a low-level HIV epidemic. Even though with a low HIV prevalence, Kosovo faces a number of threatening factors, including increased number of drug users, a stigmatized and discriminated MSM community, high percentage of youth among general population (57% of the population under the age of 25), with changing social norms and especially the sexual ones. Methods: Data collection was done using self administered structured questionnaires amongst 249 high school students. Data were analysed using the Statistical Package for Social Sciences (SPSS). Results: The findings revealed that 68% of students know that HIV transmission can be reduced by having sex with only one uninfected partner who has no other partners, 94% know that the risk of getting HIV can be reduced by using a condom every time they have sex, 68% know that a person cannot get HIV from mosquito bites, 81% know that they cannot get HIV by sharing food with someone who is infected and 46% know that a healthy looking person can have HIV. Conclusions: Seventy one percent of high school students correctly identify ways of preventing the sexual transmission of HIV and who reject the major misconceptions about HIV transmission. The findings of the study indicate a need for more health education and promotion.

Keywords: Kosovo, KPAR, HIV, high school

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Authors: Rupamoni Thakur, Madhusmita Dehingia, Narayan C. Talukdar, Mojibur R. Khan

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The human gut is an extremely active fermentation site and is inhabited by diverse bacterial species. Consumption of alcoholic beverages has been shown to substantially modulate the human gut bacterial profile (GBP) of an individual. Assam, a major north-eastern state of India, is home to a number of tribal populations of which the tea-tribes form a major community. These tea-tribal communities are known to prepare and consume a locally-prepared alcoholic beverage from fermented jaggery, whose chemical composition is unknown. In this study, we demonstrate the effect of daily intake of the locally-prepared alcoholic beverage on the GBP of the tea-tribal communities and correlate it with the changes in the biochemical biomarkers of the population. The fecal bacterial diversity of 40 drinkers and 35 non-drinking healthy individuals were analyzed by polymerase chain reaction (PCR)–denaturing gradient gel electrophoresis (DGGE). The results suggested that the GBP was significantly modulated in the fermented-beverage consuming subjects. Significant difference was also observed in the serum biochemical parameters such as triglyceride, total cholesterol and the liver marker enzymes (ASAT/ALAT and GGT). Further studies to identify the GBP of drinkers vs non-drinkers through Next-generation Sequencing (NGS) analysis and to correlate the changes with the biochemical biomarkers of the population is underway.

Keywords: alcoholic beverage, gut bacterial profile, PCR-DGGE analysis, tea-tribes of India

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Authors: Ammar Asma, Bouafia Nabiha, Ghammam Rim, Ezzi Olfa, Ben Cheikh Asma, Mahjoub Mohamed, Helali Radhia, Sma Nesrine, Chouchène Imed, Boussarsar Hamadi, Njah Mansour

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Background: Central venous catheter associated infections (CVC-AI) are among the serious hospital-acquired infections. The aims of this study are to determine the incidence of CVC-AI, and their risk factors among patients followed in a Tunisian medical intensive care unit (ICU). Materials / Methods: A prospective cohort study conducted between September 15th, 2015 and November 15th, 2016 in an 8-bed medical ICU including all patients admitted for more than 48h. CVC-AI were defined according to CDC of ATLANTA criteria. The enrollment was based on clinical and laboratory diagnosis of CVC-AI. For all subjects, age, sex, underlying diseases, SAPS II score, ICU length of stay, exposure to CVC (number of CVC placed, site of insertion and duration catheterization) were recorded. Risk factors were analyzed by conditional stepwise logistic regression. The p-value of < 0.05 was considered significant. Results: Among 192 eligible patients, 144 patients (75%) had a central venous catheter. Twenty-eight patients (19.4%) had developed CVC-AI with density rate incidence 20.02/1000 CVC-days. Among these infections, 60.7% (n=17) were systemic CVC-AI (with negative blood culture), and 35.7% (n=10) were bloodstream CVC-AI. The mean SAPS II of patients with CVC-AI was 32.76 14.48; their mean Charlson index was 1.77 1.55, their mean duration of catheterization was 15.46 10.81 days and the mean duration of one central line was 5.8+/-3.72 days. Gram-negative bacteria was determined in 53.5 % of CVC-AI (n= 15) dominated by multi-drug resistant Acinetobacter baumani (n=7). Staphylococci were isolated in 3 CVC-AI. Fourteen (50%) patients with CVC-AI died. Univariate analysis identified men (p=0.034), the referral from another hospital department (p=0.03), tobacco (p=0.006), duration of sedation (p=0.003) and the duration of catheterization (p=0), as possible risk factors of CVC-AI. Multivariate analysis showed that independent factors of CVC-AI were, male sex; OR= 5.73, IC 95% [2; 16.46], p=0.001, Ramsay score; OR= 1.57, IC 95% [1.036; 2.38], p=0.033, and duration of catheterization; OR=1.093, IC 95% [1.035; 1.15], p=0.001. Conclusion: In a monocenter cohort, CVC-AI had a high density and is associated with poor outcome. Identifying the risk factors is necessary to find solutions for this major health problem.

Keywords: central venous catheter associated infection, intensive care unit, prospective cohort studies, risk factors

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Authors: Stig H. Jørgensen, Trond Nordfjærn, Øyvind Teige Hedenstrøm, Torbjørn Rundmo

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The aim of the paper is to estimate and forecast road traffic injuries in the coming 10-15 years given new targets in urban transport policy and shifts of mode of transport, including injury cross-effects of mode changes. The paper discusses possibilities and limitations in measuring and quantifying possible injury reductions. Injury data (killed and seriously injured road users) from six urban areas in Norway from 1998-2012 (N= 4709 casualties) form the basis for estimates of changing injury patterns. For the coming period calculation of number of injuries and injury rates by type of road user (categories of motorized versus non-motorized) by sex, age and type of road are made. A prognosticated population increase (25 %) in total population within 2025 in the six urban areas will curb the proceeded fall in injury figures. However, policy strategies and measures geared towards a stronger modal shift from use of private vehicles to safer public transport (bus, train) will modify this effect. On the other side will door to door transport (pedestrians on their way to/from public transport nodes) imply a higher exposure for pedestrians (bikers) converting from private vehicle use (including fall accidents not registered as traffic accidents). The overall effect is the sum of these modal shifts in the increasing urban population and in addition diminishing return to the majority of road safety countermeasures has also to be taken into account. The paper demonstrates how uncertainties in the various estimates (prediction factors) on increasing injuries as well as decreasing injury figures may partly offset each other. The paper discusses road safety policy and welfare consequences of transport mode shift, including reduced use of private vehicles, and further environmental impacts. In this regard, safety and environmental issues will as a rule concur. However pursuing environmental goals (e.g. improved air quality, reduced co2 emissions) encouraging more biking may generate more biking injuries. The study was given financial grants from the Norwegian Research Council’s Transport Safety Program.

Keywords: road injuries, forecasting, reduced private care use, urban, Norway

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Authors: Stanisław Fic, Danuta Barnat-Hunek, Przemysław Brzyski

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The aim of the study was to evaluate the possibility of applying modified lime binder together with natural flax fibers and straw to the production of wall blocks to the usage in energy-efficient construction industry and the development of proposals for technological solutions. The following laboratory tests were performed: the analysis of the physical characteristics of the tested materials (bulk density, total porosity, and thermal conductivity), compressive strength, a water droplet absorption test, water absorption of samples, diffusion of water vapor, and analysis of the structure by using SEM. In addition, the process of surface hydrophobisation was analyzed. In the paper, there was examined the effectiveness of two formulations differing in the degree of hydrolytic polycondensation, viscosity and concentration, as these are the factors that determine the final impregnation effect. Four composites, differing in composition, were executed. Composites, as a result of the presence of flax straw and fibers showed low bulk density in the range from 0.44 to 1.29 kg/m3 and thermal conductivity between 0.13 W/mK and 0.22 W/mK. Compressive strength changed in the range from 0,45 MPa to 0,65 MPa. The analysis of results allowed observing the relationship between the formulas and the physical properties of the composites. The results of the effectiveness of hydrophobisation of composites after 2 days showed a decrease in water absorption. Depending on the formulation, after 2 days, the water absorption ratio WH of composites was from 15 to 92% (effectiveness of hydrophobization was suitably from 8 to 85%). In practice, preparations based on organic solvents often cause sealing of surface, hindering the diffusion of water vapor from materials but studies have shown good water vapor permeability by the hydrophobic silicone coating. The conducted pilot study demonstrated the possibility of applying flax composites. The article shows that the reduction of CO2 which is produced in the building process can be affected by using natural materials for the building components whose quality is not inferior as compared to the materials which are commonly used.

Keywords: ecological construction, flax fibers, hydrophobisation, lime

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Authors: Cristina Galiana Carballo, Ibon Doval Martínez

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Urban boundaries often result in a controversial limit between countryside and city in Europe. This territory is normally defined by the very limited land uses and the abundance of open space. The dimension and dynamics of peri-urbanization in the last decades have increased this land stock, which has influenced/impacted in several factors in terms of economic costs (maintenance, transport), ecological disturbances of the territory and changes in inhabitant´s behaviour. In an increasingly urbanised world and a growing urban population, cities also face challenges such as Climate Change. In this context, new near-future corrective trends including circular economies for local food supply or decentralised waste management became key strategies towards more sustainable urban models. Those new solutions need to be planned and implemented considering the potential conflict with current land uses. The city of Vitoria-Gasteiz (Basque Country, Spain) has triplicated land consumption per habitant in 10 years, resulting in a vast extension of low-density urban type confronting rural land and threatening agricultural uses, landscape and urban sustainability. Urban planning allows managing and optimum use allocation based on soil vocation and socio-ecosystem needs, while peri-urban space arises as an opportunity for developing different uses which do not match either within the compact city, not in open agricultural lands, such as medium-size agrocomposting systems or biomass plants. Therefore, a qualitative multi-criteria methodology has been developed for Vitoria-Gasteiz city to assess the spatial definition of peri-urban land. Therefore, a qualitative multi-criteria methodology has been developed for Vitoria-Gasteiz city to assess the spatial definition of peri-urban land. Climate change and circular economy were identified as frameworks where to determine future land, soil vocation and urban planning requirements which eventually become estimations of required local food and renewable energy supply along with alternative waste management system´s implementation. By means of it, it has been developed an urban planning proposal which overcomes urban-non urban dichotomy in Vitoria-Gasteiz. The proposal aims to enhance rural system and improve urban sustainability performance through the normative recognition of an agricultural peri-urban belt.

Keywords: landscape ecology, land-use management, periurban, urban planning

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Authors: Xi Wang, Yoshio Bando

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Lithium-ion batteries (LIBs) can deliver high levels of energy storage density and offer long operating lifetimes, but their power density is too low for many important applications. Therefore, we developed some new strategies and fabricated novel electrodes for fast Li transport and its facile synthesis including N-doped graphene-SnO2 sandwich papers, bicontinuous nanoporous Cu/Li4Ti5O12 electrode, and binder-free N-doped graphene papers. In addition, by using advanced in-TEM, STEM techniques and the theoretical simulations, we systematically studied and understood their storage mechanisms at the atomic scale, which shed a new light on the reasons of the ultrafast lithium storage property and high capacity for these advanced anodes. For example, by using advanced in-situ TEM, we directly investigated these processes using an individual CuO nanowire anode and constructed a LIB prototype within a TEM. Being promising candidates for anodes in lithium-ion batteries (LIBs), transition metal oxide anodes utilizing the so-called conversion mechanism principle typically suffer from the severe capacity fading during the 1st cycle of lithiation–delithiation. Also we report on the atomistic insights of the GN energy storage as revealed by in situ TEM. The lithiation process on edges and basal planes is directly visualized, the pyrrolic N "hole" defect and the perturbed solid-electrolyte-interface (SEI) configurations are observed, and charge transfer states for three N-existing forms are also investigated. In situ HRTEM experiments together with theoretical calculations provide a solid evidence that enlarged edge {0001} spacings and surface "hole" defects result in improved surface capacitive effects and thus high rate capability and the high capacity is owing to short-distance orderings at the edges during discharging and numerous surface defects; the phenomena cannot be understood previously by standard electron or X-ray diffraction analyses.

Keywords: in-situ TEM, STEM, advanced anode, lithium-ion batteries, storage mechanism

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Authors: Ahmad Sharif Ahmadi, Yoshitaka Kajita

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Kabul, the capital and largest city in Afghanistan has been experiencing a massive population expansion and fast economic development in last decade, in which urban land has increasingly expanded and formed a high informal development territory in the city. This paper investigates the urban land development direction based on the integrated urbanization trends in Kabul city since the last and the fastest ever urban land growth period (1999-2008), which is parallel with the establishment of the new government in Afghanistan. Considering the existing challenges in terms of informal settlements, squatter settlements, the population expansion of the city, and fast economic development, as well as the huge influx of returning refugees from neighboring countries, and the sprawl direction of urbanization of the Kabul city urban fringes, this research focuses on the possible urban land development direction and trends for the city. The paper studies the feasible future land development direction of Kabul city in the northern part called Shamali basin, in which district 17 is the gateway for future development. The area has much developable area including eight districts of Kabul province, and the vast area of Parwan and Kapisa provinces. The northern area of the Kabul city generally has favorable conditions for further urbanization from the city. It is a large and relatively flat area of area in the northern part of Kabul city, with ample water resources available from the Panjshir basin as a base principle of land development direction in the area.

Keywords: Kabul city, land development trends, urban land development, urbanization

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Authors: Hafsat Mustapha Hanga

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The purpose of the this study was to investigate the effect of broken home on students' academic performance. Therefore, it focused on academic performance and Parental care of the student from and intact home from a cognitive motivational perceptive. The broken and intact home and also to find out if they differ in parental care this is done by using 376 subjects out of the population of 21,378. The sample was obtained using stratified random sampling techniques as the population contained sub-groups the study design was ex-post facto. The data was collected using 3 kind of instruments. To test the first and second hypotheses. Junior secondary school placement examination result was obtained to test the academic performance of the boys fron broken home and boys from and boys from intact home and then girl from broken home and girls from intact home.T-Test was used in the analysis of first and second hypotheses. For the third hypotheses two different kind of questionnaires were developed, the first was used to identify student that are from broken home while the second was for testing parental care between the subject. Chi-square was used to analyze the third hypotheses. Alkh the three 3 hypotheses were tested and rejected and were all in favor of student from intact home. The study found that there was a significant difference in the academic performance of the boys from brokeb and boys from intact home. When boys from intact home better then those boys from broken home. It also reveals that a student from a intact from intact home receives good parental care, love and concern than those from broken home.on the strength of these findings the need to establish an institution which will help those parent who have parenting problems was stressed and also the need to foster. Home school partnership was also stressed and advocate.

Keywords: broken homes, academic performance, parental care, foster

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Authors: Peter Krupa, Svetozár Malinarič

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Transient plane source method has been used to measure the thermal diffusivity and thermal conductivity of a compact isostatic electro-ceramics at room temperature. The samples were fired at temperatures from 100 up to 1320 degrees Celsius in steps of 50. Bulk density and specific heat capacity were also measured with their corresponding standard uncertainties. The results were compared with further thermal analysis (dilatometry and thermogravimetry). Structural processes during firing were discussed.

Keywords: TPS method, thermal conductivity, thermal diffusivity, thermal analysis, electro-ceramics, firing

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Authors: Chuyuan Wang, Nayan Khare, Lily Villa, Patricia Solis, Elizabeth A. Wentz

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Maricopa County, Arizona, has a semi-arid hot desert climate that is one of the hottest regions in the United States. The exacerbated urban heat island (UHI) effect caused by rapid urbanization has made the urban area even hotter than the rural surroundings. The Phoenix metropolitan area experiences extremely high temperatures in the summer from June to September that can reach the daily highest of 120 °F (48.9 °C). Morbidity and mortality due to the environmental heat is, therefore, a significant public health issue in Maricopa County, especially because it is largely preventable. Public records from the Maricopa County Department of Public Health (MCDPH) revealed that between 2012 and 2016, there were 10,825 incidents of heat-related morbidity incidents, 267 outdoor environmental heat deaths, and 173 indoor heat-related deaths. A lot of research has examined heat-related death and its contributing factors around the world, but little has been done regarding heat-related morbidity issues, especially for regions that are naturally hot in the summer. The objective of this study is to examine the demographic, socio-economic, housing, and environmental factors that contribute to heat-related morbidity in Maricopa County. We obtained heat-related morbidity data between 2012 and 2016 at census tract level from MCDPH. Demographic, socio-economic, and housing variables were derived using 2012-2016 American Community Survey 5-year estimate from the U.S. Census. Remotely sensed Landsat 7 ETM+ and Landsat 8 OLI satellite images and Level-1 products were acquired for all the summer months (June to September) from 2012 and 2016. The National Land Cover Database (NLCD) 2016 percent tree canopy and percent developed imperviousness data were obtained from the U.S. Geological Survey (USGS). We used ordinary least squares (OLS) regression analysis to examine the empirical relationship between all the independent variables and heat-related morbidity rate. Results showed that higher morbidity rates are found in census tracts with higher values in population aged 65 and older, population under poverty, disability, no vehicle ownership, white non-Hispanic, population with less than high school degree, land surface temperature, and surface reflectance, but lower values in normalized difference vegetation index (NDVI) and housing occupancy. The regression model can be used to explain up to 59.4% of total variation of heat-related morbidity in Maricopa County. The multiscale geographically weighted regression (MGWR) technique was then used to examine the spatially varying relationships between heat-related morbidity rate and all the significant independent variables. The R-squared value of the MGWR model increased to 0.691, that shows a significant improvement in goodness-of-fit than the global OLS model, which means that spatial heterogeneity of some independent variables is another important factor that influences the relationship with heat-related morbidity in Maricopa County. Among these variables, population aged 65 and older, the Hispanic population, disability, vehicle ownership, and housing occupancy have much stronger local effects than other variables.

Keywords: census, empirical modeling, heat-related morbidity, spatial analysis

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Authors: Johnnie Hay

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New Zealand is well known for its natural beauty, diversity of people but also for its strong focus on mental health through the provision of a vast network of psycho-social support services. South African-trained psychologists often make New Zealand their new home when emigrating - as it is relatively simple to slot into the well-established mental health system. South Africa is bigger in size, population, GDP and probably people diversity than New Zealand but struggles to provide adequate educational and psychological support services to schools. This is mainly due to budgetary pressures brought about by the imperative to first ensure that the approximately 13 million learners all have a teacher in front of their classes and at an average ratio of not more than 40 learners per class. In this paper, perspectives on educational and psychological support in New Zealand and South African schools will be shared. Through basic qualitative research encompassing semi-structured interviews with two South African educational psychologists who returned from New Zealand, supplemented by document analysis, the New Zealand situation will be scrutinized. South African perspectives will be obtained through a number of semi-structured interviews and questionnaires administered by education support services specialists working in district-based support teams in three provinces of the country. This research is in process, but preliminary findings indicate large disparities between the two countries' emphasis, funding, post provisioning and structure regarding educational and psychological support services.

Keywords: educational psychological support services, support for learners experiencing special needs, education support services, diverse learner population

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Authors: Shahram Naghizadeh Raeisi, Ali Alghooneh

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The loss of curd cohesiveness and syneresis are two common problems in the ultrafiltered cheese industry. In this study, by using membrane technology and protein modification, a modified cheese was developed and its properties were compared with a control sample. In order to decrease the lactose content and adjust the protein, acidity, dry matter and milk minerals, a combination of ultrafiltration, nanofiltration and reverse osmosis technologies was employed. For protein modification, a two-stage chemical and enzymatic reaction was employed before and after ultrafiltration. The physicochemical and microstructural properties of the modified ultrafiltered cheese were compared with the control one. Results showed that the modified protein enhanced the functional properties of the final cheese significantly (pvalue< 0.05), even if the protein content was 50% lower than the control one. The modified cheese showed 21 ± 0.70, 18 ± 1.10 & 25±1.65% higher hardness, cohesiveness and water-holding capacity values, respectively, than the control sample. This behavior could be explained by the developed microstructure of the gel network. Furthermore, chemical-enzymatic modification of milk protein induced a significant change in the network parameter of the final cheese. In this way, the indices of network linkage strength, network linkage density, and time scale of junctions were 10.34 ± 0.52, 68.50 ± 2.10 & 82.21 ± 3.85% higher than the control sample, whereas the distance between adjacent linkages was 16.77 ± 1.10% lower than the control sample. These results were supported by the results of the textural analysis. A non-linear viscoelastic study showed a triangle waveform stress of the modified protein contained cheese, while the control sample showed rectangular waveform stress, which suggested a better sliceability of the modified cheese. Moreover, to study the shelf life of the products, the acidity, as well as molds and yeast population, were determined in 120 days. It’s worth mentioning that the lactose content of modified cheese was adjusted at 2.5% before fermentation, while the lactose of the control one was at 4.5%. The control sample showed 8 weeks shelf life, while the shelf life of the modified cheese was 18 weeks in the refrigerator. During 18 weeks, the acidity of modified and control samples increased from 82 ± 1.50 to 94 ± 2.20 °D and 88 ± 1.64 to 194 ± 5.10 °D, respectively. The mold and yeast populations, with time, followed the semicircular shape model (R2 = 0.92, R2adj = 0.89, RMSE = 1.25). Furthermore, the mold and yeast counts and their growth rate in the modified cheese were lower than those for control one; Aforementioned result could be explained by the shortage of the source of energy for the microorganism in the modified cheese. The lactose content of the modified sample was less than 0.2 ± 0.05% at the end of fermentation, while this was 3.7 ± 0.68% in the control sample.

Keywords: non-linear viscoelastic, protein modification, semicircular shape model, ultrafiltered cheese

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Authors: Stella Nkechi Ezeaku, Ifunanya Nkechi Ohamobi

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This study investigated the impact of economic crisis on education in Anambra state. The population of the study comprised of all principals and teachers in Anambra state numbering 5,887 (253 principles and 5,634 teachers). To guide the study, three research questions and one hypothesis were formulated correlational design was adopted. Stratified random sampling technique was used to select 200 principals and 300 teachers as respondents for the study. A researcher-developed instrument tagged Impact of Economic Crisis on Education questionnaire (IECEQ) was used to collect data needed for the study. The instrument was validated by experts in measurement and evaluation. The reliability of the instrument was established using randomly selected members of the population who did not take part in the study. The data obtained was analyzed using Cronbach alpha technique and reliability co-efficient of .801 and .803 was obtained. The data were analyzed using simple and Multiple Regression Analysis. The formulated hypothesis was tested at .05 level of significance. Findings revealed that: there is a significant relationship between economic crisis and realization of goals of secondary education. The result also shows that economic crisis affect students' academic performance, teachers' morale and productivity and principals' administrative capability. This study therefore concludes that certain strategies must be devised to minimize the impact of economic crisis on secondary education. It is recommended that all stakeholders to education should be more resourceful and self-sufficient in order to cushion the effects of economic crisis currently gripping most world economies Nigeria inclusive.

Keywords: impact, economic, crisis, education

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Authors: Temesgen Sidamo, Prakruti S. Rao, Eleni Akllilu, Workineh Shibeshi, Yumi Park, Yong-Soon Cho, Jae-Gook Shin, Scott K. Heysell, Stellah G. Mpagama, Ephrem Engidawork

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The fluoroquinolones (FQs) are used off-label for the treatment of multidrug-resistant tuberculosis (MDR-TB), and for evaluation in shortening the duration of drug-susceptible TB in recently prioritized regimens. Within the class, levofloxacin (LFX) and moxifloxacin (MXF) play a substantial role in ensuring success in treatment outcomes. However, sub-therapeutic plasma concentrations of either LFX or MXF may drive unfavorable treatment outcomes. To the best of our knowledge, the pharmacokinetics of LFX and MXF in Ethiopian patients with MDR-TB have not yet been investigated. Therefore, the aim of this study was to develop a population pharmacokinetic (PopPK) model of levofloxacin (LFX) and moxifloxacin (MXF) and assess the percent probability of target attainment (PTA) as defined by the ratio of the area under the plasma concentration-time curve over 24-h (AUC0-24) and the in vitro minimum inhibitory concentration (MIC) (AUC0-24/MIC) in Ethiopian MDR-TB patients. Steady-state plasma was collected from 39 MDR-TB patients enrolled in the programmatic treatment course and the drug concentrations were determined using optimized liquid chromatography-tandem mass spectrometry. In addition, the in vitro MIC of the patients' pretreatment clinical isolates was determined. PopPK and simulations were run at various doses, and PK parameters were estimated. The effect of covariates on the PK parameters and the PTA for maximum mycobacterial kill and resistance prevention was also investigated. LFX and MXF both fit in a one-compartment model with adjustments. The apparent volume of distribution (V) and clearance (CL) of LFX were influenced by serum creatinine (Scr), whereas the absorption constant (Ka) and V of MXF were influenced by Scr and BMI, respectively. The PTA for LFX maximal mycobacterial kill at the critical MIC of 0.5 mg/L was 29%, 62%, and 95% with the simulated 750 mg, 1000 mg, and 1500 mg doses, respectively, whereas the PTA for resistance prevention at 1500 mg was only 4.8%, with none of the lower doses achieving this target. At the critical MIC of 0.25 mg/L, there was no difference in the PTA (94.4%) for maximum bacterial kill among the simulated doses of MXF (600 mg, 800 mg, and 1000 mg), but the PTA for resistance prevention improved proportionately with dose. Standard LFX and MXF doses may not provide adequate drug exposure. LFX PopPK is more predictable for maximum mycobacterial kill, whereas MXF's resistance prevention target increases with dose. Scr and BMI are likely to be important covariates in dose optimization or therapeutic drug monitoring (TDM) studies in Ethiopian patients.

Keywords: population PK, PTA, moxifloxacin, levofloxacin, MDR-TB patients, ethiopia

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Authors: Thuy Phan, Stephanie Luallin

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Inclusive education policies have demonstrated benefits for students with and without disabilities in the US. There are several laws that relate to inclusive education, such as 'No Child Left Behind', 'The Individuals with Disabilities Education Act'. However, the application of these inclusive education laws and policies vary per state and school district. Classroom teachers in an inclusive classroom often experience confusion as to how to apply these policies in order to create appropriate inclusive learning environments that meet the abilities and needs of their diverse student population. The study aims to investigate teachers’ perspective of their capacities to create an appropriate learning environment for their diverse student population including students with disabilities. Qualitative method is implemented in this study, using open-end interview questions to investigate teachers’ perspective of their capacities to create an appropriate inclusive learning environment for all students based on current inclusive education laws and district policies in the state of Colorado, USA. These findings may indicate a lack of confidence in teachers’ capacity to create appropriate inclusive learning environments based on laws and district policies; including challenges that classroom teachers may experience in creating inclusive learning environments. The purpose of this study is to examine the adequate preparation of classroom teachers in creating inclusive classrooms with the intent of determining implications for developing policies in inclusive education.

Keywords: educator’s capacity, inclusive education, inclusive learning environment, policy

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Authors: Anass Rahouti, Guillaume Salze, Ruggiero Lovreglio, Sélim Datoussaïd

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In healthcare facilities, training the staff for firefighting and evacuation in real buildings is very challenging due to the presence of a vulnerable population in such an environment. In a standard environment, traditional approaches, such as fire drills, are often used to train the occupants and provide them with information about fire safety procedures. However, those traditional approaches may be inappropriate for a vulnerable population and can be inefficient from an educational viewpoint as it is impossible to expose the occupants to scenarios similar to a real emergency. Immersive serious games could be used as an alternative to traditional approaches to overcome their limitations. Serious games are already being used in different safety domains such as fires, earthquakes and terror attacks for several building types (e.g., office buildings, train stations, tunnels, etc.). In this study, we developed an immersive serious game to improve the fire safety skills of staff in healthcare facilities. An accurate representation of the healthcare environment was built in Unity3D by including visual and audio stimuli inspired from those employed in commercial action games. The serious game is organised in three levels. In each of them, the trainee is presented with a specific fire emergency and s/he can perform protective actions (e.g., firefighting, helping non-ambulant occupants, etc.) or s/he can ignore the opportunity for action and continue the evacuation. In this paper, we describe all the steps required to develop such a prototype, as well as the key questions that need to be answered, to develop a serious game for firefighting and evacuation in healthcare facilities.

Keywords: fire safety, healthcare, serious game, training

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Authors: Hung-Chun Lin, Tzu-Yuan Chao

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As the population aging has become an inevitable trend globally, issues of improving the well-being of elderly people in urban areas have been a challenging task for urban planners. Recent studies of ageing trend have also expended to explore the relationship between the built environment and mental condition of elderly people. These studies have proved that even though the built environment may not necessarily play the decisive role in affecting mental health, it can have positive impacts on individual mental health by promoting social linkages and social networks among older adults. There has been a great amount of relevant research examined the impact of the built environment attributes on depression in the elderly; however, most were conducted in the Western countries. Little attention has been paid in Asian cities with contrarily high density and mix-use urban contexts such as Taiwan regarding how the built environment attributes related to depression in elderly people. Hence, more empirical cross-principle studies are needed to explore the possible impacts of Asia urban characteristics on older residents’ mental condition. This paper intends to focus on Tainan city, the fourth biggest metropolis in Taiwan. We first analyze with data from National Health Insurance Research Database to pinpoint the empirical study area where residing most elderly patients, aged over 65, with depressive disorders. Secondly, we explore the relationship between specific attributes of the built environment collected from previous studies and elderly individuals who suffer from depression, under different socio-cultural and networking circumstances. To achieve the results, the research methods adopted in this study include questionnaire and database analysis, and the results will be proceeded by correlation analysis. In addition, through literature review, by generalizing the built environment factors that have been used in Western research to evaluate the relationship between built environment and older individuals with depressive disorders, a set of local evaluative indicators of the built environment for future studies will be proposed as well. In order to move closer to develop age-friendly cities and improve the well-being for the elderly in Taiwan, the findings of this paper can provide empirical results to grab planners’ attention for how built environment makes the elderly feel and to reconsider the relationship between them. Furthermore, with an interdisciplinary topic, the research results are expected to make suggestions for amending the procedures of drawing up an urban plan or a city plan from a different point of view.

Keywords: built environment, depression, elderly, Tainan

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Authors: A. Alireza Masjedi, B. Amir Taeedi

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In this research, by placing the two cylindrical piers without roughness and with roughness with riprap around its, they proceeded to a series of tests. Experiments were done by three relative diameters of riprap with density 2.1 and one rate of discharge 27 lit/s under pure water condition. In each experiment, flow depth measured in terms of failure threshold then stability number calculated by using data obtained. The results of the research showed that the riprap stability in pier with roughness is more pier without roughness because of the pier with roughness is sharp-pointed and reduced horseshoe vortex.

Keywords: riprap stability, roughness, river bend, froude number

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Authors: Alireza Masjedi, Amir Taeedi

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In this research, by placing the two cylindrical piers without roughness and with roughness with riprap around its, they proceeded to a series of tests. Experiments were done by three relative diameters of riprap with density 2.1 and one rate of discharge 27 lit/s under pure water condition. In each experiment, flow depth measured in terms of failure threshold then stability number calculated by using data obtained. The results of the research showed that the riprap stability in pier with roughness is more pier without roughness because of the pier with roughness is sharp-pointed and reduced horseshoe vortex.

Keywords: riprap stability, roughness, river bend, froude number

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Authors: Maher El-Masri, Jamie Crawley, Judy Bornais, Abeer Omar

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Background: Misuse of Emergency Department (ED) for non-urgent healthcare results in unnecessary crowdedness that can result in long ED waits and delays in treatment, diversion of ambulances to other hospitals, poor health outcomes for patients, and increased risk of death Objectives: The main purpose of this study was to explore the independent predictors of non-urgent ED visits in Erie St. Clair LHIN. Secondary purposes of the study include comparison of the rates of non-urgent ED visits between urban and rural hospitals Design: A secondary analysis of archived population-based data on 597,373 ED visits in southwestern Ontario Results The results suggest that older (OR = .992; 95% CI .992 – .993) and female patients (OR = .940; 95% CI .929 - .950) were less likely to visit ED for non-urgent causes. Non-urgent ED visits during the winter, spring, and fall were 13%, 5.8%, and 7.5%, respectively, lesser than they were during the summer time. The data further suggest that non-urgent visits were 19.6% and 21.3% less likely to occur in evening and overnight shifts compared to the day shift. Non-urgent visits were 2.76 times more likely to present to small community hospitals than large community hospitals. Health care providers were 1.92 times more likely to refer patients with non-urgent health problem to the ED than the decision taken by patients, family member or caretakers. Conclusion: In conclusion, our study highlights a number of important factors that are associated with inappropriate use of ED visits for non-urgent health problems. Knowledge of these factors could be used to address the issue of unnecessary ED crowdedness.

Keywords: emergency department, non-urgent visits, predictors, logistic regression

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Authors: Sharma Aseem, Dhurat Rachita, Pawar Varsha, Khalse Manisha

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Introduction: Androgenetic alopecia (AGA) is a prevalent condition characterized by progressive hair thinning driven by genetic and androgen-related factors. The current FDA-approved treatments include oral finasteride and topical minoxidil, though many patients seek combination therapies to enhance results. This study aims to evaluate the effectiveness of a combination therapy involving Minoxidil, Finasteride, and Capixyl™ based on feedback from dermatologists. Methodology: A survey, validated by experts, was distributed to 29 leading dermatologists across India (in Tier 1 and 2 cities). The survey examined real-world clinical experiences, focusing on patient outcomes and the overall effectiveness of the mentioned formulation. Results: Among the surveyed dermatologists, 41.4% identified women aged 35-40 as the most frequently diagnosed with female pattern hair loss. The combination therapy with Minoxidil, Finasteride, and Capixyl™ was utilized by 34.5% of dermatologists for over 60 patients per month. The majority highlighted the benefits of this combination therapy, which acts via multiple mechanisms, such as vasodilation and dihydrotestosterone (DHT) receptor blockade, resulting in improved hair regrowth. Additionally, patients demonstrated better clinical outcomes, enhanced compliance, and fewer side effects. Demographically, younger patients, particularly those with AGA for less than 10 years, responded more positively to the treatment. Early intervention led to quicker and more significant results. Overall satisfaction among dermatologists was high, with 86.2% expressing positive feedback on the therapy. In terms of treatment outcomes, 51.7% of dermatologists observed visible results within 4-6 months, while 34.5% noticed a significant reduction in hair fall within 8-12 weeks. Improvements in scalp health were reported by 48.3%, and 51.7% saw an increased hair density within 3-4 months. Despite mild side effects such as scalp irritation, dryness, flaking, and occasional issues like folliculitis, headaches, itching, and redness, patient satisfaction remained high. Dermatologists reported that 93.1% of patients experienced faster and better hair regrowth with Capixyl™ compared to Minoxidil alone. Suggestions for improving the formulation included incorporating peptides like Saw Palmetto and enhancing product packaging to better meet patient needs. Discussion: The combination of Minoxidil, Finasteride, and Capixyl™ yielded positive clinical outcomes, especially in improving hair density, scalp health, and overall patient satisfaction. Dermatologists found that Capixyl™ peptides enhanced the therapeutic effect, promoting hair regrowth and improving compliance. While side effects were generally mild, there were suggestions to further improve the formulation by adding additional peptides like Saw Palmetto. Conclusion: The combination of Minoxidil and Finasteride fortified with Capixyl™ presents a promising therapeutic option for managing AGA. Dermatologists reported significant improvements in hair density, scalp health, and patient satisfaction. With its favorable efficacy and manageable side effects, this formulation proves to be a valuable addition to the treatment landscape for AGA.

Keywords: androgenetic alopecia, combination therapy, minoxidil, finasteride, capixyl

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Authors: Angelina A. Tzacheva, Jaishree Ranganathan

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Interest in (STEM) Science Technology Engineering Mathematics education especially Computer Science education has seen a drastic increase across the country. This fuels effort towards recruiting and admitting a diverse population of students. Thus the changing conditions in terms of the student population, diversity and the expected teaching and learning outcomes give the platform for use of Innovative Teaching models and technologies. It is necessary that these methods adapted should also concentrate on raising quality of such innovations and have positive impact on student learning. Light-Weight Team is an Active Learning Pedagogy, which is considered to be low-stake activity and has very little or no direct impact on student grades. Emotion plays a major role in student’s motivation to learning. In this work we use the student feedback data with emotion classification using surveys at a public research institution in the United States. We use Actionable Pattern Discovery method for this purpose. Actionable patterns are patterns that provide suggestions in the form of rules to help the user achieve better outcomes. The proposed method provides meaningful insight in terms of changes that can be incorporated in the Light-Weight team activities, resources utilized in the course. The results suggest how to enhance student emotions to a more positive state, in particular focuses on the emotions ‘Trust’ and ‘Joy’.

Keywords: actionable pattern discovery, education, emotion, data mining

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Authors: Nilay Balkan

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Introductory statement: The purpose of this study is to understand how small business owners develop social media marketing competency, the challenges they encounter in doing so, and establish the social media training needs of such businesses. These challenges impact the extent to which small business owners build effective social media knowledge and, in turn, impact their ability to implement effective social media marketing into their business practices. This means small businesses are not fully able to benefit from social media, such as benefits to customer relationship management or increasing brand image, which would support the overall business operations for these businesses. This research is part one of a two-phased study. The first phase aims to establish the challenges small business owners face in building social media marketing competency and their specific training needs. Phase two will then focus in more depth on the barriers and challenges emerging from phase one. Summary of Methodology: Interviews with ten small business owners were conducted from various sectors, including fitness, tourism, food, and drinks. These businesses were located in the central belt of Scotland, which is an area with the highest population and business density in Scotland. These interviews were in-depth and semi-structured, with the purpose of being investigative and understanding the phenomena from the lived experience of the small business owners. A purposive sampling was used, where small business owners fulfilling certain criteria were approached to take part in the interviews. Key findings: The study found four ways in which small business owners develop their social media competency (informal methods, formal methods, learning through a network, and experimenting) and the various challenges they face with these methods. Further, the study established four barriers impacting the development of social media marketing competency among the interviewed small business owners. In doing so, preliminary support needs have also emerged. Concluding statement: The contribution of this study is to understand the challenges small business owners face when learning how to use social media for business purposes and identifying their training needs. This understanding can help the development of specific and tailored support. In addition, specific and tailored training can support small businesses in building competency. This supports small businesses to progress to the next stage of their development, which could be to further their digital transformation or grow their business. The insights from this study can be used to support business competitiveness and support small businesses to become more resilient. Moreover, small businesses and entrepreneurs share some similar characteristics, such as limited resources and conflicting priorities, and the findings of this study may be able to support entrepreneurs in their social media marketing strategies as well.

Keywords: small business, marketing theory and applications, social media marketing, strategic management, digital competency, digitalisation, marketing research and strategy, entrepreneurship

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Authors: Alina Muradyan, Lina Babayan, Arsen Nanyan, Gohar Galstyan, Vigen Khachatryan

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We present a photometric method for identifying stars, galaxies and quasars in multi-color surveys, which uses a library of ∼> 65000 color templates for comparison with observed objects. The method aims for extracting the information content of object colors in a statistically correct way, and performs a classification as well as a redshift estimation for galaxies and quasars in a unified approach based on the same probability density functions. For the redshift estimation, we employ an advanced version of the Minimum Error Variance estimator which determines the redshift error from the redshift dependent probability density function itself. The method was originally developed for the Calar Alto Deep Imaging Survey (CADIS), but is now used in a wide variety of survey projects. We checked its performance by spectroscopy of CADIS objects, where the method provides high reliability (6 errors among 151 objects with R < 24), especially for the quasar selection, and redshifts accurate within σz ≈ 0.03 for galaxies and σz ≈ 0.1 for quasars. For an optimization of future survey efforts, a few model surveys are compared, which are designed to use the same total amount of telescope time but different sets of broad-band and medium-band filters. Their performance is investigated by Monte-Carlo simulations as well as by analytic evaluation in terms of classification and redshift estimation. If photon noise were the only error source, broad-band surveys and medium-band surveys should perform equally well, as long as they provide the same spectral coverage. In practice, medium-band surveys show superior performance due to their higher tolerance for calibration errors and cosmic variance. Finally, we discuss the relevance of color calibration and derive important conclusions for the issues of library design and choice of filters. The calibration accuracy poses strong constraints on an accurate classification, which are most critical for surveys with few, broad and deeply exposed filters, but less severe for surveys with many, narrow and less deep filters.

Keywords: VO, ArVO, DFBS, FITS, image processing, data analysis

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Authors: Kwang Yeon Kim

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This paper will explore the directly proportional relationship between the influence of Hispanophone media in U.S. markets and Hispanic population growth. Though this growth has origins across south and central America, in U.S. media markets Mexican and Cuban immigrants, have traditionally been considered the most influential. Having endured significant historical discrimination, disparagement, and ethnic framing from conventional Anglophone media, such groups have sought to form their own identities as media consuming and producing Americans of Latin American origin. Although immigrants to the U.S. have traditionally faced obstacles in access to education, children of Mexican-Americans (Chicanos) and Cuban-Americans have made significant progress in overcoming these obstacles, partly explaining their media dominance. This is particularly true in the case of Cuban-Americans, for whom such media presence is not predicted by share of population. By conducting comparative studies of Chicano media and Cuban-Americans media, common ground was found in strategies of reliance on media-driven identity formation. In contrast to the mainstream media portrayal of Latino/as with limiting, negative stereotypes, Spanish-language media’s goal is to form the identity of being Latino for those living in the United States. Providing both news from countries of origin and local news within the United States, Chicano and Cuban-American media performs rituals of recollection while rooting such populations in more proximate media paradigms.

Keywords: Chicano identity, Cuban-Americans, Hispanophone media, Latino/a community

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Authors: A. Soria-Salinas, M.-P. Zorzano, J. Martín-Torres, J. Sánchez-García-Casarrubios, J.-L. Pérez-Díaz, A. Vakkada-Ramachandran

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The current state-of-the-art methods of mass gauging of Electric Propulsion (EP) propellants in microgravity conditions rely on external measurements that are taken at the surface of the tank. The tanks are operated under a constant thermal duty cycle to store the propellant within a pre-defined temperature and pressure range. We demonstrate using computational fluid dynamics (CFD) simulations that the heat-transfer within the pressurized propellant generates temperature and density anisotropies. This challenges the standard mass gauging methods that rely on the use of time changing skin-temperatures and pressures. We observe that the domes of the tanks are prone to be overheated, and that a long time after the heaters of the thermal cycle are switched off, the system reaches a quasi-equilibrium state with a more uniform density. We propose a new gauging method, which we call the Improved PVT method, based on universal physics and thermodynamics principles, existing TRL-9 technology and telemetry data. This method only uses as inputs the temperature and pressure readings of sensors externally attached to the tank. These sensors can operate during the nominal thermal duty cycle. The improved PVT method shows little sensitivity to the pressure sensor drifts which are critical towards the end-of-life of the missions, as well as little sensitivity to systematic temperature errors. The retrieval method has been validated experimentally with CO₂ in gas and fluid state in a chamber that operates up to 82 bar within a nominal thermal cycle of 38 °C to 42 °C. The mass gauging error is shown to be lower than 1% the mass at the beginning of life, assuming an initial tank load at 100 bar. In particular, for a pressure of about 70 bar, just below the critical pressure of CO₂, the error of the mass gauging in gas phase goes down to 0.1% and for 77 bar, just above the critical point, the error of the mass gauging of the liquid phase is 0.6% of initial tank load. This gauging method improves by a factor of 8 the accuracy of the standard PVT retrievals using look-up tables with tabulated data from the National Institute of Standards and Technology.

Keywords: electric propulsion, mass gauging, propellant, PVT, xenon

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Authors: Hamza Javar Magnier, Leslie V. Woodcock

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We report extensive molecular dynamics (MD) computational investigations into the thermodynamic description of supercritical properties for a model fluid that is the simplest realistic representation of atoms or molecules. The pair potential is a hard-sphere repulsion of diameter σ with a very short attraction of length λσ. When λ = 1.005 the range is so short that the model atoms are referred to as “adhesive spheres”. Molecular dimers, trimers …etc. up to large clusters, or droplets, of many adhesive-sphere atoms are unambiguously defined. This then defines percolation transitions at the molecular level that bound the existence of gas and liquid phases at supercritical temperatures, and which define the existence of a supercritical mesophase. Both liquid and gas phases are seen to terminate at the loci of percolation transitions, and below a second characteristic temperature (Tc2) are separated by the supercritical mesophase. An analysis of the distribution of clusters in gas, meso- and liquid phases confirms the colloidal nature of this mesophase. The general phase behaviour is compared with both experimental properties of the water-steam supercritical region and also with formally exact cluster theory of Mayer and Mayer. Both are found to be consistent with the present findings that in this system the supercritical mesophase narrows in density with increasing T > Tc and terminates at a higher Tc2 at a confluence of the primary percolation loci. The expended plot of the MD data points in the mesophase of 7 critical and supercritical isotherms in highlight this narrowing in density of the linear-slope region of the mesophase as temperature is increased above the critical. This linearity in the mesophase implies the existence of a linear combination rule between gas and liquid which is an extension of the Lever rule in the subcritical region, and can be used to obtain critical parameters without resorting to experimental data in the two-phase region. Using this combination rule, the calculated critical parameters Tc = 0.2007 and Pc = 0.0278 are found be agree with the values found by of Largo and coworkers. The properties of this supercritical mesophase are shown to be consistent with an alternative description of the phenomenon of critical opalescence seen in the supercritical region of both molecular and colloidal-protein supercritical fluids.

Keywords: critical opalescence, supercritical, square-well, percolation transition, critical parameters.

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Authors: Mustafa M. Donma, Orkide Donma

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Obesity is defined as a severe chronic disease characterized by a low-grade inflammatory state. Therefore, inflammatory markers gained utmost importance during the evaluation of obesity and metabolic syndrome (MetS), a disease characterized by central obesity, elevated blood pressure, increased fasting blood glucose and elevated triglycerides or reduced high density lipoprotein cholesterol (HDL-C) values. Some inflammatory markers based upon complete blood cell count (CBC) are available. In this study, it was questioned which inflammatory marker was the best to evaluate the differences between various obesity groups. 514 pediatric individuals were recruited. 132 children with MetS, 155 morbid obese (MO), 90 obese (OB), 38 overweight (OW) and 99 children with normal BMI (N-BMI) were included into the scope of this study. Obesity groups were constituted using age- and sex-dependent body mass index (BMI) percentiles tabulated by World Health Organization. MetS components were determined to be able to specify children with MetS. CBC were determined using automated hematology analyzer. HDL-C analysis was performed. Using CBC parameters and HDL-C values, ratio markers of inflammation, which cover neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), monocyte-to-HDL-C ratio (MHR) were calculated. Statistical analyses were performed. The statistical significance degree was considered as p < 0.05. There was no statistically significant difference among the groups in terms of platelet count, neutrophil count, lymphocyte count, monocyte count, and NLR. PLR differed significantly between OW and N-BMI as well as MetS. Monocyte-to HDL-C value exhibited statistical significance between MetS and N-BMI, OB, and MO groups. HDL-C value differed between MetS and N-BMI, OW, OB, MO groups. MHR was the ratio, which exhibits the best performance among the other CBC-based inflammatory markers. On the other hand, when MHR was compared to HDL-C only, it was suggested that HDL-C has given much more valuable information. Therefore, this parameter still keeps its value from the diagnostic point of view. Our results suggest that MHR can be an inflammatory marker during the evaluation of pediatric MetS, but the predictive value of this parameter was not superior to HDL-C during the evaluation of obesity.

Keywords: children, complete blood cell count, high density lipoprotein cholesterol, metabolic syndrome, obesity

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