Search results for: clinical trial development
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 19359

Search results for: clinical trial development

17259 Osteoarthritis (OA): A Total Knee Replacement Surgery

Authors: Loveneet Kaur

Abstract:

Introduction: Osteoarthritis (OA) is one of the leading causes of disability, and the knee is the most commonly affected joint in the body. The last resort for treatment of knee OA is Total Knee Replacement (TKR) surgery. Despite numerous advances in prosthetic design, patients do not reach normal function after surgery. Current surgical decisions are made on 2D radiographs and patient interviews. Aims: The aim of this study was to compare knee kinematics pre and post-TKR surgery using computer-animated images of patient-specific models under everyday conditions. Methods: 7 subjects were recruited for the study. Subjects underwent 3D gait analysis during 4 everyday activities and medical imaging of the knee joint pre- and one-month post-surgery. A 3D model was created from each of the scans, and the kinematic gait analysis data was used to animate the images. Results: Improvements were seen in a range of motion in all 4 activities 1-year post-surgery. The preoperative 3D images provide detailed information on the anatomy of the osteoarthritic knee. The postoperative images demonstrate potential future problems associated with the implant. Although not accurate enough to be of clinical use, the animated data can provide valuable insight into what conditions cause damage to both the osteoarthritic and prosthetic knee joints. As the animated data does not require specialist training to view, the images can be utilized across the fields of health professionals and manufacturing in the assessment and treatment of patients pre and post-knee replacement surgery. Future improvements in the collection and processing of data may yield clinically useful data. Conclusion: Although not yet of clinical use, the potential application of 3D animations of the knee joint pre and post-surgery is widespread.

Keywords: Orthoporosis, Ortharthritis, knee replacement, TKR

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17258 Sense of Place in Historic City

Authors: Hiba Alkhalaf

Abstract:

Historic cities and places of cultural significance is continuously under the pressure of economic development and social change that threaten its natural and cultural environment. The challenge here is to find a balance between preserving the cultural character while ensuring the socio-economic gains and continuity of its uniqueness. That is by sustaining the use, character, meaning and social interaction associated with the place, in other words the sense of place. The main argument here is what we attempt to conserve is the cultural physical and non-physical dimensions of the historic city. It is based on the proposition that what give the historic city its character is its strong sense of place- whether it is historic or current. When properly identified, its various dimensions (use, meaning and form) would help determine what to sustain and what not by making the development meaningfully related to the uniqueness of the historic place. Accordingly, those socio-economic features within the context of a changing historic environment needed to be clarified. This paper, thus, explores the various perspectives of the role of sense of place within the historic city and its connection to cultural heritage. It also reviews urban conservation practice as it is currently understood in the context of historic city development. It concludes that sense of place lies in complex interrelated relationships between various users of the place and the physical, economic, cultural, political, and environmental contexts in which they interact. This calls for the need to sustain the sense of place as part of the overall urban development and conservation strategies.

Keywords: cultural heritage, historic urban areas, urban development, sense of place

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17257 National Projects' Impact on the Regional Division

Authors: Mosaad Hamouda, Kamal Khalaf, Zaker Mousa

Abstract:

National projects are considered Egypt's future vision in investing its various resources and the best way to bring about a developmental renaissance that constitutes a quantum leap because of its developmental impact on the planning regions, which it achieves in attracting and localizing investments to achieve urban development, and what this has a noticeable impact on dividing those regions in order to achieve a developmental balance or at least reduce the severity of the disparities between them, by measuring the impact of these projects, which appear in the per capita share of the various developmental variables, and also analyzing global and local experiences so that a balanced division of the country’s regions can be reached, and the research finds a set of planning foundations that are compatible with the settlement of these national projects in the future.

Keywords: national projects, regional development, division of regions, development disparities

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17256 Comparison of an Upflow Anaerobic Sludge Blanket and an Anaerobic Filter for Treating Wheat Straw Washwater

Authors: Syazwani Idrus, S. Charles J. Banks, Sonia Heaven

Abstract:

The study compared the performance of upflow anaerobic sludge blanket (UASB) reactors and anaerobic filters (AF) for the treatment of wheat straw washwater (WSW) which has a high concentration of Potassium ions. The trial was conducted at mesophilic temperatures (37 °C). The digesters were started up over a 48-day period using a synthetic wastewater feed and reached an organic loading rate (OLR) of 6 g COD L^-1 day^-1 with a specific methane production (SMP) of 0.333 L CH4 g^-1 COD. When the feed was switched to WSW it was not possible to maintain the same loading rate as the SMP in all reactors fell sharply to less than 0.1 L CH4 g^-1 COD, with the AF affected more than the UASB. On reducing the OLR to 3 g COD L^-1 day^-1 the reactors recovered to produce 0.21 L CH4 g^-1 CODadded and gave 82% COD removal. A discrepancy between the COD consumed and the methane produced could be accounted for through increased maintenance energy requirement of the microbial community for osmo-regulation as K+ was found to accumulate in the sludge and in the UASB reached a concentration of 4.5 mg K g^-1 wet weight of granules.

Keywords: anaerobic digestion, osmotic stress, chemical oxygen demand, specific methane production

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17255 Gray’s Anatomy for Students: First South Asia Edition Highlights

Authors: Raveendranath Veeramani, Sunil Jonathan Holla, Parkash Chand, Sunil Chumber

Abstract:

Gray’s Anatomy for Students has been a well-appreciated book among undergraduate students of anatomy in Asia. However, the current curricular requirements of anatomy require a more focused and organized approach. The editors of the first South Asia edition of Gray’s Anatomy for Students hereby highlight the modifications and importance of this edition. There is an emphasis on active learning by making the clinical relevance of anatomy explicit. Learning anatomy in context has been fostered by the association between anatomists and clinicians in keeping with the emerging integrated curriculum of the 21st century. The language has been simplified to aid students who have studied in the vernacular. The original illustrations have been retained, and few illustrations have been added. There are more figure numbers mentioned in the text to encourage students to refer to the illustrations while learning. The text has been made more student-friendly by adding generalizations, classifications and summaries. There are useful review materials at the beginning of the chapters which include digital resources for self-study. There are updates on imaging techniques to encourage students to appreciate the importance of essential knowledge of the relevant anatomy to interpret images, due emphasis has been laid on dissection. Additional importance has been given to the cranial nerves, by describing their relevant details with several additional illustrations and flowcharts. This new edition includes innovative features such as set inductions, outlines for subchapters and flowcharts to facilitate learning. Set inductions are mostly clinical scenarios to create interest in the need to study anatomy for healthcare professions. The outlines are a modern multimodal facilitating approach towards various topics to empower students to explore content and direct their learning and include learning objectives and material for review. The components of the outline encourage the student to be aware of the need to create solutions to clinical problems. The outlines help students direct their learning to recall facts, demonstrate and analyze relationships, use reason to explain concepts, appreciate the significance of structures and their relationships and apply anatomical knowledge. The 'structures to be identified in a dissection' are given as Level I, II and III which represent the 'must know, desirable to know and nice to know' content respectively. The flowcharts have been added to get an overview of the course of a structure, recapitulate important details about structures, and as an aid to recall. There has been a great effort to balance the need to have content that would enable students to understand concepts as well as get the basic material for the current condensed curriculum.

Keywords: Grays anatomy, South Asia, human anatomy, students anatomy

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17254 Oat Bran Associated with Nutritional Counseling in Treating Obesity and Other Risk Factors for Cardiovascular Disease

Authors: Simone Raimondi De Souza, Glaucia Maria Moraes De Oliveira, Ronir Raggio Luiz, Glorimar Rosa

Abstract:

Introduction: Obesity is among the main risk factors for cardiovascular disease (CVD). Genesis is multifactorial, including genetic, hormonal and environmental factors disorders, among which inadequate feeding pattern, for which nutritional counseling strategies have proven effective. The consumption of beta-glucans (soluble fibers that reportedly promote satiety) present in oat bran can be an effective strategy for preventing and treating obesity. Other benefits have been observed with oat bran consumption, such as reduction of hypercholesterolemia and hyperglycemia, two other risk factors for CVD. Objectives: To analyze the effect of oat bran consumption associated with nutritional counseling in reducing body mass index (BMI), blood cholesterol, glucose profile, waist and neck circumference in obese individuals, and to evaluate the change in eating pattern. Methods: clinical trial, randomized, double-blind, placebo-controlled, lasting 90 days with adults of both genders, with BMI ≥30kg/m2. The study was approved by the Ethics in Research involving human beings in a public institute of cardiology, in Rio de Janeiro, Brazil. Individuals were invited to participate and accepted formally by signing the Terms of Consent. Participants were randomized into oat bran group (gOB) or placebo group (gPCB) and received, respectively: morning prepared consisting of 40g oat bran, 30g of skimmed milk powder and 1g sweetener sucralose; refined flour 40g rice, 30g of milk powder and 1g sweetener sucralose. The Ten Steps to Healthy Eating, of Brazilian Ministry of Health were used to support the nutritional counseling. Variables analyzed: gender; age; BMI, waist circumference (WC) neck circumference (NC); systolic blood pressure (SBP); diastolic blood pressure (DBP); food consumption, total cholesterol (TC), LDL-cholesterol (LDL-c), HDL-cholesterol (HDL-c), non-HDL cholesterol (nHDLc), triglycerides (TG), fasting glucose (FG), fasting insulin (FI) and HOMA-IR. Dietary intake was assessed by 24-hour dietary recall. The Diet Quality Index revised for the Brazilian population (IQD-R) assessed quality of feeding pattern. Statistical analyzes were performed using SPSS version 21, considering statistically significant p-value less than 0.05. Results: A total of 38 participants were included, age = 50 ± 7,6years, 63% women. 19 subjects were placed in gOB and 19 in gPCB. After intervention, statistically significant reductions were observed in the following parameters: in gOB: IQD-R, TC, LDL-c, nHDL-c, FI, SBP, DBP, BMI, WC, NC; in gPCB: IQD-R, LDL-c, SBP, DBP, BMI, WC, NC. No statistically significant differences were observed in the results between groups. Conclusion: Our results reinforce nutritional counseling as important strategy for prevention and treatment of obesity and suggest that inclusion of oat bran in daily diet can bring additional benefits controlling risk factors for CVD. More studies are needed to establish all benefits of oat bran to human health as well as the ideal daily dose for consumption.

Keywords: oat bran, cardiovascular disease, nutritional counseling, obesity

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17253 In situ Biodegradation of Endosulfan, Imidacloprid, and Carbendazim Using Indigenous Bacterial Cultures of Agriculture Fields of Uttarakhand, India

Authors: Geeta Negi, Pankaj, Anjana Srivastava, Anita Sharma

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In the present study, the presence of endosulfan, imidacloprid, carbendazim, in the soil /vegetables/cereals and water samples was observed in agriculture fields of Uttarakhand. In view of biodegradation of these pesticides, nine bacterial isolates were recovered from the soil samples of the fields which tolerated endosulfan, imidacloprid, carbendazim from 100 to 200 µg/ml. Three bacterial consortia used for in vitro bioremediation experiments were three bacterial isolates for carbendazim, imidacloprid and endosulfan, respectively. Maximum degradation (87 and 83%) of α and β endosulfan respectively was observed in soil slurry by consortium. Degradation of Imidacloprid and carbendazim under similar conditions was 88.4 and 77.5% respectively. FT-IR analysis of biodegraded samples of pesticides in liquid media showed stretching of various bonds. GC-MS of biodegraded endosulfan sample in soil slurry showed the presence of non-toxic intermediates. A pot trial with Bacterial treatments lowered down the uptake of pesticides in onion plants.

Keywords: biodegradation, carbendazim, consortium, endosulfan

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17252 Banking Sector Development and Economic Growth: Evidence from the State of Qatar

Authors: Fekri Shawtari

Abstract:

The banking sector plays a very crucial role in the economic development of the country. As a financial intermediary, it has assigned a great role in the economic growth and stability. This paper aims to examine the empirically the relationship between banking industry and economic growth in state of Qatar. We adopt the VAR vector error correction model (VECM) along with Granger causality to address the issue over the long-run and short-run between the banking sector and economic growth. It is expected that the results will give policy directions to the policymakers to make strategies that are conducive toward boosting development to achieve the targeted economic growth in current situation.

Keywords: economic growth, banking sector, Qatar, vector error correction model, VECM

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17251 Socio Economic Impact and Status of the Islamic Perspective of Veil

Authors: Shagufta Jahangir, Nadeemullah, Yaqoob, Raisa Jahangir

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The Persian language word ‘Purdah’ and in Arabic ‘Hajab’ is used for veil. Veil has been used by women for being escaped from men. In one way or the other veil has been continuously used in ancient as well as modern civilizations by women. Developed nations have blamed the use of veil an obstacle in the process of development. Therefore, modern nations have struggled to get rid of the use of veil. They argue that it is a sign of slavery for women and it is an obstacle in the path of development. The modern secular Muslims considered veil as the biggest obstacle for social and economic development. It makes a woman helpless, as being zanjir in her feet. It has become an obstacle in the process of development for women. It is also considered as a tool for segregation among men and women. The so called Muslims of the modern era are trying to introduce changes in religion by imitation the modern nations of the world. In particular ways for Muslim woman use of veil in Islam is must. It is a right provided her by religion. It provides her strength. In the Holy Quran word ‘Hajab’ is used 5 times. Islam is against domination and forceful practice of veil, as a part of teaching of Islam it is being adopted by women as a protection. This article aims at: (1) historical background of veil (2) Its existence in civilizations, (3) Meaning and interpretation of veil in Islamic context, (4) Economic impact of it on women (5) Discussion on its practice in Islamic (eastern) and other (European) circles and conclusions followed by concerted bibliography.

Keywords: veil, economic development, civilizations, obstacle, secular Muslims, segregation

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17250 Biomimetic Architecture from the Inspiration by Nature to the Innovation of the Saharan Architecture

Authors: Yassine Mohammed Benyoucef, Razin Andery Dionisovich

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Biomimicry is an old approach, but in the scientific conceptualization is new, as an approach of innovation based on the emulation of Nature, in recent years, this approach brings many potential theories and innovations in the architecture field. Indeed, these innovations have changed our view towards other Natural organisms also to the design processes in architecture, now the use of the biomimicry approach allows the application of a great sustainable development. The Sahara area is heading towards a sustainable policy with the desire to develop this rich context in terms of architecture, because of the rapid evolution of the architectural and urban concepts and the technology acceleration in one side, and under the pressure of the architectural crisis and the accelerated urbanization in the Saharan cities on the other side, the imperatives of sustainable development, ecology, climate adaptation, energy needs, are strongly imposed. Besides that, the new architectural and urban projects in the Saharan cities are not reliable in terms of energy efficiency and design and relationship with the environment. This article discusses the using of biomimetic strategy in the sustainable development of Saharan architecture. The aim of the article is to present a synthesis of biomimicry approach and propose the biomimicry as a solution for the development of Saharan architecture which can use this approach as a sustainable and innovation strategy. The biomimicry is the solution for effective strategies of development and can have a great potential point to meet the current challenges of designing efficient for forms or structures, energy efficiency, and climate issues. Moreover, the Sahara can be a favorable soil for great changes, the use of this approach is the key for the most optimal strategies and sustainable development of the Saharan architecture.

Keywords: biomimicry, Sahara, architecture, nature, innovation, technology

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17249 The Role of Vernacular Radio Stations in Enhancing Agricultural Development in Kenya; A Case of KASS FM

Authors: Thomas Kipkurgat, Silahs Chemwaina

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Communication and ICT is a crucial component in realization of vision 2030, radio has played a key role in dissemination of information to mass audience. Since time immemorial, mass media has played a vital role in passing information on agricultural development issues both locally and internationally. This paper aimed at assessing the role of community radio stations in enhancing agricultural development in Kenya. The paper sought to identify the main contributions of KASS FM radio in the agricultural development especially in rural areas, the study also aimed to establish the appropriate adjustments in editorial policies of KASS FM radio in helping to promote agricultural development related programmes in rural areas. Despite some weaknesses in radio programming and the mode of interaction with the rural people, the findings of this study showed that the rural communities are better off today than in the old days when FM radios were non-existent. KASS FM has come up with different developmental programmes that have positively contributed to changing the rural people’s ways of life. These programmes include farming, health, marital values, environment, cultural issues, human rights, democracy, religious teachings, peace and reconciliation. Such programmes feature experts, professionals and opinion leaders who address numerous topics of interest to the community. The local people participate in the production of these programmes through letters to the editor, and phone-ins, among others. Programmes such as political talk shows, which feature in KASS FM, has become one of the most important ways of community participation. The interpretation and conclusions are based on the empirical data analysis and the theories of development advanced by international development communication scholars, as presented in the paper. The study ends with some recommendations on how KASS FM can best serve the interests of the poor people in rural areas, and helps improve their lives.

Keywords: agriculture, development, communication, KASS FM, radio, rural areas, Kenya

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17248 A Quantitative Study on the “Unbalanced Phenomenon” of Mixed-Use Development in the Central Area of Nanjing Inner City Based on the Meta-Dimensional Model

Authors: Yang Chen, Lili Fu

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Promoting urban regeneration in existing areas has been elevated to a national strategy in China. In this context, because of the multidimensional sustainable effect through the intensive use of land, mixed-use development has become an important objective for high-quality urban regeneration in the inner city. However, in the long period of time since China's reform and opening up, the "unbalanced phenomenon" of mixed-use development in China's inner cities has been very serious. On the one hand, the excessive focus on certain individual spaces has led to an increase in the level of mixed-use development in some areas, substantially ahead of others, resulting in a growing gap between different parts of the inner city; On the other hand, the excessive focus on a one-dimensional element of the spatial organization of mixed-use development, such as the enhancement of functional mix or spatial capacity, has led to a lagging phenomenon or neglect in the construction of other dimensional elements, such as pedestrian permeability, green environmental quality, social inclusion, etc. This phenomenon is particularly evident in the central area of the inner city, and it clearly runs counter to the need for sustainable development in China's new era. Therefore, a rational qualitative and quantitative analysis of the "unbalanced phenomenon" will help to identify the problem and provide a basis for the formulation of relevant optimization plans in the future. This paper builds a dynamic evaluation method of mixed-use development based on a meta-dimensional model and then uses spatial evolution analysis and spatial consistency analysis with ArcGIS software to reveal the "unbalanced phenomenon " in over the past 40 years of the central city area in Nanjing, a China’s typical city facing regeneration. This study result finds that, compared to the increase in functional mix and capacity, the dimensions of residential space mix, public service facility mix, pedestrian permeability, and greenness in Nanjing's city central area showed different degrees of lagging improvement, and the unbalanced development problems in each part of the city center are different, so the governance and planning plan for future mixed-use development needs to fully address these problems. The research methodology of this paper provides a tool for comprehensive dynamic identification of mixed-use development level’s change, and the results deepen the knowledge of the evolution of mixed-use development patterns in China’s inner cities and provide a reference basis for future regeneration practices.

Keywords: mixed-use development, unbalanced phenomenon, the meta-dimensional model, over the past 40 years of Nanjing, China

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17247 ‘Doctor Knows Best’: Reconsidering Paternalism in the NICU

Authors: Rebecca Greenberg, Nipa Chauhan, Rashad Rehman

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Paternalism, in its traditional form, seems largely incompatible with Western medicine. In contrast, Family-Centred Care, a partial response to historically authoritative paternalism, carries its own challenges, particularly when operationalized as family-directed care. Specifically, in neonatology, decision-making is left entirely to Substitute Decision Makers (most commonly parents). Most models of shared decision-making employ both the parents’ and medical team’s perspectives but do not recognize the inherent asymmetry of information and experience – asking parents to act like physicians to evaluate technical data and encourage physicians to refrain from strong medical opinions and proposals. They also do not fully appreciate the difficulties in adjudicating which perspective to prioritize and, moreover, how to mitigate disagreement. Introducing a mild form of paternalism can harness the unique skillset both parents and clinicians bring to shared decision-making and ultimately work towards decision-making in the best interest of the child. The notion expressed here is that within the model of shared decision-making, mild paternalism is prioritized inasmuch as optimal care is prioritized. This mild form of paternalism is known as Beneficent Paternalism and justifies our encouragement for physicians to root down in their own medical expertise to propose treatment plans informed by medical expertise, standards of care, and the parents’ values. This does not mean that we forget that paternalism was historically justified on ‘beneficent’ grounds; however, our recommendation is that a re-integration of mild paternalism is appropriate within our current Western healthcare climate. Through illustrative examples from the NICU, this paper explores the appropriateness and merits of Beneficent Paternalism and ultimately its use in promoting family-centered care, patient’s best interests and reducing moral distress. A distinctive feature of the NICU is the fact that communication regarding a patient’s treatment is exclusively done with substitute decision-makers and not the patient, i.e., the neonate themselves. This leaves the burden of responsibility entirely on substitute decision-makers and the clinical team; the patient in the NICU does not have any prior wishes, values, or beliefs that can guide decision-making on their behalf. Therefore, the wishes, values, and beliefs of the parent become the map upon which clinical proposals are made, giving extra weight to the family’s decision-making responsibility. This leads to why Family Directed Care is common in the NICU, where shared decision-making is mandatory. However, the zone of parental discretion is not as all-encompassing as it is currently considered; there are appropriate times when the clinical team should strongly root down in medical expertise and perhaps take the lead in guiding family decision-making: this is just what it means to adopt Beneficent Paternalism.

Keywords: care, ethics, expertise, NICU, paternalism

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17246 Linking Remittances and Household Level Development in India: An Analysis of NSSO 64th Round Data

Authors: Rakesh Mishra, Mukunda Upadhyay, Rajni Singh

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This paper attempts to link remittances sent by internal as well as international out-migrants and its domestic preferences of usage in three different dimension of Household level development in India and its states. Investment of remittances in these sectors reveals for mixed choices of preferential among the states from where people have out-migrated. The multivariate analysis implies that among all three indicators of human development, health (Investment in Food and Health) is the one that attracts the major investment followed by capital formation and least on Education. Usage of the remittances has been found to be varying across all the states in India as far as usage in health, capital formation and education are concerned. Orissa, Nagaland, Madhya Pradesh, Jharkhand, Gujarat, D & H Haweli are some of the states and union territory that contributes highest of its international remittances on health, while most of the usage of the internal remittances has second or third preferences of investment on the health except for Uttar Pradesh, D & H Haweli, Arunachal Pradesh and A & N Is. This paper tries to access usage of international remittances as well as internal remittances on the flow of remittances at the micro level and its implications across three basic determinants of Human Development that is Health, Capital formation and Education coupled with the preferences of usage in presence of Several Socio economic and Demographic variable.

Keywords: multivariate analysis, household development, remittances, internal and international migration

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17245 A Dynamic Spatial Panel Data Analysis on Renter-Occupied Multifamily Housing DC

Authors: Jose Funes, Jeff Sauer, Laixiang Sun

Abstract:

This research examines determinants of multifamily housing development and spillovers in the District of Columbia. A range of socioeconomic factors related to income distribution, productivity, and land use policies are thought to influence the development in contemporary U.S. multifamily housing markets. The analysis leverages data from the American Community Survey to construct panel datasets spanning from 2010 to 2019. Using spatial regression, we identify several socioeconomic measures and land use policies both positively and negatively associated with new housing supply. We contextualize housing estimates related to race in relation to uneven development in the contemporary D.C. housing supply.

Keywords: neighborhood effect, sorting, spatial spillovers, multifamily housing

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17244 Reducing Waiting Time in Outpatient Services: Six Sigma and Technological Approach

Authors: Omkar More, Isha Saini, Gracy Mathai

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To study whether there is any clinical correlation between pterygium and dry eye and to evaluate the status of the tear film in patients with pterygium. Methods: 100 eyes with pterygium were compared with 100 control eyes without pterygium. Patients between 20 – 70 years were included in the study. A detailed history was taken and Schirmer’s test and TBUT were performed on all to evaluate the status of dry eye. Schirmer’s test ˂ 10 mm and TBUT ˂10 seconds was considered abnormal. Results: Maximum number (52) of patients affected by dry eye in both the groups were in the age group 31-40 years which statistically showed age as a significant factor of association for both pterygium and dry eye (P < 0.01).Schirmer’s test was slightly reduced in patients with pterygium(18.73±5.69 mm). TBUT was significantly reduced in the case group (12.26±2.24sec).TBUT decreased maximally in 51-60 yrs age group (13.00±2.77sec) with pterygium showing a tear film instability. On comparison of pterygia and controls with normal and abnormal tear film, Odd’s Ratio was 1.14 showing a risk of dry eye in pterygia patients to be 1.14 times higher than controls. Conclusion: Whether tear dysfunction is a precursor to pterygium growth or pterygium causes tear dysfunction is still not clear. Research and clinical evidence, however, suggest that there is a relationship between the two. This study is, therefore, undertaken to investigate the correlation between pterygium and dry eye. The patients with pterygia were compared with normals to evaluate their status regarding dryness. A close relationship exists between ocular irritation symptoms and functional evidence of tear instability. Schirmer’s test and TBUT should routinely be used in the outpatient department to diagnose dry eye in patients with pterygium and these patients should be promptly treated to prevent any sight-threatening complications.

Keywords: footfall, nursing assessment, quality improvement, six sigma

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17243 Biocellulose Template for 3D Mineral Scaffolds

Authors: C. Busuioc, G. Voicu, S. I. Jinga

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The field of tissue engineering brings new challenges in terms of proposing original solutions for ongoing medical issues, improving the biological performances of existing clinical systems and speeding the healing process for a faster recovery and a more comfortable life as patient. In this context, we propose the obtaining of 3D porous scaffolds of mineral nature, dedicated to bone repairing and regeneration purposes or employed as bioactive filler for bone cements. Thus, bacterial cellulose - calcium phosphates composite materials have been synthesized by successive immersing of the polymeric membranes in the precursor solution containing Ca2+ and [PO4]3- ions. The mineral phase deposited on the surface of biocellulose fibers was varied as amount through the number of immersing cycles. The intermediary composites were subjected to thermal treatments at different temperatures in order to remove the organic part and provide the formation of a self-sustained 3D architecture. The resulting phase composition consists of common phosphates, while the morphology largely depends on the preparation parameters. Thus, the aspect of the 3D mineral scaffolds can be tuned from a loose microstructure composed of large grains connected via monocrystalline nanorods to a trabecular pattern crossed by parallel internal channels, just like the natural bone. The bioactivity and biocompatibility of the obtained materials have been also assessed, with encouraging results in the clinical use direction. In conclusion, the compositional, structural, morphological and biological characterizations sustain the suitability of the reported biostructures for integration in hard tissue engineering applications.

Keywords: bacterial cellulose, bone reconstruction, calcium phosphates, mineral scaffolds

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17242 Strategic Interventions to Address Health Workforce and Current Disease Trends, Nakuru, Kenya

Authors: Paul Moses Ndegwa, Teresia Kabucho, Lucy Wanjiru, Esther Wanjiru, Brian Githaiga, Jecinta Wambui

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Health outcome has improved in the country since 2013 following the adoption of the new constitution in Kenya with devolved governance with administration and health planning functions transferred to county governments. 2018-2022 development agenda prioritized universal healthcare coverage, food security, and nutrition, however, the emergence of Covid-19 and the increase of non-communicable diseases pose a challenge and constrain in an already overwhelmed health system. A study was conducted July-November 2021 to establish key challenges in achieving universal healthcare coverage within the county and best practices for improved non-communicable disease control. 14 health workers ranging from nurses, doctors, public health officers, clinical officers, and pharmaceutical technologists were purposely engaged to provide critical information through questionnaires by a trained duo observing ethical procedures on confidentiality. Data analysis. Communicable diseases are major causes of morbidity and mortality. Non-communicable diseases contribute to approximately 39% of deaths. More than 45% of the population does not have access to safe drinking water. Study noted geographic inequality with respect to distribution and use of health resources including competing non-health priorities. 56% of health workers are nurses, 13% clinical officers, 7% doctors, 9%public health workers, 2% are pharmaceutical technologists. Poor-quality data limits the validity of disease-burdened estimates and research activities. Risk factors include unsafe water, sanitation, hand washing, unsafe sex, and malnutrition. Key challenge in achieving universal healthcare coverage is the rise in the relative contribution of non-communicable diseases. Improve targeted disease control with effective and equitable resource allocation. Develop high infectious disease control mechanisms. Improvement of quality data for decision making. Strengthen electronic data-capture systems. Increase investments in the health workforce to improve health service provision and achievement of universal health coverage. Create a favorable environment to retain health workers. Fill in staffing gaps resulting in shortages of doctors (7%). Develop a multi-sectional approach to health workforce planning and management. Need to invest in mechanisms that generate contextual evidence on current and future health workforce needs. Ensure retention of qualified, skilled, and motivated health workforce. Deliver integrated people-centered health services.

Keywords: multi-sectional approach, equity, people-centered, health workforce retention

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17241 Effectiveness of Traditional Chinese Medicine in the Treatment of Eczema: A Systematic Review and Meta-Analysis Based on Eczema Area and Severity Index Score

Authors: Oliver Chunho Ma, Tszying Chang

Abstract:

Background: Traditional Chinese Medicine (TCM) has been widely used in the treatment of eczema. However, there is currently a lack of comprehensive research on the overall effectiveness of TCM in treating eczema, particularly using the Eczema Area and Severity Index (EASI) score as an evaluation tool. Meta-analysis can integrate the results of multiple studies to provide more convincing evidence. Objective: To conduct a systematic review and meta-analysis based on the EASI score to evaluate the overall effectiveness of TCM in the treatment of eczema. Specifically, the study will review and analyze published clinical studies that investigate TCM treatments for eczema and use the EASI score as an outcome measure, comparing the differences in improving the severity of eczema between TCM and other treatment modalities, such as conventional Western medicine treatments. Methods: Relevant studies, including randomized controlled trials (RCTs) and non-randomized controlled trials, that involve TCM treatment for eczema and use the EASI score as an outcome measure will be searched in medical literature databases such as PubMed, CNKI, etc. Relevant data will be extracted from the selected studies, including study design, sample size, treatment methods, improvement in EASI score, etc. The methodological quality and risk of bias of the included studies will be assessed using appropriate evaluation tools (such as the Cochrane Handbook). The results of the selected studies will be statistically analyzed, including pooling effect sizes (such as standardized mean differences, relative risks, etc.), subgroup analysis (e.g., different TCM syndromes, different treatment modalities), and sensitivity analysis (e.g., excluding low-quality studies). Based on the results of the statistical analysis and quality assessment, the overall effectiveness of TCM in improving the severity of eczema will be interpreted. Expected outcomes: By integrating the results of multiple studies, we expect to provide more convincing evidence regarding the specific effects of TCM in improving the severity of eczema. Additionally, subgroup analysis and sensitivity analysis can further elucidate whether the effectiveness of TCM treatment is influenced by different factors. Besides, we will compare the results of the meta-analysis with the clinical data from our clinic. For both the clinical data and the meta-analysis results, we will perform descriptive statistics such as means, standard deviations, percentages, etc. and compare the differences between the two using statistical tests such as independent samples t-test or non-parametric tests to assess the statistical differences between them.

Keywords: Eczema, traditional Chinese medicine, EASI, systematic review, meta-analysis

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17240 Scrum Challenges and Mitigation Practices in Global Software Development of an Integrated Learning Environment: Case Study of Science, Technology, Innovation, Mathematics, Engineering for the Young

Authors: Evgeniia Surkova, Manal Assaad, Hleb Makeyeu, Juho Makio

Abstract:

The main objective of STIMEY (Science, Technology, Innovation, Mathematics, Engineering for the Young) project is the delivery of a hybrid learning environment that combines multi-level components such as social media concepts, robotic artefacts, and radio, among others. It is based on a well-researched pedagogical framework to attract European youths to STEM (science, technology, engineering, and mathematics) education and careers. To develop and integrate these various components, STIMEY is executed in iterative research cycles leading to progressive improvements. Scrum was the development methodology of choice in the project, as studies indicated its benefits as an agile methodology in global software development, especially of e-learning and integrated learning projects. This paper describes the project partners’ experience with the Scrum framework, discussing the challenges faced in its implementation and the mitigation practices employed. The authors conclude with exploring user experience tools and principles for future research, as a novel direction in supporting the Scrum development team.

Keywords: e-learning, global software development, scrum, STEM education

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17239 Potential of Grass Silage as a Source of Nutrients in Poultry Production

Authors: Hamim Abbas, Jean Luc-Hornick, Isabelle Dufrasne

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Feed costs constitute over 60% of total expenses in organic layer poultry production, with feed protein supply being a significant concern. Alfalfa-based dehydrated silage pellets are mainly diets composed of leaves (ABSP), which are non-conventional protein sources that could enhance profits by reducing feed costs and ensuring consistent availability. This experiment studied the effects on the performances of Novogen Brown light layers of a commercial control diet replaced with 10% ABSP. After a 21-day trial, this diet (ABSP) has improved the laying rate, yolk color of eggs, feed conversion rate, ω−3 (PUFAs) and ω−6/ω−3 ratio (P<0.05) while the body weight and egg weight were degraded with the substitution of the ABSP in the diet(P>0.05). The laying rate showed a tendency to increase (P=0.06). These findings suggest that ABSP can replace at least 10% of the feed in organic layer diets without compromising production parameters negatively.

Keywords: alfalfa, silage, pellet, organic layers

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17238 Anesthetic Considerations for Carotid Endarterectomy: Prospective Study Based on Clinical Trials

Authors: Ahmed Yousef A. Al Sultan

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Introduction: The aim of this review is based on clinical research that studies the changes in middle cerebral artery velocity using Transcranial Doppler (TCD) and cerebral oxygen saturation using cerebral oximetry in patients undergoing carotid endarterectomy (CEA) surgery under local anesthesia (LA). Patients with or without neurological symptoms during the surgery are taking a role in this study using triplet method of cerebral oximetry, transcranial doppler and awake test in detecting any cerebral ischemic symptoms. Methods: about one hundred patients took part during their CEA surgeries under local anesthesia, using triple assessment mentioned method, Patients requiring general anesthesia be excluded from analysis. All data were recorded at eight surgery stages separately to serve this study. Results: In total regional cerebral oxygen saturation (rSO2), middle cerebral artery (MCA) velocity, and pulsatility index were significantly decreased during carotid artery clamping step in CEA procedures on the targeted carotid side. With most observed changes in MCA velocity during the study. Discussion: Cerebral oxygen saturation and middle cerebral artery velocity were significantly decreased during clamping step of the procedures on the targeted side. The team with neurological symptoms during the procedures showed higher changes of rSO2 and MCA velocity than the team without neurological symptoms. Cerebral rSO2 and MCA velocity significantly increased directly after de-clamping of the internal carotid artery on the affected side.

Keywords: awake testing, carotid endarterectomy, cerebral oximetry, Tanscranial Doppler

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17237 An Incremental Refinement Approach to a Development of Dynamic Host Configuration Protocol (DHCP) Using Event-B

Authors: Rajaa Filali, Mohamed Bouhdadi

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This paper presents an incremental development of the Dynamic Host Configuration Protocol (DHCP) in Event-B. DHCP is widely used communication protocol, which provides a standard mechanism to obtain configuration parameters. The specification is performed in a stepwise manner and verified through a series of refinements. The Event-B formal method uses the Rodin platform to modeling and verifying some properties of the protocol such as safety, liveness and deadlock freedom. To model and verify the protocol, we use the formal technique Event-B which provides an accessible and rigorous development method. This interaction between modelling and proving reduces the complexity and helps to eliminate misunderstandings, inconsistencies, and specification gaps.

Keywords: DHCP protocol, Event-B, refinement, proof obligation, Rodin

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17236 Instructional Coaches' Perceptions of Professional Development: An Exploration of the School-Based Support Program

Authors: Youmen Chaaban, Abdallah Abu-Tineh

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This article examines the development of a professional development (PD) model for educator growth and learning that is embedded into the school context. The School based Support Program (SBSP), designed for the Qatari context, targets the practices, knowledge, and skills of both school leadership and teachers in an attempt to improve students’ learning outcomes. Key aspects of the model include the development of learning communities among teachers, strong leadership that supports school improvement activities, and the use of research-based PD to improve teacher practices and student achievement. This paper further presents the results of a qualitative study examining the perceptions of nineteen instructional coaches about the strengths of the PD program, the challenges they face in their day-to-day implementation of the program, and their suggestions for the betterment of the program’s implementation and outcomes. Data were collected from the instructional coaches through open-ended surveys followed by focus group interviews. The instructional coaches reported several strengths, which were compatible with the literature on effective PD. However, the challenges they faced were deeply rooted within the structure of the program, in addition to external factors operating at the school and Ministry of Education levels. Thus, a general consensus on the way the program should ultimately develop was reached.

Keywords: situated professional development, school reform, instructional coach, school based support program

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17235 The Effect of Public Debt on the Economic Growth and Development in Nigeria

Authors: Uzoma Emmanuel Igboji

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This paper examines the influence of public debts (external and internal) on economic growth and development in Nigeria from (1980-2015). The study uses aggregate GDP as a proxy for economic growth, per capital income as a proxy for standard of living and Government expenditure on health as a proxy for human capital development, while Foreign Direct Investment, Unemployment rate, and Oil revenue were used as control variables. The study made use of ex-post facto research design with the data extracted from the Central Bank of Nigeria (CBN) Statistical Bulletin and the World Bank database. It adopted a multiple regression analysis of the ordinary least square (OLS) method with the help of E-View version 3.0. The results revealed that external debt has a negative and insignificant effect on GDP, per capital income and human capital development. The study concluded that external debts were being channeled to meet the recurrent expenditures of the nation’s economy at the expense of productive investment that could stimulate growth and poverty alleviation. It, however, recommended that government should ensure that the bulk of the total borrowings are mostly sourced from within the domestic economy so that the repayment of the principal and interest will serve as a crowd in-effect rather that crowd out-effect which in turn further accelerates the country’s economic growth and development.

Keywords: economic growth, external debt, internal debt, Nigeria

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17234 Analytical Validity Of A Tech Transfer Solution To Internalize Genetic Testing

Authors: Lesley Northrop, Justin DeGrazia, Jessica Greenwood

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ASPIRA Labs now offers an en-suit and ready-to-implement technology transfer solution to enable labs and hospitals that lack the resources to build it themselves to offer in-house genetic testing. This unique platform employs a patented Molecular Inversion Probe (MIP) technology that combines the specificity of a hybrid capture protocol with the ease of an amplicon-based protocol and utilizes an advanced bioinformatics analysis pipeline based on machine learning. To demonstrate its efficacy, two independent genetic tests were validated on this technology transfer platform: expanded carrier screening (ECS) and hereditary cancer testing (HC). The analytical performance of ECS and HC was validated separately in a blinded manner for calling three different types of variants: SNVs, short indels (typically, <50 bp), and large indels/CNVs defined as multi-exonic del/dup events. The reference set was constructed using samples from Coriell Institute, an external clinical genetic testing laboratory, Maine Molecular Quality Controls Inc. (MMQCI), SeraCare and GIAB Consortium. Overall, the analytical performance showed a sensitivity and specificity of >99.4% for both ECS and HC in detecting SNVs. For indels, both tests reported specificity of 100%, and ECS demonstrated a sensitivity of 100%, whereas HC exhibited a sensitivity of 96.5%. The bioinformatics pipeline also correctly called all reference CNV events resulting in a sensitivity of 100% for both tests. No additional calls were made in the HC panel, leading to a perfect performance (specificity and F-measure of 100%). In the carrier panel, however, three additional positive calls were made outside the reference set. Two of these calls were confirmed using an orthogonal method and were re-classified as true positives leaving only one false positive. The pipeline also correctly identified all challenging carrier statuses, such as positive cases for spinal muscular atrophy and alpha-thalassemia, resulting in 100% sensitivity. After confirmation of additional positive calls via long-range PCR and MLPA, specificity for such cases was estimated at 99%. These performance metrics demonstrate that this tech-transfer solution can be confidently internalized by clinical labs and hospitals to offer mainstream ECS and HC as part of their test catalog, substantially increasing access to quality germline genetic testing for labs of all sizes and resources levels.

Keywords: clinical genetics, genetic testing, molecular genetics, technology transfer

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17233 The Right to Data Portability and Its Influence on the Development of Digital Services

Authors: Roman Bieda

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The General Data Protection Regulation (GDPR) will come into force on 25 May 2018 which will create a new legal framework for the protection of personal data in the European Union. Article 20 of GDPR introduces a right to data portability. This right allows for data subjects to receive the personal data which they have provided to a data controller, in a structured, commonly used and machine-readable format, and to transmit this data to another data controller. The right to data portability, by facilitating transferring personal data between IT environments (e.g.: applications), will also facilitate changing the provider of services (e.g. changing a bank or a cloud computing service provider). Therefore, it will contribute to the development of competition and the digital market. The aim of this paper is to discuss the right to data portability and its influence on the development of new digital services.

Keywords: data portability, digital market, GDPR, personal data

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17232 Disseminating Positive Psychology Resources Online: Current Research and Future Directions

Authors: Warren Jared, Bekker Jeremy, Salazar Guy, Jackman Katelyn, Linford Lauren

Abstract:

Introduction: Positive Psychology research has burgeoned in the past 20 years; however, relatively few evidence-based resources to cultivate positive psychology skills are widely available to the general public. The positive psychology resources at www.mybestself101.org were developed to assist individuals in cultivating well-being using a variety of techniques, including gratitude, purpose, mindfulness, self-compassion, savoring, personal growth, and supportive relationships. These resources are empirically based and are built to be accessible to a broad audience. Key Objectives: This presentation highlights results from two recent randomized intervention studies of specific MBS101 learning modules. A key objective of this research is to empirically assess the efficacy and usability of these online resources. Another objective of this research is to encourage the broad dissemination of online positive psychology resources; thus, recommendations for further research and dissemination will be discussed. Methods: In both interventions, we recruited adult participants using social media advertisements. The participants completed several well-being and positive psychology construct-specific measures (savoring and self-compassion measures) at baseline and post-intervention. Participants in the experimental condition were also given a feedback questionnaire to gather qualitative data on how participants viewed the modules. Participants in the self-compassion study were randomly split between an experimental group, who received the treatment, and a control group, who were placed on a waitlist. There was no control group for the savoring study. Participants were instructed to read content on the module and practice savoring or self-compassion strategies listed in the module for a minimum of twenty minutes a day for 21 days. The intervention was semi-structured, as participants were free to choose which module activities they would complete from a menu of research-based strategies. Participants tracked which activities they completed and how long they spent on the modules each day. Results: In the savoring study, participants increased in savoring ability as indicated by multiple measures. In addition, participants increased in well-being from pre- to post-treatment. In the self-compassion study, repeated measures mixed model analyses revealed that compared to waitlist controls, participants who used the MBS101 self-compassion module experienced significant improvements in self-compassion, well-being, and body image with effect sizes ranging from medium to large. Attrition was 10.5% for the self-compassion study and 71% for the savoring study. Overall, participants indicated that the modules were generally helpful, and they particularly appreciated the specific strategy menus. Participants requested more structured course activities, more interactive content, and more practice activities overall. Recommendations: Mybestself101.org is an applied positive psychology research program that shows promise as a model for effectively disseminating evidence-based positive psychology resources that are both engaging and easily accessible. Considerable research is still needed, both to test the efficacy and usability of the modules currently available and to improve them based on participant feedback. Feedback received from participants in the randomized controlled trial led to the development of an expanded, 30-day online course called The Gift of Self-Compassion and an online mindfulness course currently in development called Mindfulness For Humans.

Keywords: positive psychology, intervention, online resources, self-compassion, dissemination, online curriculum

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17231 Investigating the Role of Clam Festival for Destination Branding: A Case Study of Tainan Cigu

Authors: Lim Lie Pin, Lin Hui Wen

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Rural tourism has become popular in Taiwan, the villages based on agriculture including fishery have to follow the trend to develop the local economy and achieve the sustainable development of the rural areas. Through cultural festivals, the tourist could experience the benefit while promoting and stimulating the local development of rural tourism. Cigu is famous for salt history and abundant natural resources, such as lagoon, black-faced spoonbills and other fishery products. Digging clam has become the most special parent-child activities in Tainan and increasing awareness since it was initiated. Therefore, festival organizers and regional destination marketers need to identify visitors’ experiences attributes which lead to opportunities for industry professionals, community involvement to plan and organize regional festivals and their programmes for effective destination branding finding out more potential rural resources encouraging the local industry growth and sustainable development.

Keywords: rural tourism, cultural festival, destination branding, tourist experience, sustainable development

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17230 Characterization and Design of a Crumb Rubber Modified Asphalt Mix Formulation

Authors: H. Al-Baghli

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Laboratory trial results of mixing crumb rubber produced from discarded tires with 60/70 pen grade Kuwaiti bitumen are presented on this paper. PG grading and multiple stress creep recovery tests were conducted on Kuwaiti bitumen blended with 15% and 18% crumb rubber at temperatures ranging from 40 to 70 °C. The results from elastic recovery and non-recoverable creep presented optimum performance at 18% rubber content. The optimum rubberized-bitumen mix was next transformed into a pelletized form (PelletPave®), and was used as a partial replacement to the conventional bitumen in the manufacture of continuously graded hot mix asphalts at a number of binder contents. The trialed PelletPave® contents were at 2.5%, 3.0%, and 3.5% by mass of asphalt mix. In this investigation, it was not possible to utilize the results of standard Marshall method of mix design (i.e. volumetric, stability and flow tests) and subsequently additional assessment of mix compactability was carried out using gyratory compactor in order to determine the optimum PelletPave® and total binder contents.

Keywords: crumb rubber, Marshall mix design, PG grading, rubberized-bitumen

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