Search results for: risk sharing

Authors: Basuki Supartono, Nunuk Nugrohowati, Ryan Gamma Andiraldi

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Osteoarthritis of the knee can occur due to scoliosis. The purpose of this study is to determine the effect of scoliosis cause secondary osteoarthritis on the knee. This research use an analytic cross-sectional design. The total sample of 92 athletes scoliosis taken by simple random sampling technique. The data obtained were analyzing with Chi-square test, Fisher and Prevalence Ratio. The results of analysis show that there are influences on the incidence of scoliosis secondary osteoarthritis on the knee in athletes at the National Sports Hospital. Based on the criteria in the Cobbs angle had the results (p = 0.022 (p <0.05)), moderate Cobbs angle degree were 7.5 times more at risk of causing secondary osteoarthritis on the knee than a mild degree. While the shape of the curve scoliosis is getting results (p = 0.038 (p <0.05)), the shape of the S curve scoliosis 3.2 times more at risk of causing secondary osteoarthritis on the knee than the curve C. It can be concluded that there is significant influence between the Cobbs angle, shape of the curve scoliosis on the incidence of secondary osteoarthritis on the knee in National Sports Cibubur Hospital on July 2013- April 2014

Keywords: Cobbs angle, curve shape scoliosis, secondary osteoarthritis on the knee, analytic cross-sectional design

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Authors: Abdelghani Alidra, Mohamed Tahar Kimour

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Genetic algorithm must adapt themselves at design time to cope with the search problem specific requirements and at runtime to balance exploration and convergence objectives. In a previous article, we have shown that modeling and implementing Genetic Algorithms (GA) using the software product line (SPL) paradigm is very appreciable because they constitute a product family sharing a common base of code. In the present article we propose to extend the use of the feature model of the genetic algorithms family to model the potential states of the GA in what is called a Dynamic Software Product Line. The objective of this paper is the systematic generation of a reconfigurable architecture that supports the dynamic of the GA and which is easily deduced from the feature model. The resultant GA is able to perform dynamic reconfiguration autonomously to fasten the convergence process while producing better solutions. Another important advantage of our approach is the exploitation of recent advances in the domain of dynamic SPLs to enhance the performance of the GAs.

Keywords: self-adaptive genetic algorithms, software engineering, dynamic software product lines, reconfigurable architecture

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Authors: Khawar Naeem, Adel Elomri, Adel Zghibi

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Contamination leakage from municipal solid waste (MSW) landfills is a serious environmental challenge that poses a threat to interconnected ecosystems. It not only contaminates the soil of the saturated zone, but it also percolates down the earth and contaminates the groundwater (GW). In this concise literature review, an effort is made to understand the environmental hazards posed by this contamination to the soil and groundwater, the type of contamination, and possible solutions proposed in the literature. In the study’s second phase, the MSW management practices are explored as the landfill site dump rate and type of MSW into the landfill site directly depend on the MSW management strategies. Case studies from multiple developed and underdeveloped countries are presented, and the complex MSW management system is investigated from an operational perspective to minimize the contamination of GW. One of the significant tools used in the literature was found to be Systems Dynamic Modeling (SDM), which is a simulation-based approach to study the stakeholder’s approach. By employing the SDM approach, the risk of GW contamination can be reduced by devising effective MSW management policies, ultimately resulting in water resource sustainability and regional sustainable development.

Keywords: groundwater contamination, environmental risk, municipal solid waste management, system dynamic modeling, water resource sustainability, sustainable development

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Authors: Fatemeh Rezaei, Afsaneh Amouei, Iman Bakouei, Mahdi Sharif, Shahabeddin Sarvi, Mohammad Taghi Rahimi, Ahmad Daryani

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Background: Rodents act as reservoir host and important potential source for many zoonotic pathogens which pose a public health risk to humans. Therefore, it is necessary to investigate the prevalence of gastrointestinal and ectoparasites among rodents. Materials and Methods: 118 Rattus rattus were captured using snap live traps. Each rat was combed with a fine tooth comb to dislodge ectoparasite and studied. Various samples were collected from feces, examined wet smear, formalin-ether method and stained with modified acid-fast staining and trichrome. Result: The overall prevalence of gastrointestinal parasites of examined rats was 75.4%. Cryptosporidium 30.5%, was the most prevalent protozoan which was followed by Giardia 20.3% and Entamoeba muris 13.5%, Trichomonas muris 10.1% and Spironucleus muris 3.3%. The prevalence of helminth egg was as following Syphacia obvelata 24.5%, Hymenolepis diminuta 10.1% and Trichuris muris 9.3%. 86.4% rodents were found to be infested with ectoparasites including mite 35.6%, flea 28.4%, and lice 42.7%. A significant statistical difference was observed between prevalence and gender of infected individuals. Conclusions: The prevalence of gastrointestinal and ectoparasites of collected rats in studied area is remarkably high. In addition, Rattus rattus can be considered as potential risk for human health.

Keywords: prevalence, rodent, intestinal parasites, ecto-parasites, zoonose

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Authors: Zeeshan Hamid, Asher Ramish

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The purpose of this paper is to focus on security and safety issues facing by pharmaceutical industry globally when counterfeit drugs are in question. Hence, there is an intense need to secure and authenticate pharmaceutical products in the emerging counterfeit product market. This paper will elaborate the application of radio frequency identification (RFID) in pharmaceutical industry and to identify its key benefits for patient’s care. The benefits are: help to co-ordinate the stream of supplies, accuracy in chains of supplies, maintaining trustworthy information, to manage the operations in appropriate and timely manners and finally deliver the genuine drug to patient. It is discussed that how RFID supported supply chain information sharing (SCIS) helps to combat against counterfeit drugs. And a solution how to tag pharmaceutical products; since, some products prevent RFID implementation in this industry. In this paper, a proposed model for pharma industry distribution suggested to combat against the counterfeit drugs when they are in supply chain.

Keywords: supply chain, RFID, pharmaceutical industry, counterfeit drugs, patients care

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Authors: Vijay Meena, Arup Kumar Sarma, Chandan Mahanta

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The environment has been getting contaminated by anthropogenic processes including those that discharge heavy metals to air, soil and water. The present work emphasizes the spatial distribution and vertical profile of six heavy metals (Cu, Zn, Mn, Ni, Fe, Cr) in three layers of mid sand bars (bed surface layer, 50 cm and 100 cm depth) at 42 sampling stations covering around 600 km stretch of the Brahmaputra River, India. Heavy metal analysis was conducted on the sample collected from mid-sand bars in the river stretch to examine the impact of dredging for various hydrological operations in the future. Sediment quality was assessed by calculating six different indices viz., EF, CF, CD, PLI, Igeo, and PERI. In all sediment layers, heavy metal concentrations have been observed to be the same as listed, Fe > Mn > Zn > Ni > Cr > Cu in μg/g. The average concentration of Cu, Mn, and Fe was found in the middle layer while Zn, Ni, and Cr were in the Surface layer. EF indicates higher enrichment in reach 2 which is likely to be due to anthropogenic sources of industrial and urbanized effluents. The sediment of the mid-sand bar was generally found moderately polluted possessing low risk to aquatic lives and the environment. Suggesting, Dredging can be possible in the future. An examination of correlation matrices, principal components analysis, and cluster analyses indicated that these heavy metals possess similar anthropogenic origins for their enrichment.

Keywords: heavy metal contamination, risk assessment, anthropogenic impacts, sediment

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Authors: Raquel Dafouz Neus Cáceres, Javier Fernandez-Rubio, Belinda Huerta José Luis Rodríguez-Gil, Nicola Mastroianni, Miren López de Alda, Damià Barceló, Yolanda Valcárcel

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The region of Galicia, found in north-western (NW) Spain, is a national and world leader in shellfish, especially mussel production, and recognized for its fishing industry. Few studies have evaluated the presence of emerging contaminants in NW Spain, with those published mainly concerning the continental aquatic environment. The objective of this study was to identify the environmental risk posed by the presence of pharmaceuticals and drugs of abuse in this important coastal region. The presence of sixteen pharmaceuticals (benzodiazepines, anxiolytics, and caffeine), and 19 drugs of abuse (cocainics, amphetamine-like compounds, opiates and opioids, lysergic compounds, and cannabinoids) was assessed in 23 sites located in the Rías (Coastal inlets) of Muros, Arousa, and Pontevedra (NW Spain). Twenty-two of these locations were affected by waste-water treatment plant (WWTP) effluents, and one represented the effluent of one of these WWTPs. Venlafaxine was the pharmaceutical compound detected at higher concentration in the three Rías, with a maximum value of 291 ng/L at the site Porto do Son (Ría de Muros). Total concentration in the three Rías was 819,26 ng/L. Next, citalopram and lorazepam were the most prevalent compounds detected. Metabolite of cocaine benzoylecgonine was the drug of abuse with the highest concentration, measured at 972 ng/L in the Ría of Noia WWTP (no dilution). This compound was also detected at 142 ng/L in the site La Isla de Aros, Ría of Pontevedra. Total concentration for the three Rías was 1210 ng/L. Ephedrine was also detected at high level in the three Rías, with a total concentration of 579,28 ng/L. The results obtained for caffeine show maximum and average concentrations of 857 ng/L Isla de Arosa, Ría de Pontevedra the highest measured in seawater in Spain. A preliminary hazard assessment was carried out by comparing these measured environmental concentrations (MEC) to predicted no-effect concentrations (PNECs) for aquatic organisms. Six out of the 22 seawater samples resulted in a Hazard Quotient (HQ) from chronic exposure higher than 1 with the highest being 17.14, indicating a high probability of adverse effects in the aquatic environment. In addition, the risk was assessed on the basis of persistence, bioaccumulation, and toxicity (PBT). This work was financially supported by the Spanish Ministry of Economy and Competitiveness through the Carlos III Health Institute and the program 'Proyectos de Investigacion en Salud 2015-2017' FIS (PI14/00516), the European Regional Development Fund (ERDF), the Catalan Government (Consolidated Research Groups '2014 SGR 418 - Water and Soil Quality Unit' and 2014 SGR 291 - ICRA), and the European Union’s Seventh Framework Programme for research, technological development and demonstration under grant agreement no. 603437. The poster entitled 'Environmental Risk of Pharmaceuticals, Drugs of Abuse and Stimulant Caffeine in Marine Water: A Case Study in the North-Western of Spain'.

Keywords: drug of abuse, pharmaceuticals, caffeine, environmental risk, seawater

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Authors: Julien Caudeville, Muriel Ismert

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Analyzing the relationship between environment and health has become a major preoccupation for public health as evidenced by the emergence of the French national plans for health and environment. These plans have identified the following two priorities: (1) to identify and manage geographic areas, where hotspot exposures are suspected to generate a potential hazard to human health; (2) to reduce exposure inequalities. At a regional scale and fine resolution of exposure outcome prerequisite, environmental monitoring networks are not sufficient to characterize the multidimensionality of the exposure concept. In an attempt to increase representativeness of spatial exposure assessment approaches, risk composite indicators could be built using additional available databases and theoretical framework approaches to combine factor risks. To achieve those objectives, combining data process and transfer modeling with a spatial approach is a fundamental prerequisite that implies the need to first overcome different scientific limitations: to define interest variables and indicators that could be built to associate and describe the global source-effect chain; to link and process data from different sources and different spatial supports; to develop adapted methods in order to improve spatial data representativeness and resolution. A GIS-based modeling platform for quantifying human exposure to chemical substances (PLAINE: environmental inequalities analysis platform) was used to build health risk indicators within the Lorraine region (France). Those indicators combined chemical substances (in soil, air and water) and noise risk factors. Tools have been developed using modeling, spatial analysis and geostatistic methods to build and discretize interest variables from different supports and resolutions on a 1 km2 regular grid within the Lorraine region. By example, surface soil concentrations have been estimated by developing a Kriging method able to integrate surface and point spatial supports. Then, an exposure model developed by INERIS was used to assess the transfer from soil to individual exposure through ingestion pathways. We used distance from polluted soil site to build a proxy for contaminated site. Air indicator combined modeled concentrations and estimated emissions to take in account 30 polluants in the analysis. For water, drinking water concentrations were compared to drinking water standards to build a score spatialized using a distribution unit serve map. The Lden (day-evening-night) indicator was used to map noise around road infrastructures. Aggregation of the different factor risks was made using different methodologies to discuss weighting and aggregation procedures impact on the effectiveness of risk maps to take decisions for safeguarding citizen health. Results permit to identify pollutant sources, determinants of exposure, and potential hotspots areas. A diagnostic tool was developed for stakeholders to visualize and analyze the composite indicators in an operational and accurate manner. The designed support system will be used in many applications and contexts: (1) mapping environmental disparities throughout the Lorraine region; (2) identifying vulnerable population and determinants of exposure to set priorities and target for pollution prevention, regulation and remediation; (3) providing exposure database to quantify relationships between environmental indicators and cancer mortality data provided by French Regional Health Observatories.

Keywords: health risk, environment, composite indicator, hotspot areas

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Authors: Massimiliano Panella, Sara Bortoluzzi, Sophia Russotto, Daniele Nicolini, Carmela Rinaldi

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Osteoporosis affects more than 200 million people worldwide. About 75% of osteoporosis cases are undiagnosed or diagnosed only when a bone fracture occurs. Since osteoporosis related fractures are significant determinants of the burden of disease and health and social costs of aging populations, we believe that this is the early identification and treatment of high-risk patients should be a priority in actual healthcare systems. Screening for osteoporosis by dual energy x-ray absorptiometry (DEXA) is not cost-effective for general population. An alternative is pulse-echo ultrasound (PEUS) because of the minor costs. To this end, we developed an early detection program for osteoporosis with PEUS, and we evaluated is possible impact and sustainability. We conducted a cross-sectional study including 1,050 people in Italy. Subjects with >1 major or >2 minor risk factors for osteoporosis were invited to PEUS bone mass density (BMD) measurement at the proximal tibia. Based on BMD values, subjects were classified as healthy subjects (BMD>0.783 g/cm²) and pathological including subjects with suspected osteopenia (0.783≤BMD>0.719 g/cm²) or osteoporosis (BMD ≤ 0.719 g/cm²). The responder rate was 60.4% (634/1050). According to the risk, PEUS scan was recommended to 436 people, of whom 300 (mean age 45.2, 81% women) accepted to participate. We identified 240 (80%) healthy and 60 (20%) pathological subjects (47 osteopenic and 13 osteoporotic). We observed a significant association between high risk people and reduced bone density (p=0.043) with increased risks for female gender, older ages, and menopause (p<0.01). The yearly cost of the screening program was 8,242 euros. With actual Italian fracture incidence rates in osteoporotic patients, we can reasonably expect in 20 years that at least 6 fractures will occur in our sample. If we consider that the mean costs per fracture in Italy is today 16,785 euros, we can estimate a theoretical cost of 100,710 euros. According to literature, we can assume that the early treatment of osteoporosis could avoid 24,170 euros of such costs. If we add the actual yearly cost of the treatments to the cost of our program and we compare this final amount of 11,682 euros to the avoidable costs of fractures (24,170 euros) we can measure a possible positive benefits/costs ratio of 2.07. As a major outcome, our study let us to early identify 60 people with a significant bone loss that were not aware of their condition. This diagnostic anticipation constitutes an important element of value for the project, both for the patients, for the preventable negative outcomes caused by the fractures, and for the society in general, because of the related avoidable costs. Therefore, based on our finding, we believe that the PEUS based screening performed could be a cost-effective approach to early identify osteoporosis. However, our study has some major limitations. In fact, in our study the economic analysis is based on theoretical scenarios, thus specific studies are needed for a better estimation of the possible benefits and costs of our program.

Keywords: osteoporosis, prevention, public health, screening

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Authors: B. Rusyidi, D. Mariana

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Although reforms in trafficking regulations have taken place since 2007, Indonesia is still struggling to fight child trafficking. This study aimed to identify and assess risk factors and vulnerabilities in the life of trafficked children prior to, during, and after being trafficked in order to inform the child protection system and its policies. The study was qualitative and utilized in-depth interviews to collect data. Data were gathered in 2014 and 2015 from 15 trafficked and sexually exploited girls aged 14 to 17 years originating from West Java. Social workers, safe home personnel and parents were also included as informants. Data analysis was guided by the ecological perspective and theme analyses. The study found that risks and vulnerabilities of the victims were associated with conditions at various levels of the environment. At the micro level, risk factors and vulnerabilities included young age, family conflict/violence, involvement with the “wrong” circle of friends/peers, family poverty, lack of social and economic support for the victim’s family, and psychological damages due to trafficking experiences. At the mezzo level, the lack of structured activities after school, economic inequality, stigma towards victims, lack of services for victims, and minimum public education on human trafficking were among the community hazards that increased the vulnerability and risks. Gender inequality, consumerism, the view of children as assets, corruption, weak law enforcement, the lack of institutional support, and community-wide ignorance regarding trafficking were found as factors that increased risks and vulnerabilities at the macro level. The findings from the study underline the necessity to reduce risk factors and promote protective factors at the individual, family, community and societal levels. Shifting the current focus from tertiary to primary/prevention policies and improving institutional efforts are pressing needs in the context of reducing child trafficking in Indonesia. The roles of human service providers including social work also should be promoted.

Keywords: child trafficking, child sexual exploitation, ecological perspective, risks and vulnerabilities

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Authors: Brady Manescau, Ilyas Sellami, Khaled Chetehouna, Charles De Izarra, Rachid Nait-Said, Fati Zidani

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During a fire in an oil and gas refinery, several thermal accidents can occur and cause serious damage to people and environment. Among these accidents, the BLEVE (Boiling Liquid Expanding Vapor Explosion) is most observed and remains a major concern for risk decision-makers. It corresponds to a violent vaporization of explosive nature following the rupture of a vessel containing a liquid at a temperature significantly higher than its normal boiling point at atmospheric pressure. Their effects on the environment generally appear in three ways: blast overpressure, radiation from the fireball if the liquid involved is flammable and fragment hazards. In order to estimate the potential damage that would be caused by such an explosion, risk decision-makers often use quantitative risk analysis (QRA). This analysis is a rigorous and advanced approach that requires a reliable data in order to obtain a good estimate and control of risks. However, in most cases, the data used in QRA are obtained from the empirical correlations. These empirical correlations generally overestimate BLEVE effects because they are based on simplifications and do not take into account real parameters like the geometry effect. Considering that these risk analyses are based on an assessment of BLEVE effects on human life and plant equipment, more precise and reliable data should be provided. From this point of view, the CFD modeling of BLEVE effects appears as a solution to the empirical law limitations. In this context, the main objective is to develop a numerical tool in order to predict BLEVE thermal effects using the CFD code FDS version 6. Simulations are carried out with a mesh size of 1 m. The fireball source is modeled as a vertical release of hot fuel in a short time. The modeling of fireball dynamics is based on a single step combustion using an EDC model coupled with the default LES turbulence model. Fireball characteristics (diameter, height, heat flux and lifetime) issued from the large scale BAM experiment are used to demonstrate the ability of FDS to simulate the various steps of the BLEVE phenomenon from ignition up to total burnout. The influence of release parameters such as the injection rate and the radiative fraction on the fireball heat flux is also presented. Predictions are very encouraging and show good agreement in comparison with BAM experiment data. In addition, a numerical study is carried out on an operational propane accumulator in an Algerian gas processing plant of SONATRACH company located in the Hassi R’Mel Gas Field (the largest gas field in Algeria).

Keywords: BLEVE effects, CFD, FDS, fireball, LES, QRA

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Authors: Chastiti Mediafira Wulolo, Tri Legionosuko, Suhirwan, Yusuf

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Terrorism and radicalization have become a common threat to every nation in this world. As a part of the asymmetric warfare threat, terrorism and radicalization need a complex strategy as the problem solver. One such way is by collaborating with the international community. The Our Eyes Initiative (OEI), for example, is a cooperation pact in the field of intelligence information exchanges related to terrorism and radicalization initiated by the Indonesian Ministry of Defence. The pact has been signed by Indonesia, Philippines, Malaysia, Brunei Darussalam, Thailand, and Singapore. This cooperation mostly engages military acts as a central role, but it still requires the involvement of various parties such as the police, intelligence agencies and other government institutions. This paper will use a qualitative content analysis method to address the opportunity and enhance the optimization of OEI. As the result, it will explain how OEI takes the opportunities as the strategy for counter-terrorism by building it up as the regional cooperation, building the legitimacy of government and creating the legal framework of the information sharing system.

Keywords: our eyes initiative, terrorism, counter-terrorism, ASEAN, cooperation, strategy

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Authors: Hanan Azzam1, Nashwa Abousamra1, Amany Mansour1, Yaser Abd El-dayem2, , Solafa Elsharawy1

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Background: Inherited thrombophilias are a heterogenous group of conditions which have been implicated in a variety of pregnancy complications. More recently, deficiency of protein Z (PZ) has been liked to pregnancy complications, including preterm delivery. Aim: We designed this study to evaluate the association of inherited thrombophilias including [Protein C (PC), Protein S (PS), Anti thrombin III (ATIII) deficiency and activated protein C (APC) resistance] and protein Z deficiency with a variety of pregnancy complications. Patients and Methods: 60 women with different pregnancy complications, including 20 patients with preeclampsia, 20 patients with intrauterine growth resistance (IUGR), and 20 patients with intrauterine fetal death (IUFD), in addition to 30 healthy pregnant women were recruited for the present study. PC and free PS antigen, ATIII activity, modified functional APC-resistance, and PZ levels were determined. Results: There was no significant association between inherited thrombophilias and complicated pregnancies as regards PC deficiency (p=1.0), AT III and PS deficiency (p=0.312), and APC-resistance (P=0.083). PZ was significantly associated with complicated pregnancies (p=0.012). Patients with protein Z levels below 1.5 µg/ml were considered deficient. Accordingly, we demonstrated protein Z deficiency in 30% of complicated pregnancies (RR 6.0, 95% CI 1.29-27.90;p=0.022), 20% of preeclampsia (RR 3.5, 95% CI 0.57 – 21.28; P = 0.174), 40% of IUGR (RR 9.3 95% CI 1.72-50.61; P = 0.010) and 30% of IUFD (RR 6, 95% CI 1.07 – 33.64; P = 0.042). Conclusions: These findings indicate the absence of association of inherited thrombophilias, including PC, PS, AT III deficiency, and APC resistance with pregnancy complications. However, PZ deficiency is associated with increased risk of pregnancy complications, especially intrauterine growth restriction and intrauterine fetal death.

Keywords: protein C, protein S, thrombophelia, pregnancy, protein Z

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Authors: Serzhan Ashirov, Dana Nour, Rafat Rob, Khaled Alotaibi

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There has been a fast growth in the introduction and use of communications, information, monitoring, and sensing technologies. The new technologies are making their way to the Industrial Control Systems as embedded in products, software applications, IT services, or commissioned to enable integration and automation of increasingly global supply chains. As a result, the lines that separated the physical, digital, and cyber world have diminished due to the vast implementation of the new, disruptive digital technologies. The variety and increased use of these technologies introduce many cybersecurity risks affecting cyber-resilience of the supply chain, both in terms of the product or service delivered to a customer and members of the supply chain operation. US department of energy considers supply chain in the IR4 space to be the weakest link in cybersecurity. The IR4 identified the digitization of the field devices, followed by digitalization that eventually moved through the digital transformation space with little care for the new introduced cybersecurity risks. This paper will examine the best methodologies for securing the electrical substations from cybersecurity attacks due to supply chain risks, and due to digitization effort. SCADA systems are the most vulnerable part of the power system infrastructure due to digitization and due to the weakness and vulnerabilities in the supply chain security. The paper will discuss in details how create a secure supply chain methodology, secure substations, and mitigate the risks due to digitization

Keywords: cybersecurity, supply chain methodology, secure substation, digitization

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Authors: Rady A., Elsheshai A., Elsawy M., Nagui R.

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Background and Aim: Metabolic syndrome affect around 20% of general population , authors have incriminated antipsychotics as serious risk factor that may provoke such derangement. The aim of our study is to assess metabolic syndrome in patients presenting psychotic features (delusions and hallucinations) whether schizophrenia or mood disorder and compare results in terms of drug naïf, on medication and healthy control. Subjects and Methods: The study recruited 40 schizophrenic patients, half of them drug naïf and the other half on antipsychotics, 40 patients with mood disorder with psychotic features, half of them drug naïf and the other half on medication, 20 healthy control. Exclusion criteria were put in order to exclude patients having already endocrine or metabolic disorders that my interfere with results obtain to minimize confusion bias. Metabolic syndrome assessed by measuring parameters including weight, body mass index, waist circumference, triglyceride level, HDL, fasting glucose, fasting insulin and insulin resistance Results: No difference was found when comparing drug naïf to those on medication in both schizophrenic and psychotic mood disorder arms, schizophrenic patients whether on medication or drug naïf should difference with control group for fasting glucose, schizophrenic patients on medication also showed difference in insulin resistance compared to control group. On the other hand, patients with psychotic mood disorder whether drug naïf or on medication showed difference from control group for fasting insulin level. Those on medication also differed from control for insulin resistance Conclusion: Our study didn’t reveal difference in metabolic syndrome among patients with psychotic features whether on medication or drug naïf. Only patients with Psychotic features on medication showed insulin resistance. Schizophrenic patients drug naïf or on medication tend to show higher fasting glucose while psychotic mood disorder whether drug naïf or on medication tend to show higher fasting insulin. This study suggest that presence of psychotic features themselves regardless being on medication or not carries a risk for insulin resistance and metabolic syndrome. Limitation: This study is limited by number of participants and larger numbers in future studies should be included in order to extrapolate results. Cohort longitudinal studies are needed in order to evaluate such hypothesis.

Keywords: schizophrenia, metabolic syndrome, psychosis, insulin, resistance

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Authors: Christian N. Chibo

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Imo River Basin is located in South Eastern Nigeria comprising of 11 states of Imo, Abia, Anambra, Ebonyi, Enugu, Edo, Rivers, Cross river, AkwaIbom, Bayelsa, Delta, and Bayelsa states. The basin has a fluvial erosional system dominated by powerful rivers coming down from steep slopes in the area. This research investigated various hazards associated with flood, the vulnerable areas, elements at risk of flood and various adaptation strategies adopted by local inhabitants to cope with the hazards. The research aim is to identify, examine and assess flood hazards, vulnerability and adaptations in the Upper Imo River Basin. The study identified the role of elevation in cause of flood, elements at risk of flood as well as examine the effectiveness or otherwise of the adaptation strategies for coping with the hazards. Data for this research is grouped as primary and secondary. Their various methods of generation are field measurement, questionnaire, library websites etc. Other types of data were generated from topographical, geological, and Digital Elevation model (DEM) maps, while the hydro meteorological data was sourced from Nigeria Meteorological Agency (NIMET), Meteorological stations of Geography and Environmental Management Departments of Imo State University and Alvan Ikoku Federal College of Education. 800 copies of questionnaire were distributed using systematic sampling to 8 locations used for the pilot survey. About 96% of the questionnaire were retrieved and used for the study. 13 flood events were identified in the study area. Their causes, years and dates of events were documented in the text, and the damages they caused were evaluated. The study established that for each flood event, there is over 200mm of rain observed on the day of the flood and the day before the flood. The study also observed that the areas that situate at higher elevation (See DEM) are less prone to flood hazards while areas at low elevations are more prone to flood hazards. Elements identified to be at risk of flood are agricultural land, residential dwellings, retail trading and related services, public buildings and community services. The study thereby recommends non settlement at flood plains and flood prone areas and rearrangement of land use activities in the upper Imo River Basin among others

Keywords: flood hazard, flood plain, geomorphology, Imo River Basin

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Authors: Bahlous Afef, Bouzid Kahena, Bardkis Ahlem, Mrad Mehdi, Kalai Eya, Sonia Bahri, Abdelmoula Jaouida

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Diabetic nephropathy is the first cause of chronic renal failure and hemodialysis use in several countries including Tunisia. The role of hypertension (HT) as major risk factor for nephropathy is undeniable. The aim of our study was to determine the relationship between blood pressure and nephropathy in a population of diabetic type 2 recently discovered. Materials and methods: We conducted a prospective study focused on 60 patients with type 2 diabetes recently discovered (<5 years). Each patient have benefited from: -a full clinical examination with measurement of blood pressure - exploring a blood-glucose control and renal function -urinary exploration with the determination of proteinuria microalbuminumie of 24 hours with a immunoturbidimetric method using Architect (ABBOTT CI 8200). Results and discussion: Hypertension was present in 46.7% of cases. Twenty patients, 35% of the study population showed nephropathy. Four of these patients (6.66% of cases) had proteinuria, while 16 (26.6% of patients) had microalbuminuria (> 30mg/24 hours). Systolic blood pressure was significantly (p < 0.05) associated with the presence of nephropathy (139 +19.44) vs. for the group with normal renal function (128.65 +15.12 mmHg). Conclusion: The etiology of diabetic nephropathy is multifactorial. However, systolic blood pressure and glycemic control remains the major risk factors. Better glycemic control and treatment of hypertension allowed preventing and slowing the progression of diabetic nephropathy.

Keywords: hypertension, nephropathy, hemodialysis, diabetes

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Authors: H. Gokdemir

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All structures are subject to vertical and lateral loads. Under these loads, structures make deformations and deformation values of structural elements mustn't exceed their capacity for structural stability. Especially, lateral loads cause critical deformations because of their random directions and magnitudes. Wind load is one of the lateral loads which can act in any direction and any magnitude. Although wind has nearly no effect on reinforced concrete structures, it must be considered for steel structures, roof systems and slender structures like minarets. Therefore, every structure must be able to resist wind loads acting parallel and perpendicular to any side. One of the effective methods for resisting lateral loads is assembling cross steel elements between columns which are called as wind bracing. These cross elements increases lateral rigidity of a structure and prevent exceeding of deformation capacity of the structural system. So, this means cross elements are also effective in resisting earthquake loads too. In this paper; Effects of wind bracing to earthquake resistance of structures are studied. Structure models (with and without wind bracing) are generated and these models are solved under both earthquake and wind loads with different seismic zone parameters. It is concluded by the calculations that; in low-seismic risk zones, wind bracing can easily resist earthquake loads and no additional reinforcement for earthquake loads is necessary. Similarly; in high-seismic risk zones, earthquake cross elements resist wind loads too.

Keywords: wind bracings, earthquake, steel structures, vertical and lateral loads

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Authors: Leandro da S. Nascimento, Maristela J. Melo

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The increased competition in the globalization drives organizations to innovate in their products and services to remain competitive. Innovation and creativity are incorporated as key aspects to creating value for consumers and for the creation of competitive advantage in organizations. However, there are factors that contribute strong with development of innovation and creation in organizations. These factors are the intellectual capital and knowledge management, which together with sustainability, ensure the development of competitive strategies. However, it is understood that the role of the leader is essential to stimulate the development of human capital, because the human capital is essential for organizations of knowledge. It is the leader who drives the dissemination and sharing of knowledge, an essential aspect for the formation of intellectual capital and therefore should be managed. And it turns out that the management of knowledge through intellectual capital allows the development of environmental initiatives efficiently and effectively. Thus, the research demonstrates the importance of the role of leader / manager in organizations and seeks to analyze how managers can contribute to the adoption of sustainability through intellectual capital and knowledge management.

Keywords: intellectual capital, knowledge management, leadership role, sustainability

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Authors: Omaymah Al-Otoom, Rajesh Mehta

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Introduction: Migration is an established risk factor in the development of schizophrenia and other forms of psychosis. The exposure to different social adversities, including social isolation, discrimination, and economic stress, is thought to contribute to elevated rates of psychosis in immigrants and their children. We present a case of resistant schizophrenia in an immigrant adolescent. Case: The patient is a 15-year-old male immigrant. In October 2021, the patient was admitted for irritability, suicidal ideations, and hallucinations. He was treated with Fluoxetine 10 mg daily for irritability. In November 2021, he presented with similar manifestations. Fluoxetine was discontinued, and Risperidone 1 mg at bedtime was started for psychotic symptoms. In March 2022, he presented with commanding auditory hallucinations (voices telling him that people were going to kill his father). Risperidone was gradually increased to 2.5 mg twice daily for hallucinations. The outpatient provider discontinued Risperidone and started Olanzapine 7.5 mg and Lurasidone 40 mg daily. In August 2022, he presented with worsening paranoia due to medication non-adherence. The patient had limited improvement on medications. In October 2022, the patient presented to the ED for visual hallucinations and aggression towards the family. His medications were Olanzapine 10 mg daily, Lurasidone 60 mg daily, and Haloperidol 2.5 mg twice daily. In the ED, he received multiple as-needed medications and was placed in seclusion for his aggressive behavior. The patient showed a positive response to a higher dose of Olanzapine and decreased dose of Lurasidone. The patient was discharged home in stable condition. Two days after discharge, he was brought for bizarre behavior, visual hallucinations, and homicidal ideations at school. Due to concerns for potential antipsychotic side effects and poor response, Lurasidone and Olanzapine were discontinued, and he was discharged home on Haloperidol 5 mg in the morning and 15 mg in the evening. Clozapine treatment was recommended on an outpatient basis. He has no family history of psychotic disorders. He has no history of substance use. A medical workup was done, the electroencephalogram was normal, and the urine toxicology was negative. Discussion: Our patient was on three antipsychotics at some point with no improvement in his psychotic symptoms, which qualifies as treatment-resistant schizophrenia (TRP). It is well recognized that migrants are at higher risk of different psychiatric disorders, including posttraumatic stress disorder, affective disorders, schizophrenia, and psychosis. This is thought to be related to higher exposure to traumatic life events compared to the general population. In addition, migrants are more likely to experience poverty, separation from family members, and discrimination which could contribute to mental health issues. In one study, they found that people who migrated before the age of 18 had twice the risk of psychotic disorders compared to the native-born population. It is unclear whether migration increases the risk of treatment resistance. In a Canadian study, neither ethnicity nor migrant status was associated with treatment resistance; however, this study was limited by its small sample size. There is a need to implement psychiatric prevention strategies and outreach programs through research to mitigate the risk of mental health disorders among immigrants.

Keywords: psychosis, immigrant, adolescent, treatment resistant schizophrenia

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Authors: Erika Mattio

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The aim of this project is to study the Chinese presence in Ethiopia, in the area between the Saba River and the Coptic areas of the Tigray, with detailed documentation of the Danakil region, from which the salt pickers caravans departed; the study was created to understand the relationships and consequences of the Chinese advance in these areas, inhabited by tribes linked to ancient, still practiced religious rituals, and home to unique landscapes and archaeological sites. Official estimates of the number of Chinese in Africa vary widely; on the continent, there are increasingly diverse groups of Chinese migrants in terms of language, dialect, class, education, and employment. Based on this and on a very general state of the art, it was decided to increase the studies on this phenomenon, focusing the attention on one of the most interesting countries for its diversity, cultural wealth, and for strong Chinese presence: Ethiopia. The study will be integrated with interdisciplinary investigation methods, such as landscape archeology, historiographic research, participatory anthropology, geopolitics, and cultural anthropology and ethnology. There are two main objectives of the research. The first is to predict what will happen to these populations and how the territory will be modified, trying to monitor the growth of infrastructure in the country and the effects it will have on the population. Risk analyzes will be carried out to understand what the foreign presence may entail, such as the absence of sustenance for local populations, the ghettoization of foreigners, unemployment of natives and the exodus of the population to the capital; the relationships between families and the local population will be analyzed, trying to understand the dynamics of socialization and interaction. Thanks to the use of GIS, the areas affected by the Chinese presence will be geo-referenced and mapped, delimiting the areas most affected and creating a risk analysis, both in desert areas and in archaeologically and historically relevant areas. The second point is to document the life and rituals of Ethiopian populations in order not to lose the aspects of uniqueness that risk being lost. Local interviews will collect impressions and criticisms from the local population to understand if the Chinese presence is perceived as a threat or as a solution. Furthermore, Afar leaders in the Logya area will be interviewed, in truly exclusive research, to understand their links with the foreign presence. From the north, along the Saba river, we will move to the northwest, in the Tigray region, to know the impressions in the Coptic area, currently less threatened by the Chinese presence but still affected by urbanization proposals. There will also be documented the Coptic rituals of Gennà and Timkat, unique expressions of a millennial tradition. This will allow the understanding of whether the Maoist presence could influence the religious rites and forms of belief present in the country, or the country will maintain its cultural independence.

Keywords: Ethiopia, GIS, risk perceptions, salt caravans

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Authors: J. M. Mayoral, M. Anaya

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The urban and economic development of cities demands the construction of water use and flood control infrastructure. Likewise, it is necessary to determine the safety level of the structures built with the current standards and if it is necessary to define the reinforcement actions. The foregoing is even more important in structures of great importance, such as dams, since they imply a greater risk for the population in case of failure or undesirable operating conditions (e.g., seepage, cracks, subsidence). This article presents a methodology for determining the seismic integrity of dams in urban areas. From direct measurements of the dynamic properties using geophysical exploration and ambient seismic noise measurements, the seismic integrity of the concrete-faced rockfill dam selected as a case of study is evaluated. To validate the results, two accelerometer stations were installed (e.g., free field and crest of the dam). Once the dynamic properties were determined, three-dimensional finite difference models were developed to evaluate the dam seismic performance for different intensities of movement, considering the site response and soil-structure interaction effects. The seismic environment was determined from the uniform hazard spectra for several return periods. Based on the results obtained, the safety level of the dam against different seismic actions was determined, and the effectiveness of ambient seismic noise measurements in dynamic characterization and subsequent evaluation of the seismic integrity of urban dams was evaluated.

Keywords: risk, seismic, soil-structure interaction, urban dams

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Authors: Lavanya Dharmendran, Shenuka Singh, Sona Baburathanam

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The aim of the study is to understand the level of awareness in a community of a specific region of Kuwait regarding oral cancer and its screening methods so as to enhance the uptake of oral cancer screening methods. This is a cross-sectional study comprising 100 adult participants residing in the governate of Farwaniya, Kuwait. Participants of above 18 years of both genders will be selected using convenience sampling. Data collection includes the administration of a self-administered questionnaire. The questionnaire comprises three sections, each section assessing the knowledge, attitudes and practices of the participants’ opinions about oral cancer and screening methods. Data will be analyzed using Humphris Oral Cancer Knowledge Scale. Inferential statistics will be done using Chi-Square or Fisher’s exact test for categorical data. A level of p<.05 will be established as being significant. All ethical considerations, such as respect for personal confidentiality and informed consent, will be applied in this study. This study revealed that although respondents were aware of the term oral cancer, more than half of the study participants were unaware of the symptoms associated with this condition. Smoking and alcohol were identified as risk factors for oral cancer, but the majority of participants did not identify the Human Papilloma Virus (HPV) as an added risk factor. This suggests a greater need for dental practitioners to include educational strategies in routine dental visits to ensure greater awareness of oral cancer.

Keywords: oral cancer, oral screening, oral public health, oral health

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Authors: Marko Jankovic, Aleksandra Knezevic, Maja Cupic, Dragana Vujic, Zeljko Zecevic, Borko Gobeljic, Marija Simic, Tanja Jovanovic

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The human cytomegalovirus (CMV) is a notorious pathogen in the pediatric transplant setting. Although studies on factors in complicity with CMV infection abound, the role of age, gender, allogeneic hematopoietic stem cell transplantation (alloHSCT) modality, and underlying disease as regards CMV infection and viral load in children are poorly explored. We examined the significance of various factors related to the risk of CMV infection and viral load in Serbian children and adolescents undergoing alloHSCT. This was a prospective single centre study of thirty two pediatric patients in receipt of alloHSCT for various malignant and non-malignant disorders. Screening for active viral infection was performed by regular weekly monitoring. The Real-Time PCR method was used for CMV DNA detection and quantitation. Statistical analysis was performed using the IBM SPSS Statistics v20 software. Chi-square test was used to evaluate categorical variables. Comparison between scalar and nominal data was done by Wilcoxon-Mann-Whitney test. Pearson correlation was applied for studying the association between patient age and viral load. CMV was detected in 23 (71.9%) patients. Infection occurred significantly more often (p=0.015) in patients with haploidentical donors. The opposite was noted for matched sibling grafts (p=0.006). The viral load was higher in females (p=0.041) and children in the aftermath of alloHSCT with malignant diseases (p=0.019). There was no significant relationship between the viral infection dynamics and overt medical consequences. This is the first study of risk factors for CMV infection in Serbian pediatric alloHSCT patients. Transplanted patients presented with a high incidence of CMV viremia. The HLA compatibility of donated graft is associated with the frequency of CMV positive events. Age, gender, underlying disease, and medically relevant events were not conducive to occurrences of viremia. Notably, substantial viral burdens were evidenced in females and patients with neoplastic diseases. Studies comprising larger populations are clearly needed to scrutinize current results.

Keywords: allogeneic hematopoietic stem cell transplantation, children, cytomegalovirus, risk factors, viral load

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Authors: Sameh Shahin, Nannang Arrys

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Optimizing pit slope stability and reducing strip ratio of a mining operation are two key tasks in geotechnical engineering. With a growing demand for minerals and an increasing cost associated with extraction, companies are constantly re-evaluating the viability of mineral deposits and challenging their geological understanding. Within Rio Tinto Iron Ore, the Structural Geology (SG) team investigate and collect critical data, such as point based orientations, mapping and geological inferences from adjacent pits to re-model deposits where previous interpretations have failed to account for structurally controlled slope failures. Utilizing innovative data collection methods and data-driven investigation, SG aims to address the root causes of slope instability. Committing to a resource grid drill campaign as the primary source of data collection will often bias data collection to a specific orientation and significantly reduce the capability to identify and qualify complexity. Consequently, these limitations make it difficult to construct a realistic and coherent structural model that identifies adverse structural domains. Without the consideration of complexity and the capability of capturing these structural domains, mining operations run the risk of inadequately designed slopes that may fail and potentially harm people. Regional structural trends have been considered in conjunction with surface and in-pit mapping data to model multi-batter fold structures that were absent from previous iterations of the structural model. The risk is evident in newly identified dip-slope and rock-mass controlled sectors of the geotechnical design rather than a ubiquitous dip-slope sector across the pit. The reward is two-fold: 1) providing sectors of rock-mass controlled design in previously interpreted structurally controlled domains and 2) the opportunity to optimize the slope angle for mineral recovery and reduced strip ratio. Furthermore, a resulting high confidence model with structures and geometries that can account for historic slope instabilities in structurally controlled domains where design assumptions failed.

Keywords: structural geology, geotechnical design, optimization, slope stability, risk mitigation

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Authors: Irene H. Maralit

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Warning labels have been found to inform smokers about the health hazards of smoking, encourage smokers to quit, and prevent nonsmokers from starting to smoke. Warning labels on tobacco products are an ideal way of communicating with smokers. Since the intervention is delivered at the time of smoking, nearly all smokers are exposed to warning labels and pack-a-day smokers could be exposed to the warnings more than 7,000 times per year. Given the reach and frequency of exposure, the proponents want to know the effect of warning labels on smoking behavior. Its aims to identify the profile of the smokers associated with its behavioral variables that best describe the users’ perception. The behavioral variables are AVOID, THINK RISK and FORGO. This research study aims to determine if there is significant relationship between the effect of warning labels on cigarette package on Consumer behavior when grouped according to profile variable. The researcher used quota sampling to gather representative data through purposive means to determine the accurate representation of data needed in the study. Furthermore, the data was gathered through the use of a self-constructed questionnaire. The statistical method used were Frequency count, Chi square, multi regression, weighted mean and ANOVA to determine the scale and percentage of the three variables. After the analysis of data, results shows that most of the respondents belongs to age range 22–28 years old with percentage of 25.3%, majority are male with a total number of 134 with percentage of 89.3% and single with total number of 79 and percentage of 52.7%, mostly are high school graduates with total number of 59 and percentage of 39.3, with regards to occupation, skilled workers have the highest frequency of 37 with 24.7%, Majority of the income of the respondents falls under the range of Php 5,001-Php10,000 with 50.7%. And also with regards to the number of sticks consumed per day falls under 6–10 got the highest frequency with 33.3%. The respondents THINK RISK factor got the highest composite mean which is 2.79 with verbal interpretation of agree. It is followed by FORGO with 2.78 composite mean and a verbal interpretation of agree and AVOID variable with composite mean of 2.77 with agree as its verbal interpretation. In terms of significant relationship on the effects of cigarette label to consumer behavior when grouped according to profile variable, sex and occupation found to be significant.

Keywords: consumer behavior, smokers, warning labels, think risk avoid forgo

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Authors: Yen-An Tsai, Ching-Ling Lin, Jia-Woei Hou, Mei-Lien Chen

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Endocrine-disrupting chemicals (EDCs) adversely affect the endocrine system. Phthalates, also called phthalic acid esters (PAEs), are manmade chemicals that are used as stabilizing agents in personal care products such as perfumes, lotions, and cosmetics. The aim was to explore whether PAEs exposure was associated with central precocious puberty (CPP) or constitutional delays in growth (CDGP). This case-control study included 48 female with CPP, 37 male with constitutional delays in growth, and 127 normal children and was conducted from December 2011 to August 2014. All participants completed a structured questionnaire regarding socio-demographic characteristics, lifestyle, and secondary sexual characteristics. The analytical method was based on ultra performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) with isotope dilution for the quantitative detection of several phthalate metabolites in human urine. The risk of CPP with mep, mnbp, LMW >50th percentile were higher than those with 50th percentile were higher than those with <50 percentile in model 2. In model 1, we only found higher CDGP risk in mep, mnbp, and ΣPAEs. It shows that high phthalate exposure may associate with CDGP. In this case-control study, we found PAEs exposure was associated with central precocious puberty (CPP) or constitutional delays in growth.

Keywords: phthalates, puberty, delays, growth

Procedia PDF Downloads 173

Authors: Sonia Wahengbam, Natasha Elangbam

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Female impersonation has existed through the length of human civilization and the breadth of its cultures. Transvestism and drag queen cultures have created multi-sited spaces where in the shadow of art, one can cross the gender barrier and express one’s hidden identity. This paper will explore a dynamic cultural space that exists in Manipur, a state in the northeastern region of India, where the female impersonators (nupi shabis) of a folk theater (Shumang Leela) are using this traditional and popular art form to claim social acceptance of their homosexual identities through the medium of entertainment. It will highlight how by crossing the gender boundary, this third gender group has carved out a unique socio-economic niche where they have exploited their sexual identities to their advantage. The paper will trace the expanding cultural ‘’borderland’’ of Manipur where there is an increasing sense of ‘becoming’, belonging and sharing” of identities through the interweaving of old and new media. The research will be based on interviews with the nupi shabis, cultural critics and other experts.

Keywords: transvestism, Manipur, female impersonators (nupi shabis), Shumang Leela, gender

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Authors: K. Aisultanova, O. Abdimanuly

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The article is told about the factors influencing the formation of the national idea and national identity. Paying attention to the idea and purpose of 'Eternal county', historical dates and examples are given. The structure of the idea 'The eternal country' by ancient Turks is discussed and the history of the legend prevalent among the Kazakh people, the image of the mythical historical figures are analyzed. Al-Farabi’s philosophical work 'Honest city', Zhysip Balasagun’s poem 'Happy Knowledge' are told, the opinions of scholars researching the nation's history, literature, and culture are given. As international experience shows, the idea of a new stage in the development of the country's great national society and the state for the purpose of political, social, economic, cultural, spiritual, and the other efforts are consolidated. The idea of the national, ethnic, religious, cultural and other communities united by a group of people sharing a collective memory, goals, ideas and dreams and , world view, a complex set of beliefs and values are expressed.

Keywords: independence, historical process, national idea, the national ideology, society, state

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Authors: Wint Wint Thu, Htet Ko Ko Win, Myat Mon San, Zaw Lin Tun, Nandar Than Aye, Khin Nyein Myat, Hayman Nyo Oo, Nay Aung Lin, Kusum Thapa, Kyaw Htet Aung

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Background: In Myanmar, the intense political instability happened to start in Feb-2021, while the COVID-19 pandemic waves are also threatening the public health system, which subsequently led to severe health sector crisis, including difficulties in accessing maternal and newborn health care for vulnerable women and children. The Remote Pregnant and Newborn Care (RPNC) uses a telehealth approach United States Agency for International Development (USAID)-funded Essential Health Project. Implementation: The Remote Pregnant and Newborn Care (RPNC) service has adapted to the MNCH needs of vulnerable pregnant women and was implemented to mitigate the risk of limited access to essential quality MNH care in Yangon, Myanmar, under women, and the project trained 13 service providers on a telehealth care package for pregnancy and newborn developed Jhpiego to ensure understanding of evidence-based MNCH care practices. The phone numbers of the pregnant women were gathered through the preexisting and functioning community volunteers, who reach the most vulnerable pregnant women in the project's targeted area. A total of 212 pregnant women have been reached by service providers for RPNC during the implementation period. The trained service providers offer quality antenatal and postnatal care, including newborn care, via telephone calls. It includes 24/7 incoming calls and time-allotted outgoing calls to the pregnant women during antenatal and postnatal periods, including the newborn care. The required data were collected daily in time with the calls, and the quality of the medical services is made assured with the track of the calls, ensuring data privacy and patient confidentiality. Lessons learned: The key lessons are 1) cost-effectiveness: RPNC service could reduce out of pocket expenditure of pregnant women as it only costs 1.6 United States dollars (USD) per one telehealth call while it costs 8 to 10 USD per one time in-person care service at private service providers, including transportation cost, 2) network of care: telehealth call could not replace the in-person antenatal and postnatal care services, and integration of telehealth calls with in-person care by local healthcare providers with the support of the community is crucial for accessibility to essential MNH services by poor and vulnerable women, and 3) sharing information on health access points: most of the women seem to have financial barriers in accessing private health facilities while public health system collapse and telehealthcare could provide information on low-cost facilities and connect women to relevant health facilities. These key lessons are important for future efforts regarding the implementation of remote pregnancy and newborn care in Myanmar, especially during the political crisis and COVID-19 pandemic situation.

Keywords: telehealth, accessibility, maternal care, newborn care

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