Search results for: infectious status.

Authors: Sarika Gupta, Harshika Khanna, Ajay K Verma, Surya Kant

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Background: Drug-resistant tuberculosis (DR-TB) is a growing health challenge to global TB control efforts. Pediatric DR-TB is one of the neglected infectious diseases. In our previously published report, we have notified an increased prevalence of DR-TB in the pediatric population at a tertiary health care centre in North India which was estimated as 17.4%, 15.1%, 18.4%, and 20.3% in (%) in the year 2018, 2019, 2020, and 2021. Limited evidence exists about a pattern of drug resistance, side effect profile and programmatic outcomes of Paediatric DR-TB treatment. Therefore, this study was done to find out the pattern of resistance, side effect profile and treatment outcome. Methodology: This was a prospective cohort study conducted at the nodal drug-resistant tuberculosis centre of a tertiary care hospital in North India from January 2021 to December 2022. Subjects included children aged between 0-18 years of age with a diagnosis of DR-TB, on the basis of GeneXpert (rifampicin [RIF] resistance detected), line probe assay and drug sensitivity testing (DST) of M. tuberculosis (MTB) grown on a culture of body fluids. Children were classified as monoresistant TB, polyresistant TB (resistance to more than 1 first-line anti-TB drug, other than both INH and RIF), MDR-TB, pre-XDR-TB and XDR-TB, as per the WHO classification. All the patients were prescribed DR TB treatment as per the standard guidelines, either shorter oral DR-TB regimen or a longer all-oral MDR/XDR-TB regimen (age below five years needed modification). All the patients were followed up for side effects of treatment once per month. The patient outcomes were categorized as good outcomes if they had completed treatment and cured or were improving during the course of treatment, while bad outcomes included death or not improving during the course of treatment. Results: Of the 50 pediatric patients included in the study, 34 were females (66.7%) and 16 were male (31.4%). Around 33 patients (64.7%) were suffering from pulmonary TB, while 17 (33.3%) were suffering from extrapulmonary TB. The proportions of monoresistant TB, polyresistant TB, MDR-TB, pre-XDR-TB and XDR-TB were 2.0%, 0%, 50.0%, 30.0% and 18.0%, respectively. Good outcome was reported in 40 patients (80.0%). The 10 bad outcomes were 7 deaths (14%) and 3 (6.0%) children who were not improving. Adverse events (single or multiple) were reported in all the patients, most of which were mild in nature. The most common adverse events were metallic taste 16(31.4%), rash and allergic reaction 15(29.4%), nausea and vomiting 13(26.0%), arthralgia 11 (21.6%) and alopecia 11 (21.6%). Serious adverse event of QTc prolongation was reported in 4 cases (7.8%), but neither arrhythmias nor symptomatic cardiac side effects occurred. Vestibular toxicity was reported in 2(3.9%), and psychotic symptoms in 4(7.8%). Hepatotoxicity, hypothyroidism, peripheral neuropathy, gynaecomastia, and amenorrhea were reported in 2 (4.0%), 4 (7.8%), 2 (3.9%), 1(2.0%), and 2 (3.9%) respectively. None of the drugs needed to be withdrawn due to uncontrolled adverse events. Conclusion: Paediatric DR TB treatment achieved favorable outcomes in a large proportion of children. DR TB treatment regimen drugs were overall well tolerated in this cohort.

Keywords: pediatric, drug-resistant, tuberculosis, adverse events, treatment

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Authors: Sun-Ki Choi

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The U.S. student loan policy was initiated to improve the equality of educational opportunity and help low-income families to provide higher education opportunities for their children. However, with the increase in the average student loan amount, college graduates with student loans experience problems and restrictions in their early-career choices. This study examines the early career labor market choices of college graduates who obtained student loans to finance their higher education. In this study, National Survey of College Graduates (NSCG) data for 2017 and 2019 was used to estimate the effects of student loans on the employment status and current job wages of graduates with student loans. In the analysis, two groups of workers, those with student loans and those without loans, were compared. Using basic models and Mahalanobis distance matching, it was found that graduates who rely on student loans to finance their education are more likely to participate in the labor market than those who do not. Moreover, in entry-level jobs, graduates with student loans receive lower salaries than those without student loans. College graduates make job-related decisions based on their current and future wages and fringe benefits. Graduates with student loans tend to demonstrate risk-averse behaviors due to their financial restrictions. Thus, student loan debt creates inequity in the early-career labor market for college graduates. Furthermore, this study has implications for policymakers and researchers in terms of the student loan policy.

Keywords: student loan, wage differential, unintended consequences, mahalanobis distance matching

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Authors: Rodrigo Coelho

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We believe that in the majority of the “recent production of public space", the overvaluation of the "image", of the "ephemeral" and of the "objectual", has come to determine the configuration of banal and (more or less) arbitrary "public spaces", mostly linked to a problem of “outdoor decoration”, reflecting a clear sign of uncertainty and arbitrariness about the meaning, the role and shape of public space and public art.This "inconsistency" which is essentially linked to the loss of urban, but also social, cultural and political, vocation of the disciplines that “shape” the urban space (but is also linked to the lack of urban and technical culture of techinicians and policy makers) converted a significant set of the recently built "public space" and “urban art” into diffuse and multi-referenced pieces, which generally shares the inability of confering to the urban space, civic, aesthetic, social and symbolic meanings. In this sense we consider it is essential to undertake a theoretical reflection on the values, the meaning(s) and the shape(s) that open space, and urban art may (or must) take in the current urban and cultural context, in order to redeem for public space its status of significant physical reference, able to embody a spatial and urban identity, and simultaneously enable the collective accession and appropriation of public space. Taking as reference public space interventions built in the last decade on the European context, we will seek to explore and defend the need of considering public space as a true place of exception, an exceptional support where the emphasis is placed on the quality of the experience, especially by the relations public space/urban art can established with the city, with nature and geography in a broad sense, referring us back to a close and inseparable and timeless relationship between nature and culture.

Keywords: art, city, nature, public space

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Authors: Isaac Gbadura Adanlawo, Olusola Olalekan Elekofehinti

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This work investigated the antihyperglycemic, antioxidant and antihyperlipidemic effects of saponins from the fruit of Solanum anguivi, a plant generally used in folk medicine to treat diabetes and hypertension and to compare its effect with metformin in streptozotocin (STZ)-induced diabetic rats. Diabetes was induced in albino rats by administration of STZ (65 mg/kg) intraperitoneally. Saponin (40 and 100 mg/kg) was administered by oral gavage once daily for 21 days. Metformin (200 mg/kg b.w.) was administered as the positive control. The effect of saponin on blood glucose, serum lipids and enzymatic antioxidants defense systems, like superoxide dismutase (SOD), catalase (CAT), as well as MDA levels in serum, liver and pancreas were studied. Saponins from S. anguivi fruits reduced the blood glucose, total cholesterol (TC), triglycerides (TG) and low-density lipoprotein (LDL) levels in STZ-diabetic rats. They also significantly abolished the increase in MDA level in serum, liver and pancreas of diabetic rats. The activities of SOD and CAT in serum, liver and pancreas were significantly increased as well as concentration of HDL in the serum. Metformin had the same effect as saponin but saponins seems to be more potent in reducing serum TC, TG, LDL, and MDA, and increasing SOD and CAT. Conclusions: These results suggest that saponins from S. anguivi fruits have anti-diabetic and antihypercholesterolemic, antihypertriglyceridemic antiperoxidative activities mediated through their antioxidant properties. Also, saponins appeared to have more hypolipidemic, antiperoxidative and antioxidant activity than metformin.

Keywords: saponin, diabetes, metformin, streptozotocin, Solanum anguivi

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Authors: Imali T. Jayamanne, K. P. Asoka Ramanayake

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Transition from tertiary level education to employment is one of the challenges that many fresh university graduates face after graduation. The transition period or the waiting time to obtain the first employment varies with the socio-economic factors and the general characteristics of a graduate. Compared to other fields of study, Arts graduates in Sri Lanka, have to wait a long time to find their first employment. The objective of this study is to identify the determinants of the transition from higher education to employment of these graduates using survival models. The study is based on a survey that was conducted in the year 2016 on a stratified random sample of Arts graduates from Sri Lankan universities who had graduated in 2012. Among the 469 responses, 36 (8%) waiting times were interval censored and 13 (3%) were right censored. Waiting time for the first employment varied between zero to 51 months. Initially, the log-rank and the Gehan-Wilcoxon tests were performed to identify the significant factors. Gender, ethnicity, GCE Advanced level English grade, civil status, university, class received, degree type, sector of first employment, type of first employment and the educational qualifications required for the first employment were significant at 10%. The Cox proportional hazards model was fitted to model the waiting time for first employment with these significant factors. All factors, except ethnicity and type of employment were significant at 5%. However, since the proportional hazard assumption was violated, the lognormal Accelerated failure time (AFT) model was fitted to model the waiting time for the first employment. The same factors were significant in the AFT model as in Cox proportional model.

Keywords: AFT model, first employment, proportional hazard, survey design, waiting time

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Authors: A. Alhusban, M. Alqawasmeh, F. Alfawares

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Introduction: Diabetes is a chronic health problem and a major risk factor of stroke. A number of therapeutic modalities exist for diabetes management. It’s still unknown whether the different oral hypoglycemic agents would ameliorate the detrimental effect of diabetes on stroke severity. The objective of this work is to assess the effect of pretreatment with oral hypoglycemic agents, insulin and their combination on stroke severity at presentation. Patients and Methods: Patients admitted to the King Abdullah University Hospital (KAUH)-Jordan with ischemic stroke between January 2015 and December 2016 were evaluated and their comorbid diseases, treatment on admission and their neurologic severity was assessed using the National Institute of Health Stroke Scale (NIHSS) were documented. Stroke severity was compared for non-diabetic patients and diabetic patients treated with different antidiabetic agents. Results: Data from 324 patients with acute stroke was documented. The median age of participants was 69 years. Diabetes was documented in about 50% of the patients. Multinomial regression analysis identified diabetes treatment status as an independent predictor of neurological severity of stroke (p=0.032). Patients treated with oral hypoglycemic agents had a significantly lower NIHSS as compared to nondiabetic patients and insulin treated patients (p < 0.02). The positive effect of oral hypoglycemic agents was blunted by insulin co-treatment. Insulin did not alter the severity of stroke as compared to non-diabetics. Conclusion: Oral hypoglycemic agents may reduce the severity of neurologic deficit of ischemic stroke and may have neuroprotective effect.

Keywords: diabetes, stroke, neuroprotection, oral hypoglycemic agents

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Authors: Mzamani Aaron Mabasa

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The research study examines the reality that the Language Services Directorate can be considered a language repository hub. The study postulates that multilingual education guided by language policy implementation can improve student performance and pass rate. Various documents in the form of style guides, glossaries and tutorial letters may be used to enable students to understand complex words, sentences, phrases and paragraphs when technical vocabularies are used. This paper addresses the way in which quality assurance can transform South African official languages, including Sign Language, as mandated by the Language Policy for Higher Education. The paper further emphasizes that Language Services is unique in the sense that it involves all South African officials as tools for student support and facilitation of learning. This is in line with the Constitution of the Republic of South Africa (1996) and the Unisa Language Policy of 2023, which declares the status, parity and esteem of these official languages regarding usage in formal function domains, namely education, economy, social and politics. The aim of this paper is to ensure that quality assurance is ultimately accomplished in terms of teaching and learning standards. Eventually, all South African languages can be used for official domains to achieve functional multilingualism. This paper furthermore points out that content analysis as a research instrument as far as a qualitative approach is concerned may be used as a data collection technique.

Keywords: repository, multilingualism, policy, education

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Authors: Rawan Masarwa, Merav Ben Natan, Yaron Berkovich

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Background: Hip fracture repair surgery carries a certain mortality risk, yet evidence suggests that orthopedic surgeons often refrain from discussing this issue with patients prior to surgery. Aim: This study aims to examine whether orthopedic surgeons address the issue of one-year post-surgery mortality before hip fracture repair surgery and to explore the factors influencing this decision. Method: The study uses a cross-sectional design, administering validated digital questionnaires to 150 orthopedic surgeons. Results: A minority of orthopedic surgeons reported consistently informing patients about the risk of mortality in the year following hip fracture surgery. The primary reasons for not discussing this risk were a desire to avoid frightening patients, time constraints, and concerns about undermining patient hope. Surgeons reported a medium-high level of perceived self-efficacy, with higher self-efficacy linked to a reduced likelihood of discussing one-year mortality risk. In contrast, older age and holding a specialist status in orthopedic surgery were associated with a higher likelihood of discussing this risk with patients. Conclusions: The findings suggest a need for interventions to address communication barriers and ensure consistent provision of essential information to patients undergoing hip fracture surgery. Additionally, they emphasize the importance of considering individual factors such as self-efficacy, age, and expertise in developing strategies to enhance patient-provider communication in orthopedic care settings.

Keywords: orthopedic surgeons, hip fracture surgery, mortality risk communication, patient information

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Authors: Lorena Antonovici, Maria Nicoleta Turliuc

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The process of becoming a vegetarian involves changes in several life aspects, including health. Despite its relevance, however, little research has been carried out to analyze vegetarians' self-perceived health, and even less empirical attention has received in the Romanian population. This study aimed to assess health-related beliefs and practices among vegetarian adults in a Romanian sample. We have undertaken 20 semi-structured interviews (10 males, 10 females) based on a snowball sample with a mean age of 31 years. The interview guide was divided into three sections: causes of adopting the diet, general aspects (beliefs, practices, tensions, and conflicts) and consequences of adopting the diet (significant changes, positive aspects, and difficulties, physical and mental health). Additional anamnestic data were reported by means of a questionnaire. Data analyses were performed using Tropes text analysis software (v. 8.2) and SPSS software (v. 24.0.) Findings showed that most of the participants considered a vegetarian diet as a natural and healthy choice as opposed to meat-eating, which is not healthy, and its consumption should be moderated among omnivores. A higher proportion of participants (65%) had an average body mass index (BMI), and several women even assumed having certain affections that no longer occur after following a vegetarian diet. Moreover, participants admitted having better moods and mental health status, given their self-contentment with the dietary choice. Relatives were perceived as more skeptical about their practices than others, and especially women had this view. This study provides a valuable insight into health-related beliefs and practices and how a vegetarian diet might interact.

Keywords: beliefs, health, practices, vegetarians

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Authors: Kajal Zarei

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Supply chain management is becoming an increasingly important issue in many businesses today. In such circumstances, a number of reasons such as management deficiency in different segments of the supply chain, lack of streamlined processes, resistance to change the current systems and technologies, and lack of advanced information system have paved the ground to ask for innovative research studies. To this end, information technology (IT) is becoming a major driver to overcome the supply chain limitations and deficiencies. The emergence of IT has provided an excellent opportunity for redefining the supply chain to be more effective and competitive. This paper has investigated the IT impact on two-digit industry codes in the International Standard Industrial Classification (ISIC) that are operating in four groups of the supply chains. Firstly, the primary fields of the supply chain were investigated, and then paired comparisons of different industry parts were accomplished. Using experts' ideas and Analytical Hierarchy Process (AHP), the status of industrial activities in Kurdistan Province in Iran was determined. The results revealed that manufacturing and inventory fields have been more important compared to other fields of the supply chain. In addition, IT has had greater impact on food and beverage industry, chemical industry, wood industry, wood products, and production of basic metals. The results indicated the need to IT awareness in supply chain management; in other words, IT applications needed to be developed for the identified industries.

Keywords: supply chain, information technology, analytical hierarchy process, two-digit codes, international standard industrial classification

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Authors: Hyoung Seok Kim

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Purpose: To evaluate the clinical characteristics and surgical outcomes of retinal detachment associated with atopic dermatitis. Methods: A retrospective investigation of clinical notes of 37 patients with retinal detachment associated with atopic dermatitis was conducted from January 2019 to December 2023. Initial visual acuity, medical history, type of retinal detachment, number of tears, types of treatment, success rate of treatment, and presence of cataract were investigated. To evaluate the relationship with cataract, the patients were classified into three groups according to lens status: group A (eyes with clear lens), group B (eyes with cataract), and group C (pseudophakic eyes). Results: Of the 37 patients, 29 were male and 8 were female; 10 patients had bilateral retinal detachment (27.0%). The retinal breaks were often located temporally (89.4%), with only 5 cases (10.6%) involving nasal-side retinal breaks. No significant differ ences were noted in the ratio of males to females, age distribution, visual acuity before and after treatments, axial length, and lo cation of retina breaks among the three groups. After primary surgery, retinal detachment recurred in 12 patients (14 eyes), 5 of whom were initially diagnosed with bilateral retinal detachment. In addition, 12 of 14 eyes underwent a second operation, in which detachment recurred in 3 eyes. Conclusions: Incidence of bilateral retinal detachment was high in patients with atopic dermatitis, and the retinal breaks were of ten found on the temporal side. Retinal re-detachment was statistically high in patients with cataract or pseudophakic eyes com pared to patients with clear lens (p = 0.024).

Keywords: retinal detachment, atopic dermatitis, cataract, retina surgery

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Authors: E. Elhan Özus, Melek Tufan, Filiz Erden

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Cloth is a special wearing style of a society for a period or of a profession. Clothes reflect the social status difference than the fashion. Within this context, society forms a wearing style in the direction of its customs, usage, traditions and social structure. One of the properties of a society indicating the social levels and cultural differences differing the societies from each other is clothing style. Clothing is one of the most important needs in life depending on the individual and social attributes. The clothing which first emerged as protection means is a social fact complementing the physical and psychological existence of human being, changing forms depending on technological developments and phases, and continuously changing under the affect of fashion today. Clothing is an aesthetic value fed by the feelings of individuals. So, clothing has an indispensable place in the structure and communication of cultural and social identity within this direction. The traditional Turkish clothing has a rich ethnography. It is also possible to see the winds coming from our predecessors in these cultural assets reflecting the feelings and thoughts of Anatolian women. When the long history of our nation and the cultures interacted by our nation are taken into account, it is seen that the magnificence of our nation has also reflected into the clothing culture.For this reason, we tried to keep the traditional women’s clothing of Tekirdağ region alive by investigating and documenting them. In this study, it is purposed to contribute a little bit to protect our culture and form a source for the future generations, to carry our national cultural values from the past up to now and to the future and deliver to the young people.

Keywords: Turkish, traditional, culture, clothing

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Authors: Menouni Aziza, Chbihi Kaoutar, Duca Radu Corneliu, Gilissen Liesbeth, Bounou Salim, Godderis Lode, El Jaafari Samir

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In Africa, environmental and occupational health risks are mostly underreported. The aim of this research is to develop and implement a sentinel surveillance system comprising training and guidance of occupational physicians (OC) who will report new work-related diseases in African countries. A group of 30 OC are recruited and trained in each of the partner countries (Morocco, Benin and Ethiopia). Each committed OC is asked to recruit 50 workers during a consultation in a time-frame of 6 months (1500 workers per country). Workers are asked to fill out an online questionnaire about their health status and work conditions, including exposure to 20 chemicals. Urine and blood samples are then collected for human biomonitoring of common exposures. Some preliminary results showed that 92% of the employees surveyed are exposed to physical constraints, 44% to chemical agents, and 24% to biological agents. The most common physical constraints are manual handling of loads, noise pollution and thermal pollution. The most frequent chemical risks are exposure to pesticides and fuels. This project will allow a better understanding of effective sentinel systems as a promising method to gather high quality data, which can support policy-making in terms of preventing emerging work-related diseases.

Keywords: sentinel system, occupational diseases, human biomonitoring, Africa

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Authors: Lei Zhou, Dan Li, Ruiqi Ren, Chao Li, Yali Wang, Daxin Ni, Zijian Feng, Timothy M. Uyeki, Qun Li

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Since the first human infections with avian influenza A(H7N9) virus were identified in early 2013, 1533 cases of laboratory-confirmed A(H7N9) virus infections were reported and confirmed as of September 13, 2017. The fifth epidemic was defined as starting from September 1, 2016, and the number of A(H7N9) cases has surged since the end of December in 2016. On February 18, 2017, the A(H7N9) cases who were infected with highly pathogenic avian influenza (HPAI) virus was reported from Southern China. The HPAI A(H7N9) cases were identified and then an investigation and analyses were conducted to assess whether disease severity in humans has changed with HPAI A(H7N9) compared with low pathogenic avian influenza (LPAI) A(H7N9) virus infection. Methods: All confirmed cases with A(H7N9) virus infections reported throughout mainland China from September 1, 2016, to September 13, 2017, were included. Cases' information was extracted from field investigation reports and the notifiable infectious surveillance system to describe the demographic, clinical, and epidemiologic characteristics. Descriptive statistics were used to compare HPAI A(H7N9) cases with all LPAI A(H7N9) cases reported during the fifth epidemic. Results: A total of 27 cases of HPAI A(H7N9) virus were identified infection from five provinces, including Guangxi (44%), Guangdong (33%), Hunan (15%), Hebei (4%) and Shangxi (4%). The median age of cases of HPAI A(H7N9) virus infection was 60 years (range, 15 to 80) and most of them were male (59%) and lived in rural areas (78%). All 27 cases had live poultry related exposures within 10 days before their illness onset. In comparison with LPAI A(H7N9) case-patients, HPAI A(H7N9) case-patients were significantly more likely to live in rural areas (78% vs. 51%; p = 0.006), have exposure to the sick or dead poultry (56% vs. 19%; p = 0.000), and be hospitalized earlier (median 3 vs. 4 days; p = 0.007). No significant differences were observed in median age, sex, prevalence of underlying chronic medical conditions, median time from illness onset to first medical service seeking, starting antiviral treatment, and diagnosis. Although the median time from illness onset to death (9 vs. 13 days) was shorter and the overall case-fatality proportion (48% vs. 38%) was higher for HPAI A(H7N9) case-patients than for LPAI A(H7N9) case-patients, these differences were not statistically significant. Conclusions: Our findings indicate that HPAI A(H7N9) virus infection was associated with exposure to sick and dead poultry in rural areas when visited live poultry market or in the backyard. In the fifth epidemic in mainland China, HPAI A (H7N9) case-patients were hospitalized earlier than LPAI A(H7N9) case-patients. Although the difference was not statistically significant, the mortality of HPAI A (H7N9) case-patients was obviously higher than that of LPAI A(H7N9) case-patients, indicating a potential severity change of HPAI A(H7N9) virus infection.

Keywords: Avian influenza A (H7N9) virus, highly pathogenic avian influenza (HPAI), case-patients, poultry

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Authors: Jianghua Chen

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Sustainable urban development requires the coordination of economic growth and resource environment, and industrial transformation and upgrading is the key link. Based on the decoupling theory and the improved decoupling decomposition model, the quantitative evaluation and comprehensive analysis of the degree of decoupling between resource consumption and economic development in Jiangsu Province are conducted using the data related to the resource consumption and economic growth of the secondary and tertiary industries in Jiangsu Province from 2013 to 2018, as a way of exploring the sustainable development path of industrial transformation in Jiangsu Province. The results show that from the decoupling status, the degree of decoupling of economic development of the secondary industry to the required coke resources, water resources, and human resources is gradually deepening, and the decoupling index of economic development of the tertiary industry to the required water resources is fluctuating; from the perspective of the driving factors, the technological effect is the main driving factor to decouple the economic growth of Jiangsu Province to the resources, and the structural effect has a significant impact on the driving index of the decoupling of economic growth of the secondary and tertiary industries to the consumption of resources in Jiangsu Province. Finally, we discuss the difficulties of industrial transformation and layout faced by Jiangsu Province at present.

Keywords: resource consumption, economic growth, industrial transformation, decoupling theory

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Authors: Atousa Khodadadyan, Ali Rostami

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The objective of off-site construction manufacturing is to utilise the workforce and machinery in a controlled environment without external interference for higher productivity and quality. The usage of prefabricated components can save up to 14% of the total energy consumption in comparison with the equivalent number of cast-in-place ones. Despite the benefits of prefabrication construction, its current project practices encompass technical and managerial issues. Building design, precast components’ production, logistics, and prefabrication installation processes are still mostly discontinued and fragmented. Furthermore, collaboration among prefabrication manufacturers, transportation parties, and on-site assemblers rely on real-time information such as the status of precast components, delivery progress, and the location of components. From the technical point of view, in this industry, geometric variability is still prevalent, which can be caused during the transportation or production of components. These issues indicate that there are still many aspects of prefabricated construction that can be developed using disruptive technologies. Practical real-time risk analysis can be used to address these issues as well as the management of safety, quality, and construction environment issues. On the other hand, the lack of research about risk assessment and the absence of standards and tools hinder risk management modeling in prefabricated construction. It is essential to note that no risk management standard has been established explicitly for prefabricated construction projects, and most software packages do not provide tailor-made functions for this type of projects.

Keywords: project risk management, risk analysis, risk modelling, prefabricated construction projects

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Authors: Tahra Elobeid, Emmerich Berghofer

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The aim of this study is to find innovative approaches for the production of iron rich foods using natural iron sources. The vehicle used for fortification was sorghum whereas the iron fortificant was white bean. Fortified sorghum cookies were produced from five different mixtures; iron content, iron bioavailability, cookie texture and acceptability were measured. Cookies were prepared from the three fortified flours; 90% sorghum + 10% white bean (S9WB1), 75% sorghum + 25% white bean (S3WB1), 50% sorghum + 50% white bean (S1WB1) and 100% sorghum and 100% white bean. The functional properties gave good results in all the formulations. Statistical analysis of the iron content in the five different cookies showed that there was significant difference at the 95% confidence level (ANOVA). The iron content in all the recipes including the 100% sorghum improved, the increase ranging from 112% in 100% sorghum cookies to 476% in 100% white bean cookies. This shows that the increase in the amount of white bean used for fortification leads to the improvement of the iron content of cookies. The bioavailability of iron ranged from 21.3% in 100% sorghum to 28.6% in 100% white bean cookies. In the 100% sorghum cookies the iron bioavailability increased with reference to raw sorghum due to the addition of eggs. Bioavailability of iron in raw sorghum is 16.2%, therefore the percentage increase ranged from 5.1% to 28.6%. The cookies prepared from 10% white bean (S9WB1) scored the lowest 3.7 in terms of acceptability. They were the least preferred due to their somewhat soft texture. The 30% white bean cookies (S3WB1) gave results comparable to the 50% (S1WB1) and 100% white bean cookies. Cookies prepared with high percentage of white bean (50% and 100% white bean) gave the best results. Therefore cookie formulations from sorghum and white bean are successful in improving the iron status of anaemic individuals.

Keywords: sorghum, white bean, iron content, bioavailable iron, cookies

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Authors: Fatemeh Abdollahi, Munn-Sann Lye, Jamshid Yazdani Charati, Mehran Zarghami

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Background: The negative consequences of intimate partner violence (IPV) on children have not been studied extensively. This study aimed to determine the prevalence of different types of IPV and its association with children’s growth and developmental problems. Methods: In a descriptive-analytical study, 596 mothers of one-year-old children referred to the primary health centers in Gonbad-e- Kavoos city were recruited (2018). The data were collected using the World Health Organization Domestic Violence, Ages and Stages Questionnaire-12 and the socio-economic, obstetrics, demographic and anthropometric characteristics related questionnaire. BMI Z-Score was categorized into three grades; thin (Z<-2), normal (-2≤Z<1), and overweight-obese (Z≥1). The data were analyzed using descriptive analysis, chi-square test, and regression. Results: The prevalence of physical, psychological, and sexual IPV was 7.4%, 29.5%, and 2.4%, respectively. Most of the children were of normal weight at one-year-old (91.7%). Similarly, the prevalence of overweight and obese was 13.3% and 8%, respectively. 2% of children had developmental problems at age one. There was a significant relationship between the father’s education and occupation and IPV and children’s delay in growth, respectively. There was no significant difference between BMI Z-Score and developmental disabilities in the children in women exposed and not exposed to all types of IPV. Conclusions: The prevalence of psychological IPV was common. IPV and children’s growth problems were influenced by the father’s socio-economic status. Preventing psychological IPV as a forerunner of other types of IPV and improving the economic situation may help in the reduction of these difficulties.

Keywords: children, development, growth, intimate partner violence

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Authors: Ammal M. Metwally, Dalia M. Elmosalami, Walaa A. Fouad, Abla G. Khalifa, Lobna A. El Etreby, Mohamed AbdelRahman

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People with hepatitis C are likely to experience psychological distress related to adjustment issues following diagnosis. Objective: The study was conducted to determine the psycho-social stressors accompanying Hepatitis C virus (HCV) chronic infection. The study focused on immediate and later on reactions to being diagnosed as infected HCV patients. Effect of HCV on disruption of patients’ relationships in term of family relationship and friendship, employment and financial status was assessed. The magnitude and causes of the social stigma and its relation to awareness about illness, level of education were also assessed. Methods: During this study the subjective experiences of people having HCV was explored through a designed questionnaire targeted 540 cases; 359 males and 181 females from ten out of 21 National Treatment Reference Centers of National Hepatology and Tropical Medicine Research Institutes of Ministry of Health (MOH) hospitals. The study was conducted along a period of six months from September 2011 to March 2012. Results: The study revealed that the financial problems are the commonest problems faced by 75.5 % of the cases. More than 70% of the cases suffered from immediate sadness versus 67.4% suffered from worry. Social stigma was reported by 13 % of HCV +patients, the majority of which were females. Conclusions: Exploring the psychosocial consequences of HCV infection can act as pressing motivators for behavior change needed for limiting HCV endemicity in Egypt.

Keywords: Egypt, HCV infection, psycho-social adjustment, stigma

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Authors: Masoumeh Kazemi

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Depression is one of the most common mental disorders that damage mental health. In addition to mental distress, mental health damage affects other dimensions of human health, including physical and social health. According to the national study of diseases and injuries in Iran, the third health problem of the country is depression. The purpose of this study was to measure the level of depression in people referred to Karaj psychiatric treatment centers, and to investigate the relationship between depression and drug and alcohol consumption. The statistical population included 5000 people. Morgan table was used to determine the sample size. The research questions sought to identify the relationship between depression and factors such as drug and alcohol use, employment and marital status, and gender. Beck standard questionnaire was used to collect complete information. Cronbach's alpha coefficient was used to confirm the reliability of the questionnaire. To test research hypotheses, non-parametric methods of correlation coefficient, Spearman's rank, Mann-Whitney and Kruskal-Wallis tests were used. The results of using SPSS statistical software showed that there is a direct relationship between depression and drug and alcohol use. Also, the rate of depression was higher in women, widows and unemployed people. Finally, by conducting the present study, it is suggested that people use the following treatments in combination for effective recovery: 1. Cognitive Behavioral Therapy (CBT) 2. Interpersonal Therapy (IPT) 3. Treatment with appropriate medication 4. Special light therapy 5. Electric shock treatment (in acute and exceptional cases) 6. Self-help

Keywords: alcohol, depression, drug, Iran

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Authors: Eleni Giouli

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Distance learning provides a flexible approach to education, enabling busy learners to complete their coursework at their own pace, on their own schedule, and from a convenient location. This flexibility combined with a series of other issues; make the benefits of lifelong distance learning numerous. The purpose of the paper is to investigate whether distance education can contribute to the improvement of adult skills in Greece, highlighting in this way the necessity of the lifelong distance learning. To investigate this goal, a questionnaire is constructed and analyzed based on responses from 3,016 attendees of lifelong distance learning programs in the e-learning of the National and Kapodistrian University of Athens in Greece. In order to do so, a series of relationships is examined including the effects of a) the gender, b) the previous educational level, c) the current employment status, and d) the method used in the distance learning program, on the development of new general, technical, administrative, social, cultural, entrepreneurial and green skills. The basic conclusions that emerge after using a binary logistic framework are that the following factors are critical in order to develop new skills: the gender, the education level and the educational method used in the lifelong distance learning program. The skills more significantly affected by those factors are the acquiring new skills in general, as well as acquiring general, language and cultural, entrepreneurial and green skills, while for technical and social skills only gender and educational method play a crucial role. Moreover, routine skills and social skills are not affected by the four factors included in the analysis.

Keywords: adult skills, distance learning, education, lifelong learning

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Authors: Soraia V. M. de Sá, Miguel A. Faria, José O. Fernandes, Sara C. Cunha

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Cereals play a vital role in fulfilling the nutritional needs of children, supplying essential nutrients crucial for their growth and development. However, concerns arise due to children's heightened vulnerability due to their unique physiology, specific dietary requirements, and relatively higher intake in relation to their body weight. This vulnerability exposes them to harmful food contaminants, particularly mycotoxins, prevalent in cereals. Because of the thermal stability of mycotoxins, conventional industrial food processing often falls short of eliminating them. Children, especially those aged 4 months to 12 years, frequently encounter mycotoxins through the consumption of specialized food products, such as instant foods, breakfast cereals, bars, cookie snacks, fruit puree, and various dairy items. A close monitoring of this demographic group's exposure to mycotoxins is essential, as toxins ingestion may weaken children’s immune systems, reduce their resistance to infectious diseases, and potentially lead to cognitive impairments. The severe toxicity of mycotoxins, some of which are classified as carcinogenic, has spurred the establishment and ongoing revision of legislative limits on mycotoxin levels in food and feed globally. While EU Commission Regulation 1881/2006 addresses well-known mycotoxins in processed cereal-based foods and infant foods, the absence of regulations specifically addressing emerging mycotoxins underscores a glaring gap in the regulatory framework, necessitating immediate attention. Emerging mycotoxins have gained mounting scrutiny in recent years due to their pervasive presence in various foodstuffs, notably cereals and cereal-based products. Alarmingly, exposure to multiple mycotoxins is hypothesized to exhibit higher toxicity than isolated effects, raising particular concerns for products primarily aimed at children. This study scrutinizes the presence of 22 mycotoxins of the diverse range of chemical classes in 148 processed cereal-based foods, including 39 breakfast cereals, 25 infant formulas, 27 snacks, 25 cereal bars, and 32 cookies commercially available in Portugal. The analytical approach employed a modified QuEChERS procedure followed by ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) analysis. Given the paucity of information on the risk assessment of children to multiple mycotoxins in cereal and cereal-based products consumed by children of Portugal pioneers the evaluation of this critical aspect. Overall, aflatoxin B1 (AFB1) and aflatoxin G2 (AFG2) emerged as the most prevalent regulated mycotoxins, while enniatin B (ENNB) and sterigmatocystin (STG) were the most frequently detected emerging mycotoxins.

Keywords: cereal-based products, children´s nutrition, food safety, UPLC-MS/MS analysis

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Authors: Mary Farrell, Maria Soubra, Sandra Vega, Dorothy Kakraba, Joanne Fontanilla, Moira Kendra, Danielle Tonzola, Stephanie Chiu

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Pneumonia is the most common infectious cause of hospitalizations in the United States, with more than one million admissions annually and costs of $10 billion every year, making it the 8th leading cause of death. Aspiration pneumonia is an aggressive type of pneumonia that results from inhalation of oropharyngeal secretions and/or gastric contents and is preventable. The authors hypothesized that an evidence-based aspiration pneumonia clinical care pathway could reduce 30-day hospital readmissions and mortality rates, while improving the overall care of patients. We conducted a retrospective chart review on 979 patients discharged with aspiration pneumonia from January 2021 to December 2022 at Overlook Medical Center. The authors identified patients who were coded with aspiration pneumonia and/or stable sepsis. Secondarily, we identified 30-day readmission rates for aspiration pneumonia from a SNF. The Aspiration Pneumonia Clinical Care Pathway starts in the emergency department (ED) with the initiation of antimicrobials within 4 hours of admission and early recognition of aspiration. Once this is identified, a swallow test is initiated by the bedside nurse, and if the patient demonstrates dysphagia, they are maintained on strict nothing by mouth (NPO) followed by a speech and language pathologist (SLP) referral for an appropriate modified diet recommendation. Aspiration prevention techniques included the avoidance of straws, 45-degree positioning, no talking during meals, taking small bites, placement of the aspiration wrist band, and consuming meals out of the bed in a chair. Nursing education was conducted with a newly created online learning module about aspiration pneumonia. The authors identified 979 patients, with an average age of 73.5 years old, who were diagnosed with aspiration pneumonia on the index hospitalization. These patients were reviewed for a 30-day readmission for aspiration pneumonia or stable sepsis, and mortality rates from January 2021 to December 2022 at Overlook Medical Center (OMC). The 30-day readmission rates were significantly lower in the cohort that received the clinical care pathway (35.0% vs. 27.5%, p = 0.011). When evaluating the mortality rates in the pre and post intervention cohort the authors discovered the mortality rates were lower in the post intervention cohort (23.7% vs 22.4%, p = 0.61) Mortality among non-white (self-reported as non-white) patients were lower in the post intervention cohort (34.4% vs. 21.0% , p = 0.05). Patients who reported as a current smoker/vaper in the pre and post cohorts had increased mortality rates (5.9% vs 22%). There was a decrease in mortality for the male population but an increase in mortality for women in the pre and post cohorts (19% vs. 25%). The authors attributed this increase in mortality in the post intervention cohort to more active smokers, more former smokers, and more being admitted from a SNF. This research identified that implementation of an Aspiration Pneumonia Clinical Care Pathway showed a statistically significant decrease in readmission rates and mortality rates in non-whites. The 30-day readmission rates were lower in the cohort that received the clinical care pathway (35.0% vs. 27.5%, p = 0.011).

Keywords: aspiration pneumonia, mortality, quality improvement, 30-day pneumonia readmissions

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Authors: Lakshmi, Yakshita Awasthi, Deepika, Lovleen Jha, Archna Kumar

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From the back of centuries, plant-parasitic nematodes (PPN) have been recognized as a major threat to agriculturalists globally. It causes 21.3% global food loss annually. The utilization of harmful chemical pesticides to minimize the nematode population may cause acute and delayed health hazards and harmful impacts on human health. In recent years, a variety of plants have been evaluated for their nematicidal properties and efficacy in the management of plant-parasitic nematodes. Several Phyto-nematicides are available, but most of them are incapable of sustainable management of PPN, especially Meloidogyne spp. Thus, there is a great need for a new eco-friendly, highly efficient, sustainable control measure for this nematode species. Keeping all these facts and after reviewing the literature, aqueous extract of Cymbopogon citratus, Tagetes erecta, and Azadirachta indica were prepared by adding distilled water (1 g sample mixed with 10ml of water). In vitro studies were conducted to evaluate the efficacious nature of targeted botanicals against PPN Meloidogyne spp. The mortality status of PPN was recorded by counting the live and dead individuals after applying 100μl of selected extract. The impact was observed at different time durations, i.e., 24h and 48h. The result showed that the highest 100% mortality was at 48h in all three extracts. Thus, these extracts, with the addition of a suitable shelf-life enhancer, may be exploited in different nematode control programs as an economical, sustainable measure.

Keywords: Meloidogyne, Cymbopogon citratus, Tagetes erecta, Azadirachta indica, nematicidal

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Authors: Kamakshaiah Kolli, R. Seshadri

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Water is a key resource in all economic activities ranging from agriculture to industry. Only a tiny fraction of the planet's abundant water is available to us as fresh water. Assessment of water quality has always been paramount in the field of environmental quality management. It is the foundation for health, hygiene, progress and prosperity. With ever increasing pressure of human population, there is severe stress on water resources. Therefore efficient water management is essential to civil society for betterment of quality of life. The present study emphasizes on the groundwater quality, sources of ground water contamination, variation of groundwater quality and its spatial distribution. The bases for groundwater quality assessment are groundwater bodies and representative monitoring network enabling determination of chemical status of groundwater body. For this study, water samples were collected from various areas of the entire corporation area of Guntur. Water is required for all living organisms of which 1.7% is available as ground water. Water has no calories or any nutrients, but essential for various metabolic activities in our body. Chemical and physical parameters can be tested for identifying the portability of ground water. Electrical conductivity, pH, alkalinity, Total Alkalinity, TDS, Calcium, Magnesium, Sodium, Potassium, Chloride, and Sulphate of the ground water from Guntur district: Different areas of the District were analyzed. Our aim is to check, if the ground water from the above areas are potable or not. As multivariate are present, Data mining technique using JRIP rules was employed for classifying the ground water.

Keywords: groundwater, water quality standards, potability, data mining, JRIP, PCA, classification

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Authors: Rajnish Gourh, Nitesh Sharma, Nikhil Patil

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Introduction: Adequate nutrition is essential for improving pregnancy and its outcomes. Failure to comply with the required daily intake of nutrition can lead to complications threatening both mother and child survival. Objectives: To provide access to nutritious diet to mothers in antenatal and post-natal stage for supporting a healthy progressive pregnancy, positive delivery outcome, and lactation and to promote regular consumption of the foods by the mothers and help overcome the dietary gap by nutrition education during pregnancy time. Methodology: Total of 95 ANC mothers were identified from Malvada PHC area, in Palghar district of Maharashtra. This short-term cohort intended for the proposed supplementation and education was targeted for follow-up until birth and six-months of post-natal period. In month of May 2016 to June 2017. Results: Average weight of women was observed 40.01kg, (SD- 5.024) at registered for ANC at Centre in the first month. In same month, average Haemoglobin level of women was observed 9.13gm/dl. Average increase in weight of women during pregnancy in month October 2016 was 48.83kg. Birth weight of 14 babies was less than 2 kgs. 13 babies with birth weight in range of 2.1kgs to 2.4kgs. 68 babies with birth weight in range of 2.5kg to 3kg and above. Conclusion: Importance of consumption of food, improving levels of nutrient intake and outcome of delivery was excellent.

Keywords: delivery status, nutrition, pregnancy, education

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Authors: Hirbaye Mokona, Abebaw Gebeyehu, Aemro Zerihun

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Introduction: Attention deficit hyperactivity disorder is serious public health problem affecting millions of children throughout the world. Method: A cross-sectional study conducted from May to June 2015 among children age 6 to 17 years living in rural area of Girja district. Multi-stage cluster sampling technique was used to select 1302 study participants. Disruptive Behavior Disorder rating scale was used to collect the data. Data were coded, entered and cleaned by Epi-Data version 3.1 and analyzed by SPSS version 20. Logistic regression analysis was used and Variables that have P-values less than 0.05 on multivariable logistic regression was considered as statistically significant. Results: Prevalence of Attention deficit hyperactivity disorder (ADHD) among children age 6 to 17 years was 7.3%. Being male [AOR=1.81, 95%CI: (1.13, 2.91)]; living with single parent [AOR=5.0, 95%CI: (2.35, 10.65)]; child birth order/rank [AOR=2.35, 95%CI: (1.30, 4.25)]; low family socio-economic status [AOR= 2.43, 95%CI: (1.29, 4.59)]; maternal alcohol/khat use during pregnancy [AOR=3.14, 95%CI: (1.37, 7.37)] and complication at delivery [AOR=3.56, 95%CI: (1.19, 10.64)] were more likely to develop Attention deficit hyperactivity disorder. Conclusion: In this study, the prevalence of Attention deficit hyperactivity disorder was similar with worldwide prevalence. Prevention and early management of its modifiable risk factors should be carryout alongside increasing community awareness.

Keywords: attention deficit hyperactivity disorder, ADHD, associated factors, children, prevalence

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Authors: Asish Subedi, Krishna Pokharel, Birendra Prasad Sah, Pashupati Chaudhary

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Objectives: To evaluate an association between preoperative Nepali pain catastrophizing scale (N-PCS) scores and postoperative pain intensity and total opioid consumption. Methods: In this prospective cohort study we enrolled 135 patients with an American Society of Anaesthesiologists physical status I or II, aged between 18 and 65 years, and scheduled for surgery for lower-extremity fracture under spinal anaesthesia. Maximum postoperative pain reported during the 24 h was classified into two groups, no-mild pain group (Numeric rating scale [NRS] scores 1 to 3) and a moderate-severe pain group (NRS 4-10). The Spearman correlation coefficient was used to compare the association between the baseline N-PCS scores and outcome variables, i.e., the maximum NRS pain score and the total tramadol consumption within the first 24 h after surgery. Logistic regression models were used to identify the predictors for the intensity of postoperative pain. Results: As four patients violated the protocol, the data of 131 patients were analysed. Mean N-PCS scores reported by the moderate-severe pain group was 27.39 ±9.50 compared to 18.64 ±10 mean N-PCS scores by the no-mild pain group (p<0.001). Preoperative PCS scores correlated positively with postoperative pain intensity (r =0.39, [95% CI 0.23-0.52], p<0.001) and total tramadol consumption (r =0.32, [95% CI 0.16-0.47], p<0.001). An increase in catastrophizing scores was associated with postoperative moderate-severe pain (odds ratio, 1.08 [95% confidence interval, 1.02-1.15], p=0.006) after adjusting for gender, ethnicity and preoperative anxiety. Conclusion: Patients who reported higher pain catastrophizing preoperatively were at increased risk of experiencing moderate-severe postoperative pain.

Keywords: nepali, pain catastrophizing, postoperative pain, trauma

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Authors: Ikram Metalsi

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English as a Medium of Instruction known as (EMI) is expanding rapidly in the world. A growing volume of research has been dedicated to investigating its implementation. However, considerably less attention has been given to understanding EMI in a context where its implementation has been discussed but not yet put into practice. One such context is Algeria, where talks about a possible implementation of EMI have been going on for some time. The present study examines the current discourses and university lecturers’ attitudes towards the potential implementation of EMI as well as investigating the current implicit and explicit language policies in scientific courses in Algerian state universities. The focus is specifically on Engineering departments, as this field has gained worldwide importance in EMI research (Macaro et al. 2018), and, traditionally, French has been the MOI for Engineering in Algerian universities. Using the ROADMAPPING framework (Dafouz and Smit 2016) and the mixed method research approach, the present work explores the language in education policy (LEP) and planning situation in Algeria, the current media of instruction as well as the status and use of the English language in the scientific courses of the tertiary sector. Finally, the current study explores the perceived challenges and benefits of the implementation of EMI programmes from teachers’ perspectives with a particular focus on agency and how this potential policy implementation and teachers’ perceptions of agency around it may reflexively influence their professional identity.

Keywords: media of instruction, language in education policy, lecturers attitudes, teacher agency, professional identity

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Authors: Surachart Koyadun

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Introduction: Plasmodium knowlesi (P. knowlesi) malaria is a zoonotic disease that is classified as type 5 of human malaria. Commonly found in macaques (Macaca fascicularis) and (Macaca nemestrina), P. knowlesi is capable of resulting in both uncomplicated and severe malaria in humans. Situation of P. knowlesi malaria in Phang-Nga province for the past 3 years from 2020 – 2022 revealed no case report in 2020, however, a total of 14 cases had been reported in 2021 - 2022. This research aimed to 1) study the epidemiology of P. knowlesi, 2) examine the clinical manifestations of P. knowlesi patients, 3) analyze the ecology and entomology of P. knowlesi, and 4) analyze the diagnosis and treatment of P. knowlesi. Method: This research was a retrospective descriptive study/case report. The study was conducted in 14 patients with P. knowlesi malaria between 2021 and 2022 in 4 districts of Phang-Nga Province, Thailand including Thapput, Kapong, Takuapa and Khuraburi. Results: The study subjects of P. knowlesi malaria were all males. Most of them were working age groups as farmers and worked in forest or plantation areas. All had no history of blood transfusions. Most of the patients did not use mosquito nets and had a history of camping in the forest prior to the onset of fever. An analysis of all 14 sources of infection unveiled the area is home to macaques, and that area has detected Anopheles mosquito, which is the carrier of the disease. Majority of them got sick in the dry season of Thailand (December-April). The main symptoms brought to the hospital were fever, chills, headache, body aches. Laboratory findings on the first day of diagnosis were as follows: The white blood cell count was found within the normal range. In the proportion of white blood cells, eosinophils were found to be slightly higher than normal. Slight anemia was found on early examination. The platelet count was found to be below normal in all cases. Severely low platelet count (2,000 cells/mm3) was found in severe cases with multiple complications. No patient was found dead but 85.7% of complications were found, with acute renal failure being the most common. Patients with delayed diagnosis and treatment of malaria (inaccurate diagnosis or late access to the hospital) had the highest severity and complications than those who had seen the doctor since the first 3-4 days of illness or the screening of symptoms and risk history by the malaria clinic staff at vector-borne disease control unit. Conclusion and Recommendation: P. knowlesi malaria is an emerging infectious disease transmitted from animals to humans. There are challenges in epidemiology, entomology, ecology for effective surveillance, prevention and control. Early diagnosis and treatment would reduce complications and prevent death.

Keywords: malaria, plasmodium knowlesi, epidemiology, ecology, entomology, diagnosis, treatment

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