Search results for: surgical intensive care unite

Authors: A. F. Suleimanov, A. B. Saduakassova, V. S. Pokrovsky, D. V. Vinnikov

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Relevance: Epithelial ovarian cancer (EOC) is the most lethal gynecological malignancy, with relapse occurring in about 70% of advanced cases with poor prognoses. The aim of the study was to evaluate functional visceral fat activity (VAT) evaluated by ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) as a predictor of metastases in epithelial ovarian cancer (EOC). Materials and methods: We assessed 53 patients with histologically confirmed EOC who underwent ¹⁸F-FDG PET/CT after a surgical treatment and courses of chemotherapy. Age, histology, stage, and tumor grade were recorded. Functional VAT activity was measured by maximum standardized uptake value (SUVₘₐₓ) using ¹⁸F-FDG PET/CT and tested as a predictor of later metastases in eight abdominal locations (RE – Epigastric Region, RLH – Left Hypochondriac Region, RRL – Right Lumbar Region, RU – Umbilical Region, RLL – Left Lumbar Region, RRI – Right Inguinal Region, RP – Hypogastric (Pubic) Region, RLI – Left Inguinal Region) and pelvic cavity (P) in the adjusted regression models. We also identified the best areas under the curve (AUC) for SUVₘₐₓ with the corresponding sensitivity (Se) and specificity (Sp). Results: In both adjusted-for regression models and ROC analysis, ¹⁸F-FDG accumulation in RE (cut-off SUVₘₐₓ 1.18; Se 64%; Sp 64%; AUC 0.669; p = 0.035) could predict later metastases in EOC patients, as opposed to age, sex, primary tumor location, tumor grade, and histology. Conclusions: VAT SUVₘₐₓ is significantly associated with later metastases in EOC patients and can be used as their predictor.

Keywords: ¹⁸F-FDG, PET/CT, EOC, predictive value

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Authors: Woei-Shyan Lee, Hao-Chien Kao

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The impact deformation and fracture behaviour of cobalt-based Haynes 188 superalloy are investigated by means of a split Hopkinson pressure bar. Impact tests are performed at strain rates ranging from 1×103 s-1 to 5×103 s-1 and temperatures between 25°C and 800°C. The experimental results indicate that the flow response and fracture characteristics of cobalt-based Haynes 188 superalloy are significantly dependent on the strain rate and temperature. The flow stress, work hardening rate and strain rate sensitivity all increase with increasing strain rate or decreasing temperature. It is shown that the impact response of the Haynes 188 specimens is adequately described by the Zerilli-Armstrong fcc model. The fracture analysis results indicate that the Haynes 188 specimens fail predominantly as the result of intensive localised shearing. Furthermore, it is shown that the flow localisation effect leads to the formation of adiabatic shear bands. The fracture surfaces of the deformed Haynes 188 specimens are characterised by dimple- and / or cleavage-like structure with knobby features. The knobby features are thought to be the result of a rise in the local temperature to a value greater than the melting point.

Keywords: Haynes 188 alloy, impact, strain rate and temperature effect, adiabatic shearing

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Authors: Yan Ding, Fei Yan, Ji Liang, Hong Jiang, Xiaoguang Yang, Xu Qian

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The health status of GonjiKolela District, Amhara Region, Ethiopia is below its national average, and a sub-project of China UK Global Health Support Programme (GHSP) is expected to increase the uptake of a suite of reproductive, maternal, newborn and child health (RMNCH) interventions there. To explore what is on the ground and what could be helpful for the uptake of RMNCH services in GonjiKolela, a qualitative study was performed as part of the baseline assessment before the implementation of the project. Nine key informants from GonjiKolela were interviewed with self-designed interview guides and they were from the district Health Office, health centers, health posts, women health development army (community volunteer groups), mothers of newborns, and also a gynecologist from the maternal and child health center which is the referral center for pregnant women for this project. The interview were transcribed into words and sorted with qualitative analysis software MAXqda. Content analysis was mainly used to analyze the data. The district health office, the health centers and the health posts all had focal persons taking care of the management and provision of RMNCH services, and RMNCH related indicators were recorded and reported at each level routinely. In addition, district government and administration at community/administrative village level kept a close eye on the reduction of maternal, neonatal and child mortality. Women Health Development Amy at household level supported health workers at community/administrative village level (called health extension workers) in tracing, recording and reporting pregnant women, newborn and under-five children,organizing events for health education, demonstrating and leading health promotion activities, and stimulating the utilization of RMNCH.

Keywords: Reproductive Maternal Newborn and Child Health, Health Care Utilization, Qualitative Study, Ethiopia

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Authors: Balqees A. Al-Thuhli, Ali H. Al-Badi, Khamis Al-Gharbi

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Information technology is changing rapidly and the users’ expectations are also growing. Dealing with these changes in information technology, while satisfying the users’ needs and expectations is a big challenge. IT managers need to explore new mechanisms/strategies to enable them to cope with such challenges. The objectives of this research are to identify the significant challenges that might face IT managers in higher education institutes in the face of the high and ever growing customer expectations and to propose possible solutions to cope with such high-speed changes in information technology. To achieve these objectives, interviews with the IT professionals from different higher education institutes in Oman were conducted. In addition, documentation (printed and online) related to these institutions were studied and an intensive literature review of published work was examined. The findings of this research are expected to give a better understanding of the challenges that might face the IT managers at higher education institutes. This acquired understanding is expected to highlight the importance of being adaptable and fast in keeping up with the ever-growing technological changes. Moreover, adopting different tools and technologies could assist IT managers in developing their organisations’ IT policies and strategies.

Keywords: information technology, rapid change, CIO roles, challenges, IT managers, coping mechanisms, users' expectations

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Authors: Sorour Semsari Parapari, Mehmet Ali Gülgün, Melih Papila

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Cement production is one of the most energy-intensive processes consuming a high amount of thermal energy. Nowadays, alternative fuels are being used in cement manufacturing in a large scale as a help to provide the necessary energy. The alternative fuels could consist of any disposal like waste plastics, used tires and biomass. It has been suggested that the clinker properties might be affected by using these fuels because of foreign elements incorporation to the composition. Studying the distribution of clinker phases and their chemical composition is possible with scanning electron microscopy (SEM). In this study, clinker samples were produced using different alternative fuels in cement firing kilns. The microstructural observations by back-scattered electrons (BSE) mode in SEM (JEOL JSM-6010LV) showed that the clinker phase distribution was dissimilar in samples prepared with different alternative fuels. The alite to belite (a/b) phase content of samples was quantified by image analysis. The results showed that the a/b varied between 5.2 and 1.5 among samples as the average value for six clinker nodules. The elemental analysis by energy-dispersive x-ray spectroscopy (EDS) mounted on SEM indicated the variation in chemical composition among samples. Higher amounts of sulfur and alkalis seemed to reduce the alite phase formation in clinkers.

Keywords: alternative fuels, cement clinker, microstructure, SEM

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Authors: Anum Obaid, Bushra Noor, Zoshia Zainab

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In South Asian countries, Pakistan faces significant public health challenges regarding maternal and neonatal health (MNH). Despite global efforts to improve maternal, newborn, child, and health (MNCH) outcomes through initiatives like the Millennium Development Goals (MDGs) and Sustainable Development Goals (SDGs), high maternal and neonatal mortality rates persist. In patriarchal societies, cultural norms, family dynamics, and gender roles heavily influence healthcare accessibility and decision-making processes, often leading to delayed and inadequate maternal care. Addressing these socio-cultural barriers and enhancing healthcare resources is crucial to improving maternal health outcomes in areas like Faisalabad. A qualitative study was conducted involving two groups of informants: gynecologists practicing in private clinics and first-time pregnant women receiving care in government hospitals. Data collection included obtaining institutional permission, conducting semi-structured in-depth interviews, and using non-probability sampling techniques. A proactive strategy to overcome maternal health challenges involves using aversion therapy and disseminating knowledge among family members. This approach aims to foster a deep understanding within the family unit regarding the importance of maternal well-being, thereby creating a supportive environment and facilitating informed decision-making related to healthcare access and lifestyle choices. The findings indicate that maternal health is compromised both physiologically and psychologically, with significant implications for the baby's health. Mental well-being is profoundly affected, largely due to familial behavior and entrenched cultural taboos.

Keywords: maternal health, neonatal health, socio-cultural norms, primigravida women, gynecologist, familial conduct, cultural taboos

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Authors: Elena Kovalevich, Irina Tomasheva

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The research relevance is caused by the importance of studying features of cross-cultural communication in the system of intensive language contacts, on the one hand, and on the other – by the need of control over the language situation as cross-cultural contacts often reflect emotionally intense reality, destructive for national culture and language and also for health and mentality of the individual. The objective consists in systematization of requirements imposed by the globalized society on ethics, aesthetics and emotive component of cross-cultural communication under conditions of language hybridization of modern Russian-speaking society. Problems connected with establishing the criteria differentiating eco-friendly and eco-unfriendly communication; identifying the specifics of the eco-unfriendly communication containing language hybrids; justifying the negative impact of language hybridization on ethics and esthetics of cross-cultural communication are considered, taking into account the category of emotivity. The study makes a contribution to the development of key problems of modern linguistics connected with exploration of basics in the theory of language personality, ecology of language, emotive linguistics. The results can be used by specialists in the fields of sociolinguistics, cross-cultural communication, the national language policy.

Keywords: cross-cultural communication, eco-linguistics, ethics and aesthetics, emotivity, language hybrids

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Authors: Kriti Jain, Sucha Singh Gill

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Subsidies have been a major part of agricultural policies around the world, and more extensively since the green revolution in developing countries, for the sake of attaining higher agricultural productivity and achieving food security. But entrenched subsidies lead to distorted incentives and promote inefficiencies in the agricultural sector, threatening the viability of these very subsidies and sustainability of the agricultural production systems, posing a threat to the livelihood of farmers and laborers dependent on it. This paper analyzes the economic and ecological sustainability implications of prolonged input and output subsidies in agriculture by studying the case of Indian Punjab, an agriculturally developed state responsible for ensuring food security in the country when it was facing a major food crisis. The paper focuses specifically on the environmentally unsustainable cropping pattern changes as a result of Minimum Support Price (MSP) and assured procurement and on the resource use efficiency and cost implications of power subsidy for irrigation in Punjab. The study is based on an analysis of both secondary and primary data sources. Using secondary data, a time series analysis was done to capture the changes in Punjab’s cropping pattern, water table depth, fertilizer consumption, and electrification of agriculture. This has been done to examine the role of price and output support adopted to encourage the adoption of green revolution technology in changing the cropping structure of the state, resulting in increased input use intensities (especially groundwater and fertilizers), which harms the ecological balance and decreases factor productivity. Evaluation of electrification of Punjab agriculture helped evaluate the trend in electricity productivity of agriculture and how free power imposed further pressure on the extant agricultural ecosystem. Using data collected from a primary survey of 320 farmers in Punjab, the extent of wasteful application of groundwater irrigation, water productivity of output, electricity usage, and cost of irrigation driven electricity subsidy to the exchequer were estimated for the dominant cropping pattern amongst farmers. The main findings of the study revealed how because of a subsidy has driven agricultural framework, Punjab has lost area under agro climatically suitable and staple crops and moved towards a paddy-wheat cropping system, that is gnawing away the state’s natural resources like water table has been declining at a significant rate of 25 cms per year since 1975-76, and excessive and imbalanced fertilizer usage has led to declining soil fertility in the state. With electricity-driven tubewells as the major source of irrigation within a regime of free electricity and water-intensive crop cultivation, there is both wasteful application of irrigation water and electricity in the cultivation of paddy crops, burning an unproductive hole in the exchequer’s pocket. There is limited access to both agricultural extension services and water-conserving technology, along with policy imbalance, keeping farmers in an intensive and unsustainable production system. Punjab agriculture is witnessing diminishing returns to factor, which under the business-as-usual scenario, will soon enter the phase of negative returns to factor.

Keywords: cropping pattern, electrification, subsidy, sustainability

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Authors: Syeda Sahra, Abdullah Jahangir, Rachelle Hamadi, Ahmad Jahangir, Allison Glaser

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Background: Antimicrobial resistance is on the rise. The use of redundant and inappropriate antibiotics is contributing to recurrent infections and resistance. Newer antibiotics with more robust coverage for gram-negative bacteria are in great demand for complicated urinary tract infections (cUTIs), complicated intra-abdominal infections (cIAIs), hospital-acquired bacterial pneumonia (H.A.B.P.), and ventilator-associated bacterial pneumonia (V.A.B.P.). Objective: We performed this meta-analysis to evaluate the efficacy and safety profile of a new antibiotic, Imipenem/cilastatin/relebactam, compared to other broad-spectrum antibiotics for complicated infections. Search Strategy: We conducted a systemic review search on PubMed, Embase, and Central Cochrane Registry. Selection Criteria: We included randomized clinical trials (R.C.T.s) with the standard of care as comparator arm with Imipenem/cilastatin/relebactam as intervention arm. Analysis: For continuous variables, the mean difference was used. For discrete variables, we used the odds ratio. For effect sizes, we used a confidence interval of 95%. A p-value of less than 0.05 was used for statistical significance. Analysis was done using a random-effects model irrespective of heterogeneity. Heterogeneity was evaluated using the I2 statistic. Results: The authors observed similar efficacy at clinical and microbiologic response levels on early follow-up and late follow-up compared to the established standard of care. The incidence of drug-related adverse events, serious adverse events, and drug discontinuation due to adverse events were comparable across both groups. Conclusion: Imipenem/cilastatin/relebactam has a non-inferior safety and efficacy profile compared to peer antibiotics to treat severe bacterial infections (cUTIs, cIAIs, H.A.B.P., V.A.B.P.).

Keywords: bacterial pneumonia, complicated intra-abdominal infections, complicated urinary tract infection, Imipenem, cilastatin, relebactam

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Authors: Shruti Sengupta

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According to the nationally representative data, about 73% of India's rural workforce is engaged in agriculture. While women make significant contributions to total agriculture production, they contribute to about one-third in India. In terms of gender composition, about 80% of the female and 69% of the male workforce is engaged in agriculture in rural India. Still, it is common to find gender differences in plot management within the household. In the last two and half years, India's agri-food system has undergone several changes due to this pandemic, both the demand and supply side, making agriculture more information and knowledge-intensive. Therefore, this paper investigates, using a nationally representative sample, how information asymmetry affects the net returns per hectare of land between female and male farm managers. Empirical results show that information intensity has a significant positive effect on net farm returns per hectare. Results suggest that if females have the same access to technical information as their male counterparts, their farm income can go up by .96 pp compared to male-headed farms. Results also indicate that literate females have higher farm incomes than non-literate females. The study contributes to the literature by employing gender differentials in farm income due to the information gap.

Keywords: agriculture, gender, information asymmetry, farm income, social bias

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Authors: Remya Radhakrishnan, Hema Perinbanathan, Anukriti Rath, Reshmi Ramachandran, Rohith Thazhathuvetil Sasindrababu, Maria Karizhenskaia

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Childhood adversities have lasting effects on health and well-being. This abstract explores the connection between adverse childhood experiences (ACEs) and health consequences, including substance abuse and obesity. Understanding the impact of childhood trauma and emphasizing the importance of culturally sensitive treatments and focused interventions help to mitigate these effects. Research consistently shows a strong link between ACEs and poor health outcomes. Our team conducted a comprehensive literature review of depression and anxiety in Canadian children and youth, exploring diverse treatment methods, including medical, psychotherapy, and alternative therapies like art and music therapy. We searched Medline, Google Scholar, and St. Lawrence College Library. Only original research papers, published between 2012 and 2023, peer-reviewed, and reporting on childhood adversities on health and its treatment methods in children and youth in Canada were considered. We focused on their significance in treating depression and anxiety. According to the study's findings, the prevalence of adverse childhood experiences (ACEs) is still a significant concern. In Canada, 40% of people report having had multiple ACEs, and 78% report having had at least one ACE, highlighting the persistence of childhood adversity and indicating that the issue is unlikely to fade off in the near future. Likewise, findings revealed that individuals who experienced abuse, neglect, or violence during childhood are likelier to engage in harmful behaviors like polydrug use, suicidal ideation, and victimization and suffer from mental health problems such as depression and post-traumatic stress disorder (PTSD).

Keywords: adverse childhood experiences (ACEs), obesity, post-traumatic stress disorder (PTSD), resilience, substance abuse, trauma-informed care

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Authors: Abbas Ali Husseini, Ali Mohammad Yazdani, Fatemeh Ghadiri, Alper Şişman

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We developed a microchip device that uses surface acoustic waves for rapid lysis of low level of cell samples. The device incorporates sharp-edge glass microparticles for improved performance. We optimized the lysis conditions for high efficiency and evaluated the device's feasibility for point-of-care applications. The microchip contains a 13-finger pair interdigital transducer with a 30-degree focused angle. It generates high-intensity acoustic beams that converge 6 mm away. The microchip operates at a frequency of 16 MHz, exciting Rayleigh waves with a 250 µm wavelength on the LiNbO3 substrate. Cell lysis occurs when Candida albicans cells and glass particles are placed within the focal area. The high-intensity surface acoustic waves induce centrifugal forces on the cells and glass particles, resulting in cell lysis through lateral forces from the sharp-edge glass particles. We conducted 42 pilot cell lysis experiments to optimize the surface acoustic wave-induced streaming. We varied electrical power, droplet volume, glass particle size, concentration, and lysis time. A regression machine-learning model determined the impact of each parameter on lysis efficiency. Based on these findings, we predicted optimal conditions: electrical signal of 2.5 W, sample volume of 20 µl, glass particle size below 10 µm, concentration of 0.2 µg, and a 5-minute lysis period. Downstream analysis successfully amplified a DNA target fragment directly from the lysate. The study presents an efficient microchip-based cell lysis method employing acoustic streaming and microparticle collisions within microdroplets. Integration of a surface acoustic wave-based lysis chip with an isothermal amplification method enables swift point-of-care applications.

Keywords: cell lysis, surface acoustic wave, micro-glass particle, droplet

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Authors: Elizabeth Perry, Jylana Sheats

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Scholars posit that there is an overlap between the fields of Behavioral Economics (BE) and Behavior Science (BSci)—and that consideration of concepts from both may facilitate a greater understanding of health decision-making processes. For example, the ‘intention-action gap’ is one BE concept to explain sup-optimal decision-making. It is described as having knowledge that does not translate into behavior. Complementary best BSci practices may provide insights into behavioral determinants and relevant behavior change techniques (BCT). Within the context of BSci, this exploratory study aimed to apply a BE concept with demonstrated effectiveness in financial decision-making to a health behavior: influenza (flu) vaccine uptake. Adults aged >18 years were recruited on Amazon’s Mechanical Turk, a digital labor market where anonymous users perform simple tasks at low cost. Eligible participants were randomized into 2 groups, reviewed a scenario, and then completed a survey on the likelihood of receiving a flu shot. The ‘usual care’ group’s scenario included standard CDC guidance that supported the behavior. The ‘intervention’ group’s scenario included messaging about people who did not receive the flu shot. The framing was such that participants could learn from others’ (strangers) mistakes and the subsequent health consequences: ‘Last year, other people who didn’t get the vaccine were about twice as likely to get the flu, and a number of them were hospitalized or even died. Don’t risk it.’ Descriptive statistics and chi-square analyses were performed on the sample. There were 648 participants (usual care, n=326; int., n=322). Among racial/ethnic minorities (n=169; 57% aged < 40), the intervention group was 22% more likely to report that they were ‘extremely’ or ‘moderately’ likely to get the flu vaccine (p = 0.11). While not statistically significant, findings suggest that framing messages from the perspective of learning from the mistakes of unknown others coupled with the BCT ‘knowledge about the health consequences’ may help influence flu vaccine uptake among the study population. With the widely documented disparities in vaccine uptake, exploration of the complementary application of these concepts and strategies may be critical.

Keywords: public health, decision-making, vaccination, behavioral science

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Authors: Hela Ghali, Oumayma Ben Amor, Salwa Khefacha, Mohamed Ben Rejeb, Sirine Frigui, Meriam Tourki Dhidah, Lamine Dhidah, Houyem Said Laatiri

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Background: Blood exposure accidents are the most common problem in hospitals that threaten healthcare professionals with a high risk of infectious complications which weighs heavily on health systems worldwide. Paramedics are the highest risk group due to the nature of their daily activities. We aimed to determine knowledge and attitudes about the management of blood-exposure accidents among nurses and technicians in two pediatric departments. Materials/Methods: This is a cross-sectional descriptive study conducted on March 2017, carried out with the care staff of the pediatric ward of the Farhat Hached Teaching Hospital of Sousse and pediatric surgery of the Fattouma Bourguiba University Hospital in Monastir, using a pre- tested and self-administered questionnaire. Data entry and analysis were performed using Excel software. Results: The response rate was 85.1%. A female predominance (82.5%) was reported among respondents with a sex ratio of 0.21. 80% of the participants were under 35 years old. Seniority of less than 10 years was found in 77.5% of respondents. Only 22.5% knew the definition of a blood- exposure accident. 100% and 95% of participants reported the relative risk, respectively, to hepatitis and AIDS viruses. However, only 15% recognized the severity factors of a blood-exposure accident. Hygiene compliance was the most important dimension for almost the entire population for the prevention. On the other hand, only 12.5% knew the meaning of 'standard precautions' and ¼ considered them necessary for at-risk patients only. 40% reported being exposed at least once, among them, 87.5% used betadine, and 77.5% said that anti-infectious chemoprophylaxis is necessary regardless of the patient's serological status. However, 52.5% did not know the official reporting circuit of management of blood-exposure accident in their institutions. Conclusion: For better management of risks in hospitals and an improvement of the safety of the care, a reinforcement of the sensibilization of the caregivers with regard to the risks of blood exposure accident is necessary, while developing their knowledge to act in security.

Keywords: attitudes, blood-exposure accident, knowledge, pediatric department

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Authors: Chaich Hamza Walid

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The primary goal of this paper is to question the situation of men’s place in D.H Lawrence’s Sons and Lovers. Our question is what is the role of each man in the novel? And how a mother’s possessiveness had changed the life of all men in the family? David Herbert Lawrence was an important and controversial English writer of the 20th century. He wrote many great works, one of his most popular novels, Sons and Loves, is an autobiographical account of his youth. This novel is about the life of the Morels. The author develops the story by portraying the relationships between many characters, especially the male ones we focus on. ‘Sons and Lovers’ seems to be written especially to women, all what Lawrence wrote is about women but when we go deeper, we see that Lawrence was also interested in men. This work will approach the question in two ways. The first chapter will deal with men’s place in D.H Lawrence’s Sons and Lovers, more exactly with Paul and his father Walter Morel, and with Baxter Dawes. We will focus on each man’s behavior with one another. In the second chapter, we will analyze possessiveness, that is to say, the desire of holding or having someone as one’s own or under one’s control. We will try to prove this view from the spiritual and symbolic possession of different relationships. Our study will be through an intensive psychological analysis of a wife’s possessiveness to her husband, and a mother’s possessiveness to her son’s; William and Paul. The conclusion will review all the important aspects of this analysis. It is very important to know about men’s relationships in D.H Lawrence’s Sons and Lovers this will give us another vision of the novel, and where we can situate Paul’s true relationships, that is to say, his relationships with his father and the other men in the novel.

Keywords: language, literature, English, civilisation

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Authors: Kathryn Rooney, Kaitlyn Eddy, Evan Landers, Weihui Li

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The international mortality rate for neonates and infants has been declining at a disproportionally low rate when compared to the overall decline in child mortality in recent decades. A significant portion of infant deaths could be prevented with the implementation of low-cost and easy to use physiological monitoring devices, by enabling early identification of symptoms before they progress into life-threatening illnesses. The oral diagnostic device discussed in this paper serves to continuously monitor the key vital signs of body temperature, respiratory rate, heart rate, and oxygen saturation. The device mimics an infant pacifier, designed to be easily tolerated by infants as well as orthodontically inert. The fundamental measurements are gathered via thermistors and a pulse oximeter, each encapsulated in medical-grade silicone and wired internally to a microcontroller chip. The chip then translates the raw measurements into physiological values via an internal algorithm, before outputting the data to a liquid crystal display screen and an Android application. Additionally, a biological sample collection chamber is incorporated into the internal portion of the device. The movement within the oral chamber created by sucking on the pacifier-like device pushes saliva through a small check valve in the distal end, where it is accumulated and stored. The collection chamber can be easily removed, making the sample readily available to be tested for various diseases and analytes. With the vital sign monitoring and sample collection offered by this device, abnormal fluctuations in physiological parameters can be identified and appropriate medical care can be sought. This device enables preventative diagnosis for infants who may otherwise have gone undiagnosed, due to the inaccessibility of healthcare that plagues vast numbers of underprivileged populations.

Keywords: neonate mortality, infant mortality, low-cost diagnostics, vital signs, saliva testing, preventative care

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Authors: Zaman Jawahar, Anne Rouve-Khiev, Elizabeth Hoban, Joanne Williams

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Ensuring access to timely obstetric care is essential to prevent maternal deaths. Geographical barriers pose significant challenges for women accessing quality reproductive and maternal health services in rural Cambodia. This policy brief affirms the need to address the issue of transportation and cost (direct and indirect) as critical barriers to accessing reproductive and maternal health (RMH) services in four provinces in Northeast Cambodia (Kratie, Ratanak Kiri, Mondul Kiri, Stung Treng). A systemic search of the literature identified 1,116 articles, and only ten articles from low-and-middle-income countries met the inclusion criteria. The ten articles reported on transportation and cost related to accessing RMH services. In addition, research findings from Partnering to Save Lives (PSL) studies in the four provinces were included in the analysis. Thematic data analysis using the information in the ten articles and PSL research findings was conducted, and the findings are presented in this paper. The key findings are the critical barriers to accessing RMH services in the four provinces because women experience: 1) difficulties finding affordable transportation; 2) lack of available and accessible transportation; 3) greater distance and traveling time to services; 4) poor geographical terrain and; 5) higher opportunity costs. Distance and poverty pose a double burden for the women accessing RMH services making a facility-based delivery less feasible compared to home delivery. Furthermore, indirect and hidden costs associated with institutional delivery may have an impact on women’s decision to seek RMH care. Existing health financing schemes in Cambodia such as the Health Equity Fund (HEF) and the Voucher Scheme contributed to the solution but have also shown some limitations. These schemes contribute to improving access to RMH services for the poorest group, but the barrier of transportation costs remains. In conclusion, initiatives that are proven to be effective in the Cambodian context should continue or be expanded in conjunction with the HEF, and special consideration should be given to communities living in geographically remote regions and difficult to access areas. The following strategies are recommended: 1) maintain and further strengthen transportation support in the HEF scheme; 2) expand community-based initiatives such as Community Managed Health Equity Funds and Village Saving Loans Associations; 3) establish maternity waiting homes; and 4) include antenatal and postnatal care in the provision of integrated outreach services. This policy brief can be used to inform key policymakers and provide evidence that can assist them to develop strategies to increase poor women’s access to RMH services in low-income settings, taking into consideration the geographic distance and other indirect costs associated with a facility-based delivery.

Keywords: access, barriers, northeast Cambodia, reproductive and maternal health service, transportation and cost

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Authors: Shu-Hui Wen, Wei-Chuan Chang, Hsien-Chang Wu

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Background: Little is known about the benefits and risks of use of Chinese herbal medicine (CHM) in conditions related to hormone therapy (HT) use on the risk of ischemic stroke (IS). The aim of this study is to explore the risk of IS in menopausal women treated with HT and CHM. Materials and methods: A total of 32,441 menopausal women without surgical menopause aged 40- 65 years were selected from 2003 to 2010 using the 2-million random samples of the National Health Insurance Research Database in Taiwan. According to the medication usage of HT and CHM, we divided the current and recent users into two groups: an HT use-only group (n = 4,989) and an HT/CHM group (n = 9,265). Propensity-score matching samples (4,079 pairs) were further created to deal with confounding by indication. The adjusted hazard ratios (HR) of IS during HT or CHM treatment were estimated by the robust Cox proportional hazards model. Results: The incidence rate of IS in the HT/CHM group was significantly lower than in the HT group (4.5 vs. 12.8 per 1000 person-year, p < 0.001). Multivariate analysis results indicated that additional CHM use was significant with a lower risk of IS (HR = 0.3; 95% confidence interval, 0.21-0.43). Further subgroup analyses and sensitivity analyses had similar findings. Conclusion: We found that combined use of HT and CHM was associated with a lower risk for IS than HT use only. Further study is needed to examine possible mechanism underlying this association.

Keywords: Chinese herbal medicine, hormone therapy, ischemic stroke, menopause

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Authors: Rashed Shah, Jeanne Koepsell, Dixmer Rivera, Eric Swedberg, David Marsh

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Success of primary health care goals of health promotion and disease prevention may well be determined by community based health workers’ overall job satisfaction. It is also important to understand the ways community health workers perceive their jobs and the importance they give to the various factors influencing their job satisfaction, which is critical before making a decision for task-shifting and for expanding their scope of work. Although brigadistas are unpaid volunteers, they are formally recognized and receive support and supervision from the Ministry of Health in Nicaragua. Brigadistas are responsible for classifying and diagnosing illnesses, administering treatment, counseling mothers and care givers within the community, encouraging referral in case of serious illness and making follow-up visits at home. Some brigadistas provide more technically advanced services, including treatment for pneumonia, diarrhea, malaria and tuberculosis and/or distribution of contraceptives. Expanding brigadistas’ duties could threaten their heretofore ‘job satisfaction’. This study primarily aims to report on job satisfaction of brigadistas in Nicaragua before expanding the scope of their work by adding more responsibilities. The study was guided by the following research questions: 1) What aspects of their job made the brigadistas satisfied or dissatisfied? 2) What is the job satisfaction level of brigadistas in Nicaragua? This cross-sectional study was conducted during March – July 2014, to assess brigadistas’ job satisfaction, prior to deciding on inclusion of care for sick newborns and young infants (<2 months of age) to brigadistas’ existing service package of community case management for children of 2-59 months of age. Following stratified random sampling strategy, 15 brigadistas were randomly selected from each of the following four strata: [(1) females under 25 years of age, (2) females over 30 years of age, (3) males under 25 years of age, and (4) males over 30 years of age. Out of 45 completed in-person interview with eligible and available brigadistas, 20 (44.4%) were with female and 25 (55.6%) were with male respondents; the mean age (±sd) was found as 32.0 (±3.2) years. About 53% (24/45) brigadista mentioned “Training” as the most helpful for performing their job. Another 31% (14/45) mentioned that “feeling of doing good, supporting community, women and children” was helpful to perform their job well. When asked about difficulty, about 35.5% (16/45) brigadistas mentioned about “Lack of time” due to their responsibilities in family, farm, other work places, study and such time constraint made their job performance difficult. Measured on a 0-5 scale, estimated average job satisfaction was 4.2. Current trends in task-shifting and integrated program delivery require community health workers (like the brigadistas) to deliver several essential services, including maternal, newborn and child health, and family planning, and thereby increasing their responsibilities. Given the reported level of job satisfaction among brigadistas (4.2 out of 5), and the mentioned difficulty in performing their current job (as ‘Lack of Time’) in this study results, the policy makers and program managers in MOH should be cautious enough before making a decision to expand current scope of work for brigadistas in Nicaragua.

Keywords: Brigadisata, job satisfaction, Nicaragua, task-shifting

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Authors: Nusret Mesut Sahin

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Hrant Dink, a prominent Turkish-Armenian journalist, and editor-in-chief of the bilingual Turkish-Armenian newspaper Agos, was assassinated in Istanbul on January 19th, 2007 by a nationalist extremist, Ogun Samast. Dink had been voicing the atrocities against the Armenians between 1915 and 1922 during the Ottoman rule, and his comments on the issue appeared in the Turkish media many times before his assassination. Despite intensive media coverage of his assassination, there is not enough research analyzing how national and international media presented Dink’s assassination. In this research, a content analysis of national and international news articles (N= 139) is conducted to identify whether there is a significant difference in national and international media’s coverage of the assassination. The content of the newspaper articles is categorized and coded according to the topics covered. The findings of this research suggested that Dink’s assassination wounded Turkey’s image as a democratic country. It has also been found that the Turkish media focused on security forces and their responsibility in Dink’s assassination, whereas international media focused more on the Article 301 of the Turkish penal code, freedom of expression, and atrocities against the Armenians during the Ottoman rule.

Keywords: Hrant Dink, Armenian, journalist, assassination

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Authors: Shruti Sengupta

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According to the nationally representative data, about 73% of India's rural workforce is engaged in agriculture. While women make significant contributions to total agriculture production, they contribute to about one-third in India. In terms of gender composition, about 80% of the female and 69% of the male workforce is engaged in agriculture in rural India. Still, it is common to find gender differences in plot management within the household. In the last two and half years, India's agri-food system has undergone several changes due to this pandemic, both the demand and supply side, making agriculture more information and knowledge-intensive. Therefore, this paper investigates, using a nationally representative sample, how information asymmetry affects the net returns per hectare of land between female and male farm managers. Empirical results show that information intensity has a significant positive effect on net farm returns per hectare. Results suggest that if females have the same access to technical information as their male counterparts, their farm income can go up by .96 pp compared to male-headed farms. Results also indicate that literate females have higher farm incomes than non-literate females. The study contributes to the literature by employing gender differentials in farm income due to the information gap.

Keywords: agriculture, gender, information asymmetry, farm income, social bias

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Authors: Michelangelo Liban, Debbie Liquete

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A case of a 93-year-old Filipina who experienced a sudden onset of left-sided hemichorea hemiballismus after falling from a standing height due to dizziness and then sought consult at the Emergency Room. She was not known to have diabetes mellitus nor experienced any symptoms of diabetes aside from its rare neurological manifestation of hemichorea-hemiballismus prior to this consult. On further workup, her baseline laboratory tests at the Emergency Room Department showed a CBG of 340mg/dL, an HbA1c of 15%, no ketones were detected in her urine but a hyperdensity with a Hounsfeld unit of 38 on CT, and hyperintensity on T1 weighted MRI on her right striatum with an incidental finding of a subdural hematoma measured as a 0.7cm hyperdensity on her right temporoparietal area with no midline shift. She was then treated with Clonazepam 2mg ¼ tab twice a day before bedtime and insulin 70/30 16 units in the morning and eight units in the evening, which provided good glycemic control maintained at 140-180 mg/dL, complete cessation of the left-sided hemichorea hemiballismus was also observed. The subdural hematoma was deemed non-surgical, and she refused admission into our institution; hence observation on an outpatient basis was done. This is a case of a rare neurological manifestation of diabetes mellitus but with good treatment response to anti-chorea medications combined with diabetes medications.

Keywords: hemichorea, hemiballismus, striatopathy, diabetes

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Authors: I. Parkova, A. Vališevskis, A. Viļumsone

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Nocturnal enuresis or bed-wetting is intermittent incontinence during sleep of children after age 5 that may precipitate wide range of behavioural and developmental problems. One of the non-pharmacological treatment methods is the use of a bed-wetting alarm system. In order to improve comfort conditions of nocturnal enuresis alarm system, modular moisture sensor should be replaced by a textile sensor. In this study behaviour and moisture detection speed of woven and sewn sensors were compared by analysing change in electrical resistance after solution (salt water) was dripped on sensor samples. Material of samples has different structure and yarn location, which affects solution detection rate. Sensor system circuit was designed and two sensor tests were performed: system activation test and false alarm test to determine the sensitivity of the system and activation threshold. Sewn sensor had better result in system’s activation test – faster reaction, but woven sensor had better result in system’s false alarm test – it was less sensitive to perspiration simulation. After experiments it was found that the optimum switching threshold is 3V in case of 5V input voltage, which provides protection against false alarms, for example – during intensive sweating.

Keywords: conductive yarns, moisture textile sensor, industry, material

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Authors: Michael Stewart

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Mutation testing is a type of software testing proposed in the 1970s where program statements are deliberately changed to introduce simple errors so that test cases can be validated to determine if they can detect the errors. Test cases are executed against the mutant code to determine if one fails, detects the error and ensures the program is correct. One major issue with this type of testing was it became intensive computationally to generate and test all possible mutations for complex programs. This paper used reinforcement learning and parallel processing within the context of mutation testing for the selection of mutation operators and test cases that reduced the computational cost of testing and improved test suite effectiveness. Experiments were conducted using sample programs to determine how well the reinforcement learning-based algorithm performed with one live mutation, multiple live mutations and no live mutations. The experiments, measured by mutation score, were used to update the algorithm and improved accuracy for predictions. The performance was then evaluated on multiple processor computers. With reinforcement learning, the mutation operators utilized were reduced by 50 – 100%.

Keywords: automated-testing, machine learning, mutation testing, parallel processing, reinforcement learning, software engineering, software testing

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Authors: Siti Indati Mustapa, Hussain Ali Bekhet

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Global CO2 emission and increasing fuel consumption to meet energy demand requirement has become a threat in recent decades. Effort to reduce the CO2 emission is now a matter of priority in most countries of the world including Malaysia. Transportation has been identified as the most intensive sector of carbon-based fuels and achievement of the voluntary target to meet 40% carbon intensity reduction set at the 15th Conference of the Parties (COP15) means that the emission from the transport sector must be reduced accordingly. This posed a great challenge to Malaysia and effort has to be made to embrace suitable and appropriate energy policy for sustainable energy and emission reduction of this sector. The focus of this paper is to analyse the trends of Malaysia’s energy consumption and emission of four different transport sub-sectors (road, rail, aviation and maritime). Underlying factors influencing the growth of energy consumption and emission trends are discussed. Besides, technology status towards energy efficiency in transportation sub-sectors is presented. By reviewing the existing policies and trends of energy used, the paper highlights prospective policy options towards achieving emission reduction in the transportation sector.

Keywords: CO2 emissions, transportation sector, fuel consumption, energy policy, Malaysia

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Authors: Muhammad Rizwan Tabassum, Ao Xia, Jerry D. Murphy

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The purpose of this work is to provide a comprehensive overview of seaweed as the alternative feedstock for biofuel production and key conversion technologies. Resource depletion and climate change are the driving forces to hunt for renewable sources of energy. Macroalgae can be preferred over land based crops for biofuel production because they are not in competition with food crops for arable land, high growth rates and low lignin contents which require less energy-intensive pre-treatments. However, some disadvantages, such as high moisture content, seasonal variation in chemical composition and process inhibition limit its economic feasibility. Seaweed can be converted into gaseous and liquid fuel by different conversion technologies, but biogas via anaerobic digestion from seaweed is attracting increased attention due to its dual benefit of an economic source of bio-fuel and environment-friendly technology. Biodiesel and bioethanol conversion technologies from seaweed are still under development. A selection of high yielding seaweed species, optimal harvesting season and process optimization make them economically feasible for the alternative source of renewable and sustainable feedstock for biofuel in future.

Keywords: anaerobic digestion, biofuel, bio-methane, conversion technologies, seaweed

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Authors: Moshreka Aditi Huq

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This study shows how a progressive portion of civil intellectuals in Bangladesh contributed as the solidarity activist entities in a movement of tea workers that became the symbol of their unique moral struggle. Their passive yet sharp way of resistance, with the integration of mass tea workers of a tea estate, got demonstrated against certain private companies and government officials who approached to establish a special economic zone inside the tea garden without offering any compensation and rehabilitation for poor tea workers. Due to massive protests and rebellion, the authorized entrepreneurs had to step back and called off the project immediately. The extraordinary features of this movement generated itself from the deep core social need of indigenous tea workers who are still imprisoned in the colonial cage. Following an anthropological and ethnographic perspective, this study adopted the main three techniques of intensive interview, focus group discussion, and laborious observation, to extract empirical data. The intensive interviews were undertaken informally using a mostly conversational approach. Focus group discussions were piloted among various representative groups where observations prevailed as part of the regular documentation process. These were conducted among civil intellectual entities, tea workers, tea estate authorities, civil service authorities, and business officials to obtain a holistic view of the situation. The fieldwork was executed in capital Dhaka city, along with northern areas like Chandpur-Begumkhan Tea Estate of Chunarughat Upazilla and Habiganj city of Habiganj District of Bangladesh. Correspondingly, secondary data were accessed through books, scholarly papers, archives, newspapers, reports, leaflets, posters, writing blog, and electronic pages of social media. The study results find that: (1) civil intellectuals opposed state-sponsored business impositions by producing counter-discourse and struggled against state hegemony through the phases of the movement; (2) instead of having the active physical resistance, civil intellectuals’ strength was preferably in passive form which was portrayed through their intellectual labor; (3) the combined movement of tea workers and civil intellectuals reflected on social security of ethnic worker communities that contrasts state’s pseudo-development motives which ultimately supports offensive and oppressive neoliberal growths of economy; (4) civil intellectuals are revealed as having certain functional limitations in the process of movement organization as well as resource mobilization; (5) in specific contexts, the genuine need of protest by indigenous subaltern can overshadow intellectual elitism and helps to raise the voices of ‘subjugated knowledge’. This study is quite likely to represent two sets of apparent protagonist entities in the discussion of social injustice and oppressive development intervention. On the one, hand it may help us to find the basic functional characteristics of civil intellectuals in Bangladesh when they are in a passive mode of resistance in social movement issues. On the other hand, it represents the community ownership and inherent protest tendencies of indigenous workers when they feel threatened and insecure. The study seems to have the potential to understand the conditions of ‘subjugated knowledge’ of subalterns. Furthermore, being the memory and narratives, these ‘activism mechanisms’ of social entities broadens the path to understand ‘power’ and ‘resistance’ in more fascinating ways.

Keywords: civil intellectuals, resistance, subjugated knowledge, indigenous

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Authors: Phil P. Wagner

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There is an overwhelming amount of athlete-centric information available for sport practitioners in this era of tech and big data, but protocols in athletic rehabilitation remain arbitrary. It is a common assumption that the rate at which tissue heals amongst individuals is the same; yielding protocols that are entirely time-based. Progressing athletes through rehab programs that lack individualization can potentially expose athletes to stimuli they are not prepared for or unnecessarily lengthen their recovery period. A 7-year aggregated and anonymous database was used to develop reliable and valid assessments to measure athletic resilience. Each assessment utilizes force plate technology with proprietary protocols and analysis to provide key thresholds for injury risk and recovery. Using a T score to analyze movement qualities, much like the Z score used for bone density from a Dexa scan, specific prescriptions are provided to mitigate the athlete’s inherent injury risk. In addition to obliging to surgical clearance, practitioners must put in place a clearance protocol guided by standardized assessments and achievement in strength thresholds. In order to truly hold individuals accountable (practitioners, athletic trainers, performance coaches, etc.), success in improving pre-defined key performance indicators must be frequently assessed and analyzed.

Keywords: analytics, athlete rehabilitation, athlete resilience, injury prediction, injury prevention

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Authors: Aamna Tufail, Kajal Kotecha, Iordanis Toursounidis, Ravinder Pabla

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Introduction/Aims: Acute Myeloid Leukaemia (AML) is a part of leukaemic group of hematopoietic disorders with a varying range of presentations, including oro-facial manifestations. Early recognition and management are essential for favourable outcomes. Materials and Methods: We present our experience, clinical presentation, and clinical photographs of a patient with previously undiagnosed AML who presented with oral symptoms to the emergency department of our hospital. An analysis of clinical characteristics, diagnostic investigations, and management modalities was performed. Results/Statistics: A 58-year-old man presented to A&E reporting an 11-day history of right sided facial swelling, acute TMJ symptoms, and oral discomfort. A dentist ruled out acute dental causes one day post onset of symptoms. Initial assessment was anatomically inconsistent and did not reveal a routine oral or maxillofacial etiology. Detailed clinical examination demonstrated fever, generalised pallor, swelling and erythema of right nasolabial region, bilateral masseteric tenderness, intraoral palatal ecchymosis, palatal ulceration, buccal and labial petechiae, cervical lymphadenopathy, and haematoma on dorsum of right hand overlying right 2nd metacarpal joint. Suspecting a systemic medical cause, we requested haematological investigations, which revealed neutropenia, thrombocytopenia, and anaemia. Flow cytometry confirmed CD34 + AML. Oral discomfort was managed symptomatically. The patient was referred to a tertiary care centre for acute haematologic care, where he was treated with IV antibiotics and continuing cycles of chemotherapy. Conclusions/Clinical Relevance: Oro-facial manifestations may be the first clinical sign of AML. Awareness of its features is vital in early diagnosis. In this context, dentists and oral medicine specialists can play an important role in detecting clinical signs of haematological disorders such as AML.

Keywords: acute myeloid leukaemia, oral symptoms, ulceration, diagnosis, management

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Authors: Darya O. Prima, Elena V. Vorontsova, Yuri G. Slizhov, Andrey V. Zibarev

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A broad family of carbocycle-fluorinated aza-heterocycles including 1,3-benzodiazoles (benzimidazoles), 1,2,3-benzotriazoles, 2,1,3-benzothia/selenadiazoles and 1,4-benzodiazines (quinoxalines) was synthesized in the unified way and assessed for cytotoxicity towards the Hep2 (laryngeal epidermoid carcinoma, a kind of oral cancer) cells. The diazoles, triazoles and selenadiazoles revealed low medium inhibitory concentrations IC50 = 2.2-26.4 µМ and induced the cells’ apoptosis at low concentrations C = 1-25 µМ. For selenadiazoles, cell death dynamics was observed already in the first hours after the treatment. Replacement of one atom F by group Me2N in some cases enlarged apoptotic activity of the compounds towards the Hep2 cells. In contrast, the archetypal (i.e. non-fluorinated) 1,3-benzodiazole, 1,2,3-benzotriazole and 2,1,3-benzoselenadiazole were low toxic (IC50 > 100 µM) and induced apoptosis only at high concentrations. The chlorinated congeners of the heterocycles under discussion were highly toxic towards the Hep2 cells but revealed insignificant ability to induce their apoptosis. Overall, the findings above suggest that fluorinated 1,3-benzodiazole, 1,2,3-benzotriazole and 2,1,3-benzoselenadiazole derivatives can be considered as potential anticancer drugs. For the laryngeal epidermoid carcinoma (for which, according to available statistics, the five-year survival rate remained ~50% during the past 30 years), it is especially important since surgical treatment is seriously complicated here thus encouraging medicament one.

Keywords: Apoptosis, aza-heterocycles, cytotoxicity, fluorinated, Hep2 cells, synthesis

Procedia PDF Downloads 339