Search results for: outpatient visits

Authors: Ana Hol

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Study and work operations are being transformed with the uses of technologies and are consequently becoming global. This paper outlines lessons learned based on the international study tour that Australian Bachelor of Information Systems students undertook. This research identifies that for the study tour to be successful, students need to gain skills that global citizens require. For example, students will need to gain an understanding of local cultures, local customs and habits. Furthermore, students would also need to gain an understanding of how a field of their future career expertise operates in the host country, how study and business are conducted internationally, which tools and technologies are currently being utilized on a global scale, what trends drive future developments world-wide and how business negotiations and collaborations are being undertaken across borders. Furthermore, this research provides a guide to educators who are planning, guiding and running study tours as it outlines the requirements of having a pre-tour preparatory session, carefully planned and executed tour itineraries and post-tour sessions during which students can reflect on their experiences and lessons learned so that they can apply them to future international business visits and ventures.

Keywords: global education, international experiences, international study tours, students as global citizens, student centered education,

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Authors: Siri-orn Champatong

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The purpose of this research was to study factors that were related with travel behaviors of Thai tourists at the Ayothaya Floating Market, Phra Nakhon Sri Ayutthaya. The quantitative research was conducted with 400 samples of Thai tourists traveling to the Ayothaya Floating Market. The Questionnaire was a tool used to collect data, and the statistics used for data analysis were mean and Pearson product moment correlation coefficient. The results found that Thai tourists focused on attraction, easy access and facilities of the tourist spot at a high level. In addition, they gave priority to the marketing mix in the dimension of products, price, and distribution channels at a high level as well. For marketing promotion, it was at the moderate level. The results of hypothesis testing revealed that factors related to the attractions of the tourist destination, easy access to the tourist destination, the facilities of the tourist spot, and product and price of the marketing mix were associated with travel behaviors in the aspect of the number of visits used and the budget on tourism.

Keywords: floating market, marketing mix, tourism attractions, travelling behavior

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Authors: I. Caldas, T. Duarte

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Avoidant Restrictive Food Intake Disorder (ARFID) was included for the first time in DSM-5, replacing the old diagnosis of DSM-4 'Early Childhood Eating Disorder'. An ARFID is characterized by a restrictive/avoidant eating pattern that can lead to severe nutritional deficiency, weight loss, nutritional supplementation dependence, and poor psychosocial functioning. This eating pattern is associated with decreased interest in food, worries about food characteristics or the act of ingestion, and lack of concern with weight or body image. This paper aims to understand the impact of this new diagnosis in other Eating Disorders (ED) prevalence, as well as to compare their therapeutic approaches. Methodology: Literature reviewed by PubMed with the following keywords: 'ARFID', 'Prevalence', and 'Eating Disorders'. We selected articles related to this theme, written since 2016. Results: In a population of children hospitalized with ED, 5% to 14% was diagnosed with ARFID, and, as outpatient treatment, the prevalence was 22%. People diagnosed with ARFID have more prevalence of other comorbidities, especially autism spectrum, are younger, and are more often male. Regarding the treatment of ARFID, it most often required nasogastric feeding, and with less suffering associated with this procedure, compared to AN. Despite these differences, 12% of patients diagnosed with ARFID transited to AN during treatment, suggesting that the first pathology may be a risk factor for the development of AN. Conclusions: The differences identified between ARFID and the other EDs are important when analyzed as differential diagnostic hypotheses and therapeutic approaches. Further study is necessary regarding its prevalence, risk factors, and treatment.

Keywords: avoidant restrictive food intake disorder, ARFID, differential diagnoses, eating disorders, prevalence

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Authors: Chanpen Meenakorn

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This research aims to study; (1) behavior of the tourists affecting the satisfaction level of tourism at the Amphawa floating market in Samut Songkhram province, (2) to study the satisfaction level of tourism at the Amphawa floating market. The research method will use quantitative research; data was collected by questionnaires distributed to the tourist who visits the Amphawa floating market for 480 samples. Data was analyzed by SPSS software to process descriptive statistic including frequency, percentage, mean, standard deviation and inferential statistic is t-test, F-test, and chi-square. The results showed that the behavior of tourists had known tourist attractions in the province comes from the mouth of relatives and friends suggested that he come here before and the reasons to visit is to want to pay homage to the various temples for the frequency to visit travel an average of 2-4 times and  the satisfaction of the tourists in the province found that the satisfaction level of tourists in the province at the significant level of the place, convenient  and services have a high level of satisfaction.

Keywords: amphawa floating market behavior of the tourists, satisfaction level, sustainable tourism, Samut Songkhram province

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Authors: Siri-Orn Champatong

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This research paper was aimed to examine the relationship between visitors’ attitude towards the service marketing mix and visitors’ frequency of visit to Bangpu Recreation Centre. Based on a large and uncalculated population, the number of samples was calculated according to the formula to obtain a total of 385 samples. In collecting the samples, systematic random sampling was applied and by using of a Likert five-scale questionnaire for, a total of 21 days to collect the needed information. Mean, Standard Deviation, and Pearson’s basic statistical correlations were utilized in analyzing the data. This study discovered a high level of visitors’ attitude product and service of Bangpu Recreation Centre, price, place, promotional activities, people who provided service and physical evidence of the centre. The attitude towards process of service was discovered to be at a medium level. Additionally, the finding of an examination of a relationship between visitors’ attitude towards service marketing mix and visitors’ frequency of visit to Bangpu Recreation Centre presented that product and service, people, physical evidence and process of service provision showed a relationship with the visitors’ frequency of visit to the centre per year.

Keywords: frequency of visit, visitor, service marketing mix, Bangpu Recreation Centre

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Authors: Tayyibah Shah Alam, Joe Thomas, Nayantara Shenoy

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Presenting a case that we would like to share, the answer is straight forward but the path taken to get to the diagnosis is where it gets interesting. A 31-year-old lady presented to the Rheumatology Outpatient department with left-sided chest pain associated with left-sided elbow joint pain intensifying over the last 2 days. She had been having a prolonged history of chest pain with minimal intensity since 2016. The pain is intermittent in nature. Aggravated while exerting, lifting heavy weights and lying down. Relieved while sitting. Her physical examination and laboratory tests were within normal limits. An electrocardiogram (ECG) showed normal sinus rhythm and a chest X-ray with no significant abnormality was noted. The primary suspicion was recurrent costochondritis. Cardiac blood inflammatory markers and Echo were normal, ruling out ACS. CT chest and MRI Thorax contrast showed small ill-defined STIR hyperintensity with thin peripheral enhancement in the anterior mediastinum in the left side posterior to the 5th costal cartilage and anterior to the pericardium suggestive of changes in the fat-focal panniculitis. Confirming the diagnosis as Epicardial fat necrosis. She was started on Colchicine and Nonsteroidal anti-inflammatory drugs for 2-3 weeks, following which a repeat CT showed resolution of the lesion and improvement in her. It is often under-recognized or misdiagnosed. CT scan was collectively used to establish the diagnosis. Making the correct diagnosis prospectively alleviates unnecessary testing in favor of conservative management.

Keywords: EFN, panniculitis, unknown etiology, recurrent chest pain

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Authors: Mobina Bagherianlemraski, Parastoo Namdar

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Background: The ongoing coronavirus disease has affected most countries. This virus has high transmission power. Due to the closure of most dental clinics, millions of orthodontic patients missed their appointments during the COVID-19 pandemic. Methods: A questionnaire was developed and sent to patients receiving orthodontic treatment at a public or private clinic. Results: A total of 200 responses were analyzed: These included 153 women (76.5%) and 47 men (23.5%). The mean and standard deviation of their age was 18.92±7.23 years, with an age range of 8 to 40 years. One hundred eighty-nine patients (94.5%) had fixed appliances, and 11 patients (5.5%) had removable appliances. Of all participants, 35% (70) missed their appointments. The highest and lowest reasons for stopping appointments were concerned about the spread of COVID-19 with 28 cases (40%) and the closure of the clinic with 15 cases (21.4%). Of the 53 patients who contacted their orthodontists, 86.8 % (46) communicated via office phone and 5.7% (3) through social media. Conclusion: This study determined that the coronavirus pandemic and quarantine have had an important impact on orthodontic treatments. The greatest concern of orthodontic patients was increasing in treatment duration. Patients who used fixed appliances reported missing dental appointments more than others. Therefore, during COVID 19 Pandemic, orthodontists should prepare patients to solve their problems linked to orthodontic appliances when possible.

Keywords: orthodontic patients, coronavirus pandemic, appointments, COVID-19

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Authors: Suglo Tohari Luri

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Data analysis is an important aspect of business performance. With the application of artificial intelligence within databases, selecting a suitable database engine for an application design is also very crucial for business data analysis. The application of business intelligence (BI) software into some relational databases such as Neo4j has proved highly effective in terms of customer data analysis. Yet what remains of great concern is the fact that not all business organizations have the neo4j business intelligence software applications to implement for customer data analysis. Further, those with the BI software lack personnel with the requisite expertise to use it effectively with the neo4j database. The purpose of this research is to demonstrate how the Neo4j program code alone can be applied for the analysis of e-commerce website customer visits. As the neo4j database engine is optimized for handling and managing data relationships with the capability of building high performance and scalable systems to handle connected data nodes, it will ensure that business owners who advertise their products at websites using neo4j as a database are able to determine the number of visitors so as to know which products are visited at routine intervals for the necessary decision making. It will also help in knowing the best customer segments in relation to specific goods so as to place more emphasis on their advertisement on the said websites.

Keywords: data, engine, intelligence, customer, neo4j, database

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Authors: Megha Ramnik Kotecha

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

Keywords: dry eye, pterygium, Schirmer's test, tear break up time (TBUT)

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Authors: Wan Azuati Wan Omar, Selva Rani John Jasudass, Siti Rohaiza Md. Saad

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Introduction & objective: The objectives of this study were to assess patient’s knowledge of appropriate sublingual glyceryl trinitrate (GTN) use as well as to investigate how patients commonly store and carry their sublingual GTN tablets. Methodology: This was a cross-sectional survey, using a validated researcher-administered questionnaire. The study involved cardiac patients receiving sublingual GTN attending the outpatient and inpatient departments of Taiping Hospital, a non-academic public care hospital. The minimum calculated sample size was 92, but 100 patients were conveniently sampled. Respondents were interviewed on 3 areas, including demographic data, knowledge and use of sublingual GTN. Eight items were used to calculate each subject’s knowledge score and six items were used to calculate use score. Results: Of the 96 patients who consented to participate, majority (96.9%) were well aware of the indication of sublingual GTN. With regards to the mechanism of action of sublingual GTN, 73 (76%) patients did not know how the medication works. Majority of the patients (66.7%) knew about the proper storage of the tablet. In relation to the maximum number of sublingual GTN tablets that can be taken during each angina episode, 36.5% did not know that up to 3 tablets of sublingual GTN can be taken during each episode of angina. Fifty four (56.2%) patients were not aware that they need to replace sublingual GTN every 8 weeks after receiving the tablets. Majority (69.8%) of the patients demonstrated lack of knowledge with regards to the use of sublingual GTN as prevention of chest pain. Conclusion: Overall, patients’ knowledge regarding the self administration of sublingual GTN is still inadequate. The findings support the need for more frequent reinforcement of patient education, especially in the areas of preventive use, storage and drug stability.

Keywords: glyceryl trinitrate, knowledge, adherence, patient education

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Authors: Myriam Ferreira

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Websites and social networks allow museums to divulge their works by new and attractive means. Besides, these technologies provide tools to generate a new history of art’s contents and promote visits to their installations. At the same time, museums are proposing more and more activities to families, children and young people. However, these activities usually take place in the museum’s physical installations, while websites and social networks seem to be mainly targeted to adults. The problem is that being children and young people digital natives, they feel apart from museums, so they need a presence of museums in digital means to feel attracted to them. Some institutions are making efforts to fill this vacuum. In this paper, resources designed specifically for children and teenagers have been selected from websites and social networks of five Spanish Museums: Prado Museum, Thyssen Museum, Guggenheim Museum, America Museum and Cerralbo Museum. After that, we have carried out an investigation in a school with children and teenagers between 11 and 15 years old. Those young people have been asked about their valuation of those web pages and social networks, with quantitative-qualitative questions. The results show that the least rated resources were videos and social networks because they were considered ‘too serious’, while the most rated were games and augmented reality. These ratings confirm theoretical papers that affirm that the future of technologies applied to museums is edutainment and interaction.

Keywords: children, museums, social networks, teenagers, websites

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Authors: Xiaoming Jiang, Jinqiao Shi, Qingfeng Tan, Wentao Zhang, Xuebin Wang, Muqian Chen

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Nowadays, big companies such as Google, Microsoft, which have adequate proxy servers, have perfectly implemented their web crawlers for a certain website in parallel. But due to lack of expensive proxy servers, it is still a puzzle for researchers to crawl large amounts of information from a single website in parallel. In this case, it is a good choice for researchers to use free public proxy servers which are crawled from the Internet. In order to improve efficiency of web crawler, the following two issues should be considered primarily: (1) Tasks may fail owing to the instability of free proxy servers; (2) A proxy server will be blocked if it visits a single website frequently. In this paper, we propose Proxisch, an optimization approach of large-scale unstable proxy servers scheduling, which allow anyone with extremely low cost to run a web crawler efficiently. Proxisch is designed to work efficiently by making maximum use of reliable proxy servers. To solve second problem, it establishes a frequency control mechanism which can ensure the visiting frequency of any chosen proxy server below the website’s limit. The results show that our approach performs better than the other scheduling algorithms.

Keywords: proxy server, priority queue, optimization algorithm, distributed web crawling

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Authors: B. Nageshwar Rao

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Urinary tract infection (UTI) represents the most commonly acquired bacterial infection worldwide, with substantial morbidity, mortality, and economic burden. The objective of the study is to characterize the microbial profiles of uropathogenic in the obstetric population by RTPCR. Study design: An observational cross-sectional study was performed at a single tertiary health care hospital among 50 pregnant women with UTIs, including asymptomatic and symptomatic patients attending the outpatient department and inpatient department of Obstetrics and Gynaecology.Methods: Serotyping and genes detection of various uropathogens were studied using RTPCR. Pulse filed gel electrophoresis methods were used to determine the various genetic profiles. Results: The present study shows that CsgD protein, involved in biofilm formation in Escherichia coli, VIM1, IMP1 genes for Klebsiella were identified by using the RTPCR method. Our results showed that the prevalence of VIM1 and IMP1 genes and CsgD protein in E.coli showed a significant relationship between strong biofilm formation, and this may be due to the prevalence of specific genes. Finally, the genetic identification of RTPCR results for both bacteria was correlated with each other and concluded that the above uropathogens were common isolates in producing Biofilm in the pregnant woman suffering from urinary tract infection in our hospital observational study.

Keywords: biofilms, Klebsiella, E.coli, urinary tract infection

Procedia PDF Downloads 126

Authors: Poornima Khadanga, Gaurav Pawar, Madhavi Rairikar

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Background: The COVID 19 pandemic, with its unparalleled mental health repercussions, has impacted people globally and has catalyzed a Mental Health pandemic among the youth. The detrimental effects on mental health needs to be pondered at the earliest. Aims: To study the behavioral problems among children and adolescents visiting Psychiatry Outpatient Department Tertiary Health Care during COVID pandemic and its correlation with socio-demographic profiles. Methods: A cross sectional study was conducted by interviewing 120 participants between 4 to 17 years of age and their parents, visiting Psychiatry OPD. Behavioral problems were assessed using the Strength and Difficulties Questionnaire and diagnosed by DSM-5. Statistical analysis was done by SPSS-21. Results: Male participants showed significant association with conduct (t=2.36, p=0.02) and hyperactive problems (t=5.07, p<0.05). Increase in screen time showed a positive correlation with conduct problems (r=0.22. p=0.02). Attention Deficit Hyperkinetic Disorder (18.3%) was the most commonly diagnosed psychiatric illness. Total difficulty score was significantly associated with difficult temperament (F=68.69, p<0.05). Conclusion: The study brings to light the pattern of behavioral problems that emerged during recent times of uncertainties among the young ones, including those with special needs. The increase in disruptive behaviors with increase screen time needs to be addressed at the earliest.

Keywords: behavioral problems, pandemic, screen time, temperament

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Authors: B.S. Roopa

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Objectives: To investigate the prevalence of concomitant use of GPDs in patients treated with NSAIDs and GPDs in recommended dose and frequency as prophylaxis. And also to know the association between risk factors and prescription of GPDs in patients treated with NSAIDs. Methods: Study was a prospective, observational, cross-sectional survey. Data from patients with prescription of NSAIDs at the out-patient departments of secondary care Hospital, Nilgiris, India were collected in a specially designed proforma for a period of 45 days. Analysis using χ2 tests for discrete variables. Factors that might be associated with prescription of GPD with NSIADs were assessed in multiple logistic regression models. Results: Three hundred and three patients were included in this study, and the rate of GPD prescription was 89.1%. Most of the patients received H2-receptor antagonist, and, to a lesser degree, antacid and proton pump inhibitor. Patients with history of GI ulcer/bleeding were much more likely to be co-prescribed GPD than those who had no history of GI disorders .Compared with patients who were managed in general outpatient clinic, those managed in Secondary care hospital in Nilgrisis, India were more likely to receive GPD. Conclusions: The prescription rate of GPD with NSAIDs is high. Patients were prescribed with H2RA with dose of 150mg twice daily, which are not effective in reducing the risk of NSAIDs induced gastric ulcer. Only the frequency of NSAIDs prescription was considered significant determinant for the co-prescription with GPAs in patients who are < 65 years and ≥ 65 years old.

Keywords: gastro protective agents, non steridol anti inlfammatory agents

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Authors: André Luis Messias Dos Santos Duque, Daniela Polessa Paula, Rosane Harter Griep

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The intensity of physical activity (PA) over time is essential for health promotion. However, there are few studies that have analyzed the practice of different intensities of PA longitudinally. The objective was to identify PA intensity trajectories in men and women from a Brazilian multicentric cohort and their associated factors. Data from 10,367 participants (5,777 women and 4,590 men) aged 35 to 74 years from the baseline and two follow-up visits (2012-2014 and 2017-2019) of the Longitudinal Study of Adult Health (ELSA-Brasil) were analyzed. PA intensity (low, moderate, or high) was assessed using the leisure-time PA module of the International Physical Activity Questionnaire (IPAQ), and sociodemographic, behavioral, and clinical variables were included. Chi-square and T-student tests were used, considering a significant level of 5%. Four intensity trajectories were identified: low, moderate, high, and no pattern. Most participants (82.5% of women and 75.7% of men) had low PA intensity trajectories, and only 2% of women and 4.8% of men had high PA intensity trajectories. For both sexes, a significant difference (p<0.05) was found for age group, education level, income, smoking, type 2 diabetes, obesity, hypertriglyceridemia, and hypertension. Actions that promote the practice of high-intensity PA over time and consider sociodemographic, clinical, and behavioral factors are necessary.

Keywords: lifestyle, longterm effects, physical activity, socioeconomic factors

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Authors: Afrah S. M. Al-Mahfadi

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Climate change is a global issue that has significant impacts on water resources, resulting in environmental, economic, and political consequences. Groundwater reserves, particularly in coastal areas, are facing depletion, leading to serious problems in regions such as Yemen. This study focuses on the western coastal region of Yemen, which already faces risks such as water crises, food insecurity, and widespread poverty. Climate change exacerbates these risks by causing high temperatures, sea level rise, inadequate sea level rise, and inadequate environmental policies. Research Aim: The aim of this research is to provide a comprehensive overview of the impact of climate change on the western coastal region of Yemen. Specifically, the study aims to analyze the relationship between climate change and the loss of fresh groundwater resources in this area. Methodology: The research utilizes a combination of a literature review and three case studies conducted through site visits. Arch-GIS mapping is employed to analyze and visualize the relationship between climate change and the depletion of fresh groundwater resources. Additionally, data on precipitation from 1981 to 2020 and scenarios of projected sea level rise (SLR) are considered. Findings: The study reveals several future issues resulting from climate change. It is projected that the annual temperature will increase while the rainfall rate will decrease. Furthermore, the sea level is expected to rise by approximately 0.30 to 0.72 meters by 2100. These factors contribute to the loss of wetlands, the retreat of shorelines and estuaries, and the intrusion of seawater into the coastal aquifer, rendering drinking water from wells increasingly saline. Data Collection and Analysis Procedures: Data for this research are collected through a literature review, including studies on climate change impacts in coastal areas and the hydrogeology of the study region. Furthermore, three case studies are conducted through site visits. Arch-GIS mapping techniques are utilized to analyze the relationship between climate change and the loss of fresh groundwater resources. Historical precipitation data from 1981 to 2020 and scenarios of projected sea level rise are also analyzed. Questions Addressed: (1) What is the impact of climate change on the western coastal region of Yemen? (2) How does climate change affect the availability of fresh groundwater resources in this area? Conclusion: The study concludes that the western coastal region of Yemen is facing significant challenges due to climate change. The projected increase in temperature, decrease in rainfall, and rise in sea levels have severe implications, such as the loss of wetlands, shorelines, and estuaries. Additionally, the intrusion of seawater into the coastal aquifer further exacerbates the issue of saline drinking water. Urgent measures are needed to address climate change, including improving water management, implementing integrated coastal zone planning, raising awareness among stakeholders, and implementing emergency projects to mitigate the impacts. Recommendations: To mitigate the adverse effects of climate change, several recommendations are provided. These include improving water management practices, developing integrated coastal zone planning strategies, raising awareness among all stakeholders, improving health and education, and implementing emergency projects to combat climate change. These measures aim to enhance adaptive capacity and resilience in the face of future climate change impacts.

Keywords: climate change, groundwater, coastal wetlands, Yemen

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Authors: Mehmet Erdem Uzun, Hande Şirin, Amela Kojic Ateş, Utku Beyazıt, Aynur Bütün Ayhan

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The aim of this study was to examine the health literacy of parents with children diagnosed with ADHD. The study group consisted of 394 parents with children diagnosed with ADHD who applied to the child and adolescent psychiatry outpatient clinic of a public hospital in Bursa, Turkey. 339 mothers and 52 fathers participated in the study. The parents were administered a questionnaire prepared by the researchers in addition to the European Health Literacy Scale-Short Form. Prior to the onset of the analyses, a normality test was performed, and it was determined that the data did not show normal distribution. In this regard, Mann-Whitney U and Kruskal Wallis tests were employed in the analyses. According to the results obtained, it was determined that the health literacy of the mothers (x2=21.015, p<.001) and fathers (x2=7.462, p<.05) differed according to their education levels; that is, the health literacy level of parents who graduated from primary school was lower than the other parents. In addition, it was determined that the level of health literacy differed according to the income level of the family (x2=14.308, p<.05), and the health literacy level of the parents in the low-income group was lower than the other parents. On the other hand, it was seen that the health literacy levels of mothers and fathers did not differ according to the variables of age, whether they had social security, whether the child diagnosed with ADHD was taking medication, and if so, how long the child had been taking medication; age and gender of the child; whether there were other individuals diagnosed with ADHD in the family, and whether the child or parents had a chronic disease (p>.05). The results obtained were discussed in the light of the literature findings.

Keywords: health literacy, parents, children, ADHD

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Authors: Andri Andri, Susanthy Djajalaksana, Iin Noor Chozin

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Background: Despite advances in asthma therapies, a proportion of patients with asthma continue to have difficulty in gaining adequate asthma control. Complex immunological mechanisms and oxidative stress affect this condition, including the role of malondialdehyde (MDA) as a marker of inflammation. This research aimed to determine the effect of polyphytopharmaca administration on the value of asthma control test (ACT), blood eosinophils level and markers of MDA serum inflammation in patients with asthma. Method: Quasi experimental approach was conducted toward 15 stable asthma patients who were not fully controlled in outpatient pulmonary clinic, Public Hospital of Dr. Saiful Anwar Malang. Assessments of ACT values, eosinophil levels, and serum MDA levels were carried out before and after administration of polyphytopharmaca which contained a combination of 100 mg Nigella sativa extract, Kleinhovia hospita 100 mg, Curcuma xanthorrhiza 75 mg, and Ophiocephalus striatus 100 mg, three times daily with two capsules for 12 weeks. The ACT value was determined by the researcher by asking the patient directly, blood eosinophil levels were calculated by analyzing blood type counts, and serum MDA levels were detected by the qPCR method. Result: There was a significant enhancement of ACT value (18.07 ± 2.57 to 22.06 ± 1.83, p = 0.001) (from 60% uncontrolled ACT to 93.3% controlled ACT), a significant decrease in blood eosinophils levels (653.15 ± 276.15 pg/mL to 460.66 ± 202.04 pg/mL, p = 0.038), and decreased serum MDA levels (109.64 ± 53.77 ng / ml to 78.68 ± 64.92 ng/ml, p = 0.156). Conclusion: Administration of polyphytopharmaca can increase ACT value, decrease blood eosinophils levels and reduce MDA serum in stable asthma patients who are not fully controlled.

Keywords: asthma control test, eosinophils levels, malondialdehyde, polyphytopharmaca

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Authors: Luay Alsalmi

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Background: Facial filler is the most common type of cosmetic surgery next to botox. Permanent filler is preferred nowadays due to the low cost brought about by non-recurring injection appointments. However, such fillers pose a higher risk for complications, with even greater adverse effects when the procedure is done using unknown dermal filler injections. AIM: This study aimed to establish an algorithm to categorize and manage patients that receive permanent fillers. Materials and Methods: Twelve participants were presented to the service through emergency or as outpatient from November 2015 to May 2021. Demographics such as age, sex, date of injection, time of onset, and types of complications were collected. After examination, all cases were managed based on an algorithm established. FACE-Q was used to measure overall satisfaction and psychological well-being. Results: The algorithm to diagnose and manage these patients effectively with a high satisfaction rate was established in this study. All participants were non-smoker females with no known medical comorbidities. The algorithm presented determined the treatment plan when faced with complications. Results revealed high appearance-related psychosocial distress was observed prior to surgery, while it significantly dropped after surgery. FACE-Q was able to establish evidence of satisfactory ratings among patients prior to and after surgery. Conclusion: This treatment algorithm can guide the surgeon in formulating a suitable plan with fewer complications and a high satisfaction rate.

Keywords: facial filler, FACE-Q, psycho-social stress, botox, treatment algorithm

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Authors: Duyen Lam, Thuong Hoang, Atul Sajjanhar, Feifei Chen

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With the emerging interactive technology applications helping users connect progressively with cultural artefacts in new approaches, the cultural heritage sector gains significantly. The interactive apps’ issues can be tested via several techniques, including usability surveys and usability evaluations. The severe usability problems for museums’ interactive technologies commonly involve interactions, control, and navigation processes. This study confirms the low quality of being immersive for audio guides in navigating the exhibition and involving experience in the virtual environment, which are the most vital features of new interactive technologies such as AR and VR. In addition, our usability surveys and heuristic evaluations disclosed many usability issues of these interactive technologies relating to interaction functions. Additionally, we use the Wayback Machine to examine what interactive apps/technologies were deployed on these websites during the physical visits limited due to the COVID-19 pandemic lockdown. Based on those inputs, we propose the reflection framework to enhance the UX in the cultural heritage domain with detailed guidelines.

Keywords: framework, user experience, cultural heritage, interactive technology, museum, COVID-19 pandemic, usability survey, heuristic evaluation, guidelines

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Authors: Phillip F. Kanokanga, Patrick W. Mamimine, Molline Mwando, Charity Mapingure

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Tourism development tends to follow anchor attractions, including cities and their surroundings, while marginalizing small towns and their environs. This is even though the small towns and their hinterlands can also offer competitive tourism products. The Zimbabwe Tourism Authority (ZTA) gathers visitor statistics of major tourist destinations only thereby sidelining the density of tourist traffic that either passes through or visits the small towns in the country. Unless this problem is addressed, the tourism potential of small towns and their hinterlands will not be fully tapped for economic development. Using qualitative research methodology, this study investigated the opportunities for tourism development in the Greater Chinhoyi Area. The study revealed that the Greater Chinhoyi area had potential for heritage tourism, village tourism, urban tourism, educational tourism, dark tourism, recreational tourism, agrotourism, and nature tourism. There is a need to link the various tourism resources in the Greater Chinhoyi area to anchor attractions in dominant resorts, then develop and present the tourism products in transit towns as ‘appetisers’ or ‘appetisser attractions’ before one gets to the main destination.

Keywords: anchor attractions, appetisers, heritage tourism, agrotourism, small towns, tourism corridor, systems approach, hidden treasures

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Authors: Dongping Fang, Lian Duan, Xiaojing Yuan, Mike Xu, Allyn Klunder, Kevin Tan, Suiting Cao, Yeqing Ji

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Accurate prediction of a medical condition with straight clinical evidence is a long-sought topic in the medical management and health insurance field. Although great progress has been made with machine learning algorithms, the medical community is still, to a certain degree, suspicious about the model's accuracy and interpretability. This paper presents an innovative hierarchical attention deep learning model to achieve good prediction and clear interpretability that can be easily understood by medical professionals. This deep learning model uses a hierarchical attention structure that matches naturally with the medical history data structure and reflects the member’s encounter (date of service) sequence. The model attention structure consists of 3 levels: (1) attention on the medical code types (diagnosis codes, procedure codes, lab test results, and prescription drugs), (2) attention on the sequential medical encounters within a type, (3) attention on the medical codes within an encounter and type. This model is applied to predict the occurrence of stage 3 chronic kidney disease (CKD3), using three years’ medical history of Medicare Advantage (MA) members from a top health insurance company. The model takes members’ medical events, both claims and electronic medical record (EMR) data, as input, makes a prediction of CKD3 and calculates the contribution from individual events to the predicted outcome. The model outcome can be easily explained with the clinical evidence identified by the model algorithm. Here are examples: Member A had 36 medical encounters in the past three years: multiple office visits, lab tests and medications. The model predicts member A has a high risk of CKD3 with the following well-contributed clinical events - multiple high ‘Creatinine in Serum or Plasma’ tests and multiple low kidneys functioning ‘Glomerular filtration rate’ tests. Among the abnormal lab tests, more recent results contributed more to the prediction. The model also indicates regular office visits, no abnormal findings of medical examinations, and taking proper medications decreased the CKD3 risk. Member B had 104 medical encounters in the past 3 years and was predicted to have a low risk of CKD3, because the model didn’t identify diagnoses, procedures, or medications related to kidney disease, and many lab test results, including ‘Glomerular filtration rate’ were within the normal range. The model accurately predicts members A and B and provides interpretable clinical evidence that is validated by clinicians. Without extra effort, the interpretation is generated directly from the model and presented together with the occurrence date. Our model uses the medical data in its most raw format without any further data aggregation, transformation, or mapping. This greatly simplifies the data preparation process, mitigates the chance for error and eliminates post-modeling work needed for traditional model explanation. To our knowledge, this is the first paper on an interpretable deep-learning model using a 3-level attention structure, sourcing both EMR and claim data, including all 4 types of medical data, on the entire Medicare population of a big insurance company, and more importantly, directly generating model interpretation to support user decision. In the future, we plan to enrich the model input by adding patients’ demographics and information from free-texted physician notes.

Keywords: deep learning, interpretability, attention, big data, medical conditions

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Authors: Muneeb Nasir, Misbah Masood, Farrukh Rashid, Abubabakar Shahid

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Introduction: Neo-adjuvant chemotherapy is a potent option for triple negative breast cancer (TNBC) as these tumours lack a clearly defined therapeutic target. Several recent studies lend support that pathological complete remission (pCR) is associated with improved disease free survival (DFS) and overall survival (OS) and could be used as surrogate marker for DFS and OS in breast cancer patients. Methods: We have used a four-drug protocol in T3 and T4 TNBC patients either N+ or N- in the neo-adjuvant setting. The 15 patients enrolled in this study had a median age of 45 years. 12 patients went on to complete four planned cycles of B-CAT protocol. The chemotherapy regimen included inj. Bevacizumab 5mg/kg D1, inj. Adriamycin 50mg/m2 D1 and Docetaxel 65mg/m2 on D1. Inj. Cisplatin 60mg/m2 on D2. All patients received GCF support from D4 to D9 of each cycle. Results: Radiological assessment using ultrasound and PET-CT revealed a high percentage of responses. Radiological CR was documented in half of the patients (6/12) after four cycles. Remaining patients went on to receive 2 more cycles before undergoing radical surgery. pCR was documented in 7/12 patients and 3 more had a good partial response. The regimen was toxic and grade ¾ neutropenia was seen in 58% of patients. Four episodes of febrile neutropenia were reported and managed. Non-hematatological toxicities were common with mucositis, diarrhea, asthenia and neuropathy topping the list. Conclusion: B-CAT is a very active combination with very high pCR rates in TNBC. Toxicities though frequent, were manageable on outpatient basis. This protocol warrants further investigation.

Keywords: B-CAT:bevacizumab, cisplatin, adriamycin, taxotere, CR: complete response, pCR: pathological complete response, TNBC: triple negative breast cancer

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Authors: Kuldeep Rawat, Michael O'Shea, Maureen McGough

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The paper will discuss a National Institute of Justice (NIJ) funded project to provide cost-effective aviation technologies and research to support counter-poaching operations related to endangered, protected, and/or regulated wildlife. The goal of this project is to provide cost-effective aviation technology and research support to Kenya Wildlife Service (KWS) in their counter-poaching efforts. In pursuit of this goal, Elizabeth City State University (ECSU) is assisting the National Institute of Justice (NIJ) in enhancing the Kenya Wildlife Service’s aviation technology and related capacity to meet its counter-poaching mission. Poaching, at its core, is systemic as poachers go to the most extreme lengths to kill high target species such as elephant and rhino. These high target wildlife species live in underdeveloped or impoverished nations, where poachers find fewer barriers to their operations. In Kenya, with fifty-nine (59) parks and reserves, spread over an area of 225,830 square miles (584,897 square kilometers) adequate surveillance on the ground is next to impossible. Cost-effective aviation surveillance technologies, based on a comprehensive needs assessment and operational evaluation, are needed to curb poaching and effectively prevent wildlife trafficking. As one of the premier law enforcement Air Wings in East Africa, KWS plays a crucial role in Kenya, not only in counter-poaching and wildlife conservation efforts, but in aerial surveillance, counterterrorism and national security efforts as well. While the Air Wing has done, a remarkable job conducting aerial patrols with limited resources, additional aircraft and upgraded technology should significantly advance the Air Wing’s ability to achieve its wildlife protection mission. The project includes: (i) Needs Assessment of the KWS Air Wing, to include the identification of resources, current and prospective capacity, operational challenges and priority goals for expansion, (ii) Acquisition of Low-Cost Aviation Technology to meet priority needs, and (iii) Operational Evaluation of technology performance, with a focus on implementation and effectiveness. The Needs Assessment reflects the priorities identified through two site visits to the KWS Air Wing in Nairobi, Kenya, as well as field visits to multiple national parks receiving aerial support and interviewing/surveying KWS Air wing pilots and leadership. Needs Assessment identified some immediate technology needs that includes, GPS with upgrades, including weather application, Night flying capabilities, to include runway lights and night vision technology, Cameras and surveillance equipment, Flight tracking system and/or Emergency Position Indicating Radio Beacon, Lightweight ballistic-resistant body armor, and medical equipment, to include a customized stretcher and standard medical evacuation equipment. Results of this assessment, along with significant input from the KWS Air Wing, will guide the second phase of this project: technology acquisition. Acquired technology will then be evaluated in the field, with a focus on implementation and effectiveness. Results will ultimately be translated for any rural or tribal law enforcement agencies with comparable aerial surveillance missions and operational environments, and jurisdictional challenges, seeking to implement low-cost aviation technology. Results from Needs Assessment phase, including survey results and our ongoing technology acquisition and baseline operational evaluation will be discussed in the paper.

Keywords: aerial surveillance mission, aviation technology, counter-poaching, wildlife protection

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Authors: Ahmed Ali Torad

Abstract:

Background: Breast feeding maintains the maternal fetal immunological link, favours the transmission of immune-competence from the mother to her infant and is considered an important contributory factor to the neo natal immune defense system. Purpose: This study was conducted to investigate the effect of relaxation techniques on immunological properties of breast milk. Subjects and Methods: Thirty breast feeding mothers with a single, mature infant without any complications participated in the study. Subjects will be recruited from outpatient clinic of obstetric department of El Kasr El-Aini university hospital in Cairo. Mothers were randomly divided into two equal groups using coin toss method: Group (A) (relaxation training group) (experimental group): It will be composed of 15 women who received relaxation training program in addition to breast feeding and nutritional advices and Group (B) (control group): It will be composed of 15 women who received breast feeding and nutritional advices only. Results: The results showed that mean mother’s age was 28.4 ± 3.68 and 28.07 ± 4.09 for group A and B respectively, there were statistically significant differences between pre and post values regarding cortisol level, IgA level, leucocyte count and infant’s weight and height and there is only statistically significant differences between both groups regarding post values of all immunological variables (cortisol – IgA – leucocyte count). Conclusion: We could conclude that there is a statistically significant effect of relaxation techniques on immunological properties of breast milk.

Keywords: relaxation, breast, milk, immunology, lactation

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Authors: Muhammad Kamran Hanif Khan, Fahad Mushtaq

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Globally, the death rate from cardiovascular disease has risen over the past 20 years, but especially in low and middle-income countries (LMICS), reports the World Health Organization (WHO). Around 17.5 million deaths, or 31% of all deaths worldwide in 2012, were attributed to CVD, 80% of which occurred in low- and middle-income nations, and eighty five percent of all worldwide disability is attributable to cardiovascular disease. This study assessed the dietary habit and Cardiovascular Risk factors among the patients of coronary artery disease against matched controls. The research was a case-control study. Sample size for this case-control study was 410 CAD cases and 410 healthy controls. The case-control ratio was 1:1. Patients diagnosed with coronary artery disease were recruited from the outpatient departments and emergency rooms of four hospitals in Pakistan. The ages of people who were diagnosed with coronary artery disease were not significantly different from (mean 57.97 7.39 years) the healthy controls (mean 57.12 6.73 years). In order to determine the relationship between food consumption and the two binary outcomes, logistic regression analysis was carried out. Chicken (0.340 (0.245-0.47), p-value 0.0001), beef (0.38 (0.254-0.56), p-value 0.0001), eggs (0.297 (0.208-0.426), p-value 0.0001), and junk food (0.249 (0.167-0.372), p-value 0.0001)) were protective, while yogurt consumption more than twice weekly was risk. Conclusion: In conclusion, poor dietary habits are closely linked to the risk of CAD. Investigations based on dietary trends offer vital and practical knowledge about societal patterns.

Keywords: dietary habbits, cardiovasculardisease, CVD risk factors, hypercholesterolemia

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Authors: Merav Ben Natan, Rawan Masarwa, Yaniv Steinfeld, Yaniv Yonai, Yaron Berkovich

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Background: Intimate partner violence is a growing public health concern worldwide, and nurses are uniquely positioned to help identify and refer patients for services. Yet, intimate partner violence injury patterns and characteristics often go unrecognized. Objective: The purpose of this study is to explore injury and sociodemographic characteristics associated with intimate partner violence in women presenting to a single emergency department in Israel. Methods: This retrospective cohort study analyzed medical records of married women injured by their spouse who presented to a single emergency department in Israel from January 1, 2016, to August 31, 2020. Results: In total, 145 cases were included, of which 110 (76%) were Arab and 35 (24%) were Jewish, with a mean age of 40. Patients' injury patterns consisted of contusions, hematomas, and lacerations to the head, face, or upper extremities, not requiring hospitalization, and having a history of emergency department visits in the past 5 years. Conclusion: Identifying intimate partner violence characteristics and patterns of injury will help nurses identify, initiate treatment, and report suspected abuse.

Keywords: emergency department, female patients, injuries, intimate partner violence, israel

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Authors: Engi E. I. Sarhan, Usama M. Rashad, Ibrahim M. I. Hamoda, Mohammed K. Mohamed

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Background: This study aimed to know the effect of nitrogen-based cryotherapy on the spasticity of calf muscle in stroke patients. Patients were selected from the outpatient clinic of Neurology, Al-Mansoura general hospital, Al-Mansoura University. Subjects and methods: Thirty Stroke Patients of both sexes ranged from 45 to 60 years old were divided randomly into two equal groups, a study group (A) received a nitrogen-based cryotherapy, a selective physical therapy program and ankle foot orthosis (AFO), while as patients in control group (B) received the same program and AFO only. The treatment duration was three times per week for four weeks for both groups. We assessed spasticity of calf muscle before and after treatment subjectively using modified Ashworth scale (MAS) and objectively via measuring H / M ratio on electromyography machine. We also assessed ankle dorsiflexion ROM objectively using two dimensions motion analysis (2D). Results: After treatment, there was a highly significant improvement in the study group compared to the control group regarding the score of MAS, no significant difference in the study group compared to the control group regarding the readings of H / M ratio, highly significant improvement in the study group compared to the control group regarding the 2D motion analysis findings. Conclusion: This modality considers effective in reducing spasticity in the calf muscle and improving ankle dorsiflexion of the affected limb.

Keywords: ankle foot orthosis, nitrogen-based cryotherapy, stroke, spasticity

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Authors: Davidson E. Egirani, Nanfe R. Poyi, Napoleon Wessey

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This paper would report the environmental challenges faced by stakeholders in the development and management of mineral resources in Mindanao mining region of the Philippines. The paper would proffer solutions via the development and management of integrated mineral resource framework. This is by interfacing the views of government, operating mining companies and the mining host communities. The project methods involved the desktop review of existing local, regional, national environmental and mining legislation. This was followed up with visits to mining sites and discussions were held with stakeholders in the mineral sector. The findings from a 2-year investigation would reveal lack of information, education, and communication campaign by stakeholders on environmental, health, political, and social issues in the mining industry. Small-scale miners lack the professional muscles for a balance shift of emphasis to sustainable and responsible mining to avoid environmental degradation and human health effect. Therefore, there is a need to balance ecological requirements, sustainability of the environment and development of mineral resources. This paper would provide an environmentally friendly mineral resource development framework.

Keywords: ecological requirements, environmental degradation, human health, mining legislation, responsible mining

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