Search results for: medical data visualization

Authors: Sunglim Lee, Susumu Fujii, Koji Okamura

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Smart grid is a new approach for electric power grid that uses information and communications technology to control the electric power grid. Smart grid provides real-time control of the electric power grid, controlling the direction of power flow or time of the flow. Control devices are installed on the power lines of the electric power grid to implement smart grid. The number of the control devices should be determined, in relation with the area one control device covers and the cost associated with the control devices. One approach to determine the number of the control devices is to use the data on the surplus power generated by home solar generators. In current implementations, the surplus power is sent all the way to the power plant, which may cause power loss. To reduce the power loss, the surplus power may be sent to a control device and sent to where the power is needed from the control device. Under assumption that the control devices are installed on a lattice of equal size squares, our goal is to figure out the optimal spacing between the control devices, where the power sharing area (the area covered by one control device) is kept small to avoid power loss, and at the same time the power sharing area is big enough to have no surplus power wasted. To achieve this goal, a simulation using landscape ecology method is conducted on a sample area. First an aerial photograph of the land of interest is turned into a mosaic map where each area is colored according to the ratio of the amount of power production to the amount of power consumption in the area. The amount of power consumption is estimated according to the characteristics of the buildings in the area. The power production is calculated by the sum of the area of the roofs shown in the aerial photograph and assuming that solar panels are installed on all the roofs. The mosaic map is colored in three colors, each color representing producer, consumer, and neither. We started with a mosaic map with 100 m grid size, and the grid size is grown until there is no red grid. One control device is installed on each grid, so that the grid is the area which the control device covers. As the result of this simulation we got 350 m as the optimal spacing between the control devices that makes effective use of the surplus power for the sample area.

Keywords: landscape ecology, IT, smart grid, aerial photograph, simulation

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Authors: Maroua Sbiti, Karim Beddiar, Djaoued Beladjine, Romuald Perrault

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Productivity is decreasing in construction compared to the manufacturing industry. It seems that the sector is suffering from organizational problems and have low maturity regarding technological advances. High international competition due to the growing context of globalization, complex projects, and shorter deadlines increases these challenges. Field employees are more exposed to coordination problems than design officers. Execution collaboration is then a major issue that can threaten the cost, time, and quality completion of a project. Initially, this paper will try to identify field professional requirements as to address building management process weaknesses such as the unreliability of scheduling, the fickleness of monitoring and inspection processes, the inaccuracy of project’s indicators, inconsistency of building documents and the random logistic management. Subsequently, we will focus our attention on providing solutions to improve scheduling, inspection, and hours tracking processes using emerging lean tools and field mobility applications that bring new perspectives in terms of cooperation. They have shown a great ability to connect various field teams and make informations visual and accessible to planify accurately and eliminate at the source the potential defects. In addition to software as a service use, the adoption of the human resource module of the Enterprise Resource Planning system can allow a meticulous time accounting and thus make the faster decision making. The next step is to integrate external data sources received from or destined to design engineers, logisticians, and suppliers in a holistic system. Creating a monolithic system that consolidates planning, quality, procurement, and resources management modules should be our ultimate target to build the construction industry supply chain.

Keywords: lean, last planner system, field mobility applications, construction productivity

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Authors: Tingyu Zhang

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The horizontal ecological compensation (HEC) mechanism is the key to stimulating the active participation of the whole basin in ecological protection. In this paper, we construct an evolutionary model for HEC in the Yangtze River Economic Belt (YREB) basin with the introduction of the central government constraint and incentive mechanism (CGCIM) and explore the conditions for the realization of a (Protection and compensation) strategy that meets the social expectations. Further, the water quality-water quantity model is utilized to measure the HEC amount with the characteristic factual data of the YREB in 2020-2022. The results show that the stability of the evolutionary game model of upstream and downstream governments in the YREB is closely related to the CGCIM. If (Protection Compensation) is to be realized as the only evolutionary stable strategy of the evolutionary game system composed of upstream and downstream governments, it is necessary for the CGCIM to satisfy that the sum of the incentives for the protection side and its unilateral or bilateral constraints is greater than twice the input cost of the active strategy, and the sum of the incentives for the compensation side and its unilateral or bilateral constraints is greater than the amount of ecological compensation that needs to be paid by it when it adopts the active strategy. At this point, the total amount of HEC that the downstream government should give to the upstream government of the YREB is 2856.7 million yuan in 2020, 5782.1 million yuan in 2021, and 23166.7 million yuan in 2022. The results of the study can provide a reference for promoting the improvement and refinement of the HEC mechanism in the YREB.

Keywords: horizontal ecological compensation, Yangtze river economic belt, evolutionary game analysis, water quality and quantity model research on territorial ecological restoration in Mianzhu city, Sichuan, under the dual evaluation framework

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Authors: Christina Esti Susanti

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This study aimed to determine the effect Activities in marketing, Destination Marketing, and Environmental preservation loyalty through satisfaction at tourist destination in East Java, Indonesia. In this study population used is Surabaya citizens who had visited tourist destination in East Java, Indonesia. Characteristics of a sample of respondents in this study are: a minimum age of 17 years, and ever came in tourist destination in East Java, Indonesia with each destination more than 1 visits. Total sample 316 respondents. Data analysis tools which is used in this study is a structural equation modeling. Based on the analysis, the results of this study can be concluded that the hypothesis 1, 2, 5, and 6 are proposed in this study was rejected because not significant. The hypotheses are: (1) Activities in destination have influence which is positive effect on satisfaction in the tourist destination in East Java, Indonesia, (2) Destination marketing have influence which is positive effect on satisfaction in the tourist destination in East Java, Indonesia, (3) Activities in destination have influence which is positive effect towards loyalty through satisfaction in a tourist destination in East Java, Indonesia. (4) Destination marketing have influence which is positive effect on loyalty through satisfaction in a tourist destination in East Java, Indonesia. While the hypothesis 3, 4, and 7, is received. The hypotheses are: (1) Environmental preservation have influence which is positive effect and significant on satisfaction in the tourist destination in East Java, Indonesia. (2) Satisfaction have influence which is positive effect and significant on loyalty to the tourist destination in East Java, Indonesia. (3) Environmental preservation have influence which is positive effect and significant on loyalty through satisfaction in a tourist destination in East Java, Indonesia. Practical advice submitted to the management of tourist destinations, especially in the 10 areas where research was conducted for more attention to the condition of the physical environment to be around tourist spots / attractions, namely: the condition of roads, water supply conditions, the condition of drainage / sanitation, and the condition waste more seriously. Based on the proposal, the manager of a tourist destination seems to be working closely with the local municipal sanitation departments, local water companies local city and town local public works departments to jointly manage a tourist destination considering regional tourism is one of the region's assets and become one sources of local revenue (PAD) is vital.

Keywords: activities in marketing, destination amarketing, environmental preservation, satisfaction, loyalty

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Authors: Ali Bayram, Remzi Yiğiter

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Objective: Alzheimer's disease (AD), the most common cause of dementia, is a progressive neurodegenerative disease. At present, diagnosis of AD is rather late in the disease. Therefore, we attempted to find peripheral biomarkers for the early diagnosis of AD. Herein, we conducted a study to investigate the unc-51 like autophagy activating kinase-1 (ULK1) mRNA expression levels in human peripheral blood mononuclear cells from patients with Alzheimer's disease. Method: To determine whether ULK1 gene expression are altered in AD patients, we measured their gene expression in human peripheral blood cell in 50 patients with AD and 50 age and gender matched healthy controls by quantitative real-time PCR technique. Results: We found that both ULK1 gene expression in peripheral blood cell were significantly decreased in patients with AD as compared with controls (p <0.05). Lower levels of ULK1 gene expression were significantly associated with the increased risk for AD. Conclusions: Serine/threonine-protein kinase involved in autophagy in response to starvation. Acts upstream of phosphatidylinositol 3-kinase PIK3C3 to regulate the formation of autophagophores, the precursors of autophagosomes. Part of regulatory feedback loops in autophagy: acts both as a downstream effector and negative regulator of mammalian target of rapamycin complex 1 (mTORC1) via interaction with RPTOR. Activated via phosphorylation by AMPK and also acts as a regulator of AMPK by mediating phosphorylation of AMPK subunits PRKAA1, PRKAB2, and PRKAG1, leading to negatively regulate AMPK activity. May phosphorylate ATG13/KIAA0652 and RPTOR; however such data need additional evidences. Plays a role early in neuronal differentiation and is required for granule cell axon formation. Alzheimer is the most common neurodegenerative disease. Our results provide useful information that the ULK1 gene expression is decreased in the neurodegeneration and AD patients with, indicating their possible systemic involvement in AD.

Keywords: Alzheimer’s sisease, ULK1, mRNA expression, RT-PCR

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Authors: Alok Kumar Yadav, Saurabh Saraswat, Preeti Sirohi, Manjoo Rani, Sameer Srivastava, Manish Pratap Singh, Nand K. Singh

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The development of antibiotic resistance in bacteria is increasing at an alarming rate, and this is considered as one of the most serious threats in the history of medicine, and an alternative solution should be derived so as to tackle this problem. In many countries, people use the medicinal plants for the treatment of various diseases as these are cheaper, easily available and least toxic. Syzygium cumini is used for the treatment of various kinds of diseases but their mechanism of action is not reported. The antimicrobial activity of Syzygium cumini was tested by the well diffusion assay and zone of inhibition was reported to be 20.06 mm as compared to control with MIC of 0.3 mg/ml. Genomic DNA fragmentation of Bacillus subtilis revealed apoptosis and FE-SEM indicate cell wall cracking on several intervals of time. Propidium iodide staining results showed that few bacterial cells were stained in the control and population of stained cells increase after exposing them for various period of time. Flow cytometric kinetic data analysis on the membrane permeabilization in bacterial cell showed the significant contribution of antimicrobial potential of the seed extract on antimicrobial-induced permeabilization. Two components of Syzygium cumini methanolic seed extract was found to be quite active against four enzymes like PDB ID- 1W5D, 4OX3, 3MFD and 5E2F which have a very crucial role in membrane synthesis in Bacillus subtilis by in silico analysis. Through in silico analysis, lupeol showed highest binding energy for macromolecule 1W5D and 4OX3 whereas stigmasterol showed the highest binding energy for macromolecule 3MFD and 5E2F respectively. It showed that methanolic seed extract of Syzygium cumini can be used for the inhibition of foodborne infections caused by Bacillus subtilis and also as an alternative of prevalent antibiotics.

Keywords: antibiotics, Bacillus subtilis, inhibition, Syzygium cumini

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Authors: Mathew Saxon A, Aneeh Rajan, Sajeev P

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Many fluid flow applications employ different types of orifices to control the flow rate or to reduce the pressure. Discharge coefficients generally vary from 0.6 to 0.95 depending on the type of the orifice. The tabulated value of discharge coefficients of various types of orifices available can be used in most common applications. The upstream and downstream flow condition of an orifice is hardly considered while choosing the discharge coefficient of an orifice. But literature shows that the discharge coefficient can be affected by the presence of cross flow. Cross flow is defined as the condition wherein; a fluid is injected nearly perpendicular to a flowing fluid. Most researchers have worked on water being injected into a cross-flow of water. The present work deals with water to gas systems in which water is injected in a normal direction into a flowing stream of gas. The test article used in the current work is called thermal regulator, which is used in a liquid rocket engine to reduce the temperature of hot gas tapped from the gas generator by injecting water into the hot gas so that a cooler gas can be supplied to the turbine. In a thermal regulator, water is injected through an orifice in a normal direction into the hot gas stream. But the injection orifice had been calibrated under backpressure by maintaining a stagnant gas medium at the downstream. The motivation of the present study aroused due to the observation of a lower Cd of the orifice in flight compared to the calibrated Cd. A systematic experimental investigation is carried out in this paper to study the effect of cross-flow on the discharge coefficient of an orifice in water to a gas system. The study reveals that there is an appreciable reduction in the discharge coefficient with cross flow compared to that without cross flow. It is found that the discharge coefficient greatly depends on the ratio of momentum of water injected to the momentum of the gas cross flow. The effective discharge coefficient of different orifices was normalized using the discharge coefficient without cross-flow and it is observed that normalized curves of effective discharge coefficient of different orifices with momentum ratio collapsing into a single curve. Further, an equation is formulated using the test data to predict the effective discharge coefficient with cross flow using the calibrated Cd value without cross flow.

Keywords: cross flow, discharge coefficient, orifice, momentum ratio

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Authors: Tong Ming Liu

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Human mesenchymal stem cells (MSCs) represent the most used stem cells for clinical application, which have been used in over 1000 clinical trials to treat over 30 diseases due to multilineage differentiation potential, secretome and immunosuppression. Gene therapies of MSCs hold great promise in the treatment of many diseases due to enhanced MSC-based clinical outcomes. To identify genes for gene therapy of MSCs, by comparing gene expression profile before and after MSC differentiation following by functional screening, we have identified ZNF145 that regulated MSC differentiation. Forced expression of ZNF145 resulted in enhanced in vitro chondrogenesis of MSCs as an upstream factor of SOX9 and improved osteochondral repair upon implant into osteochondral defects in rodents. By comparing gene expression profile during differentiation of iPSCs toward MSCs, we also identified gene HOX regulating MSC stemness, which was much downregulated in late-passaged MSCs. Knockdown of this gene greatly compromised MSC stemness including abolished proliferation, decreased CFU-F, promoted senescence and reduced expression of cell surface antigens linked to the MSC phenotype. In addition, multi-linage differentiation was also greatly impaired. Notably, HOX overexpression resulted in improved multi-lineage differentiation. In the mechanism, HOX expression significantly deceased in late passage of MSCs compared with early passage of MSCs, correlating with MSC important genes. ChIP-seq data shown that HOX binds to genes related to MSC self-renewal and differentiation. Most importantly, most HOX binding sites are lost in late passage of MSCs. HOX exerts its effects by directing binding Twist1, one important gene of MSCs. The identification of the genes regulating MSC differentiation and stemness will provide and promising strategies for gene therapy of MSCs in regenerative medicine.

Keywords: mesenchymal stem cell, novel transcription factor, stemness, gene therapy, cartilage repair, signaling pathway

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Authors: Shalini Saini, Sharmila Ahuja

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Anaesthesia for caesarean section poses challenges unique to the obstetric patient due to changes in the airway and respiratory system. The choice of anaesthesia for caesarean section depends on various factors however general anaesthesia (GA) is necessary for certain situations. Supraglottic airway devices are an emerging method to secure airway, especially in difficult situations. Of these devices, proseal –LMA (PLMA) is designed to provide better protection of the airway. The use of PLMA has been reported successfully as a rescue device in difficult intubation situations and in patients undergoing elective caesarean section without any complications. The study was prospective and randomised and was designed to compare PLMA in patients undergoing elective lower segment caesarean section (LSCS) with the endotracheal tube (ETT). Patients undergoing LSCS under GA belonging to ASA grade 1 and 2 were included. Patients with the history of fewer than 6 hrs of fasting, known/predicted difficult airway, obesity, gastroesophageal reflux disease, hypertensive disorder were excluded. A standard anaesthesia protocol was followed. All patients received aspiration prophylaxis. The airway was secured with either PLMA or ETT. Parameters noted were- ease of insertion, adequacy of ventilation, hemodynamic changes at insertion and removal of device, incidence of regurgitation and aspiration. Data was analysed by unpaired t- test, Chi-square /Fisher’s test. The findings of our study indicated that PLMA was easy to insert (20.67±6.835 sec) with comparable insertion time to TT (18.33 ± 4.971, p 0.136) and adequate ventilation was achieved with very minimal hemodynamic changes seen with PLMA as compared to ETT at insertion and removal of devices (p 0.01). There was no incidence of regurgitation with the use of PLMA. The incidence of a postoperative sore throat was minimal (6.7%) with PLMA (p<0.05). PLMA appears to be a safe alternative to ETT for selected obstetric patients undergoing elective LSCS. Further study with a larger group of patients is required to establish the safety of PLMA in obstetric patients.

Keywords: caesarean section, general anaesthesia, proseal LMA, endotracheal tube

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Authors: Sadiah Baharom, Che Nidzam Che Ahmad, Saipol Barin Ramli, Asmayati Yahaya, Sopia Md Yassin

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The early childhood care and education (ECCE) in Malaysia aspire to develop children who are intellectually, emotionally, physically and spiritually balanced. This aspiration can only materialise if the early childhood program developed comprehensive and is of high quality comparable to international standards. As such, there is a pressing need to assess the quality of the program in an all-encompassing manner. The overall research project aims at developing a comprehensive and integrated model of high-quality Malaysian ECCE. One of the major objectives of this project is to assess and evaluate the scope and quality of the existing ECCE programs in Malaysia. To this end, a specific aspect of this objective is to develop and validate an instrument to assess and evaluate the ECCE curriculum of the country. Thus this paper describes the development and validation of an instrument to explore the quality of early childhood care and education curriculum currently implemented in the country’s ECCE centres. The generation of the constructs and items were based on a set of criteria mapped against existing ECCE practice, document analyses, expert interviews and panel discussions. The items went through expert validation and were field tested on 597 ECCE teachers. The data obtained went through an exploratory factor analysis to validate the constructs of the instrument followed by reliability studies on internal consistency based on the Cronbach Alpha values. The final set of items for the ECCE curriculum instrument, earmarked for the main study, consists of four constructs namely philosophy and core values, curriculum content, curriculum review and unique features. Each construct consists of between 21 to 3 items with a total of 36 items in all. The reliability coefficients for each construct range from 0.65 to 0.961. These values are within the acceptable limits for a reliable instrument to be used in the main study.

Keywords: early childhood and care education, instrument development, reliability studies, validity studies

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Authors: Salwa Obeisat

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Obesity had become a global issue and a major public health concern, because of its impact on the public health. Obstetric and midwifery evidences reported that maternal obesity an important issue, because of its associated complications like obstructed labors, infections, and hemorrhage. People who are obese are often stigmatized and blamed for their weight. Health care providers are not immune to obesity-related prejudice, and the literature features several examples of their negative attitudes towards obese patients. In Jordan, few studies were conducted to investigate obesity prevalence rate and its associated factors. The purposes of this study were to assess the health care providers' attitudes toward overweight and obese women during the childbirth in the North of Jordan and to investigate the relationships between health care providers' socio-demographic characteristics and their attitudes. A descriptive, cross-sectional design was utilized. A convenient sample was consisted of 95 midwives, 30 nurses and 62 obstetricians, who were working in the labor rooms. A self-administered questionnaire consisted of three sections: demographical data, Arabic version of Fat Phobia Scale (FPS), and Arabic version of Nurses' Attitudes toward Obesity and Obese Patients Scale (NATOOPS). Results: The study findings revealed that the majority of Jordanian health care providers held negative attitudes toward overweight and obese women during childbirth. Midwives held less negative attitudes than did obstetricians and nurses. The majority of participants were perceived the overweight and obese pregnant women during childbirth as overate people, shapeless, slow and unattractive. Age, specialty, education and years of experience were found to be associated with health care providers’ attitudes. The Conclusion: Health care providers negative attitudes toward overweight and obese pregnant women are a cause for concern. Therefore, maternal obesity was needed to be more adequately addressed in basic education courses, and in the continuing professional education classes of practicing health care providers.

Keywords: attitudes, obesity, prevalence rate, nurses, midwives, obstetrician, childbirth

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Authors: Gjergji Buzo

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This paper presents the communist policy about tangible and intangible religious heritage in Pogradec District, Albania. The district of Pogradec lies in the southeast of Albania and consists of the municipality, located on the shore of Ohrid Lake, and 7 Administrative Units, with a population of about 61,530 inhabitants. From the statistical data provided by the Institute of Statistics, the city of Pogradec has 55.9% Muslims, 19.9% Orthodox, 1.4% Catholic and 1.1% Bektashi. While the religious affiliation in the Administrative Unit is as follows: Muslim 72.1%, Orthodox 3.32%, Catholic 1.18%, Bektashi 0.2%. The percentages are approximate values, taking into consideration that 13.8% of the total population preferred not to answer the question on religion and that for 2.4% of the persons who answered, the information provided was not relevant or stated. The percentage of the persons who declared themselves as believers without belonging to any religion was 5.5 and the persons who declared themselves as a non-believer and not belonging to any religion was 2.5. Number of persons who declared themselves as evangelists was 0.1% and the number of them declared as "other Christians" was 0.1%. About 80% of the population believe in God, and most of them practice one of the monotheist religions. We have divided religious practices into three major periods. The first is until 1967, when different religions were practiced in Pogradec in harmony with each other; the second is the period 1967-1990, during which the practice of religion was prohibited, and the period after 1990, when religious freedom was restored. This article is focused on the communist period 1967-1990 when Albania (and Pogradec as part of it) became the only atheist country in the world. The object of the study is the impact of these policies on spiritual and material religious identity. The communist regime destroyed or transformed the religious objects, whether Islamic or Christian and prohibited practicing religious rituals in Albania. They followed an education policy with an atheistic spirituality among young people, characterizing religion as opium for the people. All these left traces on the people and brought a deformation of the religious identity. In order to better understand the reality of that time and how this policy was experienced by the people, we conducted a survey in Pogradect District with the participation of 1000 people.

Keywords: communism policy, heritage, identity, religion, statistics, survey

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Authors: Jorge Luis Morales Romero, Enrique Murillo Othón

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Business to business (B2B) relationships generally go beyond a purely profit-based result, with firms seeking to maintain a relationship for many years because a breakup or getting a new supplier can be very costly. Therefore, identifying the factors which determine a successful relationship in the long term is of great interest to companies. That is why their reputation and the brand image that customers have of them are among the main factors that can achieve a successful relationship; Because of the positive effect which is driven by the client’s loyalty. Additionally, the perception that a customer may have about a brand is different when it is related to goods or to services. Thereby, they create in their minds their own brand image of it based on the past experiences they have had; Thus, a positive relationship is established between goods-related brand image, service-related brand image, and customer loyalty. The present investigation examines the boundary conditions of said relationship by testing the moderating effects of trust, commitment, and relationship value in a B2B environment. All the variables were tested independently as moderators for service-related brand image/loyalty and for goods-related brand image/loyalty, as they are assumed to be separate variables. Survey data was collected through interviews with customers that have both a product-buying relationship and a service relationship with a global B2B brand of healthcare equipment operating in the Mexican healthcare market. Interviewed respondents were either the user or the purchasing manager and/or the responsible for the equipment maintenance for the customer organization. Hence, they were appropriate informants regarding the B2B relationship with this healthcare brand. The moderation models were estimated using the PROCESS macro for the Statistical Package for the Social Sciences Software (SPSS). Results show statistical evidence that both Relationship Value and Trust are significant moderators for the service-related brand image/loyalty relation but not significant for the goods-related brand/loyalty relation. On the other hand, Commitment results in a significant moderator for the goods-related brand/loyalty relation but is not significant for the service-related brand image/loyalty relation.

Keywords: commitment, trust, relationship value, loyalty, B2B, moderator

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Authors: Olaniyi Fawole, Umezuruike Opara

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Co-products obtained from pomegranate juice processing contain high levels of polyphenols with potential high added values. From value-addition viewpoint, the aim of this study was to evaluate the stability of polyphenolic concentrations in pomegranate fruit co-products in different solvent extracts and assess the effect on the total antioxidant capacity using the FRAP, DPPH˙ and ABTS˙+ assays during simulated in vitro digestion. Pomegranate juice, marc and peel were extracted in water, 50% ethanol (50%EtOH) and absolute ethanol (100%EtOH) and analysed for total phenolic concentration (TPC), total flavonoids concentration (TFC) and total antioxidant capacity in DPPH˙, ABST˙+ and FRAP assays before and after in vitro digestion. Total phenolic concentration (TPC) and total flavonoid concentration (TFC) were in the order of peel > marc > juice throughout the in vitro digestion irrespective of the extraction solvents used. However, 50% ethanol extracted 1.1 to 12-fold more polyphenols than water and ethanol solvents depending on co-products. TPC and TFC increased significantly in gastric digests. In contrast, after the duodenal, polyphenolic concentrations decreased significantly (p < 0.05) compared to those obtained in gastric digests. Undigested samples and gastric digests showed strong and positive relationships between polyphenols and the antioxidant activities measured in DPPH, ABTS and FRAP assays, with correlation coefficients (r2) ranging between 0.930 – 0.990 whereas, the correlation between polyphenols (TPC and TFC) and radical cation scavenging activity (in ABTS) were moderately positive in duodenal digests. Findings from this study also showed that the concentration of pomegranate polyphenols and antioxidant thereof during in vitro gastro-intestinal digestion may not reflect the pre-digested phenolic concentration. Thus, this study highlights the need to provide biologically relevant information on antioxidants by providing data reflecting their stability and activity after in vitro digestion.

Keywords: by-product, DPPH, polyphenols, value addition

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Authors: Akhigbe Mark, Abang Roger, Mwoltu Nanaribet, Edet Blessing

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Introduction.: The introduction of pre- exposure prophylaxis (PrEP) as a biomedical prevention method for HIV/AIDS has been around for more than a decade since the first confirmed evidence of its effectiveness when used daily as an oral pill. It is now a very valuable addition for people who are at higher risk of contracting HIV. Although globalacceptanceof PrEP hasincreased, PrEP is still highly concentrated in a small number of countries and within a small sub-population, with Kenya and South Africa accounting for only 19% of people who have received PrEP in Africa region, there is still a significant regionGap in PrEP availability and use, with only 28% of the target of 3 million in low-and middle countries currently using PrEP. Description: The purpose of this study is to find out if serum creatinine could be used as an incentive to improve PrEP uptake among Key population.Numerous approaches to increasing the uptake ofPrEP as a prevention mechanism for HIV in KPs has beenemployed, and one of them is serum creatinine. This approach is a biomarker of renal function, which was used in study as an incentive to increase PrEP uptake among key population groups (female sex workers, men who have sex with men, persons who inject drugs, transgender) in 3 states from South-South Nigeria. Whole blood samples are collected from clients, analysis of the samples is done using the clinical chemistry analyzer before they are initiated onto PrEP. Lessons learned and Recommendations: Secondary data was extracted from 3 states of HALG Implementing facilities in Southern part of Nigeria, PrEP uptake before and afterthe introduction of serum creatinine between March 2020 and August 2020 among key populationsin Nigeria. A total of 5664 patients were initiated on PrEP before, and after the introduction of serum creatinine, the PrEP uptake rate before (March 2020 to May 2020) introduction of serum creatinine accounted for only 5% of the total onset, and after (June 2020 to August 2020) introduction of serum creatinine, the uptake rate accounted for 95% of the total onset. These finding shows that increased uptake of PrEP before/after serum creatineindicates that serum creatine may be an effective stimulus for promoting PrEP in key populations.

Keywords: serum creatinine, incentives, PrEP, key populations, Nigeria

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Authors: Dimitriya A. Mihaylova, Zlatka V. Valkova-Jarvis, Georgi L. Iliev

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One possible approach for maintaining the security of communication systems relies on Physical Layer Security mechanisms. However, in wireless time division duplex systems, where uplink and downlink channels are reciprocal, the channel estimate procedure is exposed to attacks known as pilot contamination, with the aim of having an enhanced data signal sent to the malicious user. The Shifted 2-N-PSK method involves two random legitimate pilots in the training phase, each of which belongs to a constellation, shifted from the original N-PSK symbols by certain degrees. In this paper, legitimate pilots’ offset values and their influence on the detection capabilities of the Shifted 2-N-PSK method are investigated. As the implementation of the technique depends on the relation between the shift angles rather than their specific values, the optimal interconnection between the two legitimate constellations is investigated. The results show that no regularity exists in the relation between the pilot contamination attacks (PCA) detection probability and the choice of offset values. Therefore, an adversary who aims to obtain the exact offset values can only employ a brute-force attack but the large number of possible combinations for the shifted constellations makes such a type of attack difficult to successfully mount. For this reason, the number of optimal shift value pairs is also studied for both 100% and 98% probabilities of detecting pilot contamination attacks. Although the Shifted 2-N-PSK method has been broadly studied in different signal-to-noise ratio scenarios, in multi-cell systems the interference from the signals in other cells should be also taken into account. Therefore, the inter-cell interference impact on the performance of the method is investigated by means of a large number of simulations. The results show that the detection probability of the Shifted 2-N-PSK decreases inversely to the signal-to-interference-plus-noise ratio.

Keywords: channel estimation, inter-cell interference, pilot contamination attacks, wireless communications

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Authors: Oluseun S. Oyelakin, Olalekan W. Olaniyi

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A field experiment was conducted at Ido town in Ido Local Government Area of Oyo state, Nigeria to determine the effects of intercropping maize (Zea mays L.) with Jack bean (Canavalia ensiformis L.) at different spacing and weeding regimes on crops productivity. The treatments were 2 x 2 x 3 factorial arrangement involving two spatial crop arrangements. Spacing of 75 cm x 50 cm and 90 cm x 42 cm (41.667 cm) with two plants per stand resulted in plant population of approximately 53,000 plants/hectare. Also, Randomized Complete Block Design (RCBD) with two cropping patterns (sole and intercrop), three weeding regimes (weedy check, weeds once, and weed twice) with three replicates was used. Data were analyzed with SAS (Statistical Analysis System) and statistical means separated using Least Significant Difference (LSD) (P ≤ 0.05). Intercropping and crop spacing did not have significant influence on the growth parameters and yield parameters. The maize grain yield of 1.11 t/ha obtained under sole maize was comparable to 1.05 t/ha from maize/jack beans. Weeding regime significantly influenced growth and yields of maize in intercropping with Jack beans. Weeding twice resulted in significantly higher growth than that of the other weeding regimes. Plant height at 6 Weeks After Sowing (WAS) under weeding twice regime (3 and 6 WAS) was 83.9 cm which was significantly different from 67.75 cm and 53.47 cm for weeding once (3 WAS) and no weeding regimes respectively. Moreover, maize grain yield of 1.3 t/ha obtained from plots weeded twice was comparable to that of 1.23 t/ha from single weeding and both were significantly higher than 0.71 t/ha maize grain yield obtained from the no weeding control. The dry matter production of Jack beans reduced at some growth stages due to intercropping of maize with Jack beans though with no significance effect on the other growth parameters of the crop. There was no effect on the growth parameters of Jack beans in maize/jack beans intercrop based on cropping spacing while comparable growth and dry matter production in Jack beans were produced in maize/Jack beans mixture with single weeding.

Keywords: crop spacing, intercropping, growth parameter, weeding regime, sole cropping, WAS, week after sowing

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Authors: Touhami Tahenni

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Excessively wide cracks are harmful to the serviceability of reinforced concrete (RC) beams and may lead to durability problems in the longer term. They also reduce the rigidity of RC sections, rendering the tensile concrete ineffective structurally. To reduce the negative effects of cracks, steel fibers are added to concrete mixes in the same manner as aggregates. In the present work, steel fibers reinforced concrete (SFRC) beams, made of normal strength and high strength concretes, were tested in a four-point bending test using a digital image correlation technique. The beams had different volume fractions of fibres and different aspect ratios (fiber length/fiber diameter). The evaluation of flexural cracking widths was determined using Gom-Aramis software. The experimental crack widths were compared with theoretical values predicted by the technical document of Rilem TC 162-TDF. The model proposed in this document seems to be the only one that considers the efficiency of steel fibres in restraining the crack widths. However, the model of Rilem takes into account only the aspect ratio of steel fibres to predict the crack width of SFRC beams. It has been reported in several pieces of research that the contribution of steel fibres to the limitation of flexural cracking widths is based on three essential parameters namely, the volume fraction, the orientation and the aspect ratio of fibres. Referring to the literature on the flexural cracking behavior of SFRC beams and the experimental observations of the present work, a correction of the Rilem model by the introduction of these parameters in the formula is proposed. The crack widths predicted by the new empirical model were compared with the experimental results and assessed against other test data on SFRC beams taken from the literature. The modified Rilem model gives better results and is found more satisfactory in predicting the crack widths of fibres concrete.

Keywords: stee fibres, reinforced concrete, flexural cracking, tensile strength, crack width

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Authors: Mara A. C. Lopes

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Hiring a second teacher to accompany deaf students inserted at Brazilian inclusive school system has raised questions about its role in the educational process of deaf students. Federal policies determine that deaf students inserted in regular education are accompanied by sign language interpreters, which leads to the understanding that the second teacher should assume this function. However, what those professionals do is to assume the function of teaching deaf student, instead of the classroom main teacher. Historical-Cultural Psychology was used as a reference for analysis, which aimed to identify the social function of the second teacher in the classroom. Two studies were accomplished in the public schools of Sao Paulo State: In Study 1, videotaped lectures provided by the Department of Education for collective reflection about the second teacher's role were examined, to identify the social meaning of that professional activity. Study 2 aimed to analyze the process of assigning personal sense to the teacher activity, considering the opinions of 21 professionals from Sao Paulo. Those teachers were interviewed individually with the support of a semi-structured interview. The analysis method utilized was: empirical description of data; development of categories, for reality abstraction; identifying the unit analysis; and return to reality, in order to explain it. Study 1 showed that the social meaning of the second teacher's activity is, also, to teach. However, Study 2 showed that this meaning is not shared among professionals of the school, so they understand that they must act as sign language interpreters. That comprehension causes a disruption between social meaning and the personal sense they attach to their activity. It also shows the need of both teachers at the classroom planning and executing activity together. On the contrary, a relationship of subordination of one teacher to another was identified, excluding the second teacher and the deaf student of the main activity. Results indicate that the second teacher, as a teacher, must take the responsibility for deaf student education, consciously, and to promote the full development of the subjects involved.

Keywords: deaf education, historical-cultural psychology, inclusion, teacher function

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Authors: Oluwafemi Samuel Oyamakin

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The forest in Nigeria is currently estimated to extend to around 9.6 million hectares, but used to expand over central and southern Nigeria decades ago. The forest estate is shrinking due to long-term human exploitation for agricultural development, fuel wood demand, uncontrolled forest harvesting and urbanization, amongst other factors, compounded by population growth in rural areas. Nigeria has lost more than 50% of its forest cover since 1990 and currently less than 10% of the country is forested. The current deforestation rate is estimated at 3.7%, which is one of the highest in the world. Reducing Emissions from Deforestation and forest Degradation plus conservation, sustainable management of forests and enhancement of forest carbon stocks constituted what is referred to as REDD+. This study evaluated some of the existing way of computing carbon stocks using eight indigenous tree species like Mansonia, Shorea, Bombax, Terminalia superba, Khaya grandifolia, Khaya senegalenses, Pines and Gmelina arborea. While these components are the essential elements of REDD+ programme, they can be brought under a broader framework of systems analysis designed to arrive at optimal solutions for future predictions through statistical distribution pattern of carbon sequestrated by various species of tree. Available data on height and diameter of trees in Ibadan were studied and their respective potentials of carbon sequestration level were assessed and subjected to tests so as to determine the best statistical distribution that would describe the carbon sequestration pattern of trees. The result of this study suggests a reasonable statistical distribution for carbons sequestered in simulation studies and hence, allow planners and government in determining resources forecast for sustainable development especially where experiments with real-life systems are infeasible. Sustainable management of forest can then be achieved by projecting future condition of forests under different management regimes thereby supporting conservation and REDD+ programmes in Nigeria.

Keywords: REDD+, carbon, climate change, height and diameter

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Authors: Ashvinie Thembiliyagoda, Kasun De Silva, Nimal Wijayaratna

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The lowering of the riverbed level as a result of water erosion is termed as scouring. This phenomenon remarkably undermines the potential stability of the bridge pier, causing a threat of failure or collapse. The formation of vortices in the vicinity of bridges due to the obstruction caused by river flow is the main reason behind this pursuit. Scouring is aggravated by factors including high flow rates, bridge pier geometry, sediment configuration etc. Tackling scour-related problems when they become severe is more costly and disruptive compared to implementing preventive measures based on predicted scour depths. This paper presents a comprehensive investigation of the development of a numerical model that could reproduce the scouring effect around bridge piers and estimate the scour depth. The numerical model was developed for one selected bridge in Sri Lanka, the Kelanisiri Bridge. HEC-RAS two-dimensional (2D) modeling approach was utilized for the development of the model and was calibrated and validated with field data. To further enhance the reliability of the model, a physical model was developed, allowing for additional validation. Results from the numerical model were compared with those obtained from the physical model, revealing a strong correlation between the two methods and confirming the numerical model's accuracy in predicting scour depths. The findings from this study underscore the ability of the HEC-RAS two-dimensional modeling approach for the estimation of scour depth around bridge piers. The developed model is able to estimate the scour depth under varying flow conditions, and its flexibility allows it to be adapted for application to other bridges with similar hydraulic and geomorphological conditions, providing a robust tool for widespread use in scour estimation. The developed two-dimensional model not only offers reliable predictions for the case study bridge but also holds significant potential for broader implementation, contributing to the improved design and maintenance of bridge structures in diverse environments.

Keywords: piers, scouring, HEC-RAS, physical model

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Authors: Laurent Pitteloud, Jörg Meier

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Piled raft foundations represent an efficient and reliable technique for transferring high vertical and horizontal loads to the subsoil. Piled raft foundations were success­fully implemented for several high-rise buildings world­wide over the last decades. For the structural design of this foundation type the stiffnesses of both the piles and the raft have to be deter­mined for the static (e.g. dead load, live load) and the dynamic load cases (e.g. earthquake). In this context the question often arises, to which proportion wind loads are to be considered as dynamic loads. Usually a piled raft foundation has to be monitored in order to verify the design hypotheses. As an additional benefit, the analysis of this monitoring data may lead to a better under­standing of the behaviour of this foundation type for future projects in similar subsoil conditions. In case the measurement frequency is high enough, one may also draw conclusions on the effect of wind loading on the piled raft foundation. For a 41-storey office building in Basel, Switzerland, the preliminary design showed that a piled raft foundation was the best solution to satisfy both design requirements, as well as economic aspects. A high-frequency monitoring of the foundation including pile loads, vertical stresses under the raft, as well as pore water pressures was performed over 5 years. In windy situations the analysis of the measure­ments shows that the pile load increment due to wind consists of a static and a cyclic load term. As piles and raft react with different stiffnesses under static and dynamic loading, these measure­ments are useful for the correct definition of stiffnesses of future piled raft foundations. This paper outlines the design strategy and the numerical modelling of the aforementioned piled raft foundation. The measurement results are presented and analysed. Based on the findings, comments and conclusions on the definition of pile and raft stiffnesses for vertical and wind loading are proposed.

Keywords: design, dynamic, foundation, monitoring, pile, raft, wind load

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Authors: Aiydh Aljeddani

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Sustainable learning is an emerging concept that aims at enhancing sustainability literacy and competency in educational contexts. Mobile learning is one of the means increasingly used in sustainable development education nowadays. Studies which have explored this issue in the Saudi educational context so far are rare. Therefore, the current study attempted to explore the current situation of the usage of mobile learning in the Saudi elementary and secondary schools as a means of promoting sustainable learning. It also focused on how mobile learning has been implemented in those schools to promote sustainable learning and what factors have contributed to the success/failure of the implementation of mobile learning and possible ways to improve the current practice. An interpretive approach was followed in this study to gain a thorough understanding of the explored issue in the Saudi educational context using the activity theory as a lens to do so. A qualitative case study methodology in which semi-structured interviews, documents analysis and nominal group were used to gather the data for this study. Two hundred and twenty-nine participants representing several main stakeholders in the educational system took part in this study. Those included six general education schools, head teachers, teachers, students’ parents, educational supervisors, one curriculum designer and academic curriculum specialists. Through the lens of activity theory, the results of the study showed that there were contradictions in the current practice between the elements of the activity system and within each of its elements. Furthermore, several sociocultural factors have influenced both the division of labour and the community's members. These have acted as obstacles which have impeded the usage of mobile learning to promote sustainable learning in this context. It was found that shifting from the current practice to sustainable learning via the usage of mobile learning requires appropriate interrelationship between the different elements of the activity system. The study finally offers a number of recommendations to improve on the current practices and suggests areas for further studies.

Keywords: activity theory, mobile learning, sustainability competency, sustainability literacy, sustainable learning

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Authors: N. Ismail, O. Thammajinda, U. Thongpanya

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Games-based learning (GBL) has become increasingly important in teaching and learning. This paper explains the first two phases (analysis and design) of a GBL development project, ending up with a prototype design based on students’ and teachers’ perceptions. The two phases are part of a full cycle GBL project aiming to help secondary school students in Thailand in their study of Comprehensive Sex Education (CSE). In the course of the study, we invited 1,152 students to complete questionnaires and interviewed 12 secondary school teachers in focus groups. This paper found that GBL can serve students in their learning about CSE, enabling them to gain understanding of their sexuality, develop skills, including critical thinking skills and interact with others (peers, teachers, etc.) in a safe environment. The objectives of this paper are to outline the development of GBL variables from the research question(s) into the developers’ flow chart, to be responsive to the GBL beneficiaries’ preferences and expectations, and to help in answering the research questions. This paper details the steps applied to generate GBL variables that can feed into a game flow chart to develop a GBL prototype. In our approach, we detailed two models: (1) Game Elements Model (GEM) and (2) Game Object Model (GOM). There are three outcomes of this research – first, to achieve the objectives and benefits of GBL in learning, game design has to start with the research question(s) and the challenges to be resolved as research outcomes. Second, aligning the educational aims with engaging GBL end users (students) within the data collection phase to inform the game prototype with the game variables is essential to address the answer/solution to the research question(s). Third, for efficient GBL to bridge the gap between pedagogy and technology and in order to answer the research questions via technology (i.e. GBL) and to minimise the isolation between the pedagogists “P” and technologist “T”, several meetings and discussions need to take place within the team.

Keywords: games-based learning, engagement, pedagogy, preferences, prototype

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Authors: Celeste Lawson

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Learning to embrace and value teamwork assessment at a university level is critical for students, as graduates enter a real-world working environment where teamwork is likely to occur virtually. Student disdain for teamwork exercises is an area often overlooked or disregarded by academics. This research explored the implementation of an online teamwork assessment approach at a regional Australian university with a significant cohort of Distance Education students. Students had disliked teamwork for three reasons: it was not relevant to their study, the grading was unfair amongst team members, and managing the task was challenging in a virtual environment. Teamwork assessment was modified so that the task was an authentic task that could occur in real-world practice; team selection was based on the task topic rather than randomly; grading was based on the individual’s contribution to the task, and students were provided virtual team management skills as part of a the assessment. In this way, management of the team became an output of the task itself. Data was gathered over three years from student satisfaction surveys, failure rates, attrition figures, and unsolicited student comments. In one unit where this approach was adopted (Advanced Public Relations), student satisfaction increased from 3.6 (out of 5) in 2012 to 4.6 in 2016, with positive comments made about the teamwork approach. The attrition rate for another unit (Public Relations and the Media) reduced from 20.7% in 2012 to 2.2% in 2015. In 2012, criticism of teamwork assessment made up 50% of negative student feedback in Public Relations and the Media. By 2015, following the successful implementation of the teamwork assessment approach, only 12.5% of negative comments on the student satisfaction survey were critical of teamwork, while 33% of positive comments related to a positive teamwork experience. In 2016, students explicitly nominated teamwork as the best part of this unit. The approach is transferable to other disciplines and was adopted by other academics within the institution with similar results.

Keywords: assessment, distance education, teamwork, virtual

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Authors: Muhammad Nasar-U-Minallah, Dagmar Haase, Salman Qureshi, Safdar Ali Shirazi

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Urban green spaces (UGS) play a key role in the urban ecology of an area since they provide significant ecological services to compensate for natural environment functions damaged by the rapid growth of urbanization. The transformation of urban green specs to impervious landscapes has been recognized as a key factor prompting the distinctive urban heat and associated microclimatic changes. There is no doubt that urban green spaces offer a range of ecosystem services that can help to mitigate the ill effects of urbanization, heat anomalies, and climate change. The present study attempts to appraise the impact of urban green spaces on the urban thermal environment for the development of the microclimatic conditions in Lahore, Pakistan. The influence of urban heat has been studied through Landsat 8 data. The land surface temperature (LST) of Lahore was computed through the Radiative transfer method (RTM). The spatial variation of land surface temperature is retrieved to describe their local heat effect on urban microclimate. The association between the LST, normalized difference vegetation index, and the normalized difference built-up index are investigated to explore the impact of the urban green spaces and impervious surfaces on urban microclimate. The results of this study show significant changes in (impervious land surface 18% increase) land use within the study area. However, conversion of natural green cover to commercial and residential uses considerably increases the LST. Furthermore, results show that green spaces were the major heat sinks while impervious landscapes were the major heat source in the study area. Urban green spaces reveal 1 to 3℃ lower LST associated with their surrounding urban built-up area. This study shows that urban green spaces will help to mitigate the effect of urban microclimate and it is significant for the sustainable urban environment as well as to improve the quality of life of the urban inhabitants.

Keywords: thermal environmental, urban green space, cooling effect, microclimate, Lahore

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Authors: Beatrice Adeoye

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Background: One of the health challenges developing countries face is air pollution from indoor and outdoor activities. Smoke as a result of cooking, burning wastes and power generators litter the air space on a continual basis due to poverty and governance challenges. The short and long term implications of these actions are enormous and studies have attributed smoke as one of the leading preventable risk factors contributing to global burden of respiratory infections. Design/Methods: The issue at hand therefore includes an exploration of the existing policy frameworks regarding smoke, adherence to international conventions and practices, and more importantly the activities of the government in addressing these issues. Aside this, an understanding of the implications of smoke on peoples’ health and well-being also become crucial. Consequently, this article seeks to interrogate the effect of smoke on the health and well-being of Nigerians and the activities of the policy makers in addressing these challenges. Results (Main Argument): This study reviewed both primary and secondary data on poverty, smoke emission and attendant health risks coupled with existing policies on smoke and air pollution in the country. For instance, over 69% of Nigerians are poor, ranking third in the world; 2.9 billion people live in homes using wood, coal or dung as their primary cooking fuel; equally, 50.6% of Nigerians has no access to regular electricity supply. Further, sustainable policy regarding smoke emission is lacking in the country. This work further submitted that continued low standard of living as a result of governance challenges coupled with a lack of sustainable policy have aggravated the health risks related to smoke in the country. Conclusions: The implication on the health of the children, mothers and vulnerable groups for the future of the country is enormous and may continue if not addressed. Urgent attention therefore needs to be focused on this area considering what this portends for the nation now and in the future.

Keywords: air pollution, indoor, outdoor, respiratory infections

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Authors: Adawati Suhaili, Kamisah Osman, Mohd Effendi, Ewan Mohd Matore

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The global education reform has prompted Malaysia to transform the education system in Malaysia through the Malaysian Education Blueprint (MEB) 2013-2025. This transformation is aimed to achieve the top one-third rank in international assessment. The low achievement of student scientific literacy in TIMMS (Trends in International Mathematics and Science Study ) and PISA (Programme for International Student Assessment) has caused concern to the Ministry Of Education (MOE) despite various reform efforts. Therefore, an alternative action by enhancing the role of the Head of Science Panels (HoSPs) as a key change agent in catalyzing the improvement of student performance should be considered. Highlights of previous studies have shown that subject leadership is able to enhance teacher teaching quality in order to increase student learning. To lead the Science department and guide Science teachers more effectively, HoSPs need to strengthen their leadership skills. However, the issue of weaknesses in the leadership competencies of HoSPs in Malaysia has caused them to lack confidence and ability in leading the Science Department. The main objective of this study is to explore the factors that contribute to the problems faced by HoSPs at Sarawak in their leadership roles. This study used a qualitative design framework and using a semi-structured interview method for data collection. There were six informants involved in the interview consisting of lecturers, Senior Administrative Assistant Teacher and HoSPs. The findings of the study had been identified four main factors that contribute to problems in the leadership competencies of HoSPs in Sarawak, namely leadership practices, leadership structure, academic subjects and school change. The results are significant to the MOE in strengthening the leadership competencies of HoSPs in a more focus for improving the achievement of scientific literacy of students in Malaysia. This study can help improve the Hosps' leadership competencies in Malaysia.

Keywords: issues, problems, Malaysia education blueprint, leadership competencies, head of science panels

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Authors: Ulriikka Savela-Huovinen, Hanni Muukkonen, Auli Toom

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The development of workplace as a learning environment has been emphasized in research field of workplace learning. The prior literature on sensory performance emphasized the individual’s competences as assessor, while the competences in the collaborative interactional and knowledge creation practices as workplace learning method are not often mentioned. In the present study aims to find out what kinds of competences and contexts are central when assessor conducts food sensory evaluation in authentic professional context. The aim was to answer the following questions: first, what kinds of competences does sensory evaluation require according to assessors? And second, what kinds of contexts for sensory evaluation do assessors report? Altogether thirteen assessors from three Finnish food companies were interviewed by using semi-structural thematic interviews to map practices and development intentions as well as to explicate already established practices. The qualitative data were analyzed by following the principles of abductive and inductive content analysis. Analysis phases were combined and their results were considered together as a cross-analysis. When evaluated independently required competences were perception, knowledge of specific domains and methods and cognitive skills e.g. memory. Altogether, 42% of analysis units described individual evaluation contexts, 53% of analysis units described collaborative interactional contexts, and 5% of analysis units described collaborative knowledge creation contexts. Related to collaboration, analysis reviewed learning, sharing and reviewing both external and in-house consumer feedback, developing methods to moderate small-panel evaluation and developing product vocabulary collectively between the assessors. Knowledge creation contexts individualized from daily practices especially in cases product defects were sought and discussed. The study findings contribute to the explanation that sensory assessors learn extensively from one another in the collaborative interactional and knowledge creation context. Assessors learning and abilities to work collaboratively in the interactional and knowledge creation contexts need to be ensured in the development of the expertise.

Keywords: assessor, collaboration, competences, contexts, learning and practices, sensory evaluation

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Authors: Eva Kirzner

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Based on outcome studies published over the past two decades, in 2018, the ACC/AHA published new guidelines for the management of hypercholesterolemia that incorporate the use of coronary artery calcium (CAC) scanning as a decision tool for ascertaining which patients may benefit from statin therapy. This use is based on the recognition that the absence of calcium on CAC scanning (i.e., a CAC score of zero) usually signifies the absence of significant atherosclerotic deposits in the coronary arteries. Specifically, in patients with a high risk for atherosclerotic cardiovascular disease (ASCVD), initiation of statin therapy is generally recommended to decrease ASCVD risk. However, among patients with intermediate ASCVD risk, the need for statin therapy is less certain. However, there is a need for new outcome studies that provide evidence that the management of hypercholesterolemia based on these new ACC/AHA recommendations is safe for patients. Based on a Pub-Med and Google Scholar literature search, four relevant population-based or patient-based cohort studies that studied the relationship between CAC scanning, risk assessment or mortality, and statin therapy that were published between 2017 and 2021 were identified (see references). In each of these studies, patients were assessed for their baseline risk for atherosclerotic cardiovascular disease (ASCVD) using the Pooled Cohorts Equation (PCE), an ACC/AHA calculator for determining patient risk based on assessment of patient age, gender, ethnicity, and coronary artery disease risk factors. The combined findings of these four studies provided concordant evidence that a zero CAC score defines patients who remain at low clinical risk despite the non-use of statin therapy. Thus, these new studies confirm the use of CAC scanning as a safe tool for reducing the potential overuse of statin therapy among patients with zero CAC scores. Incorporating these new data suggest the following best practice: (1) ascertain ASCVD risk according to the PCE in all patients; (2) following an initial attempt trial to lower ASCVD risk with optimal diet among patients with elevated ASCVD risk, initiate statin therapy for patients who have a high ASCVD risk score; (3) if the ASCVD score is intermediate, refer patients for CAC scanning; and (4) and if the CAC score is zero among the intermediate risk ASCVD patients, statin therapy can be safely withheld despite the presence of an elevated serum cholesterol level.

Keywords: cholesterol, cardiovascular disease, statin therapy, coronary calcium

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