Search results for: the health belief model

Authors: Afrah Saad Mohsen Al-Mahfadi

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The construction of dams can provide various ecosystem services, but it can also lead to ecological changes such as habitat loss and coastal degradation. Yemen faces multiple risks, including water crises and inadequate environmental policies, which are particularly detrimental to coastal zones like the Ahwar Delta in Abyan. This study aims to examine the impacts of dam construction on downstream wetlands and propose sustainable management approaches. Research Aim: The main objective of this study is to assess the different impacts of dam construction on downstream wetlands, specifically focusing on the Ahwar Delta in Yemen. Methodology: The study utilizes a literature review approach to gather relevant information on dam impacts and adaptation measures. Interviews with decision-making stakeholders and local community members are conducted to gain insights into the specific challenges faced in the Ahwar Delta. Additionally, sensing data, such as Arc-GIS and precipitation data from 1981 to 2020, are analyzed to examine changes in hydrological dynamics. Questions Addressed: This study addresses the following questions: What are the impacts of dam construction on downstream wetlands in the Ahwar delta? How can environmental management planning activities be implemented to minimize these impacts? Findings: The results indicate several future issues arising from dam construction in the coastal areas, including land loss due to rising sea levels and increased salinity in drinking water wells. Climate change has led to a decrease in rainfall rates, impacting vegetation and increasing sedimentation and erosion. Downstream areas with dams exhibit lower sediment levels and slower flowing habitats compared to those without dams. Theoretical Importance: The findings of this study provide valuable insights into the ecological impacts of dam construction on downstream wetlands. Understanding these dynamics can inform decision-makers about the need for adaptation measures and their potential benefits in improving coastal biodiversity under dam impacts. Data Collection and Analysis Procedures: The study collects data through a literature review, interviews, and sensing technology. The literature review helps identify relevant studies on dam impacts and adaptation measures. Interviews with stakeholders and local community members provide firsthand information on the specific challenges faced in the Ahwar Delta. Sensing data, such as Arc-GIS and precipitation data, are analyzed to understand changes in hydrological dynamics over time. Conclusion: The study concludes that while the situation can worsen due to dam construction, practical adaptation measures can help mitigate the impacts. Recommendations include improving water management, developing integrated coastal zone planning, raising awareness among stakeholders, improving health and education, and implementing emergency projects to combat climate change.

Keywords: dam impact, delta wetland, hydrology, Yemen

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Authors: Salwa Mohamed Salah Eldin, Howida Kamal Ibrahim

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Introduction: Major depressive disorder affects high proportion of the world’s population presenting cost load in health care. Extended release venlafaxine is more convenient and could reduce discontinuation syndrome. The once daily dosing also reduces the potential for adverse events such as nausea due to reduced Cmax. Venlafaxine is an effective first-line agent in the treatment of depression. A once daily formulation was designed to enhance patient compliance. Complexing with a resin was suggested to improve loading of the water soluble drug. The formulated systems were thoroughly evaluated in vitro to prove superiority to previous trials and were compared to the commercial extended release product in experimental animals. Materials and Methods: Venlafaxine-resinates were prepared using Dowex®50WX4-400 and Dowex®50WX8-100 at drug to resin weight ratio of 1: 1. The prepared resinates were evaluated for their drug content, particle shape and surface properties and in vitro release profile in gradient pH. The release kinetics and mechanism were evaluated. Venlafaxine-Dowex® resinates were encapsulated using O/W solvent evaporation technique. Poly-ε-caprolactone, Poly(D, L-lactide-co-glycolide) ester, Poly(D, L-lactide) ester and Eudragit®RS100 were used as coating polymers alone and in combination. Drug-resinate microcapsules were evaluated for morphology, entrapment efficiency and in-vitro release profile. The selected formula was tested in rabbits using a randomized, single-dose, 2-way crossover study against Effexor-XR tablets under fasting condition. Results and Discussion: The equilibrium time was 30 min for Dowex®50WX4-400 and 90 min for Dowex®50WX8-100. The percentage drug loaded was 93.96 and 83.56% for both resins, respectively. Both drug-Dowex® resintes were efficient in sustaining venlafaxine release in comparison to the free drug (up to 8h.). Dowex®50WX4-400 based venlafaxine-resinate was selected for further encapsulation to optimize the release profile for once daily dosing and to lower the burst effect. The selected formula (coated with a mixture of Eudragit RS and PLGA in a ratio of 50/50) was chosen by applying a group of mathematical equations according to targeted values. It recorded the minimum burst effect, the maximum MDT (Mean dissolution time) and a Q24h (percentage drug released after 24 hours) between 95 and 100%. The 90% confidence intervals for the test/reference mean ratio of the log-transformed data of AUC0–24 and AUC0−∞ are within (0.8–1.25), which satisfies the bioequivalence criteria. Conclusion: The optimized formula could be a promising extended release form of the water soluble, short half lived venlafaxine. Being a multiple unit formulation, it lowers the probability of dose dumping and reduces the inter-subject variability in absorption.

Keywords: biodegradable polymers, cation-exchange resin, microencapsulation, venlafaxine hcl

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Authors: Shulamit Sternin, Raymond M. McKie, Carter Winberg, Robb N. Travers, Terry P. Humphreys, Elke D. Reissing

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Issues surrounding sexual consent negotiation have become a major topic of societal concern. The majority of current research focuses on the complexities of sexual consent negotiations and the multitude of nuanced issues that surround the consent obtainment of heterosexual adults in post-secondary educational institutions. To date, the only study that has addressed sexual consent negotiation behaviour in same-sex relationships focused on the extent to which individuals used a variety of different verbal and nonverbal sexual consent behaviours to initiate or respond to sexual activity. The results were consistent with trends found within heterosexual individuals; thus, suggesting that the current understanding of sexual consent negotiation, which is grounded in heterosexual research, can serve as a strong foundation for further exploration of sexual consent negotiation within same-sex relationships populations. The current study quantitatively investigated the differences between heterosexual men and gay and bisexual men (GBM) in their understanding of sexual consent negotiation. Exploring how the perceptions of GBM differ from heterosexual males provides insight into some of the unique challenges faced by GBM. Data were collected from a sample of 252 heterosexual men and 314 GBM from Canada, the United States, and Western Europe. Participants responded to the question, 'do you think sexual consent and sex negotiation is different for heterosexual men compared to gay men? If so, how?' by completed an online survey. Responses were analysed following Braun & Clarke’s (2006) six phase thematic analysis guidelines. Inter-rater coding was validated using Cohen’s Kappa value and was calculated at (ϰ = 0.84), indicating a very strong level of agreement between raters. The final thematic structure yielded four major themes: understanding of sexual interaction, unique challenges, scripted role, and universal consent. Respondents spoke to their understanding of sexual interaction, believing GBM sexual consent negotiation to be faster and more immediate. This was linked to perceptions of emotional attachment and the idea that sexual interaction and emotional involvement were distinct and separate processes in GBM sexual consent negotiation, not believed to be the case in heterosexual interactions. Unique challenges such as different protection concerns, role declaration, and sexualization of spaces were understood to hold differing levels of consideration for heterosexual men and GBM. The perception of a clearly defined sexual script for GBM was suggested as a factor that may create ambiguity surrounding sexual consent negotiation, which in turn holds significant implications on unwanted sexual experiences for GBM. Broadening the scope of the current understanding of sexual consent negotiation by focusing on heterosexual and GBM population, the current study has revealed variations in perception of sexual consent negotiation between these two populations. These differences may be understood within the context of sexual scripting theory and masculinity gender role theory. We suggest that sexual consent negotiation is a health risk factor for GBM that has not yet been adequately understood and addressed. Awareness of the perceptions that surround the sexual consent negotiation of both GBM and heterosexual men holds implications on public knowledge, which in turn can better inform policy making, education, future research, and clinical treatment.

Keywords: sexual consent, negotiation, heterosexual men, GBM, sexual script

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Authors: Lucia Liu, Matthew Koziol

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Obsessive-compulsive disorder (OCD), a long-lasting anxiety disorder involving recurrent, intrusive thoughts, affects over 2 million adults in the United States. Transcranial magnetic stimulation (TMS) stands out as a noninvasive, cutting-edge therapy that has been shown to reduce symptoms in patients with treatment-resistant OCD. The Food and Drug Administration (FDA) approved protocol pairs TMS sessions with individualized symptom provocation, aiming to improve the susceptibility of brain circuits to stimulation. However, limited standardization or guidance exists on how to conduct symptom provocation and which methods are most effective. This study aims to compare the effect of internal versus external techniques to induce obsessional stress in a clinical setting during TMS therapy. Two symptom provocation methods, (i) Asking patients thought-provoking questions about their obsessions (internal) and (ii) Requesting patients to perform obsession-related tasks (external), were employed in a crossover design with repeated measurement. Thirty-six treatments of NeuroStar TMS were administered to each of two patients over 8 weeks in an outpatient clinic. Patient One received 18 sessions of internal provocation followed by 18 sessions of external provocation, while Patient Two received 18 sessions of external provocation followed by 18 sessions of internal provocation. The primary outcome was the level of self-reported obsessional stress on a visual analog scale from 1 to 10. The secondary outcome was self-reported OCD severity, collected biweekly in a four-level Likert-scale (1 to 4) of bad, fair, good and excellent. Outcomes were compared and tested between provocation arms through repeated measures ANOVA, accounting for intra-patient correlations. Ages were 42 for Patient One (male, White) and 57 for Patient Two (male, White). Both patients had similar moderate symptoms at baseline, as determined through the Yale-Brown Obsessive Compulsive Scale (YBOCS). When comparing obsessional stress induced across the two arms of internal and external provocation methods, the mean (SD) was 6.03 (1.18) for internal and 4.01 (1.28) for external strategies (P=0.0019); ranges were 3 to 8 for internal and 2 to 8 for external strategies. Internal provocation yielded 5 (31.25%) bad, 6 (33.33%) fair, 3 (18.75%) good, and 2 (12.5%) excellent responses for OCD status, while external provocation yielded 5 (31.25%) bad, 9 (56.25%) fair, 1 (6.25%) good, and 1 (6.25%) excellent responses (P=0.58). Internal symptom provocation tactics had a significantly stronger impact on inducing obsessional stress and led to better OCD status (non-significant). This could be attributed to the fact that answering questions may prompt patients to reflect more on their lived experiences and struggles with OCD. In the future, clinical trials with larger sample sizes are warranted to validate this finding. Results support the increased integration of internal methods into structured provocation protocols, potentially reducing the time required for provocation and achieving greater treatment response to TMS.

Keywords: obsessive-compulsive disorder, transcranial magnetic stimulation, mental health, symptom provocation

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Authors: Jason M. Hegenauer, Nicholas Fucci

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In the late 1990s, a major deinstitutionalization movement of elderly patients took place, since which, the design of long-term care facilities has not been adequately analyzed in the United States. Over the course of the last 25 years, major innovations in construction methods, technology, and medicine have been developed, drastically changing the landscape of healthcare architecture. In light of recent events, and the expected increase in elderly populations with the aging of the baby-boomer generation, it is evident that reconsideration of these facilities is essential for the proper care of aging populations. The global response has been effective in stifling this pandemic; however, widespread disease still poses an imminent threat to the human race. Having witnessed the devastation Covid-19 has reaped throughout nursing homes and long-term care facilities, it is evident that the current strategies for protecting our most vulnerable populations are not enough. Light renovation of existing facilities and previously overlooked considerations for new construction projects can drastically lower the risk at nursing homes and long-term care facilities. A reconfigured entry sequence supplements several of the features which have been long-standing essentials of the design of these facilities. This research focuses on several aspects identified as needing improvement, including indoor environment quality, security measures incorporated into healthcare architecture and design, and architectural mitigation strategies for sick building syndrome. The results of this study have been compiled as 'best practices' for the design of future healthcare construction projects focused on the health, safety, and quality of life of the residents of these facilities. These design strategies, which can easily be implemented through renovation of existing facilities and new construction projects, minimize risk of infection and spread of disease while allowing routine functions to continue with minimal impact, should the need for future lockdowns arise. Through the current lockdown procedures, which were implemented during the Covid-19 pandemic, isolation of residents has caused great unrest and worry for family members and friends as they are cut off from their loved ones. At this time, data is still being reported, leaving infection and death rates inconclusive; however, recent projections in some states list long-term care facility deaths as high as 60% of all deaths in the state. The population of these facilities consists of residents who are elderly, immunocompromised, and have underlying chronic medical conditions. According to the Centers for Disease Control, these populations are particularly susceptible to infection and serious illness. The obligation to protect our most vulnerable population cannot be overlooked, and the harsh measures recently taken as a response to the Covid-19 pandemic prove that the design strategies currently utilized for doing so are inadequate.

Keywords: building security, healthcare architecture and design, indoor environment quality, new construction, sick building syndrome, renovation

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Authors: Wenyu Guo, Malachy O’Rourke, Mark Bowkett, Michael Gilchrist

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Many devices for real-time monitoring of surface water have been developed in the past few years to provide early warning of pollutions and so to decrease the risk of environmental pollution efficiently. One of the most common methodologies used in the detection system is a colorimetric process, in which a container with fixed volume is filled with target ions and reagents to combine a colorimetric dye. The colorimetric ions can sensitively absorb a specific-wavelength radiation beam, and its absorbance rate is proportional to the concentration of the fully developed product, indicating the concentration of target nutrients in the pre-mixed water samples. In order to achieve precise and rapid detection effect, channels with dimensions in the order of micrometers, i.e., microfluidic systems have been developed and introduced into these diagnostics studies. Microfluidics technology largely reduces the surface to volume ratios and decrease the samples/reagents consumption significantly. However, species transport in such miniaturized channels is limited by the low Reynolds numbers in the regimes. Thus, the flow is extremely laminar state, and diffusion is the dominant mass transport process all over the regimes of the microfluidic channels. The objective of this present work has been to analyse the mixing effect and chemistry kinetics in a stop-flow microfluidic device measuring Nitride concentrations in fresh water samples. In order to improve the temporal resolution of the Nitride microfluidic sensor, we have used computational fluid dynamics to investigate the influence that the effectiveness of the mixing process between the sample and reagent within a microfluidic device exerts on the time to completion of the resulting chemical reaction. This computational approach has been complemented by physical experiments. The kinetics of the Griess reaction involving the conversion of sulphanilic acid to a diazonium salt by reaction with nitrite in acidic solution is set in the Laminar Finite-rate chemical reaction in the model. Initially, a methodology was developed to assess the degree of mixing of the sample and reagent within the device. This enabled different designs of the mixing channel to be compared, such as straight, square wave and serpentine geometries. Thereafter, the time to completion of the Griess reaction within a straight mixing channel device was modeled and the reaction time validated with experimental data. Further simulations have been done to compare the reaction time to effective mixing within straight, square wave and serpentine geometries. Results show that square wave channels can significantly improve the mixing effect and provides a low standard deviations of the concentrations of nitride and reagent, while for straight channel microfluidic patterns the corresponding values are 2-3 orders of magnitude greater, and consequently are less efficiently mixed. This has allowed us to design novel channel patterns of micro-mixers with more effective mixing that can be used to detect and monitor levels of nutrients present in water samples, in particular, Nitride. Future generations of water quality monitoring and diagnostic devices will easily exploit this technology.

Keywords: nitride detection, computational fluid dynamics, chemical kinetics, mixing effect

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Authors: David Dolbow, Daniel Credeur, Mujtaba Rahimi, Dobrivoje Stokic, Jennifer Lemacks, Andrew Courtner

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Introduction: Obesity is at epidemic proportions in the spinal cord injury (SCI) population (66-75%), as individuals who suffer from paralysis undergo a dramatic decrease in muscle mass and a dramatic increase in adipose deposition. Obesity is a major public health concern which includes a doubling of the risk of heart disease, stroke and type II diabetes mellitus. It has been demonstrated that physical activity, and especially HIIT, can promote a healthy body composition and decrease the risk cardiometabolic disease in the able-bodied population. However, SCI typically limits voluntary exercise to the arms, but a high prevalence of shoulder pain in persons with chronic SCI (60-90%) can cause increased arm exercise to be problematic. Functional electrical stimulation (FES) cycling has proven to be a safe and effective way to exercise paralyzed leg muscles in clinical and home settings, saving the often overworked arms. Yet, HIIT-FES cycling had not been investigated prior to the current study. The purpose of this study was to investigate the body composition changes with combined HIIT-FES cycling and nutritional counseling on individuals with SCI. Design: A matched (level of injury, time since injury, body mass index) and controlled trail. Setting: University exercise performance laboratory. Subjects: Ten individuals with chronic SCI (C5-T9) ASIA impairment classification (A & B) were divided into the treatment group (n=5) for 30 minutes of HIIT-FES cycling 3 times per week for 8 weeks and nutritional counseling over the phone for 30 minutes once per week for 8 weeks and the control group (n=5) who received nutritional counseling only. Results: There was a statistically significant difference between the HIIT-FES group and the control group in mean body fat percentage change (-1.14 to +0.24) respectively, p = .030). There was also a statistically significant difference between the HIIT-FES and control groups in mean change in legs lean mass (+0.78 kg to -1.5 kg) respectively, p = 0.004. There was a nominal decrease in weight, BMI, total fat mass and a nominal increase in total lean mass for the HIIT-FES group over the control group. However, these changes were not found to be statistically significant. Additionally, there was a nominal decrease in the mean blood glucose levels for both groups 101.8 to 97.8 mg/dl for the HIIT-FES group and 94.6 to 93 mg/dl for the Nutrition only group, however, neither were found to be statistically significant. Conclusion: HIIT-FES cycling combined with nutritional counseling can provide healthful body composition changes including decreased body fat percentage in just 8 weeks. Future study recommendations include a greater number of participants, a primer electrical stimulation exercise program to better ready participants for HIIT-FES cycling and a greater volume of training above 30 minutes, 3 times per week for 8 weeks.

Keywords: body composition, functional electrical stimulation cycling, high-intensity interval training, spinal cord injury

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Authors: Anuj Tyagi, Balwinder Singh, Naveen Kumar B. T., Niraj K. Singh

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Characterization of diverse microbial communities in specific environment plays a crucial role in the better understanding of their functional relationship with the ecosystem. It is now well established that gut microbiome of fish is not the simple replication of microbiota of surrounding local habitat, and extensive species, dietary, physiological and metabolic variations in fishes may have a significant impact on its composition. Moreover, overuse of antibiotics in human, veterinary and aquaculture medicine has led to rapid emergence and propagation of antibiotic resistance genes (ARGs) in the aquatic environment. Microbial communities harboring specific ARGs not only get a preferential edge during selective antibiotic exposure but also possess the significant risk of ARGs transfer to other non-resistance bacteria within the confined environments. This phenomenon may lead to the emergence of habitat-specific microbial resistomes and subsequent emergence of virulent antibiotic-resistant pathogens with severe fish and consumer health consequences. In this study, gut microbiota of freshwater carp (Labeo rohita) was investigated by shotgun metagenomics to understand its taxonomic composition and functional capabilities. Metagenomic DNA, extracted from the fish gut, was subjected to sequencing on Illumina NextSeq to generate paired-end (PE) 2 x 150 bp sequencing reads. After the QC of raw sequencing data by Trimmomatic, taxonomic analysis by Kraken2 taxonomic sequence classification system revealed the presence of 36 phyla, 326 families and 985 genera in the fish gut microbiome. At phylum level, Proteobacteria accounted for more than three-fourths of total bacterial populations followed by Actinobacteria (14%) and Cyanobacteria (3%). Commonly used probiotic bacteria (Bacillus, Lactobacillus, Streptococcus, and Lactococcus) were found to be very less prevalent in fish gut. After sequencing data assembly by MEGAHIT v1.1.2 assembler and PROKKA automated analysis pipeline, pathway analysis revealed the presence of 1,608 Metacyc pathways in the fish gut microbiome. Biosynthesis pathways were found to be the most dominant (51%) followed by degradation (39%), energy-metabolism (4%) and fermentation (2%). Almost one-third (33%) of biosynthesis pathways were involved in the synthesis of secondary metabolites. Metabolic pathways for the biosynthesis of 35 antibiotic types were also present, and these accounted for 5% of overall metabolic pathways in the fish gut microbiome. Fifty-one different types of antibiotic resistance genes (ARGs) belonging to 15 antimicrobial resistance (AMR) gene families and conferring resistance against 24 antibiotic types were detected in fish gut. More than 90% ARGs in fish gut microbiome were against beta-lactams (penicillins, cephalosporins, penems, and monobactams). Resistance against tetracycline, macrolides, fluoroquinolones, and phenicols ranged from 0.7% to 1.3%. Some of the ARGs for multi-drug resistance were also found to be located on sequences of plasmid origin. The presence of pathogenic bacteria and ARGs on plasmid sequences suggested the potential risk due to horizontal gene transfer in the confined gut environment.

Keywords: antibiotic resistance, fish gut, metabolic pathways, microbial diversity

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Authors: Natalia Podkhodova, Olga Sheremeteva, Mariia Soldaeva

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Creating favorable conditions for students’ comprehension of mathematical content is one of the primary problems in teaching mathematics in secondary school. Psychology research has demonstrated that positive comprehension becomes possible when new information becomes part of student’s subjective experience and when linkages between the attributes of notions and various ways of their presentations can be established. The fact of comprehension includes the ability to build a working situational model and thus becomes an important means of solving mathematical problems. The article describes the implementation of a holistic approach to teaching mathematics designed to address the primary challenges of such teaching, specifically, the challenge of students’ comprehension. This approach consists of (1) establishing links between the attributes of a notion: the sense, the meaning, and the term; (2) taking into account the components of student’s subjective experience -emotional and value, contextual, procedural, communicative- during the educational process; (3) links between different ways to present mathematical information; (4) identifying and leveraging the relationships between real, perceptual and conceptual (scientific) mathematical spaces by applying real-life situational modeling. The article describes approaches to the practical use of these foundational concepts. Identifying how proposed methods and technology influence understanding of material used in teaching mathematics was the research’s primary goal. The research included an experiment in which 256 secondary school students took part: 142 in the experimental group and 114 in the control group. All students in these groups had similar levels of achievement in math and studied math under the same curriculum. In the course of the experiment, comprehension of two topics -'Derivative' and 'Trigonometric functions'- was evaluated. Control group participants were taught using traditional methods. Students in the experimental group were taught using the holistic method: under the teacher’s guidance, they carried out problems designed to establish linkages between notion’s characteristics, to convert information from one mode of presentation to another, as well as problems that required the ability to operate with all modes of presentation. The use of the technology that forms inter-subject notions based on linkages between perceptional, real, and conceptual mathematical spaces proved to be of special interest to the students. Results of the experiment were analyzed by presenting students in each of the groups with a final test in each of the studied topics. The test included problems that required building real situational models. Statistical analysis was used to aggregate test results. Pierson criterion was used to reveal the statistical significance of results (pass-fail the modeling test). A significant difference in results was revealed (p < 0.001), which allowed the authors to conclude that students in the study group showed better comprehension of mathematical information than those in the control group. Also, it was revealed (used Student’s t-test) that the students of the experimental group performed reliably (p = 0.0001) more problems in comparison with those in the control group. The results obtained allow us to conclude that increasing comprehension and assimilation of study material took place as a result of applying implemented methods and techniques.

Keywords: comprehension of mathematical content, holistic approach to teaching mathematics in secondary school, subjective experience, technology of the formation of inter-subject notions

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Authors: Maria Luiza Fulga, Georgeta Truca, Mihaela Alexandru, Andriescu Mariana, Crin Marcean

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The significance of nursing as a subject in the post-secondary healthcare curriculum is a major. We aimed to enable our students to assess the patient's risk, to establish prevention measures and to adapt to a specific learning context, in order to acquire the skills and abilities necessary for the nursing profession. In order to achieve these objectives, during the three years of study, teachers put an emphasis on acquiring communication skills, because in our country after the first cycle of hospital accreditation concluded in 2016, the National Authority for Quality of Health Management has introduced the criteria for the implementation and application of the nursing process according to the accreditation standards. According to these requirements, the nurse has to carry out the nursing assessment, based on communication as a distinct component, so that they can identify nursing diagnoses and implement the nursing plan. In this respect, we, the teachers, have refocused, by approaching various teaching strategies and preparing students for the real context of learning and applying what they learn. In the educational process, the tutors in the hospitals have an important role to play in acquiring professional skills. Students perform their activity in the hospital in accordance with the curriculum, in order to verify the practical applicability of the theoretical knowledge acquired in the school classes and also have the opportunity to acquire their skills in a real learning context. In clinical education, the student nurse learns in the middle of a guidance team which includes a practice tutor, who is a nurse that takes responsibility for the practical/clinical learning of the students in their field of activity. In achieving this objective, the tutor's abilities involve pedagogical knowledge, knowledge for the good of the individual and nursing theory, in order to be able to guide clinical practice in accordance with current requirements. The aim of this study is to find out the students’ confidence level in practice tutors in hospitals, the students’ degree of satisfaction in the pedagogical skills of the tutors and the practical applicability of the theoretical knowledge. In this study, we used as a method of investigation a student satisfaction questionnaire regarding the clinical practice in the hospital and the sample of the survey consisted of 100 students aged between 20 and 50 years, from the first, second and third year groups, with the General Nurse specialty (nurses responsible for general care), from 'Fundeni' Healthcare Post-Secondary School, Bucharest, Romania. Following the analysis of the data provided, we arrived the conclusion that the hospital tutor needs to improve his/her pedagogical skills, the knowledge of nursing diagnostics, and the implementation of the nursing plan, so that the applicability of the theoretical notions would be increased. Future plans include the pedagogical training of the medical staff, as well as updating the knowledge needed to implement the nursing process in order to meet current requirements.

Keywords: clinical training, nursing process, pedagogical skills, tutor

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Authors: Abdulkadir Sarauta

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Almost every type of industrial process involves the release of trace quantity of toxic organic and inorganic compound that up in receiving water bodies, this study was aimed at assessing the Persistent Organic Pollutant Level in Challawa River Basin of Kano State, Nigeria. And the research formed the basis of identifying the presence of PCBs and PAHs in receiving water bodies in the study area, assessing the PCBs and PAHs concentration in receiving water body of Challawa system, evaluate the concentration level of PCBs and PAHs in fishes in the study area, determine the concentration level of PCBs and PAHs in crops irrigated in the study area as well as compare the concentration of PCBs and PAHs with the acceptable limit set by Nigerian, EU, U.S and WHO standard. Data were collected using reconnaissance survey, site inspection, field survey, laboratory experiment as well as secondary data source. A total of 78 samples were collected through stratified systematic random sampling (i.e., 26 samples for each of water, crops and fish) three sampling points were chosen and designated A, B and C along the stretch of the river (i.e. up, middle, and downstream) from Yan Danko Bridge to Tambirawa bridge. The result shows that the Polychlorinated biphenyls (PCBs) was not detected while, polycyclic aromatic hydrocarbons (PAHs) was detected in the whole samples analysed at the trench of Challawa River basin in order to assess the contribution of human activities to global environmental pollution. The total concentrations of ΣPAH and ΣPCB ranges between 0.001 to 0.087mg/l and 0.00 to 0.00mg/l of water samples While, crops samples ranges between 2.0ppb to 8.1ppb and fish samples ranges from 2.0 to 6.7ppb.The whole samples are polluted because most of the parameters analyzed exceed the threshold limits set by WHO, Nigerian, U.S and EU standard. The analytical results revealed that some chemicals are present in water, crops and fishes are significantly very high at Zamawa village which is very close to Challawa industrial estate and also is main effluent discharge point and drinking water around study area is not potable for consumption. Analysis of Variance was obtained by Bartlett’s test performance. There is only significant difference in water because the P < 0.05 level of significant, But there is no difference in crops concentration they have the same performance, likes wise in the fishes. It is said to be of concern to health hazard which will increase incidence of tumor related diseases such as skin, lungs, bladder, gastrointestinal cancer, this show there is high failure of pollution abatement measures in the area. In conclusion, it can be said that industrial activities and effluent has impact on Challawa River basin and its environs especially those that are living in the immediate surroundings. Arising from the findings of this research some recommendations were made the industries should treat their liquid properly by installing modern treatment plants.

Keywords: Challawa River Basin, organic, persistent, pollutant

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Authors: Meenu S. Babu, K. Jayasankara Reddy

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Depression is a serious mental health concern that leads to significant distress and dysfunction in an individual. Due to the high physical, psychological, social, and economic burden it causes, it is important to study various bio-psycho-social factors that influence the onset, course, duration, intensity of depressive symptoms. The study aims to explore relationship between autobiographical memory (AM) functions, perceived control over stressful events and depressive symptoms. AM functions and perceived control were both found to be protective factors for individuals against depression and were both modifiable to predict better behavioral and affective outcomes. An extensive review of literatur, with a systematic search on Google Scholar, JSTOR, Science Direct and Springer Journals database, was conducted for the purpose of this review paper. These were used for all the aforementioned databases. The time frame used for the search was 2010-2021. An additional search was conducted with no time bar to map the development of the theoretical concepts. The relevant studies with quantitative, qualitative, experimental, and quasi- experimental research designs were included for the review. Studies including a sample with a DSM- 5 or ICD-10 diagnosis of depressive disorders were excluded from the study to focus on the behavioral patterns in a non-clinical population. The synthesis of the findings that were obtained from the review indicates there is a significant relationship between cognitive variables of AM functions and perceived control and depressive symptoms. AM functions were found to be have significant effects on once sense of self, interpersonal relationships, decision making, self- continuity and were related to better emotion regulation and lower depressive symptoms. Not all the components of AM function were equally significant in their relationships with various depressive symptoms. While self and directive functions were more related to emotion regulation, anhedonia, motivation and hence mood and affect, the social function was related to perceived social support and social engagement. Perceived control was found to be another protective cognitive factor that provides individuals a sense of agency and control over one’s life outcomes which was found to be low in individuals with depression. This was also associated to the locus of control, competency beliefs, contingency beliefs and subjective well being in individuals and acted as protective factors against depressive symptoms. AM and perceived control over stressful events serve adaptive functions, hence it is imperative to study these variables more extensively. They can be imperative in planning and implementing therapeutic interventions to foster these cognitive protective factors to mitigate or alleviate depressive symptoms. Exploring AM as a determining factor in depressive symptoms along with perceived control over stress creates a bridge between biological and cognitive factors underlying depression and increases the scope of developing a more eclectic and effective treatment plan for individuals. As culture plays a crucial role in AM functions as well as certain aspects of control such as locus of control, it is necessary to study these variables keeping in mind the cultural context to tailor culture/community specific interventions for depression.

Keywords: autobiographical memories, autobiographical memory functions, perceived control, depressive symptoms, depression, young adults

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Authors: Szerena Vajkovszki

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Our worldwide aging society, especially in developed countries, including members of EU, raise sophisticated sociological and economic issues and challenges to be met. As declining fertility has outstanding influence underlying this trend, numerous studies have attempted to identify, describe, measure and interpret contributing factors of the fertility rate, out of which relatively few revealed the impact of religion. Identified, examined and influential factors affecting birth rate as stated by the present scientific publications are more than a dozen out of which religious beliefs, traditions, and cultural norms were examined first with a special focus on abortion and forms of birth control. Nevertheless, connected to religion, not only these topics are crucial regarding fertility, but many others as well. Among many religious guidelines, we can separate two major categories: direct and indirect. The aim of this research was to understand what are the most crucial identified (family values, gender related behaviors, religious sentiments) and not yet identified most influential contributing religious factors. Above identifying these direct or indirect factors, it is also important to understand to what extent and how do they influence fertility, which requires a wider (inter-discipline) perspective. As proved by previous studies religion has also an influential role on health, mental state, well-being, working activity and many other components that are also related to fertility rates. All these components are inter-related. Hence direct and indirect religious effects can only be well understood if we figure out all necessary fields and their interaction. With the help of semi-structured opened interviews taking place in different countries, it was showed that indeed Buddhism has significant direct and indirect effect on fertility. Hence the initial hypothesis was proved. However, the interviews showed an overall positive effect; the results could only serve for a general understanding of how Buddhism affects fertility. Evolution of Buddhism’s direct and indirect influence may vary in different nations and circumstances according to their specific environmental attributes. According to the local patterns, with special regard to women’s position and role in the society, outstandingly indirect influences could show diversifications. So it is advisory to investigate more for a deeper and clearer understanding of how Buddhism function in different socioeconomic circumstances. For this purpose, a specific and detailed analysis was developed from recent related researches about women’s position (including family roles and economic activity) in Hungary with the intention to be able to have a complex vision of crucial socioeconomic factors influencing fertility. Further interviews and investigations are to be done in order to show a complex vision of Buddhism’s direct and indirect effect on fertility in Hungary to be able to support recommendations and policies pointing to higher fertility rates in the field of social policies. The present research could serve as a general starting point or a common basis for further specific national investigations.

Keywords: Buddhism, children, fertility, gender roles, religion, women

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Authors: Anjali Singh, Ashwani Raju, Vandana Devi, Mohmad Mohsin Atique, Satyendra Singh, Munendra Singh

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India is the biggest consumer of mercury and, consequently, a major emitter too. The increasing mercury contamination in India’s water resources has gained widespread attention and, therefore, atmospheric deposition is of critical concern. However, little emphasis was placed on the role of precipitation in the aquatic mercury cycle of the Ganga Alluvial Plain which provides drinking water to nearly 7% of the world’s human population. A majority of the precipitation here occurs primarily in 10% duration of the year in the monsoon season. To evaluate the sources and transportation of mercury, water sample analysis has been conducted from two selected sites near Lucknow, which have a strong hydraulic gradient towards the river. 31 groundwater samples from Jehta village (26°55’15’’N; 80°50’21’’E; 119 m above mean sea level) and 31 river water samples from the Behta Nadi (a tributary of the Gomati River draining into the Ganga River) were collected during the monsoon season on every alternate day between 01 July to 30 August 2019. The total mercury analysis was performed by using Flow Injection Atomic Absorption Spectroscopy (AAS)-Mercury Hybride System, and daily rainfall data was collected from the India Meteorological Department, Amausi, Lucknow. The ambient groundwater and river-water concentrations were both 2-4 ng/L as there is no known geogenic source of mercury found in the area. Before the onset of the monsoon season, the groundwater and the river-water recorded mercury concentrations two orders of magnitude higher than the ambient concentrations, indicating the regional transportation of the mercury from the non-point source into the aquatic environment. Maximum mercury concentrations in groundwater and river-water were three orders of magnitude higher than the ambient concentrations after the onset of the monsoon season characterizing the considerable mobilization and redistribution of mercury by monsoonal precipitation. About 50% of both of the water samples were reported mercury below the detection limit, which can be mostly linked to the low intensity of precipitation in August and also with the dilution factor by precipitation. The highest concentration ( > 1200 ng/L) of mercury in groundwater was reported after 6-days lag from the first precipitation peak. Two high concentration peaks (>1000 ng/L) in river-water were separately correlated with the surface flow and groundwater outflow of mercury. We attribute the elevated mercury concentration in both of the water samples before the precipitation event to mercury originating from the extensive use of agrochemicals in mango farming in the plain. However, the elevated mercury concentration during the onset of monsoon appears to increase in area wetted with atmospherically deposited mercury, which migrated down from surface water to groundwater as downslope migration is a fundamental mechanism seen in rivers of the alluvial plain. The present study underscores the significance of monsoonal precipitation in the transportation of mercury to drinking water resources of the Ganga Alluvial Plain. This study also suggests that future research must be pursued for a better understand of the human health impact of mercury contamination and for quantification of the role of Ganga Alluvial Plain in the Global Mercury Cycle.

Keywords: drinking water resources, Ganga alluvial plain, india, mercury

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Authors: Shahzada Gulfam

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Islamism was considered as a new phenomenon in Muslim World to revolt against static Religious Traditionalists and the Imperialists. Islamist political parties viewed the establishment of an Islamic state within the limits of Sharia’h as their destination. The Islamists movements like Ikhwan-ul Muslimun, Jamaat-i-Islami etc. did appear with revolutionary agenda but were contained by military forces and the secular modernists of Muslim World. The Muslim rulers, historically could not respect the democratic and moral norms and equally emerged as dictators in democracies, military rule as well as in monarchies. The Arab Spring did not follow the Islamists agenda but gathered the common masses against the corrupt rulers to have a just democratic political system. The Islamic State and Sharia’h were not their immediate targets but the achievement of moral norms in Muslim societies and eradication of dictatorial rule were the basic aims. This phenomenon is named as post-Islamism. The political struggle of PAT (Pakistan Awami Tehreek) and the PTI (Pakistan Tehreek-i-Insaf) has been following the footsteps of Arab Spring and can be noted as the extension of Arab Spring in Muslim World. The results of this struggle would define the fate of Post-Islamism in Pakistan. Has Jamaat-i-Islami got the potential to reform its agenda accordingly? This paper intends to study the Jamaat’s struggle and tries to predict Jamaat’s role in post-Islamism scenario. There is a clear distinction between the people of religion and the people following the popular materialistic westernized value system. This division is also evident in political parties. Pakistan has been ruled mostly by the secular parties and rulers. The inability to establish Islamic system by replacing the imperial system has created militancy and revolt which requires the establishment of a sound model Islamic based system in the country. The political parties of Pakistan could not device a modernize agenda, equally acceptable in modernized world and addressing the prevailing issues and also having the indigenous religious and cultural roots. The inability of Jamaat-i-Islami Pakistan to transform its agenda accordingly to serve the post-Islamism has made it irrelevant in Pakistan’s politics. Once Jamaat leaves behind its hard position as an Islamist party and accepts the post-Islamism as beginning to create its idealized state and society, it can pursue its agenda gradually. The phenomenon of post-Islamism does not make Islamists irrelevant but invites them to listen to the priorities of masses rather than insisting on the agenda of their respective ideologues to be followed for all times. The ruling Muslim democrats and military dictators of Pakistan have been following unfair means to sustain their political power which gave rise to space for the new political parties to emerge and organize agitation successfully in Pakistani Politics. Jamaat-i-Islami could not fill that space to be an agent of Post-Islamism and could not break their chains which had been tying them to the prevailing failed democracy of Pakistan. Post-Islamists are the addressers of the rulers corruption and are struggling for reforms in system. Jamaat due to its ideological compulsions could not transform its agenda accordingly. The new scenario indicates that the Post-Islamism which emerged in Arab World can be taken as first step to establish democracy and justice in state and society and then the establishment of Islamic law and the establishment of an Islamic state should have been the next targets. This gradual agenda would have delivered public support to the Jamaat which deserved that but PTI & PAT have cashed this opportunity in Pakistani politics by strengthening their respective vote banks.

Keywords: arab spring, islamic state, islamic political parties, muslim world, post-islamism

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Authors: Piotr Wadolowski, Grzegorz Krzesinski, Piotr Gutowski

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The aim of the presented work is to recognize the impact of mini-plate application approach on the stress and displacement within the stabilization devices and surrounding bones. The mini-plate osteosynthesis technique is widely used by craniofacial surgeons as an improved replacement of wire connection approach. Many different types of metal plates and screws are used to the physical connection of fractured bones. Below investigation is based on a clinical observation of patient hospitalized with mini-plate stabilization system. Analysis was conducted on a solid mandible geometry, which was modeled basis on the computed tomography scan of the hospitalized patient. In order to achieve most realistic connected system behavior, the cortical and cancellous bone layers were assumed. The temporomandibular joint was simplified to the elastic element to allow physiological movement of loaded bone. The muscles of mastication system were reduced to three pairs, modeled as shell structures. Finite element grid was created by the ANSYS software, where hexahedral and tetrahedral variants of SOLID185 element were used. A set of nonlinear contact conditions were applied on connecting devices and bone common surfaces. Properties of particular contact pair depend on screw - mini-plate connection type and possible gaps between fractured bone around osteosynthesis region. Some of the investigated cases contain prestress introduced to the mini-plate during the application, what responds the initial bending of the connecting device to fit the retromolar fossa region. Assumed bone fracture occurs within the mandible angle zone. Due to the significant deformation of the connecting plate in some of the assembly cases the elastic-plastic model of titanium alloy was assumed. The bone tissues were covered by the orthotropic material. As a loading were used the gauge force of magnitude of 100N applied in three different locations. Conducted analysis shows significant impact of mini-plate application methodology on the stress distribution within the miniplate. Prestress effect introduces additional loading, which leads to locally exceed the titanium alloy yield limit. Stress in surrounding bone increases rapidly around the screws application region, exceeding assumed bone yield limit, what indicate the local bone destruction. Approach with the doubled mini-plate shows increased stress within the connector due to the too rigid connection, where the main path of loading leads through the mini-plates instead of plates and connected bones. Clinical observations confirm more frequent plate destruction of stiffer connections. Some of them could be an effect of decreased low cyclic fatigue capability caused by the overloading. The executed analysis prove that the mini-plate system provides sufficient support to mandible fracture treatment, however, many applicable solutions shifts the entire system to the allowable material limits. The results show that connector application with the initial loading needs to be carefully established due to the small material capability tolerances. Comparison to the clinical observations allows optimizing entire connection to prevent future incidents.

Keywords: mandible fracture, mini-plate connection, numerical analysis, osteosynthesis

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Authors: Mario Tauzene Afonso Matangue, Ivan Andres Sanchez Ortiz

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The Metropolitan area of Maputo (Mozambique Capital City) is located in semi-arid zone (800 mm annual rainfall) with 1101170 million inhabitants. On the west side, there are the flatlands of Infulene where the Mulauze River flows towards to the Indian Ocean, receiving at this site, the storm water contaminated with sanitary sewage from Maputo, transported through a concrete open channel. In Infulene, local communities grow salads crops such as tomato, onion, garlic, lettuce, and cabbage, which are then commercialized and consumed in several markets in Maputo City. Lettuce is the most daily consumed salad crop in different meals, generally in fast-foods, breakfasts, lunches, and dinners. However, the risk of infection by several pathogens due to the consumption of lettuce, using the Quantitative Microbial Risk Assessment (QMRA) tools, is still unknown since there are few studies or publications concerning to this matter in Mozambique. This work is aimed at determining the annual risk arising from the consumption of lettuce grown in Infulene valley, in Maputo, using QMRA tools. The exposure model was constructed upon the volume of contaminated water remaining in the lettuce leaves, the empirical relations between the number of pathogens and the indicator of microorganisms (E. coli), the consumption of lettuce (g) and reduction of pathogens (days). The reference pathogens were Vibrio cholerae, Cryptosporidium, norovirus, and Ascaris. The water quality samples (E. coli) were collected in the storm water channel from January 2016 to December 2018, comprising 65 samples, and the urban lettuce consumption data were collected through inquiry in Maputo Metropolis covering 350 persons. A non-parametric bootstrap was performed involving 10,000 iterations over the collected dataset, namely, water quality (E. coli) and lettuce consumption. The dose-response models were: Exponential for Cryptosporidium, Kummer Confluent hypergeomtric function (1F1) for Vibrio and Ascaris Gaussian hypergeometric function (2F1-(a,b;c;z) for norovirus. The annual infection risk estimates were performed using R 3.6.0 (CoreTeam) software by Monte Carlo (Latin hypercubes), a sampling technique involving 10,000 iterations. The annual infection risks values expressed by Median and the 95th percentile, per person per year (pppy) arising from the consumption of lettuce are as follows: Vibrio cholerae (1.00, 1.00), Cryptosporidium (3.91x10⁻³, 9.72x 10⁻³), nororvirus (5.22x10⁻¹, 9.99x10⁻¹) and Ascaris (2.59x10⁻¹, 9.65x10⁻¹). Thus, the consumption of the lettuce would result in greater risks than the tolerable levels ( < 10⁻³ pppy or 10⁻⁶ DALY) for all pathogens, and the Vibrio cholerae is the most virulent pathogens, according to the hit-single models followed by the Ascaris lumbricoides and norovirus. The sensitivity analysis carried out in this work pointed out that in the whole QMRA, the most important input variable was the reduction of pathogens (Spearman rank value was 0.69) between harvest and consumption followed by water quality (Spearman rank value was 0.69). The decision-makers (Mozambique Government) must strengthen the prevention measures related to pathogens reduction in lettuce (i.e., washing) and engage in wastewater treatment engineering.

Keywords: annual infections risk, lettuce, non-parametric bootstrapping, quantitative microbial risk assessment tools

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Authors: Kbrom Mearg Haile

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Introduction: Membrane fouling is the bottleneck for the anaerobic membrane bioreactor (AnMBR) robust continuous operation, primarily caused by the mixed liquor suspended solids (MLSS) characteristics formed by aggregated flocs and a scaffold of microbial self-produced extracellular polymeric substances (EPS), which dictates the flocs integrity. Accordingly, the adhesion of EPS to the membrane surface versus their role in forming firm, elastic, and mechanically stable flocs under the reactor’s hydraulic shear is critical for minimizing interactions between EPS and colloids originating from the MLSS flocs with the membrane. This study aims to gain insight and investigate the effect of MLSS flocs properties, EPS adhesion and viscoelasticity, viscoelastic properties of the sludge, and membrane fouling propensity. Experimental: As a working hypothesis, to alter the aforementioned flocs’ and EPS’s properties, the addition of either coagulant or surfactant was carried out during the AnMBR operation. In the AnMBR, two flat-sheet 300 kDa pore size polyether sulfone (PES) membranes with a total filtration area of 352 cm2 were immersed in the AnMBR system treating municipal wastewater of Midreshet Ben-Gurion village at the Negev highlands, Israel. The system temperature, pH, biogas recirculation, and hydraulic retention time were regulated. TMP fluctuations during a 30-day experiment were recorded under three operating conditions: Baseline (without the addition of coagulating or dispersing agent), coagulant addition (FeCl3), and surfactant addition (sodium dodecyl sulfate). At the end of each experiment, EPS were extracted from the MLSS and from the fouled membrane, characterized for their protein, polysaccharides, and DOC contents, and correlated with the fouling tendency of the submerged UF membrane. The EPS adherence and viscoelastic properties were revealed using QCM-D via the PES-coated gold sensor used as a membrane-mimicking surface providing a detailed real-time EPS adhesion. The associated shifts in the resonance frequency and dissipation at different overtones were further modeled using the Voigt-based viscoelastic model (using Dfind software, Q-Sense Biolin Scientific) in which the thickness, shear modulus, and shear viscosity values of the adsorbed EPS layers on the PES coated sensor were calculated. Results and discussion: The observations obtained from the QCM-D analysis indicate a greater decrease in the frequency shift for the elevated membrane fouling scenarios, likely due to an observed decrease in the calculated shear viscosity and shear modulus of the EPS adsorbed layer, coupled with an increase in EPS layer hydrated thickness and fluidity (ΔD/Δf slopes). Further analysis is being conducted for the three major operating conditions-analyzing their effects on sludge rheology, dewaterability (capillary suction time-CST) and settle ability (SVI). The biofouling layer is further characterized microscopically using a confocal laser scanning microscope (CLSM) and scanning electron microscope (SEM), for analyzing the consistency of the development of the biofouling layer with sludge characteristics, i.e., thicker biofouling layer on the membrane surface when operated with surfactant addition, due to flocs with reduced integrity and availability of EPS/colloids to the membrane. Conversely, a thinner layer when operated with coagulant compared to the baseline experiment, due to elevation in flocs integrity.

Keywords: viscoelasticity, biofouling, viscoelastic, AnMBR, EPS, elocintegrity

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Authors: H. A. J. Nguyen, V. A. Pham

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RE:SOUNDING is an ongoing research project and artwork seeking to return the sound and knowledge of Dong Son bronze drums back to contemporary musicians. Colonial collections of ethnographic instruments are problematic in how they commit acts of conceptual, cultural, and acoustic silencing. The collection (or more honestly), the plagiarism, and pillaging of these instruments have systemically separated them from living and breathing cultures. This includes diasporic communities, who have come to resettle in close proximity - but still have little access - to the museums and galleries that display their cultural objects. Despite recent attempts to 'open up' and 'recognise' the tensions and violence of these ethnographic collections, many museums continue to structurally organize and reproduce knowledge with the same procedural distance and limitations of imperial condescension. Impatient with the slowness of these museums, our diaspora led collaborations participated in the opaque economy of the auction market to gain access and begin the process of digitally recording and archiving the actual sounds of the ancient Dong Son drum. This self-directed, self-initiated artwork not only acoustically reinvigorated an ancient instrument but redistributed these sonic materials back to contemporary musicians, composers, and their diasporic communities throughout Vietnam, South East Asia, and Australia. Our methodologies not only highlight the persistent inflexibility of museum infrastructures but demand that museums refrain from their paternalistic practice of risk-averse ownership, to seriously engage with new technologies and political formations that require all public institutions to be held accountable for the ethical and intellectual viability of their colonial collections. The integrated and practical resolve of diasporic artists and their communities are more than capable of working with new technologies to reclaim and reinvigorate what is culturally and spiritually theirs. The motivation to rematriate – as opposed to merely repatriate – the acoustic legacies of these instruments to contemporary musicians and artists is a new model for decolonial and restorative practices. Exposing the inadequacies of western scholarship that continues to treat these instruments as discreet, disembodied, and detached artifacts, these collaborative strategies have thus far produced a wealth of new knowledge – new to the west perhaps – but not that new to these, our own communities. This includes the little-acknowledged fact that the Dong Son drum were political instruments of war and technology, rather than their simplistic description in the museum and western academia as agrarian instruments of fertility and harvest. Through the collective and continued sharing of knowledge and sound materials produced from this research, these drums are gaining a contemporary relevance beyond the cultural silencing of the museum display cabinet. Acknowledgement: We acknowledge the Wurundjeri and Boon Wurrung of the Kulin Nation and the Gadigal of the Eora Nation where we began this project. We pay our respects to the Peoples, Lands, Traditional Custodians, Practices, and Creator Ancestors of these Great Nations, as well as those First Nations peoples throughout Australia, Vietnam, and Indonesia, where this research continues, and upon whose stolen lands and waterways were never ceded.

Keywords: acoustic archaeology, decolonisation, museum collections, rematriation, repatriation, Dong Son, experimental music, digital recording

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Authors: A. Falenski, A. Kaesbohrer, M. Filter

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Introduction: Risk assessments can be performed in various ways and in different degrees of complexity. In order to assess risks associated with imported foods additional information needs to be taken into account compared to a risk assessment on regional products. The present review is an overview on currently available best practise approaches and data sources used for food import risk assessments (IRAs). Methods: A literature review has been performed. PubMed was searched for articles about food IRAs published in the years 2004 to 2014 (English and German texts only, search string “(English [la] OR German [la]) (2004:2014 [dp]) import [ti] risk”). Titles and abstracts were screened for import risks in the context of IRAs. The finally selected publications were analysed according to a predefined questionnaire extracting the following information: risk assessment guidelines followed, modelling methods used, data and software applied, existence of an analysis of uncertainty and variability. IRAs cited in these publications were also included in the analysis. Results: The PubMed search resulted in 49 publications, 17 of which contained information about import risks and risk assessments. Within these 19 cross references were identified to be of interest for the present study. These included original articles, reviews and guidelines. At least one of the guidelines of the World Organisation for Animal Health (OIE) and the Codex Alimentarius Commission were referenced in any of the IRAs, either for import of animals or for imports concerning foods, respectively. Interestingly, also a combination of both was used to assess the risk associated with the import of live animals serving as the source of food. Methods ranged from full quantitative IRAs using probabilistic models and dose-response models to qualitative IRA in which decision trees or severity tables were set up using parameter estimations based on expert opinions. Calculations were done using @Risk, R or Excel. Most heterogeneous was the type of data used, ranging from general information on imported goods (food, live animals) to pathogen prevalence in the country of origin. These data were either publicly available in databases or lists (e.g., OIE WAHID and Handystatus II, FAOSTAT, Eurostat, TRACES), accessible on a national level (e.g., herd information) or only open to a small group of people (flight passenger import data at national airport customs office). In the IRAs, an uncertainty analysis has been mentioned in some cases, but calculations have been performed only in a few cases. Conclusion: The current state-of-the-art in the assessment of risks of imported foods is characterized by a great heterogeneity in relation to general methodology and data used. Often information is gathered on a case-by-case basis and reformatted by hand in order to perform the IRA. This analysis therefore illustrates the need for a flexible, modular framework supporting the connection of existing data sources with data analysis and modelling tools. Such an infrastructure could pave the way to IRA workflows applicable ad-hoc, e.g. in case of a crisis situation.

Keywords: import risk assessment, review, tools, food import

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Authors: Sergio Celaschi, Henrique Canavarro de Alencar, Claaudecir Biazoli

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Effluent quality is of the highest priority for compliance with the permit limits of environmental protection agencies and ensures the protection of their local water system. Of the pollutants monitored, the biochemical oxygen demand (BOD) posed one of the greatest challenges. This work presents a solution for wastewater treatment plants - WWTP’s ability to react to different situations and meet treatment goals. Delayed BOD5 results from the lab take 7 to 8 analysis days, hindered the WWTP’s ability to react to different situations and meet treatment goals. Reducing BOD turnaround time from days to hours is our quest. Such a solution is based on a system of two BOD bioreactors associated with Digital Twin (DT) and Machine Learning (ML) methodologies via an Internet of Things (IoT) platform to monitor and control a WWTP to support decision making. DT is a virtual and dynamic replica of a production process. DT requires the ability to collect and store real-time sensor data related to the operating environment. Furthermore, it integrates and organizes the data on a digital platform and applies analytical models allowing a deeper understanding of the real process to catch sooner anomalies. In our system of continuous time monitoring of the BOD suppressed by the effluent treatment process, the DT algorithm for analyzing the data uses ML on a chemical kinetic parameterized model. The continuous BOD monitoring system, capable of providing results in a fraction of the time required by BOD5 analysis, is composed of two thermally isolated batch bioreactors. Each bioreactor contains input/output access to wastewater sample (influent and effluent), hydraulic conduction tubes, pumps, and valves for batch sample and dilution water, air supply for dissolved oxygen (DO) saturation, cooler/heater for sample thermal stability, optical ODO sensor based on fluorescence quenching, pH, ORP, temperature, and atmospheric pressure sensors, local PLC/CPU for TCP/IP data transmission interface. The dynamic BOD system monitoring range covers 2 mg/L < BOD < 2,000 mg/L. In addition to the BOD monitoring system, there are many other operational WWTP sensors. The CPU data is transmitted/received to/from the digital platform, which in turn performs analyses at periodic intervals, aiming to feed the learning process. BOD bulletins and their credibility intervals are made available in 12-hour intervals to web users. The chemical kinetics ML algorithm is composed of a coupled system of four first-order ordinary differential equations for the molar masses of DO, organic material present in the sample, biomass, and products (CO₂ and H₂O) of the reaction. This system is solved numerically linked to its initial conditions: DO (saturated) and initial products of the kinetic oxidation process; CO₂ = H₂0 = 0. The initial values for organic matter and biomass are estimated by the method of minimization of the mean square deviations. A real case of continuous monitoring of BOD wastewater effluent quality is being conducted by deploying an IoT application on a large wastewater purification system located in S. Paulo, Brazil.

Keywords: effluent treatment, biochemical oxygen demand, continuous monitoring, IoT, machine learning

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Authors: Gachara Grace, Kebira Anthony, Harvey Jagger, Wainaina James

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Aflatoxin contamination of maize in Africa poses a major threat to food security and the health of many African people. In Kenya, aflatoxin contamination of maize is high due to the environmental, agricultural and socio-economic factors. Many studies have been conducted to understand the scope of the problem, especially at pre-harvest level. This research was carried out to gather scientific information on the fungi population, diversity and aflatoxin level during the post-harvest period. The study was conducted in three geographical locations of; Kitui, Kitale and Nakuru. Samples were collected from storage structures of farmers and transported to the Biosciences eastern and central Africa (BecA), International Livestock and Research Institute (ILRI) hub laboratories. Mycoflora was recovered using the direct plating method. A total of five fungal genera (Aspergillus, Penicillium, Fusarium, Rhizopus and Bssyochlamys spp.) were isolated from the stored maize samples. The most common fungal species that were isolated from the three study sites included A. flavus at 82.03% followed by A.niger and F.solani at 49% and 26% respectively. The aflatoxin producing fungi A. flavus was recovered in 82.03% of the samples. Aflatoxin levels were analysed on both the maize samples and in vitro. Most of the A. flavus isolates recorded a high level of aflatoxin when they were analysed for presence of aflatoxin B1 using ELISA. In Kitui, all the samples (100%) had aflatoxin levels above 10ppb with a total aflatoxin mean of 219.2ppb. In Kitale, only 3 samples (n=39) had their aflatoxin levels less than 10ppb while in Nakuru, the total aflatoxin mean level of this region was 239.7ppb. When individual samples were analysed using Vicam fluorometer method, aflatoxin analysis revealed that most of the samples (58.4%) had been contaminated. The means were significantly different (p=0.00<0.05) in all the three locations. Genetic relationships of A. flavus isolates were determined using 13 Simple Sequence Repeats (SSRs) markers. The results were used to generate a phylogenetic tree using DARwin5 software program. A total of 5 distinct clusters were revealed among the genotypes. The isolates appeared to cluster separately according to the geographical locations. Principal Coordinates Analysis (PCoA) of the genetic distances among the 91 A. flavus isolates explained over 50.3% of the total variation when two coordinates were used to cluster the isolates. Analysis of Molecular Variance (AMOVA) showed a high variation of 87% within populations and 13% among populations. This research has shown that A. flavus is the main fungal species infecting maize grains in Kenya. The influence of aflatoxins on human populations in Kenya demonstrates a clear need for tools to manage contamination of locally produced maize. Food basket surveys for aflatoxin contamination should be conducted on a regular basis. This would assist in obtaining reliable data on aflatoxin incidence in different food crops. This would go a long way in defining control strategies for this menace.

Keywords: aflatoxin, Aspergillus flavus, genotyping, Kenya

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Authors: Fatima Meirkhankyzy Shaizadina, Alua Oralovna Omarova, Praskovya Mikhailovna Britskaya, Nessipkul Oryntayevna Alysheva

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In recent years in the Republic of Kazakhstan there have been registered outbreaks of measles among the population. The objective of work was the analysis of outbreak of measles in 2014 among the population of North-Kazakhstan region of the Republic of Kazakhstan. For the analysis of the measles outbreak descriptive and analytical research, techniques were used and threshold levels of morbidity were calculated. The increase of incidence was noted from March to July. The peak was registered in May and made 9.0 per 100000 population. High rates were registered in April – 5.7 per 100000 population, and in June and July they made 5.7 and 3.1 respectively. Duration of the period of increase made 5 months. The analysis of monthly incidence of measles revealed spring and summer seasonality. Across the territory it was established that 69.2% of cases were registered in the city, 29.1% in rural areas and 1.7% of cases were brought in from other regions of Kazakhstan. The registered cases and threshold values of measles during the outbreak revealed that from 12 to 24 week, and also during the 40th week the cases exceeding the threshold levels are registered. Thus, for example, for the analyzed 1 week the number of the revealed patients made 4, which exceeds the calculated threshold value (3) by 33.3%. The data exceeding the threshold values confirm the emergence of a disease outbreak or the beginning of epidemic rise in morbidity. Epidemic rise in incidence of the population of North-Kazakhstan region was observed throughout 2014. The risk group includes 0-4 year-old children, who made 22.7%, 15-19 year-olds – 25.6%, 20-24 year-olds – 20.9%. The analysis of measles cases registration by gender revealed that women are registered 1.1 times more often than men. The ratio of women to men made 1:0.87. In social and professional groups often ill are unorganized children – 23.3% and students – 19.8%. Studying clinical manifestations of measles in the hospitalized patients, the typical beginning of a disease with expressed intoxication symptoms – weakness, sickliness was established. In individual cases expressed intoxication symptoms, hemorrhagic and dyspeptic syndromes, complications in the form of overlay of a secondary bacterial infection, which defined high severity of the illness, were registered both in adults and in children. The average duration of stay of patients in the hospital made 6.9 days. The average duration of time between date of getting the disease and date of delivery of health care made 3.6 days. Thus, the analysis of monthly incidence of measles revealed spring and summer seasonality, the peak of which was registered in May. Urban dwellers are ill more often (69.2%), while in rural areas people are ill more rarely (29.1%). Throughout 2014 an epidemic rise in incidence of the population of North-Kazakhstan region was observed. Risk group includes: children under 4 – 22.7%, 15-19 year-olds – 25.6%, 20-24 year-olds – 20.9%. The ratio of women and men made 1:0.87. The typical beginning of a disease in all hospitalized with the expressed intoxication symptoms – weakness, sickliness was established.

Keywords: epidemiological analysis, measles, morbidity, outbreak

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Authors: D. S. Gurjar, R. Kaur, K. P. Singh, R. Singh

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A greater volume of wastewater generate from urban areas in India. Due to the adequate availability, less energy requirement and nutrient richness, farmers of urban and peri-urban areas are deliberately using wastewater to grow high value vegetable crops. Wastewater contains pathogens and toxic pollutants, which can enter in the food chain system while using wastewater for irrigating vegetable crops. Hence, wastewater can use for growing commercial flower crops that may avoid food chain contamination. Tuberose (Polianthes tuberosa L.) is one of the most important commercially grown, cultivated over 30, 000 ha area, flower crop in India. Its popularity is mainly due to the sweet fragrance as well as the long keeping quality of the flower spikes. The flower spikes of tuberose has high market price and usually blooms during summer and rainy seasons when there is meager supply of other flowers in the market. It has high irrigation water requirement and fresh water supply is inadequate in tuberose growing areas of India. Therefore, wastewater may fulfill the water and nutrients requirements and may enhance the productivity of tuberose. Keeping in view, the present study was carried out at WTC farm of ICAR-Indian Agricultural Research Institute, New Delhi in 2014-15. Prajwal was the variety of test crop. The seven treatments were taken as T-1. Wastewater irrigation at 0.6 ID/CPE, T-2: Wastewater irrigation at 0.8 ID/CPE, T-3: Wastewater irrigation at 1.0 ID/CPE, T-4: Wastewater irrigation at 1.2 ID/CPE, T-5: Wastewater irrigation at 1.4 ID/CPE, T-6: Conjunctive use of Groundwater and Wastewater irrigation at 1.0 ID/CPE in cyclic mode, T-7: Control (Groundwater irrigation at 1.0 ID/CPE) in randomized block design with three replication. Wastewater and groundwater samples were collected on monthly basis (April 2014 to March 2015) and analyzed for different parameters of irrigation quality (pH, EC, SAR, RSC), pollution hazard (BOD, toxic heavy metals and Faecal coliforms) and nutrients potential (N, P, K, Cu, Fe, Mn, Zn) as per standard methods. After harvest of tuberose crop, soil samples were also collected and analyzed for different parameters of soil quality as per standard methods. The vegetative growth and flower parameters were recorded at flowering stage of tuberose plants. Results indicated that wastewater samples had higher nutrient potential, pollution hazard as compared to groundwater used in experimental crop. Soil quality parameters such as pH EC, available phosphorous & potassium and heavy metals (Cu, Fe, Mn, Zn, Cd. Pb, Ni, Cr, Co, As) were not significantly changed whereas organic carbon and available nitrogen were significant higher in the treatments where wastewater irrigations were given at 1.2 and 1.4 ID/CPE as compared to groundwater irrigations. Significantly higher plant height (68.47 cm), leaves per plant (78.35), spike length (99.93 cm), rachis length (37.40 cm), numbers of florets per spike (56.53), cut spike yield (0.93 lakh/ha) and loose flower yield (8.5 t/ha) were observed in the treatment of Wastewater irrigation at 1.2 ID/CPE. Study concluded that given quality of wastewater improves the productivity of tuberose without an adverse impact on soil quality/health. However, its long term impacts need to be further evaluated.

Keywords: conjunctive use, irrigation, tuberose, wastewater

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Authors: Tomas Makaras, Julija Razumienė, Vidutė Gurevičienė, Gintarė Sauliutė, Milda Stankevičiūtė

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Stress responses represent animal’s natural reactions to various challenging conditions and could be used as a welfare indicator. Regardless of the wide use of glucose measurements in stress evaluation, there are some inconsistencies in its acceptance as a stress marker, especially when it comes to comparison with non-invasive cortisol measurements in the fish challenging stress. To meet the challenge and to test the reliability and applicability of glucose measurement in practice, in this study, different environmental/anthropogenic exposure scenarios were simulated to provoke chemical-induced stress in fish (14-days exposure to landfill leachate) followed by a 14-days stress recovery period and under the cumulative effect of leachate fish subsequently exposed to pathogenic oomycetes (Saprolegnia parasitica) to represent a possible infection in fish. It is endemic to all freshwater habitats worldwide and is partly responsible for the decline of natural freshwater fish populations. Brown trout (Salmo trutta fario) and sea trout (Salmo trutta trutta) juveniles were chosen because of a large amount of literature on physiological stress responses in these species was known. Glucose content in fish by applying invasive and non-invasive glucose measurement procedures in different test mediums such as fish blood, gill tissues and fish-holding water were analysed. The results indicated that the quantity of glucose released in the holding water of stressed fish increased considerably (approx. 3.5- to 8-fold) and remained substantially higher (approx. 2- to 4-fold) throughout the stress recovery period than the control level suggesting that fish did not recover from chemical-induced stress. The circulating levels of glucose in blood and gills decreased over time in fish exposed to different stressors. However, the gill glucose level in fish showed a decrease similar to the control levels measured at the same time points, which was found to be insignificant. The data analysis showed that concentrations of β-D glucose measured in gills of fish treated with S. parasitica differed significantly from the control recovery, but did not differ from the leachate recovery group showing that S. parasitica presence in water had no additive effects. In contrast, a positive correlation between blood and gills glucose were determined. Parallel trends in blood and water glucose changes suggest that water glucose measurement has much potency in predicting stress. This study demonstrated that measuring β-D-glucose in fish-holding water is not stressful as it involves no handling and manipulation of an organism and has critical technical advantages concerning current (invasive) methods, mainly using blood samples or specific tissues. The quantification of glucose could be essential for studies examining the stress physiology/aquaculture studies interested in the assessment or long-term monitoring of fish health.

Keywords: brown trout, landfill leachate, sea trout, pathogenic oomycetes, β-D-glucose

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Authors: MD Mashiur Rahman, Muhammad Arshadul Haque

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Emerging conservation agriculture (CA) is an option for improving soil health and maintaining environmental sustainability for intensive agriculture, especially in the tropical climate. Three years lengthy research experiment was performed in arid climate from 2018 to 2020 at research field of Bangladesh Agricultural Research Station (RARS)F, Jamalpur (soil texture belongs to Agro-Ecological Zone (AEZ)-8/9, 24˚56'11''N latitude and 89˚55'54''E longitude and an altitude of 16.46m) to evaluate the effect of CA approaches on energy use efficiency and a streamlined life cycle greenhouse gas (GHG) emission of wheat production. For this, the conservation tillage practices (strip tillage (ST) and minimum tillage (MT)) were adopted in comparison to the conventional farmers' tillage (CT), with retained a fixed level (30 cm) of residue retention. This study examined the relationship between energy consumption and life cycle greenhouse gas (GHG) emission of wheat cultivation in Jamalpur region of Bangladesh. Standard energy equivalents megajoules (MJ) were used to measure energy from different inputs and output, similarly, the global warming potential values for the 100-year timescale and a standard unit kilogram of carbon dioxide equivalent (kg CO₂eq) was used to estimate direct and indirect GHG emissions from the use of on-farm and off-farm inputs. Farm efficiency analysis tool (FEAT) was used to analyze GHG emission and its intensity. A non-parametric data envelopment (DEA) analysis was used to estimate the optimum energy requirement of wheat production. The results showed that the treatment combination having MT with optimum energy inputs is the best suit for cost-effective, sustainable CA practice in wheat cultivation without compromising with the yield during the dry season. A total of 22045.86 MJ ha⁻¹, 22158.82 MJ ha⁻¹, and 23656.63 MJ ha⁻¹ input energy for the practice of ST, MT, and CT was used in wheat production, and output energy was calculated as 158657.40 MJ ha⁻¹, 162070.55 MJ ha⁻¹, and 149501.58 MJ ha⁻¹, respectively; where energy use efficiency/net energy ratio was found to be 7.20, 7.31 and 6.32. Among these, MT is the most effective practice option taken into account in the wheat production process. The optimum energy requirement was found to be 18236.71 MJ ha⁻¹ demonstrating for the practice of MT that if recommendations are followed, 18.7% of input energy can be saved. The total greenhouse gas (GHG) emission was calculated to be 2288 kgCO₂eq ha⁻¹, 2293 kgCO₂eq ha⁻¹ and 2331 kgCO₂eq ha⁻¹, where GHG intensity is the ratio of kg CO₂eq emission per MJ of output energy produced was estimated to be 0.014 kg CO₂/MJ, 0.014 kg CO₂/MJ and 0.015 kg CO₂/MJ in wheat production. Therefore, CA approaches ST practice with 30 cm residue retention was the most effective GHG mitigation option when the net life cycle GHG emission was considered in wheat production in the silt clay loam soil of Bangladesh. In conclusion, the CA approaches being implemented for wheat production involving MT practice have the potential to mitigate global warming potential in Bangladesh to achieve soil carbon footprint, where the life cycle assessment approach needs to be applied to a more diverse range of wheat-based cropping systems.

Keywords: conservation agriculture and tillage, energy use efficiency, life cycle GHG, Bangladesh

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Authors: Karolina Wieczorek, Sophie Wiliams

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Introduction: Patient data is often collected in Electronic Health Record Systems (EHR) for purposes such as providing care as well as reporting data. This information can be re-used to validate data models in clinical trials or in epidemiological studies. Manual validation of automated tools is vital to pick up errors in processing and to provide confidence in the output. Mentioning a disease in a discharge letter does not necessarily mean that a patient suffers from this disease. Many of them discuss a diagnostic process, different tests, or discuss whether a patient has a certain disease. The COVID-19 dataset in this study used natural language processing (NLP), an automated algorithm which extracts information related to COVID-19 symptoms, complications, and medications prescribed within the hospital. Free-text patient clinical patient notes are rich sources of information which contain patient data not captured in a structured form, hence the use of named entity recognition (NER) to capture additional information. Methods: Patient data (discharge summary letters) were exported and screened by an algorithm to pick up relevant terms related to COVID-19. Manual validation of automated tools is vital to pick up errors in processing and to provide confidence in the output. A list of 124 Systematized Nomenclature of Medicine (SNOMED) Clinical Terms has been provided in Excel with corresponding IDs. Two independent medical student researchers were provided with a dictionary of SNOMED list of terms to refer to when screening the notes. They worked on two separate datasets called "A” and "B”, respectively. Notes were screened to check if the correct term had been picked-up by the algorithm to ensure that negated terms were not picked up. Results: Its implementation in the hospital began on March 31, 2020, and the first EHR-derived extract was generated for use in an audit study on June 04, 2020. The dataset has contributed to large, priority clinical trials (including International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) by bulk upload to REDcap research databases) and local research and audit studies. Successful sharing of EHR-extracted datasets requires communicating the provenance and quality, including completeness and accuracy of this data. The results of the validation of the algorithm were the following: precision (0.907), recall (0.416), and F-score test (0.570). Percentage enhancement with NLP extracted terms compared to regular data extraction alone was low (0.3%) for relatively well-documented data such as previous medical history but higher (16.6%, 29.53%, 30.3%, 45.1%) for complications, presenting illness, chronic procedures, acute procedures respectively. Conclusions: This automated NLP algorithm is shown to be useful in facilitating patient data analysis and has the potential to be used in more large-scale clinical trials to assess potential study exclusion criteria for participants in the development of vaccines.

Keywords: automated, algorithm, NLP, COVID-19

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Authors: Brigitte Mischler, Marget Hund, Hilfiker Roger, Clare Maguire

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Background: Brain injury is one of the main causes of permanent physical disability, and improving walking ability is one of the most important goals for patients. After inpatient rehabilitation, most do not receive long-term rehabilitation services. Physical activity is important for the health prevention of the musculoskeletal system, circulatory system and the psyche. Objective: This follow-up study measured physical activity in subacute patients after traumatic brain injury and stroke. The difference in the number of steps in the inpatient setting was compared to the number of steps 1 year after the event in the outpatient setting. Methods: This follow-up study is a cross-sectional observational study with 29 participants. The measurement of daily step count over a seven-day period one year after the event was evaluated with the StepWatch™ ankle sensor. The number of steps taken one year after the event in the outpatient setting was compared with the number of steps taken during the inpatient stay and evaluated if they reached the recommended target value. Correlations between steps-count and exit domain, FAC level, walking speed, light touch, joint position sense, cognition, and fear of falling were calculated. Results: The median (IQR) daily step count of all patients was 2512 (568.5, 4070.5). During follow-up, the number of steps improved to 3656(1710,5900). The average difference was 1159(-2825, 6840) steps per day. Participants who were unable to walk independently (FAC 1) improved from 336(5-705) to 1808(92, 5354) steps per day. Participants able to walk with assistance (FAC 2-3) walked 700(31-3080) and at follow-up 3528(243,6871). Independent walkers (FAC 4-5) walked 4093(2327-5868) and achieved 3878(777,7418) daily steps at follow-up. This value is significantly below the recommended guideline. Step-count at follow-up showed moderate to high and statistically significant correlations: positive for FAC score, positive for FIM total score, positive for walking speed, and negative for fear of falling. Conclusions: Only 17% of all participants achieved the recommended daily step count one year after the event. We need better inpatient and outpatient strategies to improve physical activity. In everyday clinical practice, pedometers and diaries with objectives should be used. A concrete weekly schedule should be drawn up together with the patient, relatives, or nursing staff after discharge. This should include daily self-training, which was instructed during the inpatient stay. A good connection to social life (professional connection or a daily task/activity) can be an important part of improving daily activity. Further research should evaluate strategies to increase daily step counts in inpatient settings as well as in outpatient settings.

Keywords: neurorehabilitation, stroke, traumatic brain injury, steps, stepcount

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Authors: Ariane Plaisance, Holly O. Witteman, Patrick Michel Archambault

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Upon admission to an intensive care unit (ICU), all patients should discuss their wishes concerning life-sustaining interventions (e.g., cardiopulmonary resuscitation (CPR)). Without such discussions, interventions that prolong life at the cost of decreasing its quality may be used without appropriate guidance from patients. We employed user-centered design to adapt an existing decision aid (DA) about CPR to create a novel wiki-based DA adapted to the context of a single ICU and tailored to individual patient’s risk factors. During Phase 1, we conducted three weeks of ethnography of the decision-making context in our ICU to identify clinician and patient needs for a decision aid. During this time, we observed five dyads of intensivists and patients discussing their wishes concerning life-sustaining interventions. We also conducted semi-structured interviews with the attending intensivists in this ICU. During Phase 2, we conducted three rounds of rapid prototyping involving 15 patients and 11 other allied health professionals. We recorded discussions between intensivists and patients and used a standardized observation grid to collect patients’ comments and sociodemographic data. We applied content analysis to field notes, verbatim transcripts and the completed observation grids. Each round of observations and rapid prototyping iteratively informed the design of the next prototype. We also used the programming architecture of a wiki platform to embed the GO-FAR prediction rule programming code that we linked to a risk graphics software to better illustrate outcome risks calculated. During Phase I, we identified the need to add a section in our DA concerning invasive mechanical ventilation in addition to CPR because both life-sustaining interventions were often discussed together by physicians. During Phase II, we produced a context-adapted decision aid about CPR and mechanical ventilation that includes a values clarification section, questions about the patient’s functional autonomy prior to admission to the ICU and the functional decline that they would judge acceptable upon hospital discharge, risks and benefits of CPR and invasive mechanical ventilation, population-level statistics about CPR, a synthesis section to help patients come to a final decision and an online calculator based on the GO-FAR prediction rule. Even though the three rounds of rapid prototyping led to simplifying the information in our DA, 60% (n= 3/5) of the patients involved in the last cycle still did not understand the purpose of the DA. We also identified gaps in the discussion and documentation of patients’ preferences concerning life-sustaining interventions (e.g.,. CPR, invasive mechanical ventilation). The final version of our DA and our online wiki-based GO-FAR risk calculator using the IconArray.com risk graphics software are available online at www.wikidecision.org and are ready to be adapted to other contexts. Our results inform producers of decision aids on the use of wikis and user-centered design to develop DAs that are better adapted to users’ needs. Further work is needed on the creation of a video version of our DA. Physicians will also need the training to use our DA and to develop shared decision-making skills about goals of care.

Keywords: ethnography, intensive care units, life-sustaining therapies, user-centered design

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Authors: Martyna Ekiert, Natalia Grzechnik, Joanna Karbowniczek, Urszula Stachewicz, Andrzej Mlyniec

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Tendon grafting is a common procedure performed to treat tendon rupture. Before the surgical procedure, tissues intended for grafts (i.e., Achilles tendon) are stored in ultra-low temperatures for a long time and also may be subjected to unfavorable conditions, such as repetitive freezing (F) and thawing (T). Such storage protocols may highly influence the graft mechanical properties, decrease its functionality and thus increase the risk of complications during the transplant procedure. The literature reports on the influence of multiple F/T cycles on internal structure and mechanical properties of tendons stay inconclusive, confirming and denying the negative influence of multiple F/T at the same time. An inconsistent research methodology and lack of clear limit of F/T cycles, which disqualifies tissue for surgical graft purposes, encouraged us to investigate the issue of multiple F/T cycles by the mean of biomechanical tensile tests supported with Scanning Electron Microscope (SEM) imaging. The study was conducted on male bovine Achilles tendon-derived from the local abattoir. Fresh tendons were cleaned of excessive membranes and then sectioned to obtained fascicle bundles. Collected samples were randomly assigned to 6 groups subjected to 1, 2, 4, 6, 8 and 12 cycles of freezing-thawing (F/T), respectively. Each F/T cycle included deep freezing at -80°C temperature, followed by thawing at room temperature. After final thawing, thin slices of the side part of samples subjected to 1, 4, 8 and 12 F/T cycles were collected for SEM imaging. Then, the width and thickness of all samples were measured to calculate the cross-sectional area. Biomechanical tests were performed using the universal testing machine (model Instron 8872, INSTRON®, Norwood, Massachusetts, USA) using a load cell with a maximum capacity of 250 kN and standard atmospheric conditions. Both ends of each fascicle bundle were manually clamped in grasping clamps using abrasive paper and wet cellulose wadding swabs to prevent tissue slipping while clamping and testing. Samples were subjected to the testing procedure including pre-loading, pre-cycling, loading, holding and unloading steps to obtain stress-strain curves for representing tendon stretching and relaxation. The stiffness of AT fascicles bundle samples was evaluated in terms of modulus of elasticity (Young’s modulus), calculated from the slope of the linear region of stress-strain curves. SEM imaging was preceded by chemical sample preparation including 24hr fixation in 3% glutaraldehyde buffered with 0.1 M phosphate buffer, washing with 0.1 M phosphate buffer solution and dehydration in a graded ethanol solution. SEM images (Merlin Gemini II microscope, ZEISS®) were taken using 30 000x mag, which allowed measuring a diameter of collagen fibrils. The results confirm a decrease in fascicle bundles Young’s modulus as well as a decrease in the diameter of collagen fibrils. These results confirm the negative influence of multiple F/T cycles on the mechanical properties of tendon tissue.

Keywords: biomechanics, collagen, fascicle bundles, soft tissue

Procedia PDF Downloads 124