Search results for: health system reconstruction

Authors: Robert E. Kenney, Richard B. Aguilar, Efrain Antunez, Gregory Schor-Haskin, Rafael Rey, Catie Falcon, Luis Arce

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This study sought to explore the effect of Sarapin injections on chronic knee pain (CKP). Many adults suffer from CKP which is most often attributed to osteoarthritis. Current treatment regimens for CKP involve the use NSAIDS medications, injections with steroids/analgesic, platelet rich plasma injections, or orthopedic surgical interventions. Sarapin is a commercially available homeopathic aqueous extract from the pitcher plant. Studies on the use of Sarapin as a treatment for cervical, thoracic, and lumbosacral facet joint nerve blocks have been performed with mixed results. There is little available evidence on the use of Sarapin in CKP. This study examines the effect of a series of 3 weekly injections of aqueous Sarapin in 95 elderly patients with CKP in a primary care setting. Cano Health, a primary care group, identified 95 successive patients with CKP from its multimodal physiotherapy program for chronic pain. Patients underwent evaluation by a clinician, underwent diagnostic Xrays of the knees, and the treatment plan with three weekly Sarapin injections was discussed. A pain and functional limitation survey (a modified Lower Extremity Functional Scale (mLEFS)) was administered prior to initiating treatment (Entry Survey (ES)). Each patient received an intraarticular injection of 2 cc of aqueous Sarapin with 1cc 1% lidocaine during weeks 1, 2 and 3. The mLEFS was administered again at week 4, one week after the third Sarapin injection (Exit Survey (ExS)). Demographics: Mean Age 62 +/- 9.8; 73% female; 89% Hispanic/Latino; mean time between ES and ExS was 27.5 +/-8.2 days. Survey: The mLEFS was based on a published Lower Extremity Functional Scale and each patient rated their pain or functional limitation from 0 (no difficulty) to 5 (severe difficulty) for 10 questions. Answers were summed and compared. Maximum score for severe difficulty would be 50 points. Results: Mean pain/functional scores: ES was 30.3 +/-12.1 and ExS was 19.5 +/- 12.5. This represents a relative improvement of 35.7% (P<0.00001). A total of 81% (77/95) of the patients showed improvement in symptoms at week four as assessed by the mLEFS. There were 11 patients who reported an increase in their survey scores while 7 patients reported no change. When evaluating the cohort that reported improvement, the ES was 30.9 +/-11.4 and ExS was 16.3 +/-9.8 yielding a 47.2% relative improvement (P<0.00001). Injections were well tolerated, and no adverse events were reported. Conclusions: In this cohort of 95 elderly patients with CKP, treatment with 3 weekly injections of Sarapin significantly improved pain and function as assessed by a mLEFS survey. The majority (81%) of patients responded positively to therapy, 12% had worsening symptoms and 7% reported no change. The use of intraarticular injections of Sarapin for CKP was shown to be an effective modality of treatment. Sarapin’s low cost, tolerability, and ease of use make it an attractive alternative to NSAIDS, steroids, PRP or surgical intervention for this common debilitating condition.

Keywords: Sarapin, intraarticular, chronic knee pain, osteoarthritis

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Authors: Eman AbdelSabour

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Sustainability is increasingly being considered as a critical aspect in shaping the urban environment. It works as an invention development basis for global urban growth. Currently, different models and structures impact the means of interpreting the criteria that would be included in defining a sustainable city. There is a collective need to improve the growth path to an extremely durable path by presenting different suggestions regarding multi-scale initiatives. The global rise in urbanization has led to increased demand and pressure for better urban planning choice and scenarios for a better sustainable urban alternative. The need for an assessment tool at the urban scale was prompted due to the trend of developing increasingly sustainable urban development (SUD). The neighborhood scale is being managed by a growing research committee since it seems to be a pertinent scale through which economic, environmental, and social impacts could be addressed. Although neighborhood design is a comparatively old practice, it is in the initial years of the 21st century when environmentalists and planners started developing sustainable assessment at the neighborhood level. Through this, urban reality can be considered at a larger scale whereby themes which are beyond the size of a single building can be addressed, while it still stays small enough that concrete measures could be analyzed. The neighborhood assessment tool has a crucial role in helping neighborhood sustainability to perform approach and fulfill objectives through a set of themes and criteria. These devices are also known as neighborhood assessment tool, district assessment tool, and sustainable community rating tool. The primary focus of research has been on sustainability from the economic and environmental aspect, whereas the social, cultural issue is rarely focused. Therefore, this research is based on Doha, Qatar, the current urban conditions of the neighborhoods is discussed in this study. The research problem focuses on the spatial features in relation to the socio-cultural aspects. This study is outlined in three parts; the first section comprises of review of the latest use of wellbeing assessment methods to enhance decision process of retrofitting physical features of the neighborhood. The second section discusses the urban settlement development, regulations and the process of decision-making rule. An analysis of urban development policy with reference to neighborhood development is also discussed in this section. Moreover, it includes a historical review of the urban growth of the neighborhoods as an atom of the city system present in Doha. Last part involves developing quantified indicators regarding subjective well-being through a participatory approach. Additionally, applying GIS will be utilized as a visualizing tool for the apparent Quality of Life (QoL) that need to develop in the neighborhood area as an assessment approach. Envisaging the present QoL situation in Doha neighborhoods is a process to improve current condition neighborhood function involves many days to day activities of the residents, due to which areas are considered dynamic.

Keywords: neighborhood, subjective wellbeing, decision support tools, Doha, retrofiring

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Authors: Pi Hsia Liang

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The rise of Facebook, Twitter, and other social networks significantly changes in interconnections between people, enhancing the process of information dissemination and amplify the influence of that information. Therefore, to develop informational efficiency or signaling equilibrium type of information environment among social networks, without adverse selection effects, becomes an important issue. Thus, someone may post a piece of intentional information in relation to personal interest for trying to create marginal influence. Therefore, economists are seeking to establish theories of informational efficiency under social network environment in order to resolve adverse selection issues. Reputation could be one of the important factors in the process of creating informational efficiency. Additionally, investors how to process green information, or information of corporate social responsibility is a very important study. This study essentially employs experimental study for examining how investors use stock relevant green information in Facebook and various Taiwan local networks. Facebook, and blogs of Money DJ, Technews and cnYES, respectively, are the primary sites for this examination that also allow to differentiate effects between Facebook and other local social networks. Questionnaire is developed for such an experimental testing. Note that questionnaire allows this study to group, for example, decision frequency and length of time duration focusing on social networks that are used for discriminating investor type and competence of informed investor. This study selects 500 investors that can be separated into two respective 250 samples as the control group and 250 samples in such an experimental. The quantity of sample investor sufficiently results in statistic significance of this experimental study. The empirical results of this study can be used for explaining how financial information in relation to corporate social responsibility would be disseminated in social websites. Therefore, we can lead to better interpretation of price/earnings relationship type of study and empirical studies of green information usefulness or informational efficiency Note that the above mentioned empirical studies did not exist any social network and annual report of corporate social responsibility. This study expects to find the results that both network degree and network cluster significantly affected green information dissemination frequency. In other words, investors with more connections and with high clustered connections might exert a greater influence on their green information dissemination process. The preferred users of financial social networks could make better stock decision that could amplify effects of green information. In addition, Facebook would be more influential than other local Taiwan financial social networks, although Facebook is not a specialized financial social network. In other words, the popularity and reputation effects of Facebook significantly contribute to usefulness of green information and influence of green information. Third, it has a better chance to find rumor or cheating information in local Taiwan financial social networks than Facebook. In other words, Facebook possesses reputation effect, or a better informational efficiency. Or, even though Taiwan local financial social networks have marginal informational effects on stock price, because of shortage of informational efficiency or monitoring system, information could be a tool for those whom owning superior information.

Keywords: network effect on financial services, informational efficiency theory, social networks, social websites

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Authors: Nam Sze Cheng, P. C. Janita Chau

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Background: Eczema is a chronic inflammatory disease with high global prevalence rates in many childhood populations. It is also the most common paediatric skin problem. Although eczema education and proper skin care were effective in controlling eczema symptoms, the lack of both sufficient time for patient consultation and structured eczema education programme hindered the transferability of knowledge to patients and their parents. As a result, these young patients and their families suffer from a significant physical disability and psychological distress, which can substantially impair their quality of life. Objectives: This integrative review is to examine the effects of educational interventions for children with eczema and identify the core elements associated with an effective intervention. Methods: This integrative review targeted all articles published in 10 databases between May 2016 and February 2017 that reported the outcomes of disease interventions of any format for children and adolescents with the clinical diagnosis of eczema who were under 18 years of age. Five randomized controlled trials (RCT) and one systematic review of 10 RCTs were identified for review. All these publications had high methodological quality, except one study of web-based eczema education that was limited by selection bias and poor subject blinding. Findings: This review found that most studies adopted nurse-led or multi-disciplinary parental eczema education programme at the outpatient clinic setting. The format of these programmes included individual lectures, demonstration and group sharing, and the educational materials covered basic eczema knowledge and management as well as methods to interrupt itch-scratch cycle. The main outcome measures of these studies included severity of eczema symptoms, treatment adherence and quality of life of both patients and their families. Nine included studies reported statistically significant improvement in the primary outcome of symptom severity of these eczematous children. On the other hand, all these reviews failed to identify an effective dosage of intervention under these educational programmes that was attributed to the heterogeneity of the interventions. One study that was designed based on the social cognitive theory to guide the interventional content yielded statistically significant results. The systematic review recommended the importance of measuring parental self-efficacy. Implication: This integrative review concludes that structured educational programme can help nurses understand the theories behind different health interventions. They can then deliver eczema education to their patients in a consistent manner. These interventions also result in behavioral changes through patient education. Due to the lack of validated educational programmes in Chinese, it is imperative to conduct an RCT of eczema educational programme to investigate its effects on eczema severity, quality of life and treatment adherence in Hong Kong children as well as to promote the importance of parental self-efficacy.

Keywords: children, eczema, education, intervention

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Authors: Carine Enow-Ayor Tarkang, Victorine Neh Akenji, Dmitri Rouwet, Jodephine Njdma, Andrew Ako Ako, Franco Tassi, Jules Remy Ngoupayou Ndam

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Groundwater is the major water resource in the whole of Bafia used for drinking, domestic, poultry and agricultural purposes, and being an area of intense agriculture, there is a great necessity to do a quality assessment. Bafia is one of the main food suppliers in the Centre region of Cameroon, and so to meet their demands, the farmers make use of fertilizers and other agrochemicals to increase their yield. Less than 20% of the population in Bafia has access to piped-borne water due to the national shortage, according to the authors best knowledge very limited studies have been carried out in the area to increase awareness of the groundwater resources. The aim of this study was to assess heavy metal contamination levels in ground and surface waters and to evaluate the effects of agricultural inputs on water quality in the Bafia area. 57 water samples (including 31 wells, 20 boreholes, 4 rivers and 2 springs) were analyzed for their physicochemical parameters, while collected samples were filtered, acidified with HNO3 and analyzed by ICP-MS for their heavy metal content (Fe, Ti, Sr, Al, Mn). Results showed that most of the water samples are acidic to slightly neutral and moderately mineralized. Ti concentration was significantly high in the area (mean value 130µg/L), suggesting another Ti source besides the natural input from Titanium oxides. The high amounts of Mn and Al in some cases also pointed to additional input, probably from fertilizers that are used in the farmlands. Most of the water samples were found to be significantly contaminated with heavy metals exceeding the WHO allowable limits (Ti-94.7%, Al-19.3%, Mn-14%, Fe-5.2% and Sr-3.5% above limits), especially around farmlands and topographic low areas. The heavy metal concentration was evaluated using the heavy metal pollution index (HPI), heavy metal evaluation index (HEI) and degree of contamination (Cd), while the Ficklin diagram was used for the water based on changes in metal content and pH. The high mean values of HPI and Cd (741 and 5, respectively), which exceeded the critical limit, indicate that the water samples are highly contaminated, with intense pollution from Ti, Al and Mn. Based on the HPI and Cd, 93% and 35% of the samples, respectively, are unacceptable for drinking purposes. The lowest HPI value point also had the lowest EC (50 µS/cm), indicating lower mineralization and less anthropogenic influence. According to the Ficklin diagram, 89% of the samples fell within the near-neutral low-metal domain, while 9% fell in the near-neutral extreme-metal domain. Two significant factors were extracted from the PCA, explaining 70.6% of the total variance. The first factor revealed intense anthropogenic activity (especially from fertilizers), while the second factor revealed water-rock interactions. Agricultural activities thus have an impact on the heavy metal content of groundwater in the area; hence, much attention should be given to the affected areas in order to protect human health/life and thus sustainably manage this precious resource.

Keywords: Bafia, contamination, degree of contamination, groundwater, heavy metal pollution index

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Authors: Frederick Huie, Lauren Fusfeld, William Burchenal, Scott Howell, Alyssa McVey, Thomas F. Goss

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Alzheimer’s Disease (AD) is a degenerative brain disease characterized by memory loss and cognitive decline that presents a substantial economic burden for patients and health insurers in the US. This study evaluates the payer budget impact of the DISCERN™ test in the diagnosis and management of patients with symptoms of dementia evaluated for AD. DISCERN™ comprises three assays that assess critical factors related to AD that regulate memory, formation of synaptic connections among neurons, and levels of amyloid plaques and neurofibrillary tangles in the brain and can provide a quicker, more accurate diagnosis than tests in the current diagnostic pathway (CDP). An Excel-based model with a three-year horizon was developed to assess the budget impact of DISCERN™ compared with CDP in a Medicare Advantage plan with 1M beneficiaries. Model parameters were identified through a literature review and were verified through consultation with clinicians experienced in diagnosis and management of AD. The model assesses direct medical costs/savings for patients based on the following categories: •Diagnosis: costs of diagnosis using DISCERN™ and CDP. •False Negative (FN) diagnosis: incremental cost of care avoidable with a correct AD diagnosis and appropriately directed medication. •True Positive (TP) diagnosis: AD medication costs; cost from a later TP diagnosis with the CDP versus DISCERN™ in the year of diagnosis, and savings from the delay in AD progression due to appropriate AD medication in patients who are correctly diagnosed after a FN diagnosis.•False Positive (FP) diagnosis: cost of AD medication for patients who do not have AD. A one-way sensitivity analysis was conducted to assess the effect of varying key clinical and cost parameters ±10%. An additional scenario analysis was developed to evaluate the impact of individual inputs. In the base scenario, DISCERN™ is estimated to decrease costs by $4.75M over three years, equating to approximately $63.11 saved per test per year for a cohort followed over three years. While the diagnosis cost is higher with DISCERN™ than with CDP modalities, this cost is offset by the higher overall costs associated with CDP due to the longer time needed to receive a TP diagnosis and the larger number of patients who receive a FN diagnosis and progress more rapidly than if they had received appropriate AD medication. The sensitivity analysis shows that the three parameters with the greatest impact on savings are: reduced sensitivity of DISCERN™, improved sensitivity of the CDP, and a reduction in the percentage of disease progression that is avoided with appropriate AD medication. A scenario analysis in which DISCERN™ reduces the utilization for patients of computed tomography from 21% in the base case to 16%, magnetic resonance imaging from 37% to 27% and cerebrospinal fluid biomarker testing, positive emission tomography, electroencephalograms, and polysomnography testing from 4%, 5%, 10%, and 8%, respectively, in the base case to 0%, results in an overall three-year net savings of $14.5M. DISCERN™ improves the rate of accurate, definitive diagnosis of AD earlier in the disease and may generate savings for Medicare Advantage plans.

Keywords: Alzheimer’s disease, budget, dementia, diagnosis.

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Authors: Gelareh Ghaderi

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the overall objective of this study is to develop two alternative plans of spatial and infrastructural development for the Netwerkstad Twente (Twente region) until 2040 and to assess the impacts of those two alternative plans. This region is located on the eastern border of the Netherlands, and it comprises of five municipalities. Based on the strengths and opportunities of the five municipalities of the Netwerkstad Twente, and in order develop the region internationally, strengthen the job market and retain skilled and knowledgeable young population, two alternative visions have been developed; environmental oriented vision, and economical oriented vision. Environmental oriented vision is based mostly on preserving beautiful landscapes. Twente would be recognized as an educational center, driven by green technologies and environment-friendly economy. Market-oriented vision is based on attracting and developing different economic activities in the region based on visions of the five cities of Netwerkstad Twente, in order to improve the competitiveness of the region in national and international scale. On the basis of the two developed visions and strategies for achieving the visions, land use and infrastructural development are modeled and assessed. Based on the SWOT analysis, criteria were formulated and employed in modeling the two contrasting land use visions by the year 2040. Land use modeling consists of determination of future land use demand, assessment of suitability land (Suitability analysis), and allocation of land uses on suitable land. Suitability analysis aims to determine the available supply of land for future development as well as assessing their suitability for specific type of land uses on the basis of the formulated set of criteria. Suitability analysis was operated using CommunityViz, a Planning Support System application for spatially explicit land suitability and allocation. Netwerkstad Twente has highly developed transportation infrastructure, consists of highways network, national road network, regional road network, street network, local road network, railway network and bike-path network. Based on the assumptions of speed limitations on different types of roads provided, infrastructure accessibility level of predicted land use parcels by four different transport modes is investigated. For evaluation of the two development scenarios, the Multi-criteria Evaluation (MCE) method is used. The first step was to determine criteria used for evaluation of each vision. All factors were categorized as economical, ecological and social. Results of Multi-criteria Evaluation show that Environmental oriented cities scenario has higher overall score. Environment-oriented scenario has impressive scores in relation to economical and ecological factors. This is due to the fact that a large percentage of housing tends towards compact housing. Twente region has immense potential, and the success of this project will define the Eastern part of The Netherlands and create a real competitive local economy with innovations and attractive environment as its backbone.

Keywords: economical oriented vision, environmental oriented vision, infrastructure, land use, multi criteria assesment, vision

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Authors: Nourhan Hussein Fanaki, Hoda Mohamed Gamal El-Din Omar, Nihal Kadry Moussa, Eva Adel Edward Farid

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The resistance of staphylococci to various antibiotics has become a major concern for health care professionals. The efficacy of the combinations of selected glycopeptides (vancomycin and teicoplanin) with gentamicin or rifampicin, as well as that of gentamicin/rifampicin combination, was studied against selected pathogenic staphylococcus isolated from Egypt. The molecular distribution of genes conferring resistance to these four antibiotics was detected among tested clinical isolates. Antibiotic combinations were studied using the checkerboard technique and the time-kill assay (in both the stationary and log phases). Induction of resistance to glycopeptides in staphylococci was tried in the absence and presence of diclofenac sodium as inducer. Transmission electron microscopy was used to study the effect of glycopeptides on the ultrastructure of the cell wall of staphylococci. Attempts were made to cure gentamicin resistance plasmids and to study the transfer of these plasmids by conjugation. Trials for the transformation of the successfully isolated gentamicin resistance plasmid to competent cells were carried out. The detection of genes conferring resistance to the tested antibiotics was performed using the polymerase chain reaction. The studied antibiotic combinations proved their efficacy, especially when tested during the log phase. Induction of resistance to glycopeptides in staphylococci was more promising in presence of diclofenac sodium, compared to its absence. Transmission electron microscopy revealed the thickening of bacterial cell wall in staphylococcus clinical isolates due to the presence of tested glycopeptides. Curing of gentamicin resistance plasmids was only successful in 2 out of 9 tested isolates, with a curing rate of 1 percent for each. Both isolates, when used as donors in conjugation experiments, yielded promising conjugation frequencies ranging between 5.4 X 10-2 and 7.48 X 10-2 colony forming unit/donor cells. Plasmid isolation was only successful in one out of the two tested isolates. However, low transformation efficiency (59.7 transformants/microgram plasmid DNA) of such plasmids was obtained. Negative regulators of autolysis, such as arlR, lytR and lrgB, as well as cell-wall associated genes, such as pbp4 and/or pbp2, were detected in staphylococcus isolates with reduced susceptibility to the tested glycopeptides. Concerning rifampicin resistance genes, rpoBstaph was detected in 75 percent of the tested staphylococcus isolates. It could be concluded that in vitro studies emphasized the usefulness of the combination of vancomycin or teicoplanin with gentamicin or rifampicin, as well as that of gentamicin with rifampicin, against staphylococci showing varying resistance patterns. However, further in vivo studies are required to ensure the safety and efficacy of such combinations. Diclofenac sodium can act as an inducer of resistance to glycopeptides in staphylococci. Cell-wall thickness is a major contributor to such resistance among them. Gentamicin resistance in these strains could be chromosomally or plasmid mediated. Multiple mutations in the rpoB gene could mediate staphylococcus resistance to rifampicin.

Keywords: glycopeptides, combinations, induction, diclofenac, transmission electron microscopy, polymerase chain reaction

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Authors: Karimova Sitora Yuldashevna

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The August 2021 resurgence of Taliban as a ruling force in Afghanistan once again challenged the global community into dealing with an unprecedentedly unlike-minded government. To express their disapproval of the new regime, Western governments and intergovernmental institutions have suspended their infrastructural projects and other forms of support. Moreover, the Afghan offshore reserves were frozen, and Afghanistan was disconnected from the international financial system, which impeded even independent aid agencies’ work. The already poor provision of aid was then further complicated with political conditionality. The purpose of this paper is to investigate the efficacy of conditional aid policy in the Afghan peacebuilding under Taliban rule and provide recommendations to international donors on further course of action. Arguing that conditionality of aid is a counterproductive factor in the peacebuilding process, this paper employs scholarly literature on peacebuilding alongside reports from International non-governmental organizations INGOs who operate directly in Afghanistan. The existing debate on peacebuilding in Afghanistan revolves around aid as a means of building democratic foundation for achieving peace on communal and national levels and why the previous attempts to do so were unsuccessful. This paper focuses on how to recalibrate the approach to aid provision and peacebuilding in the new reality. In the early 2000s, amid the weak Post-Cold War international will for a profound engagement in the conflict, humanitarian and development aid became the new means of achieving peace. Aid agencies provided resources directly to communities, minimizing the risk of local disputes. Through subsidizing education, governance reforms, and infrastructural projects, international aid accelerated school enrollment, introduced peace education, funded provincial council and parliamentary elections, and helped rebuild a conflict-torn country.When the Taliban seized power, the international community called on them to build an inclusive government based on respect for human rights, particularly girls’ and women’s schooling and work, as a condition to retain the aid flow. As the Taliban clearly failed to meet the demands, development aid was withdrawn. Some key United Nation agencies also refrained from collaborating with the de-facto authorities. However, contrary to the intended change in Talibs’ behavior, such a move has only led to further deprivation of those whom the donors strived to protect. This is because concern for civilians has always been the second priority for the warring parties. This paper consists of four parts. First, it describes the scope of the humanitarian crisis that began in Afghanistan in 2001. Second, it examines the previous peacebuilding attempts undertaken by the international community and the contribution that the international aid had in the peacebuilding process. Third, the paper describes the current regime and its relationships with the international donors. Finally, the paper concludes with recommendations for donors who would have to be more realistic and reconsider their priorities. While it is certainly not suggested that the Taliban regime is legitimized internationally, the crisis calls upon donors to be more flexible in collaborating with the de-facto authorities for the sake of the civilians.

Keywords: Afghanistan, international aid, donors, peacebuilding

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Authors: Jaci Marie Mastrandrea, Rosario Haro

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Background: The National Comprehensive Cancer Network (NCCN) recommends that healthcare institutions have established processes for integrating palliative care (PC) into cancer treatment and that all cancer patients be screened for PC needs upon initial diagnosis as well as throughout the entire continuum of care (National Comprehensive Cancer Network, 2021). Early PC screening and intervention is directly associated with improved patient outcomes. The Sky Lakes Cancer Treatment Center (SLCTC) is an institution that has access to PC services yet does not have protocols in place for identifying patients with palliative needs or a standardized referral process. The aim of this quality improvement project was to improve early access to PC services by establishing a standardized screening and referral process for outpatient oncology patients. Method: The sample population included all adult patients with an oncology diagnosis who presented to the SLCTC for treatment during the project timeline. The “Palliative and Supportive Needs Assessment'' (PSNA) screening tool was developed from validated, evidence-based PC referral criteria. The tool was initially implemented using paper forms, and data was collected over a period of eight weeks. Patients were screened by nurses on the SLCTC oncology treatment team. Nurses responsible for screening patients received an educational inservice prior to implementation. Patients with a PSNA score of three or higher received an educational handout on the topic of PC and education about PC and symptom management. A score of five or higher indicates that PC referral is strongly recommended, and the patient’s EHR is flagged for the oncology provider to review orders for PC referral. The PSNA tool was approved by Sky Lakes administration for full integration into Epic-Beacon. The project lead collaborated with the Sky Lakes’ information systems team and representatives from Epic on the tool’s aesthetic and functionality within the Epic system. SLCTC nurses and physicians were educated on how to document the PSNA within Epic and where to view results. Results: Prior to the implementation of the PSNA screening tool, the SLCTC had zero referrals to PC in the past year, excluding referrals to hospice. Data was collected from the completed screening assessments of 100 patients under active treatment at the SLCTC. Seventy-three percent of patients met criteria for PC referral with a score greater than or equal to three. Of those patients who met referral criteria, 53.4% (39 patients) were referred for a palliative and supportive care consultation. Patients that were not referred to PC upon meeting criteria were flagged in EPIC for re-screening within one to three months. Patients with lung cancer, chronic hematologic malignancies, breast cancer, and gastrointestinal malignancy most frequently met the criteria for PC referral and scored highest overall on the scale of 0-12. Conclusion: The implementation of a standardized PC screening tool at the SLCTC significantly increased awareness of PC needs among cancer patients in the outpatient setting. Additionally, data derived from this quality improvement project supports the national recommendation for PC to be an integral component of cancer treatment across the entire continuum of care.

Keywords: oncology, palliative and supportive care, symptom management, outpatient oncology, palliative screening tool

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Authors: Suneet Jagdev, Hrishabh Amrodia, Siddharth Menon, Abhishek Singh, Mansi Shivhare

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Delhi, the National Capital, has undergone a surge in development rate, consequently engendering an unprecedented increase in population. Over the years the city has transformed into a car-centric infrastructure with high-speed corridors, flyovers and fast lanes. A considerable section of the population is hankering to rehabilitate to the good old cycling days, in order to contribute towards a green environment as well as to maintain their physical well-being. Furthermore, an extant section of Delhi’s population relies on cycles as their primary means of commuting in the city. Delhi has the highest number of cyclists and second highest number of pedestrians in the country. However, the tumultuous problems of unregulated traffic, inadequate space on roads, adverse weather conditions stifle them to opt for cycling. Lately, the city has been facing a conglomeration of problems such as haphazard traffic movement, clogged roads, congestion, pollution, accidents, safety issues, etc. In 1957, Delhi’s cyclists accounted for 36 per cent of trips which dropped down to a mere 4 per cent in 2008. The declining rate is due to unsafe roads and lack of proper cycle lanes. Now as the 10 percent of the city has cycle tracks. There is also a lack of public recreational activities in the city. These conundrums incite the need of a covered elevated cycling bridge track to facilitate the safe and smooth cycle commutation in the city which would also serve the purpose of an alternate urban public space over the cycle bridge reducing the cost as well as the space requirement for the same, developing a user–friendly transportation and public interaction system for urban areas in the city. Based on the archival research methodologies, the following research draws information and extracts records from the data accounts of the Delhi Metro Rail Corporation Ltd. as well as the Centre for Science and Environment, India. This research will predominantly focus on developing a prototype design for high speed elevated bicycle lanes based on different road typologies, which can be replicated with minor variations in similar situations, all across the major cities of our country including the proposed smart cities. Furthermore, how these cycling lanes could be utilized for the place making process accommodating cycle parking and renting spaces, public recreational spaces, food courts as well as convenient shopping facilities with appropriate optimization. How to preserve and increase the share of smooth and safe cycling commute cycling for the routine transportation of the urban community of the polluted capital which has been on a steady decline over the past few decades.

Keywords: bicycle track, prototype, road safety, urban spaces

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Authors: Jyoti Sahu, Vinay A. Juvekar

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Electrolytes are often used to bring about salting-in and salting-out of organic molecules and polymers (e.g. polyethylene glycols/proteins) from the aqueous solutions. For quantification of these phenomena, a thermodynamic model which can accurately predict activity coefficient of electrolyte as a function of temperature is needed. The thermodynamics models available in the literature contain a large number of empirical parameters. These parameters are estimated using lower/upper critical solution temperature of the solution in the electrolyte/organic molecule at different temperatures. Since the number of parameters is large, inaccuracy can bethe creep in during their estimation, which can affect the reliability of prediction beyond the range in which these parameters are estimated. Cloud point of solution is related to its free energy through temperature and composition derivative. Hence, the Cloud point measurement can be used for accurate estimation of the temperature and composition dependence of parameters in the model for free energy. Hence, if we use a two pronged procedure in which we first use cloud point of solution to estimate some of the parameters of the thermodynamic model and determine the rest using osmotic coefficient data, we gain on two counts. First, since the parameters, estimated in each of the two steps, are fewer, we achieve higher accuracy of estimation. The second and more important gain is that the resulting model parameters are more sensitive to temperature. This is crucial when we wish to use the model outside temperatures window within which the parameter estimation is sought. The focus of the present work is to prove this proposition. We have used electrolyte (NaCl/Na2CO3)-water-organic molecule (Iso-propanol/ethanol) as the model system. The model of Robinson-Stokes-Glukauf is modified by incorporating the temperature dependent Flory-Huggins interaction parameters. The Helmholtz free energy expression contains, in addition to electrostatic and translational entropic contributions, three Flory-Huggins pairwise interaction contributions viz., and (w-water, p-polymer, s-salt). These parameters depend both on temperature and concentrations. The concentration dependence is expressed in the form of a quadratic expression involving the volume fractions of the interacting species. The temperature dependence is expressed in the form .To obtain the temperature-dependent interaction parameters for organic molecule-water and electrolyte-water systems, Critical solution temperature of electrolyte -water-organic molecules is measured using cloud point measuring apparatus The temperature and composition dependent interaction parameters for electrolyte-water-organic molecule are estimated through measurement of cloud point of solution. The model is used to estimate critical solution temperature (CST) of electrolyte water-organic molecules solution. We have experimentally determined the critical solution temperature of different compositions of electrolyte-water-organic molecule solution and compared the results with the estimates based on our model. The two sets of values show good agreement. On the other hand when only osmotic coefficients are used for estimation of the free energy model, CST predicted using the resulting model show poor agreement with the experiments. Thus, the importance of the CST data in the estimation of parameters of the thermodynamic model is confirmed through this work.

Keywords: concentrated electrolytes, Debye-Hückel theory, interaction parameters, Robinson-Stokes-Glueckauf model, Flory-Huggins model, critical solution temperature

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Authors: Ashish Thakur

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This technical paper was written in view of focusing the biomaterials and its various applications in modern industries. Author tires to elaborate not only the medical, infect plenty of application in other industries. The scope of the research area covers the wide range of physical, biological and chemical sciences that underpin the design of biomaterials and the clinical disciplines in which they are used. A biomaterial is now defined as a substance that has been engineered to take a form which, alone or as part of a complex system, is used to direct, by control of interactions with components of living systems, the course of any therapeutic or diagnostic procedure. Biomaterials are invariably in contact with living tissues. Thus, interactions between the surface of a synthetic material and biological environment must be well understood. This paper reviews the benefits and challenges associated with surface modification of the metals in biomedical applications. The paper also elaborates how the surface characteristics of metallic biomaterials, such as surface chemistry, topography, surface charge, and wettability, influence the protein adsorption and subsequent cell behavior in terms of adhesion, proliferation, and differentiation at the biomaterial–tissue interface. The chapter also highlights various techniques required for surface modification and coating of metallic biomaterials, including physicochemical and biochemical surface treatments and calcium phosphate and oxide coatings. In this review, the attention is focused on the biomaterial-associated infections, from which the need for anti-infective biomaterials originates. Biomaterial-associated infections differ markedly for epidemiology, aetiology and severity, depending mainly on the anatomic site, on the time of biomaterial application, and on the depth of the tissues harbouring the prosthesis. Here, the diversity and complexity of the different scenarios where medical devices are currently utilised are explored, providing an overview of the emblematic applicative fields and of the requirements for anti-infective biomaterials. In addition to this, chapter introduces nanomedicine and the use of both natural and synthetic polymeric biomaterials, focuses on specific current polymeric nanomedicine applications and research, and concludes with the challenges of nanomedicine research. Infection is currently regarded as the most severe and devastating complication associated to the use of biomaterials. Osteoporosis is a worldwide disease with a very high prevalence in humans older than 50. The main clinical consequences are bone fractures, which often lead to patient disability or even death. A number of commercial biomaterials are currently used to treat osteoporotic bone fractures, but most of these have not been specifically designed for that purpose. Many drug- or cell-loaded biomaterials have been proposed in research laboratories, but very few have received approval for commercial use. Polymeric nanomaterial-based therapeutics plays a key role in the field of medicine in treatment areas such as drug delivery, tissue engineering, cancer, diabetes, and neurodegenerative diseases. Advantages in the use of polymers over other materials for nanomedicine include increased functionality, design flexibility, improved processability, and, in some cases, biocompatibility.

Keywords: nanomedicine, tissue, infections, biomaterials

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Authors: Hadi Chahal, Irini Djeran-Maigre

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This paper focuses on the hydro-mechanical behavior of polychlorinated biphenyl (PCB) polluted sediments when stored in landfills and the interaction between PCBs and geosynthetic clay liners (GCL) with respect to hydraulic performance of the liner and the overall performance and stability of landfills. A European decree, adopted in the French regulation forbids the reintroducing of contaminated dredged sediments containing more than 0,64mg/kg Σ 7 PCBs to rivers. At these concentrations, sediments are considered hazardous and a remediation process must be adopted to prevent the release of PCBs into the environment. Dredging and landfilling polluted sediments is considered an eco-environmental remediation solution. French regulations authorize the storage of PCBs contaminated components with less than 50mg/kg in municipal solid waste facilities. Contaminant migration via leachate may be possible. The interactions between PCBs contaminated sediments and the GCL barrier present in the bottom of a landfill for security confinement are not known. Moreover, the hydro-mechanical behavior of stored sediments may affect the performance and the stability of the landfill. In this article, hydro-mechanical characterization of the polluted sediment is presented. This characterization led to predict the behavior of the sediment at the storage site. Chemical testing showed that the concentration of PCBs in sediment samples is between 1.7 and 2,0 mg/kg. Physical characterization showed that the sediment is organic silty sand soil (%Silt=65, %Sand=27, %OM=8) characterized by a high plasticity index (Ip=37%). Permeability tests using permeameter and filter press showed that sediment permeability is in the order of 10-9 m/s. Compressibility tests showed that the sediment is a very compressible soil with Cc=0,53 and Cα =0,0086. In addition, effects of PCB on the swelling behavior of bentonite were studied and the hydraulic performance of the GCL in interaction with PCBs was examined. Swelling tests showed that PCBs don’t affect the swelling behavior of bentonite. Permeability tests were conducted on a 1.0 m pilot scale experiment, simulating a storage facility. PCBs contaminated sediments were directly placed over a passive barrier containing GCL to study the influence of the direct contact of polluted sediment leachate with the GCL. An automatic water system has been designed to simulate precipitation. Effluent quantity and quality have been examined. The sediment settlements and the water level in the sediment have been monitored. The results showed that desiccation affected the behavior of the sediment in the pilot test and that laboratory tests alone are not sufficient to predict the behavior of the sediment in landfill facility. Furthermore, the concentration of PCB in the sediment leachate was very low ( < 0,013 µg/l) and that the permeability of the GCL was affected by other components present in the sediment leachate. Desiccation and cracks were the main parameters that affected the hydro-mechanical behavior of the sediment in the pilot test. In order to reduce these infects, the polluted sediment should be stored at a water content inferior to its shrinkage limit (w=39%). We also propose to conduct other pilot tests with the maximum concentration of PCBs allowed in municipal solid waste facility of 50 mg/kg.

Keywords: geosynthetic clay liners, landfill, polychlorinated biphenyl, polluted dredged materials

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Authors: Daniel Gredig, Annabelle Bartelsen-Raemy

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Social work services offered to people living with diabetes tend to be moulded by the prevailing understanding that social work is to support people living with diabetes in their adherence to medical prescription and/or life style changes. As diabetes has been conceived as a condition facing no stigma, discrimination of people living with diabetes has not been considered. However, there is growing evidence of stigma. To our knowledge, nevertheless, there have been no comprehensive, in-depth studies of stigma and its impact. Against this background and challenging the present layout of services for people living with diabetes, the present study aimed to establish whether: -people living with diabetes in Switzerland experience stigma, and if so, in what context and to what extent; -experiencing stigma impacts the quality of life of those affected. It was hypothesized that stigma would impact on their quality of life. It was further hypothesized that low self-esteem, psychological distress, depression, and a lack of social support would be mediating factors. For data collection an anonymous paper-and-pencil self-administered questionnaire was used which drew on a qualitative elicitation study. Data were analysed using descriptive statistics and structural equation modelling. To generate a large and diverse convenience sample the questionnaire was distributed to the readers of journal destined to diabetics living in Switzerland issued in German and French. The sample included 3347 people with type 1 and 2 diabetes, aged 16–96, living in diverse living conditions in the German- and French-speaking areas of Switzerland. Respondents reported experiences of discrimination in various contexts and stereotyping based on the belief that diabetics have a low work performance; are inefficient in the workplace; inferior; weak-willed in their ability to manage health-related issues; take advantage of their condition and are viewed as pitiful or sick people. Respondents who reported higher levels of perceived stigma reported higher levels of psychological distress (β = .37), more pronounced depressive symptoms (β=.33), and less social support (β = -.22). Higher psychological distress (β = -.29) and more pronounced depressive symptoms (β = -.28), in turn, predicted lower quality of life. These research findings challenge the prevailing understanding of social work services for people living with diabetes in Switzerland and beyond. They call for a less individualistic approach, the consideration of the social context service users are placed in their everyday life, and addressing stigma. So, social work could partner with people living with diabetes in order to fight against discrimination and stereotypes. This could include identifying and designing educational and public awareness strategies. In direct social work with people living with diabetes, this could include broaching experiences of stigma and modes of coping with. This study was carried out in collaboration with the Swiss Diabetes Association. The association accepted the challenging conclusions from this study. It connected to the results and is currently discussing the priorities and courses of action to be taken.

Keywords: diabetes, discrimination, quality of life, services, stigma

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Authors: Álvaro Turriago-Hoyos

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Most research tends to see innovation as an explanatory factor in achieving high levels of competitiveness and productivity. More recent studies have begun to analyze the determinants of innovation in the services sector as opposed to the much-discussed industrial sector of a country’s economy. This research paper focuses on the services sector in Colombia, one of Latin America’s fastest growing and biggest economies. Over the past decade, much of Colombia’s economic expansion has relied on commodity exports (mainly oil and coffee) whilst the industrial sector has performed relatively poorly. Such developments highlight the potential of the innovative role played by the services sector of the Colombian economy and its future growth prospects. This research paper analyzes the relationship between inputs, which at the same time are internal sources of innovation (such as R&D activities), and external sources that are improved by technology acquisition. The outputs are basically the four kinds of innovation that the OECD Oslo Manual recognizes: product, process, marketing and organizational innovations. The instrument used to measure this input-output relationship is based on Knowledge Production Function approaches. We run Probit models in order to identify the existing relationships between the above inputs and outputs, but also to identify spill-overs derived from interactions of the components of the value chain of the services firms analyzed: customers, suppliers, competitors, and complementary firms. Data are obtained from the Colombian National Administrative Department of Statistics for the period 2008 to 2013 published in the II and III Colombian National Innovation Survey. A short summary of the results obtained lead to conclude that firm size and a firm’s level of technological development turn out to be important discriminating factors for the description of the innovative process at the firm level. The model’s outcomes show a positive impact on the probability of introducing any kind of innovation both on R&D and Technology Acquisition investment. Also, cooperation agreements with customers, research institutes, competitors, and the suppliers are significant. Belonging to a particular industrial group is an important determinant but only to product and organizational innovation. It is possible to establish that Health Services, Education, Computer, Wholesale trade, and Financial Intermediation are the ISIC sectors, which report the highest number of frequencies of the considered set of firms. Those five sectors of the sixteen considered, in all cases, explained more than half of the total of all kinds of innovations. Product Innovation, which is followed by Marketing Innovation, gets the highest results. Displaying the same set of firms distinguishing by size, and belonging to high and low tech services sector shows that the larger the firms the larger a number of innovations, but also that always high-tech firms show a better innovation performance.

Keywords: Colombia, determinants of innovation, innovation, services sector

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Authors: Ivanor Zardo, Fernanda Walper Da Cunha, Júlia Sarkis, Ligia Damasceno Ferreira Marczak

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Lipid oxidation is one of the most important deteriorating processes in oil industry, resulting in the losses of nutritional value of oils as well as changes in color, flavor and other physiological properties. Autoxidation of lipids occurs naturally between molecular oxygen and the unsaturation of fatty acids, forming fat-free radicals, peroxide free radicals and hydroperoxides. In order to avoid the lipid oxidation in vegetable oils, synthetic antioxidants such as butylated hydroxyanisole (BHA), butylated hydroxytoluene (BHT) and tertiary butyl hydro-quinone (TBHQ) are commonly used. However, the use of synthetic antioxidants has been associated with several health side effects and toxicity. The use of natural antioxidants as stabilizers of vegetable oils is being suggested as a sustainable alternative to synthetic antioxidants. The alternative that has been studied is the use of natural extracts obtained mainly from fruits, vegetables and seeds, which have a well-known antioxidant activity related mainly to the presence of phenolic compounds. The sunflower seed cake is rich in phenolic compounds (1 4% of the total mass), being the chlorogenic acid the major constituent. The aim of this study was to evaluate the in vitro application of the phenolic extract obtained from the sunflower seed cake as a retarder of the lipid oxidation reaction in soybean oil and to compare the results with a synthetic antioxidant. For this, the soybean oil, provided from the industry without any addition of antioxidants, was subjected to an accelerated storage test for 17 days at 65 °C. Six samples with different treatments were submitted to the test: control sample, without any addition of antioxidants; 100 ppm of synthetic antioxidant BHT; mixture of 50 ppm of BHT and 50 ppm of phenolic compounds; and 100, 500 and 1200 ppm of phenolic compounds. The phenolic compounds concentration in the extract was expressed in gallic acid equivalents. To evaluate the oxidative changes of the samples, aliquots were collected after 0, 3, 6, 10 and 17 days and analyzed for the peroxide, diene and triene conjugate values. The soybean oil sample initially had a peroxide content of 2.01 ± 0.27 meq of oxygen/kg of oil. On the third day of the treatment, only the samples treated with 100, 500 and 1200 ppm of phenolic compounds showed a considerable oxidation retard compared to the control sample. On the sixth day of the treatment, the samples presented a considerable increase in the peroxide value (higher than 13.57 meq/kg), and the higher the concentration of phenolic compounds, the lower the peroxide value verified. From the tenth day on, the samples had a very high peroxide value (higher than 55.39 meq/kg), where only the sample containing 1200 ppm of phenolic compounds presented significant oxidation retard. The samples containing the phenolic extract were more efficient to avoid the formation of the primary oxidation products, indicating effectiveness to retard the reaction. Similar results were observed for dienes and trienes. Based on the results, phenolic compounds, especially chlorogenic acid (the major phenolic compound of sunflower seed cake), can be considered as a potential partial or even total substitute for synthetic antioxidants.

Keywords: chlorogenic acid, natural antioxidant, vegetables oil deterioration, waste valorization

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Authors: Aymen Arfaoui, Abdelkader Soumaya, Noureddine Ben Ayed

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The study region is located in the Tunisian Dorsal Backland (Central Mediterranean), which is the easternmost part of the Saharan Atlas mountain range, trending southwest-northeast. Based on our fieldwork, seismic tomography images, seismicity, and previous studies, we propose an interpretation of the relationship between the surface deformation and fault kinematics in the study area and the internal dynamic processes acting in the Central Mediterranean from the Cenozoic to the present. The subduction and dynamics of internal forces beneath the complicated Maghrebides mobile belt have an impact on the Tertiary and Quaternary tectonic regimes in the Pelagian and Atlassic foreland that is part of our study region. The left lateral reactivation of the major "Tunisian N-S Axis fault" and the development of a compressional relay between the Hammamet Korbous and Messella-Ressas faults are possibly a result of tectonic stresses due to the slab roll-back following the Africa/Eurasia convergence. After the slab segmentation and its eastward migration (5–4 Ma) and the formation of the Strait of Sicily "rift zone" further east, a transtensional tectonic regime has been installed in this area. According to seismic tomography images, the STEP fault of the "North-South Axis" at Hammamet-Korbous coincides with the western edge of the "Slab windows" of the Sicilian Channel and the eastern boundary of the positive anomalies attributed to the residual Slab of Tunisia. On the other hand, significant E-W Plio-Quaternary tectonic activity may be observed along the eastern portion of this STEP fault system in the Grombalia zone as a result of recent vertical lithospheric motion in response to the lateral slab migration eastward to Sicily Channel. According to SKS fast splitting directions, the upper mantle flow pattern beneath Tunisian Dorsal is parallel to the NE-SW to E-W orientation of the Shmin identified in the study area, similar to the Plio-Quaternary extensional orientation in the Central Mediterranean. Additionally, the removal of the lithosphere and the subsequent uplift of the sub-lithospheric mantle beneath the topographic highs of the Dorsal and its surroundings may be the cause of the dominant extensional to transtensional Quaternary regime. The occurrence of strike-slip and extensional seismic events in the Pelagian block reveals that the regional transtensional tectonic regime persists today. Finally, we believe that the geodynamic history of the study area since the Cenozoic is primarily influenced by the preexisting weak zones, the African slab detachment, and the upper mantle flow pattern in the central Mediterranean.

Keywords: Tunisia, lithospheric discontinuity (STEP fault), geodynamic evolution, Tunisian dorsal backland, strike-slip fault, seismic tomography, seismicity, central Mediterranean

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Authors: Domenico Carmelo Mongelli

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The context of this research is that of the Italian reality, which, in order to adapt to the EU Directives that prohibit the production of internal combustion engines in favor of electric mobility from 2035, is extremely concerned about the significant loss of jobs resulting from the difficulty of the automotive industry in converting in such a short time and due to the reticence of potential buyers in the face of such an epochal change. The aim of the research is to evaluate for Italy the potential of the most valid alternative to this transition to electric: leaving the current production of diesel engines unchanged, no longer powered by gasoil, imported and responsible for greenhouse gas emissions, but powered entirely by a nationally produced and eco-sustainable fuel such as biodiesel. Today in Italy, the percentage of biodiesel mixed with gasoil for diesel engines is too low (around 10%); for this reason, this research aims to evaluate the functioning of current diesel engines powered 100% by biodiesel and the ability of the Italian production system to cope to this hypothesis. The research geographically identifies those abandoned lands in Italy, now out of the food market, which is best suited to an energy crop for the final production of biodiesel. The cultivation of oilseeds is identified, which for the Italian agro-industrial reality allows maximizing the agricultural and industrial yields of the transformation of the agricultural product into a final energy product and minimizing the production costs of the entire agro-industrial chain. To achieve this objective, specific databases are used, and energy and economic balances are prepared for the different agricultural product alternatives. Solutions are proposed and tested that allow the optimization of all production phases in both the agronomic and industrial phases. The biodiesel obtained from the most feasible of the alternatives examined is analyzed, and its compatibility with current diesel engines is identified, and from the evaluation of its thermo-fluid-dynamic properties, the engineering measures that allow the perfect functioning of current internal combustion engines are examined. The results deriving from experimental tests on the engine bench are evaluated to evaluate the performance of different engines fueled with biodiesel alone in terms of power, torque, specific consumption and useful thermal efficiency and compared with the performance of engines fueled with the current mixture of fuel on the market. The results deriving from experimental tests on the engine bench are evaluated to evaluate the polluting emissions of engines powered only by biodiesel and compared with current emissions. At this point, we proceed with the simulation of the total replacement of gasoil with biodiesel as a fuel for the current fleet of diesel vehicles in Italy, drawing the necessary conclusions in technological, energy, economic, and environmental terms and in terms of social and employment implications. The results allow us to evaluate the potential advantage of a total replacement of diesel fuel with biodiesel for powering road vehicles with diesel cycle internal combustion engines without significant changes to the current vehicle fleet and without requiring future changes to the automotive industry.

Keywords: biodiesel, economy, engines, environment

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Authors: Sumeet Rai, Anuj Tyagi, B. T. Naveen Kumar, Shubhkaramjeet Kaur, Niraj K. Singh

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Since their discovery, indiscriminate use of antibiotics in human, veterinary and aquaculture systems has resulted in global emergence/spread of multidrug-resistant bacterial pathogens. Thus, the need for alternative approaches to control bacterial infections has become utmost important. High selectivity/specificity of bacteriophages (phages) permits the targeting of specific bacteria without affecting the desirable flora. In this study, a lytic phage (Ahp1) specific to Aeromonas hydrophila subsp. hydrophila was isolated from finfish aquaculture pond. The host range of Ahp1 range was tested against 10 isolates of A. hydrophila, 7 isolates of A. veronii, 25 Vibrio cholerae isolates, 4 V. parahaemolyticus isolates and one isolate each of V. harveyi and Salmonella enterica collected previously. Except the host A. hydrophila subsp. hydrophila strain, no lytic activity against any other bacterial was detected. During the adsorption rate and one-step growth curve analysis, 69.7% of phage particles were able to get adsorbed on host cell followed by the release of 93 ± 6 phage progenies per host cell after a latent period of ~30 min. Phage nucleic acid was extracted by column purification methods. After determining the nature of phage nucleic acid as dsDNA, phage genome was subjected to next-generation sequencing by generating paired-end (PE, 2 x 300bp) reads on Illumina MiSeq system. De novo assembly of sequencing reads generated circular phage genome of 42,439 bp with G+C content of 58.95%. During open read frame (ORF) prediction and annotation, 22 ORFs (out of 49 total predicted ORFs) were functionally annotated and rest encoded for hypothetical proteins. Proteins involved in major functions such as phage structure formation and packaging, DNA replication and repair, DNA transcription and host cell lysis were encoded by the phage genome. The complete genome sequence of Ahp1 along with gene annotation was submitted to NCBI GenBank (accession number MF683623). Stability of Ahp1 preparations at storage temperatures of 4 °C, 30 °C, and 40 °C was studied over a period of 9 months. At 40 °C storage, phage counts declined by 4 log units within one month; with a total loss of viability after 2 months. At 30 °C temperature, phage preparation was stable for < 5 months. On the other hand, phage counts decreased by only 2 log units over a period of 9 during storage at 4 °C. As some of the phages have also been reported as glycerol sensitive, the stability of Ahp1 preparations in (0%, 15%, 30% and 45%) glycerol stocks were also studied during storage at -80 °C over a period of 9 months. The phage counts decreased only by 2 log units during storage, and no significant difference in phage counts was observed at different concentrations of glycerol. The Ahp1 phage discovered in our study had a very narrow host range and it may be useful for phage typing applications. Moreover, the endolysin and holin genes in Ahp1 genome could be ideal candidates for recombinant cloning and expression of antimicrobial proteins.

Keywords: Aeromonas hydrophila, endolysin, phage, narrow host range

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Authors: Ripon Sarkar, Kabita Chaterjee, Ananya Barui

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Smoking is one of the leading causes of oral cancer. Cigarette smoke affects various cellular parameters and alters molecular metabolism of cells. Epithelial cells losses their cytoskeleton structure, membrane integrity, cellular polarity that subsequently initiates the process of epithelial cells to mesenchymal transition due to long exposure of cigarette smoking. It changes the normal cellular metabolic activity which induces oxidative stress and enhances the reactive oxygen spices (ROS) formation. Excessive ROS and associated oxidative stress are considered to be a driving force in alteration in cellular phenotypes, polarity distribution and mitochondrial metabolism. Noninvasive assessment of such parameters plays essential role in development of routine screening system for early diagnosis of oral cancer. Electrical cell-substrate impedance sensing (ECIS) is one of such method applied for detection of cellular membrane impedance which can be correlated to cell membrane integrity. Present study intends to explore the alteration in cellular impedance along with the expression of cellular polarity molecules and cytoskeleton distributions in oral epithelial cells of habitual smokers and to correlate the outcome to that of clinically diagnosed oral leukoplakia and oral squamous cell carcinoma patients. Total 80 subjects were categorized into four study groups: nonsmoker (NS), cigarette smoker (CS), oral leukoplakia (OLPK) and oral squamous cell carcinoma (OSCC). Cytoskeleton distribution was analyzed by staining of actin filament and generation of ROS was measured using assay kit using standard protocol. Cell impedance was measured through ECIS method at different frequencies. Expression of E-cadherin and protease-activated receptor (PAR) proteins were observed through immune-fluorescence method. Distribution of actin filament is well organized in NS group however; distribution pattern was grossly varied in CS, OLPK and OSCC. Generation of ROS was low in NS which subsequently increased towards OSCC. Expressions of E-cadherin and change in cellular electrical impedance in different study groups indicated the hallmark of cancer progression from NS to OSCC. Expressions of E-cadherin, PAR protein, and cell impedance were decreased from NS to CS and farther OSCC. Generally, the oral epithelial cells exhibit apico-basal polarity however with cancer progression these cells lose their characteristic polarity distribution. In this study expression of polarity molecule and ECIS observation indicates such altered pattern of polarity among smoker group. Overall the present study monitored the alterations in intracellular ROS generation and cell metabolic function, membrane integrity in oral epithelial cells in cigarette smokers. Present study thus has clinical significance, and it may help in developing a noninvasive technique for early diagnosis of oral cancer amongst susceptible individuals.

Keywords: cigarette smoking, early oral cancer detection, electric cell-substrate impedance sensing, noninvasive screening

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Authors: Margit Kastner

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To overcome the negative consequences associated with large class sizes and to support students in developing the necessary competences (e.g., critical thinking, problem-solving, or team-work skills) a marketing course has been redesigned by implementing project-based learning with peer assessment (PBL&PA). This means that students can voluntarily take advantage of this supplementary offer and explore -in addition to attending the lecture where clicker questions are asked- a real-world problem, find a solution, and assess the results of peers while working in small collaborative groups. In order to handle this with little further effort, the process is technically supported by the university’s e-learning system in such a way that students upload their solution in form of an assignment which is then automatically distributed to peer groups who have to assess the work of three other groups. Finally, students’ work is graded automatically considering both, students’ contribution to the project and the conformity of the peer assessment. The purpose of this study is to evaluate students’ perception of PBL&PA using an online-questionnaire to collect the data. More specifically, it aims to discover students’ motivations for (not) working on a project and the benefits and problems students encounter. In addition to the survey, students’ performance was analyzed by comparing the final grades of those who participated in PBL&PA with those who did not participate. Among the 260 students who filled out the questionnaire, 47% participated in PBL&PA. Besides extrinsic motivations (bonus credits), students’ participation was often motivated by learning and social benefits. Reasons for not working on a project were connected to students’ organization and management of their studies (e.g., time constraints, no/wrong information) and teamwork concerns (e.g., missing engagement of peers, prior negative experiences). In addition, high workload and insufficient extrinsic motivation (bonus credits) were mentioned. With regards to benefits and problems students encountered during the project, students provided more positive than negative comments. Positive aspects most often stated were learning and social benefits while negative ones were mainly attached to the technical implementation. Interestingly, bonus credits were hardly named as a positive aspect meaning that intrinsic motivations have become more important when working on the project. Team aspects generated mixed feelings. In addition, students who voluntarily participated in PBL&PA were, in general, more active and utilized further course offers such as clicker questions. Examining students’ performance at the final exam revealed that students without participating in any of the offered active learning tasks performed poorest in the exam while students who used all activities were best. In conclusion, the goals of the implementation were met in terms of students’ perceived benefits and the positive impact on students’ exam performance. Since the comparison of the automatic grading with faculty grading showed valid results, it is possible to rely only on automatic grading in the future. That way, the additional workload for faculty will be within limits. Thus, the implementation of project-based learning with peer assessment can be recommended for large classes.

Keywords: automated grading, large classes, peer assessment, project-based learning

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Authors: C. Bateira, J. Fernandes, A. Costa

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The Douro Demarked Region (DDR) is a production Porto wine region. On the NE of Portugal, the strong incision of the Douro valley developed very steep slopes, organized with agriculture terraces, have experienced an intense and deep transformation in order to implement the mechanization of the work. The old terrace system, based on stone vertical wall support structure, replaced by terraces with earth embankments experienced a huge terrace instability. This terrace instability has important economic and financial consequences on the agriculture enterprises. This paper presents and develops cartographic tools to access the embankment instability and identify the area prone to instability. The priority on this evaluation is related to the use of physically based mathematical models and develop a validation process based on an inventory of the past embankment instability. We used the shallow landslide stability model (SHALSTAB) based on physical parameters such us cohesion (c’), friction angle(ф), hydraulic conductivity, soil depth, soil specific weight (ϱ), slope angle (α) and contributing areas by Multiple Flow Direction Method (MFD). A terraced area can be analysed by this models unless we have very detailed information representative of the terrain morphology. The slope angle and the contributing areas depend on that. We can achieve that propose using digital elevation models (DEM) with great resolution (pixel with 40cm side), resulting from a set of photographs taken by a flight at 100m high with pixel resolution of 12cm. The slope angle results from this DEM. In the other hand, the MFD contributing area models the internal flow and is an important element to define the spatial variation of the soil saturation. That internal flow is based on the DEM. That is supported by the statement that the interflow, although not coincident with the superficial flow, have important similitude with it. Electrical resistivity monitoring values which related with the MFD contributing areas build from a DEM of 1m resolution and revealed a consistent correlation. That analysis, performed on the area, showed a good correlation with R2 of 0,72 and 0,76 at 1,5m and 2m depth, respectively. Considering that, a DEM with 1m resolution was the base to model the real internal flow. Thus, we assumed that the contributing area of 1m resolution modelled by MFD is representative of the internal flow of the area. In order to solve this problem we used a set of generalized DEMs to build the contributing areas used in the SHALSTAB. Those DEMs, with several resolutions (1m and 5m), were built from a set of photographs with 50cm resolution taken by a flight with 5km high. Using this maps combination, we modelled several final maps of terrace instability and performed a validation process with the contingency matrix. The best final instability map resembles the slope map from a DEM of 40cm resolution and a MFD map from a DEM of 1m resolution with a True Positive Rate (TPR) of 0,97, a False Positive Rate of 0,47, Accuracy (ACC) of 0,53, Precision (PVC) of 0,0004 and a TPR/FPR ratio of 2,06.

Keywords: agricultural terraces, cartography, landslides, SHALSTAB, vineyards

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Authors: Anja I. Petrov, Milica B. Veljković, Marija M. Ćorović, Ana D. Milivojević, Milica B. Simović, Katarina M. Banjanac, Dejan I. Bezbradica

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One of the fundamental requirements for overall human well-being is a stable and balanced microbiome. Aside from the microorganisms that reside within the body, a large number of microorganisms, especially bacteria, swarming the human skin is in homeostasis with the host and represents a skin microbiota. Even though the immune system of the skin is capable of distinguishing between commensal and potentially harmful transient bacteria, the cutaneous microbial balance can be disrupted under certain circumstances. In that case, a reduction in the skin microbiota diversity, as well as changes in metabolic activity, results in dermal infections and inflammation. Probiotics and prebiotics have the potential to play a significant role in the treatment of these skin disorders. The most common resident bacteria found on the skin, Staphylococcus epidermidis, can act as a potential skin probiotic, contributing to the protection of healthy skin from pathogen colonization, such as Staphylococcus aureus, which is related to atopic dermatitis exacerbation. However, as it is difficult to meet regulations in cosmetic products, another therapy approach could be topical prebiotic supplementation of the skin microbiota. In recent research, polyphenols are attracting scientists' interest as biomolecules with possible prebiotic effects on the skin microbiota. This research aimed to determine how herbal extracts rich in different polyphenolic compounds (lemon balm, St. John's wort, coltsfoot, pine needle, and yarrow) affected the growth of S. epidermidis and S. aureus. The first part of the study involved screening plants to determine if they could be regarded as probable candidates to be skin prebiotics. The effect of each plant on bacterial growth was examined by supplementing the nutrient medium with their extracts and comparing it with control samples (without extract). The results obtained after 24 h of incubation showed that all tested extracts influenced the growth of the examined bacteria to some extent. Since lemon balm and St. John's wort extracts displayed bactericidal activity against S. epidermidis, whereas coltsfoot inhibited both bacteria equally, they were not explored further. On the other hand, pine needles and yarrow extract led to an increase in S. epidermidis/S. aureus ratio, making them prospective candidates to be used as skin prebiotics. By examining the prebiotic effect of two extracts at different concentrations, it was revealed that, in the case of yarrow, 0.1% of extract dry matter in the fermentation medium was optimal, while for the pine needle extract, a concentration of 0.05% was preferred, since it selectively stimulated S. epidermidis growth and inhibited S. aureus proliferation. Additionally, the total polyphenols and flavonoid content of the two extracts were determined, revealing different concentrations and polyphenol profiles. Since yarrow and pine extracts affected the growth of skin bacteria in a dose-dependent manner, by carefully selecting the quantities of these extracts, and thus polyphenols content, it is possible to achieve desirable alterations of skin microbiota composition, which may be suitable for the treatment of atopic dermatitis.

Keywords: herbal extracts, polyphenols, skin microbiota, skin prebiotics

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Authors: N. G. Klivleyeva, T. I. Glebova, G. V. Lukmanova, S. B. Bayseit, S. Z. Taubaeva, M. K. Kalkozhaeva

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The role of viral diseases in the general infectious disease incidence increases every year and requires special attention to the problem of interpreting the etiology of infectious agents. Influenza and acute respiratory viral infections are one of the most pressing public health issues. In the period 2012-2014, collection of 419 nasal swabs and 150 blood sera has been carried out in the patient care institutions of the various Kazakhstan regions from patients with symptoms of ARVI and pneumonia. Primary identification of biosamples for the presence of influenza viral antigens in enzyme immunoassay on nitrocellulose membrane gave positive results in 125 swabs (29.8%). Biosample screening in immunofluorescence test revealed the presence of influenza viral antigens against A/H1 in 63 samples (15.0%), A/H3 – in 70 samples (16.7%) and type B – in 9 samples (2.1%). As a result of primary infection, and successive passages in chick embryos and MDCK cell cultures, 38 HAAg were isolated from 419 samples with a clear cytopathic effect and hemagglutination titre in MDCK cell culture within 1:2-1:4, in CE - 1:8-1:256. The infectivity of isolates in chicken embryos were 3.5-6.5 lg EID50/0.2, in MDCK cell culture – 2.5-6.5 lg PFU/ml. Identification of 28 isolates was carried out in inhibition reactions of hemagglutinating activity and neuraminidase activity, showed their belonging to the influenza virus: 26 strains to A/H1N1, one - to A/H3N2, and one - to type B. Serological examination of blood sera for the presence of specific antibodies being an indirect evidence of the performed isolation and contributing to the timely interpretation of the disease etiology in the epidemics takes an important place in the comprehensive study of influenza viruses circulating among people. Serological analyzes were carried out in HAI assay using a kit consisting of 12 reference strains obtained from the WHO centre for reference and research on Influenza (CDC, Atlanta, USA) and three Kazakhstan (A/Almaty/347/09 (H1N1v), A/Almaty/462/11 (H3N2) and B/Almaty/414/10) human influenza viruses that are stored in the laboratory collection. The results of serological analysis of 150 blood sera showed that antihaemagglutinins against the A/H3N2 virus serosubtype were found in 46 samples (49.4%) out of 93 sera collected in 2012-2013. The antibody titres were within 1:160-1:320. 19 sera (20.4%) were seropositive against influenza A/H1N1 virus, the antibodies were observed in titres of 1:20-1:40. Six sera (6.4%) were positive against the influenza A/H1N1+A/H3N2 virus (mixed infection); the antibodies were recorded in titres of 1:20-1:40. Antihaemagglutinins against influenza type B virus were detected only in five sera (5.4%). The results of analysis of 57 sera collected in 2014 showed that antihaemagglutinins against A/H3N2 virus subtype were detected in 32 blood sera (56.1%) in titres of 1:160-1:640. Ten sera (17.5%) were seropositive against A/H1N1 virus; antihaemagglutinins against influenza type B virus were not detected. Therefore, virological and serological studies have shown that in Kazakhstan, as well as in the world, the influenza viruses A/H1N1, A/H3N2 and influenza B viruses were actively circulating during the epidemic seasons in 2012-2014.

Keywords: influenza, MDCK cell, serological analysis, virus

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Authors: Seung Ah Lee, Sunghyun Cho, Kyong Mee Chung

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Rapid population aging became a worldwide demographic phenomenon due to rising life expectancy and declining fertility rates. Considering the current increasing rate of population aging, it is assumed that Korean society enters into a ‘super-aged’ society in 10 years, in which people aged 65 years or older account for more than 20% of entire population. In line with this trend, ICT services aimed to help elderly people to improve the quality of life have been suggested. However, existing ICT services mainly focus on supporting health or nursing care and are somewhat limited to meet a variety of specialized needs and challenges of this population. It is pointed out that the majority of services have been driven by technology-push policies. Given that the usage of ICT services greatly vary on individuals’ socio-economic status (SES), physical and psychosocial needs, this study systematically categorized elderly population into sub-groups and identified their needs and characteristics related to ICT usage in detail. First, three assessment criteria (demographic variables including SES, cognitive functioning level, and emotional functioning level) were identified based on previous literature, experts’ opinions, and focus group interview. Second, survey questions for needs assessment were developed based on the criteria and administered to 600 respondents from a national probability sample. The questionnaire consisted of 67 items concerning demographic information, experience on ICT services and information technology (IT) devices, quality of life and cognitive functioning, etc. As the result of survey, age (60s, 70s, 80s), education level (college graduates or more, middle and high school, less than primary school) and cognitive functioning level (above the cut-off, below the cut-off) were considered the most relevant factors for categorization and 18 sub-groups were identified. Finally, 18 sub-groups were clustered into 3 groups according to following similarities; computer usage rate, difficulties in using ICT, and familiarity with current or previous job. Group 1 (‘active users’) included those who with high cognitive function and educational level in their 60s and 70s. They showed favorable and familiar attitudes toward ICT services and used the services for ‘joyful life’, ‘intelligent living’ and ‘relationship management’. Group 2 (‘potential users’), ranged from age of 60s to 80s with high level of cognitive function and mostly middle to high school graduates, reported some difficulties in using ICT and their expectations were lower than in group 1 despite they were similar to group 1 in areas of needs. Group 3 (‘limited users’) consisted of people with the lowest education level or cognitive function, and 90% of group reported difficulties in using ICT. However, group 3 did not differ from group 2 regarding the level of expectation for ICT services and their main purpose of using ICT was ‘safe living’. This study developed a systematic needs assessment tool and identified three sub-groups of elderly ICT users based on multi-criteria. It is implied that current cognitive function plays an important role in using ICT and determining needs among the elderly population. Implications and limitations were further discussed.

Keywords: elderly population, ICT, needs assessment, population aging

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Authors: Andrey Cherdantsev, Mikhail Cherdantsev, Sergey Isaenkov, Dmitriy Markovich

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In annular gas-liquid flow, liquid flows as a film along pipe walls sheared by high-velocity gas stream. Film surface is covered by large-scale disturbance waves which affect pressure drop and heat transfer in the system and are necessary for entrainment of liquid droplets from film surface into the core of gas stream. Disturbance waves are a highly complex and their properties are affected by numerous parameters. One of such aspects is flow development, i.e., change of flow properties with the distance from the inlet. In the present work, this question is studied using brightness-based laser-induced fluorescence (BBLIF) technique. This method enables one to perform simultaneous measurements of local film thickness in large number of points with high sampling frequency. In the present experiments first 50 cm of upward and downward annular flow in a vertical pipe of 11.7 mm i.d. is studied with temporal resolution of 10 kHz and spatial resolution of 0.5 mm. Thus, spatiotemporal evolution of film surface can be investigated, including scenarios of formation, acceleration and coalescence of disturbance waves. The behaviour of disturbance waves' velocity depending on phases flow rates and downstream distance was investigated. Besides measuring the waves properties, the goal of the work was to investigate the interrelation between disturbance waves properties and integral characteristics of the flow such as interfacial shear stress and flow rate of dispersed phase. In particular, it was shown that the initial acceleration of disturbance waves, defined by the value of shear stress, linearly decays with downstream distance. This lack of acceleration which may even lead to deceleration is related to liquid entrainment. Flow rate of disperse phase linearly grows with downstream distance. During entrainment events, liquid is extracted directly from disturbance waves, reducing their mass, area of interaction to the gas shear and, hence, velocity. Passing frequency of disturbance waves at each downstream position was measured automatically with a new algorithm of identification of characteristic lines of individual disturbance waves. Scenarios of coalescence of individual disturbance waves were identified. Transition from initial high-frequency Kelvin-Helmholtz waves appearing at the inlet to highly nonlinear disturbance waves with lower frequency was studied near the inlet using 3D realisation of BBLIF method in the same cylindrical channel and in a rectangular duct with cross-section of 5 mm by 50 mm. It was shown that the initial waves are generally two-dimensional but are promptly broken into localised three-dimensional wavelets. Coalescence of these wavelets leads to formation of quasi two-dimensional disturbance waves. Using cross-correlation analysis, loss and restoration of two-dimensionality of film surface with downstream distance were studied quantitatively. It was shown that all the processes occur closer to the inlet at higher gas velocities.

Keywords: annular flow, disturbance waves, entrainment, flow development

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Authors: Johns Paul, Santhosh J. Nalluveettil, P. Purushothaman, M. Premdas

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Lunar landing is one of the most critical phases of lunar mission. The lander is provided with a soft landing system to prevent structural damage of lunar module by absorbing the landing shock and also assure stability during landing. Presently available software are not capable to simulate the rigid body dynamics coupled with contact simulation and elastic/plastic deformation analysis. Hence a separate mathematical model has been generated for studying the dynamics of a typical lunar soft lander. Parameters used in the analysis includes lunar surface slope, coefficient of friction, initial touchdown velocity (vertical and horizontal), mass and moment of inertia of lander, crushing force due to energy absorbing material in the legs, number of legs and geometry of lander. The mathematical model is capable to simulate plastic and elastic deformation of honey comb, frictional force between landing leg and lunar soil, surface contact simulation, lunar gravitational force, rigid body dynamics and linkage dynamics of inverted tripod landing gear. The non linear differential equations generated for studying the dynamics of lunar lander is solved by numerical method. Matlab programme has been used as a computer tool for solving the numerical equations. The position of each kinematic joint is defined by mathematical equations for the generation of equation of motion. All hinged locations are defined by position vectors with respect to body fixed coordinate. The vehicle rigid body rotations and motions about body coordinate are only due to the external forces and moments arise from footpad reaction force due to impact, footpad frictional force and weight of vehicle. All these force are mathematically simulated for the generation of equation of motion. The validation of mathematical model is done by two different phases. First phase is the validation of plastic deformation of crushable elements by employing conservation of energy principle. The second phase is the validation of rigid body dynamics of model by simulating a lander model in ADAMS software after replacing the crushable elements to elastic spring element. Simulation of plastic deformation along with rigid body dynamics and contact force cannot be modeled in ADAMS. Hence plastic element of primary strut is replaced with a spring element and analysis is carried out in ADAMS software. The same analysis is also carried out using the mathematical model where the simulation of honeycomb crushing is replaced by elastic spring deformation and compared the results with ADAMS analysis. The rotational motion of linkages and 6 degree of freedom motion of lunar Lander about its CG can be validated by ADAMS software by replacing crushing element to spring element. The model is also validated by the drop test results of 4 leg lunar lander. This paper presents the details of mathematical model generated and its validation.

Keywords: honeycomb, landing leg tripod, lunar lander, primary link, secondary link

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Authors: Caroline McDonald-Harker, Julie Drolet

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Abstract— In the last six years Canada In the last six years Canada has experienced two major and catastrophic environmental disasters– the 2013 Southern Alberta flood and the 2016 Fort McMurray, Alberta wildfire. These two disasters resulted in damages exceeding 12 billion dollars, the costliest disasters in Canadian history. In the aftermath of these disasters, many families faced the loss of homes, places of employment, schools, recreational facilities, and also experienced social, emotional, and psychological difficulties. Children and youth are among the most vulnerable to the devastating effects of disasters due to the physical, cognitive, and social factors related to their developmental life stage. Yet children and youth also have the capacity to be resilient and act as powerful catalyst for change in their own lives and wider communities following disaster. Little is known, particularly from a sociological perspective, about the specific factors that contribute to resilience in children and youth, and effective ways to support their overall health and well-being. This paper focuses on the voices and experiences of children and youth residing in these two disaster-affected communities in Alberta, Canada and specifically examines: 1) How children and youth’s lives are impacted by the tragedy, devastation, and upheaval of disaster; 2) Ways that children and youth demonstrate resilience when directly faced with the adversarial circumstances of disaster; and 3) The cumulative internal and external factors that contribute to bolstering and supporting resilience among children and youth post-disaster. This paper discusses the characteristics associated with high levels of resilience in 183 children and youth ages 5 to 17 based on quantitative and qualitative data obtained through a mix methods approach. Child and youth participants were administered the Children and Youth Resilience Measure (CYRM-28) in order to examine factors that influence resilience processes including: individual, caregiver, and context factors. The CYRM-28 was then supplemented with qualitative interviews with children and youth to contextualize the CYRM-28 resiliency factors and provide further insight into their overall disaster experience. Findings reveal that high levels of resilience among child and youth participants is associated with both individual factors and caregiver factors, specifically positive outlook, effective communication, peer support, and physical and psychological caregiving. Individual and caregiver factors helped mitigate the negative effects of disaster, thus bolstering resilience in children and youth. This paper discusses the implications that these findings have for understanding the specific mechanisms that support the resiliency processes and overall recovery of children and youth following disaster; the importance of bridging the gap between children and youth’s needs and the services and supports provided to them post-disaster; and the need to develop resiliency processes and practices that empower children and youth as active agents of change in their own lives following disaster. These findings contribute to furthering knowledge about pragmatic and representative changes to resources, programs, and policies surrounding disaster response, recovery, and mitigation.

Keywords: children and youth, disaster, environment, resilience

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Authors: Modi Alsubaie, Chris Dickens, Barnaby Dunn, Andy Gibson, Obioha Ukoumunned, Alison Evans, Rachael Vicary, Manish Gandhi, Willem Kuyken

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Background: Depression co-occurs in 20% of people with cardiovascular disorders, can persist for years and predicts worse physical health outcomes. While psychosocial treatments have been shown to effectively treat acute depression in those with comorbid cardiovascular disorders, to date there has been no evaluation of approaches aiming to prevent relapse and treat residual depression symptoms in this group. Therefore, the current study aimed to examine the feasibility and acceptability of a randomised controlled trial design evaluating an adapted version of mindfulness-based cognitive therapy (MBCT) designed specifically for people with co-morbid depression and cardiovascular disorders. Methods: A 3-arm feasibility randomised controlled trial was conducted, comparing MBCT adapted for people with cardiovascular disorders plus treatment as usual (TAU), mindfulness-based stress reduction (MBSR) plus TAU, and TAU alone. Participants completed a set of self-report measures of depression severity, anxiety, quality of life, illness perceptions, mindfulness, self-compassion and affect and had their blood pressure taken immediately before, immediately after, and three months following the intervention. Those in the adapted-MBCT arm additionally underwent a qualitative interview to gather their views about the adapted intervention. Results: 3400 potentially eligible participants were approached when attending an outpatient appointment at a cardiology clinic or via a GP letter following a case note search. 242 (7.1%) were interested in taking part, 59 (1.7%) were screened as being suitable, and 33 (<1%) were eventually randomised to the three groups. The sample was heterogeneous in terms of whether they reported current depression or had a history of depression and the time since the onset of cardiovascular disease (one to 25 years). Of 11 participants randomised to adapted MBCT seven completed the full course, levels of home mindfulness practice were high, and positive qualitative feedback about the intervention was given. Twenty-nine out of 33 participants randomised completed all the assessment measures at all three-time points. With regards to the primary outcome (depression), five out of the seven people who completed the adapted MBCT and three out of five under MBSR showed significant clinical change, while in TAU no one showed any clinical change at the three-month follow-up. Conclusions: The adapted MBCT intervention was feasible and acceptable to participants. However, aspects of the trial design were not feasible. In particular, low recruitment rates were achieved, and there was a high withdrawal rate between screening and randomisation. Moreover, the heterogeneity in the sample was high meaning the adapted intervention was unlikely to be well tailored to all participants needs. This suggests that if the decision is made to move to a definitive trial, study recruitment procedures will need to be revised to more successfully recruit a target sample that optimally matches the adapted intervention.

Keywords: mindfulness-based cognitive therapy (MBCT), depression, cardiovascular disorders, feasibility, acceptability

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