Search results for: ethics of care

Authors: Mustafa M. Donma, Orkide Donma

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The number of indices developed for the evaluation of obesity both in adults and pediatric population is ever increasing. These indices are also used in cases with metabolic syndrome (MetS), mostly the ultimate form of morbid obesity. Aside from anthropometric measurements, formulas constituted using these parameters also find clinical use. These formulas can be listed as two groups; being weight-dependent and –independent. Some are extremely sophisticated equations and their clinical utility is questionable in routine clinical practice. The aim of this study is to compare presently available obesity indices and find the most practical one. Their associations with MetS components were also investigated to determine their capacities in differential diagnosis of morbid obesity with and without MetS. Children with normal body mass index (N-BMI) and morbid obesity were recruited for this study. Three groups were constituted. Age- and sex- dependent BMI percentiles for morbid obese (MO) children were above 99 according to World Health Organization tables. Of them, those with MetS findings were evaluated as MetS group. Children, whose values were between 85 and 15 were included in N-BMI group. The study protocol was approved by the Ethics Committee of the Institution. Parents filled out informed consent forms to participate in the study. Anthropometric measurements and blood pressure values were recorded. Body mass index, hip index (HI), conicity index (CI), triponderal mass index (TPMI), body adiposity index (BAI), body shape index (ABSI), body roundness index (BRI), abdominal volume index (AVI), waist-to-hip ratio (WHR) and waist circumference+hip circumference/2 ((WC+HC)/2) were the formulas examined within the scope of this study. Routine biochemical tests including fasting blood glucose (FBG), insulin (INS), triglycerides (TRG), high density lipoprotein-cholesterol (HDL-C) were performed. Statistical package program SPSS was used for the evaluation of study data. p<0.05 was accepted as the statistical significance degree. Hip index did not differ among the groups. A statistically significant difference was noted between N-BMI and MetS groups in terms of ABSI. All the other indices were capable of making discrimination between N-BMI-MO, N-BMI- MetS and MO-MetS groups. No correlation was found between FBG and any obesity indices in any groups. The same was true for INS in N-BMI group. Insulin was correlated with BAI, TPMI, CI, BRI, AVI and (WC+HC)/2 in MO group without MetS findings. In MetS group, the only index, which was correlated with INS was (WC+HC)/2. These findings have pointed out that complicated formulas may not be required for the evaluation of the alterations among N-BMI and various obesity groups including MetS. The simple easily computable weight-independent index, (WC+HC)/2, was unique, because it was the only index, which exhibits a valuable association with INS in MetS group. It did not exhibit any correlation with other obesity indices showing associations with INS in MO group. It was concluded that (WC+HC)/2 was pretty valuable practicable index for the discrimination of MO children with and without MetS findings.

Keywords: children, insulin, metabolic syndrome, obesity indices

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Authors: Romaric Desbrousses, Lan Lin

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The objective of this study is to determine how Canadian seismic design provisions affect the column axial load resistance of moment-resisting frame reinforced concrete buildings subjected to the differential settlement of their foundation. To do so, two four-storey buildings are designed in accordance with the seismic design provisions of the Canadian Concrete Design Standards. One building is located in Toronto, which is situated in a moderate seismic hazard zone in Canada, and the other in Vancouver, which is in Canada’s highest seismic hazard zone. A finite element model of each building is developed using SAP 2000. A 100 mm settlement is assigned to the base of the building’s center column. The axial load resistance of the column is represented by the demand capacity ratio. The analysis results show that settlement-induced tensile axial forces have a particularly detrimental effect on the conventional settling columns of the Toronto buildings which fail at a much smaller settlement that those in the Vancouver buildings. The results also demonstrate that particular care should be taken in the design of columns in short-span buildings.

Keywords: Columns, Demand, Foundation differential settlement, Seismic design, Non-linear analysis

Procedia PDF Downloads 129

Authors: Asherf El-Abaied, Elsadik Anan, Badereddin Annajar, Mustafa Saieh, Abudalnaser El-Buni

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Zoonotic Cutaneous Leishmaniasis (ZCL) has been endemic in the Northwestern region of Libya for over nine decades. Survey of sandfly fauna in the region revealed that 13 species have been recorded with various distribution and abundance patterns. Phlebotomus papatasi proved to be the main vector of the disease in many areas. To identify sandfly species present in the Al-Asaba town and determine their spatial and seasonal abundance. An epidemiological analysis of the data obtained from the recorded cases was also carried out. Sand flies collected from various sites using sticky traps and CDC miniature light traps during the period from March-November 2006. Recorded ZCL cases were collected from the local Primary Health Care Department and analysed using SPSS statistical package. Ten species of sandflies were identified, seven belong to the genus Phlebotomus and three belong to the genus Sergentomyia. P. papatasi was the most abundant species with peak season recorded in September. The prevalence of the disease was low however; notable increase of ZCL cases in last three years has been indicated.

Keywords: Cutaneous leishmaniasis, Phlebotomus papatasi, sandfly fauna, Libya

Procedia PDF Downloads 289

Authors: Mmapula Petunia Tsweleng

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This qualitative study presents an exploration and findings thereof the quality of primary caregiving relationships between adolescents orphaned through Acquired Immune Deficiency Syndrome (AIDS) and their grandmothers. This exploration was based on in-depth narratives of 6 stakeholders who provided community-based psychosocial support services to children and families affected by AIDS. The narratives show that grandmothers provided high-quality parental care and support to the orphans. Furthermore, stakeholders categorised grandmother caregiving as genuine. Findings also show that the orphans thrived emotionally, socially, and cognitively and performed well academically. However, it was also identified that grandmothers’ caregiving had elements of overprotectiveness as well as susceptibility to manipulation -which appeared to be a threat to the positive development of the orphans. Relevant interventions, with a special focus on strengthening grandmother caregiving, are needed. Special attention should be on equipping grandmothers with a better understanding of adolescent behaviours and abilities to provide appropriate monitoring and supervision.

Keywords: adolescent orphans, AIDS, caregiving relationships, grandmothers

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Authors: Okan Cakir, Ibrahim Arziman, Derya Can, Mete Erkencigil, Murat Durusu, S. Mehmet Yasar

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Introduction: Burn injuries from different types and ways commonly seen in emergency departments, approach and treatment varies from outpatient treatment to critical care unit. We wanted to mention a rare burn injury cause of air conditioner refrigerant. Case report: A 22-year-old case admitted to emergency department with a complaint of left hand burn injury and pain. In his history, he said that an accident was occurred before 30 minutes from admission while he had been trying to repair the air conditioner. Air conditioner refrigerant suddenly had erupted from its tank and burned his hand. In physical examination of extremities, second-degree burn bullae on the left hand on second and third proximal phalanx, between first and second phalanx palmar side and on hypothenar region and on third and fourth proximal phalanx and also hyperemia from hand to wrist were seen. There was no motor and sensorial deficiency. As a treatment, local silver sulfadiazine applied to the burn area and analgesic prescribed. The case called for the clinical follow-up to the plastic surgery department. Conclusion: The clinician should take a comprehensive and careful anamnesis for suitable and right management and treatment as in this case in which as well as rare and occurs different way.

Keywords: air conditioner refrigerant, burn, emergency department, rare

Procedia PDF Downloads 339

Authors: Leila Mohammadi

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This article discusses the technology of social egg freezing in the context of existing literature on medicalization, motherhood, and marketing. The social egg freezing technique offers to preserve some healthy eggs for age-related fertility decline in the future. The study draws on a qualitative analysis and participants observation of media publications, including text, images, or audio-visual about social egg freezing technology and postpone maternity, to identify and compare their communication strategies from a framing theory perspective. Using 442 surveys and 158 pieces of publications in Spanish media, this study demonstrated that the narratives used by these publications and their structures follow a marketing objective to medicalize motherhood. Within these frames, the market of preserving fertility is cast to show compassion and concern about women. In the opinion of participants, egg freezing technology liberates, empowers, and automates women from patriarchal control, and also gives them the responsibility of taking care of their body and reproductive system. This study showed this opinion is significantly influenced by media and their communication strategies supported by providers of this business.

Keywords: motherhood, social egg freezing, medicalization, marketing, media frames, fertility, assisted reproductive system

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Authors: H. K. V. Narayan

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This study was conducted at Tata Memorial Hospital (TMH), Mumbai, India. The study was to evaluate the impact of adapting Smart Card (SC) for clinical and business transactions in order to reduce Lead times and to enforce business rules of the hospital. The objective for implementing the Smart Card was to improve the patient perception of quality in terms of structures process and outcomes and also to improve the productivity of the Institution. The Smart Card was implemented in phases from 2011 and integrated with the Hospital Information System (HIS/EMR). The implementation was a learning curve for all the stake holders as software obviated the need to use hardcopies of transactions. The acceptability to the stake holders was challenge in change management. The study assessed the impact 3 years into the implementation and the observed trends have suggested that it has decreased the lead times for services and increased the no of transactions and thereby the productivity. Patients who used to complain of multiple queues and cumbersome transactions now compliment the administration for effective use of Information and Communication Technology.

Keywords: smart card, high availability of health care information, reduction in potential medical errors due to elimination of transcription errors, reduction in no of queues, increased transactions, augmentation of revenue

Procedia PDF Downloads 279

Authors: Endrick Barnacin, Jean-Luc Henry, Jimmy Nagau, Jack Molinie

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Being able to identify biological particles such as spores, viruses, or pollens is important for health care professionals, as it allows for appropriate therapeutic management of patients. Optical microscopy is a technology widely used for the analysis of these types of microorganisms, because, compared to other types of microscopy, it is not expensive. The analysis of an optical microscope slide is a tedious and time-consuming task when done manually. However, using machine learning and computer vision, this process can be automated. The first step of an automated microscope slide image analysis process is segmentation. During this step, the biological particles are localized and extracted. Very often, the use of an automatic thresholding method is sufficient to locate and extract the particles. However, in some cases, the particles are not extracted individually because they are stuck to other biological elements. In this paper, we propose a stuck particles separation method based on the use of the Sobel operator and thresholding. We illustrate it by applying it to the separation of 813 images of adjacent pollen grains. The method correctly separated 95.4% of these images.

Keywords: image segmentation, stuck particles separation, Sobel operator, thresholding

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Authors: Bruno C. Schimming, Leandro L. Martins, PatríCia F. F. Pinheiro, Raquel F. Domeniconi, FabríCio S. Oliveira

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The agouti is a wildlife rodent that can be used as an alternative source of animal protein and this species has been raised in captivity in Brazil with the aim of providing meat. Thus, the knowledge of their reproductive biology and morphology of the reproductive organs is important. The objective of this study was to describe the morphology of epididymis in the Azara’s agouti, by light microscopy. Samples of epididymis were obtained from five adult Azara’s agouti (Dasyprocta azarae) during castration surgery performed at the Municipal Zoo of Catanduva, Brazil. Fragments of the epididymal regions (initial segment, caput, corpus and cauda) were collected. The biological samples were immediately fixed in paraformaldehyde for 24 hours, followed by histologic procedures comprising embedding in ParaplastTM (Sigma, St. Louis, MO, USA), sections of 5 µm, and staining with HE and Masson’s trichrome. The epididymis was a highly convoluted tubule that links the testis to the vas deferens. The epithelium lining was pseudostratified columnar surrounded by a periductal stroma. The epithelium contains several cell types: principal, basal, apical, clear, and hallo cells. Principal cells were the most abundant cell type. There were observed also migratory cells named halo cells. The caput epididymis was divided into two different regions: initial segment and caput. The initial segment has a very wide lumen, a high epithelium with conspicuous microvilli and the lumen was wide with exfoliated material. The other region of the caput epididymis, showed a lower epithelium when compared with the initial segment, large amounts of spermatozoa in the lumen, and a cytoplasmic vacuolization. This region presented many narrows cells. Many spermatozoa appeared in the lumen of corpus epididymis. The cauda region had a lower epithelium than the other epididymal regions in the agouti. The cauda epithelium presented plicae protruding into the lumen. Large amounts of spermatozoa are also present in the lumen. Small microvilli uniformly arranged so as to form a kind of “brush border” are observed on the apical surface of the cauda epithelium. The pattern of the epithelium lining the duct of the agouti epididymis does not differ greatly from that reported to other mammals, such as domestic and wildlife animals. These findings can cooperate with future investigations especially those related to rational exploration of these animals. All experimental procedures were approved by the institutional ethics committee (CEUA 796/2015). This study was supported by FAPESP (Grants 2015/23822-1).

Keywords: wildlife, testis excurrent ducts, epididymis, morphology

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Authors: Carolina Schencke, Cristian Sandoval, Belgica Vasquez, Mariano Del Sol

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Introduction: In a burn injury, the successful repair requires not only the participation of various cells, such as granulocytes and fibroblasts, but also of collagen, which plays a crucial role as a structural and regulatory molecule of scar tissue. Since honey and ascorbic acid have presented a great therapeutic potential to cellular and structural level, experimental studies have proposed its combination in the treatment of wounds. Aim: To evaluate stereological and morphometric parameters of healing wounds, caused by burns, treated with honey Ulmo (Eucryphia cordifolia) unsupplemented, comparing its effect with Ulmo honey supplemented with ascorbic acid. Materials and Methods: Fifteen healthy adult guinea pigs (Cavia porcellus) were used, of both sexes, average weight 450 g from the Centro de Excelencia en Estudios Morfológicos y Quirúrgicos (CEMyQ) at the Universidad de La Frontera, Chile. The animals were divided at random into three groups: positive control (C+), honey only (H) and supplemented honey (SH) and were fed on pellets supplemented with ascorbic acid and water ad libitum, under ambient conditions controlled for temperature, ambient noise and a cycle of 12h light–darkness. The protocol for the experiment was approved by the Scientific Ethics Committee of the Universidad de La Frontera, Chile. The parameters measured were number density per area (NA), volume density (VV), and surface density (SV) of fibroblast; NA and VV of polymorphonuclear cells (PMN) and, evaluation of the content of collagen fibers in the scar dermis. One-way ANOVA was used for statistics analysis and its respective Post hoc tests. Results: The ANOVA analysis for NA, VV and SV of fibroblasts, NA and VV of PMN, and evaluation of collagen content, type I and III, showed that at least one group differs from other (P≤ 0.001). There were differences (P= 0.000) in NA of fibroblast between the groups [C+= 3599.560 mm-2 (SD= 764.461), H= 3355.336 mm-2 (SD= 699.443) and SH= 4253.025 mm-2 (SD= 1041.751)]. The VV and SV of fibroblast increased (P= 0.000) in the SH group [20.400% (SD= 5.897) and 100.876 mm2/mm3 (SD= 29.431), respectively], compared to the C+ [16.324% (SD= 7.719) and 81.676 mm2/mm3 (SD= 28.884), respectively). The mean values of NA and VV of PMN were higher (P= 0.000) in the H [756.875 mm-2 (SD= 516.489) and 2.686% (SD= 2.380), respectively) group. Regarding to the evaluation of the content of collagen fibers, type I and III, the one-way analysis of ANOVA showed a statistically significant difference (P< 0.05). The content of collagen fibers type I was higher in C+ (1988.292 μm2; SD= 1312.379), while the content of collagen fibers type III was higher in SH (1967.163 μm2; SD= 1047.944 μm2) group. Conclusions: The stereological results were correlated with the stage of healing observed for each group. These results suggest that the combination of honey with ascorbic acid potentiate the healing effect, where both participated synergistically.

Keywords: ascorbic acid, morphometry, stereology, Ulmo honey

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Authors: Senait Belay Adugna, Mirutse Giday, Tsegahun Manyazewal

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Background: The emergence and resurgence of zoonotic diseases have continued to be a major threat to global health and the economy. Developing countries are particularly vulnerable due to agricultural expansions and the domestication of animals by humans. Scientifically sound clinical trials are important to find better ways to prevent, diagnose, and treat zoonotic diseases, while there is a lack of evidence to inform the clinical trials’ capacity and practice in countries highly affected by the diseases. This study aimed to investigate researchers’ perceptions and experiences in conducting clinical trials on zoonotic diseases in Ethiopia. Methods: This study employed a descriptive, qualitative study design. It included major academic and research institutions in Ethiopia that had active engagements in veterinary and public health research. It included the National Veterinary Institute, the National Animal Health Diagnostic and Investigation Center, the College of Veterinary Medicine at Addis Ababa University, the Ethiopian Public Health Institute, the Armauer Hansen Research Institute, and the College of Health Sciences at Addis Ababa University. In-depth interviews were conducted with 14 senior researcher investigators in the institutions who hold a proven exhibit primarily leading research activities or research units. Data were collected from October 2019 to April 2020. Data analysis was undertaken using open code 4.03 for qualitative data analysis. Results: Five major themes, with 18 sub-themes, emerged from the in-depth interview in connection. These were: challenges in the prevention, control, and treatment of zoonotic diseases; One Health approach to mitigate zoonotic diseases; personal and institutional experiences in conducting clinical trials on zoonotic diseases; barriers in conducting clinical trials towards zoonotic diseases; and strategies that promote conducting clinical trials on zoonotic diseases. Conducting clinical trials on zoonotic diseases in Ethiopia is hampered by a lack of clearly articulated ethics and regulatory frameworks, trial experts, financial resources, and good governance. Conclusions: In Ethiopia, conducting clinical trials on zoonotic diseases deserves due attention. Strengthening institutional and human resources capacity is a precondition to harnessing effective implementation of clinical trials on zoonotic diseases in the country. In Ethiopia, where skilled human resource is scarce, the One Health approach has the potential to form multidisciplinary teams to systematically improve clinical trials capacity and outcomes in the country.

Keywords: Ethiopia, clinical triak, zoonoses, disease

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Authors: Devendra Gupta, Vikash Arya, Prabhat K. Singh

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Background: Ultrasound guidance could be beneficial in placing central venous catheters by improving the success rate, reducing the number of needle passes, and decreasing complications. Central venous cannulation set has a single puncture needle of a fixed length of 6.4 cm. However, the average distance of midpoint of IJV to the skin is around 1 cm to 2 cm. The long length needle has tendency to go in depth more than required and this is very common during learning period of any individual. Therefore, we devised a long needle with a guard which can be adjusted according to the required length. Methods: After approval from the institute ethics committee and patient’s written informed consent, a prospective, randomized, single-blinded controlled study was conducted. Adult patient aged of both sexes with ASA grade 1-2 undergoing surgery requiring internal jugular venous (IJV) access was included. After intubation, the head was rotated to the contralateral side at 30 degree head rotation on the position of the right IJV. The transducer probe a 6.5 to 13-MHz linear transducer (Sonosite, USA) had been placed at the apex of triangle with minimal pressure to avoid IJV compression. The distance from skin to midpoint of the right IJV and skin to anterior wall of Common Carotid Artery (CCA) had been done using B-mode duplex sonography with a 6.5 to 13-MHz linear transducer. Depending upon the results of randomization 420 patients had been divided into two groups of equal numbers (n=210). Group 1. USG guided right sided IJV cannulation was done with conventional (6.4 cm) needle; and Group 2. USG guided right sided IJV cannulation was done with conventional (6.4 cm) needle with guard fixed to a required length (length between skin and midpoint of IJV) by an experienced anesthesiologist. Independent observer has noted the number of attempts and occurrence of complications (CCA puncture, pneumothorax or adjacent tissue damage). Results: Demographic data were similar in both the group. The groups were comparable when considered for relationship of IJV to CCA. There was no significant difference between groups as regard to distance of midpoint of IJV to the skin (p<0.05). IJV cannulation was successfully done in single attempts in 180 (85.7%), in two attempts in 27 (12.9%) and three attempts in 3 (1.4%) in group I, whereas in single attempt in 207 (98.6%) and second attempts in 3 (1.4%) in group II (p <0.000). Incidence of carotid artery puncture was significantly more in group I (7.1%) compared to group II (0%) (p<0.000). Incidence of adjacent tissue puncture was significantly more in group I (8.6%) compared to group II (0%) (p<0.000). Conclusion: Therefore IJV catheterization using guard over the needle at predefined length with the help of real-time ultrasound results in better success rates and lower immediate complications.

Keywords: ultrasound guided, internal jugular vein cannulation, measured guided needle, common carotid artery puncture

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Authors: Pichamon Chansuchai

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This paper studied the expanding market opportunity palm oil ASEAN community: case study of Choomporn Palm Oil Cooperative as qualitative research. The purpose is to study and analyze expanding and linking the liberalization of trade in palm oil products under the terms of cooperation and ASEAN countries. Collection data were collected using participatory observation, in-depth interviews, focus groups, government officials, palm oil cooperative, entrepreneurs and farmers to exchange opinions. The study found that of major competitors is Indonesia and Malaysia which as ASEAM members countries has the potential to produce over Thailand. Thailand government must have a policy to increase the competitiveness of the palm oil Thailand. Using grants from the Free Trade Area fund should add value to agricultural products, palm oil and the development of standard products to meet the needs of the member countries. And creating a learning center of the palm oil sector can transfer knowledge, development of palm species, solution process from planting to harvest care privatization process. And the development of palm oil in order to expand market opportunities for Thailand's palm oil has the potential to be competitive in the neighboring countries and the region.

Keywords: palm oil, market, cooperative, ASEAN

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Authors: Reihaneh Mahdavishahri

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This paper provides a brief introduction to emotionally focused therapy (EFT) and its culturally sensitive and informed application when working with immigrant couples. EFT's grounding in humanistic psychology prioritizes a non-pathologizing and empathic understanding of individuals' experiences, creating a safe space for couples to explore and create new experiences without imposing judgment or prescribing the couple "the right way of interacting" with one another. EFT's emphasis on attachment, bonding, emotions, and corrective emotional experiences makes it a fitting approach to work with multicultural couples, allowing for the corrective emotional experience to be shaped and informed by the couples' unique cultural background. This paper highlights the challenges faced by immigrant couples and explores how immigration adds a complex layer to each partner’s sense of self, their attachment bond, and their sense of safety and security within their relationships. Navigating a new culture, creating a shared sense of purpose, and re-establishing emotional bonds can be daunting for immigrant couples, often leading to a deep sense of disconnection and vulnerability. Reestablishing and fostering secure attachment between the partners in the safety of the therapeutic space can be a protective factor for these couples.

Keywords: attachment, culturally informed care, emotionally focused therapy, immigration

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Authors: Lamia Bouzgarrou, Irtyah Merchaoui, Amira Omrane, Salma Kammoun, Amine Daafa, Neila Chaari

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Backgrounds: Currently, low back pain (LBP) is one of the most prevalent public health problems, which caused severe morbidity among a large portion of the adult population. It is also associated with heavy direct and indirect costs, in particular, related to absenteeism and early retirement. Health care workers are one of most occupational groups concerned by LBP, especially because of biomechanical and psycho-organizational risk factors. Our current study aims to investigate risk factors associated with chronic low back pain among Tunisian caregivers in university-hospitals. Methods: Cross-sectional study conducted over a period of 14 months, with a representative sample of caregivers, matched according to age, sex and work department, in two university-hospitals in Tunisia. Data collection included items related to socio-professional characteristics, the evaluation of the working capacity index (WAI), the occupational stress (Karazek job strain questionnaire); the quality of life (SF12), the musculoskeletal disorders Nordic questionnaire, and the examination of the spine flexibility (distance finger-ground, sit-stand maneuver and equilibrium test). Results: Totally, 293 caregivers were included with a mean age equal to 42.64 ± 11.65 years. A body mass index (BMI) exceeding 30, was noted in 20.82% of cases. Moreover, no regular physical activity was practiced in 51.9% of cases. In contrast, domestic activity equal or exceeding 20 hours per week, was reported by 38.22%. Job strain was noted in 19.79 % of cases and the work capacity was 'low' to 'average' among 27.64% of subjects. During the 12 months previous to the investigation, 65% of caregivers complained of LBP, with pain rated as 'severe' or 'extremely severe' in 54.4% of cases and with a frequency of discomfort exceeding one episode per week in 58.52% of cases. During physical examination, the mean distance finger-ground was 7.10 ± 7.5cm. Caregivers assigned to 'high workload' services had the highest prevalence of LBP (77.4%) compared to other categories of hospital services, with no statistically significant relationship (P = 0.125). LBP prevalence was statistically correlated with female gender (p = 0.01) and impaired work capacity (p < 10⁻³). Moreover, the increase of the distance finger-ground was statistically associated with LBP (p = 0.05), advanced age (p < 10⁻³), professional seniority (p < 10⁻³) and the BMI ≥ 25 (p = 0.001). Furthermore, others physical tests of spine flexibility were underperformed among LBP suffering workers with a statistically significant difference (sit-stand maneuver (p = 0.03); equilibrium test (p = 0.01)). According to the multivariate analysis, only the domestic activity exceeding 20H/week, the degraded quality of physical life, and the presence of neck pain were significantly corelated to LBP. The final model explains 36.7% of the variability of this complaint. Conclusion: Our results highlighted the elevate prevalence of LBP among caregivers in Tunisian public hospital and identified both professional and individual predisposing factors. The preliminary analysis supports the necessity of a multidimensional approach to prevent this critical occupational and public health problem. The preventive strategy should be based both on the improvement of working conditions, and also on lifestyle modifications, and reinforcement of healthy behaviors in these active populations.

Keywords: health care workers, low back pain, prevention, risk factor

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Authors: Şeyda Kaya

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The aim of this study is to examine the relationship between corporate social responsibility perception and organizational commitment among Turkish cabin crew. At the same time, the social responsibility perception and organizational commitment scores of the participants were compared according to their gender, age, education level, title, and work experience. In the globalizing world, businesses have developed some innovative marketing methods in order to survive and strengthen their place in the market. Nowadays, consumers who are connected to the brand with an emotional bond rather than being just consumers. Corporate Social Responsibility Projects, on the one hand, provide social benefit, on the other hand, increase the brand awareness of businesses by providing credibility in the eyes of consumers. The rapid increase of competition, requires businesses to use their human resources, which is the most important resource to sustain their existence, in the most effective and efficient way. For this reason, the concept of ‘Organizational Commitment’ has become an important research topic for business and academics. Although there are studies in the literature to determine the effect of the perception of corporate social Responsibility on Organizational Commitment in Banking and Finance and Tourism sectors, there are no studies conducted specifically for the Turkish aviation sector to our best knowledge. Personal information form, CSR scale, Importance of CSR scale, Organizational commitment scale were used as data collection tools in the research. CSR Scale created by Türker (2006). was used to find out how employees felt about CSR. Importance of CSR Scale through a subscale of the Perceived Role of Ethics and Social Responsibility (PRESOR) that Etheredge (1999) converted into a two-factor framework, the significance of social responsibility for employees was assessed. Organizational Commitment Scale, Mowday, Steers, and Porter (1979) created the OCQ, which uses 15 measures to evaluate global commitment to the organization. As a result of the study, there is a significant positive relationship between the participants' CSR scale sub-dimensions, CSR to Employees, CSR to Customers, CSR to Society, CSR to Government, CSR to Natural Environment, CSR to Next Generation, CSR to Governmental Organizations, Importance of CSR, and Organizational Commitment scores. As a result; as the participants' Corporate Social Responsibility scores increase, their organizational commitment increases. To summarize the findings of our study, the scores obtained from the CSR scale and the scores obtained from the Organizational Commitment scale were found to have a positive and significant relationship. In other words, if the participants value the corporate social responsibility projects of the institution they work for and think that they spare time and effort, the importance they attach to the corporate social responsibility projects and their organizational commitment to the institution they work for, increase. Similarly, the scores obtained from the Importance of CSR and the scores obtained from the Organizational Commitment scale also have a positive and significant relationship. As the importance given to corporate social responsibility projects by the participants increases, their organizational commitment to the institution they work for also increases.

Keywords: corporate social responsibility, organizational commitment, Turkish cabin crew, aviation

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Authors: Ayesha Inam, R. Moazzam, Z. Akhtar

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School readiness plays a significant role in helping a child deal with various school demands and expectations as well as in determining academic success outcomes. There is a scarcity of data concerning the condition of school readiness in Pakistan. This qualitative research seeks to examine the perspective of mothers about school readiness along with its four domains (self-care, socio-emotional, physical and cognitive) as well as about the appropriate age of entry into formal preschool. Fifteen interviews were conducted with mothers of pre-school children in Islamabad and Rawalpindi. It was found that mothers shared the common perception that children should be socially, emotionally, physically and cognitively prepared to be ready for pre-school. The results concluded that the mothers unanimously agreed in their perceptions that three to four years was the appropriate age range for children to begin pre-school and that early or late entry into pre-school had negative implications for children’s ability to learn and understand, and hence, their school readiness. Mental age was perceived as a more important criterion for deciding when to send children to pre-school. Mothers were found to send their children to school earlier, and children were found to be increasingly exposed to technology, both of which were found to influence children’s readiness for school. Both schools and mothers were found to play an instrumental role in preparing children for school and in school adjustment by nurturing their skills and abilities.

Keywords: perception of mothers, Pakistan, school readiness, entry to preschool

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Authors: Tamas Madl

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Sudden cardiac death (SCD) constitutes a large proportion of cardiovascular mortalities, provides little advance warning, and the risk is difficult to recognize based on ubiquitous, low cost medical equipment such as the standard, 12-lead, ten second ECG. Autonomic abnormalities have been shown to be strongly predictive of SCD risk; yet current methods are not trivially applicable to the brevity and low temporal and electrical resolution of standard ECGs. Here, we build horizontal visibility graph representations of very short inter-beat interval time series, and perform unsuper- vised representation learning in order to convert these variable size objects into fixed-length vectors preserving similarity rela- tions. We show that such representations facilitate classification into healthy vs. at-risk patients on two different datasets, the Mul- tiparameter Intelligent Monitoring in Intensive Care II and the PhysioNet Sudden Cardiac Death Holter Database. Our results suggest that graph representation learning of heartbeat interval time series facilitates robust classification even in sequences as short as ten seconds.

Keywords: sudden cardiac death, heart rate variability, ECG analysis, time series classification

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Authors: Rahul Magazine, Shobitha Rao

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The aim of this study was to study the prescribing pattern of drugs in patients with ARDS (Acute Respiratory Distress Syndrome) managed at a tertiary care hospital. This observational study was conducted at Kasturba Hospital, Karnataka, India. Data of patients admitted from January 2010 to December 2012 was collected. A total of 150 patients of ARDS were included. Data included patients’ age, gender, clinical disorders precipitating ARDS, and prescribing pattern of drugs. The mean age of the study population was 42.92±13.91 years. 48% of patients were less than 40 years of age. Infection was the cause of ARDS in 81.3% of subjects. Antibiotics were prescribed in all the subjects and beta-lactams were prescribed in 97.3%. 41.3% were prescribed corticosteroids, 39.3% diuretics and 89.3% intravenous fluids. Infection was the commonest etiology for ARDS, and beta-lactams were the commonest antibiotics prescribed. Corticosteroids and diuretics were prescribed in a significant number of patients. Most of the patients received intravenous fluids.

Keywords: acute respiratory syndrome, beta lactams, corticosteroids, Acute Respiratory Distress Syndrome (ARDS)

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Authors: K. Sunitra, T. Srisuda

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Centella asiatica, asiatic pennywort is a medicinal herb plant used widely which held in herbal health care group. The problem of asiatic pennywort production is the outbreak of Sclerotium rolfsii causing a damp-off disease which caused plant stem turn yellowish, finally they begin to die and result in extremely damaging to growers. Therefore, the studies were caried out to control damping off with Trichoderma sp., Bacillus subtilis and fermented banana as compared to the control to suppress with bi-culture under the laboratory condition. It was found that Trichoderma harzianum showed the highest percentage of inbihition, 69.44%. The pot experiments in greenhouse condition showed that chemical had minimum of damping-off (31.54%) and highest yield (1.20 tons/rai) and following by Trichoderma harzianum and Bacillus subtilis treatment. Due to the chemical usage leaving toxic residues on plants and affect the human bodies. Trichoderma harzianum and Bacillus subtilis should be considered as alternatives which have percent of damp-off disease and yields as follows: 45.50 and 43.75%, and 1.12 and 1.09 tons/rai, respectively. These two products are known that they have no health risk for growers and consumers in the future.

Keywords: Centella asiatica, Sclerotium rolfsii, Trichoderma harzianum, Bacillus subtilis

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Authors: Bridget J. Kenny, Elizabeth Hoban, Jo Williams

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Adolescent pregnancy presents a significant public health challenge for Cambodia. Despite declines in the overall fertility rate, the adolescent fertility rate is increasing. Adolescent pregnancy is particularly problematic in the Northeast provinces of Ratanak Kiri and Mondul Kiri where 34 percent of girls aged between 15 and 19 have begun childbearing; this is almost three times Cambodia’s national average of 12 percent. Language, cultural and geographic barriers have restricted qualitative exploration of the sexual and reproductive health (SRH) challenges that face indigenous adolescents in Northeast Cambodia. The current study sought to address this gap by exploring the SRH practices of adolescent mothers from indigenous populations in Ratanak Kiri Province. Twenty-two adolescent mothers, aged between 15 and 19, were recruited from seven indigenous villages in Ratanak Kiri Province and asked to participate in a combined body mapping exercise and semi-structured interview. Participants were given a large piece of paper (59.4 x 84.1 cm) with the outline of a female body and asked to draw the female reproductive organs onto the ‘body map’. Participants were encouraged to explain what they had drawn with the purpose of evoking conversation about their reproductive bodies. Adolescent mothers were then invited to participate in a semi-structured interview to further expand on topics of SRH. The qualitative approach offered an excellent avenue to explore the unique SRH challenges that face indigenous adolescents in rural Cambodia. In particular, the use of visual data collection methods reduced the language and cultural barriers that have previously restricted or prevented qualitative exploration of this population group. Thematic analysis yielded six major themes: (1) understanding of the female reproductive body, (2) contraceptive knowledge, (3) contraceptive use, (4) barriers to contraceptive use, (5) sexual practices, (6) contact with healthcare facilities. Participants could name several modern contraceptive methods and knew where they could access family planning services. However, adolescent mothers explained that they gained this knowledge during antenatal care visits and consequently participants had limited SRH knowledge, including contraceptive awareness, at the time of sexual initiation. Fear of the perceived side effects of modern contraception, including infertility, provided an additional barrier to contraceptive use for indigenous adolescents. Participants did not cite cost or geographic isolation as barriers to accessing SRH services. Child marriage and early sexual initiation were also identified as important factors contributing to the high prevalence of adolescent pregnancy in this population group. The findings support the Ministry of Education, Youth and Sports' (MoEYS) recent introduction of SRH education into the primary and secondary school curriculum but suggest indigenous girls in rural Cambodia require additional sources of SRH information. Results indicate adolescent girls’ first point of contact with healthcare facilities occurs after they become pregnant. Promotion of an effective continuum of care by increasing access to healthcare services during the pre-pregnancy period is suggested as a means of providing adolescents girls with an additional avenue to acquire SRH information.

Keywords: adolescent pregnancy, contraceptive use, family planning, sexual and reproductive health

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Authors: Jessica Chukwuyem Molua, Collins O Molua

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The effective dose of selected health care workers who are constantly exposed to X-ray radiation was measured using thermoluminescence dosimeters (TLD) placed over the lead apron at the chest region in all categories of medical personnel investigated. To measure radiation in all the selected hospitals to ascertain the exposure of x-ray machines at exactly 1m from the primary source. The work was carried out within a year in each of the selected centers. The personnel examination records containing the type of examination each day, peak tube voltage, tube current, and exposure time, including the actual number of films used, were obtained. A total of 40personel were examined in government hospital Agbor, 21 in central hospital Owa Alero and 18 in Okonye hospital The method used here has also been used by other researchers. Findings showed that the results obtained from the three hospitals investigated in this work were found to conform with the recommendations of the National Commission on radiological and protection {NCRP} 70 and 116 protocols. The Radiologist in the three study areas has the highest dose level, but of particular note is the dosage of the radiologist in Okonye hospital. This, as observed, is because the protective shielding parameters were inadequate and this could result in severe health consequences over time.

Keywords: radiology, health, Agbor, Owa

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Authors: Sulaiman D. Al Sabei, Amy M. Ross, Christopher S. Lee

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Nurse leaders play a fundamental role in transforming healthcare system and improving quality of patient care. Several healthcare organizations have called to increase the number of nurse leaders across all levels and in every practice setting. Identification of factors influencing nurses’ willingness to lead can inform healthcare leaders and policy makers of potentially illuminating strategies for establishing favorable work environments that motivate nurses to engage in leadership roles. The aim of this study was to investigate determinants of nurses’ willingness to engage in future leadership roles. The study was conducted at a public hospital in the Sultanate of Oman. A total of 171 registered nurses participated. A multilevel modeling was conducted. Findings revealed that 80% of nurses were likely to seek out opportunities to engage in leadership roles. The quality of the nurse-physician collegial relationships was a significant predictor of nurses’ willingness to lead. Establishing a work environment’s culture of positive nurse-physician relationships is critical to enhance nurses’ work attitude and engage them in leadership roles.

Keywords: interprofessional relationship, leadership, motivation, nurses

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Authors: Juliet Ramohai

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This paper explores how women departmental heads in higher education experience leadership in a time of the COVID-19 crises. The focus is mostly on their care and coping as they work in virtual spaces. Most scholars have looked at the effects and challenges that different employees face while working from home during a lockdown. However, very few take a dedicated focus on women in leadership and the coping mechanisms and resources that they use for effective leadership during this difficult time. The paper draws on two aspects of Sen’s Capabilities approach, functionings, and agency, to cast a closer understanding of the institutional and individual coping mechanisms that might be at these women's disposal. The qualitative approach used for this paper and a feminist lens provides a critical and in-depth understanding of the real-life stories of the women and how they make sense of their virtual leadership. Data for this paper was collected through semi-structured interviews with 10 women in the positions of head of departments and analysed thematically using capabilities approach concepts as an analytical tool. The findings in this paper indicate that functionings and freedoms are tightly linked to institutional ethnographies. These ethnographies might support or hamper coping for women leaders, especially during times of crisis.

Keywords: capability approach, women leaders, higher education, COVID-19

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Authors: T. Thulare, M. Herselman, A. Botha

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Poor system use, including inappropriate design of health information systems, causes difficulties in communication with patients and increased time spent by healthcare professionals in recording the necessary health information for medical records. System features like pop-up reminders, complex menus, and poor user interfaces can make medical records far more time consuming than paper cards as well as affect decision-making processes. Although errors associated with health information and their real and likely effect on the quality of care and patient safety have been documented for many years, more research is needed to measure the occurrence of these errors and determine the causes to implement solutions. Therefore, the purpose of this paper is to identify data integrity challenges in hospital information systems through a scoping review and based on the results provide recommendations on how to manage these. Only 34 papers were found to be most suitable out of 297 publications initially identified in the field. The results indicated that human and computerized systems are the most common challenges associated with data integrity and factors such as policy, environment, health workforce, and lack of awareness attribute to these challenges but if measures are taken the data integrity challenges can be managed.

Keywords: data integrity, data integrity challenges, hospital information systems, South Africa

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Authors: Mustafa M. Donma, Orkide Donma

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Metabolic syndrome (MetS) is a severe health problem which is common among obese individuals. The components of MetS are rather stable in adults compared to the components discussed for children. Due to the ambiguity in this group of the population, how to diagnose MetS in morbid obese (MO) children still constitutes a matter of discussion. For this purpose, a formula, which facilitates the diagnosis of MetS in MO children, was investigated. The aim of this study was to develop a formula which was capable of discriminating MO children with and without MetS findings. Study population comprised MO children. Age and sex-dependent body mass index (BMI) percentiles of the children were above 99. Metabolic syndrome components were also determined. Elevated systolic and diastolic blood pressures (SBP and DBP), elevated fasting blood glucose (FBG), elevated triglycerides (TRG), and/or depressed high density lipoprotein cholesterol (HDL-C) in addition to central obesity were listed as MetS components for each child. Presence of at least two of these components confirmed that the case was MetS. Two groups were constituted. In the first group, there were forty-two MO children without MetS components. Second group was composed of forty-four MO children with at least two MetS components. Anthropometric measurements, including weight, height, waist, and hip circumferences, were performed following physical examination. Body mass index and homeostatic model assessment of insulin resistance values were calculated. Informed consent forms were obtained from the parents of the children. Institutional Non-Interventional Ethics Committee approved the study design. Blood pressure values were recorded. Routine biochemical analysis, including FBG, insulin (INS), TRG, HDL-C were performed. The performance and the clinical utility of the Diagnostic Obesity Notation Model Assessment Metabolic Syndrome Index (DONMA MetS index) [(INS/FBG)/(HDL-C/TRG)*100] was tested. Appropriate statistical tests were applied to the study data. p value smaller than 0.05 was defined as significant. Metabolic syndrome index values were 41.6±5.1 in MO group and 104.4±12.8 in MetS group. Corresponding values for HDL-C values were 54.5±13.2 mg/dl and 44.2±11.5 mg/dl. There were statistically significant differences between the groups (p<0.001). Upon evaluation of the correlations between MetS index and HDL-C values, a much stronger negative correlation was found in MetS group (r=-0.515; p=0.001) in comparison with the correlation detected in MO group (r=-0.371; p=0.016). From these findings, it was concluded that the statistical significance degree of the difference between MO and MetS groups was highly acceptable for this recently introduced MetS index as expected. This was due to the involvement of all of the biochemically defined MetS components into the index. This is particularly important because each of these four parameters used in the formula is cardiac risk factor. Aside from discriminating MO children with and without MetS findings, MetS index introduced in this study is important from the cardiovascular risk point of view in MetS group of children.

Keywords: children, fasting blood glucose, high density lipoprotein cholesterol, index, insulin, metabolic syndrome, morbid obesity, triglycerides.

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Authors: Amer Elgerwi, Abdelrazzag El-Magdoub, Abubakr El-Mahmoudy

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There are many bacterial infections affecting sheep that necessitates antibiotic intervention. Amoxicillin is among commonly used antibiotics in such case for its broad spectrum of activity. However, the side alterations in blood and organ function that may be associated during or after treatment are questionable. Therefore, the aim of the present study was to assess the possible alterations in blood parameters and organ function bio markers of sheep that may occur following intramuscular injection of amoxicillin. Amoxicillin has been administered intramuscularly to 10 sheep at a dosage regimen of 7 mg/kg of body weight for 5 successive days. Two types of blood samples (with and without anticoagulant) were collected from the jugular vein pre- and post-administration of the drug. Amoxicillin significantly (P < 0.001) increased total leukocyte count and (P < 0.05) absolute eosinophilic count when compared with those of the control samples. Aspartate aminotransferase, alkaline phosphatase and cholesterol were significantly (P < 0.05) higher than the corresponding control values. In addition, amoxicillin significantly (P < 0.05) increased blood urea nitrogen and creatinine but decreased phosphorus level when compared with those of prior-administration samples. These data may indicate that although the side changes caused by amoxicillin are minor in sheep, yet the liver and kidney functions should be monitored during its usage in therapy and it should be used with care for treatment of sheep with renal and/or hepatic impairments.

Keywords: amoxicillin, biogram, haemogram, sheep

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Authors: Y. Lacroix, J.-F. Malbranque

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We present a chronological evolution for naval telecommunication networks. We distinguish periods: with or without multiplexers, with switch systems, with federative systems, with medium switching, and with medium switching with wireless networks. This highlights the introduction of new layers and technology in the architecture. These architectures are presented using layer models of transmission, in a unified way, which enables us to integrate pre-existing models. A ship of a naval fleet has internal communications (i.e. applications' networks of the edge) and external communications (i.e. the use of the means of transmission between edges). We propose architectures, deduced from the layer model, which are the point of convergence between the networks on board and the HF, UHF radio, and satellite resources. This modelling allows to consider end-to-end naval communications, and in a more global way, that is from the user on board towards the user on shore, including transmission and networks on the shore side. The new architectures need take care of quality of services for end-to-end communications, the more remote control develops a lot and will do so in the future. Naval telecommunications will be more and more complex and will use more and more advanced technologies, it will thus be necessary to establish clear global communication schemes to grant consistency of the architectures. Our latest model has been implemented in a military naval situation, and serves as the basic architecture for the RIFAN2 network.

Keywords: equilibrium beach profile, eastern tombolo of Giens, potential function, erosion

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Authors: Chia-Ching Tsai

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In service delivery, interpersonal interaction is the key to customer satisfaction, and apparently, the factor of human is critical in service delivery. Besides, customers quite care about the consequences of co-recovery. Thus, this research focuses on service failure caused by other customers and uses a 2x2 factorial design to investigate the impact of consequence and level of service co-recovery on post-recovery satisfaction and repurchase intent. 150 undergraduates were recruited as participants, and assigned to one of the four cells randomly. Every participant was requested to read the scenario and then rated the post-recovery satisfaction and repurchase intent. The results show that under the condition of failed co-recovery, level of co-recovery has no effect on post-recovery satisfaction, while under the condition of successful co-recovery, high-level co-recovery causes significantly higher post-recovery satisfaction than low-level co-recovery. Moreover, post-recovery satisfaction has significantly positive impact on repurchase intent. In the system of service delivery, customers interact with other customers frequently. Therefore, comparing with the literature, this research focuses on the service failure caused by other customers. This research also supplies a better understanding of customers’ view on consequences of different levels of co-recovery, which is helpful for the practitioners to make use of co-recovery.

Keywords: service failure, service co-recovery, consequence of co-recovery, level of co-recovery, post-recovery satisfaction, repurchase intent

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Authors: Mustafa M. Donma, Orkide Donma

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Obesity is known to be associated with many clinically important diseases including metabolic syndrome (MetS). Vitamin B₁₂ plays essential roles in fat and protein metabolisms and its cooperation with vitamin B₉ is well-known. The aim of this study is to investigate the possible contributions as well as associations of these micronutrients upon obesity and MetS during childhood. A total of 128 children admitted to Namik Kemal University, Medical Faculty, Department of Pediatrics Outpatient Clinics were included into the scope of this study. The mean age±SEM of 92 morbid obese (MO) children and 36 with MetS were 118.3±3.8 months and 129.5±6.4 months, respectively (p > 0.05). The study was approved by Namık Kemal University, Medical Faculty Ethics Committee. Written informed consent forms were obtained from the parents. Demographic features and anthropometric measurements were recorded. WHO BMI-for age percentiles were used. The values above 99 percentile were defined as MO. Components of MetS [waist circumference (WC), fasting blood glucose (FBG), triacylglycerol (TRG), high density lipoprotein cholesterol (HDL-Chol), systolic pressure (SP), diastolic pressure (DP)] were determined. Routine laboratory tests were performed. Serum vitamin B₁₂ concentrations were measured using electrochemiluminescence immunoassay. Vitamin B₉ was analyzed by an immunoassay analyzer. Values for vitamin B₁₂ < 148 pmol/L, 148-221 pmol/L, > 221 pmol/L were accepted as low, borderline and normal, respectively. Vitamin B₉ levels ≤ 4 mcg/L defined deficiency state. Statistical evaluations were performed by SPSSx Version 16.0. p≤0.05 was accepted as statistical significance level. Statistically higher body mass index (BMI), WC, hip circumference (C) and neck C were calculated in MetS group compared to children with MO. No difference was noted for head C. All MetS components differed between the groups (SP, DP p < 0.001; WC, FBG, TRG p < 0.01; HDL-Chol p < 0.05). Significantly decreased vitamin B₉ and vitamin B₁₂ levels were detected (p < 0.05) in children with MetS. In both groups percentage of folate deficiency was 5.5%. No cases were below < 148 pmol/L. However, in MO group 14.3% and in MetS group 22.2% of the cases were of borderline status. In MO group B₁₂ levels were negatively correlated with BMI, WC, hip C and head C, but not with neck C. WC, hip C, head C and neck C were all negatively correlated with HDL-Chol. None of these correlations were observed in the group of children with MetS. Strong positive correlation between FBG and insulin as well as strong negative correlation between TRG and HDL-Chol detected in MO children were lost in MetS group. Deficiency state end-products of both B₉ and B₁₂ may interfere with the expected profiles of MetS components. In this study, the alterations in MetS components affected vitamin B₁₂ metabolism and also its associations with anthropometric body measurements. Further increases in vitamin B₁₂ and vitamin B₉ deficiency in MetS associated with the increased vitamin B₁₂ as well as vitamin B₉ deficiency metabolites may add to MetS parameters.

Keywords: children, cobalamin, folate, metabolic syndrome, obesity

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