Search results for: binary outcomes

Authors: Temitope Francis Abiodun

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The practice of intelligence is not limited to the machinery of a nation state alone, yet not much research or analysis has been directed towards the spy-crafts and tradecrafts engaged in by violent non-state actors (VNSAs) in the international community. The rise of 'private sector intelligence' in more recent years has only just begun to be interrogated by practitioners and academics. However, the use of intelligence by insurgents and other groups assembled to achieve varied forms of politico-military outcomes has often been overlooked. This paper examined the factors and conditions that gave rise to an increase in violent non-state actors (VNSAs), strategies aiding their deployment of insurgent intelligence, and as well the implications of their activities on global security. The failed state theory was adopted, while a descriptive research design served as the framework for the study. Data were collected from primary and secondary sources. The paper, however, revealed there were massive deployments of insurgent intelligence by violent non-state actors in contrast to a faulty pre-conception that insurgents were not as highly trained in deployment of intelligence as state actors, having assumed that the VNSAs lacked the sophistication to produce intelligence. However, the strategic objectives of insurgents (VNSAs) were revealed to depend on well-organized information gathering operations that feed into the tactical executions of their insurgency. The paper recommends, therefore, there is a need for adequate training on the part of security personnel in the states to be alive to their responsibilities; and there is also a need to ensure adequate border control and management to checkmate the influx of the various violent or deadly movements across global frontiers.

Keywords: terrorism, non-violent state actors, private sector intelligence, security

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Authors: Komathy Thiagarajan, Mohd. Azizuddin Mohd. Yussof, Hasnoorina Husin, Noor Azreena Abd Aziz, Faezah Shekh Abdullah, Abdul Wahaf Abdul Wahid

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Polycystic Ovary Syndrome (PCOS) presents with a plethora of clinical features owing to the multifaceted underlying pathophysiology. This study was conducted to determine the clinical features unique to the sub fertile women attending the Sub fertility Clinic of the National Population and Family Development Board (NPFDB) so that a more holistic approach can be adopted to further enhance the pregnancy outcome in those women. This was a case-control study conducted over a span of three years (from January 2014 until December 2016), whereby women who fulfilled the Rotterdam Criteria 2004 were classified as PCOS (n=79) and women who did not fulfill the Rotterdam Criteria were classified as controls (n=88). The mean age of the women was 30.1 years and the mean duration of marriage was 3.93 years. The majority of women suffered from primary sub fertility (82.6%). The median age was lower among PCOS women (29.0 years) compared to the controls (30.0 years), p<0.05. The majority of PCOS women (43.0%) were obese (BMI > 30 kg/m2) compared to only 19.3% who were obese in the control group, p<0.05. Hypertension was present in 59.5% of PCOS women and only in 36.4% of the control group, p<0.05. There were significantly more women who presented with hirsutism in PCOS group (27.8%) as compared to the control group (5.7%), p<0.05. The findings of this study elucidate that the clinical features of significance among sub fertile women suffering from PCOS, if detected early, are amenable to lifestyle modifications and timely interventions can potentially improve the fertility outcomes in this group of women.

Keywords: clinical features, fertility, lifestyle modification, PCOS

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Authors: H. Nouri, S. Chavoshi Borujeni, S. Anderson, S. Beecham, P. Sutton

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The potential risk of salt leaching through wastewater irrigation is of concern for most local governments and city councils. Despite the necessity of salinity monitoring and management in urban greenery, most attention has been on agricultural fields. This study was defined to investigate the capability and feasibility of monitoring and predicting soil salinity using near sensing and remote sensing approaches using EM38 surveys, and high-resolution multispectral image of WorldView3. Veale Gardens within the Adelaide Parklands was selected as the experimental site. The results of the near sensing investigation were validated by testing soil salinity samples in the laboratory. Over 30 band combinations forming salinity indices were tested using image processing techniques. The outcomes of the remote sensing and near sensing approaches were compared to examine whether remotely sensed salinity indicators could map and predict the spatial variation of soil salinity through a potential statistical model. Statistical analysis was undertaken using the Stata 13 statistical package on over 52,000 points. Several regression models were fitted to the data, and the mixed effect modelling was selected the most appropriate one as it takes to account the systematic observation-specific unobserved heterogeneity. Results showed that SAVI (Soil Adjusted Vegetation Index) was the only salinity index that could be considered as a predictor for soil salinity but further investigation is needed. However, near sensing was found as a rapid, practical and realistically accurate approach for salinity mapping of heterogeneous urban vegetation.

Keywords: WorldView3, remote sensing, EM38, near sensing, urban green spaces, green smart cities

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Authors: Vun Yee Thien, Kenneth Francis Rodrigues, Clemente Michael Vui Ling Wong, Wilson Thau Lym Yong

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Transcriptomes associated with the process of photosynthesis have offered insights into the mechanism of gene regulation in terrestrial plants; however, limited information is available as far as macroalgae are concerned. This investigation aims to decipher the underlying mechanisms associated with photosynthesis in the red alga, Kappaphycus alvarezii, by performing a differential expression analysis on a de novo assembled transcriptomes. Comparative analysis of gene expression was designed to examine the alteration of light qualities and its effect on physiological mechanisms in the red alga. High-throughput paired-end RNA-sequencing was applied to profile the transcriptome of K. alvarezii irradiated with different wavelengths of light (blue 492-455 nm, green 577-492 nm and red 780-622 nm) as compared to the full light spectrum, resulted in more than 60 million reads individually and assembled using Trinity and SOAPdenovo-Trans. The transcripts were annotated in the NCBI non-redundant (nr) protein, SwissProt, KEGG and COG databases with a cutoff E-value of 1e-5 and nearly 30% of transcripts were assigned to functional annotation by Blast searches. Differential expression analysis was performed using edgeR. The DEGs were designated to six categories: BL (blue light) regulated, GL (green light) regulated, RL (red light) regulated, BL or GL regulated, BL or RL regulated, GL or RL regulated, and either BL, GL or RL regulated. These DEGs were mapped to terms in KEGG database and compared with the whole transcriptome background to search for genes that regulated by light quality. The outcomes of this study will enhance our understanding of molecular mechanisms underlying light-induced responses in red algae.

Keywords: de novo transcriptome sequencing, differential gene expression, Kappaphycus alvareziired, red alga

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Authors: Abel Olusegun Egunjobi, Olusegun Oyeleye Adesanya

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Teaching effectiveness of lecturers in a tertiary institution in Nigeria is one of the determinants of the lecturer’s productivity. In this study, therefore, lecturers’ teaching effectiveness was examined vis-à-vis their multimedia technologies utilisation in Colleges of Education (CoE) in South-West, Nigeria. This is for the purpose of ascertaining the relationship and contribution of multimedia technologies utilisation to lecturers’ teaching effectiveness in Nigerian colleges of education. The descriptive survey research design was adopted in the study, while a multi-stage sampling procedure was used in the study. A stratified sampling technique was used to select colleges of education, and a simple random sampling method was employed to select lecturers from the selected colleges of education. A total of 862 lecturers (627 males and 235 females) were selected from the colleges of education used for the study. The instrument used was lecturers’ questionnaire on multimedia technologies utilisation and teaching effectiveness with a reliability coefficient of 0.85 at 0.05 level of significance. The data collected were analysed using descriptive statistics, multiple regression, and t-test. The findings showed that the level of multimedia technologies utilisation in colleges of education was low, whereas lecturers’ teaching effectiveness was high. Findings also revealed that the lecturers used multimedia technologies purposely for personal and professional developments, so also for up to date news on economic and political matters. Also, findings indicated that laptop, Ipad, CD-ROMs, and computer instructional software were the multimedia technologies frequently utilised by the lecturers. There was also a significant difference in the teaching effectiveness between lecturers in the Federal and State COE. The government should, therefore, make adequate provision for multimedia technologies in the COE in Nigeria for lecturers’ utilisation in their instructions so as to boost their students’ learning outcomes.

Keywords: colleges of education, lecturers’ teaching effectiveness, multimedia technologies utilisation, Southwest Nigeria

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Authors: Adedoyin Opeyemi Osokoya

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The study assesses the influence of social media on perceived learning outcome of agricultural science students in tertiary institutions in Oyo state, Nigeria. The four-stage sampling procedure was used to select participants. All students in the seven tertiary institutions that offer agriculture science as a course of study in Oyo State was the population. A university, a college of agriculture and a college of education were sampled, and a department from each was randomly selected. Twenty percent of the students’ population in the respective selected department gave a sample size of 165. Questionnaire was used to collect information on respondents’ personal characteristics and information related to access to social media. Data were analysed using descriptive statistics, chi-square, correlation, and multiple regression at the 0.05 confidence level. Age and household size were 21.13 ± 2.64 years and 6 ± 2.1 persons respectively. All respondents had access to social media, majority (86.1%) owned Android phone, 57.6% and 52.7% use social media for course work and entertainment respectively, while the commonly visited sites were WhatsApp, Facebook, Google, Opera mini. Over half (53.9%) had an unfavourable attitude towards the use of social media for learning; benefits of the use of social media for learning was high (56.4%). Removal of information barrier created by distance (x̄=1.58) was the most derived benefit, while inadequate power supply (x̄=2.36), was the most severe constraints. Age (β=0.23), sex (β=0.37), ownership of Android phone (β=-1.29), attitude (β=0.37), constraints (β =-0.26) and use of social media (β=0.23) were significant predictors of influence on perceived learning outcomes.

Keywords: use of social media, agricultural science students, undergraduates of tertiary institutions, Oyo State of Nigeria

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Authors: Matheesha Herath, Ned Kinnear, Bridget Heijkoop, Eliza Bramwell, Alannah Frazetto, Amy Noll, Prajay Patel, Derek Hennessey, Greg Otto, Christopher Dobbins, Tarik Sammour, James Moore

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Background: Important incidental pathology requiring further action is commonly found during appendicectomy, macro- and microscopically. It is unknown whether the acute surgical unit (ASU) model affects the management and disclosure of these findings. Methods: An ASU model was introduced at our institution on 01/08/2012. In this retrospective cohort study, all patients undergoing appendicectomy 2.5 years before (traditional group) or after (ASU group) this date were compared. The primary outcomes were rates of appropriate management of the incidental findings and communication of the findings to the patient and to their general practitioner (GP). Results: 1,214 patients underwent emergency appendicectomy; 465 in the traditional group and 749 in the ASU group. 80 (6.6%) patients (25 and 55 in each respective period) had important incidental findings. There were 24 patients with benign polyps, 15 with neuro-endocrine tumour, 11 with endometriosis, 8 with pelvic inflammatory disease, 8 Enterobius vermicularis infection, 7 with low grade mucinous cystadenoma, 3 with inflammatory bowel disease, 2 with diverticulitis, 2 with tubo-ovarian mass, 1 with secondary appendiceal malignancy and none with primary appendiceal adenocarcinoma. One patient had dual pathologies. There was no difference between the traditional and ASU group with regards to communication of the findings to the patient (p=0.44) and their GP (p=0.27), and there was no difference in the rates of appropriate management (p=0.21). Conclusions: The introduction of an ASU model did not change rates of surgeon-to-patient and surgeon-to-GP communication nor affect rates of appropriate management of important incidental pathology during an appendectomy.

Keywords: acute care surgery, appendicitis, appendicectomy, incidental

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Authors: Anjum Afrooze

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The curriculum at General Sciences department in Prince Sultan University includes ‘Physical science’ for Computer Science, Information Technology and Business courses. Students are apathetic towards Physical Science and question, as to, ‘How this course is related to their majors?’ English is not a native language for the students and also for many instructors. More than sixty percent of the students come from institutions where English is not the medium of instruction, which makes student learning and academic achievement challenging. After observing the less enthusiastic student cohort for two consecutive semesters, the instructor was keen to find effective strategies to enhance learning and further encourage deep learning by engaging students in different tasks to empower them with necessary skills and motivate them. This study is participatory action research, in which instructor designs effective tasks to engage students in their learning. The study is conducted through two semesters with a total of 200 students. The effectiveness of this approach is studied using questionnaire at the end of each semester and teacher observation. Major outcomes of this study were overall improvement in students attitude towards science learning, enhancement of multiple skills like note taking, problem solving, language proficiency and also fortifying confidence. This process transformed instructor into engaging and reflecting practitioner. Also, these strategies were implemented by other instructors teaching the course and proved effective in opening a path to changes in related areas of the course curriculum. However, refinement in the strategies could be done based on student evaluation and instructors observation.

Keywords: group activity, language proficiency, reasoning skills, science learning

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Authors: James Jin, Weisi Xia, Runzhe Gao, Alain Vandal, Darren Svirkis, Andrew Hill

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Background: Post-haemorrhoidectomy pain is concerned by patients/clinicians. Minimizing the postoperation pain is highly interested clinically. Combinations of topical cream targeting three hypothesised post-haemorrhoidectomy pain mechanisms were developed and their effectiveness were evaluated. Specifically, a multi-centred double-blinded randomized clinical trial (RCT) was conducted in adults undergoing excisional haemorrhoidectomy. The primary analysis was conveyed on the data collected to evaluate the effectiveness of the combinations of topical cream targeting three hypothesized pain mechanisms after the operations. Methods: 192 patients were randomly allocated to 4 arms (each arm has 48 patients), and each arm was provided with pain cream 10% metronidazole (M), M and 2% diltiazem (MD), M with 4% lidocaine (ML), or MDL, respectively. Patients were instructed to apply topical treatments three times a day for 7 days, and record outcomes for 14 days after the operations. The primary outcome was VAS pain on day 4. Covariates and models were selected in the blind review stage. Multiple imputations were applied for the missingness. LMER, GLMER models together with natural splines were applied. Sandwich estimators and Wald statistics were used. P-values < 0.05 were considered as significant. Conclusions: The addition of topical lidocaine or diltiazem to metronidazole does not add any benefit. ML had significantly better pain and recovery scores than combination MDL. Multimodal topical analgesia with ML after haemorrhoidectomy could be considered for further evaluation. Further trials considering only 3 arms (M, ML, MD) might be worth exploring.

Keywords: RCT, primary analysis, multiple imputation, pain scores, haemorrhoidectomy, analgesia, lmer

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Authors: Eman M. El-Sayed, Sahar A. Abdelaziz, Maha M. Saber Abd El Latif

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Neural tube defects (NTD) are important causes of infant mortality. Poor nutrition was essential factor for central nervous system deformation. Mothers gave NTD offspring had abnormal serum levels of micronutrients. The present research was designed to study the effect of maternal micronutrient levels and oxidative stress on the incidence of NTD in offspring. The study included forty mothers; twenty of them of 30.9+7.28 years had conceived fetuses with NTD were considered as cases; and twenty mothers of 28.2 + 7.82 years with healthy neonates. We determined serum vitamin B12 and folic acid by using radioimmunoassays. Also, serum zinc was assessed using atomic absorption spectrophotometry. While serum copper and iron were measured colorimetrically and serum ceruloplasmin was analyzed by radialimmunodiffusion. Cases showed significantly lower levels of folic acid, vitamin B12 and zinc (P< 0.0005, 0.01, 0.01 respectively) than that of the control. Concentrations of copper, ceruloplasmin, and iron were markedly increased in cases as compared to controls (P < 0.01, 0.01, and 0.05 respectively). In conclusion, the current study clearly indicated the etiology of NTD cannot be explained with one strict etiologic mechanism, on the contrary, an interaction among maternal nutritional factors and oxidative stress would explain these anomalies. Vitamin B12, folic acid, and zinc supplementations should be considered for further decrease in the occurrence of NTD. Preventing excess iron during pregnancy favors better pregnancy outcomes.

Keywords: ceruloplasmin, copper, folic acid, iron, neural tube defects, oxidative stress, vitamin b12, zinc

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Authors: Muhammad Abdullah, Muhammad Atiq Ur Rehman Tariq, Faraz Ul Haq

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In developed countries, sustainability measures are widely accepted and acknowledged as crucial for addressing environmental concerns. Hydroponics, a soilless cultivation technique, has emerged as a potentially sustainable solution as it can reduce water consumption, land use, and environmental impacts. However, hydroponics may not be economically viable, especially when using reclaimed water, which may entail additional costs and risks. This study aims to address the critical question of whether hydroponics using reclaimed water can achieve a balance between sustainability and financial viability. Life Cycle Assessment (LCA) and Life Cycle Cost (LCC) will be integrated to assess the potential of hydroponics whether it is environmentally sustainable and economically viable. Life cycle assessment, or LCA, is a methodology for assessing environmental impacts associated with all the stages of the life cycle of a commercial product, process, or service. While Life Cycle Cost (LCC) is an approach that assesses the total cost of an asset over its life cycle, including initial capital costs and maintenance costs. The expected benefits of this study include supporting evidence-based decision-making for policymakers, farmers, and stakeholders involved in agriculture. By quantifying environmental impacts and economic costs, this research will facilitate informed choices regarding the adoption of hydroponics with reclaimed water. It is believed that the outcomes of this research work will help to achieve a sustainable approach to agricultural production, aligning with sustainability goals while considering economic factors by adopting hydroponic technique.

Keywords: hydroponic, life cycle assessment, life cycle cost, sustainability

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Authors: Madad Ali

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In the contemporary landscape of international travel, the infusion of digital technologies has given rise to innovative business models that are reshaping the dynamics of tourism. This research delves into the transformative potential of these novel business models within the realm of digital tourism and their multifaceted impact on local businesses, residents' quality of life, and the overall travel experience. The study focuses on the captivating backdrop of Yunnan Province, China, renowned for its rich cultural heritage and diverse ethnic minorities, to uncover the intricate nuances of this phenomenon. The primary objectives of this research encompass the identification and categorization of emerging business models facilitated by digital technologies, their implications on tourist engagement, and their integration into the operations of local businesses. By employing a mixed-methods approach, blending qualitative techniques like interviews and content analysis with quantitative tools such as surveys and data analysis, the study provides a comprehensive evaluation of these business models' effects on various dimensions of the tourism landscape. The distinctiveness of this research lies in its exclusive focus on Yunnan Province, China. By concentrating on Yunnan Province, the research contributes exceptional insights into the interplay between digital tourism, ethnic diversity, cultural heritage, and sustainable development. The study's outcomes hold significance for both scholarly discourse and the stakeholders involved in shaping the region's tourism strategies.

Keywords: business model, digital tourism, international travel, local businesses, quality of life

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Authors: Ching-Hsu Huang, Yao-Ling Liu

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Over the past several decades there has been considerable research on the topics of entrepreneurship education and nascent entrepreneurial competence. The purpose of this study is to explore the nascent entrepreneurial competence within entrepreneurship education via the use of three studies. It will be a three-phrases longitudinal study and the effective plan will combine the qualitative and quantitative mixed research methodology in order to understand the issues of nascent entrepreneurship and entrepreneurial competence in hospitality industry in Taiwan. In study one, the systematic literature reviews and twelve nascent entrepreneurs who graduated from hospitality management department will be conducted simultaneously to construct the nascent entrepreneurial competence indicators. Nine subjects who are from industry, government, and academia will be the decision makers in terms of forming the systematic nascent entrepreneurial competence indicators. The relative importance of indicators to each decision maker will be synthesized and compared using the Analytic Hierarchy Process method. According to the results of study one, this study will develop the teaching module of nascent hospitality entrepreneurship. It will include the objectives, context, content, audiences, assessment, pedagogy and outcomes. Based on the results of the second study, the quasi-experiment will be conducted in third study to explore the influence of nascent hospitality entrepreneurship teaching module on learners’ learning effectiveness. The nascent hospitality entrepreneurship education program and entrepreneurial competence will be promoted all around the hospitality industry and vocational universities. At the end, the implication for designing the nascent hospitality entrepreneurship teaching module and training programs will be suggested for the nascent entrepreneurship education. All of the proposed hypotheses will be examined and major finding, implication, discussion, and recommendations will be provided for the government and education administration in hospitality field.

Keywords: entrepreneurial competence, hospitality entrepreneurship, nascent entrepreneurial, training in hospitality entrepreneurship

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Authors: Jane Mullen, Ann Rheaume, Kevin Kelloway

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Research on the effects of inconsistent safety leadership is limited, particularly regarding employee safety behavior in organizations. Inconsistent safety leadership occurs when organizational leaders display both effective and ineffective styles of safety leadership (i.e., transformational vs laissez-faire). In this study, we examine the effect of inconsistent safety leadership style on employee safety participation. Defined as the interaction of S.A.F.E.R (Speak, Act, Focus, Engage and Recognize) leadership style and passive leadership style, inconsistent safety leadership was found to be a significant predictor of safety participation in a sample of 307 nurses in Eastern Canada. Results of the moderated regression analysis also showed a significant main effect for S.A.F.E.R leadership, but not for passive leadership. To further explore the significant interaction, the simple slopes for S.A.F.E.R leadership at high and low levels (1 SD above and below the mean) of passive leadership were plotted. As predicted, the positive effects of S.A.F.E.R leadership behavior were attenuated when leaders were perceived by employees as also displaying high levels of passive leadership (i.e., inconsistent leadership styles). The research makes important theoretical and practical contributions to the occupational health and safety literature. The results demonstrate that leadership behavior, which is characteristic of the S.A.F.E.R model, is positively associated with employee safety participation. This finding is particularly important as researchers continue to explore what leaders can do to engage employees in work-related safety activities. The results also demonstrate how passive leadership may undermine the positive outcomes associated with safety leadership behavior in organizations. The data suggest that employee safety behavior is highest when leaders engage in safety effective leadership behavior on a consistent basis, rather than periodically.

Keywords: employee safety behavior, leadership, participation, safety training

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Authors: Eduardo Costa

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Hospital strikes in the Portuguese National Health Service (NHS) are becoming increasingly frequent, raising concerns in what respects patient safety. In fact, data shows that mortality rates for patients admitted during strikes are up to 30% higher than for patients admitted in other days. This paper analyses the effects of hospital strikes on patients’ outcomes. Specifically, it analyzes the impact of different strikes (physicians, nurses and other health professionals), on in-hospital mortality rates, readmission rates and length of stay. The paper uses patient-level data containing all NHS hospital admissions in mainland Portugal from 2012 to 2017, together with a comprehensive strike dataset comprising over 250 strike days (19 physicians-strike days, 150 nurses-strike days and 50 other health professionals-strike days) from 135 different strikes. The paper uses a linear probability model and controls for hospital and regional characteristics, time trends, and changes in patients’ composition and diagnoses. Preliminary results suggest a 6-7% increase in in-hospital mortality rates for patients exposed to physicians’ strikes. The effect is smaller for patients exposed to nurses’ strikes (2-5%). Patients exposed to nurses strikes during their stay have, on average, higher 30-days urgent readmission rates (4%). Length of stay also seems to increase for patients exposed to any strike. Results – conditional on further testing, namely on non-linear models - suggest that hospital operations and service levels are partially disrupted during strikes.

Keywords: health sector strikes, in-hospital mortality rate, length of stay, readmission rate

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Authors: Shahbaz Abbas, Lin Han Chiang Hsieh

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The significant population growth and climate change issues have contributed to the natural resources depletion and their sustainability in the future. Manufacturing industries have a substantial impact on every country’s economy, but the sustainability of the industrial resources is challenging, and the policymakers have been developing the possible solutions to manage the sustainability of industrial resources such as raw material, energy, water, and industrial supply chain. In order to address these challenges, nexus approach is one of the optimization and modelling techniques in the recent sustainable environmental research. The interactions between the nexus components acknowledge that all components are dependent upon each other, and they are interrelated; therefore, their sustainability is also associated with each other. In addition, the nexus concept does not only provide the resources sustainability but also environmental sustainability can be achieved through nexus approach by utilizing the industrial waste as a resource for the industrial processes. Based on energy-water nexus, this study has developed a resource-energy-water for the sugar industry to understand the interactions between sugarcane, energy, and water towards the sustainable sugar industry. In particular, the focus of the research is the Taiwanese sugar industry; however, the same approach can be adapted worldwide to optimize the sustainability of sugar industries. It has been concluded that there are significant interactions between sugarcane, energy consumption, and water consumption in the sugar industry to manage the scarcity of resources in the future. The interactions between sugarcane and energy also deliver a mechanism to reuse the sugar industrial waste as a source of energy, consequently validating industrial and environmental sustainability. The desired outcomes from the nexus can be achieved with the modifications in the policy and regulations of Taiwanese industrial sector.

Keywords: energy-water nexus, environmental sustainability, industrial sustainability, natural resource management

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Authors: Boris Ershov

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Depression is the most common mood disorder experienced by patients who have sustained a traumatic brain injury (TBI) and is associated with poorer cognitive functional outcomes. However, in some cases, similar cognitive impairments can also be observed in depression. There is not enough information about the features of the cognitive deficit in patients with TBI in relation to patients with depression. TBI patients without depressive symptoms (TBInD, n25), TBI patients with depressive symptoms (TBID, n31), and 28 patients with bipolar II disorder (BP) were included in the study. There were no significant differences in participants in respect to age, handedness and educational level. The patients clinical status was determined by using Montgomery–Asberg Depression Rating Scale (MADRS). All participants completed a cognitive battery (The Brief Assessment of Cognition in Affective Disorders (BAC-A)). Additionally, the Rey–Osterrieth Complex Figure (ROCF) was used to assess visuospatial construction abilities and visual memory, as well as planning and organizational skills. Compared to BP, TBInD and TBID showed a significant impairments in visuomotor abilities, verbal and visual memory. There were no significant differences between BP and TBID groups in working memory, speed of information processing, problem solving. Interference effect (cognitive inhibition) was significantly greater in TBInD and TBID compared to BP. Memory bias towards mood-related information in BP and TBID was greater in comparison with TBInD. These results suggest that depressive symptoms are associated with impairments some executive functions in combination at decrease of speed of information processing.

Keywords: bipolar II disorder, depression, neurocognitive deficits, traumatic brain injury

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Authors: Raneem Osama Salem, Ayesha Nuzhat, Fatimah Nasser Al Shehri, Nasser Al Hamdan

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Background: Recently, most medical schools around the globe are using simulation for teaching and assessing students’ clinical skills and competence. There are many obstacles that could face students and faculty when simulation sessions are introduced into undergraduate curriculum. Objective: The aim of this study is to obtain the opinion of undergraduate medical students and our faculty regarding the role of simulation in undergraduate curriculum, the simulation modalities used, and perceived barriers in implementing stimulation sessions. Methods: To address the role of simulation, modalities used, and perceived challenges to implementation of simulation sessions, a self-administered pilot tested questionnaire with 18 items using a 5 point Likert scale was distributed. Participants included undergraduate male medical students (n=125) and female students (n=70) as well as the faculty members (n=14). Result: Various learning outcomes are achieved and improved through the technology enhanced simulation sessions such as communication skills, diagnostic skills, procedural skills, self-confidence, and integration of basic and clinical sciences. The use of high fidelity simulators, simulated patients and task trainers was more desirable by our students and faculty for teaching and learning as well as an evaluation tool. According to most of the students,' institutional support in terms of resources, staff and duration of sessions was adequate. However, motivation to participate in the sessions and provision of adequate feedback by the staff was a constraint. Conclusion: The use of simulation laboratory is of great benefit to the students and a great teaching tool for the staff to ensure students learning of the various skills.

Keywords: simulators, medical students, skills, simulated patients, performance, challenges, skill laboratory

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Authors: Omar Farshad Jeelani, Makaire Njie, Viktoriia M. Korzhuk

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Recently, the application of AI-powered algorithms in healthcare continues to flourish. Particularly, access to healthcare information, including patient health history, diagnostic data, and PII (Personally Identifiable Information) is paramount in the delivery of efficient patient outcomes. However, as the exchange of healthcare information between patients and healthcare providers through AI-powered solutions increases, protecting a person’s information and their privacy has become even more important. Arguably, the increased adoption of healthcare AI has resulted in a significant concentration on the security risks and protection measures to the security and privacy of healthcare data, leading to escalated analyses and enforcement. Since these challenges are brought by the use of AI-based healthcare solutions to manage healthcare data, AI-based data protection measures are used to resolve the underlying problems. Consequently, this project proposes AI-powered safeguards and policies/laws to protect the privacy of healthcare data. The project presents the best-in-school techniques used to preserve the data privacy of AI-powered healthcare applications. Popular privacy-protecting methods like Federated learning, cryptographic techniques, differential privacy methods, and hybrid methods are discussed together with potential cyber threats, data security concerns, and prospects. Also, the project discusses some of the relevant data security acts/laws that govern the collection, storage, and processing of healthcare data to guarantee owners’ privacy is preserved. This inquiry discusses various gaps and uncertainties associated with healthcare AI data collection procedures and identifies potential correction/mitigation measures.

Keywords: data privacy, artificial intelligence (AI), healthcare AI, data sharing, healthcare organizations (HCOs)

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Authors: Ibrahim Ahmed, Richard Amoateng, Akhil Jain, Mohamed Ahmed

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Alcoholic cardiomyopathy (ACM) is a type of acquired cardiomyopathy caused by chronic alcohol consumption. Frequently ACM is associated with arrhythmias such as atrial flutter. Our aim was to characterize the patient demographics and investigate the effect of atrial flutter (AF) on ACM. This was a retrospective cohort study using the Nationwide Inpatient Sample database to identify admissions in adults with principal and secondary diagnoses of alcoholic cardiomyopathy and atrial flutter from 2019. Multivariate linear and logistic regression models were adjusted for age, gender, race, household income, insurance status, Elixhauser comorbidity score, hospital location, bed size, and teaching status. The primary outcome was all-cause mortality, and secondary outcomes were the length of stay (LOS) and total charge in USD. There was a total of 21,855 admissions with alcoholic cardiomyopathy, of which 1,635 had atrial flutter (AF-ACM). Compared to Non-AF-ACM cohort, AF-ACM cohort had fewer females (4.89% vs 14.54%, p<0.001), were older (58.66 vs 56.13 years, p<0.001), fewer Native Americans (0.61% vs2.67%, p<0.01), had fewer smaller (19.27% vs 22.45%, p<0.01) & medium-sized hospitals (23.24% vs28.98%, p<0.01), but more large-sized hospitals (57.49% vs 48.57%, p<0.01), more Medicare (40.37% vs 34.08%, p<0.05) and fewer Medicaid insured (23.55% vs 33.70%, p=<0.001), fewer hypertension (10.7% vs 15.01%, p<0.05), and more obesity (24.77% vs 16.35%, p<0.001). Compared to Non-AF-ACM cohort, there was no difference in AF-ACM cohort mortality rate (6.13% vs 4.20%, p=0.0998), unadjusted mortality OR 1.49 (95% CI 0.92-2.40, p=0.102), adjusted mortality OR 1.36 (95% CI 0.83-2.24, p=0.221), but there was a difference in LOS 1.23 days (95% CI 0.34-2.13, p<0.01), total charge $28,860.30 (95% CI 11,883.96-45,836.60, p<0.01). In patients admitted with ACM, the presence of AF was not associated with a higher all-cause mortality rate or odds of all-cause mortality; however, it was associated with 1.23 days increase in LOS and a $28,860.30 increase in total hospitalization charge. Native Americans, older age and obesity were risk factors for the presence of AF in ACM.

Keywords: alcoholic cardiomyopathy, atrial flutter, cardiomyopathy, arrhythmia

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Authors: Haile F. Darge, Hsieh C. Tsai

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The tumor microenvironment affects the therapeutic outcomes of cancer disease. In a malignant tumor, overexpression of vascular endothelial growth factor (VEGF) provokes the production of pathologic vascular networks. This results in a hostile tumor environment that hinders anti-cancer drug activities and profoundly fuels tumor progression. In this study, we develop a strategy of sequential sustain release of the anti-angiogenic drug: Bevacizumab(BVZ), and anti-cancer drug: Doxorubicin(DOX) which had a synergistic effect on cancer treatment. Poly (D, L-Lactide)- Poly (ethylene glycol) –Poly (D, L-Lactide) (PDLLA-PEG-PDLLA) thermo-sensitive hydrogel was used as a vehicle for local delivery of drugs in a single platform. The in vitro release profiles of the drugs were investigated and confirmed a relatively rapid release of BVZ (73.56 ± 1.39%) followed by Dox (61.21 ± 0.62%) for a prolonged period. The cytotoxicity test revealed that the copolymer exhibited negligible cytotoxicity up to 2.5 mg ml-1 concentration on HaCaT and HeLa cells. The in vivo study on Hela xenograft nude mice verified that hydrogel co-loaded with BVZ and DOX displayed the highest tumor suppression efficacy for up to 36 days with pronounce anti-angiogenic effect of BVZ and with no noticeable damage on vital organs. Therefore, localized co-delivery of anti-angiogenic drug and anti-cancer drugs by the hydrogel system may be a promising approach for enhanced chemotherapeutic efficacy in cancer treatment.

Keywords: anti-angiogenesis, chemotherapy, controlled release, thermo-sensitive hydrogel

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Authors: Yadav R. K., Baral S.

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Introduction: Nepal is one of the world’s least developed countries and has a high incidence of tuberculosis (TB). The TB prevalence survey in 2019 showed 69,000 Nepalese is developing TB and 4,000 die every year. Given its disproportionate impact on the impoverished segments of society, TB often thrusts patients into extreme poverty or exacerbates their existing economic struggles. Consequently, not only the patients but also their families suffer from the loss of livelihood. This study aims to assess the support of nutritional allowance on treatment compliance among retreatment tuberculosis patients in Nepal. This is a secondary analysis of data from HMIS (Health Management Information System) to investigate treatment compliance among tuberculosis patients and its association with nutritional allowance. The study population consisted of all individuals (N=2972) who had received services from July 16, 2021, to December 14, 2022. The SPSS 21version was used to conduct descriptive and bivariate analysis. Out of the total TB patients (n=2972), a third-fourth (65.9%) of TB patients were male. More than one-tenth (12.3%) of respondents received a nutrition support allowance. The TB treatment compliance rate was more (89.91%) in the nutrition support allowance group compared to the non-nutritional support group (87.98%). TB patients who received the nutritional support allowance were nearly twice as likely to have a higher TB treatment compliance rate compared to those who did not receive the nutritional support allowance. Providing nutritional allowance support to tuberculosis (TB) patients can play a significant role in improving treatment compliance and outcomes. Age and the type of TB are important factors that have shown statistical significance in relation to treatment compliance. Therefore, it is recommended to provide nutritional allowance support to both new and retreatment TB patients. To enhance treatment compliance among TB patients, it is beneficial to provide timely nutrition allowances and arrange home visits by TB focal persons.

Keywords: nutrition, support, treatment compliance, TB, Nepal

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Authors: Steven Kelly

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A fundament role of the researcher is research engagement, that is, the interaction between researchers and research end-users outside of academia for the mutually beneficial transfer of knowledge, technologies, methods, or resources. While research impact is the contribution that research makes to the economy, society, environment, or culture beyond the contribution to academic research. Ironically, traditional impact metrics in the academy are designed to focus on the outputs; it dismisses the important role engagement plays in fostering a collaborative process that leads to meaningful, ethical, and useful impacts. Dr. Kelly, aNanda (First Nations) man himself, has worked closely with the Nanda community over the past decade, ensuring cultural protocols are upheld and implemented while doing research engagement. The focus was on the process, which was essential to foster a positive research impact culture. The contributions that flowed from this process were the naming of a new species of squat lobster in the Nanda language, a poster design in collaboration with The University of Melbourne, Museums Victoria and Bundiyarra - IrraWanga language centre, media coverage, and the formation of the “Nanda language, Nanda country project”. The Nanda language, Nanda country project is a language revitalization project that focused on reconnecting Nanda people with the language & culture on Nanda Country. Such outcomes are imperative on the eve of the United Nations International Decade of Indigenous Languages. In this paperDr, Kellywill discuss howNanda cultural practicesinformed research engagement to foster a collaborative processthat, in turn, ledto meaningful, ethical, and useful impacts within and outside of the academy.

Keywords: community collaboration, indigenous, nanda, research engagement, research impacts

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Authors: Sahar Esmaeili, Ramezanali Ghaderi sanavi, Masoomeh Maarefvand, Samaneh Hosseinzadeh

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Introduction: Conducted researches reveal that nowadays, 60 percent of women around the world are the households. The adverse economic condition causes female-headed households and their children to be the most vulnerable people against social harm. Mainly a symptoms of mental illness such as depression, anxiety, obsession and aggression can be seen in female-headed households and their children are potentially exposed to issues such as crime-work, child labor in the black and informal jobs, education deprivation and malnutrition. The aim of this study is to evaluate the effect of Orem self-care education with the FGC technique on the public health of female-headed households. Methods: Sixty-four Female-headed householders who were supported by Saleh Foundation participated in a clinical trial study and were assigned to the case (n=32) and control (n=32) groups. The case group received 4-session Orem’s self-care education with family group conferencing technique. Data were collected using the demographic questionnaire and General Health Questionnaire (GHQ-28) prior to intervention and post-intervention. ANOVA was used to evaluate outcomes. Results: The results showed significant improvement of the intervention group in GHQ (P<0.001) and subscales of Physical Health (P<0.001) Agitation and Insomnia (P<0.001) and Social disorder (P<0.001) and Depression (P<0.001) compared with the control group after the intervention. Conclusion: The intervention of Orem’s self-care education with family group conferencing technique was effective in improving the General Health of Female-headed households

Keywords: orem’s self-care, female-headed households, general health, group

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Authors: Charlotte Brenner, Fisayo Latilo, McKenna Causey

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This study explores the transformation of teacher candidates' beliefs regarding inclusion and inclusive teaching practices during their instructional and practicum experiences in the Canadian context. With the increasing diversity of schools, the study investigates how teacher candidates' beliefs impact their implementation of inclusive teaching practices, which are essential for meeting diverse student needs. The research examines the influence of teacher education programs, transformative learning experiences, and inclusive practicum placements on teacher candidates' beliefs about inclusion. Using a multiple case study approach, the study assesses teacher candidates' initial beliefs, documents changes in these beliefs after coursework on inclusion, and explores the supports and constraints affecting belief development in both university and practicum settings. Preliminary findings suggest that teacher candidates generally hold positive beliefs about inclusion at the outset of their teacher education programs. However, coursework and practicum experiences significantly shape their understanding of diversity, strategies for inclusion, and awareness of broader social issues related to inclusive classrooms. The research underscores the critical role of teacher education programs in shaping teacher candidates' beliefs about inclusion and highlights the value of transformative learning experiences and inclusive practicum placements in enhancing their understanding of equity and inclusion. Continued research is necessary to identify specific elements within courses and practicum experiences that promote positive beliefs about inclusive teaching practices, ultimately contributing to the creation of more equitable classrooms and improved student outcomes.

Keywords: inclusion, beliefs, teacher candidates, inclusive teaching practices

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Authors: Areej Al-Khabbaz, Swapna Goerge, Majedah Abdul-Rasoul

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Introduction: The most prevalent periodontal disease among children is gingivitis, and it usually becomes more severe in adolescence. A number of intervention studies suggested that resolution of periodontal inflammation can improve metabolic control in patients diagnosed with diabetes mellitus. Aim: to assess the effect of non-surgical periodontal therapy on glycemic control of children diagnosed with diabetes mellitus. Method: Twenty-eight children diagnosed with diabetes mellitus were recruited with established diagnosis diabetes for at least 1 year. Informed consent and child assent form were obtained from children and parents prior to enrolment. The dental examination for the participants was performed on the same week directly following their annual medical assessment. All patients had their glycosylated hemoglobin (HbA1c%) test one week prior to their annual medical and dental visit and 3 months following non-surgical periodontal therapy. All patients received a comprehensive periodontal examination The periodontal assessment included clinical attachment loss, bleeding on probing, plaque score, plaque index and gingival index. All patients were referred for non-surgical periodontal therapy, which included oral hygiene instruction and motivation followed by supra-gingival and subg-ingival scaling using ultrasonic and hand instruments. Statistical Analysis: Data were entered and analyzed using the Statistical Package for Social Science software (SPSS, Chicago, USA), version 18. Statistical analysis of clinical findings was performed to detect differences between the two groups in term of periodontal findings and HbA1c%. Binary logistic regression analysis was performed in order to examine which factors were significant in multivariate analysis after adjusting for confounding between effects. The regression model used the dependent variable ‘Improved glycemic control’, and the independent variables entered in the model were plaque index, gingival index, bleeding %, plaque Statistical significance was set at p < 0.05. Result: A total of 28 children. The mean age of the participants was 13.3±1.92 years. The study participants were divided into two groups; Compliant group (received dental scaling) and non-complaints group (received oral hygiene instructions only). No statistical difference was found between compliant and non-compliant group in age, gender distribution, oral hygiene practice and the level of diabetes control. There was a significant difference between compliant and non-compliant group in term of improvement of HBa1c before and after periodontal therapy. Mean gingival index was the only significant variable associated with improved glycemic control level. In conclusion, this study has demonstrated that non-surgical mechanical periodontal therapy can improve HbA1c% control. The result of this study confirmed that children with diabetes mellitus who are compliant to dental care and have routine professional scaling may have better metabolic control compared to diabetic children who are erratic with dental care.

Keywords: children, diabetes, metabolic control, periodontal therapy

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Authors: Christantus Begealawuh Nchongayi

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As clearly stated in goal 14 of sustainable development goals, global oceans greatly contribute to making the earth habitable for mankind. This explains why ocean governance is an important global concern today. The emerging maritime security problems and the impact of climate change on African oceans, evidenced by tropical cyclones as seen recently in the Southern region of Africa, is also an indication that maritime governance and policymaking are important elements of peace and security in Africa. Within the last decade, there have been commendable efforts towards maritime governance and policymaking in Africa, although implementation of existing maritime policies is still lacking. This paper provides a snapshot of the overall state of the maritime policymaking process in Africa. It specifically explores the challenges facing policymakers in developing national and regional maritime security strategy in the East African Community. For methodology, the paper relied on primary and secondary data. Primary data was collected from informal discussions with policymakers and key policy-making bodies in Africa, and from a survey of public opinions. The study found that the Africa Integrated Maritime Strategy (2050 AIMS) is a recent template for regional and national maritime security policymaking in Africa and that although maritime security has in the past not been prioritized in the security agenda of the East African Community, developing and aligning a regional maritime security strategy to the 2050 AIMS will result to positive regional integration outcomes in East Africa.

Keywords: 2050 Africa integrated maritime strategy, east African community, maritime policy-making, maritime security

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Authors: Orkide Donma, Mustafa M. Donma, Muhammet Demirkol, Murat Aydin, Tuba Gokkus, Burcin Nalbantoglu, Aysin Nalbantoglu, Birol Topcu

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Obesity in childhood establishes a ground for adulthood obesity. Especially morbid obesity is an important problem for the children because of the associated diseases such as diabetes mellitus, cancer and cardiovascular diseases. In this study, body mass index (BMI), body fat ratios, anthropometric measurements and ratios were evaluated together with different laboratory indices upon evaluation of obesity in morbidly obese (MO) children. Children with nutritional problems participated in the study. Written informed consent was obtained from the parents. Study protocol was approved by the Ethics Committee. Sixty-two MO girls aged 129.5±35.8 months and 75 MO boys aged 120.1±26.6 months were included into the scope of the study. WHO-BMI percentiles for age-and-sex were used to assess the children with those higher than 99^th as morbid obesity. Anthropometric measurements of the children were recorded after their physical examination. Bio-electrical impedance analysis was performed to measure fat distribution. Anthropometric ratios, body fat ratios, Index-I and Index-II as well as insulin sensitivity indices (ISIs) were calculated. Girls as well as boys were binary grouped according to homeostasis model assessment-insulin resistance (HOMA-IR) index of <2.5 and >2.5, fasting glucose to insulin ratio (FGIR) of <6 and >6 and quantitative insulin sensitivity check index (QUICKI) of <0.33 and >0.33 as the frequently used cut-off points. They were evaluated based upon their BMIs, arms, legs, trunk, whole body fat percentages, body fat ratios such as fat mass index (FMI), trunk-to-appendicular fat ratio (TAFR), whole body fat ratio (WBFR), anthropometric measures and ratios [waist-to-hip, head-to-neck, thigh-to-arm, thigh-to-ankle, height/2-to-waist, height/2-to-hip circumference (C)]. SPSS/PASW 18 program was used for statistical analyses. p≤0.05 was accepted as statistically significance level. All of the fat percentages showed differences between below and above the specified cut-off points in girls when evaluated with HOMA-IR and QUICKI. Differences were observed only in arms fat percent for HOMA-IR and legs fat percent for QUICKI in boys (p≤ 0.05). FGIR was unable to detect any differences for the fat percentages of boys. Head-to-neck C was the only anthropometric ratio recommended to be used for all ISIs (p≤0.001 for both girls and boys in HOMA-IR, p≤0.001 for girls and p≤0.05 for boys in FGIR and QUICKI). Indices which are recommended for use in both genders were Index-I, Index-II, HOMA/BMI and log HOMA (p≤0.001). FMI was also a valuable index when evaluated with HOMA-IR and QUICKI (p≤0.001). The important point was the detection of the severe significance for HOMA/BMI and log HOMA while they were evaluated also with the other indices, FGIR and QUICKI (p≤0.001). These parameters along with Index-I were unique at this level of significance for all children. In conclusion, well-accepted ratios or indices may not be valid for the evaluation of both genders. This study has emphasized the limiting properties for boys. This is particularly important for the selection process of some ratios and/or indices during the clinical studies. Gender difference should be taken into consideration for the evaluation of the ratios or indices, which will be recommended to be used particularly within the scope of obesity studies.

Keywords: anthropometry, childhood obesity, gender, insulin sensitivity index

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Authors: Katie-Beth Webster

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Mucormycosis is a rare opportunistic fungal infection that, if left untreated, can cause large scale tissue necrosis and death. There are a number of cases of this in the literature, most commonly in the head and neck region arising from sinuses. It is also usually found in immunocompromised patient subgroups. This study reviewed a number of cases of mucormycosis in previously fit and healthy young trauma patients to assess predisposing factors for infection and adequacy of current treatment paradigms. These trauma patients likely contracted the fungal infection from the soil at the site of the incident. Despite early washout and debridement of the wounds at the scene of the injury and on arrival in hospital, both these patients contracted mucormycosis. It was suspected that inadequate early debridement of soil contaminated limbs was one of the major factors that can lead to catastrophic tissue necrosis. In both cases, this resulted in the patients having a higher level of amputation than would have initially been required based on the level of their injury. This was secondary to cutaneous and soft tissue necrosis secondary to the fungal infiltration leading to osteomyelitis and systemic sepsis. In the literature, it appears diagnosis is often protracted in this condition secondary to inadequate early treatment and long processing times for fungal cultures. If fungal cultures were sent at the time of first assessment and adequate debridements are performed aggressively early, it could lead to these critically unwell trauma patients receiving appropriate antifungal and surgical treatment earlier in their episode of care. This is likely to improve long term outcomes for these patients.

Keywords: mucormycosis, plastic surgery, osteomyelitis, trauma

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Authors: Inkyong Yi

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Acute kidney injury (AKI) in trauma patients is known to be associated with multiple factors, especially shock and consequent inadequate renal perfusion, yet its clinical presentation is little known in severe trauma patients. Our aim was to investigate the clinical presentation of acute kidney injury and its outcome in severe trauma patients at a level I trauma center. A total of 93 consecutive adult trauma patients with an injury severity score (ISS) of more than 15 were analyzed retrospectively from our Level I trauma center data base. Patients with direct renal injury were excluded. Patients were dichotomized into two groups, according to the presence of AKI. Various clinical parameters were compared between two groups, with Student’s T test and Mann-Whitney’s U test. The AKI group was further dichotomized into patients who recovered within seven days, and those who required more than 7days for recovery or those who did not recover at all. Various clinical parameters associated with outcome were further analyzed. Patients with AKI (n=33, 35%) presented with significantly higher age (61.4±17.3 vs. 45.4±17.3, p < 0.0001), incidence of comorbidities (hypertension; 51.5% vs. 13.3%, OR 6.906 95%CI 2.515-18.967, diabetes; 27.3% vs. 6.7%, OR 5.250, 95%CI 1.472-18.722), odds of head and neck trauma (69.7% vs. 41.7%, OR 3.220, 95%CI 1.306-7.942) and presence of shock during emergency room care (66.7% vs 21.7% OR 7.231, 95%CI, 2.798-18.687). Among AKI patients, patients who recovered within 1 week showed lower peak lactate (4.7mmol/L, 95%CI 2.9-6.5 vs 7.3mmol/L, 95%CI 5.0-9.6, p < 0.0287), lesser units of transfusion during first 24 hours (pRBC; 20.4unit, 95%CI 12.5-28.3 vs. 58.9unit, 95%CI 39.4-78.5, p=0.0003, FFP; 16.6unit, 95%CI 6.8-26.4 vs. 56.1unit, 95%CI 26.9-85.2, p=0.0027). In severe trauma patients, patients with AKI showed different clinical presentations and worse outcomes. Initial presence of shock and higher DIC profiles may be important risk factors for AKI in severe trauma patients. In patients with AKI, peak lactate level and amounts of transfusion are related to recovery.

Keywords: acute kidney injury, lactate, transfusion, trauma

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