Search results for: association rules

Authors: Babarina Maria, Andropova Margarita

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Introduction: Hypoparathyroidism (HypoPT) is a rare endocrine disorder with an estimated prevalence of 0.25 per 1000 individuals. The most common cause of HypoPT is the loss of active parathyroid tissue following thyroid or parathyroid surgery. Sometimes permanent postoperative HypoPT occures, manifested by hypocalcemia in combination with low levels of PTH during 6 months or more after surgery. Cognitive impairments in patients with hypocalcemia due to chronic HypoPT are observed, and this can lead to problems and challenges in everyday living: memory loss and impaired concentration, that may be the cause of poor compliance. Clinical case: Patient K., 66 years old, underwent thyroidectomy in 2013 (at the age of 55) because of papillary thyroid cancer T1NxMx, histopathology findings confirmed the diagnosis. 5 years after the surgery, she was followed up on an outpatient basis, TSH levelsonly were monitored, and the dose of levothyroxine was adjusted. In 2018 due to, increasing complaints include tingling and cramps in the arms and legs, memory loss, sleep disorder, fatigue, anxiety, hair loss, muscle pain, tachycardia, positive Chvostek, and Trousseau signs were diagnosed during examination, also in blood analyses: total Ca 1.86 mmol/l (2.15-2.55), Ca++ 0.96 mmol/l (1.12-1.3), P 1.55 mmol/l (0.74-1.52), Mg 0.79 mmol/l (0.66-1.07) - chronic postoperative HypoPT was diagnosed. Therapy was initiated: alfacalcidol 0.5 mcg per day, calcium carbonate 2000 mg per day, cholecalciferol 1000 IU per day, magnesium orotate 3000 mg per day. During the case follow-up, hypocalcemia, hyperphosphatemia persisted, hypercalciuria15.7 mmol/day (2.5-6.5) was diagnosed. Dietary recommendations were given because of the high content of phosphorus rich foods, and therapy was adjusted: the dose of alfacalcidol was increased to 2.5 mcg per day, and the dose of calcium carbonate was reduced to 1500 mg per day. As part of the screening for complications of hypoPT, data for cataracts, Fahr syndrome, nephrocalcinosis, and kidney stone disease were not obtained. However, HypoPT compensation was not achieved, and therefore hydrochlorothiazide 25 mg was initiated, the dose of alfacalcidol was increased to 3 mcg per day, calcium carbonate to 3000 mg per day, magnesium orotate and cholecalciferol were continued at the same doses. Therapeutic goals were achieved: calcium phosphate product <4.4 mmol2/l2, there were no episodes of hypercalcemia, twenty-four-hour urinary calcium excretion was significantly reduced. Conclusion: Timely prescription, careful explanation of drugs usage rules, and monitoring and maintaining blood and urine parameters within the target contribute to the prevention of HypoPT complications development and life-threatening events.

Keywords: hypoparathyroidism, hypocalcemia, hyperphosphatemia, hypercalciuria

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Authors: Branka Milicic Stanic, Romana Mijovic

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In primary hyperparathyroidism, an increased risk of developing cardiovascular disease may exist due to increased activity of the renin-angiotensin-aldosterone system (RAAS). In adenomatous altered tissue of parathyroid gland, compared to normal tissue, there are two to fourfold increase in the expression of type 1 angiotensin II receptors. As there is a clear evidence of the independent role of aldosterone on the cardiovascular system, the aim of this study was to evaluate the existence of an association between aldosterone secretion and parathyroid hormone in patients with primary hyperparathyroidism. This study included 48 patients with elevated parathyroid hormone who had come to the Departement of Nuclear Medicine, Clinical Center of Vojvodina, for Parathyroid Scintigraphy. The control group consisted of 30 healthy subjects who matched age and gender to the study group. All the results were statistically processed by statistical package STATISTICA 14 (Statsoft Inc,Tulsa, OK, USA). The survey was conducted between February 2017 and April 2018 at the Departement of Nuclear Medicine and at the Departement for Endocinology Diagnoistics, in Clinical Center of Vojvodina, Novi Sad. Compared to the control group, the study group had statistically significantly higher values of aldosterone (p=0.028), total calcium (p=0.01), ionized calcium (p=0.003) and parathyroid hormone (N-TACT PTH) (p=0.00), while statistically a significant lower levels in the study group were for phosphorus (p=0.003) and vitamin D (p=0.04). A linear correlation analysis in the study group revealed a statistically significant degree of positive correlation between renin and N-TACT PTH (r=0.688, p<0.05); renin and calcium (r=0.673, p<0.05) and renin and ionized calcium (r=0.641, p<0.05). Serum aldosterone and parathyroid hormone levels (N-TACT) were correlated positively in patients with primary hyperparathyroidism (r=0.509, p<0.05). According to the linear correlation analysis in the control group, aldosterone showed no positive correlation with N-TACT PTH (r=-0.285, p>0.05), as well as total and ionized calcium (r=-0.200, p>0.05; r=-0.313, p>0.05). In multivariate regression analysis of the study group, the strongest predictive variable of aldosterone secretion was N-TACT PTH (p=0.011). Aldosterone correlated positively to PTH levels in patients with primary hyperparathyroidism, and the fact is that in these patients aldosterone might be a key mediator of cardiovascular symptoms. All this knowledge should help to find new treatments to prevent cardiovascular disease.

Keywords: aldosterone, hyperparathyroidism, parathyroid hormone, parathyroid gland

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Authors: Muhammad Asim, Mehvish Amjad

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Background: Less than half of women in South Asia (SA) use any modern contraceptive method which leads to a huge burden of unintended pregnancies, unsafe abortions, maternal deaths, and socioeconomic loss. Women empowerment plays a pivotal role in improving various health seeking behaviours, including contraceptive use. The objective of this study to explore the association between women's empowerment and modern contraceptive, among rich and poor segment of population in SA. Methods: We used the most recent, large-scale, demographic health survey data of five South Asian countries, namely Afghanistan, Pakistan, Bangladesh, India, and Nepal. The outcome variable was the current use of modern contraceptive methods. The main exposure variable was a combination (interaction) of socio-economic status (SES) and women’s level of empowerment (low, medium, and high), where SES was bifurcated into poor and rich; and women empowerment was divided into three categories: decision making, attitude to violence and social independence. Moreover, overall women empowerment indicator was also created by using three dimensions of women empowerment. We applied both descriptive statistics and multivariable logistic regression techniques for data analyses. Results: Most of the women possessed ‘medium’ level of empowerment across South Asian Countries. The lowest attitude to violence empowerment was found in Afghanistan, and the lowest social independence empowerment was observed in Bangladesh across SA. However, Pakistani women have the lowest decision-making empowerment in the region. The lowest modern contraceptive use (22.1%) was found in Afghanistan and the highest (53.2%) in Bangladesh. The multivariate results depict that the overall measure of women empowerment does not affect modern contraceptive use among poor and rich women in most of South Asian countries. However, the decision-making empowerment plays a significant role among both poor and rich women to use modern contraceptive methods across South Asian countries. Conclusions: The effect of women’s empowerment on modern contraceptive use is not consistent across countries, and among poor and rich segment of population. Of the three dimensions of women’s empowerment, the autonomy of decision making in household affairs emerged as a stronger determinant of mCPR as compared with social independence and attitude towards violence against women.

Keywords: women empowerment, modern contraceptive use, South Asia, socio economic status

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Authors: Abhinav Kumar Rajverma, Arun Kumar Misra, Abhijeet Chandra

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Family involvement in business is universal across countries, with varying characteristics. Firms of developed economies have diffused ownership structure; however, that of emerging markets have concentrated ownership structure, having resemblance with that of family firms. Optimization of dividend payout and leverage are very crucial for firm’s valuation. This paper studies dividend paying behavior of National Stock Exchange listed Indian firms from financial year 2007 to 2016. The final sample consists of 422 firms and of these more than 49% (207) are family firms. Results reveal that family firms pay lower dividend and are more leveraged compared to non-family firms. This unique data set helps to understand dividend behavior and capital structure of sample firms over a long-time period and across varying family ownership concentration. Using panel regression models, this paper examines factors affecting dividend payout and capital structure and establishes a link between the two using Two-stage Least Squares regression model. Profitability shows a positive impact on dividend and negative impact on leverage, confirming signaling and pecking order theory. Further, findings support bankruptcy theory as firm size has a positive relation with dividend and leverage and volatility shows a negative relation with both dividend and leverage. Findings are also consistent with agency theory, family ownership concentration has negative relation with both dividend payments and leverage. Further, the impact of family ownership control confirms the similar finding. The study further reveals that firms with high family ownership concentration (family control) do have an impact on determining the level of private benefits. Institutional ownership is not significant for dividend payments. However, it shows significant negative relation with leverage for both family and non-family firms. Dividend payout and leverage show mixed association with each other. This paper provides evidence of how varying level of family ownership concentration and ownership control influences the dividend policy and capital structure of firms in an emerging market like India and it can have significant contribution towards understanding and formulating corporate dividend policy decisions and capital structure for emerging economies, where majority of firms exhibit behavior of family firm.

Keywords: dividend, family firms, leverage, ownership structure

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Authors: Cheng-Chen Hsu

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Background: The ratio of the length of the second finger (index finger, 2D) to the fourth finger (ring finger, 4D) (2D:4D) is a putative marker of prenatal hormones. A low 2D:4D ratio is related to high prenatal testosterone (PT) levels. Physiological research has suggested that a low 2D:4D ratio is correlated with high sports ability. Aim: To examine the association between cardiorespiratory fitness and 2D:4D. Methods: Assessment of 2D:4D; Images of hands were collected from participants using a computer scanner. Hands were placed lightly on the surface of the plate. Image analysis was performed using Image-Pro Plus 5.0 software. Feature points were marked at the tip of the finger and at the center of the proximal crease on the second and fourth digits. Actual measurement was carried out automatically, 2D:4D was calculated by dividing 2nd by 4th digit length. YMCA 3-min Step Test; The test involves stepping up and down at a rate of 24 steps/min for 3 min; a tape recording of the correct cadence (96 beats/min) is played to assist the participant in keeping the correct pace. Following the step test, the participant immediately sits down and, within 5 s, the tester starts counting the pulse for 1 min. The score for the test, the total 1-min postexercise heart rate, reflects the heart’s ability to recover quickly. Statistical Analysis ; Pearson’s correlation (r) was used for assessing the relationship between age, physical measurements, one-minute heart rate after YMCA 3-minute step test (HR) and 2D:4D. An independent-sample t-test was used for determining possible differences in HR between subjects with low and high values of 2D:4D. All statistical analyses were carried out with SPSS 18 for Window. All P-values were two-tailed at P = 0.05, if not reported otherwise. Results: A median split by 2D:4D was applied, resulting in a high and a low group. One-minute heart rate after YMCA 3-minute step test was significantly difference between groups of male right-hand 2D:4D (p = 0.024). However, no difference in left-hand 2D:4D values between groups in male, and no digit ratio difference between groups in female. Conclusion: The results showed that cardiopulmonary fitness is related to right 2D:4D, only in men. We argue that prenatal testosterone may have an effect on cardiorespiratory fitness in male but not in female.

Keywords: college students, digit ratio, finger, step test, fitness

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Authors: Fakunle Egbo, Kammalchukwu A., Akinremi T.

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Physical activity and nutritional status influence the health status and cognition of young adults. Lack of physical activity increases the likelihood of developing obesity which leads to the risk of heart diseases and other risk factors like high blood pressure, high blood cholesterol, diabetes etc. The study employed a cross-sectional study design. The study used a multi stage sampling technique multi- stage sampling technique; Purposive, for the selection of colleges that would be used, stratified random sampling for stratifying the colleges into departments and the simple random sampling for the selection of each respondent from the departments. Structured questionnaires were used to obtain data from the respondents and pre-tested anthropometric instruments were used to get the weight and height of the respondents and statistically analyzed using SPSS version 22.0 and the TDA (Total dietary allowance) software which was used to analyze the nutrient intake of the respondents. This study showed that they comprised of 50.1% males and 40.9% females. Slightly above average 51.8% were between ages of 15-19 with mean age being 19.57 years; ages 20-24 were slightly below average at 45.7%. The male students 58.7% had vigorous physical activity, whereas majority of females 76.5% had light physical activity level. 39.1% of the male students carried out physical activity 2-3 times per week while One third of the female students (38.3%) carried out physical activity 6-7 times per week. Majority of the respondents had Inadequate Protein- 63.8%, Carbohydrate- 60.2%, and Dietary fiber- 88.8. 36% eat rice 4-6 times per week. Majority of the respondents had inadequate fruit and vegetables (Efo, Banana,) at 47.7%, 40.6% respectively. Using Body mass index, (63.2%) have normal weight. 22.9% are overweight, 6.8% are underweight, 5.4% have grade 1 obesity and 1.6% have grade II obesity. There was a statistically significant association between the physical activity of the respondents with their nutritional status (p=0.037), physical activity and sex (p=0.000), nutritional status and amount spent on food daily (p=0.007). The study concluded that the physical activity level of the respondents, most especially the females were low; One third of the students were malnourished therefore, there should be an urgent need for improving the overall health status of students by providing the students with well-equipped gyms and other sporting equipment’s that would make them participate actively and keep fit.

Keywords: physical activity, nutritional status, undergraduates, dietary pattern

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Authors: Sera Ratu, Jane Chivers, Jessica Botfield

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Objectives: The Reproductive and Family Health Association of Fiji (RFHAF) and Family Planning Australia are working together to introduce quality comprehensive sexuality education into Special Schools - which are schools for students with disability. Sexual and reproductive health information is needed by students with disability attending Special Schools. Children with special needs go through the same changes as able-bodied children. The Fiji Disability Inclusion project is a three-year project that started in 2015. One of its objectives is to increase exposure to comprehensive sexuality education for primary and secondary school students with disability. Method: A baseline survey was undertaken with 72 students with disability; it included questions about puberty, sexual health, and relationships. 34 teachers also completed a survey about their views of sexuality education and confidence in delivering it. Consent was facilitated by running information sessions with teachers and parents. The process of gaining consent and completing the surveys was designed to be accessible to students with disability. Given the sensitive nature of reproductive and sexual health, and the potential vulnerability of young people with disability, ethical considerations were important in the design and implementation of the surveys, and ethics approval was obtained. Results: Findings from the surveys suggest that students have mixed knowledge and awareness of sexual health issues. Most teachers reported a need for their students to learn about sexuality and relationships. A positive outcome of conducting the surveys was that RFHAF staff reported they have developed skills and confidence in communicating with young people with a range of disabilities. They have a greater understanding of what students want to learn, and what teachers feel is important. Conclusions: These survey findings will assist RFHAF in developing comprehensive sexuality education programs that are relevant and accessible to students in Special Schools, and to develop an appropriate professional development program for teachers. Findings may also be applicable to other Special Schools when developing sexuality education programs. The education programs developed for students as part of this project, and the professional development programs for teachers, may be relevant to other countries.

Keywords: comprehensive sexuality education, delivery, sexual and reproductive health and rights, special schools

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Authors: Kurt Willems

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This research examines complaints against grading in higher education institutions in four different European regions: England and Wales, Flanders, the Netherlands, and France. The aim of the research is to examine the correlation between the applicable type of complaint handling on the one hand, and selected qualities of the higher education landscape and of public law on the other hand. All selected regions report a rising number of complaints against grading decisions, not only as to internal complaint handling within the institution but also judicially if the dispute persists. Some regions deem their administrative court system appropriate to deal with grading disputes (France) or have even erected a specialty administrative court to facilitate access (Flanders, the Netherlands). However, at the same time, different types of (governmental) dispute resolution bodies have been established outside of the judicial court system (England and Wales, and to lesser extent France and the Netherlands). Those dispute procedures do not seem coincidental. Public law issues such as the underlying legal nature of the education institution and, eventually, the grading decision itself, have an impact on the way the academic complaint procedures are developed. Indeed, in most of the selected regions, contractual disputes enjoy different legal protection than administrative decisions, making the legal qualification of the relationship between student and higher education institution highly relevant. At the same time, the scope of competence of government over different types of higher education institutions; albeit direct or indirect (o.a. through financing and quality control) is relevant as well to comprehend why certain dispute handling procedures have been established for students. To answer the above questions, the doctrinal and comparative legal method is used. The normative framework is distilled from the relevant national legislative rules and their preparatory texts, the legal literature, the (published) case law of academic complaints and the available governmental reports. The research is mainly theoretical in nature, examining different topics of public law (mainly administrative law) and procedural law in the context of grading decisions. The internal appeal procedure within the education institution is largely left out of the scope of the research, as well as different types of non-governmental-imposed cooperation between education institutions, given the public law angle of the research questions. The research results in the categorization of different academic complaint systems, and an analysis of the possibility to introduce each of those systems in different countries, depending on their public law system and higher education system. By doing so, the research also adds to the debate on the public-private divide in higher education systems, and its effect on academic complaints handling.

Keywords: higher education, legal qualification of education institution, legal qualification of grading decisions, legal protection of students, academic litigation

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Authors: Il-Ho Kim, Samuel Noh, Kwame McKenzie, Cyu-Chul Choi

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Introduction: The ‘stress of higher status’ hypothesis suggests that workers with higher-status occupations are more likely to experience work-to-family conflict (WFC) than those with lower-status occupations. Yet, the occupational difference in WFC and its mechanisms have not been explicitly explored within Asian culture. This present study examines (a) the association between occupational status and WFC and (b) the mediating roles of work-related stressors and resources, focused on gender perspectives using a sample of Korean immigrants. Methods: Data were derived from a cross-sectional survey of foreign born Korean immigrants who were currently working at least two years in the Greater Area of Toronto or surrounding towns. The sample was stratified for equivalent presentations of micro-business owners (N=555) and paid employees in diverse occupational categories (N=733). Results: We found gender differences and similarities in the link between occupational status and WFC and the mediating roles of work-related variables. Compared to skilled/unskilled counterparts, male immigrants in professional, service, and microbusiness jobs reported higher levels of WFC, whereas female immigrants in higher-status occupations were more likely to have WFC with the exception of the highest levels of WFC among microbusiness owners. Regardless of gender, both male and female immigrants who have longer weekly work hours, shift work schedule, and high emotional and psychological demands were significantly associated with high levels of WFC. However, skill development was related to WFC only among male immigrants. Regarding the mediating roles of work-related factors, among female immigrants, the occupational difference in WFC was fully mediated by weekly work hours, shift work schedule, and emotional and psychological demands with the exception of the case of microbusiness workers. Among male immigrants, the occupational differences remained virtually unchanged after controlling for these mediators. Conclusions: Our results partially confirmed the ‘stress of higher status’ hypothesis among female immigrants. Additionally, work-related stressors seem to be critical mediators of the link between occupations and WFC only for female immigrants.

Keywords: work-to-family conflict, gender, work conditions, job demands, job resources

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Authors: Lien Gysens, Bert Vanmechelen, Maarten Haspeslagh, Piet Maes, Ann Martens

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Bovine papillomavirus (BPV) types 1 and 2 play a central role in the etiology of the most common neoplasm in horses, the equine sarcoid. The unknown mechanism behind the unique variety in a clinical presentation on the one hand and the host-dependent clinical outcome of BPV-1 infection, on the other hand, indicate the involvement of additional factors. Earlier studies have reported the potential functional significance of intratypic sequence variants, along with the existence of sarcoid-sourced BPV variants. Therefore, intratypic sequence variation seems to be an important emerging viral factor. This study aimed to give a broad insight in sarcoid-sourced BPV variation and explore its potential association with disease presentation. In order to do this, a nanopore sequencing approach was successfully optimized for screening a wide spectrum of clinical samples. Specimens of each tumour were initially screened for BPV-1/-2 by quantitative real-time PCR. A custom-designed primer set was used on BPV-positive samples to amplify the complete viral genome in two multiplex PCR reactions, resulting in a set of overlapping amplicons. For phylogenetic analysis, separate alignments were made of all available complete genome sequences for BPV-1/-2. The resulting alignments were used to infer Bayesian phylogenetic trees. We found substantial genetic variation among sarcoid-derived BPV-1, although this variation could not be linked to disease severity. Several of the BPV-1 genomes had multiple major deletions. Remarkably, the majority of the cluster within the region coding for late viral genes. Together with the extensiveness (up to 603 nucleotides) of the described deletions, this suggests an altered function of L1/L2 in disease pathogenesis. By generating a significant amount of complete-length BPV genomes, we succeeded in introducing next-generation sequencing into veterinary research focusing on the equine sarcoid, thus facilitating the first report of both nanopore-based sequencing of complete sarcoid-sourced BPV-1/-2 and the simultaneous nanopore sequencing of multiple complete genomes originating from a single clinical sample.

Keywords: Bovine papillomavirus, equine sarcoid, horse, nanopore sequencing, phylogenetic analysis

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Authors: Sara E. Baumann, Megan A. Rabin, Mary Hawk, Bhimsen Devkota, Kajol Upadhyaya, Guna Raj Shrestha, Brigit Joseph, Annika Agarwal, Jessica G. Burke

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In Nepal, prevailing sociocultural norms associated with menstruation prompt adherence to stringent rules that limit participation in daily activities. Chhaupadi is a specific menstrual tradition in Nepal in which women and girls segregate themselves and follow a series of restrictions during menstruation. Despite having numerous physical and mental health implications, extant interventions have yet to sustainably address the harms associated with chhaupadi. In this study, the authors describe insights garnered from a collaboration with community members in Dailekh district, who formulated their own approaches to mitigate the adverse facets of chhaupadi. Envisaged as an entry point to improve women’s menstrual health experiences, this investigation employed an approach that uses Human-centered Design and a community-engaged approach. The authors conducted a four-day design workshop which unfolded in two phases: The Discovery Phase, to uncover chhaupadi context and key stakeholders, and the Design Phase, to design contextually relevant interventions. Diverse community-members, including those with lived experience practicing chhaupadi, developed five intervention concepts: 1) harnessing Female Community Health Volunteers as role models, for counseling, and raising awareness; 2) focusing on mothers and mother’s groups to instigate behavioral shifts; 3) engaging the broader community in behavior change efforts; 4) empowering fathers to effect change in their homes through counseling and education; and 5) training and emboldening youth to advocate for positive change through advocacy in their schools and homes. This research underscores the importance of employing multi-level approaches tailored to specific stakeholder groups, given Nepal’s rich cultural diversity. The engagement of Female Community Health Volunteers emerged as a promising yet underexplored intervention concept for chhaupadi, warranting broader implementation. Crucially, it is also imperative for interventions to prioritize tackling deleterious aspects of the chhaupadi tradition, emphasizing safety considerations, all while acknowledging chhaupadi’s entrenched cultural history; for some, there are positive aspects of the tradition that women and girls wish to preserve.

Keywords: human-centered design, menstrual health, Nepal, community-engagement, intervention development, women's health, rural health

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Authors: Vichayada Laohapiboolkul

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Introduction: As the legal use of cannabis is being widely accepted throughout the world, medical cannabis has been explored in order to become an alternative cure for patients. Tetrahydrocannabinol (THC) and Cannabidiol (CBD) are natural cannabinoids found in the Cannabis plant which is proved to have positive treatment for various diseases and symptoms such as chronic pain, neuropathic pain, spasticity resulting from multiple sclerosis, reduce cancer-associated pain, autism spectrum disorders (ASD), dementia, cannabis and opioid dependence, psychoses/schizophrenia, general social anxiety, posttraumatic stress disorder, anorexia nervosa, attention-deficit hyperactivity disorder, and Tourette's disorder. Regardless of all the medical benefits, THC, if not metabolized, can lead to mild up to severe adverse drug reactions (ADR). The enzyme CYP2C19 was found to be one of the metabolizers of THC. However, the suballele CYP2C19*2 manifests as a poor metabolizer which could lead to higher levels of THC than usual, possibly leading to various ADRs. Objective: The aim of this study was to investigate the distribution of CYP2C19, specifically CYP2C19*2, genes in Thai patients treated with medical cannabis along with adverse drug reactions. Materials and Methods: Clinical data and EDTA whole blood for DNA extraction and genotyping were collected from patients for this study. CYP2C19*2 (681G>A, rs4244285) genotyping was conducted using the Real-time PCR (ABI, Foster City, CA, USA). Results: There were 42 medical cannabis-induced ADRs cases and 18 medical cannabis tolerance controls who were included in this study. A total of 60 patients were observed where 38 (63.3%) patients were female and 22 (36.7%) were male, with a range of age approximately 19 - 87 years. The most apparent ADRs for medical cannabis treatment were dry mouth/dry throat (76.7%), followed by tachycardia (70%), nausea (30%) and a few arrhythmias (10%). In the total of 27 cases, we found a frequency of 18 CYP2C19*1/*1 alleles (normal metabolizers, 66.7%), 8 CYP2C19*1/*2 alleles (intermediate metabolizers, 29.6%) and 1 CYP2C19*2/*2 alleles (poor metabolizers, 3.7%). Meanwhile, 63.6% of CYP2C19*1/*1, 36.3% and 0% of CYP2C19*1/*2 and *2/*2 in the tolerance controls group, respectively. Conclusions: This is the first study to confirm the distribution of CYP2C19*2 allele and the prevalence of poor metabolizer genes in Thai patients who received medical cannabis for treatment. Thus, CYP2C19 allele might serve as a pharmacogenetics marker for screening before initiating treatment.

Keywords: medical cannabis, adverse drug reactions, CYP2C19, tetrahydrocannabinol, poor metabolizer

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Authors: Mohamed Ahmed Abdelmawla

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Calling to achieve Millennium Development Goals (MDGs) engaged with agriculture, i.e. poverty alleviation targets, human resources involved in agricultural sectors with special emphasis on irrigation must receive wealth of practical experience and training. Increased food production, including staple food, is needed to overcome the present and future threats to food security. This should happen within a framework of sustainable management of natural resources, elimination of unsustainable methods of production and poverty reduction (i.e. axes of modernization). A didactic tool to confirm the task of wise and maximum utility is the best management and accurate measurement, as major requisites for modernization process. The key component to modernization as a warranted goal is adhering great attention to management and measurement issues via capacity building. As such, this paper stressed the issues of discharge management and measurement by Field Outlet Pipes (FOP) for selected ones within the Gezira Scheme, where randomly nine FOPs were selected as representative locations. These FOPs extended along the Gezira Main Canal at Kilo 57 areas in the South up to Kilo 194 in the North. The following steps were followed during the field data collection and measurements: For each selected FOP, a 90 v- notch thin plate weir was placed in such away that the water was directed to pass only through the notch. An optical survey level was used to measure the water head of the notch and FOP. Both calculated discharge rates as measured by the v – notch, denoted as [Qc], and the adopted discharges given by (MOIWR), denoted as [Qa], are tackled for the average of three replicated readings undertaken at each location. The study revealed that the FOP overestimates and sometimes underestimates the discharges. This is attributed to the fact that the original design specifications were not fulfilled or met at present conditions where water is allowed to flow day and night with high head fluctuation, knowing that the FOP is non modular structure, i.e. the flow depends on both levels upstream and downstream and confirmed by the results of this study. It is convenient and formative to quantify the discharge in FOP with weirs or Parshall flumes. Cropping calendar should be clearly determined and agreed upon before the beginning of the season in accordance and consistency with the Sudan Gezira Board (SGB) and Ministry of Irrigation and Water Resources. As such, the water indenting should be based on actual Crop Water Requirements (CWRs), not on rules of thumb (420 m3/feddan, irrespective of crop or time of season).

Keywords: management, measurement, MDGs, modernization

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Authors: O. Davies, K. Veravalli, P. Panwalkar, M. Tofighi, P. Butterick, B. Healy, A. Mofidi

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Vancomycin resistant enterococcus infection is a condition that usually impacts ICUs, transplant, dialysis, and cancer units, often as a nosocomial infection. After an outbreak in the acute trauma and orthopaedic unit in Morriston hospital, we aimed to access the conditions that predispose VRE infections in our unit. Thirteen cases of VRE infection and five cases of VRE colonisations were identified in patients who were treated for orthopaedic care between 1/1/2020 and 1/11/2021. Cases were reviewed to identify predisposing factors, specifically looking at age, presenting condition and treatment, presence of infection and antibiotic care, active haemo-oncological condition, long term renal dialysis, previous hospitalisation, VRE predisposition, and clearance (PREVENT) scores, and outcome of care. The presenting condition, treatment, presence of postoperative infection, VRE scores, age was compared between colonised and the infected cohort. VRE type in both colonised and infection group was Enterococcus Faecium in all but one patient. The colonised group had the same age (T=0.6 P>0.05) and sex (2=0.115, p=0.74), presenting condition and treatment which consisted of peri-femoral fixation or arthroplasty in all patients. The infected group had one case of myelodysplasia and four cases of chronic renal failure requiring dialysis. All of the infected patient had sustained an infected complication of their fracture fixation or arthroplasty requiring reoperation and antibiotics. The infected group had an average VRE predisposition score of 8.5 versus the score of 3 in the colonised group (F=36, p<0.001). PREVENT score was 7 in the infected group and 2 in the colonised group(F=153, p<0.001). Six patients(55%) succumbed to their infection, and one VRE infection resulted in limb loss. In the orthopaedic cohort, VRE infection is a nosocomial condition that has peri-femoral predilection and is seen in association with immunosuppression or renal failure. The VRE infection cohort has been treated for infective complication of original surgery weeks prior to VRE infection. Based on our findings, we advise avoidance of infective complications, change of practice in use of antibiotics and use radical surgery and surveillance for VRE infections beyond infective precautions. PREVENT score shows that the infected group are unlikely to clear their VRE in the future but not the colonised group.

Keywords: surgical site infection, enterococcus, orthopaedic surgery, vancomycin resistance

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Authors: Luisa Villani

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The proposal aims to express concerns about the connection between mind, body, society, and environment in the Flyers’ dance, a very well-known rotatory dance in Mexico, to create meanings and to make the apprehension of the world possible. The interaction among the brain, mind, body, and environment, and the intersubjective relation among them, means the world creates and recreates a social interaction. The purpose of this methodology, based on the embodied cognition theory, which was named “A Performance-Embodied Theory” is to find the principles and patterns that organize the culture and the rules of the apprehension of the environment by Totonac people while the dance is being performed. The analysis started by questioning how anthropologists can interpret how Totonacs transform their unconscious knowledge into conscious knowledge and how the scheme formation of imagination and their collective imagery is understood in the context of public-facing rituals, such as Flyers’ dance. The problem is that most of the time, researchers interpret elements in a separate way and not as a complex ritual dancing whole, which is the original contribution of this study. This theory, which accepts the fact that people are body-mind agents, wants to interpret the dance as a whole, where the different elements are joined to an integral interpretation. To understand incorporation, data was recollected in prolonged periods of fieldwork, with participant observation and linguistic and extralinguistic data analysis. Laban’s notation for the description and analysis of gestures and movements in the space was first used, but it was later transformed and gone beyond this method, which is still a linear and compositional one. Performance in a ritual is the actualization of a potential complex of meanings or cognitive domains among many others in a culture: one potential dimension becomes probable and then real because of the activation of specific meanings in a context. It can only be thought what language permits thinking, and the lexicon that is used depends on the individual culture. Only some parts of this knowledge can be activated at once, and these parts of knowledge are connected. Only in this way, the world can be understood. It can be recognized that as languages geometrize the physical world thanks to the body, also ritual does. In conclusion, the ritual behaves as an embodied grammar or a text in movement, which, depending on the ritual phases and the words and sentences pronounced in the ritual, activates bits of encyclopedic knowledge that people have about the world. Gestures are not given by the performer but emerge from the intentional perception in which gestures are “understood” by the audio-spectator in an inter-corporeal way. The impact of this study regards the possibility not only to disseminate knowledge effectively but also to generate a balance between different parts of the world where knowledge is shared, rather than being received by academic institutions alone. This knowledge can be exchanged, so indigenous communities and academies could be together as part of the activation and the sharing of this knowledge with the world.

Keywords: dance, flyers, performance, embodied, cognition

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Authors: Colin David La Grange, Lisa Frost Ramsay

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Hydrogen sulphide (H2S) is a minor component of landfill gas, but significant in its distinct odorous quality and its association with landfill-related community complaints. The World Health Organisation (WHO) provides two guidelines for H2S: a health guideline at 150 µg/m3 on a 24-hour average, and a nuisance guideline at 7 µg/m3 on a 30-minute average. Albeit a practical distinction for impact assessment, this paper highlights the danger of the apparent dualism between nuisance and health impact, particularly when it is used to dismiss community concerns of perceived health impacts at low concentrations of H2S, as in the case of a community battle against the impacts of a landfill in Shongweni, KwaZulu-Natal, South Africa. Here community members reported, using a community developed mobile phone application, a range of health symptoms that coincided with, or occurred subsequent to, odour events and localised H2S peaks. Local doctors also documented increased visits for symptoms of respiratory distress, eye and skin irritation, and stress after such odour events. Objectively measured H2S and other pollutant concentrations during these events, however, remained below WHO health guidelines. This case study highlights the importance of the physiological link between the experience of environmental nuisance and overall health and wellbeing, showing these to be less distinct than the WHO guidelines would suggest. The potential mechanisms of impact of an odorous plume, with key constituents at concentrations below traditional health thresholds, on psychologically and/or physiologically sensitised individuals are described. In the case of psychological sensitisation, previously documented mechanisms such as aversive conditioning and odour-triggered panic are relevant. Physiological sensitisation to environmental pollutants, evident as a seemingly disproportionate physical (allergy-type) response to either low concentrations or a short duration exposure of a toxin or toxins, remains extensively examined but still not well understood. The links between a heightened sensitivity to toxic compounds, accumulation of some compounds in the body, and a pre-existing or associated immunological stress disorder are presented as a possible explanation.

Keywords: immunological stress disorder, landfill odour, odour nuisance, odour sensitisation, toxin accumulation

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Authors: J. F. Gonzalez-Rojo, Federico Lluesma-Rodriguez, Temoatzin Gonzalez

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Hyperloop, a new mode of transport, is gaining significance. It consists of the use of a ground-based transport system which includes a levitation system, that avoids rolling friction forces, and which has been covered with a tube, controlling the inner atmosphere lowering the aerodynamic drag forces. Thus, hyperloop is proposed as a solution to the current limitation on ground transportation. Rolling and aerodynamic problems, that limit large speeds for traditional high-speed rail or even maglev systems, are overcome using a hyperloop solution. Zeleros is one of the companies developing technology for hyperloop application worldwide. It is working on a concept that reduces the infrastructure cost and minimizes the power consumption as well as the losses associated with magnetic drag forces. For this purpose, Zeleros proposes a Hybrid ElectroMagnetic Suspension (EMS) for its prototype. In the present manuscript an active and optimal electromagnetic suspension levitation method based on nearly zero power consumption individual modules is presented. This system consists of several hybrid permanent magnet-coil levitation units that can be arranged along the vehicle. The proposed unit manages to redirect the magnetic field along a defined direction forming a magnetic circuit and minimizing the loses due to field dispersion. This is achieved using an electrical steel core. Each module can stabilize the gap distance using the coil current and either linear or non-linear control methods. The ratio between weight and levitation force for each unit is 1/10. In addition, the quotient between the lifted weight and power consumption at the target gap distance is 1/3 [kg/W]. One degree of freedom (DoF) (along the gap direction) is controlled by a single unit. However, when several units are present, a 5 DoF control (2 translational and 3 rotational) can be achieved, leading to the full attitude control of the vehicle. The proposed system has been successfully tested reaching TRL-4 in a laboratory test bench and is currently in TRL-5 state development if the module association in order to control 5 DoF is considered.

Keywords: active optimal control, electromagnetic levitation, HEMS, high-speed transport, hyperloop

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Authors: Elena Pucci, Margherita Tufarelli, Leonardo Giliberti

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As central for human and social development of the future, sustainability is becoming a recurring theme also in the fashion industry, where the need to explore new possible directions aimed at achieving sustainability goals and their communication is rising. Scholars have been devoted to the overall environmental impact of the textile and fashion industry, which, emerging as one of the world’s most polluting, today concretely assumes the need to take the path of sustainability in both products and production processes. Every day we witness the impact of our consumption, showing that the sustainability concept is as vast as complex: with a sometimes ambiguous definition, sustainability can concern projects, products, companies, sales, packagings, supply chains in relation to the actors proximity as well as traceability, raw materials procurement, and disposal. However, in its primary meaning, sustainability is the ability to maintain specific values and resources for future generations. The contribution aims to address sustainability in the fashion system as a layered problem that requires substantial changes at different levels: in the fashion product (materials, production processes, timing, distribution, and disposal), in the functioning of the system (life cycle, impact, needs, communication) and last but not least in the practice of fashion design which should conceive durable, low obsolescence and possibly demountable products. Moreover, consumers play a central role for the growing awareness, together with an increasingly strong sensitivity towards the environment and sustainable clothing. Since it is also a market demand, undertaking significant efforts to achieve total transparency and sustainability in all production and distribution processes is becoming fundamental for the fashion system. Sustainability is not to be understood as purely environmental but as the pursuit of collective well-being in relation to conscious production, human rights, and social dignity with the aim to achieve intelligent, resource, and environmentally friendly production and consumption patterns. Assuming sustainability as a layered problem makes the role of communication crucial to convey scientific or production specific content so that people can obtain and interpret information to make related decisions. Hence, if it is true that “what designers make becomes the future we inhabit'', design is facing great and challenging responsibility. The fashion industry needs a system of rules able to assess the sustainability of products, which is transparent and easily interpreted by consumers, identifying and enhancing virtuous practices. There are still complex and fragmented value chains that make it extremely difficult for brands and manufacturers to know the history of their products, to identify exactly where the risks lie, and to respond to the growing demand from consumers and civil society for responsible and sustainable production practices in the fashion industry.

Keywords: fashion design, fashion system, sustainability, communication, complexity

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Authors: Sumitra Sharma, Christina Parker, Kathleen Finlayson, Clint Douglas, Niall Higgins

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Background: Telehealth services have potential to increase accessibility, utilization, and effectiveness of healthcare services. As the telehealth services are yet to integrate within regular hospital services in Nepal, the use of the telehealth services among adults with diabetes is scarce. Prior to implementation of telehealth services for adults with diabetes, it is necessary to examine influencing factors of telehealth services. Objective: This study aimed to investigate factors influencing telehealth services for diabetes care in Nepal. Methods: This study used a mixed-method study design which included a cross-sectional survey among adults with diabetes and semi-structured interviews among key healthcare professionals of Nepal. The study was conducted in a medical out-patient department of a tertiary hospital of Nepal. The survey adapted a previously validated questionnaire, while semi-structured questions for interviews were developed from literature review and experts consultation. All interviews were audio-recorded, and inductive content analysis was used to code transcripts and develop themes. For a survey, a descriptive analysis, chi-square test, and Mann Whitney U test were used to analyze the data. Results: One hundred adults with diabetes were participated in a survey, and seven healthcare professionals were recruited for interviews. In a survey, just over half of the participants (53%) were male, and others were female. Almost all participants (98%) owned a mobile phone, and 67% of them had a computer with internet access at home. Majority of participants had experience in using Facebook messenger (95%), followed by Viber (60%) and Zoom (26%). Almost all of the participants (96%) were willing to use telehealth services. There were significant associations between female sex and participants living 10 km away from the hospital with their willingness to use telehealth services. There was a significant association between participants' self-perception of good health status with their willingness to use video-conference calls and phone calls to use telehealth services. Seven themes were developed from interview data which are related to predisposing, reinforcing, and enabling factors influencing telehealth services for diabetes care in Nepal. Conclusion: In summary, several factors were found to influence the use of telehealth services for diabetes care in Nepal. For effective implementation of a sustainable telehealth services for adults with diabetes in Nepal, these factors need to be considered.

Keywords: contributing factors, diabetes mellitus, developing countries, telemedicine, telecare

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Authors: J. Niyitegeka, G. Nshimirimana, A. Silverstein, J. Odhiambo, Y. Lin, T. Nkurunziza, R. Riviello, S. Rulisa, P. Banguti, H. Magge, M. Macharia, J. P. Dushime, R. Habimana, B. Hedt-Gauthier

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In low-resource settings, women needing an emergency cesarean section experiences various delays in both reaching and receiving care that is often linked to poor neonatal outcomes. In this study, we quantified different measures of delays and assessed the association between these delays and neonatal outcomes at three rural district hospitals in Rwanda. This retrospective study included 441 neonates and their mothers who underwent emergency cesarean sections in 2015 at Butaro, Kirehe and Rwinkwavu District Hospitals. Four possible delays were measured: Time from start of labor to district hospital admission, travel time from a health center to the district hospital, time from admission to surgical incision, and time from the decision for the emergency cesarean section to surgical incision. Neonatal outcomes were categorized as unfavorable (APGAR < 7 or death) and favorable (APGAR ≥ 7). We assessed the relationship between each type of delay and neonatal outcomes using multivariate logistic regression. In our study, 38.7% (108 out of 279) of neonates’ mothers labored for 12 to 24 hours before hospital admission and 44.7% (159 of 356) of mothers were transferred from health centers that required 30 to 60 minutes of travel time to reach the district hospital. 48.1% (178 of 370) of caesarean sections started within five hours after admission and 85.2% (288 of 338) started more than thirty minutes after the decision for the emergency cesarean section was made. Neonatal outcomes were significantly worse among mothers with more than 90 minutes of travel time from the health center to the district hospital compared to health centers attached to the hospital (OR = 5.12, p = 0.02). Neonatal outcomes were also significantly different depending on decision to incision intervals; neonates with cesarean deliveries starting more than thirty minutes after decision had better outcomes than those started immediately (OR = 0.32, p = 0.04). Interventions that decrease barriers to access to maternal health care services can improve neonatal outcome after emergency cesarean section. Triaging could explain the inverse relationship between time from decision to incision and neonatal outcome; this must be studied more in the future.

Keywords: Africa, emergency obstetric care, rural health delivery, maternal and child health

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Authors: Majeda S. Hammoud

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Background and Aim: Gestational diabetes mellitus (GDM) is a common pregnancy complication affecting around 14% of pregnancies globally that carries short and long-term consequences to the mother and her child. Pre-pregnancy overweight or obesity is the most consistently and strongly associated modifiable risk factor with GDM development. This analysis aimed to determine whether vitamin D status during pregnancy modulates the effect of pre-pregnancy obesity/overweight on GDM risk while stratifying by maternal age. Methods: Data from the Kuwait Birth Cohort (KBC) study were analyzed, which enrolled pregnant women in the second or third trimester of gestation. Pre-pregnancy body mass index (BMI; kg/m2) was categorized as under/normal weight (<25.0), overweight (25.0 to <30.0), and obesity (≥30.0). 25 hydroxyvitamin D levels were measured in blood samples that were collected at recruitment and categorized as deficiency (<50 nmol/L) and insufficiency/sufficiency (≥50 nmol/L). GDM status was ascertained according to international guidelines. Logistic regression was used to evaluate associations, and adjusted odds ratios (aOR) and 95% confidence intervals (CI) were estimated. Results: The analyzed study sample included a total of 982 pregnant women, with a mean (SD) age of 31.4 (5.2) years. The prevalence of GDM was estimated to be 17.3% (95% CI: 14.9-19.7), and the prevalence of pre-pregnancy overweight and obesity was 37.8% (95% CI: 34.8-40.8) and 28.8% (95% CI: 26.0-31.7), respectively. The prevalence of gestational vitamin D deficiency was estimated to be 55.3% (95% CI: 52.2-58.4). The association between pre-pregnancy overweight or obesity with GDM risk differed according to maternal age and gestational vitamin D status (Pinteraction[BMI × age × vitamin D = 0.047). Among pregnant women aged <35 years, prepregnancy obesity compared to under/normal weight was associated with increased GDM risk among women with gestational vitamin D deficiency (aOR: 3.65, 95% CI: 1.50-8.86, p = 0.004) and vitamin D insufficiency/sufficiency (aOR: 2.55, 95% CI: 1.16-5.61, p = 0.019). In contrast, among pregnant women aged ≥35 years, pre-pregnancy obesity compared to under/normal weight was associated with increased GDM risk among women with gestational vitamin D deficiency (aOR: 9.70, 95% CI: 2.01-46.69, p = 0.005), but not among women with vitamin D insufficiency/sufficiency (aOR: 1.46, 95% CI: 0.42-5.16, p = 0.553). Conclusion: The effect of pre-pregnancy obesity on GDM risk is modulated by maternal age and gestational vitamin D status, with the effect of pre-pregnancy obesity being more pronounced among older pregnant women (aged ≥35 years) with gestational vitamin D deficiency compared to those with vitamin D insufficiency/sufficiency. Whereas, among younger women (aged <35 years), the effect of pre-pregnancy obesity on GDM risk was not modulated by gestational vitamin D status. Therefore, vitamin D supplementation among pregnant women, specifically older women with pre-pregnancy obesity, may mitigate the effect of pre-pregnancy obesity on GDM risk.

Keywords: gestational diabetes mellitus, vitamin D, obesity, body mass index

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Authors: Tiisetso Mpai, Sanjay K. Jaiswal, Felix D. Dakora

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The South African Cape fynbos biome is a global biodiversity hotspot. This biome contains a diversity of endemic shrub legumes, including Polhillia, Wiborgia, and Wiborgiella species, which are important for ecotourism as well as for improving soil fertility status. This is due to their proven N₂-fixing abilities when in association with compatible soil bacteria. In fact, Polhillia, Wiborgia, and Wiborgiella species have been reported to derive over 61% of their needed nitrogen through biological nitrogen fixation and to exhibit acid and alkaline phosphatase activity in their rhizospheres. Thus, their interactions with soil microbes may explain their survival mechanisms under the continued summer droughts and acidic, nutrient-poor soils in this region. However, information regarding their rhizosphere microbiome is still unavailable, yet it is important for Fynbos biodiversity management. Therefore, the aim of this study was to assess the microbial community structures associated with rhizosphere soils of Polhillia pallens, Polhillia brevicalyx, Wiborgia obcordata, Wiborgia sericea, and Wiborgiella sessilifolia growing at different locations of the South African Cape fynbos, during the wet and dry seasons. The hypothesis is that the microbial communities in these legume rhizospheres are the same type and are not affected by the growing season due to the restricted habitat of these wild fynbos legumes. To obtain the results, DNA was extracted from 0.5 g of each rhizosphere soil using PowerSoil™ DNA Isolation Kit, and sequences were obtained using the 16S rDNA Miseq Illumina technology. The results showed that in both seasons, bacteria were the most abundant microbial taxa in the rhizosphere soils of all five legume species, with Actinobacteria showing the highest number of sequences (about 30%). However, over 19.91% of the inhabitants in all five legume rhizospheres were unclassified. In terms of genera, Mycobacterium and Conexibacter were common in rhizosphere soils of all legumes in both seasons except for W. obcordata soils sampled during the dry season, which had Dehalogenimonas as the major inhabitant (6.08%). In conclusion, plant species and season were found to be the main drivers of microbial community structure in Cape fynbos, with the wet season being more dominant in shaping microbial diversity relative to the dry season. Wiborgia obcordata had a greater influence on microbial community structure than the other four legume species.

Keywords: 16S rDNA, Cape fynbos, endemic legumes, microbiome, rhizosphere

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Authors: Garima Singh, Kunal Malhotra

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Objective: The expansion of telehealth has been instrumental in increasing access to medical services, especially for underserved and rural communities. In 2020, 14 million patients received virtual care through telemedicine and the global telemedicine market is expected to reach up to $185 million by 2023. It provides a platform and allows a patient to receive primary care as well as specialized care using technology and the comfort of their homes. Telemedicine was particularly useful during COVID-pandemic and the number of telehealth visits increased by 5000% during that time. It continues to serve as a significant resource for patients seeking care and to bridge the gap between the disease and the treatment. Method: As per APA (American Psychiatric Association), Telemedicine is the process of providing health care from a distance through technology. It is a subset of telemedicine, and can involve providing a range of services, including evaluations, therapy, patient education and medication management. It can involve direct interaction between a physician and the patient. It also encompasses supporting primary care providers with specialist consultation and expertise. It can also involve recording medical information (images, videos, etc.) and sending this to a distant site for later review. Results: In our organization, we are using telepsychiatry and serving 25 counties and approximately 1.4 million people. We provide multiple services, including inpatient, outpatient, crisis intervention, Rehab facility, autism services, case management, community treatment and multiple other modalities. With project ECHO (Extension for Community Healthcare Outcomes) it has been used to advise and assist primary care providers in treating mental health. It empowers primary care providers to treat patients in their own community by sharing knowledge. Conclusion: Telemedicine has shown to be a great medium in meeting patients’ needs and accessible mental health. It has been shown to improve access to care in both urban and rural settings by bringing care to a patient and reducing barriers like transportation, financial stress and resources. Telemedicine is also helping with reducing ER visits, integrating primary care and improving the continuity of care and follow-up. There has been substantial evidence and research about its effectiveness and its usage.

Keywords: telehealth, telemedicine, access to care, medical technology

Procedia PDF Downloads 87

Authors: Pamela-Zoe Topalli, Niina Junttila, Päivi M. Niemi, Klaus Ranta

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Adolescents’ biased perceptions about their social competence (SC), whether negatively or positively, serve to influence their socioemotional adjustment such as early feelings of social phobia (nowadays referred to as Social Anxiety Disorder-SAD). Despite the importance of biased self-perceptions in adolescents’ psychosocial adjustment, the extent to which discrepancies between self- and others’ evaluations of one’s SC are linked to social phobic symptoms remains unclear in the literature. This study examined the perceptual discrepancy profiles between self- and peers’ as well as between self- and teachers’ evaluations of adolescents’ SC and the interrelations of these profiles with self-reported social phobic symptoms. The participants were 390 3^rd graders (15 years old) of Finnish lower secondary school (50.8% boys, 49.2% girls). In contrast with variable-centered approaches that have mainly been used by previous studies when focusing on this subject, this study used latent profile analysis (LPA), a person-centered approach which can provide information regarding risk profiles by capturing the heterogeneity within a population and classifying individuals into groups. LPA revealed the following five classes of discrepancy profiles: i) extremely negatively biased perceptions of SC, ii) negatively biased perceptions of SC, iii) quite realistic perceptions of SC, iv) positively biased perceptions of SC, and v) extremely positively biased perceptions of SC. Adolescents with extremely negatively biased perceptions and negatively biased perceptions of their own SC reported the highest number of social phobic symptoms. Adolescents with quite realistic, positively biased and extremely positively biased perceptions reported the lowest number of socio-phobic symptoms. The results point out the negatively and the extremely negatively biased perceptions as possible contributors to social phobic symptoms. Moreover, the association of quite realistic perceptions with low number of social phobic symptoms indicates its potential protective power against social phobia. Finally, positively and extremely positively biased perceptions of SC are negatively associated with social phobic symptoms in this study. However, the profile of extremely positively biased perceptions might be linked as well with the existence of externalizing problems such as antisocial behavior (e.g. disruptive impulsivity). The current findings highlight the importance of considering discrepancies between self- and others’ perceptions of one’s SC in clinical and research efforts. Interventions designed to prevent or moderate social phobic symptoms need to take into account individual needs rather than aiming for uniform treatment. Implications and future directions are discussed.

Keywords: adolescence, latent profile analysis, perceptual discrepancies, social competence, social phobia

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Authors: Abdulwakeel B. Raji

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This paper introduces a concept of an intelligent virtual learning environment that involves communication between learners and an artificially intelligent teaching agent in an attempt to replicate classroom learning interactions. The benefits of this technology over current e-learning practices is that it creates a virtual classroom where real time adaptive learning interactions are made possible. This is a move away from the static learning practices currently being adopted by e-learning systems. Over the years, artificial intelligence has been applied to various fields, including and not limited to medicine, military applications, psychology, marketing etc. The purpose of e-learning applications is to ensure users are able to learn outside of the classroom, but a major limitation has been the inability to fully replicate classroom interactions between teacher and students. This study used comparative surveys to gain information and understanding of the current learning practices in Nigerian universities and how they compare to these practices compare to the use of a developed e-learning system. The study was conducted by attending several lectures and noting the interactions between lecturers and tutors and as an aftermath, a software has been developed that deploys the use of an artificial intelligent teaching-agent alongside an e-learning system to enhance user learning experience and attempt to create the similar learning interactions to those found in classroom and lecture hall settings. Dialogflow has been used to implement a teaching-agent, which has been developed using JSON, which serves as a virtual teacher. Course content has been created using HTML, CSS, PHP and JAVASCRIPT as a web-based application. This technology can run on handheld devices and Google based home technologies to give learners an access to the teaching agent at any time. This technology also implements the use of definite clause grammars and natural language processing to match user inputs and requests with defined rules to replicate learning interactions. This technology developed covers familiar classroom scenarios such as answering users’ questions, asking ‘do you understand’ at regular intervals and answering subsequent requests, taking advanced user queries to give feedbacks at other periods. This software technology uses deep learning techniques to learn user interactions and patterns to subsequently enhance user learning experience. A system testing has been undergone by undergraduate students in the UK and Nigeria on the course ‘Introduction to Database Development’. Test results and feedback from users shows that this study and developed software is a significant improvement on existing e-learning systems. Further experiments are to be run using the software with different students and more course contents.

Keywords: virtual learning, natural language processing, definite clause grammars, deep learning, artificial intelligence

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Authors: Olga Gomez De Miranda, Jose R. Ochoa-Gomez, Stefaan De Wildeman, Luciano Monsegue, Soraya Prieto, Leire Lorenzo, Cristina Dineiro

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The chemical industry is facing a new revolution. As long as processes based on the exploitation of fossil resources emerged with force in the XIX century, Society currently demands a new radical change that will lead to the complete and irreversible implementation of a circular sustainable economic model. The implementation of biorefineries will be essential for this. There, renewable raw materials as sugars and other biomass resources are exploited for the development of new materials that will partially replace their petroleum-derived homologs in a safer, and environmentally more benign approach. Isosorbide, (1,4:3,6-dianhydro-d-glucidol) is a primary bio-based derivative obtained from the plant (poly) saccharides and a very interesting example of a useful chemical produced in biorefineries. It can, in turn, be converted to other secondary monomers as isosorbide bis-methyl carbonate (IBMC), whose main field of application can be as a key biodegradable intermediary substitute of bisphenol-A in the manufacture of polycarbonates, or as an alternative to the toxic isocyanates in the synthesis of new polyurethanes (non-isocyanate polyurethanes) both with a huge application market. New products will present advantageous mechanical or optical properties, as well as improved behavior in non-toxicity and biodegradability aspects in comparison to their petro-derived alternatives. A robust production process of IBMC, a biomass-derived chemical, is here presented. It can be used with different raw material qualities using dimethyl carbonate (DMC) as both co-reactant and solvent. It consists of the transesterification of isosorbide with DMC under soft operational conditions, using different basic catalysts, always active with the isosorbide characteristics and purity. Appropriate isolation processes have been also developed to obtain crude IBMC yields higher than 90%, with oligomers production lower than 10%, independently of the quality of the isosorbide considered. All of them are suitable to be used in polycondensation reactions for polymers obtaining. If higher qualities of IBMC are needed, a purification treatment based on nanofiltration membranes has been also developed. The IBMC reaction-isolation conditions established in the laboratory have been successfully modeled using appropriate software programs and moved to a pilot-scale (production of 100 kg of IBMC). It has been demonstrated that a highly efficient IBMC production process able to be up-scaled under suitable market conditions has been obtained. Operational conditions involved the production of IBMC involve soft temperature and energy needs, no additional solvents, and high operational efficiency. All of them are according to green manufacturing rules.

Keywords: biomass, catalyst, isosorbide bis-methyl carbonate, polycarbonate, polyurethane, transesterification

Procedia PDF Downloads 112

Authors: Manoj Kumar Reddy Pulim, Lakshmi Muthukrishnan, Geetha Jayapathy, Radhika Raman

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Introduction: In the past two decades, noninvasive positive pressure ventilation (NIPPV) emerged as one of the most important advances in the management of both acute and chronic respiratory failure in children. In the acute setting, it is an alternative to intubation with a goal to preserve normal physiologic functions, decrease airway injury, and prevent respiratory tract infections. There is a need to determine the clinical profile and parameters which point towards the need for NIV in the pediatric emergency setting. Objectives: i) To study the clinical profile of children who required non invasive ventilation and invasive ventilation, ii) To study the clinical parameters common to children who required non invasive ventilation. Methods: All children between one month to 18 years, who were intubated in the pediatric emergency department and those for whom decision to commence Non Invasive Ventilation was made in Emergency Room were included in the study. Children were transferred to the Paediatric Intensive Care Unit and started on Non Invasive Ventilation as per our hospital policy and followed up in the Paediatric Intensive Care Unit. Clinical profile of all children which included age, gender, diagnosis and indication for intubation were documented. Clinical parameters such as respiratory rate, heart rate, saturation, grunting were documented. Parameters obtained were subject to statistical analysis. Observations: Airway disease (Bronchiolitis 25%, Viral induced wheeze 22%) was a common diagnosis in 32 children who required Non Invasive Ventilation. Neuromuscular disorder was the common diagnosis in 27 children (78%) who were Intubated. 17 children commenced on Non Invasive Ventilation who later needed invasive ventilation had Neuromuscular disease. High frequency nasal cannula was used in 32, and mask ventilation in 17 children. Clinical parameters common to the Non Invasive Ventilation group were age < 1 year (17), tachycardia n = 7 (22%), tachypnea n = 23 (72%) and severe respiratory distress n = 9 (28%), grunt n = 7 (22%), SPO2 (80% to 90%) n = 16. Children in the Non Invasive Ventilation + INTUBATION group were > 3 years (9), had tachycardia 7 (41%), tachypnea 9(53%) with a male predominance n = 9. In statistical comparison among 3 groups,'p' value was significant for pH, saturation, and use of Ionotrope. Conclusion: Invasive ventilation can be avoided in the paediatric Emergency Department in children with airway disease, by commencing Non Invasive Ventilation early. Intubation in the pediatric emergency department has a higher association with neuromuscular disorders.

Keywords: clinical parameters, indications, non invasive ventilation, paediatric emergency room

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Authors: Spase Janevski

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We, as designers, should be aware of the consequences of our material selection, at the early stages of the design process. Some of the designer’s decisions can have a very significant impact on design for sustainability. The influence of this concept has led to years of research studies into eco-friendly materials and their potentials for creating new sustainable products. In order to answer the question, 'how cork has become a design trend', this paper will present an overview of the implications of the concept of design for sustainability on the potential uses of cork material. A decade ago, cork as a material had an association with wine stoppers, but with the evolution of sustainable product design as part of the concept of design for sustainability, cork now offers product designers a wide range of new materials and applications. The purpose of this paper is to show how the phenomenon of sustainability has had an impact on the progress of the material which is currently not being an integral component of the design material palette. At the beginning, the nature of the relationship between cork and sustainability will be explained through the following stages: 1) fundamental understanding of the concept of Design for Sustainability and the importance of material selection for sustainable product design, and 2) the importance of cork oak trees for the environment and the environmental impacts of cork products. In order to examine and present the influence of the sustainability on the innovation in cork applications, the paper will provide a historical overview of designing with cork. The overview will consist of four stages: 1) pre-industrial period - the period when ancient nations used cork and amphoras to store their wine; 2) industrial period - emergence and industrialization of well-known wine stoppers; 3) post-industrial period - commercializing cork products in the area of floors and coverings and first developments in industrial research; and 4) the period when large cork realized the importance of sustainability and started to focus more markedly on research and development. The existence of new cork materials, the investigation in new applications and the investment in new innovations have proved that the sustainability approach has had a great influence on the revival of this material. In addition, the paper will present some of the new cork innovative materials and applications and their potentials for designing promising and sustainable solutions with additive manufacturing technologies, such as 3D printing. Lastly, the paper will introduce some questions for further study, such as the environmental impacts of the new hybrid materials and the gap between cork industry and cork research and development teams. The paper concludes by stating that cork is not only a material for wine stoppers anymore, thanks to the awareness of the concept of design for sustainability.

Keywords: cork, design for sustainability, innovation, sustainable materials

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Authors: Zena F. Mushtaq, Iqbal M. Abbas

Abstract:

Background: Diabetes mellitus during pregnancy is one of the major medical and social problems with increasing prevalence in last decades and may lead to more vulnerable to dental problems and increased risk for periodontal diseases. Objectives: To assess oral hygiene behaviors among pregnant women with diabetes who attended primary health care centers and find out the relationship between oral hygiene behaviors and studied variables. Methodology: A cross sectional design was conducted from 7 July to 30 September 2014 on non probability (convenient sample) of 150 pregnant women with diabetes was selected from twelve Primary Health Care Centers at Baghdad city. Questionnaire format is tool for data collection which had designed and consisted of three main parts including: socio demographic, reproductive characteristics and items of oral hygiene behaviors among pregnant women with diabetes. Reliability of the questionnaire was determined through internal consistency of correlation coefficient (R= 0.940) and validity of content was determined through reviewing it by (12) experts in different specialties and was determined through pilot study. Descriptive and inferential statistics were used to analyze collected data. Result: Result of study revealed that (35.3%) of study sample was (35-39) years old with mean and SD is (X & SD = 33.57 ± 5.54) years, and (34.7%) of the study sample was graduated from primary school and less, half of the study sample was government employment and self employed, (42.7%) of the study sample had moderate socioeconomic status, the highest percentage (70.0%) of the study sample was nonsmokers, The result indicates that oral hygiene behaviors have moderate mean score in all items. There are no statistical significant association between oral hygiene domain and studied variables. Conclusions: All items related to health behavior concerning oral hygiene is in moderate mean of score, which may expose pregnant women with diabetes to high risk of periodontal diseases. Recommendations: Dental care provider should perform a dental examination at least every three months for each pregnant woman with diabetes, explanation of the effect of DM on periodontal health, oral hygiene instruction, oral prophylaxis, professional cleaning and treatment of periodontal diseases(scaling and root planing) when needed.

Keywords: diabetes, health behavior, pregnant women, oral hygiene

Procedia PDF Downloads 265

Authors: Marko Jankovic, Aleksandra Knezevic, Maja Cupic, Dragana Vujic, Zeljko Zecevic, Borko Gobeljic, Marija Simic, Tanja Jovanovic

Abstract:

The human cytomegalovirus (CMV) is a notorious pathogen in the pediatric transplant setting. Although studies on factors in complicity with CMV infection abound, the role of age, gender, allogeneic hematopoietic stem cell transplantation (alloHSCT) modality, and underlying disease as regards CMV infection and viral load in children are poorly explored. We examined the significance of various factors related to the risk of CMV infection and viral load in Serbian children and adolescents undergoing alloHSCT. This was a prospective single centre study of thirty two pediatric patients in receipt of alloHSCT for various malignant and non-malignant disorders. Screening for active viral infection was performed by regular weekly monitoring. The Real-Time PCR method was used for CMV DNA detection and quantitation. Statistical analysis was performed using the IBM SPSS Statistics v20 software. Chi-square test was used to evaluate categorical variables. Comparison between scalar and nominal data was done by Wilcoxon-Mann-Whitney test. Pearson correlation was applied for studying the association between patient age and viral load. CMV was detected in 23 (71.9%) patients. Infection occurred significantly more often (p=0.015) in patients with haploidentical donors. The opposite was noted for matched sibling grafts (p=0.006). The viral load was higher in females (p=0.041) and children in the aftermath of alloHSCT with malignant diseases (p=0.019). There was no significant relationship between the viral infection dynamics and overt medical consequences. This is the first study of risk factors for CMV infection in Serbian pediatric alloHSCT patients. Transplanted patients presented with a high incidence of CMV viremia. The HLA compatibility of donated graft is associated with the frequency of CMV positive events. Age, gender, underlying disease, and medically relevant events were not conducive to occurrences of viremia. Notably, substantial viral burdens were evidenced in females and patients with neoplastic diseases. Studies comprising larger populations are clearly needed to scrutinize current results.

Keywords: allogeneic hematopoietic stem cell transplantation, children, cytomegalovirus, risk factors, viral load

Procedia PDF Downloads 133