Search results for: edaphic factors

Authors: Dimakatso Machetele, Clare Kelso, Thea Schoeman

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In developing countries such as India, China, and South Africa, disposal of household solid waste in rural areas is of great concern. Rural communities face numerous challenges that include the absence of waste collection services and sanitation facilities. The inadequate provision of waste collection and sanitation services results to the occurrence of infectious diseases e.g., malaria. The gap in the management of household solid waste between rural and urban communities, whereby urban communities have better waste management services compared to rural areas is an environmental injustice towards rural communities. The unequal distribution of infrastructure in South Africa’s waste management is a concern that stems from the spatial inequalities of the country’s apartheid history. The Limpopo province has a higher proportion of households without waste collection services from the municipality. The present research objectives are to investigate the public’s perceptions and factors contributing to the management of household solid waste in two contrasting rural Wards in the Greater Tzaneen Municipality. There is limited data and studies that have been conducted to understand the management of household solid waste in rural areas, and specifically, for the Greater Tzaneen Municipality located in the Limpopo province, South Africa. The findings of the study will propose recommendations to the Greater Tzaneen Municipality, rural municipalities in South Africa, and globally to explore sustainable methods to manage household solid waste and explore economic opportunities within the waste management sector to alleviate poverty in rural communities.

Keywords: rural, household solid wase, perceptions, waste management

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Authors: Nasra Idilbi, Jalal Tarabeia, Layalleh Masalha, Heiam Shoufani Kassis, Gizell Green

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Background: Healthcare professionals working in underground facilities face unique challenges affecting their physical and mental health and team effectiveness. We aimed to examine how an underground work environment affects the physical and mental health and effectiveness of a multi-professional medical team in a medical center under continuous war threats and the contribution of various demographic and professional characteristics. Methods: A cross-sectional survey was disseminated electronically. The questionnaire assessed team effectiveness, the quality of the work, and the health symptoms reported by the team while working in the underground complex. Results: In total, 270 healthcare workers (mean age 40 years, 75.6% females, 88.4% nurses) completed the questionnaire. Women reported statistically significantly higher mean scores of physical strain, fatigue, and eye irritation associated with the work environment compared to men. Multiple regression analysis revealed that psychological distress, noise, and lighting in the underground compound significantly influenced team effectiveness. The qualitative analysis revealed two key themes: the mental health impact of working in an underground environment and the effects of noise and lighting on staff performance. Nurses reported feelings of suffocation, claustrophobia, and difficulty concentrating due to the enclosed space, with some expressing heightened stress levels that impaired their ability to work effectively and safely. Female staff reported more pronounced symptoms of physical strain, fatigue, and eye irritation. Additionally, the underground complex’s poor noise absorption created a highly disruptive work environment, while inadequate lighting hindered accurate patient assessments, leading to potential errors. These challenges were exacerbated by physical symptoms like headaches and nausea, which further impacted job performance. The findings underscore the significant role of environmental factors in influencing both mental health and operational effectiveness, aligning with quantitative data on the predictors of team performance. Conclusions: The underground work environment is crucial in influencing healthcare team effectiveness, with psychological distress, noise, and lighting as key factors. The study highlights the importance of creating a comfortable work environment to foster team efficiency. The findings provide valuable insights for managers in underground healthcare facilities to optimize team performance and well-being.

Keywords: team effectiveness, underground settings, healthcare, environmental factors, a mixed-methods study

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Authors: Amine M. Benmehaia, Amine Oulmane

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The supply response of agricultural commodities to changes in price incentives is an important issue for the success of any policy reform in the agricultural sector. This study aims to quantify the responsiveness of producers of some livestock commodities to price incentives in Algerian context. Time series analysis is used on annual data for a period of 52 years (1966-2018). Both co-integration and vector error correction model (VECM) are used through the Nerlove model of partial adjustment. The study attempts to determine the long-run and short-run relationships along with the magnitudes of disequilibria in the selected commodities. Results show that the short-run price elasticities are low in cow and sheep meat sectors (8.7 and 8% respectively), while their respective long-run elasticities are 16.5 and 10.5, whereas eggs and milk have very high short-run price elasticities (82 and 90% respectively) with long-run elasticities of 40 and 46 respectively. The error correction coefficient, reflecting the speed of adjustment towards the long-run equilibrium, is statistically significant and have the expected negative sign. Its estimates are 12.7 for cow meat, 33.5 for sheep meat, 46.7 for eggs and 8.4 for milk. It seems that cow meat and milk producers have a weak feedback of about 12.7% and 8.4% respectively of the previous year's disequilibrium from the long-run price elasticity, whereas sheep meat and eggs producers adjust to correct long run disequilibrium with a high speed of adjustment (33.5% and 46.7 % respectively). The implication of this is that much more in-depth research is needed to identify those factors that affect agricultural supply and to describe the effect of factors that shift supply in response to price incentives. This could provide valuable information for government in the use of appropriate policy measures.

Keywords: Algeria, cointegration, livestock, supply response, vector error correction model

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Authors: Zegeye Abebe

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Background: Unhealthy diet is a major risk factor for CRC. This study assessed diet-related CRC burden from 1990 to 2021 in Organization for Economic Co-operation and Development (OECD) nations and estimated the burden until 2050 Methods: Data for OECD countries on diet-related CRC disability-adjusted life years (DALYs) and deaths were obtained from the Global Burden of Disease (GBD), 2021. The estimated annual percent change (EAPC) was calculated to analyse the CRC burden attributable to dietary factors. A generalised additive model with negative binomial distribution was used to predict the future burden of CRC attributable to dietary factors from 2021 to 2050. Results: In 2021, the age-standardised percentage of diet-related CRC DALYs and deaths were 39.1% (95% uncertainty interval (UI): 9.3, 61.3) and 39.0% (95% UI: 9.7, 60.9), respectively, in the OECD countries. Between 1990 and 2021, the age-standardised DALYs decreased from 185 to 129 per 100,000, and deaths decreased from 8 to 6 per 100,000 population for OECD countries. Similarly, the EAPC of rates showed a downward trend (EAPCdeaths = -1.26, and EAPCDALYs = -1.20). The estimated diet-related CRC DALYs and deaths are projected to increase to 4.1 million DALYs and 0.2 million deaths by 2050. There has been a downward trend in CRC deaths (EAPC = 1.33 for both sexes) and in DALYs (-0.90 for males and -1.0 for females) from 1990 to 2050. Conclusion: Diet-related CRC burden remains significant. Implementation of nutrition intervention programmes is necessary to promote access to affordable and nutritious foods and to raise awareness about the importance of a healthy diet in reducing CRC risk.

Keywords: colorectal cancer, dietary factor, age-standardized DALYs rate, age-standardized death rate, global burden of diseases

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Authors: Tan Hui Ying Renee, Stella Rizalina Sasha, Farah Safdar Husain

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Introduction: Menopause Hormone Therapy (MHT) is an effective drug indicated for the treatment of menopausal symptoms and as replacement therapy in women who undergo premature menopause. In 2020, less than 8.8% of perimenopausal Singaporean women are on hormonal therapy, as compared to the Western population, where up to 50% may be on MHT. Factors associated with MHT utilization have been studied from patient characteristics, but the impact of locally prescribing physicians resulting in low MHT utilization has yet to be evaluated. The aim of the study is to determine the level of knowledge physicians in the Obstetrics and Gynaecology specialty have and their attitudes toward MHT. We believe that knowledge of MHT is lacking and that negative attitudes towards MHT may influence its use and undermine the benefits MHT may have for women. This paper is a part of a larger study on Singaporean physicians’ knowledge and attitudes towards MHT. Methods: This is a cross-sectional study intended to assess the knowledge and attitudes of physicians toward Menopausal Hormone Therapy. An anonymous questionnaire was disseminated via institutional internal circulations to optimize reach to physicians who may prescribe MHT, particularly in the fields of Gynaecology, Family Medicine and Endocrinology. Responses were completed voluntarily. Physicians had the option for each question to declare that they were ‘unsure’ or that the question was ‘beyond their expertise’. 21 knowledge questions tested factual recall on indications, contraindications, and risks of MHT. The remaining 6 questions were clinical scenarios crafted with the intention of testing specific principles related to the use of MHT. These questions received face validation from experts in the field. 198 responses were collected, 79 of which were from physicians in the Obstetrics and Gynaecology specialty. The data will be statistically analyzed to investigate areas that can be improved to increase the overall benefits of MHT for the Singaporean population. Results: Preliminary results show that the prevailing factors that limit Singaporean gynecologists and obstetricians from prescribing MHT are a lack of knowledge of MHT and a lack of confidence in prescribing MHT. Risks and indications of MHT were not well known by many physicians, with the majority of the questions having more than 25% incorrect and ‘unsure’ as their reply. The clinical scenario questions revealed significant shortcomings in knowledge on how to navigate real-life challenges in MHT use, with 2 of 6 questions with more than 50% incorrect or ‘beyond their expertise’ as their reply. The portion of the questionnaire that investigated the attitudes of physicians showed that though a large majority believed MHT to be an effective drug, only 40.5% were confident in prescribing it. Conclusion: Physicians in the Obstetrics and Gynaecology specialty lack knowledge and confidence in MHT. Therefore, it is imperative to formulate solutions on both the individual and institutional levels to fill these gaps and ensure that MHT is used appropriately and prescribed to the patients who need it.

Keywords: menopause, menopause hormone therapy, physician factors, obstetrics and gynecology, menopausal symptoms, Singapore

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Authors: Hamza Saeed, Khurram Iqbal Ahmad Khan

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Effective information management is crucial for any construction project and its success. Primary areas of information generation are either the construction site or the design office. There are different types of information required at different stages of construction involving various stakeholders creating complexity. There is a need for effective management of information flows to reduce uncertainty creating complexity. Nature provides a unique perspective in terms of dealing with complexity, in particular, information complexity. System dynamics methodology provides tools and techniques to address complexity. It involves modeling and simulation techniques that help address complexity. Nature has been dealing with complex systems since its creation 4.5 billion years ago. It has perfected its system by evolution, resilience towards sudden changes, and extinction of unadaptable and outdated species that are no longer fit for the environment. Nature has been accommodating the changing factors and handling complexity forever. Humans have started to look at their natural counterparts for inspiration and solutions for their problems. This brings forth the possibility of using a biomimetics approach to improve the management practices used in the construction sector. Ants inhabit different habitats. Cataglyphis and Pogonomyrmex live in deserts, Leafcutter ants reside in rainforests, and Pharaoh ants are native to urban developments of tropical areas. Detailed studies have been done on fifty species out of fourteen thousand discovered. They provide the opportunity to study the interactions in diverse environments to generate collective behavior. Animals evolve to better adapt to their environment. The collective behavior of ants emerges from feedback through interactions among individuals, based on a combination of three basic factors: The patchiness of resources in time and space, operating cost, environmental stability, and the threat of rupture. If resources appear in patches through time and space, the response is accelerating and non-linear, and if resources are scattered, the response follows a linear pattern. If the acquisition of energy through food is faster than energy spent to get it, the default is to continue with an activity unless it is halted for some reason. If the energy spent is rather higher than getting it, the default changes to stay put unless activated. Finally, if the environment is stable and the threat of rupture is low, the activation and amplification rate is slow but steady. Otherwise, it is fast and sporadic. To further study the effects and to eliminate the environmental bias, the behavior of four different ant species were studied, namely Red Harvester ants (Pogonomyrmex Barbatus), Argentine ants (Linepithema Humile), Turtle ants (Cephalotes Goniodontus), Leafcutter ants (Genus: Atta). This study aims to improve the information system in the construction sector by providing a guideline inspired by nature with a systems-thinking approach, using system dynamics as a tool. Identified factors and their interdependencies were analyzed in the form of a causal loop diagram (CLD), and construction industry professionals were interviewed based on the developed CLD, which was validated with significance response. These factors and interdependencies in the natural system corresponds with the man-made systems, providing a guideline for effective use and flow of information.

Keywords: biomimetics, complex systems, construction management, information management, system dynamics

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Authors: Terryann Clark, Kabir Dasgupta, Sonia Lewycka, Gail Pacheco, Alexander Plum

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This paper focused on two main research aims using data from the Growing Up in New Zealand (GUINZ) birth cohort: 1. To examine ethnic differences in life-course trajectories in the use and experience of healthcare services in early childhood years (namely immunisation, dental checks and use of General Practitioners (GPs)) 2. To quantify the contribution of relevant explanatory factors to ethnic differences. Current policy in New Zealand indicates there should be, in terms of associated direct costs, equitable access by ethnicity for healthcare services. However, empirical evidence points to persistent ethnic gaps in several domains. For example, the data highlighted that Māori have the lowest immunisation rates, across a number of time points in early childhood – despite having a higher antenatal intention to immunise relative to NZ European. Further to that, NZ European are much more likely to have their first-choice lead maternity caregiver (LMC) and use child dental services compared to all ethnicities. Method: This research explored the underlying mechanisms behind ethnic differences in the use and experience of child healthcare services. First, a multivariate regression analysis was used to adjust raw ethnic gaps in child health care utilisation by relevant covariates. This included a range of factors, encompassing mobility, socio-economic status, mother and child characteristics, household characteristics and other social aspects. Second, a decomposition analysis was used to assess the proportion of each ethnic gap that can be explained, as well as the main drivers behind the explained component. The analysis for both econometric approaches was repeated for each data time point available, which included antenatal, 9 months, 2 years and 4 years post-birth. Results: The following findings emerged: There is consistent evidence that Asian and Pacific peoples have a higher likelihood of child immunisation relative to NZ Europeans and Māori. This was evident at all time points except one. Pacific peoples had a lower rate relative to NZ European for receiving all first-year immunisations on time. For a number of potential individual and household predictors of healthcare service utilisation, the association is time-variant across early childhood. For example, socio-economic status appears highly relevant for timely immunisations in a child’s first year, but is then insignificant for the 15 month immunisations and those at age 4. Social factors play a key role. This included discouragement or encouragement regarding child immunisation. When broken down by source, discouragement by family has the largest marginal effect, followed by health professionals; whereas for encouragement, medical professionals have the largest positive influence. Perceived ethnically motivated discrimination by a health professional was significant with respect to both reducing the likelihood of achieving first choice LMC, and also satisfaction levels with child’s GP. Some ethnic gaps were largely unexplained, despite the wealth of factors employed as independent variables in our analysis. This included understanding why Pacific mothers are much less likely to achieve their first choice LMC compared to NZ Europeans; and also the ethnic gaps for both Māori and Pacific peoples relative to NZ Europeans concerning dental service use.

Keywords: child health, cohort analysis, ethnic disparities, primary healthcare

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Authors: Mesfin Nigussie

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The objectives of the study were to identify factors affecting rural households’ willingness to install biogas plant and amount willingness to pay in order to examine determinants of effective demand for biogas technology. A multistage sampling technique was employed to select 120 respondents for the study. The binary probit regression model was employed to identify factors affecting rural households’ decision to install biogas technology. The probit model result revealed that household size, total household income, access to extension services related to biogas, access to credit service, proximity to water sources, perception of households about the quality of biogas, perception index about attributes of biogas, perception of households about installation cost of biogas and availability of energy source were statistically significant in determining household’s decision to install biogas. Tobit model was employed to examine determinants of rural household’s amount of willingness to pay. Based on the model result, age of the household head, total annual income of the household, access to extension service and availability of other energy source were significant variables that influence willingness to pay. Providing due considerations for extension services, availability of credit or subsidy, improving the quality of biogas technology design and minimizing cost of installation by using locally available materials are the main suggestions of this research that help to create effective demand for biogas technology.

Keywords: biogas technology, effective demand, probit model, tobit model, willingnes to pay

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Authors: Miral Selim, May Haggag, Ibrahim Abotaleb

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The aging of transportation infrastructure presents significant challenges, particularly concerning the monitoring and maintenance of bridges. This study investigates the application of Random Forest algorithms for predictive modeling of bridge conditions, utilizing data from the US National Bridge Inventory (NBI). The research is significant as it aims to improve bridge management through data-driven insights that can enhance maintenance strategies and contribute to overall safety. Random Forest is chosen for its robustness, ability to handle complex, non-linear relationships among variables, and its effectiveness in feature importance evaluation. The study begins with comprehensive data collection and cleaning, followed by the identification of key variables influencing bridge condition ratings, including age, construction materials, environmental factors, and maintenance history. Random Forest is utilized to examine the relationships between these variables and the predicted bridge conditions. The dataset is divided into training and testing subsets to evaluate the model's performance. The findings demonstrate that the Random Forest model effectively enhances the understanding of factors affecting bridge conditions. By identifying bridges at greater risk of deterioration, the model facilitates proactive maintenance strategies, which can help avoid costly repairs and minimize service disruptions. Additionally, this research underscores the value of data-driven decision-making, enabling better resource allocation to prioritize maintenance efforts where they are most necessary. In summary, this study highlights the efficiency and applicability of Random Forest in predictive modeling for bridge management. Ultimately, these findings pave the way for more resilient and proactive management of bridge systems, ensuring their longevity and reliability for future use.

Keywords: data analysis, random forest, predictive modeling, bridge management

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Authors: Huimin Liu, Li Xiang, Yue Liu, Jing Wang

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Background: As one of typical case for the developing countries who are stepping into the aging times globally, more and more older people in China might face the problem of which they could not maintain normal life due to the functional disability. While the government take efforts to build long-term care system and further carry out related policies for the core concept, there is still lack of strong evidence to evaluating the profile of disability states in the elderly population and its transition rate. It has been proved that disability is a dynamic condition of the person rather than irreversible so it means possible to intervene timely on them who might be in a risk of severe disability. Objective: The aim of this study was to depict the picture of the disability transferring status of the older people in China, and then find out individual characteristics that change the state of disability to provide theory basis for disability prevention and early intervention among elderly people. Methods: Data for this study came from the 2011 baseline survey and the 2013 follow-up survey of the China Health and Retirement Longitudinal Study (CHARLS). Normal ADL function, 1~2 ADLs disability,3 or above ADLs disability and death were defined from state 1 to state 4. Multi-state Markov model was applied and the four-state homogeneous model with discrete states and discrete times from two visits follow-up data was constructed to explore factors for various progressive stages. We modeled the effect of explanatory variables on the rates of transition by using a proportional intensities model with covariate, such as gender. Result: In the total sample, state 2 constituent ratio is nearly about 17.0%, while state 3 proportion is blow the former, accounting for 8.5%. Moreover, ADL disability statistics difference is not obvious between two years. About half of the state 2 in 2011 improved to become normal in 2013 even though they get elder. However, state 3 transferred into the proportion of death increased obviously, closed to the proportion back to state 2 or normal functions. From the estimated intensities, we see the older people are eleven times as likely to develop at 1~2 ADLs disability than dying. After disability onset (state 2), progression to state 3 is 30% more likely than recovery. Once in state 3, a mean of 0.76 years is spent before death or recovery. In this model, a typical person in state 2 has a probability of 0.5 of disability-free one year from now while the moderate disabled or above has a probability of 0.14 being dead. Conclusion: On the long-term care cost considerations, preventive programs for delay the disability progression of the elderly could be adopted based on the current disabled state and main factors of each stage. And in general terms, those focusing elderly individuals who are moderate or above disabled should go first.

Keywords: Markov model, elderly people, disability, transition intensity

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Authors: Naava Dihi, Jon Anson

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Love, so it appears, is not socially blind. We show that partner selection is socially constrained, and the freedom to choose is limited by at least two major factors or capitals: on the one hand, material resources and education, locating the partners on a scale of personal achievement and economic independence. On the other, the partners' ascriptive belonging to particular ethnic, or origin, groups, differentiated by the groups' social prestige, as well as by their culture, history and even physical characteristics. However, the relative importance of achievement and ascriptive factors, as well as the overlap between them, varies from society to society, depending on the society's structure and the factors shaping it. Israeli social structure has been shaped by the waves of new immigrants who arrived over the years. The timing of their arrival, their patterns of physical settlement and their occupational inclusion or exclusion have together created a mosaic of social groups whose principal common feature has been the country of origin from which they arrived. The analysis of marriage patterns helps illuminate the social meanings of the groups and their borders. To the extent that ethnic group membership has meaning for individuals and influences their life choices, the ascriptive factor will gain in importance relative to the achievement factor in their choice of marriage partner. In this research, we examine Jewish Israeli marriage patterns by looking at the marriage choices of 5,041 women aged 15 to 49 who were single at the census in 1983, and who were married at the time of the 1995 census, 12 years later. The database for this study was a file linking respondents from the 1983 and the 1995 censuses. In both cases, 5 percent of household were randomly chosen, so that our sample includes about 4 percent of women in Israel in 1983. We present three basic analyses: (1) Who was still single in 1983, using personal and household data from the 1983 census (binomial model), (2) Who married between 1983 and a1995, using personal and household data from the 1983 census (binomial model), (3) What were the personal characteristics of the womens’ partners in 1995, using data from the 1995 census (loglinear model). We show (i) that material and cultural capital both operate to delay marriage and to increase the probability of remaining single; and (ii) while there is a clear association between ethnic group membership and education, endogamy and homogamy both operate as separate forces which constraint (but do not determine) the choice of marriage partner, and thus both serve to reproduce the current pattern of relationships, as well as identifying patterns of proximity and distance between the different groups.

Keywords: Israel, nuptiality, ascription, achievement

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Authors: Mohammed Jarrar, Shalini Behl, Nadia Shaheen, Abeer Fatima, Reem Nasab

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Skin aging is a slow multifactorial process influenced by both internal as well as external factors. Ultra-violet radiations (UV), diet, smoking and personal habits are the most common environmental factors that affect skin aging. Fat contents and fibrous proteins as collagen and elastin are core internal structural components. The direct influence of UV on elastin integrity and health is crucial on aging of skin by time. The deposition of abnormal elastic material is a major marker in a photo-aged skin. Searching for compounds that may protect against cutaneous photo-damage is highly valued. Retinoids and Alpha Hydroxy Acids protective and or repairing effects of UV have been endorsed by some researchers. For consolidating a better understanding of anti and protective effects of such anti-aging agents, we evaluated the combinatory effects of various dosages of lactic acid and retinol on the dermal fibroblasts elastin levels exposed to UV. The UV exposed cells showed significant reduction in the elastin levels. A combination of drugs with a higher concentration of lactic acid (30-35 mM) and a lower concentration of retinol (10-15mg/mL) showed to work better in enhancing elastin concentration in UV exposed cells. We assume this enhancement could be the result of increased tropo-elastin gene expression stimulated by retinol and lactic acid probably repaired the UV irradiated damage by enhancing the amount and integrity of the elastin fibers.

Keywords: alpha hydroxy acid, elastin, retinol, ultraviolet radiations

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Authors: Mounir Soule, Hindatou Saidou, Razafimahefa, Mohamed Thani Ibouroi

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High levels of habitat fragmentation and loss are the main drivers of plant species extinction. They reduce the habitat quality, which is a determining factor for the reproduction of plant species, and generate strong selective pressures for habitat selection, with impacts on the reproduction and survival of individuals. The Comorian’s yam (Dioscorea comorensis) is one of the most threatened plant species of the Comoros archipelago. The species faces one of the highest rates of habitat loss worldwide (9.3 % per year) and is classified as Endangered in the IUCN red list. Despite the nutritional potential of this tuber, the Comorian’s yam cultivation remains neglected by local populations due probably to lack of knowledge on its nutritional importance and the factors driving its spatial distribution and development. In this study, we assessed the nutritional characteristics of Dioscorea comorensis and the drivers of spatial distribution and abundance to propose conservation measures and improve crop yields. To determine the nutritional characteristics, the Kjeldahl method, the Soxhlet method, and Atwater's specific calorific coefficients methods were applied for analyzing proteins, lipids, and caloric energy respectively. In addition, atomic absorption spectrometry was used to measure mineral particles. By combining species occurrences with ecological (habitat types), climatic (temperature, rainfall, etc.), and physicochemical (soil types and quality) variables, we assessed habitat suitability and spatial distribution of the species and the factors explaining the origin, persistence, distribution and competitive capacity of a species using a Species Distribution Modeling (SDM) method. The results showed that the species contains 83.37% carbohydrates, 6.37% protein, and 0.45% lipids. In 100 grams, the quantities of Calcium, Sodium, Zinc, Iron, Copper, Potassium, Phosphorus, Magnesium, and Manganese are respectively 422.70, 599.41, 223.11, 252.32, 332.20, 780.41, 444.17, 287.71 and 220.73 mg. Its PRAL index is negative (- 9.80 mEq/100 g), and its Ca/P (0.95) and Na/K (0.77) ratios are less than 1. This species provides an energy value of 357.46 Kcal per 100 g, thanks to its carbohydrates and minerals and is distinguished from others by its high protein content, offering benefits for cardiovascular health. According to our SDM, the species has a very limited distribution, restricted to forests with higher biomass, humidity, and clay. Our findings highlight how distribution patterns are related to ecological and environmental factors. They also emphasize how the Comoros yam is beneficial in terms of nutritional quality. Our results represent a basic knowledge that will help scientists and decision-makers to develop conservation strategies and to improve crop yields.

Keywords: Dioscorea comorensis, nutritional characteristics, species distribution modeling, conservation strategies, crop yields improvement

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Authors: Melkamu A. Zeru, Aweke A. Mitiku, Endashaw Amuka

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Background: Under-five mortality is the likelihood that a baby will pass away before turning exactly 5 years old, represented as a percentage per 1,000 live births. Exploring the spatial distribution and identifying the temporal pattern is important to reducing under-five child mortality globally, including in Ethiopia. Thus, this study aimed to identify the risk factors of under-five mortality and the spatiotemporal variation in Ethiopian administrative zones. Method: This study used the 2000-2016 Ethiopian Demographic and Health Survey (EDHS) data, which were collected using a two-stage sampling method. A total of 43,029 (10,873 in 2000, 9,861 in 2005, 11,654 in 2011, and 10,641 in 2016) weighted sample under-five child mortality was used. The space-time dynamic model was employed to account for spatial and time effects in 65 administrative zones in Ethiopia. Results: From the result of a general nesting spatial-temporal dynamic model, there was a significant space-time interaction effect [γ = -0.1444, 95 % CI (-0.6680, -0.1355)] for under-five mortality. The increase in the percentages of mothers illiteracy [𝛽 = 0.4501, 95% CI (0.2442, 0.6559)], not vaccinated[𝛽= 0.7681, 95% CI (0.5683, 0.9678)], unimproved water[𝛽= 0.5801, CI (0.3793, 0.7808)] were increased death rates for under five children while increased percentage of contraceptive use [𝛽= -0.6609, 95% CI (-0.8636, -0.4582)] and ANC visit > 4 times [𝛽= -0.1585, 95% CI(-0.1812, -0.1357)] were contributed to the decreased under-five mortality rate at the zone in Ethiopia. Conclusions: Even though the mortality rate for children under five has decreased over time, still there is still higher in different zones of Ethiopia. There exists spatial and temporal variation in under-five mortality among zones. Therefore, it is very important to consider spatial neighbourhoods and temporal context when aiming to avoid under-five mortality.

Keywords: under-five children mortality, space-time dynamic, spatiotemporal, Ethiopia

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Authors: Alexandros Lioulemes, Michail Theofanidis, Varun Kanal, Konstantinos Tsiakas, Maher Abujelala, Chris Collander, William B. Townsend, Angie Boisselle, Fillia Makedon

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This paper presents a home-based robot-rehabilitation instrument, called ”MAGNI Dynamics”, that utilized a vision-based kinematic/dynamic module and an adaptive haptic feedback controller. The system is expected to provide personalized rehabilitation by adjusting its resistive and supportive behavior according to a fuzzy intelligence controller that acts as an inference system, which correlates the user’s performance to different stiffness factors. The vision module uses the Kinect’s skeletal tracking to monitor the user’s effort in an unobtrusive and safe way, by estimating the torque that affects the user’s arm. The system’s torque estimations are justified by capturing electromyographic data from primitive hand motions (Shoulder Abduction and Shoulder Forward Flexion). Moreover, we present and analyze how the Barrett WAM generates a force-field with a haptic controller to support or challenge the users. Experiments show that by shifting the proportional value, that corresponds to different stiffness factors of the haptic path, can potentially help the user to improve his/her motor skills. Finally, potential areas for future research are discussed, that address how a rehabilitation robotic framework may include multisensing data, to improve the user’s recovery process.

Keywords: human-robot interaction, kinect, kinematics, dynamics, haptic control, rehabilitation robotics, artificial intelligence

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Authors: Heena Dabas, Anju Paul, Suman Chaurasia, Ramesh Agarwal, M. Jeeva Sankar, Anurag Bajpai, Manju Saksena

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Background: Traumatic lumbar puncture (LP) is a common occurrence and causes substantial diagnostic ambiguity. There is paucity of data regarding its epidemiology. Objective: To assess the incidence and risk factors of traumatic LP in newborns. Design/Methods: In a prospective cohort study, all inborn neonates admitted in NICU and planned to undergo LP for a clinical indication of sepsis were included. Neonates with diagnosed intraventricular hemorrhage (IVH) of grade III and IV were excluded. The LP was done by operator - often a fellow or resident assisted by bedside nurse. The unit has policy of not routinely using any sedation/analgesia during the procedure. LP is done by 26 G and 0.5-inch-long hypodermic needle inserted in third or fourth lumbar space while the infant is in lateral position. The infants were monitored clinically and by continuous measurement of vital parameters using multipara monitor during the procedure. The occurrence of traumatic tap along with CSF parameters and other operator and assistant characteristics were recorded at the time of procedure. Traumatic tap was defined as presence of visible blood or more than 500 red blood cells on microscopic examination. Microscopic trauma was defined when CSF is not having visible blood but numerous RBCs. The institutional ethics committee approved the study protocol. A written informed consent from the parents and the health care providers involved was obtained. Neonates were followed up till discharge/death and final diagnosis was assigned along with treating team. Results: A total of 362 (21%) neonates out of 1726 born at the hospital were admitted during the study period (July 2016 to January, 2017). Among these neonates, 97 (26.7%) were suspected of sepsis. A total of 54 neonates were enrolled who met the eligibility criteria and parents consented to participate in the study. The mean (SD) birthweight was 1536 (732) grams and gestational age 32.0 (4.0) weeks. All LPs were indicated for late onset sepsis at the median (IQR) age of 12 (5-39) days. The traumatic LP occurred in 19 neonates (35.1%; 95% C.I 22.6% to 49.3%). Frank blood was observed in 7 (36.8%) and in the remaining, 12(63.1%) CSF was detected to have microscopic trauma. The preliminary risk factor analysis including birth weight, gestational age and operator/assistant and other characteristics did not demonstrate clinically relevant predictors. Conclusion: A significant number of neonates requiring lumbar puncture in our study had high incidence of traumatic tap. We were not able to identify modifiable risk factors. There is a need to understand the reasons and further reduce this issue for improving management in NICUs.

Keywords: incidence, newborn, traumatic, lumbar puncture

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Authors: Caitlin Bailey, Marian Frattarola Saulino, Beth Steinberg

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Today, virtually all programs offered to people with intellectual and developmental disabilities tout themselves as person-centered, community-based and inclusive, yet there is a vast range in type and quality of services that use these similar descriptors. The issue is exacerbated by the fields’ measurement practices around quality, inclusion, independent living, choice and person-centered outcomes. For instance, community inclusion for people with disabilities is often measured by the number of times person steps into his or her community. These measurement approaches set standards for quality too low so that agencies supporting group home residents to go bowling every week can report the same outcomes as an agency that supports one person to join a book club that includes people based on their literary interests rather than disability labels. Ultimately, lack of delineation in measurement contributes to the confusion between face value “quality” and true quality services and supports for many people with disabilities and their families. This exploratory study adopts alternative approaches to quality measurement including co-production methods and systems theoretical framework in order to identify the factors that 1) lead to high-quality supports and, 2) differentiate high-quality services. Project researchers have partnered with community practitioners who are all committed to providing quality services and supports but vary in the degree to which they are actually able to provide them. The study includes two parts; first, an online survey distributed to more than 500 agencies that have demonstrated commitment to providing high-quality services; and second, four in-depth case studies with agencies in three United States and Israel providing a variety of supports to children and adults with disabilities. Results from both the survey and in-depth case studies were thematically analyzed and coded. Results show that there are specific factors that differentiate service quality; however meaningful quality measurement practices also require that researchers explore the contextual factors that contribute to quality. These not only include direct services and interactions, but also characteristics of service users, their environments as well as organizations providing services, such as management and funding structures, culture and leadership. Findings from this study challenge researchers, policy makers and practitioners to examine existing quality service standards and measurements and to adopt alternate methodologies and solutions to differentiate and scale up evidence-based quality practices so that all people with disabilities have access to services that support them to live, work, and enjoy where and with whom they choose.

Keywords: co-production, inclusion, independent living, quality measurement, quality supports

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Authors: Jyh-Ping Chen, Yu-Tin Lai

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Wound healing is a complicated process involving overlapping hemostasis, inflammation, proliferation, and maturation phases. Ideal wound dressings can replace native skin functions in full thickness skin wounds through faster healing rate and also by reducing scar formation. Poly(lactic-co-glycolic acid) (PLGA) is an U.S. FDA approved biodegradable polymer to be used as ideal wound dressing material. Several in vitro and in vivo studies have demonstrated the effectiveness of curcumin in decreasing the release of inflammatory cytokines, inhibiting enzymes associated with inflammations, and scavenging free radicals that are the major cause of inflammation during wound healing. Heparin has binding affinities to various growth factors. With the unique and beneficial features offered by those molecules toward the complex process of wound healing, we postulate a composite wound dressing constructed from PLGA, curcumin and heparin would be a good candidate to accelerate scarless wound healing. In this work, we use electrospinning to prepare curcumin-loaded aligned PLGA nanofibrous membranes (PC NFMs). PC NFMs were further subject to oxygen plasma modification and surfaced-grafted with heparin through carbodiimide-mediated covalent bond formation to prepare curcumin-loaded PLGA-g-heparin (PCH) NFMs. The nanofibrous membranes could act as three-dimensional scaffolds to attract fibroblast migration, reduce inflammation, and increase wound-healing related growth factors concentrations at wound sites. From scanning electron microscopy analysis, the nanofibers in each NFM are with diameters ranging from 456 to 479 nm and with alignment angles within  0.5°. The NFMs show high tensile strength and good water absorptivity and provide suitable pore size for nutrients/wastes transport. Exposure of human dermal fibroblasts to the extraction medium of PC or PCH NFM showed significant protective effects against hydrogen peroxide than PLGA NFM. In vitro wound healing assays also showed that the extraction medium of PCH NFM showed significantly better migration ability toward fibroblasts than PC NFM, which is further better than PLGA NFM. The in vivo healing efficiency of the NFMs was further evaluated by a full thickness excisional wound healing diabetic rat model. After 14 days, PCH NFMs exhibits 86% wound closure rate, which is significantly different from other groups (79% for PC and 73% for PLGA NFM). Real-time PCR analysis indicated PC and PCH NFMs down regulated anti-oxidative enzymes like glutathione peroxidase (GPx) and superoxide dismutase (SOD), which are well-known transcription factors involved in cellular inflammatory responses to stimuli. From histology, the wound area treated with PCH NFMs showed more vascular lumen formation from immunohistochemistry of α-smooth muscle actin. The wound site also had more collagen type III (65.8%) expression and less collagen type I (3.5%) expression, indicating scar-less wound healing. From Western blot analysis, the PCH NFM showed good affinity toward growth factors from increased concentration of transforming growth factor-β (TGF-β) and fibroblast growth factor-2 (FGF-2) at the wound site to accelerate wound healing. From the results, we suggest PCH NFM as a promising candidate for wound dressing applications.

Keywords: Curcumin, heparin, nanofibrous membrane, poly(lactic-co-glycolic acid) (PLGA), wound dressing

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Authors: Omid Ghaffarzadeh Mollabashi, Sara Khorshidi, Hossein Kermanian Seyed, Majid Zabihzadeh

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The main problem that hinders the intensive use of non-wood raw materials in papermaking industry is the environmental pollution caused by black liquor. As a matter of fact, black liquor of nonwood pulping is discharged to the environment due to the lack of recovery. Traditionally, NaOH pulping produces Na-based black liquor that may increase soil erosion and reduce soil permeability. With substitution of KOH/NH4OH with NaOH as the cooking liquor, K and N can act as a soil fertilizer while offering an environmentally acceptable disposal alternative. For this purpose, rice straw samples were pulped under the following conditions; Constant factors were: straw weight: 100 gram (based on oven dry), liquor to straw ratio 7:1 and maximum temperature, 170 and 180 ºC. Variable factors for KOH cooks were: KOH dosage of 14, 17 and %20 on oven dry of straw and times at maximum temperature of 60 and 90 minutes. For KOH-NH4OH cooks, KOH dosage of 5 and %10 and NH4OH dosage of 25 and %35, both based as oven dry of straw were applied. Besides, time at maximum temperature was 90 minutes. Yield ranges of KOH and KOH-NH4OH pulp samples were obtained from 37.28 to 48.62 and 45.63 to 48.08 percent, respectively. In addition, Kappa number ranged from 21.91 to 29.85 and 55.15 to 56.25, respectively. In comparison with soda, soda-AQ, cold soda, kraft, EDA (dissolving), De-Ethylene Glycol (dissolving), burst and tensile index for KOH pulp was more in similar cooking condition. With an exception of soda pulps, tear index of the mentioned pulp is more than all compared treatments. Therefore, it can be resulted that KOH pulping method is an appropriate choice for making paper of the rice straw. Also, compared to KOH-NH4OH, KOH pulping method is more appropriate choice because of better pulping results.

Keywords: environmentally friendly process, rice straw, NH4OH-KOH pulping, pulp properties

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Authors: Ebenezer Bayode Agboola

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The study investigated the influence of socioeconomic factors on crime perpetuation among inmates of correctional facilities in South West Nigeria. A sample size of two hundred and forty-four inmates was drawn from Ado, Akure and Ilesha correctional facilities. The sample size consisted of both male and female inmates. Individual inmate was drawn through systematic sampling with the use of inmates’ register at the correctional facilities. The study employed a mixed design, which allowed the blend of both quantitative and qualitative methods. For the quantitative method, data was collected through the use of a questionnaire and for the qualitative method; data was collected with the aid of an in-depth interview (ID. Four research questions were raised for the study and analysed descriptively using simple frequency count and percentage. Five research hypotheses were formulated for the study and tested using Analysis of Variance (ANOVA) and Multiple Regressions. Based on the data analysis, findings revealed that there was a significant relationship between family history and perpetuation of crime among inmates. Though no significant relationship was found between employment and the perpetuation of crime, however, the rate of crime perpetuation by individuals was significantly found to be related to peer pressure. Also, the study further found that there was a significant relationship between the use of substances and perpetuation of crime. Lastly, it was found that there was a significant relationship between family history, employment, and peer pressure. The study recommended that Parents should pay adequate attention to their children, especially during the adolescent stage and that the Government should enact relevant laws that will checkmate the rising involvement of young people in cybercrime or internet fraud.

Keywords: crime, socio economic factor, inmates, correctional facilities, Southwest

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Authors: Dandeswar Bisoyi, Preeti Yadav, Utpal Barua

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This study address particular way that verbal information can affect the processing of positive and interesting qualities which help in making the brand attractive to the consumer. Also, it address the development of a communication strategy which is a very important part of the marketing plan we have to take into account many factors. Out of all the product strengths, the strategy has to outline one marked differential which will drive our brand. This is the fundamental base on which the entire creative strategy will be big idea-based.

Keywords: copy writing, advertisement, marketing, branding, recall

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Authors: Mohamed Adel Ahmed, Warda Youssef Morsy , Hanaa Ali El Feky

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Background: Literature review cited that sleep is absolutely essential for surviving and reclamation of the quality of life. Critically ill patients often have poor sleep quality with prolonged sleep latency, sleep fragmentation, decreased sleep efficiency and frequent arousals. Nurses have a unique role for the early diagnosis of sleep disorders, decreasing stressors levels and providing the necessary environmental regulations to create a therapeutic ambiance. The aim of the study: to assess perceived sleep quality and identify factors affecting sleep quality among adult critically ill patients At El Manial University Hospital. Research Design: A descriptive exploratory design was utilized. Research questions: a) how do adult critically ill patients perceive sleep quality in the Critical Care Department of El Manial University Hospital? b) What are the factors affecting sleep quality among adult critically ill patients at El Manial University Hospital? Setting: selected critical and cardiac care units at El Manial University Hospital. Sample: A samples of convenience consisting of 100 adult male and female patients were included in the study. Tools of data collection: tool 1: Socio-demographic and Medical Data Sheet, tool 2: Modified St Mary's Hospital Sleep Questionnaire tool 3: Factors Affecting Sleep Quality Questionnaire among ICU Patients Results: The current study revealed that 76.0% of the studied sample had lack of sleep disturbance before hospitalization. However, 84 % had sleep disturbances during ICU stay, of these more than two-thirds (67 %) had moderate sleep disturbance. Presence of strange and bad odors, noise, having pain, fear of death and a loud voice produced by the ICU personnel had the most significant negative impact on patients’ sleep in percentage of 52.4, 50, 61.9, 45.2, 52.4, respectively. Conclusion: Sleep disturbances in the ICU are multifactorial, and ICU patients’ perceived degrees of sleep disturbance as a moderate. Recommendations: Based on findings of the present study, the following are recommended to be done by ICU nurses; create a healing ICU environment that should incorporate noise, light and temperature controls; decrease stimuli during night time hours to promote regulation of the circadian rhythm, allow usage of sleeping aids such as relaxing music, eye patches and earplugs into their daily nursing practice; cluster nursing activities and eliminate non-essential treatments during night time hours to allow uninterrupted sleep periods of at least 90 minutes to complete one sleep cycle , and minimize staff conversation, alarm noise and light during the quiet night time hours.

Keywords: sleep quality, critically ill, patients, perception

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Authors: Nevila Bardhi, Joanna Magda, Kolapo Alex-Oni, Slavenka Sedlar, Paromita Hore

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The New York City Department of Health and Mental Hygiene (NYC DOHMH) receives blood lead test results for NYC residents and conducts lead poisoning case investigations for individuals with elevated blood lead levels exposed to lead occupationally and non-occupationally. To (1) improve participant engagement, (2) aid the identification of potential lead sources, and (3) better tailor recommendations to reduce lead exposure, Motivational Interviewing (MI) techniques were incorporated during risk assessment interviews of non-pregnant adults by DOHMH’s Adult Lead Poisoning Prevention (ALP) Program. MI is an evidence-based counselling method used in clinical settings that have been effective in promoting behavior change by resolving ambivalence and enhancing motivation in treating both physiological and psychological health conditions. The incorporation of MI techniques in the ALP risk assessment interview was effective in improving the identification of lead sources for non-pregnant adult cases, thus, allowing for the opportunity to better tailor lead poisoning prevention recommendations. The embedding of MI cues in the ALP risk assessment interview also significantly increased engagement in the interview process, resulting in approximately 50 more interviews conducted per year and a decrease in interview refusals during case investigations. Additionally, the pre-MI interview completion rate was 57%, while the post-MI Interview completion rate was 68%. We recommend MI techniques to be used by other lead poisoning prevention programs during lead poisoning investigations in similar diverse populations.

Keywords: lead poisoning prevention, motivational interviewing, behavior change, lead poisoning risk factors, self-efficacy

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Authors: Zubair Ahmad

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The aim of this study is to analyze the risks factors and issues with waste management in developing nations as barriers. Depending on their content and categorization, wastes are managed differently. Waste management strategies differ for liquid, solid, and organic wastes. The final stage of trash disposal entails procedures like burning, interment, recycling, and treatment. Due to the rising creation of solid waste, the growing urban population has a magnified impact on the environment and public health. All regions, but especially informal urban neighborhoods, tribal villages, and official rural settlements have a protracted backlog in waste services. Another significant impediment seen in the developing world is a lack of education and awareness of effective waste-management practices. Unauthorized dumpsites pose a serious risk to the environment since they could contain dangerous elements like radioactive, infectious, and toxic waste. Wealthier individuals are more inclined to think that their actions will have an impact on environmental problems and to act to address them. Waste managers need to take action to make sure the public is given information that is consistent with what they currently know. The results of the data analysis conducted with the aid of the various methodologies discussed in the preceding chapter are presented in this chapter by the researcher. Descriptive analysis has been used in research to determine whether or not there are relationships between variables and to determine the importance of the variables. According to a survey, there are no efforts being made to lessen the odor that garbage dump sites emit (in terms of treating or recycling the material placed at dumpsite) This might be the case since respondents only commented on the waste management conditions in their immediate surroundings and may not have fully understood the steps taken to resolve this issue.

Keywords: risk factor of waste material, lack of awareness, developing countries struggles, waste management

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Authors: Xiaoqing Peng, Aijing Luo, Yang Chen

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Background: Cyberchondria, as an "emerging risk" accompanied by the information era, is a new abnormal pattern characterized by excessive or repeated online searches for health-related information and escalating health anxiety, which endangers people's physical and mental health and poses a huge threat to public health. Objective: To explore and discuss the research status, hotspots and trends of Cyberchondria. Methods: Based on a total of 77 articles regarding "Cyberchondria" extracted from Web of Science from the beginning till October 2019, the literature trends, countries, institutions, hotspots are analyzed by bibliometric analysis, the concept definition of Cyberchondria, instruments, relevant factors, treatment and intervention are discussed as well. Results: Since "Cyberchondria" was put forward for the first time in 2001, the last two decades witnessed a noticeable increase in the amount of literature, especially during 2014-2019, it quadrupled dramatically at 62 compared with that before 2014 only at 15, which shows that Cyberchondria has become a new theme and hot topic in recent years. The United States was the most active contributor with the largest publication (23), followed by England (11) and Australia (11), while the leading institutions were Baylor University(7) and University of Sydney(7), followed by Florida State University(4) and University of Manchester(4). The WoS categories "Psychiatry/Psychology " and "Computer/ Information Science "were the areas of greatest influence. The concept definition of Cyberchondria is not completely unified in the world, but it is generally considered as an abnormal behavioral pattern and emotional state and has been invoked to refer to the anxiety-amplifying effects of online health-related searches. The first and the most frequently cited scale for measuring the severity of Cyberchondria called “The Cyberchondria Severity Scale (CSS) ”was developed in 2014, which conceptualized Cyberchondria as a multidimensional construct consisting of compulsion, distress, excessiveness, reassurance, and mistrust of medical professionals which was proved to be not necessary for this construct later. Since then, the Brazilian, German, Turkish, Polish and Chinese versions were subsequently developed, improved and culturally adjusted, while CSS was optimized to a simplified version (CSS-12) in 2019, all of which should be worthy of further verification. The hotspots of Cyberchondria mainly focuses on relevant factors as follows: intolerance of uncertainty, anxiety sensitivity, obsessive-compulsive disorder, internet addition, abnormal illness behavior, Whiteley index, problematic internet use, trying to make clear the role played by “associated factors” and “anxiety-amplifying factors” in the development of Cyberchondria, to better understand the aetiological links and pathways in the relationships between hypochondriasis, health anxiety and online health-related searches. Although the treatment and intervention of Cyberchondria are still in the initial stage of exploration, there are kinds of meaningful attempts to seek effective strategies from different aspects such as online psychological treatment, network technology management, health information literacy improvement and public health service. Conclusion: Research on Cyberchondria is in its infancy but should be deserved more attention. A conceptual consensus on Cyberchondria, a refined assessment tool, prospective studies conducted in various populations, targeted treatments for it would be the main research direction in the near future.

Keywords: cyberchondria, hypochondriasis, health anxiety, online health-related searches

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Authors: Pui-Lai To, Chechen Liao, Hen-Yi Huang

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Twenty years after Internet development, scholars have started to identify the negative impacts brought by the Internet. Overuse of Internet could develop Internet dependency and in turn cause addiction behavior. Therefore understanding the phenomenon of Internet addiction is important. With the joint efforts of experts and scholars, Internet addiction has been officially listed as a symptom that affects public health, and the diagnosis, causes and treatment of the symptom have also been explored. On the other hand, in the area of smartphone Internet usage, most studies are still focusing on the motivation factors of smartphone usage. Not much research has been done on smartphone Internet addiction. In view of the increasing adoption of smartphones, this paper is intended to find out whether smartphone Internet addiction exists in modern society or not. This study adopted the research methodology of online survey targeting users with smartphone Internet experience. A total of 434 effective samples were recovered. In terms of data analysis, Partial Least Square (PLS) in Structural Equation Modeling (SEM) is used for sample analysis and research model testing. Software chosen for statistical analysis is SPSS 20.0 for windows and SmartPLS 2.0. The research result successfully proved that smartphone users who access Internet service via smartphone could also develop smartphone Internet addiction. Factors including flow experience, depression, virtual social support, smartphone Internet affinity and maladaptive cognition all have significant and positive influence on smartphone Internet addiction. In the scenario of smartphone Internet use, descriptive norm has a positive and significant influence on perceived playfulness, while perceived playfulness also has a significant and positive influence on flow experience. Depression, on the other hand, is negatively influenced by actual social support and positive influenced by the virtual social support.

Keywords: internet addiction, smartphone usage, social support, perceived playfulness

Procedia PDF Downloads 247

Authors: Kiran Datta, Daniella Holland-Hart, Anthony Byrne

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Introduction: Oesophago-gastric (OG) cancers are the fifth commonest in the UK, accounting for over 12,000 deaths each year. Most patients will present at later stages of the disease, with only 21% of patients with stage 4 disease surviving longer than a year. As a result, many patients are unsuitable for curative surgery and instead receive palliative treatment to improve prognosis and symptom burden. However, palliative chemotherapy can result in significant toxicity: almost half of the patients are unable to complete their chemotherapy regimen, with this proportion rising significantly in older and frailer patients. In addition, clinical trials often exclude older and frailer patients due to strict inclusion criteria, meaning there is limited evidence to guide which patients are most likely to benefit from palliative chemotherapy. Inappropriate chemotherapy administration is at odds with the goals of palliative treatment and care, which are to improve quality of life, and this also represents a significant resource expenditure. This literature review aimed to examine and appraise evidence regarding treatment resilience in order to guide clinicians in identifying the most suitable candidates for palliative chemotherapy. Factors influencing treatment resilience were assessed, as measured by completion rates, dose reductions, and toxicities. Methods: This literature review was conducted using rapid review methodology, utilising modified systematic methods. A literature search was performed across the MEDLINE, EMBASE, and Cochrane Library databases, with results limited to papers within the last 15 years and available in English. Key inclusion criteria included: 1) participants with either oesophageal, gastro-oesophageal junction, or gastric cancers; 2) patients treated with palliative chemotherapy; 3) available data evaluating the association between baseline participant characteristics and treatment resilience. Results: Of the 2326 papers returned, 11 reports of 10 studies were included in this review after excluding duplicates and irrelevant papers. Treatment resilience factors that were assessed included: age, performance status, frailty, inflammatory markers, and sarcopenia. Age was generally a poor predictor for how well patients would tolerate chemotherapy, while poor performance status was a better indicator of the need for dose reduction and treatment non-completion. Frailty was assessed across one cohort using multiple screening tools and was an effective marker of the risk of toxicity and the requirement for dose reduction. Inflammatory markers included lymphopenia and the Glasgow Prognostic Score, which assessed inflammation and hypoalbuminaemia. Although quick to obtain and interpret, these findings appeared less reliable due to the inclusion of patients treated with palliative radiotherapy. Sarcopenia and body composition were often associated with chemotherapy toxicity but not the rate of regimen completion. Conclusion: This review demonstrates that there are numerous measures that can estimate the ability of patients with oesophago-gastric cancer to tolerate palliative chemotherapy, and these should be incorporated into clinical assessments to promote personalised decision-making around treatment. Age should not be a barrier to receiving chemotherapy and older and frailer patients should be included in future clinical trials to better represent typical patients with oesophago-gastric cancers. Decisions regarding palliative treatment should be guided by these factors identified as well as patient preference.

Keywords: frailty, oesophago-gastric cancer, palliative chemotherapy, treatment resilience

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Authors: Wadsana Sarakarn, Pimonpan Charoensri, Baliya Chaiyara

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Objectives: To study the outcomes of the developed nursing model to prevent early postpartum hemorrhage (PPH). Materials and Methods: The analytical study was conducted in Sunpasitthiprasong Hospital during October 1st, 2015, until May 31st, 2017. After review the prevalence, risk factors, and outcomes of postpartum hemorrhage of the parturient who gave birth in Sunpasitthiprasong Hospital, the nursing model was developed under research regulation of Kemmis&McTaggart using 4 steps of operating procedures: 1) analyzing problem situation and gathering 2) creating the plan 3) noticing and performing 4) reflecting the result of the operation. The nursing model consisted of the screening tools for risk factors associated with PPH, the clinical nursing practice guideline (CNPG), and the collecting bag for measuring postpartum blood loss. Primary outcome was early postpartum hemorrhage. Secondary outcomes were postpartum hysterectomy, maternal mortality, personnel’s practice, knowledge, and satisfaction of the nursing model. The data were analyzed by using content analysis for qualitative data and descriptive statistics for quantitative data. Results: Before using the nursing model, the prevalence of early postpartum hemorrhage was under estimated (2.97%). There were 5 cases of postpartum hysterectomy and 2 cases of maternal death due to postpartum hemorrhage. During the study period, there was 22.7% prevalence of postpartum hemorrhage among 220 pregnant women who were vaginally delivered at Sunpasitthiprasong Hospital. No maternal death or postpartum hysterectomy was reported after using the nursing model. Among 16 registered nurses at the delivery room who evaluated using of the nursing model, they reported the high level of practice, knowledge, and satisfaction Conclusion: The nursing model for the prevention of early PPH is effective to decrease early PPH and other serious complications.

Keywords: the development of a nursing model, prevention of postpartum hemorrhage, pregnant women, postpartum hemorrhage

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Authors: Lily Yarney, Emmanuel M. Y. Seidu, Thomas Chireh Kuusaanu, Belinda Adzimah-Yeboah

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Healthcare delivery is labor-intensive; the role of the health worker is, therefore, indispensable in maintaining and improving individual and population health. In Ghana, doctor-patient ratio is 1:10,450, with a disproportionate tilt in favor of the relatively resource rich southern part of the country. The Upper West Region located in Northern Ghana, is among the poorest regions in the country. The study was aimed at finding out the reasons why medical doctors are unwilling to accept postings to the Upper West Region where their services are needed most despite some efforts to attract, motivate and retain them. Current initiatives by the Ministry of Health and its partners to attract and retain doctors in the region were also examined. Qualitative methodology was employed with an in-depth interview guide to collect data. Sixteen respondents comprising medical doctors, health managers, and other health-related partners purposively selected took part in the study. Data were recorded, transcribed, coded, and categorized into themes in tandem with the objectives of the study. The study found that medical doctors are unwilling to take up appointments in the Upper West Region because of limited opportunities for career and continuing professional development, poor financial inducement, and weak leadership, among other important contextual social and cultural factors. Critical success factors to surmount these challenges include concessions and sponsorship for medical specialization training for doctors and clear implementable national and local policies on postings.

Keywords: attraction, retention, medical doctors, deprived regions, Ghana

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Authors: Charles Amoo, Joshua New, Bill Eckman

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Buildings in the United States account for a significant proportion of energy consumption and greenhouse gas (GHG) emissions, and this trend is expected to continue as well as rise in the near future. Low-income households, in particular, bear a disproportionate burden of high building energy consumption and spending due to high energy costs. Energy efficiency improvements need to reach an average of 4% per year in this decade in order to meet global net zero emissions target by 2050, but less than 1 % of U.S. buildings are improved each year. The government has recognized the importance of technology in addressing this issue, and energy efficiency programs have been developed to tackle the problem. The Weatherization Assistance Program (WAP), the largest residential whole-house energy efficiency program in the U.S., is specifically designed to reduce energy costs for low-income households. Under the WAP, energy auditors must follow specific audit procedures and use Department of Energy (DOE) approved energy audit tools or software. This article proposes an expanded framework of factors that should be considered in energy audit software that is approved for use in energy efficiency programs, particularly for low-income households. The framework includes more than 50 factors organized under 14 assessment criteria and can be used to qualitatively and quantitatively score different energy audit software to determine their suitability for specific energy efficiency programs. While the tool can be useful for developers to build new tools and improve existing software, as well as for energy efficiency program administrators to approve or certify tools for use, there are limitations to the model, such as the lack of flexibility that allows continuous scoring to accommodate variability and subjectivity. These limitations can be addressed by using aggregate scores of each criterion as weights that could be combined with value function and direct rating scores in a multicriteria decision analysis for a more flexible scoring.

Keywords: buildings, energy efficiency, energy audit, software

Procedia PDF Downloads 79