Search results for: April T. Berry

Authors: Ahmed Sami Hammami, Mohamed Jellazi

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Background: The aim of the study is to evaluate the magnitude of different psychological outcomes among Tunisian health care professionals (HCP) during the COVID-19 pandemic and to identify the associated factors. Methods: HCP completed a cross-sectional questionnaire from April 4th to April, 28th 2020. The survey collected demographic information, factors that may interfere with the psychological outcomes, behavior changes and mental health measurements. The latter was assessed through 3 scales; the 7-item questions Insomnia Severity Index, the 2-item Patient Health Questionnaire and the 2-item Generalized Anxiety Disorder. Multivariable logistic regression was conducted to identify factors associated with psychological outcomes. Results: A total of 503 HCP successfully completed the survey; among those, n=493 consented to enroll in the study, 411 [83.4%] were physicians, 323 [64.2%] were women and 271 [55%] had a second-line working position. A significant proportion of HCP had anxiety 35.7%, depression 35.1% and insomnia 23.7%. Females, those with psychiatric history and those using public transport exhibited the highest proportions for overall symptoms compared to other groups e.g., depression among females vs. males: 44,9% vs. 18,2%, P=0.00. Those with a previous medical history and nurses, had more anxiety and insomnia compared to other groups e.g. anxiety among nurses vs. interns/residents vs. attending 45,1% vs 36,1% vs 27,5%; p=0.04. Multivariable logistic regression showed that female gender was a risk factor for all psychological outcomes e.g. female sex increased the odds of anxiety by 2.86; 95% confidence interval [CI], 1, 78-4, 60; P=0.00, whereas having a psychiatric history was a risk factor for both anxiety and insomnia. (e.g. for insomnia OR=2,86; 95% [CI], 1,78-4,60; P=0.00), Having protective equipment was associated with lower risk for depression (OR=0,41; 95% CI, 0,27-0,62; P=0.00) and anxiety. Physical activity was also protective against depression and anxiety (OR=0,41, 95% CI, 0,25-0,67, P=0.00). Conclusion: Psychological symptoms are usually undervalued among HCP, though the COVID-19 pandemic played a major role in exacerbating this burden. Prompt psychological support should be endorsed and simple measures such as physical activity and ensuring the necessary protection are paramount to improve mental health outcomes and the quality of care provided to patients.

Keywords: COVID-19 pandemic, health care professionals, mental health, protective factors, psychological symptoms, risk factors

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Authors: Anupam Sibal

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Apollo Quality Program(AQP) was launched across the Apollo Group of Hospitals to address the four patient safety areas; Safety during Clinical Handovers, Medication Safety, Surgical Safety and the six International Patient Safety Goals(IPSGs) of JCI. A measurable, online, quality dashboard covering 20 process and outcome parameters was devised for monthly monitoring. The expected outcomes were also defined and categorized into green, yellow and red ranges. An audit methodology was also devised to check the processes for the measurable dashboard. Documented clinical handovers were introduced for the first time at many locations for in-house patient transfer, nursing-handover, and physician-handover. Prototype forms using the SBAR format were made. Patient-identifiers, read-back for verbal orders, safety of high-alert medications, site marking and time-outs and falls risk-assessment were introduced for all hospitals irrespective of accreditation status. Measurement of Surgical-Site-Infection (SSI) for 30 days postoperatively, was done. All hospitals now tracked the time of administration of antimicrobial prophylaxis before surgery. Situations with high risk of retention of foreign body were delineated and precautionary measures instituted. Audit of medications prescribed in the discharge summaries was made uniform. Formularies, prescription-audits and other means for reduction of medication errors were implemented. There is a marked increase in the compliance to processes and patient safety outcomes. Compliance to read-back for verbal orders rose from 86.83% in April’11 to 96.95% in June’15, to policy for high alert medications from 87.83% to 98.82%, to use of measures to prevent wrong-site, wrong-patient, wrong procedure surgery from 85.75% to 97.66%, to hand-washing from 69.18% to 92.54%, to antimicrobial prophylaxis within one hour before incision from 79.43% to 93.46%. Percentage of patients excluded from SSI calculation due to lack of follow-up for the requisite time frame decreased from 21.25% to 10.25%. The average AQP scores for all Apollo Hospitals improved from 62 in April’11 to 87.7 in Jun’15.

Keywords: clinical handovers, international patient safety goals, medication safety, surgical safety

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Authors: István János Molnár

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Hungary has a legal system that is primarily based on statutory legislation, which means that statutes are the main source of law. However, in a surprising move, the Hungarian Parliament introduced a "limited" precedent system on 1 April 2020. This reform requires Hungarian courts to consider not only statutes but also the interpretation of those statutes in decisions made by the highest court in the country, the Curia. While judge-made customary law is not completely unfamiliar in Hungarian legal practice, the introduction of this new system presents several theoretical and practical challenges that may take time to resolve.

Keywords: civil procedure, hungary, judicial practice, precedent system, sources of law

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Authors: Piotr Tylec, Julia Wierzbicka, Natalia Gajewska, Krzysztof Przeczek, Grzegorz Torbicz, Alicja Dudek, Magdalena Pisarska-Adamczyk, Mateusz Wierdak, Michal Pedziwiatr

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Introduction: Many patients have described changes in taste perception after weight loss surgery. However, little data is available about short term changes in taste after surgery. Aim: We aimed to evaluate short-term changes in taste preference after bariatric surgeries in comparison to colorectal surgeries. Material and Methods: Between April 2018 and April 2019, a total of 121 bariatric patients and 63 controls participated. Bariatric patients underwent laparoscopic sleeve gastrectomy or Roux-en-Y gastric by-pass. Controls underwent oncological colorectal surgeries. Patients who developed clinical complications requiring restriction of oral intake after surgery or withdraw their consent were excluded from the study. In the end, 85 bariatric patients and 44 controls were included. In all of them, the 16-item ERAS Protocol was applied. Using 10-points Numeric Rating Scale (1-10) patients completed questionnaire and rated their appetite and thirst (1 - no appetite/not thirsty, 10 – normal appetite/very thirsty) and flavoured standardized liquids' taste (1- horrible, 10-very tasty) and food images for the 6 group of taste (sweet, umami, sour, spicy, bitter and salty) (1 - not appetizing, 10 - very appetizing) preoperatively and on the first postoperative day. Data were analysed with Statistica 13.0 PL. Results: Analysed group consist of 129 patients (85 bariatric, 44 controls). Mean age and BMI in a research group was 44.91 years old, 46.22 kg/m² and in control group 62.09 years old, 25.87 kg/m², respectively. Our analysis revealed significant differences in changes of appetite between both groups (research: -4.55 ± 3.76 vs. control: -0.85 ± 4.37; p < 0.05), ratings bitter (research: 0.60 ± 2.98 vs. control: -0.88 ± 2.58; p < 0.05) and salty (research: 1.20 ± 3.50 vs. control: -0.52 ± 2.90; p < 0.05) flavoured liquids and ratings for sweet (research: 1.62 ± 3.31 vs. control: 0.01 ± 2.63; p < 0.05) and bitter (research: 1.21 ± 3.15 vs. control: -0.09 ± 2.25; p < 0.05) food images. There were statistically significant results in the ratings of other images, but in comparison to the control group, they were not statistically significant. Conclusion: The study showed that bariatric surgeries quickly decreases appetite and desire to eat certain types of food, such as salty. Moreover, the bitter taste was more desirable in the research group in comparison to control group. Nevertheless, the sweet taste was more appetible in the bariatric group than in control.

Keywords: bariatric surgery, general surgery, obesity, taste preference

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Authors: Saniya Ablatt, Matthew Jacobsson, Jamie Whisler, Austin Forbes

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Postoperative pancreatic fistula (POPF) is a complication that occurs in up to 41% of patients after pancreaticoduodenectomy. Although certain characteristics such as individual patient anatomy are known risk factors for POPF, the effect of barbed suture techniques remains underexplored. This study examines whether the use of Stratafix barbed suture versus PDS impacts the risk of developing POPF. After obtaining IRB exemption, a retrospective chart review was initiated involving patients who underwent pancreaticoduodenectomy for the treatment of malignant or premalignant lesions of the pancreas at our institution between April 1st 2020 and April 30th 2022. Patients were stratified into 2 groups respective to the technique used to suture the pancreatico-jejunal anastomosis: Group 1 was composed to patients in which 4.0 Stratafix® suture was used n=41. Group 1 was composed to patients in which 4.0 PDS suture was used n=42. Data regarding patient age, sex, BMI, presence or absence of biochemical leak, presence or absence of grade B & C postoperative pancreatic fistulas, rate and type of in hospital complication, rate of reoperation, 30 day readmission rate, 90 day mortality, and total mortality were compared between groups. 83 patients were included in our study with 42 receiving Stratafix and 41 receiving PDS (50.6% vs 49.4%). Stratafix patients had less biochemical leaks (0.0% vs 4.8%, p=0.19) and higher rates of POPF but this was not statistically significant (7.2% vs 2.4%, p=0.26). Additionally, there was no difference between the use of stratafix versus PDS on the risk of clinically relevant grade B or C POPF (p=0.26, OR=3.25 [CI= 0.74-16.43]). Of the independent variables including age, race, sex, BMI, and ASA class, BMI greater than 25 increased the risk of clinically relevant POPF by 7.7 times compared to patients with BMI less than 25 (p=0.03, OR=7.79 [1.04-88.51]). Despite no significant difference in primary outcomes, the Stratafix group had lower rates of secondary outcomes including 90-day mortality; bleeding, cardiac, and infectious complications; reoperation; and 30-day readmission. On statistical analysis, Stratafix decreased the risk of 30-day readmission (p=0.04, OR=0.21, CI=0.04-0.97) and had a marginally significant effect on the risk of reoperation (p=0.08, OR=0.24, CI=0.04-1.26). There was no difference between the use of Stratafix versus PDS on the risk of POPF (p=0.26). However, Stratafix decreased the risk of 30-day readmission (p=0.04) and BMI greater than 25 increased the risk of clinically relevant POPF (p=0.03).

Keywords: pancreas, hepatobiliary surgery, hepatobiliary, pancreatic leak, biochemical leak, fistula, pancreatic fistula

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Authors: Desalegn Feyissa Desu

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Drug therapy problem is a significant challenge to provide high quality health care service for the patients. It is associated with morbidity, mortality, increased hospital stay, and reduced quality of life. Moreover, pediatric patients are quite susceptible to drug therapy problems. Thus this study aimed to assess drug therapy problem and its contributing factors among pediatric patients diagnosed with infectious disease admitted to pediatric ward of Jimma university medical center, from April 1 to June 30, 2018. Prospective observational study was conducted among pediatric patients with infectious disease admitted from April 01 to June 30, 2018. Drug therapy problems were identified by using Cipolle’s and strand’s drug related problem classification method. Patient’s written informed consent was obtained after explaining the purpose of the study. Patient’s specific data were collected using structured questionnaire. Data were entered into Epi data version 4.0.2 and then exported to statistical software package version 21.0 for analysis. To identify predictors of drug therapy problems occurrence, multiple stepwise backward logistic regression analysis was done. The 95% CI was used to show the accuracy of data analysis and statistical significance was considered at p-value < 0.05. A total of 304 pediatric patients were included in the study. Of these, 226(74.3%) patients had at least one drug therapy problem during their hospital stay. A total of 356 drug therapy problems were identified among two hundred twenty six patients. Non-compliance (28.65%) and dose too low (27.53%) were the most common type of drug related problems while disease comorbidity [AOR=3.39, 95% CI= (1.89-6.08)], Polypharmacy [AOR=3.16, 95% CI= (1.61-6.20)] and more than six days stay in hospital [AOR=3.37, 95% CI= (1.71-6.64) were independent predictors of drug therapy problem occurrence. Drug therapy problems were common in pediatric patients with infectious disease in the study area. Presence of comorbidity, polypharmacy and prolonged hospital stay were the predictors of drug therapy problem in study area. Therefore, to overcome the significant gaps in pediatric pharmaceutical care, clinical pharmacists, Pediatricians, and other health care professionals have to work in collaboration.

Keywords: drug therapy problem, pediatric, infectious disease, Ethiopia

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Authors: Godfrey Nsereko, Daniel Kadobera, Denis Okethwangu, Joyce Nguna, Alex Riolexus Ario

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Background: Malaria is a leading cause of morbidity and mortality in Uganda. In April 2018, malaria cases surged in Nwoya District, northern Uganda, exceeding the action thresholds. We investigated to assess the outbreak’s magnitude, identify transmission risk factors, and recommend evidence-based control measures. Methods: We defined a malaria case as onset of fever in a resident of Nwoya District with a positive Rapid Diagnostic Test or microscopy for malaria P. falciparum from 1 February to 22 May 2018. We reviewed medical records in all health facilities of affected sub-counties to find cases. In a case-control study, we compared exposure risk factors between 107 case-persons and 107 asymptomatic controls matched by age and village. We conducted entomological assessment on vector-density and behavior. Results: We identified 3,879 case-persons (attack rate [AR]=6.5%) and 2 deaths (case-fatality rate=5.2/10,000). Females (AR=8.1%) were more affected than males (AR=4.7%). Of all age groups, the 5-18 year age group (AR=8.4%) was most affected. Heavy rain started on 4 March; a propagated outbreak began during the week of 2 April. In the case-control study, 55% (59/107) of case-patients and 18% (19/107) of controls had stagnant water around households for several days following rainfall (ORM-H=5.6, 95%CI=3.0-11); 25% (27/107) of case-patients and 51% (55/107) of controls wore long-sleeve cloths during evening hours (ORM-H=0.30, 95%CI=0.20-0.60); 29% (31/107) of case-patients and 15% (16/107) of controls did not sleep under a long-lasting insecticide-treated net (LLIN) (ORM-H=2.3, 95%CI=1.1-4.9); 37% (40/107) of case-patients and 52% (56/107) of controls had ≥1 LLIN per 2 household members (ORM-H=0.54, 95%CI=0.30-0.97). Entomological assessment indicated active breeding sites; Anopheles gambiae sensu lato species were the predominant vector. Conclusion: Increased vector breeding sites after heavy rainfall, together with inadequate malaria preventive measures caused this outbreak. We recommended increasing coverage for LLINs and larviciding breeding sites.

Keywords: malaria outbreak, Plasmodium falciparum, global health security, Uganda

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Authors: G. A. Gevorgyan, A. S. Mamyan, L. G. Stepanyan, L. R. Hambaryan

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Bacterio- and phytoplankton growth rates in 'Yerevanyan lich' reservoir and the Hrazdan river in Yerevan city, Armenia were investigated in April and June-August, 2015. Phytoplankton sampling and analysis were performed by the standard methods accepted in hydrobiological studies. The quantitative analysis of aerobic, coliform and E. coli bacteria is done by the 'RIDA COUNT' medium sheets (coated with ready-to-use culture medium). The investigations showed that the insufficient management of household discharges in Yerevan city caused the organic and fecal pollution of the Hrazdan river in this area which in turn resulted in an increase in bacterial count and increased sanitary and pathogenic risks to the environment and human health. During the investigation in April, the representatives of diatom algae prevailed quantitatively in the coastal area of 'Yerevanyan lich' reservoir, nevertheless, a significant change in the phytoplankton community in June occurred: due to green algae bloom in the reservoir, the quantitative parameters of phytoplankton increased significantly. This was probably conditioned by a seasonal increase in the water temperature in the conditions of the sufficient concentration of nutrients. However, a succession in phytoplankton groups during July-August occurred, and a dominant group (according to quantitative parameters) in the phytoplankton community was changed as follows: green algae-diatom algae-blue-green algae. Rapid increase in the quantitative parameters of diatom and blue-green algae in the reservoir may have been conditioned by increased organic matter level resulted from green algae bloom. Algal bloom in 'Yerevanyan lich' reservoir caused changes in phytoplankton community and an increase in bacterioplankton count not only in the reservoir but also in the Hrazdan river sites located in the downstream from the reservoir. Thus, the insufficient management of urban discharges and aquatic ecosystems in Yerevan city led to unfavorable changes in water quality and microbial and phytoplankton communities in “Yerevanyan lich” reservoir and the Hrazdan river which in turn caused increased sanitary and pathogenic risks to the environment and human health.

Keywords: algal bloom, bacterioplankton, phytoplankton, Hrazdan river, Yerevanyan lich reservoir

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Authors: Clara Luwe, Oliver Harness, Helena Meally, Kim Martin, Alexandra Harrington

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Background: The role of ‘Renal Specialist Podiatrist’ originated in 2022 due to prevailing evidence of patients with diabetes and end-stage renal disease (ESRD) on haemodialysis (HD) and active ulcerations that were at higher risk of rapid deterioration, foot-related hospital admissions, and lower limb amputations. This role started in April 2022 with the aim of screening all patients on haemodialysis and instigating preventative measures to reduce serious foot related complications. Methods: A comprehensive neurovascular foot assessment was completed to establish baseline vascular status and identify those with peripheral arterial disease (PAD) for all patients on HD. Individual’s foot risk was stratified, advice and education tailored and issued. Identifying all diabetes patients on HD as high-risk for diabetic foot complications. Major Findings: All patients screened revealed over half of the caseload had diabetes, and more than half had a clinical presentation of PAD. All those presenting with ulcerations had a diagnosis of diabetes. Of the presenting ulcerations, the majority of these ulcers predated the renal specialist post and were classified as severe >3 SINBAD Score. Since April’22, complications have been identified quicker, reducing the severity (SINBAD<3 or below), and have improved healing times, in line with the national average. During the eight months of the role being in place, we have seen a reduction in minor amputations and no major amputations. Conclusion: By screening all patients on haemodialysis and focusing on education, early recognition of complications, appropriate treatment, and timely onward referral, we can reduce the risk of foot Diabetic foot ulcerations and lower limb amputations. Having regular podiatry input to stratify and facilitate high-risk, active wound patients across different services has helped to keep these patients stable, prevent amputations, and reduce foot-related hospital admissions and mortality from foot-related disease. By improving the accessibility to a specialist podiatrist, patients felt able to raise concerns sooner. This has helped to implement treatment at the earliest possible opportunity, enabling the identification and healing of ulcers at an earlier and less complex stage (SINBAD <3), thus, preventing potential limb-threatening complications.

Keywords: renal, podiatry, haemodialysis, prevention, early detection

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Authors: Samul Sahile Kebede

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Back ground: -Immune hemolytic anemia commonly affects human immune deficiency, infected individuals. Among anemic HIV patients in Africa, the burden of IHA due to autoantibody was ranged from 2.34 to 3.06 due to the drug was 43.4%. IHA due to autoimmune is potentially a fatal complication of HIV, which accompanies the greatest percent from acquired hemolytic anemia. Objective: -The main aim of this study was to determine the magnitude and associated factors of immune hemolytic anemia among human immuno deficiency virus infected adults at the university of Gondar comprehensive specialized hospital north west Ethiopia from March to April 2021. Methods: - An institution-based cross-sectional study was conducted on 358 human immunodeficiency virus-infected adults selected by systematic random sampling at the University of Gondar comprehensive specialized hospital from March to April 2021. Data for socio-demography, dietary and clinical data were collected by structured pretested questionnaire. Five ml of venous blood was drawn from each participant and analyzed by Unicel DHX 800 hematology analyzer, blood film examination, and antihuman globulin test were performed to the diagnosis of immune hemolytic anemia. Data was entered into Epidata version 4.6 and analyzed by STATA version 14. Descriptive statistics were computed and firth penalized logistic regression was used to identify predictors. P value less than 0.005 interpreted as significant. Result; - The overall prevalence of immune hemolytic anemia was 2.8 % (10 of 358 participants). Of these, 5 were males, and 7 were in the 31 to 50 year age group. Among individuals with immune hemolytic anemia, 40 % mild and 60 % moderate anemia. The factors that showed association were family history of anemia (AOR 8.30 at 95% CI 1.56, 44.12), not eating meat (AOR 7.39 at 95% CI 1.25, 45.0), and high viral load 6.94 at 95% CI (1.13, 42.6). Conclusion and recommendation; Immune hemolytic anemia is less frequent condition in human immunodeficiency virus infected adults, and moderate anemia was common in this population. The prevalence was increased with a high viral load, a family history of anemia, and not eating meat. In these patients, early detection and treatment of immune hemolytic anemia is necessary.

Keywords: anemia, hemolytic, immune, auto immune, HIV/AIDS

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Authors: Fazli Rahim Shinwari, Ulrich Dittmer

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Like many megacities around the world, Kabul is facing severe problems due to the rising frequency of urban flooding. Since 2001, Kabul is experiencing rapid population growth because of the repatriation of refugees and internal migration. Due to unplanned development, green areas inside city and hilly areas within and around the city are converted into new housing towns that had increased runoff. Trenches along the roadside comprise the unplanned drainage network of the city that drains the combined sewer flow. In rainy season overflow occurs, and after streets become dry, the dust particles contaminate the air which is a major cause of air pollution in Kabul city. In this study, a stormwater management model is introduced as a basis for a systematic approach to urban drainage planning in Kabul. For this purpose, Kabul city is delineated into 8 watersheds with the help of one-meter resolution LIDAR DEM. Storm, water management model, is developed for Wazirabad catchment by using available data and literature values. Due to lack of long term metrological data, the model is only run for hourly rainfall data of a rain event that occurred in April 2016. The rain event from 1st to 3rd April with maximum intensity of 3mm/hr caused huge flooding in Wazirabad Catchment of Kabul City. Model-estimated flooding at some points of the catchment as an actual measurement of flooding was not possible; results were compared with information obtained from local people, Kabul Municipality and Capital Region Independent Development Authority. The model helped to identify areas where flooding occurred because of less capacity of drainage system and areas where the main reason for flooding is due to blockage in the drainage canals. The model was used for further analysis to find a sustainable solution to the problem. The option to construct new canals was analyzed, and two new canals were proposed that will reduce the flooding frequency in Wazirabad catchment of Kabul city. By developing the methodology to develop a stormwater management model from digital data and information, the study had fulfilled the primary objective, and similar methodology can be used for other catchments of Kabul city to prepare an emergency and long-term plan for drainage system of Kabul city.

Keywords: urban hydrology, storm water management, modeling, SWMM, GEO-SWMM, GIS, identification of flood vulnerable areas, urban flooding analysis, sustainable urban drainage

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Authors: Aysha Al Sha'aibi

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Algal blooms of the dinoflagellate species Noctiluca scintillans became frequent events in Omani waters. The current study aims at elucidating the abundance, size variation and observations on the feeding mechanism performed by this species during the winter bloom. An attempt was made, to relate observed biological parameters of the Noctiluca population to environmental factors. Field studies spanned the period from December 2014 to April 2015. Samples were collected from Bandar Rawdah (Muscat region) by Bongo nets, twice per week, from the surface and the integrated upper mixed layer. The measured environmental variables were: temperature, salinity, dissolved oxygen, chlorophyll a, turbidity, nitrite, phosphate, wind speed and rainfall. During the winter bloom (from December 2014 through February 2015), the abundance exhibited the highest concentration on 17 February (640.24×106 cell.L-1) in oblique samples and 83.9x103 cell.L-1 in surface samples, with a subsequent decline up to the end of April. The average number of food vacuoles inside Noctiluca cells was 1.5 per cell; the percentage of feeding Noctiluca compared to the entire population varied from 0.01% to 0.03%. Both the surface area of the Noctiluca symbionts (Pedinomonas noctilucae) and cell diameter were maximal in December. In oblique samples the highest average cell diameter and the surface area of symbiont algae were 751.7 µm and 179.2x103 µm2 respectively. In surface samples, highest average cell diameter and the surface area of symbionts were 760 µm and 284.05x103 µm2 respectively. No significant correlations were detected between Noctiluca’s biological parameters and environmental variables except for the correlation between cell diameter and chlorophyll a, also between symbiotic algae surface area and chlorophyll a. The high correlation of chlorophyll a was as a reason of endosymbiotic algae Pedinomonas noctilucae and green Noctiluca enhanced chlorophyll during bloom. All correlations among biological parameters were significant; they are perhaps one of major factors that mediating high growth rates, generating millions of cell per liter in a short time range. The results gained from this study will provide a beneficial background for understanding deeply the development of coastal algal blooms of Noctiluca scintillans. Moreover, results could be used in different applications related to marine environment.

Keywords: abundance, feeding activities, Noctiluca scintillans, Oman

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Authors: Ghulam Mustafa Halepota, Zaib Dahar

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Background: Low acceptance of FP services, particularly in hard to reach areas where geographic, economic, or social barriers limit-service uptake. Moreover, limited resources appeared to be a reflection of dismal contraceptive use in Pakistan. People’s Primary Health Care Initiative (PPHI) is a Public Private Partnership Program of Government of Sindh which aims to improve maternal child health through accessible family planning services in far flung areas. In 2015 PPHI launched special family planning camps to have achieved a rapid improvement in CPR. On quarterly basis, these camps focus on Long Acting Reversible Contraceptives (LARC). These camps are arranged at 250 BHU Plus (24/7 MCHCs). The Organization manages 1140 primary health care facilities all over Sindh province and focuses on maternal, newborn and child health which includes antenatal care, labor/delivery, postnatal care, family planning, immunization, nutrition, BEmONC, CEmONC, diagnostic laboratories, ambulance services. Under the FPRH program, the organization launched special family planning camps in far flung areas to achieve a rapid improvement in CPR-committed to FP 2020 goal. Objective: To assess the performance of special FP camps for the improvement of long acting reversible contraceptive in hard to reach areas. Methodology: Outreach camps are organized on quarterly basis in 250 BHUs and maternal and child health centers (available-24/7). Using observational study design, the study reports 2 years data of special FP camps conducted in 23 various districts of Sindh during April 2015-April 2017. These special camps served a range of modern contraceptive methods including IUCDs, implants, condoms, pills, and injections. Moreover, 125 male medical officers are trained across Sindh in LARC and 554 female have been trained in implants and IUCD insertions. MSI Impact calculator was used to determine health and demographic impact of services. Results: This intervention has brought exceptional results, and the response has been overwhelming in time. Total 2048 special camps during 2015 till April 2017 have been carried out. 231796 MWRAs visited camps 91% opted modern FP, of which 45% opted Implants, 6% selected IUCDs from LARC (long term reversible contraceptive) from short term, 17% opted injectable 18% choose pills, and 12% used condoms. This intervention created a high contraceptive impact in rural Sindh an estimated 125048 FP users have been created, of this 111846 LARC users and 13498 are SARC users, through this intervention an estimated 55774 unintended pregnancies, 36299 live births, 9394, 80 maternal deaths, 926 and 6077 unsafe abortion have been averted. Moreover, the intervention created an economic impact and saved 2,409,563 direct health expenditure on each woman with reproductive age. Conclusion: Special FP Camps along with routine services is an effective and acceptable model for increase in provision of long-acting and permanent methods in hard to reach areas. This innovative approach by PHHI-Sindh has also been adopted in other provinces of Pakistan.

Keywords: inequalities, special camps, family planning services, hard to reach areas

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Authors: Rock-Hyun Choi, Won-Seok Kang, Chang-Sik Son

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Physical activity is important for healthy living. Recently wearable devices which motivate physical activity are quickly developing, and become cheaper and more comfortable. In particular, fitness trackers provide a variety of information and need to provide well-analyzed, and user-friendly results. In this study, frequency analysis was performed to classify various data sets of Fitbit into simple activity status. The data from Fitbit cloud server consists of 263 subjects who were healthy factory and office workers in Korea from March 7th to April 30th, 2016. In the results, we found assumptions of activity state classification seem to be sufficient and reasonable.

Keywords: activity status, fitness tracker, heart rate, steps

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Authors: Keivan Jamshidi, Fateme Behbahani, Sara Omidi, Nadia Shahi, Alireza Farkhonde

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Amyloidosis represents a heterogenous group of diseases that have in common the deposition of fibrils composed of proteins of beta-pleated sheet structure, which can be specifically identified by histochemistry using the Congo red or similar stains. Between October 2013 to April 2014 (6 months) different patterns of renal amyloidosis was diagnosed on histopathological examination of kidneys belong to 196 out of 7065 slaughtered sheep subjected to postmortem examination. Microscopic examination of renal tissue sections stained with H&E and CR staining techniques revealed 3 patterns of renal amyloid deposition; including glomerular (22.72%), medullary (68.18%), and vascular (9.09%) were recognized. Renal medullary amyloidosis (RMA) was detected as the most prevalence pattern of renal amyloidosis in domestic sheep.

Keywords: sheep, amyloidosis, kidney, slaughterhouse

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Authors: M. Jamil Ahmad

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In this paper, the heating/cooling potential of a passive building (mosque) of Prof. K. A. Nizami center for Quranic studies at AMU Aligarh, has been evaluated on the basis of energy balance under quasi-steady state condition by incorporating the effect of ventilation. The study has been carried out for composite climate of Aligarh. The performance of the above mentioned building has been presented in this study. It is observed that the premises of the mosque are cooler than the outside ambient temperature by an average of 2°C and 4°C during the month of March and April respectively. Provision of excellent ventilation, high amount of thermal mass, high ceilings and circulation of cool natural air helps in maintaining an optimal thermal comfort temperature in the passive building.

Keywords: heating/cooling potential, passive building, ambient temperatures

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Authors: Andreanna Kalasountas

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A rampant health crisis is facing America. That health crisis is poverty. Millions of Americans live without knowing when they will eat or where they will sleep. Meanwhile, there are over 600 multi-billionaires in the United States. “In April 2021, U.S. billionaires had nearly twice as much combined wealth than the bottom half of Americans -- $4.56 trillion vs. $2.62 trillion.” It's disturbingly ironic that we live in a country where there are people with more money than they know what to do with (or could spend in a lifetime) while simultaneously, people are losing their life because they do not have enough money to survive. Accordingly, this paper argues for the end of the multi-billionaire; that wealth be capped, captured, and redistributed to the poorest among us. To accomplish this goal, this paper begins by identifying the problem, advocating for a new measurement of poverty; and concludes with a both legal and tax policy solutions and what implementation of those solutions would look like.

Keywords: health and human rights, law and policy, poverty, wealth gap

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Authors: Timothy Garvey, Don Driscoll

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Within Tasmania, the growling grass frog (Litoria raniformis) has experienced a rapid contraction in distribution. This decline is primarily attributed to habitat loss through landscape modification and improved land drainage. Reductions in seasonal water-sources have placed increasing importance on permanent water bodies for reproduction and foraging. Tasmanian agricultural and commercial forestry landscapes often feature small artificial ponds, utilized for watering livestock and fighting wildfires. Improved knowledge of how L. raniformis may be exploiting anthropogenic ponds is required for improved conservation management. We implemented telemetric tracking in order to evaluate the spatial ecology of L. raniformis (n = 20) within agricultural and managed forestry sites, with tracking conducted periodically over the breeding season (November/December, January/February, March/April). We investigated (1) potential differences in habitat utilization between agricultural and plantation sites, and (2) the post-breeding dispersal of individual frogs. Frogs were found to remain in close proximity to ponds throughout November/December, with individuals occupying vegetative depauperate water bodies beginning to disperse by January/February. Dispersing individuals traversed exposed plantation understory and agricultural pasture land in order to enter patches of native scrubland. By March/April all individuals captured at minimally vegetated ponds had retreated to adjacent scrub corridors. Animals found in ponds featuring dense riparian vegetation were not recorded to disperse. No difference in behavior was recorded between sexes. Rising temperatures coincided with increased movement by individuals towards native scrub refugia. The patterns of movement reported in this investigation emphasize the significant contribution of manmade water-bodies towards the conservation of L. raniformis within modified landscapes. The use of natural scrubland as cyclical retreats between breeding seasons also highlights the importance of the continued preservation of remnant vegetation corridors. Loss of artificial dams or buffering scrubland in heavily altered landscapes could see the breakdown of the greater L. raniformis meta-population further threatening their regional persistence.

Keywords: habitat loss, modified landscapes, spatial ecology, telemetry

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Authors: Deniz Yurtoğlu

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Aerosols directly affect the radiative balance of the earth by absorbing and/or scattering the sun rays reaching the atmosphere and indirectly affect the balance by acting as a nucleus in cloud formation. The composition, physical, and chemical properties of aerosols vary depending on their sources and the time spent in the atmosphere. The Eastern Mediterranean Basin has a high aerosol load that is formed from different sources; such as anthropogenic activities, desert dust outbreaks, and the spray of sea salt; and the area is subjected to atmospheric transport from other locations on the earth. This region, which includes the deserts of Africa, the Middle East, and the Mediterranean sea, is one of the most affected areas by climate change due to its location and the chemistry of the atmosphere. This study aims to investigate the spatiotemporal deviation of aerosol load in the Eastern Mediterranean Basin between the years 2018-2022 with the help of a new pioneer satellite of ESA (European Space Agency), Sentinel-5P. The TROPOMI (The TROPOspheric Monitoring Instrument) traveling on this low-Earth orbiting satellite is a UV (Ultraviolet)-sensing spectrometer with a resolution of 5.5 km x 3.5 km, which can make measurements even in a cloud-covered atmosphere. By using Absorbing Aerosol Index data produced by this spectrometer and special scripts written in Python language that transforms this data into images, it was seen that the majority of the aerosol load in the Eastern Mediterranean Basin is sourced from desert dust and anthropogenic activities. After retrieving the daily data, which was separated from the NaN values, seasonal analyses match with the normal aerosol variations expected, which are high in warm seasons and lower in cold seasons. Monthly analyses showed that in four years, there was an increase in the amount of Absorbing Aerosol Index in spring and winter by 92.27% (2019-2021) and 39.81% (2019-2022), respectively. On the other hand, in the summer and autumn seasons, a decrease has been observed by 20.99% (2018-2021) and 0.94% (2018-2021), respectively. The overall variation of the mean absorbing aerosol index from TROPOMI between April 2018 to April 2022 reflects a decrease of 115.87% by annual mean from 0.228 to -0.036. However, when the data is analyzed by the annual mean values of the years which have the data from January to December, meaning from 2019 to 2021, there was an increase of 57.82% increase (0.108-0.171). This result can be interpreted as the effect of climate change on the aerosol load and also, more specifically, the effect of forest fires that happened in the summer months of 2021.

Keywords: aerosols, eastern mediterranean basin, sentinel-5p, tropomi, aerosol index, remote sensing

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Authors: Andreas Walmsley, Shobana Partington, Rebecca Armstrong, Harold Goodwin

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In the UK, more than 1 in 5 workers earn less than a living wage. The hospitality sector is particularly affected where it has been claimed two thirds of workers earn less than the living wage. The UK Government is set to introduce (April 2016) a national living wage (NLW) which is therefore likely to have a significant impact on the hospitality sector. To date limited data exists that focus on how hotels are tackling the issue, what stakeholder perceptions are towards the change in legislation, and how the NLW may affect working patterns in the sector. This study draws on interviews with a range of key stakeholders such as hotel HR and general managers as well as industry representatives to explore these issues within the broader context of responsible tourism. Data collection is still ongoing and is scheduled to be completed by the end of June 2016.

Keywords: hospitality, living wage, responsible tourism, tourism employment

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Authors: Melanie Verhovnik

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School shootings are a well-known phenomenon in Germany, 14 of which have occurred to date. The first case happened half a year after the April 20th, 1999 Columbine shooting in the United States, which was at the time the most serious school shooting to have occurred anywhere in the world. The German media gave only scant attention to the subject of school shootings prior to Columbine, even though there were numerous instances of it throughout the world and several serious instances in the United States during the 1990s. A mixed method design of qualitative and quantitative content analysis was employed in order to demonstrate the main features and characteristics of core German media’s coverage of Columbine.

Keywords: Columbine, media coverage, qualitative, quantitative content analysis, school shooting

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Authors: Lidia Dzierzbicka-Glowacka, Anna Lemieszek, Mariusz Figiela

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In 2010-2011, the research on zooplankton was conducted in the southern part of the Baltic Sea to determine seasonal variability in changes occurring throughout the zooplankton in 2010 and 2011, both in the region of Gdańsk Deep, and in the western part of Gdańsk Bay. The research in the sea showed that the taxonomic composition of holoplankton in the southern part of the Baltic Sea was similar to that recorded in this region for many years. The maximum values of abundance and biomass of zooplankton both in the Deep and the Bay of Gdańsk were observed in the summer season. Copepoda dominated in the composition of zooplankton for almost the entire study period, while rotifers occurred in larger numbers only in the summer 2010 in the Gdańsk Deep as well as in May and July 2010 in the western part of Gdańsk Bay, and meroplankton – in April 2011.

Keywords: Baltic Sea, composition, Gdańsk Bay, zooplankton

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Authors: R. Islam, Rafiqul A. Tarefder

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This study presents the moisture variations of unbound layers from April 2012 to January 2014 in the Interstate 40 (I-40) pavement section in New Mexico. Three moisture probes were installed at different layers inside the pavement which measure the continuous moisture variations of the pavement. Data show that the moisture contents of unbound layers are typically constant throughout the day and month unless there is rainfall. Moisture contents of all unbound layers change with rainfall. Change in ground water table may affect the moisture content of unbound layers which has not investigated in this study. In addition, the Level 3 predictions of moisture contents using the Pavement Mechanistic-Empirical (ME) Design software are compared and found quite reasonable. However, results presented in the current study may not be applicable for pavement in other regions.

Keywords: asphalt pavement, moisture probes, resilient modulus, climate model

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Authors: A. D. Rao, Sachiko Mohanty

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The Internal Waves (IWs) are generated by the flow of barotropic tide over the rapidly varying and steep topographic features like continental shelf slope, subsurface ridges, and the seamounts, etc. The IWs of the tidal frequency are generally known as internal tides. These waves have a significant influence on the vertical density and hence causes mixing in the region. Such waves are also important in submarine acoustics, underwater navigation, offshore structures, ocean mixing and biogeochemical processes, etc. over the shelf-slope region. The seasonal variability of internal tides in the Bay of Bengal with special emphasis on its energetics is examined by using three-dimensional MITgcm model. The numerical simulations are performed for different periods covering August-September, 2013; November-December, 2013 and March-April, 2014 representing monsoon, post-monsoon and pre-monsoon seasons respectively during which high temporal resolution in-situ data sets are available. The model is initially validated through the spectral estimates of density and the baroclinic velocities. From the estimates, it is inferred that the internal tides associated with semi-diurnal frequency are more dominant in both observations and model simulations for November-December and March-April. However, in August, the estimate is found to be maximum near-inertial frequency at all the available depths. The observed vertical structure of the baroclinic velocities and its magnitude are found to be well captured by the model. EOF analysis is performed to decompose the zonal and meridional baroclinic tidal currents into different vertical modes. The analysis suggests that about 70-80% of the total variance comes from Mode-1 semi-diurnal internal tide in both observations as well as in the model simulations. The first three modes are sufficient to describe most of the variability for semidiurnal internal tides, as they represent 90-95% of the total variance for all the seasons. The phase speed, group speed, and wavelength are found to be maximum for post-monsoon season compared to other two seasons. The model simulation suggests that the internal tide is generated all along the shelf-slope regions and propagate away from the generation sites in all the months. The model simulated energy dissipation rate infers that its maximum occurs at the generation sites and hence the local mixing due to internal tide is maximum at these sites. The spatial distribution of available potential energy is found to be maximum in November (20kg/m²) in northern BoB and minimum in August (14kg/m²). The detailed energy budget calculation are made for all the seasons and results are analysed.

Keywords: available potential energy, baroclinic energy flux, internal tides, Bay of Bengal

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Authors: Da-Hye Jang, Woo-Jeong Cho

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Marine leisure tourism contributes greatly to the national economy in which the sea is located nearby and many countries are using marine tourism to create value added. The interest and investment of government and local governments on marine leisure tourism growing as a major trend of marine tourism is steadily increasing. But indiscriminate investment in marine leisure tourism such as duplicated business wastes limited resources. In other words, government and local governments need to select and concentrate on the goal they pursue by drawing priority on maritime leisure tourism policies. The purpose of this study is to analyze development strategies on supplier for marine leisure tourism and thus provide a comprehensive and rational framework for developing marine leisure tourism. In order to achieve the purpose, this study is to analyze priorities for each evaluation criterion of marine leisure tourism development policies using Analytic Hierarchy Process. In this study, a questionnaire was used as the survey tool and was developed based on the previous studies, government report, regional report, related thesis and literature for marine leisure tourism. The questionnaire was constructed by verifying the validity of contents from the expert group related to marine leisure tourism after conducting the first and second preliminary surveys. The AHP survey was conducted to experts (university professors, researchers, field specialists and related public officials) from April 6, 2018 to April 30, 2018 by visiting in person or e-mail. This study distributed 123 questionnaires and 68 valid questionnaires were used for data analysis. As a result, 4 factors with 12 detail strategies were analyzed using Excel. Extracted factors of development strategies of marine leisure tourism are consist of 4 factors such as infrastructure, popularization, law & system improvement and advancement. In conclusion, the results of the pairwise comparison of the four major factor on the first class were infrastructure, popularization, law & system improvement and advancement in order. Second, marine water front space maintenance had higher priority than marina facilities expansion and the establishment of marine leisure education center. Third, marine leisure safety·culture improvement had higher priority than strengthening experience·education program and the upkeep and open promotion event. Fourth, specialization·cluster of marine leisure tourism had higher priority than business support system of marine leisure tourism. Fifth, the revision of water-related leisure activities safety act had higher priority than an enactment of marine tourism promotion act and the foster of marina service industry. Finally, marine water front space maintenance was the most important development plan to boost marine leisure tourism.

Keywords: marine leisure tourism, marine leisure, marine tourism, analytic hierarchy process

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Authors: Waheed Akhtar

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In the current study, we aim to access the different month-wise reproductive biology of S. esocinus. Samples were collected from Rive Swat in the period of March 2022 to March 2023. Samples were collected using different gills nets of different sizes. Gonado Somatic Index and fecundity were studied using gravimetric to identify the breeding season and reproductive potential. The highest GSI was recorded in the month of April and November. Male to female ratio was in balance. The weight of the fish, size of the fish and ovary were parallel to the fecundity. This is the baseline study for the breeding biology of S. esocinus and further molecular study is required to identify the internal and external factors associated with the breeding biology of S. esocinus.

Keywords: snow trout, length and weight relationship, fecundity, river Swat

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Authors: Madiha Qureshi

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The study was designed to explore the morphological variation of Aseel chicken varieties in district Hyderabad. A survey was conducted during 5th April 2017 to 23rd August 2017 in four localities of district Hyderabad including Tandojam, Goth karan khan shoro, tower market and railway line colony. A total number of 54 samples (20 males and 34 females) of six varieties of Aseel chicken breed (Sindhi, Mottled, Black, Lakha, Jawa, Kulang) were studied and identify with different morphological characters such as comb type, size of wattles and earlobes, plumage color, shank color, beak color and eye color. Great morphological diversity was observed among these varieties, and this study provides baseline information for future research in the area.

Keywords: Aseel, Hyderabad, wattle, earlobe, comb

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Authors: Zakaria Haddad, Azzedine Nahoui, Mohamed Salmi, Ali Djagham

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Solar distillation is an effective and practical method for the production of drinking water in arid and semi-arid areas; however, this production is very limited. The aim of this work is to increase the latter by means of single slope solar still with four glass cover without augmenting volume and surface of a conventional solar still, using local materials and simple design. The equipment was tested under the climatic condition of Msila city (35°70′ N, 4°54′ E), Algeria. Performance of the use of four glass cover was studied, and exhaustive data were collected, analyzed, and presented. To show the effectiveness of the system, its performance was compared with that of the conventional solar still. The experimental study shows that the production of the proposed system achieves 5.3 l/m²/day and 5.8 l/m²/day respectively for the months of April and May, with an increase of 10% and 17% compared to the conventional solar still.

Keywords: drinking water, four glass cover, production, solar distillation

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Authors: Endalkachew Abebe Kebede, Bojin Bojinov, Andon Vasilev Andonov, Orhan Dengiz

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Remote sensing has a potential application in assessing and monitoring the plants' biophysical properties using the spectral responses of plants and soils within the electromagnetic spectrum. However, only a few reports compare the performance of different remote sensing sensors against in-situ field spectral measurement. The current study assessed the potential applications of open data source satellite images (Sentinel 2 and Landsat 9) in estimating the biophysical properties of the wheat crop on a study farm found in the village of OvchaMogila. A Landsat 9 (30 m resolution) and Sentinel-2 (10 m resolution) satellite images with less than 10% cloud cover have been extracted from the open data sources for the period of December 2021 to April 2022. An Unmanned Aerial Vehicle (UAV) has been used to capture the spectral response of plant leaves. In addition, SpectraVue 710s Leaf Spectrometer was used to measure the spectral response of the crop in April at five different locations within the same field. The ten most common vegetation indices have been selected and calculated based on the reflectance wavelength range of remote sensing tools used. The soil samples have been collected in eight different locations within the farm plot. The different physicochemical properties of the soil (pH, texture, N, P₂O₅, and K₂O) have been analyzed in the laboratory. The finer resolution images from the UAV and the Leaf Spectrometer have been used to validate the satellite images. The performance of different sensors has been compared based on the measured leaf spectral response and the extracted vegetation indices using the five sampling points. A scatter plot with the coefficient of determination (R2) and Root Mean Square Error (RMSE) and the correlation (r) matrix prepared using the corr and heatmap python libraries have been used for comparing the performance of Sentinel 2 and Landsat 9 VIs compared to the drone and SpectraVue 710s spectrophotometer. The soil analysis revealed the study farm plot is slightly alkaline (8.4 to 8.52). The soil texture of the study farm is dominantly Clay and Clay Loam.The vegetation indices (VIs) increased linearly with the growth of the plant. Both the scatter plot and the correlation matrix showed that Sentinel 2 vegetation indices have a relatively better correlation with the vegetation indices of the Buteo dronecompared to the Landsat 9. The Landsat 9 vegetation indices somewhat align better with the leaf spectrometer. Generally, the Sentinel 2 showed a better performance than the Landsat 9. Further study with enough field spectral sampling and repeated UAV imaging is required to improve the quality of the current study.

Keywords: landsat 9, leaf spectrometer, sentinel 2, UAV

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Authors: Hevriani Sevrika Mayuasti

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This research deals in improving college students’ critical thinking at English for Specific Purposes Subject. The strategy that is applied is Bloom’s Critical Thinking Questioning Strategy. The positive side of this strategy is that the given questions are developed based on Bloom’s taxonomy level. It is an action research because the researcher uses own class in doing this research. The processes of this research have been done from April to Mei 2014. There are two cycles and each cycle consists of two meetings. After doing the research, it is gotten that Bloom’s Critical Thinking Questioning Strategy improves college students’ critical thinking. It helps the students to build and elaborate their ideas. Hence, it increases students’ reading comprehension.

Keywords: critical thinking, blooms’ critical thinking, questioning, strategy

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