Search results for: nutritional guidance

Authors: Nazia Nazir

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Background: The benefits of regional anesthetic techniques are well established. Use of additives to local anesthetics can prolong these benefits. The aim of this study was to observe the effect of adding dexmedetomidine to bupivacaine for the supraclavicular block. Methods (Design): In this randomized, double-blind study, seventy ASA I & II patients of either sex undergoing elective surgeries on the upper limb were given supraclavicular block under ultrasound guidance. Group C (n=35), received 38 mL 0.25% bupivacaine + 2mL normal saline and group D received 38 mL 0.25% bupivacaine + 1 µg/kg dexmedetomidine (2mL). Patients were observed for onset, duration of motor and sensory block, duration of analgesia, sedation score, hemodynamic changes and any adverse events. Results: In group D the onset was faster (P < 0.001), duration of sensory and motor block, as well as duration of analgesia, was prolonged as compared to group C (P < 0.0001). There was significant drop in heart rate (HR) from the baseline in group D (P < 0.05) at 30, 60, 90 and 120 min, however, none of the patients dropped HR below 50/min. Mean arterial Pressure (MAP) remained unaffected. The patients in group D were effectively sedated than those in group C (P < 0.05). No adverse event was reported in either group. Conclusion: Dexmedetomidine as adjuvant to bupivacaine in supraclavicular block resulted in faster action, prolonged motor and sensory block, prolonged analgesia with hemodynamic stability and adequate sedation.

Keywords: Analgesia, bupivacaine, dexmedetomidine, supraclavicular block

Procedia PDF Downloads 154

Authors: Lovro Štefan

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The main purpose of the study was to explore if a higher level of Elderly Dietary index score was correlated with lower peak plantar pressures. One-hundred and twenty older adults aged ≥60 years participated in this cross-sectional study. To assess the level of adherence to nutritional recommendations for older adults, we used Elderly Dietary Index score. Plantar pressures beneath the forefoot, midfootandhindfootregions of the foot were determined by pressure platform. Pearson’s coefficient of correlations and partial correlations were used to calculate the relationships. In the unadjusted model, higher Elderly Dietary Index was significantly correlated with lower peak plantar pressure beneath the forefoot (r = -0.45, p<0.001) and hindfoot (r = -0.37, p<0.001) the region, while no significant correlation with peak plantar pressure beneath the (r = -0.15, p=0.113) was observed. When we adjusted for age, body-mass index and gait velocity, higher Elderly Dietary Index remained significantly correlated with lower peak plantar pressure beneath the forefoot (r = -0.41, p<0.001) and hintfoot (r = -0.32, p<0.001) region. This study shows that higher adherence to nutritional recommendations is significantly correlated with lower forefoot and hindfoot peak plantar pressures in older women.

Keywords: elderly, biomechanics, nutrition, associations, force

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Authors: Maedeh Gharazi

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Adults with age 50 and older will include more than 70% of the diabetic populace by the year 2025. More established patients with diabetes are more inclined to have concurrent ceaseless conditions like hypertension, dyslipidemia, and cardiovascular sickness that may affect their nutritious necessities. The issue of achievement and support of an ideal body weight in elderly diabetic persons may not be as direct as in other age gatherings, and the risk-benefit ratio may be diverse too. Albeit expanded predominance of overweight and weight in the elderly adds to insulin resistance and hyperglycemia, more seasoned tenants of long haul care offices who experience the ill effects of diabetes have a tendency to be underweight. Both may mean insufficient nutritional status and lead to expanded grimness and mortality. The attendant problems of appetite changes, palatability of food, dietary restrictions, loneliness, and depression may influence the sort and amount of food devoured by elderly persons. Organized screening devices may recognize nutrition related issues that warrant proof based mediations. Despite the fact that glucose control and health concerns are essential calculates diet change in the more established populace, different contemplations incorporate personal satisfaction and individual inclinations. Redoing of nutritious rules to the needs of the more seasoned diabetic patient bodes well.

Keywords: diabetes, nutritious necessities, insulin resistance, glucose control

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Authors: Herawati Tri Siswati, Nurhidayat Ana Sıdık Fatimah

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The Indonesia Basic Health Research, 2013 showed that prevalence of stunting of 6–12 children years old was 35,6%, wasting was 12,2% and obesiy was 9,2%. The Indonesian Goverment have School Health Program, held in coordination, plans, directing and responsible, developing and implement health student. However, it's implementation still under expected, while Indonesian Ministry of Health has initiated the School Health Program acceleration. This aimed is to know the influencing of training to knowledge and skill of elementary school teacher about measurement and assesment nutrirional status children. The research is quasy experimental with pre-post design, in Sleman disctrict, Yogyakarta province, Indonesia, 2015. Subject was all of elementary school teacher’s who responsible in School Health Program in Gamping sub-district, Sleman, Yogyakarta, i.e. 32 persons. The independent variable is training, while the dependent variable are teacher’s klowledge and skill on measurement and assesment nutrirional status children. The data was analized by t-test. The result showed that the knowledge score before training is 31,6±9,7 and after 56,4±12,6, with an increase 24,8±15,7, and p=0.00. The skill score before training is 46,6±11,1 and after 61,7±13, with an increase 15,2±14,2, p = 0.00. Training can increase the teacher’s klowledge and skill on measurement and assesment nutrirional status.

Keywords: training, school health program, nutritional status, children.

Procedia PDF Downloads 363

Authors: Burcu Uçan

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The certification approach differs in civil and military projects in aviation. Sets of criteria and standards created by airworthiness authorities for the determination of certification basis are distinct. While the civil standards are more understandable and clear because of not only include detailed specifications but also the help of guidance materials such as Advisory Circular, military criteria do not provide this level of guidance. Therefore, specifications that are more negotiable and sometimes more difficult to reconcile arise for the certification basis of a military aircraft. This study investigates a method of how to develop a military specification set by taking advantage of civil standards, regarding the European Military Airworthiness Criteria (EMACC) that establishes the airworthiness criteria for aircraft systems. Airworthiness Certification Criteria (MIL-HDBK-516C) is a handbook published for guidance that contains qualitative evaluation for military aircrafts meanwhile Certification Specifications (CS-29) is published for civil aircrafts by European Union Aviation Safety Agency (EASA). This method intends to compare and contrast specifications that MIL-HDBK-516C and CS-29 contain within the scope of Human Factors. Human Factors supports human performance and aims to improve system performance by encompassing knowledge from a range of scientific disciplines. Human Factors focuses on how people perform their tasks and reduce the risk of an accident occurring due to human physical and cognitive limitations. Hence, regardless of whether the project is civil or military, the specifications must be guided at a certain level by taking into account human limits. This study presents an advisory method for this purpose. The method in this study develops a solution for the military certification process by identifying the CS requirement corresponding to the criteria in the MIL-HDBK-516C by means of EMACC. Thus, it eases understanding the expectations of the criteria and establishing derived requirements. As a result of this method, it may not always be preferred to derive new requirements. Instead, it is possible to add remarks to make the expectancy of the criteria and required verification methods more comprehensible for all stakeholders. This study contributes to creating a certification basis for military aircraft, which is difficult and takes plenty of time for stakeholders to agree due to gray areas in the certification process for military aircrafts.

Keywords: human factors, certification, aerospace, requirement

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Authors: Kar Lin Nyam, Phey Yee Lim

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The aim of this study was to determine the antioxidant potential, nutritional composition, and functional properties of kenaf leaves powder. Besides, the effect of kenaf leaves powder in bread qualities, properties, and consumer acceptability were evaluated. Different formulations of bread fortified with 0%, 4% and 8% kenaf leaves powder, respectively were produced. Physical properties of bread, such as loaf volume, dough expansion, crumb colour, and bread texture, were determined. Nine points hedonic scale was utilized in sensory evaluation to determine the best formulation (the highest overall acceptability). Proximate composition, calcium content, and antioxidant properties were also determined for the best formulation. 4% leaves powder bread was the most preferred by the panelists followed by control bread, and the least preferred was being 8% leaves powder bread. 4% leaves powder bread had significantly higher value of DPPH radical scavenging capacity (8.05 mg TE/100g), total phenolic content (12.88 mg GAE/100g) and total flavonoid content (13.26 mg QE/100g) compared to control bread (1.38 mg TE/100g, 8.17 mg GAE/100g, and 8.77 mg QE/100g respectively). Besides, 4% leaves powder bread also showed higher in calcium content and total dietary fiber compared to control bread. Kenaf leaves powder is suitable to be used as a source of natural antioxidant for fortification and nutrient improver in bread.

Keywords: dietary fibre, calcium, total phenolic content, total flavonoid content

Procedia PDF Downloads 97

Authors: Amessis-Ouchemoukh Nadia, Salhi Rim, Ouchemoukh Salim, Ayad Rabha, Sadou Dyhia, Guenaoui Nawel, Hamouche Sara, Madani Khodir

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The cooking method is a key factor influencing the quality of vegetables. In this study, the effect of the most common cooking methods on the nutritional composition, phenolic content, pigment content and antioxidant activities (evaluated by DPPH, ABTS, CUPRAC, FRAP, reducing power and phosphomolybdene method) of fresh, steamed, and boiled red beet was investigated. The fresh samples showed the highest nutritional and bioactive composition compared to the cooked ones. The boiling method didn’t lead to a significant reduction (p< 0.05) in the content of phenolics, flavonoids, flavanols and DPPH, ABTS, FRAP, CUPRAC, phosphomolybdeneum and reducing power capacities. This effect was less pronounced when steam cooking was used, and the losses of bioactive compounds were lower. As a result, steam cooking resulted in greater retention of bioactive compounds and antioxidant activity compared to boiling. Overall, this study suggests that steam cooking is a better method in terms of retention of pigments and bioactive compounds and antioxidant activity of beetroot.

Keywords: beta vulgaris, cooking methods, bioactive compounds, antioxidant activities

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Authors: Christos Lampropoulos, Maria Konsta, Ifigenia Apostolou, Vicky Dradaki, Tamta Sirbilatze, Irini Dri, Christina Kordali, Vaggelis Lambas, Kostas Argyros, Georgios Mavras

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Objectives: Mediterranean diet has been associated with lower incidence of cardiovascular disease and cancer. The purpose of our study was to examine the hypothesis that Mediterranean diet may protect against mortality and reduce admission duration in elderly, hospitalized patients. Methods: Sample population included 150 patients (78 men, 72 women, mean age 80±8.2). The following data were taken into account in analysis: anthropometric and laboratory data, dietary habits (MedDiet score), patients’ nutritional status [Mini Nutritional Assessment (MNA) score], physical activity (International Physical Activity Questionnaires, IPAQ), smoking status, cause and duration of current admission, medical history (co-morbidities, previous admissions). Primary endpoints were mortality (from admission until 6 months afterwards) and duration of admission, compared to national guidelines for closed consolidated medical expenses. Logistic regression and linear regression analysis were performed in order to identify independent predictors for mortality and admission duration difference respectively. Results: According to MNA, nutrition was normal in 54/150 (36%) of patients, 46/150 (30.7%) of them were at risk of malnutrition and the rest 50/150 (33.3%) were malnourished. After performing multivariate logistic regression analysis we found that the odds of death decreased 30% per each unit increase of MedDiet score (OR=0.7, 95% CI:0.6-0.8, p < 0.0001). Patients with cancer-related admission were 37.7 times more likely to die, compared to those with infection (OR=37.7, 95% CI:4.4-325, p=0.001). According to multivariate linear regression analysis, admission duration was inversely related to Mediterranean diet, since it is decreased 0.18 days on average for each unit increase of MedDiet score (b:-0.18, 95% CI:-0.33 - -0.035, p=0.02). Additionally, the duration of current admission increased on average 0.83 days for each previous hospital admission (b:0.83, 95% CI:0.5-1.16, p<0.0001). The admission duration of patients with cancer was on average 4.5 days higher than the patients who admitted due to infection (b:4.5, 95% CI:0.9-8, p=0.015). Conclusion: Mediterranean diet adequately protects elderly, hospitalized patients against mortality and reduces the duration of hospitalization.

Keywords: Mediterranean diet, malnutrition, nutritional status, prognostic factors for mortality

Procedia PDF Downloads 280

Authors: Sharmin Shahid, Zaher Zain

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The purpose of this study is to explore and examines the theoretical frameworks of ethical leadership style and affective organizational commitment. Additionally, to investigate the extent to which employee orientation and ethical guidance either strengthen or weaken on the relationship between ethical leadership style and affective commitment. The study will also measure the mediating effects of leader’s integrity either influence to inspire and revival employee’s affective commitment or not. The methodology of the study comprised sample of 237 managers, departmental heads, top-level executives, and professors of several financial institutions, banks, and universities in Bangladesh who are directly related with decision making process of respective organization. A cross sectional research design will be used to examine the direct, moderating, and mediating analysis among the research key variables. Data were gathered based on personal administered questionnaire. The findings of the study will be significance because it will provide the real scenario of leadership style which leads to financial and strategic success of any organizations. In addition, the results will be interesting enough to find out either ethical leadership style have positive relationship with affective commitment or not. Employee-orientation and ethical guidance is a moderator to improve leadership style and affective commitment, whereas, leader’s integrity mediates the relationships between leadership style and affective organizational commitment to do the right thing in the right way for the betterment of entire organizational success. Research limitations of the study are the data collected by self administered questionnaire, a method with well-known shortcomings. Second, the study concentrated on financial institutions, banks top executives, and universities professors in Bangladesh. An important implication of the research is that the interesting findings will give some insight to the leadership style and helps management to focus on their management and leadership efficacy, as that could improve their affective organizational commitment. The findings will be original and unique value adding with the existing literature on leadership studies. The study is based on a comprehensive literature review. The results will be based on a sample of financial institutions, banks, and universities in Bangladesh. The research findings are useful to academics and corporate leaders of financial institutions, banks, and universities all over the world.

Keywords: affective organizational commitment, Bangladesh, ethical guidance, ethical leadership style

Procedia PDF Downloads 295

Authors: Nneka N. Uchegbu, Charles N. Ishiwu

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The nutritional composition and hypoglycaemic effect of crackers produced from a blend of sprouted pigeon pea, unripe plantain, and brewers’ spent grain and fed to Alloxan induced diabetic rat was investigated. Crackers were produced from different blends of sprouted pigeon pea, unripe plantain and brewers’ spent grain. The crackers were evaluated for proximate composition, amino acid profile and antinutritional factors. Blood glucose levels of normal and diabetic rats fed with the control sample and different formulations of cracker were measured. The protein content of the samples were significantly different (p < 0.05) from each other with sample A having the lowest value and sample B with the highest value. The values obtained showed that the samples contained most of the amino acids that are found in plant proteins. The levels of antinutritional factor determined were generally low. Administration of the formulated cracker meals led to a significant reduction in the fasting blood glucose level in the diabetic rats. The present study concluded that consumption of crackers produced from this composite flour can be recommended for the diabetics and those who are sceptical about the disease.

Keywords: crackers, diabetics rat, sprouted pigeon pea, unripe plantain and brewers’ spent grain

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Authors: Isiya Shinkafi Salihu

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Open education resources (OER) are open learning materials in different formats, course content and context to support learning globally. This study investigated the level of awareness of Hospitality and Tourism OER among students in the Department of Tourism and Hotel Management in a University. Specifically, it investigated students’ awareness, use and accessibility of OER in learning. The research design method used was the quantitative approach, using an online questionnaire. The thesis research shows that respondents frequently use OER but with little knowledge of the content and context of the material. Most of the respondents’ have little knowledge about the concept even though they use it. Information and communication technologies are tools for information gathering, social networking and knowledge sharing and transfer. OER are open education materials accessible online such as curriculum, maps, course materials, and videos that users create, adapt, reuse for learning and research. Few of the respondents that used OER in learning faced some challenges such as high cost of data, poor connectivity and lack of proper guidance. The results suggest a lack of awareness of OER among students in the faculty of tourism and the need for support from the teachers in the utilization of OER. The thesis also reveals that some of the international students are accessing the internet as beginners in their studies which require guidance. The research, however, recommends that further studies should be conducted to other faculties.

Keywords: creative commons, open education resources, open licenses, information and communication technology

Procedia PDF Downloads 151

Authors: B. F. Olanipekun, O. J. Oyelade, C. O. Osemobor

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Pigeon pea is a very good source of protein and micronutrient, but it is being underutilized in Nigeria because of several constraints. This research considered the effect of different processing methods on the quality attributes of pigeon pea used in bread production towards enhancing its utility. Pigeon pea was obtained at a local market and processed into the flour using three processing methods: soaking, sprouting and roasting and were used to bake bread in different proportions. Chemical composition and sensory attributes of the breads were thereafter determined. The highest values of protein and ash contents were obtained from 20 % substitution of sprouted pigeon pea in wheat flour and may be attributable to complex biochemical changes occurring during hydration, to invariably lead to protein constituent being broken down. Hydrolytic activities of the enzymes from the sprouted sample resulted in improvement in the constituent of total protein probably due to reduction in the carbohydrate content. Sensory qualities analyses showed that bread produced with soaked and roasted pigeon pea flours at 5 and 10% inclusion, respectively were mostly accepted than other blends, and products with sprouted pigeon pea flour were least accepted. The findings of this research suggest that supplementing wheat flour with sprouted pigeon peas have more nutritional potentials. However, with sensory analysis indices, the soaked and roasted pigeon peas up to 10% are majorly accepted, and also can improve the nutritional status. Overall, this will be very beneficial to population dependent on plant protein in order to combat malnutrition problems.

Keywords: pigeon pea, processing, protein, malnutrition

Procedia PDF Downloads 216

Authors: Belen Carrillo, Mauricio Mosquera

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Fatty acids are bioactive compounds widely used as nutritional supplements in the food and pharmaceutical industry. Bluefish such as sardines have a large variety of these fatty acids in their composition. The objective of this project is to extract these compounds from fishing wastes, to do this, heads of known species as Pinchagua (Opistonema libertate) were used. The conducted study represents a simplified alternative for obtaining and simultaneous saponification of oil through basic hydrolysis, which separates lipids from protein and saponifies sample all the same time to isolate the fatty acid accurately through salts formation. To do these different concentrations of sodium hydroxide were used, it was demonstrated at a concentration of 1 M the highest yield of saponified oil recovery corresponding a value of 3,64% was obtained. Subsequently, the saponified oil was subjected to an acid hydrolysis in which fatty acids were isolated. Different sulfuric acid concentrations and temperatures for the process were tested. Thus, it was shown that the great fatty acids variety were obtained at a 60 °C temperature and sulfuric acid concentration of 50% v/v. Among the obtained compounds the presence of acids such as palmitic, lauric, caproic and myristic are highlighted. Applications of this type of elements are varied and widely used in the nutritional supplements development. Thus, the described methodology proposes a simple mechanism in the revaluation of fishing industry wastes that allow directly generate high added value elements.

Keywords: fatty acids, hydrolysis, Pinchagua, saponification

Procedia PDF Downloads 150

Authors: Thais O. de Paula, Marjorie R. A. Sarmiento, Francis M. Borges, Alessandra B. Ferreira-Machado, Juliana A. Resende, Dioneia E. Cesar, Vania L. Silva, Claudio G. Diniz

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Obesity is currently a worldwide public health threat, being considered a pandemic multifactorial disease related to the human gut microbiota (GM). Add to that GM is considered an important reservoir of antimicrobial resistance genes (ARG) and little is known on GM and ARG in obesity, considering the altered physiology and xenobiotics intake. As regional and social behavior may play important roles in GM modulation, and most of the studies are based on small sample size and various methodological approaches resulting in difficulties for data comparisons, this study was focused on the investigation of GM bacterial diversity in obese (OB), overweight (OW) and eutrophic individuals (ET) considering their nutritional, clinical and social characteristics; and comparative screening of AGR related to their physiology and xenobiotics intake. Microbial community was accessed by FISH considering phyla as a taxonomic level, and PCR-DGGE followed by dendrograms evaluation (UPGMA method) from fecal metagenome of 72 volunteers classified according to their body mass index (BMI). Nutritional, clinical, social parameters and xenobiotics intake were recorded for correlation analysis. The fecal metagenome was also used as template for PCR targeting 59 different ARG. Overall, 62% of OB were hypertensive, and 12% or 4% were, regarding the OW and ET individuals. Most of the OB were rated as low income (80%). Lower relative bacterial densities were observed in the OB compared to ET for almost all studied taxa (p < 0.05) with Firmicutes/Bacteroidetes ratio increased in the OB group. OW individuals showed a bacterial density representative of GM more likely to the OB. All the participants were clustered in 3 different groups based on the PCR-DGGE fingerprint patterns (C1, C2, C3), being OB mostly grouped in C1 (83.3%) and ET mostly grouped in C3 (50%). The cluster C2 showed to be transitional. Among 27 ARG detected, a cluster of 17 was observed in all groups suggesting a common core. In general, ARG were observed mostly within OB individuals followed by OW and ET. The ratio between ARG and bacterial groups may suggest that AGR were more related to enterobacteria. Positive correlations were observed between ARG and BMI, calories and xenobiotics intake (especially use of sweeteners). As with nutritional and clinical characteristics, our data may suggest that GM of OW individuals behave in a heterogeneous pattern, occasionally more likely to the OB or to the ET. Regardless the regional and social behaviors of our population, the methodological approaches in this study were complementary and confirmatory. The imbalance of GM over the health-disease interface in obesity is a matter of fact, but its influence in host's physiology is still to be clearly elucidated to help understanding the multifactorial etiology of obesity. Although the results are in agreement with observations that GM is altered in obesity, the altered physiology in OB individuals seems to be also associated to the increased xenobiotics intake and may interfere with GM towards antimicrobial resistance, as observed by the fecal metagenome and ARG screening. Support: FAPEMIG, CNPQ, CAPES, PPGCBIO/UFJF.

Keywords: antimicrobial resistance, bacterial diversity, gut microbiota, obesity

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Authors: Hesham Abdin, Mohamed Zakaria, Talaat Abd-Elmonaem, Alaa El-Din Sayed Hafez

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Kalman filter algorithm is an estimator known as the workhorse of estimation. It has an important application in missile guidance, especially in lack of accurate data of the target due to noise or uncertainty. In this paper, a Kalman filter is used as a tracking filter in a simulated target-interceptor scenario with noise. It estimates the position, velocity, and acceleration of the target in the presence of noise. These estimations are needed for both proportional navigation and differential geometry guidance laws. A Kalman filter has a good performance at low noise, but a large noise causes considerable errors leads to performance degradation. Therefore, a new technique is required to overcome this defect using tuning factors to tune a Kalman filter to adapt increasing of noise. The values of the tuning factors are between 0.8 and 1.2, they have a specific value for the first half of range and a different value for the second half. they are multiplied by the estimated values. These factors have its optimum values and are altered with the change of the target heading. A genetic algorithm updates these selections to increase the maximum effective range which was previously reduced by noise. The results show that the selected factors have other benefits such as decreasing the minimum effective range that was increased earlier due to noise. In addition to, the selected factors decrease the miss distance for all ranges of this direction of the target, and expand the effective range which leads to increase probability of kill.

Keywords: proportional navigation, differential geometry, Kalman filter, genetic algorithm

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Authors: Deddi Nordiawan

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Effective public policy creation required a strong budget system, both in terms of design and implementation. Performance-based Budget is an evolutionary approach with two substantial characteristics; first, the strong integration between budgeting and planning, and second, its existence as guidance so that all activities and expenditures refer to measurable performance targets. There are four processes in the government that should be followed in order to make the budget become performance-based. These four processes consist of the preparation of a vision according to the bold aspiration, the formulation of outcome, the determination of output based on the analysis of organizational resources, and the formulation of Value Creation Map that contains a series of programs and activities. This is consistent with the concept of logic model which revealed that the budget performance should be placed within a relational framework of resources, activities, outputs, outcomes and impacts. Through the issuance of Law 17/2003 regarding State Finance, local governments in Indonesia have to implement performance-based budget. Central Government then issued Government Regulation 58/2005 which contains the detail guidelines how to prepare local governments budget. After a decade, implementation of performance budgeting in local government is still not fully meet expectations, though the guidance is completed, socialization routinely performed, and trainings have also been carried out at all levels. Accordingly, this study views the practice of performance-based budget at local governments as a problematic situation. This condition must be approached with a system approach that allows the solutions from many point of views. Based on the fact that the infrastructure of budgeting has already settled, the study then considering the situation as complexity. Therefore, the intervention needs to be done in the area of human activity system. Using Soft Systems Methodology, this research will reconstruct the process of performance-based budget at local governments is area of human activity system. Through conceptual models, this study will invite all actors (central government, local government, and the parliament) for dialogue and formulate interventions in human activity systems that systematically desirable and culturally feasible. The result will direct central government in revise the guidance to local government budgeting process as well as a reference to build the capacity building strategy.

Keywords: soft systems methodology, performance-based budgeting, Indonesia, public policy

Procedia PDF Downloads 215

Authors: Tareq Aljaber

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The number of mobile health apps is growing at a fast frequency as it's nearly doubled in a year between 2015 and 2016. Though, there is a lack of an effective evaluation framework to verify the usability and reliability of mobile phone health education applications which would help saving time and effort for the numerous user groups. This abstract describing a framework for evaluating mobile applications in specifically mobile health education applications, along with a guidance select tool to assist different users to select the most suitable mobile health education apps. The effective framework outcome is intended to meet the requirements and needs of the different stakeholder groups additionally to enhancing the development of mobile health education applications with software engineering approaches, by producing new and more effective techniques to evaluate such software. This abstract highlights the significance and consequences of mobile health education apps, before focusing the light on the required to create an effective evaluation framework for these apps. An explanation of the effective evaluation framework is going to be delivered in the abstract, beside with some specific evaluation metrics: an efficient hybrid of selected heuristic evaluation (HE) and usability evaluation (UE) metrics to enable the determination of the usefulness and usability of health education mobile apps. Moreover, an explanation of the qualitative and quantitative outcomes for the effective evaluation framework was accomplished using Epocrates mobile phone app in addition to some other mobile phone apps. This proposed framework-An Evaluation Framework for Mobile Health Education Apps-consists of a hybrid of 5 metrics designated from a larger set in usability evaluation and heuristic evaluation, illuminated grounded on 15 unstructured interviews from software developers (SD), health professionals (HP) and patients (P). These five metrics corresponding to explicit facets of usability recognised through a requirements analysis of typical stakeholders of mobile health apps. These five hybrid selected metrics were scattered across 24 specific questionnaire questions, which are available on request from first author. This questionnaire has been sent to 81 participants distributed in three sets of stakeholders from software developers (SD), health professionals (HP) and patients/general users (P/GU) on the purpose of ranking three sets of mobile health education applications. Finally, the outcomes from the questionnaire data helped us to approach our aims which are finding the profile for different stakeholders, finding the profile for different mobile health educations application packages, ranking different mobile health education application and guide us to build the select guidance too which is apart from the Evaluation Framework for Mobile Health Education Apps.

Keywords: evaluation framework, heuristic evaluation, usability evaluation, metrics

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Authors: Georgios A. Fragkiadakis, Antonia Psaroudaki, Theodora Mouratidou, Eirini Sfakianaki

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Research: The nutritional benefits of eating carob are many and important for the human organism, as it is a food rich in carbohydrates and low in fat and contains multiple nutrients, making it a "superfood". Within the framework of the project "Actions for the optimal utilization of the potential of carob in the Region of Crete" which is financed-supervised by the Region of Crete, a second-grade local self-government authority, with the collaboration of the University of Crete and of the Hellenic Mediterranean University, an online survey was carried out with the aim of evaluating dietary habits and views related to the consumption of carob and its products in a sample of local residents. Results and Conclusions: Of the 351 participants, 259 (73.8%) stated that they consume carob products, and 26.2% stated that they do not. Difficult access and limited availability of carob-food products (33.7%), high price (20.7%), and difficulties of use and preparation (15.2%) were cited as the main reasons for non-consumption. Other reasons, to a lesser extent, concern the taste, especially the sweet aftertaste of some products. Concerning the behavior and eating habits related to the consumption of carob products (n=259), 57.9% of the sample report that they buy carob products "sometimes"; 21.2% report "often"; 19.7% report "rarely", and a very small percentage of 1.2% report "constantly". With reference to the reasons for choosing carob products, the participants mention the main reason for their high nutritional value (51.7%), followed by 32.4% of nutritional claims and health claims, and the organoleptic characteristics (10.8%). Other positive factors are the final price of the product, the ease of use, and the respect for the local environment and producers. Some bakery products show the highest percentage of consumption among carob-food consumers, mainly in the form of rusks (86.1%) and breadsticks (70.3%). They are followed, in descending order, by bread (63.3%), toast (52.1%), and flour (50.6%). More specifically: 40.5% consume carob rusks less than once a month; 22% consume less than once a week; up to twice a week 12.4%; 6.6%, consume rusks 3 to 4 times a week, and daily 3.9%. It is worth mentioning that a high percentage of consumers of carob products recommend the consumption to their family and friends. Only a small percentage, in the range of 5%, does not recommend the consumption of carob products in their close family/social circle. The main motivating factors for the consumption of carob products are the expected effects they may have on health (74.1%) and the organoleptic characteristics with a percentage of 21.6%.

Keywords: food, consumer, preferences, carob, Crete, Greece

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Authors: Naveen Kumar B. T., Anuj Tyagi, Prabjeet Singh, Shanthanagouda A. H., Sumeet Rai

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Inland saline water resources are gaining the importance in expanding the aquaculture activities to mitigate the nutritional and food security issues of the world. For profitable and sustainable aquaculture practices, scientific farming, biosecurity measure, and best fish health management should be the integral part of developmental activities. Keeping in line with global awareness and trends, the Indian government has taken an innovative step to conduct disease surveillance and awareness programme for aquatic disease through network project. This ‘National Surveillance Programme for Aquatic Animal Diseases (NSPAAD)’ is being implemented in collaboration of national institutes and state agriculture universities with funding support from National Fisheries Development Board (NFDB), Govt. of India. Guru Angad Dev Veterinary and Animal Sciences University (GADVASU), Ludhiana, an NSPAAD collaborator, has been actively engaged in disease surveillance in the Indian state of Punjab. Shrimp farming in inland saline areas of Punjab is expanding at a tremendous pace under the guidance of GADVASU along with the support of State Fisheries Department. Under this national disease surveillance programme, we reported Enterocytozoon hepatopenaei (EHP) infection in the Litopenaeus vannamei cultured in the inland saline waters. Polymerase chain reaction (PCR) based diagnosis was carried out using the OIE (World Organisation for Animal Health) protocol. It was observed that out of 20 shrimp farms, two farms were 1st step PCR positive and two more farms were nested PCR positive. All the EHP positive ponds had shown the white faeces along with mortalities at very low rate. Therefore, implementation of biosecurity and continuous surveillance and monitoring program for finfish and shellfish aquaculture are in need of the hour to prevent and control the large-scale disease outbreaks and subsequent economic losses.

Keywords: disease, EHP, inland saline water, shrimp culture

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Authors: Sharareh Hekmat, Michelle Lane

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Pregnancy during adolescence affects both the growth and development of mother and baby, particularly in low socioeconomic and food insecure areas. This mixed methods study is aimed at discovering a need for a community-based probiotic yogurt program to assist pregnant women in the Mukuru slum Nairobi, Kenya. Surveys were conducted with pregnant women (14-25 years old, n=43), which included questionnaires on dietary intake, food access, and health/quality of life perception. The frequency and means procedure was used to analyze maternal characteristics, Women’s Dietary Diversity Score (WDDS) and Household Hunger Scale. 24-hour recalls were analyzed via ESHA Food Processor, and median nutrient intakes were reported as a percent of recommendations. An environmental scan was conducted to assess food availability, accessibility, and quality. WDDS reflected a low-moderate diet variation (3.86 food groups out of 9, SD ± 1.3) among the women. The 24-hour recall suggested an inadequate intake of many nutrients, most significantly B12, potassium and calcium. 86% of women reported little to no household hunger. However, the environmental scan revealed low quality and poor sanitation of food. This study provides evidence that a probiotic program would be desirable, and contribute to the nutritional status of women in the Mukuru community.

Keywords: dietary diversity, pregnant women, probiotics, urban slum, Kenya

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Authors: O. I. Papagianni, P. Potsaki, K. Almpounioti, D. Chatzicharalampous, A. Voutsa, O. Katira, A. Michalaki, H. C. Karantonis, A. E. Koutelidakis

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High intakes of carbohydrates and fats have been associated with an increased risk of chronic diseases due to the role of postprandial oxidative stress. This pilot nutritional intervention aimed to examine the acute effect of consuming two different types of breadsticks prepared from durum wheat flour mixtures differing in total phenolic content on postprandial inflammatory and oxidant responses in healthy volunteers. A cross-over, controlled, and single-blind clinical trial was designed, and two isocaloric high-fat and high-carbohydrate meals were tested. Serum total, HDL- and LDL-cholesterol, triglycerides, glucose, CRP, uric acid, plasma total antioxidant capacity, and antiplatelet activity were determined in fasting and 30, 60, and 120 min after consumption. The results showed a better postprandial HDL-cholesterol and total antioxidant activity response in the intervention group. The choice of durum wheat flours with higher phenolic content and antioxidant activity is presented as promising for human health, and clinical studies will expand to draw safer conclusions.

Keywords: breadsticks, durum wheat flours, postprandial inflammation, postprandial oxidative stress, ex vivo antiplatelet activity

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Authors: Shackira Am, Jos T. Puthur

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The phytostabilization potential of a halophyte Acanthus ilicifolius L. has been evaluated with special attention to the nutritional as well as anatomical adaptations developed by the plant. Distribution of essential elements influenced by the excess Zn²⁺ ions in the root tissue was studied by FEG-SEM EDX microanalysis. Significant variations were observed in the uptake and allocation of mineral elements like Mg, P, K, S, Na, Si and Al in the root of A. ilicifolius. The increase in S is in correlation with the increased synthesis of glutathione which might be involved in the biosynthesis of phytochelatins. This in turn might be aiding the plant to tolerate the adverse environmental conditions by stabilizing the excess Zn in the root tissue itself. Moreover it is revealed that most of the Zn were accumulated towards the central region near the vascular tissue. Treatment with ZnSO₄ in A. ilicifolius caused significant increase in the number of glandular trichomes on the adaxial leaf surface as compared to the leaves of control plants. In addition to this, A. ilicifolius when treated with ZnSO₄, exhibited a deeply stained layer of cells immediate to the endodermis, forming more or less a ring like structure around the xylem vessels. Phloem cells in these plants were crushed/reduced in numbers. There were no such deeply stained cells forming a ring around the xylem vessels in the control plants. These adaptive responses make the plant a suitable candidate for the phytostabilization of Zn. In addition the nutritional adjustment of the plant equips them for a better survival under increased concentration of Zn²⁺.

Keywords: Acanthus ilicifolius, mineral elements, phytostabilization, zinc

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Authors: Zviad Ghadua, Biswa Bhattacharya

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The Flash Flood Guidance (FFG) provides the rainfall amount of a given duration necessary to cause flooding. The approach is based on the development of rainfall-runoff curves, which helps us to find out the rainfall amount that would cause flooding. An alternative approach, mostly experimented with Italian Alpine catchments, is based on determining threshold discharges from past events and on finding whether or not an oncoming flood has its magnitude more than some critical discharge thresholds found beforehand. Both approaches suffer from large uncertainties in forecasting flash floods as, due to the simplistic approach followed, the same rainfall amount may or may not cause flooding. This uncertainty leads to the question whether a probabilistic model is preferable over a deterministic one in forecasting flash floods. We propose the use of a Bayesian probabilistic approach in flash flood forecasting. A prior probability of flooding is derived based on historical data. Additional information, such as antecedent moisture condition (AMC) and rainfall amount over any rainfall thresholds are used in computing the likelihood of observing these conditions given a flash flood has occurred. Finally, the posterior probability of flooding is computed using the prior probability and the likelihood. The variation of the computed posterior probability with rainfall amount and AMC presents the suitability of the approach in decision making in an uncertain environment. The methodology has been applied to the Posina basin in Italy. From the promising results obtained, we can conclude that the Bayesian approach in flash flood forecasting provides more realistic forecasting over the FFG.

Keywords: flash flood, Bayesian, flash flood guidance, FFG, forecasting, Posina

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Authors: I. Caldas, T. Duarte

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Avoidant Restrictive Food Intake Disorder (ARFID) was included for the first time in DSM-5, replacing the old diagnosis of DSM-4 'Early Childhood Eating Disorder'. An ARFID is characterized by a restrictive/avoidant eating pattern that can lead to severe nutritional deficiency, weight loss, nutritional supplementation dependence, and poor psychosocial functioning. This eating pattern is associated with decreased interest in food, worries about food characteristics or the act of ingestion, and lack of concern with weight or body image. This paper aims to understand the impact of this new diagnosis in other Eating Disorders (ED) prevalence, as well as to compare their therapeutic approaches. Methodology: Literature reviewed by PubMed with the following keywords: 'ARFID', 'Prevalence', and 'Eating Disorders'. We selected articles related to this theme, written since 2016. Results: In a population of children hospitalized with ED, 5% to 14% was diagnosed with ARFID, and, as outpatient treatment, the prevalence was 22%. People diagnosed with ARFID have more prevalence of other comorbidities, especially autism spectrum, are younger, and are more often male. Regarding the treatment of ARFID, it most often required nasogastric feeding, and with less suffering associated with this procedure, compared to AN. Despite these differences, 12% of patients diagnosed with ARFID transited to AN during treatment, suggesting that the first pathology may be a risk factor for the development of AN. Conclusions: The differences identified between ARFID and the other EDs are important when analyzed as differential diagnostic hypotheses and therapeutic approaches. Further study is necessary regarding its prevalence, risk factors, and treatment.

Keywords: avoidant restrictive food intake disorder, ARFID, differential diagnoses, eating disorders, prevalence

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Authors: Joan O. Ogundele, Aladesanmi A. Oshodi, Adekunle I. Amoo

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Abstract In-vitro multi-enzyme protein digestibility (IVMPD) and some anti-nutritional factors (ANF) of five melon (egusi) seed flours (MSF) and their protein isolates (PI) were carried out. Their PI have potentials comparable to that of soya beans. It is important to know the IVMPD and ANF of these protein sources as to ensure their safety when adapted for use as alternate protein sources to substitute for cow milk, which is relatively expensive in Nigeria. Standard methods were used to produce PI of Citrullus colocynthis, Citrullus vulgaris, African Wine Kettle gourd (Lageneria siceraria I), Basket Ball gourd (Lagenaria siceraria II) and Bushel Giant Gourd (Lageneria siceraria III) seeds and to determine the ANF and IVMPD of the MSF and PI unheated and at 37oC. Multi-enzymes used were trypsin, chymotrypsin and peptidase. IVMPD of MSF ranged from (70.67±0.70) % (C. vulgaris) to (72.07± 1.79) % (L.siceraria I) while for their PI ranged from 74.33% (C.vulgaris) to 77.55% (L.siceraria III). IVMPD of the PI were higher than those of MSF. Heating increased IVMPD of MSF with average value of 79.40% and those of PI with average of 84.14%. ANF average in MSF are tannin (0.11mg/g), phytate (0.23%). Differences in IVMPD of MSF and their PI at different temperatures may arise from processing conditions that alter the release of amino acids from proteins by enzymatic processes. ANF in MSF were relatively low, but were found to be lower in the PI, therefor making the PI safer for human consumption as an alternate source of protein.

Keywords: Anti-nutrients, Enzymatic protein digestibility, Melon (egusi)., Protein Isolates.

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Authors: Richa Jaiswal, Vidisha Sharma, Amulya Rattan, Sushma Sagar, Subodh Kumar, Amit Gupta, Biplab Mishra, Maneesh Singhal

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Background: Adequate nutritional support and daily patient monitoring have an independent therapeutic role in the successful management of high output fistulae and early recovery after abdominal trauma. Case presentation: An 18-year-old girl was brought to AIIMS emergency with alleged history of fall of a heavy weight (electric motor) over abdomen. She was evaluated as per Advanced Trauma Life Support(ATLS) protocols and diagnosed to have significant abdominal trauma. After stabilization, she was referred to Trauma center. Abdomen was guarded and focused assessment with sonography for trauma(FAST) was found positive. Complete duodenojejunal(DJ) junction transection was found at laparotomy, and end-to-end repair was done. However, patient was re-explored in view of biliary peritonitis on post-operative day3, and anastomotic leak was found with sloughing of duodenal end. Resection of non-viable segments was done followed by side-to-side anastomosis. Unfortunately, the anastomosis leaked again, this time due to a post-anastomotic kink, diagnosed on dye study. Due to hostile abdomen, the patient was planned for supportive care, with plan of build-up and delayed definitive surgery. Percutaneous transheptic biliary drainage (PTBD) and STSG were required in the course as well. Nutrition: In intensive care unit (ICU), major goals of nutritional therapy were to improve wound healing, optimize nutrition, minimize enteral feed associated complications, reduce biliary fistula output, and prepare the patient for definitive surgeries. Feeding jejunostomy (FJ) was started from day 4 at the rate of 30ml/h along with total parenteral nutrition (TPN) and intra-venous (IV) micronutrients support. Due to high bile output, bile refeed started from day 13.After 23 days of ICU stay, patient was transferred to general ward with body mass index (BMI)<11kg/m2 and serum albumin –1.5gm%. Patient was received in the ward in catabolic phase with high risk of refeeding syndrome. Patient was kept on FJ bolus feed at the rate of 30–50 ml/h. After 3–4 days, while maintaining patient diet book log it was observed that patient use to refuse feed at night and started becoming less responsive with every passing day. After few minutes of conversation with the patient for a couple of days, she complained about enteral feed discharge in urine, mild pain and sign of dumping syndrome. Dye study was done, which ruled out any enterovesical fistula and conservative management were planned. At this time, decision was taken for continuous slow rate feeding through commercial feeding pump at the rate of 2–3ml/min. Drastic improvement was observed from the second day in gastro-intestinal symptoms and general condition of the patient. Nutritional composition of feed, TPN and diet ranged between 800 and 2100 kcal and 50–95 g protein. After STSG, TPN was stopped. Periodic diet counselling was given to improve oral intake. At the time of discharge, serum albumin level was 2.1g%, weight – 38.6, BMI – 15.19 kg/m2. Patient got discharge on an oral diet. Conclusion: Successful management of post-traumatic proximal high output fistulae is a challenging task, due to impaired nutrient absorption and enteral feed associated complications. Strategic- and goal-based nutrition support can salvage such critically ill patients, as demonstrated in the present case.

Keywords: nutritional monitoring, nutritional support, duodenal fistula, abdominal trauma

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Authors: Johnson C. Y. Pang, Bo Peng, Kara K. L. Reeves, Allan C. L. Fud

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Objective: Dry needling (DN) has long been used as a treatment method for various musculoskeletal pain conditions. However, the evidence level of the studies was low due to the limitations of the methodology. Lack of randomization and inappropriate blinding is potentially the main sources of bias. A method that can differentiate clinical results due to the targeted experimental procedure from its placebo effect is needed to enhance the validity of the trial. Therefore, this study aimed to validate the method as a placebo ultrasound(US)-guided DN for patients with knee osteoarthritis (KOA). Design: This is a randomized controlled trial (RCT). Ninety subjects (25 males and 65 females) aged between 51 and 80 (61.26 ± 5.57) with radiological KOA were recruited and randomly assigned into three groups with a computer program. Group 1 (G1) received real US-guided DN, Group 2 (G2) received placebo US-guided DN, and Group 3 (G3) was the control group. Both G1 and G2 subjects received the same procedure of US-guided DN, except the US monitor was turned off in G2, blinding the G2 subjects to the incorporation of faux US guidance. This arrangement created the placebo effect intended to permit comparison of their results to those who received actual US-guided DN. Outcome measures, including the visual analog scale (VAS) and Knee injury and Osteoarthritis Outcome Score (KOOS) subscales of pain, symptoms, and quality of life (QOL), were analyzed by repeated measures analysis of covariance (ANCOVA) for time effects and group effects. The data regarding the perception of receiving real US-guided DN or placebo US-guided DN were analyzed by the chi-squared test. The missing data were analyzed with the intention-to-treat (ITT) approach if more than 5% of the data were missing. Results: The placebo US-guided DN (G2) subjects had the same perceptions as the use of real US guidance in the advancement of DN (p<0.128). G1 had significantly higher pain reduction (VAS and KOOS-pain) than G2 and G3 at 8 weeks (both p<0.05) only. There was no significant difference between G2 and G3 at 8 weeks (both p>0.05). Conclusion: The method with the US monitor turned off during the application of DN is credible for blinding the participants and allowing researchers to incorporate faux US guidance. The validated placebo US-guided DN technique can aid in investigations of the effects of US-guided DN with short-term effects of pain reduction for patients with KOA. Acknowledgment: This work was supported by the Caritas Institute of Higher Education [grant number IDG200101].

Keywords: ultrasound-guided dry needling, dry needling, knee osteoarthritis, physiotheraphy

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Authors: Emma E. Hellawell, Susan J. Hughes

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BBrownfield sites are currently being redeveloped for residential use. Information on soil contamination on these former industrial sites is collected as part of the planning process by the local government. This research project analyses this untapped resource of environmental data, using site investigation data submitted to a local Borough Council, in Surrey, UK. Over 150 site investigation reports were collected and interrogated to extract relevant information. This study involved three phases. Phase 1 was the development of a database for soil contamination information from local government reports. This database contained information on the source, history, and quality of the data together with the chemical information on the soil that was sampled. Phase 2 involved obtaining site investigation reports for development within the study area and extracting the required information for the database. Phase 3 was the data analysis and interpretation of key contaminants to evaluate typical levels of contaminants, their distribution within the study area, and relating these results to current guideline levels of risk for future site users. Preliminary results for a pilot study using a sample of the dataset have been obtained. This pilot study showed there is some inconsistency in the quality of the reports and measured data, and careful interpretation of the data is required. Analysis of the information has found high levels of lead in shallow soil samples, with mean and median levels exceeding the current guidance for residential use. The data also showed elevated (but below guidance) levels of potentially carcinogenic polyaromatic hydrocarbons. Of particular concern from the data was the high detection rate for asbestos fibers. These were found at low concentrations in 25% of the soil samples tested (however, the sample set was small). Contamination levels of the remaining chemicals tested were all below the guidance level for residential site use. These preliminary pilot study results will be expanded, and results for the whole local government area will be presented at the conference. The pilot study has demonstrated the potential for this extensive dataset to provide greater information on local contamination levels. This can help inform regulators and developers and lead to more targeted site investigations, improving risk assessments, and brownfield development.

Keywords: Brownfield development, contaminated land, local government planning data, site investigation

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Authors: Maha Mohamed Hady Ali, M. A. El-Sayed

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Camel (Camelus dromedarius) is very important animal in many arid and semi-arid zones of tropical and subtropical regions as it serves as dual purpose providing meat and milk for human and as draft animal. Camel, like other animal must receive all essential nutrients despite the hostile environment. A study was conducted to evaluate the nutritional status of some micro-minerals of camel under Egyptian environmental condition. Forty five blood samples were collected from apparently healthy male camels with an average age between 2-6 years at the slaughter house in Cairo province, Egypt. The animals were fed mainly on berseem (Trifolium alexandrinum) or concentrate with straw before slaughtering. The collected serum and feedstuff samples were subjected to copper, iron, selenium and zinc analysis using Atomic absorption spectrophotometer. The data showed variation in the level of copper, iron, selenium and zinc in the serum of the dromedary camel as well as in the feedstuffs. Furthermore, the results indicated that the micro- minerals status of feeds may not always reflected as such in camel blood suggesting some role of bioavailability. The main reason for the lack of such reflection seems to be the wide diversity exists in the surrounding environment (forages and plants) as well as the bioavailability of such minerals. Since the requirement of micro-minerals have not been established for camel, more researches must be focused on this topic.

Keywords: camel, copper, egypt, feed stuff, iron, selenium, zinc

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Authors: Oktia Woro Kasmini Handayani, Bambang Budi Raharjo, Efa Nugroho, Bertakalswa Hermawati

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Obesity prevalence and severe malnutrition in Indonesia has increased from 2007 to 2013. The utilization of local resources in nutritional program planning can be used to program efficiency and to reach the goal. The aim of this research is to plan a nutrition program based on local resources for urban fringe areas in a developing country. This research used a qualitative approach, with a focus on local resources including social capital, social system, cultural system. The study was conducted in Mijen, Central Java, as one of the urban fringe areas in Indonesia. Purposive and snowball sampling techniques are used to determine participants. A total of 16 participants took part in the study. Observation, interviews, focus group discussion, SWOT analysis, brainstorming and Miles and Huberman models were used to analyze the data. We have identified several local resources, such as the contributions from nutrition cadres, social organizations, social financial resources, as well as the cultural system and social system. The outstanding contribution of nutrition cadres is the participation and creativity to improve nutritional status. In addition, social organizations, like the role of the integrated health center for children (Pos Pelayanan Terpadu), can be engaged in the nutrition program planning. This center is supported by House of Nutrition to assist in nutrition program planning, and provide social support to families, neighbors and communities as social capitals. The study also reported that cultural systems that show appreciation for well-nourished children are a better way to improve the problem of balanced nutrition. Social systems such as teamwork and mutual cooperation can also be a potential resource to support nutritional programs and overcome associated problems. The impact of development in urban areas such as the introduction of more green areas which improve the perceived status of local people, as well as new health services facilitated by people and companies, can also be resources to support nutrition programs. Local resources in urban fringe areas can be used in the planning of nutrition programs. The expansion of partnership with all stakeholders, empowering the community through optimizing the roles of nutrition care centers for children as our recommendation with regard to nutrition program planning.

Keywords: developing country, local resources, nutrition program, urban fringe

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