Search results for: tertiary
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 669

Search results for: tertiary

159 Metabolic Variables and Associated Factors in Acute Pancreatitis Patients Correlates with Health-Related Quality of Life

Authors: Ravinder Singh, Pratima Syal

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Background: The rising prevalence and incidence of Acute Pancreatitis (AP) and its associated metabolic variables known as metabolic syndrome (MetS) are common medical conditions with catastrophic consequences and substantial treatment costs. The correlation between MetS and AP, as well as their impact on Health Related Quality of Life (HRQoL) is uncertain, and because there are so few published studies, further research is needed. As a result, we planned this study to determine the relationship between MetS components impact on HRQoL in AP patients. Patients and Methods: A prospective, observational study involving the recruitment of patients with AP with and without MetS was carried out in tertiary care hospital of North India. Patients were classified with AP if they were diagnosed with two or more components of the following criteria, abdominal pain, serum amylase and lipase levels two or more times normal, imaging trans-abdominal ultrasound, computed tomography, or magnetic resonance. The National Cholesterol Education Program–Adult Treatment Panel III (NCEP-ATP III) criterion was used to diagnose the MetS. The various socio-demographic variables were also taken into consideration for the calculation of statistical significance (P≤.05) in AP patients. Finally, the correlation between AP and MetS, along with their impact on HRQoL was assessed using Student's t test, Pearson Correlation Coefficient, and Short Form-36 (SF-36). Results: AP with MetS (n = 100) and AP without MetS (n = 100) patients were divided into two groups. Gender, Age, Educational Status, Tobacco use, Body Mass Index (B.M.I), and Waist Hip Ratio (W.H.R) were the socio-demographic parameters found to be statistically significant (P≤.05) in AP patients with MetS. Also, all the metabolic variables were also found to statistically significant (P≤.05) and found to be increased in patients with AP with MetS as compared to AP without MetS except HDL levels. Using the SF-36 form, a greater significant decline was observed in physical component summary (PCS) and mental component summary (MCS) in patients with AP with MetS as compared to patients without MetS (P≤.05). Furthermore, a negative association between all metabolic variables with the exception of HDL, and AP was found to be producing deterioration in PCS and MCS. Conclusion: The study demonstrated that patients with AP with MetS had a worse overall HRQOL than patients with AP without MetS due to number of socio-demographic and metabolic variables having direct correlation impacting physical and mental health of patients.

Keywords: metabolic disorers, QOL, cost effectiveness, pancreatitis

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158 Advancing Healthcare Excellence in China: Crafting a Strategic Operational Evaluation Index System for Chinese Hospital Departments amid Payment Reform Initiatives

Authors: Jing Jiang, Yuguang Gao, Yang Yu

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Facing increasingly challenging insurance payment pressures, the Chinese healthcare system is undergoing significant transformations, akin to the implementation of DRG payment models by the United States' Medicare. Consequently, there is a pressing need for Chinese hospitals to establish optimizations in departmental operations tailored to the ongoing healthcare payment reforms. This abstract delineates the meticulous construction of a scientifically rigorous and comprehensive index system at the departmental level in China strategically aligned with the evolving landscape of healthcare payment reforms. Methodologically, it integrates key process areas and maturity assessment theories, synthesizing relevant literature and industry standards to construct a robust framework and indicator pool. Employing the Delphi method, consultations with 21 experts were conducted, revealing a collective demonstration of high enthusiasm, authority, and coordination in designing the index system. The resulting model comprises four primary indicators -technical capabilities, cost-effectiveness, operational efficiency, and disciplinary potential- supported by 14 secondary indicators and 23 tertiary indicators with varied coefficient adjustment for department types (platform or surgical). The application of this evaluation system in a Chinese hospital within the northeastern region yielded results aligning seamlessly with the actual operational scenario. In conclusion, the index system comprehensively considers the integrity and effectiveness of structural, process, and outcome indicators and stands as a comprehensive reflection of the collective expertise of the engaged experts, manifesting in a model designed to elevate the operational management of hospital departments. Its strategic alignment with healthcare payment reforms holds practical significance in guiding departmental development positioning, brand cultivation, and talent development.

Keywords: Chinese healthcare system, Delphi method, departmental management, evaluation indicators, hospital operations, weight coefficients

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157 Evaluation of Associated Risk Factors and Determinants of near Miss Obstetric Cases at B.P. Koirala Institute of Health Sciences, Dharan

Authors: Madan Khadka, Dhruba Uprety, Rubina Rai

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Background and objective: In 2011, around 273,465 women died worldwide during pregnancy, childbirth or within 42 days after childbirth. Near-miss is recognized as the predictor of the level of care and maternal death. The objective of the study was to evaluate the associated risk factors of near-miss obstetric cases and maternal death. Material and Methods A Prospective Observational Study was done from August 1, 2014, to June 30, 2015, in Department of Obstetrics and Gynecology at BPKIHS hospital, tertiary care hospital in Eastern Nepal, Dharan. Case eligible by the 5-factor scoring system and WHO near miss criteria were evaluated. Risk factors included severe hemorrhage, hypertensive disorders, and a complication of abortion, ruptured uterus, medical/surgical condition and sepsis. Results: A total of 9,727 delivery were attended during the study period from August 2014 to June 2014. There were 6307 (71.5%) vaginal delivery and 2777(28.5%) caesarean section and 181 perinatal death with a total of 9,546 live birth. A total of 162 near miss was identified, and 16 maternal death occurred during the study. Maternal near miss rate of 16.6 per 1000 live birth, Women with life-threatening conditions (WLTC) of 172, Severe maternal outcome ratio of 18.64 per 1000 live birth, Maternal near-miss mortality ratio (MNM: 1 MD) 10.1:1, Mortality index (MI) of 8.98%. Risk factors were obstetric hemorrhage 27.8%, abortion/ectopic 27.2%, eclampsia 16%, medical/surgical condition 14.8%, sepsis 13.6%, severe preeclamsia 11.1%, ruptured uterus 3.1%, and molar pregnancy 1.9%. 19.75% were prim gravidae, with mean age 25.66 yrs, and cardiovascular and coagulation dysfunction as a major life threatening condition and sepsis (25%) was the major cause of mortality. Conclusion: Hemorrhage and hypertensive disorders are the leading causes of near miss event and sepsis as a leading cause of mortality. As near miss analysis indicates the quality of health care, it is worth presenting in national indices.

Keywords: abortion, eclampsia, hemorrhage, maternal mortility, near miss

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156 Global and Domestic Response to Boko Haram Terrorism on Cameroon 2014-2018

Authors: David Nchinda Keming

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The present study is focused on both the national and international collective fight against Boko Haram terrorism on Cameroon and the rule played by the Lake Chad Basin Countries (LCBCs) and the global community to suffocate the sect’s activities in the region. Although countries of the Lake Chad Basin include: Cameroon, Chad, Nigeria and Niger others like Benin also joined the course. The justification for the internationalisation of the fight against Boko Haram could be explained by the ecological and international climatic importance of the Lake Chad and the danger posed by the sect not only to the Lake Chad member countries but to global armed, civil servants and the international political economy. The study, therefore, kick start with Cameroon’s reaction to Boko Haram’s terrorist attacks on its territory. It further expounds on Cameroon’s request on bilateral diplomacy from members of the UN Security Council for an international collective support to staple the winds of the challenging sect. The study relies on the hypothesis that Boko Haram advanced terrorism on Cameroon was more challenging to the domestic military intelligence thus forcing the government to seek for bilateral and multilateral international collective support to secure its territory from the powerful sect. This premise is tested internationally via (multilateral cooperation, bilateral response, regional cooperation) and domestically through (solidarity parade, religious discourse, political manifestations, war efforts, the vigilantes and the way forward). To accomplish our study, we made used of the mixed research methodologies to interpret the primary, secondary and tertiary sources consulted. Our results reveal that the collective response was effectively positive justified by the drastic drop in the sect’s operations in Cameroon and the whole LCBCs. Although the sect was incapacitated, terrorism remains an international malaise and Cameroon hosts a fertile ground for terrorists’ activism. Boko Haram was just weakened and not completely defeated and could reappear someday even under a different appellation. Therefore, to absolutely eradicate terrorism in general and Boko Haram in particular, LCBCs must improve their military intelligence on terrorism and continue to collaborate with advanced experienced countries in fighting terrorism.

Keywords: Boko Haram, terrorism, domestic, international, response

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155 A Retrospective Study on the Spectrum of Infection and Emerging Antimicrobial Resistance in Type 2 Diabetes Mellitus

Authors: Pampita Chakraborty, Sukumar Mukherjee

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People with diabetes mellitus are more susceptible to developing infections, as high blood sugar levels can weaken the patient's immune system defences. People with diabetes are more adversely affected when they get an infection than someone without the disease, because you have weakened immune defences in diabetes. People who have minimally elevated blood sugar levels experience worse outcomes with infections. Diabetic patients in hospitals do not necessarily have a higher mortality rate due to infections, but they do face longer hospitalisation and recovery times. A study was done in a tertiary care unit in eastern India. Patients with type 2 diabetes mellitus infection were recruited in the study. A total of 520 cases of Type 2 Diabetes Mellitus were recorded out of which 200 infectious cases was included in the study. All subjects underwent detailed history & clinical examination. Microbiological samples were collected from respective site of the infection for microbial culture and antibiotic sensitivity test. Out of the 200 infectious cases urinary tract infection(UTI) was found in majority of the cases followed by diabetic foot ulcer (DFU), respiratory tract infection(RTI) and sepsis. It was observed that Escherichia coli was the most commonest pathogen isolated from UTI cases and Staphylococcus aureus was predominant in foot ulcers followed by other organisms. Klebsiella pneumonia was the major organism isolated from RTI and Enterobacter aerogenes was commonly observed in patients with sepsis. Isolated bacteria showed differential sensitivity pattern against commonly used antibiotics. The majority of the isolates were resistant to several antibiotics that are usually prescribed on an empirical basis. These observations are important, especially for patient management and the development of antibiotic treatment guidelines. It is recommended that diabetic patients receive pneumococcal and influenza vaccine annually to reduce morbidity and mortality. Appropriate usage of antibiotics based on local antibiogram pattern can certainly help the clinician in reducing the burden of infections.

Keywords: antimicrobial resistance, diabetic foot ulcer, respiratory tract infection, urinary tract infection

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154 Impact of Clinical Pharmacist Intervention in Improving Drug Related Problems in Patients with Chronic Kidney Disease

Authors: Aneena Suresh, C. S. Sidharth

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Drug related problems (DRPs) are common in chronic kidney disease (CKD) patients and end stage patients undergoing hemodialysis. To treat the co-morbid conditions of the patients, more complex therapeutic regimen is required, and it leads to development of DRPs. So, this calls for frequent monitoring of the patients. Due to the busy work schedules, physicians are unable to deliver optimal care to these patients. Addition of a clinical pharmacist in the team will improve the standard of care offered to CKD patients by minimizing DRPs. In India, the role of clinical pharmacists in the improving the health outcomes in CKD patients is poorly recognized. Therefore, this study is conducted to put an insight on the role of clinical pharmacist in improving Drug Related Problems in patients with chronic kidney disease, thereby helping them to achieve desired therapeutic outcomes in the patients. A prospective interventional study was conducted for a year in a 620 bedded tertiary care hospital in India. Data was collected using an unstructured questionnaire, medication charts, etc. DRPs were categorized using Hepler and Strand classification. Relationships between the age, weight, GFR, average no of medication taken, average no of comorbidities, and average length of hospital days with the DRPs were identified using Mann Whitney U test. The study population primarily constituted of patients above the age of 50 years with a mean age of 59.91±13.59. Our study showed that 25% of the population presented with DRPs. On an average, CKD patients are prescribed at least 8 medications for the treatment in our study. This explains the high incidence of drug interactions in patients suffering from CKD (45.65%). The least common DRPs in our study were found to be sub therapeutic dose (2%) and adverse drug reactions (2%). Out of this, 60 % of the DRPs were addressed successfully. In our study, there is an association between the DRPs with the average number of medications prescribed, the average number of comorbidities, and the length of the hospital days with p value of 0.022, 0.004, and 0.000, respectively. In the current study, 86% of the proposed interventions were accepted, and 41 % were implemented by the physician, and only 14% were rejected. Hence, it is evident that clinical pharmacist interventions will contribute significantly to diminish the DRPs in CKD patients, thereby decreasing the economic burden of healthcare costs and improving patient’s quality of life.

Keywords: chronic kidney disease, clinical pharmacist, drug related problem, intervention

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153 Success of Trabeculectomy: May Not Always Depend on Mitomycin C

Authors: Sushma Tejwani, Shoruba Dinakaran, Rupa Rokhade, K. Bhujang Shetty

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Introduction and aim: One of the major causes for failure of trabeculectomy is fibrosis and scarring of subconjunctival tissue around the bleb, and hence intra operative usage of anti-fibrotic agents like Mitomycin C (MMC) has become very popular. However, the long term effects of MMC like thin, avascular bleb, hypotony, bleb leaks and late onset endophthalmitis cannot be ignored, and may preclude its usage in routine trabeculectomy. In this particular study we aim to study the outcomes of trabeculectomy with and without MMC in uncomplicated glaucoma patients. Methods: Retrospective study of series of patients that underwent trabeculectomy with or without cataract surgery in glaucoma department of a tertiary eye care centre by a single surgeon for primary open angle glaucoma (POAG), angle closure glaucoma (PACG), Pseudoexfoliation glaucoma (PXF glaucoma). Patients with secondary glaucoma, juvenile and congenital glaucoma were excluded; also patients undergoing second trabeculectomy were excluded. The outcomes were studied in terms of IOP control at 1 month, 6 months, and 1 year and were analyzed separately for surgical outcomes with and without MMC. Success was considered if IOP was < 16 mmHg on applanation tonometry. Further, the necessity of medication, 5 fluorouracil (5FU) postoperative injections, needling post operatively was noted. Results: Eighty nine patient’s medical records were reviewed, of which 58 patients had undergone trabeculectomy without MMC and 31 with MMC. Mean age was 62.4 (95%CI 61- 64), 34 were females and 55 males. MMC group (n=31): Preoperative mean IOP was 21.1mmHg (95% CI: 17.6 -24.6), and 22 patients had IOP > 16. Three out of 33 patients were on single medication and rests were on multiple drugs. At 1 month (n=27) mean IOP was 12.4 mmHg (CI: 10.7-14), and 31/33 had success. At 6 months (n=18) mean IOP was 13mmHg (CI: 10.3-14.6) and 16/18 had good outcome, however at 1 year only 11 patients were available for follow up and 91% (10/11) had success. Overall, 3 patients required medication and one patient required postoperative injection of 5 FU. No MMC group (n=58): Preoperative mean IOP was 21.9 mmHg (CI: 19.8-24.2), and 42 had IOP > 16 mmHg. 12 out of 58 patients were on single medication and rests were on multiple drugs. At 1 month (n=52) mean IOP was14.6mmHg (CI: 13.2-15.9), and 45/ 58 had IOP < 16mmHg. At 6 months (n=31) mean IOP was 13.5 mmHg (CI: 11.9-15.2) and 26/31 had success, however at 1 year only 23 patients came for follow up and of these 87% (20/23) patients had success. Overall, 1 patient required needling, 5 required 5 FU injections and 5 patients required medication. The success rates at each follow up visit were not significantly different in both the groups. Conclusion: Intra-operative MMC usage may not be required in all patients undergoing trabeculectomy, and the ones without MMC also have fairly good outcomes in primary glaucoma.

Keywords: glaucoma filtration surgery, mitomycin C, outcomes of trabeculectomy, wound modulation

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152 The Study on How Outward Direct Investment of Chinese MNEs to European Union Area Affect the Domestic Industrial Structure

Authors: Nana Weng

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From 2008, Chinese Foreign Direct Investment flows to the European Union continued its rapid rise. Currently, the industrial structure adjustment in developing countries has also been placed on the international movement of factors of production. Now China economy is in an important period of transformation on industrial structure adjustment. Under the international transfer of industry background, the adjustment of industrial structure upgrading and sophistication are the key elements of a successful economic transformation. In order to achieve a virtuous cycle of foreign investment patterns and optimize the industrial structure of foreign direct investment as well, the research on the positive the role of the EU direct investment and how it impact China’s industrial structure optimization and upgrading is of great significance. In this paper, the author explained how the EU as an investment destination is different with the United States and ASEAN. Then, based on the theory of FDI and industrial structure and combining the four kinds of motives of China’s ODI in EU, this paper explained the impact mechanism which has influenced China domestic industrial structure primarily through the Transfer effect, Correlation effect and Competitive effect. On the premise that FDI activities do affect the home country’s domestic industrial structure, this paper made empirical analysis with industrial panel data. With the help of Gray Correlation Method and Limited Distributed Lags, this paper found that China/s ODI in the EU impacted the tertiary industry strongly and had a significant positive impact, particularly the manufacturing industry and the financial industry. This paper also pointed out that Chinese MNEs should realize several issues, such as pay more attention to high-tech industries so that they can make the best use of reverse technology spillover. When Chinese enterprises ‘go out,' they ought to keep in mind that domestic research and development capital contribution can make greater economic growth. Finally, based on theoretical and empirical analysis results, this paper presents the industry choice recommendations in the future of the EU direct investment, particularly through the development of the proper rational industrial policy and industrial development strategic to guide the industrial restructuring and upgrading.

Keywords: china ODI in european union, industrial structure optimization, impact mechanism, empirical analysis

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151 Jurisdiction of Military Court for Military Members Who Committed General Crimes in Indonesia's Military Justice System and Comparison with Another Countries

Authors: Dini Dewi Heniarti

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Military Court which is a judicial institution within the military institution has a heavy duty. Military court has to ensuring a fair legal process for military personnel (due process of law) and enforces military discipline. Military justice must also ensure protects the rights of military personnel. In Indonesia tren of military court changes in vision. The debate is happened on the jurisdiction of military court that allegedly has the potential existence of impunity. The Decree of People’s Consultative Assembly Number VII/MPR/2000 which states that the army general who committed the crime should not be tried in military court is one that underlies the proposed amendment limits the jurisdiction of military court. For the identify of the background in a specific format that is limited to juridical review. The goals this research is to gain knowledge, deep understanding and the concept of jurisdiction of military courts for military members who committed general crimes in adjudication procedure from the perspective of legal reform as alternative to establish independency of military judiciary. This research using Rule of Law as Grand Theory, Development Legal Theory as a Middle Theory and Criminal Justice System and concept of jurisdiction as supporting as Applied Theory. This study using a normative juridical approach, and equipped by primary data juridical approach of historical and comparative approach. The author uses descriptive analytical specifications. The main data used in this research is secondary data, which includes primary legal materials, secondary legal material and legal materials tertiary. Analysis primary data and qualitative data is done legally. Technique checking the validity of the data in this study used multiple methods with the research triangulation. This paper will demonstrate the problems concerning the jurisdiction of military courts for military personnel who committed general crimes in perspective of military justice reform Indonesia and adjudication procedures for military member who committed general crimes in the military justice system in Indonesia, as alternative to establish independency of judiciary in military justice in Indonesia. Comparative approached the military justice system from another countries is aimed to development military justice in Indonesia.

Keywords: jurisdiction, military courts, military justice, independency of judiciary

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150 Vitamin D Levels in Relation to Thyroid Disorders

Authors: Binaya Tamang, Buddhhi Raj Pokhrel, Narayan Gautam

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Background: There may be a connection between thyroid function and vitamin D status since both bind to similar nuclear hormone receptors and have similar response regions on gene promoters. The purpose of the current study was to investigate the relationship between thyroid hormones and vitamin D levels in females who were attending a tertiary care center in western Nepal and were either hypothyroid or euthyroid. Methods: This hospital-based cross-sectional study was carried out between March 2020 and March 2021 by the Biochemistry department of the Universal College of Medical Sciences (UCMS), Bhairahawa, Province No. 5, Nepal, in cooperation with Internal medicine. Prior to the study, institutional review committee approval (UCMS/IRC/008/20) was acquired from UCMS. Women who visited the Internal Medicine OPD of UCMS and were advised to get a thyroid function test (TFT) were included in the study population. Only those who were willing to participate in the study were enrolled after the goals and advantages of the study had been explained to them. Participants who had recently used vitamin D supplements and medications that affected thyroid hormones were excluded. The participants gave their consent verbally and in writing. After getting the consent, a convenient sample technique was applied. Serum was isolated after drawing 3 ml of blood in a plain vial. Chemiluminescence assay was used to analyze vitamin D and thyroid hormones (MAGLUMI 2000). SPSS version 16.0 for Windows was used to conduct the statistical analysis. Statistical significance was defined as a P-value < 0.05. Results: Majority of the study population (n=214, 71%) had insufficient serum vitamin D levels. Among the thyroid groups, the median Vitamin D levels were significantly lower in hypothyroid (16.88 ng/ml) as compared to the euthyroid groups (25.01 ng/ml) (P<0.001). Similarly, serum Vitamin D levels were considerably lower in the obese population (16.86 ng/ml) as compared to the normal BMI group (24.90 ng/ml) (P<0.001) as well as in the vegetarian (15.43 ng.ml) than mixed diet consumer (24.89 ng/ml) (P<0.01). Even after the adjustment for these variables, the Vitamin D levels were significantly lower in the hypothyroid population than in the euthyroid group (P<0.001). Conclusion: Comparing the hypothyroid population to the euthyroid, the median serum vitamin D levels were considerably lower. We were alarmed to see that the majority of euthyroid participants also had low levels of vitamin D. Therefore if left untreated, low vitamin D levels in hypothyroid patients could worsen their health further.

Keywords: vitamin D, thyroid hormones, euthyroid, hypothyroid, Nepal

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149 Educational System in Developing Countries and E-learning Evaluation in the Face of COVID Pandemic

Authors: Timothy Wale Olaosebikan

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The adverse effect of the Covid-19 outbreak and lock-downs on the world economy has coursed a major disrupt in mostly all sectors. The educational sector is not exempted from this disruption as it is one of the most affected sectors in the world. Similarly, most developing countries are still struggling to adopt/ adapt with the 21st-century advancement of technology, which includes e-learning/ e-education. Furthermore, one is left to wonder of the possibility of these countries surviving this disruption on their various educational systems that may no longer be business as usual after the Covid Pandemic era. This study evaluates the e-learning process of educational systems, especially in developing countries. The collection of data for the study was effected through the use of questionnaires with sampling drawn by stratified random sampling. The data was analyzed using descriptive and inferential statistics. The findings of the study show that about 30% of developing countries have fully adopted the e-learning system, about 45% of these countries are still struggling to upgrade while about 25% of these countries are yet to adopt the e-learning system of education. The study concludes that the sudden closure of educational institutions around the world during the Covid Pandemic period should facilitate a teaching pedagogy of e-learning and virtual delivery of courses and programmes in these developing countries. If this approach can be fully adopted, schools might have to grapple with the initial teething problems, given the sudden transition just in order to preserve the welfare of students. While progress should be made to transit as the case may be, lectures and seminars can be delivered through the web conferencing site-zoom. Interestingly, this can be done on a mobile phone. The demands of this approach would equally allow lecturers to make major changes to their work habits, uploading their teaching materials online, and get to grips with what online lecturing entails. Consequently, the study recommends that leaders of developing countries, regulatory authorities, and heads of educational institutions must adopt e-learning into their educational system. Also, e-learning should be adopted into the educational curriculum of students, especially from elementary school up to tertiary level. Total compliance to the e-learning system must be ensured on the part of both the institutions, stake holders, lecturers, tutors, and students. Finally, collaborations with developed countries and effective funding for e-learning integration must form the heart of their cardinal mission.

Keywords: Covid pandemic, developing countries, educational system, e-learning

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148 Imaging Features of Hepatobiliary Histiocytosis

Authors: Ayda Youssef, Tarek Rafaat, Iman zaky

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Purpose: Langerhans’ cell histiocytosis (LCH) is not uncommon pathology that implies aberrant proliferation of a specific dendritic (Langerhans) cell. These atypical but mature cells of monoclonal origin can infiltrate many sites of the body and may occur as localized lesions or as widespread systemic disease. Liver is one of the uncommon sites of affection. The twofold objective of this study is to illustrate the radiological presentation of this disease, and to compare these results with previously reported series. Methods and Materials: Between 2007 and 2012, 150 patients with biopsy-proven LCH were treated in our hospital, a paediatric cancer tertiary care center. A retrospective review of radiographic images and reports was performed. There were 33 patients with liver affection are stratified. All patients underwent imaging studies, mostly US and CT. A chart review was performed to obtain demographic, clinical and radiological data. They were analyzed and compared to other published series. Results: Retrospective assessment of 150 patients with LCH was performed, among them 33 patients were identified who had liver involvement. All these patients developed multisystemic disease; They were 12 females and 21 males with (n= 32), seven of them had marked hepatomegaly. Diffuse hypodense liver parenchyma was encountered in five cases, the periportal location has a certain predilection in cases of focal affection where three cases has a hypodense periportal soft tissue sheets, one of them associated with dilated biliary radicals, only one case has multiple focal lesions unrelated to portal tracts. On follow up of the patients, two cases show abnormal morphology of liver with bossy outline. Conclusion: LCH is a not infrequent disease. A high-index suspicion should be raised in the context of diagnosis of liver affection. A biopsy is recommended in the presence of radiological suspicion. Chemotherapy is the preferred therapeutic modality. Liver histiocytosis are not disease specific features but should be interpreted in conjunction with the clinical history and the results of biopsy. Clinical Relevance/Application: Radiologist should be aware of different patterns of hepatobiliary histiocytosis, Thus early diagnosis and proper management of patient can be conducted.

Keywords: langerhans’ cell histiocytosis, liver, medical and health sciences, radiology

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147 Screening of Wheat Wild Relatives as a Gene Pool for Improved Photosynthesis in Wheat Breeding

Authors: Amanda J. Burridge, Keith J. Edwards, Paul A. Wilkinson, Tom Batstone, Erik H. Murchie, Lorna McAusland, Ana Elizabete Carmo-Silva, Ivan Jauregui, Tracy Lawson, Silvere R. M. Vialet-Chabrand

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The rate of genetic progress in wheat production must be improved to meet global food security targets. However, past selection for domestication traits has reduced the genetic variation in modern wheat cultivars, a fact that could severely limit the future rate of genetic gain. The genetic variation in agronomically important traits for the wild relatives and progenitors of wheat is far greater than that of the current domesticated cultivars, but transferring these traits into modern cultivars is not straightforward. Between the elite cultivars of wheat, photosynthetic capacity is a key trait for which there is limited variation. Early screening of wheat wild relative and progenitors has shown differences in photosynthetic capacity and efficiency not only between wild relative species but marked differences between the accessions of each species. By identifying wild relative accessions with improved photosynthetic traits and characterising the genetic variation responsible, it is possible to incorporate these traits into advanced breeding programmes by wide crossing and introgression programmes. To identify the potential variety of photosynthetic capacity and efficiency available in the secondary and tertiary genepool, a wide scale survey was carried out for over 600 accessions from 80 species including those from the genus Aegilops, Triticum, Thinopyrum, Elymus, and Secale. Genotype data were generated for each accession using a ‘Wheat Wild Relative’ Single Nucleotide Polymorphism (SNP) genotyping array composed of 35,000 SNP markers polymorphic between wild relatives and elite hexaploid wheat. This genotype data was combined with phenotypic measurements such as gas exchange (CO₂, H₂O), chlorophyll fluorescence, growth, morphology, and RuBisCO activity to identify potential breeding material with enhanced photosynthetic capacity and efficiency. The data and associated analysis tools presented here will prove useful to anyone interested in increasing the genetic diversity in hexaploid wheat or the application of complex genotyping data to plant breeding.

Keywords: wheat, wild relatives, pre-breeding, genomics, photosynthesis

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146 Factors Influencing Telehealth Services for Diabetes Care in Nepal: A Mixed Method Study

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

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

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

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145 Exploring the Risks and Vulnerabilities of Child Trafficking in West Java, Indonesia

Authors: B. Rusyidi, D. Mariana

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Although reforms in trafficking regulations have taken place since 2007, Indonesia is still struggling to fight child trafficking. This study aimed to identify and assess risk factors and vulnerabilities in the life of trafficked children prior to, during, and after being trafficked in order to inform the child protection system and its policies. The study was qualitative and utilized in-depth interviews to collect data. Data were gathered in 2014 and 2015 from 15 trafficked and sexually exploited girls aged 14 to 17 years originating from West Java. Social workers, safe home personnel and parents were also included as informants. Data analysis was guided by the ecological perspective and theme analyses. The study found that risks and vulnerabilities of the victims were associated with conditions at various levels of the environment. At the micro level, risk factors and vulnerabilities included young age, family conflict/violence, involvement with the “wrong” circle of friends/peers, family poverty, lack of social and economic support for the victim’s family, and psychological damages due to trafficking experiences. At the mezzo level, the lack of structured activities after school, economic inequality, stigma towards victims, lack of services for victims, and minimum public education on human trafficking were among the community hazards that increased the vulnerability and risks. Gender inequality, consumerism, the view of children as assets, corruption, weak law enforcement, the lack of institutional support, and community-wide ignorance regarding trafficking were found as factors that increased risks and vulnerabilities at the macro level. The findings from the study underline the necessity to reduce risk factors and promote protective factors at the individual, family, community and societal levels. Shifting the current focus from tertiary to primary/prevention policies and improving institutional efforts are pressing needs in the context of reducing child trafficking in Indonesia. The roles of human service providers including social work also should be promoted.

Keywords: child trafficking, child sexual exploitation, ecological perspective, risks and vulnerabilities

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144 The Mental Workload of ICU Nurses in Performing Human-Machine Tasks: A Cross-sectional Survey

Authors: Yan Yan, Erhong Sun, Lin Peng, Xuchun Ye

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Aims: The present study aimed to explore Intensive Care Unit(ICU) nurses’ mental workload (MWL) and associated factors with it in performing human-machine tasks. Background: A wide range of emerging technologies have penetrated widely in the field of health care, and ICU nurses are facing a dramatic increase in nursing human-machine tasks. However, there is still a paucity of literature reporting on the general MWL of ICU nurses performing human-machine tasks and the associated influencing factors. Methods: A cross-sectional survey was employed. The data was collected from January to February 2021 from 9 tertiary hospitals in 6 provinces (Shanghai, Gansu, Guangdong, Liaoning, Shandong, and Hubei). Two-stage sampling was used to recruit eligible ICU nurses (n=427). The data were collected with an electronic questionnaire comprising sociodemographic characteristics and the measures of MWL, self-efficacy, system usability, and task difficulty. The univariate analysis, two-way analysis of variance(ANOVA), and a linear mixed model were used for data analysis. Results: Overall, the mental workload of ICU nurses in performing human-machine tasks was medium (score 52.04 on a 0-100 scale). Among the typical nursing human-machine tasks selected, the MWL of ICU nurses in completing first aid and life support tasks (‘Using a defibrillator to defibrillate’ and ‘Use of ventilator’) was significantly higher than others (p < .001). And ICU nurses’ MWL in performing human-machine tasks was also associated with age (p = .001), professional title (p = .002), years of working in ICU (p < .001), willingness to study emerging technology actively (p = .006), task difficulty (p < .001), and system usability (p < .001). Conclusion: The MWL of ICU nurses is at a moderate level in the context of a rapid increase in nursing human-machine tasks. However, there are significant differences in MWL when performing different types of human-machine tasks, and MWL can be influenced by a combination of factors. Nursing managers need to develop intervention strategies in multiple ways. Implications for practice: Multidimensional approaches are required to perform human-machine tasks better, including enhancing nurses' willingness to learn emerging technologies actively, developing training strategies that vary with tasks, and identifying obstacles in the process of human-machine system interaction.

Keywords: mental workload(MWL), nurse, ICU, human-machine, tasks, cross-sectional study, linear mixed model, China

Procedia PDF Downloads 60
143 Observation on Microbiological Profile of Type2 Diabetic Foot Ulcer and Its Antimicrobial Sensitivity Pattern in a Tertiary Care Hospital in Eastern India

Authors: Pampita Chakraborty, Sukumar Mukherjee

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Diabetes Mellitus (DM) is commonly encountered metabolic disorder in clinical practice. An estimated 25 percent of DM patients develop foot problems. Foot ulceration and infection are one of the major causes of morbidity, hospitalization or even amputation. Objective: To isolate and identify bacterial pathogens in Diabetic Foot Ulcer (DFU) and to observe its antimicrobial sensitivity pattern. Methodology: A prospective study was conducted for a period of 9 months at the Department of Microbiology, GD Hospital & Diabetes Institute, Kolkata. 75 DFU patients were recruited in the study. Specimens for microbiological studies obtained from ulcer base were examined as gram stained smear and was cultured aerobically on Nutrient agar, Blood agar and MacConkey agar plates. Antimicrobial sensitivity test was performed by disc diffusion techniques according to CLSI guidelines. Result: In this study out of 75cases, 73% (55/75) were male and 27% (20/75) were females with mean (SD) age of 51.11(±10) years. Out of 75 pus cultures, 63(84%) showed growth of microorganism making total of 81 bacterial isolates with 71.42% of monomicrobial infection and 28.57% of polymicrobial infection. Out of 81 isolates 53(65.43%) were gram negative and 21(25.92%) were gram positive. E.coli was relatively common isolate 21(26%) followed by Staphylococcus aureus 15(18.5%), Klebsiella pneumonia 14(17.28%), Pseudomonas aeruginosa 12 (14.81%), Proteus spp. 3 (3.70%), and Enterococcus faecalis 6 (7.40%). 75% of Gram-negative microorganism were extended Beta-lactamase enzyme (ESBL) producer and around 20 % of Klebsiella and Proteus spp. were carbapenemase enzyme producer. Among Gram positive, around 50% of S.aureus was MRSA, sensitive only to Vancomycin, Teicoplanin & Linezolid. Conclusion: More prevalence of monomicrobial gram-negative bacteria than gram-positive bacteria in DFU was observed. This study emphasizes that Beta-Lactam group of antibiotics should not be the empirical treatment of choice for Gram-negative isolates; instead alternatives like Carbapenems, Amikacin could be a better option. On the other hand, Vancomycin and Linezolid are preferred for most of the infection with gram-positive aerobes. Continuous surveillance of resistant bacteria is required for empiric therapy.

Keywords: antibiotic resistant, antimicrobial susceptibility, diabetic foot ulcer, surveillance

Procedia PDF Downloads 327
142 Postoperative Wound Infections Following Caesarean Section in Obese Patients

Authors: S. Yeo, M. Mathur

Abstract:

Introduction: Obesity, defined as a Body Mass Index (BMI) of more than or equal to 30kg/m, is associated with an increased risk of complications during pregnancy and delivery. During labour, obese mothers often require greater intervention and have higher rates of caesarean section. Despite a low overall rate of serious complications following caesarean section, a high BMI predisposes to a higher risk of postoperative complications. Our study, therefore, aimed to investigate the impact of antenatal obesity on adverse outcomes following caesarean section, particularly wound-related infections. Materials and Methods: A retrospective cohort study of all caesarean deliveries during the first quarter of a chosen year was undertaken in our hospital, which is a tertiary referral centre with > 12,000 deliveries per year. Patients’ health records and data from our hospital’s electronic labour and delivery database were reviewed. Data analysis was performed using the Statistical Package for the Social Sciences (SPSS), and odds ratios plus adjusted odd ratios were calculated with 95% confidence intervals (CI). Results: A total of 1829 deliveries were reviewed during our study period. Of these, 180 (9.8%) patients were obese. The rate of caesarean delivery was 48.9% in obese patients versus 28.1% in non-obese patients. Post-operatively, 17% of obese patients experienced wound infection versus 0.2% of non-obese patients. Obese patients were also more likely to experience major postpartum haemorrhage (4.6% vs. 0.2%) and postpartum pyrexia (18.2% vs. 5.0%) in comparison to non-obese patients. Conclusions: Obesity is a significant risk factor in the development of postoperative complications following caesarean section. Wound infection remains a major concern for obese patients undergoing major surgery and results in extensive morbidity during the postnatal period. Postpartum infection can prolong recovery and affect maternal mental health, leading to reduced perinatal bonding with long-term implications on breastfeeding and parenting confidence. This study supports the need for the development of standardized protocols specifically for obese patients undergoing caesarean section. Multidisciplinary team care, in conjunction with anaesthesia, family physicians, and plastic surgery counterparts, early on in the antenatal journey, may be beneficial where wound complications are anticipated and to minimize the burden of postoperative infection in obese mothers.

Keywords: pregnancy, obesity, caesarean, infection

Procedia PDF Downloads 45
141 Performance Evaluation of On-Site Sewage Treatment System (Johkasou)

Authors: Aashutosh Garg, Ankur Rajpal, A. A. Kazmi

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The efficiency of an on-site wastewater treatment system named Johkasou was evaluated based on its pollutant removal efficiency over 10 months. This system was installed at IIT Roorkee and had a capacity of treating 7 m3/d of sewage water, sufficient for a group of 30-50 people. This system was fed with actual wastewater through an equalization tank to eliminate the fluctuations throughout the day. Methanol and ammonium chloride was added into this equalization tank to increase the Chemical Oxygen Demand (COD) and ammonia content of the influent. The outlet from Johkasou is sent to a tertiary unit consisting of a Pressure Sand Filter and an Activated Carbon Filter for further treatment. Samples were collected on alternate days from Monday to Friday and the following parameters were evaluated: Chemical Oxygen Demand (COD), Biochemical Oxygen Demand (BOD), Total Suspended Solids (TSS), and Total Nitrogen (TN). The Average removal efficiency for Chemical Oxygen Demand (COD), Biochemical Oxygen Demand (BOD), Total Suspended Solids (TSS), and Total Nitrogen (TN) was observed as 89.6, 97.7, 96, and 80% respectively. The cost of treating the wastewater comes out to be Rs 23/m3 which includes electricity, cleaning and maintenance, chemical, and desludging costs. Tests for the coliforms were also performed and it was observed that the removal efficiency for total and fecal coliforms was 100%. The sludge generation rate is approximately 20% of the BOD removal and it needed to be removed twice a year. It also showed a very good response against the hydraulic shock load. We performed vacation stress analysis on the system to evaluate the performance of the system when there is no influent for 8 consecutive days. From the result of stress analysis, we concluded that system needs a recovery time of about 48 hours to stabilize. After about 2 days, the system returns again to original conditions and all the parameters in the effluent become within the limits of National Green Tribunal (NGT) standards. We also performed another stress analysis to save the electricity in which we turned the main aeration blower off for 2 to 12 hrs a day and the results showed that we can turn the blower off for about 4-6 hrs a day and this will help in reducing the electricity costs by about 25%. It was concluded that the Johkasou system can remove a sufficient amount of all the physiochemical parameters tested to satisfy the prescribed limit set as per Indian Standard.

Keywords: on-site treatment, domestic wastewater, Johkasou, nutrient removal, pathogens removal

Procedia PDF Downloads 56
140 The Need for Automation in the Domestic Food Processing Sector and its Impact

Authors: Shantam Gupta

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The objective of this study is to address the critical need for automation in the domestic food processing sector and study its impact. Food is the one of the most basic physiological needs essential for the survival of a living being. Some of them have the capacity to prepare their own food (like most plants) and henceforth are designated as primary food producers; those who depend on these primary food producers for food form the primary consumers’ class (herbivores). Some of the organisms relying on the primary food are the secondary food consumers (carnivores). There is a third class of consumers called tertiary food consumers/apex food consumers that feed on both the primary and secondary food consumers. Humans form an essential part of the apex predators and are generally at the top of the food chain. But still further disintegration of the food habits of the modern human i.e. Homo sapiens, reveals that humans depend on other individuals for preparing their own food. The old notion of eating raw/brute food is long gone and food processing has become very trenchant in lives of modern human. This has led to an increase in dependence on other individuals for ‘processing’ the food before it can be actually consumed by the modern human. This has led to a further shift of humans in the classification of food chain of consumers. The effects of the shifts shall be systematically investigated in this paper. The processing of food has a direct impact on the economy of the individual (consumer). Also most individuals depend on other processing individuals for the preparation of food. This dependency leads to establishment of a vital link of dependency in the food web which when altered can adversely affect the food web and can have dire consequences on the health of the individual. This study investigates the challenges arising out due to this dependency and the impact of food processing on the economy of the individual. A comparison of Industrial food processing and processing at domestic platforms (households and restaurants) has been made to provide an idea about the present scenario of automation in the food processing sector. A lot of time and energy is also consumed while processing food at home for consumption. The high frequency of consumption of meals (greater than 2 times a day) makes it even more laborious. Through the medium of this study a pressing need for development of an automatic cooking machine is proposed with a mission to reduce the inter-dependency & human effort of individuals required for the preparation of food (by automation of the food preparation process) and make them more self-reliant The impact of development of this product has also further been profoundly discussed. Assumption used: The individuals those who process food also consume the food that they produce. (They are also termed as ‘independent’ or ‘self-reliant’ modern human beings.)

Keywords: automation, food processing, impact on economy, processing individual

Procedia PDF Downloads 431
139 Strengthening Functional Community-Provider Linkages: Lessons from the Challenge Initiative for Healthy Cities Program in Indore, India

Authors: Sabyasachi Behera, Shiv Kumar, Pramod Gautam, Anisur Rahman, Pawan Pathak, Rahul Bhadouria

Abstract:

Background: The increasing proportion of population especially urban poor and vulnerable groups or groups with specific needs, with health indicators worse than their rural counterparts in India face various issues related with availability and quality of health care. The reasons are myriad, starting from information and awareness of the community, especially, in a scenario wherein the needs and challenges of floating and migrant urban populations remain poorly understood. Weak linkages between health care facilities and slum dwellers and vulnerable populations hinder the improvement of health services for urban poor. Method: To address this issue, TCIHC program is helping health department of Indore city of Madhya Pradesh to establish a referral mechanism with a dual approach: at both community and facility level. The former is based on the premise of ‘building social capital’, i.e. norms and networks within a community facilitating collective action, helps improve the demand and supply of health services at appropriate levels of care (Minus 2: Accredited Social Health Activist and Community Health Groups; Minus 1: Urban Health Nutrition Days; Zero: Urban Primary Health Center; Plus 1: secondary facility with BEmONC services; Plus 2: secondary facilities with CEmONC services; Plus 3: tertiary level facility) for the urban poor. The latter focuses on encouraging the provision of all services at various levels of service delivery points and stakeholders to function in a coordinated manner to ensure better health service availability and coverage in underserved slum areas. Results: This initiative has enhanced the utilization of community based, primary and secondary level services through defined referral pathways that are clearly known to a community dweller. Conclusion: An ideal referral mechanism should begin with referral at the community level wherein services of a frontline health care provider are accessed by them at their door-step, causing no delay in both understanding and decision on the health issues faced by them.

Keywords: levels of care, linkages, referral mechanism, service delivery

Procedia PDF Downloads 105
138 The Mental Workload of Intensive Care Unit Nurses in Performing Human-Machine Tasks: A Cross-Sectional Survey

Authors: Yan Yan, Erhong Sun, Lin Peng, Xuchun Ye

Abstract:

Aims: The present study aimed to explore Intensive Care Unit (ICU) nurses’ mental workload (MWL) and associated factors with it in performing human-machine tasks. Background: A wide range of emerging technologies have penetrated widely in the field of health care, and ICU nurses are facing a dramatic increase in nursing human-machine tasks. However, there is still a paucity of literature reporting on the general MWL of ICU nurses performing human-machine tasks and the associated influencing factors. Methods: A cross-sectional survey was employed. The data was collected from January to February 2021 from 9 tertiary hospitals in 6 provinces (Shanghai, Gansu, Guangdong, Liaoning, Shandong, and Hubei). Two-stage sampling was used to recruit eligible ICU nurses (n=427). The data were collected with an electronic questionnaire comprising sociodemographic characteristics and the measures of MWL, self-efficacy, system usability, and task difficulty. The univariate analysis, two-way analysis of variance (ANOVA), and a linear mixed model were used for data analysis. Results: Overall, the mental workload of ICU nurses in performing human-machine tasks was medium (score 52.04 on a 0-100 scale). Among the typical nursing human-machine tasks selected, the MWL of ICU nurses in completing first aid and life support tasks (‘Using a defibrillator to defibrillate’ and ‘Use of ventilator’) was significantly higher than others (p < .001). And ICU nurses’ MWL in performing human-machine tasks was also associated with age (p = .001), professional title (p = .002), years of working in ICU (p < .001), willingness to study emerging technology actively (p = .006), task difficulty (p < .001), and system usability (p < .001). Conclusion: The MWL of ICU nurses is at a moderate level in the context of a rapid increase in nursing human-machine tasks. However, there are significant differences in MWL when performing different types of human-machine tasks, and MWL can be influenced by a combination of factors. Nursing managers need to develop intervention strategies in multiple ways. Implications for practice: Multidimensional approaches are required to perform human-machine tasks better, including enhancing nurses' willingness to learn emerging technologies actively, developing training strategies that vary with tasks, and identifying obstacles in the process of human-machine system interaction.

Keywords: mental workload, nurse, ICU, human-machine, tasks, cross-sectional study, linear mixed model, China

Procedia PDF Downloads 33
137 Linguistic Politeness in Higher Education Teaching Chinese as an Additional Language

Authors: Leei Wong

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Changes in globalized contexts precipitate changing perceptions concerning linguistic politeness practices. Within these changing contexts, misunderstanding or stereotypification of politeness norms may lead to negative consequences such as hostility or even communication breakdown. With China’s rising influence, the country is offering a vast potential market for global economic development and diplomatic relations and opportunities for intercultural interaction, and many outside China are subsequently learning Chinese. These trends bring both opportunities and pitfalls for intercultural communication, including within the important field of politeness awareness. One internationally recognized benchmark for the study and classification of languages – the updated 2018 CEFR (Common European Framework of Reference for Language) Companion Volume New Descriptors (CEFR/CV) – classifies politeness as a B1 (or intermediate) level descriptor on the scale of Politeness Conventions. This provides some indication of the relevance of politeness awareness within new globalized contexts for fostering better intercultural communication. This study specifically examines Bald on record politeness strategies presented in current beginner TCAL textbooks used in Australian tertiary education through content-analysis. The investigation in this study involves the purposive sampling of commercial textbooks published in America and China followed by interpretive content analysis. The philosophical position of this study is therefore located within an interpretivist ontology, with a subjectivist epistemological perspective. It sets out with the aim to illuminate the characteristics of Chinese Bald on record strategies that are deemed significant in the present-world context through Chinese textbook writers and curriculum designers. The data reveals significant findings concerning politeness strategies in beginner stage curriculum, and also opens the way for further research on politeness strategies in intermediate and advanced level textbooks for additional language learners. This study will be useful for language teachers, and language teachers-in-training, by generating awareness and providing insights and advice into the teaching and learning of Bald on record politeness strategies. Authors of textbooks may also benefit from the findings of this study, as awareness is raised of the need to include reference to understanding politeness in language, and how this might be approached.

Keywords: linguistic politeness, higher education, Chinese language, additional language

Procedia PDF Downloads 69
136 An Integrated Approach to Syllabus Design for Business Chinese

Authors: Dongshuo Wang, Minjie Xing

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International businesses prefer to hire people who speak more than one language. With the booming of China’s market, industries and trade, business leaders are looking for people who can speak Chinese and operate successfully in a Chinese cultural context, and therefore an increasing number of tertiary students choose a Business Chinese (BC) course. As a result, BC syllabus design is urgently needed. What business knowledge should be included in China’s context? What aspects of BC culture should be included? How much Chinese language should be introduced to conduct business in China? With these research questions, this research explores a syllabus design that integrates the three aspects of subject knowledge of business in communication, business practice including the procedure of and strategies for communicating business in practice and language skills including the disciplinary and professional contexts in which linguistic choices are made. After literature review and consultancy with China-related business professionals, senior staff from business schools and representatives of students, the authors of this paper, together with language tutors drafted a syllabus based on the integrated approach to include subject knowledge, business practice and language skills. Due to the nature of this research which requires trial/test and detailed description for each correction, qualitative methods are adopted. Two in-depth focus group interviews (with 2 staff and 4 students in each group), and 18 individual interviews (8 staff and 10 students) were conducted. QDA was used for systematizing, organizing, and analysing qualitative data. It was discovered that the business knowledge related to a Chinese cultural context, including face value, networking skills, strategic plans for signing a contract, marketing, sales, and after-sale service, should be introduced through lectures and seminars; business practice could be implemented by students setting up their own companies, virtual or real; and language skills would be trained via writing business messages and presenting their companies in fairs and exhibitions. After a longitudinal study of trials and amendments for three years from 2013 to 2016, the syllabus was approved by staff and students and the university. Students appreciated the syllabus, as they could apply the subject knowledge into practice by using it in their own companies and Chinese language was used throughout the process. The syllabus is now ready to be used in universities offering BC, and the designing process can be applied to other new courses as well.

Keywords: business Chinese, syllabus design, business knowledge, language skills

Procedia PDF Downloads 307
135 Effects of Lower and Upper Body Plyometric Training on Electrocardiogram Parameters of University Athletes

Authors: T. N. Uzor, C. O. Akosile, G. O. Emeahara

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Plyometric training is a form of specialised strength training that uses fast muscular contractions to improve power and speed in sports conditioning by coaches and athletes. Despite its useful role in sports conditioning programme, the information about plyometric training on the athletes cardiovascular health especially Electrocardiogram (ECG) has not been established in the literature. The purpose of the study was to determine the effects of lower and upper body plyometric training on ECG of athletes. The study was guided by three null hypotheses. Quasi–experimental research design was adopted for the study. Seventy-two university male athletes constituted the population of the study. Thirty male athletes aged 18 to 24 years volunteered to participate in the study, but only twenty-three completed the study. The volunteered athletes were apparently healthy, physically active and free of any lower and upper extremity bone injuries for past one year and they had no medical or orthopedic injuries that may affect their participation in the study. Ten subjects were purposively assigned to one of the three groups: lower body plyometric training (LBPT), upper body plyometric training (UBPT), and control (C). Training consisted of six plyometric exercises: lower (ankle hops, squat jumps, tuck jumps) and upper body plyometric training (push-ups, medicine ball-chest throws and side throws) with moderate intensity. The general data were collated and analysed using Statistical Package for Social Science (SPSS version 22.0). The research questions were answered using mean and standard deviation, while paired samples t-test was also used to test for the hypotheses. The results revealed that athletes who were trained using LBPT had reduced ECG parameters better than those in the control group. The results also revealed that athletes who were trained using both LBPT and UBPT indicated lack of significant differences following ten weeks plyometric training than those in the control group in the ECG parameters except in Q wave, R wave and S wave (QRS) complex. Based on the findings of the study, it was recommended among others that coaches should include both LBPT and UBPT as part of athletes’ overall training programme from primary to tertiary institution to optimise performance as well as reduce the risk of cardiovascular diseases and promotes good healthy lifestyle.

Keywords: concentric, eccentric, electrocardiogram, plyometric

Procedia PDF Downloads 113
134 Seroepidemiological Study of Toxoplasma gondii Infection in Women of Child-Bearing Age in Communities in Osun State, Nigeria

Authors: Olarinde Olaniran, Oluyomi A. Sowemimo

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Toxoplasmosis is frequently misdiagnosed or underdiagnosed, and it is the third most common cause of hospitalization due to food-borne infection. Intra-uterine infection with Toxoplasma gondii due to active parasitaemia during pregnancy can cause severe and often fatal cerebral damage, abortion, and stillbirth of a fetus. The aim of the study was to investigate the prevalence of T. gondii infection in women of childbearing age in selected communities of Osun State with a view to determining the risk factors which predispose to the T. gondii infection. Five (5) ml of blood was collected by venopuncture into a plain blood collection tube by a medical laboratory scientist. Serum samples were separated by centrifuging the blood samples at 3000 rpm for 5 mins. The sera were collected with Eppendorf tubes and stored at -20°C analysis for the presence of IgG and IgM antibodies against T. gondii by commercially available enzyme-linked immunosorbent assay (ELISA) kit (Demeditec Diagnostics GmbH, Germany) conducted according to the manufacturer’s instructions. The optical densities of wells were measured by a photometer at a wavelength of 450 nm. Data collected were analysed using appropriate computer software. The overall seroprevalence of T. gondii among the women of child-bearing age in selected seven communities in Osun state was 76.3%. Out of 76.3% positive for Toxoplasma gondii infection, 70.0% were positive for anti- T. gondii IgG, and 32.3% were positive for IgM, and 26.7% for both IgG and IgM. The prevalence of T. gondii was lowest (58.9%) among women from Ile Ife, a peri-urban community, and highest (100%) in women residing in Alajue, a rural community. The prevalence of infection was significantly higher (P= 0.000) among Islamic women (87.5%) than in Christian women (70.8%). The highest prevalence (86.3%) was recorded in women with primary education, while the lowest (61.2%) was recorded in women with tertiary education (p =0.016). The highest prevalence (79.7%) was recorded in women that reside in rural areas, and the lowest (70.1%) was recorded in women that reside in peri-urban area (p=0.025). The prevalence of T. gondii infection was highest (81.4%) in women with one miscarriage, while the prevalence was lowest in women with no miscarriages (75.9%). The age of the women (p=0.042), Islamic religion (p=0.001), the residence of the women (p=0.001), and water source were all positively associated with T. gondii infection. The study concluded that there was a high seroprevalence of T. gondii recorded among women of child-bearing age in the study area. Hence, there is a need for health education and create awareness of the disease and its transmission to women of reproductive age group in general and pregnant women in particular to reduce the risk of T. gondii in pregnant women.

Keywords: seroepidemiology, Toxoplasma gondii, women, child-bearing, age, communities, Ile -Ife, Nigeria

Procedia PDF Downloads 143
133 Clinical Risk Score for Mortality and Predictors of Severe Disease in Adult Patients with Dengue

Authors: Siddharth Jain, Abhenil Mittal, Surendra Kumar Sharma

Abstract:

Background: With its recent emergence and re-emergence, dengue has become a major international public health concern, imposing significant financial burden especially in developing countries. Despite aggressive control measures in place, India experienced one of its largest outbreaks in 2015 with Delhi being most severely affected. There is a lack of reliable predictors of disease severity and mortality in dengue. The present study was carried out to identify these predictors during the 2015 outbreak. Methods: This prospective observational study conducted at an apex tertiary care center in Delhi, India included confirmed adult dengue patients admitted between August-November 2015. Patient demographics, clinical details, and laboratory findings were recorded in a predesigned proforma. Appropriate statistical tests were used to summarize and compare the clinical and laboratory characteristics and derive predictors of mortality and severe disease, while developing a clinical risk score for mortality. Serotype analysis was also done for 75 representative samples to identify the dominant serotypes. Results: Data of 369 patients were analyzed (mean age 30.9 years; 67% males). Of these, 198 (54%) patients had dengue fever, 125 (34%) had dengue hemorrhagic fever (DHF Grade 1,2)and 46 (12%) developed dengue shock syndrome (DSS). Twenty two (6%) patients died. Late presentation to the hospital (≥5 days after onset) and dyspnoea at rest were identified as independent predictors of severe disease. Age ≥ 24 years, dyspnoea at rest and altered sensorium were identified as independent predictors of mortality. A clinical risk score was developed (12*age + 14*sensorium + 10*dyspnoea) which, if ≥ 22, predicted mortality with a high sensitivity (81.8%) and specificity (79.2%). The predominant serotypes in Delhi (2015) were DENV-2 and DENV-4. Conclusion: Age ≥ 24 years, dyspnoea at rest and altered sensorium were identified as independent predictors of mortality. Platelet counts did not determine the outcome in dengue patients. Timely referral/access to health care is important. Development and use of validated predictors of disease severity and simple clinical risk scores, which can be applied in all healthcare settings, can help minimize mortality and morbidity, especially in resource limited settings.

Keywords: dengue, mortality, predictors, severity

Procedia PDF Downloads 263
132 An Empirical Study of Gender, Expectations and Actual Experiences from Industrial Work Experience of Undergraduate Accounting Students in Selected Nigerian Universities

Authors: Obiamaka Nwobu, Samuel Faboyede, O. Oluseyi

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This study investigated the influence of gender on expectations and actual experiences from Industrial Work Experience, which is an aspect of the curriculum of undergraduate accounting students in selected Nigerian Universities. A survey research design was employed. Copies of a research questionnaire were made and administered to eighty (80) accounting students in selected Nigerian Universities who embarked on Students’ Industrial Work Experience Scheme (SIWES). Their expectations were juxtaposed with their actual experiences gleaned from the Industrial Work Experience. The data for the purpose of this study was analyzed using independent sample t-test. A total of fifteen (15) male and forty four (44) female students responded to the survey. This resulted in a response rate of 73.8 per cent. The results of this study indicated that there was no significant difference in the expectation of male and female undergraduate accounting students that the internship experience will be able to prepare them for an accounting career in the future, impart relevant knowledge, relate theories to work environment, enhance knowledge in financial accounting, cost accounting, accounting software, and general practice of accounting; prepare financial statements, interpret financial statements, develop problem solving skills, communication skills, and interpersonal skills; improve personal confidence and self-esteem, increase exposure to latest technology in the workplace, build rapport and networks, provide earnings, job experience, provide information and experience to choose career path. Furthermore, findings from the survey showed that there were differences in the expectations of students and their actual experiences with respect to their ability to relate theories to work environment, enhance knowledge in financial accounting, cost accounting, accounting software and exposure to latest technology in the workplace. The study only examined the perceptions of students from two Universities in South-West Nigeria. The research instrument used in this study can be administered to undergraduate accounting students in other universities in Nigeria. The Industrial Work Experience Scheme for undergraduate accounting students should be highly encouraged by tertiary institutions in Nigeria. This will ultimately make the students well prepared for a career in accounting.

Keywords: gender, expectations, actual experiences, industrial work experience

Procedia PDF Downloads 217
131 A Review of Type 2 Diabetes and Diabetes-Related Cardiovascular Disease in Zambia

Authors: Mwenya Mubanga, Sula Mazimba

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Background: In Zambia, much of the focus on nutrition and health has been on reducing micronutrient deficiencies, wasting and underweight malnutrition and not on the rising global projections of trends in obesity and type 2 diabetes. The aim of this review was to identify and collate studies on the prevalence of obesity, diabetes and diabetes-related cardiovascular disease conducted in Zambia, to summarize their findings and to identify areas that need further research. Methods: The Medical Literature Analysis and Retrieval System (MEDLINE) database was searched for peer-reviewed articles on the prevalence of, and factors associated with obesity, type 2 diabetes, and diabetes-related cardiovascular disease amongst Zambian residents using a combination of search terms. The period of search was from 1 January 2000 to 31 December 2016. We expanded the search terms to include all possible synonyms and spellings obtained in the search strategy. Additionally, we performed a manual search for other articles and references of peer-reviewed articles. Results: In Zambia, the current prevalence of Obesity and Type 2 diabetes is estimated at 13%-16% and 2.0 – 3.0% respectively. Risk factors such as the adoption of western dietary habits, the social stigmatization associated with rapid weight loss due to Tuberculosis and/ or the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and rapid urbanization have all been blamed for fueling the increased risk of obesity and type 2 diabetes. However, unlike traditional Western populations, those with no formal education were less likely to be obese than those who attained secondary or tertiary level education. Approximately 30% of those surveyed were unaware of their diabetes diagnosis and more than 60% were not on treatment despite a known diabetic status. Socio-demographic factors such as older age, female sex, urban dwelling, lack of tobacco use and marital status were associated with an increased risk of obesity, impaired glucose tolerance and type 2 diabetes. We were unable to identify studies that specifically looked at diabetes-related cardiovascular disease. Conclusion: Although the prevalence of Obesity and Type 2 diabetes in Zambia appears low, more representative studies focusing on parts of the country outside of the main industrial zone need to be conducted. There also needs to be research on diabetes-related cardiovascular disease. National surveillance, monitoring and evaluation on all non-communicable diseases need to be prioritized and policies that address underweight, obesity and type 2 diabetes developed.

Keywords: type 2 diabetes, Zambia, obesity, cardiovascular disease

Procedia PDF Downloads 198
130 Synthesis and Characterization of pH-Responsive Nanocarriers Based on POEOMA-b-PDPA Block Copolymers for RNA Delivery

Authors: Bruno Baptista, Andreia S. R. Oliveira, Patricia V. Mendonca, Jorge F. J. Coelho, Fani Sousa

Abstract:

Drug delivery systems are designed to allow adequate protection and controlled delivery of drugs to specific locations. These systems aim to reduce side effects and control the biodistribution profile of drugs, thus improving therapeutic efficacy. This study involved the synthesis of polymeric nanoparticles, based on amphiphilic diblock copolymers, comprising a biocompatible, poly (oligo (ethylene oxide) methyl ether methacrylate (POEOMA) as hydrophilic segment and a pH-sensitive block, the poly (2-diisopropylamino)ethyl methacrylate) (PDPA). The objective of this work was the development of polymeric pH-responsive nanoparticles to encapsulate and carry small RNAs as a model to further develop non-coding RNAs delivery systems with therapeutic value. The responsiveness of PDPA to pH allows the electrostatic interaction of these copolymers with nucleic acids at acidic pH, as a result of the protonation of the tertiary amine groups of this polymer at pH values below its pKa (around 6.2). Initially, the molecular weight parameters and chemical structure of the block copolymers were determined by size exclusion chromatography (SEC) and nuclear magnetic resonance (1H-NMR) spectroscopy, respectively. Then, the complexation with small RNAs was verified, generating polyplexes with sizes ranging from 300 to 600 nm and with encapsulation efficiencies around 80%, depending on the molecular weight of the polymers, their composition, and concentration used. The effect of pH on the morphology of nanoparticles was evaluated by scanning electron microscopy (SEM) being verified that at higher pH values, particles tend to lose their spherical shape. Since this work aims to develop systems for the delivery of non-coding RNAs, studies on RNA protection (contact with RNase, FBS, and Trypsin) and cell viability were also carried out. It was found that they induce some protection against constituents of the cellular environment and have no cellular toxicity. In summary, this research work contributes to the development of pH-sensitive polymers, capable of protecting and encapsulating RNA, in a relatively simple and efficient manner, to further be applied on drug delivery to specific sites where pH may have a critical role, as it can occur in several cancer environments.

Keywords: drug delivery systems, pH-responsive polymers, POEOMA-b-PDPA, small RNAs

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