Search results for: risk of poverty

Authors: Ingrid Ruzbarska, Martin Zvonar, Piotr Oleśniewicz, Julita Markiewicz-Patkowska, Krzysztof Widawski, Daniel Puciato

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Obese children will probably become obese adults, consequently exposed to an increased risk of comorbidity and premature mortality. Body weight may be indirectly determined by continuous development of coordination and motor skills. The level of motor skills and abilities is an important factor that promotes physical activity since early childhood. The aim of the study is to thoroughly understand the internal relations between motor coordination abilities and the somatic development of prepubertal children and to determine the effect of excess body weight on motor coordination by comparing the motor ability levels of children with different body mass index (BMI) values. The data were collected from 436 children aged 7–10 years, without health limitations, fully participating in school physical education classes. Body height was measured with portable stadiometers (Harpenden, Holtain Ltd.), and body mass—with a digital scale (HN-286, Omron). Motor coordination was evaluated with the Kiphard-Schilling body coordination test, Körperkoordinationstest für Kinder. The normality test by Shapiro-Wilk was used to verify the data distribution. The correlation analysis revealed a statistically significant negative association between the dynamic balance and BMI, as well as between the motor quotient and BMI (p<0.01) for both boys and girls. The results showed no effect of gender on the difference in the observed trends. The analysis of variance proved statistically significant differences between normal weight children and their overweight or obese counterparts. Coordination abilities probably play an important role in preventing or moderating the negative trajectory leading to childhood overweight and obesity. At this age, the development of coordination abilities should become a key strategy, targeted at long-term prevention of obesity and the promotion of an active lifestyle in adulthood. Motor performance is essential for implementing a healthy lifestyle in childhood already. Physical inactivity apparently results in motor deficits and a sedentary lifestyle in children, which may be accompanied by excess energy intake and overweight.

Keywords: Childhood, KTK test, Physical education, Psychomotor competence.

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Authors: Damien Gondre, Hatem Ben Maad, Abdelkrim Trabelsi, Frédéric Kuznik, Joseph Virgone

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The use of a radiant cooling solution would enable to lower cooling needs which is of great interest when the demand is initially high (hot climate). But, radiant systems are not naturally compatibles with humid climates since a low-temperature surface leads to condensation risks as soon as the surface temperature is close to or lower than the dew point temperature. A radiant cooling system combined to a dehumidification system would enable to remove humidity for the space, thereby lowering the dew point temperature. The humidity removal needs to be especially effective near the cooled surface. This requirement could be fulfilled by a system using a single desiccant fluid for the removal of both excessive heat and moisture. This task aims at providing an estimation of the specification requirements of such system in terms of cooling power and dehumidification rate required to fulfill comfort issues and to prevent any condensation risk on the cool panel surface. The present paper develops a preliminary study on the specification requirements, performances and behavior of a combined dehumidifier/cooling ceiling panel for different operating conditions. This study has been carried using the TRNSYS software which allows nodal calculations of thermal systems. It consists of the dynamic modeling of heat and vapor balances of a 5m x 3m x 2.7m office space. In a first design estimation, this room is equipped with an ideal heating, cooling, humidification and dehumidification system so that the room temperature is always maintained in between 21^◦C and 25^◦C with a relative humidity in between 40% and 60%. The room is also equipped with a ventilation system that includes a heat recovery heat exchanger and another heat exchanger connected to a heat sink. Main results show that the system should be designed to meet a cooling power of 42W.m⁻² and a desiccant rate of 45 g_H2O.h⁻¹. In a second time, a parametric study of comfort issues and system performances has been achieved on a more realistic system (that includes a chilled ceiling) under different operating conditions. It enables an estimation of an acceptable range of operating conditions. This preliminary study is intended to provide useful information for the system design.

Keywords: Dehumidification, nodal calculation, radiant cooling panel, system sizing.

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Authors: Noda L. M., Salvador I. C, C. M. L. G. Parada, Fonseca C. R. B.

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In Brazil, neonatal mortality rate is considered incompatible with the country development conditions, and has been a Public Health concern. Reduction in infant mortality rates has also been part of the Millennium Development Goals, a commitment made by countries, members of the Organization of United Nations (OUN), including Brazil. Fetal mortality rate is considered a highly sensitive indicator of health care quality. Suitable actions, such as good quality and access to health services may contribute positively towards reduction in these fetal and neonatal rates. With appropriate antenatal follow-up and health care during gestation and delivery, some death causes could be reduced or even prevented by means of early diagnosis and intervention, as well as changes in risk factors and interventions. Objectives: To study the quality of maternal and infant health care based on fetal and neonatal mortality, as well as the possible actions to prevent those deaths in Botucatu (Brazil). Methods: Classification of prevention according to the International Classification of Diseases and the modified Wigglesworth´s classification. In order to evaluate adequacy, indicators of quality of antenatal and delivery care were established by the authors. Results: Considering fetal deaths, 56.7% of them occurred before delivery, which reveals possible shortcomings in antenatal care, and 38.2% of them were a result of intra- labor changes, which could be prevented or reduced by adequate obstetric management. These findings were different from those in the group of early neonatal deaths which were also studied. Adequacy of health services showed that antenatal and childbirth care was appropriate for 24% and 33.3% of pregnant women, respectively, which corroborates the results of prevention. These results revealed that shortcomings in obstetric and antenatal care could be the causes of deaths in the study. Early and late neonatal deaths have similar characteristics: 76% could be prevented or reduced mainly by adequate newborn care (52.9%) and adequate health care for gestational women (11.7%). When adequacy of care was evaluated, childbirth and newborn care was adequate in 25.8% and antenatal care was adequate in 16.1%. In conclusion, direct relationship was found between adequacy and quality of care rendered to pregnant women and newborns, and fetal and infant mortality. Moreover, our findings highlight that deaths could be prevented by an adequate obstetric and neonatal management.

Keywords: Fetal Mortality, Infant Mortality, Maternal-Child Health Services, Program Evaluation.

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Authors: Kemkanit Sanyanunthana

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The purpose of this research is to study the management system of information technology which supports the education of five private universities in Thailand, according to the case studies which have been developing their qualities and standards of management and education by service provision of information technology to support the excellence performance. The concept to connect information technology with a suitable system has been created by information technology administrators for development, as a system that can be used throughout the organizations to help reach the utmost benefits of using all resources. Hence, the researcher as a person who has been performing these duties within higher education is interested to do this research by selecting the Control Objective for Information and Related Technology 5 (COBIT 5) for the Malcolm Baldrige National Quality Award (MBNQA) of America, or the National Award which applies the concept of Total Quality Management (TQM) to the organization evaluation. Such evaluation is called the Education Criteria for Performance Excellence (EdPEx) focuses on studying and comparing education quality development for excellent performance using COBIT 5 in terms of information technology to study the problems and obstacles of the investigation process for an information technology system, which is considered as an instrument to drive all organizations to reach the excellence performance of the information technology, and to be the model of evaluation and analysis of the process to be in accordance with the strategic plans of the information technology in the universities. This research is conducted in the form of descriptive and survey research according to the case studies. The data collection were carried out by using questionnaires through the administrators working related to the information technology field, and the research documents related to the change management as the main study. The research can be concluded that the performance based on the APO domain process (ALIGN, PLAN AND ORGANISE) of the COBIT 5 standard frame, which emphasizes concordant governance and management of strategic plans for the organizations, could reach only 95%. This might be because of some restrictions such as organizational cultures; therefore, the researcher has studied and analyzed the management of information technology in universities as a whole, under the organizational structures, to reach the performance in accordance with the overall APO domain which would affect the determined strategic plans to be able to develop based on the excellence performance of information technology, and to apply the risk management system at the organizational level into every performance process which would develop the work effectiveness for the resources management of information technology to reach the utmost benefits. 

Keywords: COBIT 5, APO, EdPEx Criteria, MBNQA.

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Authors: Amean A. Yasir, Zainab Kh. A. Al-Mahdi Al-Amean

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In both developed and developing countries, obesity among women is increasing, but in different patterns and at very different speeds. It may have a negative effect on health, leading to reduced life expectancy and/or increased health problems. This research studied the age distribution among obese women, the types of overweight and obesity, and the extent of the problem of overweight/obesity and the obesity etiological factors among women in Hillah city in central Iraq. A total of 322 overweight and obese women were included in the study, those women were randomly selected. The Body Mass Index was used as indicator for overweight/ obesity. The incidence of overweight/obesity among age groups were estimated, the etiology factors included genetic, environmental, genetic/environmental and endocrine disease. The overweight and obese women were screened for incidence of infection and/or diseases. The study found that the prevalence of 322 overweight and obese women in Hillah city in central Iraq was 19.25% and 80.78%, respectively. The obese women types were recorded based on BMI and WHO classification as class-1 obesity (29.81%), class-2 obesity (24.22%) and class-3 obesity (26.70%), the result was discrepancy non-significant, P value < 0.05. The incidence of overweight in women was high among those aged 20-29 years (90.32%), 6.45% aged 30-39 years old and 3.22% among ≥ 60 years old, while the incidence of obesity was 20.38% for those in the age group 20-29 years, 17.30% were 30-39 years, 23.84% were 40-49 years, 16.92% were 50-59 years group and 21.53% were ≥ 60 years age group. These results confirm that the age can be considered as a significant factor for obesity types (P value < 0.0001). The result also showed that the both genetic factors and environmental factors were responsible for incidents of overweight or obesity (84.78%) p value < 0.0001. The results also recorded cases of different repeated infections (skin infection, recurrent UTI and influenza), cancer, gallstones, high blood pressure, type 2 diabetes, and infertility. Weight stigma and bias generally refers to negative attitudes; Obesity can affect quality of life, and the results of this study recorded depression among overweight or obese women. This can lead to sexual problems, shame and guilt, social isolation and reduced work performance. Overweight and Obesity are real problems among women of all age groups and is associated with the risk of diseases and infection and negatively affects quality of life. This result warrants further studies into the prevalence of obesity among women in Hillah City in central Iraq and the immune response of obese women.

Keywords: Obesity, overweight, Iraq, body mass index.

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Authors: Vladyslav Povoroznyuk, Nataliia Dzerovych, Larysa Martynyuk, Tetiana Kovtun

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Obesity and osteoporosis are the two diseases whose increasing prevalence and high impact on the global morbidity and mortality, during the two recent decades, have gained a status of major health threats worldwide. Obesity purports to affect the bone metabolism through complex mechanisms. Debated data on the connection between the bone mineral density and fracture prevalence in the obese patients are widely presented in literature. There is evidence that the correlation of weight and fracture risk is sitespecific. This study is aimed at determining the connection between the bone mineral density (BMD) and trabecular bone score (TBS) parameters in Ukrainian women suffering from obesity. We examined 1025 40-89-year-old women, divided them into the groups according to their body mass index: Group A included 360 women with obesity whose BMI was ≥30 kg/m2, and Group B – 665 women with no obesity and BMI of <30 kg/m2. The BMD of total body, lumbar spine at the site L1-L4, femur and forearm were measured by DXA (Prodigy, GEHC Lunar, Madison, WI, USA). The TBS of L1- L4 was assessed by means of TBS iNsight® software installed on our DXA machine (product of Med-Imaps, Pessac, France). In general, obese women had a significantly higher BMD of lumbar spine, femoral neck, proximal femur, total body and ultradistal forearm (p<0.001) in comparison with women without obesity. The TBS of L1-L4 was significantly lower in obese women compared to nonobese women (p<0.001). The BMD of lumbar spine, femoral neck and total body differed to a significant extent in women of 40-49, 50- 59, 60-69 and 70-79 years (p<0.05). At same time, in women aged 80-89 years the BMD of lumbar spine (p=0.09), femoral neck (p=0.22) and total body (p=0.06) barely differed. The BMD of ultradistal forearm was significantly higher in women of all age groups (p<0.05). The TBS of L1-L4 in all the age groups tended to reveal the lower parameters in obese women compared with the nonobese; however, those data were not statistically significant. By contrast, a significant positive correlation was observed between the fat mass and the BMD at different sites. The correlation between the fat mass and TBS of L1-L4 was also significant, although negative. Women with vertebral fractures had a significantly lower body weight, body mass index and total body fat mass in comparison with women without vertebral fractures in their anamnesis. In obese women the frequency of vertebral fractures was 27%, while in women without obesity – 57%.

Keywords: Bone mineral density, trabecular bone score, obesity, women.

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Authors: Fatima Muhammad Abdulkadir, D. B. Maikaje, Y. A. Umar

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A study conducted to determine cercariae diversity and prevalence of trematode infection in freshwater snails from six freshwater bodies selected by systematic random sampling in Kaduna State was carried from January 2013 to December 2013. Freshwater snails and cercariae harvested from the study sites were morphologically identified. A total of 23,823 freshwater snails were collected from the six freshwater bodies: Bagoma dam, Gimbawa dam, Kangimi dam, Kubacha dam, Manchok water intake and Saminaka water intake. The observed freshwater snail species were: Melanoides tuberculata, Biomphalaria pfeifferi, Bulinus globosus, Lymnaea natalensis, Physa sp., Cleopatra bulimoides, Bellamya unicolor and Lanistes varicus. The freshwater snails were exposed to artificial bright light from a 100 Watt electric bulb in the laboratory to induce cercarial shedding. Of the total freshwater snails collected, 10.55% released one or more types of cercariae. Seven morphological types of cercariae were shed by six freshwater snail species namely: Brevifurcate-apharyngeate distome, Amphistome, Gymnocephalus, Longifurcate-pharyngeate monostome, Longifurcate-pharyngeate distome, Echinostome and Xiphidio cercariae. Infection was monotype in most of the freshwater snails collected; however, Physa species presented a mixed infection with Gymnocephalus and Longifurcate-pharyngeate distome cercariae. B. globosus and B. pfeifferi were the most preferred intermediate hosts with the prevalence of 13.48% and 13.46%, respectively. The diversity and prevalence of cercariae varied among the six freshwater bodies with Manchok water intake having the highest infestation (14.3%) and the least recorded in Kangimi dam (3.9%). There was a correlation trend between the number of freshwater snails and trematode infection with Manchok exhibiting the highest and Bagoma none. The highest cercarial diversity was observed in B. pfeifferi and B. globosus with four morphotypes each, and the lowest was in M. tuberculata with one morphotype. The general distribution of freshwater snails and the trematode cercariae they shed suggests the risk of human and animals to trematodiasis in Manchok community. Public health education to raise awareness on individual and communal action that may control snail breeding sites, prevent transmission and provide access to treatment should be intensified.

Keywords: Cercariae, diversity, freshwater snails, prevalence, trematodiasis.

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Authors: Birgül Şakar

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This study1 holds for the formation of international financial crisis and political factors for economic crisis in Turkey, are evaluated in chronological order. The international arena and relevant studies conducted in Turkey work in the literature are assessed. The main purpose of the study is to hold the linkage between the crises and political stability in Turkey in details, and to examine the position of Turkey in this regard. The introduction part follows the literature survey on the models explaining causes and results of the crises, the second part of the study. In the third part, the formations of the world financial crises are studied. The fourth part, financial crisis in Turkey in 1994, 2000, 2001 and 2008 are reviewed and their political reasons are analyzed. In the last part of the study the results and recommendations are held. Political administrations have laid the grounds for an economic crisis in Turkey. In this study, the emergence of an economic crisis in Turkey and the developments after the crisis are chronologically examined and an explanation is offered as to the cause and effect relationship between the political administration and economic equilibrium in the country. Economic crises can be characterized as follows: high prices of consumables, high interest rates, current account deficits, budget deficits, structural defects in government finance, rising inflation and fixed currency applications, rising government debt, declining savings rates and increased dependency on foreign capital stock. Entering into the conditions of crisis during a time when the exchange value of the country-s national currency was rising, speculative finance movements and shrinking of foreign currency reserves happened due to expectations for devaluation and because of foreign investors- resistance to financing national debt, and a financial risk occurs. During the February 2001 crisis and immediately following, devaluation and reduction of value occurred in Turkey-s stock market. While changing over to the system of floating exchange rates in the midst of this crisis, the effects of the crisis on the real economy are discussed in this study. Administered politics include financial reforms, such as the rearrangement of banking systems. These reforms followed with the provision of foreign financial support. There have been winners and losers in the imbalance of income distribution, which has recently become more evident in Turkey-s fragile economy.

Keywords: Economics, marketing crisis, financial reforms, political economy

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Authors: B. Mendonça, D. Sandwell

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The Metropolitan Region of Sao Paulo (MRSP) has suffered from serious water scarcity. Consequently, the most convenient solution has been building wells to extract groundwater from local aquifers. However, it requires constant vigilance to prevent over extraction and future events that can pose serious threat to the population, such as subsidence. Radar imaging techniques (InSAR) have allowed continuous investigation of such phenomena. The analysis of data in the present study consists of 23 SAR images dated from October 2007 to March 2011, obtained by the ALOS-1 spacecraft. Data processing was made with the software GMTSAR, by using the InSAR technique to create pairs of interferograms with ground displacement during different time spans. First results show a correlation between the location of 102 wells registered in 2009 and signals of ground displacement equal or lower than -90 millimeters (mm) in the region. The longest time span interferogram obtained dates from October 2007 to March 2010. As a result, from that interferogram, it was possible to detect the average velocity of displacement in millimeters per year (mm/y), and which areas strong signals have persisted in the MRSP. Four specific areas with signals of subsidence of 28 mm/y to 40 mm/y were chosen to investigate the phenomenon: Guarulhos (Sao Paulo International Airport), the Greater Sao Paulo, Itaquera and Sao Caetano do Sul. The coverage area of the signals was between 0.6 km and 1.65 km of length. All areas are located above a sedimentary type of aquifer. Itaquera and Sao Caetano do Sul showed signals varying from 28 mm/y to 32 mm/y. On the other hand, the places most likely to be suffering from stronger subsidence are the ones in the Greater Sao Paulo and Guarulhos, right beside the International Airport of Sao Paulo. The rate of displacement observed in both regions goes from 35 mm/y to 40 mm/y. Previous investigations of the water use at the International Airport highlight the risks of excessive water extraction that was being done through 9 deep wells. Therefore, it is affirmed that subsidence events are likely to occur and to cause serious damage in the area. This study could show a situation that has not been explored with proper importance in the city, given its social and economic consequences. Since the data were only available until 2011, the question that remains is if the situation still persists. It could be reaffirmed, however, a scenario of risk at the International Airport of Sao Paulo that needs further investigation.

Keywords: Ground subsidence, interferometric satellite aperture radar (InSAR), metropolitan region of Sao Paulo, water extraction.

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Authors: A. Taqaddas

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Purpose: Planning and dosimetry of different VMAT algorithms (SmartArc, Ergo++, Autobeam) is compared with IMRT for Head and Neck Cancer patients. Modelling was performed to rule out the causes of discrepancies between planned and delivered dose. Methods: Five HNC patients previously treated with IMRT were re-planned with SmartArc (SA), Ergo++ and Autobeam. Plans were compared with each other and against IMRT and evaluated using DVHs for PTVs and OARs, delivery time, monitor units (MU) and dosimetric accuracy. Modelling of control point (CP) spacing, Leaf-end Separation and MLC/Aperture shape was performed to rule out causes of discrepancies between planned and delivered doses. Additionally estimated arc delivery times, overall plan generation times and effect of CP spacing and number of arcs on plan generation times were recorded. Results: Single arc SmartArc plans (SA4d) were generally better than IMRT and double arc plans (SA2Arcs) in terms of homogeneity and target coverage. Double arc plans seemed to have a positive role in achieving improved Conformity Index (CI) and better sparing of some Organs at Risk (OARs) compared to Step and Shoot IMRT (ss-IMRT) and SA4d. Overall Ergo++ plans achieved best CI for both PTVs. Dosimetric validation of all VMAT plans without modelling was found to be lower than ss-IMRT. Total MUs required for delivery were on average 19%, 30%, 10.6% and 6.5% lower than ss-IMRT for SA4d, SA2d (Single arc with 2⁰ Gantry Spacing), SA2Arcs and Autobeam plans respectively. Autobeam was most efficient in terms of actual treatment delivery times whereas Ergo++ plans took longest to deliver. Conclusion: Overall SA single arc plans on average achieved best target coverage and homogeneity for both PTVs. SA2Arc plans showed improved CI and some OARs sparing. Very good dosimetric results were achieved with modelling. Ergo++ plans achieved best CI. Autobeam resulted in fastest treatment delivery times.

Keywords: Dosimetry, Intensity Modulated Radiotherapy, Optimization Algorithms, Volumetric Modulated Arc Therapy.

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Authors: Josef Novák, Alena Kohoutková

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The performance of concrete structures in fire depends on several factors which include, among others, the change in material properties due to the fire. Today, fiber reinforced concrete (FRC) belongs to materials which have been widely used for various structures and elements. While the knowledge and experience with FRC behavior under ambient temperature is well-known, the effect of elevated temperature on its behavior has to be deeply investigated. This paper deals with an experimental investigation and stress‑strain relations for hybrid fiber reinforced concrete (HFRC) which contains siliceous aggregates, polypropylene and steel fibers. The main objective of the experimental investigation is to enhance a database of mechanical properties of concrete composites with addition of fibers subject to elevated temperature as well as to validate existing stress-strain relations for HFRC. Within the investigation, a unique heat transport test, compressive test and splitting tensile test were performed on 150 mm cubes heated up to 200, 400, and 600 °C with the aim to determine a time period for uniform heat distribution in test specimens and the mechanical properties of the investigated concrete composite, respectively. Both findings obtained from the presented experimental test as well as experimental data collected from scientific papers so far served for validating the computational accuracy of investigated stress-strain relations for HFRC which have been developed during last few years. Owing to the presence of steel and polypropylene fibers, HFRC becomes a unique material whose structural performance differs from conventional plain concrete when exposed to elevated temperature. Polypropylene fibers in HFRC lower the risk of concrete spalling as the fibers burn out shortly with increasing temperature due to low ignition point and as a consequence pore pressure decreases. On the contrary, the increase in the concrete porosity might affect the mechanical properties of the material. To validate this thought requires enhancing the existing result database which is very limited and does not contain enough data. As a result of the poor database, only few stress-strain relations have been developed so far to describe the structural performance of HFRC at elevated temperature. Moreover, many of them are inconsistent and need to be refined. Most of them also do not take into account the effect of both a fiber type and fiber content. Such approach might be vague especially when high amount of polypropylene fibers are used. Therefore, the existing relations should be validated in detail based on other experimental results.

Keywords: Elevated temperature, fiber reinforced concrete, mechanical properties, stress strain relation.

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Authors: Reinaldo Biscaro, Luciano R. Ferreira, Leonardo C. Biscaro, Raphael C. Biscaro, Isabela S. Vasconcelos, Laura C. R. Ferreira, Cristiano M. Galhardi, Erica P. Baciuk

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Introduction: The present study had the objective to present the profile of workers with shoulder disorders related to labor lawsuits in Brazil. The study analyzed the association between the worker’s health and the actions performed by the companies related to injured professional. The research method performed a retrospective, cross-sectional and quantitative database analysis. The documents of labor lawsuits with shoulder injury registered at the Regional Labor Court in the 15^th region (Campinas - São Paulo) were submitted to the medical examination and evaluated during the period from 2012 until 2015. The data collected were age, gender, onset of symptoms, length of service, current occupation, type of shoulder injury, referred complaints, type of acromion, associated or related diseases, company actions as CAT (workplace accident communication), compliance of NR7 by the organization (Environmental Risk Prevention Program - PPRA and Medical Coordination Program in Occupational Health - PCMSO). Results: From the 93 workers evaluated, there was a prevalence of men (58.1%), with a mean age of 42.6 y-o, and 54.8% were included in the age group 35-49 years. Regarding the length of work time in the company, 66.7% have worked for more than 5 years. There was an association between gender and current occupational status (p < 0.005), with predominance of women in household occupation (13 vs. 2) and predominance of unemployed men in job search situation (24 vs. 10) and reintegrated to work by judicial decision (8 vs. 2). There was also a correlation between pain and functional limitation (p < 0.01). There was a positive association of PPRA with the complaint of functional limitation and negative association with pain (p < 0.04). There was also a correlation between the sedentary lifestyle and the presence of PCMSO and PPRA (p < 0.04), and the absence of CAT in the companies (p < 0.001). It was concluded that the appearance or aggravation of osseous and articular shoulder pathologies in workers who have undertaken labor law suits seem to be associated with individual habits or inadequate labor practices. These data can help preventing the occurrence of these lesions by implementing local health promotion policies at work.

Keywords: Work-related accidents, cross-sectional study, shoulder lesions, labor lawsuits.

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Authors: Orkide Donma, Mustafa M. Donma

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Obesity may lead to growing serious health problems throughout the world. Vitamin D appears to play a role in cardiovascular and metabolic health. Vitamin D deficiency may add to derangements in human metabolic systems, particularly those of children. Childhood obesity is associated with an increased risk of chronic and sophisticated diseases. The aim of this study is to investigate associations as well as possible differences related to parameters affected by obesity and their relations with vitamin D status in obese (OB) and morbid obese (MO) children. This study included a total of 78 children. Of them, 41 and 37 were OB and MO, respectively. WHO BMI-for age percentiles were used for the classification of obesity. The values above 99 percentile were defined as MO. Those between 95 and 99 percentiles were included into OB group. Anthropometric measurements were recorded. Basal metabolic rates (BMRs) were measured. Vitamin D status is determined by the measurement of 25-hydroxy cholecalciferol [25- hydroxyvitamin D3, 25(OH)D] using high-performance liquid chromatography. Vitamin D status was evaluated as deficient, insufficient and sufficient. Values < 20.0 ng/ml, values between 20-30 ng/ml and values > 30.0 ng/ml were defined as vitamin D deficient, insufficient and sufficient, respectively. Optimal 25(OH)D level was defined as ≥ 30 ng/ml. SPSSx statistical package program was used for the evaluation of the data. The statistical significance degree was accepted as p < 0.05. Mean ages did not differ between the groups. Significantly increased body mass index (BMI), waist circumference (C) and neck C as well as significantly decreased fasting blood glucose (FBG) and vitamin D values were observed in MO group (p < 0.05). In OB group, 37.5% of the children were vitamin D deficient, and in MO group the corresponding value was 53.6%. No difference between the groups in terms of lipid profile, systolic blood pressure (SBP), diastolic blood pressure (DBP) and insulin values was noted. There was a severe statistical significance between FBG values of the groups (p < 0.001). Important correlations between BMI, waist C, hip C, neck C and both SBP as well as DBP were found in OB group. In MO group, correlations only with SBP were obtained. In a similar manner, in OB group, correlations were detected between SBP-BMR and DBP-BMR. However, in MO children, BMR correlated only with SBP. The associations of vitamin D with anthropometric indices as well as some lipid parameters were defined. In OB group BMI, waist C, hip C and triglycerides (TRG) were negatively correlated with vitamin D concentrations whereas none of them were detected in MO group. Vitamin D deficiency may contribute to the complications associated with childhood obesity. Loss of correlations between obesity indices-DBP, vitamin D-TRG, as well as relatively lower FBG values, observed in MO group point out that the emergence of MetS components starts during obesity state just before the transition to morbid obesity. Aside from its deficiency state, associations of vitamin D with anthropometric measurements, blood pressures and TRG should also be evaluated before the development of morbid obesity.

Keywords: Children, morbid obesity, obesity, vitamin D.

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Authors: Ali K. M. Al-Nasrawi, Uday A. Al-Hamdany, Sarah M. Hamylton, Brian G. Jones, Yasir M. Alyazichi

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Surface elevation dynamics have always responded to disturbance regimes. Creating Digital Elevation Models (DEMs) to detect surface dynamics has led to the development of several methods, devices and data clouds. DEMs can provide accurate and quick results with cost efficiency, in comparison to the inherited geomatics survey techniques. Nowadays, remote sensing datasets have become a primary source to create DEMs, including LiDAR point clouds with GIS analytic tools. However, these data need to be tested for error detection and correction. This paper evaluates various DEMs from different data sources over time for Apple Orchard Island, a coastal site in southeastern Australia, in order to detect surface dynamics. Subsequently, 30 chosen locations were examined in the field to test the error of the DEMs surface detection using high resolution global positioning systems (GPSs). Results show significant surface elevation changes on Apple Orchard Island. Accretion occurred on most of the island while surface elevation loss due to erosion is limited to the northern and southern parts. Concurrently, the projected differential correction and validation method aimed to identify errors in the dataset. The resultant DEMs demonstrated a small error ratio (≤ 3%) from the gathered datasets when compared with the fieldwork survey using RTK-GPS. As modern modelling approaches need to become more effective and accurate, applying several tools to create different DEMs on a multi-temporal scale would allow easy predictions in time-cost-frames with more comprehensive coverage and greater accuracy. With a DEM technique for the eco-geomorphic context, such insights about the ecosystem dynamic detection, at such a coastal intertidal system, would be valuable to assess the accuracy of the predicted eco-geomorphic risk for the conservation management sustainability. Demonstrating this framework to evaluate the historical and current anthropogenic and environmental stressors on coastal surface elevation dynamism could be profitably applied worldwide.

Keywords: DEMs, eco-geomorphic-dynamic processes, geospatial information science. Remote sensing, surface elevation changes.

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Authors: Samar Saadeldin Abdelmotalab Omer, Ikram Mohamed Eltayeb Elsiddig, Amna Beshir Medani Ahmed, Saad Mohamed Hussein Ayoub

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Many herbal medicinal products are considered potential anti-hypercholesterolemic agents with encouraging safety profiles, however only a limited amount of clinical research exists to support their efficacy. The present study was designed to compare the antihypercholesterolemic and antioxidant activities of the crude ethanolic extracts of Citrus reticulata fruit peel, Zingiber officinale rhizome and Sesamum indicum seeds. Forty-five rats were used throughout the experiment which are extended for four weeks. These were divided into nine groups, five rats per each group as follows; group 1 was the normal control group (rats only fed standard normal rat diet), group 2 was the hypercholesterolemic control group (rats fed only hypercholesterolemic diet which contained 1% cholesterol plus 10% saturated animal fat added to the normal rat diet), groups 3 and 4 were fed hypercholesterolemic diet in addition to Citrus reticulata ethanolic extract at doses of (250mg/kg (group 3) and 500mg/kg (group 4)) administered daily via oral route, groups 5 and 6 were given hypercholesterolemic diet in addition to Zingiber officinale ethanolic extract at doses of (250mg/kg (group 5) and 500mg/kg (group 6)) daily through oral route, groups 7 and 8 fed on hypercholesterolemic diet in addition to Sesamum indicum ethanolic extract at doses of (250mg/kg (group 7) and 500mg/kg (group 8)) daily orally; and group 9 rats were given hypercholesterolemic diet in addition to atorvastatin (0.18mg/kg) daily via oral route as a standard reference antihypercholesterolemic drug. Blood samples from all groups were drawn from the retro-orbital venous plexus four weeks following treatment after overnight fasting and the lipid profile (total cholesterol (TC), high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C) and triglyceride levels) were measured and the risk ratio (TC/HDL-C) was assessed. The antioxidant activity of the three plants extracts was determined using DPPH free-radical antioxidant assay. Results of in vivo and in vitro antihypercholesterolemic and antioxidant assay respectively, revealed that the three extracts possess comparable antioxidant and antihypercholesterolemic activities.

Keywords: Antihypercholesterolemic effects, Antioxidant activity, HDL, LDL, TC, TGs, Citrus reticulata, Sesamum indicum, Zingiber officinale.

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Authors: F. Saccucci

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Gamification has now started to take root in the post-secondary classroom. Educators have learned much about gamification to date but there is still a great deal to learn. One definition of gamification is the ability to engage post-secondary students with games that are fun and correlate to class room curriculum. There is no shortage of literature illustrating the advantages of gamification in the class room. This study is an extension of similar thought as well as an extension of a previous study where in class testing proved with the used of paired T-test that gamification did significantly improve the students’ understanding of subject material. Gamification itself in the class room can range from high end computer simulated software to paper based games of which both have advantages and disadvantages. This analysis used a paper based game to highlight certain qualitative advantages of gamification. The paper based game in this analysis was inexpensive, required low preparation time for the faculty member and consumed approximately 20 minutes of class room time. Data for the study was collected through in class student feedback surveys and narrative from the faculty member moderating the game. Students were randomly selected into groups of four. Qualitative advantages identified in this analysis included: 1. Students had a chance to meet, connect and know other students. 2. Students enjoyed the gamification process given there was a sense of fun and competition. 3. The post assessment that followed the simulation game was not part of their grade calculation therefore it was an opportunity to participate in a low risk activity whereby students could subsequently self-assess their understanding of the subject material. 4. In the view of the student, content knowledge did increase after the gamification process. These qualitative advantages identified in this analysis contribute to the argument that there should be an attempt to use gamification in today’s post-secondary class room. The analysis also highlighted that eighty (80) percent of the respondents believe twenty minutes devoted to the gamification process was appropriate, however twenty (20) percentage of respondents believed that rather than scheduling a gamification process and its post quiz in the last week, a review for the final exam may have been more useful. An additional study to this hopes to determine if the scheduling of the gamification had any correlation to a percentage of the students not wanting to be engaged in the process. As well, the additional study hopes to determine at what incremental level of time invested in class room gamification produce no material incremental benefits to the student as well as determine if any correlation exist between respondents preferring not to have it at the end of the semester to students not believing the gamification process added to the increase of their curricular knowledge.

Keywords: Gamification, inexpensive, qualitative advantages, post-secondary.

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Authors: Nilima D. Gajbhiye

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Sodium nitrate has been used industrially in a number of work fields ranging from agriculture to food industry. Sodium nitrate and nitrite are associated with a higher risk of cancer in human beings. In present study, the effect of sodium nitrate on germinating seeds was studied. Two different sets of ungerminated Vigna radiata seeds were taken. In one set Vigna radiata seeds were soaked in distilled water for 4 hours and they were allowed to germinate in distilled water (Control) and 0.1 to 1% and 10% concentrations of sodium nitrate (NaNo₃). In soaked seed set, on 2^nd day radical developed in control and 0.1 to 1% concentrations of sodium nitrate. Seeds size was enlarged in 1% and 10% concentrations of sodium nitrate. On 3^rd day in 0.1% sodium nitrate length of the radicle was 7.5cm with one leaf let and control sample showed 9cm with one leaflet. On 5^th day in 0.1% sodium nitrate length of the radicle was 10 cm with one leaf let and control sample showed 11.5cm with one leaflet. No radicle developed in 1 and 10% NaNo₃ concentrations. On 10^th day all plants including control were dead. More number of mitotic cells was observed in apical root meristems of control germinating seeds and less mitotic cells were observed in 0.1% NaNo₃ germinating seeds. But cells were elongated in 0.9%NaNo₃ concentration and particles are deposited in the cells and no mitotic cells were observed. In other sets, dry seeds were allowed to germinate in Distilled water (control) and in 0.1 to 1% and 10% concentrations of sodium nitrate. In dry seed set, on 2^nd day radicle developed from control set. In 0.1 to 1% concentrations of sodium nitration seed enlarged in size but but not allowed germination. But in 10% NaNo₃ seeds coat colour was changed from dark green to brown. On 3^rd day the radicle was developed in 0.1% concentration of NaNo₃. No growth of radicle was observed in 0.3 to 10% concentrations of NaNo₃ but plumule was observed in control plant. Seed coat color was changed from dark green to brown in color in 1% and 10% NaNo₃. On 5^th day in control seeds the radicle growth was 11cm and 0.1% NaNo₃ concentration was 1.3 cm. On 10^th day all plants including control were dead. More number of mitotic cells was observed in apical root meristems of control germinating seeds and less mitotic cells were observed in 0.1% NaNo3 germinating seeds. At higher concentrations of NaNo₃ allowed seed germination in soaked seeds but produced radicle decay. In comparison to it, in dry seed set, germination of seeds observed only in 0.1% NaNo₃ concentration. The inhibitory effect of NaNo₃ on seed germination is due to reduction of water imbibition and mitotic activity.

Keywords: Germinating seeds, NaNo3, Vigna radiate, mitotic activity.

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Authors: Jill Stephenson, Marie Vaganay, Robert Cameron, Caoimhe McGurk, Neil Hewitt

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Purpose: The key aim of the research was to identify the secondary stressors experienced by businesses affected by single or repeated flooding and to determine to what extent businesses were affected by these stressors, along with any resulting impact on health. Additionally the research aimed to establish the likelihood of businesses being re-exposed to the secondary stressors through assessing awareness of flood risk, implementation of property protection measures and level of community resilience. Design/methodology/approach: The chosen research method involved the distribution of a questionnaire survey to businesses affected by either single or repeated flood events. The questionnaire included the Impact of Event Scale (a 15-item self-report measure which assesses subjective distress caused by traumatic events). Findings: 55 completed questionnaires were returned by flood impacted businesses. 89% of the businesses had sustained internal flooding, while 11% had experienced external flooding. The results established that the key secondary stressors experienced by businesses, in order of priority, were: flood damage, fear of reoccurring flooding, prevention of access to the premise/closure, loss of income, repair works, length of closure and insurance issues. There was a lack of preparedness for potential future floods and consequent vulnerability to the emergence of secondary stressors among flood affected businesses, as flood resistance or flood resilience measures had only been implemented by 11% and 13% respectively. In relation to the psychological repercussions, the Impact of Event scores suggested that potential prevalence of posttraumatic stress disorder (PTSD) was noted among 8 out of 55 respondents (l5%). Originality/value: The results improve understanding of the enduring repercussions of flood events on businesses, indicating that not only residents may be susceptible to the detrimental health impacts of flood events and single flood events may be just as likely as reoccurring flooding to contribute to ongoing stress. Lack of financial resources is a possible explanation for the lack of implementation of property protection measures among businesses, despite 49% experiencing flooding on multiple occasions. Therefore it is recommended that policymakers should consider potential sources of financial support or grants towards flood defences for flood impacted businesses. Any form of assistance should be made available to businesses at the earliest opportunity as there was no significant association between the time of the last flood event and the likelihood of experiencing PTSD symptoms.

Keywords: Flood event, flood resilience, flood resistance, PTSD, secondary stressors.

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Authors: Orkide Donma, Mustafa M. Donma

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Basal metabolic rate is questioned as a risk factor for weight gain. The relations between basal metabolic rate and body composition have not been cleared yet. The impact of fat mass on basal metabolic rate is also uncertain. Within this context, indices based upon total body mass as well as total body fat mass are available. In this study, the aim is to investigate the potential clinical utility of these indices in the adult population. 287 individuals, aged from 18 to 79 years, were included into the scope of the study. Based upon body mass index values, 10 underweight, 88 normal, 88 overweight, 81 obese, and 20 morbid obese individuals participated. Anthropometric measurements including height (m), and weight (kg) were performed. Body mass index, diagnostic obesity notation model assessment index I, diagnostic obesity notation model assessment index II, basal metabolic rate-to-weight ratio were calculated. Total body fat mass (kg), fat percent (%), basal metabolic rate, metabolic age, visceral adiposity, fat mass of upper as well as lower extremities and trunk, obesity degree were measured by TANITA body composition monitor using bioelectrical impedance analysis technology. Statistical evaluations were performed by statistical package (SPSS) for Windows Version 16.0. Scatterplots of individual measurements for the parameters concerning correlations were drawn. Linear regression lines were displayed. The statistical significance degree was accepted as p < 0.05. The strong correlations between body mass index and diagnostic obesity notation model assessment index I as well as diagnostic obesity notation model assessment index II were obtained (p < 0.001). A much stronger correlation was detected between basal metabolic rate and diagnostic obesity notation model assessment index I in comparison with that calculated for basal metabolic rate and body mass index (p < 0.001). Upon consideration of the associations between basal metabolic rate-to-weight ratio and these three indices, the best association was observed between basal metabolic rate-to-weight and diagnostic obesity notation model assessment index II. In a similar manner, this index was highly correlated with fat percent (p < 0.001). Being independent of the indices, a strong correlation was found between fat percent and basal metabolic rate-to-weight ratio (p < 0.001). Visceral adiposity was much strongly correlated with metabolic age when compared to that with chronological age (p < 0.001). In conclusion, all three indices were associated with metabolic age, but not with chronological age. Diagnostic obesity notation model assessment index II values were highly correlated with body mass index values throughout all ranges starting with underweight going towards morbid obesity. This index is the best in terms of its association with basal metabolic rate-to-weight ratio, which can be interpreted as basal metabolic rate unit.

Keywords: Basal metabolic rate, body mass index, children, diagnostic obesity notation model assessment index, obesity.

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Authors: Markus Nordlund, Arkadiusz K. Kuczaj

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Philip Morris International (PMI) is developing a range of novel tobacco products with the potential to reduce individual risk and population harm in comparison to smoking cigarettes. One of these products is the Tobacco Heating System 2.2 (THS 2.2), (named as the Electrically Heated Tobacco System (EHTS) in this paper), already commercialized in a number of countries (e.g., Japan, Italy, Switzerland, Russia, Portugal and Romania). During use, the patented EHTS heats a specifically designed tobacco product (Electrically Heated Tobacco Product (EHTP)) when inserted into a Holder (heating device). The EHTP contains tobacco material in the form of a porous plug that undergoes a controlled heating process to release chemical compounds into vapors, from which an aerosol is formed during cooling. The aim of this work was to investigate the aerosol formation characteristics for realistic operating conditions of the EHTS as well as for relevant gas mixture compositions measured in the EHTP aerosol consisting mostly of water, glycerol and nicotine, but also other compounds at much lower concentrations. The nucleation process taking place in the EHTP during use when operated in the Holder has therefore been modeled numerically using an extended Classical Nucleation Theory (CNT) for multicomponent gas mixtures. Results from the performed simulations demonstrate that aerosol droplets are formed only in the presence of an aerosol former being mainly glycerol. Minor compounds in the gas mixture were not able to reach a supersaturated state alone and therefore could not generate aerosol droplets from the multicomponent gas mixture at the operating conditions simulated. For the analytically characterized aerosol composition and estimated operating conditions of the EHTS and EHTP, glycerol was shown to be the main aerosol former triggering the nucleation process in the EHTP. This implies that according to the CNT, an aerosol former, such as glycerol needs to be present in the gas mixture for an aerosol to form under the tested operating conditions. To assess if these conclusions are sensitive to the initial amount of the minor compounds and to include and represent the total mass of the aerosol collected during the analytical aerosol characterization, simulations were carried out with initial masses of the minor compounds increased by as much as a factor of 500. Despite this extreme condition, no aerosol droplets were generated when glycerol, nicotine and water were treated as inert species and therefore not actively contributing to the nucleation process. This implies that according to the CNT, an aerosol cannot be generated without the help of an aerosol former, from the multicomponent gas mixtures at the compositions and operating conditions estimated for the EHTP, even if all minor compounds are released or generated in a single puff.

Keywords: Aerosol, Classical Nucleation Theory (CNT), Electrically Heated Tobacco Product (EHTP), Electrically Heated Tobacco System (EHTS), modeling, multicomponent, nucleation.

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Authors: Farahnaz Amini, Woo Yun Kin, Lazwani Kolandaiveloo

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Availability of different genetic tests after completion of Human Genome Project increases the physicians’ responsibility to keep themselves update on the potential implementation of these genetic tests in their daily practice. However, due to numbers of barriers, still many of physicians are not either aware of these tests or are not willing to offer or refer their patients for genetic tests. This study was conducted an anonymous, cross-sectional, mailed-based survey to develop a primary data of Malaysian physicians’ level of knowledge and perception of gene profiling. Questionnaire had 29 questions. Total scores on selected questions were used to assess the level of knowledge. The highest possible score was 11. Descriptive statistics, one way ANOVA and chi-squared test was used for statistical analysis. Sixty three completed questionnaires were returned by 27 general practitioners (GPs) and 36 medical specialists. Responders’ age ranges from 24 to 55 years old (mean 30.2 ± 6.4). About 40% of the participants rated themselves as having poor level of knowledge in genetics in general whilst 60% believed that they have fair level of knowledge; however, almost half (46%) of the respondents felt that they were not knowledgeable about available genetic tests. A majority (94%) of the responders were not aware of any lab or company which is offering gene profiling services in Malaysia. Only 4% of participants were aware of using gene profiling for detection of dosage of some drugs. Respondents perceived greater utility of gene profiling for breast cancer (38%) compared to the colorectal familial cancer (3%). The score of knowledge ranged from 2 to 8 (mean 4.38 ± 1.67). Non- significant differences between score of knowledge of GPs and specialists were observed, with score of 4.19 and 4.58 respectively. There was no significant association between any demographic factors and level of knowledge. However, those who graduated between years 2001 to 2005 had higher level of knowledge. Overall, 83% of participants showed relatively high level of perception on value of gene profiling to detect patient’s risk of disease. However, low perception was observed for both statements of using gene profiling for general population in order to alter their lifestyle (25%) as well as having the full sequence of a patient genome for the purpose of determining a patient’s best match for treatment (18%). The lack of clinical guidelines, limited provider knowledge and awareness, lack of time and resources to educate patients, lack of evidence-based clinical information and cost of tests were the most barriers of ordering gene profiling mentioned by physicians. In conclusion Malaysian physicians who participate in this study had mediocre level of knowledge and awareness in gene profiling. The low exposure to the genetic questions and problems might be a key predictor of lack of awareness and knowledge on available genetic tests. Educational and training workshop might be useful in helping Malaysian physicians incorporate genetic profiling into practice for eligible patients.

Keywords: Gene Profiling, Knowledge, Malaysia, Physician.

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Authors: A. Kourou, S. Kyriakopoulos, N. Anyfanti

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A lot of children under the age of five spend their daytime hours away from their home, in a kindergarten. Caring for children is a serious subject, and their safety in case of earthquake is the first priority. Being aware of earthquakes helps to prioritize the needs and take the appropriate actions to limit the effects. Earthquakes occurring anywhere at any time require emergency planning. Earthquake planning is a cooperative effort and childcare providers have unique roles and responsibilities. Greece has high seismicity and Ionian Islands Region has the highest seismic activity of the country. Earthquake Planning and Protection Organization (EPPO) is a national organization in Greece. The mission of EPPO is the seismic risk reduction by designing an earthquake management program of mitigation and preparedness. Among other actions EPPO has analyzed the needs and requirements of kindergartens on earthquake protection issues and has designed specific activities to familiarize the day care centers staff being prepared for earthquakes.  This research presents the results of a survey that detects the level of earthquake preparedness of kindergartens in all over the country and Ionian Islands too. A closed-form questionnaire of 20 main questions was developed for the survey in order to detect the aspects of participants concerning the earthquake preparedness actions at individual, family and day care environment level. 2668 questionnaires were gathered from March 2014 to May 2019, and analyzed by EPPO’s Department of Education. Moreover, this paper presents the EPPO’s educational activities targeted to the Ionian Islands Region that implemented in the framework of “Telemachus” Project. To provide safe environment for children to learn, and staff to work is the foremost goal of any State, community and kindergarten. This project is funded under the Priority Axis “Environmental Protection and Sustainable Development” of Operational Plan “Ionian Islands 2014-2020”. It is increasingly accepted that emergency preparedness should be thought of as an ongoing process rather than a one-time activity. Creating an earthquake safe daycare environment that facilitates learning is a challenging task. Training, drills, and update of emergency plan should take place throughout the year at kindergartens to identify any gaps and to ensure the emergency procedures. EPPO will continue to work closely with regional and local authorities to actively address the needs of children and kindergartens before, during and after earthquakes.

Keywords: Child care centers, education on earthquake issues, emergency planning, Ionian Islands Region of Greece, kindergartens, preparedness.

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Authors: Mustafa M. Donma, Orkide Donma

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Obesity is a clinical state associated with low-grade inflammation. It is also a major risk factor for insulin resistance (IR). In its advanced stages, metabolic syndrome (MetS), a much more complicated disease which may lead to life-threatening problems, may develop. Obesity-mediated IR seems to correlate with the inflammation. Human studies performed particularly on pediatric population are scarce. The aim of this study is to detect possible associations between inflammation and IR in terms of some related ratios. 549 children were grouped according to their age- and sex-based body mass index (BMI) percentile tables of WHO. MetS components were determined. Informed consent and approval from the Ethics Committee for Clinical Investigations were obtained. The principles of the Declaration of Helsinki were followed. The exclusion criteria were infection, inflammation, chronic diseases and those under drug treatment. Anthropometric measurements were obtained. Complete blood cell, fasting blood glucose, insulin, and C-reactive protein (CRP) analyses were performed. Homeostasis model assessment of insulin resistance (HOMA-IR), systemic immune inflammation (SII) index, tense index, alanine aminotransferase to aspartate aminotransferase ratio (ALT/AST), neutrophils to lymphocyte (NLR), platelet to lymphocyte, and lymphocyte to monocyte ratios were calculated. Data were evaluated by statistical analyses. The degree for statistical significance was 0.05. Statistically significant differences were found among the BMI values of the groups (p < 0.001). Strong correlations were detected between the BMI and waist circumference (WC) values in all groups. Tense index values were also correlated with both BMI and WC values in all groups except overweight (OW) children. SII index values of children with normal BMI were significantly different from the values obtained in OW, obese, morbid obese and MetS groups. Among all the other lymphocyte ratios, NLR exhibited a similar profile. Both HOMA-IR and ALT/AST values displayed an increasing profile from N towards MetS3 group. BMI and WC values were correlated with HOMA-IR and ALT/AST. Both in morbid obese and MetS groups, significant correlations between CRP versus SII index as well as HOMA-IR versus ALT/AST were found. ALT/AST and HOMA-IR values were correlated with NLR in morbid obese group and with SII index in MetS group, (p < 0.05), respectively. In conclusion, these findings showed that some parameters may exhibit informative differences between the early and late stages of obesity. Important associations among HOMA-IR, ALT/AST, NLR and SII index have come to light in the morbid obese and MetS groups. This study introduced the SII index and NLR as important inflammatory markers for the discrimination of normal and obese children. Interesting links were observed between inflammation and IR in morbid obese children and those with MetS, both being late stages of obesity.

Keywords: Children, inflammation, insulin resistance, metabolic syndrome, obesity.

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Authors: Ilyas Khan. Liliane Pintelon, Harry Martin, Michael Shömig

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The increasing costs of healthcare on one hand, and the rise in aging population and associated chronic disease, on the other hand, are putting increasing burden on the current health care system in many Western countries. For instance, chronic kidney disease (CKD) is a common disease and in Europe, the cost of renal replacement therapy (RRT) is very significant to the total health care cost. However, the recent advancement in healthcare technology, provide the opportunity to treat patients at home in their own comfort. It is evident that home healthcare offers numerous advantages apparently, low costs and high patients’ quality of life. Despite these advantages, the intake of home hemodialysis (HHD) therapy is still low in particular in Germany. Many factors are accounted for the low number of HHD intake. However, this paper is focusing on patients’ safety-related factors of current HHD practices in Germany. The aim of this paper is to analyze the current HHD practices in Germany and to identify risks related factors if any exist. A case study has been conducted in a dialysis center which consists of four dialysis centers in the south of Germany. In total, these dialysis centers have 350 chronic dialysis patients, of which, four patients are on HHD. The centers have 126 staff which includes six nephrologists and 120 other staff i.e. nurses and administration. The results of the study revealed several risk-related factors. Most importantly, these centers do not offer allied health services at the pre-dialysis stage, the HHD training did not have an established curriculum; however, they have just recently developed the first version. Only a soft copy of the machine manual is offered to patients. Surprisingly, the management was not aware of any standard available for home assessment and installation. The home assessment is done by a third party (i.e. the machines and equipment provider) and they may not consider the hygienic quality of the patient’s home. The type of machine provided to patients at home is similar to the one in the center. The model may not be suitable at home because of its size and complexity. Even though portable hemodialysis machines, which are specially designed for home use, are available in the market such as the NxStage series. Besides the type of machine, no assistance is offered for space management at home in particular for placing the machine. Moreover, the centers do not offer remote assistance to patients and their carer at home. However, telephonic assistance is available. Furthermore, no alternative is offered if a carer is not available. In addition, the centers are lacking medical staff including nephrologists and renal nurses.

Keywords: Home hemodialysis, home hemodialysis practices, patients’ related risks in the current home hemodialysis practices, patient safety in home hemodialysis.

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Authors: Revathi S. Rajan, Pratibha Malik, Nupur Garg, Smitha Avula, Kamini A. Rao

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This study aimed to analyse the pregnancy outcomes in patients with TPO positivity after appropriate L-Thyroxin supplementation with close surveillance. All pregnant women attending the antenatal clinic at Milann-The Fertility Center, Bangalore, India- from Aug 2013 to Oct 2014 whose booking TSH was more than 2.5 mIU/L were included along with those pregnant women with prior hypothyroidism who were TPO positive. Those with TPO positive status were vigorously managed with appropriate thyroxin supplementation and the doses were readjusted every 3 to 4 weeks until delivery. Women with recurrent pregnancy loss were also tested for TPO positivity and if tested positive, were monitored serially with TSH and fT4 levels every 3 to 4 weeks and appropriately supplemented with thyroxin when the levels fluctuated. The testing was done after an informed consent in all these women. The statistical software namely SAS 9.2, SPSS 15.0, Stata 10.1, MedCalc 9.0.1, Systat 12.0 and R environment ver.2.11.1 were used for the analysis of the data. 460 pregnant women were screened for thyroid dysfunction at booking of which 52% were hypothyroid. Majority of them (31.08%) were subclinically hypothyroid and the remaining were overt. 25% of the total no. of patients screened were TPO positive. The various pregnancy complications that were observed in the TPO positive women were gestational glucose intolerance [60%], threatened abortion [21%], midtrimester abortion [4.3%], premature rupture of membranes [4.3%], cervical funneling [4.3%] and fetal growth restriction [3.5%]. 95.6% of the patients who followed up till the end delivered beyond 30 weeks. 42.6% of these patients had previous history of recurrent abortions or adverse obstetric outcome and 21.7% of the delivered babies required NICU admission. Obstetric outcomes in our study in terms of midtrimester abortions, placental abruption, and preterm delivery improved for the better after close monitoring of the thyroid hormone [TSH and fT4] levels every 3 to 4 weeks with appropriate dose adjustment throughout pregnancy. Euthyroid women with TPO positive status enrolled in the study incidentally were those with recurrent abortions/infertility and required thyroxin supplements due to elevated Thyroid hormone (TSH, fT4) levels during the course of their pregnancy. Significant associations were found with age>30 years and Hyperhomocysteinemia [p=0.017], recurrent pregnancy loss or previous adverse obstetric outcomes [p=0.067] and APLA [p=0.029]. TPO antibody levels >600 I U/ml were significantly associated with development of gestational hypertension [p=0.041] and fetal growth restriction [p=0.082]. Euthyroid women with TPO positivity were also screened periodically to counter fluctuations of the thyroid hormone levels with appropriate thyroxin supplementation. Thus, early identification along with aggressive management of thyroid dysfunction and stratification of these patients based on their TPO status with appropriate thyroxin supplementation beginning in the first trimester will aid risk modulation and also help avert complications.

Keywords: Antinuclear antibody, Subclinical hypothyroidism, Thyroxin, TPO antibody.

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Authors: S. Moustafa El Shanawany, I. Labib Salem, F. Mohamed Magdy Badr El Dine, H. Tag El Deen Abd Allah

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Thermal injuries remain a global health problem and a common issue encountered in forensic pathology. They are a devastating cause of morbidity and mortality in children and adults especially in developing countries, causing permanent disfigurement, scarring and grievous hurt. Burns have always been a matter of legal concern in cases of suicidal burns, self-inflicted burns for false accusation and homicidal attempts. Assessment of burn injuries as well as rating permanent disabilities and disfigurement following thermal injuries for the benefit of compensation claims represents a challenging problem. This necessitates the development of reliable scoring systems to yield an expected likelihood of permanent disability or fatal outcome following burn injuries. The study was designed to identify the risk factors of mortality in acute burn patients and to evaluate the applicability of FLAMES (Fatality by Longevity, APACHE II score, Measured Extent of burn, and Sex) and BOBI (Belgian Outcome in Burn Injury) model scores in predicting the outcome. The study was conducted on 100 adult patients with acute burn injuries admitted to the Burn Unit of Alexandria Main University Hospital, Egypt from October 2014 to October 2015. Victims were examined after obtaining informed consent and the data were collected in specially designed sheets including demographic data, burn details and any associated inhalation injury. Each burn patient was assessed using both BOBI and FLAMES scoring systems. The results of the study show the mean age of patients was 35.54±12.32 years. Males outnumbered females (55% and 45%, respectively). Most patients were accidently burnt (95%), whereas suicidal burns accounted for the remaining 5%. Flame burn was recorded in 82% of cases. As well, 8% of patients sustained more than 60% of total burn surface area (TBSA) burns, 19% of patients needed mechanical ventilation, and 19% of burnt patients died either from wound sepsis, multi-organ failure or pulmonary embolism. The mean length of hospital stay was 24.91±25.08 days. The mean BOBI score was 1.07±1.27 and that of the FLAMES score was -4.76±2.92. The FLAMES score demonstrated an area under the receiver operating characteristic (ROC) curve of 0.95 which was significantly higher than that of the BOBI score (0.883). A statistically significant association was revealed between both predictive models and the outcome. The study concluded that both scoring systems were beneficial in predicting mortality in acutely burnt patients. However, the FLAMES score could be applied with a higher level of accuracy.

Keywords: BOBI, Burns, FLAMES, scoring systems, outcome.

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Authors: Jacqueline P. Davies

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Introduction: Student nurses must develop skills in observation, communication and reflection as well as public health knowledge from their first year of training. This paper will explain a method developed for students to collect their own findings about public health in urban areas. These areas are both rich in the history of old public health that informs the content of many traditional public health walks, but are also locations where new public health concerns about chronic disease are concentrated. The learning method explained in this paper enables students to collect their own data and write original work as first year students. Examples of their findings will be given. Methodology: In small groups, health care students are instructed to walk in neighbourhoods near to the hospitals they will soon attend as apprentice nurses. On their walks, they wander slowly, engage in conversations, and enter places open to the public. As they drift, they observe with all five senses in the real three dimensional world to collect data for their reflective accounts of old and new public health. They are encouraged to stop for refreshments and taste, as well as look, hear, smell, and touch while on their walk. They reflect as a group and later develop an individual reflective account in which they write up their deep reflections about what they observed on their walk. In preparation for their walk, they are encouraged to look at studies of quality of Life and other neighbourhood statistics as well as undertaking a risk assessment for their walk. Findings: Reflecting on their walks, students apply theoretical concepts around social determinants of health and health inequalities to develop their understanding of communities in the neighbourhoods visited. They write about the treasured historical architecture made of stone, bronze and marble which have outlived those who built them; but also how the streets are used now. The students develop their observations into thematic analyses such as: what we drink as illustrated by the empty coke can tossed into a now disused drinking fountain; the shift in home-life balance illustrated by streets where families once lived over the shop which are now walked by commuters weaving around each other as they talk on their mobile phones; and security on the street, with CCTV cameras placed at regular intervals, signs warning trespasses and barbed wire; but little evidence of local people watching the street. Conclusion: In evaluations of their first year, students have reported the health walk as one of their best experiences. The innovative approach was commended by the UK governing body of nurse education and it received a quality award from the nurse education funding body. This approach to education allows students to develop skills in the real world and write original work.

Keywords: Education, innovation. nursing, urban.

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Authors: Ponshano Kaselekela, Simooya O. Oscar, Lunshano Boyd

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The Copperbelt University Health Services (CBUHS) was designated by the Zambia Medicines Regulatory Authority (ZAMRA), formally the Pharmaceutical Regulatory Authority (PRA) as a regional pharmacovigilance centre to carryout activities of drug safety monitoring in four provinces in Zambia. CBUHS’s mandate included stimulating the reporting of adverse drug reactions (ADRs), as well as collecting and collating ADR reports from health institutions in the four provinces. This report covers the researchers’ experiences from May 2008 to September, 2016. The main objectives are 1) to monitor ADRs in the Zambian population, 2) to disseminate information to all health professionals in the region advising that the CBU health was a centre for reporting ADRs in the region, 3) to monitor polypharmacy as well as the benefit-risk profile of medicines, 4) to generate independent, evidence based recommendations on the safety of medicines, 5) to support ZAMRA in formulating safety related regulatory decisions for medicines, and 6) to communicate findings with all key stakeholders. The methodology involved monthly visits, beginning in early May 2008 to September, 2016, by the CBUHS to health institutions in the programme areas. Activities included holding discussions with health workers, distribution of ADR forms and collection of ADRs reports. These reports, once collected, were documented and assessed at the CBUHS. A report was then prepared for ZAMRA on quarterly basis. At ZAMRA, serious ADRs were noted and recommendations made to the Ministry of Health of the Republic of Zambia. The results show that 2,600 ADRs reports were received at the pharmacovigilance regional centre. Most of the ADRs reports that received were due to antiretroviral drugs, as well as a few from anti-malarial drugs like Artemether/Lumefantrine – Coartem®. Three hundred and twelve ADRs were entered in the Uppsala Monitoring Centre WHO Vigiflow for further analysis. It was concluded that in general, 2008-16 were exciting years for the pharmacovigilance group at CBUHS. From a very tentative beginning, a lot of strides were made and contacts established with healthcare facilities in the region. The researchers were encouraged by the support received from the Copperbelt University management, the motivation provided by ZAMRA and most importantly the enthusiasm of health workers in all the health care facilities visited. As a centre for drug safety in Zambia, the results show it achieves its objectives for monitoring ADRs, Pharmacovigilance (drug safety monitoring), and activities of monitoring ADRs as well as preventing them. However, the centre faces critical challenges caused by erratic funding that prevents the smooth running of the programme.

Keywords: Assessments, evaluation, monitoring, pharmacovigilance.

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Authors: Mustafa M. Donma, Orkide Donma

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Obesity is associated with cardiovascular disease risk factors and metabolic syndrome (MetS). In this study, associations between adipokines and adipokine as well as obesity indices were evaluated. Plasma adipokine levels may exhibit variations according to body adipose tissue mass. Besides, upon consideration of obesity as an inflammatory disease, adipokines may play some roles in this process. The ratios of proinflammatory adipokines to adiponectin may act as highly sensitive indicators of body adipokine status. The aim of the study is to present some adipokine indices, which are thought to be helpful for the evaluation of childhood obesity and also to determine the best discriminators in the diagnosis of MetS. 80 prepubertal children (aged between 6-9.5 years) included in the study were divided into three groups; 30 children with normal weight (NW), 25 morbid obese (MO) children and 25 MO children with MetS. Physical examinations were performed. Written informed consent forms were obtained from the parents. The study protocol was approved by Ethics Committee of Namik Kemal University Medical Faculty. Anthropometric measurements, such as weight, height, waist circumference (C), hip C, head C, neck C were recorded. Values for body mass index (BMI), diagnostic obesity notation model assessment Index-II (D2 index) as well as waist-to-hip, head-to-neck ratios were calculated. Adiponectin, resistin, leptin, chemerin, vaspin, progranulin assays were performed by ELISA. Adipokine-to-adiponectin ratios were obtained. SPSS Version 20 was used for the evaluation of data. p values ≤ 0.05 were accepted as statistically significant. Values of BMI and D2 index, waist-to-hip, head-to-neck ratios did not differ between MO and MetS groups (p ≥ 0.05). Except progranulin (p ≤ 0.01), similar patterns were observed for plasma levels of each adipokine. There was not any difference in vaspin as well as resistin levels between NW and MO groups. Significantly increased leptin-to-adiponectin, chemerin-to-adiponectin and vaspin-to-adiponectin values were noted in MO in comparison with those of NW. The most valuable adipokine index was progranulin-to-adiponectin (p ≤ 0.01). This index was strongly correlated with vaspin-to-adiponectin ratio in all groups (p ≤ 0.05). There was no correlation between vaspin-to-adiponectin and chemerin-to--adiponectin in NW group. However, a correlation existed in MO group (r = 0.486; p ≤ 0.05). Much stronger correlation (r = 0.609; p ≤ 0.01) was observed in MetS group between these two adipokine indices. No correlations were detected between vaspin and progranulin as well as vaspin and chemerin levels. Correlation analyses showed a unique profile confined to MetS children. Adiponectin was found to be correlated with waist-to-hip (r = -0.435; p ≤ 0.05) as well as head-to-neck (r = 0.541; p ≤ 0.05) ratios only in MetS children. In this study, it has been investigated if adipokine indices have priority over adipokine levels. In conclusion, vaspin-to-adiponectin, progranulin-to-adiponectin, chemerin-to-adiponectin along with waist-to-hip and head-to-neck ratios were the optimal combinations. Adiponectin, waist-to-hip, head-to-neck, vaspin-to-adiponectin, chemerin-to-adiponectin ratios had appropriate discriminatory capability for MetS children.

Keywords: Adipokine indices, metabolic syndrome, obesity indices, pediatric obesity.

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Authors: Lee Boudreau, Ash Kumar Khaitu, Laura A. S. MacDonald

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In April 2015, a magnitude 7.8 earthquake struck Nepal, killing, injuring, and displacing thousands of people. The earthquake also damaged water and sanitation service networks, leading to a high risk of diarrheal disease and the associated negative health impacts. In response to the disaster, the Environment and Public Health Organization (ENPHO), a Kathmandu-based non-governmental organization, worked with the Centre for Affordable Water and Sanitation Technology (CAWST), a Canadian education, training and consulting organization, to develop two training programs to educate volunteers on water, sanitation, and hygiene (WASH) needs. The first training program was intended for acute response, with the second focusing on longer term recovery. A key focus was to equip the volunteers with the knowledge and skills to formulate useful WASH advice in the unanticipated circumstances they would encounter when working in affected areas. Within the first two weeks of the disaster, a two-day acute response training was developed, which focused on enabling volunteers to educate those affected by the disaster about local WASH issues, their link to health, and their increased importance immediately following emergency situations. Between March and October 2015, a total of 19 training events took place, with over 470 volunteers trained. The trained volunteers distributed hygiene kits and liquid chlorine for household water treatment. They also facilitated health messaging and WASH awareness activities in affected communities. A three-day recovery phase training was also developed and has been delivered to volunteers in Nepal since October 2015. This training focused on WASH issues during the recovery and reconstruction phases. The interventions and recommendations in the recovery phase training focus on long-term WASH solutions, and so form a link between emergency relief strategies and long-term development goals. ENPHO has trained 226 volunteers during the recovery phase, with training ongoing as of April 2016. In the aftermath of the earthquake, ENPHO found that its existing pool of volunteers were more than willing to help those in their communities who were more in need. By training these and new volunteers, ENPHO was able to reach many more communities in the immediate aftermath of the disaster; together they reached 11 of the 14 earthquake-affected districts. The collaboration between ENPHO and CAWST in developing the training materials was a highly collaborative and iterative process, which enabled the training materials to be developed within a short response time. By training volunteers on basic WASH topics during both the immediate response and the recovery phase, ENPHO and CAWST have been able to link immediate emergency relief to long-term developmental goals. While the recovery phase training continues in Nepal, CAWST is planning to decontextualize the training used in both phases so that it can be applied to other emergency situations in the future. The training materials will become part of the open content materials available on CAWST’s WASH Resources website.

Keywords: Water and sanitation, emergency response, education and training, building resilience.

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