Alarming Problem Research Articles

Perceived Stress and Coping Strategies among Medical Undergraduates in Pakistan

Background: Stress is very common and alarming problem among medical students now days. There are so many outcomes related to chronic stress like certain negative mental and physical health consequences can occur due to long standing stress. Objective: This study explores possible outcomes of the condition of stress among the medical students and their coping strategies. Study Design: Cross sectional study. Settings: All five years of medical students of Jinnah Medical and Dental College, Karachi Pakistan. Duration: This study duration was 1st January’21 to 31st December’21. Methods: This study constitutes total of 264 students whom actively get engaged in the study. As well this purposeful sample covered senior students who had already fulfilled various clinical rotations in tertiary care hospital. Among the participants semi structured interviews were conducted, in which many structured questionnaire was utilized. Results: The study revealed that about 264 out of 300 students 300 (88%) was filled in the questionnaire. Out of 264 students, 150 were females and 114 were males. Ninety-four percent of the male share physiological and emotional stress. The entire senior under graduate students belongs form fourth and a final year of Jinnah Medical and Dental College feels more stress which exceeds approximately 95%and 98% respectively. Mood swings, poor concentration and loss of temper perceived as common symptoms. Powerful stress during the academics and exams. Coping mechanisms include sports, music or hanging out with friends. Conclusion: It has been observed by the study that although student life is very much exciting and fruitful but it can also be very much affected by environmental conditions and several others challenges by others, because of its transitional duration. Apart from it there are so many challenges which the students can face practically. So there is need to consider not only the education and knowledge of medical students as well as their professional training but there is need to evaluate and enhance their quality of life during the whole tenure (in between and after medical school years for their upbringings in professional life and career growth. It has been concluded that Medical students are those pupils whom always trying and still struggling for the achievement of their goals by certain healthy and justified fruitful and healthy stress coping strategies. In this regard the substantial need for the implementation of stress management programs in order to stimulates the students’ coping capabilities.

Recent discoveries in preventing mental impairments and ICU staff interventions in post-intensive care syndrome

Introduction
 Mental impairments such as post-traumatic stress disorder, depression, and anxiety are alarming problems in the ICU-survivors population because of the higher survival rate due to medical, scientific and technological progress. There are more and more patients facing long-term emotional consequences of critical illness. The main purpose of this review is to describe recent research about possible interventions and methods of prevention of mental impairments after an ICU stay made since 2015.
 Review methods
 The review was made using online databases such as PubMed and Google Scholar.
 Brief description of the state of knowledge
 Recent trials included in our review suggest that the sedation strategy has no significant impact on mental impairments in ICU survivors. ICU diaries seem to be a well-accepted and cheap method of prevention of mental disorders after critical illness but their universal usefulness is difficult to determine because variable factors like hospital and country levels influence the trials on patients. Nurse-led intervention programs, virtual reality and antioxidants described in recent studies also show no significant decrease in PTS symptoms in ICU survivors. Initial effects of mobile apps-based psychoeducational programs are comparable to therapist-led programs.
 Summary
 We did not find any evidence-based revolutionary method of prevention or intervention to help improve the mental health of ICU survivors. We think that the growing seriousness of this problem will lead to further research to cope with this phenomenon.

Multispectral Remote Sensing Image Change Detection Based on Twin Neural Networks

Remote sensing image change detection can effectively show the change information of land surface features such as roads and buildings at different times, which plays an indispensable role in application fields such as updating building information and analyzing urban evolution. At present, multispectral remote sensing images contain more and more information, which brings new development opportunities to remote sensing image change detection. However, this information is difficult to use effectively in change detection. Therefore, a change-detection method of multispectral remote sensing images based on a Siamese neural network is proposed. The features of dual-temporal remote sensing images were extracted based on the ResNet-18 network. In order to capture the semantic information of different scales and improve the information perception and expression ability of the algorithm for the input image features, an attention module network structure is designed to further enhance the extracted feature maps. Facing the problem of false alarms in change detection, an adaptive threshold comparison loss function is designed to make the threshold more sensitive to the remote sensing images in the data set and improve the robustness of the algorithm model. Moreover, the threshold segmentation method of the measurement module is used to determine the change area to obtain a better change-detection map domain. Finally, our experimental tests show that the proposed method achieves excellent performance on the multispectral OSCD detection data sets.

RISKY BEHAVIOURS AMONG DELIVERY RIDERS AT SIGNALIZED INTERSECTIONS IN MALAYSIA

The increasing number of food delivery riders, known as P-hailing riders, has increased the number of traffic crashes involving this group. The high demand for online orders and delivery time constraints causes the delivery riders to engage in risky riding behaviours during delivery. Thus, there is a need to study this alarming problem before it becomes more serious. This study aims to determine factors influencing risky behaviours among delivery riders at signalized intersections. A roadside observation was conducted in the month of October 2022 at Subang Jaya, Selangor. A total of 19,803 delivery riders were observed for four days observations at two signalized T- and two cross-signalized intersections. A bivariate analysis (logistic regression) was applied to determine the relationship between seven risky behaviours (unfastened helmet, not wearing shoes, incomplete set of side mirrors, red light running, mobile phone use, stopping after stop lines, and abrupt lane change) with five explanatory variables including the day of the week, time of the day, weather condition, type of intersection and approach road. The result shows that red light running, and mobile phone use is more likely to occur during the weekend. Clear weather increases risky behaviours such as red light running, using a mobile phone, and abrupt lane changes. The findings of this study are useful as input to the related authorities in developing programs to decrease the number of crashes involving food delivery riders.

Editorial

Editorial

Non-invasive diagnosis of liver fibrosis in children with chronic hepatitis B by transient elastography

Background Chronic hepatitis B (CHB) is one of the most alarming global health problems. Children with CHB mostly remain asymptomatic but serious sequelae like cirrhosis and hepatocellular carcinoma may develop at any age. Liver biopsy, despite being the gold standard, is not preferable for the diagnosis of liver fibrosis because it is invasive and painful. Transient elastography, a noninvasive marker for fibrosis, could play an important role in this disease.
 Objective To observe the role of transient elastography in the assessment of the progression of liver damage in children with chronic hepatitis B.
 Methods This cross-sectional study was conducted at The Department of Paediatric Gastroenterology and Nutrition of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Based on the inclusion and exclusion criteria, there were a total of 55 cases of CHB. Besides proper clinical history, physical examination, and initial investigation, transient elastography was performed in all of the cases. Liver biopsy was taken in 20 patients with raised serum ALT level after taking proper consent. Elastographic findings were compared with clinical, biochemical, virological, and histological findings.
 Results The mean age was 11.46 (SD 3.6) years and 68.7% were male. Most (65.4%) of the patients were asymptomatic at presentation and biochemically normal. Liver stiffness measurements had positive but insignificant correlation with liver biopsy (r=0.43, P=0.06). Sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy for transient elastography were 80%, 53.3%, 36.3%, 88%, and 60% respectively. Areas under the ROC curve were 0.76 (95%CI 0.47 to 1.0) for patients with significant fibrosis (F? 2). Using a cut off value of 8.05 kPa, patients with significant fibrosis were detected with a sensitivity, specificity of 80% and 53%, respectively.
 Findings of transient elastography were significantly associated with clinical findings like anaemia, jaundice, hepatosplenomegaly, stigmata of CLD and biochemical findings like serum ALT, AST as well as virological parameters.
 Conclusion Transient elastography has a limited role in confirming a diagnosis of significant fibrosis. But because of good sensitivity, transient elastography can be used as an initial presumptive diagnostic tool for assessing significant hepatic fibrosis. A cut off value of less than 8.05 in transient elastography can be used for exclusion of significant fibrosis.

Effectiveness of a Web-Based Intervention for Preventing Substance Use in Young Adults in Taiwan: Quasi-Experimental Study.

Substance use has been one of the most alarming public health problems worldwide, particularly among younger generations. This study evaluated the effectiveness of a web-based substance use prevention intervention targeted at adults aged 20-29 years. The intervention materials comprised 5 sets of infographics and 1 animation, all of which focused on mixed themes: (1) the concept of substance use and its harmful effects on health; (2) misinformation regarding new psychoactive substances; (3) regulation of illicit drugs, particularly marijuana; (4) the brain disease model of addiction; (5) critical thinking skills that improve health literacy; and (6) decision-making and communication skills that help people refuse illegal drugs. The study assigned eligible participants into experimental and control groups on the basis of the parity of their participant numbers. These participants completed web-based baseline and follow-up questionnaires that assessed their knowledge, behavioral intention, self-efficacy, and life skills related to substance use prevention. Knowledge was assessed using 8 questions concerning understanding of substance use harms and the regulation of illicit drugs. Behavioral intention and self-efficacy were assessed using 5-point Likert-type scales. Participants' ability to apply life skills to avoid substance use was assessed using 3 testing scenarios regarding substance use. The study used generalized estimating equations to examine the intervention's effectiveness. A total of 1065 participants (539 control and 526 experimental) completed the intervention and questionnaires in 2019. The average ages of the experimental and control groups were 25.68 (SD 2.71) and 25.66 (SD 2.69) years, respectively. The study observed no significant differences in the demographic variables between the 2 groups. The results of the generalized estimating equation analyses indicated that the intervention significantly improved participants' knowledge (P<.001), behavioral intention (P<.001), and self-efficacy (P<.001) but not their life skills (P=.61) related to substance use prevention. Participants in the experimental group responded to a satisfaction survey with positive feedback on the intervention. The web-based intervention was effective in improving participants' knowledge, behavioral intention, and self-efficacy concerning substance use prevention. The findings support continued efforts to use web-based interventions to prevent substance use among young adults.

Practical conservation action on a Critically Endangered lichen species

To save a species on the verge of extinction, an urgent practical conservation action was performed on the Critically Endangered lichen species Leptogium hibernicum in Norway. A transplantation experiment at two localities was carried out in close cooperation with the responsible authorities. An alarming problem for L. hibernicum is the imminent challenge of a habitat under threat. A parallel experiment with a comparable yet common species, Leptogium saturninum, was performed to exclude variables related to the experimental method. Four years after transplantation of lichen fragments, the rate of survival has levelled off to about 12% for L. hibernicum and 19% for L. saturninum. The decrease in surviving material is largest one year after transplantation, while the amount of surviving material stabilises over the following three years. Transplantation is here shown as a promising tool for the practical conservation of red-listed lichens.

Adsorption of Ciprofloxacin Using Composite Film from PVA, Agarose and Maltodextrin

Antibiotic resistance is one of the most alarming problems today. Therefore, composite membranes have been widely applied for the removal of antibiotics from water. PVA/Agarose/Maltodextrin films have been synthesized by casting with various component ratios. They were evaluated for characteristics through moisture, solubility, expansion, and BET results. The results showed that PVA/Agarose/Maltodextrin films exhibited the best viability in the aquatic environment through low solubility (68.88% ± 0.03), high swelling (431.77% ± 5.89) and pore volume (0.034969 cm³/g). The adsorption capacity of PVA/Agarose/Maltodextrin was tested for several antibiotics such as Ciprofloxacin, Tetracycline, Oxy-Tetracycline, and Chloramphenicol. The results showed that Ciprofloxacin was removed by the PVA/Agarose/Maltodextrin films better than other antibiotics. The highest antibiotic adsorption was obtained at 20 min, temperature of 30 °C, dosage of 2 g/L, pH 6, and antibiotic concentration of 40 mg/L. Ciprofloxacin adsorption was predicted through adsorption kinetic and isothermal models. The compatibility of the Pseudo First Order kinetic and Dubinin-Radushkevich isothermal has shown that adsorption takes place according to a physical adsorption mechanism with electrostatic interactions on the surface of the material. The maximum adsorption capacity recorded at 4.48 mg/g based on the Dubinin-Radushkevich isothermal.

Challenges in implementing sustainable construction

AbstractIn response to the alarming environmental problems, there is a pressing need for a fundamental shift towards sustainable construction. However, limited attention has been given in the literature to the governance of this transformative change. The paper aims to address this research gap by investigating how the transition to sustainable construction can be realized despite the barriers encountered. The analysis focuses on the Dutch Building Agreement Steel as an illustrative case. By examining the governance structure of the Agreement and evaluating its results thus far, the study concludes that a collaborative network of partners has effectively developed a roadmap and performed accompanying activities to achieve the intended objectives. Nonetheless, a key challenge lies in mobilizing the entire construction steel chain and the government during the upcoming scale‐up phase to actively adhere to the Agreement. This new form of network governance, facilitated by an independent intermediary, does not replace traditional public governance; rather, it complements it. The approach tested in the Netherlands holds potential for application in other contexts as well.

Understanding consumer’s acceptability of the technology behind upcycled foods: An application of the technology acceptance model

In light of the global overproduction and overconsumption, the circular economy in the agri-food sector is intended as a way out to overcome the alarming problem of food waste. While the literature is mainly focused on the industrial process and its implementation, the acceptance of the technology behind upcycled food remains unexplored. By incorporating elements of the Technology Acceptance Model (TAM), the aim of this article is to adapt the TAM to the upcycled foods to improve our understanding of consumer willingness to accept food products from the circular economy through the study of the acceptability of the innovation behind these products. 726 participants passed the attention control test to ensure a good quality of the data. The resulting data confirmed the important roles of attitude, perceived usefulness, and individual variables as well as the level of innovation in the acceptability of the technology behind upcycling food and allowed an attempt to provide better visibility on the factors that influence the social acceptability of the circular economy as a solution to the problem of food waste. Efforts remain to be made at the consumer level to overcome still-significant psychological barriers to accept the technology behind circular economy when applied in the food sector.

Incipient fault diagnosis and trend prediction in nonlinear closed-loop systems with Gaussian and non-Gaussian noise

This paper proposes a methodology for incipient fault diagnosis and the corresponding trend prediction in nonlinear closed-loop systems considering stochastic Gaussian and non-Gaussian uncertainties. The proposed approach is based on the use of the particle filtering technique for estimating the system states and outputs. From these estimations, the residual signals would be generated through a mathematical filtering and augmentation technique, allowing the incipient fault estimation that is evaluated using the designed fixed and adaptive thresholds that consider system uncertainties. In this way, the fault detection performance is improved but also the false detection and false alarm problems are comprehensively addressed. Moreover, the augmented Gauss–Newton identification method is used for the incipient fault trend prediction. Finally, to evaluate the effectiveness of the proposed approach, the incipient fault diagnosis in the heat transfer unit built in the nonlinear closed-loop continuous stirred-tank reactor (CSTR) system is used. Besides, the confusion matrix is employed to assess the results from a quantitative point of view.

Prevalence, Pattern and Determinants of Substance Abuse Among Adolescents in Bagalkot, Karnataka, India

Background: Adolescence is the age of curiosity, experimentation and new roles. This is the age children start to explore the world and test everything around them. Substance abuse is an alarming problem among adolescents in India. The objective is to assess the prevalence, pattern and determinants of substance abuse among adolescents of Bagalkot. Methods: A cross sectional study with a sample of 384 adolescents, selected by disproportional stratified random sampling. WHO ASSIST was used to assess the prevalence and pattern of substance abuse. The data was entered in MS excel sheet and transferred to SPSS 18 for analysis. Results: the mean age of the sample was 16.4 ± 2.44 years. 71.9% were males and 28% were females. Among 384 adolescents 20.3% used to consume tobacco and 21.4% consumed alcohol, 2.6% consumed cannabis, 15.6% had consumed inhalants. Among Tobacco users 53.85% were 18 to19 years of age. Conclusion: The overall substance abuse among adolescents is about 21%. Age, Gender, and Peer pressure, increase the risk of substance abuse. The substance abuse prohibitor strategies must be strengthened to reduce the prevalence of substance abuse among adolescents.

Student Perceptions of Substance Use Disorder Stigma as a Factor for Health Disparities: A Mixed-Methods Study.

The prevalence of substance use disorders (SUDs) is an alarming problem in the United States; however, only a fraction of patients receive treatment. Stigma from both healthcare professionals and society at large negatively impacts SUD treatment. There are limited data regarding the perceptions of healthcare students on SUD stigma as a health disparity. We conducted a concurrent mixed-methods study among students enrolled in six health-related colleges at one mid-south health science center in the US over 3 months. Both an electronic survey consisting of 17 close-ended questions and researcher-led focus groups were conducted to understand their perceptions of stigma and SUDs. The research team followed the six steps recommended by Braun and Clarke regarding the data that aimed to capture associations between categories and extract and conceptualize the themes, and thematic analysis was done using Dedoose® (Manhattan Beach, CA, USA) qualitative software, which facilitated all the codes being kept organized and compared the frequency of codes across categories. A total of n = 428 students participated in the survey (response rate = 13%), and n = 31 students took part in five focus groups. Most student respondents, on average, either agreed or strongly agreed that: stigma currently exists in the healthcare field; stigma can lead to patients' not receiving the appropriate care for an SUD; and stigma can lead to lower quality care provided to patients with SUDs. Two themes were identified based on the thematic analysis: (1) additional training is necessary to better equip students for addressing SUDs in practice and (2) suggestions were formed to develop synergy between didactic and clinical rotations to improve SUD training. It is evident that students perceive the stigma surrounding SUDs as a detriment to patient care. Opportunities may exist in professional training programs to more seamlessly and intentionally weave SUD treatment and management concepts throughout the curriculum, as well as to empower students to operate in the complex regulatory scheme that exists for SUDs in the US.

Dental Caries among Patients Visiting the Dental Outpatient Department in a Tertiary Care Centre: A Descriptive Cross-sectional Study

Introduction: Dental caries is an alarming public health problem globally causing significant morbidity and mortality. Early diagnosis and prompt treatment help in the prevention of complications. The aim of this study was to find out the prevalence of dental caries among patients visiting the dental Outpatient Department in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients visiting the dental Outpatient Department in a tertiary care centre. Data collection was done from 15 November 2022 to 15 February 2023 after taking ethical approval from the Institutional Review Committee (Reference number: 236/078/079). All patients visiting the dental Outpatient Department above 18 years of age who provided written informed consent were included in this study. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Among 270 patients, the prevalence of dental caries was 214 (79.26%) (74.42-84.10, 95% Confidence Interval). Conclusions: The prevalence of dental caries among patients was higher than other studies done in similar settings.

Gut Microbiota and Liver Transplantation: Immune Mechanisms behind the Rejection.

Liver transplantation (LT) is the treatment of choice for patients with cirrhosis, decompensated disease, acute liver failure, and hepatocellular carcinoma (HCC). In 3-25% of cases, an alarming problem is acute and chronic cellular rejection after LT, and this event can lead to the need for new transplantation or the death of the patient. On the other hand, gut microbiota is involved in several mechanisms sustaining the model of the "gut-liver axis". These include modulation of the immune response, which is altered in case of gut dysbiosis, possibly resulting in acute graft rejection. Some studies have evaluated the composition of the gut microbiota in cirrhotic patients before and after LT, but few of them have assessed its impact on liver rejection. This review underlines the changes in gut microbiota composition before and after liver transplantation, hypothesizing possible immune mechanisms linking dysbiosis to transplantation rejection. Evaluation of changes in the gut microbiota composition in these patients is therefore essential in order to monitor the success of LT and eventually adopt appropriate preventive measures.

Forecasting road accidental deaths in India: an explicit comparison between ARIMA and exponential smoothing method

The number of deaths due to road accident is increasing day by day and has become an alarming global problem over the decades. India, with her rising motorization is no stranger to this global catastrophe. In this paper two relatively simple yet powerful and versatile techniques for forecasting time series data, autoregressive integrated moving average method (ARIMA) and exponential smoothing method are used to forecast the number of deaths due to road accidents in India from the year 2022–2031. The results based on the two methods are compared and it is found that they are in sync with each other and pre-existing literature. Furthermore, this is a unique attempt to use two time series analysis techniques on the same data and carry out a comparative analysis. The data was collected from the annual report of Ministry of Road Transport and Highways, India (2020) and Accidental Deaths & Suicides in India (ADSI) Report of National Crime Record Bureau (2021). After examining all the probable models, it is observed that ARIMA (2, 2, 2) model and exponential smoothing (M, A, N) model are suitable for the given data. Amongst the two, ARIMA (2, 2, 2) model has a lower AIC and BIC value. Thus, this comes out to be the best model as per our model selection criterion. Further, the study also reveals an upward trend of number of road accidental deaths for the upcoming 10 years in India.

Exposure to environmental concentrations of glyphosate induces cardiotoxicity through cellular senescence and reduced cell proliferation capacity

Glyphosate (GLY), the preeminent herbicide utilized globally, is known to be exposed to the environment and population on a chronic basis. Exposure to GLY and the consequent health risks are alarming public health problems that are attracting international attention. However, the cardiotoxicity of GLY has been a matter of dispute and uncertainty. Here, AC16 cardiomyocytes and zebrafish were exposed to GLY. This study found that low concentrations of GLY lead to morphological enlargement of AC16 human cardiomyocytes, indicating a senescent state. The increased expression of P16, P21, and P53 following exposure to GLY demonstrated that GLY causes senescence in AC16. Moreover, it was mechanistically confirmed that GLY-induced senescence in AC16 cardiomyocytes was produced by ROS-mediated DNA damage. In terms of in vivo cardiotoxicity, GLY decreased the proliferative capacity of cardiomyocytes in zebrafish through the notch signaling pathway, resulting in a reduction of cardiomyocytes. It was also found that GLY caused zebrafish cardiotoxicity associated with DNA damage and mitochondrial damage. KEGG analysis after RNA-seq shows a significant enrichment of protein processing pathways in the endoplasmic reticulum (ER) after GLY exposure. Importantly, GLY induced ER stress in AC16 cells and zebrafish by activating PERK–eIF2α–ATF4 pathway. Our study has thus provided the first novel insights into the mechanism underlying GLY-induced cardiotoxicity. Furthermore, our findings emphasize the need for increased attention to the potential cardiotoxic effects of GLY.

A Follow up Study Among Patients on Opioid Substitution Therapy (OST) in Terms of Relapse Rate, Factors Affecting Relapse Rate and HCV Incidence

Background: Many countries are facing a serious problem with opioid dependence. Opioid Substitution Therapy (OST) is prescribed to dependent opioid users to diminish the use and effects of illicitly acquired opioids. The high relapse rate has been affecting the effectiveness of anti-drug work all over the world.Material &amp; Methods:In this study, 200 patients were taken by simple random sampling technique. 100 patient on Buprenorphine substitution therapy and 100 on Methadone maintenance treatment were studied. Patients diagnosed as cases of Opioid dependence as per ICD-10 were selected within the first 3 months and followed up to 1 year at 3, 6 and 9 months. The study was conducted after approval from the institutional ethics and thesis committee. A 14-item questionnaire based on a four-point scale describing the number of times certain events had occurred in the previous week for relapse was used to find factors affecting relapse.Results:The relapse rate among patients in the BPN group at 3, 6 and 9 months relapse was 29.33%, 20.34% and 19.51% while in the Methadone group, it was 24.05%, 15.87% and 12% respectively. The overall HCV Incidence was 75% among patients on Opioid Substitution Therapy. Conclusion:The findings of the study highlight the role of multiple determinants in opioid dependence and relapse. The obtained results showed that HCV infection was an alarming problem among IV opiate drug users in Punjab.

An overview of the potential utilisation of oleaginous yeast for biodiesel feedstock and wastewater treatment

The modern world faces a number of alarming problems, including global warming, the energy crisis brought on by the depletion of fossil fuels, and improper waste treatment. Consequently, it is essential to pursue sustainable development and find alternative energy sources that can reduce the dependence on fossil fuels. One of the most potential concepts is using lipids produced by microbes (bacteria, algae, and yeast) as the primary raw material for generating sustainable and affordable biodiesel in conjunction with the degradation of pollutants in wastewater. Numerous characteristics of oleaginous yeast have been demonstrated, including a high lipid output, resemblance of the lipids to vegetable oils, and a low land demand. Oleaginous yeasts, which can accumulate more than 20% of dry cell weight in lipids, are among the finest microbiological possibilities capable of generating lipids in high concentrations and with the proper properties. Several oleaginous yeast species are capable of degrading up to 90% of COD in wastewater. This paper aims to give a general overview of producing biodiesel from oleaginous yeast using wastewater as a substrate source. In addition, to discussing the technical aspects of producing biodiesel from oleaginous yeasts, the paper also discusses the economic feature of biodiesel production from oleaginous yeasts.