Search results for: Very-Small Entity
Commenced in January 2007
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Paper Count: 293

Search results for: Very-Small Entity

23 Sustainable Living Where the Immaterial Matters

Authors: Maria Hadjisoteriou, Yiorgos Hadjichristou

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This paper aims to explore and provoke a debate, through the work of the design studio, “living where the immaterial matters” of the architecture department of the University of Nicosia, on the role that the “immaterial matter” can play in enhancing innovative sustainable architecture and viewing the cities as sustainable organisms that always grow and alter. The blurring, juxtaposing binary of immaterial and matter, as the theoretical backbone of the Unit is counterbalanced by the practicalities of the contested sites of the last divided capital Nicosia with its ambiguous green line and the ghost city of Famagusta in the island of Cyprus. Jonathan Hill argues that the ‘immaterial is as important to architecture as the material concluding that ‘Immaterial–Material’ weaves the two together, so that they are in conjunction not opposition’. This understanding of the relationship of the immaterial vs material set the premises and the departing point of our argument, and talks about new recipes for creating hybrid public space that can lead to the unpredictability of a complex and interactive, sustainable city. We hierarchized the human experience as a priority. We distinguish the notion of space and place referring to Heidegger’s ‘building dwelling thinking’: ‘a distinction between space and place, where spaces gain authority not from ‘space’ appreciated mathematically but ‘place’ appreciated through human experience’. Following the above, architecture and the city are seen as one organism. The notions of boundaries, porous borders, fluidity, mobility, and spaces of flows are the lenses of the investigation of the unit’s methodology, leading to the notion of a new hybrid urban environment, where the main constituent elements are in a flux relationship. The material and the immaterial flows of the town are seen interrelated and interwoven with the material buildings and their immaterial contents, yielding to new sustainable human built environments. The above premises consequently led to choices of controversial sites. Indisputably a provoking site was the ghost town of Famagusta where the time froze back in 1974. Inspired by the fact that the nature took over the a literally dormant, decaying city, a sustainable rebirthing was seen as an opportunity where both nature and built environment, material and immaterial are interwoven in a new emergent urban environment. Similarly, we saw the dividing ‘green line’ of Nicosia completely failing to prevent the trespassing of images, sounds and whispers, smells and symbols that define the two prevailing cultures and becoming a porous creative entity which tends to start reuniting instead of separating , generating sustainable cultures and built environments. The authors would like to contribute to the debate by introducing a question about a new recipe of cooking the built environment. Can we talk about a new ‘urban recipe’: ‘cooking architecture and city’ to deliver an ever changing urban sustainable organism, whose identity will mainly depend on the interrelationship of the immaterial and material constituents?

Keywords: blurring zones, porous borders, spaces of flow, urban recipe

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22 The Potential Impact of Big Data Analytics on Pharmaceutical Supply Chain Management

Authors: Maryam Ziaee, Himanshu Shee, Amrik Sohal

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Big Data Analytics (BDA) in supply chain management has recently drawn the attention of academics and practitioners. Big data refers to a massive amount of data from different sources, in different formats, generated at high speed through transactions in business environments and supply chain networks. Traditional statistical tools and techniques find it difficult to analyse this massive data. BDA can assist organisations to capture, store, and analyse data specifically in the field of supply chain. Currently, there is a paucity of research on BDA in the pharmaceutical supply chain context. In this research, the Australian pharmaceutical supply chain was selected as the case study. This industry is highly significant since the right medicine must reach the right patients, at the right time, in right quantity, in good condition, and at the right price to save lives. However, drug shortages remain a substantial problem for hospitals across Australia with implications on patient care, staff resourcing, and expenditure. Furthermore, a massive volume and variety of data is generated at fast speed from multiple sources in pharmaceutical supply chain, which needs to be captured and analysed to benefit operational decisions at every stage of supply chain processes. As the pharmaceutical industry lags behind other industries in using BDA, it raises the question of whether the use of BDA can improve transparency among pharmaceutical supply chain by enabling the partners to make informed-decisions across their operational activities. This presentation explores the impacts of BDA on supply chain management. An exploratory qualitative approach was adopted to analyse data collected through interviews. This study also explores the BDA potential in the whole pharmaceutical supply chain rather than focusing on a single entity. Twenty semi-structured interviews were undertaken with top managers in fifteen organisations (five pharmaceutical manufacturers, five wholesalers/distributors, and five public hospital pharmacies) to investigate their views on the use of BDA. The findings revealed that BDA can enable pharmaceutical entities to have improved visibility over the whole supply chain and also the market; it enables entities, especially manufacturers, to monitor consumption and the demand rate in real-time and make accurate demand forecasts which reduce drug shortages. Timely and precise decision-making can allow the entities to source and manage their stocks more effectively. This can likely address the drug demand at hospitals and respond to unanticipated issues such as drug shortages. Earlier studies explore BDA in the context of clinical healthcare; however, this presentation investigates the benefits of BDA in the Australian pharmaceutical supply chain. Furthermore, this research enhances managers’ insight into the potentials of BDA at every stage of supply chain processes and helps to improve decision-making in their supply chain operations. The findings will turn the rhetoric of data-driven decision into a reality where the managers may opt for analytics for improved decision-making in the supply chain processes.

Keywords: big data analytics, data-driven decision, pharmaceutical industry, supply chain management

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21 Emphasizing Sumak Kawsay in Peace Ethics

Authors: Lisa Tragbar

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Since the Rio declaration, the agreement resulting from the Earth Summit in 1992, the UN member states acknowledge that peace and environmental protection are deeply linked to each other. It has also been made clear by Contemporary Peace research since the early 2000 that the lack of natural resources increases conflicts, as well as potential war conflicts (general environmental conflict thesis). I argue that peace ethics need to reconsider the role of the environment in peace ethics, from conflict prevention to peacebuilding. Sumak kawsay is a concept that offers a non-anthropocentric perspective on the subject. Several Contemporary Peace Ethicists don’t take environmental peace sufficiently into account. 1. The Peace theorist Johan Galtung famously argues that positive peace depends mostly on social, economic and political factors, as institutional structures establish peace. Galtung has a relational approach to peace, yet only between human interactors. 2. Michael Fox claims in his anti-war argument to consider nonhuman entities in conflicts. Because of their species interrelation, humans cannot decide on the fate of other species. 3. Although Mark Woods considers himself a peace ecologist, following Reichberg and Syse, and argues from a duty-based perspective towards nature, he mostly focuses on the protection of the environment during war conflicts. I want to focus on a non-anthropocentric view to argue that the environment is an entity of human concern in order to construct peace. Based on the premises that the lack of natural resources create tensions that play a significant part in international conflicts and these conflicts are potential war conflicts, I argue that a non-anthropocentric account to peace ethics is an indispensable perspective towards the recovery of these resources and therefore the reduction of war conflicts. Sumak kawsay is an approach contributing to a peaceful environment, which can play a crucial role in international peacekeeping operations. To emphasize sumak kawsay in peace ethics, it is necessary to explain what this principle includes and how it renews Contemporary Peace ethics. The indigenous philosophy of life of the Andean Quechua philosophy in Ecuador and varities from other countries from the Global South include a holistic real-world vision that contains concepts like the de-hierarchization of humans and nature as well as the reciprocity principle towards nature. Sumak kawsay represents the idea of the intrinsic value of nature and an egalitarian way of life and interconnectedness between human and nonhuman entities, which has been widely neglected in Traditional War and Peace Ethics. If sumak kawsay is transferred to peacekeeping practices, peacekeepers have restorative duties not only towards humans, but also towards nature. Resource conservation and environmental protection are the first step towards a positive peace. By recognising that healthy natural resources contribute to peacebuilding, by restoring balance through compensatory justice practices like recovery, by fostering dialogue between peacekeeping forces and by entitling ecosystems with rights natural resources and environmental conflicts are more unlikely to happen. This holistic approach pays nature sufficient attention and can contribute to a positive peace.

Keywords: environment, natural resources, peace, Sumak Kawsay

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20 Achieving Sustainable Agriculture with Treated Municipal Wastewater

Authors: Reshu Yadav, Himanshu Joshi, S. K. Tripathi

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Fresh water is a scarce resource which is essential for humans and ecosystems, but its distribution is uneven. Agricultural production accounts for 70% of all surface water supplies. It is projected that against the expansion in the area equipped for irrigation by 0.6% per year, the global potential irrigation water demand would rise by 9.5% during 2021-25. This would, on one hand, have to compete against the sharply rising urban water demand. On the other, it would also have to face the fear of climate change, as temperatures rise and crop yields could drop from 10-30% in many large areas. The huge demand for irrigation combined with fresh water scarcity encourages to explore the reuse of wastewater as a resource. However, the use of such wastewater is often linked to the safety issues when used non judiciously or with poor safeguards while irrigating food crops. Paddy is one of the major crops globally and amongst the most important in South Asia and Africa. In many parts of the world, use of municipal wastewater has been promoted as a viable option in this regard. In developing and fast growing countries like India, regularly increasing wastewater generation rates may allow this option to be considered quite seriously. In view of this, a pilot field study was conducted at the Jagjeetpur Municipal Sewage treatment plant situated in the Haridwar town of Uttarakhand state, India. The objectives of the present study were to study the effect of treated wastewater on the production of various paddy varieties (Sharbati, PR-114, PB-1, Menaka, PB1121 and PB 1509) and emission of GHG gases (CO2, CH4 and N2O) as compared to the same varieties grown in the control plots irrigated with fresh water. Of late, the concept of water footprint assessment has emerged, which explains enumeration of various types of water footprints of an agricultural entity from its production to processing stages. Paddy, the most water demanding staple crop of Uttarakhand state, displayed a high green water footprint value of 2966.538 m3/ton. Most of the wastewater irrigated varieties displayed upto 6% increase in production, except Menaka and PB-1121, which showed a reduction in production (6% and 3% respectively), due to pest and insect infestation. The treated wastewater was observed to be rich in Nitrogen (55.94 mg/ml Nitrate), Phosphorus (54.24 mg/ml) and Potassium (9.78 mg/ml), thus rejuvenating the soil quality and not requiring any external nutritional supplements. Percentage increase of GHG gases on irrigation with treated municipal waste water as compared to control plots was observed as 0.4% - 8.6% (CH4), 1.1% - 9.2% (CO2), and 0.07% - 5.8% (N2O). The variety, Sharbati, displayed maximum production (5.5 ton/ha) and emerged as the most resistant variety against pests and insects. The emission values of CH4 ,CO2 and N2O were 729.31 mg/m2/d, 322.10 mg/m2/d and 400.21 mg/m2/d in water stagnant condition. This study highlighted a successful possibility of reuse of wastewater for non-potable purposes offering the potential for exploiting this resource that can replace or reduce existing use of fresh water sources in agricultural sector.

Keywords: greenhouse gases, nutrients, water footprint, wastewater irrigation

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19 A Second Chance to Live and Move: Lumbosacral Spinal Cord Ischemia-Infarction after Cardiac Arrest and the Artery of Adamkiewicz

Authors: Anna Demian, Levi Howard, L. Ng, Leslie Simon, Mark Dragon, A. Desai, Timothy Devlantes, W. David Freeman

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Introduction: Out-of-hospital cardiac arrest (OHCA) can carry a high mortality. For survivors, the most common complication is hypoxic-ischemic brain injury (HIBI). Rarely, lumbosacral spinal cord and/or other spinal cord artery ischemia can occur due to anatomic variation and variable mean arterial pressure after the return of spontaneous circulation. We present a case of an OHCA survivor who later woke up with bilateral leg weakness with preserved sensation (ASIA grade B, L2 level). Methods: We describe a clinical, radiographic, and laboratory presentation, as well as a National Library of Medicine (NLM) search engine methodology, characterizing incidence/prevalence of this entity is discussed. A 70-year-old male, a longtime smoker, and alcohol user, suddenly collapsed at a bar surrounded by friends. He had complained of chest pain before collapsing. 911 was called. EMS arrived, and the patient was in pulseless electrical activity (PEA), cardiopulmonary resuscitation (CPR) was initiated, and the patient was intubated, and a LUCAS device was applied for continuous, high-quality CPR in the field by EMS. In the ED, central lines were placed, and thrombolysis was administered for a suspected Pulmonary Embolism (PE). It was a prolonged code that lasted 90 minutes. The code continued with the eventual return of spontaneous circulation. The patient was placed on an epinephrine and norepinephrine drip to maintain blood pressure. ECHO was performed and showed a “D-shaped” ventricle worrisome for PE as well as an ejection fraction around 30%. A CT with PE protocol was performed and confirmed bilateral PE. Results: The patient woke up 24 hours later, following commands, and was extubated. He was found paraplegic below L2 with preserved sensation, with hypotonia and areflexia consistent with “spinal shock” or anterior spinal cord syndrome. MRI thoracic and lumbar spine showed a conus medullaris level spinal cord infarction. The patient was given IV steroids upon initial discovery of cord infarct. NLM search using “cardiac arrest” and “spinal cord infarction” revealed 57 results, with only 8 review articles. Risk factors include age, atherosclerotic disease, and intraaortic balloon pump placement. AoA (Artery of Adamkiewicz) anatomic variation along with existing atherosclerotic factors and low perfusion were also known risk factors. Conclusion: Acute paraplegia from anterior spinal cord infarction of the AoA territory after cardiac arrest is rare. Larger prospective, multicenter trials are needed to examine potential interventions of hypothermia, lumbar drains, which are sometimes used in aortic surgery to reduce ischemia and/or other neuroprotectants.

Keywords: cardiac arrest, spinal cord infarction, artery of Adamkiewicz, paraplegia

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18 Clinical Validation of an Automated Natural Language Processing Algorithm for Finding COVID-19 Symptoms and Complications in Patient Notes

Authors: Karolina Wieczorek, Sophie Wiliams

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Introduction: Patient data is often collected in Electronic Health Record Systems (EHR) for purposes such as providing care as well as reporting data. This information can be re-used to validate data models in clinical trials or in epidemiological studies. Manual validation of automated tools is vital to pick up errors in processing and to provide confidence in the output. Mentioning a disease in a discharge letter does not necessarily mean that a patient suffers from this disease. Many of them discuss a diagnostic process, different tests, or discuss whether a patient has a certain disease. The COVID-19 dataset in this study used natural language processing (NLP), an automated algorithm which extracts information related to COVID-19 symptoms, complications, and medications prescribed within the hospital. Free-text patient clinical patient notes are rich sources of information which contain patient data not captured in a structured form, hence the use of named entity recognition (NER) to capture additional information. Methods: Patient data (discharge summary letters) were exported and screened by an algorithm to pick up relevant terms related to COVID-19. Manual validation of automated tools is vital to pick up errors in processing and to provide confidence in the output. A list of 124 Systematized Nomenclature of Medicine (SNOMED) Clinical Terms has been provided in Excel with corresponding IDs. Two independent medical student researchers were provided with a dictionary of SNOMED list of terms to refer to when screening the notes. They worked on two separate datasets called "A” and "B”, respectively. Notes were screened to check if the correct term had been picked-up by the algorithm to ensure that negated terms were not picked up. Results: Its implementation in the hospital began on March 31, 2020, and the first EHR-derived extract was generated for use in an audit study on June 04, 2020. The dataset has contributed to large, priority clinical trials (including International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) by bulk upload to REDcap research databases) and local research and audit studies. Successful sharing of EHR-extracted datasets requires communicating the provenance and quality, including completeness and accuracy of this data. The results of the validation of the algorithm were the following: precision (0.907), recall (0.416), and F-score test (0.570). Percentage enhancement with NLP extracted terms compared to regular data extraction alone was low (0.3%) for relatively well-documented data such as previous medical history but higher (16.6%, 29.53%, 30.3%, 45.1%) for complications, presenting illness, chronic procedures, acute procedures respectively. Conclusions: This automated NLP algorithm is shown to be useful in facilitating patient data analysis and has the potential to be used in more large-scale clinical trials to assess potential study exclusion criteria for participants in the development of vaccines.

Keywords: automated, algorithm, NLP, COVID-19

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17 Purple Spots on Historical Parchments: Confirming the Microbial Succession at the Basis of Biodeterioration

Authors: N. Perini, M. C. Thaller, F. Mercuri, S. Orlanducci, A. Rubechini, L. Migliore

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The preservation of cultural heritage is one of the major challenges of today’s society, because of the fundamental right of future generations to inherit it as the continuity with their historical and cultural identity. Parchments, consisting of a semi-solid matrix of collagen produced from animal skin (i.e., sheep or goats), are a significant part of the cultural heritage, being used as writing material for many centuries. Due to their animal origin, parchments easily undergo biodeterioration. The most common biological damage is characterized by isolated or coalescent purple spots that often leads to the detachment of the superficial layer and the loss of the written historical content of the document. Although many parchments with the same biodegradative features were analyzed, no common causative agent has been found so far. Very recently, a study was performed on a purple-damaged parchment roll dated back 1244 A.D, the A.A. Arm. I-XVIII 3328, belonging to the oldest collection of the Vatican Secret Archive (Fondo 'Archivum Arcis'), by comparing uncolored undamaged and purple damaged areas of the same document. As a whole, the study gave interesting results to hypothesize a model of biodeterioration, consisting of a microbial succession acting in two main phases: the first one, common to all the damaged parchments, is characterized by halophilic and halotolerant bacteria fostered by the salty environment within the parchment maybe induced by bringing of the hides; the second one, changing with the individual history of each parchment, determines the identity of its colonizers. The design of this model was pivotal to this study, performed by different labs of the Tor Vergata University (Rome, Italy), in collaboration with the Vatican Secret Archive. Three documents, belonging to a collection of dramatically damaged parchments archived as 'Faldone Patrizi A 19' (dated back XVII century A.D.), were analyzed through a multidisciplinary approach, including three updated technologies: (i) Next Generation Sequencing (NGS, Illumina) to describe the microbial communities colonizing the damaged and undamaged areas, (ii) RAMAN spectroscopy to analyze the purple pigments, (iii) Light Transmitted Analysis (LTA) to evaluate the kind and entity of the damage to native collagen. The metagenomic analysis obtained from NGS revealed DNA sequences belonging to Halobacterium salinarum mainly in the undamaged areas. RAMAN spectroscopy detected pigments within the purple spots, mainly bacteriorhodopsine/rhodopsin-like pigments, a purple transmembrane protein containing retinal and present in Halobacteria. The LTA technique revealed extremely damaged collagen structures in both damaged and undamaged areas of the parchments. In the light of these data, the study represents a first confirmation of the microbial succession model described above. The demonstration of this model is pivotal to start any possible new restoration strategy to bring back historical parchments to their original beauty, but also to open opportunities for intervention on a huge amount of documents.

Keywords: biodeterioration, parchments, purple spots, ecological succession

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16 Biomimetic Dinitrosyl Iron Complexes: A Synthetic, Structural, and Spectroscopic Study

Authors: Lijuan Li

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Nitric oxide (NO) has become a fascinating entity in biological chemistry over the past few years. It is a gaseous lipophilic radical molecule that plays important roles in several physiological and pathophysiological processes in mammals, including activating the immune response, serving as a neurotransmitter, regulating the cardiovascular system, and acting as an endothelium-derived relaxing factor. NO functions in eukaryotes both as a signal molecule at nanomolar concentrations and as a cytotoxic agent at micromolar concentrations. The latter arises from the ability of NO to react readily with a variety of cellular targets leading to thiol S-nitrosation, amino acid N-nitrosation, and nitrosative DNA damage. Nitric oxide can readily bind to metals to give metal-nitrosyl (M-NO) complexes. Some of these species are known to play roles in biological NO storage and transport. These complexes have different biological, photochemical, or spectroscopic properties due to distinctive structural features. These recent discoveries have spawned a great interest in the development of transition metal complexes containing NO, particularly its iron complexes that are central to the role of nitric oxide in the body. Spectroscopic evidence would appear to implicate species of “Fe(NO)2+” type in a variety of processes ranging from polymerization, carcinogenesis, to nitric oxide stores. Our research focuses on isolation and structural studies of non-heme iron nitrosyls that mimic biologically active compounds and can potentially be used for anticancer drug therapy. We have shown that reactions between Fe(NO)2(CO)2 and a series of imidazoles generated new non-heme iron nitrosyls of the form Fe(NO)2(L)2 [L = imidazole, 1-methylimidazole, 4-methylimidazole, benzimidazole, 5,6-dimethylbenzimidazole, and L-histidine] and a tetrameric cluster of [Fe(NO)2(L)]4 (L=Im, 4-MeIm, BzIm, and Me2BzIm), resulted from the interactions of Fe(NO)2 with a series of substituted imidazoles was prepared. Recently, a series of sulfur bridged iron di nitrosyl complexes with the general formula of [Fe(µ-RS)(NO)2]2 (R = n-Pr, t-Bu, 6-methyl-2-pyridyl, and 4,6-dimethyl-2-pyrimidyl), were synthesized by the reaction of Fe(NO)2(CO)2 with thiols or thiolates. Their structures and properties were studied by IR, UV-vis, 1H-NMR, EPR, electrochemistry, X-ray diffraction analysis and DFT calculations. IR spectra of these complexes display one weak and two strong NO stretching frequencies (νNO) in solution, but only two strong νNO in solid. DFT calculations suggest that two spatial isomers of these complexes bear 3 Kcal energy difference in solution. The paramagnetic complexes [Fe2(µ-RS)2(NO)4]-, have also been investigated by EPR spectroscopy. Interestingly, the EPR spectra of complexes exhibit an isotropic signal of g = 1.998 - 2.004 without hyperfine splitting. The observations are consistent with the results of calculations, which reveal that the unpaired electron dominantly delocalize over the two sulfur and two iron atoms. The difference of the g values between the reduced form of iron-sulfur clusters and the typical monomeric di nitrosyl iron complexes is explained, for the first time, by of the difference in unpaired electron distributions between the two types of complexes, which provides the theoretical basis for the use of g value as a spectroscopic tool to differentiate these biologically active complexes.

Keywords: di nitrosyl iron complex, metal nitrosyl, non-heme iron, nitric oxide

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15 Re-Creating Women of the Past in Historical Series on Mexican Television: The Work of Patricia Arriaga Jordan

Authors: Maria De Los Angeles Rodriguez Cadena

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This paper discusses how the fictional versions of women of the past contribute to advance today’s ideas of social justice, personal freedom and emancipation as well as to highlight the creative challenge of constructing people and events on fictional narratives on television that incorporate multiple and simultaneous layers of meaning and complexity. This project builds on existing scholarship on audiovisual texts by exploring an influential but under-studied director. In two Mexican television series, Patricia Arriaga Jordan, an award-winning television producer, scriptwriter and director, constructs the life of two outstanding women that have played an influential role in national history and captured Mexican’s popular imagination for generations: Sor Juana Inés de la Cruz, and Malinche. Malinche (2018) tells the story of an extraordinary indigenous woman, Malintzin, during the Spanish Conquest (1511-1550) that is considered to have played a key role in the fall of the Aztec empire by acting as translator, negotiator and cultural mediator for the Spanish conquerors. Juana Ines (2016) portrays Sor Juana, a poet, essayist, playwright, theologian, philosopher, nun, of XVII century colonial Mexico, one of the brightest minds of her time, and now recognized as the first feminist of the Americas who wrote on the rights of women to an education, religious authority and feminist advocacy. Both series, as fictional narratives that recreate defining historical periods, specific events and relevant characters in the History of Mexico can be read as an example of what is called texts of cultural memory. A cultural memory text is a narrative that bonds the concepts of history, identity and belonging, and that is realized and disseminated through symbolic systems such as written documents, visual images, and dramatic representation. Cultural memory, through its narratives of historical fiction, emphasizes memory processes (historiography) and its implications and artifacts (cultural memory) mainly through the medial frameworks of remembering, which are the medial process by which memories (narratives, documents) participate in public knowledge and become collective memory. Historical fiction on television not only creates a portrayal of the past related to the real lives of protagonists, but it also significantly contributes to understand the past as an ever-evolving entity that highlights both, the necessary connection with the present as part of a developing sense of collective identity and belonging, as well as the relevance of the medium in which the past is represented and that ultimately supports the process of historical awareness. Through the emblematic recreation of national heroines and historical events in the unique context of historical drama on television, those texts constitute a venue where concepts of the past and the traditionally established ideas about history and heroines are highlighted, questioned and transformed.

Keywords: cultural memory, historical fiction, Mexico, television, women directors

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14 Small Town Big Urban Issues the Case of Kiryat Ono, Israel

Authors: Ruth Shapira

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Introduction: The rapid urbanization of the last century confronts planners, regulatory bodies, developers and most of all – the public with seemingly unsolved conflicts regarding values, capital, and wellbeing of the built and un-built urban space. This is reflected in the quality of the urban form and life which has known no significant progress in the last 2-3 decades despite the on-growing urban population. It is the objective of this paper to analyze some of these fundamental issues through the case study of a relatively small town in the center of Israel (Kiryat-Ono, 100,000 inhabitants), unfold the deep structure of qualities versus disruptors, present some cure that we have developed to bridge over and humbly suggest a practice that may be generic for similar cases. Basic Methodologies: The OBJECT, the town of Kiryat Ono, shall be experimented upon in a series of four action processes: De-composition, Re-composition, the Centering process and, finally, Controlled Structural Disintegration. Each stage will be based on facts, analysis of previous multidisciplinary interventions on various layers – and the inevitable reaction of the OBJECT, leading to the conclusion based on innovative theoretical and practical methods that we have developed and that we believe are proper for the open ended network, setting the rules for the contemporary urban society to cluster by. The Study: Kiryat Ono, was founded 70 years ago as an agricultural settlement and rapidly turned into an urban entity. In spite the massive intensification, the original DNA of the old small town was still deeply embedded, mostly in the quality of the public space and in the sense of clustered communities. In the past 20 years, the recent demand for housing has been addressed to on the national level with recent master plans and urban regeneration policies mostly encouraging individual economic initiatives. Unfortunately, due to the obsolete existing planning platform the present urban renewal is characterized by pressure of developers, a dramatic change in building scale and widespread disintegration of the existing urban and social tissue. Our office was commissioned to conceptualize two master plans for the two contradictory processes of Kiryat Ono’s future: intensification and conservation. Following a comprehensive investigation into the deep structures and qualities of the existing town, we developed a new vocabulary of conservation terms thus redefying the sense of PLACE. The main challenge was to create master plans that should offer a regulatory basis to the accelerated and sporadic development providing for the public good and preserving the characteristics of the PLACE consisting of a tool box of design guidelines that will have the ability to reorganize space along the time axis in a coherent way. In Conclusion: The system of rules that we have developed can generate endless possible patterns making sure that at each implementation fragment an event is created, and a better place is revealed. It takes time and perseverance but it seems to be the way to provide a healthy framework for the accelerated urbanization of our chaotic present.

Keywords: housing, architecture, urban qualities, urban regeneration, conservation, intensification

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13 Cuban's Supply Chains Development Model: Qualitative and Quantitative Impact on Final Consumers

Authors: Teresita Lopez Joy, Jose A. Acevedo Suarez, Martha I. Gomez Acosta, Ana Julia Acevedo Urquiaga

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Current trends in business competitiveness indicate the need to manage businesses as supply chains and not in isolation. The use of strategies aimed at maximum satisfaction of customers in a network and based on inter-company cooperation; contribute to obtaining successful joint results. In the Cuban economic context, the development of productive linkages to achieve integrated management of supply chains is considering a key aspect. In order to achieve this jump, it is necessary to develop acting capabilities in the entities that make up the chains through a systematic procedure that allows arriving at a management model in consonance with the environment. The objective of the research focuses on: designing a model and procedure for the development of integrated management of supply chains in economic entities. The results obtained are: the Model and the Procedure for the Development of the Supply Chains Integrated Management (MP-SCIM). The Model is based on the development of logistics in the network actors, the joint work between companies, collaborative planning and the monitoring of a main indicator according to the end customers. The application Procedure starts from the well-founded need for development in a supply chain and focuses on training entrepreneurs as doers. The characterization and diagnosis is done to later define the design of the network and the relationships between the companies. It takes into account the feedback as a method of updating the conditions and way to focus the objectives according to the final customers. The MP-SCIM is the result of systematic work with a supply chain approach in companies that have consolidated as coordinators of their network. The cases of the edible oil chain and explosives for construction sector reflect results of more remarkable advances since they have applied this approach for more than 5 years and maintain it as a general strategy of successful development. The edible oil trading company experienced a jump in sales. In 2006, the company started the analysis in order to define the supply chain, apply diagnosis techniques, define problems and implement solutions. The involvement of the management and the progressive formation of performance capacities in the personnel allowed the application of tools according to the context. The company that coordinates the explosives chain for construction sector shows adequate training with independence and opportunity in the face of different situations and variations of their business environment. The appropriation of tools and techniques for the analysis and implementation of proposals is a characteristic feature of this case. The coordinating entity applies integrated supply chain management to its decisions based on the timely training of the necessary action capabilities for each situation. Other cases of study and application that validate these tools are also detailed in this paper, and they highlight the results of generalization in the quantitative and qualitative improvement according to the final clients. These cases are: teaching literature in universities, agricultural products of local scope and medicine supply chains.

Keywords: integrated management, logistic system, supply chain management, tactical-operative planning

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12 Cystic Ganglionosis in Child: Rare Entity

Authors: Jatinder Pal Singh, Harpreet Singh, Gagandeep Singh Digra, Mandeep Kaur Sidhu, Pawan Kumar

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Introduction: Ganglion cyst is a benign condition in which there is a cystic lesion in relation to a joint or a tendon sheath arising from myxoid degeneration of fibrous connective tissue. These can be unilocular or multilocular. In rare cases, there may be multiple ganglion cysts, known as cystic ganglionosis. They can occur at any age but are commonly seen in adults. Clinically they may be asymptomatic or present as swelling or mass effect in adjacent structures. These are common in extremities such as hands and feet. Case Presentation: 11-year-old female child presented with slowly progressive painless swelling of her right hand since the age of 4. Antenatal and perinatal history was unremarkable. Her family history was negative. She denies fever, malaise, morning stiffness, weight loss, fatigue, restriction of joint movements, or any sensory and motor deficit. Lab parameters were negative for inflammatory or infectious etiology. No other joint or extremity involvement was present. On physical examination, the swelling was present on the dorsum and palmer aspect of the right hand and wrist. They were non-tender on palpation without any motor or sensory deficit. MRI hand revealed multiple well-defined fluid signal intensity cystic appearing lesions in periarticular/intraarticular locations in relation to distal radio-ulnar, radio-carpal, intercarpal, carpometacarpal, metacarpophalangeal and interphalangeal joints as well as peritendinous location around flexor tendons more so in the region of wrist, palm, 1st and 5th digit and along extensor tendons in the region of wrist, largest one noted along flexor pollicis longus tendon in thenar region and along 1st digit measuring approx. 4.6 x 1.2 x 1.2 centimeter. Pressure erosions and bone remodelling were noted in the bases of the 2nd to 5th metacarpals, capitate, trapezoid, the distal shaft of 1st metacarpal, and proximal phalanx of 1st digit. Marrow edema was noted in the base and proximal shaft of the 4th metacarpal and proximal shaft of the 3rd metacarpal – likely stress or pressure related. The patient was advised of aspiration, but the family refused the procedure. Therefore the patient was kept on conservative treatment. Conclusion: Cystic ganglionosis is a rare condition with very few cases reported in the medical literature. Its prevalence and association are not known because of the rarity of this condition. It should be considered as an important differential in patients presenting with soft tissue swelling in extremities. Treatment option includes conservative management, aspiration, and surgery. Aspiration has a high recurrence rate. Although surgery has a low recurrence rate, it carries a high rate of complications. Imaging with MRI is essential for confirmation of the cystic nature of lesions and their relation with the joint capsules or tendons. This helps in differentiating from other soft tissue lesions and presurgical planning.

Keywords: radiology, rare, cystic ganglionosis, child

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11 Novel Aspects of Merger Control Pertaining to Nascent Acquisition: An Analytical Legal Research

Authors: Bhargavi G. Iyer, Ojaswi Bhagat

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It is often noted that the value of a novel idea lies in its successful implementation. However, successful implementation requires the nurturing and encouragement of innovation. Nascent competitors are a true representation of innovation in any given industry. A nascent competitor is an entity whose prospective innovation poses a future threat to an incumbent dominant competitor. While a nascent competitor benefits in several ways, it is also exposed significantly and is at greater risk of facing the brunt of exclusionary practises and abusive conduct by dominant incumbent competitors in the industry. This research paper aims to explore the risks and threats faced by nascent competitors and analyse the benefits they accrue as well as the advantages they proffer to the economy; through an analytical, critical study. In such competitive market environments, a rise of the acquisitions of nascent competitors by the incumbent dominants is observed. Therefore, this paper will examine the dynamics of nascent acquisition. Further, this paper hopes to specifically delve into the role of antitrust bodies in regulating nascent acquisition. This paper also aspires to deal with the question how to distinguish harmful from harmless acquisitions in order to facilitate ideal enforcement practice. This paper proposes mechanisms of scrutiny in order to ensure healthy market practises and efficient merger control in the context of nascent acquisitions. Taking into account the scope and nature of the topic, as well as the resources available and accessible, a combination of the methods of doctrinal research and analytical research were employed, utilising secondary sources in order to assess and analyse the subject of research. While legally evaluating the Killer Acquisition theory and the Nascent Potential Acquisition theory, this paper seeks to critically survey the precedents and instances of nascent acquisitions. In addition to affording a compendious account of the legislative framework and regulatory mechanisms in the United States, the United Kingdom, and the European Union; it hopes to suggest an internationally practicable legal foundation for domestic legislation and enforcement to adopt. This paper hopes to appreciate the complexities and uncertainties with respect to nascent acquisitions and attempts to suggest viable and plausible policy measures in antitrust law. It additionally attempts to examine the effects of such nascent acquisitions upon the consumer and the market economy. This paper weighs the argument of shifting the evidentiary burden on to the merging parties in order to improve merger control and regulation and expounds on its discovery of the strengths and weaknesses of the approach. It is posited that an effective combination of factual, legal, and economic analysis of both the acquired and acquiring companies possesses the potential to improve ex post and ex ante merger review outcomes involving nascent companies; thus, preventing anti-competitive practises. This paper concludes with an analysis of the possibility and feasibility of industry-specific identification of anti-competitive nascent acquisitions and implementation of measures accordingly.

Keywords: acquisition, antitrust law, exclusionary practises merger control, nascent competitor

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10 Teaching Children about Their Brains: Evaluating the Role of Neuroscience Undergraduates in Primary School Education

Authors: Clea Southall

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Many children leave primary school having formed preconceptions about their relationship with science. Thus, primary school represents a critical window for stimulating scientific interest in younger children. Engagement relies on the provision of hands-on activities coupled with an ability to capture a child’s innate curiosity. This requires children to perceive science topics as interesting and relevant to their everyday life. Teachers and pupils alike have suggested the school curriculum be tailored to help stimulate scientific interest. Young children are naturally inquisitive about the human body; the brain is one topic which frequently engages pupils, although it is not currently included in the UK primary curriculum. Teaching children about the brain could have wider societal impacts such as increasing knowledge of neurological disorders. However, many primary school teachers do not receive formal neuroscience training and may feel apprehensive about delivering lessons on the nervous system. This is exacerbated by a lack of educational neuroscience resources. One solution is for undergraduates to form partnerships with schools - delivering engaging lessons and supplementing teacher knowledge. The aim of this project was to evaluate the success of a short lesson on the brain delivered by an undergraduate neuroscientist to primary school pupils. Prior to entering schools, semi-structured online interviews were conducted with teachers to gain pedagogical advice and relevant websites were searched for neuroscience resources. Subsequently, a single lesson plan was created comprising of four hands-on activities. The activities were devised in a top-down manner, beginning with learning about the brain as an entity, before focusing on individual neurons. Students were asked to label a ‘brain map’ to assess prior knowledge of brain structure and function. They viewed animal brains and created ‘pipe-cleaner neurons’ which were later used to depict electrical transmission. The same session was delivered by an undergraduate student to 570 key stage 2 (KS2) pupils across five schools in Leeds, UK. Post-session surveys, designed for teachers and pupils respectively, were used to evaluate the session. Children in all year groups had relatively poor knowledge of brain structure and function at the beginning of the session. When asked to label four brain regions with their respective functions, older pupils labeled a mean of 1.5 (± 1.0) brain regions compared to 0.8 (± 0.96) for younger pupils (p=0.002). However, by the end of the session, 95% of pupils felt their knowledge of the brain had increased. Hands-on activities were rated most popular by pupils and were considered the most successful aspect of the session by teachers. Although only half the teachers were aware of neuroscience educational resources, nearly all (95%) felt they would have more confidence in teaching a similar session in the future. All teachers felt the session was engaging and that the content could be linked to the current curriculum. Thus, a short fifty-minute session can successfully enhance pupils’ knowledge of a new topic: the brain. Partnerships with an undergraduate student can provide an alternative method for supplementing teacher knowledge, increasing their confidence in delivering future lessons on the nervous system.

Keywords: education, neuroscience, primary school, undergraduate

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9 Foregrounding Events in Modern Sundanese: The Pragmatics of Particle-to-Active Voice Marking Shift

Authors: Rama Munajat

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Discourse information levels may be viewed from either a background-foreground distinction or a multi-level perspective, and cross-linguistic studies on this area suggest that each information level is marked by a specific linguistic device. In this sense, Sundanese, spoken in Indonesia’s West Javanese Province, further differentiates the background and foreground information into ordinary and significant types. This paper will report an ongoing shift from particle-to-active voice marking in the way Sundanese signals foregrounding events. The shift relates to decades of contact with Bahasa Indonesia (Indonesia’s official language) and linguistic compatibility between the two surface marking strategies. Representative data analyzed include three groups of short stories in both Sundanese and Bahasa Indonesia (Indonesian) published in three periods: before 1945, 1965-2006, and 2016-2019. In the first group of Sundanese data, forward-moving events dominantly appear in particle KA (Kecap Anteuran, word-accompanying) constructions, where the KA represents different particles that co-occur with a special group of verbs. The second group, however, shows that the foregrounded events are more frequently described in active-voice forms with a subject-predicate (SP) order. Subsequently, the third offers stronger evidence for the use of the SP structure. As for the Indonesian data, the foregrounding events in the first group occur in verb-initial and passive-voice constructions, while in the second and third, the events more frequently appear in active-voice structures (subject-predicate sequence). The marking shift above suggests a structural influence from Indonesian, stemmed from generational differences among authors of the Sundanese short stories, particularly related to their education and language backgrounds. The first group of short stories – published before 1945 or before Indonesia's independence from Dutch – were written by native speakers of Sundanese who spoke Indonesian as a foreign language and went through the Dutch education system. The second group of authors, on the other hand, represents a generation of Sundanese native speakers who spoke Indonesian as a second language. Finally, the third group consists of authors who are bilingual speakers of both Sundanese and Indonesian. The data suggest that the last two groups of authors completed the Indonesian education system. With these, the use of subject-predicate sequences to denote foregrounding events began to appear more frequently in the second group and then became more dominant in those of the third. The coded data also signify that cohesion, coherence, and pragmatic purposes in Particle KA constructions are intact in their respective active-voice structure counterparts. For instance, the foregrounding events in Particle KA constructions occur in Sentence-initial KA and Pre-verbal KA forms, whereas those in the active-voice are described in Subject-Predicate (SP) and Zero-Subject active-voice patterns. Cross-language data further demonstrate that the Sentence-initial KA and the SP active-voice structures each contain an overt noun phrase (NP) co-referential with one of the entities introduced in a preceding context. Similarly, the pre-verbal KA and Zero-Subject active-voice patterns have a deleted noun phrase unambiguously referable to the only one entity previously mentioned. The presence and absence of an NP inform a pragmatic strategy to place prominence on topic/given and comment/new information, respectively.

Keywords: discourse analysis, foregrounding marking, pragmatics, language contact

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8 The Healing 'Touch' of Music: A Neuro-Acoustics Approach to Understand Its Therapeutic Effect

Authors: Jagmeet S. Kanwal, Julia F. Langley

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Music can heal the body, but a mechanistic understanding of this phenomenon is lacking. This study explores the effects of music presentation on neurologic and physiologic responses leading to metabolic changes in the human body. The mind and body co-exist in a corporeal entity and within this framework, sickness ensues when the mind-body balance goes awry. It is further hypothesized that music has the capacity to directly reset this balance. Two lines of inquiry taken together can provide a mechanistic understanding of this phenomenon 1) Empirical evidence for a sound-sensitive pressure sensor system in the body, and 2) The notion of a “healing center” within the brain that is activated by specific patterns of sounds. From an acoustics perspective, music is spatially distributed as pressure waves ranging from a few cm to several meters in wavelength. These waves interact and propagate in three-dimensions in unique ways, depending on the wavelength. Furthermore, music creates dynamically changing wave-fronts. Frequencies between 200 Hz and 1 kHz generate wavelengths that range from 5'6" to 1 foot. These dimensions are in the range of the body size of most people making it plausible that these pressure waves can geometrically interact with the body surface and create distinct patterns of pressure stimulation across the skin surface. For humans, short wavelength, high frequency (> 200 Hz) sounds are best received via cochlear receptors. For low frequency (< 200 Hz), long wavelength sound vibrations, however, the whole body may act as an ideal receiver. A vast array of highly sensitive pressure receptors (Pacinian corpuscles) is present just beneath the skin surface, as well as in the tendons, bones, several organs in the abdomen, and the sexual organs. Per the available empirical evidence, these receptors contribute to music perception by allowing the whole body to function as a sound receiver, and knowledge of how they function is essential to fully understanding the therapeutic effect of music. Neuroscientific studies have established that music stimulates the limbic system that can trigger states of anxiety, arousal, fear, and other emotions. These emotional states of brain activity play a crucial role in filtering top-down feedback from thoughts and bottom-up sensory inputs to the autonomic system, which automatically regulates bodily functions. Music likely exerts its pleasurable and healing effects by enhancing functional and effective connectivity and feedback mechanisms between brain regions that mediate reward, autonomic, and cognitive processing. Stimulation of pressure receptors under the skin by low-frequency music-induced sensations can activate multiple centers in the brain, including the amygdala, the cingulate cortex, and nucleus accumbens. Melodies in music in the low (< 600 Hz) frequency range may augment auditory inputs after convergence of the pressure-sensitive inputs from the vagus nerve onto emotive processing regions within the limbic system. The integration of music-generated auditory and somato-visceral inputs may lead to a synergistic input to the brain that promotes healing. Thus, music can literally heal humans through “touch” as it energizes the brain’s autonomic system for restoring homeostasis.

Keywords: acoustics, brain, music healing, pressure receptors

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7 A Tool to Provide Advanced Secure Exchange of Electronic Documents through Europe

Authors: Jesus Carretero, Mario Vasile, Javier Garcia-Blas, Felix Garcia-Carballeira

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Supporting cross-border secure and reliable exchange of data and documents and to promote data interoperability is critical for Europe to enhance sector (like eFinance, eJustice and eHealth). This work presents the status and results of the European Project MADE, a Research Project funded by Connecting Europe facility Programme, to provide secure e-invoicing and e-document exchange systems among Europe countries in compliance with the eIDAS Regulation (Regulation EU 910/2014 on electronic identification and trust services). The main goal of MADE is to develop six new AS4 Access Points and SMP in Europe to provide secure document exchanges using the eDelivery DSI (Digital Service Infrastructure) amongst both private and public entities. Moreover, the project demonstrates the feasibility and interest of the solution provided by providing several months of interoperability among the providers of the six partners in different EU countries. To achieve those goals, we have followed a methodology setting first a common background for requirements in the partner countries and the European regulations. Then, the partners have implemented access points in each country, including their service metadata publisher (SMP), to allow the access to their clients to the pan-European network. Finally, we have setup interoperability tests with the other access points of the consortium. The tests will include the use of each entity production-ready Information Systems that process the data to confirm all steps of the data exchange. For the access points, we have chosen AS4 instead of other existing alternatives because it supports multiple payloads, native web services, pulling facilities, lightweight client implementations, modern crypto algorithms, and more authentication types, like username-password and X.509 authentication and SAML authentication. The main contribution of MADE project is to open the path for European companies to use eDelivery services with cross-border exchange of electronic documents following PEPPOL (Pan-European Public Procurement Online) based on the e-SENS AS4 Profile. It also includes the development/integration of new components, integration of new and existing logging and traceability solutions and maintenance tool support for PKI. Moreover, we have found that most companies are still not ready to support those profiles. Thus further efforts will be needed to promote this technology into the companies. The consortium includes the following 9 partners. From them, 2 are research institutions: University Carlos III of Madrid (Coordinator), and Universidad Politecnica de Valencia. The other 7 (EDICOM, BIZbrains, Officient, Aksesspunkt Norge, eConnect, LMT group, Unimaze) are private entities specialized in secure delivery of electronic documents and information integration brokerage in their respective countries. To achieve cross-border operativity, they will include AS4 and SMP services in their platforms according to the EU Core Service Platform. Made project is instrumental to test the feasibility of cross-border documents eDelivery in Europe. If successful, not only einvoices, but many other types of documents will be securely exchanged through Europe. It will be the base to extend the network to the whole Europe. This project has been funded under the Connecting Europe Facility Agreement number: INEA/CEF/ICT/A2016/1278042. Action No: 2016-EU-IA-0063.

Keywords: security, e-delivery, e-invoicing, e-delivery, e-document exchange, trust

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6 Well Inventory Data Entry: Utilization of Developed Technologies to Progress the Integrated Asset Plan

Authors: Danah Al-Selahi, Sulaiman Al-Ghunaim, Bashayer Sadiq, Fatma Al-Otaibi, Ali Ameen

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In light of recent changes affecting the Oil & Gas Industry, optimization measures have become imperative for all companies globally, including Kuwait Oil Company (KOC). To keep abreast of the dynamic market, a detailed Integrated Asset Plan (IAP) was developed to drive optimization across the organization, which was facilitated through the in-house developed software “Well Inventory Data Entry” (WIDE). This comprehensive and integrated approach enabled centralization of all planned asset components for better well planning, enhancement of performance, and to facilitate continuous improvement through performance tracking and midterm forecasting. Traditionally, this was hard to achieve as, in the past, various legacy methods were used. This paper briefly describes the methods successfully adopted to meet the company’s objective. IAPs were initially designed using computerized spreadsheets. However, as data captured became more complex and the number of stakeholders requiring and updating this information grew, the need to automate the conventional spreadsheets became apparent. WIDE, existing in other aspects of the company (namely, the Workover Optimization project), was utilized to meet the dynamic requirements of the IAP cycle. With the growth of extensive features to enhance the planning process, the tool evolved into a centralized data-hub for all asset-groups and technical support functions to analyze and infer from, leading WIDE to become the reference two-year operational plan for the entire company. To achieve WIDE’s goal of operational efficiency, asset-groups continuously add their parameters in a series of predefined workflows that enable the creation of a structured process which allows risk factors to be flagged and helps mitigation of the same. This tool dictates assigned responsibilities for all stakeholders in a method that enables continuous updates for daily performance measures and operational use. The reliable availability of WIDE, combined with its user-friendliness and easy accessibility, created a platform of cross-functionality amongst all asset-groups and technical support groups to update contents of their respective planning parameters. The home-grown entity was implemented across the entire company and tailored to feed in internal processes of several stakeholders across the company. Furthermore, the implementation of change management and root cause analysis techniques captured the dysfunctionality of previous plans, which in turn resulted in the improvement of already existing mechanisms of planning within the IAP. The detailed elucidation of the 2 year plan flagged any upcoming risks and shortfalls foreseen in the plan. All results were translated into a series of developments that propelled the tool’s capabilities beyond planning and into operations (such as Asset Production Forecasts, setting KPIs, and estimating operational needs). This process exemplifies the ability and reach of applying advanced development techniques to seamlessly integrated the planning parameters of various assets and technical support groups. These techniques enables the enhancement of integrating planning data workflows that ultimately lay the founding plans towards an epoch of accuracy and reliability. As such, benchmarks of establishing a set of standard goals are created to ensure the constant improvement of the efficiency of the entire planning and operational structure.

Keywords: automation, integration, value, communication

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5 Chronic Progressive External Ophthalmoplegia (CPEO)

Authors: Gagandeep Singh Digra, Pawan Kumar, Mandeep Kaur Sidhu

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INTRODUCTION: Chronic Progressive External Ophthalmoplegia (CPEO), also known as Progressive External Ophthalmoplegia (PEO), is a type of eye disorder characterized by a loss of the muscle functions involved in eye and eyelid movement. CPEO can be caused by mutations in mitochondrial DNA. It typically manifests in young adults with bilateral and progressive ptosis as the most common presentation but can also present with difficulty swallowing (dysphagia) and general weakness of the skeletal muscles (myopathy), particularly in the neck, arms, or legs. CASE PRESENTATION: This is a case discussion of 3 cousins who presented to our clinic. A 23-year-old male with past surgical history (PSH) of ptosis repair 2 years ago presented with a chief complaint of nasal intonation for 1.5 years associated with difficulty swallowing. The patient also complained of nasal regurgitation of liquids. He denied any headaches, fever, seizures, weakness of arms or legs, urinary complaints or changes in bowel habits. Physical Examination was positive for facial muscle weakness, including an inability to lift eyebrows (Frontalis), inability to close eyes tightly (Orbicularis Oculi), corneal reflex absent bilaterally, difficulty clenching jaw (Masseter muscle), difficulty smiling (Zygomaticus major), inability to elevate upper lip (Zygomaticus minor). Another cousin of the first patient, a 25-year-old male with no past medical history, presented with complaints of nasal intonation for 2 years associated with difficulty swallowing. He denied a history of nasal regurgitation, headaches, fever, seizures, weakness, urinary complaints or changes in bowel habits. Physical Examination showed facial muscle weakness of the Frontalis muscle, Orbicularis Oculi muscle, Masseter Muscle, Zygomaticus Major, Zygomaticus Minor and absent corneal reflexes. A 28-year-old male, a cousin of the first two patients, presented with chief complaints of ptosis and nasal intonation for the last 8 years. He also complained of difficulty swallowing and nasal regurgitation of liquids. His physical examination showed facial muscle weakness, including frontalis muscle (inability to lift eyebrows), Orbicularis Oculi (inability to close eyes tightly), absent corneal reflexes bilaterally, Zygomaticus Major (difficulty smiling), and Zygomaticus Minor (inability to elevate upper lip). MRI brain and visual field of all the patients were normal. Differential diagnoses, including Grave’s disease, Myasthenia Gravis and Glioma, were ruled out. Due to financial reasons, muscle biopsy could not be pursued. Pedigree analysis revealed only males were affected, likely due to maternal inheritance, so the clinical diagnosis of CPEO was made. The patients underwent symptomatic management, including ptosis surgical correction for the third patient. CONCLUSION: Chronic Progressive External Ophthalmoplegia (CPEO), a rare case entity, occurs in young adults as a manifestation of mitochondrial myopathy. There are three modes of transmission- maternal transmission associated with mitochondrial point mutations, autosomal recessive, and autosomal dominant. CPEO can sometimes be difficult to diagnose, especially in asymmetric presentation. Therefore, it is crucial to keep it in differential diagnosis to avoid delay in diagnosis.

Keywords: neurology, chronic, progressive, ophthalmoplegia

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4 Sustainable Urban Regenaration the New Vocabulary and the Timless Grammar of the Urban Tissue

Authors: Ruth Shapira

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Introduction: The rapid urbanization of the last century confronts planners, regulatory bodies, developers and most of all the public with seemingly unsolved conflicts regarding values, capital, and wellbeing of the built and un-built urban space. There is an out of control change of scale of the urban form and of the rhythm of the urban life which has known no significant progress in the last 2-3 decades despite the on-growing urban population. It is the objective of this paper to analyze some of these fundamental issues through the case study of a relatively small town in the center of Israel (Kiryat-Ono, 36,000 inhabitants), unfold the deep structure of qualities versus disruptors, present some cure that we have developed to bridge over and humbly suggest a practice that may bring about a sustainable new urban environment based on timeless values of the past, an approach that can be generic for similar cases. Basic Methodologies:The object, the town of Kiryat Ono, shall be experimented upon in a series of four action processes: De-composition, Re-composition, the Centering process and, finally, Controlled Structural Disintegration. Each stage will be based on facts, analysis of previous multidisciplinary interventions on various layers – and the inevitable reaction of the OBJECT, leading to the conclusion based on innovative theoretical and practical methods that we have developed and that we believe are proper for the open ended network, setting the rules for the contemporary urban society to cluster by – thus – a new urban vocabulary based on the old structure of times passed. The Study: Kiryat Ono, was founded 70 years ago as an agricultural settlement and rapidly turned into an urban entity. In spite the massive intensification, the original DNA of the old small town was still deeply embedded, mostly in the quality of the public space and in the sense of clustered communities. In the past 20 years, the recent demand for housing has been addressed to on the national level with recent master plans and urban regeneration policies mostly encouraging individual economic initiatives. Unfortunately, due to the obsolete existing planning platform the present urban renewal is characterized by pressure of developers, a dramatic change in building scale and widespread disintegration of the existing urban and social tissue.Our office was commissioned to conceptualize two master plans for the two contradictory processes of Kiryat Ono’s future: intensification and conservation. Following a comprehensive investigation into the deep structures and qualities of the existing town, we developed a new vocabulary of conservation terms thus redefying the sense of PLACE. The main challenge was to create master plans that should offer a regulatory basis to the accelerated and sporadic development providing for the public good and preserving the characteristics of the place consisting of a tool box of design guidelines that will have the ability to reorganize space along the time axis in a sustainable way. In conclusion: The system of rules that we have developed can generate endless possible patterns making sure that at each implementation fragment an event is created, and a better place is revealed. It takes time and perseverance but it seems to be the way to provide a healthy and sustainable framework for the accelerated urbanization of our chaotic present.

Keywords: sustainable urban design, intensification, emergent urban patterns, sustainable housing, compact urban neighborhoods, sustainable regeneration, restoration, complexity, uncertainty, need for change, implications of legislation on local planning

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3 Internet of Assets: A Blockchain-Inspired Academic Program

Authors: Benjamin Arazi

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Blockchain is the technology behind cryptocurrencies like Bitcoin. It revolutionizes the meaning of trust in the sense of offering total reliability without relying on any central entity that controls or supervises the system. The Wall Street Journal states: “Blockchain Marks the Next Step in the Internet’s Evolution”. Blockchain was listed as #1 in Linkedin – The Learning Blog “most in-demand hard skills needed in 2020”. As stated there: “Blockchain’s novel way to store, validate, authorize, and move data across the internet has evolved to securely store and send any digital asset”. GSMA, a leading Telco organization of mobile communications operators, declared that “Blockchain has the potential to be for value what the Internet has been for information”. Motivated by these seminal observations, this paper presents the foundations of a Blockchain-based “Internet of Assets” academic program that joins under one roof leading application areas that are characterized by the transfer of assets over communication lines. Two such areas, which are pillars of our economy, are Fintech – Financial Technology and mobile communications services. The next application in line is Healthcare. These challenges are met based on available extensive professional literature. Blockchain-based assets communication is based on extending the principle of Bitcoin, starting with the basic question: If digital money that travels across the universe can ‘prove its own validity’, can this principle be applied to digital content. A groundbreaking positive answer here led to the concept of “smart contract” and consequently to DLT - Distributed Ledger Technology, where the word ‘distributed’ relates to the non-existence of reliable central entities or trusted third parties. The terms Blockchain and DLT are frequently used interchangeably in various application areas. The World Bank Group compiled comprehensive reports, analyzing the contribution of DLT/Blockchain to Fintech. The European Central Bank and Bank of Japan are engaged in Project Stella, “Balancing confidentiality and auditability in a distributed ledger environment”. 130 DLT/Blockchain focused Fintech startups are now operating in Switzerland. Blockchain impact on mobile communications services is treated in detail by leading organizations. The TM Forum is a global industry association in the telecom industry, with over 850 member companies, mainly mobile operators, that generate US$2 trillion in revenue and serve five billion customers across 180 countries. From their perspective: “Blockchain is considered one of the digital economy’s most disruptive technologies”. Samples of Blockchain contributions to Fintech (taken from a World Bank document): Decentralization and disintermediation; Greater transparency and easier auditability; Automation & programmability; Immutability & verifiability; Gains in speed and efficiency; Cost reductions; Enhanced cyber security resilience. Samples of Blockchain contributions to the Telco industry. Establishing identity verification; Record of transactions for easy cost settlement; Automatic triggering of roaming contract which enables near-instantaneous charging and reduction in roaming fraud; Decentralized roaming agreements; Settling accounts per costs incurred in accordance with agreement tariffs. This clearly demonstrates an academic education structure where fundamental technologies are studied in classes together with these two application areas. Advanced courses, treating specific implementations then follow separately. All are under the roof of “Internet of Assets”.

Keywords: blockchain, education, financial technology, mobile telecommunications services

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2 Social Enterprises over Microfinance Institutions: The Challenges of Governance and Management

Authors: Dean Sinković, Tea Golja, Morena Paulišić

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Upon the end of the vicious war in former Yugoslavia in 1995, international development community widely promoted microfinance as the key development framework to eradicate poverty, create jobs, increase income. Widespread claims were made that microfinance institutions would play vital role in creating a bedrock for sustainable ‘bottom-up’ economic development trajectory, thus, helping newly formed states to find proper way from economic post-war depression. This uplifting neoliberal narrative has no empirical support in the Republic of Croatia. Firstly, the type of enterprises created via microfinance sector are small, unskilled, labor intensive, no technology and with huge debt burden. This results in extremely high failure rates of microenterprises and poor individuals plunging into even deeper poverty, acute indebtedness and social marginalization. Secondly, evidence shows that microcredit is exact reflection of dangerous and destructive sub-prime lending model with ‘boom-to-bust’ scenarios in which benefits are solely extracted by the tiny financial and political elite working around the microfinance sector. We argue that microcredit providers are not proper financial structures through which developing countries should look way out of underdevelopment and poverty. In order to achieve sustainable long-term growth goals, public policy needs to focus on creating, supporting and facilitating the small and mid-size enterprises development. These enterprises should be technically sophisticated, capable of creating new capabilities and innovations, with managerial expertise (skills formation) and inter-connected with other organizations (i.e. clusters, networks, supply chains, etc.). Evidence from South-East Europe suggest that such structures are not created via microfinance model but can be fostered through various forms of social enterprises. Various legal entities may operate as social enterprises: limited liability private company, limited liability public company, cooperative, associations, foundations, institutions, Mutual Insurances and Credit union. Our main hypothesis is that cooperatives are potential agents of social and economic transformation and community development in the region. Financial cooperatives are structures that can foster more efficient allocation of financial resources involving deeper democratic arrangements and more socially just outcomes. In Croatia, pioneers of the first social enterprises were civil society organizations whilst forming a separated legal entity. (i.e. cooperatives, associations, commercial companies working on the principles of returning the investment to the founder). Ever since 1995 cooperatives in Croatia have not grown by pursuing their own internal growth but mostly by relying on external financial support. The greater part of today’s registered cooperatives tend to be agricultural (39%), followed by war veterans cooperatives (38%) and others. There are no financial cooperatives in Croatia. Due to the above mentioned we look at the historical developments and the prevailing social enterprises forms and discuss their advantages and disadvantages as potential agents for social and economic transformation and community development in the region. There is an evident lack of understanding of this business model and of its potential for social and economic development followed by an unfavorable institutional environment. Thus, we discuss the role of governance and management in the formation of social enterprises in Croatia, stressing the challenges for the governance of the country’s social enterprise movement.

Keywords: financial cooperatives, governance and management models, microfinance institutions, social enterprises

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1 Suicidal Attempts as a Reason for Emergency Medical Teams’ Call-Outs Based on Examples of Ambulance Service in Siedlce, Poland

Authors: Dawid Jakimiuk, Krzysztof Mitura, Leszek Szpakowski, Sławomir Pilip, Daniel Celiński

Abstract:

The Emergency Medical Teams (EMS) of the Ambulance Service in Siedlce serve the population living in the Mazowieckie Voivodeship (the area of eastern Poland with approximately 550,000 inhabitants). They provide health services at the pre-hospital stage to all life-threatening patients. The analysis covered the interventions of emergency medical teams in cases of suicide attempts that occurred in the years 2015-2018. The study was retrospective. The data was obtained on the basis of digital medical records of completed call-outs. When defining the disease entity, the International Statistical Classification of Diseases and Health Problems ICD-10 prepared by WHO was used. The relationship between selected disease entities and the area of EMT intervention, the patient's sex and age, and the time of occurrence of the event were investigated. Non-urban area was defined as the area inhabited by a population below 10,000 residents. Statistical analysis was performed using Pearson's Chi ^ 2 test and presenting the percentage of cases in the study group. Of all the suicide attempts, drug abuse cases were the most frequent, including: X60 (Intentional self-poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics); X61 (Intentional self-poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonian and psychotropic drugs, not elsewhere classified); X62 (Intentional self-poisoning by and exposure to narcotics and psycholeptics [hallucinogens], not elsewhere classified); X63 (Intentional self-poisoning by and exposure to other drugs acting on the autonomic nervous system); X64 (Intentional self-poisoning by and exposure to other and unspecified drugs, medicaments and biological substance) oraz X70 (Intentional self-harm by hanging, strangulation and suffocation). In total, they accounted for 69.4% of all interventions to suicide attempts in the studied period. Statistical analysis shows significant differences (χ2 = 39.30239, p <0.0001, n = 561) between the area of EMT intervention and the type of suicide attempt. In non-urban areas, a higher percentage of X70 diagnoses was recorded (55.67%), while in urban areas, X60-X64 (72.53%). In non-urban areas, a higher proportion of patients attempting suicide was observed compared to patients living in urban areas. For X70 and X60 - X64 in total, the incidence rates in non-urban areas were 80.8% and 56%, respectively. Significant differences were found (χ2 = 119.3304, p <0.0001, n = 561) depending on the method of attempting suicide in relation to the patient's sex. The percentage of women diagnosed with X60-X64 versus X70 was 87.50%, which was the largest number of patients (n = 154) as compared to men. In the case of X70 in relation to X60-X64, the percentage of men was 62.08%, which was the largest number of patients (n = 239) as compared to women (n = 22). In the case of X70, the percentage of men compared to women was as high as 92%. Significant differences were observed (χ2 = 14.94848, p <0.01058) between the hour of EMT intervention and the type of suicide attempt. The highest percentage of X70 occurred between 04:01 - 08:00 (64.44%), while X60-X64 between 00:01 - 04:00 (70.45%). The largest number of cases of all tested suicide attempts was recorded between 16:01 - 20:00 for X70 (n = 62), X60 - X64 (n = 82), respectively. The highest percentage of patients undertaking all suicide attempts studied at work was observed in the age range of 18-30 (31.5%), while the lowest was in the age group over 60 years of age. (11%). There was no significant correlation between the day of the week or individual months of the year and the type of suicide attempt - respectively (χ2 = 6.281729, p <0.39238, n = 561) and (χ2 = 3.348913, p <0.9857, n = 561). There were also no significant differences in the incidence of suicide attempts for each year in the study period (χ2 = 3.348913, p <0.9857 n = 561). The obtained results suggest the necessity to undertake preventive measures in order to minimize the number of suicide attempts. Such activities should be directed especially at young patients living in non-urban areas.

Keywords: emergency med, emergency medical team, attempted suicide, pre-hospital

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