Search results for: Clinical Application

Authors: Paul Rowley, Adam Thirkill, Nick Doylend, Philip Leicester, Becky Gough

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The dynamic performance of all energy generation technologies is impacted to varying degrees by the stochastic properties of the wider system within which the generation technology is located. This stochasticity can include the varying nature of ambient renewable energy resources such as wind or solar radiation, or unpredicted changes in energy demand which impact upon the operational behaviour of thermal generation technologies. An understanding of these stochastic impacts are especially important in contexts such as highly distributed (or embedded) generation, where an understanding of issues affecting the individual or aggregated performance of high numbers of relatively small generators is especially important, such as in ESCO projects. Probabilistic evaluation of monitored or simulated performance data is one technique which can provide an insight into the dynamic performance characteristics of generating systems, both in a prognostic sense (such as the prediction of future performance at the project’s design stage) as well as in a diagnostic sense (such as in the real-time analysis of underperforming systems). In this work, we describe the development, application and outcomes of a new approach to the acquisition of datasets suitable for use in the subsequent performance and impact analysis (including the use of Bayesian approaches) for a number of distributed generation technologies. The application of the approach is illustrated using a number of case studies involving domestic and small commercial scale photovoltaic, solar thermal and natural gas boiler installations, and the results as presented show that the methodology offers significant advantages in terms of plant efficiency prediction or diagnosis, along with allied environmental and social impacts such as greenhouse gas emission reduction or fuel affordability.

Keywords: renewable energy, dynamic performance simulation, Bayesian analysis, distributed generation

Procedia PDF Downloads 479

Authors: Abdullah Eqal Al Mazrooei

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In this work, a new nonlinear model will be introduced. The model is in the state-space form. The nonlinearity of this model is in the state equation where the state vector is multiplied by its self. This technique makes our model generalizes many famous models as Lotka-Volterra model and Lorenz model which have many applications in the real life. We will apply our new model to estimate the wind speed by using a new nonlinear estimator which suitable to work with our model.

Keywords: nonlinear systems, state-space model, Kronecker product, nonlinear estimator

Procedia PDF Downloads 674

Authors: James D. Beauchemin

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This study tested whether youth mental health care quality, operationalized as the extent to which youth and families experienced system-of-care principles in service interactions with providers, varied by level of youth need after adjusting for sociodemographic and treatment factors. The relationship of quality to clinical outcomes was also examined. Using administrative data and cross-sectional surveys from a stratified random sample of 1,124 caregivers of youths ages 5 to 20 within a statewide system-of-care, adjusted analyses indicated youths with the most intensive needs were significantly less likely to experience high-quality care (51% vs. 63%, p=0.016), with marked deficits on 6 of 9 items. Receipt of lower-quality care predicted less improvement in youth functioning. Despite considerable effort to develop systems-of-care for youths with the most severe mental health needs, these data suggest quality disparities remain for the most impaired youths. Policy and intervention development may be needed to improve the quality of care for this population.

Keywords: system-of-care, adherence, mental health, youth

Procedia PDF Downloads 142

Authors: Jane Killough

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A podcast series was developed to support learning amongst first-year undergraduate mental health nursing students. Many first-year students do not have any clinical experience and find it difficult to engage with theory, which can present as cumbersome. Further, it can be challenging to relate abstract concepts to everyday mental health practice. Mental health professionals and service users from practice were interviewed on a range of core topics that are key to year one learning. The podcasts were made available, and students could access these recordings at their convenience to fit in with busy daily routines. The aim was to enable meaningful learning by providing access to those who have lived experience and who can, in effect, bring to life the theory being taught in university and essentially bridge the theory and practice gap while fostering working relationships between practice and academics. The student experience will be evaluated using a logic model.

Keywords: education, mental health nursing students, podcast, practice, undergraduate

Procedia PDF Downloads 118

Authors: Teodora Mocan, Lucian Mocan, Cornel Iancu, Flaviu A. Tabaran, Bartos Dana, Matea Cristian

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Antimicrobial resistance, which threatens the efficacy of the existing antibiotics represents a worldwide public health issue. At the current time, vancomycin is the only responsive treatment although has significant cytotoxicity, is partially effective and it is poorly retained by infected tissues. From a clinical point of view, attractive alternative approaches for treating such Meticillin-Resistant Staphylococcus Aureus (MRSA) strains would be using agents that cause physical damage to the bacteria. Modular nanopharmaceuticals systems are being designed to address all of these multifunctional capabilities for the ideal bacterial treatment, with the ability to mix and match appropriate functions. Here we present a novel method of selective laser photothermal ablation of MRSA bacteria mediated by gold nanoparticles bound to PBP antibody against PBP protein located on the MRSA surface.

Keywords: MRSA, laser, nanoparticle, antibody

Procedia PDF Downloads 262

Authors: F. Pal-Fam, R. Hoffmann, S. Keszthelyi

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Granary weevil, Sitophilus granarius (L.) (Col.: Curculionidae) is a typical cosmopolitan pest. It can cause significant damage to stored grains, and can drastically decrease yields. Damaged grain has reduced nutritional and market value, weaker germination, and reduced weight. The commonly used protectants against stored-product pests in Europe are residual insecticides, applied directly to the product. Unfortunately, these pesticides can be toxic to mammals, the residues can accumulate in the treated products, and many pest species could become resistant to the protectants. During recent years, alternative solutions of grain protection have received increased attention. These solutions are considered as the most promising alternatives to residual insecticides. The aims of our comparative study were to obtain information about the efficacies of the 1. diatomaceous earth, 2. sterile insect technology and 3. herbal oils against the S. granarius on grain (foremost maize), and to evaluate the influence of the dose rate on weevil mortality and progeny. The main results of our laboratory experiments are the followings: 1. Diatomaceous earth was especially efficacious against S. granarius, but its insecticidal properties depend on exposure time and applied dose. The efficacy on barley was better than on maize. Mortality value of the highest dose was 85% on the 21st day in the case of barley. It can be ascertained that complete elimination of progeny was evidenced on both gain types. To summarize, a satisfactory efficacy level was obtained only on barley at a rate of 4g/kg. Alteration of efficacy between grain types can be explained with differences in grain surface. 2. The mortality consequences of Roentgen irradiation on the S. granarius was highly influenced by the exposure time, and the dose applied. At doses of 50 and 70Gy, the efficacy accepted in plant protection (mortality: 95%) was recorded only on the 21st day. During the application of 100 and 200Gy doses, high mortality values (83.5% and 97.5%) were observed on the 14th day. Our results confirmed the complete sterilizing effect of the doses of 70Gy and above. The autocide effect of 50 and 70Gy doses were demonstrated when irradiated specimens were mixed into groups of fertile specimens. Consequently, these doses might be successfully applied to put sterile insect technique (SIT) into practice. 3. The results revealed that both studied essential oils (Callendula officinalis, Hippophae rhamnoides) exerted strong toxic effect on S. granarius, but C. officinalis triggered higher mortality. The efficacy (94.62 ± 2.63%) was reached after a 48 hours exposure to H. rhamnoides oil at 2ml/kg while the application of 2ml/kg of C. officinalis oil for 24 hours produced 98.94 ± 1.00% mortality rate. Mortality was 100% at 5 ml/kg of H. rhamnoides after 24 hours duration of its application, while with C. officinalis the same value could be reached after a 12 hour-exposure to the oil. Both essential oils applied were eliminated the progeny.

Keywords: Sitophilus granarius, stored product, protection, alternative solutions

Procedia PDF Downloads 157

Authors: Amna Jalal, Muhammad Dildar Gogi, Muhammad Jalal Arif, Anum Tariq, Waleed Afzal Naveed, Talha Farooq, Mubashir Iqbal, Muhammad Junaid Nisar

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Melon fruit flies (Diptera: Tephritidae: Dacinae) are economically important pests of the cucurbits and are geographically distributed throughout the tropics and subtropics of the world. It causes heavy quantitative and qualitative losses in bitter gourd. The present experiment was carried out to evaluate the performance of different biodegradable waxes based SPLAT-MAT-CL (Specialized Pheromone and Lure Application Technology-Male Anhelation Technique- Cue Lure) formulations in bitter gourd field. Fourteen SPLAT-MAT emulsions/formulations were prepared by admixing different SPLAT matrices with toxicant (spinosad) and sex pheromone cuelure (attractant) in different proportionate percentage by weight. The results revealed that attraction and trapping of fruit flies of B. cucurbitae varied significantly for different SPLAT-MAT-CL formulations (p < 0.05). The maximum B. cucurbitae males were trapped in SPLAT-MAT-CL-7 (60 flies/trap/day) followed by SPLAT-MAT-CL-9 (40 flies/trap/day). The performance of all other formulations of SPLAT-MAT-CL was found in the order of SPLAT-MAT-CL-8 (30 flies/trap/day) > SPLAT-MAT-CL-3 (28 flies/trap/day) > SPLAT-MAT-CL-5 (25 flies/trap/day) > SPLAT-MAT-CL-4 (22 flies/trap/day) > SPLAT-MAT-CL-12 (20 flies/trap/day) SPLAT-MAT-CL-2 (19 flies/trap/day) > SPLAT-MAT-CL-14 (17 flies/trap/day) > SPLAT-MAT-CL-13 (15 flies/trap/day) > SPLAT-MAT-CL-11 (10 flies/trap/day) > SPLAT-MAT-CL-1 (8 flies/trap/day) > SPLAT-MAT-CL-10 (02 flies/trap/day). Overall, all the SPLAT-MAT-CL formulations, except SPLAT-MAT-CL-10, demonstrated higher density of captures of B. cucurbitae males as compared to standard (06 flies/trap/day). The results also demonstrate that SPLAT-MAT-CL-7, SPLAT-MAT-CL-9, SPLAT-MAT-CL-8, SPLAT-MAT-CL-3, SPLAT-MAT-CL-5, SPLAT-MAT-CL-4, SPLAT-MAT-CL-12, SPLAT-MAT-CL-2, SPLAT-MAT-CL-14, SPLAT-MAT-CL-13, SPLAT-MAT-CL-11 and SPLAT-MAT-CL-1 explained approximately 5, 4.6, 4.1, 3.6, 3.3, 3.1,2.8,2.5 and 1.6 times higher captures of B. cucurbitae males over standards. However, SPLAT-MAT-CL-10 demonstrated 3 times fewer captures of B. cucurbitae males over standards. In conclusion, SPLAT-MAT-CL-7, SPLAT-MAT-CL-9 can be exploited for the monitoring and trapping of B. cucurbitae in its IPM of program.

Keywords: attractancy, field conditions, melon fruit fly, SPLAT-MAT-CL

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Authors: Dehni Abdellatif, Lounis Mourad

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The new approach of applied spatial geostatistics in materials sciences, agriculture accuracy, agricultural statistics, permitted an apprehension of managing and monitoring the water and groundwater qualities in a relationship with salt-affected soil. The anterior experiences concerning data acquisition, spatial-preparation studies on optical and multispectral data has facilitated the integration of correction models of electrical conductivity related with soils temperature (horizons of soils). For tomography apprehension, this physical parameter has been extracted from calibration of the thermal band (LANDSAT ETM+6) with a radiometric correction. Our study area is Oran region (Northern West of Algeria). Different spectral indices are determined such as salinity and sodicity index, the Combined Spectral Reflectance Index (CSRI), Normalized Difference Vegetation Index (NDVI), emissivity, Albedo, and Sodium Adsorption Ratio (SAR). The approach of geostatistical modeling of electrical conductivity (salinity), appears to be a useful decision support system for estimating corrected electrical resistivity related to the temperature of surface soils, according to the conversion models by substitution, the reference temperature at 25°C (where hydrochemical data are collected with this constraint). The Brightness temperatures extracted from satellite reflectance (LANDSAT ETM+) are used in consistency models to estimate electrical resistivity. The confusions that arise from the effects of salt stress and water stress removed followed by seasonal application of the geostatistical analysis in Geographic Information System (GIS) techniques investigation and monitoring the variation of the electrical conductivity in the alluvial aquifer of Es-Sénia for the salt-affected soil.

Keywords: geostatistical modelling, landsat, brightness temperature, conductivity

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Authors: Eric Wilson Santos Cabral, Marta Monteiro Da Costa Cruz, Rodrigo Pirola Pestana, Vivian Andréa Parreira

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In the transportation sector in Brazil, there is a great challenge that is the maintenance of profit in the face of the great variation in the price of diesel. This directly affects the variable cost of transport companies. Within the railways, part of the great challenges is to overcome the annual budget, cargo and ore transported, thus reducing costs compared to previous years, becoming more efficient each year. Within this scenario, the railway companies are looking for effective measures, aiming at reducing the ratio of liter of diesel consumed by KTKB (Kilometer Gross Ton multiplied by thousand). This ratio represents the indicator of energy efficiency of some railroads in Brazil and in other countries. In this study, we sought to analyze the behavior of the energy efficiency indicator on two parts: The first, with the application of technologies used in locomotives, such as the start-stop system of the diesel engine and the system of tracking and monitoring of fuel. The second, evaluation of the behavior of the variation of the type of cargo transported (loading mix). The study focused on locomotive technology will be carried out using statistical analysis, behavioral evaluation in different operating conditions, such as maneuvers for trains, service trains and freight trains. The analysis will also cover the evaluation of the loading mix made using statistical analysis of the existing railroad database, comparing the energy efficiency per loading mine and type of product. With the completion of this study, the railway undertakings should be able to better target decision-making in order to achieve substantial reductions in transport costs.

Keywords: railway transport, energy efficiency, railway technology, fuel consumption

Procedia PDF Downloads 291

Authors: Wael El-Deeb

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The present study aimed to investigate the diagnostic importance of acute phase proteins in urinary tract infection (UTI) in cattle. We describe the clinical, bacteriological and biochemical findings in 99 lactating cows. Blood and urine samples from diseased (n=84) and control healthy cows (n=15) were submitted to laboratory investigations. The urine analysis revealed hematuria and pyuria in UTI group. The isolated bacteria were E.coli (43/84) Corynebacterium spp, (31/84), Proteus spp. (6/84) and Streptococcus spp (4/84). The concentrations of Haptoglobin (Hp), serum amyloid A (SAA), α1-Acid glycoprotein (AGP), fibrinogen (Fb), total protein, albumen, and globulin were higher in cows with UTI when compared to healthy ones. Fifty-one of 84 cows with UTI were successfully treated. The levels of Hp, SAA, AGP, total protein, and globulin were associated with the odds of treatment failure. Conclusively, acute phase proteins could be used as diagnostic and prognostic biomarkers in cows with UTI.

Keywords: cows, urinary, infections, haptoglobin, serum Amyloid A

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Authors: Munir Kassa, Mengistu Hailemariam, Meghan Obermeyer, Kefelegn Baruda, Yonas Getachew, Asnakech Dessie

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Improving the quality of sexual and reproductive health services that women receive is expected to have an impact on women’s satisfaction with the services, on their continued use and, ultimately, on their ability to achieve their fertility goals or reproductive intentions. Surprisingly, however, there is little empirical evidence of either whether this expectation is correct, or how best to improve service quality within sexual and reproductive health programs so that these impacts can be achieved. The Recent focus on quality has prompted more physicians to do quality improvement work, but often without the needed skill sets, which results in poorly conceived and ultimately unsuccessful improvement initiatives. As this renders the work unpublishable, it further impedes progress in the field of health care improvement and widens the quality chasm. Moreover, since 2014, the Center for International Reproductive Health Training (CIRHT) has worked diligently with 11 teaching hospitals across Ethiopia to increase access to contraception and abortion care services. This work has included improving pre-service training through education and curriculum development, expanding hands-on training to better learn critical techniques and counseling skills, and fostering a “team science” approach to research by encouraging scientific exploration. This is the first time this systematic approach has been applied and documented to improve access to high-quality services in Ethiopia. The purpose of this article is to report initiatives undertaken, and findings concluded by the clinical service team at CIRHT in an effort to provide a pragmatic approach to quality improvement projects. An audit containing nearly 300 questions about several aspects of patient care, including structure, process, and outcome indicators was completed by each teaching hospital’s quality improvement team. This baseline audit assisted in identifying major gaps and barriers, and each team was responsible for determining specific quality improvement aims and tasks to support change interventions using Shewart’s Cycle for Learning and Improvement (the Plan-Do-Study-Act model). To measure progress over time, quality improvement teams met biweekly and compiled monthly data for review. Also, site visits to each hospital were completed by the clinical service team to ensure monitoring and support. The results indicate that applying an evidence-based, participatory approach to quality improvement has the potential to increase the accessibility and quality of services in a short amount of time. In addition, continued ownership and on-site support are vital in promoting sustainability. This approach could be adapted and applied in similar contexts, particularly in other African countries.

Keywords: abortion, contraception, quality improvement, service provision

Procedia PDF Downloads 196

Authors: Ayesha Sohail, Khadija Maqbool, Anila Asif, Haroon Ahmad

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The field of tissue engineering is an active area of research. Bone tissue engineering helps to resolve the clinical problems of critical size and non-healing defects by the creation of man-made bone tissue. We will design and validate an efficient numerical model, which will simulate the effective diffusivity in bone tissue engineering. Our numerical model will be based on the finite element analysis of the diffusion-reaction equations. It will have the ability to optimize the diffusivity, even at multi-scale, with the variation of time. It will also have a special feature, with which we will not only be able to predict the oxygen, glucose and cell density dynamics, more accurately, but will also sort the issues arising due to anisotropy. We will fix these problems with the help of modifying the governing equations, by selecting appropriate spatio-temporal finite element schemes, by adaptive grid refinement strategy and by transient analysis.

Keywords: scaffolds, porosity, diffusion, transient analysis

Procedia PDF Downloads 523

Authors: Fabio L. Vieira, Micaelle F. C. Lemos, Luciano C. Lemos, Rafaela S. Oliveira, Ian A. Cunha

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Brazil has some challenges ahead related to population oral health, most of them associated with the need of expanding into the local level its promotion and prevention activities, offer equal access to services and promote changes in the lifestyle of the population. The program implemented an oral health initiative in public schools in the city of Salvador, Bahia. The mission was to improve oral health among students on primary and secondary education, from 2 to 15 years old, using the school as a pathway to increase access to healthcare. The main actions consisted of a team's visit to the schools with educational sessions for dental cavity prevention and individual assessment. The program incorporated a clinical surveillance component through a dental evaluation of every student searching for dental disease and caries, standardization of the dentists’ team to reach uniform classification on the assessments, and the use of an online platform to register data directly from the schools. Sequentially, the students with caries were referred for free clinical treatment on the program’s Health Centre. The primary purpose of this study was to analyze the effects and outcomes of this school-based oral health program. The study sample was composed by data of a period of 3 years - 2015 to 2017 - from 13 public schools on the suburb of the city of Salvador with a total number of assessments of 9,278 on this period. From the data collected the prevalence of children with decay on permanent teeth was chosen as the most reliable indicator. The prevalence was calculated for each one of the 13 schools using the number of children with 1 or more dental caries on permanent teeth divided by the total number of students assessed for school each year. Then the percentage change per year was calculated for each school. Some schools presented a higher variation on the total number of assessments in one of the three years, so for these, the percentage change calculation was done using the two years with less variation. The results show that 10 of the 13 schools presented significative improvements for the indicator of caries in permanent teeth. The mean for the number of students with caries percentage reduction on the 13 schools was 26.8%, and the median was 32.2% caries in permanent teeth institution. The highest percentage of improvement reached a decrease of 65.6% on the indicator. Three schools presented a rise in caries prevalence (8.9, 18.9 and 37.2% increase) that, on an initial analysis, seems to be explained with the students’ cohort rotation among other schools, as well as absenteeism on the treatment. In conclusion, the program shows a relevant impact on the reduction of caries in permanent teeth among students and the need for the continuity and expansion of this integrated healthcare approach. It has also been evident the significative of the articulation between health and educational systems representing a fundamental approach to improve healthcare access for children especially in scenarios such as presented in Brazil.

Keywords: primary care, public health, oral health, school-based oral health, data management

Procedia PDF Downloads 119

Authors: M. Shokry Rashwan

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This study follows a number of experiments conducted at Red River College (RRC) to investigate the short term properties of tire derived aggregate (TDA) produced from shredding off-the-road (OTR) wasted tires in a proposed new application. The application targets replacing natural material used under concrete slabs and as backfills for residential homes’ basement slabs and walls, respectively, with TDA. The experimental work included determining: compressibility, gradation distribution, unit weight, hydraulic conductivity and lateral pressure. Based on the results of those short term properties; it was decided to move forward to study the long-term performance of this otherwise waste material through on-site demonstration. A full-scale basement replicating a typical Manitoba home was therefore built at RRC where both TDA and Natural Materials (NM) were used side-by-side. A large number of sensing and measuring systems are used to compare between the performances of each material when exposed to the typical ground and weather conditions. Parameters monitored and measured include heat losses, moisture migration, drainage ability, lateral pressure, relative movements of slabs and walls, an integrity of ground water and radon emissions. Up-to-date results have confirmed part of the conclusions reached from the earlier laboratory experiments. However, other results have shown that construction practices; such as placing and compaction, may need some adjustments to achieve more desirable outcomes. This presentation provides a review of both short-term tests as well as up-to-date analysis of the on-site demonstration.

Keywords: tire derived aggregate (TDA), basement construction, TDA material properties, lateral pressure of TDA, hydraulic conductivity of TDA

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Authors: Varsha Kheradiya, Ganga Prasad Pandey

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The use of wearable antennas is rising because wireless devices become small. The wearable antenna is part of clothes used in communication applications, including energy harvesting, medical application, navigation, and tracking. In current years, Antennas embroidered on clothes, conducting antennas based on fabric, polymer embedded antennas, and inkjet-printed antennas are all attractive ways. Also shows the analysis required for wearable antennas, such as wearable antennae interacting with the human body. The primary requirements for the antenna are small size, low profile minimizing radiation absorption by the human body, high efficiency, structural integrity to survive worst situations, and good gain. Therefore, research in energy harvesting, biomedicine, and military application design is increasingly favoring flexible wearable antennas. Textile materials that are effectively used for designing and developing wearable antennas for body area networks. The wireless body area network is primarily concerned with creating effective antenna systems. The antenna should reduce their size, be lightweight, and be adaptable when integrated into clothes. When antennas integrate into clothes, it provides a convenient alternative to those fabricated using rigid substrates. This paper presents a study of U slot loaded wearable textile antenna. U slot patch antenna design is illustrated for wideband from 1GHz to 6 GHz using textile material jeans as substrate and pure copper polyester taffeta fabric as conducting material. This antenna design exhibits dual band results for WLAN at 2.4 GHz and 3.6 GHz frequencies. Also, study U slot position horizontal and vertical shifting. Shifting the horizontal positive X-axis position of the U slot produces the third band at 5.8 GHz.

Keywords: microstrip patch antenna, textile material, U slot wearable antenna, wireless body area network

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Authors: Haya Salah, Srinivas Sharan

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Healthcare facilities use appointment systems to schedule their appointments and to manage access to their medical services. With the growing demand for outpatient care, it is now imperative to manage physician's time effectively. However, high variation in consultation duration affects the clinical scheduler's ability to estimate the appointment duration and allocate provider time appropriately. Underestimating consultation times can lead to physician's burnout, misdiagnosis, and patient dissatisfaction. On the other hand, appointment durations that are longer than required lead to doctor idle time and fewer patient visits. Therefore, a good estimation of consultation duration has the potential to improve timely access to care, resource utilization, quality of care, and patient satisfaction. Although the literature on factors influencing consultation length abound, little work has done to predict it using based data-driven approaches. Therefore, this study aims to predict consultation duration using supervised machine learning algorithms (ML), which predicts an outcome variable (e.g., consultation) based on potential features that influence the outcome. In particular, ML algorithms learn from a historical dataset without explicitly being programmed and uncover the relationship between the features and outcome variable. A subset of the data used in this study has been obtained from the electronic medical records (EMR) of four different outpatient clinics located in central Pennsylvania, USA. Also, publicly available information on doctor's characteristics such as gender and experience has been extracted from online sources. This research develops three popular ML algorithms (deep learning, random forest, gradient boosting machine) to predict the treatment time required for a patient and conducts a comparative analysis of these algorithms with respect to predictive performance. The findings of this study indicate that ML algorithms have the potential to predict the provider service time with superior accuracy. While the current approach of experience-based appointment duration estimation adopted by the clinic resulted in a mean absolute percentage error of 25.8%, the Deep learning algorithm developed in this study yielded the best performance with a MAPE of 12.24%, followed by gradient boosting machine (13.26%) and random forests (14.71%). Besides, this research also identified the critical variables affecting consultation duration to be patient type (new vs. established), doctor's experience, zip code, appointment day, and doctor's specialty. Moreover, several practical insights are obtained based on the comparative analysis of the ML algorithms. The machine learning approach presented in this study can serve as a decision support tool and could be integrated into the appointment system for effectively managing patient scheduling.

Keywords: clinical decision support system, machine learning algorithms, patient scheduling, prediction models, provider service time

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Authors: Irene Capecchi, Tommaso Borghini, Iacopo Bernetti

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One of the most common pieces of equipment still used today for pruning, felling, and processing trees is the chainsaw in forestry. However, chainsaw use highlights dangers and one of the highest rates of accidents in both professional and non-professional work. Felling is proportionally the most dangerous phase, both in severity and frequency, because of the risk of being hit by the plant the operator wants to cut down. To avoid this, a correct sequence of chainsaw cuts must be taught concerning the different conditions of the tree. Virtual reality (VR) makes it possible to virtually simulate chainsaw use without danger of injury. The limitations of the existing applications are as follow. The existing platforms are not symmetrical collaborative because the trainee is only in virtual reality, and the trainer can only see the virtual environment on a laptop or PC, and this results in an inefficient teacher-learner relationship. Therefore, most applications only involve the use of a virtual chainsaw, and the trainee thus cannot feel the real weight and inertia of a real chainsaw. Finally, existing applications simulate only a few cases of tree felling. The objectives of this research were to implement and test a symmetrical collaborative training application based on VR and mixed reality (MR) with the overlap between real and virtual chainsaws in MR. The research and training platform was developed for the Meta quest 2 head-mounted display. The research and training platform application is based on the Unity 3D engine, and Present Platform Interaction SDK (PPI-SDK) developed by Meta. PPI-SDK avoids the use of controllers and enables hand tracking and MR. With the combination of these two technologies, it was possible to overlay a virtual chainsaw with a real chainsaw in MR and synchronize their movements in VR. This ensures that the user feels the weight of the actual chainsaw, tightens the muscles, and performs the appropriate movements during the test allowing the user to learn the correct body posture. The chainsaw works only if the right sequence of cuts is made to felling the tree. Contact detection is done by Unity's physics system, which allows the interaction of objects that simulate real-world behavior. Each cut of the chainsaw is defined by a so-called collider, and the felling of the tree can only occur if the colliders are activated in the right order simulating a safe technique felling. In this way, the user can learn how to use the chainsaw safely. The system is also multiplayer, so the student and the instructor can experience VR together in a symmetrical and collaborative way. The platform simulates the following tree-felling situations with safe techniques: cutting the tree tilted forward, cutting the medium-sized tree tilted backward, cutting the large tree tilted backward, sectioning the trunk on the ground, and cutting branches. The application is being evaluated on a sample of university students through a special questionnaire. The results are expected to test both the increase in learning compared to a theoretical lecture and the immersive and telepresence of the platform.

Keywords: chainsaw, collaborative symmetric virtual reality, mixed reality, operator training

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Authors: Shreya Saxena

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Background: Choledocholithiasis is a common complication of gallstone disease. Risk scoring systems exist to guide the need for further imaging or endoscopy in managing choledocholithiasis. We completed an audit to review the American Society for Gastrointestinal Endoscopy (ASGE) scoring system for prediction and management of choledocholithiasis against the current practice at a tertiary hospital to assess its utility in resource optimisation. We have now conducted a cost focused sub-analysis on patients categorized high-risk for choledocholithiasis according to the guidelines to determine any associated cost benefits. Method: Data collection from our prior audit was used to retrospectively identify thirteen patients considered high-risk for choledocholithiasis. Their ongoing management was mapped against the guidelines. Individual costs for the key investigations were obtained from our hospital financial data. Total cost for the different management pathways identified in clinical practice were calculated and compared against predicted costs associated with recommendations in the guidelines. We excluded the cost of laparoscopic cholecystectomy and considered a set figure for per day hospital admission related expenses. Results: Based on our previous audit data, we identified a77% positive predictive value for the ASGE risk stratification tool to determine patients at high-risk of choledocholithiasis. 47% (6/13) had an magnetic resonance cholangiopancreatography (MRCP) prior to endoscopic retrograde cholangiopancreatography (ERCP), whilst 53% (7/13) went straight for ERCP. The average length of stay in the hospital was 7 days, with an additional day and cost of £328.00 (£117 for ERCP) for patients awaiting an MRCP prior to ERCP. Per day hospital admission was valued at £838.69. When calculating total cost, we assumed all patients had admission bloods and ultrasound done as the gold standard. In doing an MRCP prior to ERCP, there was a 130% increase in cost incurred (£580.04 vs £252.04) per patient. When also considering hospital admission and the average length of stay, it was an additional £1166.69 per patient. We then calculated the exact costs incurred by the department, over a three-month period, for all patients, for key investigations or procedures done in the management of choledocholithiasis. This was compared to an estimate cost derived from the recommended pathways in the ASGE guidelines. Overall, 81% (£2048.45) saving was associated with following the guidelines compared to clinical practice. Conclusion: MRCP is the most expensive test associated with the diagnosis and management of choledocholithiasis. The ASGE guidelines recommend endoscopy without an MRCP in patients stratified as high-risk for choledocholithiasis. Our audit that focused on assessing the utility of the ASGE risk scoring system showed it to be relatively reliable for identifying high-risk patients. Our cost analysis has shown significant cost savings per patient and when considering the average length of stay associated with direct endoscopy rather than an additional MRCP. Part of this is also because of an increased average length of stay associated with waiting for an MRCP. The above data supports the ASGE guidelines for the management of high-risk for choledocholithiasis patients from a cost perspective. The only caveat is our small data set that may impact the validity of our average length of hospital stay figures and hence total cost calculations.

Keywords: cost-analysis, choledocholithiasis, risk stratification tool, general surgery

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Authors: Natcha Lueangapapong, Chariya Chuthapisith, Lunliya Thampratankul

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Background: There is a need to find an appropriate tool to help healthcare providers determine sleep problems in children for early diagnosis and management. The Japanese Sleep Questionnaire for Preschoolers (JSQ-P) is a parent-reported sleep questionnaire that has good psychometric properties and can be used in the context of Asian culture, which is likely suitable for Thai children. Objectives: This study aimed to translate and validate the Japanese Sleep Questionnaire for Preschoolers (JSQ-P) into a Thai version and to evaluate factors associated with sleep disorders in preschoolers. Methods: After approval by the original developer, the cross-cultural adaptation process of JSQ-P was performed, including forward translation, reconciliation, backward translation, and final approval of the Thai version of JSQ-P (TH-JSQ-P) by the original creator. This study was conducted between March 2021 and February 2022. The TH-JSQ-P was completed by 2,613 guardians whose children were aged 2-6 years twice in 10-14 days to assess its reliability and validity. Content validity was measured by an index of item-objective congruence (IOC) and a content validity index (CVI). Face validity, content validity, structural validity, construct validity (discriminant validity), criterion validity and predictive validity were assessed. The sensitivity and specificity of the TH-JSQ-P were also measured by using a total JSQ-P score cutoff point 84, recommended by the original JSQ-P and each subscale score among the clinical samples of obstructive sleep apnea syndrome. Results: Internal consistency reliability, evaluated by Cronbach’s α coefficient, showed acceptable reliability in all subscales of JSQ-P. It also had good test-retest reliability, as the intraclass correlation coefficient (ICC) for all items ranged between 0.42-0.84. The content validity was acceptable. For structural validity, our results indicated that the final factor solution for the Th-JSQ-P was comparable to the original JSQ-P. For construct validity, age group was one of the clinical parameters associated with some sleep problems. In detail, parasomnias, insomnia, daytime excessive sleepiness and sleep habits significantly decreased when the children got older; on the other hand, insufficient sleep was significantly increased with age. For criterion validity, all subscales showed a correlation with the Epworth Sleepiness Scale (r = -0.049-0.349). In predictive validity, the Epworth Sleepiness Scale was significantly a strong factor that correlated to sleep problems in all subscales of JSQ-P except in the subscale of sleep habit. The sensitivity and specificity of the total JSQ-P score were 0.72 and 0.66, respectively. Conclusion: The Thai version of JSQ-P has good internal consistency reliability and test-retest reliability. It passed 6 validity tests, and this can be used to evaluate sleep problems in preschool children in Thailand. Furthermore, it has satisfactory general psychometric properties and good reliability and validity. The data collected in examining the sensitivity of the Thai version revealed that the JSQ-P could detect differences in sleep problems among children with obstructive sleep apnea syndrome. This confirmed that the measure is sensitive and can be used to discriminate sleep problems among different children.

Keywords: preschooler, questionnaire, validation, Thai version

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Authors: Slavica P. Petrovic

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One of the key dimensions of management problems in organizations refers to the relations between stakeholders. The management problems that are characterized by conflict and coercion, in which participants do not agree on the ends and means, in which different groups, i.e., individuals, strive to – using the power they have – impose on others their favoured strategy and decisions represent the relevant research subject. Creatively managing the coercive problems in organizations, in which the sources of power can be identified, implies the emancipatory paradigm and the use of corresponding systems methodology. The main research aim is to critically reassess the theoretical foundations and methodological and methodical development of Critical Systems Heuristics (CSH) – as a valid representative of the emancipatory paradigm – in order to determine the conditions, ways, and achievements of its application in managing the coercive problems in organizations. The basic hypothesis is that CSH, as the emancipatory methodology, given its own theoretical foundations and methodological-methodical development, can be employed in a scientifically based and practically useful manner in creative addressing the coercive problems. The scientific instrumentarium corresponding to this research aim is critical systems thinking with its three key commitments to: a) Critical awareness of the strengths and weaknesses of each research instrument (theory, methodology, method, technique, model) for structuring the problem situations in organizations, b) Improvement of managing the coercive problems in organizations, and c) Pluralism – respect the different perceptions and interpretations of problem situations, and enable the combined use of research instruments. The relevant research result is that CSH – considering its theoretical foundations, methodological and methodical development – enables to reveal the normative content of the proposed or existing designs of organizational systems. Accordingly, it can be concluded that through the use of critically heuristic categories and dialectical debate between those involved and those affected by the designs, but who are not included in designing organizational systems, CSH endeavours to – in the application – support the process of improving position of all stakeholders.

Keywords: coercion and conflict in organizations, creative management, critical systems heuristics, the emancipatory systems methodology

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Authors: Mehdi Boukri, Mohammed Naboussi Farsi, Mounir Naili, Omar Amellal, Mohamed Belazougui, Ahmed Mebarki, Nabila Guessoum, Brahim Mezazigh, Mounir Ait-Belkacem, Nacim Yousfi, Mohamed Bouaoud, Ikram Boukal, Aboubakr Fettar, Asma Souki

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The seismic risk to which the urban centres are more and more exposed became a world concern. A co-operation on an international scale is necessary for an exchange of information and experiments for the prevention and the installation of action plans in the countries prone to this phenomenon. For that, the 1990s was designated as 'International Decade for Natural Disaster Reduction (IDNDR)' by the United Nations, whose interest was to promote the capacity to resist the various natural, industrial and environmental disasters. Within this framework, it was launched in 1996, the RADIUS project (Risk Assessment Tools for Diagnosis of Urban Areas Against Seismic Disaster), whose the main objective is to mitigate seismic risk in developing countries, through the development of a simple and fast methodological and operational approach, allowing to evaluate the vulnerability as well as the socio-economic losses, by probable earthquake scenarios in the exposed urban areas. In this paper, we will present the adaptation and application of this methodology to the Algerian context for the seismic risk evaluation in urban areas potentially exposed to earthquakes. This application consists to perform an earthquake scenario in the urban centre of Constantine city, located at the North-East of Algeria, which will allow the building seismic damage estimation of this city. For that, an inventory of 30706 building units was carried out by the National Earthquake Engineering Research Centre (CGS). These buildings were digitized in a data base which comprises their technical information by using a Geographical Information system (GIS), and then they were classified according to the RADIUS methodology. The study area was subdivided into 228 meshes of 500m on side and Ten (10) sectors of which each one contains a group of meshes. The results of this earthquake scenario highlights that the ratio of likely damage is about 23%. This severe damage results from the high concentration of old buildings and unfavourable soil conditions. This simulation of the probable seismic damage of the building and the GIS damage maps generated provide a predictive evaluation of the damage which can occur by a potential earthquake near to Constantine city. These theoretical forecasts are important for decision makers in order to take the adequate preventive measures and to develop suitable strategies, prevention and emergency management plans to reduce these losses. They can also help to take the adequate emergency measures in the most impacted areas in the early hours and days after an earthquake occurrence.

Keywords: seismic risk, mitigation, RADIUS, urban areas, Algeria, earthquake scenario, Constantine

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Authors: Mark Andrew

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Geopolitical tensions are at a thirty-year high, and the pace of technological innovation is driving asymmetry in force capabilities between nation states and between non-state actors. Technology futures are a vital component of defence capability growth, and investments in technology futures need to be informed by accurate and reliable forecasts of the options for ‘systems of systems’ innovation, development, and deployment. This paper describes a method for forecasting technology futures developed through an analysis of four key systems’ development stages, namely: technology domain categorisation, scanning results examining novel systems’ signals and signs, potential system-of systems’ implications in warfare theatres, and political ramifications in terms of funding and development priorities. The method has been applied to several technology domains, including physical systems (e.g., nano weapons, loitering munitions, inflight charging, and hypersonic missiles), biological systems (e.g., molecular virus weaponry, genetic engineering, brain-computer interfaces, and trans-human augmentation), and information systems (e.g., sensor technologies supporting situation awareness, cyber-driven social attacks, and goal-specification challenges to proliferation and alliance testing). Although the current application of the method has been team-centred using paper-based rapid prototyping and iteration, the application of autonomous language models (such as GPT-3) is anticipated as a next-stage operating platform. The importance of forecasting accuracy and reliability is considered a vital element in guiding technology development to afford stronger contingencies as ideological changes are forecast to expand threats to ecology and earth systems, possibly eclipsing the traditional vulnerabilities of nation states. The early results from the method will be subjected to ground truthing using longitudinal investigation.

Keywords: forecasting, technology futures, uncertainty, complexity

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Authors: Antonello Durante, James Duff, Kevin Kelly

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The visual needs of people in modern work based buildings are changing. Self-illuminated screens of computers, televisions, tablets and smart phones have changed the relationship between people and the lit environment. In the past, lighting design practice was primarily based on providing uniform horizontal illuminance on the working plane, but this has failed to ensure good quality lit environments. Lighting standards of today continue to be set based upon a 100 year old approach that at its core, considers the task illuminance of the utmost importance, with this task typically being located on a horizontal plane. An alternative method focused on appearance has been proposed, as opposed to the traditional performance based approach. Mean Room Surface Exitance (MRSE) and Target-Ambient Illuminance Ratio (TAIR) are two new metrics proposed to assess illumination adequacy in interiors. The hypothesis is that these factors will be superior to the existing metrics used, which are horizontal illuminance led. For the six past years, research has examined this, within the Dublin Institute of Technology, with a view to determining the suitability of this approach for application to general lighting practice. Since the start of this research, a number of key findings have been produced that centered on how occupants will react to various levels of MRSE. This paper provides a broad update on how this research has progressed. More specifically, this paper will: i) Demonstrate how MRSE can be measured using HDR images technology, ii) Illustrate how MRSE can be calculated using scripting and an open source lighting computation engine, iii) Describe experimental results that demonstrate how occupants have reacted to various levels of MRSE within experimental office environments.

Keywords: illumination hierarchy (IH), mean room surface exitance (MRSE), perceived adequacy of illumination (PAI), target-ambient illumination ratio (TAIR)

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Authors: Jacob Seddlemeyer, Tahar Messadi, Hongmei Gu, Mahboobeh Hemmati

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The main purpose of this first tier of the study is to quantify and compare the embodied environmental impacts associated with alternative materials applied to Adohi Hall, a residence building at the University of Arkansas campus, Fayetteville, AR. This 200,000square foot building has5 stories builtwith mass timber and is compared to another scenario where the same edifice is built with a steel frame. Based on the defined goal and scope of the project, the materials respectivetothe respective to the two building options are compared in terms of Global Warming Potential (GWP), starting from cradle to the construction site, which includes the material manufacturing stage (raw material extract, process, supply, transport, and manufacture) plus transportation to the site (module A1-A4, based on standard EN 15804 definition). The consumedfossil fuels and emitted CO2 associated with the buildings are the major reason for the environmental impacts of climate change. In this study, GWP is primarily assessed to the exclusion of other environmental factors. The second tier of this work is to evaluate Tally’s performance in the decision-making process through the design phases, as well as determine its strengths and weaknesses. Tally is a Life Cycle Assessment (LCA) tool capable of conducting a cradle-to-grave analysis. As opposed to other software applications, Tally is specifically targeted at buildings LCA. As a peripheral application, this software tool is directly run within the core modeling application platform called Revit. This unique functionality causes Tally to stand out from other similar tools in the building sector LCA analysis. The results of this study also provide insights for making more environmentally efficient decisions in the building environment and help in the move forward to reduce Green House Gases (GHGs) emissions and GWP mitigation.

Keywords: comparison, GWP, LCA, materials, tally

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Authors: Zayneb Kthiri, Walid Hamada

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The application of organic fertilizers is generally known to be useful to sustain soil fertility and plant growth, especially in poor soils, with less than 1% of organic matter, as it is very common in our Tunisian fields. Therefore, we focused on evaluating the effect of a new released liquid organic fertilizer named Solorga (with 5% of organic matter) compared to a reference product (Espartan: Kimitec, Spain) on tomato plant growth and physiology. Both fertilizers, derived from plant decomposition, were applied at an early stage in hydroponic system and under greenhouse. In hydroponic system, after 14 days of their application by root feeding, a significant difference was observed between treatments. Indeed, Solorga improved shoots and roots length, as well as the biomass respectively, by 45%, 27%, and 27.8% increase rate, while compared to control plants. However, Espartan induced less the measured parameters while compared to untreated control. Moreover, Solorga significantly increased the chlorophyll content by 42% compared to control and by 32% compared to Espartan. In the greenhouse, after 20 days of treatments, the results showed a significant effect of both fertilizers on SPAD index and the number of flowers blossom. Solorga increased the amount of chlorophyll present in the leaf by 7% compared to Espartan as well as the plant height under greenhouse. Moreover, the number of flowers blossom increased by 15% in plants treated with Solorga while compared to Espartan. Whereas, there is no notable difference between both organic fertilizers on the fruits blossom and the number of fruits per blossom. In conclusion, even though there is a difference in the organic matter between both fertilizers, Solorga improved better the plant growth in controlled conditions in hydroponic system while compared to Espartan. Altogether the obtained results are encouraging for the use of Solorga as a soil enriching source of organic matter to help plants to boost their growth and help them to overcome abiotic stresses linked to soil fertility.

Keywords: tomato, plant growth, organic fertilizer, hydroponic system, greenhouse

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Authors: Elinor Bull, Faye Horsley

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Abstract Objective: The current study investigated if there was a difference in personality factors in prisoners who had a recorded history of firesetting and who had no recorded history of firesetting. Participants: Participants were 64 male prisoners in a Category B male prison. Participants who had set a fire were identified through the prisons data base, and prisoners who had not set a fire were selected at random. Method: The study used the International Personality Item Pool-50 to measure personality factors, and prisoners who had set a fire were identified through a range of sources accessible to the prison. Analytical evaluation was done by the Multivariate Kruskal Wallis and Mann-Whitney tests. Findings: There was a significant difference between the the firesetting and non-firesetting group in the scores of the personality factor of Contentiousness. Contentiousness was significantly lower in the firesetting sample compared to the non-firesetting sample. Conclusions: Implications for clinical practice and future research are discussed.

Keywords: firesetting, personality, arson, prison, prisoners

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Authors: O. E. Eberechi, G. P. Stevens

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Legal theory has been referred to as the explanation of why things do or do not happen. It also describes situations and why they ensue. It provides a normative framework by which things are regulated and a foundation for the establishment of legal mechanisms/institutions that can bring about a desired change in a society. Furthermore, it offers recommendations in resolving practical problems and describes what the law is, what the law ought to be and defines the legal landscape generally. Some legal theories provide a universal standard, e.g. human rights, while others are capable of organizing and streamlining the collective use, and, by extension, bring order to society. Legal theory is used to explain how the world works and how it does not work. This paper will argue for the application of the principles of legal theory in the achievement of access to justice for female victims of sexual violence in refugee camps in Africa through the analysis of legal theories underpinning the access to justice for these women. It is a known fact that female refugees in camps in Africa often experience some form of sexual violation. The perpetrators of these incidents may never be apprehended, prosecuted, convicted or sentenced. Where prosecution does occur, the perpetrators are either acquitted as a result of poor investigation, inept prosecution, a lack of evidence, or the case may be dismissed owing to tardiness on the part of the prosecutor, which accounts for the culture of impunity in refugee camps. In other words, victims do not have access to the justice that could ameliorate the plight of the victims. There is, thus, a need for a legal framework that will facilitate access to justice for these victims. This paper will start with an introduction, and be followed by the definition of legal theory, its functions and its application in law. Secondly, it will provide a brief explanation of the problems faced by female refugees who are victims of sexual violence in refugee camps in Africa. Thirdly, it will embark on an analysis of theories which will be a help to an understanding of the precarious situation of female refugees, why they are violated, the need for access to justice for these victims, and the principles of legal theory in its usefulness in resolving access to justice for these victims.

Keywords: access to justice, underpinning legal theory, refugee, sexual violence

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Authors: W. Stawiński, A. Wegrzyn, O. M. Freitas, S. A. Figueiredo

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Water is a life supporting resource, crucial for humanity and essential for natural ecosystems, which have been endangered by developing industry and increasing human population. Dyes are common in effluents discharged by various industries such as paper, plastics, food, cosmetics, and textile. They produce toxic effects on animals and disturb natural biological processes in receiving waters. Having complex molecular structure and resistance to biological decomposition they are problematic and difficult to be treated by conventional methods. In the search of efficient and sustainable method, sorption has been getting more interest in application to wastewaters treatment. Clays are minerals that have a layer structure based on phyllosilicate sheets that may carry a charge, which is balanced by ions located between the sheets. These charge-balancing ions can be exchanged resulting in very good ion-exchange properties of the material. Modifications of clays enhance their properties, producing a good and inexpensive sorbent for the removal of pollutants from wastewaters. The presented work proves that the treatment of a clay, vermiculite, with nitric acid followed by washing in citric acid strongly increases the sorption of two cationic dyes, methylene blue (C.I. 52015) and astrazon red (C.I. 110825). Desorption studies showed that the best eluent for regeneration is a solution of NaCl in ethanol. Cycles of sorption and desorption in column system showed no significant deterioration of sorption capacity and proved that the material shows a very good performance as sorbent, which can be recycled and reused. The results obtained open new possibilities of further modifications on vermiculite and modifications of other materials in order to get very efficient sorbents useful for wastewater treatment.

Keywords: cationic dyestuffs, sorption and regeneration, vermiculite, wastewater treatment

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Authors: Hamideh Hamedi, Nima Rezaei, Sohrab Zendehboudi

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Separating emulsified oil contaminations from waste- or produced water is of interest to various industries. Magnetic particles (MPs) application for separating dispersed and emulsified oil from wastewater is becoming more popular. Stabilization of MPs is required through developing a coating layer on their surfaces to prevent their agglomeration and enhance their dispersibility. In this research, we study the effects of coating material, size, and concentration of iron oxide MPs on oil separation efficiency, using oil adsorption capacity measurements. We functionalize both micro-and nanoparticles of Fe3O4 using sodium dodecyl sulfate (SDS) as an anionic surfactant, cetyltrimethylammonium bromide (CTAB) as a cationic surfactant, and stearic acid (SA). The chemical structures and morphologies of these particles are characterized using Scanning Electron Microscopy (SEM), Transmission Electron Microscopy (TEM), and Energy Dispersive X-ray (EDX). The oil-water separation results indicate that a low dosage of the coated magnetic nanoparticle with CTAB (0.5 g/L MNP-CTAB) results the highest oil adsorption capacity (nearly 100%) for 1000 ppm dodecane-in-water emulsion, containing ultra-small droplets (250–300 nm). While separation efficiency of the same dosage of bare MNPs is around 57.5%. Demulsification results of magnetic microparticles (MMPs) also reveal that the functionalizing particles with CTAB increase oil removal efficiency from 86.3% for bare MMP to 92% for MMP-CTAB. Comparing the results of different coating materials implies that the major interaction reaction is an electrostatic attraction between negatively charged oil droplets and positively charged MNP-CTAB and MMP-CTAB. Furthermore, the synthesized nanoparticles could be recycled and reused; after ten cycles the oil adsorption capacity slightly decreases to near 95%. In conclusion, functionalized magnetic particles with high oil separation efficiency could be used effectively in treatment of oily wastewater. Finally, optimization of the adsorption process is required by considering the effective system variables, and fluid properties.

Keywords: oily wastewater treatment, emulsions, oil-water separation, adsorption, magnetic nanoparticles

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Authors: Paul Moses Ndegwa, Teresia Kabucho, Lucy Wanjiru, Esther Wanjiru, Brian Githaiga, Jecinta Wambui

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Health outcome has improved in the country since 2013 following the adoption of the new constitution in Kenya with devolved governance with administration and health planning functions transferred to county governments. 2018-2022 development agenda prioritized universal healthcare coverage, food security, and nutrition, however, the emergence of Covid-19 and the increase of non-communicable diseases pose a challenge and constrain in an already overwhelmed health system. A study was conducted July-November 2021 to establish key challenges in achieving universal healthcare coverage within the county and best practices for improved non-communicable disease control. 14 health workers ranging from nurses, doctors, public health officers, clinical officers, and pharmaceutical technologists were purposely engaged to provide critical information through questionnaires by a trained duo observing ethical procedures on confidentiality. Data analysis. Communicable diseases are major causes of morbidity and mortality. Non-communicable diseases contribute to approximately 39% of deaths. More than 45% of the population does not have access to safe drinking water. Study noted geographic inequality with respect to distribution and use of health resources including competing non-health priorities. 56% of health workers are nurses, 13% clinical officers, 7% doctors, 9%public health workers, 2% are pharmaceutical technologists. Poor-quality data limits the validity of disease-burdened estimates and research activities. Risk factors include unsafe water, sanitation, hand washing, unsafe sex, and malnutrition. Key challenge in achieving universal healthcare coverage is the rise in the relative contribution of non-communicable diseases. Improve targeted disease control with effective and equitable resource allocation. Develop high infectious disease control mechanisms. Improvement of quality data for decision making. Strengthen electronic data-capture systems. Increase investments in the health workforce to improve health service provision and achievement of universal health coverage. Create a favorable environment to retain health workers. Fill in staffing gaps resulting in shortages of doctors (7%). Develop a multi-sectional approach to health workforce planning and management. Need to invest in mechanisms that generate contextual evidence on current and future health workforce needs. Ensure retention of qualified, skilled, and motivated health workforce. Deliver integrated people-centered health services.

Keywords: multi-sectional approach, equity, people-centered, health workforce retention

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