Search results for: central Italy

Authors: Lam Hong Lan, Gabor Sarlos

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It is hard to search for best practices in promotion for local fashion brands in Vietnam as the industry is still very young. Local fashion start-ups have grown quickly in the last five years, thanks in part to the internet and social media. However, local designer/owners can face a huge challenge when competing with international brands in the Vietnamese market – and few local case studies are available for guidance. In response, this paper studied how local small- to medium-sized enterprises (SMEs) promote to their target customers in order to compete with international brands. Knowledge of both successful and unsuccessful approaches generated by this study is intended to both contribute to the academic literature on local fashion in Vietnam as well as to help local designers to learn from and improve their brand-building strategy. The primary study featured qualitative data collection via semi-structured depth interviews. Transcription and data analysis were conducted manually in order to identify success factors that local brands should consider as part of their promotion strategy. Purposive sampling of SMEs identified five designers in Ho Chi Minh City (the biggest city in Vietnam) and three designers in Hanoi (the second biggest) as interviewees. Participant attributes included: born in the 1980s or 1990s; familiar with internet and social media; designer/owner of a successful local fashion brand in the key middle market and/or mass market segments (which are crucial to the growth of local brands). A secondary study was conducted using social listening software to gather further qualitative data on what were considered to be successful or unsuccessful approaches to local fashion brand promotion on social media. Both the primary and secondary studies indicated that local designers had maximized their promotion budget by using owned media and earned media instead of paid media. Findings from the qualitative interviews indicate that internet and social media have been used as effective promotion platforms by local fashion start-ups. Facebook and Instagram were the most popular social networks used by the SMEs interviewed, and these social platforms were believed to offer a more affordable promotional strategy than traditional media such as TV and/or print advertising. Online stores were considered an important factor in helping the SMEs to reach customers beyond the physical store. Furthermore, a successful online store allowed some SMEs to reduce their business rental costs by maintaining their physical store in a cheaper, less central city area as opposed to a more traditional city center store location. In addition, the small comparative size of the SMEs allowed them to be more attentive to their customers, leading to higher customer satisfaction and rate of return. In conclusion, this study found that these kinds of cost savings helped the SMEs interviewed to focus their scarce resources on producing unique, high-quality collections in order to differentiate themselves from international brands. Facebook and Instagram were the main platforms used for promotion and brand-building. The main challenge to this promotion strategy identified by the SMEs interviewed was to continue to find innovative ways to maximize the impact of a limited marketing budget.

Keywords: Vietnam, SMEs, fashion brands, promotion, marketing, social listening

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Authors: Stanimira Ntermentzieva

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Gender studies in post-communist Eastern Europe emerged in the early 1990s after the collapse of the communist regime. It can be explained by a series of cultural and political factors. However, Bulgarian female composers’ contribution to Western art music has not been studied. This field shows us some aspects of the impact of globalization on gender issues. This paper outlines the female composers in the establishment of the modern Bulgarian state and society. It is dedicated to the Bulgarian award-winning female composers who studied in Western European and American universities in the 1990s. Many of them migrated to these regions as part of a great migration in which Bulgaria lost 2.3 to three million of its population and strived to modernize Bulgarian music. Nowadays, the Union of Bulgarian Composers has 262 members, but only 19 of them are women. The Grammy-awarded Penka Kouneva (b. 1967) is one of the few female composers in Hollywood. She composed and orchestrated film scores, music for video games and television. Anna-Maria Ravnopolska-Dean (b. 1960) is a Bulgarian/American harpist, arranger, composer, pedagogue and TV host. She wrote pieces for harp and chamber ensembles. Maria Panayotova (b. 1976) studied composition in the USA. Alexandra Fol (b. 1981) and Vania Angelova (b. 1954) work in Canada and are recipients of grants from the Canada Council for the Arts and the Bulgarian Ministry of Culture, among others. Afroditi Katmeridou, born in Bulgaria in 1956 by Greek parents, was the first woman who wrote electroacoustic music. One of the well-known contemporary composers is the British/Bulgarian Dobrinka Tabakova (b. 1980). She moved with her family to the United Kingdom when she was 11 and studied Composition at Guildhall School of Music and Drama in London. Her album String Paths was nominated for a Grammy award. Many female composers made a successful career in EU countries: Albena Petrovic-Vratchanska (Luxemburg), Yuliana Tochkova-Patrouilleau (France), Dariana Kumanova (Italy), Tveta Dimitrova (Austria), Ivajla Kirova (Germany), Alexandra Karastoyanova-Hermentin (Austria) and more.

Keywords: balgarian music, female composers, gender studies, western art music, migration

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Authors: Damiano Omari, Topirian Kerempe, Dibo Sama, Walter Wafula, Sharon Chepkoech, Chrispine Juma, Gilbert Kirui, Simon Mburu, Susan Keino

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The One Health concept was officially adopted by the international organizations and scholarly bodies in 1984. It aims at combining human, animal and environmental components to address global health challenges. Using collaborative efforts optimal health to people, animals, and the environment can be achieved. One health approach plays a significant approach role in prevention and control of zoonosis diseases. It has also been noted that 75% of new emerging human infectious diseases are zoonotic. In Kenya, one health has been embraced and strongly advocated for by One Health East and Central Africa (OHCEA). It was inaugurated on 17th of October 2010 at a historic meeting facilitated by USAID with participants from 7 public health schools, seven faculties of veterinary medicine in Eastern Africa and 2 American universities (Tufts and University of Minnesota) in addition to respond project staff. The study was conducted in Loitoktok Sub County, specifically in the Amboseli Ecosystem. The Amboseli ecosystem covers an area of 5,700 square kilometers and stretches between Mt. Kilimanjaro, Chyulu Hills, Tsavo West National park and the Kenya/Tanzania border. The area is arid to semi-arid and is more suitable for pastoralism with a high potential for conservation of wildlife and tourism enterprises. The ecosystem consists of the Amboseli National Park, which is surrounded by six group ranches which include Kimana, Olgulului, Selengei, Mbirikani, Kuku and Rombo in Loitoktok District. The Manyatta of study was Osiram Cultural Manyatta in Mbirikani group ranch. Apart from visiting the Manyatta, we also visited the sub-county hospital, slaughter slab, forest service, Kimana market, and the Amboseli National Park. The aim of the study was to identify the one health issues facing the community. This was done by a conducting a community needs assessment and prioritization. Different methods were used in data collection for the qualitative and numerical data. They include among others; key informant interviews and focus group discussions. We also guided the community members in drawing their Resource Map this helped identify the major resources in their land and also help them identify some of the issues they were facing. Matrix piling, root cause analysis, and force field analysis tools were used to establish the one health related priority issues facing community members. Skits were also used to present to the community interventions to the major one health issues. Some of the prioritized needs among the community were water scarcity and inadequate markets for their beadwork. The group intervened on the various needs of the Manyatta. For water scarcity, we educated the community on water harvesting methods using gutters as well as proper storage by the use of tanks and earth dams. The community was also encouraged to recycle and conserve water. To improve markets; we educated the community to upload their products online, a page was opened for them and uploading the photos was demonstrated to them. They were also encouraged to be innovative to attract more clients.

Keywords: Amboseli ecosystem, community interventions, community needs assessment and prioritization, one health issues

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Authors: Shazwanis Shukri

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The Mediterranean Sea, at the crossroads of three continents has always been the focus of pan-European and worldwide attention. Over the past decade, the Mediterranean Sea has become a hotbed for irregular migration particularly from the African continent toward the Europe. Among the major transit routes in the Mediterranean Sea include the Strait of Gibraltar, Canary Island and island of Lampedusa. In recent years, Mediterranean Sea has witnessed significant numbers of accidents and shipwrecks involving the irregular migrants and refugees trying to reach Europe via the sea. The shipwrecks and traffickers exploitation of migrants draw most of the attention particularly for the European Union (EU). This incident has been a wakeup call for the EU and become the top political agenda in the EU policy to tackle irregular migration and human smuggling at sea. EU has repeatedly addressed irregular migration as one of the threats the EU and its citizens may be confronted with and therefore immediate measures are crucial to tackle the crisis. In light of this, various initiatives have been adopted by the EU to strengthen external border control and restrict access to irregular migrants, notably through the enforcement of Frontex and Eunavfor Med. This paper analyses current development of counter-migration operations by the EU in response to migration crisis in the Mediterranean Sea. The analysis is threefold. First, this study examines the patterns and trends of irregular migration’s movements from recent perspective. Second, this study concentrates on the evolution of the EU operations that are in place in the Mediterranean Sea, notably by Frontex and Eunavfor Med to curb the influx of irregular migrants to the European countries, including, among others, Greece and Italy. Third, this study investigates the EU approaches to fight against the proliferation of human trafficking networks at sea. This study is essential to determine the roles of the EU in tackling migration crisis and human trafficking in the Mediterranean Sea and the effectiveness of their counter-migration operations to reduce the number of irregular migrants travelling via the sea. Elite interviews and document analysis were used as a methodology in this study. The study discovers that the EU operations have successfully contributed to reduce the numbers of irregular migrant’s arrival to Europe. The study also shows that the operations were effective to disrupt smugglers business models particularly from Libya. This study provides essential understanding about the roles of the EU not limited to tackle the migration crisis and disrupt trafficking networks, but also pledged to prevent further loss of lives at sea.

Keywords: European union, frontex, irregular migration, Mediterranean sea

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Authors: Jun Byung Joon, Seo Seok Hyun, Lee Seo Young

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As carbon dioxide emissions increase due to rapid industrialization and reckless development, abnormal climates such as floods and droughts are occurring. In order to respond to such climate change, the use of existing fossil fuels is reduced, and the proportion of eco-friendly renewable energy is gradually increasing. Korea is an energy resource-poor country that depends on imports for 93% of its total energy. As the global energy supply chain instability experienced due to the Russia-Ukraine crisis increases, countries around the world are resetting energy policies to minimize energy dependence and strengthen security. Seawater thermal energy is a renewable energy that replaces the existing air heat energy. It uses the characteristic of having a higher specific heat than air to cool and heat main spaces of buildings to increase heat transfer efficiency and minimize power consumption to generate electricity using fossil fuels, and Carbon dioxide emissions can be minimized. In addition, the effect on the marine environment is very small by using only the temperature characteristics of seawater in a limited way. K-water carried out a demonstration project of supplying cooling and heating energy to spaces such as the central control room and presentation room in the management building by acquiring the heat source of seawater circulated through the power plant's waterway by using the characteristics of the tidal power plant. Compared to the East Sea and the South Sea, the main system was designed in consideration of the large tidal difference, small temperature difference, and low-temperature characteristics, and its performance was verified through operation during the demonstration period. In addition, facility improvements were made for major deficiencies to strengthen monitoring functions, provide user convenience, and improve facility soundness. To spread these achievements, the basic concept was to expand the seawater heating and cooling system with a scale of 200 USRT at the Tidal Culture Center. With the operational experience of the demonstration system, it will be possible to establish an optimal seawater heat cooling and heating system suitable for the characteristics of the west coast ocean. Through this, it is possible to reduce operating costs by KRW 33,31 million per year compared to air heat, and through industry-university-research joint research, it is possible to localize major equipment and materials and develop key element technologies to revitalize the seawater heat business and to advance into overseas markets. The government's efforts are needed to expand the seawater heating and cooling system. Seawater thermal energy utilizes only the thermal energy of infinite seawater. Seawater thermal energy has less impact on the environment than river water thermal energy, except for environmental pollution factors such as bottom dredging, excavation, and sand or stone extraction. Therefore, it is necessary to increase the sense of speed in project promotion by innovatively simplifying unnecessary licensing/permission procedures. In addition, support should be provided to secure business feasibility by dramatically exempting the usage fee of public waters to actively encourage development in the private sector.

Keywords: seawater thermal energy, marine energy, tidal power plant, energy consumption

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Authors: Tamara Zappaterra

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The Learning Difficulties have an evolutionary nature. The international research has focused its analysis on the characteristics of Learning Difficulties in childhood, but we are still far from a thorough understanding of the nature of such disorders in adolescence and adulthood. Such issues become even more urgent in the university context. Spelling, meaning, and appropriate use of the specific vocabulary of the various disciplines represent an additional challenge for the dyslexic student. This paper explores the characteristics of Learning Difficulties in adulthood and the impact with the university teaching. It presents the results of an interdisciplinary project (educational, medical and engineering area) at University of Florence. The purpose of project is to design of a protocol for usability of teaching and individual study at university level. The project, after a first reconnaissance of user needs that have been reached with the participation of the very same protagonists, is at the stage of guidelines drafting for inclusion and education, to be used by teachers, students and administrative staff. The methodologies used are a questionnaire built on purpose and a series of focus groups with users. For collecting data during the focus groups it was decided to use a method typical of the Quality Function Deployment, a tool originally used for quality management, whose versatility makes it easy to use in a number of different context. The paper presents furthermore the findings of the project, the most significant elements of the guidelines for teaching, i.e. the section for teachers, whose aim is to implement a Learning Difficulties-friendly teaching, even at the university level, in compliance with italian Law 170/2010. The Guidelines for the didactic and inclusion of Learning Difficulties students of the University of Florence are articulated around a global and systemic plan of action, meant to accompany and protect the students during their study career, even before enrolling at the University, with different declination: the logistical, relational, educational, and didactic levels have been considered. These guidelines in Italy received the endorsement of the CNUDD. It is a systemic intervention plan for Learning Difficulties students, which roused and keeps rousing the interest of all the university system, with a radical consideration on academic teaching. Since while we try to provide the best Learning Difficulties-friendly didactic in compliance with the rules, no one can be exempted from a wider consideration on the nature and the quality of university teaching offered to all students.

Keywords: didactic tools, learning difficulties, special and inclusive education, university teaching

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Authors: Jing Jin

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The incorporation of artificial intelligence (AI) and machine learning (ML) in aircraft manufacturing and aerospace supply chains leads to the generation of a substantial amount of data among various tiers of suppliers and OEMs. Identifying the high-quality information challenges decision-makers. The application of AI/ML models necessitates access to 'high-quality' information to yield desired outputs. However, the process of information sharing introduces complexities, including distortion through various communication channels and biases introduced by both human and AI entities. This phenomenon significantly influences the quality of information, impacting decision-makers engaged in configuring supply chain systems. Traditionally, distorted information is categorized as 'low-quality'; however, this study challenges this perception, positing that distorted information, contributing to stakeholder goals, can be deemed high-quality within supply chains. The main aim of this study is to identify and evaluate the dimensions of information quality crucial to the UK aerospace supply chain. Guided by a central research question, "What information quality dimensions are considered when defining information quality in the UK aerospace supply chain?" the study delves into the intricate dynamics of information quality in the aerospace industry. Additionally, the research explores the nuanced impact of information distortion on stakeholders' decision-making processes, addressing the question, "How does the information distortion phenomenon influence stakeholders’ decisions regarding information quality in the UK aerospace supply chain system?" This study employs deductive methodologies rooted in positivism, utilizing a cross-sectional approach and a mono-quantitative method -a questionnaire survey. Data is systematically collected from diverse tiers of supply chain stakeholders, encompassing end-customers, OEMs, Tier 0.5, Tier 1, and Tier 2 suppliers. Employing robust statistical data analysis methods, including mean values, mode values, standard deviation, one-way analysis of variance (ANOVA), and Pearson’s correlation analysis, the study interprets and extracts meaningful insights from the gathered data. Initial analyses challenge conventional notions, revealing that information distortion positively influences the definition of information quality, disrupting the established perception of distorted information as inherently low-quality. Further exploration through correlation analysis unveils the varied perspectives of different stakeholder tiers on the impact of information distortion on specific information quality dimensions. For instance, Tier 2 suppliers demonstrate strong positive correlations between information distortion and dimensions like access security, accuracy, interpretability, and timeliness. Conversely, Tier 1 suppliers emphasise strong negative influences on the security of accessing information and negligible impact on information timeliness. Tier 0.5 suppliers showcase very strong positive correlations with dimensions like conciseness and completeness, while OEMs exhibit limited interest in considering information distortion within the supply chain. Introducing social network analysis (SNA) provides a structural understanding of the relationships between information distortion and quality dimensions. The moderately high density of ‘information distortion-by-information quality’ underscores the interconnected nature of these factors. In conclusion, this study offers a nuanced exploration of information quality dimensions in the UK aerospace supply chain, highlighting the significance of individual perspectives across different tiers. The positive influence of information distortion challenges prevailing assumptions, fostering a more nuanced understanding of information's role in the Industry 4.0 landscape.

Keywords: information distortion, information quality, supply chain configuration, UK aerospace industry

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Authors: Shereen Ismail Fawaz, Shin-Ichi Izumi, Nouran Mohamed Salah, Heba G. Saber, Ibrahim Mohamed Roushdi

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Background: Multiple sclerosis (MS) is a chronic, inflammatory, mainly demyelinating disease of the central nervous system, more common in young adults. Cerebellar involvement is one of the most disabling lesions in MS and is usually a sign of disease progression. It plays a major role in the planning, initiation, and organization of movement via its influence on the motor cortex and corticospinal outputs. Therefore, it contributes to controlling movement, motor adaptation, and motor learning, in addition to its vast connections with other major pathways controlling balance, such as the cerebellopropriospinal pathways and cerebellovestibular pathways. Hence, trying to stimulate the cerebellum by facilitatory protocols will add to our motor control and balance function. Non-invasive brain stimulation, both repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), has recently emerged as effective neuromodulators to influence motor and nonmotor functions of the brain. Anodal tDCS has been shown to improve motor skill learning and motor performance beyond the training period. Similarly, rTMS, when used at high frequency (>5 Hz), has a facilitatory effect on the motor cortex. Objective: Our aim was to determine the effect of high-frequency rTMS over the cerebellum in improving balance and functional ambulation of multiple sclerosis patients with Ataxia. Patients and methods: This was a randomized single-blinded placebo-controlled prospective trial on 40 patients. The active group (N=20) received real rTMS sessions, and the control group (N=20) received Sham rTMS using a placebo program designed for this treatment. Both groups received 12 sessions of high-frequency rTMS over the cerebellum, followed by an intensive exercise training program. Sessions were given three times per week for four weeks. The active group protocol had a frequency of 10 Hz rTMS over the cerebellar vermis, work period 5S, number of trains 25, and intertrain interval 25s. The total number of pulses was 1250 pulses per session. The control group received Sham rTMS using a placebo program designed for this treatment. Both groups of patients received an intensive exercise program, which included generalized strengthening exercises, endurance and aerobic training, trunk abdominal exercises, generalized balance training exercises, and task-oriented training such as Boxing. As a primary outcome measure the Modified ICARS was used. Static Posturography was done with: Patients were tested both with open and closed eyes. Secondary outcome measures included the expanded Disability Status Scale (EDSS) and 8 Meter walk test (8MWT). Results: The active group showed significant improvements in all the functional scales, modified ICARS, EDSS, and 8-meter walk test, in addition to significant differences in static Posturography with open eyes, while the control group did not show such differences. Conclusion: Cerebellar high-frequency rTMS could be effective in the functional improvement of balance in MS patients with ataxia.

Keywords: brain neuromodulation, high frequency rTMS, cerebellar stimulation, multiple sclerosis, balance rehabilitation

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Authors: Marilena Fatigante

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Contemporary psychoanalysis is increasingly acknowledging the existential demands of clients in psychotherapy. A significant aspect of the personal crises that patients face today is often rooted in the difficulty to find meaning in their own existence, even after working through or resolving traumatic memories and experiences. Tracing back to the correspondence between Freud and Romain Rolland (1927), psychoanalysis could not ignore that investigation of the psyche also encompasses the encounter with deep, psycho-sensory experiences, which involve a sense of "being one with the external world as a whole", the well-known “oceanic feeling”, as Rolland posed it. Despite the recognition of Non-ordinary States of Consciousness (NSC) as catalysts for transformation in clinical practice, highlighted by neuroscience and results from psychedelic-assisted therapies, there is few research on how psychoanalytic knowledge can integrate with other treatment traditions. These traditions, commonly rooted in non -Western, unconventional, and non-formal psychological knowledge, emphasize the individual’s innate tendency toward existential integrity and transcendence of self-boundaries. Inspired by an autobiographical account, this paper examines narratives of 12 individuals, who engaged in psychoanalytic therapy and also underwent treatment involving a non-formal helping relationship with an expert guide in consciousness, which included experience of this nature. The guide relies on 35 yrs of experience in Psychological, multidisciplinary studies in Human Sciences and Art, and demonstrates knowledge of many wisdom traditions, ranging from Eastern to Western philosophy, including Psychoanalysis and its development in cultural perspective (e.g, Ethnopsychiatry). Analyses focused primarily on two dimensions that research has identified as central in assessing the degree of treatment “success” in the patients’ narrative accounts of their therapies: agency and coherence, defined respectively as the increase, expressed in language, of the client’s perceived ability to manage his/her own challenges and the capacity, inherent in “narrative” itself as a resource for meaning making (Bruner, 1990), to provide the subject with a sense of unity, endowing his /her life experience with temporal and logical sequentiality. The present study reports that, in all narratives from the participants, agency and coherence are described differently than in “common” psychotherapy narratives. Although the participants consistently identified themselves as responsible agentic subject, the sense of agency derived from the non-conventional guidance pathway is never reduced to a personal, individual accomplishment. Rather, the more a new, fuller sense of “Life” (more than “Self”) develops out of the guidance pathway they engage with the expert guide, the more they “surrender” their own sense of autonomy and self-containment. Something, which Safran (2016) identified as well talking about the sense of surrender and “grace” in psychoanalytic sessions. Secondly, narratives of individuals engaging with the expert guide describe coherence not as repairing or enforcing continuity but as enhancing their ability to navigate dramatic discontinuities, falls, abrupt leaps and passages marked by feelings of loss and bereavement. The paper ultimately explores whether valid criteria can be established to analyze experiences of non-conventional paths of self-evolution. These paths are not opposed or alternative to conventional ones, and should not be simplistically dismissed as exotic or magical.

Keywords: oceanic feeling, non conventional guidance, consciousness, narratives, treatment outcomes

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Authors: Danutė Jablonskytė-Raščė, Vidas Damanauskas

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The wheat (Triticum) genus is divided into many species, of which only two are widely distributed in the world - common wheat (Triticum aestivum L.) and durum wheat (Triticum durum Desf.). Common (soft) wheat is the most common type of wheat in the world and the most suitable for the harsh climate of Lithuania, but the grains have lower protein content and poorer nutritional properties. Durum wheat is characterized by a high protein content of the grain, but it is a crop of warmer climates grown in southern countries, Italy, Spain, the United States, Egypt, etc. Today's important issue is food, its resources and quality. The research focuses on healthier food grown in our conditions, the quality of which recently depends a lot not only on the cultivation technology but also on the warming climate conditions. Climatic conditions change the distribution of fungi and their hosts. Plants that have grown in our climate for many years have adapted to the use of fungicides, so the aim is to study cereal varieties grown in warmer climates and compare them with our country's varieties, studying their nutritional value and the spread of fungal diseases. The field experiments of different varieties of wheat were conducted at Joniškėlis Experimental Station of the Lithuanian Research Centre for Agriculture and Forestry in 2023. The soil of the experimental site was Endocalcari-Endohypogleyic Cambisol (CMg-n-w-can). The research was designed to identify the resistance to leaf diseases and the nutritional value of various wheat varieties. This research aims to focus on healthier food grown in our conditions, the quality of which recently depends a lot not only on the cultivation technology but also on the conditions of the warming climate. The study found that hot and humid summer weather led to the spread of foliar diseases in wheat. Tan spot (Pyrenophora tritici-repentis) is mostly spread in wheat crops. This disease had an average prevalence of 86.90%. The wheat crop was sparse, so this year was unfavorable for the spread of powdery mildew (Blumeria graminis). Dry weather prevailed during the period of flowering of cereals, which prevented the spread of ear diseases. Examining the qualitative indicators of grain, it was found that durum wheat had the best parameters.

Keywords: varieties, wheat, leaf disease, grain quality

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Authors: Patricia Shirley Almeida Prado, Liz Brito, Selma Paixão Argollo, Gracie Moreira, Leticia Matos Sobrinho

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Diffuse idiopathic skeletal hyperostosis (DISH) is a degenerative bone disease also known as Forestier´s disease and ankylosing hyperostosis of the spine is characterized by a tendency toward ossification of half the anterior longitudinal spinal ligament without intervertebral disc disease. DISH is not considered to be osteoarthritis, although the two conditions commonly occur together. Diagnostic criteria include fusion of at least four vertebrae by bony bridges arising from the anterolateral aspect of the vertebral bodies. These vertebral bodies have a 'dripping candle wax' appearance, also can be seen periosteal new bone formation on the anterior surface of the vertebral bodies and there is no ankylosis at zygoapophyseal facet joint. Clinically, patients with DISH tend to be asymptomatic some patients mention moderate pain and stiffness in upper back. This disease is more common in man, uncommon in patients younger than 50 years and rare in patients under 40 years old. In modern populations, DISH is found in association with obesity, (type II) diabetes; abnormal vitamin A metabolism and also associated with higher levels of serum uric acid. There is also some association between the increase of risk of stroke or other cerebrovascular disease. The DISH condition can be confused with Heterotopic Ossification, what is the bone formation in the soft tissues as the result of trauma, wounding, surgery, burnings, prolonged immobility and some central nervous system disorder. All these conditions have been described extensively as myositis ossificans which can be confused with the fibrodysplasia (myositis) ossificans progressive. As in the DISH symptomatology it can be asymptomatic or extensive enough to impair joint function. A third confusion osteoarthritis disease that can bring confusion are the enthesopathies that occur in the entire skeleton being common on the ischial tuberosities, iliac crests, patellae, and calcaneus. Ankylosis of the sacroiliac joint by bony bridges may also be found. CASE 1: this case is skeletal remains presenting skull, some vertebrae and scapulae. This case remains unidentified and due to lack of bone remains. Sex, age and ancestry profile was compromised, however the DISH pathognomonic findings and diagnostic helps to estimate sex and age characteristics. Moreover to presenting DISH these skeletal remains also showed some bone alterations and non-metrics as fusion of the first vertebrae with occipital bone, maxillae and palatine torus and scapular foramen on the right scapulae. CASE 2: this skeleton remains shows an extensive bone heterotopic ossification on the great trochanter area of left femur, right fibula showed a healed fracture in its body however in its inteosseous crest there is an extensive bone growth, also in the Ilium at the region of inferior gluteal line can be observed some pronounced bone growth and the skull presented a pronounced mandibular, maxillary and palatine torus. Despite all these pronounced heterotopic ossification the whole skeleton presents moderate bone overgrowth that is not linked with aging, since the skeleton belongs to a young unidentified individual. The appropriate osteopathological diagnosis support the human identification process through medical reports and also assist with epidemiological data that can strengthen vulnerable anthropological estimates.

Keywords: bone disease, DISH, human identification, human remains

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Authors: Neusa Fernanda Torres, Buyisile Chibi, Lyn E. Middleton, Vernon P. Solomon, Tivani P. Mashamba-Thompson

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Background: Self-medication with antibiotics (SMA) is a global concern, with a higher incidence in low and middle-income countries (LMICs). Despite intense world-wide efforts to control and promote the rational use of antibiotics, continuing practices of SMA systematically exposes individuals and communities to the risk of antibiotic resistance and other undesirable antibiotic side effects. Moreover, it increases the health systems costs of acquiring more powerful antibiotics to treat the resistant infection. This review thus maps evidence on the factors influencing self-medication with antibiotics in these settings. Methods: The search strategy for this review involved electronic databases including PubMed, Web of Knowledge, Science Direct, EBSCOhost (PubMed, CINAHL with Full Text, Health Source - Consumer Edition, MEDLINE), Google Scholar, BioMed Central and World Health Organization library, using the search terms:’ Self-Medication’, ‘antibiotics’, ‘factors’ and ‘reasons’. Our search included studies published from 2007 to 2017. Thematic analysis was performed to identify the patterns of evidence on SMA in LMICs. The mixed method quality appraisal tool (MMAT) version 2011 was employed to assess the quality of the included primary studies. Results: Fifteen studies met the inclusion criteria. Studies included population from the rural (46,4%), urban (33,6%) and combined (20%) settings, of the following LMICs: Guatemala (2 studies), India (2), Indonesia (2), Kenya (1), Laos (1), Nepal (1), Nigeria (2), Pakistan (2), Sri Lanka (1), and Yemen (1). The total sample size of all 15 included studies was 7676 participants. The findings of the review show a high prevalence of SMA ranging from 8,1% to 93%. Accessibility, affordability, conditions of health facilities (long waiting, quality of services and workers) as long well as poor health-seeking behavior and lack of information are factors that influence SMA in LMICs. Antibiotics such as amoxicillin, metronidazole, amoxicillin/clavulanic, ampicillin, ciprofloxacin, azithromycin, penicillin, and tetracycline, were the most frequently used for SMA. The major sources of antibiotics included pharmacies, drug stores, leftover drugs, family/friends and old prescription. Sore throat, common cold, cough with mucus, headache, toothache, flu-like symptoms, pain relief, fever, running nose, toothache, upper respiratory tract infections, urinary symptoms, urinary tract infection were the common disease symptoms managed with SMA. Conclusion: Although the information on factors influencing SMA in LMICs is unevenly distributed, the available information revealed the existence of research evidence on antibiotic self-medication in some countries of LMICs. SMA practices are influenced by social-cultural determinants of health and frequently associated with poor dispensing and prescribing practices, deficient health-seeking behavior and consequently with inappropriate drug use. Therefore, there is still a need to conduct further studies (qualitative, quantitative and randomized control trial) on factors and reasons for SMA to correctly address the public health problem in LMICs.

Keywords: antibiotics, factors, reasons, self-medication, low and middle-income countries (LMICs)

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Authors: Simon Komesker, Achim Wagner, Martin Ruskowski

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In times of volatile markets with fluctuating demand and the uncertainty of global supply chains, flexible production systems are the key to an efficient implementation of a desired production program. In this publication, the authors present a holistic information concept taking into account various influencing factors for operating towards the global optimum. Therefore, a strategy for the implementation of multi-level planning for a flexible, reconfigurable production system with an alternative production concept in the automotive industry is developed. The main contribution of this work is a system structure mixing central and decentral planning and control evaluated in a simulation framework. The information system structure in current production systems in the automotive industry is rigidly hierarchically organized in monolithic systems. The production program is created rule-based with the premise of achieving uniform cycle time. This program then provides the information basis for execution in subsystems at the station and process execution level. In today's era of mixed-(car-)model factories, complex conditions and conflicts arise in achieving logistics, quality, and production goals. There is no provision for feedback loops of results from the process execution level (resources) and process supporting (quality and logistics) systems and reconsideration in the planning systems. To enable a robust production flow, the complexity of production system control is artificially reduced by the line structure and results, for example in material-intensive processes (buffers and safety stocks - two container principle also for different variants). The limited degrees of freedom of line production have produced the principle of progress figure control, which results in one-time sequencing, sequential order release, and relatively inflexible capacity control. As a result, modularly structured production systems such as modular production according to known approaches with more degrees of freedom are currently difficult to represent in terms of information technology. The remedy is an information concept that supports cross-system and cross-level information processing for centralized and decentralized decision-making. Through an architecture of hierarchically organized but decoupled subsystems, the paradigm of hybrid control is used, and a holonic manufacturing system is offered, which enables flexible information provisioning and processing support. In this way, the influences from quality, logistics, and production processes can be linked holistically with the advantages of mixed centralized and decentralized planning and control. Modular production systems also require modularly networked information systems with semi-autonomous optimization for a robust production flow. Dynamic prioritization of different key figures between subsystems should lead the production system to an overall optimum. The tasks and goals of quality, logistics, process, resource, and product areas in a cyber-physical production system are designed as an interconnected multi-agent-system. The result is an alternative system structure that executes centralized process planning and decentralized processing. An agent-based manufacturing control is used to enable different flexibility and reconfigurability states and manufacturing strategies in order to find optimal partial solutions of subsystems, that lead to a near global optimum for hybrid planning. This allows a robust near to plan execution with integrated quality control and intralogistics.

Keywords: holonic manufacturing system, modular production system, planning, and control, system structure

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Authors: Àidan Higgins

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Higher education will be crucial in the coming decades in helping to make Ireland a nation is known for innovation, competitive enterprise, and ongoing academic success, as well as a desirable location to live and work with a high quality of life, vibrant culture, and inclusive social structures. Higher education institutions will actively connect with each student community, society, and business; they will help students develop a sense of place and identity in Ireland and provide the tools they need to contribute significantly to the global community. It will also serve as a catalyst for novel ideas through research, many of which will become the foundation for long-lasting inventive businesses in the future as part of the 2030 National Strategy on Education focuses on change and developing our education system with a focus on how we carry out Research. The emphasis is central to knowledge transfer and a consistent research framework with exploiting opportunities and having the necessary expertise. The newly formed Technological Universities (TU) in Ireland are based on a government initiative to create a new type of higher education institution that focuses on applied and industry-focused research and education. The basis of the TU is to bring together two or more existing institutes of technology to create a larger and more comprehensive institution that offers a wider range of programs and services to students and industry partners. The TU model aims to promote collaboration between academia, industry, and community organizations to foster innovation, research, and economic development. The TU model also aims to enhance the student experience by providing a more seamless pathway from undergraduate to postgraduate studies, as well as greater opportunities for work placements and engagement with industry partners. Additionally, the TUs are designed to provide a greater emphasis on applied research, technology transfer, and entrepreneurship, with the goal of fostering innovation and contributing to economic growth. A project is a collection of organised tasks carried out precisely to produce a singular output (product or service) within a given time frame. Project management is a set of activities that facilitates the successful implementation of a project. The significant differences between research and development projects are the (lack of) precise requirements and (the inability to) plan an outcome from the beginning of the project. The evaluation criteria for a research project must consider these and other "particularities" in works; for instance, proving something cannot be done may be a successful outcome. This study intends to explore how a newly established multi-campus technological university manages research projects effectively. The study will identify the potential and difficulties of managing research projects, the tools, resources and processes available in a multi-campus Technological University context and the methods and approaches employed to deal with these difficulties. Key stakeholders like project managers, academics, and administrators will be surveyed as part of the study, which will also involve an explorative investigation of current literature and data. The findings of this study will contribute significantly to creating best practices for project management in this setting and offer insightful information about the efficient management of research projects within a multi-campus technological university.

Keywords: project management, research and research-related projects, multi-campus technology university, processes

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Authors: Ankita Baidya, Vanishri Ganakumar, Ranveer S. Jadon, Piyush Ranjan, Rita Sood

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Septic embolism can have varied presentations and clinical considerations. Infected central venous catheters are commonly associated with septic emboli but peripheral vascular catheters are rarely implicated. We describe a rare case of septic pulmonary emboli related to infected peripheral venous cannulation caused by an unusual etiological agent. A young male presented with complaints of fever, productive cough, sudden onset shortness of breath and cellulitis in both the upper limbs. He was recently hospitalised for dengue fever and administered intravenous fluids through peripheral venous line. The patient was febrile, tachypneic and in respiratory distress, there were multiple pus filled bullae in left hand alongwith swelling and erythema involving right forearm that started at the site of cannulation. Chest examination showed active accessory muscles of respiration, stony dull percussion at the base of right lung and decreased breath sounds at right infrascapular, infraaxillary and mammary area. Other system examination was within normal limits. Chest X-ray revealed bilateral multiple patchy heterogenous peripheral opacities and infiltrates with right-sided pleural effusion. Contrast-enhanced computed tomography (CECT) chest showed feeding vessel sign confirming the diagnosis as septic emboli. Venous Doppler and 2D-echocardiogarm were normal. Laboratory findings showed marked leucocytosis (22000/mm3). Pus aspirate, blood sample, and sputum sample were sent for microbiological testing. The patient was started empirically on ceftriaxone, vancomycin, and clindamycin. The Pus culture and sputum culture showed Klebsiella pneumoniae sensitive to cefoperazone-sulbactum, piperacillin-tazobactum, meropenem and amikacin. The antibiotics were modified accordingly to antimicrobial sensitivity profile to Cefoperazone-sulbactum. Bronchoalveolar lavage (BAL) was done and sent for microbiological investigations. BAL culture showed Klebsiella pneumoniae with same antimicrobial resistance profile. On day 6 of starting cefoperazone-sulbactum, he became afebrile. The skin lesions improved significantly. He was administered 2 weeks of cefoperazone–sulbactum and discharged on oral faropenem for 4 weeks. At the time of discharge, TLC was 11200/mm3 with marked radiological resolution of infection and healed skin lesions. He was kept in regular follow up. Chest X-ray and skin lesions showed complete resolution after 8 weeks. Till date, only couple of case reports of septic emboli through peripheral intravenous line have been reported in English literature. This case highlights that a simple procedure of peripheral intravenous cannulation can lead to catastrophic complication of septic pulmonary emboli and widespread cellulitis if not done with proper care and precautions. Also, the usual pathogens in such clinical settings are gram positive bacteria, but with the history of recent hospitalization, empirical therapy should also cover drug resistant gram negative microorganisms. It also emphasise the importance of appropriate healthcare practices to be taken care during all procedures.

Keywords: antibiotics, cannula, Klebsiella pneumoniae, septic emboli

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Authors: Albert W. K. Tan

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This research consolidates a comprehensive array of publications from peer-reviewed journals, case studies, and seminar reports focused on reverse logistics and network design. By synthesizing this secondary knowledge, our objective is to identify and articulate key decision factors crucial to reverse logistics network design for e-commerce. Through this exploration, we aim to present a refined mathematical model that offers valuable insights for companies seeking to optimize their reverse logistics operations. The primary goal of this research endeavor is to develop a comprehensive framework tailored to advising organizations and companies on crafting effective networks for their reverse logistics operations, thereby facilitating the achievement of their organizational goals. This involves a thorough examination of various network configurations, weighing their advantages and disadvantages to ensure alignment with specific business objectives. The key objectives of this research include: (i) Identifying pivotal factors pertinent to network design decisions within the realm of reverse logistics across diverse supply chains. (ii) Formulating a structured framework designed to offer informed recommendations for sound network design decisions applicable to relevant industries and scenarios. (iii) Propose a mathematical model to optimize its reverse logistics network. A conceptual framework for designing a reverse logistics network has been developed through a combination of insights from the literature review and information gathered from company websites. This framework encompasses four key stages in the selection of reverse logistics operations modes: (1) Collection, (2) Sorting and testing, (3) Processing, and (4) Storage. Key factors to consider in reverse logistics network design: I) Centralized vs. decentralized processing: Centralized processing, a long-standing practice in reverse logistics, has recently gained greater attention from manufacturing companies. In this system, all products within the reverse logistics pipeline are brought to a central facility for sorting, processing, and subsequent shipment to their next destinations. Centralization offers the advantage of efficiently managing the reverse logistics flow, potentially leading to increased revenues from returned items. Moreover, it aids in determining the most appropriate reverse channel for handling returns. On the contrary, a decentralized system is more suitable when products are returned directly from consumers to retailers. In this scenario, individual sales outlets serve as gatekeepers for processing returns. Considerations encompass the product lifecycle, product value and cost, return volume, and the geographic distribution of returns. II) In-house vs. third-party logistics providers: The decision between insourcing and outsourcing in reverse logistics network design is pivotal. In insourcing, a company handles the entire reverse logistics process, including material reuse. In contrast, outsourcing involves third-party providers taking on various aspects of reverse logistics. Companies may choose outsourcing due to resource constraints or lack of expertise, with the extent of outsourcing varying based on factors such as personnel skills and cost considerations. Based on the conceptual framework, the authors have constructed a mathematical model that optimizes reverse logistics network design decisions. The model will consider key factors identified in the framework, such as transportation costs, facility capacities, and lead times. The authors have employed mixed LP to find the optimal solutions that minimize costs while meeting organizational objectives.

Keywords: reverse logistics, supply chain management, optimization, e-commerce

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Authors: Camille Aouinaït, Danilo Christen, Christoph Carlen

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Introduction: Small and Medium-sized Enterprises (SMEs) are facing different challenges such as pressures on environmental resources, the rise of downstream power, and trade liberalization. Remaining competitive by implementing innovations and engaging in collaborations could be a strategic solution. In Switzerland, the Federal Institute for Research in Agriculture (Agroscope), the Federal schools of technology (EPFL and ETHZ), Cantonal universities and Universities of Applied Sciences (UAS) can provide substantial inputs. UAS were developed with specific missions to match the labor markets and society needs. Research projects produce patents, publications and improved networks of scientific expertise. The study’s goal is to measure the contribution of UAS and research organization to innovation and the impact of collaborations with partners in the non-academic environment in Swiss traditional fruit production. Materials and methods: The European projects Traditional Food Network to improve the transfer of knowledge for innovation (TRAFOON) and Social Impact Assessment of Productive Interactions between science and society (SIAMPI) frame the present study. The former aims to fill the gap between the needs of traditional food producing SMEs and innovations implemented following European projects. The latter developed a method to assess the impacts of scientific research. On one side, interviews with market players have been performed to make an inventory of needs of Swiss SMEs producing apricots and berries. The participative method allowed matching the current needs and the existing innovations coming from past European projects. Swiss stakeholders (e.g. producers, retailers, an inter-branch organization of fruits and vegetables) directly rated the needs on a five-Likert scale. To transfer the knowledge to SMEs, training workshops have been organized for apricot and berries actors separately, on specific topics. On the other hand, a mapping of a social network is drawn to characterize the links between actors, with a focus on the Swiss canton of Valais and UAS Valais Wallis. Type and frequency of interactions among actors have identified thanks to interviews. Preliminary results: A list of 369 SMEs needs grouped in 22 categories was produced with 37 fulfilled questionnaires. Swiss stakeholders rated 31 needs very important. Training workshops on apricot are focusing on varietal innovations, storage, disease (bacterial blight), pest (Drosophila suzukii), sorting and rootstocks. Entrepreneurship was targeted through trademark discussions in berry production. The UAS Valais Wallis collaborated on a few projects with Agroscope along with industries, at European and national levels. Political and public bodies interfere with the central area of agricultural vulgarization that induces close relationships between the research and the practical side. Conclusions: The needs identified by Swiss stakeholders are becoming part of training workshops to incentivize innovations. The UAS Valais Wallis takes part in collaboration projects with the research environment and market players that bring innovations helping SMEs in their contextual environment. Then, a Strategic Research and Innovation Agenda will be created in order to pursue research and answer the issues facing by SMEs.

Keywords: agriculture, innovation, knowledge transfer, university and research collaboration

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Authors: Mukhtar Maigari

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The landscape of Higher Education (HE) institutions, especially following the CVID-19 pandemic, necessitates advanced approaches to manage Indoor Environmental Quality (IEQ) which is crucial for the comfort, health, and productivity of students and staff. This study investigates the application of Building Information Modelling (BIM) as a multifaceted tool for monitoring, assessing, and controlling IEQ in HE buildings aiming to bridge the gap between traditional management practices and the innovative capabilities of BIM. Central to the study is a comprehensive literature review, which lays the foundation by examining current knowledge and technological advancements in both IEQ and BIM. This review sets the stage for a deeper investigation into the practical application of BIM in IEQ management. The methodology consists of Post-Occupancy Evaluation (POE) which encompasses physical monitoring, questionnaire surveys, and interviews under the umbrella of case studies. The physical data collection focuses on vital IEQ parameters such as temperature, humidity, CO2 levels etc, conducted by using different equipment including dataloggers to ensure accurate data. Complementing this, questionnaire surveys gather perceptions and satisfaction levels from students, providing valuable insights into the subjective aspects of IEQ. The interview component, targeting facilities management teams, offers an in-depth perspective on IEQ management challenges and strategies. The research delves deeper into the development of a conceptual BIM-based framework, informed by the insight findings from case studies and empirical data. This framework is designed to demonstrate the critical functions necessary for effective IEQ monitoring, assessment, control and automation with real time data handling capabilities. This BIM-based framework leads to the developing and testing a BIM-based prototype tool. This prototype leverages on software such as Autodesk Revit with its visual programming tool i.e., Dynamo and an Arduino-based sensor network thereby allowing for real-time flow of IEQ data for monitoring, control and even automation. By harnessing the capabilities of BIM technology, the study presents a forward-thinking approach that aligns with current sustainability and wellness goals, particularly vital in the post-COVID-19 era. The integration of BIM in IEQ management promises not only to enhance the health, comfort, and energy efficiency of educational environments but also to transform them into more conducive spaces for teaching and learning. Furthermore, this research could influence the future of HE buildings by prompting universities and government bodies to revaluate and improve teaching and learning environments. It demonstrates how the synergy between IEQ and BIM can empower stakeholders to monitor IEQ conditions more effectively and make informed decisions in real-time. Moreover, the developed framework has broader applications as well; it can serve as a tool for other sustainability assessments, like energy analysis in HE buildings, leveraging measured data synchronized with the BIM model. In conclusion, this study bridges the gap between theoretical research and real-world application by practicalizing how advanced technologies like BIM can be effectively integrated to enhance environmental quality in educational institutions. It portrays the potential of integrating advanced technologies like BIM in the pursuit of improved environmental conditions in educational institutions.

Keywords: BIM, POE, IEQ, HE-buildings

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Authors: Yik Sin Chan, Nam Weng Sit, Fook Yee Chye, van Ofwegen Leen, de Voogd Nicole, Kong Soo Khoo

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Chikungunya fever is an arboviral disease transmitted by the Aedes mosquitoes. It has resulted in epidemics of the disease in tropical countries in the Indian Ocean and South East Asian regions. The recent spread of this disease to the temperate countries such as France and Italy, coupled with the absence of vaccines and effective antiviral drugs make chikungunya fever a worldwide health threat. This study aims to investigate the anti-chikungunya virus activity of selected marine organism samples collected from Malaysian coastal areas, including seaweeds (Caulerpa racemosa, Caulerpa sertularioides and Kappaphycus alvarezii), a soft coral (Lobophytum microlobulatum) and a sponge (Spheciospongia vagabunda). Following lyophilization (oven drying at 40C for K. alvarezii) and grinding to powder form, each sample was subjected to sequential solvent extraction using hexane, chloroform, ethyl acetate, ethanol, methanol and distilled water in order to extract bioactive compounds. The antiviral activity was evaluated using monkey kidney epithelial (Vero) cells infected with the virus (multiplicity of infection=1). The cell viability was determined by Neutral Red uptake assay. 70% of the 30 extracts showed weak inhibitory activity with cell viability ≤30%. Seven of the extracts exhibited moderate inhibitory activity (cell viability: 31%-69%). These were the chloroform, ethyl acetate, ethanol and methanol extracts of C. racemosa; chloroform and ethyl acetate extracts of L. microlobulatum; and the chloroform extract of C. sertularioides. Only the hexane and ethanol extracts of L. microlobulatum showed strong inhibitory activity against the virus, resulting in cell viabilities (mean±SD; n=3) of 73.3±2.6% and 79.2±0.9%, respectively. The corresponding mean 50% effective concentrations (EC50) for the extracts were 14.2±0.2 and 115.3±1.2 µg/mL, respectively. The ethanol extract of the soft coral L. microlobulatum appears to hold the most promise for further characterization of active principles as it possessed greater selectivity index (SI>5.6) compared to the hexane extract (SI=2.1).

Keywords: antiviral, seaweed, sponge, soft coral, vero cell

Procedia PDF Downloads 264

Authors: Kanokwan Tangchitnusorn, Patcharawalai Wongboonsin

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Following the ‘Golden Age of Welfare’ which enabled post-war prosperity to European citizens in 1950s, the world has witnessed the increasing mobility across borders of older citizens of First World countries. Then, in 1990s, the international retirement migration (IRM) of older persons has become a prominent trend, in which, it requires the integration of several fields of knowledge to explain, i.e. migration studies, tourism studies, as well as, social gerontology. However, while the studies of the IRM to developed destinations in Europe (e.g. Spain, Malta, Portugal, Italy), and the IRM to developing countries like Mexico, Panama, and Morocco have been largely studied in recent decades due to their massive migration volume, the study of the IRM to remoter destinations has been far more relatively sparse and incomplete. Developing countries in Southeast Asia have noticed the increasing number of retired expats, particularly to Thailand, where the number of foreigners applying for retirement visa increased from 10,709 in 2005 to 60,046 in 2014. Additionally, it was evident that the majority of Thailand’s retirement visa applicants were Westerners, i.e. citizens of the United Kingdom, the United States, Germany, and the Nordic countries, respectively. As such trend just becoming popular in Thailand in recent decades, little is known about the IRM populations, their well-being, and their future migration plans. This study aimed to examine the subjective wellbeing or the self-evaluations of own well-being among Western retirees in Thailand, as well as, their future migration plans as whether they planned to stay here for life or otherwise. The author employed a mixed method to obtain both quantitative and qualitative data during October 2015 – May 2016, including 330 self-administered questionnaires (246 online and 84 hard-copied responses), and 21 in-depth interviews of the Western residents in Nan (2), Pattaya (4), and Chiang Mai (15). As derived from the integration of previous subjective well-being measurements (i.e. Personal Wellbeing Index (PWI), Global AgeWatch Index, and OECD guideline on measuring subjective wellbeing), this study would measure the subjective well-being of Western retirees in Thailand in 7 dimensions, including standard of living, health status, personal relationships, social connections, environmental quality, personal security and local infrastructure.

Keywords: international retirement migration, ageing, mobility, wellbeing, Western, Thailand

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Authors: R. Verwiebe, L. Seewann, M. Wolf

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This presentation addresses marginalization and discrimination as experienced by young academics with a migrant background in the Austrian labor market. Focusing on second generation academics of Central Eastern European and Turkish descent we explore two major issues. First, we ask whether their career-entry and everyday professional life entails origin-specific barriers. As educational residents, they show competences which, when lacking, tend to be drawn upon to explain discrimination: excellent linguistic skills, accredited high-level training, and networks. Second, we concentrate on how this group reacts to discrimination and overcomes experiences of marginalization. To answer these questions, we utilize recent sociological and social psychological theories that focus on the diversity of individual experiences. This distinguishes us from a long tradition of research that has dealt with the motives that inform discrimination, but has less often considered the effects on those concerned. Similarly, applied coping strategies have less often been investigated, though they may provide unique insights into current problematic issues. Building upon present literature, we follow recent discrimination research incorporating the concepts of ‘multiple discrimination’, ‘subtle discrimination’, and ‘visual social markers’. 21 problem-centered interviews are the empirical foundation underlying this study. The interviewees completed their entire educational career in Austria, graduated in different universities and disciplines and are working in their first post-graduate jobs (career entry phase). In our analysis, we combined thematic charting with a coding method. The results emanating from our empirical material indicated a variety of discrimination experiences ranging from barely perceptible disadvantages to directly articulated and overt marginalization. The spectrum of experiences covered stereotypical suppositions at job interviews, the disavowal of competencies, symbolic or social exclusion by new colleges, restricted professional participation (e.g. customer contact) and non-recruitment due to religious or ethnical markers (e.g. headscarves). In these experiences the role of the academics education level, networks, or competences seemed to be minimal, as negative prejudice on the basis of visible ‘social markers’ operated ‘ex-ante’. The coping strategies identified in overcoming such barriers are: an increased emphasis on effort, avoidance of potentially marginalizing situations, direct resistance (mostly in the form of verbal opposition) and dismissal of negative experiences by ignoring or ironizing the situation. In some cases, the academics drew into their specific competences, such as an intellectual approach of studying specialist literature, focus on their intercultural competences or planning to migrate back to their parent’s country of origin. Our analysis further suggests a distinction between reactive (i.e. to act on and respond to experienced discrimination) and preventative strategies (applied to obviate discrimination) of coping. In light of our results, we would like to stress that the tension between educational and professional success experienced by academics with a migrant background – and the barriers and marginalization they continue to face – are essential issues to be introduced to socio-political discourse. It seems imperative to publicly accentuate the growing social, political and economic significance of this group, their educational aspirations, as well as their experiences of achievement and difficulties.

Keywords: coping strategies, discrimination, labor market, second generation university graduates

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Authors: G. Suja, J. Sreekumar, A. N. Jyothi, V. S. Santhosh Mithra

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Worldwide concerns regarding food safety, environmental degradation and threats to human health have generated interest in alternative systems like organic farming. Tropical tuber crops, cassava, sweet potato, yams, and aroids are food-cum-nutritional security-cum climate resilient crops. These form stable or subsidiary food for about 500 million global population. Cassava, yams (white yam, greater yam, and lesser yam) and edible aroids (elephant foot yam, taro, and tannia) are high energy tuberous vegetables with good taste and nutritive value. Seven on-station field experiments at ICAR-Central Tuber Crops Research Institute, Thiruvananthapuram, India and seventeen on-farm trials in three districts of Kerala, were conducted over a decade (2004-2015) to compare the varietal response, yield, quality and soil properties under organic vs conventional system in these crops and to develop a learning system based on the data generated. The industrial, as well as domestic varieties of cassava, the elite and local varieties of elephant foot yam and taro and the three species of Dioscorea (yams), were on a par under both systems. Organic management promoted yield by 8%, 20%, 9%, 11% and 7% over conventional practice in cassava, elephant foot yam, white yam, greater yam and lesser yam respectively. Elephant foot yam was the most responsive to organic management followed by yams and cassava. In taro, slight yield reduction (5%) was noticed under organic farming with almost similar tuber quality. The tuber quality was improved with higher dry matter, starch, crude protein, K, Ca and Mg contents. The anti-nutritional factors, oxalate content in elephant foot yam and cyanogenic glucoside content in cassava were lowered by 21 and 12.4% respectively. Organic plots had significantly higher water holding capacity, pH, available K, Fe, Mn and Cu, higher soil organic matter, available N, P, exchangeable Ca and Mg, dehydrogenase enzyme activity and microbial count. Organic farming scored significantly higher soil quality index (1.93) than conventional practice (1.46). The soil quality index was driven by water holding capacity, pH and available Zn followed by soil organic matter. Organic management enhanced net profit by 20-40% over chemical farming. A case in point is the cost-benefit analysis in elephant foot yam which indicated that the net profit was 28% higher and additional income of Rs. 47,716 ha-1 was obtained due to organic farming. Cost-effective technologies were field validated. The on-station technologies developed were validated and popularized through on-farm trials in 10 sites (5 ha) under National Horticulture Mission funded programme in elephant foot yam and seven sites in yams and taro. The technologies are included in the Package of Practices Recommendations for crops of Kerala Agricultural University. A learning system developed using artificial neural networks (ANN) predicted the performance of elephant foot yam organic system. Use of organically produced seed materials, seed treatment in cow-dung, neem cake, bio-inoculant slurry, farmyard manure incubated with bio-inoculants, green manuring, use of neem cake, bio-fertilizers and ash formed the strategies for organic production. Organic farming is an eco-friendly management strategy that enables 10-20% higher yield, quality tubers and maintenance of soil health in tuber crops.

Keywords: eco-agriculture, quality, root crops, healthy soil, yield

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Authors: Emanuela Zilli, Antonella Ruffatto, Davide Bonaldo, Stefano Bevilacqua, Tommaso Caputo, Luisa Fontana, Carmelina Saraceno, Antonio Sturaroo, Teodoro Sava, Antonio Madia

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The new Hospital in Cittadella - ULSS 6 Euganea Health Trust, in the North-East of Italy (400 beds, project completion date in 2026), will partially take the place of the existing building. Interesting features have been suggested in order to project a modern, “environmental-friendly” and “people-friendly” building. Specific multidisciplinary meetings (involving stakeholders and professionals with different backgrounds) have been organized on a periodic basis in order to guarantee the appropriate implementation of logistic and organizational solutions related to eco-sustainability, integration with the context, and the concept of “design for all” and “humanization of care.” The resulting building will be composed of organic shapes determined by the external environment (sun movement, climate, landscape, pre-existing buildings, roads) and the needs of the internal environment (areas of care and diagnostic-treatment paths reorganized with experience gained during the pandemic), with extensive use of renewable energy, solar panels, a 4th-generation heating system, sanitised and maintainable surfaces. There is particular attention to the quality of the staff areas, which include areas dedicated to psycho-physical well-being (relax points, yoga gym), study rooms, and a centralized conference room. Outdoor recreational spaces and gardens for music and watercolour therapy will be included; atai-chi gym is dedicated to oncology patients. Integration in the urban and social context is emphasized through window placement toward the gardens (maternal-infant, mental health, and rehabilitation wards). Service areas such as dialysis, radiology, and labs have views of the medieval walls, the symbol of the city’s history. The new building has been designed to pursue the maximum level of eco-sustainability, harmony with the environment, and integration with the historical, urban, and social context; the concept of humanization of care has been considered in all the phases of the project management.

Keywords: environmental-friendly, humanization, eco-sustainability, new hospital

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Authors: Abouchouaib Belahmira, Joerg W. Schneider, Hafid Saber, Sara Akboub

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The lithofacies analyzed herein were reported from the interbedded fluvial and lacustrine deposits of the Oued Issene and El Menizla formations. These formations are part of the sedimentary fill of the Carboniferous (Stephanian) submontaneous Souss basin. The latter is situated in the western High Atlas Mountains, south-central Morocco, about 50km east of Agadir. The Souss basin started as a single basin but was separated into sub-basins called Ida Ou Zal and Ida Ou Ziki by sinistral displacement along the west branch of the Tizi N'Test Fault during the end of the Mauritanid phase of the Variscan orogeny in Morocco, after the early Stephanian (Kasimovian) and before the late middle Permian (Capitanian). The studied succession is a monotonous finning-upward sequence of 1800 m thick. It consists of fine-grained sandstone, finely bedded siltstone and thinly laminated claystone, and black shale. Herein we provide a detailed characterization of lithofacies of the upper El Menizla and Oued Issène formations, with a focus on the prevailing overbank to flood plain fine-grained lithofacies. The studied facies are capping the Stephanian alluvial fan basal clast-supported conglomerates that are intercalated bedded coarse-grained sandstones of Ikhourba Formation in the Ou Zal subbasin and Tajgaline Formation in the Ida Ou Ziki subbasin, respectively. Within the fluvial elements, only two main facies have been observed. It comprises channel-fill and channel-bar deposits, mostly occur as lenticular –shape sand bodies or sheet-like sand greenish to gray fine-to medium (Fm), massive internally structureless, or very locally exhibits a medium to large scale trough-cross bedding medium to coarse sandstone (St), observable in relatively thicker bed. These facies are laterally extensive, with a thickness varying from a few to several meters. Finer-grained sediments such as mud can be present as drapes over bedforms. Whilst the fluvial association FA1, the overbank elements are represented by a relatively wide range of 5 facies. This exhibit mostly a cm scale horizontally bedded greenish fine- to medium sand and silt, and mm scale fossiliferous thinly laminated dark gray- black Corganic-rich clays to siltstone associated with black shale. Thus, FA2 includes flood plain fines (Fh, R) associated with the paleosols and back swamp coaly clay facies (C). The floodplain lake element comprises only laminated organic-rich dark gray facies of claystone, black shale, and graded siltstone. Bedsets are dm to several meters thick (typically < 1 m thick). They are intercalated between several m-thick fluvial sandstone, extend over a few meters, and are poorly bioturbated. The lacustrine facies described in this study have been divided into two sub-facies (Fl, B) based on field observations that indicate differing environmental conditions of formation. Thus, the thorough analysis of the lithofacies of the Souss basin units allows us to reconstruct the original environment that was interpreted as a typical fluvial-dominated braided to anastomosing wide distributary channel system and surrounding deep to shallow freshwater floodplain lakes and back swamps.

Keywords: Souss, carboniferous, facies, depositional setting

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Authors: C. Bel, J. Nevado, F. Ciceri, M. Ropacki, T. Hoffmann, P. Lapunzina, C. Buesa

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Background: The Phelan-McDermid syndrome (PMS) is a genetic disorder caused by the deletion of the terminal region of chromosome 22 or mutation of the SHANK3 gene. Shank3 disruption in mice leads to dysfunction of synaptic transmission, which can be restored by epigenetic regulation with both Lysine Specific Demethylase 1 (LSD1) inhibitors. PMS subjects result in a variable degree of intellectual disability, delay or absence of speech, autistic spectrum disorders symptoms, low muscle tone, motor delays and epilepsy. Vafidemstat is an LSD1 inhibitor in Phase II clinical development with a well-established and favorable safety profile, and data supporting the restoration of memory and cognition defects as well as reduction of agitation and aggression in several animal models and clinical studies. Therefore, vafidemstat has the potential to become a first-in-class precision medicine approach to treat PMS patients. Aims: The goal of this research is to perform an observational trial to psychometrically characterize individuals carrying deletions in SHANK3 and build a foundation for subsequent precision psychiatry clinical trials with vafidemstat. Methodology: This study is characterizing the clinical profile of 20 to 40 subjects, > 16-year-old, with genotypically confirmed PMS diagnosis. Subjects will complete a battery of neuropsychological scales, including the Repetitive Behavior Questionnaire (RBQ), Vineland Adaptive Behavior Scales, Escala de Observación para el Diagnostico del Autismo (Autism Diagnostic Observational Scale) (ADOS)-2, the Battelle Developmental Inventory and the Behavior Problems Inventory (BPI). Results: By March 2021, 19 patients have been enrolled. Unsupervised hierarchical clustering of the results obtained so far identifies 3 groups of patients, characterized by different profiles of cognitive and behavioral scores. The first cluster is characterized by low Battelle age, high ADOS and low Vineland, RBQ and BPI scores. Low Vineland, RBQ and BPI scores are also detected in the second cluster, which in contrast has high Battelle age and low ADOS scores. The third cluster is somewhat in the middle for the Battelle, Vineland and ADOS scores while displaying the highest levels of aggression (high BPI) and repeated behaviors (high RBQ). In line with the observation that female patients are generally affected by milder forms of autistic symptoms, no male patients are present in the second cluster. Dividing the results by gender highlights that male patients in the third cluster are characterized by a higher frequency of aggression, whereas female patients from the same cluster display a tendency toward higher repetitive behavior. Finally, statistically significant differences in deletion sizes are detected comparing the three clusters (also after correcting for gender), and deletion size appears to be positively correlated with ADOS and negatively correlated with Vineland A and C scores. No correlation is detected between deletion size and the BPI and RBQ scores. Conclusions: Precision medicine may open a new way to understand and treat Central Nervous System disorders. Epigenetic dysregulation has been proposed to be an important mechanism in the pathogenesis of schizophrenia and autism. Vafidemstat holds exciting therapeutic potential in PMS, and this study will provide data regarding the optimal endpoints for a future clinical study to explore vafidemstat ability to treat shank3-associated psychiatric disorders.

Keywords: autism, epigenetics, LSD1, personalized medicine

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Authors: Yunwei Tang, Linhai Jing, Hui Li, Qingjie Liu, Xiuxia Li, Qi Yan, Haifeng Ding

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The giant panda (Ailuropoda melanoleuca) is an endangered species, mainly live in central China, where bamboos act as the main food source of wild giant pandas. Knowledge of spatial distribution of bamboos therefore becomes important for identifying the habitat of giant pandas. There have been ongoing studies for mapping bamboos and other tree species using remote sensing. WorldView-2 (WV-2) is the first high resolution commercial satellite with eight Multi-Spectral (MS) bands. Recent studies demonstrated that WV-2 imagery has a high potential in classification of tree species. The advanced classification techniques are important for utilising high spatial resolution imagery. It is generally agreed that object-based image analysis is a more desirable method than pixel-based analysis in processing high spatial resolution remotely sensed data. Classifiers that use spatial information combined with spectral information are known as contextual classifiers. It is suggested that contextual classifiers can achieve greater accuracy than non-contextual classifiers. Thus, spatial correlation can be incorporated into classifiers to improve classification results. The study area is located at Wuyipeng area in Wolong, Sichuan Province. The complex environment makes it difficult for information extraction since bamboos are sparsely distributed, mixed with brushes, and covered by other trees. Extensive fieldworks in Wuyingpeng were carried out twice. The first one was on 11th June, 2014, aiming at sampling feature locations for geometric correction and collecting training samples for classification. The second fieldwork was on 11th September, 2014, for the purposes of testing the classification results. In this study, spectral separability analysis was first performed to select appropriate MS bands for classification. Also, the reflectance analysis provided information for expanding sample points under the circumstance of knowing only a few. Then, a spatially weighted object-based k-nearest neighbour (k-NN) classifier was applied to the selected MS bands to identify seven land cover types (bamboo, conifer, broadleaf, mixed forest, brush, bare land, and shadow), accounting for spatial correlation within classes using geostatistical modelling. The spatially weighted k-NN method was compared with three alternatives: the traditional k-NN classifier, the Support Vector Machine (SVM) method and the Classification and Regression Tree (CART). Through field validation, it was proved that the classification result obtained using the spatially weighted k-NN method has the highest overall classification accuracy (77.61%) and Kappa coefficient (0.729); the producer’s accuracy and user’s accuracy achieve 81.25% and 95.12% for the bamboo class, respectively, also higher than the other methods. Photos of tree crowns were taken at sample locations using a fisheye camera, so the canopy density could be estimated. It is found that it is difficult to identify bamboo in the areas with a large canopy density (over 0.70); it is possible to extract bamboos in the areas with a median canopy density (from 0.2 to 0.7) and in a sparse forest (canopy density is less than 0.2). In summary, this study explores the ability of WV-2 imagery for bamboo extraction in a mountainous region in Sichuan. The study successfully identified the bamboo distribution, providing supporting knowledge for assessing the habitats of giant pandas.

Keywords: bamboo mapping, classification, geostatistics, k-NN, worldview-2

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Authors: Tugba Altin

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In an era marked by pronounced climate change consequences, communities are observed to confront traumatic events that yield both tangible and intangible repercussions. Such events not only cause discernible damage to the landscape but also deeply affect the intangible aspects, including emotional distress and disruptions to cultural landscapes. The Lytton Creek Fire of 2021 serves as a case in point. Beyond the visible destruction, the less overt but profoundly impactful disturbance to place attachment (PA) is scrutinized. PA, representing the emotional and cognitive bonds individuals establish with their environments, is crucial for understanding how such events impact cultural identity and connection to the land. The study underscores the significance of addressing both tangible and intangible traumas for holistic community recovery. As communities renegotiate their affiliations with altered environments, the cultural landscape emerges as instrumental in shaping place-based identities. This renewed understanding is pivotal for reshaping adaptation planning. The research advocates for adaptation strategies rooted in the lived experiences and testimonies of the affected populations. By incorporating both the tangible and intangible facets of trauma, planning efforts are suggested to be more culturally attuned and emotionally insightful, fostering true resonance with the affected communities. Through such a comprehensive lens, this study contributes enriching the climate change discourse, emphasizing the intertwined nature of tangible recovery and the imperative of emotional and cultural healing after environmental disasters. Following the pronounced aftermath of the Lytton Creek Fire in 2021, research aims to deeply understand its impact on place attachment (PA), encompassing the emotional and cognitive bonds individuals form with their environments. The interpretive phenomenological approach, enriched by a hermeneutic framework, is adopted, emphasizing the experiences of the Lytton community and co-researchers. Phenomenology informed the understanding of 'place' as the focal point of attachment, providing insights into its formation and evolution after traumatic events. Data collection departs from conventional methods. Instead of traditional interviews, walking audio sessions and photo elicitation methods are utilized. These allow co-researchers to immerse themselves in the environment, re-experience, and articulate memories and feelings in real-time. Walking audio facilitates reflections on spatial narratives post-trauma, while photo voices captured intangible emotions, enabling the visualization of place-based experiences. The analysis is collaborative, ensuring the co-researchers' experiences and interpretations are central. Emphasizing their agency in knowledge production, the process is rigorous, facilitated by the harmonious blend of interpretive phenomenology and hermeneutic insights. The findings underscore the need for adaptation and recovery efforts to address emotional traumas alongside tangible damages. By exploring PA post-disaster, the research not only fills a significant gap but advocates for an inclusive approach to community recovery. Furthermore, the participatory methodologies employed challenge traditional research paradigms, heralding potential shifts in qualitative research norms.

Keywords: wildfire recovery, place attachment, trauma recovery, cultural landscape, visual methodologies

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Authors: G. K. Viswanadh, B. Rajasekhar, G. Venkata Ramana

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Water distribution networks play a vital role in ensuring a reliable supply of clean water to urban areas. However, they face several challenges, including pressure control, pump speed optimization, and burst event detection. This paper combines insights from two studies to address these critical issues in Water distribution networks, focusing on the specific context of Kapra Municipality, India. The first part of this research concentrates on optimizing pressure control and pump speed in complex Water distribution networks. It utilizes the EPANET- MATLAB Toolkit to integrate EPANET functionalities into the MATLAB environment, offering a comprehensive approach to network analysis. By optimizing Pressure Reduce Valves (PRVs) and variable speed pumps (VSPs), this study achieves remarkable results. In the Benchmark Water Distribution System (WDS), the proposed PRV optimization algorithm reduces average leakage by 20.64%, surpassing the previous achievement of 16.07%. When applied to the South-Central and East zone WDS of Kapra Municipality, it identifies PRV locations that were previously missed by existing algorithms, resulting in average leakage reductions of 22.04% and 10.47%. These reductions translate to significant daily Water savings, enhancing Water supply reliability and reducing energy consumption. The second part of this research addresses the pressing issue of burst event detection and localization within the Water Distribution System. Burst events are a major contributor to Water losses and repair expenses. The study employs wireless sensor technology to monitor pressure and flow rate in real time, enabling the detection of pipeline abnormalities, particularly burst events. The methodology relies on transient analysis of pressure signals, utilizing Cumulative Sum and Wavelet analysis techniques to robustly identify burst occurrences. To enhance precision, burst event localization is achieved through meticulous analysis of time differentials in the arrival of negative pressure waveforms across distinct pressure sensing points, aided by nodal matrix analysis. To evaluate the effectiveness of this methodology, a PVC Water pipeline test bed is employed, demonstrating the algorithm's success in detecting pipeline burst events at flow rates of 2-3 l/s. Remarkably, the algorithm achieves a localization error of merely 3 meters, outperforming previously established algorithms. This research presents a significant advancement in efficient burst event detection and localization within Water pipelines, holding the potential to markedly curtail Water losses and the concomitant financial implications. In conclusion, this combined research addresses critical challenges in Water distribution networks, offering solutions for optimizing pressure control, pump speed, burst event detection, and localization. These findings contribute to the enhancement of Water Distribution System, resulting in improved Water supply reliability, reduced Water losses, and substantial cost savings. The integrated approach presented in this paper holds promise for municipalities and utilities seeking to improve the efficiency and sustainability of their Water distribution networks.

Keywords: pressure reduce valve, complex networks, variable speed pump, wavelet transform, burst detection, CUSUM (Cumulative Sum), water pipeline monitoring

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Authors: Merrick Lopez, Aashish Abraham, Melissa Egge, Marissa Hood, Jui Shah

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A 3 year old male with unknown medical history presented initially with encephalopathy, intubated for respiratory failure, and admitted to the pediatric intensive care unit (PICU) with refractory shock. During resuscitation in the emergency department, he was found to be in severe metabolic acidosis with a pH of 7.03 and escalated on vasopressor drips for hypotension. His initial sodium was 174. He was noted to have burn injuries to his scalp, forehead, right axilla, bilateral arm creases and lower legs. He had rhabdomyolysis (initial creatinine kinase 5,430 U/L with peak levels of 62,340 normal <335 U/L), cardiac injury (initial troponin 88 ng/L with peak at 145 ng/L, normal <15ng/L), hypernatremia (peak 174, normal 140), hypocalcemia, liver injury, acute kidney injury, and neuronal loss on magnetic resonance imaging (MRI). Soft restraints and a shock collar were found in the home. He was critically ill for 8 days, but was gradually weaned off drips, extubated, and started on feeds. Discussion Electrical injury, specifically lightning injury is an uncommon but devastating cause of injury in pediatric patients. This patient with suspected abusive use of a dog shock collar presented similar to a lightning strike. Common entrance points include the hands and head, similar to our patient with linear wounds on his forehead. When current enters, it passes through tissues with the least resistance. Nerves, blood vessels, and muscles, have high fluid and electrolyte content and are commonly affected. Exit points are extremities: our child who had circumferential burns around his arm creases and ankles. Linear burns preferentially follow areas of high sweat concentration, and are thought to be due to vaporization of water on the skin’s surface. The most common cause of death from a lightning strike is due to cardiopulmonary arrest. The massive depolarization of the myocardium can result in arrhythmias and myocardial necrosis. The patient presented in cardiogenic shock with evident cardiac damage. Electricity going through vessels can lead to vaporization of intravascular water. This can explain his severe hypernatremia. He also sustained other internal organ injuries (adrenal glands, pancreas, liver, and kidney). Electrical discharge also leads to direct skeletal muscle injury in addition to prolonged muscular spasm. Rhabdomyolysis, the acute damage of muscle, leads to release of potentially toxic components into the circulation which could lead to acute renal failure. The patient had severe rhabdomyolysis and renal injury. Early hypocalcemia has been consistently demonstrated in patients with rhabdomyolysis. This was present in the patient and led to increased vasopressor needs. Central nervous system injuries are also common which can include encephalopathy, hypoxic injury, and cerebral infarction. The patient had evidence of brain injury as seen on MRI. Conclusion Electrical injuries due to lightning strikes and abusive use of a dog shock collar are rare, but can both present in similar ways with respiratory failure, shock, hypernatremia, rhabdomyolysis, brain injury, and multiorgan damage. Although rare, it is essential for early identification and prompt management for acute and chronic complications in these children.

Keywords: cardiogenic shock, dog shock collar, lightning strike, rhabdomyolysis

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Authors: Wellemans Isabelle, Remmelink Myriam, Foucart Annick, Rusu Stefan, Compère Christophe

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Primary pulmonary meningioma (PPM) is a very rare tumor, and its occurrence has been reported only sporadically. Multiple PPMs are even more exceptional, and herein, we report, to the best of our knowledge, the fourth case, focusing on the clinicopathological features of the tumor. Moreover, the possible relationship between the use of progesterone–only contraceptives and the development of these neoplasms will be discussed. Case Report: We report a case of a 51-year-old female presenting three solid pulmonary nodules, with the following localizations: right upper lobe, middle lobe, and left lower lobe, described as incidental findings on computed tomography (CT) during a pre-bariatric surgery check-up. The patient revealed no drinking or smoking history. The physical exam was unremarkable except for the obesity. The lesions ranged in size between 6 and 24 mm and presented as solid nodules with lobulated contours. The largest lesion situated in the middle lobe had mild fluorodeoxyglucose (FDG) uptake on F-18 FDG positron emission tomography (PET)/CT, highly suggestive of primary lung neoplasm. For pathological assessment, video-assisted thoracoscopic middle lobectomy and wedge resection of the right upper nodule was performed. Histological examination revealed relatively well-circumscribed solid proliferation of bland meningothelial cells growing in whorls and lobular nests, presenting intranuclear pseudo-inclusions and psammoma bodies. No signs of anaplasia were observed. The meningothelial cells expressed diffusely Vimentin, focally Progesterone receptors and were negative for epithelial (cytokeratin (CK) AE1/AE3, CK7, CK20, Epithelial Membrane Antigen (EMA)), neuroendocrine markers (Synaptophysin, Chromogranin, CD56) and Estrogenic receptors. The proliferation labelling index Ki-67 was low (<5%). Metastatic meningioma was ruled out by brain and spine magnetic resonance imaging (MRI) scans. The third lesion localized in the left lower lobe was followed-up and resected three years later because of its slow but significant growth (14 mm to 16 mm), alongside two new infra centimetric lesions. Those three lesions showed a morphological and immunohistochemical profile similar to previously resected lesions. The patient was disease-free one year post-last surgery. Discussion: Although PPMs are mostly benign and slow-growing tumors with an excellent prognosis, they do not present specific radiological characteristics, and it is difficult to differentiate it from other lung tumors, histopathologic examination being essential. Aggressive behavior is associated with atypical or anaplastic features (WHO grades II–III) The etiology is still uncertain and different mechanisms have been proposed. A causal connection between sexual hormones and meningothelial proliferation has long been suspected and few studies examining progesterone only contraception and meningioma risk have all suggested an association. In line with this, our patient was treated with Levonorgestrel, a progesterone agonist, intra-uterine device (IUD). Conclusions: PPM, defined by the typical histological and immunohistochemical features of meningioma in the lungs and the absence of central nervous system lesions, is an extremely rare neoplasm, mainly solitary and associating, and indolent growth. Because of the unspecific radiologic findings, it should always be considered in the differential diagnosis of lung neoplasms. Regarding multiple PPM, only three cases are reported in the literature, and this is the first described in a woman treated by a progesterone-only IUD to the best of our knowledge.

Keywords: pulmonary meningioma, multiple meningioma, meningioma, pulmonary nodules

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