Search results for: occupational safety and health (OSH)
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 11775

Search results for: occupational safety and health (OSH)

8745 Financial Burden of Family for the Children with Autism Spectrum Disorder

Authors: M. R. Bhuiyan, S. M. M. Hossain, M. Z. Islam

Abstract:

Autism Spectrum Disorder (ASD) is the fastest growing serious developmental disorder characterized by social deficits, communicative difficulties, and repetitive behaviors. ASD is an emerging public health issue globally which is associated with huge financial burden to the family, community and the nation. The aim of this study was to assess the financial burden of family for the children with Autism spectrum Disorder. This cross-sectional study was carried out from July 2015 to June 2016 among 154 children with ASD to assess the financial burden of family. Data were collected by face-to-face interview with semi-structured questionnaire following systematic random sampling technique. Majority (73.4%) children were male and mean (±SD) age was 6.66 ± 2.97 years. Most (88.8%) of the children were from urban areas with average monthly family income Tk. 41785.71±23936.45. Average monthly direct cost of the children was Tk.17656.49 ± 9984.35, while indirect cost was Tk. 13462.90 ± 9713.54 and total treatment cost was Tk. 23076.62 ± 15341.09. Special education cost (Tk. 4871.00), cost of therapy (Tk. 4124.07) and travel cost (Tk. 3988.31) were the major types of direct cost, while loss of income (Tk.14570.18) was the chief indirect cost incurred by the families. The study found that majority (59.8%) of the children attended special schools were incurred Tk.20001-78700 as total treatment cost, which were statistically significant (p<0.001). Again, families with higher monthly family income incurred higher treatment cost (r=0.526, p<0.05). Difference between mean direct and indirect cost was found significant (t=4.190, df=61, p<0.001). According to the analysis of variance, mean difference of father’s educational status among direct cost (F=10.337, p<0.001) and total treatment cost (F=7.841, p<0.001), which were statistically significant. The study revealed that maximum children with ASD were under five years, three-fourth were male. According to monthly family income, maximum family were in middle class. The study recommends cost effective interventions and financial safety-net measures to reduce the financial burden of families for the children with ASD.

Keywords: autism spectrum disorder, financial burden, direct cost, indirect cost, special education

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8744 Individual and Contextual Factors Associated with Modern Contraceptive Use among Sexually Active Adolescents and Young Women in Zambia: A Multilevel Analysis

Authors: Chinyama Lukama, Million Phiri, Namuunda Mutombo

Abstract:

Background: Improving access and utilization to high-quality sexual and reproductive health (SRH) information and services, including family planning (FP) commodities, is central to the global developmental agenda of sub-Saharan Africa (SSA). Despite the importance of family planning use in enhancing maternal health outcomes and fertility reduction, the prevalence of adolescents and young women using modern contraception is generally low in SSA. Zambia is one of the countries in Southern Africa with a high prevalence of teenage pregnancies and fertility rates. Despite many initiatives that have been implemented to improve access and demand for family planning commodities, utilization of FP, especially among adolescents and young women, has generally been low. The objective of this research agenda was to better understand the determinants of modern contraceptive use in adolescents and young women in Zambia. This analysis produced findings that will be critical for informing the strengthening of sexual and reproductive health policy strategies aimed at bolstering the provision and use of maternal health services in order to further improve maternal health outcomes in the country. Method: The study used the recent data from the Demographic and Health Survey of 2018. A sample of 3,513 adolescents and young women (ADYW) were included in the analysis. Multilevel logistic regression models were employed to examine the association of individual and contextual factors with modern contraceptive use among adolescents and young women. Results: The prevalence of modern contraception among sexually active ADYW in Zambia was 38.1% [95% CI, 35.9, 40.4]. ADYW who had secondary or higher level education [aOR = 2.16, 95% CI=1.35–3.47], those with exposure to listening to the radio or watching television [aOR = 1.26, 95% CI=1.01–1.57], and those who had decision-making power at household level [aOR = 2.18, 95% CI=1.71–2.77] were more likely to use modern contraceptives. Conversely, strong neighborhood desire for large family size among ADYW [aOR = 0.65 95% CI = 0.47–0.88] was associated with less likelihood to use modern contraceptives. Community access to family planning information through community health worker visits increased the likelihood [aOR = 1.48, 95% CI=1.16–1.91] of using modern contraception among ADYW. Conclusion: The study found that both individual and community factors were key in influencing modern contraceptive use among adolescents and young women in Zambia. Therefore, when designing family planning interventions, the Government of Zambia, through its policymakers and sexual reproductive health program implementers at the Ministry of Health, in collaboration with stakeholders, should consider the community context. There should also be deliberate actions to encourage family planning education through the media.

Keywords: adolescents, young women, modern contraception use, fertility, family planning

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8743 Illness Perception and Health-Related Quality of Life among Young Females Living with Polycystic Ovary Syndrome

Authors: Vibha Kriti

Abstract:

Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder generally found in reproductive women. It is associated with significant reproductive, metabolic, cosmetic, and psychological consequences. Objective: There is a high prevalence of PCOS found among reproductive-age women, therefore, the major objective of the present study is to identify the illness perception of PCOS women and to explore the relationship between illness perception and health-related quality of life (HRQoL). Material and Method: A cross-sectional study was conducted in a university tertiary-care center, Sir Sunder Lal Hospital, Banaras Hindu University (B.H.U). Tools used for data collection were self-structured, which included socio-demographic status, illness perception questionnaire (revised version), and short-form 36 for assessing illness perception and health-related quality of life, respectively. Statistical analysis was done by SPSS version ‘24’. Results: The results of correlation analyses indicated that there is a strong relationship between strong illness perception and HRQoL. Stepwise regression indicated that illness identity, long illness duration, and severe consequences were associated with the worse outcome on emotional functioning and on social functioning. A high score on the controllability of the disease and seeking social support was significantly related to better functioning. Conclusion: Illness perception is an important factor in self-care behaviors in PCOS females and has a strong association with health-related quality of life and has a profound effect on it.

Keywords: polycystic ovary syndrome, illness perception, quality of life, young females, mental health

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8742 Tools and Techniques in Risk Assessment in Public Risk Management Organisations

Authors: Atousa Khodadadyan, Gabe Mythen, Hirbod Assa, Beverley Bishop

Abstract:

Risk assessment and the knowledge provided through this process is a crucial part of any decision-making process in the management of risks and uncertainties. Failure in assessment of risks can cause inadequacy in the entire process of risk management, which in turn can lead to failure in achieving organisational objectives as well as having significant damaging consequences on populations affected by the potential risks being assessed. The choice of tools and techniques in risk assessment can influence the degree and scope of decision-making and subsequently the risk response strategy. There are various available qualitative and quantitative tools and techniques that are deployed within the broad process of risk assessment. The sheer diversity of tools and techniques available to practitioners makes it difficult for organisations to consistently employ the most appropriate methods. This tools and techniques adaptation is rendered more difficult in public risk regulation organisations due to the sensitive and complex nature of their activities. This is particularly the case in areas relating to the environment, food, and human health and safety, when organisational goals are tied up with societal, political and individuals’ goals at national and international levels. Hence, recognising, analysing and evaluating different decision support tools and techniques employed in assessing risks in public risk management organisations was considered. This research is part of a mixed method study which aimed to examine the perception of risk assessment and the extent to which organisations practise risk assessment’ tools and techniques. The study adopted a semi-structured questionnaire with qualitative and quantitative data analysis to include a range of public risk regulation organisations from the UK, Germany, France, Belgium and the Netherlands. The results indicated the public risk management organisations mainly use diverse tools and techniques in the risk assessment process. The primary hazard analysis; brainstorming; hazard analysis and critical control points were described as the most practiced risk identification techniques. Within qualitative and quantitative risk analysis, the participants named the expert judgement, risk probability and impact assessment, sensitivity analysis and data gathering and representation as the most practised techniques.

Keywords: decision-making, public risk management organisations, risk assessment, tools and techniques

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8741 Optimization Based Obstacle Avoidance

Authors: R. Dariani, S. Schmidt, R. Kasper

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Based on a non-linear single track model which describes the dynamics of vehicle, an optimal path planning strategy is developed. Real time optimization is used to generate reference control values to allow leading the vehicle alongside a calculated lane which is optimal for different objectives such as energy consumption, run time, safety or comfort characteristics. Strict mathematic formulation of the autonomous driving allows taking decision on undefined situation such as lane change or obstacle avoidance. Based on position of the vehicle, lane situation and obstacle position, the optimization problem is reformulated in real-time to avoid the obstacle and any car crash.

Keywords: autonomous driving, obstacle avoidance, optimal control, path planning

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8740 Preparedness of the Mae Hong Son Province for the Aging Society

Authors: Siwaporn Mahathamnuchock, Krit Phanpanya

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This survey study aims 1) to investigate the preparation of Mae Hong Son people for entering into the aging society 2) to study awareness of public health preparedness for the aging society of Mae Hong Son Province Administrative Organization. The samples used in this study were people aged 55-60 years in Mae Hong Province. Located at Khun Yuam Sub district, Khun Yuam District, Pang Ma Pha Sub district, Pang Ma Pha District, Thung Yao Sub district, Pai District, Mae ka Tuan Sub district, Sob Moei District, Mae Sariang Sub district, Mae Sariang District, Mae Tho Sub district, Mae La Noi District. And Huai Pha Sub district, Muang Mae Hong District. The data were collected from 1,088 people by Stratified sampling Method. The instrument used in this study were 36 items of questionnaire that contains three parts: 1) Sample’s general information 2) The Interview of Mae Hong Son people’s preparation before entering aging society. 3) The Interview about preparedness of health for the aging society of Mae Hong Son Province Administrative Organization. Then analyzed the data by using percentage and standard deviation. The research found that Mae Hong Son people are preparing for an aging society as followed; psychological, residence, physical health, careers and leisure time on a large scale with an average of 3.81 (SD=0.88), 3.66 (SD=0.99), 3.53(SD=1.04) and 3.51(SD=0.89), respectively. However finances and saving were prepared on moderate scale with an average of 2.84(SD=0.89) and in the awareness of public health preparedness for the aging society of Mae Hong Son Province Administrative Organization were moderate with an average of 2.99 (SD=1.07).

Keywords: aging society, preparedness, perception, Mae Hong Son province

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8739 Relationship between Job Satisfaction, Job Stressors and Long Term Physical Morbidities among University Employees in Pakistan

Authors: Shahzad A. Mughal, Ameer A. P. Ghaloo, Faisal Laghari, Mohsin A. Mirza

Abstract:

Job satisfaction and level of job stressors among employees of a university are considered as essential factors responsible for institutional success. Job satisfaction is usually believed as a single baseline variable for the evaluation of a university human resource area. The objectives of this study were to assess the level of job satisfaction and influence of job stressors among university teachers and their association with long term physical health of the employees in government sector universities in Pakistan. A cross-sectional study was conducted on university employees including faculty members and administrative staff of three government sector universities in Sindh province of Pakistan who have completed at least ten years of their job. The study period was six months. All the employees were randomly selected. The job satisfaction scale Questionnaire with yes and no options, together with questions regarding demographic factors, job stress or other working factors and physical health issues were administered in questionnaires. These questionnaires were handed out to 100 faculty members of both genders with permanent job and 50 non faculty staff of grade 17 and above with permanent employment status. Students’ T test and one way ANOVA was applied to categorical variables and Pearson’s correlation analysis was performed to evaluate the correlations between study variables. 121 successful responses were obtained (effective respondent rate 80.6%). The average score of overall job satisfaction was 65.6%. Statistical analysis revealed that the job satisfaction and work related stressors had negative impact on overall health status of the employees with resultant less efficacy and mental stress. The positive relation was perceived by employees for organizational support and high income with job satisfaction. Demographic features such as age and female gender were also linked to the level of job satisfaction and health related issues. The total variation among all responses regarding correlation between job satisfaction job stressors and health related issues was 55%. A study was conducted on University employees of government sector Universities in Pakistan, regarding association of job satisfaction and job stressors with long term physical health of the employees. Study revealed a moderate level of job satisfaction among the employees of all universities included in this study. Attitude and personal relations with heads of the departments and institution along with salary packages were considered as biggest job stressors related correlated directly with physical health. Demographic features and gender were associated factors for job satisfaction. Organizational support was the strongest factor for job satisfaction and results pointed out that by improving support level from University may improve the quality of job satisfaction and overall health of employees.

Keywords: job satisfaction, organizational support, physical health, university employees

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8738 A Nutritional Wellness Program for Overweight Health Care Providers in Hospital Setting: A Randomized Controlled Trial Pilot Study

Authors: Kim H. K. Choy, Oliva H. K. Chu, W. Y. Keung, B. Lim, Winnie P. Y. Tang

Abstract:

Background: The prevalence of workplace obesity is rising worldwide; therefore, the workplace is an ideal venue to implement weight control intervention. This pilot randomized controlled trial aimed to develop, implement, and evaluate a nutritional wellness program for obese health care providers working in a hospital. Methods: This hospital-based nutritional wellness program was an 8-week pilot randomized controlled trial for obese health care providers. The primary outcomes were body weight and body mass index (BMI). The secondary outcomes were serum fasting glucose, fasting cholesterol, triglyceride, high-density (HDL) and low-density (LDL) lipoprotein, body fat percentage, and body mass. Participants were randomly assigned to the intervention (n = 20) or control (n = 22) group. Participants in both groups received individual nutrition counselling and nutrition pamphlets, whereas only participants in the intervention group were given mobile phone text messages. Results: 42 participants completed the study. In comparison with the control group, the intervention group showed approximately 0.98 kg weight reduction after two months. Participants in intervention group also demonstrated clinically significant improvement in BMI, serum cholesterol level, and HDL level. There was no improvement of body fat percentage and body mass for both intervention and control groups. Conclusion: The nutritional wellness program for obese health care providers was feasible in hospital settings. Health care providers demonstrated short-term weight loss, decrease in serum fasting cholesterol level, and HDL level after completing the program.

Keywords: weight management, weight control, health care providers, hospital

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8737 Identifying Indicative Health Behaviours and Psychosocial Factors Affecting Multi-morbidity Conditions in Ageing Populations: Preliminary Results from the ELSA study of Ageing

Authors: Briony Gray, Glenn Simpson, Hajira Dambha-Miller, Andrew Farmer

Abstract:

Multimorbidity may be strongly affected by a variety of conditions, factors, and variables requiring higher demands on health and social care services, infrastructure, and expenses. Holding one or more conditions increases one’s risk for development of future conditions; with patients over 65 years old at highest risk. Psychosocial factors such as anxiety and depression are rising exponentially globally, which has been amplified by the COVID19 pandemic. These are highly correlated and predict poorer outcomes when held in coexistence and increase the likelihood of comorbid physical health conditions. While possible future reform of social and healthcare systems may help to alleviate some of these mounting pressures, there remains an urgent need to better understand the potential role health behaviours and psychosocial conditions - such as anxiety and depression – may have on aging populations. Using the UK healthcare scene as a lens for analysis, this study uses big data collected in the UK Longitudinal Study of Aging (ELSA) to examine the role of anxiety and depression in ageing populations (65yrs+). Using logistic regression modelling, results identify the 10 most significant variables correlated with both anxiety and depression from data categorised into the areas of health behaviour, psychosocial, socioeconomic, and life satisfaction (each demonstrated through literature review to be of significance). These are compared with wider global research findings with the aim of better understanding the areas in which social and healthcare reform can support multimorbidity interventions, making suggestions for improved patient-centred care. Scope of future research is outlined, which includes analysis of 59 total multimorbidity variables from the ELSA dataset, going beyond anxiety and depression.

Keywords: multimorbidity, health behaviours, patient centred care, psychosocial factors

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8736 Mental Health Impacts of COVID-19 on Diverse Youth and Families in Canada

Authors: Lucksini Raveendran

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Introduction: This mixed-methods study focuses on the experiences of ethnocultural youth and families in Canada, identifying key barriers and opportunities to inform service programming and policies that can better meet their mental health needs during the COVID-19 pandemic and beyond. Methods: Mental Health Commission of Canada's Headstrong initiative administered the youth survey (April – June 2020) and family survey (June – August 2020) with a total sample size of 137 and 481 respondents, respectively. Thematic analysis was conducted to identify key challenges faced, coping strategies used, and help-seeking behaviours. A similar approach was also applied to the family survey data, but instead, a representative sample was collated to analyze geographically variable and ethnically diverse subgroups. Results and analysis: Multiple challenges have impacted families, including increased feelings of loneliness and distress from border travel restrictions, especially among those navigating pregnancy alone or managing children with developmental needs, which is often understudied. Also, marginalized groups were disproportionately affected by inequitable access to communication technologies, further deepening the digital divide. Some reported living in congregated homes with regular conflicts, thus leading to increased anxiety and exposure to violence. For many families, urbanicity and ethnicity played a key role in how families reported coping with feelings of uncertainty while managing work commitments, navigating community resources, fulfilling care responsibilities, and homeschooling children of all ages. Despite these challenges, there was evidence of post-traumatic growth and building community resiliency. Conclusions and implications for policy, practice, or additional research: There is a need to foster opportunities to promote and sustain mental health, wellness, and resilience for families through social connections. Also, intersectionality must be embedded in the collection, analysis, and application of data to improve equitable access to evidence-based and recovery-oriented mental health supports among diverse families in Canada. Lastly, address future research on the long-term COVID-19 impacts of travel border restrictions on family wellness.

Keywords: mental health, youth mental health, family wellness, health equity

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8735 Exploring the Influence of Culture on Dietary Practices and Ethnic Inequality in Health among Migrant Nigerians in the UK

Authors: Babatunde Johnson

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The rate of diseases and death from preventable diseases among ethnic minority groups is high when compared with the wider white population in the UK. This can be due in part to the diet consumed and various cultural reasons. Changes in dietary practices and the health of ethnic minority groups can be caused by the adoption of food practices of the host culture after migration (acculturation) and generational differences among migrants. However, understanding how and why these changes occur is limited due to the challenges of data collection in research. This research utilizes the interpretive phenomenological approach, coupled with Bourdieu’s theory used as the conceptual framework, and seeks an in-depth understanding of how adult immigrant Nigerians in the UK interpret their experience of the influence of ethnic and prevailing cultures on their dietary practice. Recruiting participants from a close-knit community, such as the Nigerian population in the UK, can be complex and problematic and is determined by the accessibility to the community. Although complex, the researcher leveraged the principles of Patient and Public Involvement (PPI) in gaining access to participants within the Nigerian community. This study emphasizes the need for a culturally tailored and community-centered approach to interventions geared toward the reduction of ethnic health inequality in the UK other than the existing practice, which focuses on better healthy eating through the improvement of skills and knowledge about food groups.

Keywords: culture, dietary practice, ethnic minority, health inequality

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8734 Safety Validation of Black-Box Autonomous Systems: A Multi-Fidelity Reinforcement Learning Approach

Authors: Jared Beard, Ali Baheri

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As autonomous systems become more prominent in society, ensuring their safe application becomes increasingly important. This is clearly demonstrated with autonomous cars traveling through a crowded city or robots traversing a warehouse with heavy equipment. Human environments can be complex, having high dimensional state and action spaces. This gives rise to two problems. One being that analytic solutions may not be possible. The other is that in simulation based approaches, searching the entirety of the problem space could be computationally intractable, ruling out formal methods. To overcome this, approximate solutions may seek to find failures or estimate their likelihood of occurrence. One such approach is adaptive stress testing (AST) which uses reinforcement learning to induce failures in the system. The premise of which is that a learned model can be used to help find new failure scenarios, making better use of simulations. In spite of these failures AST fails to find particularly sparse failures and can be inclined to find similar solutions to those found previously. To help overcome this, multi-fidelity learning can be used to alleviate this overuse of information. That is, information in lower fidelity can simulations can be used to build up samples less expensively, and more effectively cover the solution space to find a broader set of failures. Recent work in multi-fidelity learning has passed information bidirectionally using “knows what it knows” (KWIK) reinforcement learners to minimize the number of samples in high fidelity simulators (thereby reducing computation time and load). The contribution of this work, then, is development of the bidirectional multi-fidelity AST framework. Such an algorithm, uses multi-fidelity KWIK learners in an adversarial context to find failure modes. Thus far, a KWIK learner has been used to train an adversary in a grid world to prevent an agent from reaching its goal; thus demonstrating the utility of KWIK learners in an AST framework. The next step is implementation of the bidirectional multi-fidelity AST framework described. Testing will be conducted in a grid world containing an agent attempting to reach a goal position and adversary tasked with intercepting the agent as demonstrated previously. Fidelities will be modified by adjusting the size of a time-step, with higher-fidelity effectively allowing for more responsive closed loop feedback. Results will compare the single KWIK AST learner with the multi-fidelity algorithm with respect to number of samples, distinct failure modes found, and relative effect of learning after a number of trials.

Keywords: multi-fidelity reinforcement learning, multi-fidelity simulation, safety validation, falsification

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8733 Optimizing Coal Yard Management Using Discrete Event Simulation

Authors: Iqbal Felani

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A Coal-Fired Power Plant has some integrated facilities to handle coal from three separated coal yards to eight units power plant’s bunker. But nowadays the facilities are not reliable enough for supporting the system. Management planned to invest some facilities to increase the reliability. They also had a plan to make single spesification of coal used all of the units, called Single Quality Coal (SQC). This simulation would compare before and after improvement with two scenarios i.e First In First Out (FIFO) and Last In First Out (LIFO). Some parameters like stay time, reorder point and safety stock is determined by the simulation. Discrete event simulation based software, Flexsim 5.0, is used to help the simulation. Based on the simulation, Single Quality Coal with FIFO scenario has the shortest staytime with 8.38 days.

Keywords: Coal Yard Management, Discrete event simulation First In First Out, Last In First Out.

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8732 Preliminary Evaluation of Passive UHF-Band RFID for Identifying Floating Objects on the Sea

Authors: Yasuhiro Sato, Kodai Noma, Kenta Sawada, Kazumasa Adachi, Yoshinori Matsuura, Saori Iwanaga

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RFID system is used to identify objects such as passenger identification in public transportation, instead of linear or 2-dimensional barcodes. Key advantages of RFID system are to identify objects without physical contact, and to write arbitrary information into RFID tag. These advantages may help to improve maritime safety and efficiency of activity on the sea. However, utilization of RFID system for maritime scenes has not been considered. In this paper, we evaluate the availability of a generic RFID system operating on the sea. We measure RSSI between RFID tag floating on the sea and RFID antenna, and check whether a RFID reader can access a tag or not, while the distance between a floating buoy and the ship, and the angle are changed. Finally, we discuss the feasibility and the applicability of RFID system on the sea through the results of our preliminary experiment.

Keywords: RFID, experimental evaluation, RSSI, maritime use

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8731 A Quality Improvement Approach for Reducing Stigma and Discrimination against Young Key Populations in the Delivery of Sexual Reproductive Health and Rights Services

Authors: Atucungwiire Rwebiita

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Introduction: In Uganda, provision of adolescent sexual reproductive health and rights (SRHR) services for key population is still hindered by negative attitudes, stigma and discrimination (S&D) at both the community and facility levels. To address this barrier, Integrated Community Based Initiatives (ICOBI) with support from SIDA is currently implementing a quality improvement (QI) innovative approach for strengthening the capacity of key population (KP) peer leaders and health workers to deliver friendly SRHR services without S&D. Methods: Our innovative approach involves continuous mentorship and coaching of 8 QI teams at 8 health facilities and their catchment areas. Each of the 8 teams (comprised of 5 health workers and 5 KP peer leaders) are facilitated twice a month by two QI Mentors in a 2-hour mentorship session over a period of 4 months. The QI mentors were provided a 2-weeks training on QI approaches for reducing S&D against young key populations in the delivery of SRHR Services. The mentorship sessions are guided by a manual where teams base to analyse root causes of S&D and develop key performance indicators (KPIs) in the 1st and 2nd second sessions respectively. The teams then develop action plans in the 3rd session and review implementation progress on KPIs at the end of subsequent sessions. The KPIs capture information on the attitude of health workers and peer leaders and the general service delivery setting as well as clients’ experience. A dashboard is developed to routinely track the KPIs for S&D across all the supported health facilities and catchment areas. After 4 months, QI teams share documented QI best practices and tested change packages on S&D in a learning and exchange session involving all the teams. Findings: The implementation of this approach is showing positive results. So far, QI teams have already identified the root causes of S&D against key populations including: poor information among health workers, fear of a perceived risk of infection, perceived links between HIV and disreputable behaviour. Others are perceptions that HIV & STIs are divine punishment, sex work and homosexuality are against religion and cultural values. They have also noted the perception that MSM are mentally sick and a danger to everyone. Eight QI teams have developed action plans to address the root causes of S&D. Conclusion: This approach is promising, offers a novel and scalable means to implement stigma-reduction interventions in facility and community settings.

Keywords: key populations, sexual reproductive health and rights, stigma and discrimination , quality improvement approach

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8730 Green Design Study of Prefabricated Community Control Measures in Response to Public Health Emergencies

Authors: Enjia Zhang

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During the prevention and control of the COVID-19 pandemic, all communities in China were gated and under strict management, which was highly effective in preventing the spread of the epidemic from spreading. Based on the TRIZ theory, this paper intends to propose green design strategies of community control in response to public health emergencies and to optimize community control facilities according to the principle of minimum transformation. Through the questionnaire method, this paper investigates and summarizes the situation and problems of community control during the COVID-19 pandemic. Based on these problems, the TRIZ theory is introduced to figure out the problems and associates them with prefabricated facilities. Afterward, the innovation points and solutions of prefabricated community control measures are proposed by using the contradiction matrix. This paper summarizes the current situation of community control under public health emergencies and concludes the problems such as simple forms of temporary roadblocks, sudden increase of community traffic pressure, and difficulties to access public spaces. The importance of entrance and exit control in community control is emphasized. Therefore, the community control measures are supposed to focus on traffic control, and the external access control measures, including motor vehicles, non-motor vehicles, residents and non-residents access control, and internal public space access control measures, including public space control shared with the society or adjacent communities, are proposed in order to make the community keep the open characteristics and have the flexibility to deal with sudden public health emergencies in the future.

Keywords: green design, community control, prefabricated structure, public health emergency

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8729 Design and Implementation of a Memory Safety Isolation Method Based on the Xen Cloud Environment

Authors: Dengpan Wu, Dan Liu

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In view of the present cloud security problem has increasingly become one of the major obstacles hindering the development of the cloud computing, put forward a kind of memory based on Xen cloud environment security isolation technology implementation. And based on Xen virtual machine monitor system, analysis of the model of memory virtualization is implemented, using Xen memory virtualization system mechanism of super calls and grant table, based on the virtual machine manager internal implementation of access control module (ACM) to design the security isolation system memory. Experiments show that, the system can effectively isolate different customer domain OS between illegal access to memory data.

Keywords: cloud security, memory isolation, xen, virtual machine

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8728 Analytical Study of the Structural Response to Near-Field Earthquakes

Authors: Isidro Perez, Maryam Nazari

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Numerous earthquakes, which have taken place across the world, led to catastrophic damage and collapse of structures (e.g., 1971 San Fernando; 1995 Kobe-Japan; and 2010 Chile earthquakes). Engineers are constantly studying methods to moderate the effect this phenomenon has on structures to further reduce damage, costs, and ultimately to provide life safety to occupants. However, there are regions where structures, cities, or water reservoirs are built near fault lines. When an earthquake occurs near the fault lines, they can be categorized as near-field earthquakes. In contrary, a far-field earthquake occurs when the region is further away from the seismic source. A near-field earthquake generally has a higher initial peak resulting in a larger seismic response, when compared to a far-field earthquake ground motion. These larger responses may result in serious consequences in terms of structural damage which can result in a high risk for the public’s safety. Unfortunately, the response of structures subjected to near-field records are not properly reflected in the current building design specifications. For example, in ASCE 7-10, the design response spectrum is mostly based on the far-field design-level earthquakes. This may result in the catastrophic damage of structures that are not properly designed for near-field earthquakes. This research investigates the knowledge that the effect of near-field earthquakes has on the response of structures. To fully examine this topic, a structure was designed following the current seismic building design specifications, e.g. ASCE 7-10 and ACI 318-14, being analytically modeled, utilizing the SAP2000 software. Next, utilizing the FEMA P695 report, several near-field and far-field earthquakes were selected, and the near-field earthquake records were scaled to represent the design-level ground motions. Upon doing this, the prototype structural model, created using SAP2000, was subjected to the scaled ground motions. A Linear Time History Analysis and Pushover analysis were conducted on SAP2000 for evaluation of the structural seismic responses. On average, the structure experienced an 8% and 1% increase in story drift and absolute acceleration, respectively, when subjected to the near-field earthquake ground motions. The pushover analysis was ran to find and aid in properly defining the hinge formation in the structure when conducting the nonlinear time history analysis. A near-field ground motion is characterized by a high-energy pulse, making it unique to other earthquake ground motions. Therefore, pulse extraction methods were used in this research to estimate the maximum response of structures subjected to near-field motions. The results will be utilized in the generation of a design spectrum for the estimation of design forces for buildings subjected to NF ground motions.

Keywords: near-field, pulse, pushover, time-history

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8727 Risk Based Inspection and Proactive Maintenance for Civil and Structural Assets in Oil and Gas Plants

Authors: Mohammad Nazri Mustafa, Sh Norliza Sy Salim, Pedram Hatami Abdullah

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Civil and structural assets normally have an average of more than 30 years of design life. Adding to this advantage, the assets are normally subjected to slow degradation process. Due to the fact that repair and strengthening work for these assets are normally not dependent on plant shut down, the maintenance and integrity restoration of these assets are mostly done based on “as required” and “run to failure” basis. However unlike other industries, the exposure in oil and gas environment is harsher as the result of corrosive soil and groundwater, chemical spill, frequent wetting and drying, icing and de-icing, steam and heat, etc. Due to this type of exposure and the increasing level of structural defects and rectification in line with the increasing age of plants, assets integrity assessment requires a more defined scope and procedures that needs to be based on risk and assets criticality. This leads to the establishment of risk based inspection and proactive maintenance procedure for civil and structural assets. To date there is hardly any procedure and guideline as far as integrity assessment and systematic inspection and maintenance of civil and structural assets (onshore) are concerned. Group Technical Solutions has developed a procedure and guideline that takes into consideration credible failure scenario, assets risk and criticality from process safety and structural engineering perspective, structural importance, modeling and analysis among others. Detailed inspection that includes destructive and non-destructive tests (DT & NDT) and structural monitoring is also being performed to quantify defects, assess severity and impact on integrity as well as identify the timeline for integrity restoration. Each defect and its credible failure scenario is assessed against the risk on people, environment, reputation and production loss. This technical paper is intended to share on the established procedure and guideline and their execution in oil & gas plants. In line with the overall roadmap, the procedure and guideline will form part of specialized solutions to increase production and to meet the “Operational Excellence” target while extending service life of civil and structural assets. As the result of implementation, the management of civil and structural assets is now more systematically done and the “fire-fighting” mode of maintenance is being gradually phased out and replaced by a proactive and preventive approach. This technical paper will also set the criteria and pose the challenge to the industry for innovative repair and strengthening methods for civil & structural assets in oil & gas environment, in line with safety, constructability and continuous modification and revamp of plant facilities to meet production demand.

Keywords: assets criticality, credible failure scenario, proactive and preventive maintenance, risk based inspection

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8726 Integration of FMEA and Human Factor in the Food Chain Risk Assessment

Authors: Mohsen Shirani, Micaela Demichela

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During the last decades, a number of food crises such as Bovine Spongiform Encephalopathy (BSE), Mad-Cow disease, Dioxin in chicken food, Food-and-Mouth Disease (FMD), have certainly inflicted the reliability of the food industry. Consequently, the trend in applying different scientific methods of risk assessment in food safety has obtained more attentions in the academic and practice. However, lack of practical approach considering entire food supply chain is tangible in the academic literature. In this regard, this paper aims to apply risk assessment tool (FMEA) with integration of Human Factor along the entire supply chain of food production and test the method in a case study of Diary production, and analyze its results.

Keywords: FMEA, food supply chain, risk assessment, human factor

Procedia PDF Downloads 447
8725 Assessing the Quality of Maternity Care in Sub-Saharan Africa Using the Donabedian Quality of Care Framework: A Systematic Scoping Review

Authors: Bernice Boafoaa Gyapong, Anne Jones, Sam Bassett, Janet Anderson

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Background: Maternal mortality and morbidity are global concerns, especially in sub-Saharan Africa (SSA). Most maternal mortalities occur at the time of birth. Quality intrapartum care is essential for improving maternal and newborn health outcomes. This scoping review aimed to assess and describe the quality of care during childbirth in SSA to provide an overview of the regional trend of the quality of intrapartum care, the challenges to quality care provision, and identify research gaps. Methods: A scoping review based on Arksey and O’Malley’s scoping review framework was conducted. Medline, CINAHL, PsycINFO, and maternal-infant databases were searched to identify the relevant studies for this review. A narrative summary was presented using themes based on the Donabedian structure, process, and outcome quality of care model. Results: A total of five hundred and forty-seven (547) publications were identified. Fifty-six (56) studies conducted in twenty (20) countries were included in the review. Thirty-four (34) were quantitative, sixteen (16) were qualitative, and six (6) were mixed methods. Most of the studies were related to the process component of quality of care. The provision of emergency obstetric care services, infrastructure, and availability of essential staff and equipment for perinatal care was inadequate in many facilities, particularly rural and peripheral health facilities. Many women experienced disrespectful care during childbirth. Routine care during labour and delivery was observed to be sub-optimal, yet some women reported high satisfaction with care. The use of health facilities for delivery was lower in health centres compared to hospitals. Conclusion: There are variations in the quality of maternity care provided in SSA. Intrapartum care quality is generally deficient in SSA, particularly in peripheral health facilities, health centres, and community clinics. Many of the quality-of-care issues identified are related to the structure component. Stakeholders must develop interventions that comprehensively address these interrelated issues to improve maternal healthcare quality, especially in primary healthcare facilities.

Keywords: quality of care, maternity health, Sub-Saharan Africa, intrapartum

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8724 Geotechnical Engineering Solutions for Adaptation

Authors: Johnstone Walubengo Wangusi

Abstract:

Geotechnical engineering is a multidisciplinary field that encompasses the study of soil, rock, and groundwater properties and their interactions with civil engineering structures. This research paper provides an in-depth overview of geotechnical engineering, covering its fundamental principles, applications in civil infrastructure projects, and the challenges faced by practitioners in the field. Through a comprehensive examination of soil mechanics, foundation design, slope stability analysis, and geotechnical site investigation techniques, this paper aims to highlight the importance of geotechnical engineering in ensuring the safety, stability, and sustainability of infrastructure development. Additionally, it discusses emerging trends, innovative technologies, and future directions in geotechnical engineering research and practice.

Keywords: sustainable geotechnical engineering solutions, education and training for future generations geotechnical engineers, integration of geotechnical engineering and structural engineering, use of AI in geotechnical engineering modelling

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8723 An Electrochemical Enzymatic Biosensor Based on Multi-Walled Carbon Nanotubes and Poly (3,4 Ethylenedioxythiophene) Nanocomposites for Organophosphate Detection

Authors: Navpreet Kaur, Himkusha Thakur, Nirmal Prabhakar

Abstract:

The most controversial issue in crop production is the use of Organophosphate insecticides. This is evident in many reports that Organophosphate (OP) insecticides, among the broad range of pesticides are mainly involved in acute and chronic poisoning cases. OPs detection is of crucial importance for health protection, food and environmental safety. In our study, a nanocomposite of poly (3,4 ethylenedioxythiophene) (PEDOT) and multi-walled carbon nanotubes (MWCNTs) has been deposited electrochemically onto the surface of fluorine doped tin oxide sheets (FTO) for the analysis of malathion OP. The -COOH functionalization of MWCNTs has been done for the covalent binding with amino groups of AChE enzyme. The use of PEDOT-MWCNT films exhibited an excellent conductivity, enables fast transfer kinetics and provided a favourable biocompatible microenvironment for AChE, for the significant malathion OP detection. The prepared biosensors were characterized by Fourier transform infrared spectrometry (FTIR), Field emission-scanning electron microscopy (FE-SEM) and electrochemical studies. Various optimization studies were done for different parameters including pH (7.5), AChE concentration (50 mU), substrate concentration (0.3 mM) and inhibition time (10 min). Substrate kinetics has been performed and studied for the determination of Michaelis Menten constant. The detection limit for malathion OP was calculated to be 1 fM within the linear range 1 fM to 1 µM. The activity of inhibited AChE enzyme was restored to 98% of its original value by 2-pyridine aldoxime methiodide (2-PAM) (5 mM) treatment for 11 min. The oxime 2-PAM is able to remove malathion from the active site of AChE by means of trans-esterification reaction. The storage stability and reusability of the prepared biosensor is observed to be 30 days and seven times, respectively. The application of the developed biosensor has also been evaluated for spiked lettuce sample. Recoveries of malathion from the spiked lettuce sample ranged between 96-98%. The low detection limit obtained by the developed biosensor made them reliable, sensitive and a low cost process.

Keywords: PEDOT-MWCNT, malathion, organophosphates, acetylcholinesterase, biosensor, oxime (2-PAM)

Procedia PDF Downloads 445
8722 Assessment of Utilization of Provider Initiated HIV Testing and Counseling and Associated Factors among Adult out Patient Department Patients in Wonchi Woreda, South West Shoa Zone, Central Ethiopia

Authors: Dinka Fikadu, Mulugeta Shegaze

Abstract:

Background: Currently in health facility, provider-initiated human immunodeficiency virus testing is the key entry point to prevention, care, treatment and support services, but most people remains unaware of their HIV status due to various reasons. In many high-prevalence countries, fewer than one in ten people with HIV are aware of their HIV status. HIV, the virus that causes AIDS, “acquired immunodeficiency syndrome, "has become one of the world’s most serious health and development challenges. Reaching individuals with HIV who do not know their serostatus is a global public health priority. Objective: To assess utilization of provider initiated HIV testing and counseling and associated factors among adult outpatient department patients. Methods: Health facility based cross sectional study was conducted among 392 adult outpatient department patients in Wonchi woreda from February 24 to March 24 /2013. The study participant was recruited patients from all adult outpatient department patients of all four public health facilities of wonchi woreda using systematic sampling. A structured interviewer administered questionnaire was used to elicit all important variables from the study participants and multiple logistic regression analysis was used. Result: A total of 371 adult outpatient department patients aged between 15 to 64 years were actively participated in the study and 291(78.4%) of them utilized provider initiated HIV testing and counseling and 80(21.6%) of them refused. Knowledge on HIV is low in the study population; majority of the participants didn’t have comprehensive knowledge (64.7%) and (35.3%) fail to reject misconception about means of HIV transmission and prevention. Utilization of provider-initiated HIV testing and counseling were associated with divorced/widowed marital status[AOR (95%CI) = 0.32(0.15, 0.69)], being male sex [AOR (95%CI) =1.81(1.01, 3.24)], having comprehensive knowledge on HIV [AOR (95%CI) =0.408(0.220,0.759)],having awareness about provider initiated HIV testing and counseling [AOR(95%CI) =2.89(1.48,5.66)] and receiving test on HIV before[AOR (95%CI)=4.15(2.30, 7.47)]. Conclusion: Utilization of provider initiated HIV testing and counseling among adult outpatient departments in wonchi woreda public health facility was [(78.4%)].Strengthening health information through mass media and peer education on HIV to address barrier to testing in the community such as low awareness on PITC, to increase up take of PITC among adult OPD patients.

Keywords: utilization, human immune deficiency, testing, provider, initiate

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8721 Wind Turbine Control Performance Evaluation Based on Minimum-Variance Principles

Authors: Zheming Cao

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Control loops are the most important components in the wind turbine system. Product quality, operation safety, and the economic performance are directly or indirectly connected to the performance of control systems. This paper proposed a performance evaluation method based on minimum-variance for wind turbine control system. This method can be applied on PID controller for pitch control system in the wind turbine. The good performance result demonstrated in the paper was achieved by retuning and optimizing the controller settings based on the evaluation result. The concepts presented in this paper are illustrated with the actual data of the industrial wind farm.

Keywords: control performance, evaluation, minimum-variance, wind turbine

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8720 Schizophrenia in Childhood and Adolescence: Research Topics and Applied Methodology

Authors: Jhonas Geraldo Peixoto Flauzino, Pedro Pompeo Boechat Araujo, Alexia Allis Rocha Lima, Giovanna Biângulo Lacerda Chaves, Victor Ryan Ferrão Chaves

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Schizophrenia is characterized as a set of psychiatric signs and symptoms (syndrome) that commonly erupt in the stages of adolescence or early adulthood, being recognized as one of the most serious diseases, as it causes important problems during the life of the patient. carrier - both in mental health and in physical health and in social life. Objectives: This is an integrative literature review that aimed to verify what has been produced of scientific knowledge in the field of child and adolescent psychiatry regarding schizophrenia in these stages of life, correlated to the most discussed themes and methodologies of choice for the preparation of studies. Methods: Articles were selected from the following databases: Virtual Health Library and CAPES Journal Portal, published in the last five years; and on Google Scholar, published in 2021, totaling 62 works, searched in September 2021. Results: The studies focus mainly on diagnosis through the DSM-V (25.8%), on drug treatment (25.8%) and in psychotherapy (24.2%), most of them in the literature review format: integrative (27.4%) and systematic (24.2%). Conclusion: The themes and study methods are redundant, and do not cover in depth the immense aspects that encompass Schizophrenia in Childhood and Adolescence, giving attention to the disease in a general way or focusing on the adult patient.

Keywords: schizophrenia, mental health, childhood, adolescence

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8719 Air Pollution: The Journey from Single Particle Characterization to in vitro Fate

Authors: S. Potgieter-Vermaak, N. Bain, A. Brown, K. Shaw

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It is well-known from public news media that air pollution is a health hazard and is responsible for early deaths. The quantification of the relationship between air quality and health is a probing question not easily answered. It is known that airborne particulate matter (APM) <2.5µm deposits in the tracheal and alveoli zones and our research probes the possibility of quantifying pulmonary injury by linking reactive oxygen species (ROS) in these particles to DNA damage. Currently, APM mass concentration is linked to early deaths and limited studies probe the influence of other properties on human health. To predict the full extent and type of impact, particles need to be characterised for chemical composition and structure. APMs are routinely analysed for their bulk composition, but of late analysis on a micro level probing single particle character, using micro-analytical techniques, are considered. The latter, single particle analysis (SPA), permits one to obtain detailed information on chemical character from nano- to micron-sized particles. This paper aims to provide a snapshot of studies using data obtained from chemical characterisation and its link with in-vitro studies to inform on personal health risks. For this purpose, two studies will be compared, namely, the bioaccessibility of the inhalable fraction of urban road dust versus total suspended solids (TSP) collected in the same urban environment. The significant influence of metals such as Cu and Fe in TSP on DNA damage is illustrated. The speciation of Hg (determined by SPA) in different urban environments proved to dictate its bioaccessibility in artificial lung fluids rather than its concentration.

Keywords: air pollution, human health, in-vitro studies, particulate matter

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8718 Environment Patterns and Mental Health of Older Adults in Long-Term Care Facilities: The Role of Activity Profiles

Authors: Shiau-Fang Chao, Yu-Chih Chen

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Owing to physical limitations and restrained lifestyle, older long-term care (LTC) residents are more likely to be affected by their environment than their community-dwelling counterparts. They also participate fewer activities and experience worse mental health than healthy older adults. This study adopts the ICF model to determine the extent to which the clustered patterns of LTC environment and activity participation are associated with older residents’ mental health. Method: Data were collected from a stratified equal probability sample of 634 older residents in 155 LTC institutions in Taiwan. Latent profile analysis (LPA) and latent class analysis (LCA) were conducted to explore the profiles for environment and activity participation. Multilevel modeling was performed to elucidate the relationships among environment profiles, activity profiles, and mental health. Results: LPA identified three mutually exclusive environment profiles (Low-, Moderate-, and High-Support Environment) based on the physical, social, and attitudinal environmental domains, consolidated from 12 environmental measures. LCA constructed two distinct activity profiles (Low- and High-Activity Participation) across seven activity domains (outdoor, volunteer-led leisure, spiritual, household chores, interpersonal exchange, social, and sedentary activity) that were factored from 20 activities. Compared to the Low-Support Environment class, older adults in the Moderate- and High-Support Environment classes had better mental health. Older residents in the Moderate- and High-Support Environment classes were more likely to be in the “High Activity” class, which in turn, exhibited better mental health. Conclusion: This study advances the current knowledge through rigorous methods and study design. The study findings lead to several conclusions. First, this study supports the use of ICF framework to institutionalized older individuals with functional limitations and demonstrates that both measures of environment and activity participation can be refined from multiple indicators. Second, environmental measures that encompass the physical, social, and attitudinal domains would provide a more comprehensive assessment on the place where an older individual embeds. Third, simply counting activities in which an older individual participates or considering a certain type of activity may not capture his or her way of life. Practitioners should not only focus on group or leisure activities within the institutions; rather, more efforts should be made to consider residents’ preferences for everyday life and support their remaining ability by encouraging continuous participation in activities they still willing and capable to perform. Fourth, environment and activity participation are modifiable factors which have greater potential to strengthen older LTC residents’ mental health, and activity participation should be considered in the link between environment and mental health. A combination of enhanced physical, social, and attitudinal environments, and continual engagement in various activities may optimize older LTC residents’ mental health.

Keywords: activity, environment, mental health, older LTC residents

Procedia PDF Downloads 197
8717 Human Health Risk Assessment of Mercury-Contaminated Soils in Alebediah Mining Community, Sudan

Authors: Ahmed Elwaleed, Huiho Jeong, Ali H. Abdelbagi, Nguyen Thi Quynh, Koji Arizono, Yasuhiro Ishibashi

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Artisanal and small-scale gold mining (ASGM) poses substantial risks to both human health and the environment, particularly through contamination of soil, water, and air. Prolonged exposure to ASGM-contaminated soils can lead to acute or chronic mercury toxicity. This study assesses the human health risks associated with mercury-contaminated soils and tailings in the Alebediah mining community in Sudan. Soil samples were collected from various locations within Alebediah, including ASGM areas, farmlands, and residential areas, along with tailings samples commonly found within ASGM sites. The evaluation of potential health risks to humans included the computation of the estimated daily intake (AvDI), the hazard quotient (HQ), and the hazard index (HI) for both adults and children. The primary exposure route identified as potentially posing a significant health risk was the volatilization of mercury from tailings samples, where mercury concentrations reached up to 25.5 mg/kg. In contrast, other samples within the ASGM area showed elevated mercury levels but did not present significant health risks, with HI values below 1. However, all areas indicated HI values above 1 for the remaining exposure routes. The study observed a decrease in mercury concentration with increasing distance from the ASGM community. Additionally, soil samples revealed elevated mercury levels exceeding background values, prompting an assessment of contamination levels using the enrichment factor (EF). The findings indicated that farmlands and residential areas exhibited depleted EF, while areas surrounding the ASGM community showed none to moderate pollution. In contrast, ASGM areas exhibited significant to extreme pollution. A GIS map was generated to visually depict the extent of mercury pollution, facilitating communication with stakeholders and decision-makers.

Keywords: mercury pollution, artisanal and small-scale gold mining, health risk assessment, hazard index, soil and tailings, enrichment factor

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8716 Effectiveness of Mobile Health Augmented Cardiac Rehabilitation (MCard) on Health-Related Quality of Life among Post-Acute Coronary Syndrome Patients: A Randomized Controlled Trial

Authors: Aliya Hisam, Zia Ul Haq, Sohail Aziz, Patrick Doherty, Jill Pell

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Objective: To determine the effectiveness of Mobile health augmented Cardiac rehabilitation (MCard) on health-related quality of life (HRQoL) among post-acute coronary syndrome(post-ACS) patients. Methodology: In a randomized controlled trial, post-ACS patients were randomly allocated (1:1) to an intervention group (received MCard; counseling, empowering with self-monitoring devices, short text messages, in addition to standard post-ACS care) or control group (standard post-ACS care). HRQoL was assessed by generic Short Form-12 and MacNew quality of life myocardial infarction (QLMI) tools. Participants were followed for 24 weeks with data collection and analysis at three-time points (baseline, 12 weeks and 24 weeks). Result: At baseline, 160 patients (80 in each group; mean age 52.66+8.46 years; 126 males, 78.75%) were recruited, of which 121(75.62%) continued and were analyzed at 12-weeks and 119(74.37%) at 24-weeks. The mean SF-12 physical component score significantly improved in the MCard group at 12 weeks follow-up (48.93 vs. control 43.87, p<.001) and 24 weeks (53.52 vs. 46.82 p<.001). The mean SF-12 mental component scores also improved significantly in the MCard group at 12 weeks follow-up (44.84 vs. control 41.40, p<.001) and 24 weeks follow-up (48.95 vs 40.12, p<.001). At 12-and 24-week follow-up, all domains of MacNew QLMI (social, emotional, physical and global) were also statistically significant (p<.001) improved in the MCard group, unlike the control group. Conclusion: MCard is feasible and effective at improving all domains of HRQoL. There was an improvement in physical, mental, social, emotional and global domains among the MCard group in comparison to the control group. The addition of MCard programs to post-ACS standard care may improve patient outcomes and reduce the burden on the health care setting.

Keywords: acute coronary syndrome, mobile health augmented cardiac rehabilitation (MCard), cardiovascular diseases, cardiac rehabilitation, health-related quality of life, short form 12, MacNew QLMI

Procedia PDF Downloads 167