Search results for: incomplete spending.
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 500

Search results for: incomplete spending.

200 A Preliminary Study of the Reconstruction of Urban Residential Public Space in the Context of the “Top-down” Construction Model in China: Based on Research of TianZiFang District in Shanghai and Residential Space in Hangzhou

Authors: Wang Qiaowei, Gao Yujiang

Abstract:

With the economic growth and rapid urbanization after the reform and openness, some of China's fast-growing cities have demolished former dwellings and built modern residential quarters. The blind, incomplete reference to western modern cities and the one-off construction lacking feedback mechanism have intensified such phenomenon, causing the citizen gradually expanded their living scale with the popularization of car traffic, and the peer-to-peer lifestyle gradually settled. The construction of large-scale commercial centers has caused obstacles to small business around the residential areas, leading to space for residents' interaction has been compressed. At the same time, the advocated Central Business District (CBD) model even leads to the unsatisfactory reconstruction of many historical blocks such as the Hangzhou Southern Song Dynasty Imperial Street. However, the popularity of historical spaces such as Wuzhen and Hongcun also indicates the collective memory and needs of the street space for Chinese residents. The evolution of Shanghai TianZiFang also proves the importance of the motivation of space participants in space construction in the context of the “top-down” construction model in China. In fact, there are frequent occurrences of “reconstruction”, which may redefine the space, in various residential areas. If these activities can be selectively controlled and encouraged, it will be beneficial to activate the public space as well as the residents’ intercourse, so that the traditional Chinese street space can be reconstructed in the context of modern cities.

Keywords: rapid urbanization, traditional street space, space re-construction, bottom-up design

Procedia PDF Downloads 94
199 Juridically Secure Trade Mechanisms for Alternative Dispute Resolution in Transnational Business Negotiations

Authors: Linda Frazer

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A pluralistic methodology focuses on promoting an understanding that an alternative juridical framework for the regulation of transnational business negotiations (TBN) between private business parties is fundamentally required. This paper deals with the evolving assessment of the doctoral research of the author which demonstrated that due to insufficient juridical tools, negotiations are commonly misunderstood within the complexity of pluralistic and conflicting legal regimes. This inadequacy causes uncertainty in the enforcement of legal remedies, leaving business parties surprised. Consequently, parties cannot sufficiently anticipate when and how legal rights and obligations are created, often counting on oral or incomplete agreements which may lead to the misinterpretation of the extent of their legal rights and obligations. This uncertainty causes threats to business parties for fear of creating unintended legal obligations or, conversely, that law will not enforce intended agreements for failure to pass the tests of contractual validity. A need to find a manner to set default standards of communications and standards of conduct to monitor our evolving global trade would aid law to provide the security, predictability and foreseeability during alternative dispute resolution required by TBN parties. The conclusion of this study includes a proposal of new trade mechanisms, termed 'Bills of Negotiations' (BON) to enhance party autonomy and promote the ability for TBN parties to self-regulate within the boundaries of law. BON will be guided by a secure juridical institutionalized setting that caters to guiding communications during TBN and resolving disputes that arise along the negotiation processes on a fast track basis.

Keywords: alternative resolution disputes, ADR, good faith, good faith, juridical security, legal regulation, trade mechanisms, transnational business negotiations

Procedia PDF Downloads 130
198 Carbon Blacks: A Broad Type of Carbon Materials with Different Electrocatalytic Activity to Produce H₂O₂

Authors: Alvaro Ramírez, Martín Muñoz-Morales, Ester López- Fernández, Javier Llanos, C. Ania

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Carbon blacks are value-added materials typically produced through the incomplete combustion or thermal decomposition of hydrocarbons. Traditionally, they have been used as catalysts in many different applications, but in the last decade, their potential in green chemistry has gained significant attention. Among them, the electrochemical production of H₂O₂ has attracted interest because of their properties as high oxidant capacity or their industrial interest as a bleaching agent. Carbon blacks are commonly used in this application in a catalytic ink that is drop-casted on supporting electrodes and acts as catalysts for the electrochemical production of H₂O₂ through oxygen reduction reaction (ORR). However, the different structural and electrochemical behaviors of each type of carbon black influence their applications. In this line, the term ‘carbon black’, has to be considered as a generic name that does not guarantee any physicochemical properties if any further description is mentioned. In fact, different specific surface area (SSA), surface functional groups, porous structure, and electro catalysts effect seem very important for electrochemical applications, and considerable differences were found during the analysis of four types of carbon blacks. Thus, the aim of this work is to evaluate the influence of SSA, porous structure, oxygen functional groups, and structural defects to differentiate among these carbon blacks (e.g. Vulcan XC72, Superior Graphite Co, Printex XE2, and Prolabo) for H₂O₂ production via ORR, using carbon paper as electrode support with improved selectivity and efficiency. Results indicate that the number and size of pores, along with surface functional groups, are key parameters that significantly affect the overall process efficiency.

Keywords: carbon blacks, oxygen reduction reaction, hydrogen peroxide, porosity, surface functional groups

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197 Long-Term Cohort of Patients with Beta Thalassemia; Prevailing Role of Serum Ferritin Levels in Hypocalcemia and Growth Retardation

Authors: Shervin Rashidinia, Sara Shahmoradi, Seyyed Shahin Eftekhari, Mohsen Talebizadeh, Mohammad Saleh Sadeghi

Abstract:

Background: Beta-thalassemia Major (BTM) is a kind of hereditary hemolytic anemia which depended on regular monthly blood transfusion. However, iron deposition into the organs leads to multi-organ damage. The present study is the first study which aimed to evaluate the average of five-years serum ferritin level and compared by the prevalence of short stature and hypocalcemia. Materials/Methods: A cross-sectional retrospective study which a total of 140 patients with beta-thalassemia who were referred to Qom Thalassemia Clinic between February 2011 and July 2016 were enrolled to be reviewed. The exclusion criteria were consisting of incomplete medical records, diagnosis less than 2-years-ago and the blood transfusion less than every 4 weeks. The data including age, gender, weight, height, age of initial blood transfusion, age of initial chelation therapy, ferritin, and calcium were collected and analysis by SPSS version 24. Results: A total of 140 patients were enrolled. Of them, 75 (53.4%) were female. The mean age of the patients was 13.4±4.6 years.The mean age of initial diagnosis was 20.2±7.4 months. Hypocalcemia and short stature were occurred in 41 (29.3%) and 37 (26.4%) patients, respectively. The mean five-years serum ferritin level was significantly higher in the patients with short stature and hypocalcemia (P<0.0001). However, rise in serum ferritin level significantly increases the risk of short-stature and hypocalcemia (1.0004- and 1.0029 fold, respectively). Conclusion: We demonstrated that prevalence of short stature and hypocalcemia were significantly higher in the BTM.However, ferritin significantly increases the risk of short stature and hypocalcemia.

Keywords: beta-thalassemia, ferritin, growth retardation, hypocalcemia

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196 Public Debt and Fiscal Stability in Nigeria

Authors: Abdulkarim Yusuf

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Motivation: The Nigerian economy has seen significant macroeconomic instability, fuelled mostly by an overreliance on fluctuating oil revenues. The rising disparity between tax receipts and government spending in Nigeria necessitates government borrowing to fund the anticipated pace of economic growth. Rising public debt and fiscal sustainability are limiting the government's ability to invest in key infrastructure that promotes private investment and growth in Nigeria. Objective: This paper fills an empirical research vacuum by examining the impact of public debt on fiscal sustainability in Nigeria, given the significance of fiscal stability in decreasing poverty and the constraints that an unsustainable debt burden imposes on it. Data and method: Annual time series data covering the period 1980 to 2022 exposed to conventional and structural breaks stationarity tests and the Autoregressive Distributed Lag estimation approach were adopted for this study. Results: The results reveal that domestic debt stock, debt service payment, foreign reserve stock, exchange rate, and private investment all had a major adverse effect on fiscal stability in the long and short run, corroborating the debt overhang and crowding-out hypothesis. External debt stock, prime lending rate, and degree of trade openness, which boosted fiscal stability in the long run, had a major detrimental effect on fiscal stability in the short run, whereas foreign direct investment inflows had an important beneficial impact on fiscal stability in both the long and short run. Implications: The results indicate that fiscal measures that inspire domestic resource mobilization, sustainable debt management techniques, and dependence on external debt to boost deficit financing will improve fiscal stability and drive growth.

Keywords: ARDL co-integration, debt overhang, debt servicing, fiscal stability, public debt

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195 Impact of Changes in Travel Behavior Triggered by the Covid-19 Pandemic on Tourist Ininfrastructure. Water Reservoirs of the Vltava Cascade (Czechia) Case Study

Authors: Jiří Vágner, Dana Fialová

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The Covid-19 pandemic and its effects have triggered significant changes in travel behavior. On the contrary to a deep decline in international tourism, domestic tourism has recovered. It has not fully replaced the total volume of national tourism so far. However, from a regional point of view, and especially according to the type of destinations, regional targeting has changed significantly compared to the previous period. Urban destinations, which used to be the domain of foreign tourists, have been relatively orphaned, in contrast to destinations tied to natural attractions, which have seen seasonal increases. Even here, at a lower hierarchical geographic level, we can observe the differentiation resulting from the existing localization and infrastructure. The case study is focused on the three largest water reservoirs of the Vltava Cascade in Czechia– Lipno, Orlík, and Slapy. Based on a detailed field survey, in the periods before and during the pandemic, as well as available statistical data (Tourdata; Czech Statistical Office, Czech Cadaster and Ordnance Survey), different trends in the exploitation of these destinations with regard to existing or planned infrastructure are documented, analyzed and explained. This gives us the opportunity to discuss on concrete examples of generally known phenomena that are usually neglected in tourism: slum, brownfield, greenfield. Changes in travel behavior – especially the focus on spending leisure time individually in naturally attractive destinations – can affect the use of sites, which can be defined as a tourist or recreational slum, brownfield, but also as a tourist greenfield development. Sociocultural changes and perception of destinations by tourists and other actors represent, besides environmental changes, major trends in current tourism.

Keywords: Covid-19 pandemic, czechia, sociocultural and environmental impacts, tourist infrastructure, travel behavior, the Vltava Cascade water reservoirs

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194 Evaluating the Implementation of a Quality Management System in the COVID-19 Diagnostic Laboratory of a Tertiary Care Hospital in Delhi

Authors: Sukriti Sabharwal, Sonali Bhattar, Shikhar Saxena

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Introduction: COVID-19 molecular diagnostic laboratory is the cornerstone of the COVID-19 disease diagnosis as the patient’s treatment and management protocol depend on the molecular results. For this purpose, it is extremely important that the laboratory conducting these results adheres to the quality management processes to increase the accuracy and validity of the reports generated. We started our own molecular diagnostic setup at the onset of the pandemic. Therefore, we conducted this study to generate our quality management data to help us in improving on our weak points. Materials and Methods: A total of 14561 samples were evaluated by the retrospective observational method. The quality variables analysed were classified into pre-analytical, analytical, and post-analytical variables, and the results were presented in percentages. Results: Among the pre-analytical variables, sample leaking was the most common cause of the rejection of samples (134/14561, 0.92%), followed by non-generation of SRF ID (76/14561, 0.52%) and non-compliance to triple packaging (44/14561, 0.3%). The other pre-analytical aspects assessed were incomplete patient identification (17/14561, 0.11%), insufficient quantity of samples (12/14561, 0.08%), missing forms/samples (7/14561, 0.04%), samples in the wrong vials/empty VTM tubes (5/14561, 0.03%) and LIMS entry not done (2/14561, 0.01%). We are unable to obtain internal quality control in 0.37% of samples (55/14561). We also experienced two incidences of cross-contamination among the samples resulting in false-positive results. Among the post-analytical factors, a total of 0.07% of samples (11/14561) could not be dispatched within the stipulated time frame. Conclusion: Adherence to quality control processes is foremost for the smooth running of any diagnostic laboratory, especially the ones involved in critical reporting. Not only do the indicators help in keeping in check the laboratory parameters but they also allow comparison with other laboratories.

Keywords: laboratory quality management, COVID-19, molecular diagnostics, healthcare

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193 Pulmonary Embolism Indicative of Myxoma of the Right Atrium

Authors: A. Kherraf, M. Bouziane, A. Drighil, L. Azzouzi, R. Habbal

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Objective: Myxomas are rare heart tumors most commonly found in the left atrium. The purpose of this observation is to report a rare case of myxoma of the right atrium revealed by pulmonary embolism. Observation: A 34-year-old patient with no history presented to the emergency room with sudden onset dyspnea. Clinical examination showed arterial pressure at 110/70mmHg, tachycardia at 110bpm, and 90% oxygen saturation. The ECG enrolled in incomplete right bundle branch block. The radio-thorax was normal. Echocardiography revealed the presence of a large homogeneous intra-OD mass, contiguous to the inter-atrial septum, prolapsing through the tricuspid valve, and causing mild tricuspid insufficiency, with dilation of the right ventricle and retained systolic function with PAPs estimated at 45mmHg. A chest scan was performed, revealing the presence of right segmental pulmonary embolism. The patient was put under anticoagulant and underwent surgical resection of the mass; its pathological examination concluded to a myxoma. The post-operative consequences were simple, without recurrence of the mass after one year follow-up. Discussion: Myxomas represent 50% of heart tumors. Most often, they originate in the left atrium, and more rarely in the right atrium or the ventricles. Myxoma of the right atrium can be responsible for life-threatening pulmonary embolism. The most predictive factor for embolization remains the morphology of the myxomas; papillary or villous myxomas are the most friable. Surgery is the standard treatment, with regular postoperative follow-up to detect recurrence. Conclusion: Myxomas of the right atrium are a rare location for these tumors. Pulmonary embolism is the main complication and should routinely involve careful study of the right chambers on echocardiography.

Keywords: pulmonary embolism, myxoma, right atrium, heart tumors

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192 Effect of Globalization on Flow Performance in Godean Jathilan Pranesa Yogyakarta

Authors: Maria Armalita Tumimbang

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Jathilan or Kuda Lumping is a dance-drama with warfare as the main theme and the dancers mimicking mighty horsemen armed with sword in the middle of the battle field. However, to most people this dance-drama is more identical with magical nuanced dance and trance, beside the attractive and even dangerous acts of the dancers, such as eating shard or broken glass in a state of trance. Several music players play the accompaniment made up of incomplete gamelan set that include saron, kendang, gong, and kempul. In general, it remains unchanged with regards to the seemingly monotonous beat and occasional “bumps” that may lead the dancers into a trance state. The dances performed also tend to be of repetitive patterns. The development of Jathilan and other traditional art performance in this globalization and industrialization era can be divided into two: firstly, they are subjected to the power of industrialization, which means their performances are to be recorded for commercial purpose, and secondly, they are to be presented in live performances. To some people, live performances are preferable, and for some reasons, they represent a form of cultural résistance to globalization and industrialization. The present study is qualitative in nature. It aims to describe the music and performance of Jathilan in the era of globalization in Indonesia. The subject of this study is a traditional art group, Jathilan Kuda Pranesa of Godean, Yogyakarta. Data collection was conducted by interviews with the leader of the group, the dancers and music players, as well as the audience. The wave of globalization has brought strong capitalistic industrialization that render traditional arts simply into industrial commodities tailored to the need of the era. This very fact has made the repositioning of traditional art performance of Jathilan a necessity. And by repositioning we mean that Jathilans should be put back to their traditional forms and functions as they used to be.

Keywords: Jathilan, globalization, industrialization, music, performance

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191 Parsonage Turner Syndrome PTS, Case Report

Authors: A. M. Bumbea, A. Musetescu, P. Ciurea, A. Bighea

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Objectives: The authors present a Parsonage Turner syndrome, a rare disease characterized by onset in apparently healthy person with shoulder and/or arm pain, sensory deficit, motor deficit. The causes are not established, could be determinate by vaccination, postoperative, immunologic disease, post traumatic etc. Methods: The authors present a woman case, 32 years old, (in 2006), no medical history, with arm pain and no other symptom. The onset was sudden with pain at very high level quantified as 10 to a 0 to 10 scale, with no response to classical analgesic and corticoids. The only drugs which can reduce the intensity of pain were oxycodone hydrochloride, 60 mg daily and pregabalinum150 mg daily. After two weeks the intensity of pain was reduced to 5. The patient started a rehabilitation program. After 6 weeks the patient associated sensory and motor deficit. We performed electromyography for upper limb that showed incomplete denervation with reduced neural transmission speed. The patient receives neurotrophic drugs and painkillers for a long period and physical and kinetic therapy. After 6 months the pain was reduced to level 2 and the patient maintained only 150 mg pregabalinum for another 6 months. Then, the evaluation showed no pain but general amiotrophy in upper limb. Results: At the evaluation in 2009, the patient developed a rheumatoid syndrome with tender and swelling joints, but no positive inflammation test, no antibodies or rheumatoid factor. After two years, in 2011 the patient develops an increase of antinuclear antibodies. This context certifies the diagnosis of lupus and the patient receives the specific therapy. Conclusions: This case is not a typical case of onset of lupus with PTS, but the onset of PTS could include the onset of an immune disease.

Keywords: lupus, arm pain, patient, swelling

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190 Commodity Factory or Food Farms an Irrational Dilemma: Reflections on the Brazilian Scenario

Authors: Monica Dantas

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At what socio-economic costs can the food industry offer products at low prices? This research seeks to understand and to explore how we attribute competence and meaning, what enables the outcomes of agriculture and what institutions provides validation regarding food production. This study objective is to explain and interpret conditions of the present state of agriculture in Brazil centring on two distinct segments, agribusiness and family farming, as the Brazilian, rapidly changing political environment unfolds. The approach is grounded in multidisciplinary literature drawing from the politics of development, the sociology of food, the sustainability framework and the conceptual differences between agribusiness and family farming regarding the innate purpose of the two segments. In addition, a quantitative portion of the research includes secondary data analysis from statistical measurements, economic indicators, federal budget information, and census data to compare the two segments, conveying a general snapshot of the conditions investigated. The results raised questions about the perceived image of the success of agribusiness, against some contradicting economic checks and balances. Analyzing how public funds are invested in agriculture shed light on what can enable or undermine the development of food systems in Brazil. It also revealed how politics, ideology, and corporations might influence the Brazilian Federal. In the 2000-2018 observed timeline of annual federal spending on agriculture in Brazil, there is variation in the amount invested in family farming that seems to 'coincide' with the ideological direction of the federal government in power. It was also observed that significant changes in the institutional framework and financial support either promoted or purposely undermined family farming importance using public institutions to validate support for agribusiness.

Keywords: food politics, sustainability, family farming, food system, public budget

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189 Numerical Simulation of Different Configurations for a Combined Gasification/Carbonization Reactors

Authors: Mahmoud Amer, Ibrahim El-Sharkawy, Shinichi Ookawara, Ahmed Elwardany

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Gasification and carbonization are two of the most common ways for biomass utilization. Both processes are using part of the waste to be accomplished, either by incomplete combustion or for heating for both gasification and carbonization, respectively. The focus of this paper is to minimize the part of the waste that is used for heating biomass for gasification and carbonization. This will occur by combining both gasifiers and carbonization reactors in a single unit to utilize the heat in the product biogas to heating up the wastes in the carbonization reactors. Three different designs are proposed for the combined gasification/carbonization (CGC) reactor. These include a parallel combination of two gasifiers and carbonized syngas, carbonizer and combustion chamber, and one gasifier, carbonizer, and combustion chamber. They are tested numerically using ANSYS Fluent Computational Fluid Dynamics to ensure homogeneity of temperature distribution inside the carbonization part of the CGC reactor. 2D simulations are performed for the three cases after performing both mesh-size and time-step independent solutions. The carbonization part is common among the three different cases, and the difference among them is how this carbonization reactor is heated. The simulation results showed that the first design could provide only partial homogeneous temperature distribution, not across the whole reactor. This means that the produced carbonized biomass will be reduced as it will only fill a specified height of the reactor. To keep the carbonized product production high, a series combination is proposed. This series configuration resulted in a uniform temperature distribution across the whole reactor as it has only one source for heat with no temperature distribution on any surface of the carbonization section. The simulations provided a satisfactory result that either the first parallel combination of gasifier and carbonization reactor could be used with a reduced carbonized amount or a series configuration to keep the production rate high.

Keywords: numerical simulation, carbonization, gasification, biomass, reactor

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188 Maximum Likelihood Estimation Methods on a Two-Parameter Rayleigh Distribution under Progressive Type-Ii Censoring

Authors: Daniel Fundi Murithi

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Data from economic, social, clinical, and industrial studies are in some way incomplete or incorrect due to censoring. Such data may have adverse effects if used in the estimation problem. We propose the use of Maximum Likelihood Estimation (MLE) under a progressive type-II censoring scheme to remedy this problem. In particular, maximum likelihood estimates (MLEs) for the location (µ) and scale (λ) parameters of two Parameter Rayleigh distribution are realized under a progressive type-II censoring scheme using the Expectation-Maximization (EM) and the Newton-Raphson (NR) algorithms. These algorithms are used comparatively because they iteratively produce satisfactory results in the estimation problem. The progressively type-II censoring scheme is used because it allows the removal of test units before the termination of the experiment. Approximate asymptotic variances and confidence intervals for the location and scale parameters are derived/constructed. The efficiency of EM and the NR algorithms is compared given root mean squared error (RMSE), bias, and the coverage rate. The simulation study showed that in most sets of simulation cases, the estimates obtained using the Expectation-maximization algorithm had small biases, small variances, narrower/small confidence intervals width, and small root of mean squared error compared to those generated via the Newton-Raphson (NR) algorithm. Further, the analysis of a real-life data set (data from simple experimental trials) showed that the Expectation-Maximization (EM) algorithm performs better compared to Newton-Raphson (NR) algorithm in all simulation cases under the progressive type-II censoring scheme.

Keywords: expectation-maximization algorithm, maximum likelihood estimation, Newton-Raphson method, two-parameter Rayleigh distribution, progressive type-II censoring

Procedia PDF Downloads 143
187 The Online Power of Values: Adolescents’ Values as Predicting Factors of Their Online Bystanders’ Behavior While Witnessing Cyberbullying

Authors: Sharon Cayzer-Haller, Shir Ginosar-Yaari, Ariel Knafo-Noam

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The 21st century emerged as the digital century, and it is marked by a wide range of technological developments and changes, followed by potential changes in human communication skills. This technological revolution has changed human means of communication in many different ways: children and adolescents are spending much of their time in front of screens, participating in all sorts of online activities (even more so since the outbreak of COVID-19). The current study focuses on the role of values in adolescents' online bystanders' behavior. Values are cognitive, abstract representations of desirable goals that motivate behavior, and we hypothesized finding significant associations between specific values and differential online bystanders' feelings and behavior. Data was collected through online questionnaires that measured the participants' values, using Schwartz's short version of the Portrait Values Questionnaire (Schwartz, 2012). Participants’ online behavior was assessed in a questionnaire addressing reactions to situations of cyber shaming and cyberbullying, and specifically positive feelings and pro-social behavior (e.g., more supportive reactions) toward the victims, as opposed to different offensive behavioral reactions (such as laughing at the victim or ignoring the situation). Participants were recruited with a commercial research panel company, and 308 Israeli adolescents' values and online behavior were examined (mean age 15.2). As hypothesized, results show significant associations between self-transcendence values (universalism and benevolence) and conservation values (conformity, tradition, and security). These two groups of values were positively correlated with pro-social bystanders' feelings and behavior. On the opposite side of the values scale, the value of power was negatively associated with the participants' pro-social behavior, and positively associated with offensive behavioral reactions. Further research is needed, but we conclude that values serve as crucial guiding factors in directing adolescents' online feelings and behavior.

Keywords: adolescents, values, cyberbullying, online behavior, power

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186 Industrial Prototype for Hydrogen Separation and Purification: Graphene Based-Materials Application

Authors: Juan Alfredo Guevara Carrio, Swamy Toolahalli Thipperudra, Riddhi Naik Dharmeshbhai, Sergio Graniero Echeverrigaray, Jose Vitorio Emiliano, Antonio Helio Castro

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In order to advance the hydrogen economy, several industrial sectors can potentially benefit from the trillions of stimulus spending for post-coronavirus. Blending hydrogen into natural gas pipeline networks has been proposed as a means of delivering it during the early market development phase, using separation and purification technologies downstream to extract the pure H₂ close to the point of end-use. This first step has been mentioned around the world as an opportunity to use existing infrastructures for immediate decarbonisation pathways. Among current technologies used to extract hydrogen from mixtures in pipelines or liquid carriers, membrane separation can achieve the highest selectivity. The most efficient approach for the separation of H₂ from other substances by membranes is offered from the research of 2D layered materials due to their exceptional physical and chemical properties. Graphene-based membranes, with their distribution of pore sizes in nanometers and angstrom range, have shown fundamental and economic advantages over other materials. Their combination with the structure of ceramic and geopolymeric materials enabled the synthesis of nanocomposites and the fabrication of membranes with long-term stability and robustness in a relevant range of physical and chemical conditions. Versatile separation modules have been developed for hydrogen separation, which adaptability allows their integration in industrial prototypes for applications in heavy transport, steel, and cement production, as well as small installations at end-user stations of pipeline networks. The developed membranes and prototypes are a practical contribution to the technological challenge of supply pure H₂ for the mentioned industries as well as hydrogen energy-based fuel cells.

Keywords: graphene nano-composite membranes, hydrogen separation and purification, separation modules, indsutrial prototype

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185 The Effects of Perceived Service Quality on Customers' Satisfaction, Trust and Loyalty in Online Shopping: A Case of Saudi Consumers' Perspectives

Authors: Nawt Almutairi, Ramzi El-Haddadeh

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With the extensive increase in the number of online shops, loyalty becomes the most purpose for e-retailers by which they can maintain their exit customers and regular income instead of spending large deal of money to target new segmentation. To obtain customers’ loyalty e-marketers should firstly satisfy customers by providing a high quality of services that could fulfil their demand. They have to satisfy them to trust the web-site then increase their intention to re-visit it. This study intends to investigate to what extend the elements of e-service quality presented in the literature affect customers’ satisfaction and how these influences contribute to customers’ trust and loyalty. Three dimensions of service quality are estimated. The first element is web-site interactivity, which is perceived the quality of interactive support and the accessible communications-tool. The second aspect is security/privacy, which is perceived the quality of controlling security and privacy while transaction over the web-site. The third element is web-design that perceived a pleasant user interface with visual appealing. These elements present positive effects on shoppers’ satisfaction. Thus, To examine the proposed constructs of this research, some measurements scale-items adapted from similar prior studies. Survey data collected online from Saudi customers (n=106) were utilized to test the research hypotheses. After that, the hypotheses were analyzed by using a variety of regression tools. The analytical results of this study propose that perceived quality of interactivity and security/privacy affects customers’ satisfaction. As well as trust seems to be a substantial construct that highly affects loyalty in online shopping. This study provides a developed model to obtain a simple understanding of the series of customers’ loyalty in online shopping. One construct presenting in the research model is web-design appears to be not important antecedent of satisfaction (the path to loyalty) in online shopping.

Keywords: e-service, satisfaction, trust, loyalty

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184 A Review of Current Practices in Tattooing of Colonic Lesion at Endoscopy

Authors: Dhanashree Moghe, Roberta Bullingham, Rizwan Ahmed, Tarun Singhal

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Aim: The NHS Bowel Screening Programme recommends the use of endoscopic tattooing for suspected malignant lesions that later require surgical or endoscopic localisation, using local protocols as guidance. This is in accordance with guidance from the BSG (The British Society of Gastroenterologists). We used a well-recognised local protocol as a standard to audit current tattooing practice in a large district general hospital with no current local guidelines. Method: A retrospective quantitative analysis of 50 patients who underwent segmental colonic resection for cancer over a 6-month period in 2021. We reviewed historic electronic endoscopy reports recording relevant data on tattoo indication and placement. Secondly, we carried out an anonymous survey of 16 independent lower GI endoscopists on self-reported details of their practice. Results: In our study, 28 patients (56%) had a tattoo placed at the time of their colonoscopy. Of these, only 53% (n=15) had the tattoo distal to the lesion, with the measured distance of the tattoo from the lesion only being documented in 8 reports. Only seven patients (25%) had a circumferential (4 quadrant) placement of the tattoo. 13 patients had lesions either in the caecum or rectum, locations deemed unnecessary as per BSG guidelines. Of the survey responses collected, there were four different protocols being used to guide practice. Only 50% of respondents placed tattoos at the correct distance from the lesion, and 83% placed the correct number of tattoos. Conclusion: There is a lack of standardisation of practices in colonic tattooing demonstrated in our study with incomplete compliance to our standard. The inadequate documentation of tattoo location can contribute to confusion and inaccuracy in the intraoperative localisation of lesions. This has the potential to increase operation length and morbidity. There is a need to standardise both technique and documentation in colonoscopic tattooing practice.

Keywords: colorectal cancer, endoscopic tattooing, colonoscopy, NHS BSCP

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183 Cadaveric Assessment of Kidney Dimensions Among Nigerians - A Preliminary Report

Authors: Rotimi Sunday Ajani, Omowumi Femi-Akinlosotu

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Background: The usually paired human kidneys are retroperitoneal urinary organs with some endocrine functions. Standard text books of anatomy ascribe single value to each of the dimension of length, width and thickness. Research questions: These values do not give consideration to racial and genetic variability in human morphology. They may thus be erroneous to students and clinicians working on Nigerians. Objectives: The study aimed at establishing reference values of the kidney length, width and thickness for Nigerians using the cadaveric model. Methodology: The length, width, thickness and weight of sixty kidneys harvested from cadavers of thirty adult Nigerians (Male: Female; 27: 3) were measured. Respective volume was calculated using the ellipsoid formula. Results: The mean length of the kidney was 9.84±0.89 cm (9.63±0.88 {right}; 10.06±0.86 {left}), width- 5.18±0.70 cm (5.21±0.72 {right}; 5.14±0.70 {left}), thickness-3.45±0.56 cm (3.36±0.58 {right}, 3.53±0.55 {left}), weight-125.06±22.34 g (122.36±21.70 {right}; 127.76 ±24.02 {left}) and volume of 95.45± 24.40 cm3 (91.73± 26.84 {right}; 99.17± 25.75 {left}). Discussion: Though the values of the parameters measured were higher for the left kidney (except for the width), they were not statistically significant. The various parameters obtained by this study differ from those of similar studies from other continents. Conclusion: Stating single value for each of the parameter of length, width and thickness of the kidney as currently obtained in textbooks of anatomy may be incomplete information and hence misleading. Thus, there is the need to emphasize racial differences when stating the normal values of kidney dimensions in textbooks of anatomy. Implication for Research and Innovation: The results of the study showed the dimensions of the kidney (length, width and thickness) have interracial vagaries as they were different from those of similar studies and values stated in standard textbooks of human anatomy. Future direction: This is a preliminary report and the study will continue so that more data will be obtained.

Keywords: kidney dimensions, cadaveric estimation, adult nigerians, racial differences

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182 A Computational Investigation of Knocking Tendency in a Hydrogen-Fueled SI Engine

Authors: Hammam Aljabri, Hong G. Im

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Hydrogen is a promising future fuel to support the transition of the energy sector toward carbon neutrality. The direct utilization of H2 in Internal Combustion Engines (ICEs) is possible, and this technology faces mainly two challenges; high NOx emissions and severe knocking at mid to high loads. In this study, we numerically investigated the potential of H2 combustion in a truck-size engine operated in SI mode. To mitigate the knocking nature of H2 combustion, we have focused on studying the effects of three primary parameters; the compression ratio (CR), the air-fuel ratio, and the spark time. The baseline case was set using a CR of 16.5 and an equivalence ratio of 0.35. In simulations, the auto-ignition tendency was evaluated based on the maximum pressure rise rate and the local pressure fluctuations at the monitoring points set along the wall of the combustion chamber. To mitigate the auto-ignition tendency while enabling a wider range of engine operation, the effect of lowering the compression ratio was assessed. The results indicate that by lowering the compression ratio from 16.5:1 to 12.5:1, an indicated thermal efficiency of 47.5% can be achieved. Aiming to restrain the auto-ignition while maintaining good efficiency, a reduction in the equivalence ratio was examined under different compression ratios. The result indicates that higher compression ratios will require lower equivalence ratios, and due to practical limitations, a lower equivalence ratio of 0.25 was set as the limit. Using a compression ratio of 13.5 combined with an equivalence ratio of 0.3 resulted in an indicated thermal efficiency of 48.6%, that is, at a fixed spark time. It is found that under such lean conditions, the incomplete combustion losses and exhaust losses were high. Thus, advancing the spark time was assessed as a possible solution. The results demonstrated the advantages of advancing the spark time, where an indicated thermal efficiency exceeding 50% was achieved using a compression ratio of 14.5:1 and an equivalence ratio of 0.25.

Keywords: hydrogen, combustion, engine knock, SI engine

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181 Comparative Correlation Investigation of Polynuclear Aromatic Hydrocarbons (PAHs) in Soils of Different Land Uses: Sources Evaluation Perspective

Authors: O. Onoriode Emoyan, E. Eyitemi Akporhonor, Charles Otobrise

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Polycyclic Aromatic Hydrocarbons (PAHs) are formed mainly as a result of incomplete combustion of organic materials during industrial, domestic activities or natural occurrence. Their toxicity and contamination of terrestrial and aquatic ecosystem have been established. Though with limited validity index, previous research has focused on PAHs isomer pair ratios of variable physicochemical properties in source identification. The objective of this investigation was to determine the empirical validity of Pearson correlation coefficient (PCC) and cluster analysis (CA) in PAHs source identification along soil samples of different land uses. Therefore, 16 PAHs grouped as endocrine disruption substances (EDSs) were determined in 10 sample stations in top and sub soils seasonally. PAHs was determined the use of Varian 300 gas chromatograph interfaced with flame ionization detector. Instruments and reagents used are of standard and chromatographic grades respectively. PCC and CA results showed that the classification of PAHs along kinetically and thermodyanamically-favoured and those derived directly from plants product through biologically mediated processes used in source signature is about the predominance PAHs are likely to be. Therefore the observed PAHs in the studied stations have trace quantities of the vast majority of the sixteen un-substituted PAHs which may ultimately inhabit the actual source signature authentication. Type and extent of bacterial metabolism, transformation products/substrates, and environmental factors such as: salinity, pH, oxygen concentration, nutrients, light intensity, temperature, co-substrates and environmental medium are hereby recommended as factors to be considered when evaluating possible sources of PAHs.

Keywords: comparative correlation, kinetically and thermodynamically-favored PAHs, pearson correlation coefficient, cluster analysis, sources evaluation

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180 Health as an Agenda in Indian Politics: A Study of Election Manifestos in 16th General Elections

Authors: Kiran Bala

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Health, education and employment opportunities available for a common citizen reflect the development status of a country. Health of an individual affects the growth of a country in every aspect. According to a study by WHO, India is estimated to lose more than $237 billion of its GDP over the period 2006-15 on account of premature death and morbidity from Non-communicable diseases alone. Each year 37 million people fall below poverty line due to high expenditure on health services they have to incur. Falling sick puts a double burden on them in terms of loss of income and expenditure on health care which pushes them further into debt and poverty. Adding to the gravity of situation, public spending on health in India has itself declined after liberalization from 1.3% of GDP in 1990 to 0.9% in 1999. The Approach Paper of the Government of India to the Twelfth Five Year Plan indicated that health expenditure alone as a per cent of GDP was about 1.4 per cent (B.E.) in 2011-12. It also mentioned that if one included expenditure on rural water supply and sanitation, the figure would be about 1.8 per cent. Given the abysmally low level of priority accorded to health in Indian economic policy, it becomes rather important to study the representation of health in the Indian public sphere. To this end, this study examines the prioritization of health in the public policy agenda of the national/regional political parties as evidenced in their election manifestos at a time when the nation is poised to go for the General Elections. The paper also focuses attention on the prioritization of health in the public perception as evidenced in their reasons for their preferences for a particular party or individual contestant. To arrive at the reasons for the priority level accorded by the political actors and the citizens, the study uses Focus groups of health policy makers, media persons, medical practitioners and voters. Collected data will be analysed in the theoretical framework of spiral of silence and agenda setting theory.

Keywords: health, election manifestos, public perception, policies

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179 Story of Sexual Violence: Curriculum as Intervention

Authors: Karen V. Lee

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The background and significance of this study involves autoethnographic research about a music teacher learning how education and curriculum planning can help her overcome harmful and lasting career consequences from sexual violence. Curriculum surrounding intervention resources from education helps her cope with consequences influencing her career as music teacher. Basic methodology involves the qualitative method of research as theoretical framework where the author is drawn into a deep storied reflection about political issues surrounding teachers who need to overcome social, psychological, and health risk behaviors from violence. Sub-themes involve counseling, curriculum, adult education to ensure teachers receive social, emotional, physical, spiritual, and intervention resources that evoke visceral, emotional responses from the audience. Major findings share how stories provide helpful resources to teachers who have been victims of violence. It is hoped the research dramatizes an episodic yet incomplete story that highlights the circumstances surrounding the protagonist’s life as teacher with previous sexual violence. In conclusion, the research has a reflexive storied framework with video and music from curriculum planning that embraces harmful and lasting consequences from sexual violence. The reflexive story of the sensory experience critically seeks verisimilitude by evoking lifelike and believable feelings from others. Thus, the scholarly importance of using education and curriculum as intervention resources to accompany storied research can provide transformative aspects that can contribute to social change. Overall, the circumstance surrounding the story about sexual violence is not uncommon in society. Thus, continued education and curriculum that supports the moral mission to help teachers overcome sexual violence that socially impacts their professional lives as victims.

Keywords: education, curriculum, sexual violence, storied autoethnography

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178 Teaching Foreign Languages Across the Curriculum (FLAC): Hybrid French/English Courses and their Dual Impact on Interdisciplinarity and L2 Competency

Authors: M. Caporale

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French Curricula across the US have recently suffered low enrollment and have experienced difficulties with retention, thus resulting in fewer students minoring and majoring in French and enrolling in upper-level classes. Successful undergraduate programs offer French courses with a strong cultural and interdisciplinary or multidisciplinary component. The World Language Curriculum in liberal arts colleges in America needs to take into account the cultural aspects of the language and encourage students to think critically about the country or countries they are studying. Limiting the critical inquiry to language or literature narrowly defined provides and incomplete and stagnant picture of France and the Francophone world in today's global community. This essay discusses the creation and implementation of a hybrid interdisciplinary L1/L2 course titled "Topics in Francophone Cinema" (subtitle "Francophone Women on Screen and Behind the Camera"). Content-based interdisciplinary courses undoubtedly increase the profile of French and Francophone cultural Studies by introducing students of other disciplines to fundamental questions relating to the French and Francophone cultures (in this case, women's rights in the Francophone world). At the same time, this study determines that through targeted reading and writing assignments, sustained aural exposure to L2 through film,and student participation in a one-credit supplementary weekly practicum (creative film writing workshop), significant advances in L2 competence are achieved with students' oral and written production levels evolving from Advanced Low to Advanced-mid, as defined by the ACFL guidelines. Use of differentiated assessment methods for L1/L2 and student learning outcomes for both groups will also be addressed.

Keywords: interdisciplinary, Francophone cultural studies, language competency, content-based

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177 Plant as an Alternative for Anti Depressant Drugs St John's Wort

Authors: Mahdi Akhbardeh

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St John's wort plant can help to treat depression disease through decreasing this disease symptom, due to having some similar features of Prozac (Fluoxetine Hcl) pill. People suffering from slight depression who have fear of using antidepressants side effects can use St John's wort drops under doctor observation. This method of treatment is proposed specially to those women who are spending menopause or depression resulted from this period. St John's wort plant have proposed traditional and plant medicine as newest researches in treating mood disorders compared to Prozac (Fluoxetine Hcl) drug in treating depression disease which is being administrated in clinic research center of Washington. Objective: the aim of this study is to find an alternative treatment method in people suffering from depression which are treated with Prozac (Fluoxetine Hcl). Almost 70 percent of treatment failures with Prozac (Fluoxetine Hcl) drug in patients suffering from slight to normal depression is due to intensive side effects including: decrease in blood pressure, reduce in sexual desire and 30 percent of it is due to this drug affectless in treatment procedure which leads to leaving treatment. Results of Hypercuim plant function are exactly similar to antidepressants. Increase in serotonin amount in brain synopsis terminal end causes increase in existence time of this material in this part. In fact these two drugs have similar function. Though side effects of Hypercuim plant(St John's wort) including headache and slight nausea tolerable. Results: St John's wort plant can be used lonely in slight to normal depressions in which patients are avoiding Prozac (Fluoxetine Hcl) drug due to it's side effects. In intensive depressions through which general patients don’t indicate positive response to drug, it is probably expected relative or even complete treatment through combining antidepressants drugs with this plant. This treatment method has been investigated and confirmed in clinical tests and researches.

Keywords: depression, St John's wort, Prozac, antidepressant

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176 Urban Water Logging Adversity: A Case Study on Disruption of Urban Landscape Due to Water Logging Problems and Probable Analytical Solutions for Urban Region on Port City Chittagong, Bangladesh

Authors: Md. Obidul Haque, Abbasi Khanm

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Port city Chittagong, the commercial capital of Bangladesh, is flourished with fascinating topography and climatic context along with basic resources for livelihood; both shape this city and become living archives of its ecologies. Chittagong has been witnessing numerous urban development measures being taken by city development authority, though some of those seem incomplete because of lack of proper planning. Due to this unplanned trail, the blessings of nature have become the reason of sufferings for city dwellers. One of which is the water clogging due to heavy rainfall, seepage, high tide, absence of well-knit underground drainage system, and so on. The problem has reached such an extent that the first monsoon rain is enough to shut down the entire city and causing immense sufferings to livestock, specially most vulnerable groups such as children and office going people. Study shows that total discharge is higher than present drainage capacity of the canals, thus, resulting in overflow, as major channels are clogged up by dumping waste or illegal encroachment, which are supposed to flush out rain water. This paper aims to address natural and manmade causes behind urban water clogging, adverse socio-environmental hazardous effects, possibilities for probable solutions on basis of local people’s experience and rational urban planning and landscape architectural proposals such as facilitating well planned drainage system, along with waste management policies etc. which can be able to intervene in these movements to activate the mighty port city’s unfulfilled potentials.

Keywords: drainage, high-tide, urban storm water logging (USWL), urban planning, water management

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175 The Role of the Federal Supreme Court in Preventing the Exercise of the Right to Self-Determination

Authors: Shaho Ghafur Ahmed

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The right to self-determination of peoples is a fundamental human right recognized by the principles of international law. It could be embodied in the internal level in the form of federalism. Most federal constitutions prevented the secession of constituent entities, while some remained silent, as the case of Iraq, and rare instances of them recognize it. But, after the failure of federalism, these entities seek to separate whenever the opportunity arises. In several cases, they have resort to peaceful methods in some others they resort to force. The constitutional Supreme Court, which guaranty the unity and integrity of the State, often prevent these attempts. After not a commitment of federalism in Iraq, which has been founded since 2004, the Kurdistan region, as the only federated entity, has conducted a unilateral referendum on 25 September 2017 for its independence. The Iraqi government refused it. The Iraqi Federal Supreme Court, through interpreting the constitutional provisions, decided that this referendum and it’s purposes, which was the independence of the region, was unconstitutional. Subsequently, the Iraqi government used forces and blockaded the region so as to force it to turn off this process. So, in this paper, the right to self-determination of the peoples in federated entities and its obstacles will be discussed through the comparative legal basis and analyzing the decisions of the Federal Constitutional Courts. We will compare the role that the Supreme Court of Canada played regarding the referendum that operated in Quebec in 1995, in which it refused only the unilaterally attempts for the independence of this province. While, in the case of the Kurdistan region, the Iraqi Federal Supreme Court has definitively refused this right. No measures were taken by this Court to protect the region from the Iraqi government reactions. This decision led to the questioning of the neutrality of this Court. So, from the point of view of the Kurdistan region, this Court became a political instrument to prevent it to be independent in the international community, in the absence of a clear constitutional provision, through an abstract and an incomplete interpretation of federal constitutional provisions.

Keywords: right of self-determination, federal supreme court, supremacy of federal constitution

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174 An Assessment on Socio-Economic Impacts of Smallholder Eucalyptus Tree Plantation in the Case of Northwest Ethiopia

Authors: Mersha Tewodros Getnet, Mengistu Ketema, Bamlaku Alemu, Girma Demilew

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The availability of forest products determines the possibilities for forest-based livelihood options. Plantation forest is a widespread economic activity in highland areas of the Amhara regional state, owing primarily to degradation and limited access to natural forests. As a result, tree plantation has become one of the rural livelihood options in the area. Therefore, given the increasing importance of smallholder plantations in highland areas of Amhara Regional States, the aim of this research was to evaluate the extent of smallholder plantations and their socio-economic impact. To address the abovementioned research, a sequential embedded mixed research design was employed. This qualitative and quantitative information was gathered from both primary and secondary sources. Primary data were collected from 385 sample households, which were chosen using a three-stage, multi-stage sampling method based on the Cochran sample size formula. Both descriptive and inferential statistics were used to analyze the data. Smallholder eucalyptus plantations in the study area were discovered to be common, and they are now part of the livelihood portfolio for meeting both household wood consumption and generating cash income. According to the PSM model's ATT results, income from selling farm forest products certainly contributes more to total household income, farm expenditure per cultivated land, and education spending than non-planter households. As a result, the government must strengthen plantation practices by prioritizing specific intervention areas while implementing measures to counteract the plantation's inequality-increasing effect through a variety of means, including progressive taxation.

Keywords: smallholder plantation, Eucalyptus, propensity score matching, average treatment effect and income

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173 Case Report and Literature Review of Opalski Syndrome: A Rare Brainstem Stroke

Authors: Ramuel Spirituel Mattathiah A. San Juan, Neil Ambasing

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Background: In lateral medullary strokes, hemiparesis doesn't typically manifest due to the distinct vascular supply to the corticospinal tract located within the medulla's tegmentum. Hemiparesis resulting from a medullary infarct would likely be attributable to a medial medullary stroke characterized by contralateral hemiparesis since the corticospinal tract fibers at this level have yet to cross over. This paper reports a unique case of a lateral medullary stroke variant that presented with ipsilateral hemiparesis. Objective: There have only been 23 other cases of reported Opalski syndrome, making this only the 24th and 25th case reported worldwide. Case Presentation: A 53-year-old male was admitted with slurring of speech with gait instability, numbness on the right face, Horner’s syndrome, and 4/5 motor strength on the right extremities. Hyperreflexia was noted on the right, together with a Babinski’s sign. Cranial magnetic resonance imaging (MRI) showed an infarct on the right dorsolateral medulla. A 48-year-old male was admitted complaining of dizziness, ataxic gait, veering to the left during ambulation, left facial numbness, left hemiplegia, crossed sensory disturbance, and right limb ataxia. MRI revealed an acute left lateral medullary infarction. Conclusion: A rare type of lateral medullary infarction, the Opalski Syndrome, is a weakness ipsilateral to the lesion of the infarct. The lesion involves the ipsilateral corticospinal tract below the pyramidal decussation. The considerable diversity in the posterior brain circulation serves as a contributing factor to the clinical observation of incomplete textbook syndromes, underscoring the significance of the neurological clinical approach and a solid foundation in neuroanatomy.

Keywords: Opalski syndrome, rare stroke, stroke, Wallenberg's syndrome

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172 Establishing Combustion Behaviour for Refuse Derived Fuel Firing at Kiln Inlet through Computational Fluid Dynamics at a Cement Plant in India

Authors: Prateek Sharma, Venkata Ramachandrarao Maddali, Kapil Kukreja, B. N. Mohapatra

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Waste management is one of the pressing issues of India. Several initiatives by the Indian Government, including the recent one “Swachhata hi Seva” campaign launched by Prime Minister on 15th August 2018, can be one of the game changers to waste disposal. Under this initiative, the government, cement industry and other stakeholders are working hand in hand to dispose of single-use plastics in cement plants in rotary kilns. This is an exemplary effort and a move that establishes the Indian Cement industry as one of the key players in a circular economy. One of the cement plants in Southern India has been mandated by the state government to co-process shredded plastic and refuse-derived fuel (RDF) available in nearby regions as an alternative fuel in their cement plant. The plant has set a target of 25 % thermal substitution rate (TSR) by RDF in the next five years. Most of the cement plants in India and abroad have achieved high TSR through pre calciner firing. But the cement plant doesn’t have the precalciner and has to achieve this daunting task of 25 % TSR by firing through the main kiln burner. Since RDF is a heterogeneous waste with the change in fuel quality, it is difficult to achieve this task; hence plant has to resort to firing some portion of RDF/plastics at kiln inlet. But kiln inlet has reducing conditions as observed during measurements) under baseline condition. The combustion behavior of RDF of different sizes at different firing locations in riser was studied with the help of a computational fluid dynamics tool. It has been concluded that RDF above 50 mm size results in incomplete combustion leading to CO formation. Moreover, best firing location appears to be in the bottom portion of the kiln riser.

Keywords: kiln inlet, plastics, refuse derived fuel, thermal substitution rate

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171 The Cost of Non-Communicable Diseases in the European Union: A Projection towards the Future

Authors: Desiree Vandenberghe, Johan Albrecht

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Non-communicable diseases (NCDs) are responsible for the vast majority of deaths in the European Union (EU) and represent a large share of total health care spending. A future increase in this health and financial burden is likely to be driven by population ageing, lifestyle changes and technological advances in medicine. Without adequate prevention measures, this burden can severely threaten population health and economic development. To tackle this challenge, a correct assessment of the current burden of NCDs is required, as well as a projection of potential increases of this burden. The contribution of this paper is to offer perspective on the evolution of the NCD burden towards the future and to give an indication of the potential of prevention policy. A Non-Homogenous, Semi-Markov model for the EU was constructed, which allowed for a projection of the cost burden for the four main NCDs (cancer, cardiovascular disease, chronic respiratory disease and diabetes mellitus) towards 2030 and 2050. This simulation is done based on multiple baseline scenarios that vary in demand and supply factors such as health status, population structure, and technological advances. Finally, in order to assess the potential of preventive measures to curb the cost explosion of NCDs, a simulation is executed which includes increased efforts for preventive health care measures. According to the Markov model, by 2030 and 2050, total costs (direct and indirect costs) in the EU could increase by 30.1% and 44.1% respectively, compared to 2015 levels. An ambitious prevention policy framework for NCDs will be required if the EU wants to meet this challenge of rising costs. To conclude, significant cost increases due to Non-Communicable Diseases are likely to occur due to demographic and lifestyle changes. Nevertheless, an ambitious prevention program throughout the EU can aid in making this cost burden manageable for future generations.

Keywords: non-communicable diseases, preventive health care, health policy, Markov model, scenario analysis

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