Search results for: quality gate

Authors: Jonathan D. Recchi

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Introduction: Workplace violence is a major concern for nurses throughout the United States and is a rising occupational health hazard that has been exacerbated by both the Covid-19 pandemic and increasing patient and family member incivility. De-escalation training has been found to be an evidence-based tool for emergency department nurses to help avoid or mitigate high-risk situations that could lead to workplace violence. Many healthcare organizations either do not provide de-escalation training to their staff or only provide it sparingly, such as during new employee orientation. There is limited research in the literature on the psychological benefits of de-escalation training. Purpose: The purpose of this study is to determine if there are psychological and organizational advantages to providing emergency department nurses with de-escalation training. Equipping emergency department nurses with skills that are essential to de-escalate violent or potentially violent patients may help prevent physical, mental, and/or psychological damage to the nurse because of violence and/or threatening acts. The hypothesis is that providing de-scalation training to emergency department nurses will lead to increased nurse confidence in dealing with aggressive patients, increased resiliency, increased professional quality of life, and increased intention to stay with their current organization. This study aims to show that organizations would benefit from providing de-escalation training to all nurses operating in high-risk areas on a regular basis. Significance: Showing psychological benefits to providing evidence-based de-escalation training can provide healthcare organizations with the ability to retain a more resilient and prepared workforce. Method: This study uses a pre-experimental cross-sectional pre-/post-test design using a convenience sample of emergency department registered nurses employed across Jefferson Health Northeast (Jefferson Torresdale, Jefferson Bucks, and Jefferson Frankford. Inclusion criteria include registered nurses who work full or part-time, with 51% or more of their clinical time spent in direct clinical care. Excluded from participation are registered nurses in orientation, per-diem nurses, temporary and/or travel nurses, nurses who spend less than 51% of their time in direct patient care, and nurses who have received de-escalation training within the past two years. This study uses the Connor-Davidson Resilience Scale 10 (CD-RISC-10), the Clinician Confidence in Coping with Patient Aggression Scale, the Press Ganey Intention To Stay question, and the Professional Quality of Life Scale. Results: A Paired t-Test will be used to analyze the mean scores of the three scales and one question pre and post-intervention to determine if there is a statistically significant difference in RN resiliency, confidence in coping with patient aggression, intention to stay, and professional quality of life. Discussion and Conclusions: Upon completion, the outcomes of this intervention will show the importance of providing evidence-based de-escalation training to all nurses operating within the emergency department.

Keywords: de-escalation, nursing, emergency department, workplace violence

Procedia PDF Downloads 87

Authors: Mohammad Rahim Rahnama

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Market-transaction price for housing is the main criteria for determining municipality taxes and is determined and announced on an annual basis. Of course, there is a discrepancy between the actual value of transactions in the Bureau of Finance (P for short) or municipality (P´ for short) and the real price on the market (P˝). The present research aims to determine the real price of housing in the metropolis of Mashhad and to pinpoint the price gap with those of the aforementioned apparatuses and identify the factors affecting it. In order to reach this practical objective, Automatic Linear Modeling, which calls for an explanatory research, was utilized. The population of the research consisted of all the residential units in Mashhad, from which 317 residential units were randomly selected. Through cluster sampling, out of the 170 income blocks defined by the municipality, three blocks form high-income (Kosar), middle-income (Elahieh), and low-income (Seyyedi) strata were surveyed using questionnaires during February and March of 2015 and the information regarding the price and specifications of residential units were gathered. In order to estimate the effect of various factors on the price, the relationship between independent variables (8 variables) and the dependent variable of the housing price was calculated using Automatic Linear Modeling in SPSS. The results revealed that the average for housing price index is 788$ per square meter, compared to the Bureau of Finance’s prices which is 10$ and that of municipality’s which is 378$. Correlation coefficient among dependent and independent variables was calculated to be R²=0.81. Out of the eight initial variables, three were omitted. The most influential factor affecting the housing prices is the quality of Quality of construction (Ordinary, Full, Luxury). The least important factor influencing the housing prices is the variable of number of sides. The price gap between low-income (Seyyedi) and middle-income (Elahieh) districts was not confirmed via One-Way ANOVA but their gap with the high-income district (Kosar) was confirmed. It is suggested that city be divided into two low-income and high-income sections, as opposed three, in terms of housing prices.

Keywords: automatic linear modeling, housing prices, Mashhad, Iran

Procedia PDF Downloads 238

Authors: Stephen Grant Atkins

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Radical use of project-based learning (PBL) in a small New Zealand business school provides an opportunity to longitudinally examine its effects over a decade of pre-Covid data. Prior to this business school’s implementation of PBL, starting in 2012, the business pedagogy literature presented just one example of PBL replacing an entire core-set of courses. In that instance, a British business school merged four of its ‘degree Year 3’ accounting courses into one PBL semester. As radical as that would have seemed, to students aged 20-to-22, the PBL experiment conducted in a New Zealand business school was notably more extreme: 41 nationally-approved Learning Outcomes (L.O.s), these deriving from 8 separate core courses, were aggregated into one grand set of L.O.s, and then treated as a ‘full-year’/‘full-time’ single course. The 8 courses in question were all components of this business school’s compulsory ‘degree Year 1’ curriculum. Thus, the students involved were notably younger (…ages 17-to-19…), and no ‘part-time’ enrolments were allowed. Of interest are this PBL experiment’s effects on subsequent performance outcomes in ‘degree Years 2 & 3’ (….which continued to operate in their traditional ways). Of special interest is the quality of ‘group project’ outcomes. This is because traditionally, ‘degree Year 1’ course assessments are only minimally based on group work. This PBL experiment altered that practice radically, such that PBL ‘degree Year 1’ alumni entered their remaining two years of business coursework with far more ‘project group’ experience. Timeline-wise, thus of interest here, firstly, is ‘degree Year 2’ performance outcomes data from years 2010-2012 + 2016-2018, and likewise ‘degree Year 3’ data for years 2011-2013 + 2017-2019. Those years provide a pre-&-post comparative baseline for performance outcomes in students never exposed to this school’s radical PBL experiment. That baseline is then compared to PBL alumni outcomes (2013-2016….including’Student Evaluation of Course Quality’ outcomes…) to clarify ‘radical PBL’ effects.

Keywords: project-based learning, longitudinal mixed-methods, students criticism, effects-on-learning

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Authors: M. Naidoo

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Artificial intelligence often requires large amounts of good quality data. Within important fields, such as healthcare, the training of AI systems predominately relies on health and personal data; however, the usage of this data is complicated by various layers of law and ethics that seek to protect individuals’ privacy rights. This research seeks to establish the challenges AI and data sciences pose to (i) informational rights, (ii) privacy rights, and (iii) data protection. To solve some of the issues presented, various methods are suggested, such as embedding values in technological development, proper balancing of rights and interests, and others.

Keywords: artificial intelligence, data science, law, policy

Procedia PDF Downloads 89

Authors: Komala Arsi, Terrel Spencer, Casey M. Owens, Dan J. Donoghue, Ann M. Donoghue

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Organic poultry production is becoming increasingly popular in the United States with approximately 17% increase in the sales of organic meat and poultry in 2016. As per the National Organic Program (NOP), organic poultry production system should operate according to specific standards, including access to outdoors. In the United States, organic poultry farmers are raising both fast growing and slow growing genotypes for alternative productive systems. Even though heritage breed birds grow much slower compared to commercial breeds, many free range producers believe that they are better suited for outdoor production systems. We conducted an on-farm trial on a working pasture poultry farm to compare the performance and meat quality characteristics of a slow-growing heritage breed (Freedom Rangers, FR), and two commonly used fast growing types of chickens (Cornish cross, CC and Naked Neck, NN), raised on pasture, in side by side pens segregated by breed (n=70/breed). CC and NN group birds were reared for eight weeks whereas FR group birds were reared for 10 weeks and all the birds were commercially processed. By the end of the rearing period, the final body weight of FR group birds was significantly lower than both the fast growing genotypes (CC and NN). Both CC and NN birds showed significantly higher live weight, carcass weight as well as fillet, tender and leg yield (P < 0.05). There was no difference in the wing and rack yield among the different groups. Color of the meat was measured using CEILAB method and expressed as lightness (L), redness (a*) and yellowness (b*). The breast meat from FR birds was much redder (higher a* values) and less yellow (lesser b* values) compared to both the fast growing type of chickens (P < 0.05). Overall, fast growing genotypes produced higher carcass weight and meat yield compared to slow growing genotypes and appear to be an economical option for alternative production systems.

Keywords: fast growing chickens, meat quality, pasture, slow growing chickens

Procedia PDF Downloads 365

Authors: Chueh Chang, Chia-jung Hsieh, Fu-yu Yu, Yu-Hwa Lin

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Background:The majority of women diagnosed with breast cancer undergo treatment involving surgery and radiotherapy or chemotherapy, or both. With these major advances in breast cancer management, many patients still have to deal with short or long-term side effects and psychological distress related to the disease and treatment, which have a substantial impact on their quality of life. The Laughing Qigong Program (LQP) is an interactive laughter program that combines the physical and physiological benefits of laughter with the mental benefits of Chinese qigong. Purpose: In order to improve the quality of life for breast cancer women in the community as well as echoing the WHO 2004 “Promoting Mental Health” for every one. This study focused on how to promote the positive mental health for women of breast cancer through the “laughter program” in Taiwan. During the presentation, how to practice Laughing Qigong will be demonstrated. Method: Using nonequivalent pretest-posttest design, ix-one breast cancer patients were volunteered to enroll in this study from the Taiwan Breast Cancer Alliance (TBCA). Thirty patients were assigned to the experimental group and the other 31 patients were assigned to the control group. The women who were assigned to the experimental group received laughter program one hour per session, once a week, totally 12 sessions. All subjects were tested before and after the intervention on the following: Self-Esteem scale (RSE), Face Scale (FS), Anxiety and pain experience were measured as psychological markers; saliva cortisol (CS) as an immunological marker; blood pressure (BP), heart rate (HR),and heart rate variability (HRV) as physiological markers of the body’s response to stress. Results: After comparing the experimental and control groups, the results revealed that those breast cancer women with “laughing program” their sense of humor were improved, less uncomfortable on self report physical conditions, more positive attitudes toward stress management by using laughter, and had emotional improvement according to the face scale.

Keywords: mental health promotion, breast cancer, laughing Qigong, women

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Authors: Roxanne J. Kovacs

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This paper shows that political corruption in Ghana and Kenya does not, as is assumed by a considerable part of the academic literature, depend on the level of party competition as such, but rather on the kinds of issues that parties compete about. Party competition in Ghana revolves around party performance, which gives political leaders a strong incentive to control corruption. In contrast, party competition in Kenya revolves around ethnic identities, which directly reduces competition based on candidate quality and therefore fosters corruption.

Keywords: corruption, electoral competition, Kenya, Ghana

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Authors: Ioannis I. Αngeli

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Worldwide and mainly in the European Union, many standards, regulations, models and systems exists for the evaluation and identification of stakeholders’ requirements of individual universities and higher education (HE) in general. All systems are targeting to measure or evaluate the Universities’ Quality Assurance Systems and the services offered to the recipients of HE, mainly the students. Numerous surveys were conducted in the past either by each university or by organized bodies to identify the students’ satisfaction or to evaluate to what extent these requirements are fulfilled. In this paper, the main results of an ongoing 6-year joint research will be presented very briefly. This research deals with an in depth investigation of student’s satisfaction, students personal requirements, a cup analysis among these two parameters and compares different universities. Through this research an attempt will be made to address four very important questions in higher education establishments (HEE): (1) Are there any common requirements, parameters, good practices or questions that apply to a large number of universities that will assure that students’ requirements are fulfilled? (2) Up to what extent the individual programs of HEE fulfil the requirements of the stakeholders? (3) Are there any similarities on specific programs among European HEE? (4) To what extent the knowledge acquired in a specific course program is utilized or used in a specific country? For the execution of the research an internationally accepted questionnaire(s) was used to evaluate up to what extent the students’ requirements and satisfaction were fulfilled in 2012 and five years later (2017). Samples of students and or universities were taken from many European Universities. The questionnaires used, the sampling method and methodology adopted, as well as the comparison tables and results will be very valuable to any university that is willing to follow the same route and methodology or compare the results with their own HHE. Apart from the unique methodology, valuable results are demonstrated from the four case studies. There is a great difference between the student’s expectations or importance from what they are getting from their universities (in all parameters they are getting less). When there is a crisis or budget cut in HEE there is a direct impact to students. There are many differences on subjects taught in European universities.

Keywords: quality in higher education, students' requirements, education standards, student's survey, stakeholder's requirements, mechanical engineering courses

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Authors: Nilgün Katrancı, Pınar Göv

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With the acceleration and assessment of quality and patient safety works in healthcare services in the 21st century, activities to reduce errors have gained importance. The prevention and reduction of unintended consequences related to healthcare services and errors made during the delivery of healthcare services can be achieved by understanding the causes of the errors. Communication is the basic reason most frequently seen in such cases. Nurses who communicate with patients more closely and for longer time play a more critical role in ensuring patient safety compared to other healthcare professionals. To reduce the risk of medical errors and increase the quality of care, it is important to raise the awareness of nurses about patient safety in training period. This descriptive study was conducted between February 2017 and May 2017 to assess intern students' attitudes towards and knowledge of patient safety and medical errors. The target population of the study consists of intern students at the Faculty of Nursing in Gaziantep University (N=180). The study did not apply any sample selection method, and the research group consisted of 90 female and 37 male senior students who were available and accepted to take part in the study (N=127). The study used personal information form and medical error attitude scale to collect data. The medical error attitude scale consists of 16 items and 3 sub-dimensions. The most frequently seen medical error in the clinics the interns worked at was found as ‘Failure to comply with asepsis rules’ with a rate of 67,7%. The most frequent case among reasons for not disclosing an error is ‘noticing and correcting the error before affecting the patient’ with the rate of 70,9%. The most frequently expressed implications of disclosing a serious error for the intern students participating in the study are ‘harming patient trust (78%)’ and ‘possibility of overreaction by patient (62,2%)’. According to the results of the study, the awareness of the students about the importance of medical errors and error reporting was found high (3,48 ± 0,49). Consequently, it is important to assess and positively improve the attitudes of nurses and other healthcare professionals towards medical errors for the determination of causes of medical errors and their prevention.

Keywords: healthcare service, intern student, medical error, patient safety

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Authors: Panatda Intanin, Sangutid Thongsawad, Chirapha Tannanonta, Todsaporn Fuangrod

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Stereotactic radiosurgery (SRS) is a highly precision delivery technique that requires comprehensive quality assurance (QA) tests prior to treatment delivery. An isocenter of delivery beam plays a critical role that affect the treatment accuracy. The uncertainty of isocenter is traditionally accessed using circular cone equipment, Winston-Lutz (WL) phantom and film. This technique is considered time consuming and highly dependent on the observer. In this work, the development of multileaf collimator (MLC)-based isocenter verification tool using electronic portal imaging device (EPID) was proposed and evaluated. A mechanical isocenter alignment with ball bearing diameter 5 mm and circular cone diameter 10 mm fixed to gantry head defines the radiation field was set as the conventional WL test method. The conventional setup was to compare to the proposed setup; using MLC (10 x 10 mm) to define the radiation filed instead of cone. This represents more realistic delivery field than using circular cone equipment. The acquisition from electronic portal imaging device (EPID) and radiographic film were performed in both experiments. The gantry angles were set as following: 0°, 90°, 180° and 270°. A software tool was in-house developed using MATLAB/SIMULINK programming to determine the centroid of radiation field and shadow of WL phantom automatically. This presents higher accuracy than manual measurement. The deviation between centroid of both cone-based and MLC-based WL tests were quantified. To compare between film and EPID image, the deviation for all gantry angle was 0.26±0.19mm and 0.43±0.30 for cone-based and MLC-based WL tests. For the absolute deviation calculation on EPID images between cone and MLC-based WL test was 0.59±0.28 mm and the absolute deviation on film images was 0.14±0.13 mm. Therefore, the MLC-based isocenter verification using EPID present high sensitivity tool for SRS QA.

Keywords: isocenter verification, quality assurance, EPID, SRS

Procedia PDF Downloads 132

Authors: Tchapo Tchaga Sophia, Cai Chun

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This study measures the efficiency level of corporate governance to improve the quality level of value relevance in the resolution of market value efficiency increase issues, transparency problems, risk frauds, agency problems, investors' confidence, and decision-making issues using IFRS and Corporate Governance Acts (CGA). The final sample of this study contains 3660 firms from ten countries' stock markets from 2010 to 2020. Based on the efficiency market theory and the positive accounting theory, this paper uses multiple econometrical methods (DID method, multivariate and univariate regression methods) and models (Ohlson model and compliance index model) regression to see the incidence results of corporate governance mechanisms on the value relevance level under the influence of IFRS and corporate governance regulations act framework in Africa's stock exchanges for non-financial firms. The results on value relevance show that the corporate governance system, strengthened by the adoption of IFRS and enforcement of new corporate governance regulations, produces better financial statement information when its compliance level is high. And that is both value-relevant and comparable to results in more developed markets. Similar positive and significant results were obtained when predicting future book value per share and earnings per share through the determination of stock price and stock return. The findings of this study have important implications for regulators, academics, investors, and other users regarding the effects of IFRS and the Corporate Governance Act (CGA) on the relationship between corporate governance and accounting information relevance in the African stock market. The contributions of this paper are also based on the uniqueness of the data used in this study. The unique data is from Africa, and not all existing findings provide evidence for Africa and of the DID method used to examine the relationship between corporate governance and value relevance on African stock exchanges.

Keywords: corporate governance value, market efficiency value, value relevance, African stock market, stock return-stock price

Procedia PDF Downloads 44

Authors: Julius K. Gane, Mohamad N. Nahil, Paul T. Williams

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In today’s world of rapid population growth and a changing climate, one way to mitigate various negative effects is via renewable energy solutions. Energy and power as basic requirements in almost all human endeavours are also the banes of the changing climate and the impacts thereof. Thus it is crucial to develop innovative and environmentally friendly energy options to ameliorate various negative repercussions. Upgrading of fast pyrolysis bio-oil via hydro-treatment offers such opportunities, as quality renewable liquid transportation fuels can be produced. The process, however, is typically accompanied by bio-char formation as a by-product. The goal of this work was to study the yield and some properties of bio-chars formed from a hydrotreatment process, with an overall aim to promote the valuable utilization of wastes or by-products from renewable energy technologies. It is assumed that bio-chars that have comparable energy contents with coals will be more desirable as solid energy materials due to renewability and environmental friendliness. Therefore, the analytical work in this study focused mainly on determining the higher heating value (HHV) of the chars. The method involved the reaction of bio-oil in an autoclave supplied by the Parr Instrument Company, IL, USA. Two main parameters (different temperatures and resident times) were investigated. The chars were characterized using a Thermo EA2000 CHNS analyser, then oxygen contents and HHVs computed based on the literature. From the results, these bio-chars can readily serve as feedstocks for the production of renewable solid fuels. Their HHVs ranged between 29.26-39.18 MJ/kg, affected by different temperatures and retention times. There was an inverse relationship between the oxygen content and the HHVs of the chars. It can, therefore, be concluded that it is possible to optimize the process efficiency of the hydrotreatment process used through the production of renewable energy materials from the 'waste’ char by-products. Future work should consider developing a suitable balance between the primary objective of bio-oil upgrading processes (which is to improve the quality of the liquid fuels) and the conversion of its solid wastes into value-added products such as smokeless briquettes.

Keywords: bio-char, renewable solid biofuels, valorisation, waste-to-energy

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Authors: Li-Jun Ren, Wei Pan, Li-Li Xu, Shu-Qing An

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This study evaluated whether different matrix composition volume ratio can improve water quality in the experiment. The mechanism and adsorption capability of wetland matrixes (oyster shell, coarse slag, and volcanic rock) and their different volume ratio in group configuration during pollutants removal processes were tested. When conditions unchanged, the residence time affects the reaction effect. The average removal efficiencies of four kinds of matrix volume ratio on the TN were 62.76%, 61.54%, 64.13%, and 55.89%, respectively.

Keywords: hydraulic residence time, matrix composition, removal efficiency, volume ratio

Procedia PDF Downloads 307

Authors: S. Najafi, E. Bertini, M. Pezzotti, G.B. Tornielli, S. Zenoni

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Grapevine is an important agricultural fruit crop plant consumed worldwide and with a key role in the global economy. Grapevine is strongly affected by both biotic and abiotic stresses, which impact grape growth at different stages, such as during plant and berry development and pre- and post-harvest, consequently causing significant economic losses. Recently global warming has propelled the anticipation of the onset of berry ripening, determining the reduction of a grape color and increased volatilization of aroma compounds. Climate change could negatively alter the physiological characteristics of the grape and affect the berry and wine quality. Modern plant breeding can provide tools such as genome editing for improving grape resilience traits while maintaining intact the viticultural and oenological quality characteristics of the genotype. This study aims at developing a platform for genome editing application in grapevine plants with the final goal to improve berry quality, biotic, and abiotic resilience traits. We chose to directly deliver ribonucleoproteins (RNP, preassembled Cas protein and guide RNA) into plant protoplasts, and, from these cell structures, regenerate grapevine plants edited in specific selected genes controlling traits of interest. Edited plants regenerated by somatic embryogenesis from protoplasts will then be sequenced and molecularly characterized. Embryogenic calli of Sultana and Shiraz cultivars were initiated from unopened leaves of in-vitro shoot tip cultures and from stamens, respectively. Leaves were placed on NB2 medium while stamens on callus initiation medium (PIV) medium and incubated in the dark at 28 °C for three months. Viable protoplasts, tested by FDA staining, isolated from embryogenic calli were cultured by disc method at 1*105 protoplasts/ml. Mature well-shaped somatic embryos developed directly in the protoplast culture medium two months later and were transferred in the light into to shooting medium for further growth. Regenerated plants were then transferred to the greenhouse; no phenotypic alterations were observed when compared to non in-vitro cultured plants. The performed experiments allowed to established an efficient protocol of embryogenic calli production, protoplast isolation, and regeneration of the whole plant through somatic embryogenesis in both Sultana and Shiraz. Regenerated plants, through direct somatic embryogenesis deriving from a single cell, avoid the risk of chimerism during the regeneration process, therefore improving the genome editing process. As pre-requisite of genome editing, an efficient method for transfection of protoplast by yellow fluorescent protein (YFP) marker genes was also established and experiments of direct delivery of CRISPR–Cas9 ribonucleoproteins (RNPs) in protoplasts to achieve efficient DNA-free targeted mutations are in progress.

Keywords: CRISPR-cas9, plant regeneration, protoplast isolation, Vitis vinifera

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Authors: Rahou Mohamed , Sebaa Fethi, Cheikh Abdelmadjid

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Manufacturing tolerancing is intended to determine the intermediate geometrical and dimensional states of the part during its manufacturing process. These manufacturing dimensions also serve to satisfy not only the functional requirements given in the definition drawing but also the manufacturing constraints, for example geometrical defects of the machine, vibration, and the wear of the cutting tool. The choice of positioning has an important influence on the cost and quality of manufacture. To avoid this problem, a two-step approach have been developed. The first step is dedicated to the determination of the optimum position. As for the second step, a study was carried out for the tightening effect on the tolerance interval.

Keywords: dispersion, tolerance, manufacturing, position

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Authors: Wint Wint Thu, Htet Ko Ko Win, Myat Mon San, Zaw Lin Tun, Nandar Than Aye, Khin Nyein Myat, Hayman Nyo Oo, Nay Aung Lin, Kusum Thapa, Kyaw Htet Aung

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Background: In Myanmar, the intense political instability happened to start in Feb-2021, while the COVID-19 pandemic waves are also threatening the public health system, which subsequently led to severe health sector crisis, including difficulties in accessing maternal and newborn health care for vulnerable women and children. The Remote Pregnant and Newborn Care (RPNC) uses a telehealth approach United States Agency for International Development (USAID)-funded Essential Health Project. Implementation: The Remote Pregnant and Newborn Care (RPNC) service has adapted to the MNCH needs of vulnerable pregnant women and was implemented to mitigate the risk of limited access to essential quality MNH care in Yangon, Myanmar, under women, and the project trained 13 service providers on a telehealth care package for pregnancy and newborn developed Jhpiego to ensure understanding of evidence-based MNCH care practices. The phone numbers of the pregnant women were gathered through the preexisting and functioning community volunteers, who reach the most vulnerable pregnant women in the project's targeted area. A total of 212 pregnant women have been reached by service providers for RPNC during the implementation period. The trained service providers offer quality antenatal and postnatal care, including newborn care, via telephone calls. It includes 24/7 incoming calls and time-allotted outgoing calls to the pregnant women during antenatal and postnatal periods, including the newborn care. The required data were collected daily in time with the calls, and the quality of the medical services is made assured with the track of the calls, ensuring data privacy and patient confidentiality. Lessons learned: The key lessons are 1) cost-effectiveness: RPNC service could reduce out of pocket expenditure of pregnant women as it only costs 1.6 United States dollars (USD) per one telehealth call while it costs 8 to 10 USD per one time in-person care service at private service providers, including transportation cost, 2) network of care: telehealth call could not replace the in-person antenatal and postnatal care services, and integration of telehealth calls with in-person care by local healthcare providers with the support of the community is crucial for accessibility to essential MNH services by poor and vulnerable women, and 3) sharing information on health access points: most of the women seem to have financial barriers in accessing private health facilities while public health system collapse and telehealthcare could provide information on low-cost facilities and connect women to relevant health facilities. These key lessons are important for future efforts regarding the implementation of remote pregnancy and newborn care in Myanmar, especially during the political crisis and COVID-19 pandemic situation.

Keywords: telehealth, accessibility, maternal care, newborn care

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Authors: Ibragim Issabekov, Byron Crape, Lyazzat Toleubekova

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Background: Palliative care substantially improves the quality of life of terminally-ill patients. Symptom control is one of the keystones in the management of patients in palliative care settings, lowering distress as well as improving the quality of life of patients with end-stage diseases. The most common symptoms causing significant distress for patients are pain, nausea and vomiting, increased respiratory secretions and mental health issues like depression. Aims are: 1. to identify best practices in symptom management in palliative patients in accordance with internationally approved guidelines and compare aforementioned with actual practices in Kazakhstan; to evaluate the criteria for assessing symptoms in terminally-ill patients, 2. to review the availability and utilization of pharmaceutical agents for pain control, management of excessive respiratory secretions, nausea, and vomiting, and delirium and 3. to develop recommendations for the systematic approach to end-of-life symptom management in Kazakhstan. Methods: The use of qualitative research methods together with systematic literature review have been employed to provide a rigorous research process to evaluate current approaches for symptom management of palliative patients in Kazakhstan. Qualitative methods include in-depth semi-structured interviews of the healthcare professionals involved in palliative care provision. Results: Obstacles were found in appropriate provision of palliative care. Inadequate education and training to manage severe symptoms, poorly defined laws and regulations for palliative care provision, and a lack of algorithms and guidelines for care were major barriers in the effective provision of palliative care. Conclusion: Assessment of palliative care in this medium-income transitional-economy country is one of the first steps in the initiation of integration of palliative care into the existing health system. Achieving this requires identifying obstacles and resolving these issues.

Keywords: end-of-life care, middle income country, palliative care, symptom control

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Authors: Jinhoa Lee

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The relationships between environmental quality, energy use and economic output have created growing attention over the past decades among researchers and policy makers. Focusing on the empirical aspects of the role of CO2 emissions and energy use in affecting the economic output, this paper is an effort to fulfill the gap in a comprehensive case study at a country level using modern econometric techniques. To achieve the goal, this country-specific study examines the short-run and long-run relationships among energy consumption (using disaggregated energy sources: crude oil, coal, natural gas, electricity), carbon dioxide (CO2) emissions and gross domestic product (GDP) for Turkey using time series analysis from the year 1980-2010. To investigate the relationships between the variables, this paper employs the Phillips–Perron (PP) test for stationarity, Johansen maximum likelihood method for cointegration and a Vector Error Correction Model (VECM) for both short- and long-run causality among the research variables for the sample. All the variables in this study show very strong significant effects on GDP in the country for the long term. The long-run equilibrium in the VECM suggests negative long-run causalities from consumption of petroleum products and the direct combustion of crude oil, coal and natural gas to GDP. Conversely, positive impacts of CO2 emissions and electricity consumption on GDP are found to be significant in Turkey during the period. There exists a short-run bidirectional relationship between electricity consumption and natural gas consumption. There exists a positive unidirectional causality running from electricity consumption to natural gas consumption, while there exists a negative unidirectional causality running from natural gas consumption to electricity consumption. Moreover, GDP has a negative effect on electricity consumption in Turkey in the short run. Overall, the results support arguments that there are relationships among environmental quality, energy use and economic output but the associations can to be differed by the sources of energy in the case of Turkey over of period 1980-2010.

Keywords: CO2 emissions, energy consumption, GDP, Turkey, time series analysis

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Authors: Elizaveta Petelina, Anton Sizo

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Environmental remediation projects deal with a wide spectrum of data, including data collected during site assessment, execution of remediation activities, and environmental monitoring. Therefore, an appropriate data management is required as a key factor for well-grounded decision making. The Environmental Data Management System (EDMS) was developed to address all necessary data management aspects, including efficient data handling and data interoperability, access to historical and current data, spatial and temporal analysis, 2D and 3D data visualization, mapping, and data sharing. The system focuses on support of well-grounded decision making in relation to required mitigation measures and assessment of remediation success. The EDMS is a combination of enterprise and desktop level data management and Geographic Information System (GIS) tools assembled to assist to environmental remediation, project planning, and evaluation, and environmental monitoring of mine sites. EDMS consists of seven main components: a Geodatabase that contains spatial database to store and query spatially distributed data; a GIS and Web GIS component that combines desktop and server-based GIS solutions; a Field Data Collection component that contains tools for field work; a Quality Assurance (QA)/Quality Control (QC) component that combines operational procedures for QA and measures for QC; Data Import and Export component that includes tools and templates to support project data flow; a Lab Data component that provides connection between EDMS and laboratory information management systems; and a Reporting component that includes server-based services for real-time report generation. The EDMS has been successfully implemented for the Project CLEANS (Clean-up of Abandoned Northern Mines). Project CLEANS is a multi-year, multimillion-dollar project aimed at assessing and reclaiming 37 uranium mine sites in northern Saskatchewan, Canada. The EDMS has effectively facilitated integrated decision-making for CLEANS project managers and transparency amongst stakeholders.

Keywords: data management, environmental remediation, geographic information system, GIS, decision making

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Authors: Rishana Bilimoria, Selina Tang, Sajni Shah, Marianne Henien, Christopher Sproat

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Temporomandibular disorders (TMD) may affect up to a third of the general population, and there is evidence demonstrating the majority of Myofascial TMD cases improve after education and conservative measures. In 2015 our department implemented a modified care pathway for myofascial TMD patients in an attempt to improve the patient journey. This involved the use of an interactive group therapy approach to deliver education, reinforce conservative measures and promote self-management. Patient reported experience measures from the new group clinic revealed 71% patient satisfaction. This service is efficient in improving aspects of health status while reducing health-care costs and redistributing clinical time. Since its’ establishment, 52 hours of clinical time, resources and funding have been redirected effectively. This Quality Improvement Project was initiated because it was felt that this new service was being underutilised by our surgical teams. The ‘Plan-Do-Study-Act cycle’ (PDSA) framework was employed to analyse utilisation of the service: The ‘plan’ stage involved outlining our aims: to raise awareness amongst clinicians of the unified care pathway and to increase referral to this clinic. The ‘do’ stage involved collecting data from a sample of 96 patients over 4 month period to ascertain the proportion of Myofascial TMD patients who were correctly referred to the designated clinic. ‘Suitable’ patients who weren’t referred were identified. The ‘Study’ phase involved analysis of results, which revealed that 77% of suitable patients weren’t referred to the designated clinic. They were reviewed on other clinics, which are often overbooked, or managed by junior staff members. This correlated with our original prediction. Barriers to referral included: lack of awareness of the clinic, individual consultant treatment preferences and patient, reluctance to be referred to a ‘group’ clinic. The ‘Act’ stage involved presenting our findings to the team at a clinical governance meeting. This included demonstration of the clinical effectiveness of the care-pathway and explaining the referral route and criteria. In light of the evaluation results, it was decided to keep the group clinic and maximize utilisation. The second cycle of data collection following these changes revealed that of 66 Myofascial TMD patients over a 4 month period, only 9% of suitable patients were not seen via the designated pathway; therefore this QIP was successful in meeting the set objectives. Overall, employing the PDSA cycle in this QIP resulted in appropriate utilisation of the modified care pathway for patients with myofascial TMD in Guy’s Oral Surgery Department. In turn, this leads to high patient satisfaction with the service and effectively redirected 52 hours of clinical time. It permitted adoption of a collaborative working style with oral surgery colleagues to investigate problems, identify solutions, and collectively raise standards of clinical care to ensure we adopt a unified care pathway in secondary care management of Myofascial TMD patients.

Keywords: myofascial, quality Improvement, PDSA, TMD

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Authors: Parya Tabei, Maryam Habibifar

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Decision-making is an important cognitive function that can be defined as the process of choosing an option among available options to achieve a specific goal. Consumer ‘need’ is the main reason for purchasing decisions. Human decision-making while buying products online is subject to various factors, one of which is the quality and effect of advertising photos. Advertising photo editing can have a significant impact on people's virtual purchase decisions. This technique helps improve the quality and overall appearance of photos by adjusting various aspects such as brightness, contrast, colors, cropping, resizing, and adding filters. This study, by examining the effect of editing advertising photos on the virtual purchase decision using EEG data, tries to investigate the effect of edited images on the decision-making of customers. A group of 30 participants were asked to react to 24 edited and unedited images while their EEG was recorded. Analysis of the EEG data revealed increased alpha wave activity in the occipital regions (O1, O2) for both edited and unedited images, which is related to visual processing and attention. Additionally, there was an increase in beta wave activity in the frontal regions (FP1, FP2, F4, F8) when participants viewed edited images, suggesting involvement in cognitive processes such as decision-making and evaluating advertising content. Gamma wave activity also increased in various regions, especially the frontal and parietal regions, which are associated with higher cognitive functions, such as attention, memory, and perception, when viewing the edited images. While the visual processing reflected by alpha waves remained consistent across different visual conditions, editing advertising photos appeared to boost neural activity in frontal and parietal regions associated with decision-making processes. These Findings suggest that photo editing could potentially influence consumer perceptions during virtual shopping experiences by modulating brain activity related to product assessment and purchase decisions.

Keywords: virtual purchase decision, advertising photo, EEG parameters, decision Making

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Authors: Omar Bataineh

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Total productive maintenance (TPM) is a principle-based method that aims to get a high-level production with no breakdowns, no slow running and no defects. Key principles of TPM were applied in this work to improve the performance of the glass production line at United Beverage Company in Kuwait, which is producing bottles of soft drinks. Principles such as 5S as a foundation for TPM implementation, developing a program for equipment management, Cause and Effect Analysis (CEA), quality improvement, training and education of employees were employed. After the completion of TPM implementation, it was possible to increase the Overall Equipment Effectiveness (OEE) from 23% to 40%.

Keywords: OEE, TPM, FMEA, CEA

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Authors: Wanbao Chen, Qianqian Yao, Zhenming Zhou

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Whole grains with intact pericarp are largely resistant to digestion by ruminants because entire kernels are not conducive to bacterial attachment. But processing methods makes the starch more accessible to microbes, and increases the rate and extent of starch degradation in the rumen. To estimate the feasibility of applying a steam-flaking as the processing technique of grains for ruminants, cereal grains (maize, wheat, barley and sorghum) were processed by steam-flaking (steam temperature 105°C, heating time, 45 min). And chemical analysis, in vitro gas production, volatile fatty acid concentrations, and energetic values were adopted to evaluate the effects of steam-flaking. In vitro cultivation was conducted for 48h with the rumen fluid collected from steers fed a total mixed ration consisted of 40% hay and 60% concentrates. The results showed that steam-flaking processing had a significant effect on the contents of neutral detergent fiber and acid detergent fiber (P < 0.01). The concentration of starch gelatinization degree in all grains was also great improved in steam-flaking grains, as steam-flaking processing disintegrates the crystal structure of cereal starch, which may subsequently facilitate absorption of moisture and swelling. Theoretical maximum gas production after steam-flaking processing showed no great difference. However, compared with intact grains, total gas production at 48 h and the rate of gas production were significantly (P < 0.01) increased in all types of grain. Furthermore, there was no effect of steam-flaking processing on total volatile fatty acid, but a decrease in the ratio between acetate and propionate was observed in the current in vitro fermentation. The present study also found that steam-flaking processing increased (P < 0.05) organic matter digestibility and energy concentration of the grains. The collective findings of the present study suggest that steam-flaking processing of grains could improve their rumen fermentation and energy utilization by ruminants. In conclusion, the utilization of steam-flaking would be practical to improve the quality of common cereal grains.

Keywords: cereal grains, gas production, in vitro rumen fermentation, steam-flaking processing

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Authors: Katherine Del Carmen Camacho Zorogastua, Victor Hugo Gallo Ramos, Jhon Walter Gomez Lora

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Marine hydrocarbon exploration (oil and natural gas) activities are developed using 2D, 3D and 4D seismic prospecting techniques where sound waves are directed from a seismic vessel emitted every few seconds depending on the variety of air compressors, which cross the layers of rock at the bottom of the sea and are reflected to the surface of the water. Hydrophones receive and record the reflected energy signals for cross-sectional mapping of the lithological profile in order to identify possible areas where hydrocarbon deposits can be formed. However, they produce several significant negative environmental impacts on the marine ecosystem and in the social and economic sectors. Therefore, the objective of the research is to publicize the negative impacts and environmental measures that must be carried out during the development of these activities to prevent and mitigate water quality, the population involved (fishermen) and the marine biota (e.g., Cetaceans, fish) that are the most vulnerable. The research contains technical environmental aspects based on bibliographic sources of environmental studies approved by the Peruvian authority, research articles, undergraduate and postgraduate theses, books, guides, and manuals from Spain, Australia, Canada, Brazil, and Mexico. It describes the negative impacts on the environment and population (fishing sector), environmental prevention, mitigation, recovery and compensation measures that must be properly implemented and the cases of global sea species stranding, for which international experiences from Spain, Madagascar, Mexico, Ecuador, Uruguay, and Peru were referenced. Negative impacts on marine fauna, seawater quality, and the socioeconomic sector (fishermen) were identified. Omission or inadequate biological monitoring in mammals could alter their ability to communicate, feed, and displacement resulting in their stranding and death. In fish, they cause deadly damage to physical-physiological type and in their behavior. Inadequate wastewater treatment and waste management could increase the organic load and oily waste on seawater quality in violation of marine flora and fauna. The possible estrangement of marine resources (fish) affects the economic sector as they carry out their fishing activity for consumption or sale. Finally, it is concluded from the experiences gathered from Spain, Madagascar, Mexico, Ecuador, Uruguay, and Peru that there is a cause and effect relationship between the inadequate development of seismic exploration activities (cause) and marine species strandings (effect) since over the years, stranded or dead marine mammals have been detected on the shores of the sea in areas of seismic acquisition of hydrocarbons. In this regard, it is recommended to establish technical procedures, guidelines, and protocols for the monitoring of marine species in order to contribute to the conservation of hydrobiological resources.

Keywords: 3D seismic prospecting, cetaceans, significant environmental impacts, prevention, mitigation, recovery, environmental compensation

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Authors: ALi Zaker, Zhi Chen

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Due to the concerns about the depletion of fossil fuel sources and the deteriorating environment, the attempt to investigate the production of renewable energy will play a crucial role as a potential to alleviate the dependency on mineral fuels. In this respect, biofuels are measured as a vital nominee for national energy security and energy sustainability. Sewage sludge (SS), as an alternative source of renewable energy with a complex composition, is a major waste generated during wastewater treatment. Stricter legislation is continuously refining the requirements for the level of removal of various pollutants in treated water, causing continuous growth of sludge production, which has become a global challenge. In general, there are two main procedures for dealing with SS: incineration and landfill. However, there are a variety of limitations in these options (e.g., production of greenhouse gases and restrictive environmental regulations) in regard to negative social and economic impacts. Pyrolysis is a feasible and cost-effective technology that can simultaneously tackle boundaries concerning the current disposal routes while retrieving bioenergy. Pyrolysis of SS has drawn vigorous interest in research due to the ability of high mass yield of pyrolytic liquid production. Nonetheless, the presence of high molecular weight hydrocarbons and oxygenated- and nitrogenated compounds poses a considerable challenge. In this context, catalytic pyrolysis is another attainable route in order to upgrade the bio-oil quality. Among different catalysts (i.e., zeolites) studied for sewage sludge pyrolysis, activated chars are eco-friendly and low-cost alternatives. The beneficial features comprise comparatively large surface area, long-term stability, and enriched surface functional groups. In light of these premises, this research attempts to investigate the catalytic pyrolysis of sewage sludge with a high-performance sludge-based activated char in contrast to HZSM5 from a theoretical and experimental point of view.

Keywords: catalytic pyrolysis, sewage sludge, char, HZSM5, bio-oil.

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Authors: Maria A. Castillo H., Andres R. Leandro, Jose F. Bienvenido B.

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In 2015, Guatemala officially adopted the Sustainable Development Goals (SDG) according to the 2030 Agenda agreed by the United Nations Organization. In 2016, these objectives and goals were reviewed, and the National Priorities were established within the K'atún 2032 National Development Plan. In 2019 and 2021, progress was evaluated with 120 defined indicators, and the need to improve quality and availability of statistical data necessary for the analysis of sustainability indicators was detected, so the values to be reached in 2024 and 2032 were adjusted. The need for greater agricultural technology is one of the priorities established within SDG 2 "Zero Hunger". Within this area, protected agricultural production provides greater productivity throughout the year, reduces the use of chemical products to control pests and diseases, reduces the negative impact of climate and improves product quality. During the crisis caused by Covid-19, there was an increase in exports of fruits and vegetables produced in greenhouses from Guatemala. However, this information has not been considered in the 2021 revision of the Plan. The objective of this study is to evaluate the information available on Greenhouse Agricultural Production and its integration into the Sustainability Indicators for Guatemala. This study was carried out in four phases: 1. Analysis of the Goals established for SDG 2 and the indicators included in the K'atún Plan. 2. Analysis of Environmental, Social and Economic Indicator Models. 3. Definition of territorial levels in 2 geographic scales: Departments and Municipalities. 4. Diagnosis of the available data on technological agricultural production with emphasis on Greenhouses at the 2 geographical scales. A summary of the results is presented for each phase and finally some recommendations for future research are added. The main contribution of this work is to improve the available data that allow the incorporation of some agricultural technology indicators in the established goals, to evaluate their impact on Food Security and Nutrition, Employment and Investment, Poverty, the use of Water and Natural Resources, and to provide a methodology applicable to other production models and other geographical areas.

Keywords: greenhouses, protected agriculture, sustainable indicators, Guatemala, sustainability, SDG

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Authors: Angelo Corallo, Maria Elena Latino, Marta Menegoli

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Agri-food value chain involves various stakeholders with different roles. All of them abide by national and international rules and leverage marketing strategies to advance their products. Food products and related processing phases carry with it a big mole of data that are often not used to inform final customer. Some data, if fittingly identified and used, can enhance the single company, and/or the all supply chain creates a math between marketing techniques and voluntary traceability strategies. Moreover, as of late, the world has seen buying-models’ modification: customer is careful on wellbeing and food quality. Food citizenship and food democracy was born, leveraging on transparency, sustainability and food information needs. Internet of Things (IoT) and Analytics, some of the innovative technologies of Industry 4.0, have a significant impact on market and will act as a main thrust towards a genuine ‘4.0 change’ for agriculture. But, realizing a traceability system is not simple because of the complexity of agri-food supply chain, a lot of actors involved, different business models, environmental variations impacting products and/or processes, and extraordinary climate changes. In order to give support to the company involved in a traceability path, starting from business model analysis and related business process a Framework to Manage Product Data in Agri-Food Supply Chain for Voluntary Traceability was conceived. Studying each process task and leveraging on modeling techniques lead to individuate information held by different actors during agri-food supply chain. IoT technologies for data collection and Analytics techniques for data processing supply information useful to increase the efficiency intra-company and competitiveness in the market. The whole information recovered can be shown through IT solutions and mobile application to made accessible to the company, the entire supply chain and the consumer with the view to guaranteeing transparency and quality.

Keywords: agriculture 4.0, agri-food suppy chain, industry 4.0, voluntary traceability

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Authors: Peter Akayuure

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One key determinant of the quality of mathematics learning is the teacher’s ability to assess students adequately and effectively and make assessment an integral part of the instructional practices. If the mathematics teacher lacks the required literacy to perform classroom assessment roles, the true trajectory of learning success and attainment of curriculum expectations might be indeterminate. It is therefore important that educators and policymakers understand and seek ways to improve the literacy level of mathematics teachers to implement classroom assessments that would meet curriculum demands. This study employed a descriptive survey design to explore perceived levels of assessment literacy of mathematics teachers to implement classroom assessment with the school based assessment framework in Ghana. A 25-item classroom assessment inventory on teachers’ assessment scenarios was adopted, modified, and administered to a purposive sample of 48 mathematics teachers from eleven Senior High Schools. Seven other items were included to further collect data on their self-efficacy towards assessment literacy. Data were analyzed using descriptive and bivariate correlation statistics. The result shows that, on average, 48.6% of the mathematics teachers attained standard levels of assessment literacy. Specifically, 50.0% met standard one in choosing appropriate assessment methods, 68.3% reached standard two in developing appropriate assessment tasks, 36.6% reached standard three in administering, scoring, and interpreting assessment results, 58.3% reached standard four in making appropriate assessment decisions, 41.7% reached standard five in developing valid grading procedures, 45.8% reached standard six in communicating assessment results, and 36.2 % reached standard seven by identifying unethical, illegal and inappropriate use of assessment results. Participants rated their self-efficacy belief in performing assessments high, making the relationships between participants’ assessment literacy scores and self-efficacy scores weak and statistically insignificant. The study recommends that institutions training mathematics teachers or providing professional developments should accentuate assessment literacy development to ensure standard assessment practices and quality instruction in mathematics education at senior high schools.

Keywords: assessment literacy, mathematics teacher, senior high schools, Ghana

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Authors: Waqas Ahmed Khan, Faheem Khokhaar

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Air pollution is one of the main perpetrators of climate change. GHGs cause melting of glaciers and cause change in temperature and heavy rain fall many gasses like Formaldehyde is not direct precursor that damage ozone like CO2 or Methane but Formaldehyde (HCHO) form glyoxal (CHOCHO) that has effect on ozone. Countries around the globe have unique air quality monitoring protocols to describe local air pollution. Formaldehyde is a colorless, flammable, strong-smelling chemical that is used in building materials and to produce many household products and medical preservatives. Formaldehyde also occurs naturally in the environment. It is produced in small amounts by most living organisms as part of normal metabolic processes. Pakistan lacks the monitoring facilities on larger scale to measure the atmospheric gasses on regular bases. Formaldehyde is formed from Glyoxal and effect mountain biodiversity and livelihood. So its monitoring is necessary in order to maintain and preserve biodiversity. Objective: Present study is aimed to measure atmospheric HCHO vertical column densities (VCDs) obtained from ground-base and compute HCHO data in Punjab and elevated areas (Rawalpindi & Islamabad) by satellite observation during the time period of 2014-2015. Methodology: In order to explore the spatial distributing of H2CO, various fields campaigns including international scientist by using car Max-Doas. Major focus was on the cities along national highways and industrial region of Punjab Pakistan. Level 2 data product of satellite instruments OMI retrieved by differential optical absorption spectroscopy (DOAS) technique are used. Spatio-temporal distribution of HCHO column densities over main cities and region of Pakistan has been discussed. Results: Results show the High HCHO column densities exceeding permissible limit over the main cities of Pakistan particularly the areas with rapid urbanization and enhanced economic growth. The VCDs value over elevated areas of Pakistan like Islamabad, Rawalpindi is around 1.0×1016 to 34.01×1016 Molecules’/cm2. While Punjab has values revolving around the figure 34.01×1016. Similarly areas with major industrial activity showed high amount of HCHO concentrations. Tropospheric glyoxal VCDs were found to be 4.75 × 1015 molecules/cm2. Conclusion: Results shows that monitoring site surrounded by Margalla hills (Islamabad) have higher concentrations of Formaldehyde. Wind data shows that industrial areas and areas having high economic growth have high values as they provide pathways for transmission of HCHO. Results obtained from this study would help EPA, WHO and air protection departments in order to monitor air quality and further preservation and restoration of mountain biodiversity.

Keywords: air quality, formaldehyde, Max-Doas, vertical column densities (VCDs), satellite instrument, climate change

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Authors: Sarah Reker, Christiane H. Kellner

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From the perspective of people with disabilities, inequalities can also emerge from spatial segregation, the lack of social contacts or limited economic resources. In order to reduce or even eliminate these disadvantages and increase general well-being, community-based participation as well as decentralisation efforts within exclusively residential homes is essential. Therefore, the new research project “Index for participation development and quality of life for persons with disabilities”(TeLe-Index, 2014-2016), which is anchored at the Technische Universität München in Munich and at a large residential complex and service provider for persons with disabilities in the outskirts of Munich aims to assist the development of community-based living environments. People with disabilities should be able to participate in social life beyond the confines of the institution. Since a diverse society is a society in which different individual needs and wishes can emerge and be catered to, the ultimate goal of the project is to create an environment for all citizens–regardless of disability, age or ethnic background–that accommodates their daily activities and requirements. The UN-Convention on the Rights of Persons with Disabilities, which Germany also ratified, postulates the necessity of user-centered design, especially when it comes to evaluating the individual needs and wishes of all citizens. Therefore, a multidimensional approach is required. Based on this insight, the structure of the town-like center will be remodeled to open up the community to all people. This strategy should lead to more equal opportunities and open the way for a much more diverse community. Therefore, macro-level research questions were inspired by quality of life theory and were formulated as follows for different dimensions: •The user dimension: what needs and necessities can we identify? Are needs person-related? Are there any options to choose from? What type of quality of life can we identify? The economic dimension: what resources (both material and staff-related) are available in the region? (How) are they used? What costs (can) arise and what effects do they entail? •The environment dimension: what “environmental factors” such as access (mobility and absence of barriers) prove beneficial or impedimental? In this context, we have provided academic supervision and support for three projects (the construction of a new school, inclusive housing for children and teenagers with disabilities and the professionalization of employees with person-centered thinking). Since we cannot present all the issues of the umbrella-project within the conference framework, we will be focusing on one project more in-depth, namely “Outpatient Housing Options for Children and Teenagers with Disabilities”. The insights we have obtained until now will enable us to present the intermediary results of our evaluation. The most central questions pertaining to this part of the research were the following: •How have the existing network relations been designed? •What meaning (or significance) does the existing service offers and structures have for the everyday life of an external residential group? These issues underpinned the environmental analyses as well as the qualitative guided interviews and qualitative network analyses we carried out.

Keywords: decentralisation, environmental analyses, outpatient housing options for children and teenagers with disabilities, qualitative network analyses

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