Search results for: review study
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 50896

Search results for: review study

46966 Child Marriage in Indonesian Law Perspective

Authors: Sonny Dewi Judiasih

Abstract:

Every person retains the right to marry and starts a family through a legitimized marriage. Indonesian Marriage Act has regulated the minimum age for boys to marry is 19 while the girls is 16, with an exception that the parents could ask for an exemption to the court or to the authorized official. Despite the age limit is set by the Marriage Act, however, with the influences from adat law and islamic law which allows younger persons to marry, the child marriage phenomenon is inevitable to happen in Indonesia. Child marriages in Indonesia have shown such alarming fact where 4.8 percentage of total marriage number come from persons with the age of 10 to 14 years old. The percentage was the result from a research conducted by the National Population and Family Planning Board (BKKBN). The result shows 41.9 percent of child marriages was contributed by girls who marry in the age of 15 to 19, which mostly comes from villagers. Other fact shows 50 percent of child marriages end in divorce with grounds varied from the mental health of the children, economic situation, and so on. With more children committed early marriages, more babies will be borned from indebted families. Subsequently, the government’s program to alleviate poverty will be short of expectations. Other risk for child marriages includes death of the mother and the child after giving birth. The people have challenged the legality of child marriages through judicial review filed to the Constitutional Court. The Court decided to reinforce the age limitation previously set by the Marriage Act by issuing judicial decision no: 30-74/PUU-Xii/2014. The Court stated that changes to the age limit must be in conform with cultural and traditional situation. Further, it stated child marriages are allowed to be arranged as an “emergency exit” if the parents filed such request to an exemption on the grounds of coercive situation and after the court or the authorized officials issued its approval.

Keywords: child, marriage, court, Indonesia

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46965 Addressing Ophthalmic and Vascular Diabetic Complications in South Asians

Authors: Haaris Khan, Farhad Udwadia

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South Asians are the fastest-growing immigrant population in Canada and are 3-4 times more likely to develop diabetes. In a primary care setting, language barriers continue to persist as a prominent obstacle when delivering crucial health information. Given the abundance of languages in the South Asian community and the varying levels of English fluency, there is compelling evidence that these language barriers can adversely impact health outcomes. The microvascular and macrovascular complications of poor diabetic management are well established and universally recognized. However, these are often difficult concepts to grasp for even individuals fluent in English. In order to lessen the burden of language barriers, we developed a comprehensive guide in various languages that discuss the complications and screening guidelines for diabetic and prediabetic patients. The guide is presented in the form of a pamphlet, with an electronic version being constructed as well, that provides basic information on diabetic retinopathy, neuropathy and nephropathy as well as the screening recommendations. We also conducted a review of the literature around the topic and incorporated our findings into our project. Our goal is for primary care physicians to have this resource and to be able to provide the link or pamphlet to patients in need. Our presentation also provides a comprehensive overview of some of the other barriers that individuals in the South Asian community face when seeking care. Given the staggering number of individuals in the South Asian community with diabetes and the morbidity and mortality associated with diabetes and its complications, effective community-specific strategies are needed to mitigate the potential consequences of poor diabetes management.

Keywords: diabetes, patient education, ophthalmology, vascular surgery

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46964 Exploring Students’ Views on Science Education

Authors: Ahmad Alshammari

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This study focused on exploring the students’ views about the science education in intermediate stage in State of Kuwait. This study used Social-Culture Theory (SCT) as a theoretical framework to understand the science curriculum reform process through the socio-cultural context and to discuss and explain the study findings. This study used a multi-method design, with both quantitative and qualitative methods to collect the data: students’ questionnaires and interviews. The study sample was selected randomly. First, the questionnaire was conducted with 647 students. Then 30 students (5 in each of 6 focus groups) were chosen to conduct the in-depth interviews. The findings of this study indicated the generally negative views of most of the students about the new science curriculum. The findings showed that most of the students have a negative attitude toward science, they have difficulty understanding most of the lessons, and they do not enjoy studying the science subject. This study recommends reviewing the new science curriculum (now currently in use) and taking into account the perspectives of the students about this curriculum. Developing and adapting the new science curriculum took place without taking into consideration the socio-culture and Islamic religion of Kuwaiti students. The MoE should deal with the relationship between science and culture and between science and religion, integrating more relevant science into the curriculum.

Keywords: science education, students views, science curriculum, curriculum development

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46963 Importance of Flexibility Training for Older Adults: A Narrative Review

Authors: Andrej Kocjan

Abstract:

Introduction: Mobility has been shown to play an important role of health and quality of life among older adults. Falls, which are often related to decreased mobility, as well as to neuromuscular deficits, represent the most common injury among older adults. Fall risk has been shown to increase with reduced lower extremity flexibility. The aim of the paper is to assess the importance of flexibility training on joint range of motion and functional performance among elderly population. Methods: We performed literature research on PubMed and evaluated articles published until 2000. The articles found in the search strategy were also added. The population of interest included older adults (≥ 65 years of age). Results: Flexibility training programs still represent an important part of several rehabilitation programs. Static stretching and proprioceptive neuromuscular facilitation are the most frequently used techniques to improve the length of the muscle-tendon complex. Although the effectiveness of type of stretching seems to be related to age and gender, static stretching is a more appropriate technique to enhance shoulder, hip, and ankle range of motion in older adults. Stretching should be performed in multiple sets with holds of more than 60 seconds for a single muscle group. Conclusion: The literature suggests that flexibility training is an effective method to increase joint range of motion in older adults. In the light of increased functional outcome, activities such as strengthening, balance, and aerobic exercises should be incorporated into a training program for older people. Due to relatively little published literature, it is still not possible to prescribe detailed recommendations regarding flexibility training for older adults.

Keywords: elderly, exercise, flexibility, falls

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46962 Food Composition Tables Used as an Instrument to Estimate the Nutrient Ingest in Ecuador

Authors: Ortiz M. Rocío, Rocha G. Karina, Domenech A. Gloria

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There are several tools to assess the nutritional status of the population. A main instrument commonly used to build those tools is the food composition tables (FCT). Despite the importance of FCT, there are many error sources and variability factors that can be presented on building those tables and can lead to an under or over estimation of ingest of nutrients of a population. This work identified different food composition tables used as an instrument to estimate the nutrient ingest in Ecuador.The collection of data for choosing FCT was made through key informants –self completed questionnaires-, supplemented with institutional web research. A questionnaire with general variables (origin, year of edition, etc) and methodological variables (method of elaboration, information of the table, etc) was passed to the identified FCT. Those variables were defined based on an extensive literature review. A descriptive analysis of content was performed. Ten printed tables and three databases were reported which were all indistinctly treated as food composition tables. We managed to get information from 69% of the references. Several informants referred to printed documents that were not accessible. In addition, searching the internet was not successful. Of the 9 final tables, n=8 are from Latin America, and, n= 5 of these were constructed by indirect method (collection of already published data) having as a main source of information a database from the United States department of agriculture USDA. One FCT was constructed by using direct method (bromatological analysis) and has its origin in Ecuador. The 100% of the tables made a clear distinction of the food and its method of cooking, 88% of FCT expressed values of nutrients per 100g of edible portion, 77% gave precise additional information about the use of the table, and 55% presented all the macro and micro nutrients on a detailed way. The more complete FCT were: INCAP (Central America), Composition of foods (Mexico). The more referred table was: Ecuadorian food composition table of 1965 (70%). The indirect method was used for most tables within this study. However, this method has the disadvantage that it generates less reliable food composition tables because foods show variations in composition. Therefore, a database cannot accurately predict the composition of any isolated sample of a food product.In conclusion, analyzing the pros and cons, and, despite being a FCT elaborated by using an indirect method, it is considered appropriate to work with the FCT of INCAP Central America, given the proximity to our country and a food items list that is very similar to ours. Also, it is imperative to have as a reference the table of composition for Ecuadorian food, which, although is not updated, was constructed using the direct method with Ecuadorian foods. Hence, both tables will be used to elaborate a questionnaire with the purpose of assessing the food consumption of the Ecuadorian population. In case of having disparate values, we will proceed by taking just the INCAP values because this is an updated table.

Keywords: Ecuadorian food composition tables, FCT elaborated by direct method, ingest of nutrients of Ecuadorians, Latin America food composition tables

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46961 The Use of Geographic Information System and Spatial Statistic for Analyzing Leukemia in Kuwait for the Period of 2006-2012

Authors: Muhammad G. Almatar, Mohammad A. Alnasrallah

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This research focuses on the study of three main issues: 1) The temporal analysis of leukemia for a period of six years (2006-2012), 2) spatial analysis by investigating this phenomenon in the Kuwaiti society spatially in the residential areas within the six governorates, 3) the use of Geographic Information System technology in investigating the hypothesis of the research and its variables using the linear regression, to show the pattern of linear relationship. The study depends on utilizing the map to understand the distribution of blood cancer in Kuwait. Several geodatabases were created for the number of patients and air pollution. Spatial interpolation models were used to generate layers of air pollution in the study area. These geodatabases were tested over the past six years to reach the conclusion: Is there a relationship with significant significance between the two main variables of the study: blood cancer and air pollution? This study is the first to our best knowledge. As far as the researchers know, the distribution of this disease has not been studied geographically at the level of regions in Kuwait within six years and in specific areas as described above. This study investigates the concentration of this type of disease. The study found that there is no relationship of significant value between the two variables studied, and this may be due to the nature of the disease, which are often hereditary. On the other hand, this study has reached a number of suggestions and recommendations that may be useful to decision-makers and interested in the study of leukemia in Kuwait by focusing on the study of genetic diseases, which may be a cause of leukemia rather than air pollution.

Keywords: Kuwait, GIS, cancer, geography

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46960 The Effect of Al Andalus Improvement Model on the Teachers Performance and Their High School Students' Skills Acquiring

Authors: Sobhy Fathy A. Hashesh

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The study was carried out in the High School Classes of Andalus Private Schools, boys section, using control and experimental groups that were randomly assigned. The study investigated the effect of Al-Andalus Improvement Model (AIM) on the development of students’ skills acquiring. The society of the study composed of Al-Andalus Private Schools, high school students, boys Section (N=700), while the sample of the study composed of four randomly assigned groups two groups of teachers (N=16) and two groups of students (N=42) with one experimental group and one control group for teachers and their students respectively. The study followed the quantitative and qualitative approaches in collecting and analyzing data to investigate the study hypotheses. Results of the study revealed that there were significant statistical differences in teachers’ performances and students' skills acquiring for the favor of the experimental groups and there was a strong correlation between the teachers performances and the students skills acquiring. The study recommended the implementation of the AIM model for the sake of teachers performances and students’ learning outcomes.

Keywords: AIM, improvement model, Classera, Al-Andalus Improvement Model.

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46959 Preliminary Studies of Transient Stability for the 380 kV Connection West-Central of Saudi Electricity Company

Authors: S. Raja Mohamed, M. H Shwehdi, D. Devaraj

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This paper is to present and discuss the new planned 380 kV transmission line performance under steady and transient states. Dynamic modeling and analysis of such inter-tie, which is, proposed to transfer energy from west to south and vice versa will be demonstrated and discussed. The west-central-south inter-tie links Al-Aula-Zaba-Tabuk-Tubajal-Jawf-Hail. It is essential to investigate the transient over-voltage to assure steady and stable transmission over such inter-tie. Saudi Electricity Company (SEC) has been improving its grid to make the whole country as an interconnected system. Already east, central and west were interconnected, yet mostly each is fed with its local generation. The SEC is planning to establish many inter-ties to strengthen the transient stability of its grid. The paper studies one of the important links of 380 kV, 220 km between Tabouk and Tubarjal, which is a step towards connecting the West with the South region. Modeling and analysis using some softwares will be utilized under different scenarios. Adoption of methods to stabilize and increase its power transmission are also discussed. Improvement of power system transients has been controlled by FACTS elements such the Static Var Compensators (SVC) receiving a wide interest since many technical studies have proven their effects on damping system oscillations and stability enhancement. Illustrations of the transient at each main generating or load bus will be checked in all inter-tie links. A brief review of possible means to solve the transient over-voltage problem using different FACTS element modeling will be discussed.

Keywords: transient stability, static var compensator, central-west interconnected system, damping controller, Saudi Electricity Company

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46958 Transport Hubs as Loci of Multi-Layer Ecosystems of Innovation: Case Study of Airports

Authors: Carolyn Hatch, Laurent Simon

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Urban mobility and the transportation industry are undergoing a transformation, shifting from an auto production-consumption model that has dominated since the early 20th century towards new forms of personal and shared multi-modality [1]. This is shaped by key forces such as climate change, which has induced a shift in production and consumption patterns and efforts to decarbonize and improve transport services through, for instance, the integration of vehicle automation, electrification and mobility sharing [2]. Advanced innovation practices and platforms for experimentation and validation of new mobility products and services that are increasingly complex and multi-stakeholder-oriented are shaping this new world of mobility. Transportation hubs – such as airports - are emblematic of these disruptive forces playing out in the mobility industry. Airports are emerging as the core of innovation ecosystems on and around contemporary mobility issues, and increasingly recognized as complex public/private nodes operating in many societal dimensions [3,4]. These include urban development, sustainability transitions, digital experimentation, customer experience, infrastructure development and data exploitation (for instance, airports generate massive and often untapped data flows, with significant potential for use, commercialization and social benefit). Yet airport innovation practices have not been well documented in the innovation literature. This paper addresses this gap by proposing a model of airport innovation that aims to equip airport stakeholders to respond to these new and complex innovation needs in practice. The methodology involves: 1 – a literature review bringing together key research and theory on airport innovation management, open innovation and innovation ecosystems in order to evaluate airport practices through an innovation lens; 2 – an international benchmarking of leading airports and their innovation practices, including such examples as Aéroports de Paris, Schipol in Amsterdam, Changi in Singapore, and others; and 3 – semi-structured interviews with airport managers on key aspects of organizational practice, facilitated through a close partnership with the Airport Council International (ACI), a major stakeholder in this research project. Preliminary results find that the most successful airports are those that have shifted to a multi-stakeholder, platform ecosystem model of innovation. The recent entrance of new actors in airports (Google, Amazon, Accor, Vinci, Airbnb and others) have forced the opening of organizational boundaries to share and exchange knowledge with a broader set of ecosystem players. This has also led to new forms of governance and intermediation by airport actors to connect complex, highly distributed knowledge, along with new kinds of inter-organizational collaboration, co-creation and collective ideation processes. Leading airports in the case study have demonstrated a unique capacity to force traditionally siloed activities to “think together”, “explore together” and “act together”, to share data, contribute expertise and pioneer new governance approaches and collaborative practices. In so doing, they have successfully integrated these many disruptive change pathways and forced their implementation and coordination towards innovative mobility outcomes, with positive societal, environmental and economic impacts. This research has implications for: 1 - innovation theory, 2 - urban and transport policy, and 3 - organizational practice - within the mobility industry and across the economy.

Keywords: airport management, ecosystem, innovation, mobility, platform, transport hubs

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46957 Socio-Economic Child’S Wellbeing Impasse in South Africa: Towards a Theory-Based Solution Model

Authors: Paulin Mbecke

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Research Issue: Under economic constraints, socio-economic conditions of households worsen discounting child’s wellbeing to the bottom of many governments and households’ priority lists. In such situation, many governments fail to rebalance priorities in providing services such as education, housing and social security which are the prerequisites for the wellbeing of children. Consequently, many households struggle to respond to basic needs especially those of children. Although economic conditions play a crucial role in creating prosperity or poverty in households and therefore the wellbeing or misery for children; they are not the sole cause. Research Insights: The review of the South African Index of Multiple Deprivation and the South African Child Gauge establish the extent to which economic conditions impact on the wellbeing or misery of children. The analysis of social, cultural, environmental and structural theories demonstrates that non-economic factors contribute equally to the wellbeing or misery of children, yet, they are disregarded. In addition, the assessment of a child abuse database proves a weak correlation between economic factors (prosperity or poverty) and child’s wellbeing or misery. Theoretical Implications: Through critical social research theory and modelling, the paper proposes a Theory-Based Model that combines different factors to facilitate the understanding of child’s wellbeing or misery. Policy Implications: The proposed model assists in broad policy and decision making and reviews processes in promoting child’s wellbeing and in preventing, intervening and managing child’s misery with regard to education, housing, and social security.

Keywords: children, child’s misery, child’s wellbeing, household’s despair, household’s prosperity

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46956 Blockchain Technology Applications in Patient Tracking Systems Regarding Privacy-Preserving Concerns and COVID-19 Pandemic

Authors: Farbod Behnaminia, Saeed Samet

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The COVID-19 pandemic has paralyzed many lives until a vaccine was available, which caused the so-called “new normal.” According to the World Health Organization (WHO), COVID-19 is an infectious disease. It can cause significant illness or death in anyone. Governments and health officials tried to impose rules and regulations to avoid and slow down transmission. Therefore, software engineers worldwide developed applications to trace and track patients’ movements and notify others, mainly using Bluetooth. In this way, everyone could be informed whether they come in close contact with someone who has COVID-19 and takes proper safety precautions. Because most of the applications use technologies that can potentially reveal the user’s identity and location, researchers have debated privacy preservation and how to improve user privacy during such pandemics. Thanks to Distributed Ledger Technology (DLT), there have been some proposed methods to develop privacy-preserving Patient Tracking Systems in the last two years. As an instance of the DLT, Blockchain is like a decentralized peer-to-peer database that maintains a record of transactions. Transactions are immutable, transparent, and anonymous in this system. We conducted a comprehensive evaluation of the literature by looking for papers in the relevant field and dividing them into pre- and post-pandemic systems. Additionally, we discussed the many uses of blockchain technology in pandemic control. We found that two major obstacles facing blockchain implementation across many healthcare systems are scalability and privacy. The Polkadot platform is presented, along with a review of its efficacy in tackling current concerns. A more scalable healthcare system is achievable in the near future using Polkadot as well as a much more privacy-preserving environment.

Keywords: blockchain, electronic record management, EHR, privacy-preserving, patient tracking, COVID-19, trust and confidence, Polkadot

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46955 The Increase of Adolescent Obesity Rates after the COVID-19 Pandemic and Possible Obesity Prevention Programs for Implementation

Authors: Tatiana Pratt, Benyamin Hanasabzadeh, Panayiota Courelli

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The COVID-19 pandemic is one of the largest global public health issues of this current century. COVID-19 puts people diagnosed with obesity at higher risk of not only contracting the virus but also being hospitalized and dying, making this a vital time to implement obesity prevention programs. However, COVID-19 is predicted to rapidly increase the obesity rate in the United States due to the mandatory sedentary lifestyle the pandemic demands; this is especially harmful to adolescent-aged children because it creates lifelong unhealthy habits and behaviors. Adolescent obesity prevention programs have been rigorously implemented throughout the last century to help diminish the ever-increasing adolescent obesity rate. Since the pandemic kept adolescents inside and away from in-person school, many programs have now become ineffective due to their in-person participation. Examples of in-person participation programs include school lunch programs, OSNAP and New Moves. Therefore, online programs or remote intervention measures are now more essential. This leads to programs such as Time2bHealthy, HEALTH[e]TEEN, and SWITCH should be looked at with more vitality. Adolescents have intertwined their lives with technology and screen usage. Therefore, online and remote prevention programs will continue to play a large role in the post-pandemic era. This literature review will be reviewing past and current adolescent obesity prevention programs and their effectiveness with the new remote, sedentary lifestyle adolescents. Furthermore, it will suggest new ways to more productively decrease adolescent obesity rates by analyzing the harmful factors that COVID-19 introduced into their lifestyles.

Keywords: adolescent, obesity, overweight, COVID-19, preventative care, public health, public policy, obesity prevention programs, online programs

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46954 Academic Education and Internship towards Architecture Professional Practice

Authors: Sawsan Saridar masri, Hisham Arnaouty

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Architecture both defines and is defined by social, cultural, political and financial constraints: this is where the discipline and the profession of architecture meet. This mutual sway evolves wherever interferences in the built environment are thought-out and can be strengthened or weakened by the many ways in which the practice of architecture can be undertaken. The more familiar we are about the concerns and factors that control what can be made, the greater the opportunities to propose and make appropriate architectures. Apparently, the criteria in any qualification policy should permit flexibility of approach and will – for reasons including cultural choice, political issues, and son on – vary significantly from country to country. However the weighting of the various criteria have to ensure adequate standards both in educational system as in the professional training. This paper develops, deepens and questions about the regulatory entry routes to the professional practice of architecture in the Arab world. It is also intended to provide an informed basis about strategies for conventional and unconventional models of practice in preparation for the next stages of architect’s work experience and professional experience. With the objective of promoting the implementation of adequate built environment in the practice of architecture, a comprehensive analysis of various pathways of access to the profession are selected as case studies, encompassing examples from across the world. The review of such case studies allows the creation of a comprehensive picture in relation to the conditions for qualification of practitioners of the built environment at the level of the Middle Eastern countries and the Arab World. Such investigation considers the following aspects: professional title and domain of practice, accreditation of courses, internship and professional training, professional examination and continuing professional development.

Keywords: architecture, internship, mobility, professional practice

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46953 Prevalence of Behavioral and Emotional Problems in School Going Adolescents in India

Authors: Anshu Gupta, Charu Gupta

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Background: Adolescence is the transitional period between puberty and adulthood. It is marked by immense turmoil in emotional and behavioral spheres. Adolescents are at risk of an array of behavioral and emotional problems, resulting in social, academic and vocational function impairments. Conflicts in the family and inability of the parents to cope with the changing demands of an adolescent have a negative impact on the overall development of the child. This augers ill for the individual’s future, resulting in depression, delinquency and suicides among other problems. Aim: The aim of the study was to compare the prevalence of behavioral and emotional problems in school going adolescents aged 13 to 15 years residing in Ludhiana city. Method: A total of 1380 school children in the age group of 13 to 15 years were assessed by the adolescent health screening questionnaire (FAPS) and Youth Self-Report (2001) questionnaire. Statistical significance was ascertained by t-test, chi-square test (x²) and ANOVA, as appropriate. Results: A considerably high prevalence of behavioral and emotional problems was found in school going adolescents (26.5%), more in girls (31.7%) than in boys (24.4%). In case of boys, the maximum problem was in the 13 year age group, i.e., 28.2%, followed by a significant decline by the age of 14 years, i.e., 24.2% and 15 years, i.e., 19.6%. In case of girls also, the maximum problem was in the 13 year age group, i.e., 32.4% followed by a marginal decline in the 14 years i.e., 31.8% and 15 year age group, i.e., 30.2%. Demographic factors were non contributory. Internalizing syndrome (22.4%) was the most common problem followed by the neither internalizing nor externalizing (17.6%) group. In internalizing group, most (26.5%) of the students were observed to be anxious/ depressed. Social problem was observed to be the most frequent (10.6%) among neither internalizing nor externalizing group. Aggressive behavior was the commonest (8.4%) among externalizing group. Internalizing problems, mainly anxiety and depression, were commoner in females (30.6%) than males (24.6%). More boys (16%) than girls (13.4%) were reported to suffer from externalizing disorders. A critical review of the data showed that most of the adolescents had poor knowledge about reproductive health. Almost 36% reported that the source of their information on sexual and reproductive health being friends and the electronic media. There was a high percentage of adolescents who reported being worried about sexual abuse (20.2%) with majority of them being girls (93.6%) reflecting poorly on the social setup in the country. About 41% of adolescents reported being concerned about body weight and most of them being girls (92.4%). Up to 14.5% reported having thoughts of using alcohol or drugs perhaps due to the easy availability of substances of abuse in this part of the country. 12.8% (mostly girls) reported suicidal thoughts. Summary/conclusion: There is a high prevalence of emotional and behavioral problems among school-going adolescents. Resolution of these problems during adolescence is essential for attaining a healthy adulthood. The need of the hour is to spread awareness among caregivers and formulation of effective management strategies including school mental health programme.

Keywords: adolescence, behavioral, emotional, internalizing problem

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46952 From Social Equity to Spatial Equity in Urban Space: Precedent Study Approach

Authors: Dorsa Pourmojib, Marc J. Boutin

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Urban space is used everyday by a diverse range of urban dwellers, each with different expectations. In this space, opportunities and resources are not distributed equitably among urban dwellers, despite the importance of inclusivity. In addition, some marginalized groups may not be considered. These include people with low incomes, immigrants from diverse cultures, various age groups, and those with special needs. To this end, this research aims to enhance social equity in urban space by bridging the gap between social equity and spatial equity in the urban context. This gap in the knowledge base related to urban design may be present for several reasons; lack of studies on relationship between social equity and spatial equity in urban open space, lack of practical design strategies for promoting social equity in urban open space, lack of proper site analysis in terms of context and users of the site both for designing new urban open spaces and developing the existing ones, and lack of researchers that are designers and finally it could be related to priorities of the city’s policies in addressing such issues, since it is time, money and energy consuming. The main objective of this project is addressing the aforementioned gap in the knowledge by exploring the relationship between social equity and spatial equity in urban open space. Answering the main question of this research is a promising step to this end; 'What are the considerations towards providing social equity through the design of urban elements that offer spatial equity?' To answer the main question of this research there are several secondary questions which should be addressed. Such as; how can the characteristics of social equity be translated to spatial equity? What are the diverse user’s needs and which of their needs are not considered in that site? What are the specific elements in the site which should be designed in order to promote social equity? What is the current situation of social and spatial equity in the proposed site? To answer the research questions and achieve the proposed objectives, a three-step methodology has been implemented. Firstly, a comprehensive research framework based on the available literature has been presented. Afterwards, three different urban spaces have been analyzed in terms of specific key research questions as the precedent studies; Naqsh-e Jahan Square (Iran), Superkilen Park (Denmark) and Campo Dei Fiori (Italy). In this regard, a proper gap analysis of the current situation and the proposed situation of these sites has been conducted. Finally, by combining the extracted design considerations from the precedent studies and the literature review, practical design strategies have been introduced as a result of this research. The presented guidelines enable the designers to create socially equitable urban spaces. To conclude, this research proposes a spatial approach to social inclusion and equity in urban space by presenting a practical framework and criteria for translating social equity to spatial equity in urban areas.

Keywords: inclusive urban design, social equity, social inclusion, spatial equity

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46951 The Preparation and Effectiveness of Picture Book for Increasing Knowledge about Divorce

Authors: Denia Prameswari

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The impacts of divorce are not only felt by parents but also by children. Preschool children are the most distressed while facing parental divorce. The negative impacts of divorce on children can be minimized when children had pervious knowledge about the event. One of the method to give knowledge about divorce to children is through picture book. Unfortunately, in Indonesia, researchers have not found picture books for preschoolers about divorce. This study aims to test the effectiveness of picture book in increasing knowledge of preschool children about divorce. Formulation of picture books in this study is based on three sources of information: (1) the study of literature, (2) analysis of picture books, and (3) need assessment. This picture book that have been prepared, then used to test its effectiveness for increasing knowledge of preschool children about divorce. The test was conducted using pre and post test on 5 participants. The statistical method used in this study is paired sample t-test. The purposive sampling method was used to select the participants. The participants for this study are preschool children with parents that is undergoing divorce proceedings. The result shows that picture books in this study significantly increase preschool children's knowledge about divorce. As an additional result, parents find it easier to explain divorce to their children using the picture book from this study. For further study, researcher can make another picture book about divorce for children at different age or to face another challenging situation in life.

Keywords: divorce, parent, picture book, preschool children

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46950 Genome Editing in Sorghum: Advancements and Future Possibilities: A Review

Authors: Micheale Yifter Weldemichael, Hailay Mehari Gebremedhn, Teklehaimanot Hailesslasie

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The advancement of target-specific genome editing tools, including clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated protein9 (Cas9), mega-nucleases, base editing (BE), prime editing (PE), transcription activator-like endonucleases (TALENs), and zinc-finger nucleases (ZFNs), have paved the way for a modern era of gene editing. CRISPR/Cas9, as a versatile, simple, cost-effective and robust system for genome editing, has dominated the genome manipulation field over the last few years. The application of CRISPR/Cas9 in sorghum improvement is particularly vital in the context of ecological, environmental and agricultural challenges, as well as global climate change. In this context, gene editing using CRISPR/Cas9 can improve nutritional value, yield, resistance to pests and disease and tolerance to different abiotic stress. Moreover, CRISPR/Cas9 can potentially perform complex editing to reshape already available elite varieties and new genetic variations. However, existing research is targeted at improving even further the effectiveness of the CRISPR/Cas9 genome editing techniques to fruitfully edit endogenous sorghum genes. These findings suggest that genome editing is a feasible and successful venture in sorghum. Newer improvements and developments of CRISPR/Cas9 techniques have further qualified researchers to modify extra genes in sorghum with improved efficiency. The fruitful application and development of CRISPR techniques for genome editing in sorghum will not only help in gene discovery, creating new, improved traits in sorghum regulating gene expression sorghum functional genomics, but also in making site-specific integration events.

Keywords: CRISPR/Cas9, genome editing, quality, sorghum, stress, yield

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46949 Biophilic Design Strategies: Four Case-Studies from Northern Europe

Authors: Carmen García Sánchez

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The UN's 17 Sustainable Development Goals – specifically the nº 3 and nº 11- urgently call for new architectural design solutions at different design scales to increase human contact with nature in the health and wellbeing promotion of primarily urban communities. The discipline of Interior Design offers an important alternative to large-scale nature-inclusive actions which are not always possible due to space limitations. These circumstances provide an immense opportunity to integrate biophilic design, a complex emerging and under-developed approach that pursues sustainable design strategies for increasing the human-nature connection through the experience of the built environment. Biophilic design explores the diverse ways humans are inherently inclined to affiliate with nature, attach meaning to and derive benefit from the natural world. It represents a biological understanding of architecture which categorization is still in progress. The internationally renowned Danish domestic architecture built in the 1950´s and early 1960´s - a golden age of Danish modern architecture - left a leading legacy that has greatly influenced the domestic sphere and has further led the world in terms of good design and welfare. This study examines how four existing post-war domestic buildings establish a dialogue with nature and her variations over time. The case-studies unveil both memorable and unique biophilic resources through sophisticated and original design expressions, where transformative processes connect the users to the natural setting and reflect fundamental ways in which they attach meaning to the place. In addition, fascinating analogies in terms of this nature interaction with particular traditional Japanese architecture inform the research. They embody prevailing lessons for our time today. The research methodology is based on a thorough literature review combined with a phenomenological analysis into how these case-studies contribute to the connection between humans and nature, after conducting fieldwork throughout varying seasons to document understanding in nature transformations multi-sensory perception (via sight, touch, sound, smell, time and movement) as a core research strategy. The cases´ most outstanding features have been studied attending the following key parameters: 1. Space: 1.1. Relationships (itineraries); 1.2. Measures/scale; 2. Context: Context: Landscape reading in different weather/seasonal conditions; 3. Tectonic: 3.1. Constructive joints, elements assembly; 3.2. Structural order; 4. Materiality: 4.1. Finishes, 4.2. Colors; 4.3. Tactile qualities; 5. Daylight interplay. Departing from an artistic-scientific exploration this groundbreaking study provides sustainable practical design strategies, perspectives, and inspiration to boost humans´ contact with nature through the experience of the interior built environment. Some strategies are associated with access to outdoor space or require ample space, while others can thrive in a dense urban context without direct access to the natural environment. The objective is not only to produce knowledge, but to phase in biophilic design in the built environment, expanding its theory and practice into a new dimension. Its long-term vision is to efficiently enhance the health and well-being of urban communities through daily interaction with Nature.

Keywords: sustainability, biophilic design, architectural design, interior design, nature, Danish architecture, Japanese architecture

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46948 Reducing Defects through Organizational Learning within a Housing Association Environment

Authors: T. Hopkin, S. Lu, P. Rogers, M. Sexton

Abstract:

Housing Associations (HAs) contribute circa 20% of the UK’s housing supply. HAs are however under increasing pressure as a result of funding cuts and rent reductions. Due to the increased pressure, a number of processes are currently being reviewed by HAs, especially how they manage and learn from defects. Learning from defects is considered a useful approach to achieving defect reduction within the UK housebuilding industry. This paper contributes to our understanding of how HAs learn from defects by undertaking an initial round table discussion with key HA stakeholders as part of an ongoing collaborative research project with the National House Building Council (NHBC) to better understand how house builders and HAs learn from defects to reduce their prevalence. The initial discussion shows that defect information runs through a number of groups, both internal and external of a HA during both the defects management process and organizational learning (OL) process. Furthermore, HAs are reliant on capturing and recording defect data as the foundation for the OL process. During the OL process defect data analysis is the primary enabler to recognizing a need for a change to organizational routines. When a need for change has been recognized, new options are typically pursued to design out defects via updates to a HAs Employer’s Requirements. Proposed solutions are selected by a review board and committed to organizational routine. After implementing a change, both structured and unstructured feedback is sought to establish the change’s success. The findings from the HA discussion demonstrates that OL can achieve defect reduction within the house building sector in the UK. The paper concludes by outlining a potential ‘learning from defects model’ for the housebuilding industry as well as describing future work.

Keywords: defects, new homes, housing association, organizational learning

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46947 Designing the Maturity Model of Smart Digital Transformation through the Foundation Data Method

Authors: Mohammad Reza Fazeli

Abstract:

Nowadays, the fourth industry, known as the digital transformation of industries, is seen as one of the top subjects in the history of structural revolution, which has led to the high-tech and tactical dominance of the organization. In the face of these profits, the undefined and non-transparent nature of the after-effects of investing in digital transformation has hindered many organizations from attempting this area of this industry. One of the important frameworks in the field of understanding digital transformation in all organizations is the maturity model of digital transformation. This model includes two main parts of digital transformation maturity dimensions and digital transformation maturity stages. Mediating factors of digital maturity and organizational performance at the individual (e.g., motivations, attitudes) and at the organizational level (e.g., organizational culture) should be considered. For successful technology adoption processes, organizational development and human resources must go hand in hand and be supported by a sound communication strategy. Maturity models are developed to help organizations by providing broad guidance and a roadmap for improvement. However, as a result of a systematic review of the literature and its analysis, it was observed that none of the 18 maturity models in the field of digital transformation fully meet all the criteria of appropriateness, completeness, clarity, and objectivity. A maturity assessment framework potentially helps systematize assessment processes that create opportunities for change in processes and organizations enabled by digital initiatives and long-term improvements at the project portfolio level. Cultural characteristics reflecting digital culture are not systematically integrated, and specific digital maturity models for the service sector are less clearly presented. It is also clearly evident that research on the maturity of digital transformation as a holistic concept is scarce and needs more attention in future research.

Keywords: digital transformation, organizational performance, maturity models, maturity assessment

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46946 Study of Parameters Influencing Dwell Times for Trains

Authors: Guillaume Craveur

Abstract:

The work presented here shows a study on several parameters identified as influencing dwell times for trains. Three kinds of rolling stocks are studied for this project and the parameters presented are the number of passengers, the allocation of passengers, their priorities, the platform station height, the door width and the train design. In order to make this study, a lot of records have been done in several stations in Paris (France). Then, in order to study these parameters, numerical simulations are completed. The goal is to quantify the impact of each parameter on the dwelling times. For example, this study highlights the impact of platform height and the presence of steps between the platform and the train. Three types of station platforms are concerned by this study : ‘optimum’ station platform which is 920 mm high, standard station platform which is 550 mm high, and high station platform which is 1150 mm high and different kinds of steps exist in order to fill these gaps. To conclude, this study shows the impact of these parameters on dwell times and their impact in function of the size of population.

Keywords: dwell times, numerical tools, rolling stock, platforms

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46945 Cultural Reflection within Contemporary Residential Interior in India

Authors: Icy Vinod Sanghvi

Abstract:

In the light of rising modernism within the residential design industry, a significant growth of the western concepts of maximalism or minimalism is observed in the Indian housings. Although dynamism in design styles is natural due to the constant emergence of new innovations, it is imperative that local houses reflect cultural identity. This paper highlights the importance of ‘Indian Modernism’, and how to incorporate the same in residential design. Thus, helping the Indian culture to flourish and become a significant part of housing design in the future. A literature review was conducted to analyze and derive effective methods to build cultural value whilst catering to the urban and contemporary design industry. Alongside, a questionnaire survey was conducted to observe how the local houses are designed and to understand the preferences of people with regards to the design styles incorporated in their homes. In addition, their opinions on the excessive use of contemporary styles in home designs was recorded. The results of the same provided a better understanding of the local audience, their demands, and their willingness to adapt to contemporary designs. Studying color, materials, ornamentation, symbolism, detail, and structure offers an in-depth understanding of the essence of traditional Indian homes. These variables further provided effective solutions for design ideation and mockups for efficient traditional yet contemporary spaces. Design interventions like these can build a revolutionary set of practices that involve creating a balance between contemporary and traditional styles. The emergence of this synergy will not only make contemporary homes communicative but also allow India to compete within the global residential architecture industry with a strong foundation of its rich heritage.

Keywords: balance, contemporary design, cultural identity, Indian modernism

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46944 Review of Sulfur Unit Capacity Expansion Options

Authors: Avinashkumar Karre

Abstract:

Sulfur recovery unit, most commonly called as Claus process, is very significant gas desulfurization process unit in refinery and gas industries. Explorations of new natural gas fields, refining of high-sulfur crude oils, and recent crude expansion projects are needing capacity expansion of Claus unit for many companies around the world. In refineries, the sulphur recovery units take acid gas from amine regeneration units and sour water strippers, converting hydrogen sulfide to elemental sulfur using the Claus process. The Claus process is hydraulically limited by mass flow rate. Reducing the pressure drop across control valves, flow meters, lines, knock-out drums, and packing improves the capacity. Oxygen enrichment helps improve the capacity by removing nitrogen, this is more commonly done on all capacity expansion projects. Typical upgrades required due to oxygen enrichment are new burners, new refractory in thermal reactor, resizing of 1st condenser, instrumentation changes, and steam/condensate heat integration. Some other capacity expansion options typically considered are tail gas compressor, replacing air blower with higher head, hydrocarbon minimization in the feed, water removal, and ammonia removal. Increased capacity related upgrades in sulfur recovery unit also need changes in the tail gas treatment unit, typical changes include improvement to quench tower duty, packing area upgrades in quench and absorber towers and increased amine circulation flow rates.

Keywords: Claus process, oxygen enrichment, sulfur recovery unit, tail gas treatment unit

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46943 The Study of Public Consciousness of Undergraduate Students, Suan Sunandha Rajabhat University

Authors: Nantida Otakum

Abstract:

The purpose of the study is to study the level of public consciousness of Suan Sunandha Rajabhat University undergraduate students. This study also compares differences in the level of public consciousness among undergraduate students who are different in sex and year of study. The research methodology employed a questionnaire as a quantitative method. The respondents were undergraduate students at Suan Sunandha Rajabhat University. Totally, 400 usable questionnaires were received. Descriptive and inferential statistics were used in data analysis. The results showed that the level of public consciousness of undergraduate students was at a good level in all aspects. The aspect of social participation was at the highest level, while the aspect of shared vision was at the lowest level. The results also indicated that undergraduate students with differences in sex and year of study were not significantly different in public consciousness level.

Keywords: participation, public consciousness, Suan Sunandha Rajabhat University, undergraduate students

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46942 Improving Patient and Clinician Experience of Oral Surgery Telephone Clinics

Authors: Katie Dolaghan, Christina Tran, Kim Hamilton, Amanda Beresford, Vicky Adams, Jamie Toole, John Marley

Abstract:

During the Covid 19 pandemic routine outpatient appointments were not possible face to face. That resulted in many branches of healthcare starting virtual clinics. These clinics have continued following the return to face to face patient appointments. With these new types of clinic it is important to ensure that a high standard of patient care is maintained. In order to improve patient and clinician experience of the telephone clinics a quality improvement project was carried out to ensure the patient and clinician experience of these clinics was enhanced whilst remaining a safe, effective and an efficient use of resources. The project began by developing a process map for the consultation process and agreed on the design of a driver diagram and tests of change. In plan do study act (PDSA) cycle1 a single consultant completed an online survey after every patient encounter over a 5 week period. Baseline patient responses were collected using a follow-up telephone survey for each patient. Piloting led to several iterations of both survey designs. Salient results of PDSA1 included; patients not receiving appointment letters, patients feeling more anxious about a virtual appointment and many would prefer a face to face appointment. The initial clinician data showed a positive response with a provisional diagnosis being reached in 96.4% of encounters. PDSA cycle 2 included provision of a patient information sheet and information leaflets relevant to the patients’ conditions were developed and sent following new patient telephone clinics with follow-up survey analysis as before to monitor for signals of change. We also introduced the ability for patients to send an images of their lesion prior to the consultation. Following the changes implemented we noted an improvement in patient satisfaction and, in fact, many patients preferring virtual clinics as it lead to less disruption of their working lives. The extra reading material both before and after the appointments eased patients’ anxiety around virtual clinics and helped them to prepare for their appointment. Following the patient feedback virtual clinics are now used for review patients as well, with all four consultants within the department continuing to utilise virtual clinics. During this presentation the progression of these clinics and the reasons that these clinics are still operating following the return to face to face appointments will be explored. The lessons that have been gained using a QI approach have helped to deliver an optimal service that is valid and reliable as well as being safe, effective and efficient for the patient along with helping reduce the pressures from ever increasing waiting lists. In summary our work in improving the quality of virtual clinics has resulted in improved patient satisfaction along with reduced pressures on the facilities of the health trust.

Keywords: clinic, satisfaction, telephone, virtual

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46941 Milling Process of Rigid Flex Printed Circuit Board to Which Polyimide Covers the Whole Surface

Authors: Daniela Evtimovska, Ivana Srbinovska, Padraig O’Rourke

Abstract:

Kostal Macedonia has the challenge to mill a rigid-flex printed circuit board (PCB). The PCB elaborated in this paper is made of FR4 material covered with polyimide through the whole surface on the one side, including the tabs where PCBs need to be separated. After milling only 1.44 meters, the updraft routing tool isn’t effective and causes polyimide debris on all PCB cuts if it continues to mill with the same tool. Updraft routing tool is used for all another product in Kostal Macedonia, and it is changing after milling 60 meters. Changing the tool adds 80 seconds to the cycle time. One solution is using a laser-cut machine. Buying a laser-cut machine for cutting only one product doesn’t make financial sense. The focus is given to find an internal solution among the options under review to solve the issue with polyimide debris. In the paper, the design of the rigid-flex panel is described deeply. It is evaluated downdraft routing tool as a possible solution which could be used for the flex rigid panel as a specific product. It is done a comparison between updraft and down draft routing tools from a technical and financial aspect of view, taking into consideration the customer requirements for the rigid-flex PCB. The results show that using the downdraft routing tool is the best solution in this case. This tool is more expensive for 0.62 euros per piece than updraft. The downdraft routing tool needs to be changed after milling 43.44 meters in comparison with the updraft tool, which needs to be changed after milling only 1.44 meters. It is done analysis which actions should be taken in order further improvements and the possibility of maximum serving of downdraft routing tool.

Keywords: Kostal Macedonia, rigid flex PCB, polyimide, debris, milling process, up/down draft routing tool

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46940 Programs in Nigerian Higher Institutions and Graduates Unemployment

Authors: Evuarherhe Veronica Abolo

Abstract:

The study investigated the programs in Nigerian higher institutions and how they influence unemployment of graduates in the country. The study employed the survey design. The population of the study includes two universities, two polytechnics and two colleges of education in Lagos State. A total of 350 participants, which include graduates and students were sampled for the study. A structured interview schedule and direct observation were used to collect data on the three research questions drawn for the study. The data were analyzed using rating of the structured interview in tables and percentages. The results of the study revealed that Nigerian graduates are not only unemployed but can hardly meet the requirements of available job vacancies due to the stereotype nature in scope, content and methods of the programs in the institutions. Recommendations such as collaboration of companies (end- users) and institutions in the training of students, restructuring of the content and methodology of programs and providing soft loans and other facilities to the young graduates were proffered to reduce the rate of graduates’ unemployment in Nigeria.

Keywords: higher institution, graduate unemployment, soft loan, unemployment

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46939 The International Constitutional Order and Elements of Human Rights

Authors: Girma Y. Iyassu Menelik

Abstract:

“The world is now like a global village!” so goes the saying that shows that due to development and technology the countries of the world are now closely linked. In the field of Human rights there is a close relationship in the way that rights are recognised and enforced. This paper will show that human rights have evolved from ancient times through important landmarks such as the Magna Carta, the French Declaration of Rights of Man and of the Citizen and the American Bill of Rights. The formation of the United Nations after the Second World War resulted in the need to codify and protect human rights. There are some rights which are so fundamental that they are found in international and continental instruments, national constitutions and domestic legislation. In the civil and political sphere they include the right to vote, to freedom of association, speech and assembly, right to life, privacy and fair trial. In the economic and social sphere you have the right to work, protection of the family, social security and rights to education, health and shelter. In some instance some rights can be suspended in times of public emergency but such derogations shall be circumscribed by the law and in most constitutions such limitations are subject to judicial review. However, some rights are so crucial that they cannot be derogated from under any circumstances and these include the right to life, recognition before the law, freedom from torture and slavery and of thought, conscience and religion. International jurisprudence has been developed to protect fundamental rights and avoid discrimination on the grounds of race, colour, sex, language or social origin. The elaborate protection system go to show that these rights have become part of the international order and they have universal application. We have now got to a stage where UDHR, ICCPR and ICESCR and have come to be regarded as part of an international bill of rights with horizontal and vertical enforcement mechanisms involving state parties, NGO’s , international bodies and other organs.

Keywords: rights, international, constitutional, state, judiciary

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46938 Noise Pollution: An Emerging Threat to Urban Health

Authors: M. Sirajul Islam Molla

Abstract:

Noise pollution has been a continuous and an increasing threat to human health in urban population all over the world. The situation in Bangladesh particularly in major cities has been dangerously aggravating. Despite the government of Bangladesh have laws in its hand to curb the noise pollution the authority’s reluctance in enforcing it, is making the situation worse. We do not see any difference in some other major cities of the South Asian Regional Countries like Delhi and Kathmandu, both of the cities are facing the same situation like Dhaka. With the expansion of technology-based township all over the world, the noise pollution has been an emerging threat to urban health. The information for this review has been derived from websites of GOs, NGOs, peer-reviewed papers, seminars and symposia. The worse situation of noise pollution results in people’s irritation and protest, but in many cases, the protesters are facing the wrath of the polluters. Two such consequences in Bangladesh have resulted in killing the protesters by the polluters – one happened in Dhaka city and the other in a rural town. The law-enforcing agencies proactively do not attempt to impose the law. Noise pollution has been increasing so rapidly that it has become a burden on human health in urban populations. Prolonged exposure to higher noise causes mental stress, sleeplessness, high blood pressure, cardiac failure, respiratory disorder, miscarriage and breaks attention of students to their studies and also irritates their behavior. The noise pollution-caused mortality has also been increasing all over the world. Recommendations from the international conferences such as ICUH should be forwarded to the United Nations. The UN then should pass it on to the concerned countries. The UN should also keenly monitor if the countries have appropriate plan to curb noise pollution to meet the sustainable development goals.

Keywords: decibel, environment, noise, pollution

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46937 Multi-Institutional Report on Toxicities of Concurrent Nivolumab and Radiation Therapy

Authors: Neha P. Amin, Maliha Zainib, Sean Parker, Malcolm Mattes

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Purpose/Objectives: Combination immunotherapy (IT) and radiation therapy (RT) is an actively growing field of clinical investigation due to promising findings of synergistic effects from immune-mediated mechanisms observed in preclinical studies and clinical data from case reports of abscopal effects. While there are many ongoing trials of combined IT-RT, there are still limited data on toxicity and outcome optimization regarding RT dose, fractionation, and sequencing of RT with IT. Nivolumab (NIVO), an anti-PD-1 monoclonal antibody, has been rapidly adopted in the clinic over the past 2 years, resulting in more patients being considered for concurrent RT-NIVO. Knowledge about the toxicity profile of combined RT-NIVO is important for both the patient and physician when making educated treatment decisions. The acute toxicity profile of concurrent RT-NIVO was analyzed in this study. Materials/Methods: A retrospective review of all consecutive patients who received NIVO from 1/2015 to 5/2017 at 4 separate centers within two separate institutions was performed. Those patients who completed a course of RT from 1 day prior to initial NIVO infusion through 1 month after last NIVO infusion were considered to have received concurrent therapy and included in the subsequent analysis. Descriptive statistics are reported for patient/tumor/treatment characteristics and observed acute toxicities within 3 months of RT completion. Results: Among 261 patients who received NIVO, 46 (17.6%) received concurrent RT to 67 different sites. The median f/u was 3.3 (.1-19.8) months, and 11/46 (24%) were still alive at last analysis. The most common histology, RT prescription, and treatment site included non-small cell lung cancer (23/46, 50%), 30 Gy in 10 fractions (16/67, 24%), and central thorax/abdomen (26/67, 39%), respectively. 79% (53/67) of irradiated sites were treated with 3D-conformal technique and palliative dose-fractionation. Grade 3, 4, and 5 toxicities were experienced by 11, 1, and 2 patients, respectively. However all grade 4 and 5 toxicities were outside of the irradiated area and attributed to the NIVO alone, and only 4/11 (36%) of the grade 3 toxicities were attributed to the RT-NIVO. The irradiated site in these cases included the brain [2/10 (20%)] and central thorax/abdomen [2/19 (10.5%)], including one unexpected grade 3 pancreatitides following stereotactic body RT to the left adrenal gland. Conclusions: Concurrent RT-NIVO is generally well tolerated, though with potentially increased rates of severe toxicity when irradiating the lung, abdomen, or brain. Pending more definitive data, we recommend counseling patients on the potentially increased rates of side effects from combined immunotherapy and radiotherapy to these locations. Future prospective trials assessing fractionation and sequencing of RT with IT will help inform combined therapy recommendations.

Keywords: combined immunotherapy and radiation, immunotherapy, Nivolumab, toxicity of concurrent immunotherapy and radiation

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