Search results for: city history

Authors: Acha Mildred Endam

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Gentrification brings changes in socio-economic and environmental aspects in cities. This is a concern for local governments and urban residents, as rapid urbanization poses a challenge to SDGs 11 and 13. This paper aims to: (1) examine the dominant gentrification actions that counteract the drive towards green urbanism; (2) evaluate policy actions and institutions created to promote green urbanism; (3) explore the constraints that hinder development proponents from achieving the goal of green urbanism. A mixed research design (survey and exploratory) was used, along with snowball sampling techniques, to administer the questionnaire. Structured interviews and focus group discussions were also conducted to assess the efforts and success rate of planning and development proponents in achieving green urbanism. Secondary data provided the basis for a literature review on activities that promote brown cities, which hinder green urbanism. The results of the study revealed that gentrification in Bamenda is mainly focused on upgrading infrastructure within the city centre. This transition is accompanied by unsustainable architectural developments, sprawl into peri-urban ecosystems, and climate-incompatible developments. Efforts to achieve green urbanization in Bamenda are insignificant. Socio-economic and policy actions of residents do not reflect a move towards sustainable cities, which is a common theme in most development agendas. This undermines the ecology, health, and general well-being of its inhabitants, increasing vulnerability. The study suggests that there is a need to learn from the few green cities in Africa and adopt a holistic approach towards green urbanization. This approach should include green transportation, preservation of green spaces, and retrofitting brown buildings to green buildings, through synergies, motivation and subsidization through green governance.

Keywords: environmental sustainability, green urbanism, green governace, retrofitting

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Authors: Bartłomiej K. Sołtysik, Agnieszka Guligowska, Łukasz Kroc, Małgorzata Pigłowska, Elizavetta Fife, Tomasz Kostka

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Introduction: Functional capacity is one of the basic determinants of health in older age. Functional capacity may be influenced by multiple disorders, including cardiovascular and metabolic diseases. Nevertheless, there is relatively little evidence regarding the association of functional status and cardiometabolic risk factors. Aim: The aim of this research is to check possible association between functional capacity and cardiovascular risk factor in a group of younger seniors. Materials and Methods: The study group consisted of 300 participants aged 60-65 years (50% were women). Total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), glucose, uric acid, body mass index (BMI), waist-to-height ratio (WHtR) and blood pressure were measured. Smoking status and physical activity level (by Seven Day Physical Activity Recall Questionnaire ) were analysed. Functional status was assessed with the Timed Up and Go (TUG) Test. The data were compared according to gender, and then separately for both sexes regarding prolonged TUG score (>7 s). The limit of significance was set at p≤0.05 for all analyses. Results: Women presented with higher serum lipids and longer TUG. Men had higher blood pressure, glucose, uric acid, the prevalence of hypertension and history of heart infarct. In women group, those with prolonged TUG displayed significantly higher obesity rate (BMI, WHTR), uric acid, hypertension and ischemic heart disease (IHD), but lower physical activity level, TC or LDL-C. Men with prolonged TUG were heavier smokers, had higher TG, lower HDL and presented with higher prevalence of diabetes and IHD. Discussion: This study shows association between functional status and risk profile of cardiometabolic disorders. In women, the relationship of lower functional status to cardiometabolic diseases may be mediated by overweight/obesity. In men, locomotor problems may be related to smoking. Higher education level may be considered as a protective factor regardless of gender.

Keywords: cardiovascular risk factors, functional capacity, TUG test, seniors

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Authors: Mahmoud Abdel Hameed Shahin

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Job demands that are incompatible with an employee's skills, resources, or needs cause unpleasant emotional and physical reactions known as job stress. Nurses offer care in hospital emergency rooms all around the world, and since they operate in such a dynamic and unpredictable setting, they are constantly under pressure. It has been discovered that job stress has harmful impacts on nurses' health as well as their capacity to handle the demands of their jobs. The purpose of this study was to evaluate the level of job stress experienced by the emergency department nurses at King Fahad Specialist Hospital in Buraidah City, Saudi Arabia. In October 2021, a cross-sectional descriptive study was conducted. 80 nurses were conveniently selected for the study, the bulk of them worked at King Fahad Specialist Hospital's emergency department. An electronic questionnaire with a sociodemographic data sheet and a job stress scale was given to the participating nurses after ethical approval was received from the Ministry of Health's representative bodies. Using SPSS Version 26, both descriptive and inferential statistics were employed to analyze and tabulate the acquired data. According to the findings, the factors that contributed to the most job stress in the clinical setting were having an excessive amount of work to do and working under arbitrary deadlines, whereas the factors that contributed to the least stress were receiving the proper recognition or rewards for good work. In the emergency room of King Fahad Specialist Hospital, nurses had a moderate level of stress (M=3.32 ± 0.567/5). Based on their experience, emergency nurses' levels of job stress varied greatly, with nurses with less than a year of experience notably experiencing the lowest levels of job stress. The amount of job stress did not differ significantly based on the emergency nurses' age, nationality, gender, marital status, position, or level of education. The causes and impact of stress on emergency nurses should be identified and alleviated by hospitals through the implementation of interventional programs.

Keywords: emergency nurses, job pressure, Qassim, Saudi Arabia, job stress

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Authors: K. B. Ramappa, A. V. Manjunatha

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Consumerism in India is witnessing unprecedented growth driven by favourable demographics, rising young and working population, rising income levels, urbanization and growing brand orientation. In addition, the increasing level of awareness on health, hygiene and quality has made the consumers to think on the fairly traded goods and brands. This has made retailing extremely important to everyone because without retailers’ consumers would not have access to day-to-day products. The increased competition among different retailers has contributed significantly towards rising consumer awareness on quality products and brand loyalty. Many existing empirical studies have mainly focused on net saving of consumers at organised retail via-a-vis unorganised retail shops. In this article, authors have analysed the Bangalore consumers' attitudes towards buying of fruits and vegetables and their choice of retail outlets. The primary data was collected from 100 consumers belonging to the Bangalore City during October 2014. Sample consumers buying at supermarkets, convenience stores and hypermarkets were purposively selected. The collected data was analyzed using descriptive statistics and multinomial logit model. It was found that among all variables, quality and prices were major accountable factors for buying fruits and vegetables at organized retail shops. The empirical result of multinomial logit model reveals that annual net income was positively associated with the Big Bazar and Food World consumers and negatively associated with the Reliance Fresh, More and Niligiris consumers, as compared with the HOPCOMS consumers. Per month expenditure on fruits and vegetables was positively and age of the consumer was negatively related to the consumers’ choice of buying at modern retail markets. Consumers were willing to buy at modern retail outlets irrespective of the distance.

Keywords: organized retailers, consumers' attitude, consumers' preference, fruits, vegetables, multinomial logit, Bangalore

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Authors: Amit K. Mishra, Jaswant Singh

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The menace of plastic, which significantly pollutes the aquatic environment, has emerged as a global problem. There is an emerging concern about microplastics (MPs) accumulation in aquatic ecosystems. It is familiar to everyone that the ultimate end for most of the plastic debris is the ocean. Rivers are the efficient carriers for transferring MPs from terrestrial to aquatic, further from upstream to downstream areas, and ultimately to oceans. The root cause study can provide an effective solution to a problem; hence, tracing of MPs in the riverine system can illustrate the long-term microplastic pollution. This study aimed to investigate the occurrence and distribution of microplastic contamination in surface water and sediment of the two major river systems of Uttar Pradesh, India. One is the Gomti River, Lucknow, a tributary of the Ganga, and the second is the Saryu River, the lower part of the Ghagra River, which flows through the city of Ayodhya. In this study, the distribution and abundance of MPs in surface water and sediments of two rivers were compared. Samples of water and sediment were collected from different (four from each river) sampling stations in the river catchment of two rivers. Plastic particles were classified according to type, shape, and color. In this study, 1523 (average abundance 254) and 143 (average abundance 26) microplastics were identified in all studied sites in the Gomati River and Saryu River, respectively. Observations on samples of water showed that the average MPs concentration was 392 (±69.6) and 63 ((±18.9) particles per 50l of water, whereas the sediment sample showed that the average MPs concentration was 116 (±42.9) and 46 (±12.5) particles per 250gm of dry sediment in the Gomati River and Saryu River, respectively. The high concentration of microplastics in the Lucknow area can be attributed to human activities, population density, and the entry of various effluents into the river. Microplastics with fibrous shapes were dominated, followed by fragment shapes in all the samples. The present study is a pioneering effort to count MPs in the Gomati and Saryu River systems.

Keywords: freshwater, Gomati, microplastics, Saryu, sediment

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Authors: Nicolas Bae, Theodore L. Karavasilis

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Increasingly, a large number of new and existing tall buildings are required to improve their resilient performance against strong winds and earthquakes to minimize direct, as well as indirect damages to society. Those advent stationary functions of tall building structures in metropolitan regions can be severely hazardous, in socio-economic terms, which also increase the requirement of advanced seismic performance. To achieve these progressive requirements, the seismic reinforcement for some old, conventional buildings have become enormously costly. The methods of increasing the buildings’ resilience against wind or earthquake loads have also become more advanced. Up to now, vibration control devices, such as the passive damper system, is still regarded as an effective and an easy-to-install option, in improving the seismic resilience of buildings at affordable prices. The main purpose of this paper is to examine 1) the optimization of the shape of visco plastic brace damper (VPBD) system which is one of hybrid damper system so that it can maximize its energy dissipation capacity in tall buildings against wind and earthquake. 2) the verification of the seismic performance of the visco plastic brace damper system in tall buildings; up to forty-storey high steel frame buildings, by comparing the results of Non-Linear Response History Analysis (NLRHA), with and without a damper system. The most significant contribution of this research is to introduce the optimized hybrid damper system that is adequate for high rise buildings. The efficiency of this visco plastic brace damper system and the advantages of its use in tall buildings can be verified since tall buildings tend to be affected by wind load at its normal state and also by earthquake load after yielding of steel plates. The modeling of the prototype tall building will be conducted using the Opensees software. Three types of modeling were used to verify the performance of the damper (MRF, MRF with visco-elastic, MRF with visco-plastic model) 22-set seismic records used and the scaling procedure was followed according to the FEMA code. It is shown that MRF with viscous, visco-elastic damper, it is superior effective to reduce inelastic deformation such as roof displacement, maximum story drift, roof velocity compared to the MRF only.

Keywords: tall steel building, seismic retrofit, viscous, viscoelastic damper, performance based design, resilience based design

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Authors: Ajay Kumar Sinha, Sharad Singh, Anukriti Sinha

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Passive energy dissipation method for earthquake protection of structures is undergoing developments for improved performance. Combined use of different types of damping mechanisms has shown positive results in the near past. Different supplemental damping methods like viscous damping, frictional damping and metallic damping are being combined together for optimum performance. The conventional method of connecting passive dampers to structures is a parallel connection between the damper unit and structural member. Researchers are investigating coupling effect of different types of dampers. The most popular choice among the research community is coupling of viscous dampers and frictional dampers. The series and parallel coupling of these damping units are being studied for relative performance of the coupled system on response control of structures against earthquake. In this paper an attempt has been made to couple Fluid Viscous Dampers and Frictional Dampers in series and parallel to form a single unit of damping system. The relative performance of the coupled units has been studied on three dimensional reinforced concrete framed structure. The current theories of structural dynamics in practice for viscous damping and frictional damping have been incorporated in this study. The time history analysis of the structural system with coupled damper units, uncoupled damper units as well as of structural system without any supplemental damping has been performed in this study. The investigations reported in this study show significant improved performance of coupled system. A higher natural frequency of the system outside the forcing frequency has been obtained for structural systems with coupled damper units as against the other cases. The structural response of the structure in terms of storey displacement and storey drift show significant improvement for the case with coupled damper units as against the cases with uncoupled units or without any supplemental damping. The results are promising in terms of improved response of the structure with coupled damper units. Further investigations in this regard for a comparative performance of the series and parallel coupled systems will be carried out to study the optimum behavior of these coupled systems for enhanced response control of structural systems.

Keywords: frictional damping, parallel coupling, response control, series coupling, supplemental damping, viscous damping

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Authors: Yiling Shao, Megan Dai

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This paper attempts to explore whether the cultural infrastructure supported by the Chinese government is still subject to a logic of “strict regulation”.Previous studies have pointed out that the "paternalism" tendency of China's cultural policy always leads to excessive government intervention in cultural development, while Chinese cultural practitioners can only seek cultural autonomy in the cracks of supervision. This can also explain why Chinese cultural policies sometimes have different effects than the official expectations.But this only reflects one aspect of China's cultural policy. In fact, the welfare cultural infrastructure funded by the government seems to highlight the principles of "safeguarding citizens' cultural rights" and "citizens' voluntary" rather than "indoctrination" and "enlightenment", What new features of China's cultural policy are reflected behind this policy orientation that is completely different from the logic of "regulation", which has also become an important issue in this paper. Based on the field survey of a cultural infrastructure (Gao ming District Cultural Center) in Gao ming District, Fo shan City, Guangdong Province, China, for nearly one year, the authors have obtained many text and picture materials.The paper discusses the dual role of cultural centers in China's cultural policy -both as a formal commitment by the state to protect citizens' basic cultural rights and as a social space for citizens to use preferential policies to obtain cultural capital. All in all, the author have conclued three operational logics of the cultural infrastructure currently supported by the Chinese government (at least in developed areas): first, the cultural center has become a versatile cultural space; second, grass-roots cultural cadres can be described as "policy entrepreneurs"; third, ordinary citizens will use the officially supported cultural infrastructure to increase cultural capital. This paper argues that, in comparison to the common “regulatory hand” in the field of cultural industries, in cultural infrastructure supported by state, the authorities and citizens are not in conflict. On the contrary, authorities must adopt a de-regulatory "pleasing" strategy to gain the support of citizens.

Keywords: cultural infrastructure, cultural capital, deregulation, policy entrepreneur

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Authors: Shahid Mahmood, Ghulam Mueen-Ud-Din, Farah Naz Akbar, Yousaf Quddoos, Syeda Mahvish Zahra, Wajiha Saeed, Tayyaba Sami Ullah

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Obesity is an epidemic across the globe that affects all the segments of the population. Physical inactivity, passionate consumption of junk food, inadequate water intake and an unhealthy lifestyle are evident among university girls that are ruining their health gravely especially fat accumulation. The study was carried out to investigate the potential etiological factors of obesity development in university girls. The cross sectional study was carried out after approval of the Departmental Review Committee for Ethics (DRCE) as the par Declaration of Helsinki at Institute of Food Science and Nutrition (IFSN), University of Sargodha, Sargodha-Pakistan and Department of Food Science and Home Economics, G. C. Women University, Faisalabad-Pakistan. 400 girls were selected randomly from different departments of both universities. Nutritional status of the volunteers was assessed through approved protocols for demographics, anthropometrics, body composition, energetics, vital signs, clinical signs and symptoms, medical/family history, and dietary intake assessment (FFQ), water intake and physical activity level. The obesity was determined on body fat (%). Alarming and unheeded etiological factors for the development of obesity in girls were explored by the study. About 93 % girls had a sedentary level of physical activity, zealous consumption of junk food (5.31±1.23 servings), drank little water (1.09±0.26 L/day) that consequent high heaps of fat (35.06±3.02 %), measly body water (52.38±3.4 %), poor bone mass (05.14±0.31 Kg), and high BMI (26.68±1.14 Kg/m²) in 34% girls. The malnutrition also depicted by poor vital signs i.e. low body temperature (97.11±0.93 °F), slightly higher blood pressure (124.19±4.08 / 85.25±2.97 mmHg), rapid pulse rate (99.2 ± 6.85 beats/min), reduced blood O₂ saturation (96.53±0.96 %), scanty peak expiratory flow rate (297 ± 15.7 L /min). The outcomes of the research articulated that physical inactivity; extreme intakes of junk food, insufficient water consumption are etiological factors for obesity development among girls which are usually overlooked in Pakistan.

Keywords: informed consent, junk food, obesity, physical inactivity

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Authors: J. Lamilla-Monje, C. Solano-Puerto, L. Franco-Lara

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Trees play an essential role in cities due to their ability to provide multiple ecosystem goods and services. Bogota trees are threatened by factors such as pests, pathogens, contamination, among others. Among the pathogens, phytoplasmas are a potential risk for urban trees, generating symptoms that affect the ecosystem services that these trees provide in Bogota, an example of this is the affectation of Q. humboldtii by phytoplasmas, these bacteria are transmitted for insects of the order Hemiptera, this is why the objective of this work was to know if the climatic variables (humidity, precipitation, and temperature) and environmental variables (PM10 and PM2.5) could be related to the distribution of the Oak Quercus entomofauna and specifically with the phytoplasma vector insects in Bogota. For this study, the sampling points were distributed in areas of the city with contrasting variables in two types of locations: parks and streets. A total of 68 trees were sampled in which the associated insects were collected using two methodologies: jameo and agitation traps. The results show that insects of the order Hemiptera were the most abundant, including a total of 1682 individuals represented by 29 morphotypes, within this order individuals from eight families were collected (Aphidae, Aradidae, Berytidae, Cicadellidae, Issidae, Membracidae, Miridae, and Psyllidae), finding as possible vectors the families Cicadellidae, Membracidae, and Psyllidae with 959, 8 and 14 individuals respectively. Within the Cicadellidae family, 21 morphotypes were found, being reported as vectors in the literature: Amplicephalus, Exitianus atratus, Haldorus sp., Xestocephalus desertorum, Idiocerinae sp., Scaphytopius sp., the Membracidae family was represented by two morphotypes and the Psyllidae by one. Results that suggest that there is no correlation between climatic and environmental variables with the diversity of insects associated with oak. Knowing the vector insects of phytoplasmas in oak trees will complete the pathosystem and generate effective vector control.

Keywords: vector insects, diversity, phytoplasmas, Cicadellidae

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Authors: Yousef Alqaryouti, Mariam Al Suwaidi, Raed Mohmood AlKhuwaildi, Hind Kolthoum, Issa Youssef, Mohammed Al Imam

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The UAE has experienced rapid economic growth due to its mature oil production industry, leading to a surge in urbanization and infrastructure development in the construction sector. Sustainable development practices are becoming increasingly important, and the UAE government has taken proactive measures to promote them, including the introduction of sustainable building codes, energy-efficient technologies, and renewable energy sources. Initiatives such as the Masdar City project and the Emirates Green Building Council further demonstrate the government's commitment to a cleaner and healthier environment. By adopting sustainable practices, the UAE can reduce its carbon footprint, lessen its reliance on fossil fuels, and achieve cost savings in the long run. The purpose of this paper is to conduct a thorough review of the current state of sustainability in the construction industry of the UAE. Our research methodology includes a local market survey and qualitative observational analysis of executed housing construction projects by the Mohammed Bin Rashid Housing Establishment. The market survey assesses eleven different challenging factors that affect sustainable construction project delivery. The qualitative observational research is based on data collected from three projects, including construction progress, bill of quantity, and construction program. The study concludes that addressing these challenges requires a collaborative team approach, incentivized contracts, traditional project management practices, an integrated project team, and an increase in sustainability awareness among stakeholders. The recommendations proposed in this study aim to promote and improve the application of sustainability in the UAE's construction industry for the future.

Keywords: sustainability, construction, challenges, opportunities, case study, market survey

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Authors: Oluwatosin Adewale

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The sustainability of built heritage has become a relevant issue in recent years due to the social and economic values associated with these buildings. Heritage buildings provide a means for human perception of culture and represent a legacy of long-existing history; they define the local character of the social world and provide a vital connection to the past with their associated aesthetical and communal benefits. The identified values of heritage buildings have increased the importance of conservation and the lifecycle management of these buildings. The recent developments of digital design technology in engineering and the built environment have led to the adoption of Building Information Modelling (BIM) by the Architecture, Engineering, Construction, and Operations (AECO) industry. BIM provides a platform for the lifecycle management of a construction project through effective collaboration among stakeholders and the analysis of a digital information model. This growth in digital design technology has also made its way into the field of architectural heritage management in the form of Historic Building Information Modelling (HBIM). A reverse engineering process for digital documentation of heritage assets that draws upon similar information management processes as the BIM process. However, despite the several scientific and technical contributions made to the development of the HBIM process, it doesn't remain easy to integrate at the most practical level of heritage asset management. The main objective identified under the scope of the study is to review the limitations and challenges faced by heritage management professionals in adopting an HBIM-based asset management procedure for historic building projects. This paper uses an exploratory study in the form of semi-structured interviews to investigate the research problem. A purposive sample of heritage industry experts and professionals were selected to take part in a semi-structured interview to appraise some of the limitations and challenges they have faced with the integration of HBIM into their project workflows. The findings from this study will present the challenges and limitations faced in applying and integrating the HBIM concept for the management of historic buildings.

Keywords: building information modelling, built heritage, heritage asset management, historic building information modelling, lifecycle management

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Authors: Odaleia de O. Farias, Suzelene C. Marinho, Ecleidson B. Fragoso, Daniel S. Lima, Francisco R. S. Lira, Lara S. Araújo, Gabriel dos S. D. Soares

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In populous cities, prehospital care services that use vehicles alternative to ambulances are needed in order to reduce costs and improve response time to occurrences in areas with large concentration of people, such as leisure and tourism spaces. In this context, it was implanted a program called BIKE VIDA, that is innovative quick access and assistance program. The aim of this study is to describe the implantation and initial profile of occurrences performed by an urgency/emergency pre-hospital care service through paramedics on bicycles. It is a cross-sectional, descriptive study carried out in the city of Fortaleza, Ceara, Brazil. The data included service records from July to August 2017. Ethical aspects were respected. The service covers a perimeter of 4.5 km, divided into three areas with perimeter of 1.5 km for each paramedic, attending from 5 am to 9 pm. Materials transported by bicycles include External Automated Defibrillator - DEA, portable oxygen, oximeter, cervical collar, stethoscope, sphygmomanometer, dressing and immobilization materials and personal protective equipment. Occurrences are requested directly by calling the emergency number 192 or through direct approach to the professional. In the first month of the program, there were 93 emergencies/urgencies, mainly in the daytime period (71,0%), in males (59,7%), in the age range of 26 to 45 years (46,2%). The main nature was traumatic incidents (53.3%). Most of the cases (88,2%) did not require ambulance transport to the hospital, and there were two deaths. Pre-hospital service through bicycles is an innovative strategy in Brazil and has shown to be promising in terms of reducing costs and improving the quality of the services offered.

Keywords: emergency, response time, prehospital care, urgency

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Authors: Adriane Amend, Leidiene Ferreira Santos, Daniella Pires Nunes

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The experience of assuming or caring for older persons dependents by relatives is a complex task that encompasses or affective involvement, the demand for technical activities and or psychological support. It would be necessary to understand the situations related to the caregiver, the person and the environment, which help the family difficulty, as a caregiver to lead this role. Objective: To identify the forces that drive and restrict the care process of family caregivers of the older adults. Method: Descriptive and exploratory research, with a qualitative approach, which has as a reference the Force Field Theory. Five family caregivers of older adult’s dependents residing in the city of Palmas, Tocantins, Brazil will participate. The data were collected from December 2021 to February 2022, through a semi-structured individual interview, and submitted to content analysis. Results: As forces that drive or process of caring for family caregivers were: the account of compassionate attitudes and patience of the caregiver (I); to the collaboration of the other person to the care and to the body structure of the same (Other); and the supports of other people not cared for and structural, such as adaptations in the room, read and bathroom, as in the presence of air conditioners (Environment). Among the restrictive forces of care we mention difficulties in delegating care to another person, or stress of care and other personal demands (I); imposition of the older person about care and e a transfer from bed to hip (Other); e lack of accessibility of the house and absence of air conditioning and hospital bed (Environment). Conclusion: The results show that there are driving forces with the caregiver's attitude and feelings, a bond as an idol and support for the caregiver and the environment. On the other hand, conflicting ties, absence of physical structure and daily and continuous care shifts, can significantly compromise well-being or the cycle of older adult, caregiver and care.

Keywords: caregivers, frail elderly, perception, geriatric nursing

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Authors: Taimaz Larimian, Negin Sadeghi

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Very little is known about the impacts of urban security on the level of social sustainability within the cities of developing countries. Urban security is still struggling to find its position in the social sustainability agenda, despite the significant role of safety and security on different aspects of peoples’ lives. This paper argues that urban safety and security should be better integrated within the social sustainability framework. With this aim, this study investigates the hypothesized relationship between social sustainability and Crime Prevention through Environmental Design (CPTED) approach at the neighborhood scale. This study proposes a model of key influential dimensions of CPTED analyzed into localized factors and sub-factors. These factors are then prioritized using pairwise comparison logic and fuzzy group Analytic Hierarchy Process (AHP) method in order to determine the relative importance of each factor on achieving social sustainability. The proposed model then investigates social sustainability in six case study neighborhoods of Isfahan city based on residents’ perceptions of safety within their neighborhood. Mixed method of data collection is used by using a self-administered questionnaire to explore the residents’ perceptions of social sustainability in their area of residency followed by an on-site observation to measure the CPTED construct. In all, 150 respondents from selected neighborhoods were involved in this research. The model indicates that CPTED approach has a significant direct influence on increasing social sustainability in neighborhood scale. According to the findings, among different dimensions of CPTED, ‘activity support’ and ‘image/ management’ have the most influence on people’s feeling of safety within studied areas. This model represents a useful designing tool in achieving urban safety and security during the development of more socially sustainable and user-friendly urban areas.

Keywords: crime prevention through environmental design (CPTED), developing countries, fuzzy analytic hierarchy process (FAHP), social sustainability

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Authors: Babak Nemat

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Background and Purpose: Non-alcoholic fatty liver is one of the most common liver disorders, which, as the most important cause of death from liver disease, has unpleasant consequences and complications. The aim of this study was to investigate the effect of an educational intervention based on a health belief model to prevent non-alcoholic fatty liver among women. Materials and Methods: This experimental study was performed among 110 women referring to comprehensive health service centers in Malayer City, west of Iran, in 2023. Using the available sampling method, 110 participants were divided into experimental and control groups. The data collection tool included demographic characteristics and a questionnaire based on the health belief model. In the experimental group, three one-hour training sessions were conducted in the form of pamphlets, lectures, and group discussions. Data were analyzed using SPSS software version 21, by correlation tests, paired t-tests, and independent t-tests. Results: The mean age of participants was 38.07±6.28 years, and most of the participants were middle-aged, married, housewives with academic education, middle-income, and overweight. After the educational intervention, the mean scores of the constructs include perceived sensitivity (p=0.01), perceived severity (p=0.01), perceived benefits (p=0.01), guidance for internal (p=0.01), and external action (p=0.01), and perceived self-efficacy (p=0.01) in the experimental group were significantly higher than the control group. The score of perceived barriers in the experimental group decreased after training. The perceived obstacles score in the test group decreased after the training (15.2 ± 3.9 v.s 11.2 ± 3.3, (p<0.01). Conclusion: The findings of the study showed that the design and implementation of educational programs based on the constructs of the health belief model can be effective in preventing women from developing higher levels of non-alcoholic fatty liver.

Keywords: non-alcoholic fatty liver, health belief model, education, women

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Authors: Babawale Akin Adeyemi, Esan Temitayo, Adeyemi Olabisi Omowumi

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The paper analyzed waste disposal system in Akure, Ondo State using GIS techniques. Specifically, the study identified the spatial distribution of collection points and existing dumpsite; evaluated the accessibility of waste collection points and their proximity to each other with the view of enhancing better performance of the waste disposal system. Data for the study were obtained from both primary and secondary sources. Primary data were obtained through the administration of questionnaire. From field survey, 35 collection points were identified in the study area. 10 questionnaires were administered around each collection point making a total of 350 questionnaires for the study. Also, co-ordinates of each collection point were captured using a hand-held Global Positioning System (GPS) receiver which was used to analyze the spatial distribution of collection points. Secondary data used include administrative map collected from Akure South Local Government Secretariat. Data collected was analyzed using the GIS analytical tools which is neighborhood function. The result revealed that collection points were found in all parts of Akure with the highest concentration around the central business district. The study also showed that 80% of the collection points enjoyed efficient waste service while the remaining 20% does not. The study further revealed that most collection points in the core of the city were in close proximity to each other. In conclusion, the paper revealed the capability of Geographic Information System (GIS) as a technique in management of waste collection and disposal technique. The application of Geographic Information System (GIS) in the evaluation of the solid waste management in Akure is highly invaluable for the state waste management board which could also be beneficial to other states in developing a modern day solid waste management system. Further study on solid waste management is also recommended especially for updating of information on both spatial and non-spatial data.

Keywords: assessment, geospatial, system, waste disposal

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Authors: Nhi Ngoc Thien

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Franchising is a popular trend in Vietnam retail industry, especially in fast food industry. Several famous foreign fast food brands such as KFC, Lotteria, Jollibee or Pizza Hut invested on this potential market since the 1990s. Following this trend, in 2011, Burger King - the second largest fast food hamburger chain all over the world - entered Vietnam with its first store located in Tan Son Nhat International Airport, with the expectation to become the leading brand in the country. However, the business performance of Burger King was not going well in the first few years making it questioned about its strategy. The given assumption was that its business performance was affected negatively by its store location selection strategy. This research aims to investigate the current performance of Burger King Vietnam in terms of the controllable variables like store location as well as to explore the key factors influencing customer decision to choose Burger King. Therefore, a case study research method was conducted to approach deeply on the opinions and evaluations of 10 Burger King’s customers, Burger King's staffs and other fast food experts on Burger King’s performance through in-depth interview, direct observation and documentary analysis. Findings show that there are 8 determinants affecting the decision-making of Burger King’s customers, which are store location, quality of food, service quality, store atmosphere, price, promotion, menu and brand reputation. Moreover, findings present that Burger King’s staffs and fast food experts also mentioned the main problems of Burger King, which are about store location and food quality. As a result, there are some recommendations for Burger King Vietnam to improve its performance in the market and attract more Vietnamese target customers by giving suitable promotional activities among its customers and being differentiated itself from other fast food brands.

Keywords: overall retail strategy, controllable variables, store location, quality of food

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Authors: Li Pan

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The recently prevalent government procurement of public services in China boasts a new form of government’s provision of public service through the purchasing of social work from social organizations, a new measure of the transformation in governmental functions as well as an unprecedented opportunity for the development of social organizations. For the past few years, the phenomenon of a surge in the number of social work organizations and social work staff emerged right with the initiatives of energetically carrying out the purchase of public services by the government. Such efforts have presented the strong determination of the Chinese government in building a small government by streamlining administration and delegating part of the governmental power to social organizations. This paper is based on the 2012-2014 performance appraisal project of the Guangzhou municipal government’s purchasing of public services and the project was carried out in the summer of 2015. During the process of the appraisal, several general problems hindering the sustainable development of government purchasing of public service have been observed. As Guangzhou is among the rank of pioneer cities in the conduct of the reform, it is representative and imperative to study the sustainability of government purchasing of public service. In 2012, Guangzhou local government started contracting out public service to the community social organizations to provide general family services and special services to community residents, since when integrated family service centers and special service centers were established as platforms to provide public social service in a city-wide range. Consequently, taking an example of the current rapid development of government purchase of the integrated family services and special services in Guangzhou, this paper puts up several proposals for the sustainable development of Guangzhou municipal government’s procurement of public services on the perspective of social work’s resource dependence.

Keywords: government procurement of public services, Guangzhou, integrated family service center, social work, sustainability.

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Authors: Liong-Rung Liu, Yu-Hui Chiu, Wen-Han Chang

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Firearm injuries are high-energy injuries. The ballistic pathways could cause severe burns or chemical damages to vessels, musculoskeletal or other major organs. The high mortality rate is accompanied by complications such as sepsis. As laws prohibit gun possession, civilian gunshot wounds (GSW) are relatively rare in Taiwan. Our hospital, Mackay Memorial Hospital, located at the center of Taipei city is surrounded by nightclubs and red-light districts. Due to this unique location, our hospital becomes the first-line trauma center managing gunshot victims in Taiwan. To author’s best knowledge, there are few published research articles regarding this unique situation. We hereby analyze the distinct characteristics and length of stay (LOS) of GSW patients in the emergency room (ER) at Mackay Memorial Hospital. A 6-year retrospective analysis of 27 patients treated for GSW injuries from January 2012 to December 2017 was performed. The patients’ records were reviewed for the following analyses, 1) wound position and the correlated clinical presentations; 2) the LOS in ED of patients receiving emergency surgery for major organ or vascular injuries. We found males (96.3%) were injured by guns more often than females (3.7%) in all age groups. The most common injured site was in the extremities. With regards to the ER LOS, the average time were 72.2 ± 34.5 minutes for patients with triage I and 207.4 ± 143.9 minutes for patients with triage II. The ED LOS of patients whose ISS score were more than 15 was 59.9 ± 25.6 minutes, and 179.4 ± 119.8 minutes for patients whose ISS score were between 9 to 15, respectively. Among these 27 patients, 10 patients had emergency surgery and their average ED stay time was 104.5 ± 33.3 minutes. Even more, the average ED stay time could be shortened to 88.8 ± 32.3 minutes in the 5 patients with trauma team activation. In conclusion, trauma team activation in severe GSW patients indeed shortens the ED LOS and might initially improve the quality of patient care. This is the result of better trauma systems, including advances in care from emergency medical services and acute care surgical management.

Keywords: gunshot, length of stay, trauma, mortality

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Authors: Xiaoting Jing, Ling Huang

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After the reform and opening up, Chongqing has formed far more high-rise residential areas than other cities in its more than 40 years of urban construction. High-rise residential areas have become one of the main modern living models in Chongqing and an important carrier reflecting the city's high quality of life. Reviewing the construction process and renewal work helps understand the characteristics of high-rise residential areas in Chongqing at different stages, clarify current development demands, and look forward to the focus of future renewal work. Based on socio-economic development and policy background, the article sorts the construction process of high-rise residential areas in Chongqing into four stages: the early experimental construction period of high-rise residential areas (1978-1996), the rapid start-up period of high-rise commodity housing construction (1997-2006), the large-scale construction period of high-rise commodity housing and public rental housing (2007-2014), and the period of renewal and renovation of high-rise residential areas and step-by-step construction of quality commodity housing (2015-present). Based on the construction demands and main construction types of each stage, the article summarizes that the construction of high-rise residential areas in Chongqing features large scale, high speed, and high density. It points out that a large number of high-rise residential areas built after 2000 will become important objects of renewal and renovation in the future. Based on existing renewal work experience, it is urgent to explore a path for sustainable renewal and development in terms of policy mechanisms, digital supervision, and renewal and renovation models, leading the high-rise living in Chongqing toward high-quality development.

Keywords: high-rise residential areas, construction process, renewal and renovation, Chongqing

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Authors: Joshua Russell, Omar Zubair, Reuben Ndegwa

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Introduction: Mesenteric ischemia is an uncommon condition that can be challenging to diagnose in the acute setting, with the potential for significant morbidity and mortality. Very rarely has acute acalculous cholecystitis been described in the setting of mesenteric ischemia. Case: This was the case in a 78-year-old male, who initially presented with clinical and radiological evidence of small bowel obstruction, thought likely secondary to malignancy. The patient had a 6-week history of anorexia, worsening lower abdominal pain, and ~30kg of unintentional weight loss over a 12-month period and a CT- scan demonstrated a transition point in the distal ileum. The patient became increasingly hemodynamically unstable and peritonitic, and an emergency laparotomy was performed. Intra-operatively, however, no obvious transition point was identified, and instead, the gallbladder was markedly gangrenous and oedematous, consistent with acalculous cholecystitis. An open total cholecystectomy was subsequently performed. The patient was admitted to the Intensive Care Unit post-operatively and continued to deteriorate over the proceeding 48 hours, with two re-look laparotomies demonstrating progressively worsening bowel ischemia, initially in the distribution of the superior mesenteric artery and then the coeliac trunk. On review, the patient was found to have an aberrant right hepatic artery arising from the superior mesenteric artery. The extent of ischemia was considered non-survivable, and the patient was palliated. Discussion: Multiple theories currently exist for the underlying pathophysiology of acalculous cholecystitis, including biliary stasis, sepsis, and ischemia. This case lends further support to ischemia as the underlying etiology of acalculous cholecystitis. This is particularly the case when considered in the context of the patient’s aberrant right hepatic artery arising from the superior mesenteric artery, which occurs in 11-14% of patients. Conclusion: This case report adds further insight to the debate surrounding the pathophysiology of acalculous cholecystitis. It also presents acalculous cholecystitis as a complication of mesenteric ischemia that should always be considered, especially in the elderly patient and in the context of relatively common anatomical variations. Furthermore, the case brings to attention the importance of maintaining dynamic working diagnoses in the setting of evolving pathophysiology and clinical presentations.

Keywords: acalculous cholecystitis, anatomical variation, general surgery, mesenteric ischemia

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Authors: Neslihan Şahin Çelik, Ali Eraslan

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In recent years, mathematics educators have frequently stressed the necessity of instructing students about models and modeling approaches that encompass cognitive and metacognitive thought processes, starting from the first years of school and continuing on through the years of higher education. The purpose of this study is to examine the thought processes of 4th-grade primary school students in their modeling activities and to explore the difficulties encountered in these processes, if any. The study, of qualitative design, was conducted in the 2015-2016 academic year at a public state-school located in a central city in the Black Sea Region of Turkey. A preliminary study was first implemented with designated 4th grade students, after which the criterion sampling method was used to select three students that would be recruited into the focus group. The focus group that was thus formed was asked to work on the model eliciting activity of the Paper Airplane Problem and the entire process was recorded on video. The Paper Airplane Problem required the students to determine the winner with respect to: (a) the plane that stays in the air for the longest time; (b) the plane that travels the greatest distance in a straight-line path; and (c) the overall winner for the contest. A written transcript was made of the video recording, after which the recording and the students' worksheets were analyzed using the Blum and Ferri modeling cycle. The results of the study revealed that the students tested the hypotheses related to daily life that they had set up, generated ideas of their own, verified their models by making connections with real life, and tried to make their models generalizable. On the other hand, the students had some difficulties in terms of their interpretation of the table of data and their ways of operating on the data during the modeling processes.

Keywords: primary school students, model eliciting activity, mathematical modeling, modeling process, paper airplane problem

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Authors: Ila Gupta

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The government hospitals in India by and large lack the necessary aesthetic therapeutic components, both in their interior and exterior space designs. These components especially in terms of color application are important to the emotional as well as physical well being of the patients and other participants of the space. The preliminary survey of few government hospitals in Uttarakhand, India, reveals that the government health care industry provides a wide scope for intervention. All most all of the spaces do not adhere to a proper therapeutic color scheme which directly helps the well-being of their patients and workers. The paper aims to conduct a survey and come up with recommendations in this regard. The government hospitals also lack a proper signage system which allows the space to be more user-friendly. The hospital spaces in totality also have scope for improvement in terms of space/landscape design which enhances the work environment in an efficient and positive way. This study will thus enable to come up with feasible recommendations for healthcare and built environment as well as retrofitting the existing spaces. The objective of the paper is mainly on few case studies. The present ambience in many government hospitals generally lacks a welcoming ambience. It is proposed to select one or two government hospitals and demonstrate application of appropriate and self-sustainable color schemes, placement of artifacts, changes in outdoor and indoor space design to bring about a change that is conducive for cognitive healing. Exterior changes to existing and old hospital buildings in depressed historic areas signify financial investment and change, and have the potential to play a significant role in both urban preservation and revitalization. Changes to exterior architectural colors are perhaps the most visible signifier of such revitalization, as the use of color changes as a tool in façade and interior improvement programs. The present project will provide its recommendations on the basis of case studies done in the Indian Public Health Care system. Furthermore, the recommendations will be in accordance with the extended study conducted in Indian Ayurvedic, Yogic texts as well as Vastu texts, which provides knowledge about built environments and healing properties of color.

Keywords: color, environment, facade, architectural color history, interior improvement programs, community development, district/government hospitals

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Authors: Susan Scott, Dina Hanna, Bassel Zebian, Gary Ruiz, Sreena Das

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Although the number of cases of TB in England has fallen over the last 4 years, it remains an important public health burden with 1 in 20 cases dying annually. The vast majority of cases present in non-UK born individuals with social risk factors. We present a case of non-pulmonary TB presenting in a healthy child born in the UK to professional parents. We present a case of a healthy 10 year old boy who developed acute back pain during school PE. Over the next 5 months, he was seen by various health and allied professionals with worsening back pain and kyphosis. He became increasing unsteady and for the 10 days prior to admission to our hospital, he developed fevers. He was admitted to his local hospital for tonsillitis where he suffered two falls on account of his leg weakness. A spinal X-ray revealed a pathological fracture and gibbus formation. He was transferred to our unit for further management. On arrival, the patient had lower motor neurone signs of his left leg. He underwent spinal fixture, laminectomy and decompression. Microbiology samples taken intra-operatively confirmed Mycobacterium Tuberculosis. He had a positive Mantoux and T-spot and treatment were commenced. There was no evidence of immune compromise. The patient was born in the UK, had a BCG scar and his only travel history had been two years prior to presentation when he travelled to the Phillipines for a short holiday. The patient continues to have issues around neuropathic pain, mobility, pill burden and mild liver side effects from treatment. Discussion: There is a paucity of case reports on spinal TB in paediatrics and diagnosis is often difficult due to the non-specific symptomatology. Although prognosis on treatment is good, a delayed diagnosis can have devastating consequences. This case highlights the continued need for higher index of suspicion and diagnosis in a world with changing patterns of migration and increase global travel. Surgical intervention is limited to the most serious cases to minimise further neurological damage and improve prognosis. There remains the need for a multi-disciplinary approach to deal with challenges of treatment and rehabilitation.

Keywords: tuberculosis, non-pulmonary TB, public health burden, diagnostic challenge

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Authors: Pradip Baishya, D. K. Mahanta

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Rapid and unplanned urbanisation in most cities of India has progressively increased the problem of managing municipal waste in the past few years. With insufficient infrastructure and funds, Municipalities in most cities are struggling to cope with the pace of waste generated. Open dumping is widely in practice as a cheaper option. Scientific disposal of waste in such a large scale with the elements of segregation, recycling, landfill, and incineration involves sophisticated and expensive plants. In an effort to finding affordable and simple solutions to address this burning issue of waste disposal, a semi-mechanized plant has been designed underlying the concept of a zero waste community. The fabrication work of the waste management unit is carried out by local skills from locally available materials. A resident colony in the city of Guwahati has been chosen, which is seen as a typical representative of most cities in India in terms of size and key issues surrounding waste management. Scientific management and disposal of waste on site is carried out on the principle of reduce, reuse and recycle from segregation to compositing. It is a local community participatory model, which involves all stakeholders in the process namely rag pickers, residents, municipality and local industry. Studies were conducted to testify the plant as revenue earning self-sustaining model in the long term. Current working efficiency of plant for segregation was found to be 1kg per minute. Identifying bottlenecks in the success of the model, data on efficiency of the plant, economics of its fabrication were part of the study. Similar satellite waste management plants could potentially be a solution to supplement the waste management system of municipalities of similar sized cities in India or South East Asia with similar issues surrounding waste disposal.

Keywords: affordable, rag pickers, recycle, reduce, reuse, segregation, zero waste

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Authors: Merle Talvik, Taimi Tulva, Kristi Puusepp, Ülle Ernits

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Background data. In 1940–1941 and 1945–1991 Estonia was occupied by Soviet Union. Paternalism was a common principle in Soviet social policy, including health care. The Soviet government, not the individuals themselves, decided on achieving a person’s quality of life. With the help of Soviet ideology, the work culture of nurses was constructed and the education system was also reshaped according to the ideology. The “new period of awakening” was initiated under Gorbachev’s perestroika and glasnost (1985–1991), leading to democratization. Aim. The qualitative study aimed to analyze nursing education in Soviet Estonia in the conditions of paternalistic orientation and ideological pressure. Method. The research was conducted in 2021 and 2023. Senior nurses (aged 69–87) who had worked for at least 20 years during the Soviet era were surveyed. Thematic interviews were conducted in written form and orally (13 interviewees), followed by a focus group interview (8 interviewees). A thematic content analysis was performed. Results. Nursing is part of society’s culture and in this sense, in - terviews with nurses provide us with critical information about the functioning of society and cultural identity at a given time. During the Soviet era the training of nurses occured within vocational training institutions. The curricula underwent a shift towards a Soviet-oriented approach. A significant portion of lessons were dedicated to imparting knowledge on the principles and tenets of Communist-Marxist ideology. Therefore, practical subjects and nursing theory were frequently allocated limited space. A paternalistic orientation prevailed in health care: just as the state regulated how to cure, spread hygiene, and healthy lifestyles propaganda, training was also determined by the management of the institution, thereby limiting the person´s autonomy to decide what kind of training was needed. The research is of significant value in the context of the history of nursing, as it helps to understand the difficulties and complexity of the development of nursing on the timeline. The Soviet era still affects Estonian society today and will continue to do so in the future. The same type of developments occurred in other post-Soviet countries.

Keywords: Estonian SSR, nursing education, paternalism, senior nurse, Soviet ideology

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Authors: Amirreza Razzaghipour Sorkhab

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One of the most common disorders among humans is hearing impairment. This paper provides an evidence base that recovers understanding of Meniere’s disease and highlights the physical and mental health correlates of the disorder. Meniere's disease is more common in the elderly. The term idiopathic endolymphatic hydrops has been attributed to this disease by some in the previous. Meniere’s disease demonstrations a genetic tendency, and a family history is found in 10% of cases, with an autosomal dominant inheritance pattern. The COCH gene may be one of the hereditary factors contributing to Meniere’s disease, and the possibility of a COCH mutation should be considered in patients with Meniere’s disease symptoms. Should be considered Missense mutations in the COCH gene cause the autosomal dominant sensorineural hearing loss and vestibular disorder. Meniere’s disease is a complex, heterogeneous disorder of the inner ear and that is characterized by episodes of vertigo lasting from minutes to hours, fluctuating sensorineural hearing loss, tinnitus, and aural fullness. The existing evidence supports the suggestion that age and sleep disorder are risk factors for Meniere's disease. Many factors have been reported to precipitate the progress of Menier, including endolymphatic hydrops, immunology, viral infection, inheritance, vestibular migraine, and altered intra-labyrinthine fluid dynamics. Although there is currently no treatment that has a proven helpful effect on hearing levels or on the long-term evolution of the disease, however, in the primary stages, the hearing may improve among attacks, but a permanent hearing loss occurs in the majority of cases. Current publications have proposed a role for the intratympanic use of medicine, mostly aminoglycosides, for the control of vertigo. more than 85% of patients with Meniere's disease are helped by either changes in lifestyle and medical treatment or minimally aggressive surgical procedures such as intratympanic steroid therapy, intratympanic gentamicin therapy, and endolymphatic sac surgery. However, unilateral vestibular extirpation methods (intratympanic gentamicin, vestibular nerve section, or labyrinthectomy) are more predictable but invasive approaches to control the vertigo attacks. Medical therapy aimed at reducing endolymph volume, such as low-sodium diet, diuretic use, is the typical initial treatment.

Keywords: meniere's disease, endolymphatic hydrops, hearing loss, vertigo, tinnitus, COCH gene

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Authors: Swati Gautam, Amita Jain, Shyampyari Jaiswar

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Objective: To elucidate the role of (ApaI&TaqI) VDR gene polymorphism in the pathogenesis of female genital tuberculosis (FGTB) cases. Background: Female genital TB represents about 15-20% of total extra-pulmonary TB (EPTB). Female subjects with vitamin D deficiency have been shown to be at higher risk of pulmonary TB as well as FGTB. In same context few functional polymorphism in vitamin D receptor (VDR) gene has been considered as an important genetic risk factor that modulate the development of FGTB. Therefore we aimed, to elucidate the role of (ApaI&TaqI) VDR gene polymorphism in the pathogenesis of FGTB. Study design: Case-Control study. Sample size: Cases (60) and Controls (60). Study site: Department of Obstetrics & Gynecology & Department of Microbiology, K.G.M.U. Lucknow, (UP). Inclusion criteria: Cases: Women with age group 20-35 years, premenstrual endometrial aspiration collected and included in the study, those were positive with acid-fast bacilli (AFB)/ TB-PCR/ LJ culture/ liquid culture. Controls: Women with age group 20-35 years having no history of ATT and all test negative for TB recruited as control. Exclusion criteria: -Women with endometriosis, polycystic ovaries (PCOD), positive on Chlamydia & gonorrhea, already on anti-tubercular therapy (ATT) excluded. Materials and Methods: Blood samples were collected in EDTA tubes from cases and controls stored at -20ºC. Genomic DNA extraction was carried out by salting-out method. Genotyping of VDR gene (ApaI&TaqI) polymorphism was performed by using single amplification refractory mutation system (ARMS) PCR technique. PCR products were analyzed by electrophoresis on 2% agarose gel. Statistical analysis was done by SPSS16.3 software & computing odds ratio (OR) with 95% CI. Results: Increased risk of female genital tuberculosis was observed in AA genotype (OR =1.1419-6.212 95% CI, P*<0.036) and A allele (OR =1.255-3.518, 95% CI, P* < 0.006) in FGTB as compared to controls. Moreover A allele was found more frequent in FGTB patients. No significant difference was observed in TaqI gene polymorphism of VDR gene. Conclusion: The ApaI polymorphism is significantly associated with etiology of FGTB and plays an important role as a genetic risk factor in FGTB women.

Keywords: ARMS, ATT, EPTB, FGTB, VDR

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Authors: Ayami Umemura

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The purpose of this paper is to examine the meaning of verbalization in clinical practice using the keywords silence and singularity. A patient's experience of illness and treatment is singular, irreplaceable, and irreproducible and ultimately cannot be compared with that of others. In his book Difference and Repetition, Gilles Deleuze positioned irreplaceable singularity as the opposite concept of particularity as a generalizable and substitutable property and matched the former with universality. He also said that singularity could not be represented because of its irreplaceable nature. Representation or verbalization is a procedure that converts an irreplaceable, idiosyncratic reality into something that can be substituted. Considering the act of verbalizing medical diagnosis based on this, it can be said that diagnosis is the practice of decontextualizing and generalizing the suffering embedded in the patient's irreplaceable life history as a disease. This paper examines the above with the key concept of the practice of "non-verbalization" in traditional medical practices in Sri Lanka. In the practice of Sri Lankan traditional medicine and the inheritance of medical knowledge and care techniques, there is a tendency to avoid verbalizing specific matters or stating them aloud. Specifically, the following should be avoided. The healer informs the patient of the name of the disease, mentions the name of the herb used in front of the patient, explains the patient's condition to the healer, and referring the names of poisonous animals, such as poisonous snakes that have been damaged. And so on. Furthermore, when passing on medical knowledge and skills, it is also possible to avoid verbalizing knowledge of medicinal herbs and medical treatment methods and explaining them verbally. In addition to the local belief that the soul of language in Sri Lanka is deeply involved in this background, Sri Lankan traditional medicine has a unique view of the human body and personality that is rooted in the singularity that appears in the relationship with the movement of celestial bodies and the supernatural realm. It can be pointed out that it is premised on the view. In other words, the “silence” in Sri Lankan indigenous medicine is the reason for emphasizing specificity. Furthermore, we can say that "non-verbalization" is a practice aimed at healing. Based on these discussions, this paper will focus on the unique relationships between practitioners and patients that become invisible due to verbalization, which is overlooked by clinical medicine, where informed consent, ensuring transparency, and audit culture is dominant. We will examine the experience of treatment and aim to relativize clinical medicine, which is based on audit cultures.

Keywords: audit cultures, indigenous medicine, singularity, verbalization

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