Search results for: urban travel indicators

Authors: Mareen Brosterhaus, Antje Hammer, Steffen Kalina, Stefan Grau, Anjali A. Roeth, Hany Ashmawy, Thomas Gross, Marcel Binnebosel, Wolfram T. Knoefel, Tanja Manser

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Background: The identification of critical incidents in hospitals is an essential component of improving patient safety. To date, various methods have been used to measure and characterize such critical incidents. These methods are often viewed by physicians and nurses as external quality assurance, and this creates obstacles to the reporting events and the implementation of recommendations in practice. One way to overcome this problem is to use tools that directly involve staff in measuring indicators of quality and safety of care in the department. One such instrument is the global trigger tool (GTT), which helps physicians and nurses identify adverse events by systematically reviewing randomly selected patient records. Based on so-called ‘triggers’ (warning signals), indications of adverse events can be given. While the tool is already used internationally, its implementation in German hospitals has been very limited. Objectives: This study aimed to assess the feasibility and potential of the global trigger tool for identifying adverse events in German hospitals. Methods: A total of 120 patient records were randomly selected from two surgical, and one neurosurgery, departments of three university hospitals in Germany over a period of two months per department between January and July, 2017. The records were reviewed using an adaptation of the German version of the Institute for Healthcare Improvement Global Trigger Tool to identify triggers and adverse event rates per 1000 patient days and per 100 admissions. The severity of adverse events was classified using the National Coordinating Council for Medication Error Reporting and Prevention. Results: A total of 53 adverse events were detected in the three departments. This corresponded to adverse event rates of 25.5-72.1 per 1000 patient-days and from 25.0 to 60.0 per 100 admissions across the three departments. 98.1% of identified adverse events were associated with non-permanent harm without (Category E–71.7%) or with (Category F–26.4%) the need for prolonged hospitalization. One adverse event (1.9%) was associated with potentially permanent harm to the patient. We also identified practical challenges in the implementation of the tool, such as the need for adaptation of the global trigger tool to the respective department. Conclusions: The global trigger tool is feasible and an effective instrument for quality measurement when adapted to the departmental specifics. Based on our experience, we recommend a continuous use of the tool thereby directly involving clinicians in quality improvement.

Keywords: adverse events, global trigger tool, patient safety, record review

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Authors: Amira Mabrouk, Chokri Abdennadher

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The reduction of road congestion which is inherent to the use of vehicles is an obvious priority to public authority. Therefore, assessing the willingness to pay of an individual in order to save trip-time is akin to estimating the change in price which was the result of setting up a new transport policy to increase the networks fluidity and improving the level of social welfare. This study holds an innovative perspective. In fact, it initiates an economic calculation that has the objective of giving an estimation of the monetized time value during the trips made in Sfax. This research is founded on a double-objective approach. The aim of this study is to i) give an estimation of the monetized value of time; an hour dedicated to trips, ii) determine whether or not the consumer considers the environmental variables to be significant, iii) analyze the impact of applying a public management of the congestion via imposing taxation of city tolls on urban dwellers. This article is built upon a rich field survey led in the city of Sfax. With the use of the contingent valuation method, we analyze the “declared time preferences” of 450 drivers during rush hours. Based on the fond consideration of attributed bias of the applied method, we bring to light the delicacy of this approach with regards to the revelation mode and the interrogative techniques by following the NOAA panel recommendations bearing the exception of the valorization point and other similar studies about the estimation of transportation externality.

Keywords: willingness to pay, contingent valuation, time value, city toll

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Authors: João Gago dos Santos, Paulo Pereira Almeida

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The present study intends to deepen and understand the reasons that led to the decline and disappearance of wooden construction systems in Portugal, for that reason, its use in history must be analyzed. It is observed that this material was an integral part of the construction systems in Europe and Portugal for centuries, and it is possible to conclude that its decline happens with the appearance of hybrid construction and later with the emergence and development of reinforced concrete technology. It is also verified that wood as a constructive element, and for that reason, an element of development had great importance in national construction, with its peak being the Pombaline period, after the 1755 earthquake. In this period, the great scarcity of materials in the metropolis led to the import wood from Brazil for the reconstruction of Lisbon. This period is linked to an accentuated exploitation of forests, resulting in laws and royal decrees aimed at protecting them, guaranteeing the continued existence of profitable forests, crucial to the reconstruction effort. The following period, with the gradual loss of memory of the catastrophe, resulted in a construction that was weakened structurally as a response to a time of real estate speculation and great urban expansion. This was the moment that precluded the inexistence of the use of wood in construction. At the beginning of the 20th century and in the 30s and 40s, with the appearance and development of reinforced concrete, it became part of the great structures of the state, and it is considered a versatile material capable of resolving issues throughout the national territory. It is at this point that the wood falls into disuse and practically disappears from the new works produced.

Keywords: construction history, construction in portugal, construction systems, wood construction

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Authors: Ahmed Negm, George Aggidis, Xiandong Ma

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With the diverse nature of urban cities, customer demand patterns, landscape topologies or even seasonal weather trends; managing our water distribution networks (WDNs) has proved a complex task. These unpredictable circumstances manifest as pipe failures, intermittent supply and burst events thus adding to water loss, energy waste and increased carbon emissions. Whilst these events are unavoidable, advanced pressure management has proved an effective tool to control and mitigate them. Henceforth, water utilities have struggled with developing a real-time control method that is resilient when confronting the challenges of water distribution. In this paper we use deep reinforcement learning (DRL) algorithms as a novel pressure control strategy to minimise pressure violations and leakage under both burst and background leakage conditions. Agents based on asynchronous actor critic (A2C) and recurrent proximal policy optimisation (Recurrent PPO) were trained and compared to benchmarked optimisation algorithms (differential evolution, particle swarm optimisation. A2C manages to minimise leakage by 32.48% under burst conditions and 67.17% under background conditions which was the highest performance in the DRL algorithms. A2C and Recurrent PPO performed well in comparison to the benchmarks with higher processing speed and lower computational effort.

Keywords: deep reinforcement learning, pressure management, water distribution networks, leakage management

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Authors: Mohamad Javad Shakouri, Behshad Riahipour

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Today, the use of medicinal herbs in architecture and green space has a significant effect on the process of calming human and increases the reliability coefficient of design and design flexibility. The current research was conducted with the aim to design green roof and investigate the effect of medicinal herbs such as cress, leek, fenugreek, beet, sweet fennel, green basil, purple basil, and purslane on reducing the number of environmental pollutants (copper, zinc, and cadmium). Finally, the weight of the dry plant and the concentration of elements zinc, lead, and cadmium in the herbs was measured. According to the results, the maximum dry weight (88.10 and 73.79 g) was obtained in beet and purslane respectively and the minimum dry weight (24.12 and 25.21) was obtained in purple basil, and green basil respectively. The maximum amount of element zinc (235 and 213 mg/kg) and the maximum amount of lead (143 mg/kg) were seen in sweet fennel and purple basil. In addition, the maximum amount of cadmium (13 mg/kg) was seen in sweet fennel and purple basil and the minimum amount of lead and cadmium (78 and 7 mg/kg) was seen in green basil, and the minimum amount of zinc (110 mg/kg) was seen in leek. On the other hand, the absorption amount of element lead in the herbs beet and purslane was the same and both absorbed 123 mg/kg lead. Environmentally, if green roofs are implemented extensively and in wide dimensions in urban spaces, they will purify and reduce pollution significantly by absorbing carbon dioxide and producing oxygen.

Keywords: medicinal herbs, green space, green roof, heavy metals, lead, green basil

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Authors: Yael Wolff Sagy, Yiska Loewenberg Weisband, Vered Kaufman Shriqui, Michal Krieger, Arie Ben Yehuda, Ronit Calderon Margalit

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Background: Obesity is both a risk factor and common comorbidity of diabetes. Obesity impedes the achievement of glycemic control, and enhances damage caused by hyperglycemia to blood vessels; thus it increases diabetes-related complications. This study assessed the prevalence of obesity and morbid obesity among Israeli adults with diabetes, and estimated disparities associated with sex and socioeconomic position (SEP). Methods: A cross-sectional study was conducted in the setting of the Israeli National Program for Quality Indicators in Community Healthcare. Data on all the Israeli population is retrieved from electronic medical records of the four health maintenance organizations (HMOs). The study population included all Israeli patients with diabetes aged 20-64 with documented body mass index (BMI) in 2016 (N=180,451). Diabetes was defined as the existence of one or more of the following criteria: (a) Plasma glucose level >200 mg% in at least two tests conducted at least one month apart in the previous year; (b) HbA1c>6.5% at least once in the previous year (c) at least three prescriptions of diabetes medications were dispensed during the previous year. Two measures were included: the prevalence of obesity (defined as last BMI≥ 30 kg/m2 and <35 kg/m2) and the prevalence of morbid obesity (defined as last BMI≥ 35 kg/m2) in individuals aged 20-64 with diabetes. The cut-off value for morbid obesity was set in accordance with the eligibility criteria for bariatric surgery in diabetics. Data were collected by the HMOs and aggregated by age, sex and SEP. SEP was based on statistical areas ranking by the Israeli Central Bureau of Statistics and divided into 4 categories, ranking from 1 (lowest) to 4 (highest). Results: BMI documentation among adults with diabetes was 84.9% in 2016. The prevalence of obesity in the study population was 30.5%. Although the overall rate was similar in both sexes (30.8% in females, 30.3% in males), SEP disparities were stronger in females (32.7% in SEP level 1 vs. 27.7% in SEP level 4; 18.1% relative difference) compared to males (30.6% in SEP level 1 vs. 29.3% in SEP level 4; 4.4% relative difference). The overall prevalence of morbid obesity in this population was 20.8% in 2016. The rate among females was almost double compared to the rate in males (28.1% and 14.6%, respectively). In both sexes, the prevalence of morbid obesity was strongly associated with lower SEP. However, in females, disparities between SEP levels were much stronger (34.3% in SEP level 1 vs. 18.7% in SEP level 4; 83.4% relative difference) compared to SEP-disparities in males (15.7% in SEP level 1 vs. 12.3% in SEP level 4; 27.6% relative difference). Conclusions: The overall prevalence of BMI≥ 30 kg/m2 among adults with diabetes in Israel exceeds 50%; and the prevalence of morbid obesity suggests that 20% meet the BMI-criteria for bariatric surgery. Prevalence rates show major SEP- and sex-disparities; especially strong SEP disparities in morbid obesity among females. These findings highlight the need for greater consideration of different population groups when implementing interventions.

Keywords: diabetes, health disparities, health policy, obesity, socio-economic position

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Authors: Crystal Hoole

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Employee well-being has become an area of concern for top executives and organizations worldwide. In developing countries such as South Africa, and especially in the educational sector, employees have to deal with anxiety, stress, fear, student protests, political and economic turmoil and excessive work demands on a daily basis. Research has shown that workplaces with higher resilience and better well-being strategies also report higher productivity, increased innovation, better employee retention and better employee engagement. Many organisations offer standard employee assistance programs and once-off short interventions. However, most of these well-being initiatives are perceived as ineffective. Some of the criticism centers around a lack of holistic well-being approaches, no proof of the success of well-being initiatives, not being part of the organization’s strategies and a lack of genuine leadership support. This study attempts to illustrate how a holistic well-being intervention, over a period of 100 days, is far more effective in impacting organizational outcomes. A quasi-experimental design, with a pre-test and pro-test design with a randomization strategy, will be used. Measurements of organizational outcomes are taken at three-time points throughout the study, before, middle and after. The constructs that will be measured are employee engagement, psychological well-being, organizational culture and trust, and perceived stress. The well-being is imitative follows a salutogenesis approach and is aimed at building resilience through focusing on six focal areas, namely sleep, mindful eating, exercise, love, gratitude and appreciation, breath work and mindfulness, and finally, purpose. Certain organizational constructs, including employee engagement, psychological well-being, organizational culture and trust and perceived stress, will be measured at three-time points during the study, namely before, middle and after. A quasi-experimental, pre-test and post-test design will be applied, also using a randomization strategy to limit potential bias. Repeated measure ANCOVA will be used to determine whether any change occurred over the period of 100 days. The study will take place in a Higher Education institution in South Africa. The sample will consist of academic and administrative staff. Participants will be assigned to a test and control group. All participants will complete a survey measuring employee engagement, psychological well-being, organizational culture and trust, and perceived stress. Only the test group will undergo the well-being intervention. The study envisages contributing on several levels: Firstly, the study hopes to find a positive increase in the various well-being indicators of the participants who participated in the study and secondly to illustrate that a longer more holistic approach is successful in improving organisational success (as measured in the various organizational outcomes).

Keywords: wellbeing, resilience, organizational success, intervention

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Authors: Steven Hidalgo, Patricio Neumann

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The growth of societies has increased the consumption of raw materials and food obtained from nature. This has influenced the services offered by ecosystems to humans, mainly supply and regulation services. One of the indicators used to evaluate these services is Net Primary Productivity (NPP), which is understood as the energy stored in the form of biomass by primary organisms through the process of photosynthesis and respiration. The variation of NPP by defined area produces changes in the properties of terrestrial and aquatic ecosystems, which alter factors such as biodiversity, nutrient cycling, carbon storage and water quality. The analysis of NPP to evaluate variations in ecosystem services includes harvested NPP (understood as provisioning services), which is the raw material from agricultural systems used by humans as a source of energy and food, and the remaining NPP (expressed as a regulating service) or the amount of biomass that remains in ecosystems after the harvesting process, which is mainly related to factors such as biodiversity. Given that agriculture is a fundamental pillar of Chile's integral development, the purpose of this study is to evaluate provisioning and regulating ecosystem services in the agricultural sector, specifically in cereal production, in the communes of the central-southern regions of Chile through a conceptual framework based on the quantification of the fraction of Human Appropriation of Net Primary Productivity (HANPP) and the fraction remaining in the ecosystems (NPP remaining). A total of 161 communes were analyzed in the regions of O'Higgins, Maule, Ñuble, Bio-Bío, La Araucanía and Los Lagos, which are characterized by having the largest areas planted with cereals. It was observed that the region of La Araucanía produces the greatest amount of dry matter, understood as provisioning service, where Victoria is the commune with the highest cereal production in the country. In addition, the maximum value of HANPP was in the O'Higgins region, highlighting the communes of Coltauco, Quinta de Tilcoco, Placilla and Rengo. On the other hand, the communes of Futrono, Pinto, Lago Ranco and Pemuco, whose cereal production was important during the study, had the highest values of remaining NPP as a regulating service. Finally, an inverse correlation was observed between the provisioning and regulating ecosystem services, i.e., the higher the cereal or dry matter production in a defined area, the lower the net primary production remaining in the ecosystems. Based on this study, future research will focus on the evaluation of ecosystem services associated with other crops, such as forestry plantations, whose activity is an important part of the country's productive sector.

Keywords: provisioning services, regulating services, net primary productivity, agriculture

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Authors: Samina Nazli, Nadia Qamar, Quratulain, Akasha, Saman Jamal

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Objective: The objective is to determine the frequency of iron deficiency anemia among children having febrile seizures. A descriptive Cross-Sectional Study was done in the Pediatric Unit of Allama Iqbal Memorial Teaching Hospital Sialkot from September 2020 to February 2021. Material & Methods: A total of 70 children were studied aged six months to 10 years, with either gender presenting with febrile seizures. All data of the patients was documented, including demographic data like age, gender, residential area, educational status, socioeconomic status and clinical findings at the time of presentation like fever, fits and duration of symptoms etc. Blood hemoglobin and ferritin levels were tested for each patient to evaluate iron deficiency anemia. Results: There were 65.7% male and 34.3% female cases in this study. The age range of the patients was 6 months to 10 years, with a mean age of 4.36 ± 2.71 years. Most of the children (60%) were below three years of age. Most children belonged to low and middle socioeconomic status with a frequency of 42.8% and 45.7%, respectively. Iron deficiency anemia was found in 38.6% of cases. The majority of the mothers were illiterate (65%). There were 44.3% cases from rural areas and 55.7% from urban areas. Conclusion: Iron deficiency anemia is a common problem among children with febrile seizures, younger than 03 years and belonging to rural areas. Illiterate mothers are an important risk factor for iron deficiency anemia in their children.

Keywords: febrile seizure, iron deficiency anemia, illetrate mother, low scioeconomic status, febrile siezure

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Authors: Tae Young Jin, Jin Soo Kim

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Carbon emissions have emerged as global concerns. Intergovernmental Panel of Climate Change (IPCC) have published reports about Green House Gases (GHGs) emissions regularly. United Nations Framework Convention on Climate Change (UNFCCC) have held a conference yearly since 1995. Especially, COP21 held at December 2015 made the Paris agreement which have strong binding force differently from former COP. The Paris agreement was ratified as of 4 November 2016, they finally have legal binding. Participating countries set up their own Intended Nationally Determined Contributions (INDC), and will try to achieve this. Thus, carbon emissions must be reduced. The energy sector is one of most responsible for carbon emissions and fossil fuels particularly are. Thus, this paper attempted to examine the relationship between natural gas consumption and economic growth. To achieve this, we adopted the Cobb-Douglas production function that consists of natural gas consumption, economic growth, capital, and labor using dependent panel analysis. Data were preprocessed with Principal Component Analysis (PCA) to remove cross-sectional dependency which can disturb the panel results. After confirming the existence of time-trended component of each variable, we moved to cointegration test considering cross-sectional dependency and structural breaks to describe more realistic behavior of volatile international indicators. The cointegration test result indicates that there is long-run equilibrium relationship between selected variables. Long-run cointegrating vector and Granger causality test results show that while natural gas consumption can contribute economic growth in the short-run, adversely affect in the long-run. From these results, we made following policy implications. Since natural gas has positive economic effect in only short-run, the policy makers in developing countries must consider the gradual switching of major energy source, from natural gas to sustainable energy source. Second, the technology transfer and financing business suggested by COP must be accelerated. Acknowledgement—This work was supported by the Energy Efficiency & Resources Core Technology Program of the Korea Institute of Energy Technology Evaluation and Planning (KETEP) granted financial resource from the Ministry of Trade, Industry & Energy, Republic of Korea (No. 20152510101880) and by the National Research Foundation of Korea Grant funded by the Korean Government (NRF-205S1A3A2046684).

Keywords: developing countries, economic growth, natural gas consumption, panel data analysis

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Authors: Debasish Chowdhury, Sunil Mekale, Sarvanamurthy Sakthivel, Sukhvinder Kaur, Rambabu Khambampati, Ashok Agarwal

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Introduction: The migrant intervention in India was initiated during the National AIDS Control Program (NACP) Phase-2 (2002-2007). HIV Sentinel surveillance Studies (HSS) conducted in 2012-13 indicated higher HIV prevalence among migrants (0.99%) compared to general populations (0.35%). Migrants continue to bear a heightened risk of HIV infection which results from the condition and structure of the migration process. USAID PHFI-PIPPSE project in collaboration with the National AIDS Control Organization (NACO) developed a unique system called Migrant Service Delivery System (MSDS) to capture migrants profile with respect to their risk profile and to provide tailor made services to them. Description: MSDS is a web-based system, designed and implemented to increase service uptake among migrants through evidence based planning. 110 destination migrants Targeted Intervention (TI) from 11 states were selected for study with varied target populations in terms of occupations; to understand occupation related risk behaviors among the migrants. Occupation wise registration data of high risk vulnerable migrants were analyzed through MSDS for the period April 2014–June 2016. Analysis was made on specific indicators among these occupational groups to understand the risk behavior and their vulnerability to HIV and STIs. Findings: Out of total HIV positive migrant’s workers (N= 847) enrolled in MSDS HIV rate is found to be highest among Auto-Rickshaw (18.66%) followed by Daily wage laborers (14.46%), Loom workers (10.73%), Industrial workers (10.04%) and Construction worker 7.93%. With 45.14% positivity, industrial workers are found to be most vulnerable to Sexually Transmitted Infections (STIs) (N=10057) among all occupational categories followed by loom workers (16.28%), Skilled worker (Furniture, Jeweler)-7.14%, daily wage laborers (5.45%). Conclusion: MSDS is an effective tool to assess migrants’ risk and their vulnerability to HIV for designing evidence informed program. This system calls for a replication across all destination TIs by NACO for differential strategies for different occupation groups to ensure better yield through scientific planning of intervention among high risk and high vulnerable migrants.

Keywords: migrants, migrant service delivery system, risk, vulnerability

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Authors: Lopita Pal, Suresh V. Madha

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Wetlands are areas of marsh, fen, peat land or water, whether natural or artificial, permanent or temporary, with water that is static or flowing, fresh, brackish or salt, including areas of marine water the depth of which at low tide does not exceed six metres. The rapidly expanding human population, large scale changes in land use/land cover, burgeoning development projects and improper use of watersheds all has caused a substantial decline of wetland resources in the world. Major degradations have been impacted from agricultural, industrial and urban developments leading to various types of pollutions and hydrological perturbations. Regular fishing activities and unsustainable grazing of animals are degrading the wetlands in a slow pace. The paper focuses on the spatio-temporal change detection of the area of the water body and the main cause of this depletion. The total area under study (22°19’87’’ N, 88°20’23’’ E) is a wetland region in West Bengal of 213 sq.km. The procedure used is the Normalized Difference Water Index (NDWI) from multi-spectral imagery and Landsat to detect the presence of surface water, and the datasets have been compared of the years 2016, 2006 and 1996. The result shows a sharp decline in the area of water body due to a rapid increase in the agricultural practices and the growing urbanization.

Keywords: spatio-temporal change, NDWI, urbanization, wetland

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Authors: Hlabishi Peter Ntloana

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This paper aims to present the effectiveness of the Spatial Planning and Land Use Management Act, 2013, in addressing key spatial challenges in Fetakgomo Tubatse Local Municipality, mainly focusing on Apel nodal point. Spatial Planning and Land Use Management Act, 2013, popularly known as SPLUMA, aimed at addressing emerging and existing spatial planning and land use management challenges in South Africa. There are critical key spatial challenges that are continuously encountered in Apel Nodal Point, which include dispersed rural settlement mainly in a communal settlement. The spatial patterns and rural settlements development patterns are a challenge, and such results in uncoordinated human settlements. The objective of this research paper is to analyze the spatial planning of Apel nodal points and determine the effectiveness of the SPLUMA policy. Key Informant interviews were conducted with 20 participants, and also the municipal Spatial Development Framework was considered to explore more challenges and proposed recommendations. The results divulged that there is a huge gap in addressing spatial planning, mainly in rural areas, and correlation with the findings of the Municipal Spatial Development framework. In conclusion, spatial planning remains a critical dilemma in most rural settlements, and there must be programmes and strategies to balance the effectiveness of spatial planning in urban and rural settlements.

Keywords: land use management, rural settlement, spatial development framework, spatial planning

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Authors: Anđelka Stojanović, Ivan Mihajlović, Ivica Nikolić

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In the past years, due to the financial crisis and the tightening of conditions on the labor market, young people are facing great challenges in achieving financial independence and finding their place in society. Higher unemployment rates, poorer living conditions, separation from the labor market, and longer school-to-work transitions particularly affect rural youth and make significant differences between youth groups in rural and urban areas. Improving employability skills and development of instruments for further learning among young people “Not in Education, Employment, or Training” (NEET) should not be only the concerns of these people, already adequately be directed and supported by the institutions. According to the World Bank data, the share of youth not in education, employment or training (NEET), in the European Union in the past few years decreases but still shows a significant share in the total percentage of the youth population. In 2017 rate was 10.96% while in 2018 that value was 10.38%. When observing individual countries in Europe, especially those with lower incomes, this rate is much higher. It was concluded that this topic was not sufficiently elaborated and presented in the social and scientific environment. Therefore, the aim of this paper is to identify and systematize the problems of school-to-work transition among young NEETs living in rural areas as well as the initiatives for addressing their problems.

Keywords: NEET youth, risks and initiatives, rural youth, school-to-work transition

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Authors: Mohammad Ali Al Qatawneh, Bespalchuk Pavel Ivanovich

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Computer navigation has been introduced in total knee arthroplasty to improve the accuracy of the procedure. Computer navigation improves the accuracy of bone resection in the coronal and sagittal planes. It was also noted that it normalizes the rotational alignment of the femoral component and fully assesses and balances the deformation of soft tissues in the coronal plane. The work is devoted to the advantages of using computer navigation technology in total knee arthroplasty in 62 patients (11 men and 51 women) suffering from gonarthrosis, aged 51 to 83 years, operated using a computer navigation system, followed up to 3 years from the moment of surgery. During the examination, the deformity variant was determined, and radiometric parameters of the knee joints were measured using the Knee Society Score (KSS), Functional Knee Society Score (FKSS), and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scales. Also, functional stress tests were performed to assess the stability of the knee joint in the frontal plane and functional indicators of the range of motion. After surgery, improvement was observed in all scales; firstly, the WOMAC values decreased by 5.90 times, and the median value to 11 points (p < 0.001), secondly KSS increased by 3.91 times and reached 86 points (p < 0.001), and the third one is that FKSS data increased by 2.08 times and reached 94 points (p < 0.001). After TKA, the axis deviation of the lower limbs of more than 3 degrees was observed in 4 patients at 6.5% and frontal instability of the knee joint just in 2 cases at 3.2%., The lower incidence of sagittal instability of the knee joint after the operation was 9.6%. The range of motion increased by 1.25 times; the volume of movement averaged 125 degrees (p < 0.001). Computer navigation increases the accuracy of the spatial orientation of the endoprosthesis components in all planes, reduces the variability of the axis of the lower limbs within ± 3 °, allows you to achieve the best results of surgical interventions, and can be used to solve most basic tasks, allowing you to achieve excellent and good outcomes of operations in 100% of cases according to the WOMAC scale. With diaphyseal deformities of the femur and/or tibia, as well as with obstruction of their medullary canal, the use of computer navigation is the method of choice. The use of computer navigation prevents the occurrence of flexion contracture and hyperextension of the knee joint during the distal sawing of the femur. Using the navigation system achieves high-precision implantation for the endoprosthesis; in addition, it achieves an adequate balance of the ligaments, which contributes to the stability of the joint, reduces pain, and allows for the achievement of a good functional result of the treatment.

Keywords: knee joint, arthroplasty, computer navigation, advantages

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Authors: K. P. Ganesh, T. Gomathi, L. Arul Pragasan

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Degradation of lake water quality is one of the serious environmental threats for the last few decades, particularly, the lakes situated in and around urban and industrial areas. The present study aimed to analyze the physicochemical and biological parameters, and metal elements to determine the water quality of Krishnampathi, Ukkadam, Kurichi, Sulur and Singanallur Lakes. Of the 23 physicochemical parameters analyzed in the five lakes, except TDS, Chloride and Total hardness values all the 20 parameters were found within the prescribed limit as recommended by World Health Organization (WHO) and Bureau of Indian Standards (BIS). In case of biological parameter, both Total Coliform and Fecal Coliform bacteria (Escherichia coli) were identified. This indicates the contamination of lakes by fecal matter, and warns of potential of disease causing by viruses, bacteria and other organisms. Among the twelve metal elements (Al, Cr, Mn, Fe, Ni, Cu, Zn, As, Se, Mo, Cd and Pb) determined by inductively coupled plasma-mass spectroscopy, except Cd (for all lakes), and Pb (for Ukkadam, Kurichi, Sulur & Singanallur), all the elements were found above the prescribed limits of BIS. The results of the present study revealed that all the five major lakes of Coimbatore were contaminated. It is recommended that proper implementation of the new wetland waste management system and monitoring of water quality be of the urgent need to sustain the water bodies for future generations.

Keywords: heavy metals, inductively coupled plasma-mass spectroscopy, physicochemical and biological parameters, water quality

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Authors: Tania Chalton

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In June 2013, an independent review of the Liverpool Care Pathway (LCP) identified a number of problems with the implementation of the LCP in the UK and recommended that it be replaced by individual care plans for each patient. As a result of the UK findings, in November 2013 the Ministry of Health (MOH) commissioned the Palliative Care Council to initiate a programme of work to investigate an appropriate approach for the care of people in their last days of life in New Zealand (NZ). The Last Days of Life Working Group commenced a process to develop national consensus on the care of people in their last days of life in April 2014. In order to develop its advice for the future provision of care to people in their last days of life, the Working Group (WG) established a comprehensive work programme and as a result has developed a series of working papers. Specific areas of focus included: An analysis of the UK Independent Review findings and an assessment of these findings to the NZ context. A stocktake of services providing care to people in their last days of life, including aged residential care (ARC); hospices; hospitals; and primary care. International and NZ literature reviews of evidence and best practice. Survey of family to understand the consumer perspective on the care of people in their last days of life. Key aspects of care that required further considerations for NZ were: Terminology: clarify terminology used in the last days of life and in relation to death and dying. Evidenced based: including specific review of evidence regarding, spiritual, culturally appropriate care as well as dementia care. Diagnosis of dying: need for both guidance around the diagnosis of dying and communication with family. Workforce issues: access to an appropriate workforce after hours. Nutrition and hydration: guidance around appropriate approaches to nutrition and hydration. Symptom and pain management: guidance around symptom management. Documentation: documentation of the person’s care which is robust enough for data collection and auditing requirements, not ‘tick box’ approach to care. Education and training: improved consistency and access to appropriate education and training. Leadership: A dedicated team or person to support and coordinate the introduction and implementation of any last days of life model of care. Quality indicators and data collection: model of care to enable auditing and regular reviews to ensure on-going quality improvement. Cultural and spiritual: address and incorporate any cultural and spiritual aspects. A final document was developed incorporating all the evidence which provides guidance to the health sector on best practice for people at end of life: “Principles and guidance for the last days of life: Te Ara Whakapiri”.

Keywords: end of life, guidelines, New Zealand, palliative care

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Authors: Zachary Cooper-Baldock, Paulo E. Santos, Russell S. A. Brinkworth, Karl Sammut

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In recent years, large unmanned underwater vehicles such as the Boeing Voyager and Anduril Ghost Shark have been developed. These vessels can be structured to contain onboard internal payload bays. These payload bays can serve a variety of purposes – including the launch and recovery (LAR) of smaller underwater vehicles. The LAR of smaller vessels is extremely important, as it enables transportation over greater distances, increased time on station, data transmission and operational safety. The larger vessel and its payload bay structure complicate the LAR of UUVs in contrast to static docks that are affixed to the seafloor, as they actively impact the local flow field. These flow field impacts require analysis to determine if UUV vessels can be safely launched and recovered inside the motherships. This research seeks to determine the hydrodynamic forces exerted on a vertically over-actuated, small, unmanned underwater vehicle (OUUV) during an internal LAR manoeuvre and compare this to an under-actuated vessel (UUUV). In this manoeuvre, the OUUV is navigated through the stern wake region of the larger vessel to a set point within the internal payload bay. The manoeuvre is simulated using ANSYS Fluent computational fluid dynamics models, covering the entire recovery of the OUUV and UUUV. The analysis of the OUUV is compared against the UUUV to determine the differences in the exerted forces. Of particular interest are the drag, pressure, turbulence and flow field effects exerted as the OUUV is driven inside the payload bay of the larger vessel. The hydrodynamic forces and flow field disturbances are used to determine the feasibility of making such an approach. From the simulations, it was determined that there was no significant detrimental physical forces, particularly with regard to turbulence. The flow field effects exerted by the OUUV are significant. The vertical thrusters exert significant wake structures, but their orientation ensures the wake effects are exerted below the UUV, minimising the impact. It was also seen that OUUV experiences higher drag forces compared to the UUUV, which will correlate to an increased energy expenditure. This investigation found no key indicators that recovery via a mothership payload bay was not feasible. The turbulence, drag and pressure phenomenon were of a similar magnitude to existing static and towed dock structures.

Keywords: underwater vehicles, submarine, autonomous underwater vehicles, AUV, computational fluid dynamics, flow fields, pressure, turbulence, drag

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Authors: A. Ribeiro, N. Pacheco, M. Soares, N. Valério, L. Nascimento, A. Silva, C. Vilarinho, J. Carvalho

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Hydrogen will play a key role in changing the current global energy paradigm, associated with the high use of fossil fuels and the release of greenhouse gases. This work intended to identify and quantify the potential of Solid Recovered Fuels (SFR) existing in Portugal and project the cost of hydrogen, produced through its steam gasification in different scenarios, associated with the size or capacity of the plant and the existence of carbon capture and storage (CCS) systems. Therefore, it was performed a techno-economic analysis simulation using an ASPEN base model, the H2A Hydrogen Production Model Version 3.2018. Regarding the production of SRF, it was possible to verify the annual production of more than 200 thousand tons of SRF in Portugal in 2019. The results of the techno-economic analysis simulations showed that in the scenarios containing a high (200,000 tons/year) and medium (40,000 tons/year) amount of SFR, the cost of hydrogen production was competitive concerning the current prices of hydrogen. The results indicate that scenarios 1 and 2, which use 200,000 tons of SRF per year, have lower hydrogen production values, 1.22 USD/kg H2 and 1.63 USD/kg H2, respectively. The cost of producing hydrogen without carbon capture and storage (CCS) systems in an average amount of SFR (40,000 tons/year) was 1.70 USD/kg H2. In turn, scenarios 5 (without CCS) and 6 (with CCS), which use only 683 tons of SFR from urban sources, have the highest costs, 6.54 USD/kg H2 and 908.97 USD/kg H2, respectively. Therefore, it was possible to conclude that there is a huge potential for the use of SRF for the production of hydrogen through steam gasification in Portugal.

Keywords: gasification, hydrogen, solid recovered fuels, techno-economic analysis, waste-to-energy

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Authors: Orkide Donma, Mustafa M. Donma

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Association between insulin resistance (IR) and hematological parameters has long been a matter of interest. Within this context, body mass index (BMI), red blood cells, white blood cells and platelets were involved in this discussion. Parameters related to platelets associated with IR may be useful indicators for the identification of IR. Platelet indices such as mean platelet volume (MPV), platelet distribution width (PDW) and plateletcrit (PCT) are being questioned for their possible association with IR. The aim of this study was to investigate the association between platelet (PLT) count as well as PLT indices and the surrogate indices used to determine IR in morbid obese (MO) children. A total of 167 children participated in the study. Three groups were constituted. The number of cases was 34, 97 and 36 children in the normal BMI, MO and metabolic syndrome (MetS) groups, respectively. Sex- and age-dependent BMI-based percentile tables prepared by World Health Organization were used for the definition of morbid obesity. MetS criteria were determined. BMI values, homeostatic model assessment for IR (HOMA-IR), alanine transaminase-to-aspartate transaminase ratio (ALT/AST) and diagnostic obesity notation model assessment laboratory (DONMA-lab) index values were computed. PLT count and indices were analyzed using automated hematology analyzer. Data were collected for statistical analysis using SPSS for Windows. Arithmetic mean and standard deviation were calculated. Mean values of PLT-related parameters in both control and study groups were compared by one-way ANOVA followed by Tukey post hoc tests to determine whether a significant difference exists among the groups. The correlation analyses between PLT as well as IR indices were performed. Statistically significant difference was accepted as p-value < 0.05. Increased values were detected for PLT (p < 0.01) and PCT (p > 0.05) in MO group compared to those observed in children with N-BMI. Significant increases for PLT (p < 0.01) and PCT (p < 0.05) were observed in MetS group in comparison with the values obtained in children with N-BMI (p < 0.01). Significantly lower MPV and PDW values were obtained in MO group compared to the control group (p < 0.01). HOMA-IR (p < 0.05), DONMA-lab index (p < 0.001) and ALT/AST (p < 0.001) values in MO and MetS groups were significantly increased compared to the N-BMI group. On the other hand, DONMA-lab index values also differed between MO and MetS groups (p < 0.001). In the MO group, PLT was negatively correlated with MPV and PDW values. These correlations were not observed in the N-BMI group. None of the IR indices exhibited a correlation with PLT and PLT indices in the N-BMI group. HOMA-IR showed significant correlations both with PLT and PCT in the MO group. All of the three IR indices were well-correlated with each other in all groups. These findings point out the missing link between IR and PLT activation. In conclusion, PLT and PCT may be related to IR in addition to their identities as hemostasis markers during morbid obesity. Our findings have suggested that DONMA-lab index appears as the best surrogate marker for IR due to its discriminative feature between morbid obesity and MetS.

Keywords: children, insulin resistance, metabolic syndrome, plateletcrit, platelet indices

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Authors: Abubakar Samaila

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Pastoralism has been an old practice in the Sahel region of west Africa. In recent years, pastoralists in Nigeria have increasingly been migrating on seasonal transhumance southward from the neighboring countries, especially Niger Republic, in search of better grazing conditions due to mainly, climate change. This has increased pressure on farm lands which instigate farmer-herder conflicts. These conflicts occur mainly between farmers and pastoralists but also between pastoralist groups themselves. However, there has been a shift in these conflicts recently to involve traditional institutions and, in some cases, the local authorities along the borderlands. The involvement of local institutions in the conflict has created an incentive to local actors, particularly pastoralcommunity-based groups, in responding to these violent threats. As pastoralists are mobile, these conflicts became difficult to contain and, thus, spill across borders. Consequently, the conflict has now transformed into an urbanized regional conflicts that involve some major cities along the Nigeria-Niger borderlands; Sokoto, Zamfara, and Katsina on the Nigerian side andDosso, Tahoa andMaradi in Niger republic. These areas are now experiencing unprecedented growing wave of violence that have become complex and escalates into a hydra-social conflict. The aim of this research is to investigate how the fluidities of Nigeria-Niger borderland intensified armed conflicts between the local pastoral organizations and sedentary populationspreading to some urban cities along the borderlands. The paper further suggests alternative approaches towards addressing the perennial crisis in African borderlands.

Keywords: pastoralism, climate change, conflict, nigeria, niger, borderlands

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Authors: Khrystyna Pavlyk

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In the OECD countries, percentage of adults with higher education degrees has increased by 10 % during 2000-2010. Continuously increasing demand for higher education gives universities a chance of becoming key players in socio-economic development of a territory (region or city) via knowledge creation, knowledge transfer, and knowledge spillovers. During previous decade, universities have tried to support spin-offs and start-ups, introduced courses on sustainability and corporate social responsibility. While much has been done, new trends are starting to emerge in search of better approaches. Recently a number of universities created centers that conduct research in a field social entrepreneurship, which in turn underpin educational programs run at these universities. The list includes but is not limited to the Centre for Social Economy at University of Liège, Institute for Social Innovation at ESADE, Skoll Centre for Social Entrepreneurship at Oxford, Centre for Social Entrepreneurship at Rosklide, Social Entrepreneurship Initiative at INSEAD. Existing literature already examined social entrepreneurship centers in terms of position in the institutional structure, initial and additional funding, teaching initiatives, research achievements, and outreach activities. At the same time, Universities can become social enterprises themselves. Previous research revealed that universities use both business and social entrepreneurship models. Universities which are mainly driven by a social mission are more likely to transform into social entrepreneurial institutions. At the same time, currently, there is no clear understanding of what social entrepreneurship in higher education is about and thus social entrepreneurship in higher education needs to be studied and promoted at the same time. Main roles which socially oriented university can play in city development include: buyer (implementation of socially focused local procurement programs creates partnerships focused on local sustainable growth.); seller (centers created by universities can sell socially oriented goods and services, e.g. in consultancy.); employer (Universities can employ socially vulnerable groups.); business incubator (which will help current student to start their social enterprises). In the paper, we will analyze these in more detail. We will also examine a number of indicators that can be used to assess the impact, both direct and indirect, that universities can have on city's economy. At the same time, originality of this paper mainly lies not in methodological approaches used, but in countries evaluated. Social entrepreneurship is still treated as a relatively new phenomenon in post-transitional countries where social services were provided only by the state for many decades. Paper will provide data and example’s both from developed countries (the US and EU), and those located in CIS and CEE region.

Keywords: social enterprise, university, regional economic development, comparative study

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Authors: Rajkumar Ghosh

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Fluoride contamination in water and its subsequent impact on agricultural practices is a growing concern in various regions worldwide, including North 24 Parganas, West Bengal, India. This study aimed to investigate the extent of fluoride contamination in the region's water sources and evaluate its effects on crop production and quality. A comprehensive survey of water sources, including wells, ponds, and rivers, was conducted to assess the fluoride levels in North 24 Parganas. Water samples were collected and analyzed using standard methods, and the fluoride concentration was determined. The findings revealed significant fluoride contamination in the water sources, surpassing the permissible limits recommended by national and international standards. To assess the effects of fluoride contamination on crops, field experiments were carried out in selected agricultural areas. Various crops commonly cultivated in the region, such as paddy, wheat, vegetables, and fruits, were examined for their growth, yield, and nutritional quality parameters. Additionally, soil samples were collected from the study sites to analyse the fluoride levels and their potential impact on soil health. The results demonstrated the adverse effects of fluoride contamination on crop growth and yield. Reduced plant height, stunted root development, decreased biomass accumulation, and diminished crop productivity were observed in fluoride-affected areas compared to uncontaminated control sites. Furthermore, the nutritional composition of crops, including micronutrients and mineral content, was significantly altered under high fluoride exposure, leading to potential health risks for consumers. The study also assessed the impact of fluoride on soil quality and found a negative correlation between fluoride concentration and soil health indicators, such as pH, organic matter content, and nutrient availability. These findings emphasize the need for sustainable soil management practices to mitigate the harmful effects of fluoride contamination and maintain agricultural productivity. Overall, this study highlights the alarming issue of fluoride contamination in water sources and its detrimental effects on crop production and quality in North 24 Parganas, West Bengal, India. The findings underscore the urgency for implementing appropriate water treatment measures, promoting awareness among farmers and local communities, and adopting sustainable agricultural practices to mitigate fluoride contamination and safeguard the region's agricultural ecosystem.

Keywords: agricultural ecosystem, water treatment, sustainable agricultural, fluoride contamination

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Authors: Azadeh Rezafar

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Iran is one of the oldest countries with traditional culture in the world. All over the history Iranians had traditional architectural designs, which were at the same time sustainable, ecological, functional and environmental consistent. These human scale architectures were built for maximum use, comfort, climate adaptation with available resources and techniques. Climate variability of the country caused developing of variety design methods. More of these methods such as windcatchers in Yazd City or Panam (Insulation) were scientific solutions at the same time. Renewable energy resources were used in these methods that featured in them. While climate and ecological issues were dominant parts of these traditional designs, aesthetic and beauty issues were not ignored. Conformity with the community’s culture caused more compact designs that the visual aesthetics of them can be seen inside of them. Different organizations of space were used for these visual aesthetic issues inside the houses as well as historical urban designs. For example dry and hot climates in central parts of the country designed with centralized organization. Most central parts of these designs functioned as a courtyard for temperate the air in the summer. This paper will give summary descriptive information about traditional Iranian architectural style by figures all around the country with different climate conditions, while focus of the paper is traditional architectural design of the central part of the country, with dry and hot climate condition. This information may be useful for contemporary architectural designs, which are designed without noticing to the vernacular condition and caused cities look like each other.

Keywords: architectural design, traditional design, Iran, sustainability

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Authors: Mitakshara Sharma, S. K. Nema, Sanjeev Narang

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Diabetes mellitus (DM) is a group of metabolic disorders characterized by metabolic abnormalities, chronic hyperglycaemia and long term macrovascular & microvascular complications. Vascular complications are due to platelet hyperactivity and dysfunction, increased inflammation, altered coagulation and endothelial dysfunction. Large proportion of patients with Type II DM suffers from preventable vascular angiopathies, and there is need to develop risk factor modifications and interventions to reduce impact of complications. These complications are attributed to platelet activation, recognised by increase in Platelet Volume Indices (PVI) including Mean Platelet Volume (MPV) and Platelet Distribution Width (PDW). The current study is prospective analytical study conducted over 2 years. Out of 1100 individuals, 930 individuals fulfilled inclusion criteria and were segregated into three groups on basis of glycosylated haemoglobin (HbA1C): - (a) Diabetic, (b) Non-Diabetic and (c) Subjects with Impaired fasting glucose (IFG) with 300 individuals in IFG and non-diabetic groups & 330 individuals in diabetic group. Further, diabetic group was divided into two groups on the basis of presence or absence of known diabetes related vascular complications. Samples for HbA1c and PVI were collected using Ethylene diamine tetraacetic acid (EDTA) as anticoagulant and processed on SYSMEX-X-800i autoanalyser. The study revealed gradual increase in PVI from non-diabetics to IFG to diabetics. PVI were markedly increased in diabetic patients. MPV and PDW of diabetics, IFG and non diabetics were (17.60 ± 2.04)fl, (11.76 ± 0.73)fl, (9.93 ± 0.64)fl and (19.17 ± 1.48)fl, (15.49 ± 0.67)fl, (10.59 ± 0.67)fl respectively with a significant p value 0.00 and a significant positive correlation (MPV-HbA1c r = 0.951; PDW-HbA1c r = 0.875). MPV & PDW of subjects with diabetes related complications were higher as compared to those without them and were (17.51±0.39)fl & (15.14 ± 1.04)fl and (20.09 ± 0.98) fl & (18.96 ± 0.83)fl respectively with a significant p value 0.00. There was a significant positive correlation between PVI and duration of diabetes across the groups (MPV-HbA1c r = 0.951; PDW-HbA1c r = 0.875). However, a significant negative correlation was found between glycaemic levels and total platelet count (PC- HbA1c r =-0.164). This is multi-parameter and comprehensive study with an adequately powered study design. It can be concluded from our study that PVI are extremely useful and important indicators of impending vascular complications in all patients with deranged glycaemic control. Introduction of automated cell counters has facilitated the availability of PVI as routine parameters. PVI is a useful means for identifying larger & active platelets which play important role in development of micro and macro angiopathic complications of diabetes leading to mortality and morbidity. PVI can be used as cost effective markers to predict and prevent impending vascular events in patients with Diabetes mellitus especially in developing countries like India. PVI, if incorporated into protocols for management of diabetes, could revolutionize care and curtail the ever increasing cost of patient management.

Keywords: diabetes, IFG, HbA1C, MPV, PDW, PVI

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Authors: Elizabeth Spink

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The United Nations' Sustainable Development Goal 6 sets a target for safe and affordable drinking water for all. Developing country governments aiming to achieve this goal often face significant challenges when trying to service last mile customers, particularly those in peri-urban and rural areas. Expansion of water networks often requires high connection fees from households, and demand for connections may be low if there are cheaper substitute sources of water available. This research studies the effect of the availability of substitute sources of water on demand for individual water connections in Livingstone, Zambia, using an event study analysis of metering campaigns. Metering campaigns reduce the share of a household's neighbors that can provide free water to the household if their water connection becomes disconnected due to nonpayment. The results show that household payments in newly metered regions increase by 10 percentage points in the months following metering events, with a decrease in disconnections of 6 percentage points for low-income households. To isolate the effect of changes in a household's substitution possibilities, a similar analysis is conducted among households that neighbor the metered region. These results show mixed evidence of the impact of substitutes on payment behavior and disconnections. The results suggest that metering may be effective in increasing household demand for individual water connections primarily through a lower monthly cost burden for newly metered households.

Keywords: piped-water access, water demand, water utilities, water sharing

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Authors: Radek Richtr, Petr Paus

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The connection to the primal environment, living and growing nature is disappearing for most of the residents in urban core areas nowadays. Most of the residents perceive scattered green mass like more technical objects than sentient living organisms. The Arboretum is a type of application from the 'serious games' genre -it is a research experiment masked as a gaming environment. In used virtual and augmented reality environments, every city district is represented by central objects; Pillars created as a result of resident’s consensus. Every player can furthermore plant and grow virtual organic seeds everywhere he wants. Seeds sprout, and their form is determined by both players’ choice and nearest pillar. Every house, private rooms, and even workspace get their new living virtual avatar-connected 'residents' growing from player-planted seeds. Every room or workspace is transformed into (calming) nature scene, reflecting in some way both players and community spirit and together create a vicinity environment. The conceptual design phase of the project is crucial and allows for the identification of the fundamental problems through abstraction. The project that centers on wide community usage needs a clear and accessible interface. Simultaneously the conceptual design allows early sharing of project ideas and creating public concern. The paper discusses the current conceptual model of an Arboretum project (which is part of a whole widespread project) and its validation.

Keywords: augmented reality, conceptual design, mixed reality, social engineering

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Authors: Murat Zencirkiran, Nilufer Seyidoglu Akdeniz, Elvan Ender Altay, Zeynep Pirselimoglu Batman

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Monumental trees make an important contribution to the cultural interaction between societies. At the same time, monument trees, which are considered as symbols of some beliefs, are living beings that are transmitted from generation to generation. Mystical, folkloric and dimensional aspects of our cultural heritage and the link between the past and present, the memorial trees of the generations of the stories conveyed the story of the legends at the same time with the aesthetic features of the objects attract attention. There are many monumental trees that witness historical processes in Bursa, which is a land of very different cultures from the Prusias (BC 232-192). Within this scope, monumental trees located within the boundaries of Bursa province and their contribution to urban culture were evaluated. Monument plane trees recorded in Bursa and its districts were determined by the Ministry of Environment and Urbanization, the Governorship of Bursa, the Provincial Directorate of Environment and Urbanism, the Directorate of Protection of Natural Assets, and these trees were examined in situ. As a result of the inspections made, the monument trees living today are classified according to their species. Within the scope of the study, it was determined that there were 1001 monumental tree species in different species within the boundaries of Bursa province. 71.83% of the recorded species were Platanus species and 11.79% were Pinus species. On the other hand, the stories about the contribution of cultural landscapes to the examples of living or now-disappearing examples of Bursa history from these monumental trees have been compiled and presented in the study.

Keywords: Bursa, cultural landscape, landscape, monumental trees

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Authors: Maher El-Masri, Jamie Crawley, Judy Bornais, Abeer Omar

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Background: Misuse of Emergency Department (ED) for non-urgent healthcare results in unnecessary crowdedness that can result in long ED waits and delays in treatment, diversion of ambulances to other hospitals, poor health outcomes for patients, and increased risk of death Objectives: The main purpose of this study was to explore the independent predictors of non-urgent ED visits in Erie St. Clair LHIN. Secondary purposes of the study include comparison of the rates of non-urgent ED visits between urban and rural hospitals Design: A secondary analysis of archived population-based data on 597,373 ED visits in southwestern Ontario Results The results suggest that older (OR = .992; 95% CI .992 – .993) and female patients (OR = .940; 95% CI .929 - .950) were less likely to visit ED for non-urgent causes. Non-urgent ED visits during the winter, spring, and fall were 13%, 5.8%, and 7.5%, respectively, lesser than they were during the summer time. The data further suggest that non-urgent visits were 19.6% and 21.3% less likely to occur in evening and overnight shifts compared to the day shift. Non-urgent visits were 2.76 times more likely to present to small community hospitals than large community hospitals. Health care providers were 1.92 times more likely to refer patients with non-urgent health problem to the ED than the decision taken by patients, family member or caretakers. Conclusion: In conclusion, our study highlights a number of important factors that are associated with inappropriate use of ED visits for non-urgent health problems. Knowledge of these factors could be used to address the issue of unnecessary ED crowdedness.

Keywords: emergency department, non-urgent visits, predictors, logistic regression

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Authors: Pegah Farshadmanesh, Jamshid Mohammadi, Mehdi Modares

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In nearly all earthquakes of the past century that resulted in moderate to significant damage, the occurrence of postearthquake fire ignition (PEFI) has imposed a serious hazard and caused severe damage, especially in urban areas. In order to reduce the loss of life and property caused by post-earthquake fires, there is a crucial need for predictive models to estimate the PEFI risk. The parameters affecting PEFI risk can be categorized as: 1) factors influencing fire ignition in normal (non-earthquake) condition, including floor area, building category, ignitability, type of appliance, and prevention devices, and 2) earthquake related factors contributing to the PEFI risk, including building vulnerability and earthquake characteristics such as intensity, peak ground acceleration, and peak ground velocity. State-of-the-art statistical PEFI risk models are solely based on limited available earthquake data, and therefore they cannot predict the PEFI risk for areas with insufficient earthquake records since such records are needed in estimating the PEFI model parameters. In this paper, the correlation between normal condition ignition risk, peak ground acceleration, and PEFI risk is examined in an effort to offer a means for predicting post-earthquake ignition events. An illustrative example is presented to demonstrate how such correlation can be employed in a seismic area to predict PEFI hazard.

Keywords: fire risk, post-earthquake fire ignition (PEFI), risk management, seismicity

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