Search results for: Don August G. Delgado
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 508

Search results for: Don August G. Delgado

58 Peak Constituent Fluxes from Small Arctic Rivers Generated by Late Summer Episodic Precipitation Events

Authors: Shawn G. Gallaher, Lilli E. Hirth

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As permafrost thaws with the continued warming of the Alaskan North Slope, a progressively thicker active thaw layer is evidently releasing previously sequestered nutrients, metals, and particulate matter exposed to fluvial transport. In this study, we estimate material fluxes on the North Slope of Alaska during the 2019-2022 melt seasons. The watershed of the Alaskan North Slope can be categorized into three regions: mountains, tundra, and coastal plain. Precipitation and discharge data were collected from repeat visits to 14 sample sites for biogeochemical surface water samples, 7 point discharge measurements, 3 project deployed meteorology stations, and 2 U. S. Geological Survey (USGS) continuous discharge observation sites. The timing, intensity, and spatial distribution of precipitation determine the material flux composition in the Sagavanirktok and surrounding bodies of water, with geogenic constituents (e.g., dissolved inorganic carbon (DIC)) expected from mountain flushed events and biogenic constituents (e.g., dissolved organic compound (DOC)) expected from transitional tundra precipitation events. Project goals include connecting late summer precipitation events to peak discharge to determine the responses of the watershed to localized atmospheric forcing. Field study measurements showed widespread precipitation in August 2019, generating an increase in total suspended solids, dissolved organic carbon, and iron fluxes from the tundra, shifting the main-stem mountain river biogeochemistry toward tundra source characteristics typically only observed during the spring floods. Intuitively, a large-scale precipitation event (as defined by this study as exceeding 12.5 mm of precipitation on a single observation day) would dilute a body of water; however, in this study, concentrations increased with higher discharge responses on several occasions. These large-scale precipitation events continue to produce peak constituent fluxes as the thaw layer increases in depth and late summer precipitation increases, evidenced by 6 large-scale events in July 2022 alone. This increase in late summer events is in sharp contrast to the 3 or fewer large events in July in each of the last 10 years. Changes in precipitation intensity, timing, and location have introduced late summer peak constituent flux events previously confined to the spring freshet.

Keywords: Alaska North Slope, arctic rivers, material flux, precipitation

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57 Hybrid Solutions in Physicochemical Processes for the Removal of Turbidity in Andean Reservoirs

Authors: María Cárdenas Gaudry, Gonzalo Ramces Fano Miranda

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Sediment removal is very important in the purification of water, not only for reasons of visual perception but also because of its association with odor and taste problems. The Cuchoquesera reservoir, which is in the Andean region of Ayacucho (Peru) at an altitude of 3,740 meters above sea level, visually presents suspended particles and organic impurities indicating that it contains water of dubious quality to deduce that it is suitable for direct consumption of human beings. In order to quantitatively know the degree of impurities, water quality monitoring was carried out from February to August 2018, in which four sampling stations were established in the reservoir. The selected measured parameters were electrical conductivity, total dissolved solids, pH, color, turbidity, and sludge volume. The indicators of the studied parameters exceed the permissible limits except for electrical conductivity (190 μS/cm) and total dissolved solids (255 mg/L). In this investigation, the best combination and the optimal doses of reagents were determined that allowed the removal of sediments from the waters of the Cuchoquesera reservoir, through the physicochemical process of coagulation-flocculation. In order to improve this process during the rainy season, six combinations of reagents were evaluated, made up of three coagulants (ferric chloride, ferrous sulfate, and aluminum sulfate) and two natural flocculants: prickly pear powder (Opuntia ficus-indica) and tara gum (Caesalpinia spinoza). For each combination of reagents, jar tests were developed following the central composite experimental design (CCED), where the design factors were the doses of coagulant and flocculant and the initial turbidity. The results of the jar tests were adjusted to mathematical models, obtaining that to treat the water from the Cuchoquesera reservoir, with a turbidity of 150 UTN and a color of 137 U Pt-Co, 27.9 mg/L of the coagulant aluminum sulfate with 3 mg/L of the natural tara gum flocculant to produce a purified water quality of 1.7 UTN of turbidity and 3.2 U Pt-Co of apparent color. The estimated cost of the dose of coagulant and flocculant found was 0.22 USD/m³. This is how “grey-green” technologies can be used as a combination in nature-based solutions in water treatment, in this case, to achieve potability, making it more sustainable, especially economically, if green technology is available at the site of application of the nature-based hybrid solution. This research is a demonstration of the compatibility of natural coagulants/flocculants with other treatment technologies in the integrated/hybrid treatment process, such as the possibility of hybridizing natural coagulants with other types of coagulants.

Keywords: prickly pear powder, tara gum, nature-based solutions, aluminum sulfate, jar test, turbidity, coagulation, flocculation

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56 Tracing a Timber Breakthrough: A Qualitative Study of the Introduction of Cross-Laminated-Timber to the Student Housing Market in Norway

Authors: Marius Nygaard, Ona Flindall

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The Palisaden student housing project was completed in August 2013 and was, with its eight floors, Norway’s tallest timber building at the time of completion. It was the first time cross-laminated-timber (CLT) was utilized at this scale in Norway. The project was the result of a concerted effort by a newly formed management company to establish CLT as a sustainable and financially competitive alternative to conventional steel and concrete systems. The introduction of CLT onto the student housing market proved so successful that by 2017 more than 4000 individual student residences will have been built using the same model of development and construction. The aim of this paper is to identify the key factors that enabled this breakthrough for CLT. It is based on an in-depth study of a series of housing projects and the role of the management company who both instigated and enabled this shift of CLT from the margin to the mainstream. Specifically, it will look at how a new building system was integrated into a marketing strategy that identified a market potential within the existing structure of the construction industry and within the economic restrictions inherent to student housing in Norway. It will show how a key player established a project model that changed both the patterns of cooperation and the information basis for decisions. Based on qualitative semi-structured interviews with managers, contractors and the interdisciplinary teams of consultants (architects, structural engineers, acoustical experts etc.) this paper will trace the introduction, expansion and evolution of CLT-based building systems in the student housing market. It will show how the project management firm’s position in the value chain enabled them to function both as a liaison between contractor and client, and between contractor and producer. A position that allowed them to improve the flow of information. This ensured that CLT was handled on equal terms to other structural solutions in the project specifications, enabling realistic pricing and risk evaluation. Secondly, this paper will describe and discuss how the project management firm established and interacted with a growing network of contractors, architects and engineers to pool expertise and broaden the knowledge base across Norway’s regional markets. Finally, it will examine the role of the client, the building typology, and the industrial and technological factors in achieving this breakthrough for CLT in the construction industry. This paper gives an in-depth view of the progression of a single case rather than a broad description of the state of the art of large-scale timber building in Norway. However, this type of study may offer insights that are important to the understanding not only of specific markets but also of how new technologies should be introduced in big and well-established industries.

Keywords: cross-laminated-timber (CLT), industry breakthrough, student housing, timber market

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55 Fish Catch Composition from Gobind Sagar Reservoir during 2006-2012

Authors: Krishan Lal, Anish Dua

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Gobind Sagar Reservoir has been created in Himachal Pradesh, India (31° 25´ N and 76 ° 25´E) by damming River Sutlej at village Bhakra in 1963. The average water spread area of this reservoir is 10,000 hectares. Fishermen have organized themselves in the form of co-operative societies. 26 fisheries co-operative societies were working in Gobind Sagar Reservoir up till 2012. June and July months were observed as closed season, no fishing was done during this period. Proper record maintaining of fish catch was done at different levels by the state fisheries department. Different measures like minimum harvestable size, mesh size regulation and prohibition of illegal fishing etc. were taken for fish conservation. Fishermen were actively involved in the management. Gill nets were used for catching fishes from this reservoir. State fisheries department is realizing 15% royalty of the sold fish. Data used in this paper is about the fish catch during 2006-2012 and were obtained from the state fisheries department, Himachal Pradesh. Catla catla, Labeo rohita, Cirrhinus mrigala, Sperata seenghala, Cyprinus carpio, Tor putitora, Hypophthalmichthys molitrix, Labeo calbasu, Labeo dero and Ctenopharyngodon idella etc., were the fish species exploited for commercial purposes. Total number of individuals of all species caught was 3141236 weighing 5637108.9 kg during 2006-2012. H. molitrix was introduced accidently in this reservoir and was making a good share of fish catch in this reservoir. The annual catch of this species was varying between 161279.6 kg, caught in 2011 and 788030.8 kg caught in 2009. Total numbers of individuals of C. idella caught were 8966 weighing 64320.2 kg. The catch of Cyprinus carpio was varying between 144826.1 kg caught in 2006 and 214480.1 kg caught in 2010. Total catch of Tor putitora was 180263.2 kg during 2006-2012. Total catch of L. dero, S. seenghala and Catla catla remained 100637.4 kg, 75297.8 kg and 561802.9 kg, respectively, during 2006-2012. Maximum fish catch was observed during the months of August (after observing Closed Season). Maximum catch of exotic carps was from Bhakra area of the reservoir which has fewer fluctuations in water levels. The reservoir has been divided into eight beats for administrative purpose, to avoid conflicts between operating fisheries co-operative societies for area of operation. Fish catch was more by co-operative societies operating in the area of reservoir having fewer fluctuations in water level and catch was less by co-operative societies operating in the area of more fluctuations in water level. Species-wise fish catch by different co-operative societies from their allotted area was studied. This reservoir is one of most scientifically managed reservoirs.

Keywords: co-operative societies, fish catch, fish species, reservoir

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54 Statistical Comparison of Ensemble Based Storm Surge Forecasting Models

Authors: Amin Salighehdar, Ziwen Ye, Mingzhe Liu, Ionut Florescu, Alan F. Blumberg

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Storm surge is an abnormal water level caused by a storm. Accurate prediction of a storm surge is a challenging problem. Researchers developed various ensemble modeling techniques to combine several individual forecasts to produce an overall presumably better forecast. There exist some simple ensemble modeling techniques in literature. For instance, Model Output Statistics (MOS), and running mean-bias removal are widely used techniques in storm surge prediction domain. However, these methods have some drawbacks. For instance, MOS is based on multiple linear regression and it needs a long period of training data. To overcome the shortcomings of these simple methods, researchers propose some advanced methods. For instance, ENSURF (Ensemble SURge Forecast) is a multi-model application for sea level forecast. This application creates a better forecast of sea level using a combination of several instances of the Bayesian Model Averaging (BMA). An ensemble dressing method is based on identifying best member forecast and using it for prediction. Our contribution in this paper can be summarized as follows. First, we investigate whether the ensemble models perform better than any single forecast. Therefore, we need to identify the single best forecast. We present a methodology based on a simple Bayesian selection method to select the best single forecast. Second, we present several new and simple ways to construct ensemble models. We use correlation and standard deviation as weights in combining different forecast models. Third, we use these ensembles and compare with several existing models in literature to forecast storm surge level. We then investigate whether developing a complex ensemble model is indeed needed. To achieve this goal, we use a simple average (one of the simplest and widely used ensemble model) as benchmark. Predicting the peak level of Surge during a storm as well as the precise time at which this peak level takes place is crucial, thus we develop a statistical platform to compare the performance of various ensemble methods. This statistical analysis is based on root mean square error of the ensemble forecast during the testing period and on the magnitude and timing of the forecasted peak surge compared to the actual time and peak. In this work, we analyze four hurricanes: hurricanes Irene and Lee in 2011, hurricane Sandy in 2012, and hurricane Joaquin in 2015. Since hurricane Irene developed at the end of August 2011 and hurricane Lee started just after Irene at the beginning of September 2011, in this study we consider them as a single contiguous hurricane event. The data set used for this study is generated by the New York Harbor Observing and Prediction System (NYHOPS). We find that even the simplest possible way of creating an ensemble produces results superior to any single forecast. We also show that the ensemble models we propose generally have better performance compared to the simple average ensemble technique.

Keywords: Bayesian learning, ensemble model, statistical analysis, storm surge prediction

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53 Human Immuno-Deficiency Virus Co-Infection with Hepatitis B Virus and Baseline Cd4+ T Cell Count among Patients Attending a Tertiary Care Hospital, Nepal

Authors: Soma Kanta Baral

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Background: Since 1981, when the first AIDS case was reported, worldwide, more than 34 million people have been infected with HIV. Almost 95 percent of the people infected with HIV live in developing countries. As HBV & HIV share similar routes of transmission by sexual intercourse or drug use by parenteral injection, co-infection is common. Because of the limited access to healthcare & HIV treatment in developing countries, HIV-infected individuals are present late for care. Enumeration of CD4+ T cell count at the time of diagnosis has been useful to initiate the therapy in HIV infected individuals. The baseline CD4+ T cell count shows high immunological variability among patients. Methods: This prospective study was done in the serology section of the Department of Microbiology over a period of one year from august 2012 to July 2013. A total of 13037 individuals subjected for HIV test were included in the study comprising of 4982 males & 8055 females. Blood sample was collected by vein puncture aseptically with standard operational procedure in clean & dry test-tube. All blood samples were screened for HIV as described by WHO algorithm by Immuno-chromatography rapid kits. Further confirmation was done by biokit ELISA method as per the manufacturer’s guidelines. After informed consent, HIV positive individuals were screened for HBsAg by Immuno-chromatography rapid kits (Hepacard). Further confirmation was done by biokit ELISA method as per the manufacturer’s guidelines. EDTA blood samples were collected from the HIV sero-positive individuals for baseline CD4+ T count. Then, CD4+ T cells count was determined by using FACS Calibur Flow Cytometer (BD). Results: Among 13037 individuals screened for HIV, 104 (0.8%) were found to be infected comprising of 69(66.34%) males & 35 (33.65%) females. The study showed that the high infection was noted in housewives (28.7%), active age group (30.76%), rural area (56.7%) & in heterosexual route (80.9%) of transmission. Out of total HIV infected individuals, distribution of HBV co-infection was found to be 6(5.7%). All co- infected individuals were married, male, above the age of 25 years & heterosexual route of transmission. Baseline CD4+ T cell count of HIV infected patient was found higher (mean CD4+ T cell count; 283cells/cu.mm) than HBV co-infected patients (mean CD4+ T cell count; 91 cells/cu.mm). Majority (77.2%) of HIV infected & all co-infected individuals were presented in our center late (CD4+ T cell count;< 350/cu. mm) for diagnosis and care. Majority of co- infected 4 (80%) were late presented with advanced AIDS stage (CD4+ count; <200/cu.mm). Conclusions: The study showed a high percentage of HIV sero-positive & co- infected individuals. Baseline CD4+ T cell count of majority of HIV infected individuals was found to be low. Hence, more sustained and vigorous awareness campaigns & counseling still need to be done in order to promote early diagnosis and management.

Keywords: HIV/AIDS, HBsAg, co-infection, CD4+

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52 Cut-Off of CMV Cobas® Taqman® (CAP/CTM Roche®) for Introduction of Ganciclovir Pre-Emptive Therapy in Allogeneic Hematopoietic Stem Cell Transplant Recipients

Authors: B. B. S. Pereira, M. O. Souza, L. P. Zanetti, L. C. S. Oliveira, J. R. P. Moreno, M. P. Souza, V. R. Colturato, C. M. Machado

Abstract:

Background: The introduction of prophylactic or preemptive therapies has effectively decreased the CMV mortality rates after hematopoietic stem cell transplantation (HSCT). CMV antigenemia (pp65) or quantitative PCR are methods currently approved for CMV surveillance in pre-emptive strategies. Commercial assays are preferred as cut-off levels defined by in-house assays may vary among different protocols and in general show low reproducibility. Moreover, comparison of published data among different centers is only possible if international standards of quantification are included in the assays. Recently, the World Health Organization (WHO) established the first international standard for CMV detection. The real time PCR COBAS Ampliprep/ CobasTaqMan (CAP/CTM) (Roche®) was developed using the WHO standard for CMV quantification. However, the cut-off for the introduction of antiviral has not been determined yet. Methods: We conducted a retrospective study to determine: 1) the sensitivity and specificity of the new CMV CAP/CTM test in comparison with pp65 antigenemia to detect episodes of CMV infection/reactivation, and 2) the cut-off of viral load for introduction of ganciclovir (GCV). Pp65 antigenemia was performed and the corresponding plasma samples were stored at -20°C for further CMV detection by CAP/CTM. Comparison of tests was performed by kappa index. The appearance of positive antigenemia was considered the state variable to determine the cut-off of CMV viral load by ROC curve. Statistical analysis was performed using SPSS software version 19 (SPSS, Chicago, IL, USA.). Results: Thirty-eight patients were included and followed from August 2014 through May 2015. The antigenemia test detected 53 episodes of CMV infection in 34 patients (89.5%), while CAP/CTM detected 37 episodes in 33 patients (86.8%). AG and PCR results were compared in 431 samples and Kappa index was 30.9%. The median time for first AG detection was 42 (28-140) days, while CAP/CTM detected at a median of 7 days earlier (34 days, ranging from 7 to 110 days). The optimum cut-off value of CMV DNA was 34.25 IU/mL to detect positive antigenemia with 88.2% of sensibility, 100% of specificity and AUC of 0.91. This cut-off value is below the limit of detection and quantification of the equipment which is 56 IU/mL. According to CMV recurrence definition, 16 episodes of CMV recurrence were detected by antigenemia (47.1%) and 4 (12.1%) by CAP/CTM. The duration of viremia as detected by antigenemia was shorter (60.5% of the episodes lasted ≤ 7 days) in comparison to CAP/CTM (57.9% of the episodes lasting 15 days or more). This data suggests that the use of antigenemia to define the duration of GCV therapy might prompt early interruption of antiviral, which may favor CMV reactivation. The CAP/CTM PCR could possibly provide a safer information concerning the duration of GCV therapy. As prolonged treatment may increase the risk of toxicity, this hypothesis should be confirmed in prospective trials. Conclusions: Even though CAP/CTM by ROCHE showed great qualitative correlation with the antigenemia technique, the fully automated CAP/CTM did not demonstrate increased sensitivity. The cut-off value below the limit of detection and quantification may result in delayed introduction of pre-emptive therapy.

Keywords: antigenemia, CMV COBAS/TAQMAN, cytomegalovirus, antiviral cut-off

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51 Assessment of Taiwan Railway Occurrences Investigations Using Causal Factor Analysis System and Bayesian Network Modeling Method

Authors: Lee Yan Nian

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Safety investigation is different from an administrative investigation in that the former is conducted by an independent agency and the purpose of such investigation is to prevent accidents in the future and not to apportion blame or determine liability. Before October 2018, Taiwan railway occurrences were investigated by local supervisory authority. Characteristics of this kind of investigation are that enforcement actions, such as administrative penalty, are usually imposed on those persons or units involved in occurrence. On October 21, 2018, due to a Taiwan Railway accident, which caused 18 fatalities and injured another 267, establishing an agency to independently investigate this catastrophic railway accident was quickly decided. The Taiwan Transportation Safety Board (TTSB) was then established on August 1, 2019 to take charge of investigating major aviation, marine, railway and highway occurrences. The objective of this study is to assess the effectiveness of safety investigations conducted by the TTSB. In this study, the major railway occurrence investigation reports published by the TTSB are used for modeling and analysis. According to the classification of railway occurrences investigated by the TTSB, accident types of Taiwan railway occurrences can be categorized into: derailment, fire, Signal Passed at Danger and others. A Causal Factor Analysis System (CFAS) developed by the TTSB is used to identify the influencing causal factors and their causal relationships in the investigation reports. All terminologies used in the CFAS are equivalent to the Human Factors Analysis and Classification System (HFACS) terminologies, except for “Technical Events” which was added to classify causal factors resulting from mechanical failure. Accordingly, the Bayesian network structure of each occurrence category is established based on the identified causal factors in the CFAS. In the Bayesian networks, the prior probabilities of identified causal factors are obtained from the number of times in the investigation reports. Conditional Probability Table of each parent node is determined from domain experts’ experience and judgement. The resulting networks are quantitatively assessed under different scenarios to evaluate their forward predictions and backward diagnostic capabilities. Finally, the established Bayesian network of derailment is assessed using investigation reports of the same accident which was investigated by the TTSB and the local supervisory authority respectively. Based on the assessment results, findings of the administrative investigation is more closely tied to errors of front line personnel than to organizational related factors. Safety investigation can identify not only unsafe acts of individual but also in-depth causal factors of organizational influences. The results show that the proposed methodology can identify differences between safety investigation and administrative investigation. Therefore, effective intervention strategies in associated areas can be better addressed for safety improvement and future accident prevention through safety investigation.

Keywords: administrative investigation, bayesian network, causal factor analysis system, safety investigation

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50 Prevention of Preterm Birth and Management of Uterine Contractions with Traditional Korean Medicine: Integrative Approach

Authors: Eun-Seop Kim, Eun-Ha Jang, Rana R. Kim, Sae-Byul Jang

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Objective: Preterm labor is the most common antecedent of preterm birth(PTB), which is characterized by regular uterine contraction before 37 weeks of pregnancy and cervical change. In acute preterm labor, tocolytics are administered as the first-line medication to suppress uterine contractions but rarely delay pregnancy to 37 weeks of gestation. On the other hand, according to the Korean Traditional Medicine, PTB is caused by the deficiency of Qi and unnecessary energy in the body of the mother. The aim of this study was to demonstrate the benefit of Traditional Korean Medicine as an adjuvant therapy in management of early uterine contractions and the prevention of PTB. Methods: It is a case report of a 38-year-old woman (0-0-6-0) hospitalized for irregular uterine contractions and cervical change at 33+3/7 weeks of gestation. Past history includes chemical pregnancies achieved by Artificial Rroductive Technology(ART), one stillbirth (at 7 weeks) and a laparoscopic surgery for endometriosis. After seven trials of IVF and articificial insemination, she had succeeded in conception via in-vitro fertilization (IVF) with help of Traditional Korean Medicine (TKM) treatments. Due to irregular uterine contractions and cervical changes, 2 TKM were prescribed: Gami-Dangguisan, and Antae-eum, known to nourish blood and clear away heat. 120ml of Gami-Dangguisan was given twice a day monring and evening along with same amount of Antae-eum once a day from 31 August 2013 to 28 November 2013. Tocolytics (Ritodrine) was administered as a first aid for maintenance of pregnancy. Information regarding progress until the delivery was collected during the patient’s visit. Results: On admission, the cervix of 15mm in length and cervical os with 0.5cm-dilated were observed via ultrasonography. 50% cervical effacement was also detected in physical examination. Tocolysis had been temporarily maintained. As a supportive therapy, TKM herbal preparations(gami-dangguisan and Antae-eum) were concomitantly given. As of 34+2/7 weeks of gestation, however intermittent uterine contractions appeared (5-12min) on cardiotocography and vaginal bleeding was also smeared at 34+3/7 weeks. However, enhanced tocolytics and continuous administration of herbal medicine sustained the pregnancy to term. At 37+2/7 weeks, no sign of labor with restored cervical length was confirmed. The woman gave a term birth to a healthy infant via vaginal delivery at 39+3/7 gestational weeks. Conclusions: This is the first successful case report about a preter labor patient administered with conventional tocolytic agents as well as TKM herbal decoctions, delaying delivery to term. This case deserves attention considering it is rare to maintain gestation to term only with tocolytic intervention. Our report implies the potential of herbal medicine as an adjuvant therapy for preterm labor treatment. Further studies are needed to assess the safety and efficacy of TKM herbal medicine as a therapeutic alternative for curing preterm birth.

Keywords: preterm labor, traditional Korean medicine, herbal medicine, integrative treatment, complementary and alternative medicine

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49 Privacy Paradox and the Internet of Medical Things

Authors: Isabell Koinig, Sandra Diehl

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In recent years, the health-care context has not been left unaffected by technological developments. In recent years, the Internet of Medical Things (IoMT)has not only led to a collaboration between disease management and advanced care coordination but also to more personalized health care and patient empowerment. With more than 40 % of all health technology being IoMT-related by 2020, questions regarding privacy become more prevalent, even more so during COVID-19when apps allowing for an intensive tracking of people’s whereabouts and their personal contacts cause privacy advocates to protest and revolt. There is a widespread tendency that even though users may express concerns and fears about their privacy, they behave in a manner that appears to contradict their statements by disclosing personal data. In literature, this phenomenon is discussed as a privacy paradox. While there are some studies investigating the privacy paradox in general, there is only scarce research related to the privacy paradox in the health sector and, to the authors’ knowledge, no empirical study investigating young people’s attitudes toward data security when using wearables and health apps. The empirical study presented in this paper tries to reduce this research gap by focusing on the area of digital and mobile health. It sets out to investigate the degree of importance individuals attribute to protecting their privacy and individual privacy protection strategies. Moreover, the question to which degree individuals between the ages of 20 and 30 years are willing to grant commercial parties access to their private data to use digital health services and apps are put to the test. To answer this research question, results from 6 focus groups with 40 participants will be presented. The focus was put on this age segment that has grown up in a digitally immersed environment. Moreover, it is particularly the young generation who is not only interested in health and fitness but also already uses health-supporting apps or gadgets. Approximately one-third of the study participants were students. Subjects were recruited in August and September 2019 by two trained researchers via email and were offered an incentive for their participation. Overall, results indicate that the young generation is well informed about the growing data collection and is quite critical of it; moreover, they possess knowledge of the potential side effects associated with this data collection. Most respondents indicated to cautiously handle their data and consider privacy as highly relevant, utilizing a number of protective strategies to ensure the confidentiality of their information. Their willingness to share information in exchange for services was only moderately pronounced, particularly in the health context, since health data was seen as valuable and sensitive. The majority of respondents indicated to rather miss out on using digital and mobile health offerings in order to maintain their privacy. While this behavior might be an unintended consequence, it is an important piece of information for app developers and medical providers, who have to find a way to find a user base for their products against the background of rising user privacy concerns.

Keywords: digital health, privacy, privacy paradox, IoMT

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48 Procedure for Monitoring the Process of Behavior of Thermal Cracking in Concrete Gravity Dams: A Case Study

Authors: Adriana de Paula Lacerda Santos, Bruna Godke, Mauro Lacerda Santos Filho

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Several dams in the world have already collapsed, causing environmental, social and economic damage. The concern to avoid future disasters has stimulated the creation of a great number of laws and rules in many countries. In Brazil, Law 12.334/2010 was created, which establishes the National Policy on Dam Safety. Overall, this policy requires the dam owners to invest in the maintenance of their structures and to improve its monitoring systems in order to provide faster and straightforward responses in the case of an increase of risks. As monitoring tools, visual inspections has provides comprehensive assessment of the structures performance, while auscultation’s instrumentation has added specific information on operational or behavioral changes, providing an alarm when a performance indicator exceeds the acceptable limits. These limits can be set using statistical methods based on the relationship between instruments measures and other variables, such as reservoir level, time of the year or others instruments measuring. Besides the design parameters (uplift of the foundation, displacements, etc.) the dam instrumentation can also be used to monitor the behavior of defects and damage manifestations. Specifically in concrete gravity dams, one of the main causes for the appearance of cracks, are the concrete volumetric changes generated by the thermal origin phenomena, which are associated with the construction process of these structures. Based on this, the goal of this research is to propose a monitoring process of the thermal cracking behavior in concrete gravity dams, through the instrumentation data analysis and the establishment of control values. Therefore, as a case study was selected the Block B-11 of José Richa Governor Dam Power Plant, that presents a cracking process, which was identified even before filling the reservoir in August’ 1998, and where crack meters and surface thermometers were installed for its monitoring. Although these instruments were installed in May 2004, the research was restricted to study the last 4.5 years (June 2010 to November 2014), when all the instruments were calibrated and producing reliable data. The adopted method is based on simple linear correlations procedures to understand the interactions among the instruments time series, verifying the response times between them. The scatter plots were drafted from the best correlations, which supported the definition of the limit control values. Among the conclusions, it is shown that there is a strong or very strong correlation between ambient temperature and the crack meters and flowmeters measurements. Based on the results of the statistical analysis, it was possible to develop a tool for monitoring the behavior of the case study cracks. Thus it was fulfilled the goal of the research to develop a proposal for a monitoring process of the behavior of thermal cracking in concrete gravity dams.

Keywords: concrete gravity dam, dams safety, instrumentation, simple linear correlation

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47 Impact of Traffic Restrictions due to Covid19, on Emissions from Freight Transport in Mexico City

Authors: Oscar Nieto-Garzón, Angélica Lozano

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In urban areas, on-road freight transportation creates several social and environmental externalities. Then, it is crucial that freight transport considers not only economic aspects, like retailer distribution cost reduction and service improvement, but also environmental effects such as global CO2 and local emissions (e.g. Particulate Matter, NOX, CO) and noise. Inadequate infrastructure development, high rate of urbanization, the increase of motorization, and the lack of transportation planning are characteristics that urban areas from developing countries share. The Metropolitan Area of Mexico City (MAMC), the Metropolitan Area of São Paulo (MASP), and Bogota are three of the largest urban areas in Latin America where air pollution is often a problem associated with emissions from mobile sources. The effect of the lockdown due to COVID-19 was analyzedfor these urban areas, comparing the same period (January to August) of years 2016 – 2019 with 2020. A strong reduction in the concentration of primary criteria pollutants emitted by road traffic were observed at the beginning of 2020 and after the lockdown measures.Daily mean concentration of NOx decreased 40% in the MAMC, 34% in the MASP, and 62% in Bogota. Daily mean ozone levels increased after the lockdown measures in the three urban areas, 25% in MAMC, 30% in the MASP and 60% in Bogota. These changes in emission patterns from mobile sources drastically changed the ambient atmospheric concentrations of CO and NOX. The CO/NOX ratioat the morning hours is often used as an indicator of mobile sources emissions. In 2020, traffic from cars and light vehicles was significantly reduced due to the first lockdown, but buses and trucks had not restrictions. In theory, it implies a decrease in CO and NOX from cars or light vehicles, maintaining the levels of NOX by trucks(or lower levels due to the congestion reduction). At rush hours, traffic was reduced between 50% and 75%, so trucks could get higher speeds, which would reduce their emissions. By means an emission model, it was found that an increase in the average speed (75%) would reduce the emissions (CO, NOX, and PM) from diesel trucks by up to 30%. It was expected that the value of CO/NOXratio could change due to thelockdownrestrictions. However, although there was asignificant reduction of traffic, CO/NOX kept its trend, decreasing to 8-9 in 2020. Hence, traffic restrictions had no impact on the CO/NOX ratio, although they did reduce vehicle emissions of CO and NOX. Therefore, these emissions may not adequately represent the change in the vehicle emission patterns, or this ratio may not be a good indicator of emissions generated by vehicles. From the comparison of the theoretical data and those observed during the lockdown, results that the real NOX reduction was lower than the theoretical reduction. The reasons could be that there are other sources of NOX emissions, so there would be an over-representation of NOX emissions generated by diesel vehicles, or there is an underestimation of CO emissions. Further analysis needs to consider this ratioto evaluate the emission inventories and then to extend these results forthe determination of emission control policies to non-mobile sources.

Keywords: COVID-19, emissions, freight transport, latin American metropolis

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46 Analysis of Tilting Cause of a Residential Building in Durres by the Use of Cptu Test

Authors: Neritan Shkodrani

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On November 26, 2019, an earthquake hit the central western part of Albania. It was assessed as Mw 6.4. Its epicenter was located offshore north western Durrës, about 7 km north of the city. In this paper, the consequences of settlements of very soft soils have been discussed for the case of a residential building, mentioned as “K Building”, which was suffering a significant tilting after the earthquake. “KBuilding” is an RC framed building having 12+1 (basement) storiesand a floor area of 21000 m2. The construction of the building was completed in 2012. “KBuilding”, located in Durres city, suffered severe non-structural damage during November 26, 2019, Durrës Earthquake sequences. During the in-site inspections immediately after the earthquake, the general condition of the buildings, the presence of observable settlements on the ground, and the crack situation in the structure were determined, and damage inspection were performed. It was significant to note that the “K Building” presented tilting that might be attributed, as it was believed at the beginning, partially to the failure of the columns of the ground floor and partially to liquefaction phenomena, but it did not collapse. At the first moment was not clear if the foundation had a bearing capacity failure or the foundation failed because of the soil liquefaction. Geotechnical soil investigations by using CPTU test were executed, and their data are usedto evaluatebearing capacity, consolidation settlement of the mat foundation, and soil liquefaction since they were believed to be the main reasons of this building tilting.Geotechnical soil investigation consist in 5 (five) Static Cone Penetration tests with pore pressure measurement (piezocone test). They reached a penetration depth of 20.0 m to 30.0 mand, clearly shown the presence of very soft and organic soils in the soil profile of the site. Geotechnical CPT based analysis of bearing capacity, consolidation, and secondary settlement are applied, and results are reported for each test. These results shown very small values of allowable bearing capacity and very high values of consolidation and secondary settlements. Liquefaction analysis based on the data of CPTU tests and the characteristics of ground shaking of the mentioned earthquake has shown the possibility of liquefaction for some layers of the considered soil profile, but the estimated vertical settlements are at a small range and clearly shown that the main reason of the building tilting was not related to the consequences of liquefaction, but was an existing settlement caused from the applied bearing pressure of this building. All the CPTU tests were carried out on August 2021, almost two years after the November 26, 2019, Durrës Earthquake and when the building itself was demolished. After removing the mat foundation on September 2021, it was possible to carry out CPTU tests even on the footprint of the existing building, which made possible to observe the effects of long time applied of foundation bearing pressure to the consolidation on the considered soil profile.

Keywords: bearing capacity, cone penetration test, consolidation settlement, secondary settlement, soil liquefaction, etc

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45 Ankle Fracture Management: A Unique Cross Departmental Quality Improvement Project

Authors: Langhit Kurar, Loren Charles

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Introduction: In light of recent BOAST 12 (August 2016) published guidance on management of ankle fractures, the project aimed to highlight key discrepancies throughout the care trajectory from admission to point of discharge at a district general hospital. Wide breadth of data covering three key domains: accident and emergency, radiology, and orthopaedic surgery were subsequently stratified and recommendations on note documentation, and outpatient follow up were made. Methods: A retrospective twelve month audit was conducted reviewing results of ankle fracture management in 37 patients. Inclusion criterion involved all patients seen at Darent Valley Hospital (DVH) emergency department with radiographic evidence of an ankle fracture. Exclusion criterion involved all patients managed solely by nursing staff or having sustained purely ligamentous injury. Medical notes, including discharge summaries and the PACS online radiographic tool were used for data extraction. Results: Cross-examination of the A & E domain revealed limited awareness of the BOAST 12 recent publication including requirements to document skin integrity and neurovascular assessment. This had direct implications as this would have changed the surgical plan for acutely compromised patients. The majority of results obtained from the radiographic domain were satisfactory with appropriate X-rays taken in over 95% of cases. However, due to time pressures within A & E, patients were often left without a post manipulation XRAY in a backslab. Poorly reduced fractures were subsequently left for a long period resulting in swollen ankles and a time-dependent lag to surgical intervention. This had knocked on implications for prolonged inpatient stay resulting in hospital-acquired co-morbidity including pressure sores. Discussion: The audit has highlighted several areas of improvement throughout the disease trajectory from review in the emergency department to follow up as an outpatient. This has prompted the creation of an algorithm to ensure patients with significant fractures presenting to the emergency department are seen promptly and treatment expedited as per recent guidance. This includes timing for X-rays taken in A & E. Re-audit has shown significant improvement in both documentation at time of presentation and appropriate follow-up strategies. Within the orthopedic domain, we are in the process of creating an ankle fracture pathway to ensure imaging and weight bearing status are made clear to the consulting clinicians in an outpatient setting. Significance/Clinical Relevance: As a result of the ankle fracture algorithm we have adapted the BOAST 12 guidance to shape an intrinsic pathway to not only improve patient management within the emergency department but also create a standardised format for follow up.

Keywords: ankle, fracture, BOAST, radiology

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44 Post-Soviet Georgia in Visual History Analysis

Authors: Ana Nemsadze

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Contemporary era and society are called postindustrial era and postindustrial society and/or informational era and informational society. Today science intends to define concept of information and comprehend informations role and function in contemporary society. Organization of social environment and governance of public processes on the base of information and tools of communication are main characteristics of informational era. This was defined by technological changes which were accomplished in culture in the second half of twentieth century. Today Georgia as an independent state needs to create an informational discourse of the country and therefore it is very important to study political and social cases which accomplished in the country after collapse of the Soviet Union because they start to define the present and the future of the country. The purpose of this study is to analyze political cases of the latest history of Georgia in terms of culture and information, concretely to elucidate which political cases transformed social life of post Soviet Georgia most of all who accomplished these political cases which visual and verbal messages was each political case spread with. The research is conducted on the base of interview. Participants of the interview are people of various specializations. Their professional activity is related to reflections on culture and theme of visual communication. They are philosophers sociologists a journalist media researcher a politologist a painter. The participants of the interview enumerated political cases and characterized them separately. Every expert thinks that declaration of independence of Georgia is the most important fact among all facts which were implemented in Georgia after collapse of the Soviet Union. The research revealed important social and political cases. Most of the cases are related to independence and territorial integrity of the state. Presidents of Georgia Zviad Gamsakhurdia Eduard Shevardnadze Mikheil Saakashvili Catholocos-Patriarch of All Georgia, the Archbishop of Mtskheta Tbilisi and Metropolitan bishop of Bichvinta and Tskhum Abkhazia Ilia II, businessman Bidzina Ivanishvili assumed dominating roles in cases. Verbal narrative of the cases accomplished during Zviad Gamsakhurdia presidential term expresses national freedom and visual part of cases of the same period expresses ruin of social-political structure. Verbal narrative of the cases accomplished during Eduard Sevardnadze presidential term expresses Free State and stability and reestablishment of Georgias political function in international relations and visual part of cases of the same period describes the most important moment of his presidential term and Eduard Shevardnadzes face appears too. Verbal narrative of the cases accomplished during Mikheil Saakashvilis presidential term expresses social renewal and visual part of cases of the same period describes August war and Mikheil Saakashvilis face appears too. The results of the study also reveal other details of visual verbal narrative of political and social cases of post Soviet Georgia. This gives a chance to start further reflection.

Keywords: culture, narrative, post soviet, visual communication

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43 The Publishing Process and Results of the Chinese Annotated Edition of John Dewey’s “Experience and Education: The 60th Anniversary Edition”

Authors: Wen-jing Shan

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The Chinese annotated edition of “Experience and education: The 60th anniversary edition,” originally written in English by John Dewey (1859-1952), was published in 2015 by this author. A report of the process and results of the translation and annotation of the book is the purpose of this paper. It is worth mentioning that the original 1938 edition was considered as the best concise statement on education by John Dewey, one the most important educational theorists of the twentieth century. One of the features of this The 60th anniversary edition is that the original publisher, Kappa Delta Pi International Honor Society, invited four contemporary Deweyan scholars who had been awarded the Society’s Laureate Scholar to write a review of the book published by Dewey, who was the first to receive this honor. The four scholars are Maxine Greene(1917-2014), Philip W. Jackson(1928-2015), Linda Darling-Hammond(1951-), and O. L. Davis, Jr.(1928-). The original 1938 edition, the best concise statement on education by the most important educational theorist of the twentieth century, was translated into Chinese for five times after its publication in the U.S.A, three in the 1940s, one in the 1990s, and one in 2010s. Nonetheless, the five translations have few or no annotations and have some flaws of mis-interpretations and lack of information. The author retranslated and annotated the book to make the interpretations more faithful, expressive, and elegant, and providing the readers with more understanding and more correct information. This author started the project of translation and annotation sponsored by Taiwan Ministry of Science and Technology in August 2011 and finished and published by July 2015. The work, the author, did was divided into three stages. First, in the preparatory stage of the project, the summary of each chapter, the rationale of the book, the textual commentary, the development of the original and Chinese editions, and reviews and criticisms, as well as Dewey’s biography and bibliography were initially investigated. Secondly, on the basis of the above preliminary work, the translation with annotation of Experience and Education, an epitome of Dewey’s biography and bibliography, a chronology, and a critical introduction for the Experience and Education were written. In the critical introduction, Dewey’s philosophy of experience and educational ideas will be examined along the timeline of human thought. And the vast literature about Dewey and his work will be instrumental to reveal the historical significance of Experience and Education on the modern age and make the critical introduction more knowledgeable. Third, the final stage took another two years to review and revise the draft of the work and send it for publication. There are two parts in the book. The first part is a scholarly introduction including Dewey’s chronicle (in short form), Dewey’s mind, people and life, the importance of “Experience and education”, the necessity of re-translation and re-annotation of “Experience and education” into Chinese. The second part is the re-translation and re-annotation version, including Dewey’s “Experience and education” and four papers written by contemporary scholars.

Keywords: John Dewey, experience and education: the 60th anniversary edition, translation, annotation

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42 An Integrated Approach to Cultural Heritage Management in the Indian Context

Authors: T. Lakshmi Priya

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With the widening definition of heritage, the challenges of heritage management has become more complex . Today heritage not only includes significant monuments but comprises historic areas / sites, historic cities, cultural landscapes, and living heritage sites. There is a need for a comprehensive understanding of the values associated with these heritage resources, which will enable their protection and management. These diverse cultural resources are managed by multiple agencies having their own way of operating in the heritage sites. An Integrated approach to management of these cultural resources ensures its sustainability for the future generation. This paper outlines the importance of an integrated approach for the management and protection of complex heritage sites in India by examining four case studies. The methodology for this study is based on secondary research and primary surveys conducted during the preparation of the conservation management plansfor the various sites. The primary survey included basic documentation, inventorying, and community surveys. Red Fort located in the city of Delhi is one of the most significant forts built in 1639 by the Mughal Emperor Shahjahan. This fort is a national icon and stands testimony to the various historical events . It is on the ramparts of Red Fort that the national flag was unfurled on 15th August 1947, when India became independent, which continues even today. Management of this complex fort necessitated the need for an integrated approach, where in the needs of the official and non official stakeholders were addressed. The understanding of the inherent values and significance of this site was arrived through a systematic methodology of inventorying and mapping of information. Hampi, located in southern part of India, is a living heritage site inscribed in the World Heritage list in 1986. The site comprises of settlements, built heritage structures, traditional water systems, forest, agricultural fields and the remains of the metropolis of the 16th century Vijayanagar empire. As Hampi is a living heritage site having traditional systems of management and practices, the aim has been to include these practices in the current management so that there is continuity in belief, thought and practice. The existing national, regional and local planning instruments have been examined and the local concerns have been addressed.A comprehensive understanding of the site, achieved through an integrated model, is being translated to an action plan which safeguards the inherent values of the site. This paper also examines the case of the 20th century heritage building of National Archives of India, Delhi and protection of a 12th century Tomb of Sultan Ghari located in south Delhi. A comprehensive understanding of the site, lead to the delineation of the Archaeological Park of Sultan Ghari, in the current Master Plan for Delhi, for the protection of the tomb and the settlement around it. Through this study it is concluded that the approach of Integrated Conservation has enabled decision making that sustains the values of these complex heritage sites in Indian context.

Keywords: conservation, integrated, management, approach

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41 Evaluation of Feasibility of Ecological Sanitation in Central Nepal

Authors: K. C. Sharda

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Introduction: In the world, almost half of the population are lacking proper access to improved sanitation services. In Nepal, large number of people are living without access to any sanitation facility. Ecological sanitation toilet which is defined as water conserving and nutrient recycling system for use of human urine and excreta in agriculture would count a lot to utilize locally available resources, to regenerate soil fertility, to save national currency and to achieve the goal of elimination open defecation in country like Nepal. The objectives of the research were to test the efficacy of human urine for improving crop performance and to evaluate the feasibility of ecological sanitation in rural area of Central Nepal. Materials and Methods: The field investigation was carried out at Palung Village Development Committee (VDC) of Makawanpur District, Nepal from March – August, 2016. Five eco-san toilets in two villages (Angare and Bhot Khoriya) were constructed and questionnaire survey was carried out. During the questionnaire survey, respondents were asked about socio-economic parameters, farming practices, awareness of ecological sanitation and fertilizer value of human urine and excreta in agriculture. In prior to a field experiment, soil was sampled for analysis of basic characteristics. In the field experiment, cauliflower was cultivated for a month in the two sites to compare the fertilizer value of urine with chemical fertilizer and no fertilizer with three replications. The harvested plant samples were analyzed to understand the nutrient content in plant with different treatments. Results and Discussion: Eighty three percent respondents were engaged in agriculture growing mainly vegetables, which may raise the feasibility of ecological sanitation. In the study area, water deficiencies in dry season, high demand of chemical fertilizer, lack of sanitation awareness were found to be solved. The soil at Angare has sandier texture and lower nitrogen content compared to that in Bhot Khoriya. While the field experiment in Angare showed that the aboveground biomass of cauliflower in the urine fertilized plot were similar with that in the chemically fertilized plot and higher than those in the non-fertilized plots, no significant difference among the treatments were found in Bhot Khoriya. The more distinctive response of crop growth to the three treatments in the former might be attributed to the poorer soil productivity, which in turn could be caused by the poorer inherent soil fertility and the poorer past management by the farmer in Angare. Thus, use of urine as fertilizer could help poor farmers with low quality soil. The significantly different content of nitrogen and potassium in the plant samples among three treatments in Bhot Khoriya would require further investigation. When urine is utilized as a fertilizer, the productivity could be increased and the money to buy chemical fertilizer would be utilized in other livelihood activities. Ecological sanitation is feasible in the area with similar socio-economic parameter.

Keywords: cauliflower, chemical fertilizer, ecological sanitation, Nepal, urine

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40 Role of HIV-Support Groups in Mitigating Adverse Sexual Health Outcomes among HIV Positive Adolescents in Uganda

Authors: Lilian Nantume Wampande

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Group-based strategies in the delivery of HIV care have opened up new avenues not only for meaningful participation for HIV positive people but also platforms for deconstruction and reconstruction of knowledge about living with the virus. Yet the contributions of such strategies among patients who live in high risk areas are still not explored. This case study research assessed the impact of HIV support networks on sexual health outcomes of HIV positive out-of-school adolescents residing in fishing islands of Kalangala in Uganda. The study population was out-of-school adolescents living with HIV and their sexual partners (n=269), members of their households (n=80) and their health service providers (n=15). Data were collected via structured interviews, observations and focus group discussions between August 2016 and March 2017. Data was then analyzed inductively to extract key themes related to the approaches and outcomes of the groups’ activities. The study findings indicate that support groups unite HIV positive adolescents in a bid for social renegotiation to achieve change but individual constraints surpass the groups’ intentions. Some adolescents for example reported increased fear which led to failure to cope, sexual violence, self-harm and denial of status as a result of the high expectations placed on them as members of the support groups. Further investigations around this phenomenon show that HIV networks play a monotonous role as information sources for HIV positive out-of-school adolescents which limit their creativity to seek information elsewhere. Results still indicate that HIV adolescent groups recognize the complexity of long-term treatment and stay in care leading to improved immunity for the majority yet; there is still scattered evidence about how effective they are among adolescents at different phases in the disease trajectory. Nevertheless, the primary focus of developing adolescent self-efficacy and coping skills significantly address a range of disclosure difficulties and supports autonomy. Moreover, the peer techniques utilized in addition to the almost homogeneous group characteristics accelerates positive confidence, hope and belongingness. Adolescent HIV-support groups therefore have the capacity to both improve and/or worsen sexual health outcomes for a young adolescent who is out-of-school. Communication interventions that seek to increase awareness about ‘self’ should therefore be emphasized more than just fostering collective action. Such interventions should be sensitive to context and gender. In addition, facilitative support supervision done by close and trusted health care providers, most preferably Village Health Teams (who are often community elected volunteers) would help to follow-up, mentor, encourage and advise this young adolescent in matters involving sexuality and health outcomes. HIV/AIDS prevention programs have extended their efforts beyond individual focus to those that foster collective action, but programs should rekindle interpersonal level strategies to address the complexity of individual behavior.

Keywords: adolescent, HIV, support groups, Uganda

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39 Associated Factors of Hypercholesterolemia, Hyperuricemia and Double Burden of Hypercuricémia-Hypercholesterolemia in Gout Patients: Hospital Based Study

Authors: Pierre Mintom, Armel Assiene Agamou, Leslie Toukem, William Dakam, Christine Fernande Nyangono Biyegue

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Context: Hyperuricemia, the presence of high levels of uric acid in the blood, is a known precursor to the development of gout. Recent studies have suggested a strong association between hyperuricemia and disorders of lipoprotein metabolism, specifically hypercholesterolemia. Understanding the factors associated with these conditions in gout patients is essential for effective treatment and management. Research Aim: The objective of this study was to determine the prevalence of hyperuricemia, hypercholesterolemia, and the double burden of hyperuricemia-hypercholesterolemia in the gouty population. Additionally, the study aimed to identify the factors associated with these conditions. Methodology: The study utilized a database from a survey of 150 gouty patients recruited at the Laquintinie Hospital in Douala between August 2017 and February 2018. The database contained information on anthropometric parameters, biochemical markers, and the food and drugs consumed by the patients. Hyperuricemia and hypercholesterolemia were defined based on specific serum uric acid and total cholesterol thresholds, and the double burden was defined as the co-occurrence of hyperuricemia and hypercholesterolemia. Findings: The study found that the prevalence rates for hyperuricemia, hypercholesterolemia, and the double burden were 61.3%, 76%, and 50.7% respectively. Factors associated with these conditions included hypertriglyceridemia, atherogenicity index TC/HDL ratio, atherogenicity index LDL/HDL ratio, family history, and the consumption of specific foods and drinks. Theoretical Importance: The study highlights the strong association between hyperuricemia and dyslipidemia, providing important insights for guiding treatment strategies in gout patients. Additionally, it emphasizes the significance of nutritional education in managing these metabolic disorders, suggesting the need to address eating habits in gout patients. Data Collection and Analysis Procedures: Data was collected through surveys and medical records of gouty patients. Information on anthropometric parameters, biochemical markers, and dietary habits was recorded. Prevalence rates and associated factors were determined through statistical analysis, employing odds ratios to assess the risks. Question Addressed: The study aimed to address the prevalence rates and associated factors of hyperuricemia, hypercholesterolemia, and the double burden in gouty patients. It sought to understand the relationships between these conditions and determine their implications for treatment and nutritional education. Conclusion: Findings show that it’s exists an association between hyperuricemia and hypercholesterolemia in gout patients, thus creating a double burden. The findings underscore the importance of considering family history and eating habits in addressing the double burden of hyperuricemia-hypercholesterolemia. This study provides valuable insights for guiding treatment approaches and emphasizes the need for nutritional education in gout patients. This study specifically focussed on the sick population. A case–control study between gouty and non-gouty populations would be interesting to better compare and explain the results observed.

Keywords: gout, hyperuricemia, hypercholesterolemia, double burden

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38 Fake News Domination and Threats on Democratic Systems

Authors: Laura Irimies, Cosmin Irimies

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The public space all over the world is currently confronted with the aggressive assault of fake news that have lately impacted public agenda setting, collective decisions and social attitudes. Top leaders constantly call out most mainstream news as “fake news” and the public opinion get more confused. "Fake news" are generally defined as false, often sensational, information disseminated under the guise of news reporting and has been declared the word of the year 2017 by Collins Dictionary and it also has been one of the most debated socio-political topics of recent years. Websites which, deliberately or not, publish misleading information are often shared on social media where they essentially increase their reach and influence. According to international reports, the exposure to fake news is an undeniable reality all over the world as the exposure to completely invented information goes up to the 31 percent in the US, and it is even bigger in Eastern Europe countries, such as Hungary (42%) and Romania (38%) or in Mediterranean countries, such as Greece (44%) or Turkey (49%), and lower in Northern and Western Europe countries – Germany (9%), Denmark (9%) or Holland (10%). While the study of fake news (mechanism and effects) is still in its infancy, it has become truly relevant as the phenomenon seems to have a growing impact on democratic systems. Studies conducted by the European Commission show that 83% of respondents out of a total of 26,576 interviewees consider the existence of news that misrepresent reality as a threat for democracy. Studies recently conducted at Arizona State University show that people with higher education can more easily spot fake headlines, but over 30 percent of them can still be trapped by fake information. If we were to refer only to some of the most recent situations in Romania, fake news issues and hidden agenda suspicions related to the massive and extremely violent public demonstrations held on August 10th, 2018 with a strong participation of the Romanian diaspora have been massively reflected by the international media and generated serious debates within the European Commission. Considering the above framework, the study raises four main research questions: 1. Is fake news a problem or just a natural consequence of mainstream media decline and the abundance of sources of information? 2. What are the implications for democracy? 3. Can fake news be controlled without restricting fundamental human rights? 4. How could the public be properly educated to detect fake news? The research uses mostly qualitative but also quantitative methods, content analysis of studies, websites and media content, official reports and interviews. The study will prove the real threat fake news represent and also the need for proper media literacy education and will draw basic guidelines for developing a new and essential skill: that of detecting fake in news in a society overwhelmed by sources of information that constantly roll massive amounts of information increasing the risk of misinformation and leading to inadequate public decisions that could affect democratic stability.

Keywords: agenda setting democracy, fake news, journalism, media literacy

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37 Teleconnection between El Nino-Southern Oscillation and Seasonal Flow of the Surma River and Possibilities of Long Range Flood Forecasting

Authors: Monika Saha, A. T. M. Hasan Zobeyer, Nasreen Jahan

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El Nino-Southern Oscillation (ENSO) is the interaction between atmosphere and ocean in tropical Pacific which causes inconsistent warm/cold weather in tropical central and eastern Pacific Ocean. Due to the impact of climate change, ENSO events are becoming stronger in recent times, and therefore it is very important to study the influence of ENSO in climate studies. Bangladesh, being in the low-lying deltaic floodplain, experiences the worst consequences due to flooding every year. To reduce the catastrophe of severe flooding events, non-structural measures such as flood forecasting can be helpful in taking adequate precautions and steps. Forecasting seasonal flood with a longer lead time of several months is a key component of flood damage control and water management. The objective of this research is to identify the possible strength of teleconnection between ENSO and river flow of Surma and examine the potential possibility of long lead flood forecasting in the wet season. Surma is one of the major rivers of Bangladesh and is a part of the Surma-Meghna river system. In this research, sea surface temperature (SST) has been considered as the ENSO index and the lead time is at least a few months which is greater than the basin response time. The teleconnection has been assessed by the correlation analysis between July-August-September (JAS) flow of Surma and SST of Nino 4 region of the corresponding months. Cumulative frequency distribution of standardized JAS flow of Surma has also been determined as part of assessing the possible teleconnection. Discharge data of Surma river from 1975 to 2015 is used in this analysis, and remarkable increased value of correlation coefficient between flow and ENSO has been observed from 1985. From the cumulative frequency distribution of the standardized JAS flow, it has been marked that in any year the JAS flow has approximately 50% probability of exceeding the long-term average JAS flow. During El Nino year (warm episode of ENSO) this probability of exceedance drops to 23% and while in La Nina year (cold episode of ENSO) it increases to 78%. Discriminant analysis which is known as 'Categoric Prediction' has been performed to identify the possibilities of long lead flood forecasting. It has helped to categorize the flow data (high, average and low) based on the classification of predicted SST (warm, normal and cold). From the discriminant analysis, it has been found that for Surma river, the probability of a high flood in the cold period is 75% and the probability of a low flood in the warm period is 33%. A synoptic parameter, forecasting index (FI) has also been calculated here to judge the forecast skill and to compare different forecasts. This study will help the concerned authorities and the stakeholders to take long-term water resources decisions and formulate policies on river basin management which will reduce possible damage of life, agriculture, and property.

Keywords: El Nino-Southern Oscillation, sea surface temperature, surma river, teleconnection, cumulative frequency distribution, discriminant analysis, forecasting index

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36 Contribution to the Understanding of the Hydrodynamic Behaviour of Aquifers of the Taoudéni Sedimentary Basin (South-eastern Part, Burkina Faso)

Authors: Kutangila Malundama Succes, Koita Mahamadou

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In the context of climate change and demographic pressure, groundwater has emerged as an essential and strategic resource whose sustainability relies on good management. The accuracy and relevance of decisions made in managing these resources depend on the availability and quality of scientific information they must rely on. It is, therefore, more urgent to improve the state of knowledge on groundwater to ensure sustainable management. This study is conducted for the particular case of the aquifers of the transboundary sedimentary basin of Taoudéni in its Burkinabe part. Indeed, Burkina Faso (and the Sahel region in general), marked by low rainfall, has experienced episodes of severe drought, which have justified the use of groundwater as the primary source of water supply. This study aims to improve knowledge of the hydrogeology of this area to achieve sustainable management of transboundary groundwater resources. The methodological approach first described lithological units regarding the extension and succession of different layers. Secondly, the hydrodynamic behavior of these units was studied through the analysis of spatio-temporal variations of piezometric. The data consists of 692 static level measurement points and 8 observation wells located in the usual manner in the area and capturing five of the identified geological formations. Monthly piezometric level chronicles are available for each observation and cover the period from 1989 to 2020. The temporal analysis of piezometric, carried out in comparison with rainfall chronicles, revealed a general upward trend in piezometric levels throughout the basin. The reaction of the groundwater generally occurs with a delay of 1 to 2 months relative to the flow of the rainy season. Indeed, the peaks of the piezometric level generally occur between September and October in reaction to the rainfall peaks between July and August. Low groundwater levels are observed between May and July. This relatively slow reaction of the aquifer is observed in all wells. The influence of the geological nature through the structure and hydrodynamic properties of the layers was deduced. The spatial analysis reveals that piezometric contours vary between 166 and 633 m with a trend indicating flow that generally goes from southwest to northeast, with the feeding areas located towards the southwest and northwest. There is a quasi-concordance between the hydrogeological basins and the overlying hydrological basins, as well as a bimodal flow with a component following the topography and another significant component deeper, controlled by the regional gradient SW-NE. This latter component may present flows directed from the high reliefs towards the sources of Nasso. In the source area (Kou basin), the maximum average stock variation, calculated by the Water Table Fluctuation (WTF) method, varies between 35 and 48.70 mm per year for 2012-2014.

Keywords: hydrodynamic behaviour, taoudeni basin, piezometry, water table fluctuation

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35 Conditionality of Aid as a Counterproductive Factor in Peacebuilding in the Afghan Context

Authors: Karimova Sitora Yuldashevna

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The August 2021 resurgence of Taliban as a ruling force in Afghanistan once again challenged the global community into dealing with an unprecedentedly unlike-minded government. To express their disapproval of the new regime, Western governments and intergovernmental institutions have suspended their infrastructural projects and other forms of support. Moreover, the Afghan offshore reserves were frozen, and Afghanistan was disconnected from the international financial system, which impeded even independent aid agencies’ work. The already poor provision of aid was then further complicated with political conditionality. The purpose of this paper is to investigate the efficacy of conditional aid policy in the Afghan peacebuilding under Taliban rule and provide recommendations to international donors on further course of action. Arguing that conditionality of aid is a counterproductive factor in the peacebuilding process, this paper employs scholarly literature on peacebuilding alongside reports from International non-governmental organizations INGOs who operate directly in Afghanistan. The existing debate on peacebuilding in Afghanistan revolves around aid as a means of building democratic foundation for achieving peace on communal and national levels and why the previous attempts to do so were unsuccessful. This paper focuses on how to recalibrate the approach to aid provision and peacebuilding in the new reality. In the early 2000s, amid the weak Post-Cold War international will for a profound engagement in the conflict, humanitarian and development aid became the new means of achieving peace. Aid agencies provided resources directly to communities, minimizing the risk of local disputes. Through subsidizing education, governance reforms, and infrastructural projects, international aid accelerated school enrollment, introduced peace education, funded provincial council and parliamentary elections, and helped rebuild a conflict-torn country.When the Taliban seized power, the international community called on them to build an inclusive government based on respect for human rights, particularly girls’ and women’s schooling and work, as a condition to retain the aid flow. As the Taliban clearly failed to meet the demands, development aid was withdrawn. Some key United Nation agencies also refrained from collaborating with the de-facto authorities. However, contrary to the intended change in Talibs’ behavior, such a move has only led to further deprivation of those whom the donors strived to protect. This is because concern for civilians has always been the second priority for the warring parties. This paper consists of four parts. First, it describes the scope of the humanitarian crisis that began in Afghanistan in 2001. Second, it examines the previous peacebuilding attempts undertaken by the international community and the contribution that the international aid had in the peacebuilding process. Third, the paper describes the current regime and its relationships with the international donors. Finally, the paper concludes with recommendations for donors who would have to be more realistic and reconsider their priorities. While it is certainly not suggested that the Taliban regime is legitimized internationally, the crisis calls upon donors to be more flexible in collaborating with the de-facto authorities for the sake of the civilians.

Keywords: Afghanistan, international aid, donors, peacebuilding

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34 Assessing the Risk of Socio-economic Drought: A Case Study of Chuxiong Yi Autonomous Prefecture, China

Authors: Mengdan Guo, Zongmin Wang, Haibo Yang

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Drought is one of the most complex and destructive natural disasters, with a huge impact on both nature and society. In recent years, adverse climate conditions and uncontrolled human activities have exacerbated the occurrence of global droughts, among which socio-economic droughts are closely related to human survival. The study of socio-economic drought risk assessment is crucial for sustainable social development. Therefore, this study comprehensively considered the risk of disaster causing factors, the exposure level of the disaster-prone environment, and the vulnerability of the disaster bearing body to construct a socio-economic drought risk assessment model for Chuxiong Prefecture in Yunnan Province. Firstly, a threedimensional frequency analysis of intensity area duration drought was conducted, followed by a statistical analysis of the drought risk of the socio-economic system. Secondly, a grid analysis model was constructed to assess the exposure levels of different agents and study the effects of drought on regional crop growth, industrial economic growth, and human consumption thresholds. Thirdly, an agricultural vulnerability model for different irrigation levels was established by using the DSSAT crop model. Industrial economic vulnerability and domestic water vulnerability under the impact of drought were investigated by constructing a standardized socio-economic drought index and coupling water loss. Finally, the socio-economic drought risk was assessed by combining hazard, exposure, and vulnerability. The results show that the frequency of drought occurrence in Chuxiong Prefecture, Yunnan Province is relatively high, with high population and economic exposure concentrated in urban areas of various counties and districts, and high agricultural exposure concentrated in mountainous and rural areas. Irrigation can effectively reduce agricultural vulnerability in Chuxiong, and the yield loss rate under the 20mm winter irrigation scenario decreased by 10.7% compared to the rain fed scenario. From the perspective of comprehensive risk, the distribution of long-term socio-economic drought risk in Chuxiong Prefecture is relatively consistent, with the more severe areas mainly concentrated in Chuxiong City and Lufeng County, followed by counties such as Yao'an, Mouding and Yuanmou. Shuangbai County has the lowest socio-economic drought risk, which is basically consistent with the economic distribution trend of Chuxiong Prefecture. And in June, July, and August, the drought risk in Chuxiong Prefecture is generally high. These results can provide constructive suggestions for the allocation of water resources and the construction of water conservancy facilities in Chuxiong Prefecture, and provide scientific basis for more effective drought prevention and control. Future research is in the areas of data quality and availability, climate change impacts, human activity impacts, and countermeasures for a more comprehensive understanding and effective response to drought risk in Chuxiong Prefecture.

Keywords: DSSAT model, risk assessment, socio-economic drought, standardized socio-economic drought index

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33 Raman Spectroscopy of Fossil-like Feature in Sooke #1 from Vancouver Island

Authors: J. A. Sawicki, C. Ebrahimi

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The first geochemical, petrological, X-ray diffraction, Raman, Mössbauer, and oxygen isotopic analyses of very intriguing 13-kg Sooke #1 stone covered in 70% of its surface with black fusion crust, found in and recovered from Sooke Basin, near Juan de Fuca Strait, in British Columbia, were reported as poster #2775 at LPSC52 in March. Our further analyses reported in poster #6305 at 84AMMS in August and comparisons with the Mössbauer spectra of Martian meteorite MIL03346 and Martian rocks in Gusev Crater reported by Morris et al. suggest that Sooke #1 find could be a stony achondrite of Martian polymict breccia type ejected from early watery Mars. Here, the Raman spectra of a carbon-rich ~1-mm² fossil-like white area identified in this rock on a surface of polished cut have been examined in more detail. The low-intensity 532 nm and 633 nm beams of the InviaRenishaw microscope were used to avoid any destructive effects. The beam was focused through the microscope objective to a 2 m spot on a sample, and backscattered light collected through this objective was recorded with CCD detector. Raman spectra of dark areas outside fossil have shown bands of clinopyroxene at 320, 660, and 1020 cm-1 and small peaks of forsteritic olivine at 820-840 cm-1, in agreement with results of X-ray diffraction and Mössbauer analyses. Raman spectra of the white area showed the broad band D at ~1310 cm-1 consisting of main mode A1g at 1305 cm⁻¹, E2g mode at 1245 cm⁻¹, and E1g mode at 1355 cm⁻¹ due to stretching diamond-like sp3 bonds in diamond polytype lonsdaleite, as in Ovsyuk et al. study. The band near 1600 cm-1 mostly consists of D2 band at 1620 cm-1 and not of the narrower G band at 1583 cm⁻¹ due to E2g stretching in planar sp2 bonds that are fundamental building blocks of carbon allotropes graphite and graphene. In addition, the broad second-order Raman bands were observed with 532 nm beam at 2150, ~2340, ~2500, 2650, 2800, 2970, 3140, and ~3300 cm⁻¹ shifts. Second-order bands in diamond and other carbon structures are ascribed to the combinations of bands observed in the first-order region: here 2650 cm⁻¹ as 2D, 2970 cm⁻¹ as D+G, and 3140 cm⁻¹ as 2G ones. Nanodiamonds are abundant in the Universe, found in meteorites, interplanetary dust particles, comets, and carbon-rich stars. The diamonds in meteorites are presently intensely investigated using Raman spectroscopy. Such particles can be formed by CVD process and during major impact shocks at ~1000-2300 K and ~30-40 GPa. It cannot be excluded that the fossil discovered in Sooke #1 could be a remnant of an alien carbon organism that transformed under shock impact to nanodiamonds. We trust that for the benefit of research in astro-bio-geology of meteorites, asteroids, Martian rocks, and soil, this find deserves further, more thorough investigations. If possible, the Raman SHERLOCK spectrometer operating on the Perseverance Rover should also search for such objects in the Martian rocks.

Keywords: achondrite, nanodiamonds, lonsdaleite, raman spectra

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32 Creating an Impact through Environmental Law and Policy with a Focus on Environmental Science Restoration with Social Impacts

Authors: Lauren Beth Birney

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BOP-CCERS is a consortium of scientists, K-16 New York City students, faculty, academicians, teachers, stakeholders, STEM Industry professionals, CBO’s, NPO’s, citizen scientists, and local businesses working in partnership to restore New York Harbor’s oyster populations while at the same time providing clean water in New York Harbor. BOP-CCERS gives students an opportunity to learn hands-on about environmental stewardship as well as environmental law and policy by giving students real responsibility. The purpose of this REU will allow for the BOP CCERS Project to further broaden its parameters into the focus of environmental law and policy where further change can be affected. Creating opportunities for undergraduates to work collaboratively with graduate students in law and policy and envision themselves in STEM careers in the field of law continues to be of importance in this project. More importantly, creating opportunities for underrepresented students to pursue careers in STEM Education has been a goal of the project over the last ten years. By raising the level of student interest in community-based citizen science integrated into environmental law and policy, a more diversified workforce will be fostered through the momentum of this dynamic program. The continuing climate crisis facing our planet calls for 21st-century skill development that includes learning and innovation skills derived from critical thinking, which will help REU students address the issues of climate change facing our planet. The demand for a climate-friendly workforce will continue to be met through this community-based citizen science effort. Environmental laws and policies play a crucial role in protecting humans, animals, resources, and habitats. Without these laws, there would be no regulations concerning pollution or contamination of our waterways. Environmental law serves as a mechanism to protect the land, air, water, and soil of our planet. To protect the environment, it is crucial that future policymakers and legal experts both understand and value the importance of environmental protection. The Environmental Law and Policy REU provides students with the opportunity to learn, through hands-on work, the skills, and knowledge needed to help foster a legal workforce centered around environmental protection while participating alongside the BOP CCERS researchers in order to gain research experience. Broadening this area to law and policy will further increase these opportunities and permit students to ultimately affect and influence larger-scale change on a global level while further diversifying the STEM workforce. Students’ findings will be shared at the annual STEM Institute at Pace University in August 2022. Basic research methodologies include qualitative and quantitative analysis performed by the research team. Early findings indicate that providing students with an opportunity to experience, explore and participate in environmental science programs such as these enhances their interests in pursuing STEM careers in Law and Policy, with the focus being on providing opportunities for underserved, marginalized, and underrepresented populations.

Keywords: environmental restoration science, citizen science, environmental law and policy, STEM education

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31 Heat Accumulation in Soils of Belarus

Authors: Maryna Barushka, Aleh Meshyk

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The research analyzes absolute maximum soil temperatures registered at 36 gauge stations in Belarus from 1950 to 2013. The main method applied in the research is cartographic, in particular, trend surface analysis. Warming that had never been so long and intensive before started in 1988. The average temperature in January and February of that year exceeded the norm by 7-7.5 С, in March and April by 3-5С. In general, that year, as well as the year of 2008, happened to be the hottest ones in the whole period of instrumental observation. Yearly average air temperature in Belarus in those years was +8.0-8.2 С, which exceeded the norm by 2.0 – 2.2 С. The warming has been observed so far. The only exception was in 1996 when the yearly average air temperature in Belarus was below normal by 0.5 С. In Belarus the value of trend line of standard temperature deviation in the warmest months (July-August) has been positive for the past 25 years. In 2010 absolute maximum air and soil temperature exceeded the norm at 15 gauge stations in Belarus. The structure of natural processes includes global, regional, and local constituents. Trend surface analysis of the investigated characteristics makes it possible to determine global, regional, and local components. Linear trend surface shows the occurrence of weather deviations on a global scale, outside Belarus. Maximum soil temperature appears to be growing in the south-west direction with the gradient of 5.0 С. It is explained by the latitude factor. Polynomial trend surfaces show regional peculiarities of Belarus. Extreme temperature regime is formed due to some factors. The prevailing one is advection of turbulent flow of the ground layer of the atmosphere. In summer influence of the Azores High producing anticyclones is great. The Gulf Stream current forms the values of temperature trends in a year period. The most intensive flow of the Gulf Stream in the second half of winter and the second half of summer coincides with the periods of maximum temperature trends in Belarus. It is possible to estimate a local component of weather deviations in the analysis of the difference in values of the investigated characteristics and their trend surfaces. Maximum positive deviation (up to +4 С) of averaged soil temperature corresponds to the flat terrain in Pripyat Polesie, Brest Polesie, and Belarusian Poozerie Area. Negative differences correspond to the higher relief which partially compensates extreme heat regime of soils. Another important factor for maximum soil temperature in these areas is peat-bog soils with the least albedo of 8-15%. As yearly maximum soil temperature reaches 40-60 С, this could be both negative and positive factors for Belarus’s environment and economy. High temperature causes droughts resulting in crops dying and soil blowing. On the other hand, vegetation period has lengthened thanks to bigger heat resources, which allows planting such heat-loving crops as melons and grapes with appropriate irrigation. Thus, trend surface analysis allows determining global, regional, and local factors in accumulating heat in the soils of Belarus.

Keywords: soil, temperature, trend surface analysis, warming

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30 Navigating States of Emergency: A Preliminary Comparison of Online Public Reaction to COVID-19 and Monkeypox on Twitter

Authors: Antonia Egli, Theo Lynn, Pierangelo Rosati, Gary Sinclair

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The World Health Organization (WHO) defines vaccine hesitancy as the postponement or complete denial of vaccines and estimates a direct linkage to approximately 1.5 million avoidable deaths annually. This figure is not immune to public health developments, as has become evident since the global spread of COVID-19 from Wuhan, China in early 2020. Since then, the proliferation of influential, but oftentimes inaccurate, outdated, incomplete, or false vaccine-related information on social media has impacted hesitancy levels to a degree described by the WHO as an infodemic. The COVID-19 pandemic and related vaccine hesitancy levels have in 2022 resulted in the largest drop in childhood vaccinations of the 21st century, while the prevalence of online stigma towards vaccine hesitant consumers continues to grow. Simultaneously, a second disease has risen to global importance: Monkeypox is an infection originating from west and central Africa and, due to racially motivated online hate, was in August 2022 set to be renamed by the WHO. To better understand public reactions towards two viral infections that became global threats to public health no two years apart, this research examines user replies to threads published by the WHO on Twitter. Replies to two Tweets from the @WHO account declaring COVID-19 and Monkeypox as ‘public health emergencies of international concern’ on January 30, 2020, and July 23, 2022, are gathered using the Twitter application programming interface and user mention timeline endpoint. Research methodology is unique in its analysis of stigmatizing, racist, and hateful content shared on social media within the vaccine discourse over the course of two disease outbreaks. Three distinct analyses are conducted to provide insight into (i) the most prevalent topics and sub-topics among user reactions, (ii) changes in sentiment towards the spread of the two diseases, and (iii) the presence of stigma, racism, and online hate. Findings indicate an increase in hesitancy to accept further vaccines and social distancing measures, the presence of stigmatizing content aimed primarily at anti-vaccine cohorts and racially motivated abusive messages, and a prevalent fatigue towards disease-related news overall. This research provides value to non-profit organizations or government agencies associated with vaccines and vaccination programs in emphasizing the need for public health communication fitted to consumers' vaccine sentiments, levels of health information literacy, and degrees of trust towards public health institutions. Considering the importance of addressing fears among the vaccine hesitant, findings also illustrate the risk of alienation through stigmatization, lead future research in probing the relatively underexamined field of online, vaccine-related stigma, and discuss the potential effects of stigma towards vaccine hesitant Twitter users in their decisions to vaccinate.

Keywords: social marketing, social media, public health communication, vaccines

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29 Developing Effective Strategies to Reduce Hiv, Aids and Sexually Transmitted Infections, Nakuru, Kenya

Authors: Brian Bacia, Esther Githaiga, Teresia Kabucho, Paul Moses Ndegwa, Lucy Gichohi

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Purpose: The aim of the study is to ensure an appropriate mix of evidence-based prevention strategies geared towards the reduction of new HIV infections and the incidence of Sexually transmitted Illnesses Background: In Nakuru County, more than 90% of all HIV-infected patients are adults and on a single-dose medication-one pill that contains a combination of several different HIV drugs. Nakuru town has been identified as the hardest hit by HIV/Aids in the County according to the latest statistics from the County Aids and STI group, with a prevalence rate of 5.7 percent attributed to the high population and an active urban center. Method: 2 key studies were carried out to provide evidence for the effectiveness of antiretroviral therapy (ART) when used optimally on preventing sexual transmission of HIV. Discussions based on an examination, assessments of successes in planning, program implementation, and ultimate impact of prevention and treatment were undertaken involving health managers, health workers, community health workers, and people living with HIV/AIDS between February -August 2021. Questionnaires were carried out by a trained duo on ethical procedures at 15 HIV treatment clinics targeting patients on ARVs and caregivers on ARV prevention and treatment of pediatric HIV infection. Findings: Levels of AIDS awareness are extremely high. Advances in HIV treatment have led to an enhanced understanding of the virus, improved care of patients, and control of the spread of drug-resistant HIV. There has been a tremendous increase in the number of people living with HIV having access to life-long antiretroviral drugs (ARV), mostly on generic medicines. Healthcare facilities providing treatment are stressed challenging the administration of the drugs, which require a clinical setting. Women find it difficult to take a daily pill which reduces the effectiveness of the medicine. ART adherence can be strengthened largely through the use of innovative digital technology. The case management approach is useful in resource-limited settings. The county has made tremendous progress in mother-to-child transmission reduction through enhanced early antenatal care (ANC) attendance and mapping of pregnant women Recommendations: Treatment reduces the risk of transmission to the child during pregnancy, labor, and delivery. Promote research of medicines through patients and community engagement. Reduce the risk of transmission through breastfeeding. Enhance testing strategies and strengthen health systems for sustainable HIV service delivery. Need exists for improved antenatal care and delivery by skilled birth attendants. Develop a comprehensive maternal reproductive health policy covering equitability, efficient and effective delivery of services. Put in place referral systems.

Keywords: evidence-based prevention strategies, service delivery, human management, integrated approach

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