Search results for: intensive care unit
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 6334

Search results for: intensive care unit

1144 IRIS An Interactive Video Game for Children with Long-Term Illness in Hospitals

Authors: Ganetsou Evanthia, Koutsikos Emmanouil, Austin Anna Maria

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Information technology has long served the needs of individuals for learning and entertainment, but much less for children in sickness. The aim of the proposed online video game is to provide immersive learning opportunities as well as essential social and emotional scenarios for hospital-bound children with long-term illness. Online self-paced courses on chosen school subjects, including specialised software and multisensory assessments, aim at enhancing children’s academic achievement and sense of inclusion, while doctor minigames familiarise and educate young patients on their medical conditions. Online ethical dilemmas will offer children opportunities to contemplate on the importance of medical procedures and following assigned medication, often challenging for young patients; they will therefore reflect on their condition, reevaluate their perceptions about hospitalisation, and assume greater personal responsibility for their progress. Children’s emotional and psychosocial needs are addressed by engaging in social conventions, such as interactive, daily, collaborative mini games with other hospitalised peers, like virtual competitive sports games, weekly group psychodrama sessions, and online birthday parties or sleepovers. Social bonding is also fostered by having a virtual pet to interact with and take care of, as well as a virtual nurse to discuss and reflect on the mood of the day, engage in constructive dialogue and perspective taking, and offer reminders. Access to the platform will be available throughout the day depending on the patient’s health status. The program is designed to minimise escapism and feelings of exclusion, and can flexibly be adapted to offer post-treatment and a support online system at home.

Keywords: long-term illness, children, hospital, interactive games, cognitive, socioemotional development

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1143 The Role of Surgery to Remove the Primary Tumor in Patients with Metastatic Breast Cancer

Authors: A. D. Zikiryahodjaev, L. V. Bolotina, A. S. Sukhotko

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Purpose. To evaluate the expediency and timeliness of performance of surgical treatment as a component of multi-therapy treatment of patients with stage IV breast cancers. Materials and Methods. This investigation comparatively analyzed the results of complex treatment with or without surgery in patients with metastatic breast cancer. We analyzed retrospectively treatment experience of 196 patients with generalized breast cancer in the department of oncology and breast reconstructive surgery of P.A. Herzen Moscow Cancer Research Institute from 2000 to 2012. The average age was (58±1,1) years. Invasive ductul carcinoma was verified in128 patients (65,3%), invasive lobular carcinoma-33 (16,8%), complex form - 19 (9,7%). Complex palliative care involving drug and radiation therapies was performed in two patient groups. The first group includes 124 patients who underwent surgical intervention as complex treatment, the second group includes 72 patients with only medical therapy. Standard systemic therapy was given to all patients. Results. Overall, 3-and 5-year survival in fist group was 43,8 and 21%, in second - 15,1 and 9,3% respectively [p=0,00002 log-rank]. Median survival in patients with surgical treatment composed 32 months, in patients with only systemic therapy-21. The factors having influencing an influence on the prognosis and the quality of life outcomes for of patients with generalized breast cancer were are also studied: hormone-dependent tumor, Her2/neu hyper-expression, reproductive function status (age, menopause existence). Conclusion.Removing primary breast tumor in patients with generalized breast cancer improve long-term outcomes. Three- and five-year survival increased by 28,7 and 16,3% respectively, and median survival–for 11 months. These patients may benefit from resection of the breast tumor. One explanation for the effect of this resection is that reducing the tumor load influences metastatic growth.

Keywords: breast cancer, combination therapy, factors of prognosis, primary tumor

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1142 Depositional Environment and Diagenetic Alterations, Influences of Facies and Fine Kaolinite Formation Migration on Sandstones’ Reservoir Quality, Sarir Formation, Sirt Basin Libya

Authors: Faraj M. Elkhatri, Hana Ali Allafi

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The spatial and temporal distribution of diagenetic alterations related impact on the reservoir quality of the Sarir Formation. (present day burial depth of about 9000 feet) Depositional facies and diagenetic alterations are the main controls on reservoir quality of Sarir Formation Sirt Ba-sin Libya; these based on lithology and grain size as well as authigenic clay mineral types and their distributions. However, petrology investigation obtained on study area with five sandstone wells concentrated on main rock components and the parameters that may have impacts on reservoirs. the main authigenic clay minerals are kaolinite and dickite, these investigations have confirmed by X.R.D analysis and clay fraction. mainly Kaolinite and Dickite were extensively presented on all of wells with high amounts. As well as trace of detrital smectite and less amounts of illitized mud-matrix are possibly find by SEM image. Thin layers of clay presented as clay-grain coatings in local depth interpreted as remains of dissolved clay matrix is partly transformed into kaolinite adjacent and towards pore throat. This also may have impacts on most of the pore throats of this sandstone which are open and relatively clean with some of fine martial have been formed on occluded pores. This material is identified by EDS analysis to be collections of not only kaolinite booklets, but also small, disaggregated kaolinite platelets derived from the dis-aggregation of larger kaolinite booklets. These patches of kaolinite not only fill this pore, but also coat some of the sur-rounding framework grains. Quartz grains often enlarged by authigenic quartz overgrowths partially occlude and re-duce porosity. Scanning Electron Microscopy with Energy Dispersive Spectroscopy (SEM) was conducted on the post-test samples to examine any mud filtrate particles that may be in the pore throats. Semi-qualitative elemental data on select-ed minerals observed during the SEM study were obtained using an Energy Dispersive Spectroscopy (EDS) unit. The samples showed mostly clean open pore throats, with limited occlusion by kaolinite.

Keywords: por throat, formation damage, porosity lose, solids plugging

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1141 A Deluge of Disaster, Destruction, Death and Deception: Negative News and Empathy Fatigue in the Digital Age

Authors: B. N. Emenyeonu

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Initially identified as sensationalism in the eras of yellow journalism and tabloidization, the inclusion of news which shocks or provokes strong emotional responses among readers, viewers, and browsers has not only remained a persistent feature of journalism but has also seemingly escalated in the current climate of digital and social media. Whether in the relentless revelation of scandals in high places, profiles on people displaced by sporadic wars or natural disasters, gruesome accounts of trucks plowing into pedestrians in a city centre, or the coverage of mourners paying tributes to victims of a mass shooting, mainstream, and digital media are often awash with tragedy, tears, and trauma. While it may aim at inspiring sympathy, outrage, or even remedial reactions, it would appear that the deluge of grief and misery in the news merely generates in the audience a feeling that borders on hearing or seeing too much to care or act. This feeling also appears to be accentuated by the dizzying diffusion of social media news and views, most of whose authenticity is not easily verifiable. Through a survey of 400 regular consumers of news and an in-depth interview of 10 news managers in selected media organizations across the Middle East, this study therefore investigates public attitude to the profusion of bad news in mainstream and digital media. Among other targets, it examines whether the profusion of bad news generates empathy fatigue among the audience and, if so, whether there is any association between biographic variables (profession, age, and gender) and an inclination to empathy fatigue. It also seeks to identify which categories of bad news and media are most likely to drag the audience into indifference. In conclusion, the study discusses the implications of the findings for mass-mediated advocacies such as campaigns against conflicts, corruption, nuclear threats, terrorism, gun violence, sexual crimes, and human trafficking, among other threats to humanity.

Keywords: digital media, empathy fatigue, media campaigns, news selection

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1140 A Simulation-Based Investigation of the Smooth-Wall, Radial Gravity Problem of Granular Flow through a Wedge-Shaped Hopper

Authors: A. F. Momin, D. V. Khakhar

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Granular materials consist of particulate particles found in nature and various industries that, due to gravity flow, behave macroscopically like liquids. A fundamental industrial unit operation is a hopper with inclined walls or a converging channel in which material flows downward under gravity and exits the storage bin through the bottom outlet. The simplest form of the flow corresponds to a wedge-shaped, quasi-two-dimensional geometry with smooth walls and radially directed gravitational force toward the apex of the wedge. These flows were examined using the Mohr-Coulomb criterion in the classic work of Savage (1965), while Ravi Prakash and Rao used the critical state theory (1988). The smooth-wall radial gravity (SWRG) wedge-shaped hopper is simulated using the discrete element method (DEM) to test existing theories. DEM simulations involve the solution of Newton's equations, taking particle-particle interactions into account to compute stress and velocity fields for the flow in the SWRG system. Our computational results are consistent with the predictions of Savage (1965) and Ravi Prakash and Rao (1988), except for the region near the exit, where both viscous and frictional effects are present. To further comprehend this behaviour, a parametric analysis is carried out to analyze the rheology of wedge-shaped hoppers by varying the orifice diameter, wedge angle, friction coefficient, and stiffness. The conclusion is that velocity increases as the flow rate increases but decreases as the wedge angle and friction coefficient increase. We observed no substantial changes in velocity due to varying stiffness. It is anticipated that stresses at the exit result from the transfer of momentum during particle collisions; for this reason, relationships between viscosity and shear rate are shown, and all data are collapsed into a single curve. In addition, it is demonstrated that viscosity and volume fraction exhibit power law correlations with the inertial number and that all the data collapse into a single curve. A continuum model for determining granular flows is presented using empirical correlations.

Keywords: discrete element method, gravity flow, smooth-wall, wedge-shaped hoppers

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1139 Effect of Mobile Phone Text Message Reminders on Adherence to Routine Prenatal Iron/Folic Acid Supplement among Pregnant Women: A Pilot Study

Authors: Nneka U. Igboeli, Maxwell O. Adibe

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Iron and folate supplementation in pregnancy are important interventions that prevent maternal anaemia and fetal anomaly. Thus, daily oral doses of iron and folic acid are recommended throughout pregnancy as part of antenatal care. However, low adherence has been a major drawback leading to low effectiveness of these programs. The effect of mobile text message reminders to pregnant women to take their routine medications on adherence was evaluated in this study. The first 100 women who consented to the study were recruited and randomized to either receive a text message reminder on adherence to routine medications or not. Adherence was assessed using the 8-item Modified Morisky Adherence Scale (8-MMAS). The folders of successfully recruited women were tagged with the a study number assigned to each of them. The womens’ phone numbers were collected and these were used to send text messages reminders on adhering to routine drugs only to women in the intervention group. The text messages were sent three times per week for a period of four weeks with an adherence reassessment at the one month follow-up antenatal visit for recruited women. At one month follow-up, the lost to follow-up were 6 (16%) women for the intervention group and 17 (34%) for the control group. The across group mean difference in adherence score was 0.07 (-0.96 – 1.10) at baseline and 0.3 (-0.31 – 0.92) after intervention, both insignificant at p > 0.05. The within group change were increases of 0.58 (0.00 – 1.16) (p = 0.05) from baseline for the intervention group and a 0.35 (-0.51 – 1.20) (p = 0.395) for the control group. Non-significant increase in adherence scores were recorded for both groups. However, the increase in adherence scores of women in the intervention group was greater and may be potentially transformed into more positive results if the study period is increased with possibly reduced study drop-outs shows great promise for more positive results.

Keywords: adherence, mobile phone, pregnant women, reminders

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1138 Effects of Hydroxysafflor Yellow a (HSYA) on UVA-Induced Damage in HaCaT Keratinocytes

Authors: Szu-Chieh Yu, Pei-Chin Chiand, Chih-Yi Lin, Yi-Wen Chien

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UV radiation from sunlight cause numbers of acute and chronic skin damage which can result in inflammation, immune changes, physical changes and DNA damage that facilitates skin aging and the development of skin carcinogenesis. Reactive oxygen species (ROS) are generated by excessive solar UV radiation, resulting in oxidative damage to cellar components, proteins, lipids, and nucleic acids. Thus, antioxidation plays an important role that protects skin against ROS-induced injury. Safflower (Carthamus tinctorius L.) is an important Chinese medicine contained abundance flavones and hydroxysafflor yellow A (HSYA) which is main active ingredient. HSYA is part of quinochalcone and has unique structures of hydroxy groups that provided the antioxidant effect. In this study, the aim was to investigate the protective role of HYSA in human keratinocytes (HaCaT) against UVA-induced oxidative damage and the possible mechanism. The HaCaT cells were UVA-irradiated and the effects of HYSA on cell viability, reactive oxygen species generation, DNA fragmentation and lipid peroxidation were measured. The mRNA expression of matrix metalloproteinase Ι (MMP Ι), cyclooxygenase-2 (COX-2) were determined by RT-PCR. In this study, UVA exposure lead to decrease in cell viability and increase in reactive oxygen species generation in HaCaT cells. HYSA could effectively increase the viability of HaCaT cells after UVA exposure and protect them from UVA-induced oxidative stress. Moreover, HYSA can reduce inflammation through inhibition the mRNA expression of MMP Ι and COX-2. Our results suggest that HSYA can act as a free radical scavenger while keratinocytes were photodamaged. HYSA could be a useful natural medicine for the protection of epidermal cells from UVA-induced damage and will be developed into products for skin care.

Keywords: HaCaT keratinocytes, hydroxysafflor yellow A (HSYA), MMP Ι, oxidative stress

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1137 Common Caper (Capparis Spinosa L.) From Oblivion and Neglect to the Interface of Medicinal Plants

Authors: Ahmad Alsheikh Kaddour

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Herbal medicine has been a long-standing phenomenon in Arab countries since ancient times because of its breadth and moderate temperament. Therefore, it possesses a vast natural and economic wealth of medicinal and aromatic herbs. This prompted ancient Egyptians and Arabs to discover and exploit them. The economic importance of the plant is not only from medicinal uses; it is a plant of high economic value for its various uses, especially in food, cosmetic and aromatic industries. It is also an ornamental plant and soil stabilization. The main objective of this research is to study the chemical changes that occur in the plant during the growth period, as well as the production of plant buds, which were previously considered unwanted plants. The research was carried out in the period 2021-2022 in the valley of Al-Shaflah (common caper), located in Qumhana village, 7 km north of Hama Governorate, Syria. The results of the research showed a change in the percentage of chemical components in the plant parts. The ratio of protein content and the percentage of fatty substances in fruits and the ratio of oil in the seeds until the period of harvesting of these plant parts improved, but the percentage of essential oils decreased with the progress of the plant growth, while the Glycosides content where improved with the plant aging. The production of buds is small, with dimensions as 0.5×0.5 cm, which is preferred for commercial markets, harvested every 2-3 days in quantities ranging from 0.4 to 0.5 kg in one cut/shrubs with 3 years’ age as average for the years 2021-2022. The monthly production of a shrub is between 4-5 kg per month. The productive period is 4 months approximately. This means that the seasonal production of one plant is 16-20 kg and the production of 16-20 tons per year with a plant density of 1,000 shrubs per hectare, which is the optimum rate of cultivation in the unit of mass, given the price of a kg of these buds is equivalent to 1 US $; however, this means that the annual output value of the locally produced hectare ranges from 16,000 US $ to 20,000 US $ for farmers. The results showed that it is possible to transform the cultivation of this plant from traditional random to typical areas cultivation, with a plant density of 1,000-1,100 plants per hectare according to the type of soil to obtain production of medicinal and nutritious buds, as well as, the need to pay attention to this national wealth and invest in the optimal manner, which leads to the acquisition of hard currency through export to support the national income.

Keywords: common caper, medicinal plants, propagation, medical, economic importance

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1136 Eosinopenia: Marker for Early Diagnosis of Enteric Fever

Authors: Swati Kapoor, Rajeev Upreti, Monica Mahajan, Abhaya Indrayan, Dinesh Srivastava

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Enteric Fever is caused by gram negative bacilli Salmonella typhi and paratyphi. It is associated with high morbidity and mortality worldwide. Timely initiation of treatment is a crucial step for prevention of any complications. Cultures of body fluids are diagnostic, but not always conclusive or practically feasible in most centers. Moreover, the results of cultures delay the treatment initiation. Serological tests lack diagnostic value. The blood counts can offer a promising option in diagnosis. A retrospective study to find out the relevance of leucopenia and eosinopenia was conducted on 203 culture proven enteric fever patients and 159 culture proven non-enteric fever patients in a tertiary care hospital in New Delhi. The patient details were retrieved from the electronic medical records section of the hospital. Absolute eosinopenia was considered as absolute eosinophil count (AEC) of less than 40/mm³ (normal level: 40-400/mm³) using LH-750 Beckman Coulter Automated machine. Leucopoenia was defined as total leucocyte count (TLC) of less than 4 X 10⁹/l. Blood cultures were done using BacT/ALERT FA plus automated blood culture system before first antibiotic dose was given. Case and control groups were compared using Pearson Chi square test. It was observed that absolute eosinophil count (AEC) of 0-19/mm³ was a significant finding (p < 0.001) in enteric fever patients, whereas leucopenia was not a significant finding (p=0.096). Using Receiving Operating Characteristic (ROC) curves, it was observed that patients with both AEC < 14/mm³ and TCL < 8 x 10⁹/l had 95.6% chance of being diagnosed as enteric fever and only 4.4% chance of being diagnosed as non-enteric fever. This result was highly significant with p < 0.001. This is a very useful association of AEC and TLC found in enteric fever patients of this study which can be used for the early initiation of treatment in clinically suspected enteric fever patients.

Keywords: absolute eosinopenia, absolute eosinophil count, enteric fever, leucopenia, total leucocyte count

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1135 Evaluate Effects of Different Curing Methods on Compressive Strength, Modulus of Elasticity and Durability of Concrete

Authors: Dhara Shah, Chandrakant Shah

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Construction industry utilizes plenty of water in the name of curing. Looking at the present scenario, the days are not so far when all construction industries will have to switch over to an alternative-self curing system, not only to save water for sustainable development of the environment but also to promote indoor and outdoor construction activities even in water scarce areas. At the same time, curing is essential for the development of proper strength and durability. IS 456-2000 recommends a curing period of 7 days for ordinary Portland cement concrete, and 10 to 14 days for concrete prepared using mineral admixtures or blended cements. But, being the last act in the concreting operations, it is often neglected or not fully done. Consequently, the quality of hardened concrete suffers, more so, if the freshly laid concrete gets exposed to the environmental conditions of low humidity, high wind velocity and high ambient temperature. To avoid the adverse effects of neglected or insufficient curing, which is considered a universal phenomenon, concrete technologist and research scientists have come up with curing compounds. Concrete is said to be self-cured, if it is able to retain its water content to perform chemical reaction for the development of its strength. Curing compounds are liquids which are either incorporated in concrete or sprayed directly onto concrete surfaces and which then dry to form a relatively impermeable membrane that retards the loss of moisture from the concrete. They are an efficient and cost-effective means of curing concrete and may be applied to freshly placed concrete or that which has been partially cured by some other means. However, they may affect the bond between concrete and subsequent surface treatments. Special care in the choice of a suitable compound needs to be exercised in such circumstances. Curing compounds are generally formulated from wax emulsions, chlorinated rubbers, synthetic and natural resins, and from PVA emulsions. Their effectiveness varies quite widely, depending on the material and strength of the emulsion.

Keywords: curing methods, self-curing compound, compressive strength, modulus of elasticity, durability

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1134 Supportive Group Therapy: Its Effects on Depression, Self-Esteem and Quality of Life Among Institutionalized Elderly

Authors: Hannah Patricia S., Louise Margarrette R., Josking Oliver L., Denisse Katrina C., Justine Kali O.

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Aims: In the Philippines, there has been an astronomical increase in the population of elderly sent to nursing home facilities which has been studied to induce despair and loss of self-worth. Nurses in institutionalized facilities generally care for the elderly. Although supportive group therapy has been explored to mend this psychological disparity, nursing research has limited published studies about this in the institutionalized setting. Hence, the study determined the effectiveness of supportive group therapy in depression, self-esteem and quality of life among institutionalized elderly. Methodology: A one-group pre-test-post-test design was conducted among 20-purposively selected institutionalized elderly after the Ethics Research Board approval. All eligible participants underwent the supportive group therapy after being subdivided into session groups. The Geriatric Depression Scale, which has a Cronbach’s alpha coefficient of 0.90; the Rosenberg Self-Esteem, which has a Cronbach’s alpha coefficient = 0.84; and the Older People Quality of Life, which has a Cronbach’s alpha coefficient =0.88, were utilized to measure depression, self-esteem, and quality of life, respectively. Descriptive statistics and Repeated Measures-Multivariate Analysis of Variance (RM-MANOVA) analyzed gathered data. Results: Results showed that the supportive group therapy significantly decreased post-test depression scores (F(1,19)=78.69,p=0.0001,partial η2=0.805), significantly improved post-test self-esteem score (F(1,19)=28.07,p=0.0001,partial η2=0.596), and significantly increased the post-test quality of life (F(1,19)=79.73,p=0.0001,partial η2=0.808) after the intervention has been rendered. Conclusion: Supportive group therapy is effective in alleviating depression and in improving self-esteem and quality of life among institutionalized elderly and can be utilized by nursing homes as an intervention to improve the over-all psychosocial status of elderly patients.

Keywords: supportive group therapy, institutionalized elderly, depression, self-esteem, quality of life

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1133 Exploring the Correlation between Body Constitution of an Individual as Per Ayurveda and Gut Microbiome in Healthy, Multi Ethnic Urban Population in Bangalore, India

Authors: Shalini TV, Gangadharan GG, Sriranjini S Jaideep, ASN Seshasayee, Awadhesh Pandit

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Introduction: Prakriti (body-mind constitution of an individual) is a conventional, customized and unique understanding of which is essential for the personalized medicine described in Ayurveda, Indian System of Medicine. Based on the Doshas( functional, bio humoral unit in the body), individuals are categorized into three major Prakriti- Vata, Pitta, and Kapha. The human gut microbiome hosts plenty of highly diverse and metabolically active microorganisms, mainly dominated by the bacteria, which are known to influence the physiology of an individual. Few researches have shown the correlation between the Prakriti and the biochemical parameters. In this study, an attempt was made to explore any correlation between the Prakriti (phenotype of an individual) with the Genetic makeup of the gut microbiome in healthy individuals. Materials and methods: 270 multi-ethnic, healthy volunteers of both sex with the age group between 18 to 40 years, with no history of antibiotics in the last 6 months were recruited into three groups of Vata, Pitta, and Kapha. The Prakriti of the individual was determined using Ayusoft, a software designed by CDAC, Pune, India. The volunteers were subjected to initial screening for the assessment of their height, weight, Body Mass Index, Vital signs and Blood investigations to ensure they are healthy. The stool and saliva samples of the recruited volunteers were collected as per the standard operating procedure developed, and the bacterial DNA was isolated using Qiagen kits. The extracted DNA was subjected to 16s rRNA sequencing using the Illumina kits. The sequencing libraries are targeting the variable V3 and V4 regions of the 16s rRNA gene. Paired sequencing was done on the MiSeq system and data were analyzed using the CLC Genomics workbench 11. Results: The 16s rRNA sequencing of the V3 and V4 regions showed a diverse pattern in both the oral and stool microbial DNA. The study did not reveal any specific pattern of bacterial flora amongst the Prakriti. All the p-values were more than the effective alpha values for all OTUs in both the buccal cavity and stool samples. Therefore, there was no observed significant enrichment of an OTU in the patient samples from either the buccal cavity or stool samples. Conclusion: In healthy volunteers of multi-ethnicity, due to the influence of the various factors, the correlation between the Prakriti and the gut microbiome was not seen.

Keywords: gut microbiome, ayurveda Prakriti, sequencing, multi-ethnic urban population

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1132 Solar Photovoltaic Driven Air-Conditioning for Commercial Buildings: A Case of Botswana

Authors: Taboka Motlhabane, Pradeep Sahoo

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The global demand for cooling has grown exponentially over the past century to meet economic development and social needs, accounting for approximately 10% of the global electricity consumption. As global temperatures continue to rise, the demand for cooling and heating, ventilation and air-conditioning (HVAC) equipment is set to rise with it. The increased use of HVAC equipment has significantly contributed to the growth of greenhouse gas (GHG) emissions which aid the climate crisis- one of the biggest challenges faced by the current generation. The need to address emissions caused directly by HVAC equipment and electricity generated to meet the cooling or heating demand is ever more pressing. Currently, developed countries account for the largest cooling and heating demand, however developing countries are anticipated to experience a huge increase in population growth in 10 years, resulting in a shift in energy demand. Developing countries, which are projected to account for nearly 60% of the world's GDP by 2030, are rapidly building infrastructure and economies to meet their growing needs and meet these projections. Cooling, a very energy-intensive process that can account for 20 % to 75% of a building's energy, depending on the building's use. Solar photovoltaic (PV) driven air-conditioning offers a great cost-effective alternative for adoption in both residential and non-residential buildings to offset grid electricity, particularly in countries with high irradiation, such as Botswana. This research paper explores the potential of a grid-connected solar photovoltaic vapor-compression air-conditioning system for the Peter-Smith herbarium at the Okavango Research Institute (ORI) University of Botswana campus in Maun, Botswana. The herbarium plays a critical role in the collection and preservation of botanical data, dating back over 100 years, with pristine collection from the Okavango Delta, a UNESCO world heritage site and serves as a reference and research site. Due to the herbarium’s specific needs, it operates throughout the day and year in an attempt to maintain a constant herbarium temperature of 16°?. The herbarium model studied simulates a variable-air-volume HVAC system with a system rating of 30 kW. Simulation results show that the HVAC system accounts for 68.9% of the building's total electricity at 296 509.60 kWh annually. To offset the grid electricity, a 175.1 kWp nominal power rated PV system requiring 416 modules to match the required power, covering an area of 928 m2 is used to meet the HVAC system annual needs. An economic assessment using PVsyst found that for an installation priced with average solar PV prices in Botswana totalled to be 787 090.00 BWP, with annual operating costs of 30 500 BWP/year. With self-project financing, the project is estimated to have recouped its initial investment within 6.7 years. At an estimated project lifetime of 20 years, the Net Present Value is projected at 1 565 687.00 BWP with a ROI of 198.9%, with 74 070.67 tons of CO2 saved at the end of the project lifetime. This study investigates the performance of the HVAC system to meet the indoor air comfort requirements, the annual PV system performance, and the building model has been simulated using DesignBuilder Software.

Keywords: vapor compression refrigeration, solar cooling, renewable energy, herbarium

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1131 The Economic Burden of Mental Disorders: A Systematic Review

Authors: Maria Klitgaard Christensen, Carmen Lim, Sukanta Saha, Danielle Cannon, Finley Prentis, Oleguer Plana-Ripoll, Natalie Momen, Kim Moesgaard Iburg, John J. McGrath

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Introduction: About a third of the world’s population will develop a mental disorder over their lifetime. Having a mental disorder is a huge burden in health loss and cost for the individual, but also for society because of treatment cost, production loss and caregivers’ cost. The objective of this study is to synthesize the international published literature on the economic burden of mental disorders. Methods: Systematic literature searches were conducted in the databases PubMed, Embase, Web of Science, EconLit, NHS York Database and PsychInfo using key terms for cost and mental disorders. Searches were restricted to 1980 until May 2019. The inclusion criteria were: (1) cost-of-illness studies or cost-analyses, (2) diagnosis of at least one mental disorder, (3) samples based on the general population, and (4) outcome in monetary units. 13,640 publications were screened by their title/abstract and 439 articles were full-text screened by at least two independent reviewers. 112 articles were included from the systematic searches and 31 articles from snowball searching, giving a total of 143 included articles. Results: Information about diagnosis, diagnostic criteria, sample size, age, sex, data sources, study perspective, study period, costing approach, cost categories, discount rate and production loss method and cost unit was extracted. The vast majority of the included studies were from Western countries and only a few from Africa and South America. The disorder group most often investigated was mood disorders, followed by schizophrenia and neurotic disorders. The disorder group least examined was intellectual disabilities, followed by eating disorders. The preliminary results show a substantial variety in the used perspective, methodology, costs components and outcomes in the included studies. An online tool is under development enabling the reader to explore the published information on costs by type of mental disorder, subgroups, country, methodology, and study quality. Discussion: This is the first systematic review synthesizing the economic cost of mental disorders worldwide. The paper will provide an important and comprehensive overview over the economic burden of mental disorders, and the output from this review will inform policymaking.

Keywords: cost-of-illness, health economics, mental disorders, systematic review

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1130 A Practical Approach Towards Disinfection Challenges in Sterile Manufacturing Area

Authors: Doris Lacej, Eni Bushi

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Cleaning and disinfection procedures are essential for maintaining the cleanliness status of the pharmaceutical manufacturing environment particularly of the cleanrooms and sterile unit area. The Good Manufacturing Practice (GMP) Annex 1 recommendation highly requires the implementation of the standard and validated cleaning and disinfection protocols. However, environmental monitoring has shown that even a validated cleaning method with certified agents may result in the presence of atypical microorganisms’ colony that exceeds GMP limits for a specific cleanroom area. In response to this issue, this case study aims to arrive at the root cause of the microbial contamination observed in the sterile production environment in Profarma pharmaceutical industry in Albania through applying a problem-solving practical approach that ensures the appropriate sterility grade. The guidelines and literature emphasize the importance of several factors in the prevention of possible microbial contamination occurring in cleanrooms, grade A and C. These factors are integrated into a practical framework, to identify the root cause of the presence of Aspergillus Niger colony in the sterile production environment in Profarma pharmaceutical industry in Albania. In addition, the application of a semi-automatic disinfecting system such as H2O2 FOG into sterile grade A and grade C cleanrooms has been an effective solution in eliminating the atypical colony of Aspergillus Niger. Selecting the appropriate detergents and disinfectants at the right concentration, frequency, and combination; the presence of updated and standardized guidelines for cleaning and disinfection as well as continuous training of operators on these practices in accordance with the updated GMP guidelines are some of the identified factors that influence the success of achieving sterility grade. However, to ensure environmental sustainability it is important to be prepared for identifying the source of contamination and making the appropriate decision. The proposed case-based practical approach may help pharmaceutical companies to achieve sterile production and cleanliness environmental sustainability in challenging situations. Apart from the integration of valid agents and standardized cleaning and disinfection protocols according to GMP Annex 1, pharmaceutical companies must be careful and investigate the source and all the steps that can influence the results of an abnormal situation. Subsequently apart from identifying the root cause it is important to solve the problem with a successful alternative approach.

Keywords: cleanrooms, disinfectants, environmental monitoring, GMP Annex 1

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1129 Functional Traits and Agroecosystem Multifunctionality in Summer Cover Crop Mixtures and Monocultures

Authors: Etienne Herrick

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As an economically and ecologically feasible method for farmers to introduce greater diversity into their crop rotations, cover cropping presents a valuable opportunity for improving the sustainability of food production. Planted in-between cash crop growing seasons, cover crops serve to enhance agroecosystem functioning, rather than being destined for sale or consumption. In fact, cover crops may hold the capacity to deliver multiple ecosystem functions or services simultaneously (multifunctionality). Building upon this line of research will not only benefit society at present, but also support its continued survival through its potential for restoring depleted soils and reducing the need for energy-intensive and harmful external inputs like fertilizers and pesticides. This study utilizes a trait-based approach to explore the influence of inter- and intra-specific interactions in summer cover crop mixtures and monocultures on functional trait expression and ecosystem services. Functional traits that enhance ecosystem services related to agricultural production include height, specific leaf area (SLA), root, shoot ratio, leaf C and N concentrations, and flowering phenology. Ecosystem services include biomass production, weed suppression, reduced N leaching, N recycling, and support of pollinators. Employing a trait-based approach may allow for the elucidation of mechanistic links between plant structure and resulting ecosystem service delivery. While relationships between some functional traits and the delivery of particular ecosystem services may be readily apparent through existing ecological knowledge (e.g. height positively correlating with weed suppression), this study will begin to quantify those relationships so as to gain further understanding of whether and how measurable variation in functional trait expression across cover crop mixtures and monocultures can serve as a reliable predictor of variation in the types and abundances of ecosystem services delivered. Six cover crop species, including legume, grass, and broadleaf functional types, were selected for growth in six mixtures and their component monocultures based upon the principle of trait complementarity. The tricultures (three-way mixtures) are comprised of a legume, grass, and broadleaf species, and include cowpea/sudex/buckwheat, sunnhemp/sudex/buckwheat, and chickling vetch/oat/buckwheat combinations; the dicultures contain the same legume and grass combinations as above, without the buckwheat broadleaf. By combining species with expectedly complimentary traits (for example, legumes are N suppliers and grasses are N acquirers, creating a nutrient cycling loop) the cover crop mixtures may elicit a broader range of ecosystem services than that provided by a monoculture, though trade-offs could exist. Collecting functional trait data will enable the investigation of the types of interactions driving these ecosystem service outcomes. It also allows for generalizability across a broader range of species than just those selected for this study, which may aid in informing further research efforts exploring species and ecosystem functioning, as well as on-farm management decisions.

Keywords: agroecology, cover crops, functional traits, multifunctionality, trait complementarity

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1128 The Impact of the Variation of Sky View Factor on Landscape Degree of Enclosure of Urban Blue and Green Belt

Authors: Yi-Chun Huang, Kuan-Yun Chen, Chuang-Hung Lin

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Urban Green Belt and Blue is a part of the city landscape, it is an important constituent element of the urban environment and appearance. The Hsinchu East Gate Moat is situated in the center of the city, which not only has a wealth of historical and cultural resources, but also combines the Green Belt and the Blue Belt qualities at the same time. The Moat runs more than a thousand meters through the vital Green Belt and the Blue Belt in downtown, and each section is presented in different qualities of moat from south to north. The water area and the green belt of surroundings are presented linear and banded spread. The water body and the rich diverse river banks form an urban green belt of rich layers. The watercourse with green belt design lets users have connections with blue belts in different ways; therefore, the integration of Hsinchu East Gate and moat have become one of the unique urban landscapes in Taiwan. The study is based on the fact-finding case of Hsinchu East Gate Moat where situated in northern Taiwan, to research the impact between the SVF variation of the city and spatial sequence of Urban Green Belt and Blue landscape and visual analysis by constituent cross-section, and then comparing the influence of different leaf area index – the variable ecological factors to the degree of enclosure. We proceed to survey the landscape design of open space, to measure existing structural features of the plant canopy which contain the height of plants and branches, the crown diameter, breast-height diameter through access to diagram of Geographic Information Systems (GIS) and on-the-spot actual measurement. The north and south districts of blue green belt areas are divided 20 meters into a unit from East Gate Roundabout as the epicenter, and to set up a survey points to measure the SVF above the survey points; then we proceed to quantitative analysis from the data to calculate open landscape degree of enclosure. The results can be reference for the composition of future river landscape and the practical operation for dynamic space planning of blue and green belt landscape.

Keywords: sky view factor, degree of enclosure, spatial sequence, leaf area indices

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1127 Analyzing Habits of Brushing Teeth in Yuzawa Town, Japan

Authors: Takeo Shibata, Arihito Endo, Akemi Kunimatsu, Chika Hiraga, Yoko Shimizu

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Introduction: Yuzawa Town, located in the Niigata prefecture of Japan, is famous for its hot springs. A health promotion program, Yuzawa family health plan, was initiated in 2002. It has been held for fifteen years. We evaluated the profiles of brushing teeth in adults. Subjects: 368 questionnaires were corrected from people who live in Yuzawa town. The range of age was between nineteen and sixty-four years old. Methods: Mann-Whitney’s U test and Kruskal-Wallis test were used to evaluate significant differences in frequencies of brushing teeth per a day. Chi-square test and the adjusted residuals were used to evaluate when they brush their teeth. Results: Women showed greater frequencies of brushing teeth per a day than men. No difference was shown by age. Construction workers showed fewer frequencies of brushing teeth. Specialized technicians, clerical workers, and housewives showed greater frequencies. People who know Yuzawa family health plan, take a regular life, or take a breakfast every day showed greater frequencies. People who think not healthy, don’t care a balance of foods, don’t take yearly health check-up, or smoke showed fewer frequencies. After breakfast, women and specialized technicians showed greater frequencies, and construction workers and self-employed workers showed fewer frequencies. After lunch, clerical workers and specialized technicians showed greater frequencies. There was no significant difference at after waking up, after dinner, and before going to bed. Construction workers showed a lower rate of having a marital partner and having information of health. Conclusion: Gender and occupational differences were shown in frequencies of brushing teeth per a day. A promotion of teeth brushing for male, especially construction workers and self-employed workers, is needed.

Keywords: health promotion, Yuzawa family health plan, brushing teeth, occupational difference

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1126 Mobilizing Resources for Social Entrepreneurial Opportunity: A Framework of Engagement Strategy

Authors: Balram Bhushan

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The emergence of social entrepreneurship challenges the strict categorization of not-for-profit, for-profit and hybrid organizations. Although the blurring of boundaries helps social entrepreneurial organizations (SEOs) make better use of emerging opportunities, it poses a significant challenge while mobilizing money from different sources. Additionally, for monetary resources, the legal framework of the host country may further complicate the issue by imposing strict accounting standards. Under such circumstances, the resource providers fail to recognize the suitable engagement strategy with the SEO of their choice. Based on the process of value creation and value capture, this paper develops a guiding framework for resource providers to design an appropriate mix of engagement with the identified SEOs. Essentially, social entrepreneurship creates value at the societal level, but value capture is a characteristic of an organization. Additionally, SEOs prefer value creation over value capture. The paper argued that the nature of the relationship between value creation and value capture determines the extent of blurred boundaries of the organization. Accordingly, synergistic, antagonistic and sequential relationships were proposed between value capture and value creation. When value creation is synergistically associated with value creation, the preferred nature of such action falls within the nature of for-profit organizations within the strictest legal framework. Banks offering micro-loans are good examples of this category. Opposite to this, the antagonist relationship between value creation and value capture, where value capture opportunities are sacrificed for value creation, dictates non-profit organizational structure. Examples of this category include non-government organizations and charity organizations. Finally, the sequential relationship between value capture opportunities is followed for value creation opportunities and guides the action closer to the hybrid structure. Examples of this category include organizations where a non-for-profit unit controls for-profit units of the organization either legally or structurally. As an SEO may attempt to utilize multiple entrepreneurial opportunities falling across any of the three relationships between value creation and value capture, the resource providers need to evaluate an appropriate mix of these relationships before designing their engagement strategies. The paper suggests three guiding principles for the engagement strategy. First, the extent of investment should be proportional to the synergistic relationship between value capture and value creation. Second, the subsidized support should be proportional to the sequential relationship. Finally, the funding (charity contribution) should be proportional to the antagonistic relationship. Finally, the resource providers are needed to keep a close watch on the evolving relationship between value creation and value capture for introducing appropriate changes in their engagement strategy.

Keywords: social entrepreneurship, value creation, value capture, entrepreneurial opportunity

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1125 Effects of Bilateral Electroconvulsive Therapy on Autobiographical Memories in Asian Patients

Authors: Lai Gwen Chan, Yining Ong, Audrey Yoke Poh Wong

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Background. The efficacy of electroconvulsive therapy (ECT) as a form of treatment to a range of mental disorders is well-established. However, ECT is often associated with either temporary or persistent cognitive side-effects, resulting in the failure of wider prescription. Of which, retrograde amnesia is the most commonly reported cognitive side-effect. Most studies found a recalling deficit in autobiographical memories to be short-term, although a few have reported more persistent amnesic effects. Little is known about ECT-related amnesic effects in Asian population. Hence, this study aims to resolve conflicting findings, as well as to better elucidate the effects of ECT on cognitive functioning in a local sample. Method: 12 patients underwent bilateral ECT under the care of Psychological Medicine Department, Tan Tock Seng Hospital, Singapore. Participants’ cognition and level of functioning were assessed at four time-points: before ECT, between the third and fourth induced seizure, at the end of the whole course of ECT, and two months after the index course of ECT. Results: It was found that Global Assessment of Functioning scores increased significantly at the completion of ECT. Case-by-case analyses also revealed an overall improvement in Personal Semantic and Autobiographical memory two months after the index course of ECT. A transient dip in both personal semantic and autobiographical memory scores was observed in one participant between the third and fourth induced seizure, but subsequently resolved and showed better performance than at baseline. Conclusions: The findings of this study suggest that ECT is an effective form of treatment to alleviate the severity of symptoms of the diagnosis. ECT does not affect attention, language, executive functioning, personal semantic and autobiographical memory adversely. The findings suggest that Asian patients may respond to bilateral ECT differently from Western samples.

Keywords: electroconvulsive therapy (ECT), autobiographical memory, cognitive impairment, psychiatric disorder

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1124 Harnessing Community Benefits; Case Study of REDD+ in Ghana

Authors: Abdul-Razak Saeed

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Addressing the climate change crisis that this generation faces has evolved to include the consideration of a policy mechanism referred to as reduced emissions from deforestation and forest degradation with plus components of conservation, sustainable forest management and enhancement of forest carbon stocks (REDD+). REDD+ emerged from the International level of UNFCCC but its implementation is by developing countries. It challenges the development paradigm of nations that depend on the unsustainable clearing of forests and land use change for economic development whilst posing as an opportunity or risk for forest community livelihoods, institutions and their interaction with the forest resources. As a novel policy mechanism, it is imperative to gain global insight into local contexts of its implementation and to understand local level mobilization of their agency for institutional sustainability as reconfigured by new carbon economy initiatives like REDD+. Using a systematic review process, as the initial stages of this study, secondary data of REDD+ projects across the globe were evaluated to pick up gaps in research and that of on ground REDD+ implementation. Primary data was gathered from 30 actors in the government, NGO, private sector and traditional authorities using face-to-face semi structured interviews in Ghana; participation in meetings and workshops and policy and strategy document reviews. Preliminary findings of the study include REDD+ knowledge being a key determinant of power distribution and affects who shapes the process; in Ghana, informal relationships are playing key roles in advancing REDD+ unlike in traditional forestry and a subjectivity shift of local communities from an 'emotive-link' of environmental care to one of 'economic self-seeking and enriching' domain of thought.

Keywords: climate change, communities, forests, REDD+

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1123 Studies on Space-Based Laser Targeting System for the Removal of Orbital Space Debris

Authors: Krima M. Rohela, Raja Sabarinath Sundaralingam

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Humans have been launching rockets since the beginning of the space age in the late 1950s. We have come a long way since then, and the success rate for the launch of rockets has increased considerably. With every successful launch, there is a large amount of junk or debris which is released into the upper layers of the atmosphere. Space debris has been a huge concern for a very long time now. This includes the rocket shells released from the launch and the parts of defunct satellites. Some of this junk will come to fall towards the Earth and burn in the atmosphere. But most of the junk goes into orbit around the Earth, and they remain in orbits for at least 100 years. This can cause a lot of problems to other functioning satellites and may affect the future manned missions to space. The main concern of the space-debris is the increase in space activities, which leads to risks of collisions if not taken care of soon. These collisions may result in what is known as Kessler Syndrome. This debris can be removed by a space-based laser targeting system. Hence, the matter is investigated and discussed. The first step in this involves launching a satellite with a high-power laser device into space, above the debris belt. Then the target material is ablated with a focussed laser beam. This step of the process is highly dependent on the attitude and orientation of the debris with respect to the Earth and the device. The laser beam will cause a jet of vapour and plasma to be expelled from the material. Hence, the force is applied in the opposite direction, and in accordance with Newton’s third law of motion, this will cause the material to move towards the Earth and get pulled down due to gravity, where it will get disintegrated in the upper layers of the atmosphere. The larger pieces of the debris can be directed towards the oceans. This method of removal of the orbital debris will enable safer passage for future human-crewed missions into space.

Keywords: altitude, Kessler syndrome, laser ablation, Newton’s third law of motion, satellites, Space debris

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1122 Study of the Hydrodynamic of Electrochemical Ion Pumping for Lithium Recovery

Authors: Maria Sofia Palagonia, Doriano Brogioli, Fabio La Mantia

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In the last decade, lithium has become an important raw material in various sectors, in particular for rechargeable batteries. Its production is expected to grow more and more in the future, especially for mobile energy storage and electromobility. Until now it is mostly produced by the evaporation of water from salt lakes, which led to a huge water consumption, a large amount of waste produced and a strong environmental impact. A new, clean and faster electrochemical technique to recover lithium has been recently proposed: electrochemical ion pumping. It consists in capturing lithium ions from a feed solution by intercalation in a lithium-selective material, followed by releasing them into a recovery solution; both steps are driven by the passage of a current. In this work, a new configuration of the electrochemical cell is presented, used to study and optimize the process of the intercalation of lithium ions through the hydrodynamic condition. Lithium Manganese Oxide (LiMn₂O₄) was used as a cathode to intercalate lithium ions selectively during the reduction, while Nickel Hexacyano Ferrate (NiHCF), used as an anode, releases positive ion. The effect of hydrodynamics on the process has been studied by conducting the experiments at various fluxes of the electrolyte through the electrodes, in terms of charge circulated through the cell, captured lithium per unit mass of material and overvoltage. The result shows that flowing the electrolyte inside the cell improves the lithium capture, in particular at low lithium concentration. Indeed, in Atacama feed solution, at 40 mM of lithium, the amount of lithium captured does not increase considerably with the flux of the electrolyte. Instead, when the concentration of the lithium ions is 5 mM, the amount of captured lithium in a single capture cycle increases by increasing the flux, thus leading to the conclusion that the slowest step in the process is the transport of the lithium ion in the liquid phase. Furthermore, an influence of the concentration of other cations in solution on the process performance was observed. In particular, the capturing of the lithium using a different concentration of NaCl together with 5 mM of LiCl was performed, and the results show that the presence of NaCl limits the amount of the captured lithium. Further studies can be performed in order to understand why the full capacity of the material is not reached at the highest flow rate. This is probably due to the porous structure of the material since the liquid phase is likely not affected by the convection flow inside the pores. This work proves that electrochemical ion pumping, with a suitable hydrodynamic design, enables the recovery of lithium from feed solutions at the lower concentration than the sources that are currently exploited, down to 1 mM.

Keywords: desalination battery, electrochemical ion pumping, hydrodynamic, lithium

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1121 Experimental Study Analyzing the Similarity Theory Formulations for the Effect of Aerodynamic Roughness Length on Turbulence Length Scales in the Atmospheric Surface Layer

Authors: Matthew J. Emes, Azadeh Jafari, Maziar Arjomandi

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Velocity fluctuations of shear-generated turbulence are largest in the atmospheric surface layer (ASL) of nominal 100 m depth, which can lead to dynamic effects such as galloping and flutter on small physical structures on the ground when the turbulence length scales and characteristic length of the physical structure are the same order of magnitude. Turbulence length scales are a measure of the average sizes of the energy-containing eddies that are widely estimated using two-point cross-correlation analysis to convert the temporal lag to a separation distance using Taylor’s hypothesis that the convection velocity is equal to the mean velocity at the corresponding height. Profiles of turbulence length scales in the neutrally-stratified ASL, as predicted by Monin-Obukhov similarity theory in Engineering Sciences Data Unit (ESDU) 85020 for single-point data and ESDU 86010 for two-point correlations, are largely dependent on the aerodynamic roughness length. Field measurements have shown that longitudinal turbulence length scales show significant regional variation, whereas length scales of the vertical component show consistent Obukhov scaling from site to site because of the absence of low-frequency components. Hence, the objective of this experimental study is to compare the similarity theory relationships between the turbulence length scales and aerodynamic roughness length with those calculated using the autocorrelations and cross-correlations of field measurement velocity data at two sites: the Surface Layer Turbulence and Environmental Science Test (SLTEST) facility in a desert ASL in Dugway, Utah, USA and the Commonwealth Scientific and Industrial Research Organisation (CSIRO) wind tower in a rural ASL in Jemalong, NSW, Australia. The results indicate that the longitudinal turbulence length scales increase with increasing aerodynamic roughness length, as opposed to the relationships derived by similarity theory correlations in ESDU models. However, the ratio of the turbulence length scales in the lateral and vertical directions to the longitudinal length scales is relatively independent of surface roughness, showing consistent inner-scaling between the two sites and the ESDU correlations. Further, the diurnal variation of wind velocity due to changes in atmospheric stability conditions has a significant effect on the turbulence structure of the energy-containing eddies in the lower ASL.

Keywords: aerodynamic roughness length, atmospheric surface layer, similarity theory, turbulence length scales

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1120 Optimising Participation in Physical Activity Research for Adults with Intellectual Disabilities

Authors: Yetunde M. Dairo, Johnny Collett, Helen Dawes

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Background and Aim: Engagement with physical activity (PA) research is poor among adults with intellectual disabilities (ID), particularly in those from residential homes. This study explored why, by asking managers of residential homes, adults with ID and their carers. Methods: Participants: A convenient sample of 23 individuals from two UK local authorities, including a group of ID residential home managers, adults with ID and their support staff. Procedures: A) Residential home managers (n=6) were asked questions about their willingness to allow their residents to participate in PA research; B) eleven adults with ID and their support workers (n=6) were asked questions about their willingness to accept 7-day accelerometer monitoring and/or the International Physical Activity Questionnaire-short version (IPAQ-s) as PA measures. The IPAQ-s was administered by the researcher and they were each provided with samples of accelerometers to try on. Results: A) Five out of six managers said that the burden of wearing the accelerometer for seven days would be too high for the people they support, the majority of whom might be unable to express their wishes. They also said they would be unwilling to act as proxy respondents for the same reason. Additionally, they cited time pressure, understaffing, and reluctance to spend time on the research paperwork as further reasons for non-participation. B) All 11 individuals with ID completed the IPAQ-s while only three accepted the accelerometer, one of whom was deemed inappropriate to wear it. Reasons for rejecting accelerometers included statements from participants of: ‘too expensive’, ‘too heavy’, ‘uncomfortable’, and two people said they would not want to wear it for more than one day. All adults with ID (11) and their support workers (6) provided information about their physical activity levels through the IPAQ-s. Conclusions: Care home managers are a barrier to research participation. However, adults with ID would be happy for the IPAQ-s as a PA measure, but less so for the 7-day accelerometer monitoring. In order to improve participation in this population, the choice of PA measure is considered important. Moreover, there is a need for studies exploring how best to engage ID residential home managers in PA research.

Keywords: intellectual disability, physical activity measurement, research engagement, research participation

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1119 Supply Side Barriers to Maternal Health Care Utilization in District Gwadar, Balochistan

Authors: Changaiz Khan

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Pakistan has the highest rates of maternal mortality in South Asia. From the year 2000 to 2017 the global rate of maternal mortality has decreased up to 39 %. In the context of South Asia, it has decreased by 59% since 2000s. Pakistan has also reduced the rate of maternal mortality, but there is a difference on the provincial level. According to the report of the National Institute of Population Studies (NIPS) conducted in 2020, the MMR in Balochistan has crossed the ratio of most of the South Asian countries, i.e., 298 maternal deaths per 100,000 live births. In comparison, the province of Punjab has the lowest maternal mortality rate i.e. 157 deaths (per 100,000 live births). The rate of maternal mortality is much higher in Balochistan as compared to the other provinces. This research is aimed to discuss the supply side barriers and utilization of maternal healthcare services in the District Gwadar. Likert scale survey method has been used to collect data from the Healthcare Professionals from hospitals -private and government- and the maternal healthcare receiver, that is patient. Semi-structured interviews of healthcare professionals such as doctors, nurses, and Lab technicians have also been conducted. It has been found in this research study that the hospitals in Gwadar district are lagging behind in providing modern maternal healthcare to women due to the lack of staff training, medicine supply, and Laboratories. Moreover, the system of the lady health worker is also not catering to the needs of the women in District Gwadar. It has been recommended in the study that first of all the government should fulfill the supply of the medicine in the hospital. Secondly, the government should open laboratories in the hospitals. Thirdly, the government should increase the funding of the government hospital and the allocation of lady health workers in District Gwadar, Balochistan should be increased.

Keywords: maternal mortality, neonatal, postnatal, supply barriers, patients, healthcare professionals, laboratory, medical supply, training

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1118 Organisational Culture and the Role of the Mental Health Nurse: An Ethnography of the New Graduate Nurse Experience

Authors: Mary-Ellen Hooper, Graeme Browne, Anthony Paul O'Brien

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Background: It has been reported that the experience of the organisational workplace culture for new graduate mental health nurses plays an important role in their attraction and retention to the discipline. Additionally, other research indicates that a negative workplace culture contributes to their dissatisfaction and attrition rate. Method: An ethnographic research design was applied to explore the subcultural experiences of new graduate nurses as they encounter mental health nursing. Data was collected between April and September 2017 across 6 separate Australian, NSW, mental health units. Data comprised of semi-structured interviews (n=24) and 31 episodes of field observation (62 hours). A total number of 26 new graduate and recent graduate nurses participated in the study – 14 new graduate nurses and 12 recently graduated nurses. Results: A key finding from this study was the New Graduate difficulty in articulating the role the of mental health nurse. Participants described a dichotomy between their ideological view of the mental health nurse and the reality of clinical practice. The participants’ ideological view of the mental health nurse involved providing holistic and individualised care within a flexible framework. Participants, however, described feeling powerless to change the recovery practices within the mental health service(s) because of their low status within the hierarchy. Resulting in participants choosing to fit into the existing culture, or considering leaving the field altogether. Conclusion: An incongruence between the values and ideals of an organisational culture and the reality shock of practice are shown to contribute to role ambiguity within its members. New graduate nurses entering the culture of mental health nursing describe role ambiguity resulting in dissatisfaction with practice. The culture and philosophy inherent to a service are posited to be crucial in creating positive experiences for graduate nurses.

Keywords: culture, mental health nurse, mental health nursing role, new graduate nurse

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1117 Analysis of Eco-Efficiency and the Determinants of Family Agriculture in Southeast Spain

Authors: Emilio Galdeano-Gómez, Ángeles Godoy-Durán, Juan C. Pérez-Mesa, Laura Piedra-Muñoz

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Eco-efficiency is receiving ever-increasing interest as an indicator of sustainability, as it links environmental and economic performances in productive activities. In agriculture, these indicators and their determinants prove relevant due to the close relationships in this activity between the use of natural resources, which is generally limited, and the provision of basic goods to society. In this context, various analyses have focused on eco-efficiency by considering individual family farms as the basic production unit. However, not only must the measure of efficiency be taken into account, but also the existence of a series of factors which constitute socio-economic, political-institutional, and environmental determinants. Said factors have been studied to a lesser extent in the literature. The present work analyzes eco-efficiency at a micro level, focusing on small-scale family farms as the main decision-making units in horticulture in southeast Spain, a sector which represents about 30% of the fresh vegetables produced in the country and about 20% of those consumed in Europe. The objectives of this study are a) to obtain a series of eco-efficiency indicators by estimating several pressure ratios and economic value added in farming, b) to analyze the influence of specific social, economic and environmental variables on the aforementioned eco-efficiency indicators. The present work applies the method of Data Envelopment Analysis (DEA), which calculates different combinations of environmental pressures (water usage, phytosanitary contamination, waste management, etc.) and aggregate economic value. In a second stage, an analysis is conducted on the influence of the socio-economic and environmental characteristics of family farms on the eco-efficiency indicators, as endogeneous variables, through the use of truncated regression and bootstrapping techniques, following Simar-Wilson methodology. The results reveal considerable inefficiency in aspects such as waste management, while there is relatively little inefficiency in water usage and nitrogen balance. On the other hand, characteristics, such as product specialization, the adoption of quality certifications and belonging to a cooperative do have a positive impact on eco-efficiency. These results are deemed to be of interest to agri-food systems structured on small-scale producers, and they may prove useful to policy-makers as regards managing public environmental programs in agriculture.

Keywords: data envelopment analysis, eco-efficiency, family farms, horticulture, socioeconomic features

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1116 The Importance of Value Added Services Provided by Science and Technology Parks to Boost Entrepreneurship Ecosystem in Turkey

Authors: Faruk Inaltekin, Imran Gurakan

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This paper will aim to discuss the importance of value-added services provided by Science and Technology Parks for entrepreneurship development in Turkey. Entrepreneurship is vital subject for all countries. It has not only fostered economic development but also promoted innovation at local and international levels. To foster high tech entrepreneurship ecosystem, Technopark (Science and Technology Park/STP) concept was initiated with the establishment of Silicon Valley in the 1950s. The success and rise of Silicon Valley led to the spread of technopark activities. Developed economies have been setting up projects to plan and build STPs since the 1960s and 1970s. To promote the establishment of STPs, necessary legislations were made by Ministry of Science, Industry, and Technology in 2001, Technology Development Zones Law (No. 4691) and it has been revised in 2016 to provide more supports. STPs’ basic aim is to provide customers high-quality office spaces with various 'value added services' such as business development, network connections, cooperation programs, investor/customers meetings and internationalization services. For this aim, STPs should help startups deal with difficulties in the early stages and to support mature companies’ export activities in the foreign market. STPs should support the production, commercialization and more significantly internationalization of technology-intensive business and foster growth of companies. Nowadays within this value-added services, internationalization is very popular subject in the world. Most of STPs design clusters or accelerator programs in order to support their companies in the foreign market penetration. If startups are not ready for international competition, STPs should help them to get ready for foreign market with training and mentoring sessions. These training and mentoring sessions should take a goal based approach to working with companies. Each company has different needs and goals. Therefore the definition of ‘success' varies for each company. For this reason, it is very important to create customized value added services to meet the needs of startups. After local supports, STPs should also be able to support their startups in foreign market. Organizing well defined international accelerator program plays an important role in this mission. Turkey is strategically placed between key markets in Europe, Russia, Central Asia and the Middle East. Its population is young and well educated. So both government agencies and the private sectors endeavor to foster and encourage entrepreneurship ecosystem with many supports. In sum, the task of technoparks with these and similar value added services is very important for developing entrepreneurship ecosystem. The priorities of all value added services are to identify the commercialization and growth obstacles faced by entrepreneurs and get rid of them with the one-to-one customized services. Also, in order to have a healthy startup ecosystem and create sustainable entrepreneurship, stakeholders (technoparks, incubators, accelerators, investors, universities, governmental organizations etc.) should fulfill their roles and/or duties and collaborate with each other. STPs play an important role as bridge for these stakeholders & entrepreneurs. STPs always should benchmark and renew services offered to how to help the start-ups to survive, develop their business and benefit from these stakeholders.

Keywords: accelerator, cluster, entrepreneurship, startup, technopark, value added services

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1115 Health Literacy and Knowledge Related to Tuberculosis among Outpatients at a Referral Hospital in Lima, Peru

Authors: Rosalina Penaloza, Joanna Navarro, Pauline Jolly, Anna Junkins, Carlos Seas, Larissa Otero

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Background: Tuberculosis (TB) case detection in Peru relies on passive case finding. This strategy relies on the assumption that the community is aware that a persistent cough is a possible symptom of TB and that formal health care needs to be sought. Despite its importance, health knowledge specific to TB is underexplored in Peru. This study aimed to assess health literacy and level of TB knowledge among outpatients attending a referral hospital in Lima, Peru. The goal was to ascertain knowledge gaps in key areas relating to TB, to identify and prioritize subgroups for intervention, and to provide insight for policy and community interventions considering health literacy. Methods: An observational cross-sectional study was conducted using a survey to measure sociodemographic factors, tuberculosis knowledge, and health literacy. Bivariate and Multivariate logistic regression was performed to study the associations between variables and to account for potential confounders. The study was conducted at Hospital Cayetano Heredia in Lima, Peru from June – August 2017. Results: 272 participants were included in the analysis. 57.7% knew someone who had had TB before, 9% had had TB in the past. Two weeks a cough was correctly identified as a symptom that could be TB by 69.1%. High TB knowledge was found among 149 (54.8%) participants. High health literacy was found among 193 (71.0%) participants. Health literacy and TB knowledge were not significantly associated (OR 0.9 (95%CI 0.5-1.5)). After controlling for sex, age, district, education, health insurance, frequency of hospital visits and previous TB diagnosis: High TB knowledge was associated with knowing someone with TB (aOR 2.7 (95%CI 1.6-4.7)) and being a public transport driver, (aOR 0.2 (95%CI 0.05-0.9)). Not being poor was the single factor associated with high health literacy (aOR 3.8 (95%CI 1.6-8.9)). Conclusions: TB knowledge was fair, though 30% did not know the most important symptom of TB. Tailoring educational strategies to risk groups may enhance passive case detection especially amongst transport workers in Lima, Peru.

Keywords: health literacy, Peru, tuberculosis, tuberculosis knowledge

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