Search results for: enthalpy change

Authors: Rasha Elhawari

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Heritage language learners (HLL) are part of the linguistic reality in Foreign Language Learning (FLL). These learners present several characteristics that are different from non-heritage language learners. They have a personal connection with the language and their motivation to learn the language is partly because of this personal connection. In Canada there is a large diversity in the foreign language learning classroom; the Arabic language classroom is no exception. The Arabic HLL is unique for more than one reason. First, is the fact that the Arabic language is spoken across twenty-two Arab countries across the Arab World. Across the Arab World there is a standard variation and a local dialect that co-exist side by side, i.e. diaglossia exists in a strong and unique way as a feature of Arabic. Second, Arabic is the language that all Muslims across the Muslim World use for their prayers. This raises a number of points when we consider Arabic as a Heritage Language; namely the role of diaglossia, culture and religion. The fact that there is a group of leaners that can be regarded as HLL who are not of Arabic speaking background but are Muslims and use the language for religious purposes is unique, thus course developers and language instructors need take this into consideration. The paper takes a closer look at this distinction and establishes sub-groups the Arabic HLLs in a language and/or culture specific way related mainly to the Arabic HLL. It looks at the learners at the beginners’ Arabic class at the undergraduate university level over a period of three years in order to define this learner. Learners belong to different groups and backgrounds but they all share common characteristics. The paper presents a detailed look at the learner types present at this class in order to help prepare and develop material for this specific learner group. The paper shows that separate HLL and non-HLL courses, especially at the introductory and intermediate level, is successful in resolving some of the pedagogical problems that occur in the Arabic as a Foreign Language classroom. In conclusion, the paper recommends the development of HLL courses at the early levels of language learning. It calls for a change in the pedagogical practices to overcome some of the challenges learner in the introductory Arabic class can face.

Keywords: Arabic, Heritage Language, langauge learner, teaching

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Authors: Dona Ghosh, Zakir Husain

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In India, the increase in share of aged has generated many social and economic issues, of which health concerns is a major challenge that society must confront in coming years. Self-reported health (SRH) is a popular health measure in this regard but has been questioned in recent years due to its heavy dependence on the socioeconomic status. So, the validity of SRH, as a measure of health status during old age, is needed to be verified. This paper emphasizes on the self-reported health and related inconsistent responses among elderly in India. The objective of the study is bifurcated into two parts: firstly, to identify the socioeconomic determinants of subjective health status and its change over time; and secondly, to analyse the role of the socioeconomic components in providing inconsistent responses regarding the health status of elderly. Inconsistency in response can rise in two ways: positive response bias (if an individual has a health problem but reports his/her health as good) and negative response bias (if bad health is reported even if there is no health problem). However, in the present study, we focus only on the negative response bias of elderly individuals. To measure the inconsistencies in responses, self-reported health is compared with two types of physical health conditions – existence of chronicle ailment and physical immobility. Using NSS dataset of 60th and 71st rounds, the study found that subjective health has worsened over time in both rural and urban areas. Findings suggest that inconsistency in responses, related to chronic ailment, vary across social classes, living environments, geographical regions, age groups and education levels. On the contrary, variation in inconsistent responses regarding physical mobility is quite rare and difficult to explain by socioeconomic characteristics because most of the indicators are found to be insignificant in this regard. The findings indicate that in case of chronicle ailment, inconsistency between objective and subjective health status largely depends on socioeconomic conditions but the importance of such factors disappears for physical immobility.

Keywords: India, aging, self-reported health, inconsistent responses

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Authors: Mohammed Sghir Taleb

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Introduction The date palm (Phoenix dactylifera L.) represents an essential element of the oasis ecosystem for Saharan and pre-Saharan regions of Morocco. It plays an important role, not only due to its economic importance, but also its ecological adaptation to, firstly, to ensure necessary protection for crops against underlying warm and dry sales, and secondly to contribute to the fight against desertification. This is one of the oldest cultivated plant species best adapted to difficult climatic conditions of the Saharan and pre-Saharan regions, because of its ecological requirements and economically most suitable for investing in oasis agriculture. Methodology The methodology is mainly based on a literature review of principal theses and projects for the conservation of flora and vegetation. Results The date palm has multiple uses. Indeed, it produces fruits rich in nutrients, provides a multitude of secondary products and generates needed revenue for the survival of oasis populations. In Morocco, the development and modernization of the date palm sector face, both upstream and downstream of the industry, several major constraints. In addition to climate constraints (prolonged drought), in its environment (lack of water resources), to the incessant invasion of disease Bayoud, Moroccan palm ecosystem suffers from a low level of technical and traditional practices prevail and traditional, from the choice of variety and site preparation up to harvesting and recycling of products. Conclusion The date palm plays an important role in the socioeconomic development of local and national level. However, this ecosystem however, is subject to numerous degradation factors caused by anthropogenic action and climate change. to reverse the trends, several programs have been developed by Morocco for the restoration of degraded areas and the development of the Phoenix dactylifera ecosystem to meet the needs of local populations and the development of the national economy.

Keywords: efforts, flora, ecosystem, forest, conservation, Morocco

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Authors: Laurie U. deBettencourt

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During pre-service field experiences teacher candidates are often asked to reflect as part of their training and in this investigation candidates’ reflective journal entries were reviewed, coded and analyzed with results suggesting teacher candidates need more direct instruction on how to describe, analyze, and make judgements on their instructional practices so that their practices improve over time. Teacher education programs often incorporate reflective-based activities during field experiences. The purpose of this investigation was to determine if special education teacher candidate’s reflective practices changed as they completed their two supervised field experiences and to determine what topics the candidates focused on in their reflections. The six females graduate students were completing two field experiences in special education classrooms within one academic year as part of their coursework leading to a master’s degree and special education teacher state certification. Each candidate wrote 15 reflection journal entries (approximately 200 words each) per field experience. Each of the journal entries were reviewed sentence by sentence to determine a reflective practice score and to determine the topics discussed. The reflective practice score was calculated using four dimensions of reflection (describe, analyze, judge, and apply) in order to create a continuous variable representing their reflective practice across four points of time. A One-way Repeated Measures Analysis of Variance (ANOVA) suggested that special education teacher candidates did not change their reflective practices over time (i.e., at time-point one the practitioner’s mean score was 56.0 out of 100 (SD = 7.6), 53.8 (SD = 4.3) at time-point two, 51.2 (SD = 4.5) at time-point three, and 57.7 (SD = 8.2) at time-point four). Qualitative findings suggest candidates focused mostly on themselves in their reflections. Conclusions suggest the need for teacher preparation programs to provide more direct instruction on how a teacher should reflect. Specific implications are provided for teacher training and future research.

Keywords: field experiences, reflective practices, special educators, teacher preparation

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Authors: Selim Kara, Ertan Arda, Fahrettin Dolastir, Önder Pekcan

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Biomaterials and thin film coatings play a fundamental role in medical, food and pharmaceutical industries. Carrageenan is a linear sulfated polysaccharide extracted from algae and seaweeds. To date, such biomaterials have been used in many smart drug delivery systems due to their biocompatibility and antimicrobial activity properties. Poly (N-isopropylacrylamide) (PNIPAm) gels and copolymers have also been used in medical applications. PNIPAm shows lower critical solution temperature (LCST) property at about 32-34 °C which is very close to the human body temperature. Below and above the LCST point, PNIPAm gels exhibit distinct phase transitions between swollen and collapsed states. A special class of gels are microgels which can react to environmental changes significantly faster than microgels due to their small sizes. Quartz crystal microbalance (QCM) measurement technique is one of the attractive techniques which has been used for monitoring the thin-film formation process. A sensitive QCM system was designed as to detect 0.1 Hz difference in resonance frequency and 10-7 change in energy dissipation values, which are the measures of the deposited mass and the film rigidity, respectively. PNIPAm microgels with the diameter around few hundred nanometers in water were produced via precipitation polymerization process. 5 MHz quartz crystals with functionalized gold surfaces were used for the deposition of the carrageenan molecules and microgels in the solutions which were slowly pumped through a flow cell. Interactions between charged carrageenan and microgel particles were monitored during the formation of the film layers, and the Sauerbrey masses of the deposited films were calculated. The critical phase transition temperatures around the LCST were detected during the heating and cooling cycles. It was shown that it is possible to monitor the interactions between PNIPAm microgels and biopolymer molecules, and it is also possible to specify the critical phase transition temperatures by using a QCM system.

Keywords: carrageenan, phase transitions, PNIPAm microgels, quartz crystal microbalance (QCM)

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Authors: D. O. Ramadan, R. S. Dwyer-Joyce

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The measurement of the interface conditions in a cutting tool contact is essential information for performance monitoring and control. This interface provides the path for the heat flux to the cutting tool. This elevate in the cutting tool temperature leads to motivate the mechanism of tool wear, thus affect the life of the cutting tool and the productivity. This zone is representative by the tool-chip interface. Therefore, understanding and monitoring this interface is considered an important issue in machining. In this paper, an acoustic emission (AE) technique was used to find the correlation between AE parameters and the tool-chip interface. For this reason, a response surface design (RSD) has been used to analyse and optimize the machining parameters. The experiment design was based on the face centered, central composite design (CCD) in the Minitab environment. According to this design, a series of orthogonal cutting experiments for different cutting conditions were conducted on a Triumph 2500 lathe machine to study the sensitivity of the acoustic emission (AE) signal to change in tool-chip contact length. The cutting parameters investigated were the cutting speed, depth of cut, and feed and the experiments were performed for 6082-T6 aluminium tube. All the orthogonal cutting experiments were conducted unlubricated. The tool-chip contact area was investigated using a scanning electron microscope (SEM). The results obtained in this paper indicate that there is a strong dependence of the root mean square (RMS) on the cutting speed, where the RMS increases with increasing the cutting speed. A dependence on the tool-chip contact length has been also observed. However there was no effect observed of changing the cutting depth and feed on the RMS. These dependencies have been clarified in terms of the strain and temperature in the primary and secondary shear zones, also the tool-chip sticking and sliding phenomenon and the effect of these mechanical variables on dislocation activity at high strain rates. In conclusion, the acoustic emission technique has the potential to monitor in situ the tool-chip interface in turning and consequently could indicate the approaching end of life of a cutting tool.

Keywords: Acoustic emission, tool-chip interface, orthogonal cutting, monitoring

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Authors: Ramesh Bhat, Ammu Somanath, A. K. Nayanatara

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Background: The increasing prevalence of overweight and obesity is a critical public health problem for women. The negative effect of stress on memory and cognitive functions has been widely explored for decades in numerous research projects using a wide range of methodology. Deterioration of memory and other brain functions are hallmarks of Alzheimer’s disease. Estrogen fluctuations and withdrawal have myriad direct effects on the central nervous system that have the potential to influence cognitive functions. Aim: The present study aims to compare the effect of stress on the cognitive functions in overweight/obese women before and after menopause. Material and Methods: A total of 142 female subjects constituting women before menopause between the age group of 18–44 years and women after menopause between the age group of 45–60 years were included in the sample. Participants were categorized into overweight/obese groups based on the body mass index. The Perceived Stress Scale (PSS) the major tool was used for measuring the perception of stress. Based on the stress scale measurement each group was classified into with stress and without stress. Addenbrooke’s cognitive Examination-III was used for measuring the cognitive functions. Results: Premenopausal women with stress showed a significant (P<0.05) decrease in the cognitive parameters such as attention and orientation Fluency, language and visuospatial ability. Memory did not show any significant change in this group. Whereas, in the postmenopausal stressed women all the cognitive functions except fluency showed a significant (P<0.05) decrease after menopause stressed group. Conclusion: Stress is a significant factor on the cognitive functions of obese and overweight women before and after menopause. Practice of Yoga, Encouragement in activities like gardening, embroidery, games and relaxation techniques should be recommended to prevent stress. Insights into the neurobiology before and after menopause can be gained from future studies examining the effect on the HPA axis in relation to cognition and stress.

Keywords: cognition, stress, premenopausal, body mass index

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Authors: Aashutosh A. Tadse, Kush Mehta, Hardik Vyas

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Friction Stir Welding is a process in which an FSW tool produces friction heat and thus penetrates through the junction and upon rotation carries out the weld by exchange of material within the 2 metals being welded. It involves holding the workpieces stiff enough to bear the force of the tool moving across the junction to carry out a successful weld. The weld that has flat plates as workpieces, has a quite simpler geometry in terms of fixture holding them. In the case of FSW of pipes, the pipes need to be held firm with the chucks and jaws according to the diameter of the pipes being welded; the FSW tool is then revolved around the pipes to carry out the weld. Machine requires a larger area and it becomes more costly because of such a setup. To carry out the weld on the Milling machine, the newly designed fixture must be set-up on the table of milling machine and must facilitate rotation of pipes by the motor being shafted to one end of the fixture, and the other end automatically rotated because of the rotating jaws held tight enough with the pipes. The set-up has tapered cones as the jaws that would go in the pipes thus holding it with the help of its knurled surface providing the required grip. The process has rotation of pipes with the stationary rotating tool penetrating into the junction. The FSW on pipes in this process requires a very low RPM of pipes to carry out a fine weld and the speed shall change with every combination of material and diameter of pipes, so a variable speed setting motor shall serve the purpose. To withstand the force of the tool, an attachment to the shaft is provided which will be diameter specific that will resist flow of material towards the center during the weld. The welded joint thus carried out will be proper to required standards and specifications. Current industrial requirements state the need of space efficient, cost-friendly and more generalized form of fixtures and set-ups of machines to be put up. The proposed design considers every mentioned factor and thus proves to be positive in the same.

Keywords: force of tool, friction stir welding, milling machine, rotation of pipes, tapered cones

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Authors: Yulna Yulnafatmawita, Syafrimen Yasin, Lusi Maira

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Irrigation source is one of the factors affecting physical properties of rice field. This research was aimed to determine the impact of polluted irrigation wáter on soil physical properties of rice field. The study site was located in Koto Nan IV, Dharmasraya Regency, West Sumatra, Indonesia. The rice field was irrigated with wáter from Momongan river in which people do gold mining. The soil was sampled vertically from the top to 100 cm depth with 20 cm increment of soil profile from 2 year-fallowed rice field, as well as from the top 20 cm of cultivated rice field from the terrace-1 (the highest terrace) to terrace-5 (the lowest terrace) position. Soil samples were analysed in laboratory. For comparison, rice field receiving irrigation wáter from non-polluted source was also sampled at the top 20 cm and anaysed for the physical properties. The result showed that there was a change in soil physical properties of rice field after 9 years of getting irrigation from the river. Based on laboratory analyses, the total suspended solid (TSS) in the tailing reached 10,736 mg/L. The texture of rice field at polluted rice field (PRF) was dominated (>55%) by sand particles at the top 100 cm soil depth, and it tended to linearly decrease (R2=0.65) from the top 20 cm to 100 cm depth. Likewise, the sand particles also linearly decreased (R2=0.83), but clay particles linearly increased (R2=0.74) horizontally as the distance from the wáter input (terrace-1) was fartherst. Compared to nonpolluted rice field (NPRF), percentage of sand was higher, and clay was lower at PRF. This sandy texture of soil in PRF increased soil hydraulic conductivity (up to 19.1 times), soil bulk density (by 38%), and sharply decreased SOM (by 88.5 %), as well as soil total pore (by 22.1%) compared to the NPRF at the top 20 cm soil. The rice field was suggested to be reclaimed before reusing it. Otherwise the soil characteristics requirement, especially soil wáter retention, for rice field could not be fulfilled.

Keywords: gold mine tailing, polluted irrigation, rice field, soil physical properties

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Authors: Abdullah Alhaqbani

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Purpose: Implementing continuous improvement is a challenge that public sector organisations face in becoming successful. Many obstacles hinder public organisations from successfully implementing continuous improvement. This paper aims to highlight the key core obstacles that face public organisations to implement continuous improvement programmes. Approach: Based on the literature, this paper reviews 66 papers that were published between 2000 and 2013 and that focused on the concept of continuous improvement and improvement methodologies in the context of public sector organisations. The methodologies for continuous improvement covered in these papers include Total Quality Management, Six Sigma, process re-engineering, lean thinking and Kaizen. Findings: Of the 24 obstacles found in the literature, 11 barriers were seen as core barriers that frequently occurred in public sector organisations. The findings indicate that lack of top management commitment; organisational culture and political issues and resistance to change are significant obstacles for improvement programmes. Moreover, this review found that improvement methodologies share some core barriers to successful implementation within public organisations. These barriers as well are common in the different geographic area. For instance lack of top management commitment and training that found in the education sector in Albanian are common barriers of improvement studies in Kuwait, Saudi Arabia, Spain, UK and US. Practical implications: Understanding these core issues and barriers will help managers of public organisations to improve their strategies with respect to continuous improvement. Thus, this review highlights the core issues that prevent a successful continuous improvement journey within the public sector. Value: Identifying and understanding the common obstacles to successfully implementing continuous improvement in the public sector will help public organisations to learn how to improve in launching and successfully sustaining such programmes. However, this is not the end; rather, it is just the beginning of a longer improvement journey. Thus, it is intended that this review will identify key learning opportunities for public sector organisations in developing nations which will then be tested via further research.

Keywords: continuous improvement, total quality management, obstacles, public sector

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Authors: Pebri Nurhayati, Rozanah Ahlam Fadiyah

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In the development of the city often use rural areas that can not be separated from the change in land use that lead to the degradation of urban green space in the city fringe. In the long run, the degradation of green open space this can impact on the decline of ecological, psychological and public health. Therefore, this research aims to (1) determine the relationship between the parameters of the degradation rate of urban development with green space, (2) develop a spatial model of the impact of urban development on the degradation of green open space with remote sensing techniques and Geographical Information Systems in an integrated manner. This research is a descriptive research with data collection techniques of observation and secondary data . In the data analysis, to interpret the direction of urban development and degradation of green open space is required in 2005-2010 ASTER image with NDVI. Of interpretation will generate two maps, namely maps and map development built land degradation green open space. Secondary data related to the rate of population growth, the level of accessibility, and the main activities of each city map is processed into a population growth rate, the level of accessibility maps, and map the main activities of the town. Each map is used as a parameter to map the degradation of green space and analyzed by non-parametric statistical analysis using Crosstab thus obtained value of C (coefficient contingency). C values were then compared with the Cmaximum to determine the relationship. From this research will be obtained in the form of modeling spatial map of the City Development Impact Degradation Green Space in Urban Fringe eastern city of Yogyakarta 2005-2010. In addition, this research also generate statistical analysis of the test results of each parameter to the degradation of green open space in the Urban Fringe eastern city of Yogyakarta 2005-2010.

Keywords: spatial analysis, urban development, degradation of green space, urban fringe

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Authors: Tamas Garamhegyi, Jozsef Kovacs, Rita Pongracz, Peter Tanos, Balazs Trasy, Norbert Magyar, Istvan G. Hatvani

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Like most environmental processes, shallow groundwater fluctuation under natural circumstances also behaves periodically. With the statistical tools at hand, it can easily be determined if a period exists in the data or not. Thus, the question may be raised: Does the estimated average period time characterize the whole time period, or not? This is especially important in the case of such complex phenomena as shallow groundwater fluctuation, driven by numerous factors. Because of the continuous changes in the oscillating components of shallow groundwater time series, the most appropriate method should be used to investigate its periodicity, this is wavelet spectrum analysis. The aims of the research were to investigate the periodic behavior of the shallow groundwater time series of an agriculturally important and drought sensitive region in Central-Eastern Europe and its relationship to the European pressure action centers. During the research ~216 shallow groundwater observation wells located in the eastern part of the Great Hungarian Plain with a temporal coverage of 50 years were scanned for periodicity. By taking the full-time interval as 100%, the presence of any period could be determined in percentages. With the complex hydrogeological/meteorological model developed in this study, non-periodic time intervals were found in the shallow groundwater levels. On the local scale, this phenomenon linked to drought conditions, and on a regional scale linked to the maxima of the regional air pressures in the Gulf of Genoa. The study documented an important link between shallow groundwater levels and climate variables/indices facilitating the necessary adaptation strategies on national and/or regional scales, which have to take into account the predictions of drought-related climatic conditions.

Keywords: climate change, drought, groundwater periodicity, wavelet spectrum and coherence analyses

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Authors: Maria Ahmad, Alexandra Valetopoulou, Michael D. Christian

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Background: London’s Air Ambulance (LAA) provides advanced pre-hospital trauma care across London, bringing specialist resources and expert trauma teams to patients. Since its inception 32 years ago, LAA has treated over 40,000 pre-hospital patients and significantly contributed to pre-hospital patient care in London. To the authors’ best knowledge, this is the first analysis to quantify the magnitude of the publication impact of LAA on the international field of pre-hospital medicine. Method: We searched the Scopus, Web of Science, Google Scholar and PubMed databases to identify LAA focused articles. These were defined as articles on the topic of pre-hospital medicine which either utilised data from LAA, or focused on LAA patients, or were authored by LAA clinicians. A bibliometric analysis was conducted and the impact of each eligible article was classified as either: high (article directly influenced the change or creation of clinical guidelines); medium (the article was referenced in clinical guidelines or had >20 Google Scholar citations or >10 PubMed citations); or low impact (article had <20 Google Scholar citations or <10 PubMed citations). Results: The literature search yielded 1,120 articles in total. 198 articles met our inclusion criteria, and their full text was analysed to determine the level of impact. 19 articles were classified as high-impact, 76 as medium-impact, and 103 as low-impact. 20 of the 76 medium-impact articles were referenced in clinical guidelines but had not prompted changes to the guidelines. Conclusion: To our knowledge, this review is the first to quantify the significant publication impact of LAA within the field of pre-hospital medicine over the last 32 years. LAA publications have focused on and driven clinical innovations in trauma care, particularly in pre-hospital anaesthesia, haemorrhage control, and major incidents, with many impacting national and international guidelines. We recommend a greater emphasis on multidisciplinary pre-hospital collaboration in publications in future research and quality improvement projects across all pre-hospital services.

Keywords: air ambulance, pre-hospital medicine, London’s Air Ambulance, London HEMS

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Authors: Ticijana Prijon, Branko Ermenc

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Background: Blunt aortic trauma (BAT) includes various morphological changes that occur during deceleration, acceleration and/or body compression in traffic accidents. The various forms of BAT, from limited laceration of the intima to complete transection of the aorta, depends on the force acting on the vessel wall and the tolerance of the aorta to injury. The force depends on the change in velocity, the dynamics of the accident and of the seating position in the car. Tolerance to aortic injury depends on the anatomy, histological structure and pathomorphological alterations due to aging or disease of the aortic wall.An overview of the literature and medical documentation reveals that different terms are used to describe certain forms of BAT, which can lead to misinterpretation of findings or diagnoses. We therefore, propose a classification that would enable uniform systematic screening of all forms of BAT. We have classified BAT into three morphologycal types: TYPE I (intramural), TYPE II (transmural) and TYPE III (multiple) aortic ruptures with appropriate subtypes. Methods: All car accident casualties examined at the Institute of Forensic Medicine from 2001 to 2009 were included in this retrospective study. Autopsy reports were used to determine the occurrence of each morphological type of BAT in deceased drivers, front seat passengers and other passengers in cars and to define the morphology of BAT in relation to the accident dynamics and the age of the fatalities. Results: A total of 391 fatalities in car accidents were included in the study. TYPE I, TYPE II and TYPE III BAT were observed in 10,9%, 55,6% and 33,5%, respectively. The incidence of BAT in drivers, front seat and other passengers was 36,7%, 43,1% and 28,6%, respectively. In frontal collisions, the incidence of BAT was 32,7%, in lateral collisions 54,2%, and in other traffic accidents 29,3%. The average age of fatalities with BAT was 42,8 years and of those without BAT 39,1 years. Conclusion: Identification and early recognition of the risk factors of BAT following a traffic accident is crucial for successful treatment of patients with BAT. Front seat passengers over 50 years of age who have been injured in a lateral collision are the most at risk of BAT.

Keywords: aorta, blunt trauma, car accidents, morphology, risk factors

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Authors: Sergey V. Vinogradov

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Coastal communities are presently facing increased vulnerabilities due to rising sea levels and shifts in global climate patterns, a trend expected to escalate in the long run. To address the needs of government entities, the public sector, and private enterprises, there is an urgent need to thoroughly investigate, assess, and manage the present and projected risks associated with coastal flooding, including storm surges, sea level rise, and nuisance flooding. In response to these challenges, a practical approach to evaluating storm surge inundation risks has been developed. This methodology offers an integrated assessment of potential flood risk in targeted coastal areas. The physical modeling framework involves simulating synthetic storms and utilizing hydrodynamic models that align with projected future climate and ocean conditions. Both publicly available and site-specific data form the basis for a risk assessment methodology designed to translate inundation model outputs into statistically significant projections of expected financial and operational consequences. This integrated approach produces measurable indicators of impacts stemming from floods, encompassing economic and other dimensions. By establishing connections between the frequency of modeled flood events and their consequences across a spectrum of potential future climate conditions, our methodology generates probabilistic risk assessments. These assessments not only account for future uncertainty but also yield comparable metrics, such as expected annual losses for each inundation event. These metrics furnish stakeholders with a dependable dataset to guide strategic planning and inform investments in mitigation. Importantly, the model's adaptability ensures its relevance across diverse coastal environments, even in instances where site-specific data for analysis may be limited.

Keywords: climate, coastal, surge, risk

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Authors: Nazaitul Idya Hamzah, Muhammad Syafiq Mazli, Maszatul Akmar Mustafa

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The peak demand forecast is crucial to identify the future generation plant up needed in the long-term capacity planning analysis for Peninsular Malaysia as well as for the transmission and distribution network planning activities. Currently, peak demand forecast (in Mega Watt) is derived from the generation forecast by using load factor assumption. However, a forecast using this method has underperformed due to the structural changes in the economy, emerging trends and weather uncertainty. The dynamic changes of these drivers will result in many possible outcomes of peak demand for Peninsular Malaysia. This paper will look into the independent model of peak demand forecasting. The model begins with the selection of driver variables to capture long-term growth. This selection and construction of variables, which include econometric, emerging trend and energy variables, will have an impact on the peak forecast. The actual framework begins with the development of system energy and load shape forecast by using the system’s hourly data. The shape forecast represents the system shape assuming all embedded technology and use patterns to continue in the future. This is necessary to identify the movements in the peak hour or changes in the system load factor. The next step would be developing the peak forecast, which involves an iterative process to explore model structures and variables. The final step is combining the system energy, shape, and peak forecasts into the hourly system forecast then modifying it with the forecast adjustments. Forecast adjustments are among other sales forecasts for electric vehicles, solar and other adjustments. The framework will result in an hourly forecast that captures growth, peak usage and new technologies. The advantage of this approach as compared to the current methodology is that the peaks capture new technology impacts that change the load shape.

Keywords: hourly load profile, load forecasting, long term peak demand forecasting, peak demand

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Authors: N. Al Khashan, H. Al Shammari, W. Al Bahli

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Patients who are eligible to receive treatment at the National Guard Health Affairs (NGHA), Saudi Arabia will typically have four medical record numbers (MRN), one in each of the geographical areas. More hospitals and primary healthcare facilities in other geographical areas will launch soon which means more MRNs. When patients own four MRNs, this will cause major drawbacks in patients’ quality of care such as creating new medical files in different regions for relocated patients and using referral system among regions. Consequently, the access to a patient’s medical record from other regions and the interoperability of health information between the four hospitals’ information system would be challenging. Thus, there is a need to unify medical records among these five facilities. As part of the effort to increase the quality of care, a new Hospital Information Systems (HIS) was implemented in all NGHA facilities by the end of 2016. NGHA’s plan is put to be aligned with the Saudi Arabian national transformation program 2020; whereby 70% citizens and residents of Saudi Arabia would have a unified medical record number that enables transactions between multiple Electronic Medical Records (EMRs) vendors. The aim of the study is to explore the plan, the challenges and barriers of unifying the 4 MRNs into one Enterprise Patient Identifier (EPI) in NGHA hospitals by December 2018. A descriptive study methodology was used. A journey map and a project plan are created to be followed by the project team to ensure a smooth implementation of the EPI. It includes the following: 1) Approved project charter, 2) Project management plan, 3) Change management plan, 4) Project milestone dates. Currently, the HIS is using the regional MRN. Therefore, the HIS and all integrated health care systems in all regions will need modification to move from MRN to EPI without interfering with patient care. For now, the NGHA have successfully implemented an EPI connected with the 4 MRNs that work in the back end in the systems’ database.

Keywords: consumer health, health informatics, hospital information system, universal medical record number

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Authors: Wen-Ting Wang, Wei-An Tsai, Rong-Hong Hsieh

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Long term taking high fat diet can lead to over production of energy, result in accumulation of body fat, dyslipidemia and increased lipid metabolism in the body. Over metabolism of lipid results in excessive reactive oxygen species and oxidative stress, may also cause mitochondrial dysfunction and cell death. Krill oil, fish oil and linseed oil are good sources of n-3 polyunsaturated fatty acids (PUFA). The present study investigated the effect of high fat diet and various oil rich of n-3 fatty acids on mitochondrial function and cell membrane composition. Six-weeks old male Spraque-Dawley rats were randomly divided into 8 groups including: control group, high fat diet group, low dosage and high dosage krill oil group, low dosage and high dosage fish oil group, and low dosage and high dosage linseed oil group. After 12 weeks of experimental period, the low dosage krill oil, fish oil group and linseed oil group with different dosage prevented mitochondrial dysfunction caused by high fat diet. The supplementation of different oils increased plasma, erythrocyte and mitochondrial n-3/n-6 ratio and further increased the proportion of PUFA in erythrocyte and mitochondrial membrane. It also decreased serum triglyceride (TG) and low density lipoprotein cholesterol (LDL-C) concentration. However, there was no significant change in serum total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), biomarker of liver function, glucose, insulin, homeostasis model assessment-insulin resistance (HOMA-IR) and plasma malonadialdehyde (MDA) concentration when compared with high fat diet group. The supplementation of different sources of n-3 PUFA can maintain mitochondrial function and modulate cell membrane fatty acid composition in high fat diet conditions, and there is a positive relationship between mitochondrial function and mitochondrial membrane composition.

Keywords: fish oil, linseed oil, mitochondria, n-3 PUFA

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Authors: Yindi Zhao, Yun Zhang, Silu Xia, Lixin Wu

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The contours and areas of water surfaces, especially lakes, often change due to natural disasters and construction activities. It is an effective way to extract and update water contours from satellite images using image processing algorithms. However, to produce optimal water surface contours that are close to true boundaries is still a challenging task. This paper compares the performances of three different level set models, including the Chan-Vese (CV) model, the signed pressure force (SPF) model, and the region-scalable fitting (RSF) energy model for extracting lake contours. After experiment testing, it is indicated that the RSF model, in which a region-scalable fitting (RSF) energy functional is defined and incorporated into a variational level set formulation, is superior to CV and SPF, and it can get desirable contour lines when there are “holes” in the regions of waters, such as the islands in the lake. Therefore, the RSF model is applied to extracting lake contours from Landsat satellite images. Four temporal Landsat satellite images of the years of 2000, 2005, 2010, and 2014 are used in our study. All of them were acquired in May, with the same path/row (121/036) covering Xuzhou City, Jiangsu Province, China. Firstly, the near infrared (NIR) band is selected for water extraction. Image registration is conducted on NIR bands of different temporal images for information update, and linear stretching is also done in order to distinguish water from other land cover types. Then for the first temporal image acquired in 2000, lake contours are extracted via the RSF model with initialization of user-defined rectangles. Afterwards, using the lake contours extracted the previous temporal image as the initialized values, lake contours are updated for the current temporal image by means of the RSF model. Meanwhile, the changed and unchanged lakes are also detected. The results show that great changes have taken place in two lakes, i.e. Dalong Lake and Panan Lake, and RSF can actually extract and effectively update lake contours using multi-temporal satellite image.

Keywords: level set model, multi-temporal image, lake contour extraction, contour update

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Authors: Naeemeh Silvari

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The tourism industry is important for different nations in two ways. Apart from economic benefits, it provides a basis for getting acquainted with the culture of different regions of the world. Depending on the capacities and contexts of their geography, countries try to attract more people to their country in different ways. Health tourism has been an important branch of the tourism industry in recent years, and many countries around the world are trying to make progress in this field and attract many tourists from around the world. Iran, like many developing countries in the Middle East and East Asia, is trying to improve and develop tourist attractions in the field of health. Due to the cheapness of providing medical services to tourists, many people have traveled to Iran for medical and health care. However, there is a long way to go before recognizing and reaching the desired position in this field. Due to the direct relationship between tourism and culture, the negative attitude towards the context of Iran has caused foreign travelers not to choose this country as their tourist destination. In this article, we tried to study the change in their attitude towards Iran by using semi-structured interviews of foreign travelers who traveled to Iran for treatment and medical services. The text of the interviews was coded and analyzed by MAX QDA software. Many of the people in the sample were from Middle Eastern and Arabic-speaking countries. Influenced by the media, they felt rejected by the Iranians before the trip. During their stay in Iran and in connection with the health care staff, in the first stage, they pointed out that many of their anxieties about the kind of treatment of Iranians have been allayed. In addition to the satisfaction with the medical services provided, they considered the atmosphere of Iranians' interaction with foreign travelers to be relatively appropriate, and some stated that Iran would be the destination of their leisure trip in the future. At the end of the research, policymakers were suggested that in order to resolve cultural contradictions rooted in values, they should first be recognized and seek to use other opportunities to resolve contradictions and form interactions with other cultures.

Keywords: cultural conflict, health tourism, cultural prejudice, advertising and media

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Authors: Rahaf Mandura

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Background: Idiopathic intracranial hypertension (IIH) is a disorder with elevated intracranial pressure (ICP) more than 250 mm H₂O, without evidence of meningeal inflammation, space-occupying lesion, or venous thrombosis. The aim of this research is to study the clinical profile, evaluation, management, and visual outcome in a hospital-based population of IIH cases in Jeddah. Methodology: This is a retrospective observational study that included the medical records of all patients referred to neuro-ophthalmology service for evaluation of papilledema. The medical records have been reviewed from October 2018 to February 2020 at Jeddah Eye Hospital (JEH), Saudi Arabia. A total of fifty-one patients presented with papilledema in the studied period. Forty-seven patients met our inclusion criteria and were included in the study. Results: Most of the patients were females (43, 91.5%) with a mean age of presentation of 30.83±11.40 years. The most common presenting symptom was headache (40 patients, 85.1%), followed by transient visual obscuration (20 patients, 42.6%), and reduced visual acuity (15 patients, 31.9%). All 47 patients were started on medical treatment with oral acetazolamide with four patients (8.5%) shifted to topiramate because of the lack of response or intolerance to acetazolamide while four patients (8.5%) underwent lumbar-peritoneal shunt because of inadequate control of the disease despite the treatment with medical therapy. For both eyes, the change in visual acuity across all assessment points was statistically significant. Nevertheless, there were no significant changes in the visual field findings among all of the compared assessment points. Conclusion: The present study has shown that IIH-related papilledema is common in young female patients with headaches, transient visual obscurations and reduced visual acuity. Those are the commonest symptoms in our IIH population. Medical treatment of IIH is significantly efficacious and should be considered in order to enhance the prognosis of IIH-related complications. Therefore, the visual status should be frequently monitored for these patients.

Keywords: idiopathic intracranial hypertension, intracranial hypertension, papilledema, headache

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Authors: Apoorva Bamal, Agnieszka Indiana Olbert

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Floods are known to be one of the most devastating hydro-climatic events, impacting a wide range of stakeholders in terms of environmental, social and economic losses. With difference in inundation durations and level of impact, flood hazards are of different degrees and strength. Amongst various set of domains being impacted by floods, environmental degradation in terms of water quality deterioration is one of the majorly effected but less highlighted domains across the world. The degraded water quality is caused by numerous natural and anthropogenic factors that are both point and non-point sources of pollution. Therefore, it is essential to understand the nature and source of the water pollution due to flooding. The major impact of floods is not only on the physico-chemical water quality parameters, but also on the biological elements leading to a vivid influence on the aquatic ecosystem. This deteriorated water quality is impacting many water categories viz. agriculture, drinking water, aquatic habitat, and miscellaneous services requiring an appropriate water quality to survive. This study identifies, reviews, evaluates and assesses multiple researches done across the world to determine the impact of floods on water quality. With a detailed statistical analysis of top relevant researches, this study is a synopsis of the methods used in assessment of impact of floods on water quality in different geographies, and identifying the gaps for further abridgement. As per majority of the studies, different flood magnitudes have varied impact on the water quality parameters leading to either increased or decreased values as compared to the recommended values for various categories. There is also an evident shift of the biological elements in the impacted waters leading to a change in its phenology and inhabitants of the specified water body. This physical, chemical and biological water quality degradation by floods is dependent upon its duration, extent, magnitude and flow direction. Therefore, this research provides an overview into the multiple impacts of floods on water quality, along with a roadmap of way forward to an efficient and uniform linkage of floods and impacted water quality dynamics.

Keywords: floods, statistical analysis, water pollution, water quality

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Authors: Sadeq Al Yaari, Muhammad Alkhunayn, Adham Al Yaari, Aayah Al Yaari, Montaha Al Yaari, Ayman Al Yaari, Sajedah Al Yaari, Fatehi Eissa

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The recent rise of smart educational aids and the move away from traditional listening aids are leading to a fundamental shift in the way in which individuals with attention and listening problems (ALP) manipulate listening inputs and/or act appropriately to the spoken information presented to them. A total sample of twenty-six ALP pupils (m=20 and f=6) between 7-12 years old was selected from different strata based on gender, region and school. In the sample size, thirteen (10 males and 3 females) received the treatment in terms of smart classes provided with smart educational aids in a listening course that lasted for four months, while others did not (they studied the same course by the same instructor but in ordinary class). A pretest was administered to assess participants’ levels, and a posttest was given to evaluate their attention and listening comprehension performance, namely in phonetic and phonological tests with sociolinguistic themes that have been designed for this purpose. Test results were analyzed both psychoneurolinguistically and statistically. Results reveal a remarkable change in pupils’ behavioral listening where scores witnessed a significant difference in the performance of the experimental ALP group in the pretest compared to the posttest (Pupils performed better at the pretest-posttest on phonetics than at the two tests on phonology). It is concluded that smart educational aids designed for listening skills help not only increase the listening command of pupils with ALP to understand what they listen to but also develop their interactive listening capability and, at the same rate, are responsible for increasing concentrated and in-depth listening capacity. Plus, ALP pupils become able to grasp the audio content of text recordings, including educational audio recordings, news, oral stories and tales, views, spiritual/religious text and general knowledge. However, the pupils have not experienced individual smart audio-visual aids that connect listening to other language receptive and productive skills, which could be the future area of research.

Keywords: smart aids, attention, listening, problems

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Authors: Lubna Azmi, Ila Shukla, Shyam Sundar Gupta, Padam Kant, Ch. V. Rao

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Gastric ulcer is a major global health threat, and it is the leading cause of stomach cancer death worldwide. Helicobacter pylori bacteriumis the most important etiologic factor for gastric ulcer. This infection is highly pervasive in South Asian developing countries, especially in India, Nepal, Srilanka etc. due to diversification in geographic area. Pathophysiology of gastric mucosal damage associated with non-invasive bacterium has not justified in detail, but it leads to change in histopathology, immunochemistry of the gastric and duodenal reason of host. The mechanism responsible for bacteria tissue tropism and mucosal damage in stomach variance during the disease is not clearly described and understood scientifically in treatment and control of pathogenic organisms. Polyphenols are secondary metabolites of plants and are generally involved in defense against aggression by pathogens. 2-(3,4-dihydroxyphenyl)-3,5,7-trihydroxychromen-4-one and 1-hydroxy-5,7-dimethoxy-2-naphthalene-carboxaldehyde are polyphenolic compound obtained from popular Indian medicinal plants ghavpatta (ArgeriaspeciosaLinn.f) andBael (Aeglemarmelos) have long been used in traditional Ayurvedic Indian medicine for various diseases. They have promising effects on ulcer, as detailed investigation has made in our laboratory. Therefore, the aim of present study is to explore membrane –dependent morphogenesis of H. pylori and associated apoptosis-mediated cell death. Based on this we analyzed immune gene expression in stomach of experimental animals with H. pylori, using quantitative reverse transcription polymerase chain reaction(q RT-PCR). This revealed rapid induction of prostaglandin, interferon I (INF-I), interferon II (INF-II) and INF-I associated genes in the infected animal. Ultrastructural changes associated with H. pylori will be taken for advanced studies. This investigation shows that the biomarkers eradicate H. pylori bacterium caused gastric ulcer which is a major risk factor for gastric cancer.

Keywords: gastric ulcer, Helicobacter pylori, immunochemistry, polyphenols

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Authors: Scott A. Abbott

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This paper examines the increase in the occurrence of natural disasters worldwide and the need to support vulnerable communities in post-disaster recovery. Preparation and implementation of post-disaster recovery projects need to be improved to allow communities to recover infrastructure, housing, economically and socially following a catastrophe. With the continual rise in catastrophic events worldwide due to climate change, impacts on construction resources affect the ability for post-disaster recovery to be undertaken. This research focuses on case studies of catastrophic events in Queensland, Australia, to contribute to the body of knowledge and gain valuable insights on lessons learned from past events and how they have been managed. The aim of this research is to adopt qualitative data using semi-structured interviews from participants predominantly from the insurance sector to understand barriers that have previously and currently exist in post-disaster recovery. Existing literature was reviewed to reveal gaps in knowledge that needed to be tested. Qualitative data was collected and summarised from field research with the results analysed and discussed. Barriers that impacted post-disaster recovery included time, cost, and resource capability and capacity. Causal themes that impacted time and cost were identified as decision making, pre-planning, and preparedness, as well as effective communication across stakeholders. The research study applied a qualitative approach to the existing literature and case studies across Queensland, Australia, to identify existing and new barriers that impact post-disaster recovery. It was recommended to implement effective procurement strategies to assist in cost control; implement pre-planning and preparedness strategies across funder, contractor, and local governments; more effective and timely decision making to reduce time and cost impacts.

Keywords: construction recovery, cost, disaster recovery, resources, time

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Authors: Ghada Ben Hamad, Zohir Younsi, Hassane Naji, Noureddine Lebaz, Naoual Belouaggadia

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This study deals with a bifunctional micro-encapsulated phase change (MCP) material, capric-stearic acid/graphene oxide-TiO2, which has been successfully developed by in situ hydrolysis and polycondensation of tetrabutyl titanate and modification of graphene oxide (GO) on the TiO2 doped shell. The use of graphene and doped TiO2 is a promising approach to provide photocatalytic activity under visible light and improve the microcapsules physicochemical properties. The morphology and chemical structure of the resulting microcapsule samples were determined by using Fourier transform infrared (FT-IR) spectroscopy, scanning electronic microscope (SEM), and X-ray diffractometer (XRD) methods. The ultraviolet, visible spectrophotometer (UV–vis), the differential scanning calorimeter (DSC) and the thermogravimetric analyzer (TGA) were used to investigate the absorption of visible and ultraviolet (UV), the thermal properties, and thermal stabilities of the microcapsules. Note that, the visible light photocatalytic activity was assessed for the toluene and benzene gaseous removal in a suitable test room. The microcapsules exhibit an interesting spherical morphology and an average diameter of 15 to 25 μm. The addition of graphene can enhance the rigidity of the shell and improve the microcapsules thermal reliability. At the same time, the thermal analysis tests showed that the synthesized microcapsules had a high solar thermal energy-storage and better thermal stability. In addition, the capric-stearic acid microcapsules exhibited high solar photocatalytic activity with respect to atmospheric pollutants under natural sunlight. The fatty acid samples obtained with the GO/TiO2 shell showed great potential for applications of solar energy storage, solar photocatalytic degradation of air pollutants and buildings energy conservation.

Keywords: thermal energy storage, microencapsulation, titanium dioxide, photocatalysis, graphene oxide

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Authors: Diana Flores Galindo, Richard Gil Herrera

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Nowadays, Lean Manufacturing and Industry 4.0 are very important in every country. One of the main benefits is continued market presence. It has been identified that there is a need to change existing educational programs, as well as update the knowledge and skills of existing employees. It should be borne in mind that behind each technological improvement, there is a human being. Human talent cannot be neglected. The main objectives of this article are to review the link between Lean Manufacturing, the incorporation of Industry 4.0 and the steps to follow to implement it; analyze the current situation and study the implications and benefits of this new trend, with a particular focus on Mexico. Lean Manufacturing and Industry 4.0 implementation waves must always take care of the most important capital – intellectual capital. The methodology used in this article comprised the following steps: reviewing the reality of the fourth industrial revolution, reviewing employees’ skills on the journey to become world-class, and analyzing the situation in Mexico. Lean Manufacturing and Industry 4.0 were studied not as exclusive concepts, but as complementary ones. The methodological framework used is focused on motivating companies’ collaborators to guarantee common results, innovate, and remain in the market in the face of new requirements from company stakeholders. The key findings were that both trends emphasize the need to improve communication across the entire company and incorporate new technologies into everyday work, from the shop floor to administrative staff, to help improve processes. Taking care of people, activities and processes will bring a company success. In the specific case of Mexico, companies in all sectors need to be aware of and implement technological improvements according to their specific needs. Low-cost labor represents one of the most typical barriers. In conclusion, companies must build a roadmap according to their strategy and needs to achieve their short, medium- and long-term goals.

Keywords: lean management, lean manufacturing, industry 4.0, motivation, SWOT analysis, Hoshin Kanri

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Authors: Adel A. Ghobbar

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The airline industry is continuously challenging how to safely increase the service life of the aircraft with limited maintenance budgets. Operators are looking for the most qualified maintenance providers of aircraft components, offering the finest customer service. Component owner and maintenance provider is offering an Abacus agreement (Aircraft Component Leasing) to increase the efficiency and productivity of the customer service. To increase the customer service, the current focus on No Fault Found (NFF) units must change into the focus on Early Failure (EF) units. Since the effect of EF units has a significant impact on customer satisfaction, this needs to increase the reliability of EF units at minimal cost, which leads to the goal of this paper. By identifying the reliability of early failure (EF) units with regards to No Fault Found (NFF) units, in particular, the root cause analysis with an integrated cost analysis of EF units with the use of a failure mode analysis tool and a cost model, there will be a set of EF maintenance improvements. The data used for the investigation of the EF units will be obtained from the Pentagon system, an Enterprise Resource Planning (ERP) system used by Fokker Services. The Pentagon system monitors components, which needs to be repaired from Fokker aircraft owners, Abacus exchange pool, and commercial customers. The data will be selected on several criteria’s: time span, failure rate, and cost driver. When the selected data has been acquired, the failure mode and root cause analysis of EF units are initiated. The failure analysis approach tool was implemented, resulting in the proposed failure solution of EF. This will lead to specific EF maintenance improvements, which can be set-up to decrease the EF units and, as a result of this, increasing the reliability. The investigated EFs, between the time period over ten years, showed to have a significant reliability impact of 32% on the total of 23339 unscheduled failures. Since the EFs encloses almost one-third of the entire population.

Keywords: supportability, no fault found, FMEA, early failure, availability, operational reliability, predictive model

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Authors: Kate E Morris, Mark Sumner, Mark Taylor, Amanda Joynes, Yue Guo

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Garment durability, which encompasses physical and emotional factors, has been identified as a critical ingredient in producing clothing with increased lifespans, battling overconsumption, and subsequently tackling the catastrophic effects of climate change. Eco-design for Sustainable Products Regulation (ESPR) and Extended Producer Responsibility (EPR) schemes have been suggested and will be implemented across Europe and the UK which might require brands to declare a garment’s durability credentials to be able to sell in that market. There is currently no consistent method of measuring the overall durability of a garment. Measuring the physical durability of garments is difficult and current assessment methods lack objectivity and reliability or don’t reflect the complex nature of durability for different garment categories. This study presents a novel and reproducible methodology for testing and ranking the absolute durability of 5 commercially available garment types, Formal Trousers, Casual Trousers, Denim Jeans, Casual Leggings and Underwear. A total of 112 garments from 21 UK brands were assessed. Due to variations in end use, different factors were considered across the different garment categories when evaluating durability. A physical testing protocol was created, tailored to each category, to dictate the necessary test results needed to measure the absolute durability of the garments. Multiple durability factors were used to modulate the ranking as opposed to previous studies which only reported on single factors to evaluate durability. The garments in this study were donated by the signatories of the Waste Resource Action Programme’s (WRAP) Textile 2030 initiative as part of their strategy to reduce the environmental impact of UK fashion. This methodology presents a consistent system for brands and policymakers to follow to measure and rank various garment type’s physical durability. Furthermore, with such a methodology, the durability of garments can be measured and new standards for improving durability can be created to enhance utilisation and improve the sustainability of the clothing on the market.

Keywords: circularity, durability, garment testing, ranking

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Authors: Maryam Zahmatkesh

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Middle managers form a significant occupational category in organisations. They undertake a vital role, as they sit between the operational and strategic roles. Traditionally they were acting as diplomat administrators, and were only in power to meet the demands of professionals. Following the introduction of internal market, in line with the principles of New Public Management, middle managers have been considered as change agents. More recently, in the debates of middle managers, there is emphasis on entrepreneurialism and enacting strategic role. It was assumed that granting autonomy to the local organisations and the inception of semi-autonomous hospitals (Foundation Trusts in England and Board of Trustees in Iran) would give managers more autonomy to act proactively and innovatively. This thesis explores the hospital middle managers’ perception of and responses to public management reforms (in particular, hospital autonomy) in England and Iran. In order to meet the aims of the thesis, research was undertaken within the interpretative paradigm, in line with social constructivism. Data were collected from interviews with forty-five middle managers, observational fieldwork and documentary analysis across four teaching university hospitals in England and Iran. The findings show the different ways middle managers’ autonomy is constrained in the two countries. In England, middle managers have financial and human recourses, but their autonomy is constrained by government policy and targets. In Iran, middle managers are less constrained by government policy and targets, but they do not have financial and human resources to exercise autonomy. Unbalanced autonomy causes tension and frustration for middle managers. According to neo-institutional theory, organisations are deeply embedded within social, political, economic and normative settings that exert isomorphic and internal population-level pressures to conform to existing and established modes of operation. Health systems which are seeking to devolve autonomy to middle managers must appreciate the multidimensional nature of the autonomy, as well as the wider environment that organisations are embedded, if they are about to improve the performance of managers and their organisations.

Keywords: autonomy, healthcare organisations, middle managers, new public management

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