Search results for: national one health platform
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 13824

Search results for: national one health platform

8274 Monitoring Spatial Distribution of Blue-Green Algae Blooms with Underwater Drones

Authors: R. L. P. De Lima, F. C. B. Boogaard, R. E. De Graaf-Van Dinther

Abstract:

Blue-green algae blooms (cyanobacteria) is currently a relevant ecological problem that is being addressed by most water authorities in the Netherlands. These can affect recreation areas by originating unpleasant smells and toxins that can poison humans and animals (e.g. fish, ducks, dogs). Contamination events usually take place during summer months, and their frequency is increasing with climate change. Traditional monitoring of this bacteria is expensive, labor-intensive and provides only limited (point sampling) information about the spatial distribution of algae concentrations. Recently, a novel handheld sensor allowed water authorities to quicken their algae surveying and alarm systems. This study converted the mentioned algae sensor into a mobile platform, by combining it with an underwater remotely operated vehicle (also equipped with other sensors and cameras). This provides a spatial visualization (mapping) of algae concentrations variations within the area covered with the drone, and also in depth. Measurements took place in different locations in the Netherlands: i) lake with thick silt layers at the bottom, very eutrophic former bottom of the sea and frequent / intense mowing regime; ii) outlet of waste water into large reservoir; iii) urban canal system. Results allowed to identify probable dominant causes of blooms (i), provide recommendations for the placement of an outlet, day-night differences in algae behavior (ii), or the highlight / pinpoint higher algae concentration areas (iii). Although further research is still needed to fully characterize these processes and to optimize the measuring tool (underwater drone developments / improvements), the method here presented can already provide valuable information about algae behavior and spatial / temporal variability and shows potential as an efficient monitoring system.

Keywords: blue-green algae, cyanobacteria, underwater drones / ROV / AUV, water quality monitoring

Procedia PDF Downloads 188
8273 Dietary Micronutritient and Health among Youth in Algeria

Authors: Allioua Meryem

Abstract:

Similar to much of the developing world, Algeria is currently undergoing an epidemiological transition. While mal- and under-nutrition and infectious diseases used to be the main causes of poor health, today there is a higher proportion of chronic, non-communicable diseases (NCDs), including cardiovascular disease, diabetes mellitus, cancer, etc. According to estimates for Algeria from the World Health Organization (WHO), NCDs accounted for 63% of all deaths in 2010. The objective of this study was the assessment of eating habits and anthropometric characteristics in a group of youth aged 15 to 19 years in Tlemcen. This study was conducted on a total effective of 806 youth enrolled in a descriptive cross-sectional study; the classification of nutritional status has been established by international standards IOTF, youth were defined as obese if they had a BMI ≥ 95th percentile, and youth with 85th ≤ BMI ≤ 95th percentile were defined as overweight. Wc is classified by the criteria HD, Wc with moderate risk ≥ 90th percentile and Wc with high risk ≥ 95th percentile. The dietary assessment was based on a 24-hour dietary recall assisted by food records. USDA’S nutrient database for Nutrinux® program was used to analyze dietary intake. Nutrients adequacy ratio was calculated by dividing daily individual intake to dietary recommended intake DRI for each nutrient. 9% of the population was overweight, 3% was obese, 7.5% had abdominal obesity, foods eaten in moderation are chips, cookies, chocolate 1-3 times/day and increased consumption of fried foods in the week, almost half of youth consume sugary drinks more than 3 times per week, we observe a decreased intake of energy, protein (P < 0.001, P = 0.003), SFA (P = 0.018), the NAR of phosphorus, iron, magnesium, vitamin B6, vitamin E, folate, niacin, and thiamin reflecting less consumption of fruit, vegetables, milk, and milk products. Youth surveyed have eating habits at risk of developing obesity and chronic disease.

Keywords: food intake, health, anthropometric characteristics, Algeria

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8272 Running Head: Psychological Inflexibility and Distress

Authors: Steven M. Sanders, April T. Berry, David W. Hollingsworth

Abstract:

Previous research has shown that veterans have higher rates of mental health concerns compared to non-veteran populations. A potential risk factor for the development of mental health concerns (i.e., depression & anxiety), particularly in Black veterans, is psychological inflexibility. Psychological inflexibility, a component of Acceptance & Commitment Therapy (ACT), is a process by which behavior is expressed in ways that attempt to control emotional and psychological reactions to uncomfortable stimuli and situations rather than by direct contingencies or personal values. The present study explored the relationship between psychological inflexibility, symptoms of depression, and symptoms of anxiety in a sample of 131 Black veterans. Results demonstrated that Black veterans who endorsed psychological inflexibility also endorsed higher levels of both depression and anxiety symptomology. These findings indicate the deleterious consequences of experiencing psychological inflexibility, which could be treated through ACT.

Keywords: psychological flexibility, veteran, black, psychological distress

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8271 Non-Burn Treatment of Health Care Risk Waste

Authors: Jefrey Pilusa, Tumisang Seodigeng

Abstract:

This research discusses a South African case study for the potential of utilizing refuse-derived fuel (RDF) obtained from non-burn treatment of health care risk waste (HCRW) as potential feedstock for green energy production. This specific waste stream can be destroyed via non-burn treatment technology involving high-speed mechanical shredding followed by steam or chemical injection to disinfect the final product. The RDF obtained from this process is characterised by a low moisture, low ash, and high calorific value which means it can be potentially used as high-value solid fuel. Due to the raw feed of this RDF being classified as hazardous, the final RDF has been reported to be non-infectious and can blend with other combustible wastes such as rubber and plastic for waste to energy applications. This study evaluated non-burn treatment technology as a possible solution for on-site destruction of HCRW in South African private and public health care centres. Waste generation quantities were estimated based on the number of registered patient beds, theoretical bed occupancy. Time and motion study was conducted to evaluate the logistics viability of on-site treatment. Non-burn treatment technology for HCRW is a promising option for South Africa, and successful implementation of this method depends upon the initial capital investment, operational cost and environmental permitting of such technology; there are other influencing factors such as the size of the waste stream, product off-take price as well as product demand.

Keywords: autoclave, disposal, fuel, incineration, medical waste

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8270 Rural-To-Urban Migrants' Experiences with Primary Care in Four Types of Medical Institutions in Guangzhou, China

Authors: Jiazhi Zeng, Leiyu Shi, Xia Zou, Wen Chen, Li Ling

Abstract:

Background: China is facing the unprecedented challenge of rapidly increasing rural-to-urban migration. Due to the household registration system, migrants are in a vulnerable state when they attempt to access to primary care services. A strong primary care system can reduce health inequities and mitigate socioeconomic disparities in healthcare utilization. Literature indicated that migrants were more reliant on the primary care system than local residents. Although the Chinese government has attached great importance to creating an efficient health system, primary care services are still underutilized. The referral system between primary care institutions and hospitals has not yet been completely established in China. The general populations often go directly to hospitals instead of primary care institutions for their primary care. Primary care institutions generally consist of community health centers (CHCs) and community health stations (CHSs) in urban areas, and township health centers (THCs) and rural health stations (THSs) in rural areas. In addition, primary care services are also provided by the outpatient department of municipal hospitals and tertiary hospitals. A better understanding of migrants’ experiences with primary care in the above-mentioned medical institutions is critical for improving the performance of primary care institutions and providing indications of the attributes that require further attention. The purpose of this pioneering study is to explore rural-to-urban migrants’ experiences in primary care, compare their primary care experiences in four types of medical institutions in Guangzhou, China, and suggest implications for targeted interventions to improve primary care for the migrants. Methods: This was a cross-sectional study conducted with 736 rural-to-urban migrants in Guangzhou, China, in 2014. A multistage sampling method was employed. A validated Chinese version of Primary Care Assessment Tool - Adult Short Version (PCAT-AS) was used to collect information on migrants’ primary care experiences. The PCAT-AS consists of 10 domains. Analysis of covariance was conducted for comparison on PCAT domain scores and total scores among migrants accessing four types of medical institutions. Multiple linear regression models were used to explore factors associated with PCAT total scores. Results: After controlling for socio-demographic characteristics, migrant characteristics, health status and health insurance status, migrants accessing primary care in tertiary hospitals had the highest PCAT total scores when compared with those accessing primary care THCs/ RHSs (25.49 vs. 24.18, P=0.007) and CHCs/ CHSs(25.49 vs. 24.24, P=0.006). There was no statistical significant difference for PCAT total scores between migrants accessing primary care in CHCs/CHSs and those in municipal hospitals (24.24 vs. 25.02, P=0.436). Factors positively associated with higher PCAT total scores also included insurance covering parts of healthcare payment (P < 0.001). Conclusions: This study highlights the need for improvement in primary care provided by primary care institutions for rural-to-urban migrants. Migrants receiving primary care from THCs, RHSs, CHSs and CHSs reported worse primary care experiences than those receiving primary care from tertiary hospitals. Relevant policies related to medical insurance should be implemented for providing affordable healthcare services for migrants accessing primary care. Further research exploring the specific reasons for poorer PCAT scores of primary care institutions users will be needed.

Keywords: China, PCAT, primary care, rural-to-urban migrants

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8269 Analyze the Effect of TETRA, Terrestrial Trunked Radio, Signal on the Health of People Working in the Gas Refinery

Authors: Mohammad Bagher Heidari, Hefzollah Mohammadian

Abstract:

TETRA (Terrestrial Trunked Radio) is a digital radio communication standard, which has been implemented in several different parts of the gas refinery ninth (phase 12th) by South Pars Gas Complex. Studies on possible impacts on the users' health considering different exposure conditions are missing. Objectives: To investigate possible acute effects of electromagnetic fields (EMF) of two different levels of TETRA hand-held transmitter signals on cognitive function and well-being in healthy young males. Methods: In the present double-blind cross-over study possible effects of short-term (2.5 h) EMF exposure of handset-like signals of TETRA (450 - 470 MHz) were studied in 30 healthy male participants (mean ± SD: 25.4 ±2.6 years). Individuals were tested on nine study days, on which they were exposed to three different exposure conditions (Sham, TETRA 1.5 W/kg and TETRA 10.0 W/kg) in a randomly assigned and balanced order. Participants were tested in the afternoon at a fixed timeframe. Results: Attention remained unchanged in two out of three tasks. In the working memory, significant changes were observed in two out of four subtasks. Significant results were found in 5 out of 35 tested parameters, four of them led to an improvement in performance. Mood, well-being and subjective somatic complaints were not affected by TETRA exposure. Conclusions: The results of the present study do not indicate a negative impact of a short-term EMF- effect of TETRA on cognitive function and well-being in healthy young men.

Keywords: TETRA (terrestrial trunked radio), electromagnetic fields (EMF), mobile telecommunication health research (MTHR), antenna

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8268 Biotech Processes to Recover Valuable Fraction from Buffalo Whey Usable in Probiotic Growth, Cosmeceutical, Nutraceutical and Food Industries

Authors: Alberto Alfano, Sergio D’ambrosio, Darshankumar Parecha, Donatella Cimini, Chiara Schiraldi.

Abstract:

The main objective of this study regards the setup of an efficient small-scale platform for the conversion of local renewable waste materials, such as whey, into added-value products, thereby reducing environmental impact and costs deriving from the disposal of processing waste products. The buffalo milk whey derived from the cheese-making process, called second cheese whey, is the main by-product of the dairy industry. Whey is the main and most polluting by-product obtained from cheese manufacturing consisting of lactose, lactic acid, proteins, and salts, making whey an added-value product. In Italy, and in particular, in the Campania region, soft cheese production needs a large volume of liquid waste, especially during late spring and summer. This project is part of a circular economy perspective focused on the conversion of potentially polluting and difficult to purify waste into a resource to be exploited, and it embodies the concept of the three “R”: reduce, recycle, and reuse. Special focus was paid to the production of health-promoting biomolecules and biopolymers, which may be exploited in different segments of the food and pharmaceutical industries. These biomolecules may be recovered through appropriate processes and reused in an attempt to obtain added value products. So, ultrafiltration and nanofiltration processes were performed to fractionate bioactive components starting from buffalo milk whey. In this direction, the present study focused on the implementation of a downstream process that converts waste generated from food and food processing industries into added value products with potential applications. Owing to innovative downstream and biotechnological processes, rather than a waste product may be considered a resource to obtain high added value products, such as food supplements (probiotics), cosmeceuticals, biopolymers, and recyclable purified water. Besides targeting gastrointestinal disorders, probiotics such as Lactobacilli have been reported to improve immunomodulation and protection of the host against infections caused by viral and bacterial pathogens. Interestingly, also inactivated microbial (probiotic) cells and their metabolic products, indicated as parabiotic and postbiotics, respectively, have a crucial role and act as mediators in the modulation of the host’s immune function. To boost the production of biomass (both viable and/or heat inactivated cells) and/or the synthesis of growth-related postbiotics, such as EPS, efficient and sustainable fermentation processes are necessary. Based on a “zero-waste” approach, wastes generated from local industries can be recovered and recycled to develop sustainable biotechnological processes to obtain probiotics as well as post and parabiotic, to be tested as bioactive compounds against gastrointestinal disorders. The results have shown it was possible to recover an ultrafiltration retentate with suitable characteristics to be used in skin dehydration, to perform films (i.e., packaging for food industries), or as a wound repair agent and a nanofiltration retentate to recover lactic acid and carbon sources (e.g., lactose, glucose..) used for microbial cultivation. On the side, the last goal is to obtain purified water that can be reused throughout the process. In fact, water reclamation and reuse provide a unique and viable opportunity to augment traditional water supplies, a key issue nowadays.

Keywords: biotech process, downstream process, probiotic growth, from waste to product, buffalo whey

Procedia PDF Downloads 53
8267 Machine Learning for Exoplanetary Habitability Assessment

Authors: King Kumire, Amos Kubeka

Abstract:

The synergy of machine learning and astronomical technology advancement is giving rise to the new space age, which is pronounced by better habitability assessments. To initiate this discussion, it should be recorded for definition purposes that the symbiotic relationship between astronomy and improved computing has been code-named the Cis-Astro gateway concept. The cosmological fate of this phrase has been unashamedly plagiarized from the cis-lunar gateway template and its associated LaGrange points which act as an orbital bridge to the moon from our planet Earth. However, for this study, the scientific audience is invited to bridge toward the discovery of new habitable planets. It is imperative to state that cosmic probes of this magnitude can be utilized as the starting nodes of the astrobiological search for galactic life. This research can also assist by acting as the navigation system for future space telescope launches through the delimitation of target exoplanets. The findings and the associated platforms can be harnessed as building blocks for the modeling of climate change on planet earth. The notion that if the human genus exhausts the resources of the planet earth or there is a bug of some sort that makes the earth inhabitable for humans explains the need to find an alternative planet to inhabit. The scientific community, through interdisciplinary discussions of the International Astronautical Federation so far has the common position that engineers can reduce space mission costs by constructing a stable cis-lunar orbit infrastructure for refilling and carrying out other associated in-orbit servicing activities. Similarly, the Cis-Astro gateway can be envisaged as a budget optimization technique that models extra-solar bodies and can facilitate the scoping of future mission rendezvous. It should be registered as well that this broad and voluminous catalog of exoplanets shall be narrowed along the way using machine learning filters. The gist of this topic revolves around the indirect economic rationale of establishing a habitability scoping platform.

Keywords: machine-learning, habitability, exoplanets, supercomputing

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8266 Machine Learning for Exoplanetary Habitability Assessment

Authors: King Kumire, Amos Kubeka

Abstract:

The synergy of machine learning and astronomical technology advancement is giving rise to the new space age, which is pronounced by better habitability assessments. To initiate this discussion, it should be recorded for definition purposes that the symbiotic relationship between astronomy and improved computing has been code-named the Cis-Astro gateway concept. The cosmological fate of this phrase has been unashamedly plagiarized from the cis-lunar gateway template and its associated LaGrange points which act as an orbital bridge to the moon from our planet Earth. However, for this study, the scientific audience is invited to bridge toward the discovery of new habitable planets. It is imperative to state that cosmic probes of this magnitude can be utilized as the starting nodes of the astrobiological search for galactic life. This research can also assist by acting as the navigation system for future space telescope launches through the delimitation of target exoplanets. The findings and the associated platforms can be harnessed as building blocks for the modeling of climate change on planet earth. The notion that if the human genus exhausts the resources of the planet earth or there is a bug of some sort that makes the earth inhabitable for humans explains the need to find an alternative planet to inhabit. The scientific community, through interdisciplinary discussions of the International Astronautical Federation so far, has the common position that engineers can reduce space mission costs by constructing a stable cis-lunar orbit infrastructure for refilling and carrying out other associated in-orbit servicing activities. Similarly, the Cis-Astro gateway can be envisaged as a budget optimization technique that models extra-solar bodies and can facilitate the scoping of future mission rendezvous. It should be registered as well that this broad and voluminous catalog of exoplanets shall be narrowed along the way using machine learning filters. The gist of this topic revolves around the indirect economic rationale of establishing a habitability scoping platform.

Keywords: exoplanets, habitability, machine-learning, supercomputing

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8265 A New Suburb Renovation Concept

Authors: Anu Soikkelii, Laura Sorri

Abstract:

Finnish national research project, User- and Business-oriented Suburb Renovation Concept (KLIKK), was started in January 2012 and will end in June 2014. The perspective of energy efficiency is emphasised in the project, but also it addresses what improving the energy efficiency of suburban apartment buildings means from the standpoint of architecturally valuable buildings representing different periods. The project will also test the impacts of stricter energy efficiency requirements on renovation projects. The primary goal of the project is to develop a user-oriented, industrial, economic renovation concept for suburban apartment building renovation, extension and construction of additional storeys. The concept will make it possible to change from performance- and cost-based operation to novel service- and user-oriented, site-specifically tailored renovation methods utilizing integrated order and delivery chains.The present project is collaborating with Ministry of the Environment and participating cities in developing a new type of lighter town planning model for suburban renovations and in-fill construction. To support this, the project will simultaneously develop practices for environmental impact assessment tools in renovation and suburban supplementary and in-fill construction.

Keywords: energy efficiency, prefabrication, renovation concept, suburbs, sustainability, user-orientated

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8264 Applying EzRAD Method for SNPs Discovery in Population Genetics of Freshwater and Marine Fish in the South of Vietnam

Authors: Quyen Vu Dang Ha, Oanh Truong Thi, Thuoc Tran Linh, Kent Carpenter, Thinh Doan Vu, Binh Dang Thuy

Abstract:

Enzyme restriction site associated DNA (EzRAD) has recently emerged as a promising genomic approach for exploring fish genetic diversity on a genome-wide scale. This is a simplified method for genomic genotyping in non-model organisms and applied for SNPs discovery in the population genetics of freshwater and marine fish in the South of Vietnam. The observations of regional-scale differentiation of commercial freshwater fish (smallscale croakers Boesemania microlepis) and marine fish (emperor Lethrinus lentjan) are clarified. Samples were collected along Hau River and coastal area in the south and center Vietnam. 52 DNA samples from Tra Vinh, An Giang Province for Boesemania microlepis and 34 DNA samples of Lethrinus lentjan from Phu Quoc, Nha Trang, Da Nang Province were used to prepare EzRAD libraries from genomic DNA digested with MboI and Sau3AI. A pooled sample of regional EzRAD libraries was sequenced using the HiSeq 2500 Illumina platform. For Boesemania microlepis, the small scale population different from upstream to downstream of Hau river were detected, An Giang population exhibited less genetic diversity (SNPs per individual from 14 to 926), in comparison to Tra Vinh population (from 11 to 2172). For Lethrinus lentjan, the result showed the minor difference between populations in the Northern and the Southern Mekong River. The numbers of contigs and SNPs vary from 1315 to 2455 and from 7122 to 8594, respectively (P ≤ 0.01). The current preliminary study reveals regional scale population disconnection probably reflecting environmental changing. Additional sampling and EzRad libraries need to be implemented for resource management in the Mekong Delta.

Keywords: Boesemania microlepis, EzRAD, Lethrinus lentjan, SNPs

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8263 Decoupling PM₂.₅ Emissions and Economic Growth in China over 1998-2016: A Regional Investment Perspective

Authors: Xi Zhang, Yong Geng

Abstract:

It is crucial to decouple economic growth from environmental pollution in China. This study aims to evaluate the decoupling degree between PM₂.₅ emissions and economic growth in China from a regional investment perspective. Using the panel data of 30 Chinese provinces for the period of 1998-2016, this study combines decomposition analysis with decoupling analysis to identify the roles of conventional factors and three novel investment factors in the mitigation and decoupling of PM₂.₅ emissions in China and its four sub-regions. The results show that China’s PM₂.₅ emissions were weakly decoupled to economic growth during the period of 1998-2016, as well as in China’s four sub-regions. At the national level, investment scale played the dominant role while investment structure had a marginal effect. In contrast, emission intensity was the largest driver in promoting the decoupling effect, followed by investment efficiency and energy intensity. The investment scale effect in the western region far exceeded those in other three sub-regions. At the provincial level, the investment structure of Inner Mongolia and investment scales of Xinjiang and Inner Mongolia had the greatest impacts on PM₂.₅ emission growth. Finally, several policy recommendations are raised for China to mitigate its PM₂.₅ emissions.

Keywords: decoupling, economic growth, investment, PM₂.₅ emissions

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8262 A Fluid-Walled Microfluidic Device for Cell Migration Studies

Authors: Cyril Deroy, Agata Rumianek, David R. Greaves, Peter R. Cook, Edmond J. Walsh

Abstract:

Various microfluidic platforms have been developed in the past couple of decades offering experimental methods for the study of cell migration; however, their implementation in the laboratory has remained limited. Some reasons cited for the lack of uptake include the technical complexity of the devices, high failure rate associated with gas-bubbles, biocompatibility concerns with the use of polydimethylsiloxane (PDMS) and equipment/time/expertise requirements for operation and manufacture. As sample handling remains challenging due to the closed format of microfluidic devices, open microfluidic systems have been developed offering versatility and simplicity of use. Rather than confining fluids by solid walls, samples can be accessed directly over the open platform, by removing at least one of the solid boundaries, such as the cover. In this paper, a method for the fabrication of open fluid-walled microfluidic circuits for cell migration studies is introduced, where only materials commonly used by the life-science community are required; tissue culture dishes and cell media. The simplicity of the method, and ability to retrieve cells of interest are two key features of the method. Both passive and active flow-devices can be created in this way. To demonstrate the versatility of the method a cell migration assay is performed, which requires fabricating circuits for establishing chemical gradients, loading cells and incubating, creating chemical gradients, real time imaging of cell migration and finally retrieval of cells. The open architecture has high fidelity as it eliminates air bubble related failures and enables the precise control of gradients. The ability to fabricate custom microfluidic designs in minutes should make this method suitable for use in a wide range of cell migration studies.

Keywords: chemotaxis, fluid walls, gradient generation, open microfluidics

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8261 Association between Caries Status of First Permanent Molar with Oral Health Care Practice in Children Aged 9-12 Years in Lubuk Kilangan, Padang City

Authors: Cytha Nilam Chairani, Ditha Noviantika, Hidayati Amir, Nurul Khairiyah, Siti Rahmadita, Fadila Khairani

Abstract:

Background: Dental caries is one of the most common diseases with high prevalence in children. The first permanent molar (FPM) has an essential role in establishing the occlusion. Nevertheless, FPM is very prone to caries because of various factors, such as their anatomical structure and early emergence in oral cavity. It is due to the little knowledge from parents and children regarding the timing of emergence of FPM in oral cavity which is still considered as primary teeth. Furthermore, the lack of knowledge from parents and children may affect their oral hygiene practice resulting to carious process. Objective: The aim of this study was to assess the status of FPM caries and its association with children’s oral hygiene practice in 9-12-year-old school children in Lubuk Kilangan Community Health Centre, Padang City. Methods: A cross-sectional study was performed in 50 school children (9-12 years old) using random sampling technique from two randomly selected schools in Lubuk Kilangan Community Health Centre, Padang City. A questionnaire was developed from other studies consisting of four closed ended questions regarding oral health practice. The data obtained were analyzed statistically using Mann-Whitney Test to assess the status of FPM caries and its association with children’s oral hygiene practice. Results: The results showed that 32% of children had FPMs sound and the remaining 68% had FPMs carious which were grouped into 1-2 FPMs carious (60%) and 3-4 FPMs carious (8%). The caries status of mandibular FPM (64%) was higher compared to maxillary FPM (10%). Conclusion: There was significant association in subject who did not visit dentist in the last 6 months which had more carious FPMs compared to subject who visited dentist (p < 0.05). There was no significant association between the status of FPM caries and knowledge of the timing eruption of FPM, oral hygiene instruction from parents and tooth brushing (p > 0.05).

Keywords: dental caries, children, first permanent molar, oral hygiene practice

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8260 Off-Body Sub-GHz Wireless Channel Characterization for Dairy Cows in Barns

Authors: Said Benaissa, David Plets, Emmeric Tanghe, Jens Trogh, Luc Martens, Leen Vandaele, Annelies Van Nuffel, Frank A. M. Tuyttens, Bart Sonck, Wout Joseph

Abstract:

The herd monitoring and managing - in particular the detection of ‘attention animals’ that require care, treatment or assistance is crucial for effective reproduction status, health, and overall well-being of dairy cows. In large sized farms, traditional methods based on direct observation or analysis of video recordings become labour-intensive and time-consuming. Thus, automatic monitoring systems using sensors have become increasingly important to continuously and accurately track the health status of dairy cows. Wireless sensor networks (WSNs) and internet-of-things (IoT) can be effectively used in health tracking of dairy cows to facilitate herd management and enhance the cow welfare. Since on-cow measuring devices are energy-constrained, a proper characterization of the off-body wireless channel between the on-cow sensor nodes and the back-end base station is required for a power-optimized deployment of these networks in barns. The aim of this study was to characterize the off-body wireless channel in indoor (barns) environment at 868 MHz using LoRa nodes. LoRa is an emerging wireless technology mainly targeted at WSNs and IoT networks. Both large scale fading (i.e., path loss) and temporal fading were investigated. The obtained path loss values as a function of the transmitter-receiver separation were well fitted by a lognormal path loss model. The path loss showed an additional increase of 4 dB when the wireless node was actually worn by the cow. The temporal fading due to movement of other cows was well described by Rician distributions with a K-factor of 8.5 dB. Based on this characterization, network planning and energy consumption optimization of the on-body wireless nodes could be performed, which enables the deployment of reliable dairy cow monitoring systems.

Keywords: channel, channel modelling, cow monitoring, dairy cows, health monitoring, IoT, LoRa, off-body propagation, PLF, propagation

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8259 Identifying the Goals of a Multicultural Curriculum for the Primary Education Course

Authors: Fatemeh Havas Beigi

Abstract:

The purpose of this study is to identify the objectives of a multicultural curriculum for the primary education period from the perspective of ethnic teachers and education experts and cultural professionals. The research paradigm is interpretive, the research approach is qualitative, the research strategy is content analysis, the sampling method is purposeful and it is a snowball, and the sample of informants in the research for Iranian ethnic teachers and experts until the theoretical saturation was estimated to be 67 people. The data collection tools used were based on semi-structured interviews and individual interviews and focal interviews were used to collect information. The data format was also in audio format and the first period coding and the second coding were used to analyze the data. Based on data analysis 11 Objective: Paying attention to ethnic equality, expanding educational opportunities and justice, peaceful coexistence, anti-ethnic and racial discrimination education, paying attention to human value and dignity, accepting religious diversity, getting to know ethnicities and cultures, promoting teaching-learning, fostering self-confidence, building national unity, and developing cultural commonalities for a multicultural curriculum were identified.

Keywords: objective, multicultural curriculum, connect, elementary education period

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8258 An Evaluation of a Psychotherapeutic Service for Engineering Students: The Role of Race, Gender and Language

Authors: Nazeema Ahmed

Abstract:

Mental health in higher education has received increasing attention over the past few decades. The high academic demands of the engineering degree, coupled with students’ mental health challenges, have led to higher education institutions offering psychotherapeutic services to students. This paper discusses an evaluation of the psychotherapy service at the University of Cape Town. The aim was to determine (i) the efficacy of the service; and (ii) the impact of race, gender, and language of the therapist on the students’ therapeutic process. An online survey was sent to 109 students who attended psychotherapy. The majority expressed favorable experiences of psychotherapy, with reports of increased capacity to engage with their academic work. Most students did not experience the gender, race, or language of the psychologists to be barriers to their therapy. The findings point to a need for ongoing psychological support for students.

Keywords: psychotherapy, efficacy, engineering, education

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8257 Ergonomic Design of Speed Control Humps/Dips

Authors: Emad Khorshid, Habib Awada

Abstract:

Newly developed Ergonomic speed control hump/Dip designs are conducted. The numerical simulation for the driver-vehicle-hump dynamic system will be performed using computer software. The design problem for which the speed hump or dip should provide: (1) discomfort feeling to the driver if speed is over the specified limit, and (2) normal/good comfort level to the driver (and or other passengers) if the speed is within the limit. For comparison reasons, different vehicles suspension systems (active, semi-active and non-active suspension) are used in the simulation. The measuring of the acceptable range of vibration will be referenced to the British standard BS6841, ISO 2631/1 and the new ISO 2631/5. All these standards are related to human health and comfort level in terms of acceptable range of whole body vibration exposure.

Keywords: speed hump, speed dip, ergonomic design, human health, vehicle modeling

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8256 Synthesis, Electrochemical and Fluorimetric Analysis of Caffeic Cinnamic and Acid-Conjugated Hemorphine Derivatives Designed as Potential Anticonvulsant Agents

Authors: Jana Tchekalarova, Stela Georgieva, Petia Peneva, Petar Todorov

Abstract:

In the present study, a series of bioconjugates of N-modified hemorphine analogs containing second pharmacophore cinnamic acids (CA) or caffeic acid (KA) were synthesized by a traditional solid-phase Fmoc chemistry method for peptide synthesis. Electrochemical and fluorometric analysis and in vivo anticonvulsant activity in mice were conducted on the compounds. The three CA (H4-CA, H5-CA, and H7-CA) and three KA (H4-KA, H5-KA, and H7-KA)-conjugated hemorphine derivatives showed dose-dependent anticonvulsant activity in the maximal electroshock test (MES) in mice. The KA-conjugated H5-KA derivate was the only compound that suppressed clonic seizures at the lowest dose of 0.5 µg/mouse in the scPTZ test. The activity against the psychomotor seizures in the 6-Hz test was detected only for the H4-CA (0.5 µg) and H4-KA (0.5 µg and 1 µg), respectively. The peptide derivates did not exhibit neurotoxicity in the rotarod test. Our findings suggest that conjugated CA and KA hemorphine peptides can be used as a background for developing hemorphin-related analogs with anticonvulsant activity. Acknowledgments: This study is funded by the European Union-NextGenerationEU, through the National Recovery and Resilience Plan of the Republic of Bulgaria, project № BG-RRP-2.004-0002, "BiOrgaMCT".

Keywords: hemorphins, SPSS, caffeic/cinnamic acid, anticonvulsant activity, electrochemistry, fluorimetry

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8255 The Relationship between Agile Methodology and Organizational and Professional Stress of Employees of IT Companies

Authors: Ilya Vladimirovich Konevtsev, Elena Anatolievna Rodionova

Abstract:

This work is devoted to the study of the impact of the methodology of flexible management in IT companies on the level of organizational and professional stress of employees. It is assumed that the level of organizational and professional stress will decrease statistically significantly, provided that the company operates in accordance with the principles of flexible methodology, including Scrum or Kanban frameworks. The professional health of employees of various companies in the modern world is a stable interest for organizational psychology and many other related disciplines. The urgency of the problem is due to the fact that professional health is an extremely important factor that ensures the well-being, involvement, and interest of an employee in the activity, which directly affects his efficiency and work results. The use of modern methodologies for managing projects, teams, and entire companies, as practice shows, largely contributes to improving the efficiency and satisfaction of employees, but it is still not clear what factors contribute to this result. The purpose of this study is largely to clarify the question of how HR management methodologies affect the professional health of company employees. The study involved 44 employees of IT companies, of which 27 are men and 17 women, where Agile management methodology is used, and 41 employees of IT companies (33 men, 8 women) where Agile is not used. As a result, it was found out that the use of Agile methodology is interrelated with low indicators of organizational stress and professional stress; however, regression analysis showed that only the Kanban framework acts as a predictor of reducing professional stress, while the level of organizational stress is statistically significantly reduced when using Scrum and Kanban.

Keywords: professional stress, organizational stress, agile, scrum, Kanban

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8254 Assessment of Heavy Metals Contamination Levels in Groundwater: A Case Study of the Bafia Agricultural Area, Centre Region Cameroon

Authors: Carine Enow-Ayor Tarkang, Victorine Neh Akenji, Dmitri Rouwet, Jodephine Njdma, Andrew Ako Ako, Franco Tassi, Jules Remy Ngoupayou Ndam

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Groundwater is the major water resource in the whole of Bafia used for drinking, domestic, poultry and agricultural purposes, and being an area of intense agriculture, there is a great necessity to do a quality assessment. Bafia is one of the main food suppliers in the Centre region of Cameroon, and so to meet their demands, the farmers make use of fertilizers and other agrochemicals to increase their yield. Less than 20% of the population in Bafia has access to piped-borne water due to the national shortage, according to the authors best knowledge very limited studies have been carried out in the area to increase awareness of the groundwater resources. The aim of this study was to assess heavy metal contamination levels in ground and surface waters and to evaluate the effects of agricultural inputs on water quality in the Bafia area. 57 water samples (including 31 wells, 20 boreholes, 4 rivers and 2 springs) were analyzed for their physicochemical parameters, while collected samples were filtered, acidified with HNO3 and analyzed by ICP-MS for their heavy metal content (Fe, Ti, Sr, Al, Mn). Results showed that most of the water samples are acidic to slightly neutral and moderately mineralized. Ti concentration was significantly high in the area (mean value 130µg/L), suggesting another Ti source besides the natural input from Titanium oxides. The high amounts of Mn and Al in some cases also pointed to additional input, probably from fertilizers that are used in the farmlands. Most of the water samples were found to be significantly contaminated with heavy metals exceeding the WHO allowable limits (Ti-94.7%, Al-19.3%, Mn-14%, Fe-5.2% and Sr-3.5% above limits), especially around farmlands and topographic low areas. The heavy metal concentration was evaluated using the heavy metal pollution index (HPI), heavy metal evaluation index (HEI) and degree of contamination (Cd), while the Ficklin diagram was used for the water based on changes in metal content and pH. The high mean values of HPI and Cd (741 and 5, respectively), which exceeded the critical limit, indicate that the water samples are highly contaminated, with intense pollution from Ti, Al and Mn. Based on the HPI and Cd, 93% and 35% of the samples, respectively, are unacceptable for drinking purposes. The lowest HPI value point also had the lowest EC (50 µS/cm), indicating lower mineralization and less anthropogenic influence. According to the Ficklin diagram, 89% of the samples fell within the near-neutral low-metal domain, while 9% fell in the near-neutral extreme-metal domain. Two significant factors were extracted from the PCA, explaining 70.6% of the total variance. The first factor revealed intense anthropogenic activity (especially from fertilizers), while the second factor revealed water-rock interactions. Agricultural activities thus have an impact on the heavy metal content of groundwater in the area; hence, much attention should be given to the affected areas in order to protect human health/life and thus sustainably manage this precious resource.

Keywords: Bafia, contamination, degree of contamination, groundwater, heavy metal pollution index

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8253 Modeling Operating Theater Scheduling and Configuration: An Integrated Model in Health-Care Logistics

Authors: Sina Keyhanian, Abbas Ahmadi, Behrooz Karimi

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We present a multi-objective binary programming model which considers surgical cases are scheduling among operating rooms and the configuration of surgical instruments in limited capacity hospital trays, simultaneously. Many mathematical models have been developed previously in the literature addressing different challenges in health-care logistics such as assigning operating rooms, leveling beds, etc. But what happens inside the operating rooms along with the inventory management of required instruments for various operations, and also their integration with surgical scheduling have been poorly discussed. Our model considers the minimization of movements between trays during a surgery which recalls the famous cell formation problem in group technology. This assumption can also provide a major potential contribution to robotic surgeries. The tray configuration problem which consumes surgical instruments requirement plan (SIRP) and sequence of surgical procedures based on required instruments (SIRO) is nested inside the bin packing problem. This modeling approach helps us understand that most of the same-output solutions will not be necessarily identical when it comes to the rearrangement of surgeries among rooms. A numerical example has been dealt with via a proposed nested simulated annealing (SA) optimization approach which provides insights about how various configurations inside a solution can alter the optimal condition.

Keywords: health-care logistics, hospital tray configuration, off-line bin packing, simulated annealing optimization, surgical case scheduling

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8252 Integrating Sexual Reproductive Health and Rights in Promoting Gender Equality, Equity, and Empowerment of Women

Authors: Danielle G. Saique

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Introduction: Promoting Gender Equality, Equity and Empowerment of Women (GEE&EW) can be attained by practicing thereby exercising Sexual and Reproductive Health and Rights (SRHR). Gender Inequality is manifested thru Violence Against Women (VAW). Objectives: This study presents causes, prevalence, effects of Gender Inequality for not practicing and violating SRHR. This proposes Action Plan by promoting, integrating SRHR in the “holistic approach” of Social Work education, practice and service-delivery in any work-set-ups. Limitations: VAW cases showed victim and violator are known, related and living together. Cases transpired at home, reported, investigated in the police and filed in the legal court of law for the year 2013. Methods: Data from blotters, reports, filed cases, case studies gathered by the Social Worker (SWr). Qualitative analysis identified cause, prevalence of VAW related in violating SRHR. SWr serves innovative interventions in any work settings by applying SRHR background, skills in educating, counseling client-victims. Results: 65 VAW cases on non-negotiation or refusal of practicing SRHR. Non-acceptance of Family Planning yielded unwanted, unplanned pregnancies, abandoned children, battered women. Neglected pre-post natal maternal care caused complications or death. Rape, incest led trauma or death. Unsafe, unprotected sex transmitted STDs. Conclusions: Non-availing SRHR from health facilities, from Medical Health SWr concluded to non-practicing or violating rights to life, health care, protection, rights to information, education, rights to plan family, rights from torture, ill-treatment. VAW brings undesirable effects to the well-being, wellness and humaneness of the victim. Recommendations: The innovative intervention services on SRHR of a SWr and the findings, results in violating SRHR are recommendations in Action Planning by adding “The SRHR Concepts” in Social Work thereby preventing VAW; empowering women’s rights to development, gender equality, equity liberty, security, freedom; resilience and involvement in promoting, practicing, exercising SRHR at home. Recommended therefore to duplicate this innovative practice and experience on SRHR as implemented by the SWr in any work setting.

Keywords: women development, promoting gender equality, equity, empowerment of women

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8251 Enhancing a Recidivism Prediction Tool with Machine Learning: Effectiveness and Algorithmic Fairness

Authors: Marzieh Karimihaghighi, Carlos Castillo

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This work studies how Machine Learning (ML) may be used to increase the effectiveness of a criminal recidivism risk assessment tool, RisCanvi. The two key dimensions of this analysis are predictive accuracy and algorithmic fairness. ML-based prediction models obtained in this study are more accurate at predicting criminal recidivism than the manually-created formula used in RisCanvi, achieving an AUC of 0.76 and 0.73 in predicting violent and general recidivism respectively. However, the improvements are small, and it is noticed that algorithmic discrimination can easily be introduced between groups such as national vs foreigner, or young vs old. It is described how effectiveness and algorithmic fairness objectives can be balanced, applying a method in which a single error disparity in terms of generalized false positive rate is minimized, while calibration is maintained across groups. Obtained results show that this bias mitigation procedure can substantially reduce generalized false positive rate disparities across multiple groups. Based on these results, it is proposed that ML-based criminal recidivism risk prediction should not be introduced without applying algorithmic bias mitigation procedures.

Keywords: algorithmic fairness, criminal risk assessment, equalized odds, recidivism

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8250 An Evaluation of Air Pollutant Concentrations in Gyor, Hungary

Authors: Andrea Szabo Nagy, Zsofia Csanadi

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The purpose of this study was to evaluate the concentration levels of common inorganic gases, benzene and particulate matter (PM₁₀ and PM₂.₅) in ambient air of Győr (Hungary) based on the latest published monitoring data. The concentrations of PM10-bound heavy metals (Pb, Cd, As and Ni) and some polycyclic aromatic hydrocarbons (PAHs) were also assessed. The levels of pollutants were compared with the Hungarian and EU limit or target values defined for health protection and the WHO air quality guidelines (AQGs) or estimated reference levels. Based on the Hungarian or the EU air quality standards and using the Hungarian Air Quality Index it was found that mainly an excellent (SO₂, CO, C₆H₆, heavy metals) or good (NO₂, O₃, PM₁₀, PM₂.₅, benzo(a)pyrene (BaP)) air quality was observed in the urban area of Győr for the year 2016. The annual mean pollutant concentrations (excluding BaP) were not exceeded or just reached the WHO AQGs or reference levels.

Keywords: aerosols, air pollutant, air quality, health protection

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8249 Tuberculosis Outpatient Treatment in the Context of Reformation of the Health Care System

Authors: Danylo Brindak, Viktor Liashko, Olexander Chepurniy

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Despite considerable experience in implementation of the best international approaches and services within response to epidemy of multi-drug resistant tuberculosis, the results of situation analysis indicate the presence of faults in this area. In 2014, Ukraine (for the first time) was included in the world’s five countries with the highest level of drug-resistant tuberculosis. The effectiveness of its treatment constitutes only 35% in the country. In this context, the increase in allocation of funds to control the epidemic of multidrug-resistant tuberculosis does not produce perceptible positive results. During 2001-2016, only the Global Fund to fight AIDS, Tuberculosis, and Malaria allocated to Ukraine more than USD 521,3 million for programs of tuberculosis and HIV/AIDS control. However, current conditions in post-Semashko system create little motivation for rational use of resources or cost control at inpatient TB facilities. There is no motivation to reduce overdue hospitalization and to target resources to priority sectors of modern tuberculosis control, including a model of care focused on the patient. In the presence of a line-item budget at medical institutions, based on the input factors as the ratios of beds and staff, there is a passive disposal of budgetary funds by health care institutions and their employees who have no motivation to improve quality and efficiency of service provision. Outpatient treatment of tuberculosis is being implemented in Ukraine since 2011 and has many risks, namely creation of parallel systems, low consistency through dependence on funding for the project, reduced the role of the family doctor, the fragmentation of financing, etc. In terms of reforming approaches to health system financing, which began in Ukraine in late 2016, NGO Infection Control in Ukraine conducted piloting of a new, motivating method of remuneration of employees in primary health care. The innovative aspect of this funding mechanism is cost according to results of treatment. The existing method of payment on the basis of the standard per inhabitant (per capita ratio) was added with motivating costs according to results of work. The effectiveness of such treatment of TB patients at the outpatient stage is 90%, while in whole on the basis of a current system the effectiveness of treatment of newly diagnosed pulmonary TB with positive swab is around 60% in the country. Even though Ukraine has 5.24 TB beds per 10 000 citizens. Implemented pilot model of ambulatory treatment will be used for the creation of costs system according to results of activities, the integration of TB and primary health and social services and their focus on achieving results, the reduction of inpatient treatment of tuberculosis.

Keywords: health care reform, multi-drug resistant tuberculosis, outpatient treatment efficiency, tuberculosis

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8248 Prediction of Childbearing Orientations According to Couples' Sexual Review Component

Authors: Razieh Rezaeekalantari

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Objective: The purpose of this study was to investigate the prediction of parenting orientations in terms of the components of couples' sexual review. Methods: This was a descriptive correlational research method. The population consisted of 500 couples referring to Sari Health Center. Two hundred and fifteen (215) people were selected randomly by using Krejcie-Morgan-sample-size-table. For data collection, the childbearing orientations scale and the Multidimensional Sexual Self-Concept Questionnaire were used. Result: For data analysis, the mean and standard deviation were used and to analyze the research hypothesis regression correlation and inferential statistics were used. Conclusion: The findings indicate that there is not a significant relationship between the tendency to childbearing and the predictive value of sexual review (r = 0.84) with significant level (sig = 219.19) (P < 0.05). So, with 95% confidence, we conclude that there is not a meaningful relationship between sexual orientation and tendency to child-rearing.

Keywords: couples referring, health center, sexual review component, parenting orientations

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8247 Health State Utility Values Related to COVID-19 Pandemic Using EQ-5D: A Systematic Review and Meta-Analysis

Authors: Xu Feifei

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The prevalence of COVID-19 currently is the biggest challenge to improving people's quality of life. Its impact on the health-related quality of life (HRQoL) is highly uncertain and has not been summarized so far. The aim of the present systematic review was to assess and provide an up-to-date analysis of the impact of the COVID-19 pandemic on the HRQoL of participants who have been infected, have not been infected but isolated, frontline, with different diseases, and the general population. Therefore, an electronic search of the literature in PubMed databases was performed from 2019 to July 2022 (without date restriction). PRISMA guideline methodology was employed, and data regarding the HRQoL were extracted from eligible studies. Articles were included if they met the following inclusion criteria: (a) reports on the data collection of the health state utility values (HSUVs) related to COVID-19 from 2019 to 2021; (b) English language and peer-reviewed journals; and (c) original HSUV data; (d) using EQ-5D tool to quantify the HRQoL. To identify studies that reported the effects on COVID-19, data on the proportion of overall HSUVs of participants who had the outcome were collected and analyzed using a one-group meta-analysis. As a result, thirty-two studies fulfilled the inclusion criteria and, therefore, were included in the systematic review. A total of 45295 participants and provided 219 means of HSUVs during COVID-19 were included in this systematic review. The range of utility is from 0.224 to 1. The study included participants from Europe (n=16), North America (n=4), Asia (n=10), South America (n=1), and Africa (n=1). Twelve articles showed that the HRQoL of the participants who have been infected with COVID-19 (range of overall HSUVs from 0.6125 to 0.863). Two studies reported the population of frontline workers (the range of overall HSUVs from 0.82 to 0.93). Seven of the articles researched the participants who had not been infected with COVID-19 but suffered from morbidities during the pandemic (range of overall HSUVs from 0.5 to 0.96). Thirteen studies showed that the HRQoL of the respondents who have not been infected with COVID-19 and without any morbidities (range of overall HSUVs from 0.64 to 0.964). Moreover, eighteen articles reported the outcomes of overall HSUVs during the COVID-19 pandemic in different population groups. The estimate of overall HSUVs of direct COVID-19 experience population (n=1333) was 0.751 (95% CI 0.670 - 0.832, I2 = 98.64%); the estimate of frontline population (n=610) was 0.906 ((95% CI 0.854 – 0.957, I2 = 98.61%); participants with different disease (n=132) were 0.768 (95% CI 0.515 - 1.021, I2= 99.26%); general population without infection history (n=29,892) was 0.825 (95% CI 0.766 - 0.885, I2 =99.69%). Conclusively, taking into account these results, this systematic review might confirm that COVID-19 has a negative impact on the HRQoL of the infected population and illness population. It provides practical value for cost-effectiveness model analysis of health states related to COVID-19.

Keywords: COVID-19, health-related quality of life, meta-analysis, systematic review, utility value

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8246 An Approach of Computer Modalities for Exploration of Hieroglyphics Substantial in an Investigation

Authors: Aditi Chauhan, Neethu S. Mohan

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In the modern era, the advancement and digitalization in technology have taken place during an investigation of crime scene. The rapid enhancement and investigative techniques have changed the mean of identification of suspect. Identification of the person is one of the significant aspects, and personal authentication is the key of security and reliability in society. Since early 90 s, people have relied on comparing handwriting through its class and individual characteristics. But in today’s 21st century we need more reliable means to identify individual through handwriting. An approach employing computer modalities have lately proved itself auspicious enough in exploration of hieroglyphics substantial in investigating the case. Various software’s such as FISH, WRITEON, and PIKASO, CEDAR-FOX SYSTEM identify and verify the associated quantitative measure of the similarity between two samples. The research till date has been confined to identify the authorship of the concerned samples. But prospects associated with the use of computational modalities might help to identify disguised writing, forged handwriting or say altered or modified writing. Considering the applications of such modal, similar work is sure to attract plethora of research in immediate future. It has a promising role in national security too. Documents exchanged among terrorist can also be brought under the radar of surveillance, bringing forth their source of existence.

Keywords: documents, identity, computational system, suspect

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8245 Regionalism or Ladder-Up: A Theoretical Perspective of Association of Southeast Asian Nations’ Reactions to Belt and Road Initiative

Authors: Yunqi Wang

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As a vital region to the Chinese Belt and Road Initiative (BRI), members of the Association of Southeast Asian Nations (ASEAN) have responded to the grand strategy differently. Some expressed fervent support, while others played the 'hedging' card between great powers. This paper explores the underlying rationale behind such complexity by proposing two theoretical explanations: a Regionalism Hypothesis, where countries respond with hedging, balancing, and bandwagoning behaviours in line with national interests and norm-based 'ASEAN-Way'; and a Ladder-up Hypothesis, where countries consider the initiative as an incentive to remove bottlenecks of climbing up the economic ladder in Rostow's stage of the growth model. By analysing reactions from Myanmar, Laos, Indonesia, and Singapore, two patterns are observed. On an empirical note, the more developed economies are more inclined to the Regionalist explanation. On a theoretical note, there has been a gradual convergence between the two explanations, given the impact of economic globalisation on ASEAN. This paper will contribute to the current theoretical vacancy in the study of ASEAN and BRI by capturing the particular norms shared by this regional entity.

Keywords: ASEAN, belt and road initiative, hedging, Rostow's stages of growth, regionalism

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