Search results for: public health risks

Authors: Maria L. Ulloa, Ruth M. Crawford, Stephanie Kelly, Joey Domdom

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In recent decades health and social service delivery have become more collaborative and interdisciplinary. Emerging trends suggest the need for an integrative and interprofessional approach to meet the challenges faced by professionals navigating the complexities of health and social service practice environments. Terms such as multidisciplinary practice, interprofessional collaboration, interprofessional education and transprofessional practice have become the common language used across a range of social services and health providers in western democratic systems. In Aotearoa New Zealand, one example of an interprofessional collaborative approach to curriculum design and delivery in health and social service is the development of an innovative Masters of Professional Practice programme. This qualification is the result of a strategic partnership between two tertiary institutions – Whitireia New Zealand (NZ) and the Wellington Institute of Technology (Weltec) in Wellington. The Master of Professional Practice programme was designed and delivered from the perspective of a collaborative, interprofessional and relational approach. Teachers and students in the programme come from a diverse range of cultural, professional and personal backgrounds and are engaged in courses using a blended learning approach that incorporates the values and pedagogies of interprofessional education. Students are actively engaged in professional practice while undertaking the programme. This presentation describes the themes of exploratory qualitative formative observations of engagement in class and online, student assessments, student research projects, as well as qualitative interviews with the programme teaching staff. These formative findings reveal the development of critical practice skills around the common themes of the programme: research and evidence based practice, education, leadership, working with diversity and advancing critical reflection of professional identities and interprofessional practice. This presentation will provide evidence of enhanced learning experiences in higher education and learning in multi-disciplinary contexts.

Keywords: diversity, exploratory research, interprofessional education, professional identity

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Authors: S. Ravindran, Y.Liu, I. Gratchev, D.Jeng

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Rainfall-induced shallow landslides are more common in the northern New South Wales (NSW), Australia. From 2009 to 2017, around 105 rainfall-induced landslides occurred along the road corridors and caused temporary road closures in the northern NSW. Rainfall causing shallow landslides has different distributions of rainfall varying from uniform, normal, decreasing to increasing rainfall intensity. The duration of rainfall varied from one day to 18 days according to historical data. The objective of this research is to analyse slope instability of some of the sites in the northern NSW by varying cumulative rainfall using SLOPE/W and SEEP/W and compare with field data of rainfall causing shallow landslides. The rainfall data and topographical data from public authorities and soil data obtained from laboratory tests will be used for this modelling. There is a likelihood of shallow landslides if the cumulative rainfall is between 100 mm to 400 mm in accordance with field data.

Keywords: landslides, modelling, rainfall, suction

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Authors: Medha Basu, Kumardeb Banerjee, Dipak Ghosh

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After the massive blow of the COVID-19 pandemic, several health hazards have been reported all over the world. Serious cases of Major Depressive Disorder (MDD) are seen to be common in about 15% of the global population, making depression one of the leading mental health diseases, as reported by the World Health Organization. Various psychological and pharmacological treatment techniques are regularly being reported. Music, a globally accepted mode of entertainment, is often used as a therapeutic measure to treat various health conditions. We have tried to understand how Indian Classical Music can affect the overall well-being of the human brain. A case study has been reported here, where a Flute-rendition has been chosen from a detailed audience response survey, and the effects of that clip on human brain conditions have been studied from both psychological and neural perspectives. Taking help from internationally-accepted depression-rating scales, two questionnaires have been designed to understand both the prolonged and immediate effect of music on various emotional states of human lives. Thereafter, from EEG experiments on 5 participants using the same clip, the parameter ‘ALAY’, alpha frontal asymmetry (alpha power difference of right and left frontal hemispheres), has been calculated. Works of Richard Davidson show that an increase in the ‘ALAY’ value indicates a decrease in depressive symptoms. Using the non-linear technique of MFDFA on EEG analysis, we have also calculated frontal asymmetry using the complexity values of alpha-waves in both hemispheres. The results show a positive correlation between both the psychological survey and the EEG findings, revealing the prominent role of music on the human brain, leading to a decrease in mental unrest and an increase in overall well-being. In this study, we plan to propose the scientific foundation of music therapy, especially from a neurocognition perspective, with appropriate neural bio-markers to understand the positive and remedial effects of music on the human brain.

Keywords: music therapy, EEG, psychological survey, frontal alpha asymmetry, wellbeing

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Authors: Maarja Karbus, Elsbet Lippmaa, Kadri Kööp, Mare Tupits

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Aim: The aim is to describe the experiences and needs of mothers of children with cancer in coping with the child's illness. Background: Cancer affects different life areas. Especially if it is a child, in this case the whole family is involved. Loved ones are mentally affected, there are limitations, and life changes need to be made to make the whole treatment regimen and recovery as comfortable as possible. Also, the whole process is expensive and time consuming. The research is part of a larger project that covers the experiences and needs of parents of children with chronic illness and coping strategies related to the child's illness. Design: Qualitative, empirical, descriptive research. Method: Semi-structured interviews were used to collect data and inductive content analysis was used to analyze the data. The interviews were conducted in the autumn of 2020, 5 respondents participated in the research. Results and Conclusions: The research revealed that the mothers' experiences of coping with a child's disease included health-related experiences, material aspects, changes in lifestyle, support systems and contact with professionals. Regarding the organizational and material aspects of life, the subjects presented experiences with economic problems, adaptation of changes in lifestyle, access to information and changes in the treatment process. With regard to health, the respondents identified experiences with the mother's physical and mental health and experiences with the health of an ill child. The experience of different support systems was related to the support of family, friends, acquaintances, various organizations and specialists. Experiences with specialist support included experiences with family relationships and positive and negatiive experiences with staff. The mothers' needs in dealing with the child's disease included the mother's emotional needs, the support of other family members, and the need for various support systems and services. The needs of coping with the child were the need for understanding, support, confidence, the need to be strong and courageous, the need to ignore one's own needs, and the need for personal time and rest. The needs of other family members included the needs of an ill child and the need to pay attention to other children in the family. The needs of different supporters and services were related to different helpers and different services.

Keywords: cancer, mother, coping, child, need, experience, illness

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Authors: Goran Sporiš, Dinko Vuleta, Stefan Lovro

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The purpose of the present study was to determine the associations between health-related quality of life (HRQOL) and physical activity (PA) in different domains. In this cross-sectional study, participants were 169 Croatian police officers (mean age 35.14±8.95 yrs, mean height 180.93±7.53 cm, mean weight 88.39±14.05 kg, mean body-mass index 26.90±3.39 kg/m2). The dependent variables were two general domains extracted from the HRQOL questionnaire: (1) physical component scale (PCS) and (2) mental component scale (MCS). The independent variables were job-related, transport, domestic and leisure-time PA, along with other factors: age, body-mass index, smoking status, psychological distress, socioeconomic status and time spent in sedentary behaviour. The associations between dependent and independent variables were analyzed by using multiple regression analysis. Significance was set up at p < 0.05. PCS was positively associated with leisure-time PA (β 0.28, p < 0.001) and socioeconomic status (SES) (β 0.16, p=0.005), but inversely associated with job-related PA (β -0.15, p=0.012), domestic-time PA (β -0.14, p=0.014), age (β -0.12, p=0.050), psychological distress (β -0.43, p<0.001) and sedentary behaviour (β -0.15, p=0.009). MCS was positively associated with leisure-time PA (β 0.19, p=0.013) and SES (β 0.20, p=0.002), while inversely associated with age (β -0.23, p=0.001), psychological distress (β -0.27, p<0.001) and sedentary behaviour (β -0.22, p=0.001). Our results added new information about the associations between domain-specific PA and both physical and mental component scale in police officers. Future studies should deal with the same associations in other stressful occupations.

Keywords: health, fitness, police force, relations

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Authors: Suyeon Bae, Abimbola Asojo, Denise Guerin, Caren Martin

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Post-occupancy evaluations (POEs) have been recognized for documenting occupant well-being and responses to indoor environmental quality (IEQ) factors such as thermal, lighting, and acoustic conditions. Sustainable Post-Occupancy evaluation survey (SPOES) developed by an interdisciplinary team at a Midwest University provides an evidence-based quantitative analysis of occupants’ satisfaction in office, classroom, and residential spaces to help direct attention to successful areas and areas that need improvement in buildings. SPOES is a self-administered and Internet-based questionnaire completed by building occupants. In this study, employees in three different office buildings rated their satisfaction on a Likert-type scale about 12 IEQ criteria including thermal condition, indoor air quality, acoustic quality, daylighting, electric lighting, privacy, view conditions, furnishings, appearance, cleaning and maintenance, vibration and movement, and technology. Employees rated their level of satisfaction on a Likert-type scale from 1 (very dissatisfied) to 7 (very satisfied). They also rate the influence of their physical environment on their perception of their work performance and the impact of their primary workspaces on their health on a scale from 1 (hinders) to 7 (enhances). Building A is a three-story building that includes private and group offices, classrooms, and conference rooms and amounted to 55,000 square-feet for primary workplace (N=75). Building B, a six-story building, consisted of private offices, shared enclosed office, workstations, and open desk areas for employees and amounted to 14,193 square-feet (N=75). Building C is a three-story 56,000 square-feet building that included classrooms, therapy rooms, an outdoor playground, gym, restrooms, and training rooms for clinicians (N=76). The results indicated that 10 IEQs for Building A except acoustic quality and privacy showed statistically significant correlations on the impact of the primary workspace on health. In Building B, 11 IEQs except technology showed statistically significant correlations on the impact of the primary workspace on health. Building C had statistically significant correlations between all 12 IEQ and the employees’ perception of the impact of their primary workspace on their health in two-tailed correlations (P ≤ 0.05). Out of 33 statistically significant correlations, 25 correlations (76%) showed at least moderate relationship (r ≥ 0.35). For the three buildings, daylighting, furnishings, and indoor air quality IEQs ranked highest on the impact on health. IEQs about vibration and movement, view condition, and electric lighting ranked second, followed by IEQs about cleaning and maintenance and appearance. These results imply that 12 IEQs developed in SPOES are highly related to employees’ perception of how their primary workplaces impact their health. The IEQs in this study offer an opportunity for improving occupants’ well-being and the built environment.

Keywords: post-occupancy evaluation, built environment, sustainability, well-being, indoor air quality

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Authors: Kacper Tomasz Kröber-Mulawa

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This paper will address the topic of data ownership from an economic perspective, and examples of economic limitations of data property rights will be provided, which have been identified using methods and approaches of economic analysis of law. To properly build a background for the economic focus, in the beginning a short perspective of data and data ownership in the EU’s legal system will be provided. It will include a short introduction to its political and social importance and highlight relevant viewpoints. This will stress the importance of a Single Market for data but also far-reaching regulations of data governance and privacy (including the distinction of personal and non-personal data, data held by public bodies and private businesses). The main discussion of this paper will build upon the briefly referred to legal basis as well as methods and approaches of economic analysis of law.

Keywords: antitrust, data, data ownership, digital economy, property rights

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Authors: Zhiqiang Zhu, Khalegh Barati, Xuesong Shen

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Due to the energy consumption caused by the construction industry, the public is paying more and more attention to the sustainability of the buildings. With the advancement of research on recycled aggregates, it has become possible to replace natural aggregates with recycled aggregates and to achieve a reduction in energy consumption of materials during construction. The purpose of this paper is to quantitatively compare the emergy consumption of natural aggregate concrete (NAC) and recycled aggregate concrete (RAC). To do so, the emergy analysis method is adopted. Using this technique, it can effectively analyze different forms of energy and substance. The main analysis object is the direct and indirect emergy consumption of the stages in concrete production. Therefore, for indirect energy, consumption of production machinery and transportation vehicle also need to be considered. Finally, the emergy values required to produce the two concrete types are compared to analyze whether the RAC can reduce emergy consumption.

Keywords: sustainable construction, NAC, RAC, emergy, concrete

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Authors: Lilian Nantume Wampande

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

Keywords: adolescent, HIV, support groups, Uganda

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Authors: Xavier McCreanor, Rowena Naidoo, Verusia Chetty

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Background: The growing trend of children with disabilities being excluded from physical education classes due to a lack of inclusive education training for educators is concerning. This poses a significant health risk to disabled children worldwide, including those attending mainstream schools in South Africa. Unfortunately, disabled children often feel left out and uncomfortable in physical education classes. The current public school system faces challenges in providing quality physical education to disabled children, as classes need to be tailored to their specific needs. Although studies have pointed to the need for training, there is limited understanding of the teaching methods and curricula required for the inclusive education of children with disabilities. Objective: Given the lack of practical guidance, teaching methods, and resources, a scoping review was conducted to map and summarise the existing literature on teaching physical education to children with disabilities. The review aimed to identify the information regarding curricula used to teach children with disabilities, elaborate on the teaching methodologies, and report on the findings of relevant studies. Methods: The researchers searched the literature in the following electronic databases: Google Scholar; EBSCOhost; the Cochrane Library; PubMed; and Science Direct. The research team also conducted a reference list search to ensure that all relevant articles were included in the study. The researchers followed an initial screening process and two more screening levels to extract the data collaboratively, organize it into themes and sub-themes, summarise them, and report the results in a descriptive and narrative synthesis. Results and Conclusion: A scoping review of the past decade’s research on inclusive physical education for students with disabilities revealed persistent exclusion and insufficient involvement. The challenges are due to inaccessible facilities and negative attitudes. To address these obstacles, structural changes, inclusive policies, accessible facilities, and comprehensive training for physical education instructors are crucial. However, challenges such as inadequate policies and guidelines, financial limitations, and a shortage of specialists and resources hinder the implementation of inclusive physical education. Overcoming these challenges requires a collaborative effort. Creating a supportive environment, providing customized activities, and adopting effective teaching methods are essential to promote inclusivity and enhance the learning experiences of students with disabilities.

Keywords: adapted physical activity, disability, physical education, schools

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Authors: Toufic Sarieddine

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As the belt and road Initiative (henceforth, BRI) enters its 9th year, Iran and China are forging stronger ties on economic and military fronts, a development which has not only caused alarm in Washington but also risks staining China’s relationships with the oil-rich Gulf monarchies. World-systems theory has been used to examine the impact of the BRI on the current world order, with scholarship split on the capacity of China to emerge as a hegemon contending with the US or even usurping it. This paper argues the emergence of a new China-centered world-system comprised of states/areas and processes participating in the BRI and overlapping with the global world-system under (shaky) US hegemony. This world-system centers around China as core and hegemon via economic domination, capable new institutions (Shanghai Cooperation Council), legal modi operandi, the common goal of infrastructure development to rally support among developing states, and other indicators of hegemony outlined in world-systems theory. In this regard, while states like Pakistan could become peripheries to China in the BRI-bound world-system via large-scale projects such as the China-Pakistan Economic Corridor, Iran has greater capacities and influence in the Middle East, making it superior to a periphery. This paper thus argues that the increasing proximity between Iran and China sees the former becoming a semi-periphery with respect to China within the BRI-bound world-system, having economic dependence on its new core and hegemon while simultaneously wielding political and military influence on weaker states such as Iraq, Lebanon, Yemen, and Syria. The indicators for peripheralization as well as the characteristics of a semi-periphery outlined in world-systems theory are used to examine the current economic, political, and militaristic dimensions of Iran and China’s growing relationship, as well as the trajectory of these dimensions as part of the BRI-bound world-system.

Keywords: belt and road initiative, China, China-Middle East relations, Iran, world-systems analysis

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Authors: Amit Kumar Dwivedi, Priyanko Ghosh

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Data Envelopment analysis (DEA) has been used to calculate the technical and scale efficiency measures of the public and private sugar manufacturing firms of the Indian Sugar Industry (2006 to 2010). Within DEA framework, the input & Output oriented Variable Returns to Scale (VRS) & Constant Return to Scale (CRS) model is employed for the study of Decision making units (DMUs). A representative sample of 43 firms which account for major portion of the total market share is studied. The selection criterion for the inclusion of a firm in the analysis was the total sales of INR 5,000 million or more in the year 2010. After reviewing the literature it is found that no study has been conducted in the context of Indian sugar manufacturing firms in the Post-liberalization era which motivates us to initiate the study.

Keywords: technical efficiency, Indian sugar manufacturing units, DEA, input output oriented

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Authors: Nadjet Brahmia

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The growing needs of displacements led advanced countries in this field install new specific transport systems, able to palliate any deficiencies, especially when regular public transport does not adequately meet the requests of users. In this context, on-demand transportation (ODT) are very efficient; they rely on techniques based on the location of trip generators which should be assured effectively with the use of operators responsible of the advance reservation, planning and organization, and studying the different ODT criteria (organizational, technical, geographical, etc.). As the advanced countries in the field of transport, some developing countries are involved in the adaptation of the new technologies to reduce the deficit in their communication system. This communication presents the study of an ODT implementation in the west of Algeria, by developing the Geomatics side of the study. This part requires the use of specific systems (such as GIS, RDBMS…), so we developed the process through an application in an environment of mobility by using the computer tools dedicated to the management of the entities related to the transport field.

Keywords: ODT, geomatics, GIS, transport systems

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Authors: Goran Begović

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In recent years, many researchers are focusing on non-intrusive measuring methods when it comes to human biosignals. These methods provide solutions for everyday use, whether it’s health monitoring or finessing the workout routine. One of the biggest issues with these solutions is that the sensors’ accuracy is highly variable due to many factors, such as ambiental light, skin color diversity, etc. That is why we wanted to explore different outcomes under those kinds of circumstances in order to find the most optimal algorithm(s) for extracting heart rate (HR) information. The optimization of such algorithms can benefit the wider, cheaper, and safer application of home health monitoring, without having to visit medical professionals as often when it comes to observing heart irregularities. In this study, we explored the accuracy of infrared (IR), red, and green LED sensorics in a controlled environment and compared the results with a medically accurate ECG monitoring device.

Keywords: data science, ECG, heart rate, holter monitor, LED sensors

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Authors: O. Benabdeljelil, A. Karioun, S. Amami, R. Rouger, M. Hamidine

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A model for preventing the risks related to climate conditions in the agricultural sector is presented. It will determine the yearly optimum premium to be paid by a producer in order to reach his required turnover. The model is based on both climatic stability and 'soft' responses of usually grown species to average climate variations at the same place and inside a safety ball which can be determined from past meteorological data. This allows the use of linear regression expression for dependence of production result in terms of driving meteorological parameters, the main ones of which are daily average sunlight, rainfall and temperature. By simple best parameter fit from the expert table drawn with professionals, optimal representation of yearly production is determined from records of previous years, and yearly payback is evaluated from minimum yearly produced turnover. The model also requires accurate pricing of commodity at N+1. Therefore, a pricing model is developed using 3 state variables, namely the spot price, the difference between the mean-term and the long-term forward price, and the long-term structure of the model. The use of historical data enables to calibrate the parameters of state variables, and allows the pricing of commodity. Application to beet sugar underlines pricer precision. Indeed, the percentage of accuracy between computed result and real world is 99,5%. Optimal premium is then deduced and gives the producer a useful bound for negotiating an offer by insurance companies to effectively protect its harvest. The application to beet production in French Oise department illustrates the reliability of present model with as low as 6% difference between predicted and real data. The model can be adapted to almost any agricultural field by changing state parameters and calibrating their associated coefficients.

Keywords: agriculture, production model, optimal price, meteorological factors, 3-factor model, parameter calibration, forward price

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Authors: Si Jack Chong, Chew Theng Yap, Wan Loong James Mok

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Introduction: Regional burn centres face the spectra of introduced multi-drug resistant organisms (MDRO) from transfer patients resident in MDRO endemic countries. MDRO can cause severe nosocomial infection, which in massive burn patients, will lead to greater morbidity and mortality and strain the institution financially. We aim to highlight 4 key measures that have effectively prevented transmission of imported MDRO. Methods: A case of Candida auris (C. auris) from a massive burn patient transferred from an MDRO endemic country is used to illustrate the measures. C. auris is a globally emerging multi-drug resistant fungal pathogen causing nosocomial transmission. Results: Infection control measures used to mitigate the risk of outbreak from transfer cases are: (1) Multidisciplinary team approach involving Infection Control and Infectious Disease specialists early to ensure appropriate antibiotics use and implementation of barrier measures, (2) aseptic procedures for dressing change with strict isolation and donning of personal protective equipment in the ward, (3) early screening of massive burn patient from MDRO endemic region, (4) hydrogen peroxide vaporization terminal cleaning for operating theatres and rooms. Conclusion: The prevalence of air travel and international transfer to regional burn centres will need effective infection control measures to reduce the risk of transmission from imported massive burn patients. In our centre, we have effectively implemented 4 measures which have reduced the risks of local contamination. We share a recent case report to illustrate successful management of a potential MDRO outbreak resulting from transfer of massive burn patient resident in an MDRO endemic area.

Keywords: burns, burn unit, cross infection, infection control

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Authors: Mariel Encar H. Uy, Paula Marie G. Pacle

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The purpose of this research is to present a Single Country Comparative Contextual Description Study of Strong Islamic Influences in Relation to the Politics of Republic of Indonesia. This paper recognizes that even the coalition of secular and moderate Islamic parties protect the minority rights of all the constituents, Islam is still the dominant religion among the other recognized religions in Indonesia (Christianity, Hinduism and Buddhism). In this study, it will also detail the involvement on the religions’ beliefs and techniques; participation of political actors, depending on what religion they belong and adhere to; the tensions whenever the government interferes with Islamists and other religions; the government’s solution or public policies implemented to maintain peace and order of Indonesia. This paper will develop a conceptual framework to describe how the Religion and Political Stability is interdependent with each other.

Keywords: diversity of religion in indonesia, secularization in Indonesia, motivations of political actors, voter turnouts based on religion

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Authors: Wiseman Emmanuel Nkhomah, Chiyembekezo Kachimanga, Moses Banda Aron, Julia Higgins, Manuel Mulwafu, Kondwani Mpinga, Mwayi Chunga, Grace Momba, Enock Ndarama, Dickson Sumphi, Atupere Phiri, Fabien Munyaneza

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Background: Data is key to supporting health service delivery as stakeholders, including NGOs rely on it for effective service delivery, decision-making, and system strengthening. Several studies generated debate on data quality from national health management information systems (HMIS) in sub-Saharan Africa. This limits the utilization of data in resource-limited settings, which already struggle to meet standards set by the World Health Organization (WHO). We aimed to evaluate data quality improvement of Neno district HMIS over a 4-year period (2018 – 2021) following quarterly data reviews introduced in January 2020 by the district health management team and Partners In Health. Methods: Exploratory Mixed Research was used to examine report rates, followed by in-depth interviews using Key Informant Interviews (KIIs) and Focus Group Discussions (FGDs). We used the WHO module desk review to assess the quality of HMIS data in the Neno district captured from 2018 to 2021. The metrics assessed included the completeness and timeliness of 34 reports. Completeness was measured as a percentage of non-missing reports. Timeliness was measured as the span between data inputs and expected outputs meeting needs. We computed T-Test and recorded P-values, summaries, and percentage changes using R and Excel 2016. We analyzed demographics for key informant interviews in Power BI. We developed themes from 7 FGDs and 11 KIIs using Dedoose software, from which we picked perceptions of healthcare workers, interventions implemented, and improvement suggestions. The study was reviewed and approved by Malawi National Health Science Research Committee (IRB: 22/02/2866). Results: Overall, the average reporting completeness rate was 83.4% (before) and 98.1% (after), while timeliness was 68.1% and 76.4 respectively. Completeness of reports increased over time: 2018, 78.8%; 2019, 88%; 2020, 96.3% and 2021, 99.9% (p< 0.004). The trend for timeliness has been declining except in 2021, where it improved: 2018, 68.4%; 2019, 68.3%; 2020, 67.1% and 2021, 81% (p< 0.279). Comparing 2021 reporting rates to the mean of three preceding years, both completeness increased from 88% to 99% (in 2021), while timeliness increased from 68% to 81%. Sixty-five percent of reports have maintained meeting a national standard of 90%+ in completeness while only 24% in timeliness. Thirty-two percent of reports met the national standard. Only 9% improved on both completeness and timeliness, and these are; cervical cancer, nutrition care support and treatment, and youth-friendly health services reports. 50% of reports did not improve to standard in timeliness, and only one did not in completeness. On the other hand, factors associated with improvement included improved communications and reminders using internal communication, data quality assessments, checks, and reviews. Decentralizing data entry at the facility level was suggested to improve timeliness. Conclusion: Findings suggest that data quality in HMIS for the district has improved following collaborative efforts. We recommend maintaining such initiatives to identify remaining quality gaps and that results be shared publicly to support increased use of data. These results can inform Ministry of Health and its partners on some interventions and advise initiatives for improving its quality.

Keywords: data quality, data utilization, HMIS, collaboration, completeness, timeliness, decision-making

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Authors: Allioua Meryem

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

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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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Authors: Hai L. Tran

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Previous research on agenda setting effects has often focused on the top-down influence of the media at the aggregate level, while overlooking the capacity of audience members to select media and content to fit their individual dispositions. The decentralized characteristics of online communication and digital news create more choices and greater user control, thereby enabling each audience member to seek out a unique blend of media sources, issues, and elements of messages and to mix them into a coherent individual picture of the world. This study examines how audiences use media differently depending on their prior dispositions, thereby making sense of the world in ways that are congruent with their preferences and cognitions. The current undertaking is informed by theoretical frameworks from two distinct lines of scholarship. According to the ideological migration hypothesis, individuals choose to live in communities with ideologies like their own to satisfy their need to belong. One tends to move away from Zip codes that are incongruent and toward those that are more aligned with one’s ideological orientation. This geographical division along ideological lines has been documented in social psychology research. As an extension of agenda setting, the agendamelding hypothesis argues that audiences seek out information in attractive media and blend them into a coherent narrative that fits with a common agenda shared by others, who think as they do and communicate with them about issues of public. In other words, individuals, through their media use, identify themselves with a group/community that they want to join. Accordingly, the present study hypothesizes that because ideology plays a role in pushing people toward a physical community that fits their need to belong, it also leads individuals to receive an idiosyncratic blend of media and be influenced by such selective exposure in deciding what issues are more relevant. Consequently, the individualized focus of media choices impacts how audiences perceive political news coverage and what they know about political issues. The research project utilizes recent data from The American Trends Panel survey conducted by Pew Research Center to explore the nuanced nature of agenda setting at the individual level and amid heightened polarization. Hypothesis testing is performed with both nonparametric and parametric procedures, including regression and path analysis. This research attempts to explore the media-public relationship from a bottom-up approach, considering the ability of active audience members to select among media in a larger process that entails agenda setting. It helps encourage agenda-setting scholars to further examine effects at the individual, rather than aggregate, level. In addition to theoretical contributions, the study’s findings are useful for media professionals in building and maintaining relationships with the audience considering changes in market share due to the spread of digital and social media.

Keywords: agenda setting, agendamelding, audience fragmentation, ideological migration, partisanship, polarization

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Authors: Faye Cosgrove, Donna Peacock

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This paper examines current state strategies for dealing with vulnerable people in police custody and identifies the underpinning discourses and practices which inform these strategies. It has previously been argued that the state has utilised contradictory and conflicting responses to the control of crime, by employing opposing strategies of denial and adaptation in order to simultaneously both display sovereignty and disclaim responsibility. This paper argues that these contradictory strategies are still being employed in contemporary criminal justice, although the focus and the purpose have now shifted. The focus is upon the ‘vulnerable’ suspect, whose social identity is as incongruous, complex and contradictory as his social environment, and the purpose is to redirect attention away from negative state practices, whilst simultaneously displaying a compassionate and benevolent countenance in order to appeal to the voting public. The findings presented here result from intensive qualitative research with police officers, with health care professionals, and with civilian volunteers who work within police custodial environments. The data has been gathered over a three-year period and includes observational and interview data which has been thematically analysed to expose the underpinning mechanisms from which the properties of the system emerge. What is revealed is evidence of contemporary state practices of denial relating to the harms of austerity and the structural relations of vulnerability, whilst simultaneously adapting through processes of ‘othering’ of the vulnerable, ‘responsibilisation’ of citizens, defining deviance down through diversionary practices, and managing success through redefining the aims of the system. The ‘vulnerable’ suspect is subject to individual pathologising, and yet the nature of risk is aggregated. ‘Vulnerable’ suspects are supported in police custody by private citizens, by multi-agency partnerships, and by for-profit organisations, while the state seeks to collate and control services, and thereby to retain a veneer of control. Late modern ambivalence to crime control and the associated contradictory practices of abjuration and adjustment have extended to state responses to vulnerable suspects. The support available in the custody environment operates to control and minimise operational and procedural risk, rather than for the welfare of the detained person, and in fact, the support available is discovered to be detrimental to the very people that it claims to benefit. The ‘vulnerable’ suspect is now subject to the bifurcated logics employed at the new limits of the sovereign state.

Keywords: custody, policing, sovereign state, vulnerability

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Authors: Arda Ozkurt, Ozlem Bozkurt

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Brain-computer interfaces (BCIs) are devices that output commands by interpreting the data collected from the brain. Electroencephalography (EEG) is a non-invasive method to measure the brain's electrical activity. Since it was invented by Hans Berger in 1929, it has led to many neurological discoveries and has become one of the essential components of non-invasive measuring methods. Despite the fact that it has a low spatial resolution -meaning it is able to detect when a group of neurons fires at the same time-, it is a non-invasive method, making it easy to use without possessing any risks. In EEG, electrodes are placed on the scalp, and the voltage difference between a minimum of two electrodes is recorded, which is then used to accomplish the intended task. The recordings of EEGs include, but are not limited to, the currents along dendrites from synapses to the soma, the action potentials along the axons connecting neurons, and the currents through the synaptic clefts connecting axons with dendrites. However, there are some sources of noise that may affect the reliability of the EEG signals as it is a non-invasive method. For instance, the noise from the EEG equipment, the leads, and the signals coming from the subject -such as the activity of the heart or muscle movements- affect the signals detected by the electrodes of the EEG. However, new techniques have been developed to differentiate between those signals and the intended ones. Furthermore, an EEG device is not enough to analyze the data from the brain to be used by the BCI implication. Because the EEG signal is very complex, to analyze it, artificial intelligence algorithms are required. These algorithms convert complex data into meaningful and useful information for neuroscientists to use the data to design BCI devices. Even though for neurological diseases which require highly precise data, invasive BCIs are needed; non-invasive BCIs - such as EEGs - are used in many cases to help disabled people's lives or even to ease people's lives by helping them with basic tasks. For example, EEG is used to detect before a seizure occurs in epilepsy patients, which can then prevent the seizure with the help of a BCI device. Overall, EEG is a commonly used non-invasive BCI technique that has helped develop BCIs and will continue to be used to detect data to ease people's lives as more BCI techniques will be developed in the future.

Keywords: BCI, EEG, non-invasive, spatial resolution

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Authors: Oyuntsetseg Sandag, Lkhagvadorj Khosbayar, Naidansuren Tsendeekhuu, Densenbal Dansran, Bandi Solongo

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Introduction: Obstructive sleep apnea (OSA) is a common disorder affecting at least 2% to 4% of the adult population. It is estimated that nearly 80% of men and 93% of women with moderate to severe sleep apnea are undiagnosed. A number of screening questionnaires and clinical screening models have been developed to help identify patients with OSA, also it’s indeed to clinical practice. Purpose of study: Determine dependence of obstructive sleep apnea between for severe risk and risk factor. Material and Methods: A cross-sectional study included 114 patients presenting from theCentral state 3th hospital and Central state 1th hospital. Patients who had obstructive sleep apnea (OSA)selected in this study. Standard StopBang questionnaire was obtained from all patients.According to the patients’ response to the StopBang questionnaire was divided into low risk, intermediate risk, and high risk.Descriptive statistics were presented mean ± standard deviation (SD). Each questionnaire was compared on the likelihood ratio for a positive result, the likelihood ratio for a negative test result of regression. Statistical analyses were performed utilizing SPSS 16. Results: 114 patients were obtained (mean age 48 ± 16, male 57)that divided to low risk 54 (47.4%), intermediate risk 33 (28.9%), high risk 27 (23.7%). Result of risk factor showed significantly increasing that mean age (38 ± 13vs. 54 ± 14 vs. 59 ± 10, p<0.05), blood pressure (115 ± 18vs. 133 ± 19vs. 142 ± 21, p<0.05), BMI(24 IQR 22; 26 vs. 24 IQR 22; 29 vs. 28 IQR 25; 34, p<0.001), neck circumference (35 ± 3.4 vs. 38 ± 4.7 vs. 41 ± 4.4, p<0.05)were increased. Results from multiple logistic regressions showed that age is significantly independently factor for OSA (odds ratio 1.07, 95% CI 1.02-1.23, p<0.01). Predictive value of age was significantly higher factor for OSA (AUC=0.833, 95% CI 0.758-0.909, p<0.001). Our study showing that risk of OSA is beginning 47 years old (sensitivity 78.3%, specifity74.1%). Conclusions: According to most of all patients’ response had intermediate risk and high risk. Also, age, blood pressure, neck circumference and BMI were increased such as risk factor was increased for OSA. Especially age is independently factor and highest significance for OSA. Patients’ age one year is increased likelihood risk factor 1.1 times is increased.

Keywords: obstructive sleep apnea, Stop-Bang, BMI (Body Mass Index), blood pressure

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

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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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Authors: Mohammad Bagher Heidari, Hefzollah Mohammadian

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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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Authors: Marko Spasojevic, Ying Hei Chui, Yuxiang Chen

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Increasing the level of exterior insulation in residential buildings is a popular way for improving the thermal characteristic of building enclosure and reducing heat loss. However, the layout and properties of materials composing the wall have a great effect on moisture accumulation within the wall cavity, long-term durability of a wall as well as the structural performance. A one-dimensional hygrothermal modeling has been performed to investigate moisture condensation risks and the drying capacity of standard 2×4 and 2×6 light wood-frame wall assemblies including exterior low-permeance extruded polystyrene (XPS) insulation. The analysis considered two different wall configurations whereby the rigid insulation board was placed either between Oriented Strand Board (OSB) sheathing and the stud or outboard to the structural sheathing. The thickness of the insulation varied between 0 mm and 50 mm and the analysis has been conducted for eight different locations in Canada, covering climate zone 4 through zone 8. Results show that the wall configuration with low-permeance insulation inserted between the stud and OSB sheathing accumulates more moisture within the stud cavity, compared to the assembly with the same insulation placed exterior to the sheathing. On the other hand, OSB moisture contents of the latter configuration were markedly higher. Consequently, the analysis of hygrothermal performance investigated and compared moisture accumulation in both the OSB and stud cavity. To investigate the structural performance of the wall and the effect of soft insulation layer inserted between the sheathing and framing, forty nail connection specimens were tested. Results have shown that both the connection strength and stiffness experience a significant reduction as the insulation thickness increases. These results will be compared with results from a full-scale shear wall tests in order to investigate if the capacity of shear walls with insulated sheathing would experience a similar reduction in structural capacities.

Keywords: hygrothermal analysis, insulated sheathing, moisture performance, nail joints, wood shear wall

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Authors: Lancelot Boulet, Pierre Benard, Ghislain Lartigue, Vincent Moureau, Nicolas Chauvet, Sheddia Didorally

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International aeronautic standards demand a fire certification for engines that demonstrate their resistance. This demonstration relies on tests performed with prototype engines in the late stages of the development. Hardest tests require to place a kerosene standardized flame in front of the engine casing during a given time with imposed temperature and heat flux. The purpose of this work is to provide a better characterization of a kerosene/air certification burner in order to minimize the risks of test failure. A first Large-Eddy Simulation (LES) study of the certification burner permitted to model and simulate this burner, including both adiabatic and Conjugate Heat Transfer (CHT) computations. Carried out on unstructured grids with 40 million tetrahedral cells, using the finite-volume YALES2 code, spray combustion, forced convection on walls and conduction in the solid parts of the burner were coupled to achieve a detailed description of heat transfer. It highlighted the fact that conduction inside the solid has a real impact on the flame topology and the combustion regime. However, in the absence of radiative heat transfer, unrealistic temperature of the equipment was obtained. The aim of the present study is to include the radiative heat transfer in order to reach the same temperature given by experimental measurements. First, various test-cases are conducted to validate the coupling between the different heat solvers. Then, adiabatic case, CHT case, as well as CHT including radiative transfer are studied and compared. The LES model is finally applied to investigate the heat transfer in a flame impaction configuration. The aim is to progress on fire test modeling so as to reach a good confidence level as far as success of the certification test is concerned.

Keywords: conjugate heat transfer, fire resistance test, large-eddy simulation, radiative transfer, turbulent combustion

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Authors: Catherine Constantinidis (Nee Tsacalos)

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This paper presents one aspect of the larger Masters qualitative study exploring the roles of married Greek Orthodox clergy, the Priest and Presbytera, under the wing of the Greek Orthodox Archdiocese of Australia. This ground breaking research necessitated the creation of primary data within a phenomenological paradigm drawing from lived experiences of the Priests and Presbyteres in contemporary society. As a Social Worker, a bilingual (Greek/English) Mental Health practitioner and a Presbytera, the questions constantly raised and pondered are: Who do the Priest and Presbytera turn to when they experience difficulties or problems? Where do they go for support? What is in place for their emotional and psychological health and well-being? Who cares for the spiritual carer? Who is there to catch our falling clergy and their wives? What is their 'safety net'? Identified phenomena of angst, stress, frustration and confusion experienced by the Priest and (by extension) the Presbytera, within their position, coupled with basic assumptions, perceptions and expectations about their roles, the role of the organisation (the Church), and their role as spouse often caused confusion and in some cases conflict. Unpacking this complex and multi-dimensional relationship highlighted not only the roller coaster of emotions, potentially affecting their physical and mental health, but also the impact on the interwoven relationships of marriage and ministry. The author considers these phenomena in the light of bilingual cultural and religious organisational practice frameworks, specifically the Greek Orthodox Church, whilst filtering these findings through a mental health lens. One could argue that it is an expectation that clergy (and by default their wives) take on the responsibility to be kind, nurturing and supportive to others. However, when it comes to taking care of self, they are not nearly as kind. This research looks at a recurrent theme throughout the interviews where all participants talked about limited support systems and poor self care strategies and the impact this has on their ministry, mental, emotional, and physical health and ultimately on their relationships with self and others. The struggle all participants encountered at some point in their ministry was physical, spiritual and psychological burn out. The overall aim of the researcher is to provide a voice for the Priest and the Presbytera painting a clearer picture of these roles and facilitating an awareness of struggles and dilemmas faced in their ministry. It is hoped these identified gaps in self care strategies and support systems will provide solid foundations for building a culturally sensitive, empathetic and effective support system framework, incorporating the spiritual and psychological well-being of the Priest and Presbytera, a ‘safety net’. A supplementary aim is to inform and guide ministry practice frameworks for clergy, spouses, the church hierarchy and religious organisations on a local and global platform incorporating some sort of self-care system.

Keywords: care for the carer, mental health, Priest, Presbytera, religion, support system

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

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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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