Search results for: advance care planning

Authors: Lebeza Alemu Tenaw, Fei Wan Ngai

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Background: Postpartum depression is the most common mental health disorder that occurs after childbirth, and it is more prevalent among teenage mothers compared to adults. Although there is emerging evidence suggesting psychosocial interventions can decrease postpartum depression, there are no consistent findings regarding the effectiveness of these interventions, especially for teenage mothers. The current review aimed to investigate the effectiveness of psychosocial interventions in preventing postpartum depression among teenage mothers. Methods: The Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) manual was implemented to select articles from online databases. The articles were searched using the Population, Intervention, Control, and Outcome (PICO) model. The quality of the articles was assessed using the Cochrane Collaboration Risk of Bias assessment tool. The statistical analyses were performed using Stata 17, and the effect size was estimated using the standard mean difference score of depression between the intervention and control groups. Heterogeneity between the studies was assessed through the I2 statistic and Q statistic, while the publication bias was evaluated using the asymmetry of the funnel plot and Egger's test. Results: In this systematic review, a total of nine articles were included. While psychosocial interventions demonstrated in reducing the risk of postpartum depression compared to usual maternal care, it is important to note that the mean difference score of depression was significant in only three of the included studies. The overall meta-analysis finding revealed that psychosocial interventions were effective in preventing postpartum depression, with a pooled effect size of -0.5 (95% CI: -0.95, -0.06) during the final time postpartum depression assessment. The heterogeneity level was found to be substantial, with an I2 value of 82.3%. However, no publication bias was observed. Conclusion: The review findings suggest that psychosocial interventions initiated during the late antenatal and early postnatal periods effectively prevent postpartum depression. The interventions were found to be more beneficial during the first three months of the postpartum period. However, this review also highlighted that there is a scarcity of interventional studies conducted in low-income countries, indicating the need for further studies in diverse communities.

Keywords: teenage pregnancy, postpartum depression, review

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Authors: Nafiseh Mirabdolhosseini, Jerry Zhou, Vincent Ho

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The dramatic global rise in acid reflux has also led to oesophageal adenocarcinoma (OAC) becoming the fastest-growing cancer in developed countries. While gastroscopy with biopsy is used to diagnose OAC patients, this labour-intensive and expensive process is not suitable for population screening. This study aims to design, develop, and implement a minimally invasive system to capture optical data of the distal oesophagus for rapid screening of potential abnormalities. To develop the system and understand user requirements, a user-centric approach was employed by utilising co-design strategies. Target users’ segments were identified, and 38 patients and 14 health providers were interviewed. Next, the technical requirements were developed based on consultations with the industry. A minimally invasive optical system was designed and developed considering patient comfort. This system consists of the sensing catheter, controller unit, and analysis program. Its procedure only takes 10 minutes to perform and does not require cleaning afterward since it has a single-use catheter. A prototype system was evaluated for safety and efficacy for both laboratory and clinical performance. This prototype performed successfully when submerged in simulated gastric fluid without showing evidence of erosion after 24 hours. The system effectively recorded a video of the mid-distal oesophagus of a healthy volunteer (34-year-old male). The recorded images were used to develop an automated program to identify abnormalities in the distal oesophagus. Further data from a larger clinical study will be used to train the automated program. This system allows for quick visual assessment of the lower oesophagus in primary care settings and can serve as a screening tool for oesophageal adenocarcinoma. In addition, this system is able to be coupled with 24hr ambulatory pH monitoring to better correlate oesophageal physiological changes with reflux symptoms. It also can provide additional information on lower oesophageal sphincter functions such as opening times and bolus retention.

Keywords: endoscopy, MedTech, oesophageal adenocarcinoma, optical system, screening tool

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Authors: Mark White

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The best practices for owners and urban planners to manage tsunami risk have evolved during the last fifty years, and related technical advances have created opportunities for them to obtain better performance than in earlier cataclysmic tsunami inundations. This basic pattern is illustrated at Hilo Bay, the waterfront area of Hilo, Hawaii, an urban seaport which faces the most severe tsunami hazard of the Hawaiian archipelago. Since April 1, 1946, Hilo Bay has endured tsunami waves with a maximum water height exceeding 2.5 meters following four severe earthquakes: Unimak Island (Mw 8.6, 6.1 m) in 1946; Valdiva (Mw 9.5, the largest earthquake of the 20th century, 10.6 m) in 1960; William Prince Sound (Mw 9.2, 3.8 m) in 1964; and Kalapana (Mw 7.7, the largest earthquake in Hawaii since 1868, 2.6 m) in 1975. Ignoring numerous smaller tsunamis during the same time frame, these four cataclysmic tsunamis have caused property losses in Hilo to exceed $1.25 billion and more than 150 deaths. It is reasonable to foresee another cataclysmic tsunami inundating the urban core of Hilo in the next 50 years, which, if unchecked, could cause additional deaths and losses in the hundreds of millions of dollars. Urban planners and individual owners are now in a position to reduce these losses in the next foreseeable tsunami that generates maximum water heights between 2.5 and 10 meters in Hilo Bay. Since 1946, Hilo planners and individual owners have already created buffer zones between the shoreline and its historic downtown area. As these stakeholders make inevitable improvements to the built environment along and adjacent to the shoreline, they should incorporate new methods for better managing the obvious tsunami risk at Hilo. At the planning level, new manmade land forms, such as tsunami parks and inundation reservoirs, should be developed. Individual owners should require their design professionals to include sacrificial seismic and tsunami fuses that will perform well in foreseeable severe events and that can be easily repaired in the immediate aftermath. These investments before the next cataclysmic tsunami at Hilo will yield substantial reductions in property losses and fatalities.

Keywords: hilo, tsunami parks, reservoirs, fuse systems, risk managment

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Authors: E. Maoz

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Background: As a teaching method, project-based learning is strongly linked to developing students’ critical thinking skills. It combines creative independent thinking, team work, and disciplinary subject-field integration. In the 'Introduction to Nursing Research Methods' course (year 3, Generic Track), project based learning is used to teach the topic of 'Evidence-Based Nursing'. This topic examines a clinical care issue encountered by students in the field. At the end of their project, students present proposals for managing the said issue. Proposals are the product of independent integrative thinking integrating a wide range of factors influencing the issue’s management. Method: Papers by 27 groups of students (165 students) were content analyzed to identify which themes emerged from the students' recommendations for managing the clinical issue. Findings: Five main themes emerged—current management approach; adapting procedures in line with current recent research recommendations; training for change (veteran nursing staff, beginner students, patients, significant others); analysis of 'economic benefit vs. patient benefit'; multidisciplinary team engagement in implementing change in practice. Two surprising themes also emerged: advertising and marketing using new technologies, which reflects how the new generation thinks. Summary and Recommendations: Among the main challenges in nursing education is training nursing graduates to think independently, integratively, and critically. Combining PBL with classical teaching methods stimulates students cognitively while opening new vistas with implications on all levels of the profession: management, research, education, and practice. Advanced students can successfully grasp and interpret the current state of clinical practice. They are competent and open to leading change and able to consider the diverse factors and interconnections that characterize the nurse's work.

Keywords: evidence based nursing, critical thinking skills, project based learning, students education

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Authors: Calvince Okome Odeny

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There is a current action to increase radiotherapy services in Kenya. The National government of Kenya, in collaboration with the county governments, has embarked on building radiotherapy centers in all 47 regions of the country. As these new centers are established in Kenya, it has to be ensured that minimum radiation safety standards are in place prior to operation. For full implementation of this, it is imperative that more Research and training for regulators are done on radiation protection, and safety and national regulatory infrastructure is geared towards ensuring radiation protection and safety in all aspects of the use of external radiotherapy practices. The present work aims at reviewing the level of protection and safety for patients and staff during external beam radiotherapy using Linac in Kenya and provides relevant guidance to improve protection and safety. A retrospective evaluation was done to verify whether those occupationally exposed workers and patients are adequately protected from the harmful effect of radiation exposure during the treatment procedures using Linac. The project was experimental Research, also including an analysis of resource documents obtained from the literature and international organizations. The critical findings of the work revealed that the key elements of protection of occupationally exposed workers and patients include a comprehensive quality Management system governing all planned activities from siting, safety, and design of the Facility, construction, acceptance testing, commissioning, operation, and decommissioning of the Facility; Government empowering the Regulatory Authority to license Medical Linear facilities and to enforce the applicable regulations to ensure adequate protection; A comprehensive Radiation Protection and Safety program must be established to ensure adequate safety and protection of workers and patients during treatment planning and treatment delivery of patients and categories of staff associated with the Facility must be well educated and trained to perform professionally with a commitment to sound safety culture. Relevant recommendations from the findings are shared with the Medical Linear Accelerator facilities and the regulatory authority to provide guidance and continuous improvement of protection and safety to improve regulatory oversight.

Keywords: oncology, radiotherapy, protection, staff

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Authors: Hani Malik

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Background: Clinician burnout is a growing phenomenon in current health systems worldwide. Increasing emotional exhaustion, depersonalisation, and reduced personal accomplishment threaten the effective delivery of healthcare. This can potentially be mitigated by mindfulness practice, which has shown promising results in reducing burnout, restoring compassion, and preventing moral injury in clinicians. Objectives: To conduct a scoping review and identify high-quality studies on mindfulness practice in clinician burnout, synthesize themes that emerge from these studies, and discuss the implications of the results to healthcare leadership and innovation. Methodology: A focused scoping review was carried out to investigate the effects of mindfulness practice on clinician burnout. High-ranking journals were targeted to analyse high-quality studies and synthesize common themes in the literature. Studies conducted on current, practicing physicians were included. Mindfulness practice of varying forms was the main intervention studied. Grey literature and studies conducted only on allied health personnel were excluded from this review. Analysis:31 studies were included in this scoping review. Mindfulness practice was found to decrease emotional exhaustion and depersonalisation while improving mood, responses to stress, and vigour. Self-awareness, compassion, and empathy were also increased in study participants. From this review, four themes emerged which include: innovations in mindfulness practice, mindfulness and positive psychology, the impact of mindfulness on work and patient care, and barriers and facilitators to clinician mindfulness practice. Conclusion: Mindfulness had widely been reported to benefit mental health and well-being, but the studies reviewed seemed to adopt a mono focus and omitted key considerations to healthcare leadership, systems-level culture, and practices. Mindfulness practice is a quintessential component of positive psychology and is inherently linked to effective leadership. A mindful and compassionate clinician leader will play a crucial role in addressing gaps in current practice, prioritise staff mental health, and provide a supportive platform for innovation.

Keywords: mindfulness practice, clinician burnout, healthcare leadership, COVID-19

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Authors: Clinton Adas

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Antibiotic resistance has been identified by the World Health Organisation as a real possibility for the 21st Century. While many factors contribute to this, one of the more significant is industrial animal farming and its effect on the food chain and environment. Livestock consumes a significant portion of antibiotics sold globally, and these are used to make animals grow faster for profit purposes, to prevent illness caused by inhumane living conditions, and to treat disease when it breaks out. Many of these antibiotics provide little benefit to animals, and most are the same as those used by humans - including those deemed critical to human health that should therefore be used sparingly. Antibiotic resistance contributes to growing numbers of illnesses and death in humans, and the excess usage of these medications results in waste that enters the environment and is harmful to many ecological processes. This combination of antimicrobial resistance and environmental degradation furthermore harms the economic well-being and prospects of many. Using an interdisciplinary approach including medical, environmental, economic, and legal studies, the paper evaluates the dynamic between animal welfare and commerce and argues that while animal welfare is not of great concern to many, this approach is ultimately harming human welfare too. It is, however, proposed that both could be addressed under a One Health and Welfare approach, as we cannot continue to ignore the linkages between animals, the environment, and people. The evaluation of industrial animal farming is therefore considered through three aspects – the environmental impact, which is measured by pollution that causes environmental degradation; the human impact, which is measured by the rise of illnesses from pollution and antibiotics resistance; and the economic impact, which is measured through costs to the health care system and the financial implications of industrial farming on the economic well-being of many. These three aspects are considered in light of the Sustainable Development Goals that provide additional tangible metrics to evidence the negative impacts. While the research addresses the welfare of farmed animals, there is potential for these principles to be extrapolated into other contexts, including wildlife and habitat protection. It must be noted that while the question of animal rights in industrial animal farming is acknowledged and of importance, this is a separate matter that is not addressed here.

Keywords: animal and human welfare, industrial animal farming, one health and welfare, sustainable development goals

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Authors: Yuen Man Yan

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Peer support has been a rising prevalent mental health service in the globe. The community-based mental health services employ persons with lived experience of mental illness to be peer support workers (PSWs) to provide peer support service to those who are in the progress of recovery (PIRs). It represents the transformation of mental health service system to a recovery-oriented and person-centered care. Literatures proved the feasibility and effectiveness of the peer support service. Researchers have attempted to explore the unique good qualities of peer support service that benefit the PIRs. Empirical researches found that the strength of the relationship between those who sought for change and the change agents positively related to the outcomes in one-to-one therapies across theoretical orientations. However, there is lack of literature on investigating the relationship building between the PSWs and PIRs in the one-to-one community-based peer support service. This study aims to identify and characterise the relationship in the community-based one-to-one peer support service from the perspectives of PSWs and PIRs; and to conceptualize the components of relationship building between PSWs and PIRs in the community-based one-to-one peer support service. The study adopted the constructivist grounded theory approach. 10 pairs of the PSWs and PIRs participated in the study. Data were collected through multiple qualitative methods, including observation of the interaction and exchange of the PSWs and PIRs in the 1ₛₜ, 3ᵣ𝒹 and 9th sessions of the community-based one-to-one peer support service; and semi-structural interview with the PSWs and PIRs separately after the 3ᵣ𝒹and 9ₜₕ session of the peer support service. This presentation is going to report the preliminary findings of the study. PSWs and PIRs identified their relationship as “life alliance”. Empathy was found to be one of key components of the relationship between the PSWs and the PIRs. Unlike the empathy, as explained by Carl Roger, in which the service provider was able to put themselves into the shoes of the service recipients as if he was the service recipients, the intensity of the empathy was much greater in the relationship between PSWs and PIRs because PSWs had the lived experience of mental illness and recovery. The dimensions of the empathy in the relationship between PSWs and PIRs was found to be multiple, not only related to the mental illness but also related to various aspects in life, like family relationship, employment, interest of life, self-esteem and etc.

Keywords: person with lived experience, peer support worker, peer support service, relationship building, therapeutic alliance, community-based mental health setting

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Authors: Abram Zoltan

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Over the past hundred years, human activities, particularly the burning of fossil fuels, have released enough carbon dioxide and other greenhouse gases to dissipate additional heat into the lower atmosphere and affect the global climate. Climate change affects many social and environmental determinants of health: clean air, safe drinking water, and adequate food. Our aim is to draw attention to the effects of climate change on the health and health care system. Improving climate awareness and the knowledge related to climate change's health impacts are essential among medical students and practicing medical doctors. Therefore, in their everyday practice, they also need some assistance and up-to-date knowledge of how climate change can endanger human health and deal with these novel health problems. Our activity, based on the cooperation of more universities, aims to develop new curriculum outlines and learning materials on climate change's health impacts for medical schools. Special attention is intended to pay to the possible preventative measures against these impacts. For all of this, the project plans to create new curriculum outlines and learning materials for medical students, elaborate methodological guidelines and create training materials for medical doctors' postgraduate learning programs. The target groups of the project are medical students, educational staff of medical schools and universities, practicing medical doctors with special attention to the general practitioners and family doctors. We had searched various surveys, domestic and international studies about the effects of climate change and statistical estimation of the possible consequences. The health effects of climate change can be measured only approximately by considering only a fraction of the potential health effects and assuming continued economic growth and health progress. We can estimate that climate change is expected to cause about 250,000 more deaths. We conclude that climate change is one of the most serious problems of the 21st century, affecting all populations. In the short- to medium-term, the health effects of climate change will be determined mainly by human vulnerability. In the longer term, the effects depend increasingly on the extent to which transformational action is taken now to reduce emissions. We can contribute to reducing environmental pollution by raising awareness and by educating the population.

Keywords: climate change, health impacts, medical students, education

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Authors: Eric A. Morris, Xia Liu, Yee Ka Wong, Greg J. Evans, Jeff R. Brook

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Air quality monitoring stations tend to be widely distributed and are often located far from major roadways, thus, determining where, when, and which traffic-related air pollutants (TRAPs) have the greatest impact on public health becomes a matter of extrapolation. Compact, multipollutant sensor systems are an effective solution as they enable several TRAPs to be monitored in a geospatially dense network, thus filling in the gaps between conventional monitoring stations. This work describes two applications of one such system named AirSENCE for gathering actionable air quality data relevant to smart city infrastructures. In the first application, four AirSENCE devices were co-located with traffic monitors around the perimeter of a city block in Oshawa, Ontario. This study, which coincided with the COVID-19 outbreak of 2020 and subsequent lockdown measures, demonstrated a direct relationship between decreased traffic volumes and TRAP concentrations. Conversely, road construction was observed to cause elevated TRAP levels while reducing traffic volumes, illustrating that conventional smart city sensors such as traffic counters provide inadequate data for inferring air quality conditions. The second application used two AirSENCE sensors on opposite sides of a major 2-way commuter road in Toronto. Clear correlations of TRAP concentrations with wind direction were observed, which shows that impacted areas are not necessarily static and may exhibit high day-to-day variability in air quality conditions despite consistent traffic volumes. Both of these applications provide compelling evidence favouring the inclusion of air quality sensors in current and future smart city infrastructure planning. Such sensors provide direct measurements that are useful for public health alerting as well as decision-making for projects involving traffic mitigation, heavy construction, and urban renewal efforts.

Keywords: distributed sensor network, continuous ambient air quality monitoring, Smart city sensors, Internet of Things, traffic-related air pollutants

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Authors: Dilek Cetin Alisar, Oya Umit Yemisci, Selin Ozen, Seyhan Sozay

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New approaches and treatment modalities are being developed to make patients more functional and independent in stroke rehabilitation. One of these approaches is transcranial direct stimulation therapy (tDCS), which aims to improve the hemiplegic upper limb function of stroke patients. tDCS therapy is not in the routine rehabilitation program; however, the studies about tDCS therapy on stroke rehabilitation was increased in recent years. Evaluate the effect of tDCS treatment on upper extremity motor function in patients with subacute stroke was aimed in our study. 32 stroke patients (16 tDCS group, 16 sham groups) who were hospitalized for rehabilitation in Başkent University Physical Medicine and Rehabilitation Clinic between 01.08.2016-20.01-2018 were included in the study. The conventional upper limb rehabilitation program was used for both tDCS and control group patients for 3 weeks, 5 days a week, for 60-120 minutes a day. In addition to the conventional stroke rehabilitation program in the tDAS group, bihemispheric tDCS was administered for 30 minutes daily. Patients were evaluated before treatment and after 1 week of treatment. Functional independence measure self-care score (FIM), Brunnstorm Recovery Stage (BRS), and Fugl-Meyer (FM) upper extremity motor function scale were used. There was no difference in demographic characteristics between the groups. There were no significant differences between BRS and FM scores in two groups, but there was a significant difference FIM score (p=0.05. FIM, BRS, and FM scores are significantly in the tDCS group, when before therapy and after 1 week of therapy, however, no difference is found in the shame group (p < 0,001). When FBS and FM scores were compared, there were statistical significant differences in tDCS group (p < 0,001). In conclusion, this randomized double-blind study showed that bihemispheric tDCS treatment was found to be superior to upper extremity motor and functional enhancement in addition to conventional rehabilitation methods in subacute stroke patients. In order for tDCS therapy to be used routinely in stroke rehabilitation, there is a need for more comprehensive, long-termed, randomized controlled clinical trials in order to find answers to many questions, such as the duration and intensity of treatment.

Keywords: cortical stimulation, motor function, rehabilitation, stroke

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Authors: David C. Boettiger, Tracy Kuo Lin, Maram Almansour, Mariam M. Hamza, Reem Alsukait, Christopher H. Herbst, Nada Altheyab, Ayman Afghani, Faisal Kattan

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Background The number of people aged greater than 65 years per 100 people aged 20–64 years is expected to almost double in The Kingdom of Saudi Arabia (KSA) between 2020 and 2030. We therefore aimed to quantify the growing non-communicable disease (NCD) burden in KSA between 2020 and 2030, and the impact this will have on the national health budget. Methods Ten priority NCDs were selected: ischemic heart disease, stroke, type 2 diabetes, chronic obstructive pulmonary disease, chronic kidney disease, dementia, depression, osteoarthritis, colorectal cancer, and breast cancer. Age- and sex-specific prevalence was projected for each priority NCD between 2020 and 2030. Treatment coverage rates were applied to the projected prevalence estimates to calculate the number of patients incurring treatment costs for each condition. For each priority NCD, the average cost-of-illness was estimated based on published literature. The impact of changes to our base-case model in terms of assumed disease prevalence, treatment coverage, and costs of care, coming into effect from 2023 onwards, were explored. Results The prevalence estimates for colorectal cancer and stroke were estimated to almost double between 2020 and 2030 (97% and 88% increase, respectively). The only priority NCD prevalence projected to increase by less than 60% between 2020 and 2030 was for depression (22% increase). It is estimated that the total cost of managing priority NCDs in KSA will increase from USD 19.8 billion in 2020 to USD 32.4 billion in 2030 (an increase of USD 12.6 billion or 63%). The largest USD value increases were projected for osteoarthritis (USD 4.3 billion), diabetes (USD 2.4 billion), and dementia (USD 1.9 billion). In scenario analyses, our 2030 projection for the total cost of managing priority NCDs varied between USD 29.2 billion - USD 35.7 billion. Conclusions Managing the growing NCD burden in KSA’s aging population will require substantial healthcare spending increases over the coming years.

Keywords: aging, non communicable disease, costs, Saudi Arabia

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Authors: Arman Kishan, Sanjay Kubsad, Steve Li, Mark Haft, Duc Nguyen, Dawn Laporte

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Objective: Carpal tunnel syndrome can be managed surgically with endoscopic or open carpal tunnel release (CTR). Rheumatoid arthritis (RA) is a known risk factor for Carpal Tunnel Syndrome (CTS) and is believed to be related to compression of the median nerve secondary to inflammation. We aimed to analyze national trends, outcomes, and patient-specific comorbidities associated with ECTR and OCTR in patients with RA. Methods: A retrospective cohort study was conducted using the PearlDiver database, identifying 683 RA patients undergoing ECTR and 4234 undergoing OCTR between 2010 and 2014. Demographic data, comorbidities, and complication rates were analyzed. Univariate and multivariable analyses assessed differences between the treatment methods. Results:  Patients with RA undergoing ECTR in comparison to OCTR had no significant differences in medical comorbidities such as hypertension, obesity, chronic kidney disease, hypothyroidism and diabetes mellitus. Patients in the ECTR group reported a risk ratio of 1.44 (95%CI: 1.10-1.89, p=0.01) of requiring repeat procedures within 90 days of the initial procedure. Five-year trends in ECTR and OCTR procedures reported a combined annual growth rate of 5.6% and 13.15, respectively. Conclusion: Endoscopic and open approaches to CTR are important considerations in surgical planning. RA and ECTR have previously been identified as independent risk factors for revision CTR. Our study has identified the 90-day risk of repeat procedures to be elevated in the ECTR group in comparison to the OCTR group. Additionally, the growth of OCTR procedures has outpaced the growth of ECTR procedures in the same period, likely in response to the trend of ECTR leading to higher rates of repeat procedures. The need for revision following ECTR in patients with RA could be related to chronic inflammation leading to transverse carpal ligament thickening and concomitant tenosynovitis. Future directions could include further characterization of repeat procedures performed in this subset of patients. 

Keywords: endoscopic treatment of carpal tunnel syndrome, open treatment of carpal tunnel syndrome, rheumatoid arthritis, trends analysis, carpal tunnel syndrome

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Authors: Mohamed H. Khalil

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Water is one of the most crucial elements which influence human lives and development. Noteworthy, over the last few years, GIS plays a significant role in optimizing water management systems, especially after exponential developing in this sector. In this context, the Egyptian government initiated an advanced ‘GIS-Web Based System’. This system is efficiently designed to tangibly assist and optimize the complement and integration of data between departments of Call Center, Operation and Maintenance, and laboratory. The core of this system is a unified ‘Data Model’ for all the spatial and tabular data of the corresponding departments. The system is professionally built to provide advanced functionalities such as interactive data collection, dynamic monitoring, multi-user editing capabilities, enhancing data retrieval, integrated work-flow, different access levels, and correlative information record/track. Noteworthy, this cost-effective system contributes significantly not only in the completeness of the base-map (93%), the water network (87%) in high level of details GIS format, enhancement of the performance of the customer service, but also in reducing the operating costs/day-to-day operations (~ 5-10 %). In addition, the proposed system facilitates data exchange between different departments (Call Center, Operation and Maintenance, and laboratory), which allowed a better understanding/analyzing of complex situations. Furthermore, this system reflected tangibly on: (i) dynamic environmental monitor/water quality indicators (ammonia, turbidity, TDS, sulfate, iron, pH, etc.), (ii) improved effectiveness of the different water departments, (iii) efficient deep advanced analysis, (iv) advanced web-reporting tools (daily, weekly, monthly, quarterly, and annually), (v) tangible planning synthesizing spatial and tabular data; and finally, (vi) scalable decision support system. It is worth to highlight that the proposed future plan (second phase) of this system encompasses scalability will extend to include integration with departments of Billing and SCADA. This scalability will comprise advanced functionalities in association with the existing one to allow further sustainable contributions.

Keywords: GIS Web-Based, base-map, water network, decision support system

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Authors: V. Argyropoulos, M. Nikolaraizi, K. Tanou

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There is little available information concerning the cognitive and communicative abilities of the people who are deaf-blind. This mainly stems from the general inadequacy of existing assessment instruments employed with deafblind individuals. Although considerable variability exists with regard to cognitive capacities of the deaf-blind, careful examination of the literature reveals that the majority of these persons suffer from significant deficits in cognitive and adaptive functioning. The few reports available primarily are case studies, narrative program descriptions, or position papers by workers in the field. Without the objective verification afforded by controlled research, specialists in psychology, education, and other rehabilitation services must rely on personal speculations or biases to guide their decisions in the planning, implementation, and evaluation of services to deaf-blind children and adults. This paper highlights the framework and discusses the results of an action research network. The aim of this study was twofold: a) to describe and analyse the different ways in which a student with deafblindness approached a number of developmental issues such as novel tasks, exploration and manipulation of objects, reactions to social stimuli, motor coordination, and quality of play and b) to map the appropriate functional approach for the specific student that could be used to develop strategies for classroom participation and socialization. The persons involved in this collaborative action research scheme were general teachers, a school counsellor, academic staff and student teachers. Rating scales and checklists were used to gather information in natural activities and settings, and additional data were also obtained through interviews with the educators of the student. The findings of this case study indicated that there is a great need to focus on the development of effective intervention strategies. The results showed that the identification of positive reinforcers for this population might represent an important and challenging aspect of behaviour programmes. Finally, the findings suggest that additional empirical work is needed to increase attention to methodological and social validity issues.

Keywords: action research, cognitive and communicative abilities, deafblindness, effective strategies

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Authors: David Serero, Loic Couton, Jean-Denis Parisse, Robert Leroy

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This paper presents an analysis method of airflow at the periphery of several typologies of architectural volumes. To understand the complexity of the urban environment on the airflows in the city, we compared three sites at different architectural scale. The research sets a method to identify the optimal location for the installation of wind turbines on the edges of a building and to achieve an improvement in the performance of energy extracted by precise localization of an accelerating wing called “aero foil”. The objective is to define principles for the installation of wind turbines and natural ventilation design of buildings. Instead of theoretical winds analysis, we combined numerical aeraulic simulations using STAR CCM + software with wind data, over long periods of time (greater than 1 year). If airflows computer fluid analysis (CFD) simulation of buildings are current, we have calibrated a virtual wind tunnel with wind data using in situ anemometers (to establish localized cartography of urban winds). We can then develop a complete volumetric model of the behavior of the wind on a roof area, or an entire urban island. With this method, we can categorize: - the different types of wind in urban areas and identify the minimum and maximum wind spectrum, - select the type of harvesting devices - fixing to the roof of a building, - the altimetry of the device in relation to the levels of the roofs - The potential nuisances around. This study is carried out from the recovery of a geolocated data flow, and the connection of this information with the technical specifications of wind turbines, their energy performance and their speed of engagement. Thanks to this method, we can thus define the characteristics of wind turbines to maximize their performance in urban sites and in a turbulent airflow regime. We also study the installation of a wind accelerator associated with buildings. The “aerofoils which are integrated are improvement to control the speed of the air, to orientate it on the wind turbine, to accelerate it and to hide, thanks to its profile, the device on the roof of the building.

Keywords: wind energy harvesting, wind turbine selection, urban wind potential analysis, CFD simulation for architectural design

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Authors: Rachel deCatanzaro, Madeline Austen, Ken Tuininga, Kathy St. Laurent, Christina Rohe

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In Canada, the federal Species at Risk Act (SARA) provides protection for wildlife species at risk and a national legislative framework for the conservation or recovery of species that are listed as endangered, threatened, or special concern under Schedule 1 of SARA. Key aspects of the federal species at risk program include the development of recovery documents (recovery strategies, action plans, and management plans) outlining threats, objectives, and broad strategies or measures for conservation or recovery of the species; the identification and protection of critical habitat for threatened and endangered species; and working with groups and organizations to implement on-the-ground recovery actions. Environment Canada’s progress on the development of recovery documents and on the identification and protection of critical habitat in Ontario will be presented, along with successes and challenges associated with on-the ground implementation of recovery actions. In Ontario, Environment Canada is currently involved in several recovery and monitoring programs for at-risk bird species such as the Loggerhead Shrike, Piping Plover, Golden-winged Warbler and Cerulean Warbler and has provided funding for a wide variety of recovery actions targeting priority species at risk and geographic areas each year through stewardship programs including the Habitat Stewardship Program, Aboriginal Fund for Species at Risk, and the Interdepartmental Recovery Fund. Key research needs relevant to the recovery of species at risk have been identified, and include: surveys and monitoring of population sizes and threats, population viability analyses, and addressing knowledge gaps identified for individual species (e.g., species biology and habitat needs). The engagement of all levels of government, the local and international conservation communities, and the scientific research community plays an important role in the conservation and recovery of species at risk in Ontario– through surveying and monitoring, filling knowledge gaps, conducting public outreach, and restoring, protecting, or managing habitat – and will be critical to the continued success of the federal species at risk program.

Keywords: conservation biology, habitat protection, species at risk, wildlife recovery

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Authors: Pampita Chakraborty, Sukumar Mukherjee

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People with diabetes mellitus are more susceptible to developing infections, as high blood sugar levels can weaken the patient's immune system defences. People with diabetes are more adversely affected when they get an infection than someone without the disease, because you have weakened immune defences in diabetes. People who have minimally elevated blood sugar levels experience worse outcomes with infections. Diabetic patients in hospitals do not necessarily have a higher mortality rate due to infections, but they do face longer hospitalisation and recovery times. A study was done in a tertiary care unit in eastern India. Patients with type 2 diabetes mellitus infection were recruited in the study. A total of 520 cases of Type 2 Diabetes Mellitus were recorded out of which 200 infectious cases was included in the study. All subjects underwent detailed history & clinical examination. Microbiological samples were collected from respective site of the infection for microbial culture and antibiotic sensitivity test. Out of the 200 infectious cases urinary tract infection(UTI) was found in majority of the cases followed by diabetic foot ulcer (DFU), respiratory tract infection(RTI) and sepsis. It was observed that Escherichia coli was the most commonest pathogen isolated from UTI cases and Staphylococcus aureus was predominant in foot ulcers followed by other organisms. Klebsiella pneumonia was the major organism isolated from RTI and Enterobacter aerogenes was commonly observed in patients with sepsis. Isolated bacteria showed differential sensitivity pattern against commonly used antibiotics. The majority of the isolates were resistant to several antibiotics that are usually prescribed on an empirical basis. These observations are important, especially for patient management and the development of antibiotic treatment guidelines. It is recommended that diabetic patients receive pneumococcal and influenza vaccine annually to reduce morbidity and mortality. Appropriate usage of antibiotics based on local antibiogram pattern can certainly help the clinician in reducing the burden of infections.

Keywords: antimicrobial resistance, diabetic foot ulcer, respiratory tract infection, urinary tract infection

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Authors: Burhan Khan

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Objective: This study aims to enhance the body of knowledge about the vulnerabilities of child waste pickers in solid waste management. The primary objective of this research is to investigate the occupational menaces and their potential harm to the health of child waste pickers. Material and Methods: The present study design is descriptive in nature and involves children aged 5 through 14, who were rummaging through garbage in the roads and streets of Aligarh city, Uttar Pradesh. The researcher adopted an empirical approach to interview 65 participants (27 boys and 38 girls) across Aligarh city, Uttar Pradesh. The majority of the participants are Muslims (76.9 %), scheduled Castes (13.8 %), and Hindus (9.2 %). Out of 65 participants, 73.8% of children were migrated within the last five years. The primary data were analysed by utilising descriptive statistics, including frequencies, cross-tabs, means, and percentages. Results: The results show that the vast majority of children (87.7%) have experienced superficial injuries or open wound at their work. More than 32% were suffering from respiratory problems such as coughing, wheezing and short of breath, close to 37% reported skin problems like allergy, irritation and bruising and 4.6% had eye problems such as pain and irritation in eyes. Nearly 78% of children lift and carry a heavy load like large garbage bags. Over 83% informed that they sort through refuse in a filthy environment such as open dumpsites, effluents, and runnels. Conclusion: This research provides pieces of evidence of how children are being tormented in the rag-picking sector. It has been observed that child rag pickers are susceptible to injuries or illnesses due to work-related risks and toxic environment. In India, there is no robust policy to address the concerns of waste pickers and laws to protect their rights. Consequently, these deprived communities of rag pickers, especially children, have become more vulnerable over time in India. Hence, this research paper calls for a quick response to the exigencies of child rag picker by developing a holistic approach that deals with education, medical care, sanitation, and nutrition for child rag pickers.

Keywords: child rag pickers, health impairments, occupational hazards, toxic environment

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Authors: Nastja Utrosa, Matevz Juvancic

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Hospital buildings are complex public environments characterized by intricate functional arrangements and architectural layouts. Effective wayfinding is essential for patients, visitors, students, and staff. However, spatial orientation planning is often overlooked until after construction. While these environments meet functional needs, they frequently neglect the psychological aspects of user experience. This study investigates wayfinding within complex urban healthcare environments, focusing on the influences of spatial design, spatial cognition, and user experience. The inherent complexity of these environments, with extensive spatial dimensions and dispersed buildings, exacerbates the problem. Gradual expansions and additions contribute to disorientation and navigational difficulties for users. Effective route guidance in urban healthcare settings has become increasingly crucial. However, research on the environmental elements that influence wayfinding in such environments remains limited. To address this gap, we conducted a study at the University Medical Centre Ljubljana (UMCL), Slovenia's largest university hospital. Using a questionnaire, we assessed how individuals' perceptions and use of outdoor hospital spaces with a diverse sample (n=179). We evaluated the area’s usability by analyzing visit frequency, stops, modes of arrival, and parking patterns and examined the visitors' age distribution. Additionally, we investigated spatial aids and the use of color as an orientation element at three specific locations within the medical center. Our study explored the impact of color on entrance selection and the effectiveness of warm versus cool colors for wayfinding. Our findings highlight the significance of graphic adjustments in shaping perceptions of hospital outdoor spaces. Most participants preferred visually organized entrances, underscoring the importance of effective visual communication. Implementing these adaptations can substantially enhance the user experience, reducing stress and increasing satisfaction in hospital environments.

Keywords: hospital layout design, healthcare facilities, wayfinding, navigational aids, spatial orientation, color, signage

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Authors: Anjana Aggarwal, Sheilja Walia

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Prevalence of obesity and overweight is increasing due to sedentary lifestyles and busy schedules of people that spend less time on physical exercise. To reduce weight, people are finding easier and more convenient ways. The easiest solution is the use of dietary supplements and fat burners. These are products that decrease body weight by increasing the basal metabolic rate. Various reports have been published on the consumption of fat burners leading to heart palpitations, seizures, anxiety, depression, psychosis, bradycardia, insomnia, muscle contractions, hepatotoxicity, and even liver failure. Case reports and series are reporting that the ingredients present in the fat burners caused acute liver failure (ALF) and hepatic toxicity in many cases. Another contributing factor is the absence of regulations from the Food and Drug Administration on these products, leading to increased consumption and a higher risk of liver diseases among the population. This systematic review aims to attain a better understanding of the dietary supplements used globally to reduce weight and document the case reports/series of acute liver failure caused by the consumption of fat burners. Electronic databases like PubMed, Cochrane, Google Scholar, etc., will be systematically searched for relevant articles. Various websites of dietary products and brands that sell such supplements, Journals of Hepatology, National and international projects launched for ALF, and their reports, along with the review of grey literature, will also be done to get a better understanding of the topic. After discussing with the co-author, the selection and screening of the articles will be performed by the author. The studies will be selected based on the predefined inclusion and exclusion criteria. The case reports and case series that will be included in the final list of the studies will be assessed for methodological quality using the CARE guidelines. The results from this study will provide insights and a better understanding of fat burners. Since the supplements are easily available in the market without any restrictions on their sale, people are unaware of their adverse effects. The consumption of these supplements causes acute liver failure. Thus, this review will provide a platform for future larger studies to be conducted.

Keywords: acute liver failure, dietary supplements, fat burners, weight loss supplements

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Authors: Hannah Rosenqvist, Fanny Guay

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Critical infrastructure protection has been an important topic for several years. Programmes such as the European Programme for Critical Infrastructure Protection (EPCIP), Critical Infrastructure Warning Information Network (CIWIN) and the European Reference Network for Critical Infrastructure Protection (ENR-CIP) have been the pillars to the work done since 2006. However, measuring critical infrastructure resilience has not been an easy task. This has to do with the fact that the concept of resilience has several definitions and is applied in different domains such as engineering and social sciences. Since June 2015, the EU project IMPROVER has been focusing on developing a methodology for implementing a combination of societal, organizational and technological resilience concepts, in the hope to increase critical infrastructure resilience. For this paper, we performed research on how to include societal resilience as a form of measurement of the context of critical infrastructure resilience. Because one of the main purposes of critical infrastructure (CI) is to deliver services to the society, we believe that societal resilience is an important factor that should be considered when assessing the overall CI resilience. We found that existing methods for CI resilience assessment focus mainly on technical aspects and therefore that is was necessary to develop a resilience model that take social factors into account. The model developed within the project IMPROVER aims to include the community’s expectations of infrastructure operators as well as information sharing with the public and planning processes. By considering such aspects, the IMPROVER framework not only helps operators to increase the resilience of their infrastructures on the technical or organizational side, but aims to strengthen community resilience as a whole. This will further be achieved by taking interdependencies between critical infrastructures into consideration. The knowledge gained during this project will enrich current European policies and practices for improved disaster risk management. The framework for societal resilience analysis is based on three dimensions for societal resilience; coping capacity, adaptive capacity and transformative capacity which are capacities that have been recognized throughout a widespread literature review in the field. A set of indicators have been defined that describe a community’s maturity within these resilience dimensions. Further, the indicators are categorized into six community assets that need to be accessible and utilized in such a way that they allow responding to changes and unforeseen circumstances. We conclude that the societal resilience model developed within the project IMPROVER can give a good indication of the level of societal resilience to critical infrastructure operators.

Keywords: community resilience, critical infrastructure protection, critical infrastructure resilience, societal resilience

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Authors: Haoyu Zhao, Qianshu Ma, Min Xie, Yunqi Huang, Yunjia Liu, Huan Song, Hongsheng Gui, Mingli Li, Qiang Wang

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Rationale: Bipolar disorder (BD) and major depressive disorder (MDD), as severe chronic illnesses that restrict patients’ psychosocial functioning and reduce their quality of life, are both categorized into mood disorders. Emerging evidence has suggested that the reliability of self-rated health (SRH) was wellvalidated and that the risk of various health outcomes, including mortality and health care costs, could be predicted by SRH. Compared with other lengthy multi-item patient-reported outcomes (PRO) measures, SRH was proven to have a comparable predictive ability to predict mortality and healthcare utilization. However, to our knowledge, no study has been conducted to assess the association between SRH and hospitalization among people with mental disorders. Therefore, our study aims to determine the association between SRH and subsequent all-cause hospitalizations in patients with BD and MDD. Methods: We conducted a prospective cohort study on people with BD or MDD in the UK from 2006 to 2010 using UK Biobank touchscreen questionnaire data and linked administrative health databases. The association between SRH and 2-year all-cause hospitalizations was assessed using proportional hazard regression after adjustment for sociodemographics, lifestyle behaviors, previous hospitalization use, the Elixhauser comorbidity index, and environmental factors. Results: A total of 29,966 participants were identified, experiencing 10,279 hospitalization events. Among the cohort, the average age was 55.88 (SD 8.01) years, 64.02% were female, and 3,029 (10.11%), 15,972 (53.30%), 8,313 (27.74%), and 2,652 (8.85%) reported excellent, good, fair, and poor SRH, respectively. Among patients reporting poor SRH, 54.19% had a hospitalization event within 2 years compared with 22.65% for those having excellent SRH. In the adjusted analysis, patients with good, fair, and poor SRH had 1.31 (95% CI 1.21-1.42), 1.82 (95% CI 1.68-1.98), and 2.45 (95% CI 2.22, 2.70) higher hazards of hospitalization, respectively, than those with excellent SRH. Conclusion: SRH was independently associated with subsequent all-cause hospitalizations in patients with BD or MDD. This large study facilitates rapid interpretation of SRH values and underscores the need for proactive SRH screening in this population, which might inform resource allocation and enhance high-risk population detection.

Keywords: severe mental illnesses, hospitalization, risk prediction, patient-reported outcomes

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Authors: Dawd Ahmed, Venkatesh Uddameri

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Agriculture in Ethiopia is the main economic sector influenced by agricultural drought. A simultaneous assessment of drought trends using multiple drought indicators is useful for drought planning and management. Intra-season and seasonal drought trends in Ethiopia were studied using a suite of drought indicators. Standardized Precipitation Index (SPI), Standardized Precipitation Evapotranspiration Index (SPEI), Palmer Drought Severity Index (PDSI), and Z-index for long-rainy, dry, and short-rainy seasons are used to identify drought-causing mechanisms. The Statistical software package R version 3.5.2 was used for data extraction and data analyses. Trend analysis indicated shifts in late-season long-rainy season precipitation into dry in the southwest and south-central portions of Ethiopia. Droughts during the dry season (October–January) were largely temperature controlled. Short-term temperature-controlled hydrologic processes exacerbated rainfall deficits during the short rainy season (February–May) and highlight the importance of temperature- and hydrology-induced soil dryness on the production of short-season crops such as tef. Droughts during the long-rainy season (June–September) were largely driven by precipitation declines arising from the narrowing of the intertropical convergence zone (ITCZ). Increased dryness during long-rainy season had severe consequences on the production of corn and sorghum. PDSI was an aggressive indicator of seasonal droughts suggesting the low natural resilience to combat the effects of slow-acting, moisture-depleting hydrologic processes. The lack of irrigation systems in the nation limits the ability to combat droughts and improve agricultural resilience. There is an urgent need to monitor soil moisture (a key agro-hydrologic variable) to better quantify the impacts of meteorological droughts on agricultural systems in Ethiopia.

Keywords: autocorrelation, climate change, droughts, Ethiopia, food security, palmer z-index, PDSI, SPEI, SPI, trend analysis

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Authors: Anne Waithira Dormal

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Climate change is threatening pastoral livelihoods in Kajiado County, Kenya, through water shortages, livestock deaths, and increasing poverty. This study examines how these impacts differ for men and women within these communities. Limited access to resources, limited land and livestock rights, and limited decision-making power increase women's vulnerability, which is further burdened by traditional gender roles in water procurement. The research recognizes the complexity of climate change and emphasizes that factors such as wealth, family dynamics, and socioeconomic status also influence resilience. Effective adaptation strategies must address all genders. While livestock farming provides a safety net, socioeconomic empowerment through access to credit, healthcare, and education strengthens entire communities. An intersectional perspective that takes ethnicity, social status, and other factors into account is also crucial. This research, therefore, aims to examine how gender-specific adaptation strategies interact with gender and socioeconomic factors to determine the resilience of these Kenyan pastoralist communities. Such strategies, which address the specific needs and vulnerabilities of men and women, are expected to lead to increased resilience to climate change. The aim of the study is to identify effective, gender-specific adaptation strategies that can be integrated into climate change planning and implementation. Additionally, research awaits a deeper understanding of how socioeconomic factors interact with gender to influence vulnerability and resilience within these communities. The study uses a gender-sensitive qualitative approach with focus group discussions in four different pastoral and agropastoral communities. Both qualitative and demographic data are used to capture sources of income, education level, and household size of focus group respondents to increase the power of the analysis. While the research acknowledges the limitations of specific focus sites and potential biases in self-reporting, it offers valuable insights into gender and climate change in pastoral contexts. This study contributes to understanding gender-based vulnerabilities and building resilience in these communities.

Keywords: climate adaptation strategies, climate change, climate resilience, gendered vulnerability, pastoralism

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Authors: Dany I. Doughan, Nizam S. Najd

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Different governments in today’s global pandemic are approaching the challenging and complex issue of mitigating the spread of the SARS-CoV-2 virus differently while simultaneously considering their national economic and operational bottom lines. One of the most notable successes has been Taiwan's multifaceted virus containment approach, which resulted in a substantially lower incidence rate compared to Sweden’s chief mitigation tactic of herd immunity. From a classic Swiss Cheese Model perspective, integrating more fail-safe layers of defense against the virus in Taiwan’s approach compared to Sweden’s meant that in Taiwan, the government did not have to resort to extreme measures like the national lockdown Sweden is currently contemplating. From an optimized virus spread mitigation solution development standpoint using the Solutions Principle, the Taiwanese and Swedish solutions were desirable economically by businesses that remained open and non-economically or socially by individuals who enjoyed fewer disruptions from what they considered normal before the pandemic. Out of the two, the Taiwanese approach was more feasible long-term from a workforce management and quality control perspective for healthcare facilities and their professionals who were able to provide better, longer, more attentive care to the fewer new positive COVID-19 cases. Furthermore, the Taiwanese approach was more applicable as an overall model to emulate thanks in part to its short-term and long-term multilayered approach, which allows for the kind of flexibility needed by other governments to fully or partially adapt or adopt said, model. The Swedish approach, on the other hand, ignored the biochemical nature of the virus and relied heavily on short-term personal behavioral adjustments and conduct modifications, which are not as reliable as establishing required societal norms and awareness programs. The available international data on COVID-19 cases and the published governmental approaches to control the spread of the coronavirus support a better fit into the Solutions Principle of Taiwan’s Swiss Cheese Model success story compared to Sweden’s.

Keywords: coronavirus containment and mitigation, solutions principle, Swiss Cheese Model, viral mutation

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Authors: Michely Vargas Delpupo, José Geraldo Romanello Bueno

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The right to basic sanitation, was elevated to the category of fundamental right by the Brazilian Constitution of 1988 to protect the ecologically balanced environment, ensuring social rights to health and adequate housing warranting dignity of the human person as a principle of the Brazilian Democratic State. Because of their essentiality to the Brazilian population, this article seeks to understand why universal access to basic sanitation is a goal so difficult to achieve in Brazil. Therefore, this research uses the deductive and analytical method. Given the nature of the research literature, research techniques were centered in specialized books on the subject, journals, theses and dissertations, laws, relevant law case and raising social indicators relating to the theme. The relevance of the topic stems, among other things, the fact that sanitation services are essential for a dignified life, i.e. everyone is entitled to the maintenance of the necessary existence conditions are satisfied. However, the effectiveness of this right is undermined in society, since Brazil has huge deficit in sanitation services, denying thus a worthy life to most of the population. Thus, it can be seen that the provision of water and sewage services in Brazil is still characterized by a large imbalance, since the municipalities with lower population index have greater disability in the sanitation service. The truth is that the precariousness of water and sewage services in Brazil is still very concentrated in the North and Northeast regions, limiting the effective implementation of the Law 11.445/2007 in the country. Therefore, there is urgent need for a positive service by the State in the provision of sanitation services in order to prevent and control disease, improve quality of life and productivity of individuals, besides preventing contamination of water resources. More than just social and economic necessity, there is even a an obligation of the government to implement such services. In this sense, given the current scenario, to achieve universal access to basic sanitation imposes many hurdles. These are mainly in the field of properly formulated and implemented public policies, i.e. it requires an excellent institutional organization, management services, strategic planning, social control, in order to provide answers to complex challenges.

Keywords: fundamental rights, health, sanitation, universal access

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Authors: Meng-Cong Zheng, Yu-Sheng Chen

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The meeting behavior is a pervasive kind of interaction, which often occurs between the passenger and the shuttle. However, the meeting point set up at the Taoyuan International Airport is too far from the entry-exit, often causing passengers to stop searching near the entry-exit. When the number of people waiting for the rush hour increases, it often results in chaos in the waiting area. This study tried to find out what is the key factor to promote the rapid finding of each other between the passengers and the pick-ups. Then we implemented several design proposals to improve the meeting behavior of passengers and pick-ups based on behavior mapping and post-occupancy evaluation to enhance their meeting efficiency in unfamiliar environments. The research base is the reception hall of the second terminal of Taoyuan International Airport. Behavioral observation and mapping are implemented on the entry of inbound passengers into the welcome space, including the crowd distribution of the people who rely on the separation wall in the waiting area, the behavior of meeting and the interaction between the inbound passengers and the pick-ups. Then we redesign the space planning and signage design based on post-occupancy evaluation to verify the effectiveness of space plan and signage design. This study found that passengers ignore existing meeting-point designs which are placed on distant pillars at both ends. The position of the screen affects the area where the receiver is stranded, causing the pick-ups to block the passenger's moving line. The pick-ups prefer to wait where it is easy to watch incoming passengers and where it is closest to the mode of transport they take when leaving. Large visitors tend to gather next to landmarks, and smaller groups have a wide waiting area in the lobby. The location of the meeting point chosen by the pick-ups is related to the view of the incoming passenger. Finally, this study proposes an improved design of the meeting point, setting the traffic information in it, so that most passengers can see the traffic information when they enter the country. At the same time, we also redesigned the pick-ups desk to improve the efficiency of passenger meeting.

Keywords: meeting point design, post-occupancy evaluation, behavioral mapping, international airport

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Authors: Fawad Hussain, Saleh Abdullah Saleh, Mohammad Basir B Saud, Mohd Azwardi Md. Isa

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It is very important for a developing nation to develop their infrastursture on the prime priority because their infrastursture particularly their roads and transporation functions as a blood in the system. Almost 1.1 billion populations share the travel and transportation industry in India. On the other hand, the Pakistan transportation industry is also extensive and elevating about 170 million users of transportation. Indian and Pakistani specifically within bus industry have good interconnectivity within and between the urban and rural areas as well as connectivity between the two countries, which is dramatically helping the economic alleviation of both countries. Due to high economic instability, unemployment and poverty rate are among the reasons why both the governments are very committed and seriously taken further action to help boost their economy. They believe that any form of transportation development would play a vital role in the development of land, infrastructure which could indirectly support many other industries’ development, such as tourism, freighting and shipping businesses, just to mention a few. However, it seems that their previous transportation planning in the due course has failed to meet the fast growing demand. As with the spin of time, both the countries are looking forward for a reasonable, safe and economical long term solutions, which is from time to time keep appreciating and reacting according to other key economic drivers. Content analysis method and case study approach is used in this paper and secondary data from the bureau of statistic is used for case analysis. The paper centered on the mobility concerns of the lower and middle income people in India and Pakistan. The paper is aimed to highlight the weaknesses, opportunities and limitations resulting from low priority industry for government, which is making the either country's public suffer. The paper has concluded that the main issue is identified as the slow, inappropriate and unfavorable decisions which are not in favor of long term country’s economic development and public welfare as well as interest. The paper also recommends to future market sense public and private transportation, which has failed to meet the public expectations.

Keywords: bus transportation industries, transportation demand, government parallel initiatives, road and traffic congestions

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Authors: Sushma Tejwani, Shoruba Dinakaran, Rupa Rokhade, K. Bhujang Shetty

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Introduction and aim: One of the major causes for failure of trabeculectomy is fibrosis and scarring of subconjunctival tissue around the bleb, and hence intra operative usage of anti-fibrotic agents like Mitomycin C (MMC) has become very popular. However, the long term effects of MMC like thin, avascular bleb, hypotony, bleb leaks and late onset endophthalmitis cannot be ignored, and may preclude its usage in routine trabeculectomy. In this particular study we aim to study the outcomes of trabeculectomy with and without MMC in uncomplicated glaucoma patients. Methods: Retrospective study of series of patients that underwent trabeculectomy with or without cataract surgery in glaucoma department of a tertiary eye care centre by a single surgeon for primary open angle glaucoma (POAG), angle closure glaucoma (PACG), Pseudoexfoliation glaucoma (PXF glaucoma). Patients with secondary glaucoma, juvenile and congenital glaucoma were excluded; also patients undergoing second trabeculectomy were excluded. The outcomes were studied in terms of IOP control at 1 month, 6 months, and 1 year and were analyzed separately for surgical outcomes with and without MMC. Success was considered if IOP was < 16 mmHg on applanation tonometry. Further, the necessity of medication, 5 fluorouracil (5FU) postoperative injections, needling post operatively was noted. Results: Eighty nine patient’s medical records were reviewed, of which 58 patients had undergone trabeculectomy without MMC and 31 with MMC. Mean age was 62.4 (95%CI 61- 64), 34 were females and 55 males. MMC group (n=31): Preoperative mean IOP was 21.1mmHg (95% CI: 17.6 -24.6), and 22 patients had IOP > 16. Three out of 33 patients were on single medication and rests were on multiple drugs. At 1 month (n=27) mean IOP was 12.4 mmHg (CI: 10.7-14), and 31/33 had success. At 6 months (n=18) mean IOP was 13mmHg (CI: 10.3-14.6) and 16/18 had good outcome, however at 1 year only 11 patients were available for follow up and 91% (10/11) had success. Overall, 3 patients required medication and one patient required postoperative injection of 5 FU. No MMC group (n=58): Preoperative mean IOP was 21.9 mmHg (CI: 19.8-24.2), and 42 had IOP > 16 mmHg. 12 out of 58 patients were on single medication and rests were on multiple drugs. At 1 month (n=52) mean IOP was14.6mmHg (CI: 13.2-15.9), and 45/ 58 had IOP < 16mmHg. At 6 months (n=31) mean IOP was 13.5 mmHg (CI: 11.9-15.2) and 26/31 had success, however at 1 year only 23 patients came for follow up and of these 87% (20/23) patients had success. Overall, 1 patient required needling, 5 required 5 FU injections and 5 patients required medication. The success rates at each follow up visit were not significantly different in both the groups. Conclusion: Intra-operative MMC usage may not be required in all patients undergoing trabeculectomy, and the ones without MMC also have fairly good outcomes in primary glaucoma.

Keywords: glaucoma filtration surgery, mitomycin C, outcomes of trabeculectomy, wound modulation

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