Search results for: comprehensive review

Authors: Kaori Nakamura, Shun Su, Yusak Sulio, Daisuke Fukuda

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Active modes of transportation, such as walking and cycling, are crucial in promoting healthy and sustainable urban environments. Encouraging the use of these modes requires a well-designed road environment that ensures safety and comfort. Understanding what constitutes a safe environment for these users is essential. While previous research mainly focuses on subjective safety or the likelihood of collisions, there needs to be more analysis of the real-time experiences of travelers and dynamic transitions of their discomfort perceptions. Post-ride surveys or pre-ride impressions, the typical evaluation methods in past studies, may not accurately capture the immediate reactions and discomforts experienced during their rides. Though past experimental studies may also use physiological and behavioral data to evaluate road designs, they evaluated road design by comparing time-average physiological and behavioral data across different designs. This study aims to investigate the effects of the dynamic riding environmental changes experienced by cyclists during their rides on their dynamic physiological and behavioral responses and then explore how these conditions contribute to cyclists' overall subjective safety and comfort. We conducted an experiment with 24 participants who cycled approximately 500 meters in a virtual reality (VR) environment designed to mimic a typical road environment of Japanese local towns where lanes for cyclists and regular cars are adjacent in limited road spaces. Participants experienced six road designs varying in width, separation type, and bike lane color. We measured their physiological data, such as heart rate and skin conductance, and behavioral data, including steering, acceleration, and coordination of bicycles. Questionnaires for eliciting subjective impressions were conducted before and after each ride. The data analysis results indicate that wider paths (i.e., 1.5m and 2m width) are preferred, enhancing perceived safety and reducing stress, as supported by lower heart rates and skin conductance levels over narrower ones (1m width). Designs with clear divisions from car lanes may enhance perceived safety and reduce stress. The analysis of the physiological data also supports these arguments, showing that lower heart rates and skin conductance levels are found in wider, clearly marked paths. Further, the drift-diffusion decision model was performed to reveal whether different road environment designs may impact dynamic decision-making processes and physiological attributes. Designing a 1.5m wide bike lane with clear divisions from car lanes showed the highest level of clarity and safety in decision-making parameters. In contrast, designs without clear separations from car lanes resulted in less favorable decision-making outcomes. These results coincide with previous primary research indicating a preference for bike lane widths more significant than 1.5m. In conclusion, the analysis using the drift-diffusion decision model showed that decision-making ease slightly differs from subjective safety perceptions, providing a comprehensive understanding of how different road designs impact users. This study offers a solid foundation for assessing the perceptions of active mode users and highlights the importance of considering both real-time physiological and subjective data in designing road environments that encourage active transportation modes.

Keywords: active transport modes, cognitive and decision-making modeling, road environment designs, virtual reality experiment

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Authors: Arlinda Memetaj

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A sound system of administrative justice represents a vital element of democratic governance. The proper control of public administration consists not only of a sound civil service framework and legislative oversight, but empowerment of the public and courts to hold public officials accountable for their decision-making through the application of fair administrative procedural rules and the use of appropriate administrative appeals processes and judicial review. The establishment of both effective public administration and administrative justice system has been for a long period of time among the most ‘important and urgent’ final strategic objectives of almost any country in the Balkans region, including Macedonia, Albania and Kosovo. Closely related to this is their common strategic goal to enter the membership in the European Union, which requires fulfilling of many criteria and standards as incorporated in EU acquis communautaire. The latter is presently done with the framework of the Stabilization and Association Agreement which each of these countries has concluded with the EU accordingly. To above aims, each of the three countries has so far adopted a huge series of legislative and strategic documents related to any aspects of their individual administrative justice system. ‘Changes and reforms’ in this field have been thus the most frequent terms being used in any of these countries. The three countries have already established their own national administrative judiciary, while permanently amending their laws on the general administrative procedure introducing thereby considerable innovations concerned. National administrative courts are expected to have crucial important role within the broader judiciary systems-related reforms of these countries; they are designed to check the legality of decisions of the state administration with the aim to guarantee an effective protection of human rights and legitimate interests of private persons through a regular, conform, fast and reasonable judicial administrative process. Further improvements in this field are presently an integral crucial part of all the relevant national strategic documents including the ones on judiciary reform and public administration reform, as adopted by each of the three countries; those strategic documents are designed among others to provide effective protection of their citizens` rights` of administrative justice. On the basis of the later, the paper finally is aimed at highlighting selective common challenges and problems of the three countries on their European road, while claiming (among others) that the current status quo situation in each of them may be overcome only if there is a proper implementation of the administrative courts decisions and a far stricter international monitoring process thereof. A new approach and strong political commitment from the highest political leadership is thus absolutely needed to ensure the principles of transparency, accountability and merit in public administration. The main methods used in this paper include the analytical and comparative ones due to the very character of the paper itself.

Keywords: administrative courts , administrative justice, administrative procedure, benefit, effective administrative justice, human rights, implementation, monitoring, reform

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Authors: Victoria L. Chester, Usha Kuruganti

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The forest industry is a major economic sector of Canada and also one of the most dangerous industries for workers. The use of mechanized mobile forestry harvesting machines has successfully reduced the incidence of injuries in forest workers related to manual labor. However, these machines have also created additional concerns, including a high machine operation learning curve, increased the length of the workday, repetitive strain injury, cognitive load, physical and mental fatigue, and increased postural loads due to sitting in a confined space. It is critical to obtain objective performance data for employers to develop appropriate work practices for this industry, however ergonomic field studies of this industry are lacking mainly due to the difficulties in obtaining comprehensive data while operators are cutting trees in the woods. The purpose of this study was to establish a measurement and experimental protocol to examine the effects of worker skill level and movement training speed (joystick crane speed) on harvesting performance using a forestry simulator. A custom wrist angle measurement device was developed as part of the study to monitor Euler angles during operation of the simulator. The device of the system consisted of two accelerometers, a Bluetooth module, three 3V coin cells, a microcontroller, a voltage regulator and an application software. Harvesting performance and crane data was provided by the simulator software and included tree to frame collisions, crane to tree collisions, boom tip distance, number of trees cut, etc. A pilot study of 3 operators with various skill levels was tested to identify factors that distinguish highly skilled operators from novice or intermediate operators. Dependent variables such as reaction time, math skill, past work experience, training movement speed (e.g. joystick control speeds), harvesting experience level, muscle activity, and wrist biomechanics were measured and analyzed. A 10-channel wireless surface EMG system was used to monitor the amplitude and mean frequency of 10 upper extremity muscles during pre and postperformance on the forestry harvest stimulator. The results of the pilot study showed inconsistent changes in median frequency pre-and postoperation, but there was the increase in the activity of the flexor carpi radialis, anterior deltoid and upper trapezius of both arms. The wrist sensor results indicated that wrist supination and pronation occurred more than flexion and extension with radial-ulnar rotation demonstrating the least movement. Overall, wrist angular motion increased as the crane speed increased from slow to fast. Further data collection is needed and will help industry partners determine those factors that separate skill levels of operators, identify optimal training speeds, and determine the length of training required to bring new operators to an efficient skill level effectively. In addition to effective and employment training programs, results of this work will be used for selective employee recruitment strategies to improve employee retention after training. Further, improved training procedures and knowledge of the physical and mental demands on workers will lead to highly trained and efficient personnel, reduced risk of injury, and optimal work protocols.

Keywords: EMG, forestry, human factors, wrist biomechanics

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Authors: Shamsulhaq Amin

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Unbound granular materials (UGMs) are pivotal in ensuring long-term quality, especially in the layers under the surface of flexible pavements and other constructions. This study seeks to better understand the behavior of the UGMs by looking at popular models for predicting lasting deformation under various levels of stresses and load cycles. These models focus on variables such as the number of load cycles, stress levels, and features specific to materials and were evaluated on the basis of their ability to accurately predict outcomes. The study showed that these factors play a crucial role in how well the models work. Therefore, the research highlights the need to look at a wide range of stress situations to more accurately predict how much the UGMs bend or shift. The research looked at important factors, like how permanent deformation relates to the number of times a load is applied, how quickly this phenomenon happens, and the shakedown effect, in two different types of UGMs: granite and limestone. A detailed study was done over 100,000 load cycles, which provided deep insights into how these materials behave. In this study, a number of factors, such as the level of stress applied, the number of load cycles, the density of the material, and the moisture present were seen as the main factors affecting permanent deformation. It is vital to fully understand these elements for better designing pavements that last long and handle wear and tear. A series of laboratory tests were performed to evaluate the mechanical properties of materials and acquire model parameters. The testing included gradation tests, CBR tests, and Repeated load triaxial tests. The repeated load triaxial tests were crucial for studying the significant components that affect deformation. This test involved applying various stress levels to estimate model parameters. In addition, certain model parameters were established by regression analysis, and optimization was conducted to improve outcomes. Afterward, the material parameters that were acquired were used to construct graphs for each model. The graphs were subsequently compared to the outcomes obtained from the repeated load triaxial testing. Additionally, the models were evaluated to determine if they demonstrated the two inherent deformation behaviors of materials when subjected to repetitive load: the initial phase, post-compaction, and the second phase volumetric changes. In this study, using log-log graphs was key to making the complex data easier to understand. This method made the analysis clearer and helped make the findings easier to interpret, adding both precision and depth to the research. This research provides important insight into picking the right models for predicting how these materials will act under expected stress and load conditions. Moreover, it offers crucial information regarding the effect of load cycle and permanent deformation as well as the shakedown effect on granite and limestone UGMs.

Keywords: permanent deformation, unbound granular materials, load cycles, stress level

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Authors: Amjad Ali Khan, Muhammad Ishaq Saqi, Kashif Ali

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The focus of hydrocarbon exploration in Pakistan has been primarily on conventional hydrocarbon resources. Directorate General Petroleum Concessions (DGPC) has taken the lead on the assessment of indigenous unconventional oil and gas resources, which has resulted in a ‘Shale Oil/Gas Resource Assessment Study’ conducted with the help of USAID. This was critically required in the energy-starved Pakistan, where the gap between indigenous oil & gas production and demand continues to widen for a long time. Exploration & exploitation of indigenous unconventional resources of Pakistan have become vital to meet our energy demand and reduction of oil and gas import bill of the country. This study has attempted to bridge a critical gap in geological information about the potential of shale gas & oil in Pakistan in the four formations, i.e., Sembar, Lower Goru, Ranikot and Ghazij in the Middle and Lower Indus Basins, which were selected for the study as for resource assessment for shale gas & oil. The primary objective of the study was to estimate and establish shale oil/gas resource assessment of the study area by carrying out extensive geological analysis of exploration, appraisal and development wells drilled in the Middle and Lower Indus Basins, along with identification of fairway(s) and sweet spots in the study area. The Study covers the Lower parts of the Middle Indus basins located in Sindh, southern Punjab & eastern parts of the Baluchistan provinces, with a total sedimentary area of 271,795 km2. Initially, 1611 wells were reviewed, including 1324 wells drilled through different shale formations. Based on the availability of required technical data, a detailed petrophysical analysis of 124 wells (21 Confidential & 103 in the public domain) has been conducted for the shale gas/oil potential of the above-referred formations. The core & cuttings samples of 32 wells and 33 geochemical reports of prospective Shale Formations were available, which were analyzed to calibrate the results of petrophysical analysis with petrographic/ laboratory analyses to increase the credibility of the Shale Gas Resource assessment. This study has identified the most prospective intervals, mainly in Sembar and Lower Goru Formations, for shale gas/oil exploration in the Middle and Lower Indus Basins of Pakistan. The study recommends seven (07) sweet spots for undertaking pilot projects, which will enable to evaluate of the actual production capability and production sustainability of shale oil/gas reservoirs of Pakistan for formulating future strategies to explore and exploit shale/oil resources of Pakistan including fiscal incentives required for developing shale oil/gas resources of Pakistan. Some E&P Companies are being persuaded to make a consortium for undertaking pilot projects that have shown their willingness to participate in the pilot project at appropriate times. The location for undertaking the pilot project has been finalized as a result of a series of technical sessions by geoscientists of the potential consortium members after the review and evaluation of available studies.

Keywords: conventional resources, petrographic analysis, petrophysical analysis, unconventional resources, shale gas & oil, sweet spots

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Authors: Mulindwa Gerald

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Forced Migration is believed to be the most pressing issue in migration studies today, it therefore makes it of paramount importance that we examine the efficacy of the prevailing laws, treaties, conventions and global policies of refugee management. It suffices to note that the existing policies are vague and ambiguous encouraging the hospitality but not assessing the social economic impact to not only the refugees but also their host communities. The commentary around the Off-shore arrangements like one of UK-Rwanda and the legal implications of the same, make it even more fascinating. These are issues that need to be amplified and captured in the Migration Policies. In Uganda, a small landlocked country in East Africa, there always appeared new faces who were refugees from the Congo and Rwanda the neighboring countries to the West and South West respectively. The refugees would migrate to Uganda with absolutely no idea whatsoever how they were going to meet the daily needs of life, no food, no shelter, no clothing. It interest’s one’s mind to conscientiously interrogate the policy issues surrounding refugee management. The 1951 convention sets a number of obligations to states and the conundrum, faced by citizens of the universe interested in Migration studies is ensuring maximum compliance to these obligations considering the resource challenges. States have a duty to protect refugees in accordance with Article 14 of the Universal Declaration for Human Rights which was adopted by the 1951 convention, these speak to rights like the most important right of refugees known as the Principle of Non-Refoulement, which prohibits expulsion or return of refugees or asylum seekers The International Organization for Migrations projection of the number of migrants globally by 2050 was overwhelmingly surpassed by 2019 due to wars, conflicts that have been experienced in different parts of the globe. This is also due natural calamities and tough economic conditions. It is a descriptive analysis that encompasses a qualitative design research based on a case study involving both desk research and field study. The use of qualitative research approaches like interview guides, document review and direct observation methods helped to bring in the experience, social, behavioral and cultural aspects of the respondents into the study, and since qualitative research uses subjective information and not limited to the rigidly definable variables, thus it helped to explore the research area of the study. it therefore verily believe that this paper is going to trigger perspectives and spark a conversation on this really pressing global issue of refugees and asylum seekers, it is suggesting viable solutions to the management challenges while making recommendations like the ensuring that no refugees or asylum seekers are closed at any borders on the globe for instance a concerted effort of all global players to ensure that refugees are protected efficiently.

Keywords: management, migration, refugees, rights

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Authors: Chang Liu, Hanwen Zhang, Vikash Sharma, Don Eliseo Lucerno-Prisno III, Emmanuel Yujuico, Maulik Chokshi, Prashanthi Krishnakumar, Bach Xuan Tran, Giang Thu Vu, Kamilla Anna Pinter, Shenglan Tang

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Background and Aims: Globally, many health systems focus on hospital-based healthcare models targeting acute care and disease treatment, which are not effective in addressing the challenges of ageing populations, chronic conditions, multi-morbidities, and increasingly unhealthy lifestyles. Recently, integrated care programs on chronic diseases have been developed, piloted, and implemented to meet such challenges. However, integrated care programs in the Asia-Pacific region vary in the levels of integration from linkage to coordination to full integration. This study aims to identify and analyze existing cases of integrated care in the Asia-Pacific region and identify the facilitators and barriers in order to improve existing cases and inform future cases. Methods: The study is a comparative study, with a combination approach of desk-based research and key informant interviews. The selected countries included in this study represent a good mix of lower-middle income countries (the Philippines, India, Vietnam, and Fiji), upper-middle income country (China), and high-income country (Singapore) in the Asia-Pacific region. Existing integrated care programs were identified through the scoping review approach. Trigger, history, general design, beneficiaries, and objectors were summarized with barriers and facilitators of integrated care based on key informant interviews. Representative case(s) in each country were selected and comprehensively analyzed through deep-dive case studies. Results: A total of 87 existing integrated care programs on chronic diseases were found in all countries, with 44 in China, 21 in Singapore, 12 in India, 5 in Vietnam, 4 in the Philippines, and 1 in Fiji. 9 representative cases of integrated care were selected for in-depth description and analysis, with 2 in China, the Philippines, and Vietnam, and 1 in Singapore, India, and Fiji. Population aging and the rising chronic disease burden have been identified as key drivers for almost all the six countries. Among the six countries, Singapore has the longest history of integrated care, followed by Fiji, the Philippines, and China, while India and Vietnam have a shorter history of integrated care. Incentives, technologies, education, and performance evaluation would be crucial for developing strategies for implementing future programs and improve already existing programs. Conclusion: Integrated care is important for addressing challenges surrounding the delivery of long-term care. To date, there is an increasing trend of integrated care programs on chronic diseases in the Asia-Pacific region, and all six countries in our study set integrated care as a direction for their health systems transformation.

Keywords: integrated healthcare, integrated care delivery, chronic diseases, Asia-Pacific region

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Authors: Shreya Saxena

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Background: Choledocholithiasis is a common complication of gallstone disease. Risk scoring systems exist to guide the need for further imaging or endoscopy in managing choledocholithiasis. We completed an audit to review the American Society for Gastrointestinal Endoscopy (ASGE) scoring system for prediction and management of choledocholithiasis against the current practice at a tertiary hospital to assess its utility in resource optimisation. We have now conducted a cost focused sub-analysis on patients categorized high-risk for choledocholithiasis according to the guidelines to determine any associated cost benefits. Method: Data collection from our prior audit was used to retrospectively identify thirteen patients considered high-risk for choledocholithiasis. Their ongoing management was mapped against the guidelines. Individual costs for the key investigations were obtained from our hospital financial data. Total cost for the different management pathways identified in clinical practice were calculated and compared against predicted costs associated with recommendations in the guidelines. We excluded the cost of laparoscopic cholecystectomy and considered a set figure for per day hospital admission related expenses. Results: Based on our previous audit data, we identified a77% positive predictive value for the ASGE risk stratification tool to determine patients at high-risk of choledocholithiasis. 47% (6/13) had an magnetic resonance cholangiopancreatography (MRCP) prior to endoscopic retrograde cholangiopancreatography (ERCP), whilst 53% (7/13) went straight for ERCP. The average length of stay in the hospital was 7 days, with an additional day and cost of £328.00 (£117 for ERCP) for patients awaiting an MRCP prior to ERCP. Per day hospital admission was valued at £838.69. When calculating total cost, we assumed all patients had admission bloods and ultrasound done as the gold standard. In doing an MRCP prior to ERCP, there was a 130% increase in cost incurred (£580.04 vs £252.04) per patient. When also considering hospital admission and the average length of stay, it was an additional £1166.69 per patient. We then calculated the exact costs incurred by the department, over a three-month period, for all patients, for key investigations or procedures done in the management of choledocholithiasis. This was compared to an estimate cost derived from the recommended pathways in the ASGE guidelines. Overall, 81% (£2048.45) saving was associated with following the guidelines compared to clinical practice. Conclusion: MRCP is the most expensive test associated with the diagnosis and management of choledocholithiasis. The ASGE guidelines recommend endoscopy without an MRCP in patients stratified as high-risk for choledocholithiasis. Our audit that focused on assessing the utility of the ASGE risk scoring system showed it to be relatively reliable for identifying high-risk patients. Our cost analysis has shown significant cost savings per patient and when considering the average length of stay associated with direct endoscopy rather than an additional MRCP. Part of this is also because of an increased average length of stay associated with waiting for an MRCP. The above data supports the ASGE guidelines for the management of high-risk for choledocholithiasis patients from a cost perspective. The only caveat is our small data set that may impact the validity of our average length of hospital stay figures and hence total cost calculations.

Keywords: cost-analysis, choledocholithiasis, risk stratification tool, general surgery

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Authors: Rajkumar Ghosh, Ananya Mukhopadhyay

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This scientific paper presents a thorough investigation into the integration of roof-mounted photovoltaic (PV) array systems and home rooftop rainwater collection systems in a remote community in Himachal Pradesh, India, with the goal of optimum utilization of natural resources for attaining sustainable living conditions by 2030. The study looks into the technical feasibility, environmental benefits, and socioeconomic impacts of this integrated method, emphasizing its ability to handle energy and water concerns in remote rural regions. This comprehensive method not only provides a sustainable source of electricity but also ensures a steady supply of clean water, promoting resilience and improving the quality of life for the village's residents. This research highlights the potential of such integrated systems in supporting sustainable conditions in rural areas through a combination of technical feasibility studies, economic analysis, and community interaction. There would be 20690 villages and 1.48 million homes (23.79% annual growth rate) in Himachal Pradesh if all residential buildings in the state had roof-mounted photovoltaic arrays to capture solar energy for power generation. The energy produced is utilized to power homes, lessening dependency on traditional fossil fuels. The same residential buildings housed domestic rooftop rainwater collection systems. Rainwater runoff from rooftops is collected and stored in tanks for use in a number of residential purposes, such as drinking, cooking, and irrigation. The gathered rainfall enhances the region's limited groundwater resources, easing the strain on local wells and aquifers. Although Himachal Pradesh of India is a Power state, the PV arrays have reduced the reliance of village on grid power and diesel generators by providing a steady source of electricity. Rooftop rainwater gathering has not only increased residential water supply but it has also lessened the burden on local groundwater resources. This helps to replenish groundwater and offers a more sustainable water supply for the town. The neighbourhood has saved money by utilizing renewable energy and rainwater gathering. Furthermore, lower fossil fuel consumption reduces greenhouse gas emissions, which helps to mitigate the effects of climate change. The integrated strategy of installing grid connected rooftop photovoltaic arrays and home rooftop rainwater collecting systems in Himachal Pradesh rural community demonstrates a feasible model for sustainable development. According to “Swaran Jayanti Energy Policy of Himachal Pradesh”, Himachal Pradesh is planned 10 GW from rooftop mode from Solar Power. Government of India provides 40% subsidy on solar panel of 1-3 kw and subsidy of Rs 6,000 per kw per year to encourage domestic consumers of Himachal Pradesh. This effort solves energy and water concerns, improves economic well-being, and helps to conserve the environment. Such integrated systems can serve as a model for sustainable development in rural areas not only in Himachal Pradesh, but also in other parts of the world where resource scarcity is a major concern. Long-term performance and scalability of such integrated systems should be the focus of future study. Efforts should also be made to duplicate this approach in other rural areas and examine its socioeconomic and environmental implications over time.

Keywords: renewable energy, photovoltaic arrays, rainwater harvesting, sustainability, rural development, Himachal Pradesh, India

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Authors: Digdem M. Siyez, Bariscan Ozturk, Erol Esen, Ender Siyez, Yelda Kagnici, Bahar Baran

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Infertility is a reproductive disease identified with the absence of pregnancy after regular unprotected sexual intercourse that has been lasting for 12 months or more. Some of the factors that cause infertility, which has been considered as a social and societal issue since the first days of the humankind, are preventable. These are veneral diseases, age, the frequency of the intercourse and its timing, drug use, bodyweight, environmental and professional conditions. Having actual information about the reproductive health is essential to take protective and preventive measures, and it is accepted as the most effective way to reduce the rate of infertility. However, during the literature review, it has been observed that there are so few studies that focus on the prevention of the infertility. The aim of this study is to develop a psycho-education program to reduce infertility among university students and also to evaluate the program’s effectiveness. It is believed that this program will increase the information level about infertility among the university students, help them to adopt healthy attitudes, develop life skills, create awareness about the risk factors and also contribute to the literature. Throughout the study, first, the contents of sexual/reproductive health programs developed for university students were examined by the researches. Besides, “Views about Reproductive Health Psycho-education Program Survey” was developed and applied to 10221 university students from 21 universities. In accordance with the literature and the university students’ views about reproductive health psycho-education program consisting of 9 sessions each of which lasts for 90 minutes was developed. The pilot program was carried out with 16 volunteer undergraduate students attending to a state university. During the evaluation of the pilot study, at the end of each session “Session Evaluation Form” and at the end of the entire program “Program Evaluation Form” were administered to the participants. Besides, one week after the end of the program, a focus group with half of the group, and individual interviews with the rest were conducted. Based on the evaluations, it was determined that the session duration is enough, the teaching methods meet the expectation, the techniques applied are appropriate and clear, and the materials are adequate. Also, an extra session was added to psycho-education program based on the feedbacks of the participants. In order to evaluate program’s effectiveness, Solomon control group design will be used. According to this design, the research has 2 experiment groups and 2 control groups. The participants who voluntarily participated in the research after the announcement of the psycho-education program were divided into experiment and control groups. In the experiment 1 and control 1 groups, “Personal Information Test”, “Infertility Information Test” and “Infertility Attitude Scale”, “Self Identification Inventory” and “Melbourne Decision Scale” were administered as a preliminary test. Currently, at the present stage, psycho-education still continues. After this 10-week program, the same tests will be administered again as the post-tests. The decision upon which statistical method will be applied in the analysis will be made afterwards according to whether the data meets the presuppositions or not.

Keywords: infertility, prevention, psycho-education, reproductive health

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Authors: Dominik Halstrup, Marlene Schriever

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The industry, as one of the main energy consumer, is of critical importance along the way of transforming the energy system to Renewable Energies. The distributed character of the Energy Transition demands for further flexibility being introduced to the grid. In order to shed further light on the acceptance of Electric Energy Storage (ESS) from an industrial point of view, this study therefore examines the German manufacturing industry. The analysis in this paper uses data composed of a survey amongst 101 manufacturing companies in Germany. Being part of a two-stage research design, both qualitative and quantitative data was collected. Based on a literature review an acceptance concept was developed in the paper and four user-types identified: (Dedicated) User, Impeded User, Forced User and (Dedicated) Non-User and incorporated in the questionnaire. Both descriptive and bivariate analysis is deployed to identify the level of acceptance in the different organizations. After a factor analysis has been conducted, variables were grouped to form independent acceptance factors. Out of the 22 organizations that do show a positive attitude towards ESS, 5 have already implemented ESS and show a positive attitude towards ESS. They can be therefore considered ‘Dedicated Users’. The remaining 17 organizations have a positive attitude but have not implemented ESS yet. The results suggest that profitability plays an important role as well as load-management systems that are already in place. Surprisingly, 2 organizations have implemented ESS even though they have a negative attitude towards it. This is an example for a ‘Forced User’ where reasons of overriding importance or supporters with overriding authority might have forced the company to implement ESS. By far the biggest subset of the sample shows (critical) distance and can therefore be considered ‘(Dedicated) Non-Users’. The results indicate that the majority of the respondents have not thought ESS in their own organization through yet. For the majority of the sample one can therefore not speak of critical distance but rather a distance due to insufficient information and the perceived unprofitability. This paper identifies the relative state of acceptance of ESS in the manufacturing industry as well as current reasons for hindrance and perspectives for future growth of ESS in an industrial setting from a policy level. The interest that is currently generated by the media could be channeled and taken into a more substantial and individual discussion about ESS in an industrial setting. If the current perception of profitability could be addressed and communicated accordingly, ESS and their use in for instance cooperative business models could become a topic for more organizations in Germany and other parts of the world. As price mechanisms tend to favor existing technologies, policy makers need to further access the use of ESS and acknowledge the positive effects when integrated in an energy system. The subfields of generation, transmission and distribution become increasingly intertwined. New technologies and business models, such as ESS or cooperative arrangements entering the market, increase the number of stakeholders. Organizations need to find their place within this array of stakeholders.

Keywords: acceptance, energy storage solutions, German energy transition, manufacturing industry

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Authors: Sean Yao Zu Kong, Khong Yik Chew

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Introduction: We described a case report of the successful use of advanced surgical techniques in a patient with recurrent breast cancer who underwent a wide resection including the hemi-sternum, clavicle, multiple ribs, and a lobe of the lung due to tumor involvement. This extensive resection exposed critical structures, requiring a creative approach to reconstruction. To address this complex chest wall reconstruction, a free fibula flap and a 4-zone rectus abdominis musculocutaneous flap were successfully utilized. The use of a free vascularized bone flap allowed for rapid osteointegration and resistance against osteoradionecrosis after adjuvant radiation, while a four-zone tram flap allowed for reconstruction of both the chest wall and breast mound. Although limited recipient vessels made free flaps challenging, the free fibula flap served as both a bony reconstruction and vascular conduit, supercharged with the distal peroneal artery and veins of the peroneal artery from the fibula graft. Our approach highlights the potential of advanced surgical techniques to improve outcomes in complex cases of chest wall reconstruction in patients with recurrent breast cancer, which is becoming increasingly relevant as breast cancer incidence rates increases. Case presentation: This report describes a successful reconstruction of a patient with recurrent breast cancer who required extensive resection, including the anterior chest wall, clavicle, and sternoclavicular joint. Challenges arose due to the loss of accessory muscles and the non-rigid rib cage, which could lead to compromised ventilation and instability. A free fibula osteocutaneous flap and a four-zone TRAM flap with vascular supercharging were utilized to achieve long-term stability and function. The patient has since fully recovered, and during the review, both flaps remained viable, and chest mound reconstruction was satisfactory. A planned nipple/areolar reconstruction was offered pending the patient’s decision after adjuvant radiotherapy. Conclusion: In conclusion, this case report highlights the successful use of innovative surgical techniques in addressing a complex case of recurrent breast cancer requiring extensive resection and radical reconstruction. Our approach, utilized a combination of a free fibula flap and a 4-zone rectus abdominis musculocutaneous flap, demonstrates the potential for advanced techniques in chest wall reconstruction to minimize complications and ensure long-term stability and function. As the incidence of breast cancer continues to rise, it is crucial that healthcare professionals explore and utilize innovative techniques to improve patient outcomes and quality of life.

Keywords: free fibula flap, rectus abdominis musculocutaneous flap, post-adjuvant radiotherapy, reconstructive surgery, malignancy

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Authors: Büşra Durmaz, Füsun Curaoğlu

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While technology-oriented developments in the modern world change our perceptions of time and speed, they also force our food consumption patterns, such as getting pleasure from what we eat and eating slowly. The habit of eating quickly and hastily causes not only the feeling of not understanding the taste of the food eaten but also the inability to postpone the feeling of satiety and, therefore, many health problems. In this context, especially in the last ten years, in the field of industrial design, food manufacturers for healthy living and consumption have been collaborating with industrial designers on food design. The consumers of the new century, who are in an uncontrolled time intensity, receive support from small snacks as a source of happiness and pleasure in the little time intervals they can spare. At this point, especially chocolate has been a source of happiness for its consumers as a source of both happiness and pleasure for hundreds of years. However, when the portions have eaten cannot be controlled, a pleasure food such as chocolate can cause both health problems and many emotional problems, especially the feeling of guilt. Fast food, which is called food that is prepared and consumed quickly, has been increasing rapidly around the world in recent years. This study covers the process and results of a chocolate design based on the user experience of a university-industry cooperation project carried out within the scope of Eskişehir Technical University graduation projects. The aim of the project is a creative product design that will enable the user to experience chocolate consumption with a healthy eating approach. For this, while concepts such as pleasure, satiety, and taste are discussed; A survey with 151 people and semi-structured face-to-face interviews with 7 people during the experience design process within the scope of the user-oriented design approach, mainly literature review, within the scope of main topics such as mouth anatomy, tongue structure, taste, the functions of the eating action in the brain, hormones and chocolate, video A case study based on the research paradigm of Qualitative Research was structured within the scope of different research processes such as analysis and project diaries. As a result of the research, it has been reached that the melting in the mouth is the preferred experience of the users in order to spread the experience of eating chocolate for a long time based on pleasure while eating chocolate with healthy portions. In this context, researches about the production of sketches, mock-ups and prototypes of the product are included in the study. As a result, a product packaging design has been made that supports the active role of the senses such as sight, smell and hearing, where consumption begins, in order to consume chocolate by melting and to actively secrete the most important stimulus salivary glands in order to provide a healthy and long-term pleasure-based consumption.

Keywords: chocolate, eating habit, pleasure, saturation, sense of taste

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Authors: Richard Harrison

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Developing competency in mathematics and related critical thinking skills is essential to the education of undergraduate students of Science, Technology, Engineering and Mathematics (STEM). Recently, the HE sector has been impacted by a seemingly widening disconnect between the mathematical competency of incoming first-year STEM students and their entrance qualification tariffs. Despite relatively high grades in A-Level Mathematics, students may initially lack fundamental skills in key areas such as algebraic manipulation and have limited capacity to apply problem solving strategies. Compounded by compensatory measures applied to entrance qualifications during the pandemic, there has been an associated decline in student performance on introductory university mathematics modules. In the UK, a number of online resources have been developed to help scaffold the transition to university mathematics. However, in general, these do not offer a structured learning journey focused on individual developmental needs, nor do they offer an experience coherent with the teaching and learning characteristics of the destination institution. In order to address some of these issues, a bespoke framework has been designed and implemented on our VLE in the Faculty of Engineering & Physical Sciences (FEPS) at the University of Surrey. Called the FEPS Maths Support Framework, it was conceived to scaffold the mathematical development of individuals prior to entering the university and during the early stages of their transition to undergraduate studies. More than 90% of our incoming STEM students voluntarily participate in the process. Students complete a set of initial diagnostic questions in the late summer. Based on their performance and feedback on these questions, they are subsequently guided to self-select specific mathematical topic areas for review using our proprietary resources. This further assists students in preparing for discipline related diagnostic tests. The framework helps to identify students who are mathematically weak and facilitates early intervention to support students according to their specific developmental needs. This paper presents a summary of results from a rich data set captured from the framework over a 3-year period. Quantitative data provides evidence that students have engaged and developed during the process. This is further supported by process evaluation feedback from the students. Ranked performance data associated with seven key mathematical topic areas and eight engineering and science discipline areas reveals interesting patterns which can be used to identify more generic relative capabilities of the discipline area cohorts. In turn, this facilitates evidence based management of the mathematical development of the new cohort, informing any associated adjustments to teaching and learning at a more holistic level. Evidence is presented establishing our framework as an effective early intervention strategy for addressing the sector-wide issue of supporting the mathematical development of STEM students transitioning to HE

Keywords: competency, development, intervention, scaffolding

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Authors: Frederick Huie, Lauren Fusfeld, William Burchenal, Scott Howell, Alyssa McVey, Thomas F. Goss

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Alzheimer’s Disease (AD) is a degenerative brain disease characterized by memory loss and cognitive decline that presents a substantial economic burden for patients and health insurers in the US. This study evaluates the payer budget impact of the DISCERN™ test in the diagnosis and management of patients with symptoms of dementia evaluated for AD. DISCERN™ comprises three assays that assess critical factors related to AD that regulate memory, formation of synaptic connections among neurons, and levels of amyloid plaques and neurofibrillary tangles in the brain and can provide a quicker, more accurate diagnosis than tests in the current diagnostic pathway (CDP). An Excel-based model with a three-year horizon was developed to assess the budget impact of DISCERN™ compared with CDP in a Medicare Advantage plan with 1M beneficiaries. Model parameters were identified through a literature review and were verified through consultation with clinicians experienced in diagnosis and management of AD. The model assesses direct medical costs/savings for patients based on the following categories: •Diagnosis: costs of diagnosis using DISCERN™ and CDP. •False Negative (FN) diagnosis: incremental cost of care avoidable with a correct AD diagnosis and appropriately directed medication. •True Positive (TP) diagnosis: AD medication costs; cost from a later TP diagnosis with the CDP versus DISCERN™ in the year of diagnosis, and savings from the delay in AD progression due to appropriate AD medication in patients who are correctly diagnosed after a FN diagnosis.•False Positive (FP) diagnosis: cost of AD medication for patients who do not have AD. A one-way sensitivity analysis was conducted to assess the effect of varying key clinical and cost parameters ±10%. An additional scenario analysis was developed to evaluate the impact of individual inputs. In the base scenario, DISCERN™ is estimated to decrease costs by $4.75M over three years, equating to approximately $63.11 saved per test per year for a cohort followed over three years. While the diagnosis cost is higher with DISCERN™ than with CDP modalities, this cost is offset by the higher overall costs associated with CDP due to the longer time needed to receive a TP diagnosis and the larger number of patients who receive a FN diagnosis and progress more rapidly than if they had received appropriate AD medication. The sensitivity analysis shows that the three parameters with the greatest impact on savings are: reduced sensitivity of DISCERN™, improved sensitivity of the CDP, and a reduction in the percentage of disease progression that is avoided with appropriate AD medication. A scenario analysis in which DISCERN™ reduces the utilization for patients of computed tomography from 21% in the base case to 16%, magnetic resonance imaging from 37% to 27% and cerebrospinal fluid biomarker testing, positive emission tomography, electroencephalograms, and polysomnography testing from 4%, 5%, 10%, and 8%, respectively, in the base case to 0%, results in an overall three-year net savings of $14.5M. DISCERN™ improves the rate of accurate, definitive diagnosis of AD earlier in the disease and may generate savings for Medicare Advantage plans.

Keywords: Alzheimer’s disease, budget, dementia, diagnosis.

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Authors: Neeraj Vij, Amber Brennan, Jenni Winters, Hadi Salehi, Hamy Temkit, Emily Andrisevic, Mohan V. Belthur

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Idiopathic clubfoot is a common lower extremity deformity with an incidence of 1:500. The Ponseti Method is well known as the gold standard of treatment. However, there is limited functional data demonstrating correction of the clubfoot after treatment with the Ponseti method. The purpose of this study was to study the clinical and functional outcomes after the Ponseti method with the Clubfoot Disease-Specific Instrument (CDS) and pedobarography. This IRB-approved prospective study included patients aged 3-18 who were treated for idiopathic clubfoot with the Ponseti method between January 2008 and December 2018. Age-matched controls were identified through siblings of clubfoot patients and other community members. Treatment details were collected through a chart review of the included patients. Laboratory assessment included a physical exam, gait analysis, and pedobarography. The Pediatric Outcomes Data Collection Instrument and the Clubfoot Disease-Specific Instrument were also obtained on clubfoot patients (CF). The Wilcoxson rank-sum test was used to study differences between the CF patients and the typically developing (TD) patients. Statistical significance was set at p < 0.05. There were a total of 37 enrolled patients in our study. 21 were priorly treated for CF and 16 were TD. 94% of the CF patients had bilateral involvement. The age at the start of treatment was 29 days, the average total number of casts was seven to eight, and the average total number of casts after Achilles tenotomy was one. The reoccurrence rate was 25%, tenotomy was required in 94% of patients, and ≥1 tenotomy was required in 25% of patients. There were no significant differences between step length, step width, stride length, force-time integral, maximum peak pressure, foot progression angles, stance phase time, single-limb support time, double limb support time, and gait cycle time between children treated with the Ponseti method and typically developing children. The average post-treatment Pirani and Dimeglio scores were 5.50±0.58 and 15.29±1.58, respectively. The average post-treatment PODCI subscores were: Upper Extremity: 90.28, Transfers: 94.6, Sports: 86.81, Pain: 86.20, Happiness: 89.52, Global: 88.6. The average post-treatment Clubfoot Disease-Specific Instrument scores subscores were: Satisfaction: 73.93, Function: 80.32, Overall: 78.41. The Ponseti Method has a very high success rate and remains to be the gold standard in the treatment of idiopathic clubfoot. Timely management leads to good outcomes and a low need for repeated Achilles tenotomy. Children treated with the Ponseti method demonstrate good functional outcomes as measured through pedobarography. Pedobarography may have clinical utility in studying congenital foot deformities. Objective measures for hours of brace wear could represent an improvement in clubfoot care.

Keywords: functional outcomes, pediatric deformity, patient-reported outcomes, talipes equinovarus

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Authors: Philipp Sommer, Amgad Agoub

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The construction sector significantly impacts global CO₂ emissions, particularly through the energy usage of residential buildings. To address this, various governments, including Germany's, are focusing on reducing emissions via sustainable refurbishment initiatives. This study examines the application of machine learning (ML) to estimate energy demands dynamically in residential buildings and enhance the potential for large-scale sustainable refurbishment. A major challenge in Germany is the lack of extensive publicly labeled datasets for energy performance, as energy performance certificates, which provide critical data on building-specific energy requirements and consumption, are not available for all buildings or require on-site inspections. Conversely, England and other countries in the European Union (EU) have rich public datasets, providing a viable alternative for analysis. This research adapts insights from these English datasets to the German context by developing a comprehensive data schema and calibration dataset capable of predicting building energy demand effectively. The study proposes a minimal feature set, determined through feature importance analysis, to optimize the ML model. Findings indicate that ML significantly improves the scalability and accuracy of energy demand forecasts, supporting more effective emissions reduction strategies in the construction industry. Integrating energy performance certificates into municipal heat planning in Germany highlights the transformative impact of data-driven approaches on environmental sustainability. The goal is to identify and utilize key features from open data sources that significantly influence energy demand, creating an efficient forecasting model. Using Extreme Gradient Boosting (XGB) and data from energy performance certificates, effective features such as building type, year of construction, living space, insulation level, and building materials were incorporated. These were supplemented by data derived from descriptions of roofs, walls, windows, and floors, integrated into three datasets. The emphasis was on features accessible via remote sensing, which, along with other correlated characteristics, greatly improved the model's accuracy. The model was further validated using SHapley Additive exPlanations (SHAP) values and aggregated feature importance, which quantified the effects of individual features on the predictions. The refined model using remote sensing data showed a coefficient of determination (R²) of 0.64 and a mean absolute error (MAE) of 4.12, indicating predictions based on efficiency class 1-100 (G-A) may deviate by 4.12 points. This R² increased to 0.84 with the inclusion of more samples, with wall type emerging as the most predictive feature. After optimizing and incorporating related features like estimated primary energy consumption, the R² score for the training and test set reached 0.94, demonstrating good generalization. The study concludes that ML models significantly improve prediction accuracy over traditional methods, illustrating the potential of ML in enhancing energy efficiency analysis and planning. This supports better decision-making for energy optimization and highlights the benefits of developing and refining data schemas using open data to bolster sustainability in the building sector. The study underscores the importance of supporting open data initiatives to collect similar features and support the creation of comparable models in Germany, enhancing the outlook for environmental sustainability.

Keywords: machine learning, remote sensing, residential building, energy performance certificates, data-driven, heat planning

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Authors: Kimberly Winnie Achieng Otieno

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The Nairobi Hospital plays a pivotal role in healthcare provision in East and Central Africa, yet it faces challenges in providing accessible dialysis care. This paper explores strategic interventions to enhance dialysis care, improve access and streamline health information management, with an aim of fostering an integrated and patient-centered healthcare system in our region. Challenges at The Nairobi Hospital The Nairobi Hospital currently grapples with insufficient dialysis machines which results in extended turn around times. This issue stems from both staffing bottle necks and infrastructural limitations given our growing demand for renal care services. Our Paper-based record keeping system and fragmented flow of information downstream hinders the hospital’s ability to manage health data effectively. There is also a need for investment in expanding The Nairobi Hospital dialysis facilities to far reaching communities. Setting up satellite clinics that are closer to people who live in areas far from the main hospital will ensure better access to underserved areas. Community Outreach and Education Implementing education programs on kidney health within local communities is vital for early detection and prevention. Collaborating with local leaders and organizations can establish a proactive approach to renal health hence reducing the demand for acute dialysis interventions. We can amplify this effort by expanding The Nairobi Hospital’s corporate social responsibility outreach program with weekend engagement activities such as walks, awareness classes and fund drives. Enhancing Efficiency in Dialysis Care Demand for dialysis services continues to rise due to an aging Kenyan population and the increasing prevalence of chronic kidney disease (CKD). Present at this years International Nursing Conference are a diverse group of caregivers from around the world who can share with us their process optimization strategies, patient engagement techniques and resource utilization efficiencies to catapult The Nairobi Hospital to the 21st century and beyond. Plans are underway to offer ongoing education opportunities to keep staff updated on best practices and emerging technologies in addition to utilizing a patient feedback mechanisms to identify areas for improvement and enhance satisfaction. Staff empowerment and suggestion boxes address The Nairobi Hospital’s organizational challenges. Current financial constraints may limit a leapfrog in technology integration such as the acquisition of new dialysis machines and an investment in predictive analytics to forecast patient needs and optimize resource allocation. Streamlining Health Information Management Fully embracing a shift to 100% Electronic Health Records (EHRs) is a transformative step toward efficient health information management. Shared information promotes a holistic understanding of patients’ medical history, minimizing redundancies and enhancing overall care quality. To manage the transition to community-based care and EHRs effectively, a phased implementation approach is recommended. Conclusion By strategically enhancing dialysis care access and streamlining health information management, The Nairobi Hospital can strengthen its position as a leading healthcare institution in both East and Central Africa. This comprehensive approach aligns with the hospital’s commitment to providing high-quality, accessible, and patient-centered care in an evolving landscape of healthcare delivery.

Keywords: Africa, urology, diaylsis, healthcare

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Authors: Rafael Sousa Santos, Clara Pimena Do Vale, Barbara Bogoni, Poul Henning Kirkegaard

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The representative component, a determining aspect of the architect's training, has been marked by an exponential and unprecedented development. However, the multiplication of possibilities has also multiplied uncertainties about architectural design teaching, and by extension, about the very principles of architectural education. In this paper, it is intended to present the results of a research developed on the following problem: the relation between the forms of representation and the architectural design teaching-learning processes. The research had as its object the educational model of two schools – the Politecnico di Milano (POLIMI) and the Faculty of Architecture of the University of Porto (FAUP) – and was led by three main objectives: to characterize the educational model followed in both schools focused on the representative component and its role; to interpret the relation between forms of representation and the architectural design teaching-learning processes; to consider their possibilities of valorisation. Methodologically, the research was conducted according to a qualitative embedded multiple-case study design. The object – i.e., the educational model – was approached in both POLIMI and FAUP cases considering its Context and three embedded unities of analysis: the educational Purposes, Principles, and Practices. In order to guide the procedures of data collection and analysis, a Matrix for the Characterization (MCC) was developed. As a methodological tool, the MCC allowed to relate the three embedded unities of analysis with the three main sources of evidence where the object manifests itself: the professors, expressing how the model is assumed; the architectural design classes, expressing how the model is achieved; and the students, expressing how the model is acquired. The main research methods used were the naturalistic and participatory observation, in-person-interview and documentary and bibliographic review. The results reveal the importance of the representative component in the educational model of both cases, despite the differences in its role. In POLIMI's model, representation is particularly relevant in the teaching of architectural design, while in FAUP’s model, it plays a transversal role – according to an idea of 'general training through hand drawing'. In fact, the difference between models relative to representation can be partially understood by the level of importance that each gives to hand drawing. Regarding the teaching of architectural design, the two cases are distinguished in the relation with the representative component: while in POLIMI the forms of representation serve essentially an instrumental purpose, in FAUP they tend to be considered also for their methodological dimension. It seems that the possibilities for valuing these models reside precisely in the relation between forms of representation and architectural design teaching. It is expected that the knowledge base developed in this research may have three main contributions: to contribute to the maintenance of the educational model of POLIMI and FAUP; through the precise description of the methodological procedures, to contribute by transferability to similar studies; through the critical and objective framework of the problem underlying the forms of representation and its relation with architectural design teaching, to contribute to the broader discussion concerning the contemporary challenges on architectural education.

Keywords: architectural design teaching, architectural education, educational models, forms of representation

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Authors: Takoua Soltani, Imen Soltani, Taoufik Aguili

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The communications' and radar systems' demands give rise to new developments in the domain of active integrated antennas (AIA) and arrays. The main advantages of AIA arrays are the simplicity of fabrication, low cost of manufacturing, and the combination between free space power and the scanner without a phase shifter. The integrated active antenna modeling is the coupling between the electromagnetic model and the transport model that will be affected in the high frequencies. Global modeling of active circuits is important for simulating EM coupling, interaction between active devices and the EM waves, and the effects of EM radiation on active and passive components. The current review focuses on the modeling of the active element which is a MESFET transistor immersed in a rectangular waveguide. The proposed EM analysis is based on the Method of Moments combined with the Generalised Equivalent Circuit method (MOM-GEC). The Method of Moments which is the most common and powerful software as numerical techniques have been used in resolving the electromagnetic problems. In the class of numerical techniques, MOM is the dominant technique in solving of Maxwell and Transport’s integral equations for an active integrated antenna. In this situation, the equivalent circuit is introduced to the development of an integral method formulation based on the transposition of field problems in a Generalised equivalent circuit that is simpler to treat. The method of Generalised Equivalent Circuit (MGEC) was suggested in order to represent integral equations circuits that describe the unknown electromagnetic boundary conditions. The equivalent circuit presents a true electric image of the studied structures for describing the discontinuity and its environment. The aim of our developed method is to investigate the antenna parameters such as the input impedance and the current density distribution and the electric field distribution. In this work, we propose a global EM modeling of the MESFET AsGa transistor using an integral method. We will begin by describing the modeling structure that allows defining an equivalent EM scheme translating the electromagnetic equations considered. Secondly, the projection of these equations on common-type test functions leads to a linear matrix equation where the unknown variable represents the amplitudes of the current density. Solving this equation resulted in providing the input impedance, the distribution of the current density and the electric field distribution. From electromagnetic calculations, we were able to present the convergence of input impedance for different test function number as a function of the guide mode numbers. This paper presents a pilot study to find the answer to map out the variation of the existing current evaluated by the MOM-GEC. The essential improvement of our method is reducing computing time and memory requirements in order to provide a sufficient global model of the MESFET transistor.

Keywords: active integrated antenna, current density, input impedance, MESFET transistor, MOM-GEC method

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Authors: Samuel Sii, David Homewood, Brendan Dittmer, Tony Nzembela, Jonathan O’Brien, Niall Corcoran, Dinesh Agarwal

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Introduction: Innovation is key to the advancement of medicine and improvement in patient care. This is particularly true in surgery, where pioneering techniques have transformed operative management from a historically highly risky peri-morbid and disfiguring to the contemporary low-risk, sterile and minimally invasive treatment modality. There is a delicate balance between enabling innovation and minimizing patient harm. Publication and discussion of novel surgical techniques allow for independent expert review. Recent journals have increasingly stringent requirements for publications and often require larger case volumes for novel techniques to be published. This potentially impairs the initial publication of novel techniques and slows innovation. The historical perspective provides a better understanding of how requirements for the publication of new techniques have evolved over time. This is essential in overcoming challenges in developing novel techniques. Aims and Objectives: We explore how novel techniques in Urology have been published over the past 200 years. Our objective is to describe the trend and publication requirements of novel urological techniques, both historical and present. Methods: We assessed all major urological operations using multipronged historical analysis. An initial literature search was carried out through PubMed and Google Scholar for original literature descriptions, followed by reference tracing. The first publication of each pioneering urological procedure was recorded. Data collected includes the year of publication, description of the procedure, number of cases and outcomes. Results: 65 papers describing pioneering techniques in Urology were identified. These comprised of 2 experimental studies, 17 case reports and 46 case series. These papers described various pioneering urological techniques in urological oncology, reconstructive urology and endourology. We found that, historically, techniques were published with smaller case numbers. Often, the surgical technique itself was a greater focus of the publication than patient outcome data. These techniques were often adopted prior to larger publications. In contrast, the risks and benefits of recent novel techniques are often well-defined prior to adoption. This historical perspective is important as recent journals have requirements for larger case series and data outcomes. This potentially impairs the initial publication of novel techniques and slows innovation. Conclusion: A better understanding of historical publications and their effect on the adoption of urological techniques into common practice could assist the current generation of Urologists in formulating a safe, efficacious process in promoting surgical innovation and the development of novel surgical techniques. We propose the reassessment of requirements for the publication of novel operative techniques by splitting technical perspectives and data-orientated case series. Existing frameworks such as IDEAL and ASERNIP-S should be integrated into current processes when investigating and developing new surgical techniques to ensure efficacious and safe innovation within surgery is encouraged.

Keywords: urology, surgical innovation, novel surgical techniques, publications

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Authors: Rahaf Mandura, Fatmah Abusharkh, Layan Kurdi, Rahaf Shigdar, Khadijah Alattas

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Introduction: Age-related macular degeneration (AMD) in older individuals are serious health issues that severely impact the quality of life of millions globally. In 2020, the fourth leading cause of blindness worldwide was AMD. The global prevalence of AMD is estimated to be around 8.7%. AMD is a progressive disease involving the macular region of the retina, and it has a complex pathophysiology. RPE cell dysfunction plays a crucial step in the pathway leading to irreversible degeneration of photoreceptors with yellowish lipid-rich, protein-containing drusen deposits accumulating between Bruch's membrane and the RPE. Furthermore, lipofuscinogenesis, drusogenesis, inflammation, and neovascularization are four main processes responsible for the formation of the two types of AMD: the wet (exudative, neovascular) and dry (non-exudative, geographic atrophy) types. We retrospectively evaluated the prevalence of AMD among patients visiting the retina clinic at King Abdulaziz University Hospital (Jeddah, Makkah Province, Saudi Arabia) to identify the commonly associated risk factors of AMD. Methods: The records of 3,067 individuals from 2017 to 2021 were reviewed. Of these, 1,935 satisfied the inclusion criteria and were included in this study. We excluded all patient below 18 years, and those who did not undergo fundus imaging or attend their booked appointments, follow-ups, treatments, and referrals were excluded. Results: The prevalence of AMD among the patients was 4%. The age of patients with AMD was significantly greater than those without AMD (72.4 ± 9.8 years vs. 57.2 ± 15.5 years; p < 0.001). Participants with a family history of AMD tended to have the disease more than those without such a history (85.7% vs. 45%; p = 0.043). Ex- and current smokers were more likely to have AMD than non-smokers (34% and 18.6% vs. 7.2%; p < 0.001). Patients with hypertension and those without type 1 diabetes were at a higher risk of developing AMD than those without hypertension (5.5% vs. 2.8%; p = 0.002) and those with type 1 diabetes (4.2% vs. 0.8%; p = 0.040). In contrast, sex, nationality, type 2 diabetes, and abnormal lipid profile were not significantly associated with AMD. Regarding the clinical characteristics of AMD cases, most cases (70.4%) were of the dry type and affected both eyes (77.2%). The disease duration was ≥5 years in 43.1% of the patients. The most frequent chronic diseases associated with AMD were type 2 diabetes (69.1%), hypertension (61.7%), and dyslipidemia (18.5%). Conclusion: In summary, our single tertiary center study showed that AMD is widely prevalent in Jeddah, Saudi Arabia (4%) and linked to a wide range of risk factors. Some of these are modifiable risk factors that can be adjusted to help reduce AMD occurrence. Furthermore, this study has shown the importance of screening and follow-up of family members of patients with AMD to promote early detection and intervention of AMD. We recommend conducting further research on AMD in Saudi Arabia. Concerning the study design, a community-based cross-sectional study would be more helpful for assessing the disease's prevalence. Finally, recruiting a larger sample size is required for more accurate estimation.

Keywords: age related macular degeneration, prevelence, risk factor, dry AMD

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Authors: Langhit Kurar, Loren Charles

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Introduction: In light of recent BOAST 12 (August 2016) published guidance on management of ankle fractures, the project aimed to highlight key discrepancies throughout the care trajectory from admission to point of discharge at a district general hospital. Wide breadth of data covering three key domains: accident and emergency, radiology, and orthopaedic surgery were subsequently stratified and recommendations on note documentation, and outpatient follow up were made. Methods: A retrospective twelve month audit was conducted reviewing results of ankle fracture management in 37 patients. Inclusion criterion involved all patients seen at Darent Valley Hospital (DVH) emergency department with radiographic evidence of an ankle fracture. Exclusion criterion involved all patients managed solely by nursing staff or having sustained purely ligamentous injury. Medical notes, including discharge summaries and the PACS online radiographic tool were used for data extraction. Results: Cross-examination of the A & E domain revealed limited awareness of the BOAST 12 recent publication including requirements to document skin integrity and neurovascular assessment. This had direct implications as this would have changed the surgical plan for acutely compromised patients. The majority of results obtained from the radiographic domain were satisfactory with appropriate X-rays taken in over 95% of cases. However, due to time pressures within A & E, patients were often left without a post manipulation XRAY in a backslab. Poorly reduced fractures were subsequently left for a long period resulting in swollen ankles and a time-dependent lag to surgical intervention. This had knocked on implications for prolonged inpatient stay resulting in hospital-acquired co-morbidity including pressure sores. Discussion: The audit has highlighted several areas of improvement throughout the disease trajectory from review in the emergency department to follow up as an outpatient. This has prompted the creation of an algorithm to ensure patients with significant fractures presenting to the emergency department are seen promptly and treatment expedited as per recent guidance. This includes timing for X-rays taken in A & E. Re-audit has shown significant improvement in both documentation at time of presentation and appropriate follow-up strategies. Within the orthopedic domain, we are in the process of creating an ankle fracture pathway to ensure imaging and weight bearing status are made clear to the consulting clinicians in an outpatient setting. Significance/Clinical Relevance: As a result of the ankle fracture algorithm we have adapted the BOAST 12 guidance to shape an intrinsic pathway to not only improve patient management within the emergency department but also create a standardised format for follow up.

Keywords: ankle, fracture, BOAST, radiology

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Authors: Lilia Edit Aparicio Pico, Paulo Cesar Coronado Sánchez, Roberto Ferro Escobar

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This paper presents the implementation of telemedicine services for physiotherapy, occupational therapy, and speech therapy rehabilitation, utilizing telebroadcasting of audiovisual content to enhance comprehensive patient recovery in rural areas of San Vicente del Caguán municipality, characterized by high levels of social conflict in Colombia. The region faces challenges such as dysfunctional problems, physical rehabilitation needs, and a high prevalence of hearing diseases, leading to neglect and substandard health services. Limited access to healthcare due to communication barriers and transportation difficulties exacerbates these issues. To address these challenges, a research initiative was undertaken to leverage information and communication technologies (ICTs) to improve healthcare quality and accessibility for this vulnerable population. The primary objective was to develop a tele-rehabilitation system to provide asynchronous online therapies and teleconsultation services for patient follow-up during the recovery process. The project comprises two components: Communication systems and human development. A technological component involving the establishment of a wireless network connecting rural centers and the development of a mobile application for video-based therapy delivery. Communications systems will be provided by a radio link that utilizes internet provided by the Colombian government, located in the municipality of San Vicente del Caguán to connect two rural centers (Pozos and Tres Esquinas) and a mobile application for managing videos for asynchronous broadcasting in sidewalks and patients' homes. This component constitutes an operational model integrating information and telecommunications technologies. The second component involves pedagogical and human development. The primary focus is on the patient, where performance indicators and the efficiency of therapy support were evaluated for the assessment and monitoring of telerehabilitation results in physical, occupational, and speech therapy. They wanted to implement a wireless network to ensure audiovisual content transmission for tele-rehabilitation, design audiovisual content for tele-rehabilitation based on services provided by the ESE Hospital San Rafael in physiotherapy, occupational therapy, and speech therapy, develop a software application for fixed and mobile devices enabling access to tele-rehabilitation audiovisual content for healthcare personnel and patients and finally to evaluate the technological solution's contribution to the ESE Hospital San Rafael community. The research comprised four phases: wireless network implementation, audiovisual content design, software application development, and evaluation of the technological solution's impact. Key findings include the successful implementation of virtual teletherapy, both synchronously and asynchronously, and the assessment of technological performance indicators, patient evolution, timeliness, acceptance, and service quality of tele-rehabilitation therapies. The study demonstrated improved service coverage, increased care supply, enhanced access to timely therapies for patients, and positive acceptance of teletherapy modalities. Additionally, the project generated new knowledge for potential replication in other regions and proposed strategies for short- and medium-term improvement of service quality and care indicators

Keywords: e-health, medical informatics, telemedicine, telerehabilitation, virtual therapy

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Authors: Peninah Agaba, Monica Magadi, Bev Orton

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Uganda is one of the countries with high maternal mortality (336/100,000) where adolescents account for 24 percent of the total maternal deaths. Research shows that use of maternal health services may prevent some of these deaths and good provider attitudes attract adolescents to use the services. However, poor health provider’s attitudes discourage adolescents from seeking the services during the maternity period. This study explores the experiences of unmarried female adolescents at the health facilities during the maternity period. The study population is unmarried adolescent girls aged 10-19 years who were pregnant or had given birth within three years before the interview. This is a special interest group that requires attention throughout this period. Most of the pregnancies among unmarried adolescents are unwanted; as a result, many of them have been abused and neglected by parents and close family members including partners who deny fatherhood of the pregnancy/child. These adolescents hope to find comfort from health providers like being listened to during counseling, not abused and judged; unfortunately this is not the case always. The research was approved by the University of Hull, School of Education and Social Sciences ethics review committee, Mildmay Uganda Research Ethics Committee and Uganda National Council of Science and Technology. The study was carried out in Bushenyi and Kibale districts in Western Uganda. Fourteen in-depth interviews and seven focus group discussions were completed in the local languages and later transcribed to English language. Thematic analysis to identify the themes was done. Adolescents were aged 16-19 years, two had become pregnant before 15 years. Most had not completed secondary education; none had tertiary education and three of the 14 IDI adolescent participants wanted to get pregnant. Analysis shows varied experiences; most adolescents were abused verbally and physically by the health providers due to their young age of pregnancy, lack of essential items during this period (maternity dresses, children clothes, delivery kit) and fear of labour pains. Another cause for abuse was these adolescents coming for antenatal care with no partners yet the implementation of a policy on increasing male involvement in reproductive health in Uganda requires them to attend antenatal care with their partners and most of these unmarried adolescents have no partners to accompany them. Despite the above challenges, the study also identified the care some of these unmarried adolescents received during the maternity visits for example they were not abused, were provided with appropriate information and supported with child care. The study identified abuse and support the unmarried adolescents received during the maternity period. Efforts to provide adolescents with adequate information including what to expect during labour by providers and provision of basic needs are essential. Health providers should have trainings on client care especially how to embrace unmarried adolescents when they come to access maternity services. More so, the policy on improving male involvement in RH issues need to be considerate of unmarried adolescents who in most cases do not have the partners to go with to access maternity care.

Keywords: abuse, maternity care, Uganda, unmarried, adolescents

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Authors: Rumbidzai Sipiwe Zimvumi

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The study aimed to identify the top management team attributes for ambidexterity in small and medium-sized enterprises by utilizing the upper echelons theory. The conventional opinion holds that an organization's ability to pursue both exploitative and explorative innovation methods at the same time is reflected in its ambidexterity. Top-level managers are critical to this matrix because they forecast and explain strategic choices that guarantee success by improving organizational performance. Since the focus of the study was on the unique characteristics of TMTs that can facilitate ambidexterity, the primary goal was to comprehend how TMTs in SMEs can better manage ambidexterity. The study used document analysis to collect information on ambidexterity and TMT traits. Finding, choosing, assessing, and synthesizing data from peer-reviewed publications allowed for the review and evaluation of papers. The fact that SMEs will perform better if they can achieve a balance between exploration and exploitation cannot be overstated. Unfortunately, exploitation is the main priority for most SMEs. The results showed that some of the noteworthy TMT traits that support ambidexterity in SMEs are age diversity, shared responsibility, leadership impact, psychological safety, and self-confidence. It has been shown that most SMEs confront significant obstacles in recruiting people, including formalizing their management and assembling executive teams with seniority. Small and medium-sized enterprises (SMEs) are often held by families or people who neglect to keep their personal lives apart from the firm, which eliminates the opportunity for management and staff to take the initiative. This helps to explain why exploitative strategies, which preserve present success, are used rather than explorative strategies, which open new economic opportunities and dimensions. It is evident that psychological safety deteriorates, and creativity is hindered in the process. The study makes the case that TMTs who are motivated to become ambidextrous can exist. According to the report, small- and medium-sized business owners should value the opinions of all parties involved and provide their managers and regular staff the freedom to think creatively and in a safe environment. TMTs who experience psychological safety are more likely to be inventive, creative, and productive. A team's collective perception that it is acceptable to take chances, voice opinions and concerns, ask questions, and own up to mistakes without fear of unfavorable outcomes is known as team psychological safety. Thus, traits like age diversity, leadership influence, learning agility, psychological safety, and self-assurance are critical to the success of SMEs. As a solution to ensuring ambidexterity is attained, the study suggests a clear separation of ownership and control, the adoption of technology to stimulate creativity, team spirit and excitement, shared accountability, and good management of diversity. Among the suggestions for the SME's success are resource allocation and important collaborations.

Keywords: navigating, ambidexterity, top management team, small and medium enterprises

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Authors: Celine Shi Ying Lee, Jong Jian Lee

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Background: Infectious keratitis is one of the leading causes of blindness worldwide. Prompt treatment with effective medication will control the infection early, preventing corneal scarring and visual loss. fluoroquinolones ophthalmic medication is used because of its broad-spectrum properties, potency, good intraocular penetration, and low toxicity. The study aims to evaluate the treatment outcome of corneal ulcers using Levofloxacin 1.5% ophthalmic solution (LVFX) with adjuvant oral ciprofloxacin when indicated and apply this treatment strategy in primary health care as first-line treatment. Methods: Patients with infective corneal ulcer treated in an eye center were recruited. Inclusion criteria includes Corneal infection consistent with bacterial keratitis, single or multiple small corneal ulcers. Treatment regime: LVFX hourly for the first 2 days, 2 hourly from the 3rd day, and 3 hourly on the 5th day of review. Adjuvant oral ciprofloxacin 500mg BD was administered for 5 days if there were multiple corneal ulcers or when the location of the cornea ulcer was central or paracentral. Results: 47 subjects were recruited. There were 16 (34%) males and 31 (66%) females. 40 subjects (85%) were contact lens (CL) related to corneal ulcer, and 7 subjects (15%) were non-contact lens related. 42 subjects (89%) presented with one ulcer, of which 20 of them (48%) needed adjuvant therapy. 5 subjects presented with 2 or 3 ulcers, of which 3 needed adjuvant therapy. A total of 23 subjects (49%) was given adjuvant therapy (oral ciprofloxacin 500mg BD for 5 days).21 of them (91%) were CL related. All subjects recovered fully, and the average duration of treatment was 3.7 days, with 49% of the subjects resolved on the 3rd day, 38% on the 5thday of and 13% on the 7thday. All subjects showed symptoms of relief of pain, light-sensitivity, and redness on the 3rd day with full visual recovery post-treatment. No adverse drug reactions were recorded. Conclusion: Our treatment regime demonstrated good clinical outcome as first-line treatment for corneal ulcers. A corneal ulcer is a common eye condition in Singapore, mainly due to CL wear. Pseudomonas aeruginosa is the most frequent and potentially sight-threatening pathogen involved in CL related corneal ulcer. Coagulase-negative Staphylococci, Staphylococcus aureus, and Streptococcus Pneumoniae were seen in non-CL users. All these bacteria exhibit good sensitivity rates to ciprofloxacin and levofloxacin. It is therefore logical in our study to use LVFX Eyedrops and adjuvant ciprofloxacin oral antibiotics when indicated as first line treatment for most corneal ulcers. Our study of patients, both CL related and non-CL related, have shown good clinical response and full recovery using the above treatment strategy. There was also a full restoration of visual acuity in all the patients. Eye-trained primary Healthcare practitioners can consider adopting this treatment strategy as first line treatment in patients with corneal ulcers. This is relevant during the COVID pandemic, where hospitals are overwhelmed with patients and in regions with limited access to specialist eye care. This strategy would enable early treatment with better clinical outcome.

Keywords: corneal ulcer, levofloxacin hydrate, treatment strategy, ciprofloxacin

Procedia PDF Downloads 154

Authors: Rajender Dahiya

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Investigation outcomes of major process incidents have been consistent for decades and validate that the causes and consequences are often identical. The debate remains as we continue to experience similar process incidents even with enormous development of new tools, technologies, industry standards, codes, regulations, and learning processes? The objective of this paper is to investigate the most common causes of major industrial incidents and reveal industry challenges and best practices to prevent such incidents. The author, in his current role, performs audits and inspections of a variety of high-hazard industries in North America, including petroleum refineries, chemicals, petrochemicals, manufacturing, etc. In this paper, he shares real life scenarios, examples, and case studies from high hazards operating facilities including key challenges and best practices. This case study will provide a clear understanding of the importance of near miss incident investigation. The incident was a Safe operating limit excursion. The case describes the deficiencies in management programs, the competency of employees, and the culture of the corporation that includes hazard identification and risk assessment, maintaining the integrity of safety-critical equipment, operating discipline, learning from process safety near misses, process safety competency, process safety culture, audits, and performance measurement. Failure to identify the hazards and manage the risks of highly hazardous materials and processes is one of the primary root-causes of an incident, and failure to learn from past incidents is the leading cause of the recurrence of incidents. Several investigations of major incidents discovered that each showed several warning signs before occurring, and most importantly, all were preventable. The author will discuss why preventable incidents were not prevented and review the mutual causes of learning failures from past major incidents. The leading causes of past incidents are summarized below. Management failure to identify the hazard and/or mitigate the risk of hazardous processes or materials. This process starts early in the project stage and continues throughout the life cycle of the facility. For example, a poorly done hazard study such as HAZID, PHA, or LOPA is one of the leading causes of the failure. If this step is performed correctly, then the next potential cause is. Management failure to maintain the integrity of safety critical systems and equipment. In most of the incidents, mechanical integrity of the critical equipment was not maintained, safety barriers were either bypassed, disabled, or not maintained. The third major cause is Management failure to learn and/or apply learning from the past incidents. There were several precursors before those incidents. These precursors were either ignored altogether or not taken seriously. This paper will conclude by sharing how a well-implemented operating management system, good process safety culture, and competent leaders and staff contributed to managing the risks to prevent major incidents.

Keywords: incident investigation, risk management, loss prevention, process safety, accident prevention

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Authors: Anna Demian, Levi Howard, L. Ng, Leslie Simon, Mark Dragon, A. Desai, Timothy Devlantes, W. David Freeman

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Introduction: Out-of-hospital cardiac arrest (OHCA) can carry a high mortality. For survivors, the most common complication is hypoxic-ischemic brain injury (HIBI). Rarely, lumbosacral spinal cord and/or other spinal cord artery ischemia can occur due to anatomic variation and variable mean arterial pressure after the return of spontaneous circulation. We present a case of an OHCA survivor who later woke up with bilateral leg weakness with preserved sensation (ASIA grade B, L2 level). Methods: We describe a clinical, radiographic, and laboratory presentation, as well as a National Library of Medicine (NLM) search engine methodology, characterizing incidence/prevalence of this entity is discussed. A 70-year-old male, a longtime smoker, and alcohol user, suddenly collapsed at a bar surrounded by friends. He had complained of chest pain before collapsing. 911 was called. EMS arrived, and the patient was in pulseless electrical activity (PEA), cardiopulmonary resuscitation (CPR) was initiated, and the patient was intubated, and a LUCAS device was applied for continuous, high-quality CPR in the field by EMS. In the ED, central lines were placed, and thrombolysis was administered for a suspected Pulmonary Embolism (PE). It was a prolonged code that lasted 90 minutes. The code continued with the eventual return of spontaneous circulation. The patient was placed on an epinephrine and norepinephrine drip to maintain blood pressure. ECHO was performed and showed a “D-shaped” ventricle worrisome for PE as well as an ejection fraction around 30%. A CT with PE protocol was performed and confirmed bilateral PE. Results: The patient woke up 24 hours later, following commands, and was extubated. He was found paraplegic below L2 with preserved sensation, with hypotonia and areflexia consistent with “spinal shock” or anterior spinal cord syndrome. MRI thoracic and lumbar spine showed a conus medullaris level spinal cord infarction. The patient was given IV steroids upon initial discovery of cord infarct. NLM search using “cardiac arrest” and “spinal cord infarction” revealed 57 results, with only 8 review articles. Risk factors include age, atherosclerotic disease, and intraaortic balloon pump placement. AoA (Artery of Adamkiewicz) anatomic variation along with existing atherosclerotic factors and low perfusion were also known risk factors. Conclusion: Acute paraplegia from anterior spinal cord infarction of the AoA territory after cardiac arrest is rare. Larger prospective, multicenter trials are needed to examine potential interventions of hypothermia, lumbar drains, which are sometimes used in aortic surgery to reduce ischemia and/or other neuroprotectants.

Keywords: cardiac arrest, spinal cord infarction, artery of Adamkiewicz, paraplegia

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Authors: Sadi Ali, Yaser Kishawi

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As part of Palestine, Gaza Strip (365 km2 and 1.8 million habitants) is considered a semi-arid zone relies solely on the Coastal Aquifer. The coastal aquifer is only source of water with only 5-10% suitable for human use. This barely cover the domestic and agricultural needs of Gaza Strip. Palestinian Water Authority Strategy is to find non-conventional water resource from treated wastewater to irrigate 1500 hectares and serves over 100,000 inhabitants. A new WWTP project is to replace the old-overloaded Biet Lahia WWTP. The project consists of three parts; phase A (pressure line & 9 infiltration basins - IBs), phase B (a new WWTP) and phase C (Recovery and Reuse Scheme – RRS – to capture the spreading plume). Currently, phase A is functioning since Apr 2009. Since Apr 2009, a monitoring plan is conducted to monitor the infiltration rate (I.R.) of the 9 basins. Nearly 23 million m3 of partially treated wastewater were infiltrated up to Jun 2014. It is important to maintain an acceptable rate to allow the basins to handle the coming quantities (currently 10,000 m3 are pumped an infiltrated daily). The methodology applied was to review and analysis the collected data including the I.R.s, the WW quality and the drying-wetting schedule of the basins. One of the main findings is the relation between the Total Suspended Solids (TSS) at BLWWTP and the I.R. at the basins. Since April 2009, the basins scored an average I.R. of about 2.5 m/day. Since then the records showed a decreasing pattern of the average rate until it reached the lower value of 0.42 m/day in Jun 2013. This was accompanied with an increase of TSS (mg/L) concentration at the source reaching above 200 mg/L. The reducing of TSS concentration directly improved the I.R. (by cleaning the WW source ponds at Biet Lahia WWTP site). This was reflected in an improvement in I.R. in last 6 months from 0.42 m/day to 0.66 m/day then to nearly 1.0 m/day as the average of the last 3 months of 2013. The wetting-drying scheme of the basins was observed (3 days wetting and 7 days drying) besides the rainfall rates. Despite the difficulty to apply this scheme accurately a control of flow to each basin was applied to improve the I.R. The drying-wetting system affected the I.R. of individual basins, thus affected the overall system rate which was recorded and assessed. Also the ploughing activities at the infiltration basins as well were recommended at certain times to retain a certain infiltration level. This breaks the confined clogging layer which prevents the infiltration. It is recommended to maintain proper quality of WW infiltrated to ensure an acceptable performance of IBs. The continual maintenance of settling ponds at BLWWTP, continual ploughing of basins and applying soil treatment techniques at the IBs will improve the I.R.s. When the new WWTP functions a high standard effluent quality (TSS 20mg, BOD 20 mg/l and TN 15 mg/l) will be infiltrated, thus will enhance I.R.s of IBs due to lower organic load.

Keywords: SAT, wastewater quality, soil remediation, North Gaza

Procedia PDF Downloads 221