Search results for: primary care givers
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 7764

Search results for: primary care givers

1194 The Acquisition of /r/ By Setswana-Learning Children

Authors: Keneilwe Matlhaku

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Crosslinguistic studies (theoretical and clinical) have shown delays and significant misarticulation in the acquisition of the rhotics. This article provides a detailed analysis of the early development of the rhotic phoneme, an apical trill /r/, by monolingual Setswana (Tswana S30) children of age ranges between 1 and 4 years. The data display the following trends: (1) late acquisition of /r/; (2) a wide range of substitution patterns involving this phoneme (i.e., gliding, coronal stopping, affrication, deletion, lateralization, as well as, substitution to a dental and uvular fricative). The primary focus of the article is on the potential origins of these variations of /r/, even within the same language. Our data comprises naturalistic longitudinal audio recordings of 6 children (2 males and 4 females) whose speech was recorded in their homes over a period of 4 months with no or only minimal disruptions in their daily environments. Phon software (Rose et al. 2013; Rose & MacWhinney 2014) was used to carry out the orthographic and phonetic transcriptions of the children’s data. Phon also enabled the generation of the children’s phonological inventories for comparison with adult target IPA forms. We explain the children’s patterns through current models of phonological emergence (MacWhinney 2015) as well as McAllister Byun, Inkelas & Rose (2016); Rose et al., (2022), which highlight the perceptual and articulatory factors influencing the development of sounds and sound classes. We highlight how the substitution patterns observed in the data can be captured through a consideration of the auditory properties of the target speech sounds, combined with an understanding of the types of articulatory gestures involved in the production of these sounds. These considerations, in turn, highlight some of the most central aspects of the challenges faced by the child toward learning these auditory-articulatory mappings. We provide a cross-linguistic survey of the acquisition of rhotic consonants in a sample of related and unrelated languages in which we show that the variability and volatility in the substitution patterns of /r/ is also brought about by the properties of the children’s ambient languages. Beyond theoretical issues, this article sets an initial foundation for developing speech-language pathology materials and services for Setswana learning children, an emerging area of public service in Botswana.

Keywords: rhotic, apical trill, Phon, phonological emergence, auditory, articulatory, mapping

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1193 Land Degradation Vulnerability Modeling: A Study on Selected Micro Watersheds of West Khasi Hills Meghalaya, India

Authors: Amritee Bora, B. S. Mipun

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Land degradation is often used to describe the land environmental phenomena that reduce land’s original productivity both qualitatively and quantitatively. The study of land degradation vulnerability primarily deals with “Environmentally Sensitive Areas” (ESA) and the amount of topsoil loss due to erosion. In many studies, it is observed that the assessment of the existing status of land degradation is used to represent the vulnerability. Moreover, it is also noticed that in most studies, the primary emphasis of land degradation vulnerability is to assess its sensitivity to soil erosion only. However, the concept of land degradation vulnerability can have different objectives depending upon the perspective of the study. It shows the extent to which changes in land use land cover can imprint their effect on the land. In other words, it represents the susceptibility of a piece of land to degrade its productive quality permanently or in the long run. It is also important to mention that the vulnerability of land degradation is not a single factor outcome. It is a probability assessment to evaluate the status of land degradation and needs to consider both biophysical and human induce parameters. To avoid the complexity of the previous models in this regard, the present study has emphasized on to generate a simplified model to assess the land degradation vulnerability in terms of its current human population pressure, land use practices, and existing biophysical conditions. It is a “Mixed-Method” termed as the land degradation vulnerability index (LDVi). It was originally inspired by the MEDALUS model (Mediterranean Desertification and Land Use), 1999, and Farazadeh’s 2007 revised version of it. It has followed the guidelines of Space Application Center, Ahmedabad / Indian Space Research Organization for land degradation vulnerability. The model integrates the climatic index (Ci), vegetation index (Vi), erosion index (Ei), land utilization index (Li), population pressure index (Pi), and cover management index (CMi) by giving equal weightage to each parameter. The final result shows that the very high vulnerable zone primarily indicates three (3) prominent circumstances; land under continuous population pressure, high concentration of human settlement, and high amount of topsoil loss due to surface runoff within the study sites. As all the parameters of the model are amalgamated with equal weightage further with the help of regression analysis, the LDVi model also provides a strong grasp of each parameter and how far they are competent to trigger the land degradation process.

Keywords: population pressure, land utilization, soil erosion, land degradation vulnerability

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1192 Reading Strategies of Generation X and Y: A Survey on Learners' Skills and Preferences

Authors: Kateriina Rannula, Elle Sõrmus, Siret Piirsalu

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Mixed generation classroom is a phenomenon that current higher education establishments are faced with daily trying to meet the needs of modern labor market with its emphasis on lifelong learning and retraining. Representatives of mainly X and Y generations in one classroom acquiring higher education is a challenge to lecturers considering all the characteristics that differ one generation from another. The importance of outlining different strategies and considering the needs of the students lies in the necessity for everyone to acquire the maximum of the provided knowledge as well as to understand each other to study together in one classroom and successfully cooperate in future workplaces. In addition to different generations, there are also learners with different native languages which have an impact on reading and understanding texts in third languages, including possible translation. Current research aims to investigate, describe and compare reading strategies among the representatives of generation X and Y. Hypotheses were formulated - representatives of generation X and Y use different reading strategies which is also different among first and third year students of the before mentioned generations. Current study is an empirical, qualitative study. To achieve the aim of the research, relevant literature was analyzed and a semi-structured questionnaire conducted among the first and third year students of Tallinn Health Care College. Questionnaire consisted of 25 statements on the text reading strategies, 3 multiple choice questions on preferences considering the design and medium of the text, and three open questions on the translation process when working with a text in student’s third language. The results of the questionnaire were categorized, analyzed and compared. Both, generation X and Y described their reading strategies to be 'scanning' and 'surfing'. Compared to generation X, first year generation Y learners valued interactivity and nonlinear texts. Students frequently used strategies of skimming, scanning, translating and highlighting together with relevant-thinking and assistance-seeking. Meanwhile, the third-year generation Y students no longer frequently used translating, resourcing and highlighting while Generation X learners still incorporated these strategies. Knowing about different needs of the generations currently inside the classrooms and on the labor market enables us with tools to provide sustainable education and grants the society a work force that is more flexible and able to move between professions. Future research should be conducted in order to investigate the amount of learning and strategy- adoption between generations. As for reading, main suggestions arising from the research are as follows: make a variety of materials available to students; allow them to select what they want to read and try to make those materials visually attractive, relevant, and appropriately challenging for learners considering the differences of generations.

Keywords: generation X, generation Y, learning strategies, reading strategies

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1191 Reducing Unnecessary CT Aorta Scans in the Emergency Department

Authors: Ibrahim Abouelkhir

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Background: Prior to this project, the number of CT aorta requests from our Emergency Department (ED) was reported by the radiology department to be high with a low positive event rate: only 1- 2% of CT aortas performed were positive for acute aortic syndrome. This trend raised concerns about the time required to process and report these scans, potentially impacting the timely reporting of other high-priority imaging, such as trauma-related scans. Other harms identified were unnecessary radiation, patients spending longer in ED contributing to overcrowding, and, most importantly, the patient not getting the right care the first time. The radiology department also raised the problem of reporting bias because they expected our CT aortas to be normal. Aim: The main aim of this project was to reduce the number of unnecessary CT aortas requested, which would be shown by 1. Number of CT aortas requested and 2. Positive event rate. Methodology: This was a quality improvement project carried out in the ED at Frimley Park Hospital, UK. Starting from 1 st January 2024, we recorded the number of days required to reach 35 CT aorta requests. We looked at all patients presenting to the ED over the age of 16 for whom a CT aorta was requested by the ED team. We looked at how many of these scans were positive for acute aortic syndrome. The intervention was a change in practice: all CT aortas should be approved by an ED consultant or ST4+ registrar (5th April 2024). We then reviewed the number of days it took to reach a total of 35 CT aorta requests following the intervention and again reviewed how many were positive. Results: Prior to the intervention, 35 CT Aorta scans were performed over a 20-day period. Following the implementation of the ED senior doctor vetting process, the same number of CT Aorta scan requests was observed over 50 days - more than twice the pre-intervention period. This indicates a significant reduction in the rate of CT Aorta scans being requested. During the pre-intervention phase, there were two positive cases of acute aortic syndrome. In the post-intervention period, there were zero. Conclusion: The mandatory review of CT Aorta scan requested by the ED consultant effectively reduced the number of scans requested. However, this intervention did not lead to an increase in positive scan results. We noted that post-intervention, approximately 50% of scans had been approved by registrar-grade doctors and, only 50% had been approved by ED consultants, and the majority were not in-person reviews. We wonder if restricting the approval to consultant grade only might improve the results, and furthermore, in person reviews should be the gold standard.

Keywords: quality improvement project, CT aorta scans, emergency department, radiology department, aortic dissection, scan request vetting, clinical outcomes, imaging efficiency

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1190 Efficacy of Ergonomics Ankle Support on Squatting Pushing Skills during the Second Stage of Labor

Authors: Yu-Ching Lin, Meei-Ling Gau, Ghi-Hwei Kao, Hung-Chang Lee

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Objective: To compare the pushing experiences and birth outcomes of three different pushing positions during the second stage of labor. The three positions were: semi-recumbent, squatting, and squatting with the aid of ergonomically designed ankle supports. Methods: A randomized controlled trial was conducted at a regional teaching hospital in northern Taiwan. Data were collected from 168 primiparous women in their 38th to 42nd gestational week. None of the participants received epidural analgesia during labor and all were free of pregnancy and labor-related complications. Intervention: During labor, after full cervical dilation and when the fetal head had descended to at least the +1 station and had turned to the occiput anterior position, the experimental group was asked to push in the squatting position while wearing the ergonomically designed ankle supports; comparison group A was asked to push in the squatting position without the use of these supports; and comparison group B was asked to push in a standard semi-recumbent position. Measures: The participants completed a demographic and obstetrics datasheet, the Short Form McGill Pain Questionnaire (MPQ-SF), and the Labor Pushing Experience scale within 4-hours postpartum. Conclusion: In terms of delivery time, the duration between the start of pushing to crowning for the experimental group (squatting with ankle supports) averaged 25.52 minutes less (F =6.02, p< .05) than the time for comparison group B (semi-recumbent). Furthermore, the duration between the start of pushing to infant birth averaged 25.21 minutes less for the experimental group than for comparison group B (F =6.14, p< .05). Moreover, the experimental group had a lower average VAS pain score (5.05±3.22) than comparison group B and the average McGill pain score for the experimental group was lower than both comparison groups (F=18.12, p< .001). In summary, the participants in the group that delivered from a squatting position with ankle supports had better labor pushing experiences than their peers in the comparison groups. Results: In comparison to both unsupported squatting and semi-recumbent pushing, squatting with the aid of ergonomically designed ankle supports reduced pushing times, ameliorated labor pain, and improved the pushing experience. Clinical application and suggestion: The squatting with ankle-support intervention introduced in the present study may significantly reduce tiredness and difficulties in maintaining balance as well as increase pushing efficiency. Thus, this intervention may reduce the caring needs of women during the second stage of labor. This intervention may be introduced in midwifery education programs and in clinical practice as a method to improve the care of women during the second stage of labor.

Keywords: second stage of labor, pushing, squatting with ankle supports, squatting

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1189 The Foucaultian Relationship between Power and Knowledge: Genealogy as a Method for Epistemic Resistance

Authors: Jana Soler Libran

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The primary aim of this paper is to analyze the relationship between power and knowledge suggested in Michel Foucault's theory. Taking into consideration the role of power in knowledge production, the goal is to evaluate to what extent genealogy can be presented as a practical method for epistemic resistance. To do so, the methodology used consists of a revision of Foucault’s literature concerning the topic discussed. In this sense, conceptual analysis is applied in order to understand the effect of the double dimension of power on knowledge production. In its negative dimension, power is conceived as an organ of repression, vetoing certain instances of knowledge considered deceitful. In opposition, in its positive dimension, power works as an organ of the production of truth by means of institutionalized discourses. This double declination of power leads to the first main findings of the present analysis: no truth or knowledge can lie outside power’s action, and power is constituted through accepted forms of knowledge. To second these statements, Foucaultian discourse formations are evaluated, presenting external exclusion procedures as paradigmatic practices to demonstrate how power creates and shapes the validity of certain epistemes. Thus, taking into consideration power’s mechanisms to produce and reproduce institutionalized truths, this paper accounts for the Foucaultian praxis of genealogy as a method to reveal power’s intention, instruments, and effects in the production of knowledge. In this sense, it is suggested to consider genealogy as a practice which, firstly, reveals what instances of knowledge are subjugated to power and, secondly, promotes aforementioned peripherical discourses as a form of epistemic resistance. In order to counterbalance these main theses, objections to Foucault’s work from Nancy Fraser, Linda Nicholson, Charles Taylor, Richard Rorty, Alvin Goldman, or Karen Barad are discussed. In essence, the understanding of the Foucaultian relationship between power and knowledge is essential to analyze how contemporary discourses are produced by both traditional institutions and new forms of institutionalized power, such as mass media or social networks. Therefore, Michel Foucault's practice of genealogy is relevant, not only for its philosophical contribution as a method to uncover the effects of power in knowledge production but also because it constitutes a valuable theoretical framework for political theory and sociological studies concerning the formation of societies and individuals in the contemporary world.

Keywords: epistemic resistance, Foucault’s genealogy, knowledge, power, truth

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1188 Screening for Non-hallucinogenic Neuroplastogens as Drug Candidates for the Treatment of Anxiety, Depression, and Posttraumatic Stress Disorder

Authors: Jillian M. Hagel, Joseph E. Tucker, Peter J. Facchini

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With the aim of establishing a holistic approach for the treatment of central nervous system (CNS) disorders, we are pursuing a drug development program rapidly progressing through discovery and characterization phases. The drug candidates identified in this program are referred to as neuroplastogens owing to their ability to mediate neuroplasticity, which can be beneficial to patients suffering from anxiety, depression, or posttraumatic stress disorder. These and other related neuropsychiatric conditions are associated with the onset of neuronal atrophy, which is defined as a reduction in the number and/or productivity of neurons. The stimulation of neuroplasticity results in an increase in the connectivity between neurons and promotes the restoration of healthy brain function. We have synthesized a substantial catalogue of proprietary indolethylamine derivatives based on the general structures of serotonin (5-hydroxytryptamine) and psychedelic molecules such as N,N-dimethyltryptamine (DMT) and psilocin (4-hydroxy-DMT) that function as neuroplastogens. A primary objective in our screening protocol is the identification of derivatives associated with a significant reduction in hallucination, which will allow administration of the drug at a dose that induces neuroplasticity and triggers other efficacious outcomes in the treatment of targeted CNS disorders but which does not cause a psychedelic response in the patient. Both neuroplasticity and hallucination are associated with engagement of the 5HT2A receptor, requiring drug candidates differentially coupled to these two outcomes at a molecular level. We use novel and proprietary artificial intelligence algorithms to predict the mode of binding to the 5HT2A receptor, which has been shown to correlate with the hallucinogenic response. Hallucination is tested using the mouse head-twitch response model, whereas mouse marble-burying and sucrose preference assays are used to evaluate anxiolytic and anti-depressive potential. Neuroplasticity is assays using dendritic outgrowth assays and cell-based ELISA analysis. Pharmacokinetics and additional receptor-binding analyses also contribute the selection of lead candidates. A summary of the program is presented.

Keywords: neuroplastogen, non-hallucinogenic, drug development, anxiety, depression, PTSD, indolethylamine derivatives, psychedelic-inspired, 5-HT2A receptor, computational chemistry, head-twitch response behavioural model, neurite outgrowth assay

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1187 The Risk of Occupational Health in the Shipbuilding Industry in Bangladesh

Authors: Md. Rashel Sheikh

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The shipbuilding industry in Bangladesh had become a fast-growing industry in recent years when it began to export newly built ships. The various activities of shipbuilding industries in their limited, confined spaces added occupational worker exposures to chemicals, dusts, and metal fumes. The aim of this literature search is to identify the potential sources of occupational health hazards in shipyards and to promote the regulation of appropriate personal protective equipment (PPE) for the workers. In shipyards, occupational workers are involved in various activities, such as the manufacture, repair, maintenance, dismantling of boats and ships, building small ocean-going vessels and ferries. The occupational workers in the shipbuilding industry suffer from a number of hazardous issues, such as asthma, dermatitis, hearing deficits, and musculoskeletal disorders. The use of modern technologies, such as underwater plasma welding, electron beam welding, and friction stir welding and laser cutting and welding, and appropriate PPE (i.e., long-sleeved shirt and long pants, shoes plus socks, safety masks, chemical resistant gloves, eyewear, face shield, and respirators) can help reduce the occupational exposure to environmental hazards created by different activities in the shipyards. However, most shipyards in Bangladesh use traditional methods, e.g., flame cutting and arc, that add hazardous waste and pollutants to the environment in and around the shipyard. The safety and security of occupational workers in the shipyard workplace are very important. It is the primary responsibility of employers to ensure the safety and security of occupational workers in the shipyards. Employers must use advanced technologies and supply adequate and appropriate PPE for the workers. There are a number of accidents and illnesses that happen daily in the shipyard industries in Bangladesh due to the negligence and lack of adequate technologies and appropriate PPE. In addition, there are no specific regulations and implementations available to use the PPE. It is essential to have PPE regulations and strict enforcement for the adoption of PPE in the shipbuilding industries in Bangladesh. Along with the adoption of PPE with regular health examinations, health education to the workers regarding occupational hazards and lifestyle diseases are also important and require reinforcement. Monitoring health and safety hazards in shipyards are essential to enhance worker protection, and ensure worker safety, and mitigate workplace injuries and illnesses.

Keywords: shipbuilding Industries, health education, occupational health hazards, personal protective equipment, shipyard workers, occupational workers, shipyards

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1186 Scalable UI Test Automation for Large-scale Web Applications

Authors: Kuniaki Kudo, Raviraj Solanki, Kaushal Patel, Yash Virani

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This research mainly concerns optimizing UI test automation for large-scale web applications. The test target application is the HHAexchange homecare management WEB application that seamlessly connects providers, state Medicaid programs, managed care organizations (MCOs), and caregivers through one platform with large-scale functionalities. This study focuses on user interface automation testing for the WEB application. The quality assurance team must execute many manual users interface test cases in the development process to confirm no regression bugs. The team automated 346 test cases; the UI automation test execution time was over 17 hours. The business requirement was reducing the execution time to release high-quality products quickly, and the quality assurance automation team modernized the test automation framework to optimize the execution time. The base of the WEB UI automation test environment is Selenium, and the test code is written in Python. Adopting a compilation language to write test code leads to an inefficient flow when introducing scalability into a traditional test automation environment. In order to efficiently introduce scalability into Test Automation, a scripting language was adopted. The scalability implementation is mainly implemented with AWS's serverless technology, an elastic container service. The definition of scalability here is the ability to automatically set up computers to test automation and increase or decrease the number of computers running those tests. This means the scalable mechanism can help test cases run parallelly. Then test execution time is dramatically decreased. Also, introducing scalable test automation is for more than just reducing test execution time. There is a possibility that some challenging bugs are detected by introducing scalable test automation, such as race conditions, Etc. since test cases can be executed at same timing. If API and Unit tests are implemented, the test strategies can be adopted more efficiently for this scalability testing. However, in WEB applications, as a practical matter, API and Unit testing cannot cover 100% functional testing since they do not reach front-end codes. This study applied a scalable UI automation testing strategy to the large-scale homecare management system. It confirmed the optimization of the test case execution time and the detection of a challenging bug. This study first describes the detailed architecture of the scalable test automation environment, then describes the actual performance reduction time and an example of challenging issue detection.

Keywords: aws, elastic container service, scalability, serverless, ui automation test

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1185 Variability in Contraception Choices and Abortion Rates among Female Garment Factory Workers in Urban and Rural Cambodia

Authors: Olalekan Olaluwoye, Joanne Williams, Elizabeth Hoban

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Background: Modern contraceptives are effective in preventing unwanted pregnancies and therefore the potential to reduce abortion rates. There is a need for information about how rates of contraceptive use and abortion vary across Cambodia and the relationship between the prevalence of modern contraception use and abortion rates. This study compares the use of contraception and abortion among female garment factory workers in rural and urban areas of Cambodia. Method: Cross-sectional surveys were conducted with 1701 women working in eleven garment factories in rural and urban areas of Cambodia. Sexual and reproductive health data were collected using Audio-Assisted Survey Interviews and analysed using STATA 14 software. Findings: Over 70% of the respondents were less than 30 years of age across both rural and urban settings and over 50% have only primary education, thus the study population was largely young women with limited education. A significantly higher proportion of the rural women earned over $200 in the previous month compared with their urban counterparts. The majority of the urban women (51.5%) were married, while single women (46.9%) made up the largest group working in the rural factories. A significantly larger proportion of women in the rural areas (83.9%) were sexually active compared to the urban women (50.9%). More women from the rural areas (41.4%) had been pregnant at some time compared with the urban population (37.7%). The use of any contraceptive method among sexually active women was significantly higher in the rural areas (80.1%) compared to the urban areas (65.7%) with p-value=0.000. However, among those women who used contraception, the prevalence of modern contraception use was slightly higher in the urban population (68.8% urban, 63.4% rural, p-value=0.1). For women who had a history of pregnancy the abortion prevalence was higher among rural women (43.8%) compared to their urban counterparts (37.7%). Regression analysis showed that after adjustment for the demographic variables (age, relationship status, income, education) only age and relationship status had a significant influence on the use of modern contraception.Single females who were sexually active and older women, who had potentially completed their families, were more likely to choose modern contraception. Conclusion: Although overall the use of contraception was higher among rural women, the use of modern contraception was higher among urban women.This finding may partly explain the higher rates of abortion among women in the rural areas as traditional contraception methods have higher failure rates and are more likely to result in an unplanned pregnancy.Despite the regional variation, the high rates of abortion across the country suggest there is a need for improve education on family planning among female garment factory workers in Cambodia.

Keywords: abortion, Cambodia, contraception, garment factory

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1184 Beyond the Flipped Classroom: A Tool to Promote Autonomy, Cooperation, Differentiation and the Pleasure of Learning

Authors: Gabriel Michel

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The aim of our research is to find solutions for adapting university teaching to today's students and companies. To achieve this, we have tried to change the posture and behavior of those involved in the learning situation by promoting other skills. There is a gap between the expectations and functioning of students and university teaching. At the same time, the business world needs employees who are obviously competent and proficient in technology, but who are also imaginative, flexible, able to communicate, learn on their own and work in groups. These skills are rarely developed as a goal at university. The flipped classroom has been one solution. Thanks to digital tools such as Moodle, for example, but the model behind them is still centered on teachers and classic learning scenarios: it makes course materials available without really involving them and encouraging them to cooperate. It's against this backdrop that we've conducted action research to explore the possibility of changing the way we learn (rather than teach) by changing the posture of both the classic student and the teacher. We hypothesized that a tool we developed would encourage autonomy, the possibility of progressing at one's own pace, collaboration and learning using all available resources(other students, course materials, those on the web and the teacher/facilitator). Experimentation with this tool was carried out with around thirty German and French first-year students at the Université de Lorraine in Metz (France). The projected changesin the groups' learning situations were as follows: - use the flipped classroom approach but with a few traditional presentations by the teacher (materials having been put on a server) and lots of collective case solving, - engage students in their learning by inviting them to set themselves a primary objective from the outset, e.g. “Assimilating 90% of the course”, and secondary objectives (like a to-do list) such as “create a new case study for Tuesday”, - encourage students to take control of their learning (knowing at all times where they stand and how far they still have to go), - develop cooperation: the tool should encourage group work, the search for common solutions and the exchange of the best solutions with other groups. Those who have advanced much faster than the others, or who already have expertise in a subject, can become tutors for the others. A student can also present a case study he or she has developed, for example, or share materials found on the web or produced by the group, as well as evaluating the productions of others, - etc… A questionnaire and analysis of assessment results showed that the test group made considerable progress compared with a similar control group. These results confirmed our hypotheses. Obviously, this tool is only effective if the organization of teaching is adapted and if teachers are willing to change the way they work.

Keywords: pedagogy, cooperation, university, learning environment

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1183 Renewable Energy Storage Capacity Rating: A Forecast of Selected Load and Resource Scenario in Nigeria

Authors: Yakubu Adamu, Baba Alfa, Salahudeen Adamu Gene

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As the drive towards clean, renewable and sustainable energy generation is gradually been reshaped by renewable penetration over time, energy storage has thus, become an optimal solution for utilities looking to reduce transmission and capacity cost, therefore the need for capacity resources to be adjusted accordingly such that renewable energy storage may have the opportunity to substitute for retiring conventional energy systems with higher capacity factors. Considering the Nigeria scenario, where Over 80% of the current Nigerian primary energy consumption is met by petroleum, electricity demand is set to more than double by mid-century, relative to 2025 levels. With renewable energy penetration rapidly increasing, in particular biomass, hydro power, solar and wind energy, it is expected to account for the largest share of power output in the coming decades. Despite this rapid growth, the imbalance between load and resources has created a hindrance to the development of energy storage capacity, load and resources, hence forecasting energy storage capacity will therefore play an important role in maintaining the balance between load and resources including supply and demand. Therefore, the degree to which this might occur, its timing and more importantly its sustainability, is the subject matter of the current research. Here, we forecast the future energy storage capacity rating and thus, evaluate the load and resource scenario in Nigeria. In doing so, We used the scenario-based International Energy Agency models, the projected energy demand and supply structure of the country through 2030 are presented and analysed. Overall, this shows that in high renewable (solar) penetration scenarios in Nigeria, energy storage with 4-6h duration can obtain over 86% capacity rating with storage comprising about 24% of peak load capacity. Therefore, the general takeaway from the current study is that most power systems currently used has the potential to support fairly large penetrations of 4-6 hour storage as capacity resources prior to a substantial reduction in capacity ratings. The data presented in this paper is a crucial eye-opener for relevant government agencies towards developing these energy resources in tackling the present energy crisis in Nigeria. However, if the transformation of the Nigeria. power system continues primarily through expansion of renewable generation, then longer duration energy storage will be needed to qualify as capacity resources. Hence, the analytical task from the current survey will help to determine whether and when long-duration storage becomes an integral component of the capacity mix that is expected in Nigeria by 2030.

Keywords: capacity, energy, power system, storage

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1182 Sensitivity Analysis of the Heat Exchanger Design in Net Power Oxy-Combustion Cycle for Carbon Capture

Authors: Hirbod Varasteh, Hamidreza Gohari Darabkhani

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The global warming and its impact on climate change is one of main challenges for current century. Global warming is mainly due to the emission of greenhouse gases (GHG) and carbon dioxide (CO2) is known to be the major contributor to the GHG emission profile. Whilst the energy sector is the primary source for CO2 emission, Carbon Capture and Storage (CCS) are believed to be the solution for controlling this emission. Oxyfuel combustion (Oxy-combustion) is one of the major technologies for capturing CO2 from power plants. For gas turbines, several Oxy-combustion power cycles (Oxyturbine cycles) have been investigated by means of thermodynamic analysis. NetPower cycle is one of the leading oxyturbine power cycles with almost full carbon capture capability from a natural gas fired power plant. In this manuscript, sensitivity analysis of the heat exchanger design in NetPower cycle is completed by means of process modelling. The heat capacity variation and supercritical CO2 with gaseous admixtures are considered for multi-zone analysis with Aspen Plus software. It is found that the heat exchanger design has a major role to increase the efficiency of NetPower cycle. The pinch-point analysis is done to extract the composite and grand composite curve for the heat exchanger. In this paper, relationship between the cycle efficiency and the minimum approach temperature (∆Tmin) of the heat exchanger has also been evaluated.  Increase in ∆Tmin causes a decrease in the temperature of the recycle flue gases (RFG) and an overall decrease in the required power for the recycled gas compressor. The main challenge in the design of heat exchangers in power plants is a tradeoff between the capital and operational costs. To achieve lower ∆Tmin, larger size of heat exchanger is required. This means a higher capital cost but leading to a better heat recovery and lower operational cost. To achieve this, ∆Tmin is selected from the minimum point in the diagrams of capital and operational costs. This study provides an insight into the NetPower Oxy-combustion cycle’s performance analysis and operational condition based on its heat exchanger design.

Keywords: carbon capture and storage, oxy-combustion, netpower cycle, oxy turbine cycles, zero emission, heat exchanger design, supercritical carbon dioxide, oxy-fuel power plant, pinch point analysis

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1181 Groundwater Influences Wellbeing of Farmers from Semi-Arid Areas of India: Assessment of Subjective Wellbeing

Authors: Seemabahen Dave, Maria Varua, Basant Maheshwari, Roger Packham

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The declining groundwater levels and quality are acknowledged to be affecting the well-being of farmers especially those located in the semi-arid regions where groundwater is the only source of water for domestic and agricultural use. Further, previous studies have identified the need to examine the quality of life of farmers beyond economic parameters and for a shift in setting rural development policy goals to the perspective of beneficiaries. To address these gaps, this paper attempts to ascertain the subjective wellbeing of farmers from two semi-arid regions of India. The study employs the integrated conceptual framework for the assessment of individual and regional subjective wellbeing developed by Larson in 2009 at Australia. The method integrates three domains i.e. society, natural environment and economic services consisting of 37 wellbeing factors. The original set of 27 revised wellbeing factors identified by John Ward is further revised in current study to make it more region specific. Generally, researchers in past studies select factors of wellbeing based on literature and assign the weights arbitrary. In contrast, the present methodology employs a unique approach by asking respondents to identify the factors most important to their wellbeing and assign weights of importance based on their responses. This method minimises the selection bias and assesses the wellbeing from farmers’ perspectives. The primary objectives of this study are to identify key wellbeing attributes and to assess the influence of groundwater on subjective wellbeing of farmers. Findings from 507 farmers from 11 villages of two watershed areas of Rajasthan and Gujarat, India chosen randomly and were surveyed using a structured face-to-face questionnaire are presented in this paper. The results indicate that significant differences exist in the ranking of wellbeing factors at individual, village and regional levels. The top five most important factors in the study areas include electricity, irrigation infrastructure, housing, land ownership, and income. However, respondents are also most dissatisfied with these factors and correspondingly perceive a high influence of groundwater on them. The results thus indicate that intervention related to improvement of groundwater availability and quality will greatly improve the satisfaction level of well-being factors identified by the farmers.

Keywords: groundwater, farmers, semi-arid regions, subjective wellbeing

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1180 Ochratoxin-A in Traditional Meat Products from Croatian Households

Authors: Jelka Pleadin, Nina Kudumija, Ana Vulic, Manuela Zadravec, Tina Lesic, Mario Skrivanko, Irena Perkovic, Nada Vahcic

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Products of animal origin, such as meat and meat products, can contribute to human mycotoxins’ intake coming as a result of either indirect transfer from farm animals exposed to naturally contaminated grains and feed (carry-over effects) or direct contamination with moulds or naturally contaminated spice mixtures used in meat production. Ochratoxin A (OTA) is mycotoxin considered to be of the outermost importance from the public health standpoint in connection with meat products. The aim of this study was to investigate the occurrence of OTA in different traditional meat products circulating on Croatian markets during 2018, produced by a large number of households situated in eastern and north Croatian regions using a variety of technologies. Concentrations of OTA were determined in traditional meat products (n = 70), including dry fermented sausages (Slavonian kulen, Slavonian sausage, Istrian sausage and domestic sausage; n = 28), dry-cured meat products (pancetta, pork rack and ham; n = 22) and cooked sausages (liver sausages, black pudding sausages and pate; n = 20). OTA was analyzed by use of quantitative screening immunoassay method (ELISA) and confirmed for positive samples (higher than the limit of detection) by liquid chromatography tandem mass spectrometry (LC-MS/MS) method. Whereas the bacon samples contaminated with OTA were not found, its level in dry fermented sausages ranged from 0.22 to 2.17 µg/kg and in dry-cured meat products from 0.47 to 5.35 µg/kg, with in total 9% of positive samples. Besides possible primary contamination of these products arising due to improper manufacturing or/and storage conditions, observed OTA contamination could also be the consequence of secondary contamination that comes as a result of contaminated feed the animals were fed on. OTA levels obtained in cooked sausages ranged from 0.32 to 4.12 µg/kg (5% of positives) and could probably be linked to the contaminated raw materials (liver, kidney and spices) used in the sausages production. The results showed an occasional OTA contamination of traditional meat products, pointing that to avoid such contamination on households these products should be produced and processed under standardized and well-controlled conditions. Further investigations should be performed in order to identify mycotoxin-producing moulds on the surface of the products and to define preventative measures that can reduce the contamination of traditional meat products during their production on households and period of storage.

Keywords: Croatian households, ochratoxin-A, traditional cooked sausages, traditional dry-cured meat products

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1179 Heat Transfer and Trajectory Models for a Cloud of Spray over a Marine Vessel

Authors: S. R. Dehghani, G. F. Naterer, Y. S. Muzychka

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Wave-impact sea spray creates many droplets which form a spray cloud traveling over marine objects same as marine vessels and offshore structures. In cold climates such as Arctic reigns, sea spray icing, which is ice accretion on cold substrates, is strongly dependent on the wave-impact sea spray. The rate of cooling of droplets affects the process of icing that can yield to dry or wet ice accretion. Trajectories of droplets determine the potential places for ice accretion. Combining two models of trajectories and heat transfer for droplets can predict the risk of ice accretion reasonably. The majority of the cooling of droplets is because of droplet evaporations. In this study, a combined model using trajectory and heat transfer evaluate the situation of a cloud of spray from the generation to impingement. The model uses some known geometry and initial information from the previous case studies. The 3D model is solved numerically using a standard numerical scheme. Droplets are generated in various size ranges from 7 mm to 0.07 mm which is a suggested range for sea spray icing. The initial temperature of droplets is considered to be the sea water temperature. Wind velocities are assumed same as that of the field observations. Evaluations are conducted using some important heading angles and wind velocities. The characteristic of size-velocity dependence is used to establish a relation between initial sizes and velocities of droplets. Time intervals are chosen properly to maintain a stable and fast numerical solution. A statistical process is conducted to evaluate the probability of expected occurrences. The medium size droplets can reach the highest heights. Very small and very large droplets are limited to lower heights. Results show that higher initial velocities create the most expanded cloud of spray. Wind velocities affect the extent of the spray cloud. The rate of droplet cooling at the start of spray formation is higher than the rest of the process. This is because of higher relative velocities and also higher temperature differences. The amount of water delivery and overall temperature for some sample surfaces over a marine vessel are calculated. Comparing results and some field observations show that the model works accurately. This model is suggested as a primary model for ice accretion on marine vessels.

Keywords: evaporation, sea spray, marine icing, numerical solution, trajectory

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1178 Prioritizing Ecosystem Services for South-Central Regions of Chile: An Expert-Based Spatial Multi-Criteria Approach

Authors: Yenisleidy Martinez Martinez, Yannay Casas-Ledon, Jo Dewulf

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The ecosystem services (ES) concept has contributed to draw attention to the benefits ecosystems generate for people and how necessary natural resources are for human well-being. The identification and prioritization of the ES constitute the first steps to undertake conservation and valuation initiatives on behalf of people. Additionally, mapping the supply of ES is a powerful tool to support decision making regarding the sustainable management of landscape and natural resources. In this context, the present study aimed to identify, prioritize and map the primary ES in Biobio and Nuble regions using a methodology that combines expert judgment, multi-attribute evaluation methods, and Geographic Information Systems (GIS). Firstly, scores about the capacity of different land use/cover types to supply ES and the importance attributed to each service were obtained from experts and stakeholders via an online survey. Afterward, the ES assessment matrix was constructed, and the weighted linear combination (WLC) method was applied to mapping the overall capacity of supply of provisioning, regulating and maintenance, and cultural services. Finally, prioritized ES for the study area were selected and mapped. The results suggest that native forests, wetlands, and water bodies have the highest supply capacities of ES, while urban and industrial areas and bare areas have a very low supply of services. On the other hand, fourteen out of twenty-nine services were selected by experts and stakeholders as the most relevant for the regions. The spatial distribution of ES has shown that the Andean Range and part of the Coastal Range have the highest ES supply capacity, mostly regulation and maintenance and cultural ES. This performance is related to the presence of native forests, water bodies, and wetlands in those zones. This study provides specific information about the most relevant ES in Biobio and Nuble according to the opinion of local stakeholders and the spatial identification of areas with a high capacity to provide services. These findings could be helpful as a reference by planners and policymakers to develop landscape management strategies oriented to preserve the supply of services in both regions.

Keywords: ecosystem services, expert judgment, mapping, multi-criteria decision making, prioritization

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1177 NHS Tayside Plastic Surgery Induction Cheat Sheet and Video

Authors: Paul Holmes, Mike N. G.

Abstract:

Foundation-year doctors face increased stress, pressure and uncertainty when starting new rotations throughout their first years of work. This research questionnaire resulted in an induction cheat sheet and induction video that enhanced the Junior doctor's understanding of how to work effectively within the plastic surgery department at NHS Tayside. The objectives and goals were to improve the transition between cohorts of junior doctors in ward 26 at Ninewells Hospital. Before this quality improvement project, the induction pack was 74 pages long and over eight years old. With the support of consultant Mike Ng a new up-to-date induction was created. This involved a questionnaire and cheat sheet being developed. The questionnaire covered clerking, venipuncture, ward pharmacy, theatres, admissions, specialties on the ward, the cardiac arrest trolley, clinical emergencies, discharges and escalation. This audit has three completed cycles between August 2022 and August 2023. The cheat sheet developed a concise two-page A4 document designed for doctors to be able to reference easily and understand the essentials. The document format is a table containing ward layout; specialty; location; physician associate, shift patterns; ward rounds; handover location and time; hours coverage; senior escalation; nights; daytime duties, meetings/MDTs/board meetings, important bleeps and codes; department guidelines; boarders; referrals and patient stream; pharmacy; absences; rota coordinator; annual leave; top tips. The induction video is a 10-minute in-depth explanation of all aspects of the ward. The video explores in more depth the contents of the cheat sheet. This alternative visual format familiarizes the junior doctor with all aspects of the ward. These were provided to all foundation year 1 and 2 doctors on ward 26 at Ninewells Hospital at NHS Tayside Scotland. This work has since been adopted by the General Surgery Department, which extends to six further wards and has improved the effective handing over of the junior doctor’s role between cohorts. There is potential to further expand the cheat sheet to other departments as the concise document takes around 30 minutes to complete by a doctor who is currently on that ward. The time spent filling out the form provides vital information to the incoming junior doctors, which has a significant possibility to improve patient care.

Keywords: induction, junior doctor, handover, plastic surgery

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1176 Nutrition Transition in Bangladesh: Multisectoral Responsiveness of Health Systems and Innovative Measures to Mobilize Resources Are Required for Preventing This Epidemic in Making

Authors: Shusmita Khan, Shams El Arifeen, Kanta Jamil

Abstract:

Background: Nutrition transition in Bangladesh has progressed across various relevant socio-demographic contextual issues. For a developing country like Bangladesh, its is believed that, overnutrition is less prevalent than undernutrition. However, recent evidence suggests that a rapid shift is taking place where overweight is subduing underweight. With this rapid increase, for Bangladesh, it will be challenging to achieve the global agenda on halting overweight and obesity. Methods: A secondary analysis was performed from six successive national demographic and health surveys to get the trend on undernutrition and overnutrition for women from reproductive age. In addition, national relevant policy papers were reviewed to determine the countries readiness for whole of the systems approach to tackle this epidemic. Results: Over the last decade, the proportion of women with low body mass index (BMI<18.5), an indicator of undernutrition, has decreased markedly from 34% to 19%. However, the proportion of overweight women (BMI ≥25) increased alarmingly from 9% to 24% over the same period. If the WHO cutoff for public health action (BMI ≥23) is used, the proportion of overweight women has increased from 17% in 2004 to 39% in 2014. The increasing rate of obesity among women is a major challenge to obstetric practice for both women and fetuses. In the long term, overweight women are also at risk of future obesity, diabetes, hyperlipidemia, hypertension, and heart disease. These diseases have serious impact on health care systems. Costs associated with overweight and obesity involves direct and indirect costs. Direct costs include preventive, diagnostic, and treatment services related to obesity. Indirect costs relate to morbidity and mortality costs including productivity. Looking at the Bangladesh Health Facility Survey, it is found that the country is bot prepared for providing nutrition-related health services, regarding prevention, screening, management and treatment. Therefore, if this nutrition transition is not addressed properly, Bangladesh will not be able to achieve the target of the NCD global monitoring framework of the WHO. Conclusion: Addressing this nutrition transition requires contending ‘malnutrition in all its forms’ and addressing it with integrated approaches. Whole of the systems action is required at all levels—starting from improving multi-sectoral coordination to scaling up nutrition-specific and nutrition-sensitive mainstreamed interventions keeping health system in mind.

Keywords: nutrition transition, Bangladesh, health system, undernutrition, overnutrition, obesity

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1175 Unveiling Adorno’s Concern for Revolutionary Praxis and Its Enduring Significance: A Philosophical Analysis of His Writings on Sociology and Philosophy

Authors: Marie-Josee Lavallee

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Adorno’s reputation as an abstract and pessimistic thinker who indulged in a critic of capitalist society and culture without bothering himself with opening prospects for change, and who has no interest in political activism, recently begun to be questioned. This paper, which has a twofold objective, will push revisionist readings a step further by putting forward the thesis that revolutionary praxis has been an enduring concern for Adorno, surfacing throughout his entire work. On the other hand, it will hold that his understanding of the relationships between theory and praxis, which will be explained by referring to Ernst Bloch’s distinction between the warm and cold currents of Marxism, can help to interpret the paralysis of revolutionary practice in our own time under a new light. Philosophy and its tasks have been an enduring topic of Adorno’s work from the 1930s to Negativ Dialektik. The writings in which he develops these ideas stand among his most obscure and abstract so that their strong ties to the political have remained mainly overlooked. Adorno’s undertaking of criticizing and ‘redeeming’ philosophy and metaphysics is inseparable from a care for retrieving the capacity to act in the world and to change it. Philosophical problems are immanent to sociological problems, and vice versa, he underlines in his Metaphysik. Begriff and Problem. The issue of truth cannot be severed from the contingent context of a given idea. As a critical undertaking extracting its contents from reality, which is what philosophy should be from Adorno's perspective, the latter has the potential to fully reveal the reification of the individual and consciousness resulting from capitalist economic and cultural domination, thus opening the way to resistance and revolutionary change. While this project, according to his usual method, is sketched mainly in negative terms, it also exhibits positive contours which depict a socialist society. Only in the latter could human suffering end, and mutilated individuals experiment with reconciliation in an authentic way. That Adorno’s continuous plea for philosophy’s self-critic and renewal hides an enduring concern for revolutionary praxis emerges clearly from a careful philosophical analysis of his writings on philosophy and a selection of his sociological work, coupled with references to his correspondences. This study points to the necessity of a serious re-evaluation of Adorno’s relationship to the political, which will impact on the interpretation of his whole oeuvre, is much needed. In the second place, Adorno's dialectical conception of theory and praxis is enlightening for our own time, since it suggests that we are experiencing a phase of creative latency rather an insurmountable impasse.

Keywords: Frankfurt school, philosophy and revolution, revolutionary praxis, Theodor W. Adorno

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1174 Promoting 'One Health' Surveillance and Response Approach Implementation Capabilities against Emerging Threats and Epidemics Crisis Impact in African Countries

Authors: Ernest Tambo, Ghislaine Madjou, Jeanne Y. Ngogang, Shenglan Tang, Zhou XiaoNong

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Implementing national to community-based 'One Health' surveillance approach for human, animal and environmental consequences mitigation offers great opportunities and value-added in sustainable development and wellbeing. 'One Health' surveillance approach global partnerships, policy commitment and financial investment are much needed in addressing the evolving threats and epidemics crises mitigation in African countries. The paper provides insights onto how China-Africa health development cooperation in promoting “One Health” surveillance approach in response advocacy and mitigation. China-Africa health development initiatives provide new prospects in guiding and moving forward appropriate and evidence-based advocacy and mitigation management approaches and strategies in attaining Universal Health Coverage (UHC) and Sustainable Development Goals (SDGs). Early and continuous quality and timely surveillance data collection and coordinated information sharing practices in malaria and other diseases are demonstrated in Comoros, Zanzibar, Ghana and Cameroon. Improvements of variety of access to contextual sources and network of data sharing platforms are needed in guiding evidence-based and tailored detection and response to unusual hazardous events. Moreover, understanding threats and diseases trends, frontline or point of care response delivery is crucial to promote integrated and sustainable targeted local, national “One Health” surveillance and response approach needs implementation. Importantly, operational guidelines are vital in increasing coherent financing and national workforce capacity development mechanisms. Strengthening participatory partnerships, collaboration and monitoring strategies in achieving global health agenda effectiveness in Africa. At the same enhancing surveillance data information streams reporting and dissemination usefulness in informing policies decisions, health systems programming and financial mobilization and prioritized allocation pre, during and post threats and epidemics crises programs strengths and weaknesses. Thus, capitalizing on “One Health” surveillance and response approach advocacy and mitigation implementation is timely in consolidating Africa Union 2063 agenda and Africa renaissance capabilities and expectations.

Keywords: Africa, one health approach, surveillance, response

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1173 Organized Crime-A Social Challenge for Kosovo towards European Union Integration

Authors: Samedin Mehmeti

Abstract:

Very tens political and economic situation, in particular armed conflicts that followed at the time of the destruction of the former Yugoslavia, influenced migrations and displacement of population. Especially setting international sanctions and embargo influenced the creation of organized criminal groups. A lot of members of the former Yugoslav security apparatus in collaboration with ordinary criminal groups engaged in: smuggling of goods, petroleum and arms, sale and transport of drugs, payable murder, damage to public property, kidnappings, extortion, racketeering, etc. This tradition of criminality, of course in other forms and with other methods, has continued after conflicts and continues with a high intensity even in nowadays. One of the most delicate problems of organized crime activity is the impact on the economic sphere, where organized crime opposes and severely damages national security and economy to criminalize it in certain sectors and directions. Organized crime groups including who find Kosovo as a place to develop their criminal activities are characterized by: loyalty of many people especially through family connections and kinship in carrying out criminal activities and the existence of powerful hierarchy of leadership which in many cases include the corrupt officials of state apparatus. Groups have clear hierarchy and flexible structure of command, each member within the criminal group knows his duties concrete. According to statistics presented in police reports its notable that Kosovo has a large number of cases of organized crime, cultivation, trafficking and possession of narcotics. As already is very well known that one of the primary conditions that must be fulfilled on track toward integration in the European Union is precisely to prevent and combat organized crime. Kosovo has serious problems with prosecutorial and judicial system. But the misuse of public funds, even those coming directly from EU budget or the budget of the European Union member states, have a negative impact on this process. The economic crisis that has gripped some of the EU countries has led to the creation of an environment in which there are far fewer resources and opportunities to invest in preventing and combating organized crime within member states. This automatically reduces the level of financial support for other countries in the fight against organized crime. Kosovo as a poor country, now has less likely benefiting from the support tools that will be eventually offered by Europe set of in this area.

Keywords: police, european integration, organized crime, narcotics

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1172 Determination of the Needs for Development of Infertility Psycho-Educational Program and the Design of a Website about Infertility for University Students

Authors: Bahar Baran, Şirin Nur Kaptan, D.Yelda Kağnıcı, Erol Esen, Barışcan Öztürk, Ender Siyez, Diğdem M Siyez

Abstract:

It is known that some factors associated with infertility have preventable characteristics and that young people's knowledge levels in this regard are inadequate, but very few studies focus on effective prevention studies on infertility. Psycho-educational programs have an important place for infertility prevention efforts. Nowadays, considering the households' utilization rates from technology and the Internet, it seems that young people have applied to websites as a primary source of information related to a health problem they have encountered. However, one of the prerequisites for the effectiveness of websites or face-to-face psycho-education programs is to consider the needs of participants. In particular, it is expected that these programs will be appropriate to the cultural infrastructure and the diversity of beliefs and values in society. The aim of this research is to determine what university students want to learn about infertility and fertility and examine their views on the structure of the website. The sample of the research consisted of 9693 university students who study in 21 public higher education programs in Turkey. 51.6 % (n = 5002) were female and 48.4% (n = 4691) were male. The Needs Analysis Questionnaire developed by the researchers was used as data collection tool in the research. In the analysis of the data, descriptive analysis was conducted in SPSS software. According to the findings, among the topics that university students wanted to study about infertility and fertility, the first topics were 'misconceptions about infertility' (94.9 %), 'misconceptions about sexual behaviors' (94.6 %), 'factors affecting infertility' (92.8 %), 'sexual health and reproductive health' (92.5 %), 'sexually transmitted diseases' (92.7 %), 'sexuality and society' (90.9 %), 'healthy life (help centers)' (90.4 %). In addition, the questions about how the content of the website should be designed for university students were analyzed descriptively. According to the results, 91.5 % (n = 8871) of the university students proposed to use frequently asked questions and their answers, 89.2 % (n = 8648) stated that expert video should be included, 82.6 % (n = 8008) requested animations and simulations, 76.1 % (n = 7380) proposed different content according to sex and 66 % (n = 6460) proposed different designs according to sex. The results of the research indicated that the findings are similar to the contents of the program carried out in other countries in terms of the topics to be studied. It is suggested to take into account the opinions of the participants during the design of website.

Keywords: infertility, prevention, psycho-education, web based education

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1171 Factors Affecting the Success of Premarital Screening Service in Middle Eastern Islamic Countries

Authors: Wafa Al Jabri

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Background: In Middle Eastern Islamic Countries (MEICs), there is a high prevalence of genetic blood disorders (GBDs), particularly sickle cell disease and thalassemia. The GBDs are considered a major public health concern, especially with the increase in affected populations along with the associated psychological, social, and financial cost of management. Despite the availability of premarital screening services (PSS) that aim to identify the asymptomatic carriers of GBDs and provide genetic counseling to couples in order toreduce the prevalence of these diseases; yet, the success rate of PSS is very low due to religious and socio-cultural concerns. Purpose: This paper aims to highlight the factors that affect the success of PSS in MEICs. Methods: A literature review of articles located in CINAHL, PubMed, SCOPUS, and MedLinewas carried out using the following terms: “premarital screening,” “success,” “effectiveness,” and “ genetic blood disorders.” Second, a hand search of the reference lists and Google searches were conducted to find studies that did not exist in the primary database searches. Only studies which are conducted in MEICs countries and published in the last five years were included. Studies that were not published in English were excluded. Results: Fourteen articles were included in the review. The results showed that PSS in most of the MEICs was successful in achieving its objective of identifying high-risk marriages; however, the service failed to meetitsultimate goal of reducing the prevalence of GBDs. Various factors seem to hinder the success of PSS, including poor public awareness, late timing of the screening, culture and social stigma, religious beliefs, availability of prenatal diagnosis and therapeutic abortion, emotional factors, and availability of genetic counseling services. However, poor public awareness, late timing of the screening, and unavailability of adequate counseling services were the most common barriers identified. Conclusion: Overcoming the identified barriers by providing effective health education programs, offering the screening test to young adults at an earlier stage, and tailoring the genetic counseling would be crucial steps to provide a framework for an effective PSS in MEICs.

Keywords: premarital screening, success, effectiveness, and genetic blood disorders

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1170 Possibilities and Challenges for District Heating

Authors: Louise Ödlund, Danica Djuric Ilic

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From a system perspective, there are several benefits of DH. A possibility to utilize the excess heat from waste incineration and biomass-based combined heat and power (CHP) production (e.g. possibility to utilize the excess heat from electricity production) are two examples. However, in a future sustainable society, the benefits of DH may be less obvious. Due to the climate changes and increased energy efficiency of buildings, the demand for space heating is expected to decrease. Due to the society´s development towards circular economy, a larger amount of the waste will be material recycled, and the possibility for DH production by the energy recovery through waste incineration will be reduced. Furthermore, the benefits of biomass-based CHP production will be less obvious since the marginal electricity production will no longer be linked to high greenhouse gas emissions due to an increased share of renewable electricity capacity in the electricity system. The purpose of the study is (1) to provide an overview of the possible development of other sectors which may influence the DH in the future and (2) to detect new business strategies which would enable for DH to adapt to the future conditions and remain competitive to alternative heat production in the future. A system approach was applied where DH is seen as a part of an integrated system which consists of other sectors as well. The possible future development of other sectors and the possible business strategies for DH producers were searched through a systematic literature review In order to remain competitive to the alternative heat production in the future, DH producers need to develop new business strategies. While the demand for space heating is expected to decrease, the space cooling demand will probably increase due to the climate changes, but also due to the better insulation of buildings in the cases where the home appliances are the heat sources. This opens up a possibility for applying DH-driven absorption cooling, which would increase the annual capacity utilization of the DH plants. The benefits of the DH related to the energy recovery from the waste incineration will exist in the future since there will always be a need to take care of materials and waste that cannot be recycled (e.g. waste containing organic toxins, bacteria, such as diapers and hospital waste). Furthermore, by operating central controlled heat pumps, CHP plants, and heat storage depending on the intermittent electricity production variation, the DH companies may enable an increased share of intermittent electricity production in the national electricity grid. DH producers can also enable development of local biofuel supply chains and reduce biofuel production costs by integrating biofuel and DH production in local DH systems.

Keywords: district heating, sustainable business strategies, sustainable development, system approach

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1169 Targeted Photodynamic Therapy for Intraperitoneal Ovarian Cancer, A Way to Stimulate Anti-Tumoral Immune Response

Authors: Lea Boidin, Martha Baydoun, Bertrand Leroux, Olivier Morales, Samir Acherar, Celine Frochot, Nadira Delhem

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Ovarian cancer (OC) is one of the most defying diseases in gynecologic oncology. Even though surgery remains crucial in the therapy of patients with primary ovarian cancer, recurrent recidivism calls for the development of new therapy protocols to propose for patients dealing with this cancer. FRα is described as a tumor‐associated antigen in OC, where FRα expression is usually linked with more poorly differentiated, aggressive tumors. The Photodynamic treatment (PDT) available data have shown improvements in the uptake of small tumors and in the induction of a proper anti-tumoral immune response. In order to target specifically peritoneal metastatis, which overexpress FRα, a new-patented PS coupled with folic acid has been developed in our team. Herein we propose PDT using this new patented PS for PDT applied in an in vivo mice model. The efficacy of the treatment was evaluated in mice without and with PBMC reconstitution. Mice were divided into four groups: Non-Treated, PS, Light Only, and PDT Treated and subjected to illumination by laser set at 668nm with a duration of illumination of 45 minutes (or 1 min of illumination followed by 2 minutes of pause repeated 45 times). When mice were not reconstituted and after fractionized PDT protocol, a significant decrease in the tumor volume was noticed. An induction in the anti-tumoral cytokine IFNγ chaperoned this decrease while a subsequent inhibition in the cytokine TGFβ. Even more crucial, when mice were reconstituted and upon PDT, the fold of tumor decrease was even higher. An immune response was activated decoded with an increase in NK, CD3 +, LT helper and Cytotoxic T cells. Thereafter, an increase in the expression of the cytokines IFNγ and TNFα were noticed while an inhibition in TGFβ, IL8 and IL10 accompanied this immune response activation. Therefore, our work has shown for the first time that a fractionized PDT protocol using a folate-targeted PDT is effective for treatment of ovarian cancer. The interest in using PDT in this case, goes beyond the local induction of tumor apoptosis only, but can promote subsequent anti-tumor response. Most of the therapies currently used to treat ovarian cancer, have an uncooperative outcomes on the host immune response. The readiness of a tumor adjuvant treatment like PDT adequate in eliminating the tumor and in concert stimulating anti-tumor immunity would be weighty.

Keywords: folate receptor, ovarian cancer, photodynamic therapy, humanized mice model

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1168 Effect on the Integrity of the DN300 Pipe and Valves in the Cooling Water System Imposed by the Pipes and Ventilation Pipes above in an Earthquake Situation

Authors: Liang Zhang, Gang Xu, Yue Wang, Chen Li, Shao Chong Zhou

Abstract:

Presently, more and more nuclear power plants are facing the issue of life extension. When a nuclear power plant applies for an extension of life, its condition needs to meet the current design standards, which is not fine for all old reactors, typically for seismic design. Seismic-grade equipment in nuclear power plants are now generally placed separately from the non-seismic-grade equipment, but it was not strictly required before. Therefore, it is very important to study whether non-seismic-grade equipment will affect the seismic-grade equipment when dropped down in an earthquake situation, which is related to the safety of nuclear power plants and future life extension applications. This research was based on the cooling water system with the seismic and non-seismic grade equipment installed together, as an example to study whether the non-seismic-grade equipment such as DN50 fire pipes and ventilation pipes arranged above will damage the DN300 pipes and valves arranged below when earthquakes occur. In the study, the simulation was carried out by ANSYS / LY-DYNA, and Johnson-Cook was used as the material model and failure model. For the experiments, the relative positions of objects in the room were restored by 1: 1. In the experiment, the pipes and valves were filled with water with a pressure of 0.785 MPa. The pressure-holding performance of the pipe was used as a criterion for damage. In addition to the pressure-holding performance, the opening torque was considered as well for the valves. The research results show that when the 10-meter-long DN50 pipe was dropped from the position of 8 meters height and the 8-meter-long air pipe dropped from a position of 3.6 meters height, they do not affect the integrity of DN300 pipe below. There is no failure phenomenon in the simulation as well. After the experiment, the pressure drop in two hours for the pipe is less than 0.1%. The main body of the valve does not fail either. The opening torque change after the experiment is less than 0.5%, but the handwheel of the valve may break, which affects the opening actions. In summary, impacts of the upper pipes and ventilation pipes dropdown on the integrity of the DN300 pipes and valves below in a cooling water system of a typical second-generation nuclear power plant under an earthquake was studied. As a result, the functionality of the DN300 pipeline and the valves themselves are not significantly affected, but the handwheel of the valve or similar articles can probably be broken and need to take care.

Keywords: cooling water system, earthquake, integrity, pipe and valve

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1167 Assess the Accessibility to Culturally Competent Mental Health Services for Haitian Communities in New York State

Authors: Natacha Julceus Fabien, Maryse Emmanuel Garcy

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Mental illness encompasses more than two hundred types of mental troubles, and more than half of the American population is at risk of being affected. If not effectively treated, mental illness can have dire consequences on health, the economy, and society. New York State, the second state after Florida with the most prominent Haitian/American, counted 180,710 inhabitants distributed in 60321 households in 2021, with almost half 46.4% being less than 35 years old. Studies show that while blacks are resilient, they are more likely to have severe mental diseases leading to disabilities compared to their white counterparts. Cultural competence in mental health services can narrow health disparities. Achieving this cultural competency in the health system involves good coordination in a robust health system where everyone is ready to contribute to its practical implementation. An effective way to address the issue is to have good baseline knowledge. However, there is not enough data that specifically informs on the accessibility to culturally competent mental health services for the Haitian American communities in New York. The purpose of this Community Needs Assessment is to assess the accessibility of minorities, particularly Haitian communities in New York, to culturally competent mental health services. This assessment will be conducted in the ten regions of New York State. Providers, clients, members of the community, and minority organizations will be recruited to collect quantitative and qualitative data. The quantitative part will be done in two surveys, one collecting primary data from the general population receiving the services and the other from health providers that provide health services. The questions and answers will be saved in Excel and analyzed on SPSS. For qualitative data, focus groups and in-depth guide interviews will be conducted and analyzed through Strengths, Weaknesses, Opportunities, and Threats (SWOT) Analysis of how the population and critical informants understand and identify cultural competency components in the mental health system. This research will be presented at the HAFALI research forum and specific minority organizations in New York. It will be submitted to mental health conferences and specific journals for publication. It will be shared with the heads of the community health service and the heads of the New York State Office of Mental Health. This needs assessment will be used as a tool to improve access to culturally competent mental health services nationally and worldwide.

Keywords: mental health, minorities, New York, needs assessment

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1166 Development of a Bi-National Thyroid Cancer Clinical Quality Registry

Authors: Liane J. Ioannou, Jonathan Serpell, Joanne Dean, Cino Bendinelli, Jenny Gough, Dean Lisewski, Julie Miller, Win Meyer-Rochow, Stan Sidhu, Duncan Topliss, David Walters, John Zalcberg, Susannah Ahern

Abstract:

Background: The occurrence of thyroid cancer is increasing throughout the developed world, including Australia and New Zealand, and since the 1990s has become the fastest increasing malignancy. Following the success of a number of institutional databases that monitor outcomes after thyroid surgery, the Australian and New Zealand Endocrine Surgeons (ANZES) agreed to auspice the development of a bi-national thyroid cancer registry. Objectives: To establish a bi-national population-based clinical quality registry with the aim of monitoring and improving the quality of care provided to patients diagnosed with thyroid cancer in Australia and New Zealand. Patients and Methods: The Australian and New Zealand Thyroid Cancer Registry (ANZTCR) captures clinical data for all patients, over the age of 18 years, diagnosed with thyroid cancer, confirmed by histopathology report, that have been diagnosed, assessed or treated at a contributing hospital. Data is collected by endocrine surgeons using a web-based interface, REDCap, primarily via direct data entry. Results: A multi-disciplinary Steering Committee was formed, and with operational support from Monash University the ANZTCR was established in early 2017. The pilot phase of the registry is currently operating in Victoria, New South Wales, Queensland, Western Australia and South Australia, with over 30 sites expected to come on board across Australia and New Zealand in 2018. A modified-Delphi process was undertaken to determine the key quality indicators to be reported by the registry, and a minimum dataset was developed comprising information regarding thyroid cancer diagnosis, pathology, surgery, and 30-day follow up. Conclusion: There are very few established thyroid cancer registries internationally, yet clinical quality registries have shown valuable outcomes and patient benefits in other cancers. The establishment of the ANZTCR provides the opportunity for Australia and New Zealand to further understand the current practice in the treatment of thyroid cancer and reasons for variation in outcomes. The engagement of endocrine surgeons in supporting this initiative is crucial. While the pilot registry has a focus on early clinical outcomes, it is anticipated that future collection of longer-term outcome data particularly for patients with the poor prognostic disease will add significant further value to the registry.

Keywords: thyroid cancer, clinical registry, population health, quality improvement

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1165 Thyroid Cancer Treatment in Yemen Under Blockade Conditions and Absence of Radioactive Iodine

Authors: Anis Al-Yakhiri

Abstract:

Introduction: The World Health Organization (WHO) classifies malignant epithelial thyroid tumors into four major groups (papillary, follicular, medullar and undifferentiated) . Papillary thyroid carcinoma (PTC) is the most common type, for about eight out of ten thyroid cancers belong to this histological type. Radioactive iodine (RAI) is considered effective for patients with total or nearly total thyroidectomy, but the beneficial effects of RAI are still controversial. War conditions forced us to study alternative methods of using radioactive iodine in the treatment of patients with PTC. Material and methods: Between January 2014 and June 2021, in Al-Yakhiri hospital, 57 Total Thyroidectomy with Radical BilateralNeckDissection (RBND) were performed, 50 for malignant disease,7 for false positive cytology.RBND involves surgical clearance of Levels II-VI. Mean age was 40.7 years old and 92% of the patients were female. 7(14%) patients had hypothyroidism which required preoperative thyroid hormone treatment. The Thyroid Stimulating Hormone- Suppression Therapy (TSH-ST) immediately started after RBND for mostpatients on the first day. It consisted in reducing the level of TSH< 0.1 mIU/L. Results: The Apron flap was used on most operations (40)80% and with lateral extensions had 10(20%). RBND involves surgical clearance of Levels II-VI performed in all operated patients, besides that, 4(8%) of them had resection of sternocleidomastoid muscle (SCM) and accessory nerve (XIn) and internal jugular vein (IJV) withclearance of Levels IB. The PTC was the most common 80.9% (38 patients from 47)by histopathological report. and 4(8%) patients of 50 had resection of sternocleidomastoid muscle (SCM) and accessory nerve (XIn) and internal jugular vein (IJV). The postoperative mortality rate not observed (0%). The postoperative morbidity rate was 22.8% (n =13).Seroma(8.7%),Hypocalcimia(7%), Wound infection(5.3%), Bleeding(1.8%). To suppress TSH and growth of any residual thyroid theTSH-ST (levothyroxine150 – 600mcg)was performed in all patients 57(100%) on the first day afterRBND. We tracked the results of treatment for two years in 30 patients with PTC, only 3 of them received radioactive iodine abroad. Biennial Recurrence rate for PTC appeared in one woman (2%), who had RAI postoperatively in the form of neck lymph nodes metastasis. Conclusion: For patients with PTC, thyroidectomy plus prophylacticRBND is a safe and efficient procedure and it results in lower recurrence rate. Postoperative treatment with exogenous thyroid hormone in doses sufficient to suppress TSH (not less than 150mcg), decreases incidence of recurrence. Total Thyroidectomy with RBND followed by TSH-ST, in our opinion, applicable optimal treatment scheme care for this patient population.

Keywords: thyroid cancer, Yemen war, absence of radioactive iodine, neck dissection, surgery results

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