Search results for: government services

Authors: Rajkumar Ghosh

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Water scarcity is a pressing issue in urban areas, even in smart cities where efficient resource management is a priority. This scarcity is mainly caused by factors such as lifestyle changes, excessive groundwater extraction, over-usage of water, rapid urbanization, and uncontrolled population growth. In the specific case of Gomti Nagar, Lucknow, Uttar Pradesh, India, the depletion of groundwater resources is particularly severe, leading to a water imbalance and posing a significant challenge for the region's sustainable development. The aim of this study is to address the water shortage in the Gomti Nagar region by focusing on the implementation of artificial groundwater recharge methods. Specifically, the research aims to investigate the effectiveness of rainwater collection through rooftop rainwater harvesting systems (RTRWHs) as a sustainable approach to reduce aquifer depletion and bridge the gap between groundwater recharge and extraction. The research methodology for this study involves the utilization of RTRWHs as the main method for collecting rainwater. This approach is considered effective in managing and conserving water resources in a sustainable manner. The focus is on implementing RTRWHs in residential and commercial buildings to maximize the collection of rainwater and its subsequent utilization for various purposes in the Gomti Nagar region. The study reveals that the installation of RTRWHs in the Gomti Nagar region has a positive impact on addressing the water scarcity issue. Currently, RTRWHs cover only a small percentage (0.04%) of the total rainfall collected in the region. However, when RTRWHs are installed in all buildings, their influence on increasing water availability and reducing aquifer depletion will be significantly greater. The study also highlights the significant water imbalance of 24519 ML/yr in the region, emphasizing the urgent need for sustainable water management practices. This research contributes to the theoretical understanding of sustainable water management systems in smart cities. By highlighting the effectiveness of RTRWHs in reducing aquifer depletion, it emphasizes the importance of implementing such systems in urban areas. The findings of this study can serve as a basis for policymakers, urban planners, and developers to prioritize and incentivize the installation of RTRWHs as a potential solution to the water shortage crisis. The data for this study were collected through various sources such as government reports, surveys, and existing groundwater abstraction patterns. The collected data were then analysed to assess the current water situation, groundwater depletion rate, and the potential impact of implementing RTRWHs. Statistical analysis and modelling techniques were employed to quantify the water imbalance and evaluate the effectiveness of RTRWHs. The findings of this study demonstrate that the implementation of RTRWHs can effectively mitigate the water scarcity crisis in Gomti Nagar. By reducing aquifer depletion and bridging the gap between groundwater recharge and extraction, RTRWHs offer a sustainable solution to the region's water scarcity challenges. The study highlights the need for widespread adoption of RTRWHs in all buildings and emphasizes the importance of integrating such systems into the urban planning and development process. By doing so, smart cities like Gomti Nagar can achieve efficient water management, ensuring a better future with improved water availability for its residents.

Keywords: rooftop rainwater harvesting, rainwater, water management, aquifer

Procedia PDF Downloads 69

Authors: Kimberly Samaha

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The Bio-Hub Ecosystem model was developed to address a critical area of concern within the global energy market regarding biomass as a feedstock for power plants. Yet the lack of an economically-viable business model for bioenergy facilities has resulted in the continuation of idled and decommissioned plants. This study analyzed data and submittals to the Born Global Maine Innovation Challenge. The Innovation Challenge was a global innovation challenge to identify process innovations that could address a ‘whole-tree’ approach of maximizing the products, byproducts, energy value and process slip-streams into a circular zero-waste design. Participating companies were at various stages of developing bioproducts and included biofuels, lignin-based products, carbon capture platforms and biochar used as both a filtration medium and as a soil amendment product. This case study shows the QCA (Qualitative Comparative Analysis) methodology of the prequalification process and the resulting techno-economic model that was developed for the maximizing profitability of the Bio-Hub Ecosystem through continuous expansion of system waste streams into valuable process inputs for co-hosts. A full site plan for the integration of co-hosts (biorefinery, land-based shrimp and salmon aquaculture farms, a tomato green-house and a hops farm) at an operating forestry-based biomass to energy plant in West Enfield, Maine USA. This model and process for evaluating the profitability not only proposes models for integration of forestry, aquaculture and agriculture in cradle-to-cradle linkages of what have typically been linear systems, but the proposal also allows for the early measurement of the circularity and impact of resource use and investment risk mitigation, for these systems. In this particular study, profitability is assessed at two levels CAPEX (Capital Expenditures) and in OPEX (Operating Expenditures). Given that these projects start with repurposing facilities where the industrial level infrastructure is already built, permitted and interconnected to the grid, the addition of co-hosts first realizes a dramatic reduction in permitting, development times and costs. In addition, using the biomass energy plant’s waste streams such as heat, hot water, CO₂ and fly ash as valuable inputs to their operations and a significant decrease in the OPEX costs, increasing overall profitability to each of the co-hosts bottom line. This case study utilizes a proprietary techno-economic model to demonstrate how utilizing waste streams of a biomass energy plant and/or biorefinery, results in significant reduction in OPEX for both the biomass plants and the agriculture and aquaculture co-hosts. Economically viable Bio-Hubs with favorable environmental and community impacts may prove critical in garnering local and federal government support for pilot programs and more wide-scale adoption, especially for those living in severely economically depressed rural areas where aging industrial sites have been shuttered and local economies devastated.

Keywords: bio-economy, biomass energy, financing, zero-waste

Procedia PDF Downloads 111

Authors: Dong Yue, Hua Chen

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The study region Xihu Harbor in Xiangshan County, Ningbo City is located in the central coast of Zhejiang Province. Concerning the wave dispating issue, Ningbo government firstly introduced Spartina alterniflora in 1980s. In the 1990s, S. alterniflora spread so rapidly thus a ‘grassland’ in the sea has been created nowadays. It has become the most important invasive plant of China’s coastal tidal flats. Although S. alterniflora had some ecological and economic functions, it has also brought series of hazards. It has ecological hazards on many aspects, including biomass and biodiversity, hydrodynamic force and sedimentation process, nutrient cycling of tidal flat, succession sequence of soil and plants and so on. On engineering, it courses problems of poor drainage and channel blocking. On economy, the hazard mainly reflected in the threat on aquaculture industry. The purpose of this study is to explore an ecological, feasible and economical way to manage Spartina alterniflora and use the land formed by it, taking Xihu Harbor in Xiangshan County as a case. Comparison method, mathematical modeling, qualitative and quantitative analysis are utilized to proceed the study. Main outcomes are as follows. By comparing a series of S. alterniflora managing methods which include the combination of mechanical cutting and hydraulic reclamation, waterlogging, herbicide and biological substitution from three standpoints – ecology, engineering and economy. It is inferred that the combination of mechanical cutting and hydraulic reclamation is among the top rank of S. alternifora managing methods. The combination of mechanical cutting and hydraulic reclamation means using large-scale mechanical equipment like large screw seagoing dredger to excavate the S. alterniflora with root and mud together. Then the mix of mud and grass was blown off nearby coastal tidal zone transported by pipelines, which can cushion the silt of tidal zone to form a land. However, as man-made land by coast, the reclamation area’s ecological sensitivity is quite high and will face high possibility of flood threat. Therefore, the reclamation area has many reasonability requirements, including ones on location, specific scope, water surface rate, direction of main watercourse, site of water-gate, the ratio of ecological land to urban construction land. These requirements all became important basis when the planning was being made. The water system planning, green space system planning, road structure and land use all need to accommodate the ecological requests. Besides, the profits from the formed land is the managing project’s source of funding, so how to utilize land efficiently is another considered point in the planning. It is concluded that by aiming at managing a large area of S. alterniflora, the combination of mechanical cutting and hydraulic reclamation is an ecological, feasible and economical method. The planning of reclamation area should fully respect the natural environment and possible disasters. Then the planning which makes land use efficient, reasonable, ecological will promote the development of the area’s city construction.

Keywords: ecological management, ecological planning method, reclamation area, Spartina alternifora, Xihu harbor

Procedia PDF Downloads 292

Authors: B. Philip, J. Littlewood, R. Radford, N. Evans, T. Whyman, D. P. Jones

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UK buildings and energy infrastructures are heavily dependent on natural gas, a large proportion of which is used for domestic space heating. However, approximately half of the gas consumed in the UK is imported. Improving energy security and reducing carbon emissions are major government drivers for reducing gas dependency. In order to do so there needs to be a wholesale shift in the energy provision to householders without impacting on thermal comfort levels, convenience or cost of supply to the end user. Heat pumps are seen as a potential alternative in modern well insulated homes, however, can the same be said of older homes? A large proportion of housing stock in Britain was built prior to 1919. The age of the buildings bears testimony to the quality of construction; however, their thermal performance falls far below the minimum currently set by UK building standards. In recent years significant sums of money have been invested to improve energy efficiency and combat fuel poverty in some of the most deprived areas of Wales. Increasing energy efficiency of older properties remains a significant challenge, which cannot be achieved through insulation and air-tightness interventions alone, particularly when alterations to historically important architectural features of the building are not permitted. This paper investigates the energy demand of pre-1919 dwellings in a former Welsh mining village, the feasibility of meeting that demand using water from the disused mine workings to supply a district heat network and potential barriers to success of the scheme. The use of renewable solar energy generation and storage technologies, both thermal and electrical, to reduce the load and offset increased electricity demand, are considered. A wholistic surveying approach to provide a more accurate assessment of total household heat demand is proposed. Several surveying techniques, including condition surveys, air permeability, heat loss calculations, and thermography were employed to provide a clear picture of energy demand. Additional insulation can bring unforeseen consequences which are detrimental to the fabric of the building, potentially leading to accelerated dilapidation of the asset being ‘protected’. Increasing ventilation should be considered in parallel, to compensate for the associated reduction in uncontrolled infiltration. The effectiveness of thermal performance improvements are demonstrated and the detrimental effects of incorrect material choice and poor installation are highlighted. The findings show estimated heat demand to be in close correlation to household energy bills. Major areas of heat loss were identified such that improvements to building thermal performance could be targeted. The findings demonstrate that the use of heat pumps in older buildings is viable, provided sufficient improvement to thermal performance is possible. Addition of passive solar thermal and photovoltaic generation can help reduce the load and running cost for the householder. The results were used to predict future heat demand following energy efficiency improvements, thereby informing the size of heat pumps required.

Keywords: heat demand, heat pump, renewable energy, retrofit

Procedia PDF Downloads 83

Authors: Tzipi Eshet

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The primary objectives of this work are the examination of public preferences and attributed importance to different characteristics of coastal cliff protection alternatives, and drawing conclusions about the applicable alternative in Beit-Yanai beach. Erosion of coastal cliffs is a natural phenomenon that occurs in many places in the world. This creates problems along the coastlines, which are densely populated areas with highly developed economic activity. In recent years, various aspects of the aeolianite cliffs along the Israeli coast have been studied extensively. There is a consensus among researchers regarding a general trend of cliff retreat. This affects civilian infrastructure, wildlife habitats and heritage values, as well as Increases the risk to human life. The Israeli government, committed to the integrated coastal zones management approach, decided on a policy and guidelines to deal with cliff erosion, which includes establishing physical protection on land and in the sea, sand nourishment and runoff drainage. Physical protection solutions to reduce the rate of retreat of the cliffs are considerably important both for planning authorities and visitors to the beach. Direct costs of different protection alternatives, as well as external costs and benefits, may vary, thus affecting consumer preferences. Planning and execution of sustainable coastal cliff protection alternatives must take into account the different characteristics and their impact on aspects of economics, environment and leisure. The rocky shore of Beit-Yanai Beach was chosen as a case study to examine the nature of the influence of various protective solutions on consumer preferences. This beach is located in the center of Israel's coastline, and acts as a focus of attraction for recreation, land and sea sports, and educational activities as well. If no action will be taken, cliff retreat will continue. A survey was conducted to reveal the importance of coastal protection alternatives characteristics and the visual preferences to visitors at beach Beit-Yanai and residents living on the cliff (N=287). Preferences and willingness-to-pay were explored using Contingent-Ranking and Choice-Experiments techniques. Results show that visitors’ and residents’ willingness-to-pay for coastal cliff protection alternatives is affected both by financial and environmental aspects, as well as leisure. They prefer coastal cliff protection alternatives that are not visible and do not need constant maintenance, do not affect the quality of seawater or the habitats of wildlife and do not lower the security level of the swimmers. No significant difference was found comparing willingness-to-pay among local and non-local users. Additionally, they mostly prefer a protection solution which is integrated in the coastal landscape and maintains the natural appearance of the beach. Of the possible protection alternatives proposed for the protection of the cliff in Beit Yanai beach are two techniques that meet public preferences: rock revetments and submerged detached breakwaters. Results indicate that the visiting public prefer the implementation of these protection alternatives and will be willing to pay for them. Future actions to reduce retreat rate in Beit-Yanai have to consider implications on the economic, environmental and social conditions, along with weighting public interest against the interest of the individual.

Keywords: contingent-ranking, choice-experiments, coastal cliff protection, erosion of coastal cliffs, environment

Procedia PDF Downloads 273

Authors: Yuguang Gao, Mingtao Deng

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The integration of independently operating hospitals into a unified healthcare service system has become a strategic imperative in the pursuit of hospitals’ high-quality development. Central to the concept of group governance over such transformation, exemplified by a collaborative medical alliance, is the delineation of shared value, vision, and goals. Given the inherent disparity in capabilities among hospitals within the alliance, particularly in the treatment of different diseases characterized by Disease Related Groups (DRG) in terms of effectiveness, efficiency and resource utilization, this study aims to address the centralized decision-making of intra-hospital patient referral within the medical alliance to enhance the overall production and quality of service provided. We first introduce the notion of production utility, where a higher production utility for a hospital implies better performance in treating patients diagnosed with that specific DRG group of diseases. Then, a Discrete-Event Simulation (DES) framework is established for patient referral among hospitals, where patient flow modeling incorporates a queueing system with fixed capacities for each hospital. The simulation study begins with a two-member alliance. The pivotal strategy examined is a "whether-to-refer" decision triggered when the bed usage rate surpasses a predefined threshold for either hospital. Then, the decision encompasses referring patients to the other hospital based on DRG groups’ production utility differentials as well as bed availability. The objective is to maximize the total production utility of the alliance while minimizing patients’ average length of stay and turnover rate. Thus the parameter under scrutiny is the bed usage rate threshold, influencing the efficacy of the referral strategy. Extending the study to a three-member alliance, which could readily be generalized to multi-member alliances, we maintain the core setup while introducing an additional “which-to-refer" decision that involves referring patients with specific DRG groups to the member hospital according to their respective production utility rankings. The overarching goal remains consistent, for which the bed usage rate threshold is once again a focal point for analysis. For the two-member alliance scenario, our simulation results indicate that the optimal bed usage rate threshold hinges on the discrepancy in the number of beds between member hospitals, the distribution of DRG groups among incoming patients, and variations in production utilities across hospitals. Transitioning to the three-member alliance, we observe similar dependencies on these parameters. Additionally, it becomes evident that an imbalanced distribution of DRG diagnoses and further disparity in production utilities among member hospitals may lead to an increase in the turnover rate. In general, it was found that the intra-hospital referral mechanism enhances the overall production utility of the medical alliance compared to individual hospitals without partnership. Patients’ average length of stay is also reduced, showcasing the positive impact of the collaborative approach. However, the turnover rate exhibits variability based on parameter setups, particularly when patients are redirected within the alliance. In conclusion, the re-structuring of diagnostic disease groups within the medical alliance proves instrumental in improving overall healthcare service outcomes, providing a compelling rationale for the government's promotion of patient referrals within collaborative medical alliances.

Keywords: collaborative medical alliance, disease related group, patient referral, simulation

Procedia PDF Downloads 30

Authors: Man Ying Kang, Joshua Kin Man Nan

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The prolonged pandemic has posed alarming public health challenges to various parts of the world, and face-to-face mental health treatment is largely discounted for the control of virus transmission, online psychological services and self-help mental health kits have become essential. Online self-help mindfulness-based interventions have proved their effects on fostering mental health for different populations over the globe. This paper was to test the effectiveness of an online short-term audio-based mindfulness (SAM) program in enhancing wellbeing, dispositional mindfulness, and reducing stress and negative affect in community settings in China, and to explore possible mechanisms of how dispositional mindfulness, stress, and negative affect influenced the intervention effects on wellbeing. Community-dwelling adults were recruited via online social networking sites (e.g., QQ, WeChat, and Weibo). Participants (n=100) were randomized into the mindfulness group (n=50) and a waitlist control group (n=50). In the mindfulness group, participants were advised to spend 10–20 minutes listening to the audio content, including mindful-form practices (e.g., eating, sitting, walking, or breathing). Then practice daily mindfulness exercises for 3 weeks (a total of 21 sessions), whereas those in the control group received the same intervention after data collection in the mindfulness group. Participants in the mindfulness group needed to fill in the World Health Organization Five Well-Being Index (WHO), Positive and Negative Affect Schedule (PANAS), Perceived Stress Scale (PSS), and Freiburg Mindfulness Inventory (FMI) four times: at baseline (T0) and at 1 (T1), 2 (T2), and 3 (T3) weeks while those in the waitlist control group only needed to fill in the same scales at pre- and post-interventions. Repeated-measure analysis of variance, paired sample t-test, and independent sample t-test was used to analyze the variable outcomes of the two groups. The parallel process latent growth curve modeling analysis was used to explore the longitudinal moderated mediation effects. The dependent variable was WHO slope from T0 to T3, the independent variable was Group (1=SAM, 2=Control), the mediator was FMI slope from T0 to T3, and the moderator was T0NA and T0PSS separately. The different levels of moderator effects on WHO slope was explored, including low T0NA or T0PSS (Mean-SD), medium T0NA or T0PSS (Mean), and high T0NA or T0PSS (Mean+SD). The results found that SAM significantly improved and predicted higher levels of WHO slope and FMI slope, as well as significantly reduced NA and PSS. FMI slope positively predict WHO slope. FMI slope partially mediated the relationship between SAM and WHO slope. Baseline NA and PSS as the moderators were found to be significant between SAM and WHO slope and between SAM and FMI slope, respectively. The conclusion was that SAM was effective in promoting levels of mental wellbeing, positive affect, and dispositional mindfulness as well as reducing negative affect and stress in community settings in China. SAM improved wellbeing faster through the faster enhancement of dispositional mindfulness. Participants with medium-to-high negative affect and stress buffered the therapy effects of SAM on wellbeing improvement speed.

Keywords: mindfulness, negative affect, stress, wellbeing, randomized control trial

Procedia PDF Downloads 90

Authors: Alberto Azevedo, Ricardo Martins, André B. Fortunato, Anabela Oliveira

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Water is under severe threat today because of the rising population, increased agricultural and industrial needs, and the intensifying effects of climate change. Due to sea-level rise, erosion, and demographic pressure, the coastal regions are of significant concern to the scientific community. The Water Monitoring Sentinel Cloud platform (WORSICA) service is focused on providing new tools for monitoring water in coastal and inland areas, taking advantage of remote sensing, in situ and tidal modeling data. WORSICA is a service that can be used to determine the coastline, coastal inundation areas, and the limits of inland water bodies using remote sensing (satellite and Unmanned Aerial Vehicles - UAVs) and in situ data (from field surveys). It applies to various purposes, from determining flooded areas (from rainfall, storms, hurricanes, or tsunamis) to detecting large water leaks in major water distribution networks. This service was built on components developed in national and European projects, integrated to provide a one-stop-shop service for remote sensing information, integrating data from the Copernicus satellite and drone/unmanned aerial vehicles, validated by existing online in-situ data. Since WORSICA is operational using the European Open Science Cloud (EOSC) computational infrastructures, the service can be accessed via a web browser and is freely available to all European public research groups without additional costs. In addition, the private sector will be able to use the service, but some usage costs may be applied, depending on the type of computational resources needed by each application/user. Although the service has three main sub-services i) coastline detection; ii) inland water detection; iii) water leak detection in irrigation networks, in the present study, an application of the service to Óbidos lagoon in Portugal is shown, where the user can monitor the evolution of the lagoon inlet and estimate the topography of the intertidal areas without any additional costs. The service has several distinct methodologies implemented based on the computations of the water indexes (e.g., NDWI, MNDWI, AWEI, and AWEIsh) retrieved from the satellite image processing. In conjunction with the tidal data obtained from the FES model, the system can estimate a coastline with the corresponding level or even topography of the inter-tidal areas based on the Flood2Topo methodology. The outcomes of the WORSICA service can be helpful for several intervention areas such as i) emergency by providing fast access to inundated areas to support emergency rescue operations; ii) support of management decisions on hydraulic infrastructures operation to minimize damage downstream; iii) climate change mitigation by minimizing water losses and reduce water mains operation costs; iv) early detection of water leakages in difficult-to-access water irrigation networks, promoting their fast repair.

Keywords: remote sensing, coastline detection, water detection, satellite data, sentinel, Copernicus, EOSC

Procedia PDF Downloads 105

Authors: Yael Rieder, Yael Gilboa, S. O. Adva, Efrat Halevi, Ronnie Tepper

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Background: Operation of ultrasound equipment is a core skill for many clinical specialties. As part of the training program at -Simultech- a simulation center for Ob\Gyn at the Meir Medical Center, Israel, teaching how to operate ultrasound equipment requires dealing with misunderstandings of spatial and 3D orientation, failure of the operator to hold a transducer correctly, and limited ability to evaluate the data on the screen. We have developed a platform intended to endow physicians and sonographers with clinical and operational skills of obstetric ultrasound. Simultech's simulations are focused on medical knowledge, risk management, technology operations and physician-patient communication. The simulations encompass extreme work conditions. Setup: Between eight and ten of the eight hundred and fifty physicians and sonographers of the Clalit health services from seven hospitals and eight community centers across Israel, participate in individual Ob/Gyn training sessions each week. These include Ob/Gyn specialists, experts, interns, and sonographers. Innovative teaching and training methodologies: The six-hour training program includes: (1) An educational computer program that challenges trainees to deal with medical questions based upon ultrasound pictures and films. (2) Sophisticated hands-on simulators that challenge the trainees to practice correct grip of the transducer, elucidate pathology, and practice daily tasks such as biometric measurements and analysis of sonographic data. (3) Participation in a video-taped simulation which focuses on physician-patient communications. In the simulation, the physician is required to diagnose the clinical condition of a hired actress based on the data she provides and by evaluating the assigned ultrasound films accordingly. Giving ‘bad news’ to the patient may put the physician in a stressful situation that must be properly managed. (4) Feedback at the end of each phase is provided by a designated trainer, not a physician, who is specially qualified by Ob\Gyn senior specialists. (5) A group exercise in which the trainer presents a medico-legal case in order to encourage the participants to use their own experience and knowledge to conduct a productive ‘brainstorming’ session. Medical cases are presented and analyzed by the participants together with the trainer's feedback. Findings: (1) The training methods and content that Simultech provides allows trainees to review their medical and communications skills. (2) Simultech training sessions expose physicians to both basic and new, up-to-date cases, refreshing and expanding the trainee's knowledge. (3) Practicing on advanced simulators enables trainees to understand the sonographic space and to implement the basic principles of ultrasound. (4) Communications simulations were found to be beneficial for trainees who were unaware of their interpersonal skills. The trainer feedback, supported by the recorded simulation, allows the trainee to draw conclusions about his performance. Conclusion: Simultech was found to contribute to physicians at all levels of clinical expertise who deal with ultrasound. A break in daily routine together with attendance at a neutral educational center can vastly improve performance and outlook.

Keywords: medical training, simulations, ultrasound, Simultech

Procedia PDF Downloads 252

Authors: Rifilwe Victor Modiba, Stefan Hendric Foord

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Alien invasive plants (IAP’s) have considerable negative impacts on freshwater habitats and South Africa has implemented an innovative Work for Water (WfW) programme for the systematic removal of these plants aimed at, amongst other objectives, restoring biodiversity and ecosystem services in these threatened habitats. These restoration processes are expensive and have to be evidence-based. In this study in-stream macroinvertebrate and adult Odonata assemblages were used as indicators of restoration success by quantifying the response of biodiversity metrics for these two groups to the removal of IAP’s in a strategic water resource of South Africa that is extensively invaded by invasive alien plants (IAP’s). The study consisted of a replicated design that included 45 sampling units, viz. 15 invaded, 15 uninvaded and 15 cleared sites stratified across the upper reaches of six sub-catchments of the Luvuvhu river catchment, Limpopo Province. Cleared sites were only considered if they received at least two WfW treatments in the last 3 years. The Benthic macroinvertebrate and adult Odonate assemblages in each of these sampling were surveyed from between November and March, 2013/2014 and 2014/2015 respectively. Generalized Linear Models (GLM) with a log link function and Poisson error distribution were done for metrics (invaded, cleared, and uninvaded) whose residuals were not normally distributed or had unequal variance and for abundance. RDA was done for EPTO genera (Ephemeroptera, Plecoptera, Trichoptera and Odonata) and adult Odonata species abundance. GLM was done to for the abundance of Genera and Odonates that had the association with the RDA environmental factors. Sixty four benthic macroinvertebrate families, 57 EPTO genera, and 45 adult Odonata species were recorded across all 45 sampling units. There was no significant difference between the SASS5 total score, ASPT, and family richness of the three invasion classes. Although clearing only had a weak positive effect on the adult Odonate species richness it had a positive impact on DBI scores. These differences were mainly the result of significantly larger DBI scores in the cleared sites as compared to the invaded sites. Results suggest that water quality is positively impacted by repeated clearing pointing to the importance of follow up procedures after initial clearing. Adult Odonate diversity as measured by richness, endemicity, threat and distribution respond positively to all forms of the clearing. The clearing had a significant impact on Odonate assemblage structure but did not affect EPTO structure. Variation partitioning showed that 21.8% of the variation in EPTO assemblage can be explained by spatial and environmental variables, 16% of the variation in Odonate structure was explained by spatial and environmental variables. The response of the diversity metrics to clearing increased in significance at finer taxonomic resolutions, particularly of adult Odonates whose metrics significantly improved with clearing and whose structure responded to both invasion and clearing. The study recommends the use of DBI for surveying river health when hydraulic biotopes are poor.

Keywords: DBI, evidence-based conservation, EPTO, macroinvetebrates

Procedia PDF Downloads 170

Authors: Ma Chu Jui

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Culture plays a pivotal role in shaping societal responses to change and fostering adaptability. In the realm of healthcare provision, hospitals serve as dynamic settings molded by the cultural consciousness of healthcare professionals. This intricate interplay extends to their expectations of leadership, communication styles, and attitudes towards patient care. Recognizing the cultural inclinations of healthcare professionals becomes imperative in navigating this complex landscape. This study will utilize Hofstede's Value Survey Module 2013 (VSM 2013) as a comprehensive analytical tool. The targeted participants for this research are in-service nursing professionals with a tenure of at least three months, specifically employed in the nursing department of an Eastern hospital. This quantitative approach seeks to quantify diverse cultural tendencies among the targeted nursing professionals, elucidating not only abstract cultural concepts but also revealing their cultural inclinations across different dimensions. The study anticipates gathering between 400 to 500 responses, ensuring a robust dataset for a comprehensive analysis. The focused approach on nursing professionals within the Eastern hospital setting enhances the relevance and specificity of the cultural insights obtained. The research aims to contribute valuable knowledge to the understanding of cultural tendencies among in-service nursing personnel in the nursing department of this specific Eastern hospital. The VSM 2013 will be initially distributed to this specific group to collect responses, aiming to calculate scores on each of Hofstede's six cultural dimensions—Power Distance Index (PDI), Individualism vs. Collectivism (IDV), Uncertainty Avoidance Index (UAI), Masculinity vs. Femininity (MAS), Long-Term Orientation vs. Short-Term Normative Orientation (LTO), and Indulgence vs. Restraint (IVR). the study unveils a significant correlation between different cultural dimensions and healthcare professionals' tendencies in understanding leadership expectations through PDI, grasping behavioral patterns via IDV, acknowledging risk acceptance through UAI, and understanding their long-term and short-term behaviors through LTO. These tendencies extend to communication styles and attitudes towards patient care. These findings provide valuable insights into the nuanced interconnections between cultural factors and healthcare practices. Through a detailed analysis of the varying levels of these cultural dimensions, we gain a comprehensive understanding of the predominant inclinations among the majority of healthcare professionals. This nuanced perspective adds depth to our comprehension of how cultural values shape their approach to leadership, communication, and patient care, contributing to a more holistic understanding of the healthcare landscape. A profound comprehension of the cultural paradigms embraced by healthcare professionals holds transformative potential. Beyond a mere understanding, it acts as a catalyst for elevating the caliber of healthcare services. This heightened awareness fosters cohesive collaboration among healthcare teams, paving the way for the establishment of a unified healthcare ethos. By cultivating shared values, our study envisions a healthcare environment characterized by enhanced quality, improved teamwork, and ultimately, a more favorable and patient-centric healthcare landscape. In essence, our research underscores the critical role of cultural awareness in shaping the future of healthcare delivery.

Keywords: hofstede's cultural, cultural dimensions, cultural values in healthcare, cultural awareness in nursing

Procedia PDF Downloads 38

Authors: Vaiddehi Bansal, Laura Hinson, Mayumi Rezwan, Erin Leasure, Mithila Iyer, Connor Roth, Poulomi Pal, Kareem Kysia

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As digital usage becomes increasingly ubiquitous worldwide, technology-facilitated gender-based violence (GBV) has garnered increasing attention in the recent years, especially during the COVID-19 pandemic. This form of violence is defined as “action by one or more people that harms others based on their sexual or gender identity or by enforcing harmful gender norms. This action is carried out using the internet and/or mobile technology that harms others based on their sexual or gender identity or by enforcing harmful gender norms”.Common forms of technology-facilitated GBV include cyberstalking, cyberbullying, sexual harassment, image-based abuse, doxing, hacking, gendertrolling, hate speech, and impersonation. Most literature on this pervasive yet complex issue has emerged from high-income countries, and few studies comprehensively summarize its prevalence, manifestations, and implications. This rigorous scoping review examines the evidence base of this phenomenon in low and middle-income countries across Asia, summarizing trends and gaps to inform actionable recommendations. The research team developed search terms to conduct a comprehensive search of peer-reviewed and grey literature. Query results were eligible for inclusion if they were published in English between 2006-2021 and with an explicit emphasis on technology-facilitated violence, gender, and the countries of interest in the Asia region. Title, abstracts, and full-texts were independently screened by two reviewers based on inclusion criteria, and data was extracted through deductive coding. Of 2,042 articles screened, 97 met inclusion criteria. The review revealed a gap in the evidence-base in Central Asia and the Pacific Islands. Findings across South and Southeast Asia indicate that technology-facilitated GBV comprises various forms of abuse, violence, and harassment that are largely shaped by country-specific societal norms and technological landscapes. The literature confirms that women, girls, and sexual minorities, especially those with intersecting marginalized identities, are often more vulnerable to experiencing online violence. Cultural norms and patriarchal structures tend to stigmatize survivors, limiting their ability to seek social and legal support. Survivors are also less likely to report their experience due to barriers such as lack of awareness of reporting mechanisms, the perception that digital platforms will not address their complaints, and cumbersome reporting systems. The COVID-19 pandemic has further exacerbated perpetration and strained support mechanisms. Prevalence varies by the form of violence but is difficult to estimate accurately due to underreporting and disjointed, outdated, or non-existent legal definitions. Addressing technology-facilitated GBV in Asia requires collective action from multiple actors, including government authorities, technology companies, digital and feminist movements, NGOs, and researchers.

Keywords: gender-based violence, technology, online sexual harassment, image-based abuse

Procedia PDF Downloads 103

Authors: Jaco Oosthuizen, Nerina C. Van Der Merwe

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The National Health Laboratory Services in Bloemfontien has been the diagnostic testing facility for 1830 patients for familial breast cancer since 1997. From the cohort, 540 were comprehensively screened using High-Resolution Melting Analysis or Next Generation Sequencing for the presence of point mutations and/or indels. Approximately 90% of these patients stil remain undiagnosed as they are BRCA1/2 negative. Multiplex ligation-dependent probe amplification was initially added to screen for copy number variation detection, but with the introduction of next generation sequencing in 2017, was substituted and is currently used as a confirmation assay. The aim was to investigate the viability of utilizing internationally designed copy number variation detection assays based on mostly European/Caucasian genomic data for use within a South African context. The multiplex ligation-dependent probe amplification technique is based on the hybridization and subsequent ligation of multiple probes to a targeted exon. The ligated probes are amplified using conventional polymerase chain reaction, followed by fragment analysis by means of capillary electrophoresis. The experimental design of the assay was performed according to the guidelines of MRC-Holland. For BRCA1 (P002-D1) and BRCA2 (P045-B3), both multiplex assays were validated, and results were confirmed using a secondary probe set for each gene. The next generation sequencing technique is based on target amplification via multiplex polymerase chain reaction, where after the amplicons are sequenced parallel on a semiconductor chip. Amplified read counts are visualized as relative copy numbers to determine the median of the absolute values of all pairwise differences. Various experimental parameters such as DNA quality, quantity, and signal intensity or read depth were verified using positive and negative patients previously tested internationally. DNA quality and quantity proved to be the critical factors during the verification of both assays. The quantity influenced the relative copy number frequency directly whereas the quality of the DNA and its salt concentration influenced denaturation consistency in both assays. Multiplex ligation-dependent probe amplification produced false positives due to ligation failure when ligation was inhibited due to a variant present within the ligation site. Next generation sequencing produced false positives due to read dropout when primer sequences did not meet optimal multiplex binding kinetics due to population variants in the primer binding site. The analytical sensitivity and specificity for the South African population have been proven. Verification resulted in repeatable reactions with regards to the detection of relative copy number differences. Both multiplex ligation-dependent probe amplification and next generation sequencing multiplex panels need to be optimized to accommodate South African polymorphisms present within the genetically diverse ethnic groups to reduce the false copy number variation positive rate and increase performance efficiency.

Keywords: familial breast cancer, multiplex ligation-dependent probe amplification, next generation sequencing, South Africa

Procedia PDF Downloads 210

Authors: Raquel Dafouz Neus Cáceres, Javier Fernandez-Rubio, Belinda Huerta José Luis Rodríguez-Gil, Nicola Mastroianni, Miren López de Alda, Damià Barceló, Yolanda Valcárcel

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The region of Galicia, found in north-western (NW) Spain, is a national and world leader in shellfish, especially mussel production, and recognized for its fishing industry. Few studies have evaluated the presence of emerging contaminants in NW Spain, with those published mainly concerning the continental aquatic environment. The objective of this study was to identify the environmental risk posed by the presence of pharmaceuticals and drugs of abuse in this important coastal region. The presence of sixteen pharmaceuticals (benzodiazepines, anxiolytics, and caffeine), and 19 drugs of abuse (cocainics, amphetamine-like compounds, opiates and opioids, lysergic compounds, and cannabinoids) was assessed in 23 sites located in the Rías (Coastal inlets) of Muros, Arousa, and Pontevedra (NW Spain). Twenty-two of these locations were affected by waste-water treatment plant (WWTP) effluents, and one represented the effluent of one of these WWTPs. Venlafaxine was the pharmaceutical compound detected at higher concentration in the three Rías, with a maximum value of 291 ng/L at the site Porto do Son (Ría de Muros). Total concentration in the three Rías was 819,26 ng/L. Next, citalopram and lorazepam were the most prevalent compounds detected. Metabolite of cocaine benzoylecgonine was the drug of abuse with the highest concentration, measured at 972 ng/L in the Ría of Noia WWTP (no dilution). This compound was also detected at 142 ng/L in the site La Isla de Aros, Ría of Pontevedra. Total concentration for the three Rías was 1210 ng/L. Ephedrine was also detected at high level in the three Rías, with a total concentration of 579,28 ng/L. The results obtained for caffeine show maximum and average concentrations of 857 ng/L Isla de Arosa, Ría de Pontevedra the highest measured in seawater in Spain. A preliminary hazard assessment was carried out by comparing these measured environmental concentrations (MEC) to predicted no-effect concentrations (PNECs) for aquatic organisms. Six out of the 22 seawater samples resulted in a Hazard Quotient (HQ) from chronic exposure higher than 1 with the highest being 17.14, indicating a high probability of adverse effects in the aquatic environment. In addition, the risk was assessed on the basis of persistence, bioaccumulation, and toxicity (PBT). This work was financially supported by the Spanish Ministry of Economy and Competitiveness through the Carlos III Health Institute and the program 'Proyectos de Investigacion en Salud 2015-2017' FIS (PI14/00516), the European Regional Development Fund (ERDF), the Catalan Government (Consolidated Research Groups '2014 SGR 418 - Water and Soil Quality Unit' and 2014 SGR 291 - ICRA), and the European Union’s Seventh Framework Programme for research, technological development and demonstration under grant agreement no. 603437. The poster entitled 'Environmental Risk of Pharmaceuticals, Drugs of Abuse and Stimulant Caffeine in Marine Water: A Case Study in the North-Western of Spain'.

Keywords: drug of abuse, pharmaceuticals, caffeine, environmental risk, seawater

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Authors: Tristance Kee

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With an unprecedented increase in elderly population around the world, the severe lack of quality housing and health-and-safety provisions to serve this cohort cannot be ignored any longer. Many elderly citizens, especially singletons, live in unsafe housing conditions with poorly executed planning and design. Some suffer from deteriorating mobility, sight and general alertness and their sub-standard living conditions further hinder their daily existence. This research explains how concepts such as Universal Design and Co-Design operate in a high density city such as Hong Kong, China where innovative design can become an alternative solution where government and the private sector fail to provide quality elderly friendly facilities to promote a sustainable urban development. Unlike other elderly research which focuses more on housing policies, nursing care and theories, this research takes a more progressive approach by providing an in-depth impact assessment on how innovative design can be practical solutions for creating a more sustainable built environment. The research objectives are to: 1) explain the relationship between innovative design for elderly and a healthier and sustainable environment; 2) evaluate the impact of human ergonomics with the use of universal design; and 3) explain how innovation can enhance the sustainability of a city in improving citizen’s sight, sound, walkability and safety within the ageing population. The research adopts both qualitative and quantitative methodologies to examine ways to improve elderly population’s relationship to our built environment. In particular, the research utilizes collected data from questionnaire survey and focus group discussions to obtain inputs from various stakeholders, including designers, operators and managers related to public housing, community facilities and overall urban development. In addition to feedbacks from end-users and stakeholders, a thorough analysis on existing elderly housing facilities and Universal Design provisions are examined to evaluate their adequacy. To echo the theme of this conference on Innovation and Sustainable Development, this research examines the effectiveness of innovative design in a risk-benefit factor assessment. To test the hypothesis that innovation can cater for a sustainable development, the research evaluated the health improvement of a sample size of 150 elderly in a period of eight months. Their health performances, including mobility, speech and memory are monitored and recorded on a regular basis to assess if the use of innovation does trigger impact on improving health and home safety for an elderly cohort. This study was supported by district community centers under the auspices of Home Affairs Bureau to provide respondents for questionnaire survey, a standardized evaluation mechanism, and professional health care staff for evaluating the performance impact. The research findings will be integrated to formulate design solutions such as innovative home products to improve elderly daily experience and safety with a particular focus on the enhancement on sight, sound and mobility safety. Some policy recommendations and architectural planning recommendations related to Universal Design will also be incorporated into the research output for future planning of elderly housing and amenity provisions.

Keywords: elderly population, innovative design, sustainable built environment, universal design

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Authors: Md. Nuru Miah, A. F. M. Akhter Uddin

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Medicinal plants are grown naturally in a tropical environment in Bangladesh and used as drug and therapeutic agents in the health care system. According to Bangladesh Agricultural Research Institute (BARI), there are 722 species of medicinal plants in the country. Of them, 255 plants are utilized by the manufacturers of Ayurvedic and Unani medicines. Medicinal plants like Aloevera, Ashwagonda, shotomul,Tulsi, Vuikumra, Misridana are extensively cultivated in some selected areas as well; where Aloevera scored the highest position in production. In the early 1980, Ayurvedic and Unani companies procured 80 percent of medicinal plants from natural forests, and the rest 20 percent was imported. Now the scenario has changed; 80 percent is imported, and the rest 20 percent is collected from local products(Source: Astudy on sectorbased need assessment of Business promotion council-Herbal products and medicinal plants, page-4). Uttara Development Program Society, a leading Non- Government development organization in Bangladesh, has been implementing a value chain development project under promoting Agricultural commercialization and Enterprises of Pally Karma Sahayak Foundation (PKSF) funded by the International Fund for Agricultural Development (IFAD) in Natore Sadar Upazila from April 2017 to sustainably develop the technological interventions for products and market development. The ultimate goal of the project is to increase income, generate employment and develop this sector as a sustainable business enterprise. Altogether 10,000 farmers (Nursery owners, growers, input supplier, processors, whole sellers, and retailers) are engaged in different activities of the project. The entrepreneurs engaged in medicinal plant cultivation did not know and follow environmental and good agricultural practices. They used to adopt traditional methodology in production and processing. Locally the farmers didn’t have any positive initiative to expand their business as well as developvalue added products. A lot of diversified products could be possible to develop and marketed with the introduction of post-harvest processing technology and market linkage with the local and global buyer. Training is imparted to the nursery owners and herbal growers on production technologies, sowing method, use of organic fertilizers/compost/pesticides, harvesting procedures, and storage facilities. Different types of herbal tea like Rosella, Moringa, Tulshi, and Basak are being produced and packed locally with a good scope of its marketing in different cities of the country. The project has been able to achieve a significant impact in the development of production technologies, but still, there is room for further improvement in processing, packaging, and marketing level. The core intervention of the current project to develop some entrepreneurs for branding, packaging, promotion, and marketing while considering environment friendly practices. The present strategies will strengthen the knowledge and skills of the entrepreneurs for the production and marketing of their products, maintaining worldwide accepted compliance system for easy access to the global market.

Keywords: aloe vera, herbs and shrubs, market, interventions

Procedia PDF Downloads 68

Authors: Eli Avraham

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The Arab Spring was widely covered in the global media and the number of Western tourists traveling to the area began to fall. The goal of this study was to analyze which media strategies marketers in Middle Eastern countries chose to employ in their attempts to repair the negative image of the area in the wake of the Arab Spring. Several studies were published concerning image-restoration strategies of destinations during crises around the globe; however, these strategies were not part of an overarching theory, conceptual framework or model from the fields of crisis communication and image repair. The conceptual framework used in the current study was the ‘multi-step model for altering place image’, which offers three types of strategies: source, message and audience. Three research questions were used: 1.What public relations crisis techniques and advertising campaign components were used? 2. What media policies and relationships with the international media were adopted by Arab officials? 3. Which marketing initiatives (such as cultural and sports events) were promoted? This study is based on qualitative content analysis of four types of data: 1) advertising components (slogans, visuals and text); (2) press interviews with Middle Eastern officials and marketers; (3) official media policy adopted by government decision-maker (e.g. boycotting or arresting newspeople); and (4) marketing initiatives (e.g. organizing heritage festivals and cultural events). The data was located in three channels from December 2010, when the events started, to September 31, 2013: (1) Internet and video-sharing websites: YouTube and Middle Eastern countries' national tourism board websites; (2) News reports from two international media outlets, The New York Times and Ha’aretz; these are considered quality newspapers that focus on foreign news and tend to criticize institutions; (3) Global tourism news websites: eTurbo news and ‘Cities and countries branding’. Using the ‘multi-step model for altering place image,’ the analysis reveals that Middle Eastern marketers and officials used three kinds of strategies to repair their countries' negative image: 1. Source (cooperation and media relations; complying, threatening and blocking the media; and finding alternatives to the traditional media) 2. Message (ignoring, limiting, narrowing or reducing the scale of the crisis; acknowledging the negative effect of an event’s coverage and assuring a better future; promotion of multiple facets, exhibitions and softening the ‘hard’ image; hosting spotlight sporting and cultural events; spinning liabilities into assets; geographic dissociation from the Middle East region; ridicule the existing stereotype) and 3. Audience (changing the target audience by addressing others; emphasizing similarities and relevance to specific target audience). It appears that dealing with their image problems will continue to be a challenge for officials and marketers of Middle Eastern countries until the region stabilizes and its regional conflicts are resolved.

Keywords: Arab spring, cultural events, image repair, Middle East, tourism marketing

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Authors: Olia Kanevskaia

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Standardization has been in the limelight of numerous academic studies. Typically described as ‘any set of technical specifications that either provides or is intended to provide a common design for a product or process’, standards do not only set quality benchmarks for products and services, but also spur competition and innovation, resulting in advantages for manufacturers and consumers. Their contribution to globalization and technology advancement is especially crucial in the Information and Communication Technology (ICT) and telecommunications sector, which is also characterized by a weaker state-regulation and expert-based rule-making. Most of the standards developed in that area are interoperability standards, which allow technological devices to establish ‘invisible communications’ and to ensure their compatibility and proper functioning. This type of standard supports a large share of our daily activities, ranging from traffic coordination by traffic lights to the connection to Wi-Fi networks, transmission of data via Bluetooth or USB and building the network architecture for the Internet of Things (IoT). A large share of ICT standards is developed in the specialized voluntary platforms, commonly referred to as Standards Development Organizations (SDOs), which gather experts from various industry sectors, private enterprises, governmental agencies and academia. The institutional architecture of these bodies can vary from semi-public bodies, such as European Telecommunications Standards Institute (ETSI), to industry-driven consortia, such as the Internet Engineering Task Force (IETF). The past decades witnessed a significant shift of standard setting to those institutions: while operating independently from the states regulation, they offer a rather informal setting, which enables fast-paced standardization and places technical supremacy and flexibility of standards above other considerations. Although technical norms and specifications developed by such nongovernmental platforms are not binding, they appear to create significant regulatory impact. In the United States (US), private voluntary standards can be used by regulators to achieve their policy objectives; in the European Union (EU), compliance with harmonized standards developed by voluntary European Standards Organizations (ESOs) can grant a product a free-movement pass. Moreover, standards can de facto manage the functioning of the market when other regulative alternatives are not available. Hence, by establishing (potentially) mandatory norms, SDOs assume regulatory functions commonly exercised by States and shape their own legal order. The purpose of this paper is threefold: First, it attempts to shed some light on SDOs’ institutional architecture, focusing on private, industry-driven platforms and comparing their regulatory frameworks with those of formal organizations. Drawing upon the relevant scholarship, the paper then discusses the extent to which the formulation of technological standards within SDOs constitutes a private legal order, operating in the shadow of governmental regulation. Ultimately, this contribution seeks to advise whether a state-intervention in industry-driven standard setting is desirable, and whether the increasing regulatory importance of SDOs should be addressed in legislation on standardization.

Keywords: private order, standardization, standard-setting organizations, transnational law

Procedia PDF Downloads 145

Authors: Alexander David Natanson

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This paper focuses on the effect of Sanctuary and Immigration and Customs Enforcement (ICE) policies on local economies. "Sanctuary cities" refers to municipal jurisdictions that limit their cooperation with the federal government's efforts to enforce immigration. Using county-level data from the American Community Survey and ICE data on economic indicators from 2006 to 2018, this study isolates the effects of local immigration policies on U.S. counties. The investigation is accomplished by simultaneously studying the policies' effects in counties where immigrants' families are persecuted via collaboration with Immigration and Customs Enforcement (ICE), in contrast to counties that provide protections. The analysis includes a difference-in-difference & two-way fixed effect model. Results are robust to nearest-neighbor matching, after the random assignment of treatment, after running estimations using different cutoffs for immigration policies, and with a regression discontinuity model comparing bordering counties with opposite policies. Results are also robust after restricting the data to a single-year policy adoption, using the Sun and Abraham estimator, and with event-study estimation to deal with the staggered treatment issue. In addition, the study reverses the estimation to understand what drives the decision to choose policies to detect the presence of reverse causality biases in the estimated policy impact on economic factors. The evidence demonstrates that providing protections to undocumented immigrants increases economic activity. The estimates show gains in per capita income ranging from 3.1 to 7.2, median wages between 1.7 to 2.6, and GDP between 2.4 to 4.1 percent. Regarding labor, sanctuary counties saw increases in total employment between 2.3 to 4 percent, and the unemployment rate declined from 12 to 17 percent. The data further shows that ICE policies have no statistically significant effects on income, median wages, or GDP but adverse effects on total employment, with declines from 1 to 2 percent, mostly in rural counties, and an increase in unemployment of around 7 percent in urban counties. In addition, results show a decline in the foreign-born population in ICE counties but no changes in sanctuary counties. The study also finds similar results for sanctuary counties when separating the data between urban, rural, educational attainment, gender, ethnic groups, economic quintiles, and the number of business establishments. The takeaway from this study is that institutional inclusion creates the dynamic nature of an economy, as inclusion allows for economic expansion due to the extension of fundamental freedoms to newcomers. Inclusive policies show positive effects on economic outcomes with no evident increase in population. To make sense of these results, the hypothesis and theoretical model propose that inclusive immigration policies play an essential role in conditioning the effect of immigration by decreasing uncertainties and constraints for immigrants' interaction in their communities, decreasing the cost from fear of deportation or the constant fear of criminalization and optimize their human capital.

Keywords: inclusive and exclusive institutions, post matching, fixed effect, time trend, regression discontinuity, difference-in-difference, randomization inference and sun, Abraham estimator

Procedia PDF Downloads 63

Authors: Shana Malio-Satele, Lemalu Silao Vaisola Sefo

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Introductory Statement: South Seas Healthcare is Ōtara’s largest Pacific health provider in South Auckland, New Zealand. Our vision is excellent health and well-being for Pacific people and all communities through strong Pacific values. During the DELTA and Omicron outbreak of COVID-19, our Pacific people, indigenous Māori, and the community of South Auckland were disproportionately affected and faced significant hardship with existing inequities magnified. This study highlights the community-based learnings of harnessing community-based strengths such as indigenous resilience, family-informed experiences and stories that provide critical insights that inform health reform changes that will be sustainable and equitable for all indigenous populations. This study is based on critical learnings acquired during COVID-19 that challenge the deficit narrative common in healthcare about indigenous populations. This study shares case studies of marginalised groups and religious groups and the successful application of indigenous cultural strengths, such as collectivism, positive protective factors, and using trusted relationships to create meaningful change in the way healthcare is delivered. The significance of this study highlights the critical conditions needed to adopt a community-informed way of creating integrated healthcare that works and the role that the community can play in being part of the solution. Methodologies: Key methodologies utilised are indigenous and Pacific-informed. To achieve critical learnings from the community, Pacific research methodologies, heavily informed by the Polynesian practice, were applied. Specifically, this includes; Teu Le Va (Understanding the importance of trusted relationships as a way of creating positive health solutions); The Fonofale Methodology (A way of understanding how health incorporates culture, family, the physical, spiritual, mental and other dimensions of health, as well as time, context and environment; The Fonua Methodology – Understanding the overall wellbeing and health of communities, families and individuals and their holistic needs and environmental factors and the Talanoa methodology (Researching through conversation, where understanding the individual and community is through understanding their history and future through stories). Major Findings: Key findings in the study included: 1. The collectivist approach in the community is a strengths-based response specific to populations, which highlights the importance of trusted relationships and cultural values to achieve meaningful outcomes. 2. The development of a “village model” which identified critical components to achieving health reform change; system navigation, a sense of service that was culturally responsive, critical leadership roles, culturally appropriate support, and the ability to influence the system enablers to support an alternative way of working. Concluding Statement: There is a strong connection between community-based strengths being implemented into healthcare strategies and reforms and the sustainable success of indigenous populations and marginalised communities accessing services that are cohesive, equitably resourced, accessible and meaningful for families. This study highlights the successful community-informed approaches and practices used during the COVID-19 response in New Zealand that are now being implemented in the current health reform.

Keywords: indigenous voice, community voice, health reform, New Zealand

Procedia PDF Downloads 66

Authors: Vasundhara H. Krishnani, Ajay Saini, Dibesh Karmacharya, Salit Kark

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Illegal Wildlife Trade is one of the most pressing global conservation challenges. Unregulated wildlife trade can threaten biodiversity, contribute to habitat loss, limit sustainable development efforts, and expedite species declines and extinctions. In low-income and middle-income countries, such as Nepal and other countries in Asia and Africa, many of the people engaged in the early stages of illegal wildlife trade, which includes the hunting and transportation of wildlife, belong to Indigenous tribes and local communities.These countries primarily rely on punitive measures to prevent and suppress Illegal Wildlife Trade. For example, in Nepal, people involved in wildlife crimes can often be sentenced to incarceration and a hefty fine and serve up to 15 years in prison. Despite these harsh punitive measures, illegal wildlife trade remains a significant conservation challenge in many countries. The aim of this study was to examine factors affecting the participation of Indigenous communities in Illegal Wildlife Trade while recording the experiences of members of the Indigenous Chepang community, some of whom were imprisoned for their alleged involvement in rhino poaching. Chepangs, belonging to traditionally a hunter-gatherer community, are often considered an isolated and marginalized Indigenous community, some of whom live around the Chitwan National Park in Nepal. Established in 1973, Chitwan National Park is situated in the Chitwan Valley of Nepal and was one of the first regions that was declared as a protected area in Nepal, aiming to protect the one-horned rhinoceros as a flagship species. Conducted over a period of three years, this study used semi-structured interviews and focus group discussions to collect data from Illegal Wildlife Trade offenders, family members of offenders, community Elders, NGO personnel, community forest representatives, Chepang community representatives, and Government school teachers from the region surrounding Chitwan National Park. The study also examined the social, cultural, health, and financial impacts that the imprisonment of offenders had on the families of the community members, especially women and children. The results suggest that involvement of the members of the Chepang community living around Chitwan National Park in the poaching of the one-horned rhinoceros (Rhinoceros unicornis) can be attributed to a range of factors, some of which include: lack of livelihood opportunities, lack of awareness regarding wildlife rules and regulations and poverty.This work emphasises the need for raising awareness and building programs to enhance alternative livelihood training and empower indigenous and marginalised communities that provide sustainable alternatives. Furthermore, the issue needs to be addressed as a community solution which includes all community members. We suggest this multi-pronged approach can benefit wildlife conservation by reducing illegal poaching and wildlife trade, as well as community conservation in regions with similar challenges. By actively involving and empowering local communities, the communities become key stakeholders in the conservation process. This involvement contributes to protecting wildlife and natural ecosystems while simultaneously providing sustainable livelihood options for local communities.

Keywords: alternative livelihoods, chepang community, illegal wildlife trade, low-and middle-income countries, nepal, one-horned rhinoceros

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Authors: Abha Gupta, Deepak K. Mishra

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The focus of food security studies in India has been on the adequacy of calories and its linkage with poverty level. India currently being undergoing a massive demographic and epidemiological transition has demonstrated a decline in average physical activity with improved mechanization and urbanization. Food consumption pattern is also changing with decreasing intake of coarse cereals and a marginal increase in the consumption of fruits, vegetables and meat products resulting into a nutrition transition in the country. However, deficiency of essential micronutrients such as vitamins and minerals is rampant despite their growing importance in fighting back with lifestyle and other modern diseases. The calorie driven studies can hardly tackle the complex problem of malnutrition. This paper fills these research lacuna and analyses mean intake of different major and micro-nutrients among different socio-economic groups and adequacy of these nutrients from recommended dietary allowance. For the purpose, a cross-sectional survey covering 304 households selected through proportional stratified random sampling was conducted in six villages of Aligarh district of the state of Uttar Pradesh, India. Data on quantity consumed of 74 food items grouped into 10 food categories with a recall period of seven days was collected from the households and converted into energy, protein, fat, carbohydrate, calcium, iron, thiamine, riboflavin, niacin and vitamin C using standard guidelines of National Institute of Nutrition. These converted nutrients were compared with recommended norms given by National Nutrition Monitoring Bureau. Per capita nutrient adequacy was calculated by dividing mean nutrient intake by the household size and then by comparing it with recommended norm. Findings demonstrate that source of both macro and micro-nutrients are mainly cereals followed by milk, edible oil and sugar items. Share of meat in providing essential nutrients is very low due to vegetarian diet. Vegetables, pulses, nuts, fruits and dry fruits are a poor source for most of the nutrients. Further analysis evinces that intake of most of the nutrients is higher than the recommended norm. Riboflavin is the only vitamin whose intake is less than the standard norm. Poor group, labour, small farmers, Muslims, scheduled caste demonstrate comparatively lower intake of all nutrients than their counterpart groups, though, they get enough macro and micro-nutrients significantly higher than the norm. One of the major reasons for higher intake of most of the nutrients across all socio-economic groups is higher consumption of monotonous diet based on cereals and milk. Most of the nutrients get their major share from cereals particularly wheat and milk intake. It can be concluded from the analysis that although there is adequate intake of most of the nutrients in the diet of rural population yet their source is mainly cereals and milk products depicting a monotonous diet. Hence, more efforts are needed to diversify the diet by giving more focus to the production of other food items particularly fruits, vegetables and pulse products. Awareness among the population, more accessibility and incorporating food items other than cereals in government social safety programmes are other measures to improve food security in India.

Keywords: hidden hunger, India, nutrients, recommended norm

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Authors: Hari K. Adhikari, Keshab Sharma, K. C. Apil

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The Gorkha Nepal earthquake of moment magnitude (Mw) 7.8 hit the central region of Nepal on April 25, 2015; with the epicenter about 77 km northwest of Kathmandu Valley. This paper aims to explore challenges of reconstruction in the rural earthquake-stricken areas of Nepal. The Gorkha earthquake on April 25, 2015, has significantly affected the livelihood of people and overall economy in Nepal, causing severe damage and destruction in central Nepal including nation’s capital. A larger part of the earthquake affected area is difficult to access with rugged terrain and scattered settlements, which posed unique challenges and efforts on a massive scale reconstruction and rehabilitation. 800 thousand buildings were affected leaving 8 million people homeless. Challenge of reconstruction of optimum 800 thousand houses is arduous for Nepal in the background of its turmoil political scenario and weak governance. With significant actors involved in the reconstruction process, no appreciable relief has reached to the ground, which is reflected over the frustration of affected people. The 2015 Gorkha earthquake is one of most devastating disasters in the modern history of Nepal. Best of our knowledge, there is no comprehensive study on reconstruction after disasters in modern Nepal, which integrates the necessary information to deal with challenges and opportunities of reconstructions. The study was conducted using qualitative content analysis method. Thirty engineers and ten social mobilizes working for reconstruction and more than hundreds local social workers, local party leaders, and earthquake victims were selected arbitrarily. Information was collected through semi-structured interviews and open-ended questions, focus group discussions, and field notes, with no previous assumption. Author also reviewed literature and document reviews covering academic and practitioner studies on challenges of reconstruction after earthquake in developing countries such as 2001 Gujarat earthquake, 2005 Kashmir earthquake, 2003 Bam earthquake and 2010 Haiti earthquake; which have very similar building typologies, economic, political, geographical, and geological conditions with Nepal. Secondary data was collected from reports, action plans, and reflection papers of governmental entities, non-governmental organizations, private sector businesses, and the online news. This study concludes that inaccessibility, absence of local government, weak governance, weak infrastructures, lack of preparedness, knowledge gap and manpower shortage, etc. are the key challenges of the reconstruction after 2015 earthquake in Nepal. After scrutinizing different challenges and issues, study counsels that good governance, integrated information, addressing technical issues, public participation along with short term and long term strategies to tackle with technical issues are some crucial factors for timely and quality reconstruction in context of Nepal. Sample collected for this study is relatively small sample size and may not be fully representative of the stakeholders involved in reconstruction. However, the key findings of this study are ones that need to be recognized by academics, governments, and implementation agencies, and considered in the implementation of post-disaster reconstruction program in developing countries.

Keywords: Gorkha earthquake, reconstruction, challenges, policy

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Authors: Joel Niklaus, Matthias Sturmer

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The publication of judicial proceedings is a cornerstone of many democracies. It enables the court system to be made accountable by ensuring that justice is made in accordance with the laws. Equally important is privacy, as a fundamental human right (Article 12 in the Declaration of Human Rights). Therefore, it is important that the parties (especially minors, victims, or witnesses) involved in these court decisions be anonymized securely. Today, the anonymization of court decisions in Switzerland is performed either manually or semi-automatically using primitive software. While much research has been conducted on anonymization for tabular data, the literature on anonymization for unstructured text documents is thin and virtually non-existent for court decisions. In 2019, it has been shown that manual anonymization is not secure enough. In 21 of 25 attempted Swiss federal court decisions related to pharmaceutical companies, pharmaceuticals, and legal parties involved could be manually re-identified. This was achieved by linking the decisions with external databases using regular expressions. An automated re-identification system serves as an automated test for the safety of existing anonymizations and thus promotes the right to privacy. Manual anonymization is very expensive (recurring annual costs of over CHF 20M in Switzerland alone, according to an estimation). Consequently, many Swiss courts only publish a fraction of their decisions. An automated anonymization system reduces these costs substantially, further leading to more capacity for publishing court decisions much more comprehensively. For the re-identification system, topic modeling with latent dirichlet allocation is used to cluster an amount of over 500K Swiss court decisions into meaningful related categories. A comprehensive knowledge base with publicly available data (such as social media, newspapers, government documents, geographical information systems, business registers, online address books, obituary portal, web archive, etc.) is constructed to serve as an information hub for re-identifications. For the actual re-identification, a general-purpose language model is fine-tuned on the respective part of the knowledge base for each category of court decisions separately. The input to the model is the court decision to be re-identified, and the output is a probability distribution over named entities constituting possible re-identifications. For the anonymization system, named entity recognition (NER) is used to recognize the tokens that need to be anonymized. Since the focus lies on Swiss court decisions in German, a corpus for Swiss legal texts will be built for training the NER model. The recognized named entities are replaced by the category determined by the NER model and an identifier to preserve context. This work is part of an ongoing research project conducted by an interdisciplinary research consortium. Both a legal analysis and the implementation of the proposed system design ESRA will be performed within the next three years. This study introduces the system design of ESRA, an end-to-end system for re-identification and anonymization of Swiss court decisions. Firstly, the re-identification system tests the safety of existing anonymizations and thus promotes privacy. Secondly, the anonymization system substantially reduces the costs of manual anonymization of court decisions and thus introduces a more comprehensive publication practice.

Keywords: artificial intelligence, courts, legal tech, named entity recognition, natural language processing, ·privacy, topic modeling

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Authors: Bensaid A., Mostephaoui T., Nedjai R.

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Nowadays, wetlands are the subject of contradictory debates opposing scientific, political and administrative meanings. Indeed, given their multiple services (drinking water, irrigation, hydrological regulation, mineral, plant and animal resources...), wetlands concentrate many socio-economic and biodiversity issues. In some regions, they can cover vast areas (>100 thousand ha) of the landscape, such as the Camargue area in the south of France, inside the Rhone delta. The high biological productivity of wetlands, the strong natural selection pressures and the diversity of aquatic environments have produced many species of plants and animals that are found nowhere else. These environments are tremendous carbon sinks and biodiversity reserves depending on their age, composition and surrounding environmental conditions, wetlands play an important role in global climate projections. Covering more than 3% of the earth's surface, wetlands have experienced since the beginning of the 1990s a tremendous revival of interest, which has resulted in the multiplication of inventories, scientific studies and management experiments. The geographical and physical characteristics of the wetlands of the central region conceal a large number of natural habitats that harbour a great biological diversity. These wetlands, one of the natural habitats, are still influenced by human activities, especially agriculture, which affects its layout and functioning. In this perspective, decision-makers need to delimit spatial objects (natural habitats) in a certain way to be able to take action. Thus, wetlands are no exception to this rule even if it seems to be a difficult exercise to delimit a type of environment as whose main characteristic is often to occupy the transition between aquatic and terrestrial environment. However, it is possible to map wetlands with databases, derived from the interpretation of photos and satellite images, such as the European database Corine Land cover, which allows quantifying and characterizing for each place the characteristic wetland types. Scientific studies have shown limitations when using high spatial resolution images (SPOT, Landsat, ASTER) for the identification and characterization of small wetlands (1 hectare). To address this limitation, it is important to note that these wetlands generally represent spatially complex features. Indeed, the use of very high spatial resolution images (>3m) is necessary to map small and large areas. However, with the recent evolution of artificial intelligence (AI) and deep learning methods for satellite image processing have shown a much better performance compared to traditional processing based only on pixel structures. Our research work is also based on spectral and textural analysis on THR images (Spot and IRC orthoimage) using two object-oriented approaches, the nearest neighbour approach (k-NN) and the Super Vector Machine approach (SVM). The k-NN approach gave good results for the delineation of wetlands (wet marshes and moors, ponds, artificial wetlands water body edges, ponds, mountain wetlands, river edges and brackish marshes) with a kappa index higher than 85%.

Keywords: land development, GIS, sand dunes, segmentation, remote sensing

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Authors: Abdullah Nurus Salam Khan, Farhana Karim, Mohiuddin Ahsanul Kabir Chowdhury, S. Masum Billah, Nabila Zaka, Alexander Manu, Shams El Arifeen

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Globally, pre-eclampsia (PE) and ante-partum haemorrhage (APH) are two major causes of maternal mortality. Prompt identification and management of these conditions depend on competency of the birth attendants. Since these conditions are infrequent to be observed, clinical vignette based assessment could identify the extent of health worker’s competence in managing emergency obstetric care (EmOC). During June-August 2016, competence of 39 medical officers (MO) and 95 nurses working in obstetric ward of 15 government health facilities (3 district hospital, 12 sub-district hospital) was measured using clinical vignettes on PE and APH. The vignettes resulted in three outcome measures: total vignette scores, scores for diagnosis component, and scores for management component. T-test was conducted to compare mean vignette scores and linear regression was conducted to measure the strength and association of vignette scores with different cadres of health workers, facility’s readiness for EmOC and average annual utilization of normal deliveries after adjusting for type of health facility, health workers’ work experience, training status on managing maternal complication. For each of the seven component of EmOC items (administration of injectable antibiotics, oxytocic and anticonvulsant; manual removal of retained placenta, retained products of conception; blood transfusion and caesarean delivery), if any was practised in the facility within last 6 months, a point was added and cumulative EmOC readiness score (range: 0-7) was generated for each facility. The yearly utilization of delivery cases were identified by taking the average of all normal deliveries conducted during three years (2013-2015) preceding the survey. About 31% of MO and all nurses were female. Mean ( ± sd) age of the nurses were higher than the MO (40.0 ± 6.9 vs. 32.2 ± 6.1 years) and also longer mean( ± sd) working experience (8.9 ± 7.9 vs. 1.9 ± 3.9 years). About 80% health workers received any training on managing maternal complication, however, only 7% received any refresher’s training within last 12 months. The overall vignette score was 8.8 (range: 0-19), which was significantly higher among MO than nurses (10.7 vs. 8.1, p < 0.001) and the score was not associated with health facility types, training status and years of experience of the providers. Vignette score for management component (range: 0-9) increased with higher annual average number of deliveries in their respective working facility (adjusted β-coefficient 0.16, CI 0.03-0.28, p=0.01) and increased with each unit increase in EmOC readiness score (adjusted β-coefficient 0.44, CI 0.04-0.8, p=0.03). The diagnosis component of vignette score was not associated with any of the factors except it was higher among the MO than the nurses (adjusted β-coefficient 1.2, CI 0.13-2.18, p=0.03). Lack of competence in diagnosing and managing obstetric complication by the nurses than the MO is of concern especially when majority of normal deliveries are conducted by the nurses. Better EmOC preparedness of the facility and higher utilization of normal deliveries resulted in higher vignette score for the management component; implying the impact of experiential learning through higher case management. Focus should be given on improving the facility readiness for EmOC and providing the health workers periodic refresher’s training to make them more competent in managing obstetric cases.

Keywords: Bangladesh, emergency obstetric care, clinical vignette, competence of health workers

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Authors: Richard McGregor, Carmen Reaiche, Stephen Boyle

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Cyber threats are a relatively recent phenomenon and offer cyber insurers a dynamic and intelligent peril. As individuals en mass become increasingly digitally dependent, Personal Cyber Insurance (PCI) offers an attractive option to mitigate cyber risk at a personal level. This abstract proposes a literature review that conceptualises a framework for siting Personal Cyber Insurance (PCI) within the context of cyberspace. The lack of empirical research within this domain demonstrates an immediate need to define the scope of PCI to allow cyber insurers to understand personal cyber risk threats and vectors, customer awareness, capabilities, and their associated needs. Additionally, this will allow cyber insurers to conceptualise appropriate frameworks allowing effective management and distribution of PCI products and services within a landscape often in-congruent with risk attributes commonly associated with traditional personal line insurance products. Cyberspace has provided significant improvement to the quality of social connectivity and productivity during past decades and allowed enormous capability uplift of information sharing and communication between people and communities. Conversely, personal digital dependency furnish ample opportunities for adverse cyber events such as data breaches and cyber-attacksthus introducing a continuous and insidious threat of omnipresent cyber risk–particularly since the advent of the COVID-19 pandemic and wide-spread adoption of ‘work-from-home’ practices. Recognition of escalating inter-dependencies, vulnerabilities and inadequate personal cyber behaviours have prompted efforts by businesses and individuals alike to investigate strategies and tactics to mitigate cyber risk – of which cyber insurance is a viable, cost-effective option. It is argued that, ceteris parabus, the nature of cyberspace intrinsically provides characteristic peculiarities that pose significant and bespoke challenges to cyber insurers, often in-congruent with risk attributes commonly associated with traditional personal line insurance products. These challenges include (inter alia) a paucity of historical claim/loss data for underwriting and pricing purposes, interdependencies of cyber architecture promoting high correlation of cyber risk, difficulties in evaluating cyber risk, intangibility of risk assets (such as data, reputation), lack of standardisation across the industry, high and undetermined tail risks, and moral hazard among others. This study proposes a thematic overview of the literature deemed necessary to conceptualise the challenges to issuing personal cyber coverage. There is an evident absence of empirical research appertaining to PCI and the design of operational business models for this business domain, especially qualitative initiatives that (1) attempt to define the scope of the peril, (2) secure an understanding of the needs of both cyber insurer and customer, and (3) to identify elements pivotal to effective management and profitable distribution of PCI - leading to an argument proposed by the author that postulates that the traditional general insurance customer journey and business model are ill-suited for the lineaments of cyberspace. The findings of the review confirm significant gaps in contemporary research within the domain of personal cyber insurance.

Keywords: cyberspace, personal cyber risk, personal cyber insurance, customer journey, business model

Procedia PDF Downloads 81

Authors: Mary T. McKinley

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As socio-economic globalization impacts education and turns knowledge into a commodity, institutions of higher education are becoming more intentional about infusing a global and intercultural perspective into education via the recruitment of international students. Coming from dissimilar cultures, many of these students are evaluated and held accountable to Euro-American values of independence, self-reliance, and autonomy. Not surprisingly, these students often experience culture shock with deleterious effects on their mental health and academic functioning. Thus, it is critical to understand the experiences of international students with the hope that such knowledge will keep the field of psychology from promulgating Eurocentric ideals and values and prevent the training of these students as good-enough White therapists. Using a critical narrative inquiry framework, this study elicits stories about the challenges encountered by international students as they navigate their clinical training in the presence of acculturative stress and potentially different worldviews. With its emphasis on story-telling as meaning making, narrative research design is hinged on the assumption that people are interpretive beings who make meaning of themselves and their world through the language of stories. Also, dominant socially-constructed narratives play a central role in creating and maintaining hegemonic structures that privilege certain individuals and ideologies at the expense of others. On this premise, narrative inquiry begins with an exploration of the experiences of participants in their lived stories. Bounded narrative segments were read, interpreted, and analyzed using a critical events approach. Throughout the process, issues of reliability and researcher bias were addressed by keeping a reflective analytic memo, as well as triangulating the data using peer-reviewers and check-ins with participants. The findings situate culture at the epicenter of international students’ acculturation challenges as well as their resiliency in psychology doctoral programs. It was not uncommon for these international students to experience ethical dilemmas inherent in learning content that conflicted with their cultural beliefs and values. Issues of cultural incongruence appear to be further exacerbated by visible markers for differences like speech accent and clothing attire. These stories also link the acculturative stress reported by international students to the experiences of perceived racial discrimination and lack of support from the faculty, administration, peers, and the society at large. Beyond the impact on the international students themselves, there are implications for internationalization in psychology with the goal of equipping doctoral programs to be better prepared to meet the needs of their international students. More than ever before, programs need to liaise with international students’ services and work in tandem to meet the unique needs of this population of students. Also, there exists a need for multiculturally competent supervisors working with international students with varying degrees of acculturation. In addition to making social justice and advocacy salient in students’ multicultural training, it may be helpful for psychology doctoral programs to be more intentional about infusing cross-cultural theories, indigenous psychotherapies, and/or when practical, the possibility for geographically cross-cultural practicum experiences in the home countries of international students while taking into consideration the ethical issues for virtual supervision.

Keywords: decolonizing pedagogies, international students, multiculturalism, psychology doctoral programs

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Authors: Nervana Elbakary, Sami Ouanes, Sadaf Riaz, Oraib Abdallah, Islam Mahran, Noriya Al-Khuzaei, Yassin Eltorki

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Major Depressive Disorder (MDD) requires therapeutic interventions during the initial month after being diagnosed for better disease outcomes. International guidelines recommend a duration of 4–12 weeks for an initial antidepressant (IAD) trial at an optimized dose to get a response. If depressive symptoms persist after this duration, guidelines recommend switching, augmenting, or combining strategies as the next step. Most patients with MDD in the mental health setting have been labeled incorrectly as treatment-resistant where in fact they have not been subjected to an adequate trial of guideline-recommended therapy. Premature discontinuation of IAD due to ineffectiveness can cause unfavorable consequences. Avoiding irrational practices such as subtherapeutic doses of IAD, premature switching between the ADs, and refraining from unjustified polypharmacy can help the disease to go into a remission phase We aimed to determine the prevalence and the patterns of strategies applied after an IAD was changed because of a suboptimal response as a primary outcome. Secondary outcomes included the median survival time on IAD before any change; and the predictors that were associated with IAD change. This was a retrospective cross- sectional study conducted in Mental Health Services in Qatar. A dataset between January 1, 2018, and December 31, 2019, was extracted from the electronic health records. Inclusion and exclusion criteria were defined and applied. The sample size was calculated to be at least 379 patients. Descriptive statistics were reported as frequencies and percentages, in addition, to mean and standard deviation. The median time of IAD to any change strategy was calculated using survival analysis. Associated predictors were examined using two unadjusted and adjusted cox regression models. A total of 487 patients met the inclusion criteria of the study. The average age for participants was 39.1 ± 12.3 years. Patients with first experience MDD episode 255 (52%) constituted a major part of our sample comparing to the relapse group 206(42%). About 431 (88%) of the patients had an occurrence of IAD change to any strategy before end of the study. Almost half of the sample (212 (49%); 95% CI [44–53%]) had their IAD changed less than or equal to 30 days. Switching was consistently more common than combination or augmentation at any timepoint. The median time to IAD change was 43 days with 95% CI [33.2–52.7]. Five independent variables (age, bothersome side effects, un-optimization of the dose before any change, comorbid anxiety, first onset episode) were significantly associated with the likelihood of IAD change in the unadjusted analysis. The factors statistically associated with higher hazard of IAD change in the adjusted analysis were: younger age, un-optimization of the IAD dose before any change, and comorbid anxiety. Because almost half of the patients in this study changed their IAD as early as within the first month, efforts to avoid treatment failure are needed to ensure patient-treatment targets are met. The findings of this study can have direct clinical guidance for health care professionals since an optimized, evidence-based use of AD medication can improve the clinical outcomes of patients with MDD; and also, to identify high-risk factors that could worsen the survival time on IAD such as young age and comorbid anxiety

Keywords: initial antidepressant, dose optimization, major depressive disorder, comorbid anxiety, combination, augmentation, switching, premature discontinuation

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Authors: Roland F. Karthaus, Rachel S. O'Brien

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Over the past decade, the authors have undertaken applied research aimed at enabling transformation within the prison service to improve conditions and outcomes for those living, working and visiting in prisons in the UK and the communities they serve. The research has taken place against a context of reducing resources and public discontent at increasing levels of violence, deteriorating conditions and persistently high levels of re-offending. Top-down governmental policies have mainly been ineffectual and in some cases counter-productive. The prison service is characterised by hierarchical organisation, and the research has applied design thinking at multiple levels to challenge and precipitate change: top-down, middle-out and bottom-up. The research employs three distinct but related approaches, system design (top-down): working at the national policy level to analyse the changing policy context, identifying opportunities and challenges; engaging with the Ministry of Justice commissioners and sector organisations to facilitate debate, introducing new evidence and provoking creative thinking, place-based design (middle-out): working with individual prison establishments as pilots to illustrate and test the potential for local empowerment, creative change, and improved architecture within place-specific contexts and organisational hierarchies, everyday design (bottom-up): working with individuals in the system to explore the potential for localised, significant, demonstrator changes; including collaborative design, capacity building and empowerment in skills, employment, communication, training, and other activities. The research spans a series of projects, through which the methodological approach has developed responsively. The projects include a place-based model for the re-purposing of Ministry of Justice land assets for the purposes of rehabilitation; an evidence-based guide to improve prison design for health and well-being; capacity-based employment, skills and self-build project as a template for future open prisons. The overarching research has enabled knowledge to be developed and disseminated through policy and academic networks. Whilst the research remains live and continuing; key findings are emerging as a basis for a new methodological approach to effecting change in the UK prison service. An interdisciplinary approach is necessary to overcome the barriers between distinct areas of the prison service. Sometimes referred to as total environments, prisons encompass entire social and physical environments which themselves are orchestrated by institutional arms of government, resulting in complex systems that cannot be meaningfully engaged through narrow disciplinary lenses. A scalar approach is necessary to connect strategic policies with individual experiences and potential, through the medium of individual prison establishments, operating as discrete entities within the system. A reflexive process is necessary to connect research with action in a responsive mode, learning to adapt as the system itself is changing. The role of individuals in the system, their latent knowledge and experience and their ability to engage and become agents of change are essential. Whilst the specific characteristics of the UK prison system are unique, the approach is internationally applicable.

Keywords: architecture, design, policy, prison, system, transformation

Procedia PDF Downloads 116