Search results for: service failure recovery

Authors: Atucungwiire Rwebiita

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Introduction: In Uganda, provision of adolescent sexual reproductive health and rights (SRHR) services for key population is still hindered by negative attitudes, stigma and discrimination (S&D) at both the community and facility levels. To address this barrier, Integrated Community Based Initiatives (ICOBI) with support from SIDA is currently implementing a quality improvement (QI) innovative approach for strengthening the capacity of key population (KP) peer leaders and health workers to deliver friendly SRHR services without S&D. Methods: Our innovative approach involves continuous mentorship and coaching of 8 QI teams at 8 health facilities and their catchment areas. Each of the 8 teams (comprised of 5 health workers and 5 KP peer leaders) are facilitated twice a month by two QI Mentors in a 2-hour mentorship session over a period of 4 months. The QI mentors were provided a 2-weeks training on QI approaches for reducing S&D against young key populations in the delivery of SRHR Services. The mentorship sessions are guided by a manual where teams base to analyse root causes of S&D and develop key performance indicators (KPIs) in the 1st and 2nd second sessions respectively. The teams then develop action plans in the 3rd session and review implementation progress on KPIs at the end of subsequent sessions. The KPIs capture information on the attitude of health workers and peer leaders and the general service delivery setting as well as clients’ experience. A dashboard is developed to routinely track the KPIs for S&D across all the supported health facilities and catchment areas. After 4 months, QI teams share documented QI best practices and tested change packages on S&D in a learning and exchange session involving all the teams. Findings: The implementation of this approach is showing positive results. So far, QI teams have already identified the root causes of S&D against key populations including: poor information among health workers, fear of a perceived risk of infection, perceived links between HIV and disreputable behaviour. Others are perceptions that HIV & STIs are divine punishment, sex work and homosexuality are against religion and cultural values. They have also noted the perception that MSM are mentally sick and a danger to everyone. Eight QI teams have developed action plans to address the root causes of S&D. Conclusion: This approach is promising, offers a novel and scalable means to implement stigma-reduction interventions in facility and community settings.

Keywords: key populations, sexual reproductive health and rights, stigma and discrimination , quality improvement approach

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Authors: Dangut Maren David, Skaf Zakwan

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Adequate monitoring of vehicle component in other to obtain high uptime is the goal of predictive maintenance, the major challenge faced by businesses in industries is the significant cost associated with a delay in service delivery due to system downtime. Most of those businesses are interested in predicting those problems and proactively prevent them in advance before it occurs, which is the core advantage of Prognostic Health Management (PHM) application. The recent emergence of industry 4.0 or industrial internet of things (IIoT) has led to the need for monitoring systems activities and enhancing system-to-system or component-to- component interactions, this has resulted to a large generation of data known as big data. Analysis of big data represents an increasingly important, however, due to complexity inherently in the dataset such as imbalance classification problems, it becomes extremely difficult to build a model with accurate high precision. Data-driven predictive modeling for condition-based maintenance (CBM) has recently drowned research interest with growing attention to both academics and industries. The large data generated from industrial process inherently comes with a different degree of complexity which posed a challenge for analytics. Thus, imbalance classification problem exists perversely in industrial datasets which can affect the performance of learning algorithms yielding to poor classifier accuracy in model development. Misclassification of faults can result in unplanned breakdown leading economic loss. In this paper, an advanced approach for handling imbalance classification problem is proposed and then a prognostic model for predicting aircraft component replacement is developed to predict component replacement in advanced by exploring aircraft historical data, the approached is based on hybrid ensemble-based method which improves the prediction of the minority class during learning, we also investigate the impact of our approach on multiclass imbalance problem. We validate the feasibility and effectiveness in terms of the performance of our approach using real-world aircraft operation and maintenance datasets, which spans over 7 years. Our approach shows better performance compared to other similar approaches. We also validate our approach strength for handling multiclass imbalanced dataset, our results also show good performance compared to other based classifiers.

Keywords: prognostics, data-driven, imbalance classification, deep learning

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Authors: S. Cheng, C. Catallo

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Introduction: Canada's healthcare and social services systems are failing high risk, vulnerable older adults. Care for vulnerable older Canadians (65 and older) is not optimal in Canada. It does not address the care needs of vulnerable, high risk adults using a holistic approach. Given the growing aging population, and the care needs for seniors with complex conditions is one of the highest in Canada's health care system, there is a sense of urgency to optimize care. Integration of health and social services is an emerging trend in Canada when compared to European countries. There is no common and universal understanding of healthcare and social services integration within the country. Consequently, a clear understanding and definition of integrated health and social services are absent in Canada. Objectives: A study was undertaken to develop a case definition for integrated health and social care initiatives that serve older adults, which was then tested against three Canadian integrated initiatives. Methodology: A limited literature review was undertaken to identify common characteristics of integrated health and social care initiatives that serve older adults, and comprised both scientific and grey literature, in order to develop a case definition. Three Canadian integrated initiatives that are located in the province of Ontario, were identified using an online search and a screening process. They were surveyed to determine if the literature-based integration definition applied to them. Results: The literature showed that there were 24 common healthcare and social services integration characteristics that could be categorized into ten themes: 1) patient-care approach; 2) program goals; 3) measurement; 4) service and care quality; 5) accountability and responsibility; 6) information sharing; 7) Decision-making and problem-solving; 8) culture; 9) leadership; and 10) staff and professional interaction. The three initiatives showed agreement on all the integration characteristics except for those characteristics associated with healthcare and social care professional interaction, collaborative leadership and shared culture. This disagreement may be due to several reasons, including the existing governance divide between the healthcare and social services sectors within the province of Ontario that has created a ripple effect in how professions in the two different sectors interact. In addition, the three initiatives may be at maturing levels of integration, which may explain disagreement on the characteristics associated with leadership and culture. Conclusions: The development of a case definition for healthcare and social services integration that incorporates common integration characteristics can act as a useful instrument in identifying integrated healthcare and social services, particularly given the emerging and evolutionary state of this phenomenon within Canada.

Keywords: Canada, case definition, healthcare and social services integration, integration, seniors health, services delivery

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Authors: Sthanu Mahadev, Wen Chan, Melanie Lim

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Anisotropy dominated continuous-fiber composite materials have garnered attention in numerous mechanical and aerospace structural applications. Tailored mechanical properties in advanced composites can exhibit superiority in terms of stiffness-to-weight ratio, strength-to-weight ratio, low-density characteristics, coupled with significant improvements in fatigue resistance as opposed to metal structure counterparts. Extensive research has demonstrated their core potential as more than just mere lightweight substitutes to conventional materials. Prior work done by Mahadev and Chan focused on formulating a modified composite shell theory based prognosis methodology for investigating the structural response of thin-walled circular cylindrical shell type composite configurations under in-plane mechanical loads respectively. The prime motivation to develop this theory stemmed from its capability to generate simple yet accurate closed-form analytical results that can efficiently characterize circular composite shell construction. It showcased the development of a novel mathematical framework to analytically identify the location of the centroid for thin-walled, open cross-section, curved composite shells that were characterized by circumferential arc angle, thickness-to-mean radius ratio, and total laminate thickness. Ply stress variations for curved cylindrical shells were analytically examined under the application of centric tensile and bending loading. This work presents a cost-effective, small-platform experimental methodology by taking advantage of the full-field measurement capability of digital image correlation (DIC) for an accurate assessment of key mechanical parameters such as in-plane mechanical stresses and strains, centroid location etc. Mechanical property measurement of advanced composite materials can become challenging due to their anisotropy and complex failure mechanisms. Full-field displacement measurements are well suited for characterizing the mechanical properties of composite materials because of the complexity of their deformation. This work encompasses the fabrication of a set of curved cylindrical shell coupons, the design and development of a novel test-fixture design and an innovative experimental methodology that demonstrates the capability to very accurately predict the location of centroid in such curved composite cylindrical strips via employing a DIC based strain measurement technique. Error percentage difference between experimental centroid measurements and previously estimated analytical centroid results are observed to be in good agreement. The developed analytical modified-shell theory provides the capability to understand the fundamental behavior of thin-walled cylindrical shells and offers the potential to generate novel avenues to understand the physics of such structures at a laminate level.

Keywords: anisotropy, composites, curved cylindrical shells, digital image correlation

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Authors: Noriyuki Suyama

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This paper discusses purchasing behavior in retail stores, with a particular focus on the impact of weather changes on customers' purchasing behavior. Weather conditions are one of the factors that greatly affect the management and operation of retail stores. However, there is very little research on the relationship between weather conditions and marketing from an academic perspective, although there is some importance from a practical standpoint and knowledge based on experience. For example, customers are more hesitant to go out when it rains than when it is sunny, and they may postpone purchases or buy only the minimum necessary items even if they do go out. It is not difficult to imagine that weather has a significant impact on consumer behavior. To the best of the authors' knowledge, there have been only a few studies that have delved into the purchasing behavior of individual customers. According to Hirata (2018), the economic impact of weather in the United States is estimated to be 3.4% of GDP, or "$485 billion ± $240 billion per year. However, weather data is not yet fully utilized. Representative industries include transportation-related industries (e.g., airlines, shipping, roads, railroads), leisure-related industries (e.g., leisure facilities, event organizers), energy and infrastructure-related industries (e.g., construction, factories, electricity and gas), agriculture-related industries (e.g., agricultural organizations, producers), and retail-related industries (e.g., retail, food service, convenience stores, etc.). This paper focuses on the retail industry and advances research on weather. The first reason is that, as far as the author has investigated the retail industry, only grocery retailers use temperature, rainfall, wind, weather, and humidity as parameters for their products, and there are very few examples of academic use in other retail industries. Second, according to NBL's "Toward Data Utilization Starting from Consumer Contact Points in the Retail Industry," labor productivity in the retail industry is very low compared to other industries. According to Hirata (2018) mentioned above, improving labor productivity in the retail industry is recognized as a major challenge. On the other hand, according to the "Survey and Research on Measurement Methods for Information Distribution and Accumulation (2013)" by the Ministry of Internal Affairs and Communications, the amount of data accumulated by each industry is extremely large in the retail industry, so new applications are expected by analyzing these data together with weather data. Third, there is currently a wealth of weather-related information available. There are, for example, companies such as WeatherNews, Inc. that make weather information their business and not only disseminate weather information but also disseminate information that supports businesses in various industries. Despite the wide range of influences that weather has on business, the impact of weather has not been a subject of research in the retail industry, where business models need to be imagined, especially from a micro perspective. In this paper, the author discuss the important aspects of the impact of weather on marketing strategies in the non-food retail industry.

Keywords: consumer behavior, weather marketing, marketing science, big data, retail marketing

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Authors: Noor Hasmini Abd Ghani

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Brand resonance is among of new focused strategy that getting more attention in nowadays by larger companies for their long-term market survival. The brand resonance emphasizing of two main characteristics that are intensity and activity able to generate psychology bond and enduring relationship between a brand and consumer. This strong attachment relationship has represented brand resonance with the concept of consumer brand relationship (CBR) that exhibit competitive advantage for long-term market survival. The main consideration toward this brand resonance approach is not only in the context of larger companies but also can be adapted in Small and Medium Enterprises (SMEs) as well. The SMEs have been recognized as vital pillar to the world economy in both developed and emergence countries are undeniable due to their economic growth contributions, such as opportunity for employment, wealth creation, and poverty reduction. In particular, the facts that SMEs in Malaysia are pivotal to the well-being of the Malaysian economy and society are clearly justified, where the SMEs competent in provided jobs to 66% of the workforce and contributed 40% to the GDP. As regards to it several sectors, the SMEs service category that covers the Food & Beverage (F&B) sector is one of the high-potential industries in Malaysia. For that reasons, SMEs strong brand or brand equity is vital to be developed for their long-term market survival. However, there’s still less appropriate strategies in develop their brand equity. The difficulties have never been so evident until Covid-19 swept across the globe from 2020. Since the pandemic began, more than 150,000 SMEs in Malaysia have shut down, leaving more than 1.2 million people jobless. Otherwise, as the SMEs are the pillar of any economy for the countries in the world, and with negative effect of COVID-19 toward their economic growth, thus, their protection has become important more than ever. Therefore, focusing on strategy that able to develop SMEs strong brand is compulsory. Hence, this is where the strategy of brand resonance is introduced in this study. Mainly, this study aims to investigate the impact of CBR as a predictor and mediator in the context of social media marketing (SMM) activities toward SMEs e-brand equity (or strong brand) building. The study employed the quantitative research design concerning on electronic survey method with the valid response rate of 300 respondents. Interestingly, the result revealed the importance role of CBR either as predictor or mediator in the context of SMEs SMM as well as brand equity development. Further, the study provided several theoretical and practical implications that can benefit the SMEs in enhancing their strategic marketing decision.

Keywords: SME brand equity, SME social media marketing, SME consumer brand relationship, SME brand resonance

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Authors: Mariyah Poonawala, Selvan Ravindran, Anuradha Vaidya

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Despite much progress in understanding the regulatory factors and cytokines that support the maturation of the various cell lineages of the hematopoietic system, factors that govern the self-renewal and proliferation of hematopoietic stem cells (HSCs) is still a grey area of research. Hematopoietic stem cell transplantation (HSCT) has evolved over the years and gained tremendous importance in the treatment of both malignant and non-malignant diseases. However, factors such as graft rejection and multiple organ failure have challenged HSCT from time to time, underscoring the urgent need for development of milder processes for successful hematopoietic transplantation. An emerging concept in the field of stem cell biology states that the interactions between the bone-marrow micro-environment and the hematopoietic stem and progenitor cells is essential for regulation, maintenance, commitment and proliferation of stem cells. Understanding the role of mesenchymal stromal cells in modulating the functionality of HSCs is, therefore, an important area of research. Trans-resveratrol has been extensively studied for its various properties to combat and prevent cancer, diabetes and cardiovascular diseases etc. The aim of the present study was to understand the effect of trans-resveratrol on HSCs using single and co-culture systems. We have used KG1a cells since it is a well accepted hematopoietic stem cell model system. Our preliminary experiments showed that low concentrations of trans-resveratrol stimulated the HSCs to undergo proliferation whereas high concentrations of trans-resveratrol did not stimulate the cells to proliferate. We used a murine fibroblast cell line, M210B4, as a stromal feeder layer. On culturing the KG1a cells with M210B4 cells, we observed that the stimulatory as well as inhibitory effects of trans-resveratrol at low and high concentrations respectively, were enhanced. Our further experiments showed that low concentration of trans-resveratrol reduced the generation of reactive oxygen species (ROS) and nitric oxide (NO) whereas high concentrations increased the oxidative stress in KG1a cells. We speculated that perhaps the oxidative stress was imposing inhibitory effects at high concentration and the same was confirmed by performing an apoptotic assay. Furthermore, cell cycle analysis and growth kinetic experiments provided evidence that low concentration of trans-resveratrol reduced the doubling time of the cells. Our hypothesis is that perhaps at low concentration of trans-resveratrol the cells get pushed into the G0/G1 phase and re-enter the cell cycle resulting in their proliferation, whereas at high concentration the cells are perhaps arrested at G2/M phase or at cytokinesis and therefore undergo apoptosis. Liquid Chromatography-Quantitative-Time of Flight–Mass Spectroscopy (LC-Q-TOF MS) analyses indicated the presence of trans-resveratrol and its metabolite(s) in the supernatant of the co-cultured cells incubated with high concentration of trans-resveratrol. We conjecture that perhaps the metabolites of trans-resveratrol are responsible for the apoptosis observed at the high concentration. Our findings may shed light on the unsolved problems in the in vitro expansion of stem cells and may have implications in the ex vivo manipulation of HSCs for therapeutic purposes.

Keywords: co-culture system, hematopoietic micro-environment, KG1a cell line, M210B4 cell line, trans-resveratrol

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Authors: Inas Raafat, Azza El Bassiouny, Waldemar L. Olszewsky, Nagui E. Mikhail, Mona Nossier, Nora E. I. El-Bassiouni, Mona Zoheiry, Houda Abou Taleb, Noha Abd El-Aal, Ali Baioumy, Shimaa Attia

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Background: Orthotopic liver transplantation is an established treatment for patients with severe acute and end-stage chronic liver disease. The shortage of donor organs continues to be the rate-limiting factor for liver transplantation throughout the world. Hepatocyte transplantation is a promising treatment for several liver diseases and can, also, be used as a "bridge" to liver transplantation in cases of liver failure. Aim of the work: This study was designed to develop a highly efficient protocol for isolation and transplantation of hepatocytes in experimental Lewis rat model to provide satisfactory guidelines for future application on humans.Materials and Methods: Hepatocytes were isolated from the liver by double perfusion technique and bone marrow cells were isolated by centrifugation of shafts of tibia and femur of donor Lewis rats. Recipient rats were subjected to sub-lethal dose of irradiation 2 days before transplantation. In a laparotomy operation the spleen was injected by freshly isolated hepatocytes and bone marrow cells were injected intravenously. The animals were sacrificed 45 day latter and splenic sections were prepared and stained with H & E, PAS AFP and Prox1. Results: The data obtained from this study showed that the double perfusion technique is successful in separation of hepatocytes regarding cell number and viability. Also the method used for bone marrow cells separation gave excellent results regarding cell number and viability. Intrasplenic engraftment of hepatocytes and live tissue formation within the splenic tissue were found in 70% of cases. Hematoxylin and eosin stained splenic sections from 7 rats showed sheets and clusters of cells among the splenic tissues. Periodic Acid Schiff stained splenic sections from 7 rats showed clusters of hepatocytes with intensely stained pink cytoplasmic granules denoting the presence of glycogen. Splenic sections from 7 rats stained with anti-α-fetoprotein antibody showed brownish cytoplasmic staining of the hepatocytes denoting positive expression of AFP. Splenic sections from 7 rats stained with anti-Prox1 showed brownish nuclear staining of the hepatocytes denoting positive expression of Prox1 gene on these cells. Also, positive expression of Prox1 gene was detected on lymphocytes aggregations in the spleens. Conclusions: Isolation of liver cells by double perfusion technique using collagenase buffer is a reliable method that has a very satisfactory yield regarding cell number and viability. The intrasplenic route of transplantation of the freshly isolated liver cells in an immunocompromised model was found to give good results regarding cell engraftment and tissue formation. Further studies are needed to assess function of engrafted hepatocytes by measuring prothrombin time, serum albumin and bilirubin levels.

Keywords: Lewis rats, hepatocytes, BMCs, transplantation, AFP, Prox1

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Authors: Eleni Karasavvidou

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Social and anthropological research, parallel to Gender Studies, highlighted the relationship between social structures and symbolic forms as an important field of interaction and recording of 'social trends.' Since the study of representations can contribute to the understanding of the social functions and power relations, they encompass. This ‘mirage,’ however, has not only to do with the representations themselves but also with the ways they are received and the film or critical narratives that are established as dominant or alternative. Cinema and the criticism of its cultural products are no exception. Even in the rapidly changing media landscape of the 21st century, movies remain an integral and widespread part of popular culture, making films an extremely powerful means of 'legitimizing' or 'delegitimizing' visions of domination and commonsensical gender stereotypes throughout society. And yet it is film criticism, the 'language per se,' that legitimizes, reinforces, rewards and reproduces (or at least ignores) the stereotypical depictions of female roles that remain common in the realm of film images. This creates the need for this issue to have emerged (also) in academic research questioning gender criteria in film reviews as part of the effort for an inclusive art and society. Qualitative content analysis is used to examine female roles in selected Oscar-nominated films against their reviews from leading websites and newspapers. This method was chosen because of the complex nature of the depictions in the films and the narratives they evoke. The films were divided into basic scenes depicting social functions, such as love and work relationships, positions of power and their function, which were analyzed by content analysis, with borrowings from structuralism (Gennette) and the local/universal images of intercultural philology (Wierlacher). In addition to the measurement of the general ‘representation-time’ by gender, other qualitative characteristics were also analyzed, such as: speaking time, sayings or key actions, overall quality of the character's action in relation to the development of the scenario and social representations in general, as well as quantitatively (insufficient number of female lead roles, fewer key supporting roles, relatively few female directors and people in the production chain and how they might affect screen representations. The quantitative analysis in this study was used to complement the qualitative content analysis. Then the focus shifted to the criteria of film criticism and to the rhetorical narratives that exclude or highlight in relation to gender identities and functions. In the criteria and language of film criticism, stereotypes are often reproduced or allegedly overturned within the framework of apolitical "identity politics," which mainly addresses the surface of a self-referential cultural-consumer product without connecting it more deeply with the material and cultural life. One of the prime examples of this failure is the Bechtel Test, which tracks whether female characters speak in a film regardless of whether women's stories are represented or not in the films analyzed. If perceived unbiased male filmmakers still fail to tell truly feminist stories, the same is the case with the criteria of criticism and the related interventions.

Keywords: representations, context analysis, reviews, sexist stereotypes

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Authors: Zülfiye Bıkmaz, Aytolan Yıldırım

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This study was planned as a descriptive regressive study in order to determine the relationship between the competency levels of working nurses, the levels of competency expected by nursing students, the critical thinking disposition of nurses, their perceived autonomy levels, and certain socio demographic characteristics. It is also a methodological study with regard to the intercultural adaptation of the Nursing Competence Scale (NCS) in both working and student samples. The sample of the study group of nurses at a university hospital for at least 6 months working properly and consists of 443 people filled out questionnaires. The student group, consisting of 543 individuals from the 4 public university nursing 3rd and 4th grade students. Data collection tools consisted of a questionnaire prepared in order to define the socio demographic, economic, and personal characteristics of the participants, the ‘Nursing Competency Scale’, the ‘Autonomy Subscale of the Sociotropy – Autonomy Scale’, and the ‘California Critical Thinking Disposition Inventory’. In data evaluation, descriptive statistics, nonparametric tests, Rasch analysis and correlation and regression tests were used. The language validity of the ‘NCS’ was performed by translation and back translation, and the context validity of the scale was performed with expert views. The scale, which was formed into its final structure, was applied in a pilot application from a group consisting of graduate and student nurses. The time constancy of the test was obtained by analysis testing retesting method. In order to reduce the time problems with the two half reliability method was used. The Cronbach Alfa coefficient of the scale was found to be 0.980 for the nurse group and 0.986 for the student group. Statistically meaningful relationships between competence and critical thinking and variables such as age, gender, marital status, family structure, having had critical thinking training, education level, class of the students, service worked in, employment style and position, and employment duration were found. Statistically meaningful relationships between autonomy and certain variables of the student group such as year, employment status, decision making style regarding self, total duration of employment, employment style, and education status were found. As a result, it was determined that the NCS which was adapted interculturally was a valid and reliable measurement tool and was found to be associated with autonomy and critical thinking.

Keywords: nurse, nursing student, competence, autonomy, critical thinking, Rasch analysis

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Authors: Michael N. O'Sullivan, Con Sheahan

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Researchers have spent decades developing tools and techniques to aid teams in the new product development (NPD) process. Despite this, it is evident that there is a huge gap between their academic prevalence and their industry adoption. For the fuzzy front-end, in particular, there is a wide range of tools to choose from, including the Kano Model, the House of Quality, and many others. In fact, there are so many tools that it can often be difficult for teams to know which ones to use and how they interact with one another. Moreover, while the benefits of using these tools are obvious to industrialists, they are rarely used as they carry a learning curve that is too steep and they become too complex to manage over time. In essence, it is commonly believed that they are simply not worth the effort required to learn and use them. This research explores a streamlined process for the fuzzy front-end, assembling the most effective tools and making them accessible to everyone. The process was developed iteratively over the course of 3 years, following over 80 final year NPD teams from engineering, design, technology, and construction as they carried a product from concept through to production specification. Questionnaires, focus groups, and observations were used to understand the usability issues with the tools involved, and a human-centred design approach was adopted to produce a solution to these issues. The solution takes the form of physical toolkit, similar to a board game, which allows the team to play through an example of a new product development in order to understand the process and the tools, before using it for their own product development efforts. A complimentary website is used to enhance the physical toolkit, and it provides more examples of the tools being used, as well as deeper discussions on each of the topics, allowing teams to adapt the process to their skills, preferences and product type. Teams found the solution very useful and intuitive and experienced significantly less confusion and mistakes with the process than teams who did not use it. Those with a design background found it especially useful for the engineering principles like Quality Function Deployment, while those with an engineering or technology background found it especially useful for design and customer requirements acquisition principles, like Voice of the Customer. Products developed using the toolkit are added to the website as more examples of how it can be used, creating a loop which helps future teams understand how the toolkit can be adapted to their project, whether it be a small consumer product or a large B2B service. The toolkit unlocks the potential of these beneficial tools to those in industry, both for large, experienced teams and for inexperienced start-ups. It allows users to assess the market potential of their product concept faster and more effectively, arriving at the product design stage with technical requirements prioritized according to their customers’ needs and wants.

Keywords: new product development, fuzzy front-end, usability, Kano model, quality function deployment, voice of customer

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Authors: S. B. R. Slagmulder

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Monitoring inspiratory effort and dynamic lung stress in patients on pressure support ventilation in the ICU is important for protecting against self inflicted lung injury (P-SILI) and diaphragm dysfunction. Strategies to address the detrimental effects of respiratory drive and effort can lead to improved patient outcomes. Two non-invasive estimation methods, occlusion pressure (Pocc) and P0.1, have been proposed for achieving lung and diaphragm protective ventilation. However, their relationship and interpretation in neuro ICU patients is not well understood. P0.1 is the airway pressure measured during a 100-millisecond occlusion of the inspiratory port. It reflects the neural drive from the respiratory centers to the diaphragm and respiratory muscles, indicating the patient's respiratory drive during the initiation of each breath. Occlusion pressure, measured during a brief inspiratory pause against a closed airway, provides information about the inspiratory muscles' strength and the system's total resistance and compliance. Research Objective: Understanding the relationship between Pocc and P0.1 in brain-injured patients can provide insights into the interpretation of these values in pressure support ventilation. This knowledge can contribute to determining extubation readiness and optimizing ventilation strategies to improve patient outcomes. The central goal is to asses a study protocol for determining the relationship between Pocc and P0.1 in brain-injured patients on pressure support ventilation and their ability to predict successful extubation. Additionally, comparing these values between brain-damaged and non-brain-damaged patients may provide valuable insights. Key Areas of Inquiry: 1. How do Pocc and P0.1 values correlate within brain injury patients undergoing pressure support ventilation? 2. To what extent can Pocc and P0.1 values serve as predictive indicators for successful extubation in patients with brain injuries? 3. What differentiates the Pocc and P0.1 values between patients with brain injuries and those without? Methodology: P0.1 and occlusion pressures are standard measurements for pressure support ventilation patients, taken by attending doctors as per protocol. We utilize electronic patient records for existing data. Unpaired T-test will be conducted to compare P0.1 and Pocc values between both study groups. Associations between P0.1 and Pocc and other study variables, such as extubation, will be explored with simple regression and correlation analysis. Depending on how the data evolve, subgroup analysis will be performed for patients with and without extubation failure. Results: While it is anticipated that neuro patients may exhibit high respiratory drive, the linkage between such elevation, quantified by P0.1, and successful extubation remains unknown The analysis will focus on determining the ability of these values to predict successful extubation and their potential impact on ventilation strategies. Conclusion: Further research is pending to fully understand the potential of these indices and their impact on mechanical ventilation in different patient populations and clinical scenarios. Understanding these relationships can aid in determining extubation readiness and tailoring ventilation strategies to improve patient outcomes in this specific patient population. Additionally, it is vital to account for the influence of sedatives, neurological scores, and BMI on respiratory drive and occlusion pressures to ensure a comprehensive analysis.

Keywords: brain damage, diaphragm dysfunction, occlusion pressure, p0.1, respiratory drive

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Authors: Nareshkumar Harale, B. B. Meshram

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The continued exponential growth of successful cyber intrusions against today’s businesses has made it abundantly clear that traditional perimeter security measures are no longer adequate and effective. We evolved the network trust architecture from trust-untrust to Zero-Trust, With Zero Trust, essential security capabilities are deployed in a way that provides policy enforcement and protection for all users, devices, applications, data resources, and the communications traffic between them, regardless of their location. Information exchange over the Internet, in spite of inclusion of advanced security controls, is always under innovative, inventive and prone to cyberattacks. TCP/IP protocol stack, the adapted standard for communication over network, suffers from inherent design vulnerabilities such as communication and session management protocols, routing protocols and security protocols are the major cause of major attacks. With the explosion of cyber security threats, such as viruses, worms, rootkits, malwares, Denial of Service attacks, accomplishing efficient and effective intrusion detection and prevention is become crucial and challenging too. In this paper, we propose a design and analysis model for next generation network intrusion detection and protection system as part of layered security strategy. The proposed system design provides intrusion detection for wide range of attacks with layered architecture and framework. The proposed network intrusion classification framework deals with cyberattacks on standard TCP/IP protocol, routing protocols and security protocols. It thereby forms the basis for detection of attack classes and applies signature based matching for known cyberattacks and data mining based machine learning approaches for unknown cyberattacks. Our proposed implemented software can effectively detect attacks even when malicious connections are hidden within normal events. The unsupervised learning algorithm applied to network audit data trails results in unknown intrusion detection. Association rule mining algorithms generate new rules from collected audit trail data resulting in increased intrusion prevention though integrated firewall systems. Intrusion response mechanisms can be initiated in real-time thereby minimizing the impact of network intrusions. Finally, we have shown that our approach can be validated and how the analysis results can be used for detecting and protection from the new network anomalies.

Keywords: network intrusion detection, network intrusion prevention, association rule mining, system analysis and design

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Authors: Ellen Patricia, Marilou Hyson

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Coaching has been showing great potential to strengthen the impact of brief group trainings and help early childhood teachers solve specific problems at work with the goal of raising the quality of early childhood services. However, there have been some doubts about the benefits that village teachers can receive from coaching. It is perceived that village teachers may struggle with the thinking skills needed to make coaching beneficial. Furthermore, there are reservations about whether principals and supervisors in villages are open to coaching’s facilitative approach, as opposed to the directive approach they have been using. As such, the use of coaching to develop the professionalism of early childhood teachers in the villages needs to be examined. The Coaching Pilot for early childhood teachers in Indonesia villages provides insights for the above issues. The Coaching Pilot is part of the ECED Frontline Pilot, which is a collaboration project between the Government of Indonesia and the World Bank with the support from the Australian Government (DFAT). The Pilot started with coordinated efforts with the local government in two districts to select principals and supervisors who have been equipped with basic knowledge about early childhood education to take part in 2-days coaching training. Afterwards, the participants were asked to collect 25 hours of coaching early childhood teachers who have participated in the Enhanced Basic Training for village teachers. The participants who completed this requirement were then invited to come for an assessment of their coaching skills. Following that, a qualitative evaluation was conducted using in-depth interviews and Focus Group Discussion techniques. The evaluation focuses on the impact of the coaching pilot in helping the village teachers to develop in their professionalism, as well as on the sustainability of the intervention. Results from the evaluation indicated that although their low education may limit their thinking skills, village teachers benefited from the coaching that they received. Moreover, the evaluation results also suggested that with enough training and support, principals and supervisors in the villages were able to provide an adequate coaching service for the teachers. On top of that, beyond this small start, interest is growing, both within the pilot districts and even beyond, due to word of mouth of the benefits that the Coaching Pilot has created. The districts where coaching was piloted have planned to continue the coaching program, since a number of early childhood teachers have requested to be coached, and a number of principals and supervisors have also requested to be trained as a coach. Furthermore, the Association for Early Childhood Educators in Indonesia has started to adopt coaching into their program. Although further research is needed, the Coaching Pilot suggests that coaching can positively impact early childhood teachers in villages, and village principals and supervisors can become a promising source of future coaches. As such, coaching has a significant potential to become a sustainable model for a continuous professional development program for early childhood teachers in villages.

Keywords: coaching, coaching pilot, early childhood teachers, principals and supervisors, village teachers

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Authors: Natalie Hoyer

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Usually, steel structures are designed for the upper region of the steel toughness-temperature curve. To address the reduced toughness properties in the temperature transition range, additional safety assessments based on fracture mechanics are necessary. These assessments enable the appropriate selection of steel materials to prevent brittle fracture. In this context, recommendations were established in 2011 to regulate the appropriate selection of steel grades for bridge bearing components. However, these recommendations are no longer fully aligned with more recent insights: Designing bridge bearings and their components in accordance with DIN EN 1337 and the relevant sections of DIN EN 1993 has led to an increasing trend of using large plate thicknesses, especially for long-span bridges. However, these plate thicknesses surpass the application limits specified in the national appendix of DIN EN 1993-2. Furthermore, compliance with the regulations outlined in DIN EN 1993-1-10 regarding material toughness and through-thickness properties requires some further modifications. Therefore, these standards cannot be directly applied to the material selection for bearings without additional information. In addition, recent findings indicate that certain bridge bearing components are subjected to high fatigue loads, necessitating consideration in structural design, material selection, and calculations. To address this issue, the German Center for Rail Traffic Research initiated a research project aimed at developing a proposal to enhance the existing standards. This proposal seeks to establish guidelines for the selection of steel materials for bridge bearings to prevent brittle fracture, particularly for thick plates and components exposed to specific fatigue loads. The results derived from theoretical analyses, including finite element simulations and analytical calculations, are verified through component testing on a large-scale. During these large-scale tests, where a brittle failure is deliberately induced in a bearing component, an artificially generated defect is introduced into the specimen at the predetermined hotspot. Subsequently, a dynamic load is imposed until the crack initiation process transpires, replicating realistic conditions akin to a sharp notch resembling a fatigue crack. To stop the action of the dynamic load in time, it is important to precisely determine the point at which the crack size transitions from stable crack growth to unstable crack growth. To achieve this, the potential drop measurement method is employed. The proposed paper informs about the choice of measurement method (alternating current potential drop (ACPD) or direct current potential drop (DCPD)), presents results from correlations with created FE models, and may proposes a new approach to introduce beach marks into the fracture surface within the framework of potential drop measurement.

Keywords: beach marking, bridge bearing design, brittle fracture, design for fatigue, potential drop

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Authors: Pamela Chia, Tay Yoong Chuan

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Introduction: Severe pulmonary hypertension (PH) patients requiring non-cardiac surgery risk have increased mortality rates ranging. These patients are plagued with cardiorespiratory failure, dysrhythmias and anticoagulation potentially with concurrent sepsis and renal insufficiency, perioperative morbidity. We present a deaf-mute patient with severe idiopathic PH emergently prepared for ruptured ectopic laparotomy. Case Report: A 20 year-old female, 62kg (BMI 25 kg/m2) with severe idiopathic PH (2DE Ejection Fraction was 41%, Pulmonary Artery Systolic Pressure (PASP) 105 mmHg, Right ventricle strain and hypertrophy) and selective mutism was rushed in for emergency laparotomy after presenting to the emergency department for abdominal pain. The patient had an NYHA Class II with room air SpO2 93-95%. While awaiting lung transplant, the patient takes warfarin, Sildanefil, Macitentan and even Selexipag for rising PASP. At presentation, vital signs: BP 95/63, HR 119 SpO2 88% (room air). Despite decreasing haemoglobin 14 to 10g/dL, INR 2.59 was reversed with prothrombin concentrate, and Vitamin K. ECG revealed Right Bundle Branch Block with right ventricular strain and x-ray showed cardiomegaly, dilated Right Ventricle, Pulmonary Arteries, basal atelectasis. Arterial blood gas showed compensated metabolic acidosis pH 7.4 pCO2 32 pO2 53 HCO3 20 BE -4 SaO2 88%. The cardiothoracic surgeon concluded no role for Extracorporeal Membrane Oxygenation (ECMO). We inserted invasive arterial and central venous lines with blood transfusion via an 18G cannula before the patient underwent a midline laparotomy, haemostasis of ruptured ovarian cyst with 2.4L of clots under general anesthesia and FloTrac cardiac output monitoring. Rapid sequence induction was done with Midazolam/Propofol, remifentanil infusion, and rocuronium. The patient was maintained on Desflurane. Blood products and colloids were transfused for further 1.5L blood loss. Postoperatively, the patient was transferred to the intensive care unit and was extubated uneventfully 7hours later. The patient went home a week later. Discussion: Emergency hemostasis laparotomy in anticoagulated WHO Class I PH patient awaiting lung transplant with no ECMO backup poses tremendous stress on the deaf-mute patient and the anesthesiologist. Balancing hemodynamics avoiding hypotension while awaiting hemostasis in the presence of pulmonary arterial dilators and anticoagulation requires close titration of volatiles, which decreases RV contractility. We review the contraindicated anesthetic agents (ketamine, N2O), choice of vasopressors in hypotension to maintain Aortic-right ventricular pressure gradients and nitric oxide use perioperatively. Conclusion: Interdisciplinary communication with a deaf-mute moribund patient and anesthesia considerations pose many rare challenges worth sharing.

Keywords: pulmonary hypertension, case report, warfarin reversal, emergency surgery

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Authors: Sara Matsuzaka

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At the center of emerging policy debates on the rights of transgender individuals in public accommodations is the collision of gender binary views with transgender perspectives that challenge conventional gender norms. The results of such socio-political debates could have significant ramifications for the policies and infrastructures of public and private institutions nationwide, including within the addiction treatment field. Despite having disproportionately high rates of substance use disorder compared to the general population, transgender individuals experience significant barriers to engaging in addiction treatment programs. Inpatient addiction treatment centers were originally designed to treat heterosexual cisgender populations and, as such, feature gender segregated housing, bathrooms, and counseling sessions. Such heteronormative structural barriers, combined with exposures to stigmatic al attitudes, may dissuade transgender populations from benefiting from the addiction treatment they so direly need. A literature review is performed to explore the mechanisms by which gender segregation alienates transgender populations within inpatient addiction treatment. The constituent parts of the current debate on the rights of transgender individuals in public accommodations are situated the context of inpatient addiction treatment facilities. Minority Stress Theory is used as a theoretical framework for understanding substance abuse issues among transgender populations as a maladaptive behavioral response for coping with chronic stressors related to gender minority status and intersecting identities. The findings include that despite having disproportionately high rates of substance use disorder compared to the general population, transgender individuals experience significant barriers to engaging in and benefiting from addiction treatment. These barriers are present in the form of anticipated or real interpersonal stigma and discrimination by service providers and structural stigma in the form of policy and programmatic components in addiction treatment that marginalize transgender populations. Transphobic manifestations within addiction treatment may dissuade transgender individuals from seeking help, if not reinforce a lifetime of stigmatic experience, potentially exacerbating their substance use issues. Conclusive recommendations for social workers and addiction treatment professionals include: (1) dismantling institutional policies around gender segregation that alienate transgender individuals, (2) developing policies that provide full protections for transgender clients against discrimination based on their gender identity, and (3) implementing trans-affirmative cultural competency training requirements for all staff. Directions for future research are provided.

Keywords: addiction treatment, gender segregation, stigma, transgender

Procedia PDF Downloads 184

Authors: Vanlounni Sibounheuang, Wanarat Anusornsangiam, Pattarin Kittiboonyakun, Chanthanom Manithip

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In worldwide, one of the most common use of oral anticoagulant is warfarin. Its margin between therapeutic inhibition of clot formation and bleeding complications is narrow. Mahosot Hospital, warfarin clinic had not been established yet. The descriptive study was conducted by investigating drug-related problems of outpatients using warfarin, the value of the international normalized ratio (INR) higher than normal ranges (25.40 % of the total 272 outpatients) were mostly identified at Lao-Luxembourg Heart Centre, Mahosot Hospital, Lao PDR. This result led to the present study conducting qualitative interviews in order to help establish a warfarin clinic at Mahosot Hospital for the better outcomes of patients using warfarin. The purpose of this study was to explore perspectives of healthcare professional providing services for outpatients using warfarin. The face to face, in-depth interviews were undertaken among nine healthcare professionals (doctor=3, nurse=3, pharmacist=3) working at out-patient clinic, Lao-Luxembourg Heart Centre, Mahosot Hospital, Lao PDR. The interview guides were developed, and they were validated by the experts in the fields of qualitative research. Each interview lasted approximately 20 minutes. Three major themes emerged; healthcare professional’s experiences of current practice problems with warfarin therapy, healthcare professionals’ views of medical problems related to patients using warfarin, and healthcare professionals’ perspectives on ways of service improvement. All healthcare professionals had the same views that it’s difficult to achieve INR goal for individual patients because of some important patient barriers especially lack of knowledge about to use warfarin properly and safety, patients not regularly follow-up due to problems with transportations and financial support. Doctors and nurses agreed to have a pharmacist running a routine warfarin clinic and provided counselling to individual patients on the following points: how to take drug properly and safety, drug-drug and food-drug interactions, common side effects and how to manage them, lifestyle modifications. From the interviews, some important components of the establishment of a warfarin clinic included financial support, increased human resources, improved the system of keeping patients’ medical records, short course training for pharmacists. This study indicated the acceptance of healthcare professionals on the important roles of pharmacists and the feasibility of setting up warfarin clinic by working together with the multidisciplinary health care team in order to help improve health outcomes of patients using warfarin at Mahosot Hospital, Lao PDR.

Keywords: perspectives, healthcare professional, warfarin therapy, Mahosot Hospital

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Authors: Desjardin, Michaels, Martinez, Ulmann

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Copper IUD is one of the most efficient and cost-effective contraception. However, pain at insertion hampers the use of this method. This is especially unfortunate in nulliparous women, often younger, who are excellent candidates for this contraception, including Emergency Contraception. Standard insertion procedure of a copper IUD usually involves measurement of uterine cavity with an hysterometer and the use of a tenaculum in order to facilitate device insertion. Both procedures lead to patient pain which often constitutes a limitation of the method. To overcome these issues, we have developed a modified insertor combined with a copper IUD. The singular design of the inserter includes a flexible inflatable membrane technology allowing an easy access to the uterine cavity even in case of abnormal uterine positions or narrow cervical canal. Moreover, this inserter makes possible a direct IUD insertion with no hysterometry and no need for tenaculum. To assess device effectiveness and patient-reported pain, a study was conducted at two clinics in Fance with 31 individuals who wanted to use a copper IUD as contraceptive method. IUD insertions have been performed by four healthcare providers. Operators completed questionnaire and evaluated effectiveness of the procedure (including IUD correct fundal placement and other usability questions) as their satisfaction. Patient also completed questionnaire and pain during procedure was measured on a 10-cm Visual Analogue Scale (VAS). Analysis of the questionnaires indicates that correct IUD placement took place in more than 93% of women, which is a standard efficacy rate. It also demonstrates that IUD insertion resulted in no, light or moderate pain predominantly in nulliparous women. No insertion resulted in severe pain (none above 6cm on a 10-cm VAS). This translated by a high level of satisfaction from both patients and practitioners. In addition, this modified inserter allowed a simplification of the insertion procedure: correct fundal placement was ensured with no need for hysterometry (100%) prior to insertion nor for cervical tenaculum to pull on the cervix (90%). Avoidance of both procedures contributed to the decrease in pain during insertion. Taken together, the results of the study demonstrate that this device constitutes a significant advance in the use of copper IUDs for any woman. It allows a simplification of the insertion procedure: there is no need for pre-insertion hysterometry and no need for traction on the cervix with tenaculum. Increased comfort during insertion should allow a wider use of the method for nulliparous women and for emergency contraception. In addition, pain is often underestimated by practitioners, but fear of pain is obviously one of the blocking factors as indicated by the analysis of the questionnaire. This evaluation brings interesting information on the use of this modified inserter for standard copper IUD and promising perspectives to set up a changement in the standard of IUD insertion procedure.

Keywords: contraceptio, IUD, innovation, pain

Procedia PDF Downloads 57

Authors: Roberta Pecoraro, Elena Maria Scalisi

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Engineered Nanoparticles (ENPs) and Nanomaterials (ENMs) concern an active research area and a sector in full expansion. They have physical-chemical characteristics and small size that improve their performance compared to common materials. Due to the increase in their production and their subsequent release into the environment, new strategies are emerging to assess risk of nanomaterials. NPs can be released into the environment through aquatic systems by human activities and exert toxicity on living organisms. We evaluated the potential toxic effect of cerium oxide (CeO2) nanoparticles because it’s used in different fields due to its peculiar properties. In order to assess nanoparticles toxicity, Fish Embryo Toxicity (FET) test was performed. Powders of CeO2 NPs supplied by the CNR-IMM of Catania are indicated as CeO2 type 1 (as-prepared) and CeO2 type 2 (modified), while CeO2 type 3 (commercial) is supplied by Sigma-Aldrich. Starting from a stock solution (0.001g/10 ml dilution water) of each type of CeO2 NPs, the other concentration solutions were obtained adding 1 ml of the stock solution to 9 ml of dilution water, leading to three different solutions of concentration (10-4, 10-5, 10-6 g/ml). All the solutions have been sonicated to avoid natural tendency of NPs to aggregate and sediment. FET test was performed according to the OECD guidelines for testing chemicals using our internal protocol procedure. A number of eight selected fertilized eggs were placed in each becher filled with 5 ml of each concentration of the three types of CeO2 NPs; control samples were incubated only with dilution water. Replication was performed for each concentration. During the exposure period, we observed four endpoints (embryo coagulation, lack of formation of somites, failure to lift the yolk bag, no heartbeat) by a stereomicroscope every 24 hours. Immunohistochemical analysis on treated larvae was performed to evaluate the expression of metallothioneins (MTs), Heat Shock Proteins 70 (HSP70) and 7-ethoxyresorufin-O-diethylase (EROD). Our results have not shown evident alterations on embryonic development because all embryos completed the development and the hatching of the eggs, started around the 48th hour after exposure, took place within the last observation at 72 hours. A good reactivity, both in the embryos and in the newly hatched larvae, was found. The presence of heartbeat has also been observed in embryos with reduced mobility confirming their viability. A higher expression of EROD biomarker was observed in the larvae exposed to the three types of CeO2, showing a clear difference with the control. A weak positivity was found for MTs biomarker in treated larvae as well as in the control. HSP70 are expressed homogeneously in all the type of nanoparticles tested but not too much greater than control. Our results are in agreement with other studies in the literature, in which the exposure of Danio rerio larvae to other metal oxide nanoparticles does not show adverse effects on survival and hatching time. Further studies are necessary to clarify the role of these NPs and also to solve conflicting opinions.

Keywords: Danio rerio, endpoints, fish embryo toxicity test, metallic nanoparticles

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Authors: Rene Hellmuth

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Factory planning has the task of designing products, plants, processes, organization, areas, and the construction of a factory. The requirements for factory planning and the building of a factory have changed in recent years. Regular restructuring of the factory building is becoming more important in order to maintain the competitiveness of a factory. Restrictions in new areas, shorter life cycles of product and production technology as well as a VUCA world (Volatility, Uncertainty, Complexity & Ambiguity) lead to more frequent restructuring measures within a factory. A building information model (BIM) is the planning basis for rebuilding measures and becomes an indispensable data repository to be able to react quickly to changes. Use as a planning basis for restructuring measures in factories only succeeds if the BIM model has adequate data quality. Under this aspect and the industrial requirement, three data quality factors are particularly important for this paper regarding the BIM model: up-to-dateness, completeness, and correctness. The research question is: how can a BIM model be kept up to date with required data quality and which visualization techniques can be applied in a short period of time on the construction site during conversion measures? An as-is analysis is made of how BIM models and digital factory models (including laser scans) are currently being kept up to date. Industrial companies are interviewed, and expert interviews are conducted. Subsequently, the results are evaluated, and a procedure conceived how cost-effective and timesaving updating processes can be carried out. The availability of low-cost hardware and the simplicity of the process are of importance to enable service personnel from facility mnagement to keep digital factory models (BIM models and laser scans) up to date. The approach includes the detection of changes to the building, the recording of the changing area, and the insertion into the overall digital twin. Finally, an overview of the possibilities for visualizations suitable for construction sites is compiled. An augmented reality application is created based on an updated BIM model of a factory and installed on a tablet. Conversion scenarios with costs and time expenditure are displayed. A user interface is designed in such a way that all relevant conversion information is available at a glance for the respective conversion scenario. A total of three essential research results are achieved: As-is analysis of current update processes for BIM models and laser scans, development of a time-saving and cost-effective update process and the conception and implementation of an augmented reality solution for BIM models suitable for construction sites.

Keywords: building information modeling, digital factory model, factory planning, restructuring

Procedia PDF Downloads 88

Authors: Robert Pocklington

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Most current language courses expect students to be ‘vocational’, sacrificing their free time in order to learn. However, pupils with a full-time job, or bringing up children, hardly have a spare moment. Others just need the language as a tool or a qualification, as if it were book-keeping or a driving license. Then there are children in unstructured families whose stressful life makes private study almost impossible. And the countless parents whose evenings and weekends have become a nightmare, trying to get the children to do their homework. There are many arguments against homework being a necessity (rather than an optional extra for more ambitious or dedicated students), making a clear case for teaching methods which facilitate full learning of the key content within the classroom. A methodology which could be described as Programmed Mastery Learning has been used at Fluency Language Academy (Spain) since 1992, to teach English to over 4000 pupils yearly, with a staff of around 100 teachers, barely requiring homework. The course is structured according to the tenets of Programmed Learning: small manageable teaching steps, immediate feedback, and constant successful activity. For the Mastery component (not stopping until everyone has learned), the memorisation and practice are entrusted to flashcard-based drilling in the classroom, leading all students to progress together and develop a permanently growing knowledge base. Vocabulary and expressions are memorised using flashcards as stimuli, obliging the brain to constantly recover words from the long-term memory and converting them into reflex knowledge, before they are deployed in sentence building. The use of grammar rules is practised with ‘cue’ flashcards: the brain refers consciously to the grammar rule each time it produces a phrase until it comes easily. This automation of lexicon and correct grammar use greatly facilitates all other language and conversational activities. The full B2 course consists of 48 units each of which takes a class an average of 17,5 hours to complete, allowing the vast majority of students to reach B2 level in 840 class hours, which is corroborated by an 85% pass-rate in the Cambridge University B2 exam (First Certificate). In the past, studying for qualifications was just one of many different options open to young people. Nowadays, youngsters need to stay at school and obtain qualifications in order to get any kind of job. There are many students in our classes who have little intrinsic interest in what they are studying; they just need the certificate. In these circumstances and with increasing government pressure to minimise failure, teachers can no longer think ‘If they don’t study, and fail, its their problem’. It is now becoming the teacher’s problem. Teachers are ever more in need of methods which make their pupils successful learners; this means assuring learning in the classroom. Furthermore, homework is arguably the main divider between successful middle-class schoolchildren and failing working-class children who drop out: if everything important is learned at school, the latter will have a much better chance, favouring inclusiveness in the language classroom.

Keywords: flashcard drilling, fluency method, mastery learning, programmed learning, teaching English as a foreign language

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Authors: Varis Ransibrahmanakul, Doug Pirhalla, Scott Sheridan, Cameron Lee

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U.S. coastal areas and ecosystems are facing multiple sea level rise threats and effects: heavy rain events, cyclones, and changing wind and weather patterns all influence coastal flooding, sedimentation, and erosion along critical barrier islands and can strongly impact habitat resiliency and water quality in protected habitats. These impacts are increasing over time and have accelerated the need for new tracking techniques, models and tools of flood risk to support enhanced preparedness for coastal management and mitigation. To address this issue, NOAA National Ocean Service (NOS) evaluated new metrics from satellite altimetry AVISO/Copernicus and MODIS IR flood extents to isolate nodes atmospheric variability indicative of elevated sea level and nuisance flood events. Using de-trended time series of cross-shelf sea surface heights (SSH), we identified specific Self Organizing Maps (SOM) nodes and transitions having a strongest regional association with oceanic spatial patterns (e.g., heightened downwelling favorable wind-stress and enhanced southward coastal transport) indicative of elevated coastal sea levels. Results show the impacts of the inverted barometer effect as well as the effects of surface wind forcing; Ekman-induced transport along broad expanses of the U.S. eastern coastline. Higher sea levels and corresponding localized flooding are associated with either pattern indicative of enhanced on-shore flow, deepening cyclones, or local- scale winds, generally coupled with an increased local to regional precipitation. These findings will support an integration of satellite products and will inform seasonal outlook model development supported through NOAAs Climate Program Office and NOS office of Center for Operational Oceanographic Products and Services (CO-OPS). Overall results will prioritize ecological areas and coastal lab facilities at risk based on numbers of nuisance flood projected and inform coastal management of flood risk around low lying areas subjected to bank erosion.

Keywords: AVISO satellite altimetry SSHA, MODIS IR flood map, nuisance flood, remote sensing of flood

Procedia PDF Downloads 122

Authors: Natia Tsiklashvili, Tamari Poladashvili

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Education is one of the fundamental factors of economic prosperity in all respects. It is impossible to talk about the sustainable economic development of the country without substantial investments in human capital and investment into higher educational institutions. Education improves the standard of living of the population and expands the opportunities to receive more benefits, which will be equally important for both the individual and the society as a whole. There are growing initiatives among educated people such as entrepreneurship, technological development, etc. At the same time, the distribution of income between population groups is improving. The given paper discusses the scientific literature in the field of sustainable development through higher educational institutions. Scholars of economic theory emphasize a few major aspects that show the role of higher education in economic growth: a) Alongside education, human capital gradually increases which leads to increased competitiveness of the labor force, not only in the national but also in the international labor market (Neoclassical growth theory), b) The high level of education can increase the efficiency of the economy, investment in human capital, innovation, and knowledge are significant contributors to economic growth. Hence, it focuses on positive externalities and spillover effects of a knowledge-based economy which leads to economic development (endogenous growth theory), c) Education can facilitate the diffusion and transfer of knowledge. Hence, it supports macroeconomic sustainability and microeconomic conditions of individuals. While discussing the economic importance of education, we consider education as the spiritual development of the human that advances general skills, acquires a profession, and improves living conditions. Scholars agree that human capital is not only money but liquid assets, stocks, and competitive knowledge. The last one is the main lever in the context of increasing human competitiveness and high productivity. To address the local issues, the present article researched ten educational institutions across Georgia, including state and private HEIs. Qualitative research was done by analyzing in-depth interweaves of representatives from each institution, and respondents were rectors/vice-rectors/heads of quality assurance service at the institute. The result shows that there is a number of challenges that institution face in order to maintain sustainable development and be the strong links to education and the labor market. Mostly it’s contacted with bureaucracy, insufficient finances they receive, and local challenges that differ across the regions.

Keywords: higher education, higher educational institutions, sustainable development, regions, Georgia

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Authors: Banafsheh Nikmehr, Mohsen Bahrami, Yueqiang Song, Anuradha Koduru, Ayse K. Vuruskan, Hongkun Lu, Mallory Pitts, Tolga B. Mesen, Tamer M. Yalcinkaya

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The number of people who receive in vitro fertilization (IVF) treatment has increased on a startling trajectory over the past two decades. Despite advances in this field, particularly the introduction of intracytoplasmic sperm injection (ICSI) and the preimplantation genetic screening (PGS), the IVF success remains low. A major factor contributing to IVF failure is embryonic aneuploidy (abnormal chromosome content), which often results in miscarriage and birth defects. Although PGS is often used as the standard diagnostic tool to identify aneuploid embryos, it is an invasive approach that could affect the embryo development, and yet inaccessible to many patients due its high costs. As such, there is a clear need for a non-invasive cost-effective approach to identify euploid embryos for single embryo transfer (SET). The reported differences between morphokinetic behaviors of aneuploid and euploid embryos has shown promise to address this need. However, current literature is inconclusive and further research is urgently needed to translate current findings into clinical diagnostics. In this ongoing study, we found significant differences between morphokinetic behaviors of euploid and aneuploid embryos that provides important insights and reaffirms the promise of such behaviors for developing non-invasive methodologies. Methodology—A total of 242 embryos (euploid: 149, aneuploid: 93) from 74 patients who underwent IVF treatment in Carolinas Fertility Clinics in Winston-Salem, NC, were analyzed. All embryos were incubated in an EmbryoScope incubator. The patients were randomly selected from January 2019 to June 2021 with most patients having both euploid and aneuploid embryos. All embryos reached the blastocyst stage and had known PGS outcomes. The ploidy assessment was done by a third-party testing laboratory on day 5-7 embryo biopsies. The morphokinetic variables of each embryo were measured by the EmbryoViewer software (Uniesense FertiliTech) on time-lapse images using 7 focal depths. We compared the time to: pronuclei fading (tPNf), division to 2,3,…,9 cells (t2, t3,…,t9), start of embryo compaction (tSC), Morula formation (tM), start of blastocyst formation (tSC), blastocyst formation (tB), and blastocyst expansion (tEB), as well as intervals between them (e.g., c23 = t3 – t2). We used a mixed regression method for our statistical analyses to account for the correlation between multiple embryos per patient. Major Findings— The average age of the patients was 35.04 yrs. The average patient age associated with euploid and aneuploid embryos was not different (P = 0.6454). We found a significant difference in c45 = t5-t4 (P = 0.0298). Our results indicated this interval on average lasts significantly longer for aneuploid embryos - c45(aneuploid) = 11.93hr vs c45(euploid) = 7.97hr. In a separate analysis limited to embryos from the same patients (patients = 47, total embryos=200, euploid=112, aneuploid=88), we obtained the same results (P = 0.0316). The statistical power for this analysis exceeded 87%. No other variable was different between the two groups. Conclusion— Our results demonstrate the importance of morphokinetic variables as potential biomarkers that could aid in non-invasively characterizing euploid and aneuploid embryos. We seek to study a larger population of embryos and incorporate the embryo quality in future studies.

Keywords: IVF, embryo, euploidy, aneuploidy, morphokinteic

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Authors: Silas Webb, Joseph Hartland

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Background: Long-term retention of patients on ART has become a major health challenge in Sub-Saharan Africa (SSA). In 2010 a systematic review of 39 papers found that 30% of patients were no longer taking their ARTs two years after starting treatment. In the same review, it was noted that there was a paucity of data as to why patients become lost to follow-up (LTFU) in SSA. This project was performed in Mulanje Mission Hospital in Malawi as part of Swindon Academy’s Global Health eSSC. The HIV prevalence for Malawi is 10.3%, one of the highest rates in the world, however prevalence soars to 18% in the Mulanje. Therefore it is essential that patients at risk of being LTFU are identified early and managed appropriately to help them continue to participate in the service. Methodology: All patients on adult antiretroviral formulations at MMH, who were classified as ‘defaulters’ (patients missing a scheduled follow up visit by more than two months) over the last 12 months were included in the study. Demographic varibales were collected from Mastercards for data analysis. A comparison group of patients currently not lost to follow up was created by using all of the patients who attended the HIV clinic between 18th-22nd July 2016 who had never defaulted from ART. Data was analysed using the chi squared (χ²) test, as data collected was categorical, with alpha levels set at 0.05. Results: Overall, 136 patients had defaulted from ART over the past 12 months at MMH. Of these, 43 patients had missing Mastercards, so 93 defaulter datasets were analysed. In the comparison group 93 datasets were also analysed and statistical analysis done using Chi-Squared testing. A higher proportion of men in the defaulting group was noted (χ²=0.034) and defaulters tended to be younger (χ²=0.052). 94.6% of patients who defaulted were taking Tenofovir, Lamivudine and Efavirenz, the standard first line ART therapy in Malawi. The mean length of time on ART was 39.0 months (RR: -22.4-100.4) in the defaulters group and 47.3 months (RR: -19.71-114.23) in the control group, with a mean difference of 8.3 less months in the defaulters group (χ ²=0.056). Discussion: The findings in this study echo the literature, however this review expands on that and shows the demographic for the patient at most risk of defaulting and being LTFU would be: a young male who has missed more than 4 doses of ART and is within his first year of treatment. For the hospital, this data is important at it identifies significant areas for public health focus. For instance, fear of disclosure and stigma may be disproportionately affecting younger men, so interventions can be aimed specifically at them to improve their health outcomes. The mean length of time on medication was 8.3 months less in the defaulters group, with a p-value of 0.056, emphasising the need for more intensive follow-up in the early stages of treatment, when patients are at the highest risk of defaulting.

Keywords: anti-retroviral therapy, ART, HIV, lost to follow up, Malawi

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Authors: Nautiyal Ruchira, Nautiyal Hemant, Chaudhury Devnanda, Bhargava Surbhi, Chauhan Nidhi

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Introduction: South East Asian region contributes 2.5 million cases of malaria each year to the global burden of 300 to 500 million of which 76% is reported from India. Government of India launched a national program almost half a century ago, still malaria remains a major public health challenge. Pregnant women are more susceptible to severe malaria and its fetomaternal complications. Inadequate surveillance and under-reporting underestimates the problem. Aim: Present study aimed to analyze the clinical course and pattern of malaria during pregnancy and to study the feto-maternal outcome. Methodology: This is a prospective observational study carried out at Himalayan Institute of Medical Sciences – a tertiary care center in the sub-Himalayan state of Uttarakhand, Northern India. All the pregnant women with malaria and its complications were recruited in the study during 2009 to 2014 which included referred cases from the state of western Uttar Pradesh. A thorough history and clinical examination were carried out to assess maternal and fetal condition. Relevant investigations including haemogram, platelet count, LFT, RFT, and USG was done. Blood slides and rapid diagnostic tests were done to diagnose the type of malaria.The primary outcomes measured were the type of malaria infection, maternal complications associated with malaria, outcome of pregnancy and effect on the fetus. Results: 67 antenatal cases with malaria infection were studied. 71% patients were diagnosed with plasmodium vivax infection, 25% cases were plasmodium falciparum positive and in 3% cases mixed infection was found. 38(56%) patients were primigravida and 29(43%) were multiparous. Most of the patients had already received some treatment from their local doctors and presented with severe malaria with the complications. Thrombocytopenia was the commonest manifestation seen in 35(52%) patients, jaundice in 28%, severe anemia in 18%, and severe oligohydramnios in 10% and renal failure in 6% cases. Regarding pregnancy outcome there were 44 % preterm deliveries, 22% had IUFD and abortions in 6% cases.20% of newborn were low birth weight and 6% were IUGR. There was only one maternal death which occurred due to ARDS in falciparum malaria. Although Plasmodium vivax was the main parasite considering the severity of clinical presentation, all the patients received intensive care. As most of the patients had received chloroquine therapy hence they were treated with IV artesunate followed by oral artemesinin combination therapy. Other therapies in the form of packed RBC’s and platelet transfusions, dialysis and ventilator support were provided when required. Conclusion: Even in areas with annual parasite index (API) less than 2 like ours, malaria in pregnancy could be an alarming problem. Vivax malaria cannot be considered benign in pregnancy because of high incidence of morbidity. Prompt diagnosis and aggressive treatment can reduce morbidity and mortality significantly. Increased community level research, integrating ANC checkups with the distribution of insecticide-treated nets in areas of high endemicity, imparting education and awareness will strengthen the existing control strategies.

Keywords: severe malaria, pregnancy, plasmodium vivax, plasmodium falciparum

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Authors: Nana Bolashvili, Vakhtang Geladze, Tamazi Karalashvili, Nino Machavariani, George Geladze, Davit Kartvelishvili, Ana Karalashvili

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Fresh water is the major natural resource of Georgia. The average perennial sum of the rivers' runoff in Georgia is 52,77 km³, out of which 9,30 km³ inflows from abroad. The major volume of transit river runoff is ascribed to the Chorokhi river. Average perennial runoff in Western Georgia is 41,52 km³, in Eastern Georgia 11,25 km³. The indices of Eastern and Western Georgia were calculated with 50% and 90% river runoff respectively, while the same index calculation for other countries is based on a 50% river runoff. Out of total volume of resources, 133,2 m³/sec (4,21 km³) has been geologically prospected by the State Commission on Reserves and Acknowledged as reserves available for exploitation, 48% (2,02 km³) of which is in Western Georgia and 2,19 km³ in Eastern Georgia. Considering acknowledged water reserves of all categories per capita water resources accounts to 2,2 m³/day, whereas high industrial category -0. 88 m³ /day fresh drinking water. According to accepted norms, the possibility of using underground water reserves is 2,5 times higher than the long-term requirements of the country. The volume of abundant fresh-water reserves in Georgia is about 150 m³/sec (4,74 km³). Water in Georgia is consumed mostly in agriculture for irrigation purposes. It makes 66,4% around Georgia, in Eastern Georgia 72,4% and 38% in Western Georgia. According to the long-term forecast provision of population and the territory with water resources in Eastern Georgia will be quite normal. A bit different is the situation in the lower reaches of the Khrami and Iori rivers which could be easily overcome by corresponding financing. The present day irrigation system in Georgia does not meet the modern technical requirements. The overall efficiency of their majority varies between 0,4-0,6. Similar is the situation in the fresh water and public service water consumption. Organization of the mentioned systems, installation of water meters, introduction of new methods of irrigation without water loss will substantially increase efficiency of water use. Besides new irrigation norms developed from agro-climatic, geographical and hydrological angle will significantly reduce water waste. Taking all this into account we assume that for irrigation agricultural lands in Georgia is necessary 6,0 km³ water, 5,5 km³ of which goes to Eastern Georgia on irrigation arable areas. To increase water supply in Eastern Georgian territory and its population is possible by means of new water reservoirs as the runoff of every river considerably exceeds the consumption volume. In conclusion, we should say that fresh water resources by which Georgia is that rich could be significant source for barter exchange and investment attraction. Certain volume of fresh water can be exported from Western Georgia quite trouble free, without bringing any damage to population and hydroecosystems. The precise volume of exported water per region/time and method/place of water consumption should be defined after the estimation of different hydroecosystems and detailed analyses of water balance of the corresponding territories.

Keywords: GIS, management, rivers, water resources

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Authors: Steven G. Sclan

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Background: Since December 2019, the world has been afflicted by the spread of the Severe Acute Respiratory Syndrome-Corona Virus-2 (SARS-CoV-2), which is responsible for the condition referred to as Covid-19. The illness has had a cataclysmic impact on the political, social, economic, and overall well-being of the population of the entire globe. While Covid-19 has had a substantial universal fatality impact, it may have an even greater effect on the socioeconomic, medical well-being, and healthcare planning for remaining societies. Significance: As these numbers illustrate, many more persons survive the infection than die from it, and many of those patients have noted ongoing, persistent symptoms after successfully enduring the acute phase of the illness. Recognition and understanding of these symptoms are crucial for developing and arranging efficacious models of care for all patients (whether or not having been hospitalized) surviving acute covid illness and plagued by post-acute symptoms. Furthermore, regarding Covid infection in children (< 18 y/o), although it may be that Covid “+” children are not major vectors of infective transmission, it now appears that many more children than initially thought are carrying the virus without accompanying obvious symptomatic expression. It seems reasonable to wonder whether viral effects occur in children – those children who are Covid “+” and now asymptomatic – and if, over time, they might also experience similar symptoms. An even more significant question is whether Covid “+” asymptomatic children might manifest increased multiple health problems as they grow – i.e., developmental complications (e.g., physical/medical, metabolic, neurobehavioral, etc.) – in comparison to children who had been consistently Covid “ - ” during the pandemic. Topics Addressed and Theoretical Importance: This review is important because of the description of both quantitative and qualitative methods for clinical and biomedical research. Topics reviewed will consider the importance of well-designed, comprehensive (i.e., quantitative and qualitative methods) longitudinal studies of Post Covid-19 symptoms in both adults and children. Also reviewed will be general characteristics of longitudinal studies and a presentation of a model for a proposed study. Also discussed will be the benefit of longitudinal studies for the development of efficacious interventions and for the establishment of cogent, practical, and efficacious community healthcare service planning for post-acute covid patients. Conclusion: Results of multi-dimensional, longitudinal studies will have important theoretical implications. These studies will help to improve our understanding of the pathophysiology of long COVID and will aid in the identification of potential targets for treatment. Such studies can also provide valuable insights into the long-term impact of COVID-19 on public health and socioeconomics.

Keywords: COVID-19, post-COVID-19, long COVID, longitudinal research, quantitative research, qualitative research

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Authors: Till Gramberg

Abstract:

In the dynamic world of machine and plant engineering, stagnation in the growth of new product sales compels companies to reconsider their business models. The increasing shift toward service orientation, known as "servitization," along with challenges posed by digitalization and sustainability, necessitates an adaptation of product portfolio management (PPM). Against this backdrop, this study investigates the current challenges and requirements of PPM in this industrial context and develops a framework for the application of generative artificial intelligence (AI) to enhance agility and efficiency in PPM processes. The research approach of this study is based on a mixed-method design. Initially, qualitative interviews with industry experts were conducted to gain a deep understanding of the specific challenges and requirements in PPM. These interviews were analyzed using the Gioia method, painting a detailed picture of the existing issues and needs within the sector. This was complemented by a quantitative online survey. The combination of qualitative and quantitative research enabled a comprehensive understanding of the current challenges in the practical application of machine and plant engineering PPM. Based on these insights, a specific framework for the application of generative AI in PPM was developed. This framework aims to assist companies in implementing faster and more agile processes, systematically integrating dynamic requirements from trends such as digitalization and sustainability into their PPM process. Utilizing generative AI technologies, companies can more quickly identify and respond to trends and market changes, allowing for a more efficient and targeted adaptation of the product portfolio. The study emphasizes the importance of an agile and reactive approach to PPM in a rapidly changing environment. It demonstrates how generative AI can serve as a powerful tool to manage the complexity of a diversified and continually evolving product portfolio. The developed framework offers practical guidelines and strategies for companies to improve their PPM processes by leveraging the latest technological advancements while maintaining ecological and social responsibility. This paper significantly contributes to deepening the understanding of the application of generative AI in PPM and provides a framework for companies to manage their product portfolios more effectively and adapt to changing market conditions. The findings underscore the relevance of continuous adaptation and innovation in PPM strategies and demonstrate the potential of generative AI for proactive and future-oriented business management.

Keywords: servitization, product portfolio management, generative AI, disruptive innovation, machine and plant engineering

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