Search results for: access regulation
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 4683

Search results for: access regulation

3963 Weighing the Economic Cost of Illness Due to Dysentery and Cholera Triggered by Poor Sanitation in Rural Faisalabad, Pakistan

Authors: Syed Asif Ali Naqvi, Muhammad Azeem Tufail

Abstract:

Inadequate sanitation causes direct costs of treating illnesses and loss of income through reduced productivity. This study estimated the economic cost of health (ECH) due to poor sanitation and factors determining the lack of access to latrine for the rural, backward hamlets and slums of district Faisalabad, Pakistan. Cross sectional data were collected and analyzed for the study. As the population under study was homogenous in nature, it is why a simple random sampling technique was used for the collection of data. Data of 440 households from 4 tehsils were gathered. The ordinary least square (OLS) model was used for health cost analysis, and the Probit regression model was employed for determining the factors responsible for inaccess to toilets. The results of the study showed that condition of toilets, situation of sewerage system, access to adequate sanitation, Cholera, diarrhea and dysentery, Water and Sanitation Agency (WASA) maintenance, source of medical treatment can plausibly have a significant connection with the dependent variable. Outcomes of the second model showed that the variables of education, family system, age, and type of dwelling have positive and significant sway with the dependent variable. Variable of age depicted an insignificant association with access to toilets. Variable of monetary expenses would negatively influence the dependent variable. Findings revealed the fact, health risks are often exacerbated by inadequate sanitation, and ultimately, the cost on health also surges. Public and community toilets for youths and social campaigning are suggested for public policy.

Keywords: sanitation, toilet, economic cost of health, water, Punjab

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3962 Cumulus-Oocyte Complexes and Follicular Fluid Proteins of Pig during Folliculogenesis

Authors: Panomporn Wisuthseriwong, Hatairuk Tungkasen, Siyaporn Namsongsan, Chanikarn Srinark, Mayuva Youngsabanant-Areekijseree

Abstract:

The objective of the present study was to evaluate the morphology of porcine cumulus-oocyte complexes (pCOCs) and follicular fluid during follicular development. The samples were obtained from local slaughterhouses in Nakorn Pathom Province, Thailand. Pigs were classified as either in the follicular phase or luteal phase. Porcine follicles (n = 3,510) were categorized as small (1-3 mm in diameters; n=2,910), medium (4-6 mm in diameters; n=530) and large (7-8 mm in diameters; n=70). Then pCOCs and follicular fluid were collected. Finally, we found that the oocytes can be categorized into intact cumulus cells layer oocyte, multi-cumulus cells layer oocyte, partial cumulus cells layer oocyte, completely denuded oocyte and degenerated oocyte. They showed high percentage of intact and multi-cumulus cells layer oocytes from small follicles (54.68%) medium follicles (69.06%) and large follicles (68.57%), which have high potential to develop into matured oocytes in vitro. Protein composition of the follicular fluid was separated by SDS-PAGE technique. The result shows that the protein molecular weight in the small and medium follicles are 23, 50, 66, 75, 92, 100, 132, 163, 225 and >225 kDa. Meanwhile, protein molecular weight in large follicles are 12, 16, 23, 50, 66, 75, 92, 100, 132, 163, 225 and >225 kDa. All proteins play an important role in promotion and regulation on development, maturation of oocytes and regulation of ovulation. We conclude that the results of discovery can be used porcine secretion proteins for supplement in IVM/IVF technology. Acknowledgements: The project was funded by a grant from Silpakorn University Research and Development Institute (SURDI) and Faculty of Science, Silpakorn University, Thailand.

Keywords: porcine follicles, porcine oocyte, follicular fluid, SDS-PAGE

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3961 Involvement of BCRP/ABCG2 in Protective Mechanisms of Resveratrol against Methotrexate-Induced Renal Damage in Rats

Authors: Mohamed A. Morsy, Azza A. El-Sheikh, Abdulla Y. Al-Taher

Abstract:

Resveratrol (RES) is a well-known polyphenol antioxidant. We have previously shown that testicular protective effect of RES against the anticancer drug methotrexate (MTX)-induced toxicity involves transporter-mediated mechanisms. Here, we investigated the effect of RES on MTX-induced nephrotoxicity. Rats were administered RES (10 mg/kg/day) for 8 days, with or without a single MTX dose (20 mg/kg i.p.) at day 4 of the experiment. MTX induced nephrotoxicity evident by significantly increase in serum blood urea nitrogen and creatinine compared to control, as well as distortion of kidney microscopic structure. MTX also significantly increased renal nitric oxide level, with induction of inducible nitric oxide synthase expression. MTX also significantly up-regulated fas ligand and caspase 3. Administering RES prior to MTX significantly improved kidney function and microscopic picture, as well as significantly decreased nitrosative and apoptotic markers compared to MTX alone. RES, but not MTX, caused significant increase in expression of breast cancer resistance protein (BCRP), an apical efflux renal transporter that participates in urinary elimination of both MTX and RES. Interestingly, concomitant MTX and RES caused further up-regulation of renal Bcrp compared to RES alone. Using Human BCRP ATPase assay, both RES and MTX exhibited dose-dependent increase in ATPase activity, with Km values of 0.52 ± 0.03 and 30.9 ± 4.2 µM, respectively. Furthermore, combined RES and MTX caused ATPase activity which was significantly less than maximum ATPase activity attained by the positive control; sulfasalazine (12.5 µM). In conclusion, RES exerted nephro-protection against MTX-induced toxicity through anti-nitrosative and anti-apoptotic effects, as well as via up-regulation of renal Bcrp.

Keywords: methotrexate, resveratrol, nephrotoxicity, breast cancer resistance protein

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3960 Relationship between Creative Market Actor and Traditional Market Vendor toward a Sustainable Market Model in Jakarta, Indonesia

Authors: Galuh Pramesti

Abstract:

In Indonesia, the rise of the middle class and consumer purchasing power has created a trend of shifting the traditional into a modern retail market. Development of the creative economy as an impact of the global economy has invaded the traditional market, due to low rents and minimum innovation, raising the issue of sustainability and urban resilience for survival of the traditional market. The study aims to understand the current market conditions by examining the challenges, resiliency, and identify the relationship between the traditional market and creative market. Using a single-case study approach as the research methodology, Santa Market has been chosen as the case study. It is a pilot project of collaboration between a traditional market and creative economy in Jakarta, Indonesia. The research was conducted as a qualitative study through in-depth interviews with the market vendors and the market management, besides a desk-based study of the leasing data and spatial analysis. The findings indicate traffic fluctuation as the main challenge. It is related to the tenant’s presence, rental fluctuation, gentrification, infrastructure, and market competition. Thus, the findings on resilience show a different response for creative and traditional markets. The traditional market’s response remained stable with minimum innovation, whereas the creative market relies on technological development. Regarding the relationship, supply and demand have become the main relationship occurring in Santa Market. It is then developed into the context of society and regulation. The conclusion provides recommendations for more solid regulation to protect the market tenants from stakeholder interests that can disrupt market viability, and a critical discussion on the concept of collaboration between traditional and creative markets. There is also a suggestion for further study on relation with the surroundings, to create a holistic study on how the collaboration can work well in the traditional market.

Keywords: creative economy, market sustainability, traditional market, urban resilience

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3959 Assessment of Access to Water, Sanitation and Hygiene, in Relation to the SDG 6, in Small Towns in Senegal: The Case of the Town of Foundiougne

Authors: Elhadji Mamadou Sonko, Ndiogou Sankhare, Jean Birane Gning, Cheikh Diop

Abstract:

In Senegal, small towns have problems of access to water, hygiene, and sanitation. This study aims to assess the situation in Foundiougne. The methodology includes a literature review, semi-structured interviews with stakeholders, surveys of 100 households, and observation. The results show that 35% of households have unimproved water services, 46% have limited service, and 19% have basic service. Regarding sanitation, 77% of households have basic sanitation services, and 23% have limited sanitation services. Manual emptying alone is practiced by 4% of households, while 17% combine it with mechanical emptying. Household wastewater is disposed of in streets, vacant land, and concession yards. The emptied sludge is discharged into the environment without treatment. Hand washing is practiced by 98% of households. These results show that there is real work to be done at the small towns level to close the water and sanitation gap in order to achieve SDG 6 targets in Senegal.

Keywords: foundiougne, SDG 6, senegal, small towns, water sanitation ang hygiene

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3958 Social Inclusion in Higher Institutions: The Plights of Students with Disabilities in Kaduna Polytechnic, Nigeria

Authors: Mairo H. Ipadeola, Catherine James Atteng

Abstract:

The term social inclusion refers to a process by which those disadvantaged in society can have access to fully participate in education like others. Student with special needs are expected to learn along with their peers within the some educational institutions which provide adequate access for all. There for, the study sort to understand the typical ways in which students with disabilities (SWD) were denied from fully participating as students in Kaduna Polytechnic. In doing this, two (2) objectives and research questions were raised. Firstly, to explore the attitudes of others towards students with disabilities in the institutions and secondly, to ascertain the extent of social participation and physical accessibility for students with disabilities (SWD) while in the institutions. Based on the objectives the paper postulated the research questions: what are the attitudes of management, teachers, and students towards students with special need in Kaduna Polytechnic and to what extent did the students with disabilities experience social participation and physical accessibility within Kaduna Polytechnic school environment? The study area was Kaduna Polytechnic. The study engaged the interview for the data collected which were transcribed and analyzed by thematic coding. The findings were categorized under themes, sub-themes, and codes. The findings revealed that the perception, behavior, and association experiences of students with disabilities within Kaduna Polytechnic were not encouraging. Their experiences were characterized by negative attitudes, feelings of rejection, neglect, and bullying. Data generated on social participation indicated that 71% of the respondents believed that learning, school activities, recreations, and student politics between SWD and the other student were in the direction of low / very low. All the respondents, particularly students with blindness and physical challenges faced difficulty with environmental and physical access above all within the school environment, classroom, walkways and ramps, Also, directions were none existent in most departments with physical access to classrooms, toilets, cafeterias, and school shops absent or very low (71% and 29% of the respondents). The conclusion was that the physical barriers limited the possibilities of social participation of SWD.The paper made some recommendations such as mass public enlightenment on radio and television to change the perception of society about people with disability. Also, the federal, state, and local governments enact building acts for fresh builders and adopted measures and time frames for existing public buildings to be made accessible for people with disabilities. All stakeholders should ensure that the five (5) percent budget set aside by State Universal Basic Education Board (SUBEB) and/or Tertiary Education Trust Fund (TETFUND) for the provision of specialized equipment and facilities for the student with special needs should be used prudently spent and monitored by the board.cm.

Keywords: social inclusion, students with disability, social participation, environmental/physical access

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3957 Utilization of a Telepresence Evaluation Tool for the Implementation of a Distant Education Program

Authors: Theresa Bacon-Baguley, Martina Reinhold

Abstract:

Introduction: Evaluation and analysis are the cornerstones of any successful program in higher education. When developing a program at a distant campus, it is essential that the process of evaluation and analysis be orchestrated in a timely manner with tools that can identify both the positive and negative components of distant education. We describe the utilization of a newly developed tool used to evaluate and analyze the successful expansion to a distant campus using Telepresence Technology. Like interactive television, Telepresence allows live interactive delivery but utilizes broadband cable. The tool developed is adaptable to any distant campus as the framework for the tool was derived from a systematic review of the literature. Methodology: Because Telepresence is a relatively new delivery system, the evaluation tool was developed based on a systematic review of literature in the area of distant education and ITV. The literature review identified four potential areas of concern: 1) technology, 2) confidence in the system, 3) faculty delivery of the content and, 4) resources at each site. Each of the four areas included multiple sub-components. Benchmark values were determined to be 80% or greater positive responses to each of the four areas and the individual sub-components. The tool was administered each semester during the didactic phase of the curriculum. Results: Data obtained identified site-specific issues (i.e., technology access, student engagement, laboratory access, and resources), as well as issues common at both sites (i.e., projection screen size). More specifically, students at the parent location did not have adequate access to printers or laboratory space, and students at the distant campus did not have adequate access to library resources. The evaluation tool identified that both sites requested larger screens for visualization of the faculty. The deficiencies were addressed by replacing printers, including additional orientation for students on library resources and increasing the screen size of the Telepresence system. When analyzed over time, the issues identified in the tool as deficiencies were resolved. Conclusions: Utilizing the tool allowed adjustments of the Telepresence delivery system in a timely manner resulting in successful implementation of an entire curriculum at a distant campus.

Keywords: physician assistant, telepresence technology, distant education, assessment

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3956 Natural Monopolies and Their Regulation in Georgia

Authors: Marina Chavleishvili

Abstract:

Introduction: Today, the study of monopolies, including natural monopolies, is topical. In real life, pure monopolies are natural monopolies. Natural monopolies are used widely and are regulated by the state. In particular, the prices and rates are regulated. The paper considers the problems associated with the operation of natural monopolies in Georgia, in particular, their microeconomic analysis, pricing mechanisms, and legal mechanisms of their operation. The analysis was carried out on the example of the power industry. The rates of natural monopolies in Georgia are controlled by the Georgian National Energy and Water Supply Regulation Commission. The paper analyzes the positive role and importance of the regulatory body and the issues of improving the legislative base that will support the efficient operation of the branch. Methodology: In order to highlight natural monopolies market tendencies, the domestic and international markets are studied. An analysis of monopolies is carried out based on the endogenous and exogenous factors that determine the condition of companies, as well as the strategies chosen by firms to increase the market share. According to the productivity-based competitiveness assessment scheme, the segmentation opportunities, business environment, resources, and geographical location of monopolist companies are revealed. Main Findings: As a result of the analysis, certain assessments and conclusions were made. Natural monopolies are quite a complex and versatile economic element, and it is important to specify and duly control their frame conditions. It is important to determine the pricing policy of natural monopolies. The rates should be transparent, should show the level of life in the country, and should correspond to the incomes. The analysis confirmed the significance of the role of the Antimonopoly Service in the efficient management of natural monopolies. The law should adapt to reality and should be applied only to regulate the market. The present-day differential electricity tariffs varying depending on the consumed electrical power need revision. The effects of the electricity price discrimination are important, segmentation in different seasons in particular. Consumers use more electricity in winter than in summer, which is associated with extra capacities and maintenance costs. If the price of electricity in winter is higher than in summer, the electricity consumption will decrease in winter. The consumers will start to consume the electricity more economically, what will allow reducing extra capacities. Conclusion: Thus, the practical realization of the views given in the paper will contribute to the efficient operation of natural monopolies. Consequently, their activity will be oriented not on the reduction but on the increase of increments of the consumers or producers. Overall, the optimal management of the given fields will allow for improving the well-being throughout the country. In the article, conclusions are made, and the recommendations are developed to deliver effective policies and regulations toward the natural monopolies in Georgia.

Keywords: monopolies, natural monopolies, regulation, antimonopoly service

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3955 Increasing Sulfur Handling Cost Efficiency Using the Eco Sulfur Paving Block Method at PT Pertamina EP Field Cepu

Authors: Adha Bayu Wijaya, A. Zainal Abidin, Naufal Baihaqi, Joko Suprayitno, Astika Titistiti, Muslim Adi Wijaya, Endah Tri Lestari, Agung Wibowo

Abstract:

Sulfur is a non-metallic chemical element in the form of a yellow crystalline solid with the chemical formula, and is formed from several types of natural and artificial chemical reactions. Commercial applications of sulfur processed products can be found in various aspects of life, for example in the use of processed sulfur as paving blocks. The Gundih Central Processing Plant (CPP) is capable of producing 14 tons/day of sulfur pellets. This amount comes from the high H2S content of the wells with a total concentration of 20,000 ppm and a volume accumulation of 14 MMSCFD acid gas. H2S is converted to sulfur using the thiobacillus microbe in the Biological Sulfur Recovery Unit (BSRU) with a sulfur product purity level greater than 95%. In 2018 sulfur production at Gundih CPP was recorded at 4044 tons which could potentially trigger serious problems from an environmental aspect. The use of sulfur as material for making paving blocks is an alternative solution in addressing the potential impact on the environment, as regulated by Government Regulation No.22 of Year 2021 concerning the Waste Management of Non-Hazardous and Toxic Substances (B3), and the high cost of handling sulfur by third parties. The design mix of ratio sulfur paving blocks is 22% cements, rock ash 67%, and 11% of sulfur pellets. The sulfur used in making the paving mixture is pure sulfur, namely the side product category without any contaminants, thereby eliminating the potential for environmental pollution when implementing sulfur paving. Strength tests of sulfur paving materials have also been confirmed by external laboratories. The standard used in making sulfur paving blocks refers to the SNI 03-0691-1996 standard. With the results of sulfur paving blocks made according to quality B. Currently, sulfur paving blocks are used in building access to wells locations and in public roads in the Cepu Field area as a contribution from Corporate Social Responsibility (CSR).

Keywords: sulphur, innovation, paving block, CSR, sulphur paving

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3954 3D Remote Sensing Images Parallax Refining Based On HTML5

Authors: Qian Pei, Hengjian Tong, Weitao Chen, Hai Wang, Yanrong Feng

Abstract:

Horizontal parallax is the foundation of stereoscopic viewing. However, the human eye will feel uncomfortable and it will occur diplopia if horizontal parallax is larger than eye separation. Therefore, we need to do parallax refining before conducting stereoscopic observation. Although some scholars have been devoted to online remote sensing refining, the main work of image refining is completed on the server side. There will be a significant delay when multiple users access the server at the same time. The emergence of HTML5 technology in recent years makes it possible to develop rich browser web application. Authors complete the image parallax refining on the browser side based on HTML5, while server side only need to transfer image data and parallax file to browser side according to the browser’s request. In this way, we can greatly reduce the server CPU load and allow a large number of users to access server in parallel and respond the user’s request quickly.

Keywords: 3D remote sensing images, parallax, online refining, rich browser web application, HTML5

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3953 Integration of the Battery Passport into the eFTI Platform to Improve Digital Data Exchange in the Context of Battery Transport

Authors: Max Plotnikov, Arkadius Schier

Abstract:

To counteract climate change, the European Commission adopted the European Green Deal (EDG) in 2019. Some of the main objectives of the EDG are climate neutrality by 2050, decarbonization, sustainable mobility, and the shift from a linear economy to a circular economy in the European Union. The mobility turnaround envisages, among other things, the switch from classic internal combustion vehicles to electromobility. The aforementioned goals are therefore accompanied by increased demand for lithium-ion batteries (LIBs) and the associated logistics. However, this inevitably gives rise to challenges that need to be addressed. Depending on whether the LIB is transported by road, rail, air, or sea, there are different regulatory frameworks in the European Union that relevant players in the value chain must adhere to. LIBs are classified as Dangerous Goods Class 9, and against this backdrop, there are various restrictions that need to be adhered to when transporting them for various actors. Currently, the exchange of information in the value chain between the various actors is almost entirely paper-based. Especially in the transport of dangerous goods, this often leads to a delay in the transport or to incorrect data. The exchange of information with the authorities is particularly essential in this context. A solution for the digital exchange of information is currently being developed. Electronic freight transport information (eFTI) enables fast and secure exchange of information between the players in the freight transport process. This concept is to be used within the supply chain from 2025. Another initiative that is expected to improve the monitoring of LIB in this context, among other things, is the battery pass. In July 2023, the latest battery regulation was adopted in the Official Journal of the European Union. This battery pass gives different actors static as well as dynamic information about the batteries depending on their access rights. This includes master data such as battery weight or battery category or information on the state of health or the number of negative events that the battery has experienced. The integration of the battery pass with the eFTI platform will be investigated for synergy effects in favor of the actors for battery transport.

Keywords: battery logistics, battery passport, data sharing, eFTI, sustainability

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3952 Increasing Access to Upper Limb Reconstruction in Cervical Spinal Cord Injury

Authors: Michelle Jennett, Jana Dengler, Maytal Perlman

Abstract:

Background: Cervical spinal cord injury (SCI) is a devastating event that results in upper limb paralysis, loss of independence, and disability. People living with cervical SCI have identified improvement of upper limb function as a top priority. Nerve and tendon transfer surgery has successfully restored upper limb function in cervical SCI but is not universally used or available to all eligible individuals. This exploratory mixed-methods study used an implementation science approach to better understand these factors that influence access to upper limb reconstruction in the Canadian context and design an intervention to increase access to care. Methods: Data from the Canadian Institute for Health Information’s Discharge Abstracts Database (CIHI-DAD) and the National Ambulatory Care Reporting System (NACRS) were used to determine the annual rate of nerve transfer and tendon transfer surgeries performed in cervical SCI in Canada over the last 15 years. Semi-structured interviews informed by the consolidated framework for implementation research (CFIR) were used to explore Ontario healthcare provider knowledge and practices around upper limb reconstruction. An inductive, iterative constant comparative process involving descriptive and interpretive analyses was used to identify themes that emerged from the data. Results: Healthcare providers (n = 10 upper extremity surgeons, n = 10 SCI physiatrists, n = 12 physical and occupational therapists working with individuals with SCI) were interviewed about their knowledge and perceptions of upper limb reconstruction and their current practices and discussions around upper limb reconstruction. Data analysis is currently underway and will be presented. Regional variation in rates of upper limb reconstruction and trends over time are also currently being analyzed. Conclusions: Utilization of nerve and tendon transfer surgery to improve upper limb reconstruction in Canada remains low. There are a complex array of interrelated individual-, provider- and system-level barriers that prevent individuals with cervical SCI from accessing upper limb reconstruction. In order to offer equitable access to care, a multi-modal approach addressing current barriers is required.

Keywords: cervical spinal cord injury, nerve and tendon transfer surgery, spinal cord injury, upper extremity reconstruction

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3951 Evaluation of Green Infrastructure with Different Woody Plants Practice and Benefit Using the Stormwater Management-HYDRUS Model

Authors: Bei Zhang, Zhaoxin Zhang, Lidong Zhao

Abstract:

Green infrastructures (GIs) for rainwater management can directly meet the multiple purposes of urban greening and non-point source pollution control. To reveal the overall layout law of GIs dominated by typical woody plants and their impact on urban environmental effects, we constructed a HYDRUS-1D and Stormwater management (SWMM) coupling model to simulate the response of typical root woody plant planting methods on urban hydrological. The results showed that the coupling model had high adaptability to the simulation of urban surface runoff control effect under different woody plant planting methods (NSE ≥0.64 and R² ≥ 0.71). The regulation effect on surface runoff showed that the average runoff reduction rate of GIs increased from 60 % to 71 % with the increase of planting area (5% to 25%) under the design rainfall event of the 2-year recurrence interval. Sophora japonica with tap roots was slightly higher than that of without plants (control) and Malus baccata (M. baccata) with fibrous roots. The comprehensive benefit evaluation system of rainwater utilization technology was constructed by using an analytic hierarchy process. The coupling model was used to evaluate the comprehensive benefits of woody plants with different planting areas in the study area in terms of environment, economy, and society. The comprehensive benefit value of planting 15% M. baccata was the highest, which was the first choice for the planting of woody plants in the study area. This study can provide a scientific basis for the decision-making of green facility layouts of woody plants.

Keywords: green infrastructure, comprehensive benefits, runoff regulation, woody plant layout, coupling model

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3950 Assessment of the Growth Enhancement Support Scheme in Adamawa State, Nigeria

Authors: Oto J. Okwu, Ornan Henry, Victor A. Otene

Abstract:

The agricultural sector contributes a great deal to the sustenance of Nigeria’s food security and economy, with an attendant impact on rural development. In spite of the relatively high number of farmers in the country, self-sufficiency in food production is still a challenge. Farmers are faced with myriad problems which hinder their production efficiency, one of which is their access to agricultural inputs required for optimum production. To meet the challenges faced by farmers, the government at the federal level has come up with many agricultural policies, one of which is the Agricultural Transformation Agenda (ATA). The Growth Enhancement Support Scheme (GESS) is one of the critical components of ATA, which is aimed at ensuring the effective distribution of agricultural inputs delivered directly to farmers, and at a regulated cost. After about 8 years of launching this policy, it will be necessary to carry out an assessment of GESS and determine the impact it has made on rural farmers with respect to their access to farm inputs. This study was carried out to assess the Growth Enhancement Support Scheme (GESS) in Adamawa State, Nigeria. Crop farmers who registered under the GESS in Adamawa State, Nigeria, formed the population for the study. Primary data for the study were obtained through a survey, and the use of a structured questionnaire. A sample size of 167 respondents was selected using multi-stage, purposive, and random sampling techniques. The validity and reliability of the research instrument (questionnaire) were obtained through pilot testing and test-retest method, respectively. The objectives of the study were to determine the difference in the level of access to agricultural inputs before and after GESS, determine the difference in cost of agricultural inputs before and after GESS, and to determine the challenges faced by rural farmers in accessing agricultural inputs through GESS. Both descriptive and inferential statistics were used in analyzing the collected data. Specifically, Mann-Whitney, student t-test, and factor analysis were used to test the stated hypotheses. Research findings revealed there was a significant difference in the level of access to farm inputs after the introduction of GESS (Z=14.216). Also, there was a significant difference in the cost of agro-inputs after the introduction of GESS (Pr |T| > |t|= 0.0000). The challenges faced by respondents in accessing agro-inputs through GESS were administrative and technical in nature. Based on the findings of the research, it was recommended that efforts be made by the government to sustain the GESS, as it has significantly improved the level of farmers’ access to agricultural inputs and has reduced the cost of agro-inputs, while administrative challenges faced by the respondents in accessing inputs be addressed by the government, and extension agents assist the farmers to overcome the technical challenges they face in accessing inputs.

Keywords: agricultural policy, agro-inputs, assessment, growth enhancement support scheme, rural farmers

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3949 The Inherent Flaw in the NBA Playoff Structure

Authors: Larry Turkish

Abstract:

Introduction: The NBA is an example of mediocrity and this will be evident in the following paper. The study examines and evaluates the characteristics of the NBA champions. As divisions and playoff teams increase, there is an increase in the probability that the champion originates from the mediocre category. Since it’s inception in 1947, the league has been mediocre and continues to this day. Why does a professional league allow any team with a less than 50% winning percentage into the playoffs? As long as the finances flow into the league, owners will not change the current algorithm. The objective of this paper is to determine if the regular season has meaning in finding an NBA champion. Statistical Analysis: The data originates from the NBA website. The following variables are part of the statistical analysis: Rank, the rank of a team relative to other teams in the league based on the regular season win-loss record; Winning Percentage of a team based on the regular season; Divisions, the number of divisions within the league and Playoff Teams, the number of playoff teams relative to a particular season. The following statistical applications are applied to the data: Pearson Product-Moment Correlation, Analysis of Variance, Factor and Regression analysis. Conclusion: The results indicate that the divisional structure and number of playoff teams results in a negative effect on the winning percentage of playoff teams. It also prevents teams with higher winning percentages from accessing the playoffs. Recommendations: 1. Teams that have a winning percentage greater than 1 standard deviation from the mean from the regular season will have access to playoffs. (Eliminates mediocre teams.) 2. Eliminate Divisions (Eliminates weaker teams from access to playoffs.) 3. Eliminate Conferences (Eliminates weaker teams from access to the playoffs.) 4. Have a balanced regular season schedule, (Reduces the number of regular season games, creates equilibrium, reduces bias) that will reduce the need for load management.

Keywords: alignment, mediocrity, regression, z-score

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3948 Haematology and Serum Biochemical Profile of Laying Chickens Reared on Deep Litter System with or without Access to Grass or Legume Pasture under Humid Tropical Climate

Authors: E. Oke, A. O. Ladokun, J. O. Daramola, O. M. Onagbesan

Abstract:

There has been a growing interest on the effects of access to pasture on poultry health status. However, there is a paucity of data on the relative benefits of grass and legume pastures. An experiment was conducted to determine the effects of rearing systems {deep litter system (DL), deep litter with access to legumes (LP) or grass (GP) pastures} haematology and serum chemistry of ISA Brown layers. The study involved the use of two hundred and forty 12 weeks old pullets. The birds were reared until 60 weeks of age. Eighty birds were assigned to each treatment; each treatment had four replicates of 20 birds each. Blood samples (2.5 ml) were collected from the wing vein of two birds per replicate and serum chemistry and haematological parameters were determined. The results showed that there were no significant differences between treatments in all the parameters considered at 18 weeks of age. At 24 weeks old, the percentage of heterophyl (HET) in DL and LP were similar but higher than that of GP. The ratio of H:L was higher (P<0.05) in DL than those of LP and GP while LP and GP were comparable. At week 38 of age, the percentage of PCV in the birds in LP and GP were similar but the birds in DL had significantly lower level than that of GP. In the early production phase, serum total protein of the birds in LP was similar to that of GP but higher (P<0.05) than that of DL. At the peak production phase (week 38), the total protein in GP and DL were similar but significantly lower than that of LP. The albumin level in LP was greater (P<0.05) than GP but similar to that of DL. In the late production phase, the total protein in LP was significantly higher than that of DL but similar to that of GP. It was concluded that rearing chickens in either grass or legume pasture did not have deleterious effects on the health of laying chickens but improved some parameters including blood protein and HET/lymphocyte.

Keywords: rearing systems, stylosanthes, cynodon serum chemistry, haematology, hen

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3947 Structural Design and Environmental Analysis of Oyster Mushroom Cultivation House in Korea

Authors: Lee Sunghyoun, Yu Byeongkee, Kim Hyuckjoo, Yun Namkyu, Jung Jongcheon

Abstract:

Most of the recent on-sale oyster mushrooms are raised in a oyster mushroom house, in which the necessary adjustment of growing condition is feasible. The rationale for such artificial growing is the impossibility of successive cultivation in the case of a natural cultivation due to external weather conditions. A oyster mushroom house adopts an equipment called growing bed, laying one growing bed upon another in a multi-column fashion, growing and developing the mushrooms on the respective equipments. The indispensable environment management factors of mushroom cultivation are temperature, humidity, and CO2; on which an appropriate regulation of the three requisites is a necessitated condition for the sake of the total output’s increase. However, due to the multiple layers of growing bed’s disturbance on air circulation, a oyster mushroom house’s internal environmental uniformity meets with considerable instability. This research presents a technology which assures the facilitation of environment regulation over all the internal space of a oyster mushroom house, irrespective of its location. The research staff reinforced the oyster mushroom house’s insulation in order to minimize the external environment’s influence on the oyster mushroom house’s internal environment and installed circulation fan to improve the oyster mushroom house’s interior environmental uniformity. Also, the humidifier nozzle’s position was set to prevent dew condensation when humidifying. As a result, a highly sophisticated management over all the oyster mushroom house‘s internal space was realized with the temperature of 0.2~1.3℃, and the relative humidity of 2~7% at the cultivating stage of mushroom’s growth. Therefore, to maximize oyster mushroom house‘s internal environmental uniformity, it can be concluded that consideration of various factors such as insulation reinforcement, decision on the humidifier nozzle’s location, disposition of circulation fan’s installation and the direction of wind discharge is needed.

Keywords: mushroom growing facility, environmental uniformity, temperature, relative humidity, CO2 concentration

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3946 A Comparative Study of Specific Assessment Criteria Related to Commercial Vehicle Drivers

Authors: Nur Syahidatul Idany Abdul Ghani, Rahizar Ramli, Jamilah Mohamad, Ahmad Saifizul, Mohamed Rehan Karim

Abstract:

Increasing fatalities in road accidents in Malaysia over the last 10 years are quite alarming. Based on Malaysian Institute of Road Safety Research (Miros) latest research ‘Predicting Malaysian Road Fatalities for year 2020; it is predicted that road fatalities in Malaysia for 2015 is 8,780 and 10,716 for the year 2020 which 30 percent of fatalities were caused by accidents involving commercial vehicles. Government, related agencies and NGOs have continuously and persistently work to reduce the statistics through enforcement, educating the public, training to drivers, road safety campaigns, advertisements etc. However, the trend of casualties does not show encouraging pattern but instead, steadily growing. Thus, this comparative study reviews the literature pertaining on method of measurement used to evaluate commercial drivers competency. In several studies driving competency has been assessed with different assessment based on the license procedures and requirements according to the country regulation. The assessment criteria that has been establish for commercial drivers generally focus on driving tasks and assessment e.g. theory test, medical test and road assessment rather than driving competency test or physical test. Realizing the importance of specific assessment test for drivers competency this comparative study reviews the most discussed literature related to competency assessment method to identify competency of the drivers include (1. judgement and reaction, 2. skill of drivers, 3. experiences and fatigue). The concluding analysis of this paper is a comparative table for assessment methodology to access driver’s competency. A comparative study is a further discussion reviewing past literature to provide an overview on existing assessment test and potential subject matters that can be identified for further studies to increase awareness of the drivers, passengers as well as the authorities about the importance of competent drivers in order to improve safety in commercial vehicles.

Keywords: commercial vehicles, driver’s competency, specific assessment

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3945 Medical Knowledge Management since the Integration of Heterogeneous Data until the Knowledge Exploitation in a Decision-Making System

Authors: Nadjat Zerf Boudjettou, Fahima Nader, Rachid Chalal

Abstract:

Knowledge management is to acquire and represent knowledge relevant to a domain, a task or a specific organization in order to facilitate access, reuse and evolution. This usually means building, maintaining and evolving an explicit representation of knowledge. The next step is to provide access to that knowledge, that is to say, the spread in order to enable effective use. Knowledge management in the medical field aims to improve the performance of the medical organization by allowing individuals in the care facility (doctors, nurses, paramedics, etc.) to capture, share and apply collective knowledge in order to make optimal decisions in real time. In this paper, we propose a knowledge management approach based on integration technique of heterogeneous data in the medical field by creating a data warehouse, a technique of extracting knowledge from medical data by choosing a technique of data mining, and finally an exploitation technique of that knowledge in a case-based reasoning system.

Keywords: data warehouse, data mining, knowledge discovery in database, KDD, medical knowledge management, Bayesian networks

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3944 Analysis and the Fair Distribution Modeling of Urban Facilities in Kabul City

Authors: Ansari Mohammad Reza, Hiroko Ono, Fakhrullah Sarwari

Abstract:

Our world is fast heading toward being a predominantly urban planet. This can be a double-edged sword reality where it is as much frightening as it seems interesting. Moreover, a look to the current predictions and taking into the consideration the fact that about 90 percent of the coming urbanization is going to be absorbed by the towns and the cities of the developing countries of Asia and Africa, directly provide us the clues to assume a much more tragic ending to this story than to the happy one. Likewise, in a situation wherein most of these countries are still severely struggling to find the proper answer to their very first initial questions of urbanization—e.g. how to provide the essential structure for their cities, define the regulation, or even design the proper pattern on how the cities should be expanded—thus it is not weird to claim that most of the coming urbanization of the world is going to happen informally. This reality could not only bring the feature, landscape or the picture of the cities of the future under the doubt but at the same time provide the ground for the rise of a bunch of other essential questions of how the facilities would be distributed in these cities, or how fair will this pattern of distribution be. Kabul the capital of Afghanistan, as a city located in the developing world that its process of urbanization has been starting since 2001 and currently hold the position to be the fifth fastest growing city in the world, contained to a considerable slum ratio of 0.7—that means about 70 percent of its population is living in the informal areas—subsequently could be a very good case study to put this questions into the research and find out how the informal development of a city can lead to the unfair and unbalanced distribution of its facilities. Likewise, in this study we tried our best to first propose the ideal model for the fair distribution of the facilities in the Kabul city—where all the citizens have the same equal chance of access to the facilities—and then evaluate the situation of the city based on how fair the facilities are currently distributed therein. We subsequently did it by the comparative analysis between the existing facility rate in the formal and informal areas of the city to the one that was proposed as the fair ideal model.

Keywords: Afghanistan, facility distribution, formal settlements, informal settlements, Kabul

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3943 Ecological Concerns in Food Systems: An Ethnographical Approach on Vegan Impact in Governmentality

Authors: Jessica Gonzalez

Abstract:

Veganism, along with different types of vegetarianism, consists in the abstinence of animal products. Far from being only an alimentary regulation, it stands as a political posture against the food industry generating itself a set of beliefs, prohibitions, and attitudes that compel the individual to a reevaluation of his obligations towards the environment. Veganism defends animal rights and at the same time reinforces a different conception of natural resources embodying it in alimentary restrictions. These practices emerge in the context of alimentary modernity, which is characterized by bringing new concerns to the consumer. An increased skepticism towards the government ability to protect food supply; a notable distrust toward the market guaranties on providing safe food with sustainable techniques and the desire to react to the neoliberal forms of exploitation are some of its consequences of this phenomenon. This study aims to approach the concept of governmentality as a coproduced system of legitimized practices and knowledge, formed by the interaction of the different actors that are involved. In a scenario where the State seems to retreat from centralized regulation of food production giving up importance to citizens, dietary consultants, farmers, and stockbreeders, veganism plays its role on the conformation of distinctive forms of environmentalism, nature rights and responses to ecological crisis. The ethnographic method allows observing the mechanisms of interaction of consumers and discourses with the mainstream food system, providing evidence about the means of generation of new conceptions about nature and the environment. The paper focuses on how the dietary restrictions, consumption patterns and public discourses of vegans in Barcelona impact local consumption, demonstrating its relevance as a mechanism that associates particular concerns about food with political economy.

Keywords: animal rights, environmentalism, food system, governmentality, veganism

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3942 Improving Infant Vaccination Rates Through Expanded Access to Care

Authors: Aidan Jacobsen, Morgan Motia, David Sam, Jonathan Mudge

Abstract:

Background: The Centers for Disease Control (CDC) lists vaccine requirements for children under two years old to correlate with development markers. CDC lists the coverage by age 24 months to be at least 90% nationally and 84% for Rhode Island Blackstone Valley Community Health Center (BVCHC) in Central Falls, Rhode Island, currently has a completed vaccination rate of 51% for children by the age of 24 months. Current barriers to care for up to date well child vaccinations include lack of transportation, parental work, childcare, and other social stressors. Objective: Increase the vaccination rate of children under the age of 24 months at BVCHC. Conduct a literature review to identify the common barriers preventing children under 24 months from receiving vaccinations. Reduce the barriers to expand access to vaccination care for infants Methods: Setting: Blackstone Valley Community Health Center, Pawtucket, RI Participants: (n=41), Patients between the age of 20-24 months, not up to date with the CDC vaccination recommendations and without a future appointment. QI Intervention: Patients were contacted via phone and offered an appointment during extra Saturday clinic hours in order to receive up to date vaccine care. A Saturday vaccine clinic was established specifically for patients in need of vaccines and having identified barriers to care. Conclusions: Expanding clinic hours and targeting non vaccine up –to-date patients can increase the current standard of childhood immunizations at BVCHC. Overcoming barriers preventing childhood immunization can improve access to providing up to date vaccinations. Other barriers still deter from reaching the national standard of immunizations rates.

Keywords: vaccinations, well child care, barriers to care, social determinants of health

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3941 An Integrated Theoretical Framework on Mobile-Assisted Language Learning: User’s Acceptance Behavior

Authors: Gyoomi Kim, Jiyoung Bae

Abstract:

In the field of language education research, there are not many tries to empirically examine learners’ acceptance behavior and related factors of mobile-assisted language learning (MALL). This study is one of the few attempts to propose an integrated theoretical framework that explains MALL users’ acceptance behavior and potential factors. Constructs from technology acceptance model (TAM) and MALL research are tested in the integrated framework. Based on previous studies, a hypothetical model was developed. Four external variables related to the MALL user’s acceptance behavior were selected: subjective norm, content reliability, interactivity, self-regulation. The model was also composed of four other constructs: two latent variables, perceived ease of use and perceived usefulness, were considered as cognitive constructs; attitude toward MALL as an affective construct; behavioral intention to use MALL as a behavioral construct. The participants were 438 undergraduate students who enrolled in an intensive English program at one university in Korea. This particular program was held in January 2018 using the vacation period. The students were given eight hours of English classes each day from Monday to Friday for four weeks and asked to complete MALL courses for practice outside the classroom. Therefore, all participants experienced blended MALL environment. The instrument was a self-response questionnaire, and each construct was measured by five questions. Once the questionnaire was developed, it was distributed to the participants at the final ceremony of the intensive program in order to collect the data from a large number of the participants at a time. The data showed significant evidence to support the hypothetical model. The results confirmed through structural equation modeling analysis are as follows: First, four external variables such as subjective norm, content reliability, interactivity, and self-regulation significantly affected perceived ease of use. Second, subjective norm, content reliability, self-regulation, perceived ease of use significantly affected perceived usefulness. Third, perceived usefulness and perceived ease of use significantly affected attitude toward MALL. Fourth, attitude toward MALL and perceived usefulness significantly affected behavioral intention to use MALL. These results implied that the integrated framework from TAM and MALL could be useful when adopting MALL environment to university students or adult English learners. Key constructs except interactivity showed significant relationships with one another and had direct and indirect impacts on MALL user’s acceptance behavior. Therefore, the constructs and validated metrics is valuable for language researchers and educators who are interested in MALL.

Keywords: blended MALL, learner factors/variables, mobile-assisted language learning, MALL, technology acceptance model, TAM, theoretical framework

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3940 Knowledge Management to Develop the Graduate Study Programs

Authors: Chuen-arom Janthimachai-amorn, Chirawadee Harnrittha

Abstract:

This study aims to identify the factors facilitating the knowledge management to develop the graduate study programs to achieve success and to identify the approaches in developing the graduate study programs in the Rajbhat Suansunantha University. The 10 respondents were the administrators, the faculty, and the personnel of its Graduate School. The research methodology was based on Pla-too Model of the Knowledge Management Institute (KMI) by allocating the knowledge indicators, the knowledge creation and search, knowledge systematization, knowledge processing and filtering, knowledge access, knowledge sharing and exchanges and learning. The results revealed that major success factors were knowledge indicators, evident knowledge management planning, knowledge exchange and strong solidarity of the team and systematic and tenacious access of knowledge. The approaches allowing the researchers to critically develop the graduate study programs were the environmental data analyses, the local needs and general situations, data analyses of the previous programs, cost analyses of the resources, and the identification of the structure and the purposes to develop the new programs.

Keywords: program development, knowledge management, graduate study programs, Rajbhat Suansunantha University

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3939 Effective Strategies Migrants Adopted to Improve Food Security in a Regional Area of Australia

Authors: Joanne Sin Wei Yeoh, Quynh Lê, Daniel R. Terry, Rosa Mc Manamey

Abstract:

Food security is a global issue and one of the concerns in Australia, particularly in regional and rural areas. Despite Australia’s current ability to produce enough food to feed more than its current population, evidence has been accumulating over the last decade to demonstrate many Australians struggle to feed themselves, including immigrants from cultural and linguistically diverse (CALD) backgrounds. This study aims to identify the acculturation strategies used by migrants to enhance their approach to food security in Tasmania. The study employed a mixed methods approach that used both questionnaires and semi-structured interviews with migrants living in Tasmania. Descriptive and inferential statistics was used to analyse data collected from questionnaire, whereas, thematic analysis was employed to analyse the interview data. Migrants (n=301) completed the questionnaire with a response rate of 50.2% and 33 follow-up interviews were conducted. We found that majority of the migrants (70.0%) replaced food ingredients and went without the food they could not buy from shops with similar ingredients. Support and advice from friends were effective ways to improve their food access. Additionally, length of stays in Tasmania and region of origin were significantly associated with the ways migrants dealing with food security. The interview results revealed that migrants managed to adapt to the new food culture by using different acculturation strategies, including access food ingredients from other country; adjusting or adapting; home gardening and access to technology. In addition, social and cultural capitals were also treated as vital roles in improving migrants’ food security. To summarize, migrants employed different strategies for food security while acculturating into the new environment. Our findings could become the guidelines for migrants and relevant government or private sectors that address food security.

Keywords: food security, migrants, strategies, inferential statistics

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3938 Consumer Market of Agricultural Products and Agricultural Policy in Georgia

Authors: G. Erkomaishvili, M. Kobalava, T. Lazariashvili, M. Saghareishvili

Abstract:

The article discusses the consumer market of agricultural products and agricultural policy in Georgia. It is noted that development of the strategic areas of the agricultural sector needs a special support. These strategic areas should create the country's major export potential. It is important to develop strategies to access to the international markets, form extensive marketing network etc., which will become the basis for the promotion and revenue growth of the country. The Georgian agricultural sector, with the right state policy and support, can achieve success and gain access to the world market with competitive agricultural products. The paper discusses the current condition of agriculture, export and import of agricultural products and agricultural policy in Georgia. The conducted research concludes the information that there is an increasing demand on the green goods in the world market. Natural and climatic conditions of Georgia give a serious possibility of implementing it. The research presents an agricultural development strategy in Georgia and the findings and based on them recommendations are proposed.

Keywords: agriculture, export-import of agricultural products, agricultural cooperative society, agricultural policy, agricultural insurance

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3937 Phosphate Regulation of Arbuscular Mycorrhiza Symbiosis in Rice

Authors: Debatosh Das, Moxian Chen, Jianhua Zhang, Caroline Gutjahr

Abstract:

Arbuscular mycorrhiza (AM) is a mutualistic symbiosis between plant roots and Glomeromycotina fungi, which is activated under low but inhibited by high phosphate. The effect of phosphate on AM development has been observed for many years, but mechanisms regulating it under contrasting phosphate levels remain unknown. Based on previous observations that promoters of several AM functional genes contain PHR binding motifs, we hypothesized that PHR2, a master regulator of phosphate starvation response in rice, was recruited to regulate AM symbiosis development. We observed a drastic reduction in root colonization and significant AM transcriptome modulation in phr2. PHR2 targets genes required for root colonization and AM signaling. The role of PHR2 in improving root colonization, mycorrhizal phosphate uptake, and growth response was confirmed in field soil. In conclusion, rice PHR2, which is considered a master regulator of phosphate starvation responses, acts as a positive regulator of AM symbiosis between Glomeromycotina fungi and rice roots. PHR2 directly targets the transcription of plant strigolactone and AM genes involved in the establishment of this symbiosis. Our work facilitates an understanding of ways to enhance AMF propagule populations introduced in field soils (as a biofertilizer) in order to restore the natural plant-AMF networks disrupted by modern agricultural practices. We show that PHR2 is required for AM-mediated improvement of rice yield in low phosphate paddy field soil. Thus, our work contributes knowledge for rational application of AM in sustainable agriculture. Our data provide important insights into the regulation of AM by the plant phosphate status, which has a broad significance in agriculture and terrestrial ecosystems.

Keywords: biofertilizer, phosphate, mycorrhiza, rice, sustainable, symbiosis

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3936 Comparative Proteomic Analysis of Rice bri1 Mutant Leaves at Jointing-Booting Stage

Authors: Jiang Xu, Daoping Wang, Yinghong Pan

Abstract:

The jointing-booting stage is a critical period of both vegetative growth and reproductive growth in rice. Therefore, the proteomic analysis of the mutant Osbri1, whose corresponding gene OsBRI1 encodes the putative BRs receptor OsBRI1, at jointing-booting stage is very important for understanding the effects of BRs on vegetative and reproductive growth. In this study, the proteomes of leaves from an allelic mutant of the DWARF 61 (D61, OsBRI1) gene, Fn189 (dwarf54, d54) and its wild-type variety T65 (Taichung 65) at jointing-booting stage were analysed by using a Q Exactive plus orbitrap mass spectrometer, and more than 3,100 proteins were identified in each sample. Ontology analysis showed that these proteins distribute in various space of the cells, such as the chloroplast, mitochondrion, and nucleus, they functioned as structural components and/or catalytic enzymes and involved in many physiological processes. Moreover, quantitative analysis displayed that 266 proteins were differentially expressed in two samples, among them, 77 proteins decreased and 189 increased more than two times in Fn189 compared with T65, the proteins whose content decreased in Fn189 including b5-like Heme/Steroid binding domain containing protein, putative retrotransposon protein, putative glutaminyl-tRNA synthetase, and higher content proteins such as mTERF, putative Oligopeptidase homologue, zinc knuckle protein, and so on. A former study founded that the transcription level of a mTERF was up-regulated in the leaves of maize seedling after EBR treatment. In our experiments, it was interesting that one mTERF protein increased, but another mTERF decreased in leaves of Fn189 at jointing-booting stage, which suggested that BRs may have differential regulation mechanisms on the expression of various mTERF proteins. The relationship between other differential proteins with BRs is still unclear, and the effects of BRs on rice protein contents and its regulation mechanisms still need further research.

Keywords: bri1 mutant, jointing-booting stage, proteomic analysis, rice

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3935 Availability Strategy of Medical Information for Telemedicine Services

Authors: Rozo D. Juan Felipe, Ramírez L. Leonardo Juan, Puerta A. Gabriel Alberto

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The telemedicine services require correct computing resource management to guarantee productivity and efficiency for medical and non-medical staff. The aim of this study was to examine web management strategies to ensure the availability of resources and services in telemedicine so as to provide medical information management with an accessible strategy. In addition, to evaluate the quality-of-service parameters, the followings were measured: delays, throughput, jitter, latency, available bandwidth, percent of access and denial of services based of web management performance map with profiles permissions and database management. Through 24 different test scenarios, the results show 100% in availability of medical information, in relation to access of medical staff to web services, and quality of service (QoS) of 99% because of network delay and performance of computer network. The findings of this study suggest that the proposed strategy of web management is an ideal solution to guarantee the availability, reliability, and accessibility of medical information. Finally, this strategy offers seven user profile used at telemedicine center of Bogota-Colombia keeping QoS parameters suitable to telemedicine services.

Keywords: availability, medical information, QoS, strategy, telemedicine

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3934 Impact of Lack of Testing on Patient Recovery in the Early Phase of COVID-19: Narratively Collected Perspectives from a Remote Monitoring Program

Authors: Nicki Mohammadi, Emma Reford, Natalia Romano Spica, Laura Tabacof, Jenna Tosto-Mancuso, David Putrino, Christopher P. Kellner

Abstract:

Introductory Statement: The onset of the COVID-19 pandemic demanded an unprecedented need for the rapid development, dispersal, and application of infection testing. However, despite the impressive mobilization of resources, individuals were incredibly limited in their access to tests, particularly during the initial months of the pandemic (March-April 2020) in New York City (NYC). Access to COVID-19 testing is crucial in understanding patients’ illness experiences and integral to the development of COVID-19 standard-of-care protocols, especially in the context of overall access to healthcare resources. Succinct Description of basic methodologies: 18 Patients in a COVID-19 Remote Patient Monitoring Program (Precision Recovery within the Mount Sinai Health System) were interviewed regarding their experience with COVID-19 during the first wave (March-May 2020) of the COVID-19 pandemic in New York City. Patients were asked about their experiences navigating COVID-19 diagnoses, the health care system, and their recovery process. Transcribed interviews were analyzed for thematic codes, using grounded theory to guide the identification of emergent themes and codebook development through an iterative process. Data coding was performed using NVivo12. References for the domain “testing” were then extracted and analyzed for themes and statistical patterns. Clear Indication of Major Findings of the study: 100% of participants (18/18) referenced COVID-19 testing in their interviews, with a total of 79 references across the 18 transcripts (average: 4.4 references/interview; 2.7% interview coverage). 89% of participants (16/18) discussed the difficulty of access to testing, including denial of testing without high severity of symptoms, geographical distance to the testing site, and lack of testing resources at healthcare centers. Participants shared varying perspectives on how the lack of certainty regarding their COVID-19 status affected their course of recovery. One participant shared that because she never tested positive she was shielded from her anxiety and fear, given the death toll in NYC. Another group of participants shared that not having a concrete status to share with family, friends and professionals affected how seriously onlookers took their symptoms. Furthermore, the absence of a positive test barred some individuals from access to treatment programs and employment support. Concluding Statement: Lack of access to COVID-19 testing in the first wave of the pandemic in NYC was a prominent element of patients’ illness experience, particularly during their recovery phase. While for some the lack of concrete results was protective, most emphasized the invalidating effect this had on the perception of illness for both self and others. COVID-19 testing is now widely accessible; however, those who are unable to demonstrate a positive test result but who are still presumed to have had COVID-19 in the first wave must continue to adapt to and live with the effects of this gap in knowledge and care on their recovery. Future efforts are required to ensure that patients do not face barriers to care due to the lack of testing and are reassured regarding their access to healthcare. Affiliations- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 2Abilities Research Center, Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY

Keywords: accessibility, COVID-19, recovery, testing

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