Search results for: regional events

Authors: Fedili Benamar, Beloulou Mohamed Lamine, Ouahes Hassane, Ghattas Samir

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 Background and aims: Peripheral regional anesthesia has been integrated into most analgesia protocols for total knee arthroplasty which considered among the most painful surgeries with a huge potential for chronicization. The adductor canal block (ACB) has gained popularity. Similarly, the IPACK block has been described to provide analgesia of the posterior knee capsule. This study aimed to evaluate the analgesic efficacy of this block in patients undergoing primary PTG. Methods: 90 patients were randomized to receive either an IPACK, an anterior sciatic block, or a sham block (30 patients in each group + multimodal analgesia and a catheter in the KCA adductor canal). GROUP 1 KCA GROUP 2 KCA+BSA GROUP 3 KCA+IPACK The analgesic blocks were done under echo-guidance preoperatively respecting the safety rules, the dose administered was 20 cc of ropivacaine 0.25% was used. We were to assess posterior knee pain 6 hours after surgery. Other endpoints included quality of recovery after surgery, pain scores, opioid requirements (PCA morphine)(EPI info 7.2 analysis). Results: -groups were matched -A predominance of women (4F/1H). -average age: 68 +/-7 years -the average BMI =31.75 kg/m2 +/- 4. -70% of patients ASA2 ,20% ASA3. -The average duration of the intervention: 89 +/- 19 minutes. -Morphine consumption (PCA) significantly higher in group 1 (16mg) & group 2 (8mg) group 3 (4mg) - The groups were matched . -There was a correlation between the use of the ipack block and postoperative pain Conclusions :In a multimodal analgesic protocol, the addition of IPACK block decreased pain scores and morphine consumption ,

Keywords: regional anesthesia, analgesia, total knee arthroplasty, the adductor canal block (acb), the ipack block, pain

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Authors: Ali Reza Ghanbarnezhad Ghazvini, Seyyed Hamid Reza Mosayyebi

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In recent years, an earthquake has occurred approximately every five years in certain regions of Iran. To mitigate the impact of these seismic events, it is crucial to identify and thoroughly assess the vulnerability of buildings and infrastructure, ensuring their safety through principled reinforcement. By adopting new methods of risk assessment, we can effectively reduce the potential risks associated with future earthquakes. In our research, we have observed that the coefficient of behavior in the fourth chapter is 1.65 for the initial structure and 1.72 for the Superframe structure. This indicates that the Superframe structure can enhance the strength of the main structural members by approximately 10% through the utilization of super beams. Furthermore, based on the comparative analysis between the two structures conducted in this study, we have successfully designed a stronger structure with minimal changes in the coefficient of behavior. Additionally, this design has allowed for greater energy dissipation during seismic events, further enhancing the structure's resilience to earthquakes. By comprehensively examining and reinforcing the vulnerability of buildings and infrastructure, along with implementing advanced risk assessment techniques, we can significantly reduce casualties and damages caused by earthquakes in Iran. The findings of this study offer valuable insights for civil engineering professionals in the field of structural engineering, aiding them in designing safer and more resilient structures.

Keywords: modal pushover analysis, response modification factor, high-strength concrete, concrete shear walls, high-rise building

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Authors: Ahmed M. Gad, Ahmed S. Hweidi

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Background: Defects of the little finger and adjacent areas are not uncommon. It could be a traumatic, post-burn, or after contracture release. Different options could be used for resurfacing these defect, including skin grafts, local or regional flaps. Ulnar para-metacarpal flap described by Bakhach in 1995 based on the distal division of the dorsal branch of the ulnar artery considered a good option for that. In this work, we applied the concept of propeller flap for better mobilization and in-setting of the ulnar para-metacarpal flap. Methods: The study included 15 cases with 4 females and 11 male patients. 10 of the patients had severe post-burn contractures of little finger, and 5 had post-traumatic little finger defects. Contractures were released and resulting soft tissue defects were reconstructed with propeller ulnar para-metacarpal artery flap. The flap based on two main perforators communicating with the palmar system, it was raised based on one of them depending on the extent of the defect and rotated 180 degrees after judicious dissection of the perforator. Results: 13 flaps survived completely, one of the cases developed partial skin loss, which healed by dressing, another flap was completely lost and covered later by a full-thickness skin graft. Conclusion: Ulnar para-metacarpal flap is a reliable option to resurface the little finger as well as adjacent areas. The application of the propeller flap concept based on whether the proximal or distal communicating branch makes the rotation and in-setting of the flap easier.

Keywords: little finger defects, propeller flap, regional hand defects, ulnar parametacarpal flap

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Authors: Ewa Bednorz, Marek Polrolniczak, Bartosz Czernecki, Arkadiusz Marek Tomczyk

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This study is meant as a contribution to the research of the upwelling phenomenon, which is one of the most pronounced examples of the sea-atmosphere coupling. The aim is to confirm the atmospheric forcing of the sea waters circulation and sea surface temperature along the variously oriented Baltic Sea coasts and to find out macroscale and regional circulation patterns triggering upwelling along different sections of this relatively small and semi-closed sea basin. The mean daily sea surface temperature data from the summer seasons (June–August) of the years 1982–2017 made the basis for the detection of upwelling cases. For the atmospheric part of the analysis, monthly indices of the Northern Hemisphere macroscale circulation patterns were used. Besides, in order to identify the local direction of airflow, the daily zonal and meridional regional circulation indices were constructed and introduced to the analysis. Finally, daily regional circulation patterns over the Baltic Sea region were distinguished by applying the principal component analysis to the gridded mean daily sea level pressure data. Within the Baltic Sea, upwelling is the most frequent along the zonally oriented northern coast of the Gulf of Finland, southern coasts of Sweden, and along the middle part of the western Gulf of Bothnia coast. Among the macroscale circulation patterns, the Scandinavian type (SCAND), with a primary circulation center located over Scandinavia, has the strongest impact on the horizontal flow of surface sea waters in the Baltic Sea, which triggers upwelling. An anticyclone center over Scandinavia in the positive phase of SCAND enhances the eastern airflow, which increases upwelling frequency along southeastern Baltic coasts. It was proved in the study that the zonal circulation has a stronger impact on upwelling occurrence than the meridional one, and it could increase/decrease a chance of upwelling formation by more than 70% in some coastal sections. Positive and negative phases of six distinguished regional daily circulation patterns made 12 different synoptic situations which were analyzed in the terms of their influence on the upwelling formation. Each of them revealed some impact on the frequency of upwelling in some coastal section of the Baltic Sea; however, two kinds of synoptic situations seemed to have the strongest influence, namely, the first kind representing pressure patterns enhancing the zonal flow and the second kind representing synoptic patterns with a cyclone/anticyclone centers over southern Scandinavia. Upwelling occurrence appeared to be particularly strongly reliant on the atmospheric conditions in some specific coastal sections, namely: the Gulf of Finland, the south eastern Baltic coasts (Polish and Latvian-Lithuanian section), and the western part of the Gulf of Bothnia. Concluding, it can be stated that atmospheric conditions strongly control the occurrence of upwelling within the Baltic Sea basin. Both local and macroscale circulation patterns expressed by the location of the pressure centers influence the frequency of this phenomenon; however, the impact strength varies, depending on the coastal region. Acknowledgment: This research was funded by the National Science Centre, Poland, grant number 2016/21/B/ST10/01440.

Keywords: Baltic Sea, circulation patterns, coastal upwelling, synoptic conditions

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Authors: Marju Ben Sayed, Shigeko Haruyama

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Among all kinds of natural disaster, the flood is a common feature in rapidly urbanizing Dhaka city. In this research, assessment of flood risk of Dhaka metropolitan area has been investigated by using an integrated approach of GIS, remote sensing and socio-economic data. The purpose of the study is to measure the flooding risk concerning with the flood protection embankment in big flooding events (1988, 1998 and 2004) and urbanization of Dhaka metropolitan zone. In this research, we considered the Dhaka city into two parts; East Dhaka (outside the flood protection embankment) and West Dhaka (inside the flood protection embankment). Using statistical data, we explored the socio-economic status of the study area population by comparing the density of population, land price and income level. We have drawn the cross section profile of the flood protection embankment into three different points for realizing the flooding risk in the study area, especially in the big flooding year (1988, 1998 and 2004). According to the physical condition of the study area, the land use/land cover map has been classified into five classes. Comparing with each land cover unit, historical weather station data and the socio-economic data, the flooding risk has been evaluated. Moreover, we compared between DEM data and each land cover units to find out the relationship with flood. It is expected that, this study could contribute to effective flood forecasting, relief and emergency management for a future flood event in Dhaka city.

Keywords: land use, land cover change, socio-economic, Dhaka city, GIS, flood

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Authors: José Ramón López-Mínguez, Estrella Suárez-Corchuelo, Sergio López-Tejero, Luis Nombela-Franco, Xavier Freixa-Rofastes, Guillermo Bastos-Fernández, Xavier Millán-Álvarez, Raúl Moreno-Gómez, José Antonio Fernández-Díaz, Ignacio Amat-Santos, Tomás Benito-González, Fernando Alfonso-Manterola, Pablo Salinas-Sanguino, Pedro Cepas-Guillén, Dabit Arzamendi, Ignacio Cruz-González, Juan Manuel Nogales-Asensio

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Background and objectives: The treatment of patients with non-valvular atrial fibrillation (NVAF) who need coronary stenting is challenging. The objective of the study was to determine whether left atrial appendage occlusion (LAAO) could be a feasible option and benefit these patients. To this end, we studied the impact of LAAO plus antiplatelet drugs vs oral anticoagulants (OAC) (including direct OAC) plus antiplatelet drugs in these patients’ long-term outcomes. Methods: The results of 207 consecutive patients with NVAF who underwent coronary stenting were analyzed. A total of 146 patients were treated with OAC (75 with acenocoumarol, 71 with direct OAC) while 61 underwent LAAO. The median follow-up was 35 months. Patients also received antiplatelet therapy as prescribed by their cardiologist. The study received the proper ethical oversight. Results: Age (mean 75.7 years), and the past medical history of stroke were similar in both groups. However, the LAAO group had more unfavorable characteristics (history of coronary artery disease [CHA2DS2-VASc], and significant bleeding [BARC ≥ 2] and HAS-BLED). The occurrence of major adverse events (death, stroke/transient ischemic events, major bleeding) and major cardiovascular events (cardiac death, stroke/transient ischemic attack, and myocardial infarction) were significantly higher in the OAC group compared to the LAAO group: 19.75% vs 9.06% (HR, 2.18; P = .008) and 6.37% vs 1.91% (HR, 3.34; P = .037), respectively. Conclusions: In patients with NVAF undergoing coronary stenting, LAAO plus antiplatelet therapy produced better long-term outcomes compared to treatment with OAC plus antiplatelet therapy despite the unfavorable baseline characteristics of the LAAO group.

Keywords: stents, atrial fibrillation, anticoagulants, left atrial appendage occlusion

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Authors: Baluku Nathan

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Infection prevention and control (IPC) is a practical, evidence-based approach that prevents patients and emergency health workers from being harmed by avoidable infections as a result of antimicrobial resistance; all hospital infection control programs put together various practices which, when used appropriately, restrict the spread of infection. A breach in these control practices facilitates the transmission of infections from patients to health workers, other patients and attendants. It is, therefore, important for all EMTs and patients to adhere to them strictly. It is also imperative for administrators to ensure the implementation of the infection control program for their facilities. Purpose: The purpose of this study was to investigate the influencing factors of prevention practices against Infection exposure among emergency medical technicians (EMTs) in the emergency department at Mbarara hospital. Methodology: This was a descriptive cross-sectional study that employed a self-reported questionnaire that was filled out by 32 EMTs in the emergency department from 12th February to 3rd march 2022. The questionnaire consisted of items concerning the defensive environment and other Factors influencing Infection prevention and control practices in the accident and emergency department of Mbarara hospital. Results: From the findings, majority16(50%) always used protective gear when doing clinical work,14 (43.8%) didn’t use protective gear, citing they were only assisting those performing resuscitations, gumboots were the least used protective gear with only3(9.4%) usage. Regarding disposal techniques of specific products like blood and sharps, results showed 10 (31.3%) said blood is disposed of in red buckets, 5(15.6%) in yellow buckets and only5(15.6%) in black buckets and 12(37.5%) didn’t respond. However, 28(87.5%) said sharps were disposed of in a sharps container. The majority, 17(53.1%), were not aware of the infection control guidelines even though they were pinned on walls of the emergency rooms,15(46.9%) said they had never had quality assurance monitoring events,14(43.8%) said monitoring was continuous while15(46.9 %) said it was discrete. Conclusions: The infection control practices at the emergency department were inadequate in view of less than 100% of the EMTs observing the five principles of infection prevention, such as the use of personal protective equipment and proper waste disposal in appropriate color-coded bins. Dysfunctional infection prevention and control committees accompanied by inadequate supervision to ensure infection control remained a big challenge.

Keywords: infection prevention, influencing factors, emergency medical technician (EMT), emergency unit

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Authors: Baluku Nathan

Abstract:

Infection prevention and control (IPC) is a practical, evidence-based approach that prevents patients and emergency health workers from being harmed by avoidable infections as a result of antimicrobial resistance; all hospital infection control programs put together various practices which, when used appropriately, restrict the spread of infection. A breach in these control practices facilitates the transmission of infections from patients to health workers, other patients, and attendants. It is, therefore important for all emergency medical technicians (EMTs) and patients to strictly adhere to them. It is also imperative for administrators to ensure the implementation of the infection control programme for their facilities. Purpose: The purpose of this study was to investigate the influencing factors of prevention practices against infection exposure among emergency medical technicians (EMTs) in the emergency department at Mbarara hospital. Methodology: This was a descriptive cross-sectional study that employed a self-reported questionnaire that was filled out by 32 EMTs in the emergency department from 12th February to 3rd march 2022. The questionnaire consisted of items concerning the defensive environment and other factors influencing infection prevention and control practices in the accident and emergency department of Mbarara hospital. Results: From the findings, the majority 16 (50%) always used protective gear when doing clinical work, 14 (43.8%) didn’t use protective gear, citing they were only assisting those performing resuscitations, gumboots were the least used protective gear with only3(9.4%) usage. About disposal techniques of specific products like blood and sharps, results showed 10 (31.3%) said blood is disposed of in red buckets, 5 (15.6%) in yellow buckets, and only 5(15.6%) in black buckets, and 12(37.5%) didn’t respond, however, 28(87.5%) said sharps were disposed of in a sharps container. The majority, 17 (53.1%), were not aware of the infection control guidelines even though they were pinned on walls of the emergency rooms, 15(46.9%) said they have never had quality assurance monitoring events, 14(43.8%) said monitoring was continuous while 15(46.9 %) said it was discrete. Conclusions: The infection control practices at the emergency department were inadequate in view of less than 100% of the EMTs observing the five principles of infection prevention, such as the use of personal protective equipment and proper waste disposal in appropriate color-coded bins. Dysfunctional infection prevention and control committees accompanied by inadequate supervision to ensure infection control remained a big challenge.

Keywords: emergency medical technician, infection prevention, influencing factors, infection control

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Authors: M. Ashok Williams, T. V. Lakshmi Kumar

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The life cycle of Black carbon aerosols depends on their physical removal processes from the atmosphere during the precipitation events. Black Carbon (BC) mass concentration has been analysed during rainy and non-rainy days of Northeast (NE) Monsoon months of the years 2015 and 2017 over a semi-urban environment near Chennai (12.81 N, 80.03 E), located on the east coast of India. BC, measured using an Aethalometer (AE-31) has been related to the atmospheric boundary layer height (BLH) obtained from the ERA Interim Reanalysis data during rainy and non-rainy days on monthly mean basis to understand the wet removal of BC over the study location. The study reveals that boundary layer height has a profound effect on the BC concentration on rainy days and non rainy days. It is found that the BC concentration in the night time is lower on rainy days compared to non rainy days owing to wash out on rainy days and the boundary layer height remaining nearly the same on rainy and non rainy days. On the other hand, in the daytime, it is found that the BC concentration remains nearly the same on rainy and non rainy days whereas the boundary layer height is lower on rainy days compared to non rainy days. This reveals that in daytime, lower boundary layer heights compensate for the wet removal effect on BC concentration on rainy days. A quantitative relation is found between the product of BC and BLH during rainy and non-rainy days which indicates the extent of redistribution of BC during non-rainy days when compared to the rainy days. Further work on the wet removal processes of the BC is in progress considering the individual rain events and other related parameters like wind speed.

Keywords: black carbon aerosols, atmospheric boundary layer, scavenging processes, tropical coastal location

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Authors: Moufida Benmoussa

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Since the escalation of the Syrian conflict in 2011, 6.9 million Syrians have fled to neighbouring countries, and 6.7 have remained displaced in Syria. Out of the 6.9 who fled Syria, over one million have crossed the Mediterranean Sea and become refugees and asylum seekers in various European countries. As a European and a member country of the EU, the Republic of Ireland was not an exception. In response to the refugee crisis caused mainly by the Syrian displacement, Ireland established the Syrian Humanitarian Admission Programme (SHAM) in 2014 and the Irish Refugee Protection Programme (IRPP) in 2015, followed by its second phase in 2019. In light of these events, Irish print media played a significant role in covering the Irish government’s decisions, political stance, and public opinion on the debate on taking Syrian refugees into Ireland. Considering the tremendous impact of media on politics and public opinion, my research examined how The Irish Times and Irish Independent framed Syrian migration to Ireland. I adopted a qualitative framing analysis to identify the prominent framings in these two newspapers. The collection of newspaper articles focused on three periods. The first period is from the first of January 2014 to the end of December 2014. During this period, the media covered the launch of the Syrian Humanitarian Admission Programme (SHAP) and stories about the first arrival of the Syrian refugees to Ireland. The second period is the year 2015. During this year, various events gained the attention of the Irish media. These events include Ireland’s establishment of the Irish Refugee Protection Programme, the Paris attacks, and the publishing of Aylan Kurdi’s Photograph. The third period is from the first of December 2019 to the thirtieth of January 2020. In this period, the media covered the convention of Ireland with the UNHCR and the European Union to provide sanctuary to 2900 refugees in the years 2020, 2021, 2022, and 2023. The primary findings of my study indicate that The Irish Times and Irish Independent’s framing of Syrian migration to Ireland was various. My research findings indicate that The Irish Times and Irish Independent’s framing of Syrian migration to Ireland was varied and asymmetrical. The dominant frames used by these two newspapers are humanitarian, responsibility, contribution, burden, intruder, and threat. The former three frames positively perceive Syrian migration to Ireland and support the Irish government’s decisions to welcome more Syrian refugees. On the other hand, the last three frames perceive Syrian migration and refugees negatively and stand for the principle that Ireland should not take Syrian refugees.

Keywords: framing, Syrian migration, Ireland, newspaper

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Authors: Frikha Rim, Abdelmoula Bouayed Nouha, Rebai Tarek

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Pregnancy is a hypercoagulable state which causing a defective maternal haemostatic response and leading to thrombosis of the uteroplacental vasculature, that might cause pregnancy complications as recurrent pregnancy loss (RPL). Since heritable Thrombophilic defects are associated with increased thrombosis, their prevalence was evaluated in patients with special emphasis on combinations of the above pathologies. Especially, Factor V Leiden (FVL) G1691A, methylene tetra hydro folate reductase (MTHFR) C677T, and factor II (FII) G20210A mutations are three important causes of thrombophilia, which might be related to recurrent pregnancy loss (RPL). In this study we evaluated the presence of these three mutations [factor V Leiden (FVL), prothrombin G20210A (PTG) and methylenetetrahydrofolate reductase (MTHFR) C677T] amongst 35 Tunisian women with more than 2 miscarriages, referred to our genetic counseling. DNA was extracted from peripheral blood samples and PCR-RFLP was performed for the molecular diagnosis of each mutation. Factor V Leiden and Prothrombin mutation were detected respectively in 5.7% and 2.9% of women with particular history of early fetal loss and thrombotic events. Despites the luck of strength of this study, we insist that testing for the most inherited thrombophilia (FVL and FII mutation) should be performed in women with RPL in the context of thrombotic events. Multi-centre collaboration is necessary to clarify the real impact of thrombotic molecular defects on the pregnancy outcome, to ascertain the effect of thrombophilia on recurrent pregnancy loss and then to evaluate the appropriate therapeutic approach.

Keywords: thrombophilia, recurrent pregnancy loss, factor V Leiden, prothrombin G20210A, methylene tetra hydro folate reductase

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Authors: Roger M. Wall, David G. Proverbs, Yamina Silva, Danny Scipion

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This paper critically reviews the outcomes of a 4 day workshop focused on building resilience to El Niño related Flood Events in northern Perú. The workshop was run jointly by Birmingham City University (BCU) in partnership with Instituto Geofísico del Perú (IGP) and was hosted by the Universidad de Piura (UDEP). The event took place in August 2018 and was funded by the Newton-Paulet fund administered by the British Council. The workshop was a response to the severe flooding experienced in Piura during the El Niño event of March 2017 which damaged over 100,000 homes and destroyed much local infrastructure including around 100 bridges. El Niño is a recurrent event and there is concern that its frequency and intensity may change in the future as a consequence of climate change. A group of 40 early career researchers and practitioners from the UK and Perú were challenged with working together across disciplines to identify key cross-cutting themes and make recommendations for building resilience to similar future events. Key themes identified on day 1 of the workshop were governance; communities; risk information; river management; urban planning; health; and infrastructure. A field study visit took place on day 2 so that attendees could gain first-hand experience of affected and displaced communities. Each of the themes was then investigated in depth on day 3 by small interdisciplinary teams drawing on their own expertise, local knowledge and the experiences of the previous day’s field trip. Teams were responsible for developing frameworks for analysis of their chosen theme and presenting their findings to the whole group. At this point, teams worked together to develop links between the different themes so that an integrated approach could be developed and presented on day 4. This paper describes the approaches taken by each team and the way in which these were integrated to form an holistic picture of the whole system. The findings highlighted the importance of risk-related information and the need for strong governance structures to enforce planning regulations and development. The structured facilitation approach proved to be very effective and it is recommended that the process be repeated with a broader group of stakeholders from across the region.

Keywords: El Niño, integrated flood risk management, Perú, structured facilitation, systems approach, resilience

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Authors: Bartosz Osiecki, Jane Liu

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Pollutants emitted from forest fires such as PM₂.₅ and carbon monoxide (CO) have been found to impact the air quality of distant regions through long-range transport. PM₂.₅ is of particular concern due to its transport capacity and implications for human respiratory and cardiovascular health. As such, significant increases in PM₂.₅ concentrations have been exhibited in urban areas downwind of fire sources. This study seeks to expand on this literature by evaluating the impacts of long-range forest fire emission transport on air quality in Toronto, Ontario, as a means of evaluating the vulnerability of this major urban center to distant fire events. In order to draw correlations between the fire event and air pollution episode in Toronto, MODIS fire count data and HYPLSIT trajectories are used to assess the date, location, and severity of the fire and track the trajectory of emissions (respectively). Forward and back-trajectories are run, terminating at the West Toronto air monitoring station. PM₂.₅ and CO concentrations in Toronto during September 2017 are found to be significantly elevated, which is likely attributable to the fire activity. Other sites in Ontario including Toronto (East, North, Downtown), Mississauga, Brampton, and Hamilton (Downtown) exhibit similar peaks in PM₂.₅ concentrations. This work sheds light on the non-local, natural factors influencing air quality in urban areas. This is especially important in the context of climate change which is expected to exacerbate intense forest fire events in the future.

Keywords: air quality, forest fires, PM₂.₅, Toronto

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Authors: Daniel Murrant, Andrew Quinn, Lee Chapman

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A growing population has led to increasing global water and energy demand. This demand, combined with the effects of climate change and an increasing need to maintain and protect the natural environment, represents a potentially severe threat to many national infrastructure systems. This has resulted in a considerable quantity of published material on the interdependencies that exist between the supply of water and the thermal generation of electricity, often known as the water-energy nexus. Focusing specifically on the UK, there is a growing concern that the future availability of water may at times constrain thermal electricity generation, and therefore hinder the UK in meeting its increasing demand for a secure, and affordable supply of low carbon electricity. To provide further information on the threat the water-energy nexus may pose to the UK’s energy system, this paper models the regional water demand of UK thermal electricity generation in 2030 and 2050. It uses the strategically important Energy Systems Modelling Environment model developed by the Energy Technologies Institute. Unlike previous research, this paper was able to use abstraction and consumption factors specific to UK power stations. It finds that by 2050 the South East, Yorkshire and Humber, the West Midlands and North West regions are those with the greatest freshwater demand and therefore most likely to suffer from a lack of resource. However, it finds that by 2050 it is the East, South West and East Midlands regions with the greatest total water (fresh, estuarine and seawater) demand and the most likely to be constrained by environmental standards.

Keywords: climate change, power station cooling, UK water-energy nexus, water abstraction, water resources

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Authors: Tamar Arieli

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Cross-border cooperation has long been hailed as a means for stabilizing and normalizing relations between former enemies. Cooperation in problem-solving and realizing of local interests in post-conflict environments can indeed serve as a basis for developing dialogue and meaningful relations between neighbors across borders. Hence the potential for formerly sealed borders to serve as a basis for generating local and national perceptions of interdependence and as a buffer against the resume of conflict. Central questions which arise for policy-makers and third parties are how to facilitate cross-border cooperation and which areas of cooperation best serve to normalize post-conflict border regions. The Israel-Jordan border functions as a post-conflict border, in that it is a peaceful border since the 1994 Israel-Jordan peace treaty yet cross-border relations are defined but the highly securitized nature of the border region and the ongoing Arab-Israel regional conflict. This case study is based on long term qualitative research carried out in the border regions of both Israel and Jordan, which mapped and analyzed cross-border in a wide range of activities – social interactions sponsored by peace-facilitating NGOs, government sponsored agricultural cooperation, municipal initiated emergency planning in cross-border continuous urban settings, private cross-border business ventures and various environmental cooperative initiatives. These cooperative initiatives are evaluated through multiple interviews carried out with initiators and partners in cross-border cooperation as well as analysis of documentation, funding and media. These cooperative interactions are compared based on levels of cross-border local and official awareness and involvement as well as sustainability over time. This research identifies environmental cooperation as the most sustainable area of cross- border cooperation and as most conducive to generating perceptions of regional interdependence. This is a variation to the ‘New Middle East’ vision of business-based cooperation leading to conflict amelioration and regional stability. Environmental cooperation serving the public good rather than personal profit enjoys social legitimization even in the face of widespread anti-normalization sentiments common in the post-conflict environment. This insight is examined in light of philosophical and social aspects of the natural environment and its social perceptions. This research has theoretical implications for better understanding dynamics of cooperation and conflict, as well as practical ramifications for practitioners in border region policy and management.

Keywords: borders, cooperation, post-conflict, security

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Authors: Friba Haidari

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The aim of the study is to identify Russia's role in managing the Nagorno-Karabakh conflict betweenArmenia and Azerbaijan during the years 1990 to 2020. The Nagorno-Karabakh crisis can not be considered a mere territorial conflict but also a crossroads of interests of foreign actors. Geopolitical rivalries and the access to energy by regional and trans-regional actors have complicated the crisis and created a security challenge in the region, which is likely to escalate into a full-blown war between the parties involved. The geopolitical situation of Nagorno-Karabakh and its current situation have affected all peripheral states in some way. Russia, as one of the main actors in this scene, has been actively involved since the beginning of the crisis. The Russians have always sought to strengthen their influence and presence in the Nagorno-Karabakh crisis. Russia's efforts to weaken the role of the Minsk Group, The presence of Western actors, and the deployment of Russian forces in the disputed area can be assessed in this context. However, this study seeks to answer the question of what role did Russia play in managing the Nagorno-Karabakh conflict between Armenia and Azerbaijan between 1990 and 2020? The study hypothesizes that Russia has prevented the escalation of the Nagorno-Karabakh conflict through mediation and some coercion. This study is divided into four parts, including conflict management as a theoretical framework; Examining the competition and the role of actors in the Caucasus region, especially the role of the Minsk Group, and what approach or tools and methods Russia has used in its foreign policy in managing the conflict, and finally what are the relations between the countries involved and what will be Russia's role in the future? Was discussed. This study examines the analysis and transfer of ideas and information using authoritative international sources with an explanatory method and shares its results with everyone.

Keywords: Russia, conflict, nagorno-karabakh, management

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Authors: Lydia Ouma Radoli

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The paradox of documenting history through visuals that objectify gruesome images to depict the prominence of stories intrigues media researchers. In East Africa, the topic has been captured in a variety of media frames, but scantly in scholarly work. This paper adopts Visual Rhetoric and Framing Theories to tease out the drivers behind the criteria for the selection of violent visuals. The paper projects that quantitative and qualitative literature regarding journalists’ personal and work-related exposure to PSTD will give insights into the concept of trauma journalism - reporting of horrific events, e.g., violent crime and terror. The data will be collected through methods such as document analysis (photographs and videos) and in-depth interviews to summarize the informational contents with respect to the research objectives and questions. The study is hinged on the background that the criterion for news production is constructed from the idea that ‘if there’s violence, conflict, and death involved, the story gets top priority.’ The anticipated outcome is to establish trauma experiences of visual rhetors, suggest mitigations, and address gaps in academic research. The findings of the study will sustain the critical role of visual rhetors. Further, media practitioners may find the study useful in assessing the effects and values of visual witnessing. Historically, the criterion for visual news production has been that if there’s violence, conflict, and death involved, the story gets top priority. To capture the goriness of the images, media theorists and sociologists have used the expression: “If it bleeds, it leads.” The statement assumes that audiences are attracted to pictures that show violent images. Further, research on visual aspects of Television news has shown its ability to hold viewers’ attention and cause aggression. This paper samples images and narratives from Journalists who have covered trauma-related events. The samples are indicative of the problem under study, which depicts journalists exposed to traumatic events as not receiving any Psycho-social support within newsrooms. It is hoped that the study could inform policy and practice within developing countries through the interpretations of theoretical and empirical explanations of existing trauma phenomena among journalists.

Keywords: visual-witnessing, media culture, visual rhetoric, imaging violence in East Africa

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Authors: Sandeep J. Kumar

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Urbanisation is considered as the primary driver of land use and land cover change that has direct link to population and economic growth. In India, as well as in other developing countries, cities are urbanizing at an alarming rate. This unprecedented and uncontrolled urbanisation can result in urban sprawl. Due to a number of factors, urban sprawl is recognised to be a result of poor planning, inadequate policies, and poor governance. Urban sprawl may be seen as posing a threat to the development of sustainable cities. Hence, it is very essential to manage this. Planning for predicted future growth is critical to avoid the negative effects of urban growth at the local and regional levels. Thiruvananthapuram being the capital city of Kerala is a city of economic success, challenges, and opportunities. Urbanization trends in the city have paved way for Urban Sprawl. This thesis aims to formulate a framework to combat the emerging urban sprawl in the city of Thiruvananthapuram. For that, the first step was to quantify trends of urban growth in Thiruvananthapuram city using Geographical Information System(GIS) and remote sensing techniques. The technique and results obtained in the study are extremely valuable in analysing the land use changes. Secondly, these change in the trends were analysed through some of the critical factors that helped the study to understand the underlying issues of the existing city structure that has resulted in urban sprawl. Anticipating development trends can modify the current order. This can be productively resolved using regional and municipal planning and management strategies. Hence efficient strategies to curb the sprawl in Thiruvananthapuram city have been formulated in this study that can be considered as recommendations for future planning.

Keywords: urbanisation, urban sprawl, geographical information system(GIS), thiruvananthapuram

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Authors: Takahiro Katayama, Hsueh-Sheng Chang

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Due to the global climate change, it has increased the extreme rainfall that led to serious floods around the world. In recent years, urbanization and population growth also tend to increase the number of impervious surfaces, resulting in significant loss of life and property during floods especially for the urban areas of Taiwan. In the past, the primary governmental response to floods was structural flood control and the only flood protection standards in use were the design standards. However, these design standards of flood control facilities are generally calculated based on current hydrological conditions. In the face of future extreme events, there is a high possibility to surpass existing design standards and cause damages directly and indirectly to the public. To cope with the frequent occurrence of floods in recent years, it has been pointed out that there is a need for a different standard called FPSR (Flood Protection Standard of Regions) in Taiwan. FPSR is mainly used for disaster reduction and used to ensure that hydraulic facilities draining regional flood immediately under specific return period. FPSR could convey a level of flood risk which is useful for land use planning and reflect the disaster situations that a region can bear. However, little has been reported on FPSR and its impacts to the public in Taiwan. Hence, this study proposes a quantity procedure to evaluate the FPSR. This study aimed to examine FPSR of the region and public perceptions of and knowledge about FPSR, as well as the public’s WTP (willingness to pay) for FPSR. The research is conducted via literature review and questionnaire method. Firstly, this study will review the domestic and international research on the FPSR, and provide the theoretical framework of FPSR. Secondly, CVM (Contingent Value Method) has been employed to conduct this survey and using double-bounded dichotomous choice, close-ended format elicits households WTP for raising the protection level to understand the social costs. The samplings of this study are citizens living in Taichung city, Taiwan and 700 samplings were chosen in this study. In the end, this research will continue working on surveys, finding out which factors determining WTP, and provide some recommendations for adaption policies for floods in the future.

Keywords: climate change, CVM (Contingent Value Method), FPSR (Flood Protection Standard of Regions), urban flooding

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Authors: Sendy Ghirardi, Pau Rausell Köster

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The European Commission increasingly pushes cultural policies towards social outcomes and local and regional authorities also call for culture-driven strategies for local development and prosperity and therefore, the measurement of cultural participation becomes increasingly more significant for evidence-based policy-making processes. Cultural participation involves various kinds of social and economic spillovers that combine social and economic objectives of value creation, including social sustainability and respect for human values. Traditionally, from the economic perspective, cultural consumption is measured by the value of financial transactions in purchasing, subscribing to, or renting cultural equipment and content, addressing the market value of cultural products and services. The main sources of data are the household spending survey and merchandise trade survey, among others. However, what characterizes the cultural consumption is that it is linked with the hedonistic and affective dimension rather than the utilitarian one. In fact, nowadays, more and more attention is being paid to the social and psychological dimensions of culture. The aim of this work is to present a comprehensive approach to measure the impacts of cultural participation and cultural users’ behaviour, combining both socio-psychological and economic approaches. The model combines contingent evaluation techniques with the individual characteristic and perception analysis of the cultural experiences to evaluate the cognitive, aesthetic, emotive and social impacts of cultural participation. To investigate the comprehensive approach to measure the impact of the cultural events on individuals, the research has been designed on the basis of prior theoretical development. A deep literature methodology has been done to develop the theoretical model applied to the web platform to measure the impacts of cultural experience on individuals. The developed framework aims to become a democratic tool for evaluating the services that cultural or policy institutions can adopt through the use of an interacting platform that produces big data benefiting academia, cultural management and policies. The Au Culture is a prototype based on an application that can be used on mobile phones or any other digital platform. The development of the AU Culture Platform has been funded by the Valencian Innovation Agency (Government of the Region of Valencia) and it is part of the Horizon 2020 project MESOC.

Keywords: comprehensive approach, cultural participation, economic dimension, socio-psychological dimension

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Authors: Seolah Lee, Yoohyk Jang, Soyoung Lee, Kon Chu, Sang Kun Lee

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Objective: The International League Against Epilepsy (ILAE) currently suggests a topiramate serum level range of 5-20 mg/L. However, numerous institutions have observed substantial drug response at lower levels. This study aims to investigate the correlation between topiramate serum levels, drug responsiveness, and adverse events to establish a more accurate and tailored therapeutic range. Methods: We retrospectively analyzed topiramate serum samples collected between January 2017 and January 2022 at Seoul National University Hospital. Clinical data, including serum levels, antiseizure regimens, seizure frequency, and adverse events, were collected. Patient responses were categorized as "insufficient" (reduction in seizure frequency <50%) or "sufficient" (reduction ≥ 50%). Within the "sufficient" group, further subdivisions included seizure-free and tolerable seizure subgroups. A population pharmacokinetic model estimated serum levels from spot measurements. ROC curve analysis determined the optimal serum level cut-off. Results: A total of 389 epilepsy patients, with 555 samples, were reviewed, having a mean dose of 178.4±117.9 mg/day and a serum level of 3.9±2.8 mg/L. Out of the samples, only 5.6% (n=31) exhibited insufficient response, with a mean serum level of 3.6±2.5 mg/L. In contrast, 94.4% (n=524) of samples demonstrated sufficient response, with a mean serum level of 4.0±2.8 mg/L. This difference was not statistically significant (p = 0.45). Among the 78 reported adverse events, logistic regression analysis identified a significant association between ataxia and serum concentration (p = 0.04), with an optimal cut-off value of 6.5 mg/L. In the subgroup of patients receiving monotherapy, those in the tolerable seizure group exhibited a significantly higher serum level compared to the seizure-free group (4.8±2.0 mg/L vs 3.4±2.3 mg/L, p < 0.01). Notably, patients in the tolerable seizure group displayed a higher likelihood of progressing into drug-resistant epilepsy during follow-up visits compared to the seizure-free group. Significance: This study proposed an optimal therapeutic concentration for topiramate based on the patient's responsiveness to the drug and the incidence of adverse effects. We employed a population pharmacokinetic model and analyzed topiramate serum levels to recommend a serum level below 6.5 mg/L to mitigate the risk of ataxia-related side effects. Our findings also indicated that topiramate dose elevation is unnecessary for suboptimal responders, as the drug's effectiveness plateaus at minimal doses.

Keywords: topiramate, therapeutic range, low dos, antiseizure effect

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Authors: Maariyah Irfan

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Intro: Current cardiovascular (CV) care faces challenges such as low budgets and high hospital admission rates. This review aims to evaluate Big Data in CV healthcare management through the use of wearable devices in atrial fibrillation (AF) detection. AF may present intermittently, thus it is difficult for a healthcare professional to capture and diagnose a symptomatic rhythm. Methods: The iRhythm ZioPatch, AliveCor portable electrocardiogram (ECG), and Apple Watch were chosen for review due to their involvement in controlled clinical trials, and their integration with smartphones. The cost-effectiveness and AF detection of these devices were compared against the 12-lead ambulatory ECG (Holter monitor) that the NHS currently employs for the detection of AF. Results: The Zio patch was found to detect more arrhythmic events than the Holter monitor over a 2-week period. When patients presented to the emergency department with palpitations, AliveCor portable ECGs detected 6-fold more symptomatic events compared to the standard care group over 3-months. Based off preliminary results from the Apple Heart Study, only 0.5% of participants received irregular pulse notifications from the Apple Watch. Discussion: The Zio Patch and AliveCor devices have promising potential to be implemented into the standard duty of care offered by the NHS as they compare well to current routine measures. Nonetheless, companies must address the discrepancy between their target population and current consumers as those that could benefit the most from the innovation may be left out due to cost and access.

Keywords: atrial fibrillation, big data, cardiovascular healthcare management, wearable devices

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Authors: Emery Jr. Coppola

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Water resources are being depleted and degraded at an alarming and non-sustainable rate worldwide. In some areas, it is progressing more slowly. In other areas, irreversible damage has already occurred, rendering regions largely unsuitable for human existence with destruction of the environment and the economy. Today, 2.5 billion people or 36 percent of the world population live in water-stressed areas. The convergence of factors that created this global water crisis includes local, regional, and global failures. In this paper, a survey of some of these factors is presented. They include abuse of political power and regulatory acquiescence, improper planning and design, ignoring good science and models, systemic failures, and division between the powerful and the powerless. Increasing water demand imposed by exploding human populations and growing economies with short-falls exacerbated by climate change and continuing water quality degradation will accelerate this growing water crisis in many areas. Without regional measures to improve water efficiencies and protect dwindling and vulnerable water resources, environmental and economic displacement of populations and conflict over water resources will only grow. Perhaps more challenging, a global commitment is necessary to curtail if not reverse the devastating effects of climate change. Factors will be illustrated by real-world examples, followed by some partial solutions offered by water experts for helping to mitigate the growing water crisis. These solutions include more water efficient technologies, education and incentivization for water conservation, wastewater treatment for reuse, and improved data collection and utilization.

Keywords: climate change, water conservation, water crisis, water technologies

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Authors: Genevieve D. Fernandes, Nisha P. Naik

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All through the ages in all human civilizations, men have been engaged in construction activity, not only to build their dwellings and house their activities, but also roads, bridges to facilitate means of transport, and communication etc. The main concern in this activity was to ensure safety and reduce the collapse of the buildings and other structures. But even after taking all precautions, it is impossible to guarantee safety and collapse because of several unforeseen reasons like faulty constructions, design errors, overloading, soil liquefaction, gas explosion, material degradation, terrorist attacks and economic factors also contributing to the collapse. It is also uneconomical to design the structure for unforeseen events unless they have a reasonable chance of occurrence. In order to ensure safety and prevent collapse, many guidelines have been framed by local bodies and government authorities in many countries like the United States Department of Defence (DOD), United States General Service Administration (GSA) and Euro-Codes in European Nations. Some other practices are followed to incorporate redundancies in the structure like detailing, ductile designs, tying of elements at particular locations, and provision of hinges and interconnections. It is also to be admitted that a full-proof safe design structure for accidental events cannot be prepared and implemented as it is uneconomical and the chances of such occurrences are less. This paper reviews past case studies of the collapse of structures with the aim of developing an understanding of the collapse mechanism. This study will definitely help to bring about a detailed improvement in the design to maximise the quality of the construction at a minimal cost.

Keywords: unforeseen factors, progressive collapse, collapse resisting mechanisms, column removal scenario

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Authors: Otu Otu Akanu

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The nexus between migration, national security, and human rights has become increasingly complex, particularly within Nigeria's geopolitical landscape. This study explores how Nigeria navigates the balance between safeguarding national security and upholding human rights amidst escalating regional crises, such as conflicts in the Lake Chad Basin and the Sahel. Through a comprehensive analysis of policy frameworks, security measures, and human rights protocols, this paper critically examines the challenges and opportunities in Nigeria's approach. The study employed a multidisciplinary methodology, integrating perspectives from International Relations, Human Security Studies, and Migration Law to provide a holistic understanding of the issue. Drawing on primary data from government reports, policy documents, and interviews with key stakeholders, alongside secondary literature, the study reveals a persistent tension between security imperatives and human rights obligations. While Nigeria has made strides in enhancing its security architecture, the findings highlight significant gaps in the protection of migrants' rights, often exacerbated by external pressures and domestic political dynamics. The paper argues that a recalibration of Nigeria's security and human rights policies is imperative for achieving sustainable peace and security in the region. By offering policy recommendations rooted in international best practices, this study contributes to the ongoing discourse on migration and security in West Africa and provides a framework for other nations grappling with similar challenges. This research underscores the need for an integrated approach that transcends traditional security paradigms, advocating a more inclusive and human-centered strategy in addressing the complexities of migration and national security.

Keywords: migration, national security, human rights, nigeria, west africa.

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Authors: Ana Gabriela Diaz, Luis Fermín Córdova, Jr., Roberto Lamazares

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The island of Cuba, the largest of the Greater Antilles, is located in the tropical North Atlantic. It is annually affected by numerous weather events, which have caused severe damage to our coastal areas. In the same way that many other coastlines around the world, the beautiful beaches of the Hicacos Peninsula also suffer from erosion. This leads to a structural regression of the coastline. If measures are not taken, the hotels will be exposed to the advance of the sea, and it will be a serious problem for the economy. With the aim of studying the intensity of this type of activity, specialists of group of coastal and marine engineering from CIH, in the framework of the research conducted within the project MEGACOSTAS 2, provide their research to simulate extreme events and assess their impact in coastal areas, mainly regarding the definition of flood volumes and morphodynamic changes in sandy beaches. The main objective of this work is the evaluation of the process of Varadero beach erosion (the coastal sector has an important impact in the country's economy) on the Hicacos Peninsula for different paths of hurricanes. The mathematical model XBeach, which was integrated into the Coastal engineering system introduced by the project of MEGACOSTA 2 to determine the area and the more critical profiles for the path of hurricanes under study, was applied. The results of this project have shown that Center area is the greatest dynamic area in the simulation of the three paths of hurricanes under study, showing high erosion volumes and the greatest average length of regression of the coastline, from 15- 22 m.

Keywords: beach, erosion, mathematical model, coastal areas

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Authors: Javier Varillas, Jorge Alcalá

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We investigate dislocation avalanche phenomena in face-centered cubic (FCC) and body-centered cubic (BCC) crystals using massive, large-scale molecular dynamics (MD) simulations. The analysis is focused on the intermittent development of dense dislocation arrangements subjected to uniaxial tensile straining under displacement control. We employ a novel computational scheme that allows us to inject an entangled dislocation structure in periodic MD domains. We assess the emission of plastic bursts (or dislocation avalanches) in terms of the sharp stress drops detected in the stress-strain curve. The plastic activity corresponds to the sporadic operation of specific dislocation glide processes exhibiting quiescent periods between successive avalanche events. We find that the plastic intermittences in our simulations do not overlap in time under sufficiently low strain rates as dissipation operates faster than driving, where the dense dislocation networks evolve through the emission of dislocation avalanche events whose carried slip adheres to self-organized power-law distributions. These findings enable the extension of the slip distributions obtained from strict displacement-controlled micropillar compression experiments towards smaller values of slip size. Our results furnish further understanding upon the development of entangled dislocation networks in metal plasticity, including specific mechanisms of dislocation propagation and annihilation, along with the evolution of specific dislocation populations through dislocation density analyses.

Keywords: dislocations, intermittent plasticity, molecular dynamics, slip distributions

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Authors: Euripides Antoniades

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In 1821 the Greek Revolution movement, under the political influence that arose from the French revolution, and the corresponding movements in Italy, Germany and America, requested the liberation of the nation and the establishment of an independent national state. Published topics in the British press regarding the Greek Revolution, focused on : a) the right of the Greeks to claim their freedom from Turkish domination in order to establish an independent state based on the principle of national autonomy, b) criticism regarding Turkish rule as illegal and the power of the Ottoman Sultan as arbitrary, c) the recognition of the Greek identity and its distinction from the Turkish one and d) the endorsement Greeks as the descendants of ancient Greeks. The advantage of newspaper as a media is sharing information and ideas and dealing with issues in greater depth and detail, unlike other media, such as radio or television. The London Times is a print publication that presents, in chronological or thematic order, the news, opinions or announcements about the most important events that have occurred in a place during a specified period of time. This paper employs the rich archive of The London Times archive by quoting extracts from publications of that period, to convey the British public perspective regarding the Greek Revolution from its beginning until the London Protocol of 1828. Furthermore, analyses the publications of the British newspaper in terms of the number of references to the Greek revolution, front page and editorial references as well as the size of publications on the revolution during the period 1821-1828. A combination of qualitative and quantitative content analysis was applied. An attempt was made to record Greek Revolution references along with the usage of specific words and expressions that contribute to the representation of the historical events and their exposure to the reading public. Key finds of this research reveal that a) there was a frequency of passionate daily articles concerning the events in Greece, their length, and context in The London Times, b) the British public opinion was influenced by this particular newspaper and c) the newspaper published various news about the revolution by adopting the role of animator of the Greek struggle. For instance, war events and the battles of Wallachin and Moldavia, Hydra, Crete, Psara, Mesollogi, Peloponnese were presented not only for informing the readers but for promoting the essential need for freedom and the establishment of an independent Greek state. In fact, this type of news was the main substance of the The London Times’ structure, establishing a positive image about the Greek Revolution contributing to the European diplomatic development such as the standpoint of France, - that did not wish to be detached from the conclusions regarding the English loans and the death of Alexander I of Russia and his succession by the ambitious Nicholas. These factors offered a change in the attitude of the British and Russians respectively assuming a positive approach towards Greece. The Great Powers maintained a neutral position in the Greek-Ottoman conflict, same time they engaged in Greek power increasement by offering aid.

Keywords: Greece, revolution, newspaper, the London times, London, great britain, mass media

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Authors: Morteza Ghourchi, Meraj Jafari, Atena Soheilazizi

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Today, with the globalization of communications and the connection of countries within the framework of the global economy, free zones play the most important role as the engine of global economic development and globalization of countries. In this regard, corridors have a fundamental role in linking countries and free zones physically with each other. One of these corridors is the New Silk Road corridor (One Belt, One Road initiative), which is being built by China to connect with European countries. In connecting this corridor to European countries, Iran and Turkey are among the countries that play an important role in linking China to European countries through this corridor. The New Silk Road corridor, by connecting Iran’s free zones (Sarakhs and Maku) and Turkey’s free zones (Anatolia and Europe), can provide the best opportunity for expanding economic cooperation and regional development between Iran and Turkey. It can also provide economic links between Iran and Turkey with Central Asian countries and especially the port of Khorgos. On the other hand, it can expand Iran-Turkey economic relations more than ever before with Europe in a vast economic network. The research method was descriptive-analytical, using library resources, documents of Iranian free zones, and the Internet. In an interview with Fars News Agency, Mohammad Reza Kalaei, CEO of Sarakhs Free Zone, said that the main goal of Sarakhs Special Economic Zone is to connect Iran with the Middle East and create a transit corridor towards East Asian countries, including Turkey. Also, according to an interview with Hussein Gharousi, CEO of Maku Free Zone, the importance of this region is due to the fact that Maku Free Zone, due to its geographical location and its position on the China-Europe trade route, the East-West corridor, which is the closest point to the European Union through railway and transit routes, and also due to its proximity to Eurasian countries, is an ideal opportunity for industrial and technological companies. Creating a transit corridor towards East Asian countries, including Turkey, is one of the goals of this project Free zones between Iran and Turkey can sign an agreement within the framework of the New Silk Road to expand joint investments and economic cooperation towards regional convergence. The purpose of this research is to develop economic links between Iranian and Turkish free zones along the New Silk Road, which will lead to the expansion and development of regional cooperation between the two countries within the framework of neighboring policies. The findings of this research include the development of economic diplomacy between the Secretariat of the Supreme Council of Free Zones of Iran and the General Directorate of Free Zones of Turkey, the agreement to expand cooperation between the free zones of Sarakhs, Maku, Anatolia, and Europe, holding biennial conferences between Iranian free zones along the New Silk Road with Turkish free zones, creating a joint investment fund between Iran and Turkey in the field of developing free zones along the Silk Road, helping to attract tourism between Iranian and Turkish free zones located along the New Silk Road, improving transit infrastructure and transportation to better connect Iranian free zones to Turkish free zones, communicating with China, and creating joint collaborations between China’s dry ports and its free zones with Iranian and Turkish free zones.

Keywords: network economy, new silk road (one belt, one road initiative), free zones (Sarakhs, Maku, Anatolia, Europe), regional development, neighborhood policies

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Authors: Sugam Kale, Arif Uzair Bin Mohammed Roslan, Cindy Lee, Syed Beevee Mohammed Ismail

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Preemptive analgesia is an established concept in the modern practice of anaesthesia. To be most effective, it is best instituted earlier than the surgical stimulus and should last beyond the offset of surgically induced pain till healing is complete. Whereas the start of afferent pain blockade with regional anaesthesia is common, its effect often falls short to cover the entire period of pain impulses making their way to CNS in the post-operative period. We tried to use a combination of two regional anaesthetic techniques used sequentially to overcome this handicap. Madam S., a 56 year old lady, was scheduled for elective surgery for pancreatic cancer. She underwent laparotomy and distal pancreatectomy, splenectomy, bilateral salpingo oophorectomy, and sigmoid colectomy. Surgery was expected to be extensive, and it was presumed that the standard pain relief with PCA with opiates and oral analgesics would not be adequate. After counselling the patient pre-operative about the technique of regional anaesthesia techniques, including epidural catheterization and rectus sheath catheter placement, their benefits, and potential complications, informed consent was obtained. Epidural catheter was placed awake, and general anaesthesia was then induced. Epidural infusion of local anaesthetics was started prior to surgical incision and was continued till 60 hours into the postoperative period. Before skin closure, the surgeons inserted commercially available rectus sheath catheters bilaterally along the midline incision used for laparotomy. After 46 hours post-op, local anaesthetic infusion via these was started as bridging while the epidural infusion rate was tapered off. The epidural catheter was removed at 75 hours. Elastomeric pumps were used to provide local anaesthetic infusion with the ability to vary infusion rates. Acute pain service followed up the patient’s vital signs and effectiveness of pain relief twice daily or more frequently as required. Rectus sheath catheters were removed 137 hours post-op. The patient had good post-op analgesia with the minimal additional analgesic requirement. For the most part, the visual analog score (VAS) for pain remained at 1-3 on a scale of 1 to 10. Haemodynamics remained stable, and surgical recovery was as expected. Minimal opiate requirement after an extensive laparotomy also translates to the early return of intestinal motility. Our experience was encouraging, and we are hoping to extend this combination of two regional anaesthetic techniques to patients undergoing similar surgeries. Epidural analgesia is denser and offers excellent pain relief for both visceral and somatic pain in the first few days after surgery. As the pain intensity grows weaker, rectus sheath block and oral analgesics provide almost the same degree of pain relief after the epidural catheter is removed. We discovered that the background infusion of local anaesthetic down the rectus sheath catherter largely reduced the requirement for other classes of analgesics. We aim to study this further with a larger patient cohort and hope that it may become an established clinical practice that benefits patients everywhere.

Keywords: rectus sheath, epidural infusion, post operative analgesia, elastomeric

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