Search results for: community based rehabilitation

Authors: Alexandra McKinzie, Lucy Brown, Sarah Komanapalli, Sarah Swiezy, Caitlin Bernard

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Background: While 25% of US women will seek an abortion before age 45, targeted laws have led to a decline in abortion clinics, subsequently leaving 96% of Indiana counties and the 70% of Hoosier women residing in these counties without access to services they desperately need.1,2 Despite the need for a physician workforce that is educated and able to provide full-spectrum reproductive health care, few medical institutions have a standardized family planning and abortion pre-clinical curriculum. Methods: A Qualtrics survey was disseminated to students from Indiana University School of Medicine (IUSM) to evaluate (1) student interest in curriculum reform, (2) self-assessed preparedness to counsel on contraceptive and pregnancy options, and (3) preferred modality of instruction for family planning and abortion topics. Based on the pre-panel survey feedback, a case-based pregnancy options counseling panel will be implemented in the students’ pre-clinical, didactic course Endocrine, Reproductive, Musculoskeletal, Dermatologic Systems (ERMD) in February 2022. A Qualtrics post-panel survey will be disseminated to evaluate students’ perceived efficacy and quality of the panel, as well as their self-assessed preparedness to counsel on pregnancy options. Results: Participants in the pre-panel survey (n=303) were primarily female (61.72%) and White (74.43%). Across all class levels, many (60.80%) students expected to learn about family planning and abortion in their pre-clinical education. While most (84-88%) participants felt prepared to counsel about common, non-controversial pharmacotherapies (e.g. beta-blockers and diuretics), only 20% of students felt prepared to counsel on abortion options. Overall, 85.67% of students believed that IUSM should enhance its reproductive health coverage in pre-clinical, didactic courses. Traditional lectures, panels, and direct clinical exposure were the most popular instructional modalities. Expected Results: The authors predict that following the panel, students will indicate improved confidence in providing pregnancy options counseling. Additionally, students will provide constructive feedback on the structure and content of the panel for incorporation into future years’ curriculum. Conclusions: IUSM students overwhelmingly expressed interest in expanding their pre-clinical curriculum’s coverage of family planning and abortion topics. To specifically improve students’ self-assessed preparedness to provide pregnancy options counseling and address students’ self-cited learning gaps, a case-based provider panel session will be implemented in response to students’ preferred modality feedback.

Keywords: options counseling, family planning, abortion, curriculum reform, case-based panel

Procedia PDF Downloads 128

Authors: Julia Wong, Hua Beng Lim, Petrina Goh, Johanna Foo, Caleb Ng, Nurul ‘Aqilah Bte Mohd Taufek

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Animal-assisted therapy (AAT) utilizes human-animal interaction to achieve specific therapeutic goals, and its efficacy has been demonstrated across various settings overseas. The use of AAT in Singapore, however, is still limited. Ang Mo Kio-Thye Hua Kwan (AMKH) is one of the first community hospitals in Singapore to use AAT to complement its occupational therapy services with elderly patients. This study explored the perspectives of AMKH’s occupational therapists (OTs) in relation to AAT to understand barriers and enablers in implementing and practising AAT. We also examined how OTs at-large across practice settings perceive AAT. A mixed method design was used. 64 OTs at-large participated in on online survey, and 7 AMKH OTs were interviewed individually via Zoom. Survey results were analysed with descriptive and Mann-Whitney U tests. Interviews were thematically analysed. AMKH OTs perceived various benefits of AAT articulated in overseas studies in domains such as motivation and participation, emotional, social interaction, sensory tactile stimulation, and cognition. Interestingly, this perception was also supported by 67% of OTs who had responded to the survey, even though most of the OTs who had participated in the survey had no experience in AAT. Despite the perceived benefits of AAT, both OTs from AMKH and those at-large articulated concerns on risks pertaining to AAT (e.g., allergies, unexpected animal behaviour, infections, etc). However, AMKH OTs shared several ways to mitigate these risks, demonstrating their ability to develop a safe program. For e.g., volunteers and their dogs must meet specific recruitment criteria, stringent protocols are used to screen and match dogs with patients, and there are strict exclusion criteria for patients participating in AAT. AMKH OTs’ experience suggests that additional skills and knowledge are required to implement AAT, therefore, healthcare institutions should first consider improving their staff training and risk mitigation knowledge before implementing AAT. They can also refer to AMKH’s AAT protocols and those found in overseas studies, but institutions must adapt the protocols to fit their institutional settings and patients’ profiles.

Keywords: animal-assisted therapy, dog-assisted therapy, occupational therapy, complementary therapy

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Authors: Amar Aliche, Hocine Hammoum, Karima Bouzelha, Arezki Ben Abderrahmane

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Traditionally, the dimensioning of storage tanks is conducted with a deterministic approach based on partial coefficients of safety. These coefficients are applied to take into account the uncertainties related to hazards on properties of materials used and applied loads. However, the use of these safety factors in the design process does not assure an optimal and reliable solution and can sometimes lead to a lack of robustness of the structure. The reliability theory based on a probabilistic formulation of constructions safety can respond in an adapted manner. It allows constructing a modelling in which uncertain data are represented by random variables, and therefore allows a better appreciation of safety margins with confidence indicators. The work presented in this paper consists of a mecano-reliability analysis of a concrete storage tank placed on ground. The classical method of Monte Carlo simulation is used to evaluate the failure probability of concrete tank by considering the seismic acceleration as random variable.

Keywords: reliability approach, storage tanks, monte carlo simulation, seismic acceleration

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Authors: Muhammad Jum’at Dasuki

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This study investigates the ethical implications of post-fuel subsidy removal support initiatives in Kwara State, Nigeria, with a focus on the application of Islamic principles. The contentious issue of subsidy removal carries significant social and economic consequences, emphasizing the crucial role of ethical considerations in policy implementation. The research provides a comprehensive background on fuel subsidy removal in Nigeria and its implications. Examining post-fuel subsidy removal palliative measures in Kwara State, the study focuses on design and implementation challenges, ethical considerations, transparency, equity, and public trust. Utilizing a case study approach offers insights and best practices. The methodology includes primary sources through in-depth oral interviews and secondary sources like textbooks and journals, aiming for a holistic understanding of the ethical dimensions of support initiatives within the context of Islamic principles in Kwara State. The objective is to contribute to policy decisions and community development. The study recommends an ethically sound implementation of post-fuel subsidy removal support initiatives, emphasizing transparency, accountability, and inclusivity. It advocates for the inclusiveness of governmental palliatives, reaching both civil servants and common individuals in the state. Continuous distribution during fuel subsidy removal challenges is deemed vital. Additionally, extending free or subsidized transportation beyond higher institutions to the general populace is suggested. Consideration should also be given to reducing governmental hospital bills or providing free health services. The study underscores the importance of Islamic ethics in Nigerian governance and employs a case study approach to assess palliative measures in Kwara State, offering practical insights for policymakers and stakeholders.

Keywords: considerations, ethical, palliative, post-fuel subsidy removal

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Authors: Ersin Sener, Ibrahim Demir, Hasan Aykut Karaboga, Kadir Kilinc

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Bayesian methods, which have very wide range of applications, are implemented to the data obtained from the production of F class fly ash-based geopolymer bricks’ experimental design. In this study, dependent variable is compressive strength, independent variables are treatment type (oven and steam), treatment time, molding time, temperature, water absorbtion ratio and density. The effect of independent variables on compressive strength is investigated. There is no difference among treatment types, but there is a correlation between independent variables. Therefore, hierarchical Bayesian path analysis is applied. In consequence of analysis we specified that treatment time, temperature and density effects on compressive strength is higher, molding time, and water absorbtion ratio is relatively low.

Keywords: experimental design, F class fly ash, geopolymer bricks, hierarchical Bayesian path analysis

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Authors: Umut Tac, Leyla Tavacioglu, Pelin Bolat

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Human factor has been one of the elements that cause vulnerabilities which can be resulted with accidents in maritime transportation. When the roots of human factor based accidents are analyzed, gaps in performing cognitive abilities (reaction time, attention, memory…) are faced as the main reasons for the vulnerabilities in complex environment of maritime systems. Thus cognitive processes in maritime systems have arisen important subject that should be investigated comprehensively. At this point, neurocognitive tests such as reaction time analysis tests have been used as coherent tools that enable us to make valid assessments for cognitive status. In this respect, the aim of this study is to evaluate the reaction time (response time or latency) of seafarers due to their occupational experience and age. For this study, reaction time for different maneuverers has been taken while the participants were performing a sea voyage through a simulator which was run up with a certain scenario. After collecting the data for reaction time, a statistical analyze has been done to understand the relation between occupational experience and cognitive abilities.

Keywords: cognitive abilities, human factor, neurocognitive test battery, reaction time

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Authors: Natalia Fijol, Aji P. Mathew

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We present the processing and characterisation of three-dimensional (3D) monolith filters based on polylactic acid (PLA) reinforced with various nature-derived nanospecies such as hydroxyapatite, modified cellulose fibers and chitin fibers. The nanospecies of choice were dispersed in PLA through Thermally Induced Phase Separation (TIPS) method. The biocomposites were developed via solvent-assisted blending and the obtained pellets were further single-screw extruded into 3D-printing filaments and processed into various geometries using Fused Deposition Modelling (FDM) technique. The printed prototypes included cubic, cylindrical and hour-glass shapes with diverse patterns of printing infill as well as varying pore structure including uniform and multiple level gradual pore structure. The pores and channel structure as well as overall shape of the prototypes were designed in attempt to optimize the flux and maximize the adsorption-active time. FDM is a cost and energy-efficient method, which does not require expensive tools and elaborated post-processing maintenance. Therefore, FDM offers the possibility to produce customized, highly functional water purification filters with tuned porous structures suitable for removal of wide range of common water pollutants. Moreover, as 3D printing becomes more and more available worldwide, it allows producing portable filters at the place and time where they are most needed. The study demonstrates preparation route for the PLA-based, fully biobased composite and their processing via FDM technique into water purification filters, addressing water treatment challenges on an industrial scale.

Keywords: fused deposition modelling, water treatment, biomaterials, 3D printing, nanocellulose, nanochitin, polylactic acid

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Authors: Daniel Gidey, Kunwar Siddarth Dadhwal

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By evaluating India's aid systems and ongoing development initiatives, this conference paper offers light on India's role as a source of developmental assistance in Africa. This research attempts to provide insights into the developing landscape of foreign aid and development cooperation by focusing on understanding India's motivations and strategy. In recent years, India's connection with Africa has grown significantly, driven by economic, political, and strategic reasons. This conference paper covers India's many forms of aid, including financial, capacity building efforts, technical assistance, and infrastructure development projects, via a thorough investigation. The article seeks to establish India's priorities and highlight the possible impacts of its development assistance in Africa by examining the industries and locations of concentration. Using secondary data sources, the investigation delves into the underlying goals of India's aid policy in Africa. It investigates whether India's development assistance is consistent with its broader geopolitical aims, such as access to resources, competing with regional rivals, or strengthening diplomatic ties. Furthermore, the article investigates how India's aid policy combines the ideals of South-South cooperation and mutual development, as well as the ramifications for recipient countries. Furthermore, the paper assesses the efficacy and sustainability of India's aid operations in Africa. It takes into account the elements that influence their success, the problems they face, and the amount to which they contribute to local development goals, community empowerment, and poverty alleviation. The study also focuses on the accountability systems, transparency, and knowledge transfer aspects of India's development assistance. By providing a detailed examination of India's aid endeavors in Africa, the paper adds to the current literature on international development cooperation. By offering fresh insights into the motives, strategies, and impacts of India's assistance programs, it seeks to enhance understanding of the emerging patterns in South-South cooperation and the complex dynamics of contemporary international aid architecture.

Keywords: India, Africa, developmental assistance, aid projects and South-South cooperation

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Authors: Chithra A. V., Somoshree Datta, Sandeep Nithyanandan

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Sign Language Recognition (SLR) is the process of interpreting and translating sign language into spoken or written language using technological systems. It involves recognizing hand gestures, facial expressions, and body movements that makeup sign language communication. The primary goal of SLR is to facilitate communication between hearing- and speech-impaired communities and those who do not understand sign language. Due to the increased awareness and greater recognition of the rights and needs of the hearing- and speech-impaired community, sign language recognition has gained significant importance over the past 10 years. Technological advancements in the fields of Artificial Intelligence and Machine Learning have made it more practical and feasible to create accurate SLR systems. This paper presents a distinct approach to SLR by framing it as a video classification problem using Deep Learning (DL), whereby a combination of Convolutional Neural Networks (CNNs) and Recurrent Neural Networks (RNNs) has been used. This research targets the integration of sign language recognition into healthcare settings, aiming to improve communication between medical professionals and patients with hearing impairments. The spatial features from each video frame are extracted using a CNN, which captures essential elements such as hand shapes, movements, and facial expressions. These features are then fed into an RNN network that learns the temporal dependencies and patterns inherent in sign language sequences. The INCLUDE dataset has been enhanced with more videos from the healthcare domain and the model is evaluated on the same. Our model achieves 91% accuracy, representing state-of-the-art performance in this domain. The results highlight the effectiveness of treating SLR as a video classification task with the CNN-RNN architecture. This approach not only improves recognition accuracy but also offers a scalable solution for real-time SLR applications, significantly advancing the field of accessible communication technologies.

Keywords: sign language recognition, deep learning, convolution neural network, recurrent neural network

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Authors: Oyuna Weina

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This study examines how musicians use visual and zoological metaphors for singing technique and voice quality in a genre of traditional music called urtiin duu (‘long song’) in Alshaa, Inner Mongolia, China. Previous studies have discussed melodic contour in Mongol music, but little study of the intersection of singing technique, visual and zoological metaphors has yet been undertaken. The purpose of this study is to address this lack by analysing urtiin duu itself, traditional pedagogy and performances, all of which have been inspired and are assessed by reference to nature and mobile pastoral herding practices. This study investigates the visual and zoological metaphors related to urtiin duu especially colour, the shape of the circle and animals in the Mongol community. Urtiin duu singing is associated with certain colours in song texts, in selection of repertoire and in the status of singers. Musicians also use colour to describe timbre. These colours in turn reference worship of nature, religions, and daily practices of most Mongols in Alshaa. Moreover, voice quality and singing technique are often related to the animals not only in song text but also in the approach to breathing and to melodic contour. Additionally, the concept of boronhoi (‘the shape of circle’), not only is applied to the melodic contour but also to the voice quality and singing technique. These three factors illustrate the connections among nature, spiritual world and everyday herding life of Mongols. These different connections provide evidence of multi-layered meanings. In contemporary Alshaa, urtiin duu singers received Western musical training from the city and returned to their homelands to perform urtiin duu. In doing so, they are also trying to reconnect with the history, nature and spiritual world in order to achieve their ideal sound. Within a multicultural society, singers negotiate amongst themselves, and with ethnic groups, audiences and government officials. The power of the metaphor therefore assists and reconnects the strength of regional identity and ethnic identity in Alshaa.

Keywords: Alshaa, urtiin duu, visual, zoological metaphors

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Authors: Shih-Wen Hsiao, Chu-Hsuan Lee, Rong-Qi Chen

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When it comes to last, it is regarded as the critical foundation of shoe design and development. Not only the last relates to the comfort of shoes wearing but also it aids the production of shoe styling and manufacturing. In order to enhance the efficiency and application of last development, a computer aided methodology for customized last form designs is proposed in this study. The reverse engineering is mainly applied to the process of scanning for the last form. Then the minimum energy is used for the revision of surface continuity, the surface of the last is reconstructed with the feature curves of the scanned last. When the surface of a last is reconstructed, based on the foundation of the proposed last form reconstruction module, the weighted arithmetic mean method is applied to the calculation on the shape morphing which differs from the grading for the control mesh of last, and the algorithm of subdivision is used to create the surface of last mesh, thus the feet-fitting 3D last form of different sizes is generated from its original form feature with functions remained. Finally, the practicability of the proposed methodology is verified through later case studies.

Keywords: 3D last design, customization, reverse engineering, weighted morphing, shape blending

Procedia PDF Downloads 329

Authors: Mercy D. Chirwa, Juliet Nyasulu, Lebisti Modiba, Makombo Ganga-Limando

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Maternal death review is an initiative that provides a deeper understanding of the causes and circumstances sorounding of maternal deaths in Malawi and globally. Midwives are frontline members of the healthcare team and have stories about what pregnant women go through as such they are better placed to contribute to these reviews. Despite midwives’ participation as members of the facility-based maternal death review team, maternal deaths continues to occur. A lot has been documented around processes involved in maternal review, however, not much has been written around challenges experienced by midwives in maternal death review. This study explored the challenges faced by midwives in the implementation of maternal death reviews in the context of the healthcare system in Malawi. Methodology: This was a qualitative exploratory study design. Focus group discussions and individual face-to-face interviews were used to collect data in the study. A total of 40 midwives, who met the inclusion criteria, participated in the study. Data was analysed manually using a thematic content procedure. Findings: The four major challenges identified were: knowledge and skill gaps; lack of leadership and accountability; lack of institutional political will and inconsistency in conducting FBMDR, impeding midwives’ effective contribution to the implementation of maternal death review. The practical solutions and recommendations that emerged were: need-based knowledge and skills updates, supportive leadership, effective and efficient interdisciplinary work ethics, and sustained availability of material and human resources. Conclusion: Midwives have the highest potential to contribute to the reduction of maternal deaths. Practice development strategies are required to improve their practice in all the areas they are challenged with.

Keywords: facility-based maternal death review, maternal deaths, midwife, midwife challenges

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Authors: F. Nasser-Abu Alhija

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In many countries, much efforts and resources are devoted to empowering and integrating minorities within the mainstream population. Major ventures in this route are crafted in higher education institutions where different outreach programs and methods such as lenient entry requirements, monitory incentives, learning skills workshops, tutoring and mentoring, are utilized. Although there is some information regarding these programs, their effectiveness still needs to be thoroughly examined. The Ethiopian community In Israel is one of the minority groups that has been targeted by sponsoring foundations and higher education institutions with the aim to ease the access, persistence and success of its young people in higher education and later in the job market. The evaluation study we propose to present focuses on the implementation of a program designed for this purpose. This program offers relevant candidates for study at a prestigious university a variety of generous incentives that include tuitions, livening allowance, tutoring, mentoring, skills and empowerment workshops and cultural meetings. Ten students were selected for the program and they started their studies in different subject areas before three and half years. A longitudinal evaluation has been conducted since the implementation of the program. Data were collected from different sources: participating students, program coordinator, mentors, tutors, program documents and university records. Questionnaires and interviews were used for collecting data on the different components of the program and on participants' perception of their effectiveness. Participants indicate that the lenient entry requirements and the monitory incentives are critical for starting their studies. During the first year, skills and empowering workshops, torturing and mentoring were evaluated as very important for persistence and success in studies. Tutoring was perceived as very important also at the second year but less importance is attributed to mentoring. Mixed results regarding integration in the Israeli culture emerged. The results are discussed with reference to findings from different settings around the world.

Keywords: access to higher education, minority groups, monitory incentives, torturing, mentoring

Procedia PDF Downloads 363

Authors: M. Meftahi, M. Hoseinzadeh, S. A. Naeini

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Selection of soil bearing capacity is an important issue that should be investigated under different conditions. The bearing capacity of foundation around of soil slope is based on the active and passive forces. On the other hand, due to extension of urban structures, it is inevitable to put the foundations together. Concerning the two cases mentioned above, investigating the behavior of adjacent foundations which are constructed besides soil slope is essential. It should be noted that, according to the conditions, the bearing capacity of adjacent foundations can be less or more than mat foundations. Also, soil reinforcement increases the bearing capacity of adjacent foundations, and the amount of its increase depends on the distance between foundations. In this research, based on numerical studies, a method is presented for evaluating ultimate bearing capacity of adjacent foundations at different intervals. In the present study, the effect of foundation width, the center to center distance of adjacent foundations and reinforced soil has been investigated on the bearing capacity of adjacent foundations beside soil slope. The results indicate that, due to interference of failure surfaces created under foundation, it depends on their intervals and the ultimate bearing capacity of foundation varies.

Keywords: adjacent foundation, bearing capacity, reinforcements, settlement, numerical analysis

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Authors: Nurzarimah Jamil, Mohd Nazaruddin Jamil

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This paper is a preliminary study about The Importance of Political Advice in Islam: Ḥadīth Thematical Study by showing the concept and proper ways to advice to politician based on hadith Prophet Muhammad (PBUH). The unique of political advice in Islam that Muslim already have the strong and fulfil example that can be apply in nowadays governance that is the way of political and leadership Prophet Muhammad show in his time. As a political leader, the Prophet Muhammad (PBUH) established a great state whose capital was Madinah. However, his real political leadership was in the realm of morality and spirituality in which he conducted himself perfectly in situations of weakness as well as strength. His way of dealing in Makkah and Madinah indicates his great political leadership. Based on fact nowadays some of the country not practicing the proper way to advice to rulers or governance that make a lot of madness around them. This paper also aims the concept and the proper way that can be following to all Muslim to advising by the politeness, justice and kindness.

Keywords: Hadith, leadership, political advice, Prophet Muhammad

Procedia PDF Downloads 418

Authors: E. M. D. Akuoko, Eliana Vasquez Osorio, Marcel Van Herk, Marianne Aznar

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Radiotherapy is an integral part of treatment for many patients with breast cancer. However, side effects can occur, e.g., fibrosis or erythema. If patients at higher risks of radiation-induced side effects could be identified before treatment, they could be given more individual information about the risks and benefits of radiotherapy. We hypothesize that breast density is correlated with the risk of side effects and present a novel method for automatic evaluation based on radiotherapy planning CT scans. Methods: 799 supine CT scans of breast radiotherapy patients were available from the REQUITE dataset. The methodology was first established in a subset of 114 patients (cohort 1) before being applied to the whole dataset (cohort 2). All patients were scanned in the supine position, with arms up, and the treated breast (ipsilateral) was identified. Manual experts contour available in 96 patients for both the ipsilateral and contralateral breast in cohort 1. Breast tissue was segmented using atlas-based automatic contouring software, ADMIRE® v3.4 (Elekta AB, Sweden). Once validated, the automatic segmentation method was applied to cohort 2. Breast density was then investigated by thresholding voxels within the contours, using Otsu threshold and pixel intensity ranges based on Hounsfield units (-200 to -100 for fatty tissue, and -99 to +100 for fibro-glandular tissue). Volumetric breast density (VBD) was defined as the volume of fibro-glandular tissue / (volume of fibro-glandular tissue + volume of fatty tissue). A sensitivity analysis was performed to verify whether calculated VBD was affected by the choice of breast contour. In addition, we investigated the correlation between volumetric breast density (VBD) and patient age and breast size. VBD values were compared between ipsilateral and contralateral breast contours. Results: Estimated VBD values were 0.40 (range 0.17-0.91) in cohort 1, and 0.43 (0.096-0.99) in cohort 2. We observed ipsilateral breasts to be denser than contralateral breasts. Breast density was negatively associated with breast volume (Spearman: R=-0.5, p-value < 2.2e-16) and age (Spearman: R=-0.24, p-value = 4.6e-10). Conclusion: VBD estimates could be obtained automatically on a large CT dataset. Patients’ age or breast volume may not be the only variables that explain breast density. Future work will focus on assessing the usefulness of VBD as a predictive variable for radiation-induced side effects.

Keywords: breast cancer, automatic image segmentation, radiotherapy, big data, breast density, medical imaging

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Authors: Peiyin Hung, Katy Kozhimannil, Michelle Casey, Ira Moscovice

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Background/Objective: The loss of obstetric services has been a pressing concern in urban and rural areas nationwide. This study aims to determine factors that contribute to the loss of obstetric care through closures of a hospital or obstetric unit. Methods: Data from 2002-2013 American Hospital Association annual surveys were used to identify hospitals providing obstetric services. We linked these data to Medicare Healthcare Cost Report Information for hospital financial indicators, the US Census Bureau’s American Community Survey for zip-code level characteristics, and Area Health Resource files for county- level clinician supply measures. A discrete-time multinomial logit model was used to determine contributing factors to obstetric unit or hospital closures. Results: Of 3,551 hospitals providing obstetrics services during 2002-2013, 82% kept units open, 12% stopped providing obstetrics services, and 6% closed down completely. State-level variations existed. Factors that significantly increased hospitals’ probability of obstetric unit closures included lower than 250 annual birth volume (adjusted marginal effects [95% confidence interval]=34.1% [28%, 40%]), closer proximity to another hospital with obstetric services (per 10 miles: -1.5% [-2.4, -0.5%]), being in a county with lower family physician supply (-7.8% [-15.0%, -0.6%), being in a zip code with higher percentage of non-white females (per 10%: 10.2% [2.1%, 18.3%]), and with lower income (per $1,000 income: -0.14% [-0.28%, -0.01%]). Conclusions: Over the past 12 years, loss of obstetric services has disproportionately affected areas served by low-volume urban and rural hospitals, non-white and low-income communities, and counties with fewer family physicians, signaling a need to address maternity care access in these communities.

Keywords: access to care, obstetric care, service line discontinuation, hospital, obstetric unit closures

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Authors: Gia Surguladze, Nino Topuria, Lily Petriashvili, Giorgi Surguladze

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Modeling of building processes of a multimodal freight transportation support information system is discussed based on modern CASE technologies. Functional efficiencies of ports in the eastern part of the Black Sea are analyzed taking into account their ecological, seasonal, resource usage parameters. By resources, we mean capacities of berths, cranes, automotive transport, as well as work crews and neighbouring airports. For the purpose of designing database of computer support system for Managerial (Logistics) function, using Object-Role Modeling (ORM) tool (NORMA – Natural ORM Architecture) is proposed, after which Entity Relationship Model (ERM) is generated in automated process. The software is developed based on Process-Oriented and Service-Oriented architecture, in Visual Studio.NET environment.

Keywords: seaport resources, business-processes, multimodal transportation, CASE technology, object-role model, entity relationship model, SOA

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Authors: Clemens Pizzinini, Philipp Rosner, David Ziegler, Markus Lienkamp

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Transportation is a constitutional part of most supply and value chains in modern economies. Smallholder farmers in rural Ethiopia face severe challenges along their supply and value chains. In particular, suitable, affordable, and available transport services are in high demand. To develop a context-specific technical solutions, a problem-to-solution methodology based on the interaction with technology is developed. With this approach, we fill the gap between proven transportation assessment frameworks and general user-centered techniques. Central to our approach is an electric test vehicle that is implemented in rural supply and value chains for research, development, and testing. Based on our objective and the derived methodological requirements, a set of existing methods is selected. Local partners are integrated into an organizational framework that executes major parts of this research endeavour in the Arsi Zone, Oromia Region, Ethiopia.

Keywords: agricultural value chain, participatory methods, agile methods, sub-Saharan Africa, Ethiopia, electric vehicle, transport service

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Authors: Nourhane Mohamed El Haridi, Mostafa El Arabi, Zeyad El Sayad

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Biomimicry is defined, by Benyus the natural sciences writer, as imitating or taking inspiration from nature’s forms and processes to solve human problems. Biomimicry is the conscious emulation of life’s genius. As the design community realizes the tremendous impact human constructions have on the world, environmental designers look to new approaches like biomimicry to advance sustainable design. Building leading the declaration made by biomimicry scientists that a full imitation of nature engages form, ecosystem, and process; this paper uses a logic approach to interpret human and environmental wholeness. Designers would benefit from both integrating social theory with environmental thinking and from combining their substantive skills with techniques for getting sustainable biomimic urban design. Integrating biomimicryʹs “Life’s Principles” into a built environment process model will make biomimicry more accessible and thus more widely accepted throughout the industry, and the sustainability of all species will benefit. The Biomimicry Guild hypothesizes the incorporation of these principles, called Lifeʹs Principles, increase the likelihood of sustainability for a respective design, and make it more likely that the design will have a greater impact on sustainability for future generations of all species as mentioned by Benyus in her book. This thesis utilizes Life’s Principles as a foundation for a design process model intended for application on built environment projects at various scales. This paper takes a look at the importance of the integration of biomimicry in urban design to get more sustainable cities and better life, by analyzing the principles of both sustainability and biomimicry, and applying these ideas on futuristic or existing cities to make a biomimic sustainable city more healthier and more conductive to life, and get a better biomimic urban design. A group of experts, architects, biologists, scientists, economists and ecologists should work together to face all the financial and designing difficulties, to have better solutions and good innovative ideas for biomimic sustainable urban design, it is not the only solution, but it is one of the best studies for a better future.

Keywords: biomimicry, built environment, sustainability, urban design

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Authors: Samrat Vikramaditya Tiwari, Atul Sewaiwar, Yeon-Ho Chung

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Device-to-device (D2D) communication is considered a promising technique to provide wireless peer-to-peer communication services. Due to increasing demand on mobile services, available spectrum for radio frequency (RF) based communications becomes scarce. Recently, visible light communications (VLC) has evolved as a high speed wireless data transmission technology for indoor environments with abundant available bandwidth. In this paper, a novel VLC based D2D communication that provides wireless peer-to-peer communication is proposed. Potential low operating power devices for an efficient D2D communication over increasing distance of separation between devices is analyzed. Optical repeaters (OR) are also proposed to enhance the performance in an environment where direct D2D communications yield degraded performance. Simulation results show that VLC plays an important role in providing efficient D2D communication up to a distance of 1 m between devices. It is also found that the OR significantly improves the coverage distance up to 3.5 m.

Keywords: visible light communication, light emitting diode, device-to-device, optical repeater

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Authors: Mohammad Julhas Sujan, Md. Ferdous Alam

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Maternal, neonatal, and child health (MNCH) holds one of the prime focuses in Bangladesh’s national healthcare system. To save the lives of mothers and children, knowing the stock of MNCH medicines in different healthcare facilities and when to replenish them are essential. A robust information system not only facilitates efficient management of the essential MNCH medicines but also helps effective allocation of scarce resources. In Bangladesh, Supply chain management of the 25-essential life-saving medicines are currently tracked and monitored via an electronic logistics management information system (eLMIS). Our aim was to conduct a cross-sectional study with a year (2020) worth of data from 24 districts of Bangladesh to evaluate how eLMIS is helping the Government and other stakeholders in efficient supply chain management. Data were collected from 4711 healthcare facilities ranging from primary to secondary levels within a district. About 90% (4143) are community clinics which are considered primary health care facilities in Bangladesh. After eLMIS implementation, the average reporting rate across the districts has been increased (> 97%). The month of stock (MOS) of zinc is an average 6 months compared to Inj. Magnesium Sulphate which will take 2.5 years to consume according to the current average monthly consumption (AMC). Due to first approaching expiry, Tab. Misoprostol, 7.1% Chlorhexidine and Inj. Oxytocin may become unusable. Moreover, Inj. Oxytocin is temperature sensitive and may reduce its efficacy if it is stocked for a longer period. In contrast, Zinc should be sufficiently stocked to prevent sporadic stockouts. To understand how data are collected, transmitted, processed, and aggregated for MNCH medicines in a faster and timely manner, an electronic logistics management information system (eLMIS) is necessary. We recommend the use of such a system in developing countries like Bangladesh for efficient supply chain management of essential MNCH medicines.

Keywords: adaption, eLMIS, MNCH, live-saving medicines

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Authors: Laurence Weinberg, Dominic Walpole, Dong-Kyu Lee, Michael D’Silva, Jian W. Chan, Lachlan F. Miles, Bradley Carp, Adam Wells, Tuck S. Ngun, Siven Seevanayagam, George Matalanis, Ziauddin Ansari, Rinaldo Bellomo, Michael Yii

Abstract:

Background: There have been multiple recent advancements in the selection, optimization and management of cardiac surgical patients. However, there is limited data regarding the outcomes of nonagenarians undergoing cardiac surgery, despite this vulnerable cohort increasingly receiving these interventions. This study describes the patient characteristics, management and outcomes of a group of nonagenarians undergoing cardiac surgery in the context of contemporary peri-operative care. Methods: A retrospective observational study was conducted of patients 90 to 99 years of age (i.e., nonagenarians) who had undergone cardiac surgery requiring a classic median sternotomy (i.e., open-heart surgery). All operative indications were included. Patients who underwent minimally invasive surgery, transcatheter aortic valve implantation and thoracic aorta surgery were excluded. Data were collected from four hospitals in Victoria, Australia, over an 8-year period (January 2012 – December 2019). The primary objective was to assess six-month mortality in nonagenarians undergoing open-heart surgery and to evaluate the incidence and severity of postoperative complications using the Clavien-Dindo classification system. The secondary objective was to provide a detailed description of the characteristics and peri-operative management of this group. Results: A total of 12,358 adult patients underwent cardiac surgery at the study centers during the observation period, of whom 18 nonagenarians (0.15%) fulfilled the inclusion criteria. The median (IQR) [min-max] age was 91 years (90.0:91.8) [90-94] and 14 patients (78%) were men. Cardiovascular comorbidities, polypharmacy and frailty, were common. The median (IQR) predicted in-hospital mortality by EuroSCORE II was 6.1% (4.1-14.5). All patients were optimized preoperatively by a multidisciplinary team of surgeons, cardiologists, geriatricians and anesthetists. All index surgeries were performed on cardiopulmonary bypass. Isolated coronary artery bypass grafting (CABG) and CABG with aortic valve replacement were the most common surgeries being performed in four and five patients, respectively. Half the study group underwent surgery involving two or more major procedures (e.g. CABG and valve replacement). Surgery was undertaken emergently in 44% of patients. All patients except one experienced at least one postoperative complication. The most common complications were acute kidney injury (72%), new atrial fibrillation (44%) and delirium (39%). The highest Clavien-Dindo complication grade was IIIb occurring once each in three patients. Clavien-Dindo grade IIIa complications occurred in only one patient. The median (IQR) postoperative length of stay was 11.6 days (9.8:17.6). One patient was discharged home and all others to an inpatient rehabilitation facility. Three patients had an unplanned readmission within 30 days of discharge. All patients had follow-up to at least six months after surgery and mortality over this period was zero. The median (IQR) duration of follow-up was 11.3 months (6.0:26.4) and there were no cases of mortality observed within the available follow-up records. Conclusion: In this group of nonagenarians undergoing cardiac surgery, postoperative six-month mortality was zero. Complications were common but generally of low severity. These findings support carefully selected nonagenarian patients being offered cardiac surgery in the context of contemporary, multidisciplinary perioperative care. Further, studies are needed to assess longer-term mortality and functional and quality of life outcomes in this vulnerable surgical cohort.

Keywords: cardiac surgery, mortality, nonagenarians, postoperative complications

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Authors: Khosro Barkhordari, Fateme Sadr, Mina Pashang

Abstract:

Back ground: Blood transfusion is one of the major issues in cardiac surgery patients. Transfusing patients based on fixed cut-off points of hemoglobin is the current protocol in most institutions. The hemoglobin level of 7- 10 has been suggested for blood transfusion in cardiac surgery patients. We aimed to evaluate if blood transfusion based on change in percentage of hematocrit has different outcomes. Methods: In this retrospective cohort study, we investigated the early postoperative outcome of cardiac surgery patients who received blood transfusions at Tehran Heart Center Hospital, IRAN. We reviewed and analyzed the basic characteristics and clinical data of 700 patients who met our exclusion and inclusion criteria. The two groups of blood transfused patients were compared, those who have 30-50 percent decrease in basal hematocrit versus those with 10 -29 percent decrease. Results: This is ongoing study, and the results would be completed in two weeks after analysis of the date. Conclusion: Early analysis has shown no difference in early post-operative outcomes between the two groups, but final analysis will be completed in two weeks. 1-Department of Anesthesiology and Critical Care, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, IRAN 2- Department of Research, Tehran Heart Center, Tehran, IRAN Quantitative variables were compared using the Student t-test or the Mann‐Whitney U test, as appropriate, while categorical variables were compared using the χ2 or the Fisher exact test, as required. Our intention was to compare the early postoperative outcomes between the two groups, which include 30 days mortality, Length of ICU stay, Length of hospital stay, Intubation time, Infection rate, acute kidney injury, and respiratory complications. The main goal was to find if transfusing blood based on changes in hematocrit from a basal level was better than to fixed cut-off point regarding early post-operative outcomes. This has not been studied enough and may need randomized control trials.

Keywords: post-operative, cardiac surgery, outcomes, blood transfusion

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Authors: Chalachew Gashu, Yoseph Kassa, Habtamu Geremew, Mengestie Mulugeta

Abstract:

Background and Aims: Severe acute malnutrition remains a significant health challenge, particularly in low‐ and middle‐income countries. The aim of this study was to determine the survival time of under‐five children with severe acute malnutrition. Methods: A retrospective cohort study was conducted at a hospital, focusing on under‐five children with severe acute malnutrition. The study included 322 inpatients admitted to the Chiro hospital in Chiro, Ethiopia, between September 2019 and August 2020, whose data was obtained from medical records. Survival functions were analyzed using Kaplan‒Meier plots and log‐rank tests. The survival time of severe acute malnutrition was further analyzed using the Cox proportional hazards model and Bayesian parametric survival models, employing integrated nested Laplace approximation methods. Results: Among the 322 patients, 118 (36.6%) died as a result of severe acute malnutrition. The estimated median survival time for inpatients was found to be 2 weeks. Model selection criteria favored the Bayesian Weibull accelerated failure time model, which demonstrated that age, body temperature, pulse rate, nasogastric (NG) tube usage, hypoglycemia, anemia, diarrhea, dehydration, malaria, and pneumonia significantly influenced the survival time of severe acute malnutrition. Conclusions: This study revealed that children below 24 months, those with altered body temperature and pulse rate, NG tube usage, hypoglycemia, and comorbidities such as anemia, diarrhea, dehydration, malaria, and pneumonia had a shorter survival time when affected by severe acute malnutrition under the age of five. To reduce the death rate of children under 5 years of age, it is necessary to design community management for acute malnutrition to ensure early detection and improve access to and coverage for children who are malnourished.

Keywords: Bayesian analysis, severe acute malnutrition, survival data analysis, survival time

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Authors: Walid M. Adel, Liang Guo-Zhu

Abstract:

To investigate the characterization of the mechanical properties of composite solid propellant (CSP) based on hydroxyl-terminated polybutadiene (HTPB) at different temperatures and strain rates, uniaxial tensile tests were conducted over a range of temperatures -60 °C to +76 °C and strain rates 0.000164 to 0.328084 s^-1 using a conventional universal testing machine. From the experimental data, it can be noted that the mechanical properties of AP/HTPB propellant are mainly dependent on the applied strain rate and the temperature condition. The stress-strain responses exhibited an initial yielding followed by the viscoelastic phase, which was strongly affected by the strain rate and temperature. It was found that the mechanical properties increased with both increasing strain rate and decreasing temperature. Based on the experimental tests, the master curves of the tensile properties are drawn using predetermined shift factor and the results were discussed. This work is a first step in preliminary investigation the nonlinear viscoelasticity behavior of CSP.

Keywords: AP/HTPB composite solid propellant, mechanical behavior, nonlinear viscoelastic, tensile test, strain rate

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Authors: Yan Chen, Hongbing Li, Ruirui Zhai

Abstract:

Innovation driven and innovation in the process of new-type urbanization is a major strategic choice for the introduction of foreign capital and the process of economic development. This research investigates the effect of urbanization, FDI and environmental regulations on innovation performance of enterprises, based on Chinese Industrial Statistics Database of 2004 to 2007 and data at province-level. It is found that the FDI from U.S. and environmental regulations will hinder the creativity of Chinese industry through reducing the R&D of them. However, the FDI from U.S. enhances the ability of domestic enterprises to attain “compensation from innovation” following the environmental regulations. Meanwhile, we confirm that environmental regulation can contribute to the innovation spillover of FDI from U.S. Furthermore, the channel of effect is discussed. In addition, FDI from EU and Japan are further examined. Unlike the FDI from U.S., the FDI from EU and Japan both have the positive innovation spillover effect, but through the same channel referred above which exist in FDI. Further analysis based on "innovation-driven effect" of urbanization is developed, and it is found that urbanization has an innovation-driven effect on environmental regulation and FDI spillover. The regulation of FDI from the United States and the European Union outperforms the FDI from Japan at a restrained degree.

Keywords: environmental regulations, FDI, innovation-driven, innovation performance

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Authors: Gelareh Ghaderi

Abstract:

the overall objective of this study is to develop two alternative plans of spatial and infrastructural development for the Netwerkstad Twente (Twente region) until 2040 and to assess the impacts of those two alternative plans. This region is located on the eastern border of the Netherlands, and it comprises of five municipalities. Based on the strengths and opportunities of the five municipalities of the Netwerkstad Twente, and in order develop the region internationally, strengthen the job market and retain skilled and knowledgeable young population, two alternative visions have been developed; environmental oriented vision, and economical oriented vision. Environmental oriented vision is based mostly on preserving beautiful landscapes. Twente would be recognized as an educational center, driven by green technologies and environment-friendly economy. Market-oriented vision is based on attracting and developing different economic activities in the region based on visions of the five cities of Netwerkstad Twente, in order to improve the competitiveness of the region in national and international scale. On the basis of the two developed visions and strategies for achieving the visions, land use and infrastructural development are modeled and assessed. Based on the SWOT analysis, criteria were formulated and employed in modeling the two contrasting land use visions by the year 2040. Land use modeling consists of determination of future land use demand, assessment of suitability land (Suitability analysis), and allocation of land uses on suitable land. Suitability analysis aims to determine the available supply of land for future development as well as assessing their suitability for specific type of land uses on the basis of the formulated set of criteria. Suitability analysis was operated using CommunityViz, a Planning Support System application for spatially explicit land suitability and allocation. Netwerkstad Twente has highly developed transportation infrastructure, consists of highways network, national road network, regional road network, street network, local road network, railway network and bike-path network. Based on the assumptions of speed limitations on different types of roads provided, infrastructure accessibility level of predicted land use parcels by four different transport modes is investigated. For evaluation of the two development scenarios, the Multi-criteria Evaluation (MCE) method is used. The first step was to determine criteria used for evaluation of each vision. All factors were categorized as economical, ecological and social. Results of Multi-criteria Evaluation show that Environmental oriented cities scenario has higher overall score. Environment-oriented scenario has impressive scores in relation to economical and ecological factors. This is due to the fact that a large percentage of housing tends towards compact housing. Twente region has immense potential, and the success of this project will define the Eastern part of The Netherlands and create a real competitive local economy with innovations and attractive environment as its backbone.

Keywords: economical oriented vision, environmental oriented vision, infrastructure, land use, multi criteria assesment, vision

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Authors: Mehena Fedoul

Abstract:

This paper examines the intersection of race, gender, and disability through a Critical disability race theory and black feminist disability perspective in Keah Brown's memoir, "The Pretty One." The background of the study highlights the significance of intersectionality in understanding the multifaceted experiences of individuals who navigate multiple marginalized identities. The study contributes to the underrepresented field of disability studies from Critical race and black feminist perspectives, shedding light on the unique challenges and resilience of black disabled women. The study employs a qualitative analysis of Keah Brown's memoir as a primary text. Drawing on intersectionality theory and black feminist disability scholarship, the analysis focuses on how Brown's memoir illuminates the ways in which her race, gender, and disability intersect and shape her lived experiences. The analysis reveals how Brown's memoir challenges traditional notions of disability, beauty, and empowerment through the unapologetic celebration of her blackness, femaleness, and disability. The major findings of the study indicate that Brown's memoir provides a powerful narrative of the complexity, uniqueness and richness of the lived experiences of black disabled women. It demonstrates how the intersectionality of race, gender, and disability shapes Brown's identity, body image, relationships, and societal interactions. The paper also highlights how Brown's memoir emphasizes the importance of inclusivity and intersectionality in understanding and addressing the challenges faced by black disabled women. In conclusion, this study offers a critical analysis of the intersection of race, gender, and disability in Keah Brown's memoir, "The Pretty One," from a black feminist disability perspective. It contributes to the growing body of literature that recognizes the significance of intersectionality in understanding the experiences of marginalized individuals in the disability community. The study underscores the need for more inclusive and intersectional perspectives in disability studies and advocates for greater recognition of the voices and experiences of black disabled women in academic and societal discourse.

Keywords: disability studies, intersectionality, black feminism, Keah Brown

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Authors: Kahina Amal Djiar, Mouna Gharbi, Maha Messaoudene, Oumelkheir Chareb

Abstract:

Over the last decade, Algerian authorities have implemented an ambitious program of urban renewal, which includes important relocation operations. The objectives behind such strategic interventions are on the one hand, to carry out an incremental approach aiming at eradicating precarious housing and on the other hand, to diversify alternative housing options for families requiring better living spaces. It is precisely for these same purposes that the Djenan el-Hassan and Carrières Jaubert estates, which are both located in Algiers, have undergone major urban transformations. These dwelling sites were built as part of the famous "Battle of Housing", which was launched by French colonial administration in the 1950s just before the independence of Algeria in 1962. Today, the Djenan el-Hassan estate is almost entirely demolished following the relocation of 171 families. The Carrières Jaubert estate, for its part, has seen two kinds of operations. The first has been shaped by a process of urban requalification and redevelopment, which allowed some of the residents to stay on site after the transformation of most housing cells into larger apartments. The second operation has required the relocation of over 300 families to entirely newly built dwellings. Such projects of urban renewal are supposed to create new opportunities, not only in terms of local urban development, but also in terms of social perspectives for those families who are involved, either directly or indirectly, in the process of relocation. In fact, the percentage of urban violence in Algiers has increased instead. Recent events in the newly built estates show that residents are repeatedly experiencing and even instigating episodes of brutality, hostility and aggression. The objective of this paper is to examine the causes that have engendered such rise in urban violence in newly built housing estates in Algiers. This paper aims to present the findings of a recent qualitative research and highlight the way that poorly designed neighbourhood, combined with a relocation process that leaves little room for community participation, create inevitably severe social tensions.

Keywords: relocation, social housing, violence, Algiers

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