Search results for: advanced care planning
Commenced in January 2007
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Edition: International
Paper Count: 8605

Search results for: advanced care planning

115 Understanding Responses of the Bee Community to an Urbanizing Landscape in Bengaluru, South India

Authors: Chethana V. Casiker, Jagadishakumara B., Sunil G. M., Chaithra K., M. Soubadra Devy

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A majority of the world’s food crops depends on insects for pollination, among which bees are the most dominant taxon. Bees pollinate vegetables, fruits and oilseeds which are rich in essential micronutrients. Besides being a prerequisite for a nutritionally secure diet, agrarian economies such as India depend heavily on pollination for good yield and quality of the product. As cities all over the world expand rapidly, large tracts of green spaces are being built up. This, along with high usage of agricultural chemicals has reduced floral diversity and shrunk bee habitats. Indeed, pollinator decline is being reported from various parts of the world. Further, the FAO has reported a huge increase in the area of land under cultivation of pollinator-dependent crops. In the light of increasing demand for pollination and disappearing natural habitats, it is critical to understand whether and how urban spaces can support pollinators. To this end, this study investigates the influence of landscape and local habitat quality on bee community dynamics. To capture the dynamics of expanding cityscapes, the study employs a space for time substitution, wherein a transect along the gradient of urbanization substitutes a timeframe of increasing urbanization. This will help understand how pollinators would respond to changes induced by increasing intensity of urbanization in the future. Bengaluru, one of the fastest growing cities of Southern India, is an excellent site to study impacts associated with urbanization. With sites moving away from the Bengaluru’s centre and towards its peripheries, this study captures the changes in bee species diversity and richness along a gradient of urbanization. Bees were sampled under different land use types as well as in different types of vegetation, including plantations, croplands, fallow land, parks, lake embankments, and private gardens. The relationship between bee community metrics and key drivers such as a percentage of built-up area, land use practices, and floral resources was examined. Additionally, data collected using questionnaire interviews were used to understand people’s perceptions towards and level of dependence on pollinators. Our results showed that urban areas are capable of supporting bees. In fact, a greater diversity of bees was recorded in urban sites compared to adjoining rural areas. This suggests that bees are able to seek out patchy resources and survive in small fragments of habitat. Bee abundance and species richness correlated positively with floral abundance and richness, indicating the role of vegetation in providing forage and nesting sites which are crucial to their survival. Bee numbers were seen to decrease with increase in built-up area demonstrating that impervious surfaces could act as deterrents. Findings from this study challenge the popular notion of cities being biodiversity-bare spaces. There is indeed scope for conserving bees in urban landscapes, provided that there are city-scale planning and local initiative. Bee conservation can go hand in hand with efforts such as urban gardening and terrace farming that could help cities urbanize sustainably.

Keywords: bee, landscape ecology, urbanization, urban pollination

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114 Prevalence, Median Time, and Associated Factors with the Likelihood of Initial Antidepressant Change: A Cross-Sectional Study

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

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

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

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113 Suitability Assessment of Water Harvesting and Land Restoration in Catchment Comprising Abandoned Quarry Site in Addis Ababa, Ethiopia

Authors: Rahel Birhanu Kassaye, Ralf Otterpohl, Kumelachew Yeshitila

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Water resource management and land degradation are among the critical issues threatening the suitable livability of many cities in developing countries such as Ethiopia. Rapid expansion of urban areas and fast growing population has increased the pressure on water security. On the other hand, the large transformation of natural green cover and agricultural land loss to settlement and industrial activities such as quarrying is contributing to environmental concerns. Integrated water harvesting is considered to play a crucial role in terms of providing alternative water source to insure water security and helping to improve soil condition, agricultural productivity and regeneration of ecosystem. Moreover, it helps to control stormwater runoff, thus reducing flood risks and pollution, thereby improving the quality of receiving water bodies and the health of inhabitants. The aim of this research was to investigate the potential of applying integrated water harvesting approaches as a provision for water source and enabling land restoration in Jemo river catchment consisting of abandoned quarry site adjacent to a settlement area that is facing serious water shortage in western hilly part of Addis Ababa city, Ethiopia. The abandoned quarry site, apart from its contribution to the loss of aesthetics, has resulted in poor water infiltration and increase in stormwater runoff leading to land degradation and flooding in the downstream. Application of GIS and multi-criteria based analysis are used for the assessment of potential water harvesting technologies considering the technology features and site characteristics of the case study area. Biophysical parameters including precipitation, surrounding land use, surface gradient, soil characteristics and geological aspects are used as site characteristic indicators and water harvesting technologies including retention pond, check dam, agro-forestation employing contour trench system were considered for evaluation with technical and socio-economic factors used as parameters in the assessment. The assessment results indicate the different suitability potential among the analyzed water harvesting and restoration techniques with respect to the abandoned quarry site characteristics. Application of agro-forestation with contour trench system with the revegetation of indigenous plants is found to be the most suitable option for reclamation and restoration of the quarry site. Successful application of the selected technologies and strategies for water harvesting and restoration is considered to play a significant role to provide additional water source, maintain good water quality, increase agricultural productivity at urban peri-urban interface scale and improve biodiversity in the catchment. The results of the study provide guideline for decision makers and contribute to the integration of decentralized water harvesting and restoration techniques in the water management and planning of the case study area.

Keywords: abandoned quarry site, land reclamation and restoration, multi-criteria assessment, water harvesting

Procedia PDF Downloads 192
112 Children’s Experience of the Built Environment in the Initial Stages of a Settlement Formation: Case Study of Shahid-Keshvari New Settlement, Isfahan, Iran

Authors: Hassan Sheikh, Mehdi Nilipour, Amiraslan Fila

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Many conventional town planning processes do little to give children and young people a voice on what is important about the urban environment. As a result of paying little attention to the children, their physical, social and mental needs are hardly met in urban environments. Therefore, urban spaces are impotent to attract children, while their recreational space has been confined to home or virtual spaces. Since children are just taking the first steps to learn the world beyond house borders, their living environment will profoundly influence almost all aspects of their lives. This puts a great deal of responsibility on the shoulders of planners, who need to balance a number of different issues in urban design to make places more child-friendly. The main purpose of present research is to analyze and plan a child-friendly environment in an on-going urban settlement development for the benefit of all residents. Assessing children’s needs and regard them in development strategies and policies will help to “plan for children”. Following this purpose, based on child-friendly environment studies, indicators of child-friendly environments were collected. Then three distinct characteristics of case study, which are being under-construction, lack of social ties between dwellers and high-rise building, determined seven indicators included basic services, Urban and environmental qualities, Family, kin, peers and community, Sense of belonging and continuity, participation, Safety, security and freedom of movement and human scale. With the survey, Informal observation and participation in small communities, essential data has been collected and analyzed by SPSS software. The field study is Shahid-Keshvari town in Isfahan, Iran. Eighty-six middle childhood, children (ages 8-13) participated. The results show Children's satisfaction is correlated with basic services and the quality of the environment, social environment and the safety and security. The considerable number of children and youth (55%) like to live somewhere other than the town. Satisfaction and sense of belonging and continuity have a strong inverse correlation with age. In other words, as age increases, satisfaction and consequently a sense of belonging will be reduced; thus children and youth consider their future somewhere out of the town. The main reason for dissatisfaction was the basic services and social environment. More than half of children (55%) expressed their wish to develop basic services in terms of availability, hierarchy, and quality. Among all recreational places, children showed more interest to the parks. About three-quarters (76%) considered building a park as a crucial item for residents. The significant number of children (54%) want to have a relationship with more friends. This could be due to the serious shortage of the leisure spaces such as parks or playgrounds. Also, the space around the house or space between the apartments has not been designed for play or children’s activities. Moreover, the presence of strangers and construction workers have a negative impact on children's sense of peace and security; 60% of children are afraid of theft and 36% of children found strangers as a menace. The analysis of children’s issues and suggestions provides an insight to plan and design of child-friendly environment in new towns.

Keywords: child-friendly city (CFC), child-friendly environment, child participation, under-construction environment, Isfahan Shahid-Keshvari Town

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111 Factors Affecting Treatment Resilience in Patients with Oesophago-Gastric Cancers Undergoing Palliative Chemotherapy: A Literature Review

Authors: Kiran Datta, Daniella Holland-Hart, Anthony Byrne

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Introduction: Oesophago-gastric (OG) cancers are the fifth commonest in the UK, accounting for over 12,000 deaths each year. Most patients will present at later stages of the disease, with only 21% of patients with stage 4 disease surviving longer than a year. As a result, many patients are unsuitable for curative surgery and instead receive palliative treatment to improve prognosis and symptom burden. However, palliative chemotherapy can result in significant toxicity: almost half of the patients are unable to complete their chemotherapy regimen, with this proportion rising significantly in older and frailer patients. In addition, clinical trials often exclude older and frailer patients due to strict inclusion criteria, meaning there is limited evidence to guide which patients are most likely to benefit from palliative chemotherapy. Inappropriate chemotherapy administration is at odds with the goals of palliative treatment and care, which are to improve quality of life, and this also represents a significant resource expenditure. This literature review aimed to examine and appraise evidence regarding treatment resilience in order to guide clinicians in identifying the most suitable candidates for palliative chemotherapy. Factors influencing treatment resilience were assessed, as measured by completion rates, dose reductions, and toxicities. Methods: This literature review was conducted using rapid review methodology, utilising modified systematic methods. A literature search was performed across the MEDLINE, EMBASE, and Cochrane Library databases, with results limited to papers within the last 15 years and available in English. Key inclusion criteria included: 1) participants with either oesophageal, gastro-oesophageal junction, or gastric cancers; 2) patients treated with palliative chemotherapy; 3) available data evaluating the association between baseline participant characteristics and treatment resilience. Results: Of the 2326 papers returned, 11 reports of 10 studies were included in this review after excluding duplicates and irrelevant papers. Treatment resilience factors that were assessed included: age, performance status, frailty, inflammatory markers, and sarcopenia. Age was generally a poor predictor for how well patients would tolerate chemotherapy, while poor performance status was a better indicator of the need for dose reduction and treatment non-completion. Frailty was assessed across one cohort using multiple screening tools and was an effective marker of the risk of toxicity and the requirement for dose reduction. Inflammatory markers included lymphopenia and the Glasgow Prognostic Score, which assessed inflammation and hypoalbuminaemia. Although quick to obtain and interpret, these findings appeared less reliable due to the inclusion of patients treated with palliative radiotherapy. Sarcopenia and body composition were often associated with chemotherapy toxicity but not the rate of regimen completion. Conclusion: This review demonstrates that there are numerous measures that can estimate the ability of patients with oesophago-gastric cancer to tolerate palliative chemotherapy, and these should be incorporated into clinical assessments to promote personalised decision-making around treatment. Age should not be a barrier to receiving chemotherapy and older and frailer patients should be included in future clinical trials to better represent typical patients with oesophago-gastric cancers. Decisions regarding palliative treatment should be guided by these factors identified as well as patient preference.

Keywords: frailty, oesophago-gastric cancer, palliative chemotherapy, treatment resilience

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110 Turn Organic Waste to Green Fuels with Zero Landfill

Authors: Xu Fei (Philip) WU

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As waste recycling concept been accepted more and more in modern societies, the organic portion of the municipal waste become a sires issue in today’s life. Depend on location and season, the organic waste can bee anywhere between 40-65% of total municipal solid waste. Also composting and anaerobic digestion technologies been applied in this field for years, however both process have difficulties been selected by economical and environmental factors. Beside environmental pollution and risk of virus spread, the compost is not a product been welcomed by people even the waste management has to give up them at no cost. The anaerobic digester has to have 70% of water and keep at 35 degree C or above; base on above conditions, the retention time only can be up to two weeks and remain solid has to be dewater and composting again. The enhancive waste water treatment has to be added after. Because these reasons, the voice of suggesting cancelling recycling program and turning all waste to mass burn incinerations have been raised-A process has already been proved has least energy efficiency and most air pollution problem associated process. A newly developed WXF Bio-energy process employs recently developed and patented pre-designed separation, multi-layer and multi-cavity successive bioreactor landfill technology. It features an improved leachate recycling technology, technologies to maximize the biogas generation rate and a reduced overall turnaround period on the land. A single properly designed and operated site can be used indefinitely. In this process, all collected biogas will be processed to eliminate H2S and other hazardous gases. The methane, carbon dioxide and hydrogen will be utilized in a proprietary process to manufacture methanol which can be sold to mitigate operating costs of the landfill. This integration of new processes offers a more advanced alternative to current sanitary landfill, incineration and compost technology. Xu Fei (Philip) Wu Xu Fei Wu is founder and Chief Scientist of W&Y Environmental International Inc. (W & Y), a Canadian environmental and sustainable energy technology company with patented landfill processes and proprietary waste to energy technologies. He has worked in environmental and sustainable energy fields over the last 25 years. Before W&Y, he worked for Conestoga-Rovers & Associates Limited, Microbe Environmental Science and Technology Inc. of Canada and The Ministry of Nuclear Industry and Ministry of Space Flight Industry of China. Xu Fei Wu holds a Master of Engineering Science degree from The University of Western Ontario. I wish present this paper as an oral presentation only Selected Conference Presentations: • “Removal of Phenolic Compounds with Algae” Presented at 25th Canadian Symposium on Water Pollution Research (CAWPRC Conference), Burlington, Ontario Canada. February, 1990 • “Removal of Phenolic Compounds with Algae” Presented at Annual Conference of Pollution Control Association of Ontario, London, Ontario, Canada. April, 1990 • “Removal of Organochlorine Compounds in a Flocculated Algae Photo-Bioreactor” Presented at International Symposium on Low Cost and Energy Saving Wastewater Treatment Technologies (IAWPRC Conference), Kiyoto, Japan, August, 1990 • “Maximizing Production and Utilization of Landfill Gas” 2009 Wuhan International Conference on Environment(CAWPRC Conference, sponsored by US EPA) Wuhan, China. October, 2009. • “WXF Bio-Energy-A Green, Sustainable Waste to Energy Process” Presented at 9Th International Conference Cooperation for Waste Issues, Kharkiv, Ukraine March, 2012 • “A Lannfill Site Can Be Recycled Indefinitely” Presented at 28th International Conference on solid Waste Technology and Management, Philadelphia, Pennsylvania, USA. March, 2013. Hosted by The Journal of Solid Waste Technology and Management.

Keywords: green fuel, waste management, bio-energy, sustainable development, methanol

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109 Predicting Career Adaptability and Optimism among University Students in Turkey: The Role of Personal Growth Initiative and Socio-Demographic Variables

Authors: Yagmur Soylu, Emir Ozeren, Erol Esen, Digdem M. Siyez, Ozlem Belkis, Ezgi Burc, Gülce Demirgurz

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The aim of the study is to determine the predictive power of personal growth initiative, socio-demographic variables (such as sex, grade, and working condition) on career adaptability and optimism of bachelor students in Dokuz Eylul University in Turkey. According to career construction theory, career adaptability is viewed as a psychosocial construct, which refers to an individual’s resources for dealing with current and expected tasks, transitions and traumas in their occupational roles. Career optimism is defined as positive results for future career development of individuals in the expectation that it will achieve or to put the emphasis on the positive aspects of the event and feel comfortable about the career planning process. Personal Growth Initiative (PGI) is defined as being proactive about one’s personal development. Additionally, personal growth is defined as the active and intentional engagement in the process of personal. A study conducted on college students revealed that individuals with high self-development orientation make more effort to discover the requirements of the profession and workspaces than individuals with low levels of personal development orientation. University life is a period that social relations and the importance of academic activities are increased, the students make efforts to progress through their career paths and it is also an environment that offers opportunities to students for their self-realization. For these reasons, personal growth initiative is potentially an important variable which has a key role for an individual during the transition phase from university to the working life. Based on the review of the literature, it is expected that individual’s personal growth initiative, sex, grade, and working condition would significantly predict one’s career adaptability. In the relevant literature, it can be seen that there are relatively few studies available on the career adaptability and optimism of university students. Most of the existing studies have been carried out with limited respondents. In this study, the authors aim to conduct a comprehensive research with a large representative sample of bachelor students in Dokuz Eylul University, Izmir, Turkey. By now, personal growth initiative and career development constructs have been predominantly discussed in western contexts where individualistic tendencies are likely to be seen. Thus, the examination of the same relationship within the context of Turkey where collectivistic cultural characteristics can be more observed is expected to offer valuable insights and provide an important contribution to the literature. The participants in this study were comprised of 1500 undergraduate students being included from thirteen faculties in Dokuz Eylul University. Stratified and random sampling methods were adopted for the selection of the participants. The Personal Growth Initiative Scale-II and Career Futures Inventory were used as the major measurement tools. In data analysis stage, several statistical analysis concerning the regression analysis, one-way ANOVA and t-test will be conducted to reveal the relationships of the constructs under investigation. At the end of this project, we will be able to determine the level of career adaptability and optimism of university students at varying degrees so that a fertile ground is likely to be created to carry out several intervention techniques to make a contribution to an emergence of a healthier and more productive youth generation in psycho-social sense.

Keywords: career optimism, career adaptability, personal growth initiative, university students

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108 Location3: A Location Scouting Platform for the Support of Film and Multimedia Industries

Authors: Dimitrios Tzilopoulos, Panagiotis Symeonidis, Michael Loufakis, Dimosthenis Ioannidis, Dimitrios Tzovaras

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The domestic film industry in Greece has traditionally relied heavily on state support. While film productions are crucial for the country's economy, it has not fully capitalized on attracting and promoting foreign productions. The lack of motivation, organized state support for attraction and licensing, and the absence of location scouting have hindered its potential. Although recent legislative changes have addressed the first two of these issues, the development of a comprehensive location database and a search engine that would effectively support location scouting at the pre-production location scouting is still in its early stages. In addition to the expected benefits of the film, television, marketing, and multimedia industries, a location-scouting service platform has the potential to yield significant financial gains locally and nationally. By promoting featured places like cultural and archaeological sites, natural monuments, and attraction points for visitors, it plays a vital role in both cultural promotion and facilitating tourism development. This study introduces LOCATION3, an internet platform revolutionizing film production location management. It interconnects location providers, film crews, and multimedia stakeholders, offering a comprehensive environment for seamless collaboration. The platform's central geodatabase (PostgreSQL) stores each location’s attributes, while web technologies like HTML, JavaScript, CSS, React.js, and Redux power the user-friendly interface. Advanced functionalities, utilizing deep learning models, developed in Python, are integrated via Node.js. Visual data presentation is achieved using the JS Leaflet library, delivering an interactive map experience. LOCATION3 sets a new standard, offering a range of essential features to enhance the management of film production locations. Firstly, it empowers users to effortlessly upload audiovisual material enriched with geospatial and temporal data, such as location coordinates, photographs, videos, 360-degree panoramas, and 3D location models. With the help of cutting-edge deep learning algorithms, the application automatically tags these materials, while users can also manually tag them. Moreover, the application allows users to record locations directly through its user-friendly mobile application. Users can then embark on seamless location searches, employing spatial or descriptive criteria. This intelligent search functionality considers a combination of relevant tags, dominant colors, architectural characteristics, emotional associations, and unique location traits. One of the application's standout features is the ability to explore locations by their visual similarity to other materials, facilitated by a reverse image search. Also, the interactive map serves as both a dynamic display for locations and a versatile filter, adapting to the user's preferences and effortlessly enhancing location searches. To further streamline the process, the application facilitates the creation of location lightboxes, enabling users to efficiently organize and share their content via email. Going above and beyond location management, the platform also provides invaluable liaison, matchmaking, and online marketplace services. This powerful functionality bridges the gap between visual and three-dimensional geospatial material providers, local agencies, film companies, production companies, etc. so that those interested in a specific location can access additional material beyond what is stored on the platform, as well as access production services supporting the functioning and completion of productions in a location (equipment provision, transportation, catering, accommodation, etc.).

Keywords: deep learning models, film industry, geospatial data management, location scouting

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107 Addressing the Gap in Health and Wellbeing Evidence for Urban Real Estate Brownfield Asset Management Social Needs and Impact Analysis Using Systems Mapping Approach

Authors: Kathy Pain, Nalumino Akakandelwa

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The study explores the potential to fill a gap in health and wellbeing evidence for purposeful urban real estate asset management to make investment a powerful force for societal good. Part of a five-year programme investigating the root causes of unhealthy urban development funded by the United Kingdom Prevention Research Partnership (UKPRP), the study pilots the use of a systems mapping approach to identify drivers and barriers to the incorporation of health and wellbeing evidence in urban brownfield asset management decision-making. Urban real estate not only provides space for economic production but also contributes to the quality of life in the local community. Yet market approaches to urban land use have, until recently, insisted that neo-classical technology-driven efficient allocation of economic resources should inform acquisition, operational, and disposal decisions. Buildings in locations with declining economic performance have thus been abandoned, leading to urban decay. Property investors are recognising the inextricable connection between sustainable urban production and quality of life in local communities. The redevelopment and operation of brownfield assets recycle existing buildings, minimising embodied carbon emissions. It also retains established urban spaces with which local communities identify and regenerate places to create a sense of security, economic opportunity, social interaction, and quality of life. Social implications of urban real estate on health and wellbeing and increased adoption of benign sustainability guidance in urban production are driving the need to consider how they affect brownfield real estate asset management decisions. Interviews with real estate upstream decision-makers in the study, find that local social needs and impact analysis is becoming a commercial priority for large-scale urban real estate development projects. Evidence of the social value-added of proposed developments is increasingly considered essential to secure local community support and planning permissions, and to attract sustained inward long-term investment capital flows for urban projects. However, little is known about the contribution of population health and wellbeing to socially sustainable urban projects and the monetary value of the opportunity this presents to improve the urban environment for local communities. We report early findings from collaborations with two leading property companies managing major investments in brownfield urban assets in the UK to consider how the inclusion of health and wellbeing evidence in social valuation can inform perceptions of brownfield development social benefit for asset managers, local communities, public authorities and investors for the benefit of all parties. Using holistic case studies and systems mapping approaches, we explore complex relationships between public health considerations and asset management decisions in urban production. Findings indicate a strong real estate investment industry appetite and potential to include health as a vital component of sustainable real estate social value creation in asset management strategies.

Keywords: brownfield urban assets, health and wellbeing, social needs and impact, social valuation, sustainable real estate, systems mapping

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106 A Study on Economic Impacts of Entrepreneurial Firms and Self-Employment: Minority Ethnics in Putatan, Penampang, Inanam, Menggatal, Uitm, Tongod, Sabah, Malaysia

Authors: Lizinis Cassendra Frederick Dony, Jirom Jeremy Frederick Dony, Andrew Nicholas, Dewi Binti Tajuddin

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Starting and surviving a business is influenced by various entrepreneurship socio-economics activities. The study revealed that some of the entrepreneurs are not registered under SME but running own business as an intermediary with the private organization entrusted as “Self-Employed.” SME is known as “Small Medium Enterprise” contributes growth in Malaysia. Therefore, the entrepreneurialism business interest and entrepreneurial intention enhancing new spurring production, expanding employment opportunities, increasing productivity, promoting exports, stimulating innovation and providing new avenue in the business market place. This study has identified the unique contribution to the full understanding of complex mechanisms through entrepreneurship obstacles and education impacts on happiness and well-being to society. Moreover, “Ethnic” term has defined as a curious meaning refers to a classification of a large group of people customs implies to ancestral, racial, national, tribal, religious, linguistic and cultural origins. It is a social phenomenon.1 According to Sabah data population is amounting to 2,389,494 showed the predominant ethnic group being the Kadazan Dusun (18.4%) followed by Bajau (17.3%) and Malays (15.3%). For the year 2010, data statistic immigrants population report showed the amount to 239,765 people which cover 4% of the Sabahan’s population.2 Sabah has numerous group of talented entrepreneurs. The business environment among the minority ethnics are influenced with the business sentiment competition. The literature on ethnic entrepreneurship recognizes two main type entrepreneurships: the middleman and enclave entrepreneurs. According to Adam Smith,3 there are evidently some principles disposition to admire and maintain the distinction business rank status and cause most universal business sentiments. Due to credit barriers competition, the minority ethnics are losing the business market and since 2014, many illegal immigrants have been found to be using permits of the locals to operate businesses in Malaysia.4 The development of small business entrepreneurship among the minority ethnics in Sabah evidenced based variety of complex perception and differences concepts. The studies also confirmed the effects of heterogeneity on group decision and thinking caused partly by excessive pre-occupation with maintaining cohesiveness and the presence of cultural diversity in groups should reduce its probability.5 The researchers proposed that there are seven success determinants particularly to determine the involvement of minority ethnics comparing to the involvement of the immigrants in Sabah. Although, (SMEs) have always been considered the backbone of the economy development, the minority ethnics are often categorized it as the “second-choice.’ The study showed that illegal immigrants entrepreneur imposed a burden on Sabahan social programs as well as the prison, court and health care systems. The tension between the need for cheap labor and the impulse to protect Malaysian in Sabah workers, entrepreneurs and taxpayers, among the subjects discussed in this study. This is clearly can be advantages and disadvantages to the Sabah economic development.

Keywords: entrepreneurial firms, self-employed, immigrants, minority ethnic, economic impacts

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105 Revolutionizing Manufacturing: Embracing Additive Manufacturing with Eggshell Polylactide (PLA) Polymer

Authors: Choy Sonny Yip Hong

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This abstract presents an exploration into the creation of a sustainable bio-polymer compound for additive manufacturing, specifically 3D printing, with a focus on eggshells and polylactide (PLA) polymer. The project initially conducted experiments using a variety of food by-products to create bio-polymers, and promising results were obtained when combining eggshells with PLA polymer. The research journey involved precise measurements, drying of PLA to remove moisture, and the utilization of a filament-making machine to produce 3D printable filaments. The project began with exploratory research and experiments, testing various combinations of food by-products to create bio-polymers. After careful evaluation, it was discovered that eggshells and PLA polymer produced promising results. The initial mixing of the two materials involved heating them just above the melting point. To make the compound 3D printable, the research focused on finding the optimal formulation and production process. The process started with precise measurements of the PLA and eggshell materials. The PLA was placed in a heating oven to remove any absorbed moisture. Handmade testing samples were created to guide the planning for 3D-printed versions. The scrap PLA was recycled and ground into a powdered state. The drying process involved gradual moisture evaporation, which required several hours. The PLA and eggshell materials were then placed into the hopper of a filament-making machine. The machine's four heating elements controlled the temperature of the melted compound mixture, allowing for optimal filament production with accurate and consistent thickness. The filament-making machine extruded the compound, producing filament that could be wound on a wheel. During the testing phase, trials were conducted with different percentages of eggshell in the PLA mixture, including a high percentage (20%). However, poor extrusion results were observed for high eggshell percentage mixtures. Samples were created, and continuous improvement and optimization were pursued to achieve filaments with good performance. To test the 3D printability of the DIY filament, a 3D printer was utilized, set to print the DIY filament smoothly and consistently. Samples were printed and mechanically tested using a universal testing machine to determine their mechanical properties. This testing process allowed for the evaluation of the filament's performance and suitability for additive manufacturing applications. In conclusion, the project explores the creation of a sustainable bio-polymer compound using eggshells and PLA polymer for 3D printing. The research journey involved precise measurements, drying of PLA, and the utilization of a filament-making machine to produce 3D printable filaments. Continuous improvement and optimization were pursued to achieve filaments with good performance. The project's findings contribute to the advancement of additive manufacturing, offering opportunities for design innovation, carbon footprint reduction, supply chain optimization, and collaborative potential. The utilization of eggshell PLA polymer in additive manufacturing has the potential to revolutionize the manufacturing industry, providing a sustainable alternative and enabling the production of intricate and customized products.

Keywords: additive manufacturing, 3D printing, eggshell PLA polymer, design innovation, carbon footprint reduction, supply chain optimization, collaborative potential

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104 Developing a Cloud Intelligence-Based Energy Management Architecture Facilitated with Embedded Edge Analytics for Energy Conservation in Demand-Side Management

Authors: Yu-Hsiu Lin, Wen-Chun Lin, Yen-Chang Cheng, Chia-Ju Yeh, Yu-Chuan Chen, Tai-You Li

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Demand-Side Management (DSM) has the potential to reduce electricity costs and carbon emission, which are associated with electricity used in the modern society. A home Energy Management System (EMS) commonly used by residential consumers in a down-stream sector of a smart grid to monitor, control, and optimize energy efficiency to domestic appliances is a system of computer-aided functionalities as an energy audit for residential DSM. Implementing fault detection and classification to domestic appliances monitored, controlled, and optimized is one of the most important steps to realize preventive maintenance, such as residential air conditioning and heating preventative maintenance in residential/industrial DSM. In this study, a cloud intelligence-based green EMS that comes up with an Internet of Things (IoT) technology stack for residential DSM is developed. In the EMS, Arduino MEGA Ethernet communication-based smart sockets that module a Real Time Clock chip to keep track of current time as timestamps via Network Time Protocol are designed and implemented for readings of load phenomena reflecting on voltage and current signals sensed. Also, a Network-Attached Storage providing data access to a heterogeneous group of IoT clients via Hypertext Transfer Protocol (HTTP) methods is configured to data stores of parsed sensor readings. Lastly, a desktop computer with a WAMP software bundle (the Microsoft® Windows operating system, Apache HTTP Server, MySQL relational database management system, and PHP programming language) serves as a data science analytics engine for dynamic Web APP/REpresentational State Transfer-ful web service of the residential DSM having globally-Advanced Internet of Artificial Intelligence (AI)/Computational Intelligence. Where, an abstract computing machine, Java Virtual Machine, enables the desktop computer to run Java programs, and a mash-up of Java, R language, and Python is well-suited and -configured for AI in this study. Having the ability of sending real-time push notifications to IoT clients, the desktop computer implements Google-maintained Firebase Cloud Messaging to engage IoT clients across Android/iOS devices and provide mobile notification service to residential/industrial DSM. In this study, in order to realize edge intelligence that edge devices avoiding network latency and much-needed connectivity of Internet connections for Internet of Services can support secure access to data stores and provide immediate analytical and real-time actionable insights at the edge of the network, we upgrade the designed and implemented smart sockets to be embedded AI Arduino ones (called embedded AIduino). With the realization of edge analytics by the proposed embedded AIduino for data analytics, an Arduino Ethernet shield WizNet W5100 having a micro SD card connector is conducted and used. The SD library is included for reading parsed data from and writing parsed data to an SD card. And, an Artificial Neural Network library, ArduinoANN, for Arduino MEGA is imported and used for locally-embedded AI implementation. The embedded AIduino in this study can be developed for further applications in manufacturing industry energy management and sustainable energy management, wherein in sustainable energy management rotating machinery diagnostics works to identify energy loss from gross misalignment and unbalance of rotating machines in power plants as an example.

Keywords: demand-side management, edge intelligence, energy management system, fault detection and classification

Procedia PDF Downloads 229
103 Microdiamond and Moissanite Inclusions in Garnets from Pohorje Mountains, Eastern Alps, Slovenia

Authors: Mirijam Vrabec, Marian Janak, Bojan Ambrozic, Angelja K. Surca, Nastja Rogan Smuc, Nina Zupancic, Saso Sturm

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Natural microdiamonds and moissanite (SiC) can form during the orogenic events under ultrahigh-pressure metamorphic conditions (UHP), when parts of Earth’s crust are subducted to extreme depths. So far, such processes were identified only in few places on the Earth, and therefore, represent unique opportunity to study the evolution of the Earth’s deep interior. An important discovery of microdiamonds and moissanite was reported from Pohorje, (Slovenia), where they occurred as single or polyphase inclusions in garnets. Metasedimentary rocks from Pohorje are predominantly gneisses representing parts of the Austroalpine metamorphic units of the Eastern Alps. During Cretaceous orogeny, (ca. 95–92 Ma) continental crustal rocks were deeply subducted to the mantle depths (below 100 km) and metamorphosed at pressures exceeding 3.5 GPa and temperatures between 800–850 °C. Microstructural and phase analysis of the inclusions as well as detailed elemental analysis of host garnets were carried out combining several analytical techniques: optical microscope in plane polarized transmitted light, electron probe microanalysis (EPMA) with wavelength-dispersive x-ray spectrometry (WDS) and field-emission scanning microscope (FEG-SEM) with energy-dispersive x-ray spectroscopy (EDS). Micro-Raman analysis revealed sharp, first order diamond bands sometimes accompanied by graphite bands implying that transformation of diamond back to graphite occurred. To study the chemical and crystallographic relationship between microdiamonds and co-inclusions, advanced techniques of transmission electron microscopy (TEM) were applied, which included high-angle annular dark-field scanning transmission electron microscopy (HAADF-STEM), combined with EDS and electron energy-loss spectroscopy (EELS). To prepare electron transparent TEM lamellae selectively a dual-beam Focused Ion Beam/SEM (FIB/SEM) was employed. Detailed study of TEM lamellae, which was cross-sectioned from the highly faceted inclusion body located within the host garnet crystal matrix, revealed rich and rather complex internal structure. Namely, the negative crystal facets of the main inclusion body were typically decorated with up to 1 μm thick amorphous layer, reflecting the general garnet composition with slight variations in Fe/Ca content. Within these layers, ELNES analysis revealed the presence of a 28–30 nm thick layer of amorphous carbon. The very last section of this layer corresponds to composition of SiO2. Within the inclusion, besides diamond and moissanite alumosilicate mineral with pronounced layered structure, iron sulfides and chlorine were identified under TEM and CO2 and CH4 using Raman. Moissanite is found as single crystal or composed from numerous highly textured nano-crystals with the average size of 10 nm. Moissanite inclusions were found embedded inside the amorphous crust implying that moissanite crystalized well before the deposition of the amorphous layer. From the microstructural, crystallographic and chemical observations so far we can deduce, that polyphase inclusions in diamond bearing garnets from Pohorje most probably crystallized from reduced supercritical fluids. Based on layered interface structure of the host mineral multiphase process of crystallization is possible. The presence of microdiamonds and moissanite in rocks from Pohorje demonstrates that these parts of the Eastern Alps were subducted to extreme depths, and were subsequently exhumed back to the Earth's surface without complete breakdown of UHP mineral phases, allowing a rear and exceptional opportunity to study them in-situ.

Keywords: diamond, fluid inclusions, moissanite, TEM, UHP metamorphism.

Procedia PDF Downloads 278
102 Raman Spectral Fingerprints of Healthy and Cancerous Human Colorectal Tissues

Authors: Maria Karnachoriti, Ellas Spyratou, Dimitrios Lykidis, Maria Lambropoulou, Yiannis S. Raptis, Ioannis Seimenis, Efstathios P. Efstathopoulos, Athanassios G. Kontos

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Colorectal cancer is the third most common cancer diagnosed in Europe, according to the latest incidence data provided by the World Health Organization (WHO), and early diagnosis has proved to be the key in reducing cancer-related mortality. In cases where surgical interventions are required for cancer treatment, the accurate discrimination between healthy and cancerous tissues is critical for the postoperative care of the patient. The current study focuses on the ex vivo handling of surgically excised colorectal specimens and the acquisition of their spectral fingerprints using Raman spectroscopy. Acquired data were analyzed in an effort to discriminate, in microscopic scale, between healthy and malignant margins. Raman spectroscopy is a spectroscopic technique with high detection sensitivity and spatial resolution of few micrometers. The spectral fingerprint which is produced during laser-tissue interaction is unique and characterizes the biostructure and its inflammatory or cancer state. Numerous published studies have demonstrated the potential of the technique as a tool for the discrimination between healthy and malignant tissues/cells either ex vivo or in vivo. However, the handling of the excised human specimens and the Raman measurement conditions remain challenging, unavoidably affecting measurement reliability and repeatability, as well as the technique’s overall accuracy and sensitivity. Therefore, tissue handling has to be optimized and standardized to ensure preservation of cell integrity and hydration level. Various strategies have been implemented in the past, including the use of balanced salt solutions, small humidifiers or pump-reservoir-pipette systems. In the current study, human colorectal specimens of 10X5 mm were collected from 5 patients up to now who underwent open surgery for colorectal cancer. A novel, non-toxic zinc-based fixative (Z7) was used for tissue preservation. Z7 demonstrates excellent protein preservation and protection against tissue autolysis. Micro-Raman spectra were recorded with a Renishaw Invia spectrometer from successive random 2 micrometers spots upon excitation at 785 nm to decrease fluorescent background and secure avoidance of tissue photodegradation. A temperature-controlled approach was adopted to stabilize the tissue at 2 °C, thus minimizing dehydration effects and consequent focus drift during measurement. A broad spectral range, 500-3200 cm-1,was covered with five consecutive full scans that lasted for 20 minutes in total. The average spectra were used for least square fitting analysis of the Raman modes.Subtle Raman differences were observed between normal and cancerous colorectal tissues mainly in the intensities of the 1556 cm-1 and 1628 cm-1 Raman modes which correspond to v(C=C) vibrations in porphyrins, as well as in the range of 2800-3000 cm-1 due to CH2 stretching of lipids and CH3 stretching of proteins. Raman spectra evaluation was supported by histological findings from twin specimens. This study demonstrates that Raman spectroscopy may constitute a promising tool for real-time verification of clear margins in colorectal cancer open surgery.

Keywords: colorectal cancer, Raman spectroscopy, malignant margins, spectral fingerprints

Procedia PDF Downloads 72
101 Utilization of Informatics to Transform Clinical Data into a Simplified Reporting System to Examine the Analgesic Prescribing Practices of a Single Urban Hospital’s Emergency Department

Authors: Rubaiat S. Ahmed, Jemer Garrido, Sergey M. Motov

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Clinical informatics (CI) enables the transformation of data into a systematic organization that improves the quality of care and the generation of positive health outcomes.Innovative technology through informatics that compiles accurate data on analgesic utilization in the emergency department can enhance pain management in this important clinical setting. We aim to establish a simplified reporting system through CI to examine and assess the analgesic prescribing practices in the EDthrough executing a U.S. federal grant project on opioid reduction initiatives. Queried data points of interest from a level-one trauma ED’s electronic medical records were used to create data sets and develop informational/visual reporting dashboards (on Microsoft Excel and Google Sheets) concerning analgesic usage across several pre-defined parameters and performance metrics using CI. The data was then qualitatively analyzed to evaluate ED analgesic prescribing trends by departmental clinicians and leadership. During a 12-month reporting period (Dec. 1, 2020 – Nov. 30, 2021) for the ongoing project, about 41% of all ED patient visits (N = 91,747) were for pain conditions, of which 81.6% received analgesics in the ED and at discharge (D/C). Of those treated with analgesics, 24.3% received opioids compared to 75.7% receiving opioid alternatives in the ED and at D/C, including non-pharmacological modalities. Demographics showed among patients receiving analgesics, 56.7% were aged between 18-64, 51.8% were male, 51.7% were white, and 66.2% had government funded health insurance. Ninety-one percent of all opioids prescribed were in the ED, with intravenous (IV) morphine, IV fentanyl, and morphine sulfate immediate release (MSIR) tablets accounting for 88.0% of ED dispensed opioids. With 9.3% of all opioids prescribed at D/C, MSIR was dispensed 72.1% of the time. Hydrocodone, oxycodone, and tramadol usage to only 10-15% of the time, and hydromorphone at 0%. Of opioid alternatives, non-steroidal anti-inflammatory drugs were utilized 60.3% of the time, 23.5% with local anesthetics and ultrasound-guided nerve blocks, and 7.9% with acetaminophen as the primary non-opioid drug categories prescribed by ED providers. Non-pharmacological analgesia included virtual reality and other modalities. An average of 18.5 ED opioid orders and 1.9 opioid D/C prescriptions per 102.4 daily ED patient visits was observed for the period. Compared to other specialties within our institution, 2.0% of opioid D/C prescriptions are given by ED providers, compared to the national average of 4.8%. Opioid alternatives accounted for 69.7% and 30.3% usage, versus 90.7% and 9.3% for opioids in the ED and D/C, respectively.There is a pressing need for concise, relevant, and reliable clinical data on analgesic utilization for ED providers and leadership to evaluate prescribing practices and make data-driven decisions. Basic computer software can be used to create effective visual reporting dashboards with indicators that convey relevant and timely information in an easy-to-digest manner. We accurately examined our ED's analgesic prescribing practices using CI through dashboard reporting. Such reporting tools can quickly identify key performance indicators and prioritize data to enhance pain management and promote safe prescribing practices in the emergency setting.

Keywords: clinical informatics, dashboards, emergency department, health informatics, healthcare informatics, medical informatics, opioids, pain management, technology

Procedia PDF Downloads 120
100 The Safe Introduction of Tocilizumab for the Treatment of SARS-CoV-2 Pneumonia at an East London District General Hospital

Authors: Andrew Read, Alice Parry, Kate Woods

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Since the advent of the SARS-CoV-2 pandemic, the search for medications that can reduce mortality and morbidity has been a global research priority. Several multi-center trials have recently demonstrated improved mortality associated with the use of Tocilizumab, an interleukin-6 receptor antagonist, in patients with severe SARS-CoV-2 pneumonia. Initial data supported the administration in patients requiring respiratory support (non-invasive or invasive ventilation), but more recent data has shown benefit in all hypoxic patients. At the height of the second wave of COVID-19 infections in London, our hospital introduced the use of Tocilizumab for patients with severe COVID-19. Tocilizumab is licensed for use in chronic inflammatory conditions and has been associated with an increased risk of severe bacterial and fungal infections, as well as reactivation of chronic viral infections (e.g., hepatitis B). It is a specialist drug that suppresses the formation of C-reactive protein (CRP) for 6 – 12 weeks. It is not widely used by the general medical community. We aimed to assess Tocilizumab use in our hospital and to implement changes to the protocol as required to ensure administration was safe and appropriate. A retrospective study design was used to assess prescriptions over an initial 3-week period in both intensive care and on the medical wards. This amounted to a total of 13 patients. The initial data collection identified four key areas of concern: adherence to national and local inclusion & exclusion criteria; a collection of appropriate screening blood prior to administration; documentation of informed consent or best interest decision and documentation of Tocilizumab administration on patient discharge information, to alert future healthcare providers that typical measures of inflammation and infection, such as CRP, are unreliable for up to 3-months. Data were collected from electronic notes, blood results and observation charts, and cross referenced with pharmacy data. Initial results showed that all four key areas were completed in approximately 50% of cases. Of particular concern was adherence to exclusion criteria, such as current evidence of bacterial infection, and ensuring the correct screening blood was sent to exclude infections such as hepatitis. To remedy this and improve patient safety, the initial data was presented to relevant healthcare professionals. Subsequently, three interventions were introduced and education on each provided to hospital staff. An electronic ‘order set’ collating the appropriate screening blood was created simplifying the screening process. Pre-formed electronic documentation which can be inserted into the notes was created to provide a framework for consent discussions and reduce the time needed for junior doctors to complete this task. Additionally, a ‘Tocilizumab’ administration card was created and administered via pharmacy. This was distributed to each patient on discharge to ensure future healthcare professionals were aware of the potential effects of Tocilizumab administration, including suppression of CRP. Following these changes, repeat data collection over two months illustrated that each of the 4 safety aspects was met with a 100% success rate in every patient. Although this demonstrates good progress and effective interventions the challenge will be to maintain this progress. The audit data collection is ongoing

Keywords: education, patient safety , SARS-CoV-2, Tocilizumab

Procedia PDF Downloads 153
99 Examining the Behavioral, Hygienic and Expectational Changes in Adolescents and Young Women during COVID-19 Quarantine in Colombia

Authors: Rocio Murad, Marcela Sanchez, Mariana Calderon Jaramillo, Danny Rivera, Angela Cifuentes, Daniela Roldán, Juan Carlos Rivillas

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Women and girls have specific health needs, but during health pandemics such as COVID19 they are less likely to have access to quality essential health information, commodities and services, or insurance coverage for routine and catastrophic health expenses, especially in rural and marginalized communities. This is compounded by multiple or intersecting inequalities, such as ethnicity, socioeconomic status, disability, age, geographic location, and sexual orientation, among others. Despite concerted collective action, there is a lack of information on the situation of women, adolescents and youth, including gender inequalities exacerbated by the pandemic. Much more needs to be done to amplify the lived realities of women and adolescents in global and national advocacy and policy responses. The COVID 19 pandemic reflects the need for systematic advocacy policies based on the lived experiences of women and adolescents, underpinned by human rights. This research is part of the initiative of Profamilia Association (Solidarity Study), and its objective is twofold: i) to analyze the behavioral changes and immediate expectations of Colombians during the stage of relaxation of the confinement measures decreed by the national government; and ii) to identify the needs, experiences and resilient practices of adolescents and young women during the COVID-19 crisis in Colombia. Descriptive analysis of data collected by Profamilia through the Solidaridad study, an exploratory cross-sectional descriptive study that used subnational level data from a nonprobabilistic sample survey conducted to 1735 adults, between September 01 and 11, 2020. Interviews were conducted with key stakeholders about their experiences during COVID19, under three key axes: i) main challenges for adolescents and young women; ii) examples of what has worked well in responding to the challenge; and iii) how/what services are/should be provided during COVID-19 (and beyond) to address the challenge. Interviewees were selected based on prior mapping of social groups of interest. In total, 23 adolescents and young women participated in the interviews. The results show that people adopted behavioral changes such as wearing masks, avoiding people with symptoms, and reducing mobility, but there was also a doubling of concerns for many reasons, from effects on mental health, sexual health, and unattended reproductive health to the burden of care and working at home. The favorable perception that people had at the beginning of the quarantine about the response and actions of the national and local government to control Covid-19 decreased over the course of the quarantine. The challenges and needs of adolescents and young women were highlighted during the most restrictive measures to contain the COVID-19 pandemic, which resulted in disruptions to daily activities, education and work, as well as restrictions to mobility and social interaction. Concerns raised by participants included: impact on mental health and wellbeing due to disruption of daily life; limitations in access to formal and informal education; food insecurity; migration; loss of livelihoods; lack of access to health information and services; limitations to sexual and reproductive health and rights; insecurity problems; and problems in communication and treatment among household members.

Keywords: COVID-19, changes in behavior, adolescents, women

Procedia PDF Downloads 81
98 Methotrexate Associated Skin Cancer: A Signal Review of Pharmacovigilance Center

Authors: Abdulaziz Alakeel, Abdulrahman Alomair, Mohammed Fouda

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Introduction: Methotrexate (MTX) is an antimetabolite used to treat multiple conditions, including neoplastic diseases, severe psoriasis, and rheumatoid arthritis. Skin cancer is the out-of-control growth of abnormal cells in the epidermis, the outermost skin layer, caused by unrepaired DNA damage that triggers mutations. These mutations lead the skin cells to multiply rapidly and form malignant tumors. The aim of this review is to evaluate the risk of skin cancer associated with the use of methotrexate and to suggest regulatory recommendations if required. Methodology: Signal Detection team at Saudi Food and Drug Authority (SFDA) performed a safety review using National Pharmacovigilance Center (NPC) database as well as the World Health Organization (WHO) VigiBase, alongside with literature screening to retrieve related information for assessing the causality between skin cancer and methotrexate. The search conducted in July 2020. Results: Four published articles support the association seen while searching in literature, a recent randomized control trial published in 2020 revealed a statistically significant increase in skin cancer among MTX users. Another study mentioned methotrexate increases the risk of non-melanoma skin cancer when used in combination with immunosuppressant and biologic agents. In addition, the incidence of melanoma for methotrexate users was 3-fold more than the general population in a cohort study of rheumatoid arthritis patients. The last article estimated the risk of cutaneous malignant melanoma (CMM) in a cohort study shows a statistically significant risk increase for CMM was observed in MTX exposed patients. The WHO database (VigiBase) searched for individual case safety reports (ICSRs) reported for “Skin Cancer” and 'Methotrexate' use, which yielded 121 ICSRs. The initial review revealed that 106 cases are insufficiently documented for proper medical assessment. However, the remaining fifteen cases have extensively evaluated by applying the WHO criteria of causality assessment. As a result, 30 percent of the cases showed that MTX could possibly cause skin cancer; five cases provide unlikely association and five un-assessable cases due to lack of information. The Saudi NPC database searched to retrieve any reported cases for the combined terms methotrexate/skin cancer; however, no local cases reported up to date. The data mining of the observed and the expected reporting rate for drug/adverse drug reaction pair is estimated using information component (IC), a tool developed by the WHO Uppsala Monitoring Centre to measure the reporting ratio. Positive IC reflects higher statistical association, while negative values translated as a less statistical association, considering the null value equal to zero. Results showed that a combination of 'Methotrexate' and 'Skin cancer' observed more than expected when compared to other medications in the WHO database (IC value is 1.2). Conclusion: The weighted cumulative pieces of evidence identified from global cases, data mining, and published literature are sufficient to support a causal association between the risk of skin cancer and methotrexate. Therefore, health care professionals should be aware of this possible risk and may consider monitoring any signs or symptoms of skin cancer in patients treated with methotrexate.

Keywords: methotrexate, skin cancer, signal detection, pharmacovigilance

Procedia PDF Downloads 93
97 Navigating Rapids And Collecting Medical Insights: A Data Collection Of Athletes Presenting To The Medical Team At The International Canoe Federation Canoe Slalom World Championships 2023

Authors: Dr Grace Scaplehorn, Mr Muhammad Adeel Akhtar, Dr Jane Gibson

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Background: Canoe Slalom entails the skilful navigation of a carbon composite canoe or kayak through a series of 18-25 hanging gates, strategically positioned along the course, either upstream or downstream, amidst currents of whitewater rapids in natural and man-made river settings. Athletes compete individually in timed trials, competing for the fastest course time, typically around 80 to 120 seconds. In the new discipline of Kayak Cross, descents of the course are initiated by groups of four athletes freefalling simultaneously from a starting platform situated 3m above the river. Kayak Cross athletes, in contrast to Canoe Slalom, can make physical contact with suspended gates without incurring time penalties and are required to perform a kayak roll half way down the course. The Canoe Slalom World Championships were held at Lee Valley Whitewater Centre, London, from 19th to 24th September 2023. The event comprised 299 international athletes competing for 10 World Championship titles in Canoe/Kayak Slalom events (Olympic Debut Munich 1972), and the new Kayak Cross discipline (Olympic Debut Paris 2024). The inaugural appearance of Kayak Cross at the World Championships occurred in 2017, in Pau, France. There is limited literature surrounding Kayak Cross and the incidence of athlete injuries compared to traditional Canoe Slalom, hence it was felt important to undertake this review to address the perception that the event is dangerous. Aim: The study aimed to quantify and collate data collected from athletes presenting to the event medical centre. Methods: Athletes’ details were collected at initial assessments from the start of the practice period (16th–18th September) and throughout the event. Demographics such as age, sex and nationality were recorded along with presenting complaints, treatment, medication administered and outcome. Specifically, injuries were then sub-classified into body regions. The data does not include athletes who sought medical attention from their own governing body’s medical team. Results: During the 8-day period, there were 11 individual presentations to the medical centre, 3.7% of the athlete population (n=299). The mean age was 23.9 years (n=7), 6 were male (n=10). The most common presentation was minor injury (n=9), with 6 being musculoskeletal and 3 comprising skin damage, followed by insect sting/allergy (n=1) and pain relief requests (n=1). Five presentations were event-related, all being musculoskeletal injuries; 2 shoulder/arm, 1 head/neck, 1 hand/wrist and 1 other (data was not recorded). Of these injuries, the only intervention was 2 cases of 400mg Ibuprofen, which was given to both shoulder/arm injuries. Four of the 11 presentations were pre-existing injuries, which had been exacerbated due to increased intensity of practice. Two patients were advised to return for review, with 100% compliance. There were no unplanned re-presentations, and no emergency transfers to secondary care. Both the Kayak Cross and Canoe Slalom competitions resulted in 1 new event-related athlete presentation each. Conclusion: The event resulted in a negligible incidence of presentations at the medical centre, for both Kayak Cross and Canoe Slalom. This data holds significance in informing risk assessments and medical protocols necessary for the organisation of canoe slalom events.

Keywords: canoe slalom, kayak cross, athlete injuries, event injuries

Procedia PDF Downloads 33
96 The Multiplier Effects of Intelligent Transport System to Nigerian Economy

Authors: Festus Okotie

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Nigeria is the giant of Africa with great and diverse transport potentials yet to be fully tapped into and explored.it is the most populated nation in Africa with nearly 200 million people, the sixth largest oil producer overall and largest oil producer in Africa with proven oil and gas reserves of 37 billion barrels and 192 trillion cubic feet, over 300 square kilometers of arable land and significant deposits of largely untapped minerals. A world bank indicator which measures trading across border ranked Nigeria at 183 out of 185 countries in 2017 and although different governments in the past made efforts through different interventions such as 2007 ports reforms led by Ngozi Okonjo-Iweala, a former minister of Finance and world bank managing director also attempted to resolve some of the challenges such as infrastructure shortcomings, policy and regulatory inconsistencies, overlapping functions and duplicated roles among the different MDA’S. It is one of the fundamental structures smart nations and cities are using to improve the living conditions of its citizens and achieving sustainability. Examples of some of its benefits includes tracking high pedestrian areas, traffic patterns, railway stations, planning and scheduling bus times, it also enhances interoperability, creates alerts of transport situation and has swift capacity to share information among the different platforms and transport modes. It also offers a comprehensive approach to risk management, putting emergency procedures and response capabilities in place, identifying dangers, including vandalism or violence, fare evasion, and medical emergencies. The Nigerian transport system is urgently in need of modern infrastructures such as ITS. Smart city transport technology helps cities to function productively, while improving services for businesses and lives of is citizens. This technology has the ability to improve travel across traditional modes of transport, such as cars and buses, with immediate benefits for city dwellers and also helps in managing transport systems such as dangerous weather conditions, heavy traffic, and unsafe speeds which can result in accidents and loss of lives. Intelligent transportation systems help in traffic control such as permitting traffic lights to react to changing traffic patterns, instead of working on a fixed schedule in traffic. Intelligent transportation systems is very important in Nigeria’s transportation sector and so would require trained personnel to drive its efficiency to greater height because the purpose of introducing it is to add value and at the same time reduce motor vehicle miles and traffic congestion which is a major challenge around Tin can island and Apapa Port, a major transportation hub in Nigeria. The need for the federal government, state governments, houses of assembly to organise a national transportation workshop to begin the process of addressing the challenges in our nation’s transport sector is highly expedient and so bills that will facilitate the implementation of policies to promote intelligent transportation systems needs to be sponsored because of its potentials to create thousands of jobs for our citizens, provide farmers with better access to cities and a better living condition for Nigerians.

Keywords: intelligent, transport, system, Nigeria

Procedia PDF Downloads 93
95 Urban Flood Resilience Comprehensive Assessment of "720" Rainstorm in Zhengzhou Based on Multiple Factors

Authors: Meiyan Gao, Zongmin Wang, Haibo Yang, Qiuhua Liang

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Under the background of global climate change and rapid development of modern urbanization, the frequency of climate disasters such as extreme precipitation in cities around the world is gradually increasing. In this paper, Hi-PIMS model is used to simulate the "720" flood in Zhengzhou, and the continuous stages of flood resilience are determined with the urban flood stages are divided. The flood resilience curve under the influence of multiple factors were determined and the urban flood toughness was evaluated by combining the results of resilience curves. The flood resilience of urban unit grid was evaluated based on economy, population, road network, hospital distribution and land use type. Firstly, the rainfall data of meteorological stations near Zhengzhou and the remote sensing rainfall data from July 17 to 22, 2021 were collected. The Kriging interpolation method was used to expand the rainfall data of Zhengzhou. According to the rainfall data, the flood process generated by four rainfall events in Zhengzhou was reproduced. Based on the results of the inundation range and inundation depth in different areas, the flood process was divided into four stages: absorption, resistance, overload and recovery based on the once in 50 years rainfall standard. At the same time, based on the levels of slope, GDP, population, hospital affected area, land use type, road network density and other aspects, the resilience curve was applied to evaluate the urban flood resilience of different regional units, and the difference of flood process of different precipitation in "720" rainstorm in Zhengzhou was analyzed. Faced with more than 1,000 years of rainstorm, most areas are quickly entering the stage of overload. The influence levels of factors in different areas are different, some areas with ramps or higher terrain have better resilience, and restore normal social order faster, that is, the recovery stage needs shorter time. Some low-lying areas or special terrain, such as tunnels, will enter the overload stage faster in the case of heavy rainfall. As a result, high levels of flood protection, water level warning systems and faster emergency response are needed in areas with low resilience and high risk. The building density of built-up area, population of densely populated area and road network density all have a certain negative impact on urban flood resistance, and the positive impact of slope on flood resilience is also very obvious. While hospitals can have positive effects on medical treatment, they also have negative effects such as population density and asset density when they encounter floods. The result of a separate comparison of the unit grid of hospitals shows that the resilience of hospitals in the distribution range is low when they encounter floods. Therefore, in addition to improving the flood resistance capacity of cities, through reasonable planning can also increase the flood response capacity of cities. Changes in these influencing factors can further improve urban flood resilience, such as raise design standards and the temporary water storage area when floods occur, train the response speed of emergency personnel and adjust emergency support equipment.

Keywords: urban flood resilience, resilience assessment, hydrodynamic model, resilience curve

Procedia PDF Downloads 22
94 The Healthcare Costs of BMI-Defined Obesity among Adults Who Have Undergone a Medical Procedure in Alberta, Canada

Authors: Sonia Butalia, Huong Luu, Alexis Guigue, Karen J. B. Martins, Khanh Vu, Scott W. Klarenbach

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Obesity is associated with significant personal impacts on health and has a substantial economic burden on payers due to increased healthcare use. A contemporary estimate of the healthcare costs associated with obesity at the population level are lacking. This evidence may provide further rationale for weight management strategies. Methods: Adults who underwent a medical procedure between 2012 and 2019 in Alberta, Canada were categorized into the investigational cohort (had body mass index [BMI]-defined class 2 or 3 obesity based on a procedure-associated code) and the control cohort (did not have the BMI procedure-associated code); those who had bariatric surgery were excluded. Characteristics were presented and healthcare costs ($CDN) determined over a 1-year observation period (2019/2020). Logistic regression and a generalized linear model with log link and gamma distribution were used to assess total healthcare costs (comprised of hospitalizations, emergency department visits, ambulatory care visits, physician visits, and outpatient prescription drugs); potential confounders included age, sex, region of residence, and whether the medical procedure was performed within 6-months before the observation period in the partial adjustment, and also the type of procedure performed, socioeconomic status, Charlson Comorbidity Index (CCI), and seven obesity-related health conditions in the full adjustment. Cost ratios and estimated cost differences with 95% confidence intervals (CI) were reported; incremental cost differences within the adjusted models represent referent cases. Results: The investigational cohort (n=220,190) was older (mean age: 53 standard deviation [SD]±17 vs 50 SD±17 years), had more females (71% vs 57%), lived in rural areas to a greater extent (20% vs 14%), experienced a higher overall burden of disease (CCI: 0.6 SD±1.3 vs 0.3 SD±0.9), and were less socioeconomically well-off (material/social deprivation was lower [14%/14%] in the most well-off quintile vs 20%/19%) compared with controls (n=1,955,548). Unadjusted total healthcare costs were estimated to be 1.77-times (95% CI: 1.76, 1.78) higher in the investigational versus control cohort; each healthcare resource contributed to the higher cost ratio. After adjusting for potential confounders, the total healthcare cost ratio decreased, but remained higher in the investigational versus control cohort (partial adjustment: 1.57 [95% CI: 1.57, 1.58]; full adjustment: 1.21 [95% CI: 1.20, 1.21]); each healthcare resource contributed to the higher cost ratio. Among urban-dwelling 50-year old females who previously had non-operative procedures, no procedures performed within 6-months before the observation period, a social deprivation index score of 3, a CCI score of 0.32, and no history of select obesity-related health conditions, the predicted cost difference between those living with and without obesity was $386 (95% CI: $376, $397). Conclusions: If these findings hold for the Canadian population, one would expect an estimated additional $3.0 billion per year in healthcare costs nationally related to BMI-defined obesity (based on an adult obesity rate of 26% and an estimated annual incremental cost of $386 [21%]); incremental costs are higher when obesity-related health conditions are not adjusted for. Results of this study provide additional rationale for investment in interventions that are effective in preventing and treating obesity and its complications.

Keywords: administrative data, body mass index-defined obesity, healthcare cost, real world evidence

Procedia PDF Downloads 81
93 Gene Expression Meta-Analysis of Potential Shared and Unique Pathways Between Autoimmune Diseases Under anti-TNFα Therapy

Authors: Charalabos Antonatos, Mariza Panoutsopoulou, Georgios K. Georgakilas, Evangelos Evangelou, Yiannis Vasilopoulos

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The extended tissue damage and severe clinical outcomes of autoimmune diseases, accompanied by the high annual costs to the overall health care system, highlight the need for an efficient therapy. Increasing knowledge over the pathophysiology of specific chronic inflammatory diseases, namely Psoriasis (PsO), Inflammatory Bowel Diseases (IBD) consisting of Crohn’s disease (CD) and Ulcerative colitis (UC), and Rheumatoid Arthritis (RA), has provided insights into the underlying mechanisms that lead to the maintenance of the inflammation, such as Tumor Necrosis Factor alpha (TNF-α). Hence, the anti-TNFα biological agents pose as an ideal therapeutic approach. Despite the efficacy of anti-TNFα agents, several clinical trials have shown that 20-40% of patients do not respond to treatment. Nowadays, high-throughput technologies have been recruited in order to elucidate the complex interactions in multifactorial phenotypes, with the most ubiquitous ones referring to transcriptome quantification analyses. In this context, a random effects meta-analysis of available gene expression cDNA microarray datasets was performed between responders and non-responders to anti-TNFα therapy in patients with IBD, PsO, and RA. Publicly available datasets were systematically searched from inception to 10th of November 2020 and selected for further analysis if they assessed the response to anti-TNFα therapy with clinical score indexes from inflamed biopsies. Specifically, 4 IBD (79 responders/72 non-responders), 3 PsO (40 responders/11 non-responders) and 2 RA (16 responders/6 non-responders) datasetswere selected. After the separate pre-processing of each dataset, 4 separate meta-analyses were conducted; three disease-specific and a single combined meta-analysis on the disease-specific results. The MetaVolcano R package (v.1.8.0) was utilized for a random-effects meta-analysis through theRestricted Maximum Likelihood (RELM) method. The top 1% of the most consistently perturbed genes in the included datasets was highlighted through the TopConfects approach while maintaining a 5% False Discovery Rate (FDR). Genes were considered as Differentialy Expressed (DEGs) as those with P ≤ 0.05, |log2(FC)| ≥ log2(1.25) and perturbed in at least 75% of the included datasets. Over-representation analysis was performed using Gene Ontology and Reactome Pathways for both up- and down-regulated genes in all 4 performed meta-analyses. Protein-Protein interaction networks were also incorporated in the subsequentanalyses with STRING v11.5 and Cytoscape v3.9. Disease-specific meta-analyses detected multiple distinct pro-inflammatory and immune-related down-regulated genes for each disease, such asNFKBIA, IL36, and IRAK1, respectively. Pathway analyses revealed unique and shared pathways between each disease, such as Neutrophil Degranulation and Signaling by Interleukins. The combined meta-analysis unveiled 436 DEGs, 86 out of which were up- and 350 down-regulated, confirming the aforementioned shared pathways and genes, as well as uncovering genes that participate in anti-inflammatory pathways, namely IL-10 signaling. The identification of key biological pathways and regulatory elements is imperative for the accurate prediction of the patient’s response to biological drugs. Meta-analysis of such gene expression data could aid the challenging approach to unravel the complex interactions implicated in the response to anti-TNFα therapy in patients with PsO, IBD, and RA, as well as distinguish gene clusters and pathways that are altered through this heterogeneous phenotype.

Keywords: anti-TNFα, autoimmune, meta-analysis, microarrays

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92 Effects of Heart Rate Variability Biofeedback to Improve Autonomic Nerve Function, Inflammatory Response and Symptom Distress in Patients with Chronic Kidney Disease: A Randomized Control Trial

Authors: Chia-Pei Chen, Yu-Ju Chen, Yu-Juei Hsu

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The prevalence and incidence of end-stage renal disease in Taiwan ranks the highest in the world. According to the statistical survey of the Ministry of Health and Welfare in 2019, kidney disease is the ninth leading cause of death in Taiwan. It leads to autonomic dysfunction, inflammatory response and symptom distress, and further increases the damage to the structure and function of the kidneys, leading to increased demand for renal replacement therapy and risks of cardiovascular disease, which also has medical costs for the society. If we can intervene in a feasible manual to effectively regulate the autonomic nerve function of CKD patients, reduce the inflammatory response and symptom distress. To prolong the progression of the disease, it will be the main goal of caring for CKD patients. This study aims to test the effect of heart rate variability biofeedback (HRVBF) on improving autonomic nerve function (Heart Rate Variability, HRV), inflammatory response (Interleukin-6 [IL-6], C reaction protein [CRP] ), symptom distress (Piper fatigue scale, Pittsburgh Sleep Quality Index [PSQI], and Beck Depression Inventory-II [BDI-II] ) in patients with chronic kidney disease. This study was experimental research, with a convenience sampling. Participants were recruited from the nephrology clinic at a medical center in northern Taiwan. With signed informed consent, participants were randomly assigned to the HRVBF or control group by using the Excel BINOMDIST function. The HRVBF group received four weekly hospital-based HRVBF training, and 8 weeks of home-based self-practice was done with StressEraser. The control group received usual care. We followed all participants for 3 months, in which we repeatedly measured their autonomic nerve function (HRV), inflammatory response (IL-6, CRP), and symptom distress (Piper fatigue scale, PSQI, and BDI-II) on their first day of study participation (baselines), 1 month, and 3 months after the intervention to test the effects of HRVBF. The results were analyzed by SPSS version 23.0 statistical software. The data of demographics, HRV, IL-6, CRP, Piper fatigue scale, PSQI, and BDI-II were analyzed by descriptive statistics. To test for differences between and within groups in all outcome variables, it was used by paired sample t-test, independent sample t-test, Wilcoxon Signed-Rank test and Mann-Whitney U test. Results: Thirty-four patients with chronic kidney disease were enrolled, but three of them were lost to follow-up. The remaining 31 patients completed the study, including 15 in the HRVBF group and 16 in the control group. The characteristics of the two groups were not significantly different. The four-week hospital-based HRVBF training combined with eight-week home-based self-practice can effectively enhance the parasympathetic nerve performance for patients with chronic kidney disease, which may against the disease-related parasympathetic nerve inhibition. In the inflammatory response, IL-6 and CRP in the HRVBF group could not achieve significant improvement when compared with the control group. Self-reported fatigue and depression significantly decreased in the HRVBF group, but they still failed to achieve a significant difference between the two groups. HRVBF has no significant effect on improving the sleep quality for CKD patients.

Keywords: heart rate variability biofeedback, autonomic nerve function, inflammatory response, symptom distress, chronic kidney disease

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91 Living in the Edge: Crisis in Indian Tea Industry and Social Deprivation of Tea Garden Workers in Dooars Region of India

Authors: Saraswati Kerketta

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Tea industry is one of the oldest organised sector of India. It employs roughly 1.5 million people directly. Since the last decade Indian tea industry, especially in the northern region is experiencing worst crisis in the post-independence period. Due to many reason the prices of tea show steady decline. The workers are paid one of the lowest wage in tea industry in the world (1.5$ a day) below the UN's $2 a day for extreme poverty. The workers rely on addition benefits from plantation which includes food, housing and medical facilities. These have been effective means of enslavement of generations of labourers by the owners. There is hardly any change in the tea estates where the owners determine the fate of workers. When the tea garden is abandoned or is closed all the facilities disappear immediately. The workers are the descendants of tribes from central India also known as 'tea tribes'. Alienated from their native place, the geographical and social isolation compounded their vulnerability of these people. The economy of the region being totally dependent on tea has resulted in absolute unemployment for the workers of these tea gardens. With no other livelihood and no land to grow food, thousands of workers faced hunger and starvation. The Plantation Labour Act which ensures the decent working and living condition is violated continuously. The labours are forced to migrate and are also exposed to the risk of human trafficking. Those who are left behind suffers from starvation, malnutrition and disease. The condition in the sick tea plantation is no better. Wage are not paid regularly, subsidised food, fuel are also not supplied properly. Health care facilities are in very bad shape. Objectives: • To study the socio-cultural and demographic characteristics of the tea garden labourers in the study area. • To examine the social situation of workers in sick estates in dooars region. • To assess the magnitude of deprivation the impact of economic crisis on abandoned and closed tea estates in the region. Data Base: The study is based on data collected from field survey. Methods: Quantative: Cross-Tabulation, Regression analysis. Qualitative: Household Survey, Focussed Group Discussion, In-depth interview of key informants. Findings: Purchasing power parity has declined since in last three decades. There has been many fold increase in migration. Males migrates long distance towards central and west and south India. Females and children migrates both long and short distance. No one has reported to migrate back to the place of origin of their ancestors. Migrant males work mostly as construction labourers and as factory workers whereas females and children work as domestic help and construction labourers. In about 37 cases either they haven't contacted their families in last six months or are not traceable. The families with single earning members are more likely to migrate. Burden of disease and the duration of sickness, abandonment and closure of plantation are closely related. Death tolls are likely to rise 1.5 times in sick tea gardens and three times in closed tea estates. Sixty percent of the people are malnourished in the sick tea gardens and more than eighty five per cent in abandoned and sick tea gardens.

Keywords: migration, trafficking, starvation death, tea garden workers

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90 Design and Implementation of an Affordable Electronic Medical Records in a Rural Healthcare Setting: A Qualitative Intrinsic Phenomenon Case Study

Authors: Nitika Sharma, Yogesh Jain

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Introduction: An efficient Information System helps in improving the service delivery as well provides the foundation for policy and regulation of other building blocks of Health System. Health care organizations require an integrated working of its various sub-systems. An efficient EMR software boosts the teamwork amongst the various sub-systems thereby resulting in improved service delivery. Although there has been a huge impetus to EMR under the Digital India initiative, it has still not been mandated in India. It is generally implemented in huge funded public or private healthcare organizations only. Objective: The study was conducted to understand the factors that lead to the successful adoption of an affordable EMR in the low level healthcare organization. It intended to understand the design of the EMR and address the solutions to the challenges faced in adoption of the EMR. Methodology: The study was conducted in a non-profit registered Healthcare organization that has been providing healthcare facilities to more than 2500 villages including certain areas that are difficult to access. The data was collected with help of field notes, in-depth interviews and participant observation. A total of 16 participants using the EMR from different departments were enrolled via purposive sampling technique. The participants included in the study were working in the organization before the implementation of the EMR system. The study was conducted in one month period from 25 June-20 July 2018. The Ethical approval was taken from the institute along with prior approval of the participants. Data analysis: A word document of more than 4000 words was obtained after transcribing and translating the answers of respondents. It was further analyzed by focused coding, a line by line review of the transcripts, underlining words, phrases or sentences that might suggest themes to do thematic narrative analysis. Results: Based on the answers the results were thematically grouped under four headings: 1. governance of organization, 2. architecture and design of the software, 3. features of the software, 4. challenges faced in adoption and the solutions to address them. It was inferred that the successful implementation was attributed to the easy and comprehensive design of the system which has facilitated not only easy data storage and retrieval but contributes in constructing a decision support system for the staff. Portability has lead to increased acceptance by physicians. The proper division of labor, increased efficiency of staff, incorporation of auto-correction features and facilitation of task shifting has lead to increased acceptance amongst the users of various departments. Geographical inhibitions, low computer literacy and high patient load were the major challenges faced during its implementation. Despite of dual efforts made both by the architects and administrators to combat these challenges, there are still certain ongoing challenges faced by organization. Conclusion: Whenever any new technology is adopted there are certain innovators, early adopters, late adopters and laggards. The same pattern was followed in adoption of this software. He challenges were overcome with joint efforts of organization administrators and users as well. Thereby this case study provides a framework of implementing similar systems in public sector of countries that are struggling for digitizing the healthcare in presence of crunch of human and financial resources.

Keywords: EMR, healthcare technology, e-health, EHR

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89 Future Research on the Resilience of Tehran’s Urban Areas Against Pandemic Crises Horizon 2050

Authors: Farzaneh Sasanpour, Saeed Amini Varaki

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Resilience is an important goal for cities as urban areas face an increasing range of challenges in the 21st century; therefore, according to the characteristics of risks, adopting an approach that responds to sensitive conditions in the risk management process is the resilience of cities. In the meantime, most of the resilience assessments have dealt with natural hazards and less attention has been paid to pandemics.In the covid-19 pandemic, the country of Iran and especially the metropolis of Tehran, was not immune from the crisis caused by its effects and consequences and faced many challenges. One of the methods that can increase the resilience of Tehran's metropolis against possible crises in the future is future studies. This research is practical in terms of type. The general pattern of the research will be descriptive-analytical and from the point of view that it is trying to communicate between the components and provide urban resilience indicators with pandemic crises and explain the scenarios, its future studies method is exploratory. In order to extract and determine the key factors and driving forces effective on the resilience of Tehran's urban areas against pandemic crises (Covid-19), the method of structural analysis of mutual effects and Micmac software was used. Therefore, the primary factors and variables affecting the resilience of Tehran's urban areas were set in 5 main factors, including physical-infrastructural (transportation, spatial and physical organization, streets and roads, multi-purpose development) with 39 variables based on mutual effects analysis. Finally, key factors and variables in five main areas, including managerial-institutional with five variables; Technology (intelligence) with 3 variables; economic with 2 variables; socio-cultural with 3 variables; and physical infrastructure, were categorized with 7 variables. These factors and variables have been used as key factors and effective driving forces on the resilience of Tehran's urban areas against pandemic crises (Covid-19), in explaining and developing scenarios. In order to develop the scenarios for the resilience of Tehran's urban areas against pandemic crises (Covid-19), intuitive logic, scenario planning as one of the future research methods and the Global Business Network (GBN) model were used. Finally, four scenarios have been drawn and selected with a creative method using the metaphor of weather conditions, which is indicative of the general outline of the conditions of the metropolis of Tehran in that situation. Therefore, the scenarios of Tehran metropolis were obtained in the form of four scenarios: 1- solar scenario (optimal governance and management leading in smart technology) 2- cloud scenario (optimal governance and management following in intelligent technology) 3- dark scenario (optimal governance and management Unfavorable leader in intelligence technology) 4- Storm scenario (unfavorable governance and management of follower in intelligence technology). The solar scenario shows the best situation and the stormy scenario shows the worst situation for the Tehran metropolis. According to the findings obtained in this research, city managers can, in order to achieve a better tomorrow for the metropolis of Tehran, in all the factors and components of urban resilience against pandemic crises by using future research methods, a coherent picture with the long-term horizon of 2050, from the path Provide urban resilience movement and platforms for upgrading and increasing the capacity to deal with the crisis. To create the necessary platforms for the realization, development and evolution of the urban areas of Tehran in a way that guarantees long-term balance and stability in all dimensions and levels.

Keywords: future research, resilience, crisis, pandemic, covid-19, Tehran

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88 Hybrid GNN Based Machine Learning Forecasting Model For Industrial IoT Applications

Authors: Atish Bagchi, Siva Chandrasekaran

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Background: According to World Bank national accounts data, the estimated global manufacturing value-added output in 2020 was 13.74 trillion USD. These manufacturing processes are monitored, modelled, and controlled by advanced, real-time, computer-based systems, e.g., Industrial IoT, PLC, SCADA, etc. These systems measure and manipulate a set of physical variables, e.g., temperature, pressure, etc. Despite the use of IoT, SCADA etc., in manufacturing, studies suggest that unplanned downtime leads to economic losses of approximately 864 billion USD each year. Therefore, real-time, accurate detection, classification and prediction of machine behaviour are needed to minimise financial losses. Although vast literature exists on time-series data processing using machine learning, the challenges faced by the industries that lead to unplanned downtimes are: The current algorithms do not efficiently handle the high-volume streaming data from industrial IoTsensors and were tested on static and simulated datasets. While the existing algorithms can detect significant 'point' outliers, most do not handle contextual outliers (e.g., values within normal range but happening at an unexpected time of day) or subtle changes in machine behaviour. Machines are revamped periodically as part of planned maintenance programmes, which change the assumptions on which original AI models were created and trained. Aim: This research study aims to deliver a Graph Neural Network(GNN)based hybrid forecasting model that interfaces with the real-time machine control systemand can detect, predict machine behaviour and behavioural changes (anomalies) in real-time. This research will help manufacturing industries and utilities, e.g., water, electricity etc., reduce unplanned downtimes and consequential financial losses. Method: The data stored within a process control system, e.g., Industrial-IoT, Data Historian, is generally sampled during data acquisition from the sensor (source) and whenpersistingin the Data Historian to optimise storage and query performance. The sampling may inadvertently discard values that might contain subtle aspects of behavioural changes in machines. This research proposed a hybrid forecasting and classification model which combines the expressive and extrapolation capability of GNN enhanced with the estimates of entropy and spectral changes in the sampled data and additional temporal contexts to reconstruct the likely temporal trajectory of machine behavioural changes. The proposed real-time model belongs to the Deep Learning category of machine learning and interfaces with the sensors directly or through 'Process Data Historian', SCADA etc., to perform forecasting and classification tasks. Results: The model was interfaced with a Data Historianholding time-series data from 4flow sensors within a water treatment plantfor45 days. The recorded sampling interval for a sensor varied from 10 sec to 30 min. Approximately 65% of the available data was used for training the model, 20% for validation, and the rest for testing. The model identified the anomalies within the water treatment plant and predicted the plant's performance. These results were compared with the data reported by the plant SCADA-Historian system and the official data reported by the plant authorities. The model's accuracy was much higher (20%) than that reported by the SCADA-Historian system and matched the validated results declared by the plant auditors. Conclusions: The research demonstrates that a hybrid GNN based approach enhanced with entropy calculation and spectral information can effectively detect and predict a machine's behavioural changes. The model can interface with a plant's 'process control system' in real-time to perform forecasting and classification tasks to aid the asset management engineers to operate their machines more efficiently and reduce unplanned downtimes. A series of trialsare planned for this model in the future in other manufacturing industries.

Keywords: GNN, Entropy, anomaly detection, industrial time-series, AI, IoT, Industry 4.0, Machine Learning

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87 Workflow Based Inspection of Geometrical Adaptability from 3D CAD Models Considering Production Requirements

Authors: Tobias Huwer, Thomas Bobek, Gunter Spöcker

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Driving forces for enhancements in production are trends like digitalization and individualized production. Currently, such developments are restricted to assembly parts. Thus, complex freeform surfaces are not addressed in this context. The need for efficient use of resources and near-net-shape production will require individualized production of complex shaped workpieces. Due to variations between nominal model and actual geometry, this can lead to changes in operations in Computer-aided process planning (CAPP) to make CAPP manageable for an adaptive serial production. In this context, 3D CAD data can be a key to realizing that objective. Along with developments in the geometrical adaptation, a preceding inspection method based on CAD data is required to support the process planner by finding objective criteria to make decisions about the adaptive manufacturability of workpieces. Nowadays, this kind of decisions is depending on the experience-based knowledge of humans (e.g. process planners) and results in subjective decisions – leading to a variability of workpiece quality and potential failure in production. In this paper, we present an automatic part inspection method, based on design and measurement data, which evaluates actual geometries of single workpiece preforms. The aim is to automatically determine the suitability of the current shape for further machining, and to provide a basis for an objective decision about subsequent adaptive manufacturability. The proposed method is realized by a workflow-based approach, keeping in mind the requirements of industrial applications. Workflows are a well-known design method of standardized processes. Especially in applications like aerospace industry standardization and certification of processes are an important aspect. Function blocks, providing a standardized, event-driven abstraction to algorithms and data exchange, will be used for modeling and execution of inspection workflows. Each analysis step of the inspection, such as positioning of measurement data or checking of geometrical criteria, will be carried out by function blocks. One advantage of this approach is its flexibility to design workflows and to adapt algorithms specific to the application domain. In general, within the specified tolerance range it will be checked if a geometrical adaption is possible. The development of particular function blocks is predicated on workpiece specific information e.g. design data. Furthermore, for different product lifecycle phases, appropriate logics and decision criteria have to be considered. For example, tolerances for geometric deviations are different in type and size for new-part production compared to repair processes. In addition to function blocks, appropriate referencing systems are important. They need to support exact determination of position and orientation of the actual geometries to provide a basis for precise analysis. The presented approach provides an inspection methodology for adaptive and part-individual process chains. The analysis of each workpiece results in an inspection protocol and an objective decision about further manufacturability. A representative application domain is the product lifecycle of turbine blades containing a new-part production and a maintenance process. In both cases, a geometrical adaptation is required to calculate individual production data. In contrast to existing approaches, the proposed initial inspection method provides information to decide between different potential adaptive machining processes.

Keywords: adaptive, CAx, function blocks, turbomachinery

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86 Methodology for Temporary Analysis of Production and Logistic Systems on the Basis of Distance Data

Authors: M. Mueller, M. Kuehn, M. Voelker

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In small and medium-sized enterprises (SMEs), the challenge is to create a well-grounded and reliable basis for process analysis, optimization and planning due to a lack of data. SMEs have limited access to methods with which they can effectively and efficiently analyse processes and identify cause-and-effect relationships in order to generate the necessary database and derive optimization potential from it. The implementation of digitalization within the framework of Industry 4.0 thus becomes a particular necessity for SMEs. For these reasons, the abstract presents an analysis methodology that is subject to the objective of developing an SME-appropriate methodology for efficient, temporarily feasible data collection and evaluation in flexible production and logistics systems as a basis for process analysis and optimization. The overall methodology focuses on retrospective, event-based tracing and analysis of material flow objects. The technological basis consists of Bluetooth low energy (BLE)-based transmitters, so-called beacons, and smart mobile devices (SMD), e.g. smartphones as receivers, between which distance data can be measured and derived motion profiles. The distance is determined using the Received Signal Strength Indicator (RSSI), which is a measure of signal field strength between transmitter and receiver. The focus is the development of a software-based methodology for interpretation of relative movements of transmitters and receivers based on distance data. The main research is on selection and implementation of pattern recognition methods for automatic process recognition as well as methods for the visualization of relative distance data. Due to an existing categorization of the database regarding process types, classification methods (e.g. Support Vector Machine) from the field of supervised learning are used. The necessary data quality requires selection of suitable methods as well as filters for smoothing occurring signal variations of the RSSI, the integration of methods for determination of correction factors depending on possible signal interference sources (columns, pallets) as well as the configuration of the used technology. The parameter settings on which respective algorithms are based have a further significant influence on result quality of the classification methods, correction models and methods for visualizing the position profiles used. The accuracy of classification algorithms can be improved up to 30% by selected parameter variation; this has already been proven in studies. Similar potentials can be observed with parameter variation of methods and filters for signal smoothing. Thus, there is increased interest in obtaining detailed results on the influence of parameter and factor combinations on data quality in this area. The overall methodology is realized with a modular software architecture consisting of independently modules for data acquisition, data preparation and data storage. The demonstrator for initialization and data acquisition is available as mobile Java-based application. The data preparation, including methods for signal smoothing, are Python-based with the possibility to vary parameter settings and to store them in the database (SQLite). The evaluation is divided into two separate software modules with database connection: the achievement of an automated assignment of defined process classes to distance data using selected classification algorithms and the visualization as well as reporting in terms of a graphical user interface (GUI).

Keywords: event-based tracing, machine learning, process classification, parameter settings, RSSI, signal smoothing

Procedia PDF Downloads 105