Search results for: local cluster detection

Authors: Rajkumar Ghosh

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Fluoride contamination in water and its subsequent impact on agricultural practices is a growing concern in various regions worldwide, including North 24 Parganas, West Bengal, India. This study aimed to investigate the extent of fluoride contamination in the region's water sources and evaluate its effects on crop production and quality. A comprehensive survey of water sources, including wells, ponds, and rivers, was conducted to assess the fluoride levels in North 24 Parganas. Water samples were collected and analyzed using standard methods, and the fluoride concentration was determined. The findings revealed significant fluoride contamination in the water sources, surpassing the permissible limits recommended by national and international standards. To assess the effects of fluoride contamination on crops, field experiments were carried out in selected agricultural areas. Various crops commonly cultivated in the region, such as paddy, wheat, vegetables, and fruits, were examined for their growth, yield, and nutritional quality parameters. Additionally, soil samples were collected from the study sites to analyse the fluoride levels and their potential impact on soil health. The results demonstrated the adverse effects of fluoride contamination on crop growth and yield. Reduced plant height, stunted root development, decreased biomass accumulation, and diminished crop productivity were observed in fluoride-affected areas compared to uncontaminated control sites. Furthermore, the nutritional composition of crops, including micronutrients and mineral content, was significantly altered under high fluoride exposure, leading to potential health risks for consumers. The study also assessed the impact of fluoride on soil quality and found a negative correlation between fluoride concentration and soil health indicators, such as pH, organic matter content, and nutrient availability. These findings emphasize the need for sustainable soil management practices to mitigate the harmful effects of fluoride contamination and maintain agricultural productivity. Overall, this study highlights the alarming issue of fluoride contamination in water sources and its detrimental effects on crop production and quality in North 24 Parganas, West Bengal, India. The findings underscore the urgency for implementing appropriate water treatment measures, promoting awareness among farmers and local communities, and adopting sustainable agricultural practices to mitigate fluoride contamination and safeguard the region's agricultural ecosystem.

Keywords: agricultural ecosystem, water treatment, sustainable agricultural, fluoride contamination

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Authors: Sumeyra Yakar

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The idea of this research had its genesis from the writer's interest in Shi'i school and religio-political atmosphere in contemporary Iran. The research aims to identify how the past dynamics between political and legal figures and their relationship between each other affect contemporary relationship between political and religious authorities at the local and global level. It attempts to explore religio-politic Shi'i figures and their relationship with the official jurisprudence from the 15th century to the contemporary period. The mutual interaction between the opinion and acts of political figures and jurisprudential institutions enlightens the role of religious values to control the mass population. After the collapse of the Safawīd Dynasty, Shi'i believers lost their political guardian and legal independence, and the situation gave them the inspiration to create unique ideologies or political approaches to solve the governance crisis. The analysis of authoritative political figures and their scholastic contributions elucidate the connection between political powers and religious doctrines under the protection of sectarian oriented theocratic governments. Additionally, understanding the incremental influence of political (historical) Shi'i figures into religious doctrines shed lights on the chronological development of peculiar government style and authoritative hierarchy in contemporary Shi’i communities. The research as being interdisciplinary one offers to create an academic awareness between legal and political factors in Shi’i school of thought and encompasses political, religious, social, financial and cultural atmospheres of the countries in which the political figures lived. The Iranian regime enshrines the principle of vilāyāt-i faqīh (guardianship of the jurist) which enables jurists to solve the conflict between law as an ideal system, in theory, and law in practice. The paper aims to show how the religious, educational system works in harmony with the governmental authorities with the concept of vilāyāt-i faqīh in Iran and contributes to the creation of religious custom in the society. Contemporary relationship between the political figures and religious authorities in Iran will be explained by religio-legal dimensions. The methodology that will be applied by the study has been chosen in order to acquire information and deduce conclusions from the opinions of the scholars. Thus, the research method is mainly descriptive and qualitative. Three lines of description are pursued throughout the study; the explanation of political ideas belonging to the religio-political figures theoretically depending on written texts; the description of approaches adopted by contemporary Iranian and Saudi scholars relating to the legal systems (theoretically); and the explanation of the responses of governmental authorities.

Keywords: clergy (‘ulamā), guardianship of the jurist (vilāyāt-i faqīh), Iran, Shi’i figures

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Authors: Ahmed Elsayed, Andrew Shea, Nicolas Kelly, John Allison

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In northern European climates, domestic space heating and hot water represents a significant proportion of total primary total primary energy use and meeting these demands from a national electricity grid network supplied by renewable energy sources provides an opportunity for a significant reduction in EU CO₂ emissions. However, in order to adapt to the intermittent nature of renewable energy generation and to avoid co-incident peak electricity usage from consumers that may exceed current capacity, the demand for heat must be decoupled from its generation. Storage of heat within the fabric of dwellings for use some hours, or days, later provides a route to complete decoupling of demand from supply and facilitates the greatly increased use of renewable energy generation into a local or national electricity network. The integration of thermal energy storage into the building fabric for retrieval at a later time requires much evaluation of the many competing thermal, physical, and practical considerations such as the profile and magnitude of heat demand, the duration of storage, charging and discharging rate, storage media, space allocation, etc. In this paper, the authors report investigations of thermal storage in building fabric using concrete material and present an evaluation of several factors that impact upon performance including heating pipe layout, heating fluid flow velocity, storage geometry, thermo-physical material properties, and also present an investigation of alternative storage materials and alternative heat transfer fluids. Reducing the heating pipe spacing from 200 mm to 100 mm enhances the stored energy by 25% and high-performance Vacuum Insulation results in heat loss flux of less than 3 W/m², compared to 22 W/m² for the more conventional EPS insulation. Dense concrete achieved the greatest storage capacity, relative to medium and light-weight alternatives, although a material thickness of 100 mm required more than 5 hours to charge fully. Layers of 25 mm and 50 mm thickness can be charged in 2 hours, or less, facilitating a fast response that could, aggregated across multiple dwellings, provide significant and valuable reduction in demand from grid-generated electricity in expected periods of high demand and potentially eliminate the need for additional new generating capacity from conventional sources such as gas, coal, or nuclear.

Keywords: fabric integrated thermal storage, FITS, demand side management, energy storage, load shifting, renewable energy integration

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Authors: Andrew Green, Jiaming Liu, Kellathur Srinivasan, Raymond Chua

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Introduction: The size of Singapore’s online health product (HP) market (e-commerce) is largely unknown. However, it is recognized that a large majority comes from overseas and thus, unregulated. As buying HP from unauthorized sources significantly compromises public health safety, understanding e-commerce users’ demographics and their perceptions on online HP purchasing becomes a pivotal first step to form a basis for recommendations in Singapore’s pharmacovigilance efforts. Objective: To assess the prevalence of online HP purchasing behaviour among Singaporean e-commerce users. Methodology: This is a cross-sectional study targeting Singaporean e-commerce users recruited from various local websites and online forums. Participants were not randomized into study arms but instead stratified by random sampling method based on participants’ age. A self-administered anonymous questionnaire was used to explore participants' demographics, online HP purchasing behaviour, knowledge and attitude. The association of different variables with online HP purchasing behaviour was analysed using logistic regression statistics. Main outcome measures: Prevalence of HP e-commerce users in Singapore (%) and variables that contribute to the prevalence (adjusted prevalent ratio). Results: The study recruited 372 complete and valid responses. The prevalence of online HP consumers among e-commerce users in Singapore is estimated to be 55.9% (1.7 million consumers). Online purchasing of complementary HP (46.9%) was the most prevalent, followed by medical devices (21.6%) and Western medicine (20.5%). Multivariate analysis showed that age is an independent variable that correlates with the likelihood of buying HP online. The prevalence of HP e-commerce users is highest in the 35-44 age group (64.1%) and lowest among the 16-24 age group (36.4%). The most bought HP through the internet are vitamins and minerals (21.5%), non-herbal (15.9%), herbal (13.9%), weight loss (8.7%) and sports (8.4%) supplements. While the top 3 products are distributed equally between the genders, there is a skew towards female respondents (12.4% in females vs. 4.9% in males) for weight loss supplements and towards males (13.2% in males vs. 3.7% in females) for sports supplements. Even though online consumers are in the younger age brackets, our study found that up to 72.0% of HP bought online are bought for others (buyer’s family and/or friends). Multivariate analysis showed a statistically significant association between purchasing HP through online means and the perceptions that 'internet is safe' (adjusted Prevalence Ratio=1.15, CI 1.03-1.28), 'buying HP online is time saving' (PR=1.17, CI 1.01-1.36), and 'recognition of HP brand' (PR=1.21 CI 1.06-1.40). Conclusions: This study has provided prevalence data for online HP market in Singapore, and has allowed the country’s regulatory body to formulate a targeted pharmacovigilance approach to this growing problem.

Keywords: e-commerce, pharmaceuticals, pharmacovigilance, Singapore

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Authors: Sara Saboonian, Pierre Filion

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There are two distinct planning approaches attempting to transform the North American suburb so as to reduce its adverse environmental impacts. The first one, the recentralization approach, proposes intensification, multi-functionality and more reliance on public transit and walking. It thus offers an alternative to the prevailing low-density, spatial specialization and automobile dependence of the North American suburb. The second approach concentrates instead on the provision of green infrastructure, which rely on natural systems rather than on highly engineered solutions to deal with the infrastructure needs of suburban areas. There are tensions between these two approaches as recentralization generally overlooks green infrastructure, which can be space consuming (as in the case of water retention systems), and thus conflicts with the intensification goals of recentralization. The research investigates three Canadian planned suburban centres in the Greater Toronto Area, where recentralization is the current planning practice, despite rising awareness of the benefits of green infrastructure. Methods include reviewing the literature on green infrastructure planning, a critical analysis of the Ontario provincial plans for recentralization, surveying residents’ preferences regarding alternative suburban development models, and interviewing officials who deal with the local planning of the three centres. The case studies expose the difficulties in creating planned suburban centres that accommodate green infrastructure while adhering to recentralization principles. Until now, planners have been mostly focussed on recentralization at the expense of green infrastructure. In this context, the frequent lack of compatibility between recentralization and the space requirements of green infrastructure explains the limited presence of such infrastructures in planned suburban centres. Finally, while much attention has been given in the planning discourse to the economic and lifestyle benefits of recentralization, much less has been made of the wide range of advantages of green infrastructure, which explains limited public mobilization over the development of green infrastructure networks. The paper will concentrate on ways of combining recentralization with green infrastructure strategies and identify the aspects of the two approaches that are most compatible with each other. The outcome of such blending will marry high density, public-transit oriented developments, which generate walkability and street-level animation, with the presence of green space, naturalized settings and reliance on renewable energy. The paper will advance a planning framework that will fuse green infrastructure with recentralization, thus ensuring the achievement of higher density and reduced reliance on the car along with the provision of critical ecosystem services throughout cities. This will support and enhance the objectives of both green infrastructure and recentralization.

Keywords: environmental-based planning, green infrastructure, multi-functionality, recentralization

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Authors: Adam Aboalkaz, Rana Shamoon, Duncan Meikle, James Lewis

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Background and aims: In orthopaedic theatres, radiological screening during operations is a commonly used and useful technique to visualise and guide the operating surgeon. Within any theatre using ionising radiation, it is imperative that the use of protective equipment and the wearing of a dosimeter at all times. 1. To assess compliance with use of protective equipment during orthopaedic procedures involving ionising radiation. 2. To assess the radiation risk knowledge of staff members regularly present in an orthopaedic theatre of a national major trauma centre, in accordance to the ionising radiation regulation (2000) guidelines. Method: We conducted an Observational study of 21 operations at the University Hospital of Wales, which is a major trauma centre, recording the compliance with use of protective equipment (lead aprons and thyroid shields) and dosimeters. The observations were performed sporadically over a two week period to ensure that all staff in monitored operating theatres were not aware of the ongoing study, as to avoid bias. A questionnaire testing the knowledge of trainees and staff within the orthopaedic department was given following completion of the initial phase of the study, with 19 responses. The questions were based on knowledge of ionising radiation exposure and monitoring. The questions also tested the general staff knowledge of what equipment should be worn and where to locate such equipment. Results: This study found that only 25% of staff members were wearing thyroid protectors when less than 1 meter from the radiation source and only 50% were wearing appropriate lead aprons whilst in this same vicinity. The study also showed that 0% of all staff members used a dosimeter whilst in an area of radiation exposure. From the distributed questionnaires, only 40% of staff understood where to stand whilst radiation was being used, and only 25% of staff knew where to find protective equipment. Conclusion: Overall our audit showed poor compliance with regards to the National and local policies, due to lack of awareness of the policy and lack of basic ionising radiation exposure knowledge. It was evident from the observational study and questionnaire that staff were not fully aware of what equipment should be worn, where to find such equipment and did not appreciate that the distance from the ionising radiation source altered its exposure effect. This lack of knowledge may affect the staff health and safety after long term exposure. Changes to clinical practice: From the outcome of this study, we managed to drastically increase awareness of ionising radiation within the orthopaedic department. A mandatory teaching session on the safety of ionising radiation has been incorporated into the orthopaedic induction week for all staff. The dosimeters have been moved to a visible location within the trauma operating theatre and all staff made aware of where to find protective equipment.

Keywords: audit, ionising radiation, observational study, protection

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Authors: Jinlu Ruan, Liang Chen, Bo Liu, Xiaoping Ouyang, Zhichao Zhu, Zhongbing Zhang, Shiyi He, Mengxuan Xu

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Plastic scintillators play an important role in the measurement of a mixed neutron/gamma pulsed radiation, neutron radiography and pulse shape discrimination technology. In some research, these luminescent properties are necessary that photons produced by the interactions between a plastic scintillator and radiations can be detected as much as possible by the photoelectric detectors and more photons can be emitted from the scintillators along a specific direction where detectors are located. Unfortunately, a majority of these photons produced are trapped in the plastic scintillators due to the total internal reflection (TIR), because there is a significant light-trapping effect when the incident angle of internal scintillation light is larger than the critical angle. Some of these photons trapped in the scintillator may be absorbed by the scintillator itself and the others are emitted from the edges of the scintillator. This makes the light extraction of plastic scintillators very low. Moreover, only a small portion of the photons emitted from the scintillator easily can be detected by detectors effectively, because the distribution of the emission directions of this portion of photons exhibits approximate Lambertian angular profile following a cosine emission law. Therefore, enhancing the light extraction efficiency and adjusting the emission angular profile become the keys for improving the number of photons detected by the detectors. In recent years, photonic crystal structures have been covered on inorganic scintillators to enhance the light extraction efficiency and adjust the angular profile of scintillation light successfully. However, that, preparation methods of photonic crystals will deteriorate performance of plastic scintillators and even destroy the plastic scintillators, makes the investigation on preparation methods of photonic crystals for plastic scintillators and luminescent properties of plastic scintillators with photonic crystal structures inadequate. Although we have successfully made photonic crystal structures covered on the surface of plastic scintillators by a modified self-assembly technique and achieved a great enhance of light extraction efficiency without evident angular-dependence for the angular profile of scintillation light, the preparation of photonic crystal structures with large area (the diameter is larger than 6cm) and perfect periodic structure is still difficult. In this paper, large area photonic crystals on the surface of scintillators were prepared by nanoimprint lithography firstly, and then a conformal layer with material of high refractive index on the surface of photonic crystal by atomic layer deposition technique in order to enhance the stability of photonic crystal structures and increase the number of leaky modes for improving the light extraction efficiency. The luminescent properties of the plastic scintillator with photonic crystals prepared by the mentioned method are compared with those of the plastic scintillator without photonic crystal. The results indicate that the number of photons detected by detectors is increased by the enhanced light extraction efficiency and the angular profile of scintillation light exhibits evident angular-dependence for the scintillator with photonic crystals. The mentioned preparation of photonic crystals is beneficial to scintillation detection applications and lays an important technique foundation for the plastic scintillators to meet special requirements under different application backgrounds.

Keywords: angular profile, atomic layer deposition, light extraction efficiency, plastic scintillator, photonic crystal

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Authors: Begum Koru, Isik Aybay, Demet Celik Ulusoy

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The discipline of law is quite complex and has its own terminology. Apart from written legal rules, there is also living law, which refers to legal practice. Basic legal rules aim at the happiness of individuals in social life and have different characteristics in different branches such as public or private law. On the other hand, law is a national phenomenon. The law of one nation and the legal system applied on the territory of another nation may be completely different. People who are experts in a particular field of law in one country may have insufficient expertise in the law of another country. Today, in addition to the local nature of law, international and even supranational law rules are applied in order to protect basic human values and ensure the protection of human rights around the world. Systems that offer algorithmic solutions to legal problems using artificial intelligence (AI) tools will perhaps serve to produce very meaningful results in terms of human rights. However, algorithms to be used should not be developed by only computer experts, but also need the contribution of people who are familiar with law, values, judicial decisions, and even the social and political culture of the society to which it will provide solutions. Otherwise, even if the algorithm works perfectly, it may not be compatible with the values of the society in which it is applied. The latest developments involving the use of AI techniques in legal systems indicate that artificial law will emerge as a new field in the discipline of law. More AI systems are already being applied in the field of law, with examples such as predicting judicial decisions, text summarization, decision support systems, and classification of documents. Algorithms for legal systems employing AI tools, especially in the field of prediction of judicial decisions and decision support systems, have the capacity to create automatic decisions instead of judges. When the judge is removed from this equation, artificial intelligence-made law created by an intelligent algorithm on its own emerges, whether the domain is national or international law. In this work, the aim is to make a general analysis of this new topic. Such an analysis needs both a literature survey and a perspective from computer experts' and lawyers' point of view. In some societies, the use of prediction or decision support systems may be useful to integrate international human rights safeguards. In this case, artificial law can serve to produce more comprehensive and human rights-protective results than written or living law. In non-democratic countries, it may even be thought that direct decisions and artificial intelligence-made law would be more protective instead of a decision "support" system. Since the values of law are directed towards "human happiness or well-being", it requires that the AI algorithms should always be capable of serving this purpose and based on the rule of law, the principle of justice and equality, and the protection of human rights.

Keywords: AI and law, artificial law, protection of human rights, AI tools for legal systems

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Authors: Samar Mousa, Ryan Kerstein, Mohanad Adam

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Regional anaesthesia has been associated with favourable outcomes in patients undergoing a wide range of surgeries. Beneficial effects have been demonstrated in terms of postoperative respiratory and cardiovascular endpoints, 7-day survival, time to ambulation and hospital discharge, and postoperative analgesia. Our project aimed at assessing the regional anaesthesia practice in the plastic surgery department of Buckinghamshire trust and finding out ways to improve the service in collaboration with the anaesthesia team. It is a retrospective study associated with a questionnaire filled out by plastic surgeons and anaesthetists to get the full picture behind the numbers. The study period was between 1/3/2022 and 23/5/2022 (12 weeks). The operative notes of all patients who had an operation under plastic surgery, whether emergency or elective, were reviewed. The criteria of suitable candidates for the regional block were put by the consultant anaesthetists as follows: age above 16, single surgical site (arm, forearm, leg, foot), no drug allergy, no pre-existing neuropathy, no bleeding disorders, not on ant-coagulation, no infection to the site of the block. For 12 weeks, 1061 operations were performed by plastic surgeons. Local cases were excluded leaving 319 cases. Of the 319, 102 patients were suitable candidates for regional block after applying the previously mentioned criteria. However, only seven patients had their operations under the regional block, and the rest had general anaesthesia that could have been easily avoided. An online questionnaire was filled out by both plastic surgeons and anaesthetists of different training levels to find out the reasons behind the obvious preference for general over regional anaesthesia, even if this was against the patients’ interest. The questionnaire included the following points: training level, time taken to give GA or RA, factors that influence the decision, percentage of RA candidates that had GA, reasons behind this percentage, recommendations. Forty-four clinicians filled out the questionnaire, among which were 23 plastic surgeons and 21 anaesthetists. As regards the training level, there were 21 consultants, 4 associate specialists, 9 registrars, and 10 senior house officers. The actual percentage of patients who were good candidates for RA but had GA instead is 93%. The replies estimated this percentage as between 10-30%. 29% of the respondents thought that this percentage is because of surgeons’ preference to have GA rather than RA for their operations without medical support for the decision. 37% of the replies thought that anaesthetists prefer giving GA even if the patient is a suitable candidate for RA. 22.6% of the replies thought that patients refused to have RA, and 11.3% had other causes. The recommendations were in 5 main accesses, which are protocols and pathways for regional blocks, more training opportunities for anaesthetists on regional blocks, providing a separate block room in the hospital, better communication between surgeons and anaesthetists, patient education about the benefits of regional blocks.

Keywords: regional anaesthesia, regional block, plastic surgery, general anaesthesia

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Authors: S. A. Krutovertsev, A. E. Tarasova, L. S. Krutovertseva, O. M. Ivanova

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The aim of the work was to get stable sensitive films with good sensitivity to ethanolamine (C2H7NO) in air. Ethanolamine is used as adsorbent in different processes of gas purification and separation. Besides it has wide industrial application. Chemical sensors of sorption type are widely used for gas analysis. Their behavior is determined by sensor characteristics of sensitive sorption layer. Forming conditions and characteristics of chemical gas sensors based on nanostructured modified silica films activated by different admixtures have been studied. As additives molybdenum containing polyoxometalates of the eighteen series were incorporated in silica films. The method of hydrolythic polycondensation from tetraethyl orthosilicate solutions was used for forming such films in this work. The method’s advantage is a possibility to introduce active additives directly into an initial solution. This method enables to obtain sensitive thin films with high specific surface at room temperature. Particular properties make polyoxometalates attractive as active additives for forming of gas-sensitive films. As catalyst of different redox processes, they can either accelerate the reaction of the matrix with analyzed gas or interact with it, and it results in changes of matrix’s electrical properties Polyoxometalates based films were deposited on the test structures manufactured by microelectronic planar technology with interdigitated electrodes. Modified silica films were deposited by a casting method from solutions based on tetraethyl orthosilicate and polyoxometalates. Polyoxometalates were directly incorporated into initial solutions. Composite nanostructured films were deposited by drop casting method on test structures with a pair of interdigital metal electrodes formed at their surface. The sensor’s active area was 4.0 x 4.0 mm, and electrode gap was egual 0.08 mm. Morphology of the layers surface were studied with Solver-P47 scanning probe microscope (NT-MDT, Russia), the infrared spectra were investigated by a Bruker EQUINOX 55 (Germany). The conditions of film formation varied during the tests. Electrical parameters of the sensors were measured electronically in real-time mode. Films had highly developed surface with value of 450 m2/g and nanoscale pores. Thickness of them was 0,2-0,3 µm. The study shows that the conditions of the environment affect markedly the sensors characteristics, which can be improved by choosing of the right procedure of forming and processing. Addition of polyoxometalate into silica film resulted in stabilization of film mass and changed markedly of electrophysical characteristics. Availability of Mn3P2Mo18O62 into silica film resulted in good sensitivity and selectivity to ethanolamine. Sensitivity maximum was observed at weight content of doping additive in range of 30–50% in matrix. With ethanolamine concentration changing from 0 to 100 ppm films’ conductivity increased by 10-12 times. The increase of sensor’s sensitivity was received owing to complexing reaction of tested substance with cationic part of polyoxometalate. This fact results in intramolecular redox reaction which sharply change electrophysical properties of polyoxometalate. This process is reversible and takes place at room temperature.

Keywords: ethanolamine, gas analysis, polyoxometalate, silica film

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Authors: Arun Perumbilavil Anand

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For the past few years, the state of Kerala has been witnessing a large inflow of migrant workers from other states of the country, which emerged as a result of demographic transition and Gulf emigration. The in-migration patterns in Kerala have changed over the time with the migrants having a higher residence history bringing their families to the state, thereby making the process more complicated and divergent in its approach. These developments have led to an increase in the young migrant population at least in some parts of the state, which has opened up doubts and questions related to their future in the host society. At this juncture, the study ponders into the factors that are associated with the assimilation and wellbeing of migrant children in the society of Kerala. As one of the objectives, the study also analyzed the influence and role played by the educational institutions (both public and private) in meeting the needs and aspirations of both the children and their parents. The study gains significance as it tries to identify various impediments that hinder the cognitive skill formation and behaviour patterns of the migrant children in the host society. Data and Methodology: The study is based on the primary data collected through a series of interviews and interactions held with parents, children, and teachers of different educational institutions, including both public and private. The primary survey also made use of research techniques like observation, in-depth interviews, and case study method. The study was conducted in schools in the Kanjikode area of the Palakkad district in Kerala. The findings of the study are on the basis of a survey conducted in four schools and 40 migrant children. Findings: The study found that majority of the children have wholly integrated and assimilated into the host society. The influence of the peer group was quite visible in giving stimulus to the assimilation process. Most of the children do not have any emotional or cultural sentiments attached to their state of origin, and they consider Kerala as their ‘home state’ and the local language (Malayalam) as their ‘mother tongue'. The study could also find that the existing education system in the host society fails to meet the needs and aspirations of migrants as well as that of their children. On a comparative scale, to some extent, private schools have succeeded in fulfiling the special requirements of the migrant children. An interesting point that the study could pinpoint at is that the children of the migrants show better health conditions and wellbeing than compared to the natives, which is usually addressed as an epidemiologic paradox. As a concluding remark, the study recommends the inclusion concept of inclusive education into the education system of the state with giving due emphasis on those who are at higher risk of being excluded or marginalized, along with fostering increased interaction between diverse groups.

Keywords: assimilation, Kerala, migrant children, well-being

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Authors: Hyoshin Kim

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Most post-secondary educational institutions have offered a wide variety of professional development programs and resources in order to advance the quality of education. Such programs are designed to support faculty members by focusing on topics such as course design, behavioral learning objectives, class discussion, and evaluation methods. These are based on good intentions and might help both new and experienced educators. However, the fundamental flaw is that these ‘effective methods’ are assumed to work regardless of what we teach and whom we teach. This paper is focused on intercultural intelligence and its application to education. It presents a comprehensive literature review on context and cultural diversity in terms of beliefs, values and worldviews. What has worked well with a group of homogeneous local students may not work well with more diverse and international students. It is because students hold different notions of what is means to learn or know something. It is necessary for educators to move away from certain sets of generic teaching skills, which are based on a limited, particular view of teaching and learning. The main objective of the research is to expand our teaching strategies by incorporating what students bring to the course. There have been a growing number of resources and texts on teaching international students. Unfortunately, they tend to be based on the deficiency model, which treats diversity not as strengths, but as problems to be solved. This view is evidenced by the heavy emphasis on assimilationist approaches. For example, cultural difference is negatively evaluated, either implicitly or explicitly. Therefore the pressure is on culturally diverse students. The following questions reflect the underlying assumption of deficiencies: - How can we make them learn better? - How can we bring them into the mainstream academic culture?; and - How can they adapt to Western educational systems? Even though these questions may be well-intended, there seems to be something fundamentally wrong as the assumption of cultural superiority is embedded in this kind of thinking. This paper examines how educators can incorporate intercultural intelligence into the course design by utilizing a variety of tools such as pre-course activities, peer learning and reflective learning journals. The main goal is to explore ways to engage diverse learners in all aspects of learning. This can be achieved by activities designed to understand their prior knowledge, life experiences, and relevant cultural identities. It is crucial to link course material to students’ diverse interests thereby enhancing the relevance of course content and making learning more inclusive. Internationalization of higher education can be successful only when cultural differences are respected and celebrated as essential and positive aspects of teaching and learning.

Keywords: intercultural competence, intercultural intelligence, teaching and learning, post-secondary education

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Authors: P. T. Collett, M. Kershaw

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Introduction: The discussion regarding which method of anesthesia provides better results for lower limb arthroplasty is a continuing debate. Multiple meta-analysis has been performed with no clear consensus. The current recommendation is to use neuraxial anesthesia for lower limb arthroplasty; however, the evidence to support this decision is weak. The Enhanced Recovery After Surgery (ERAS) society has recommended, either technique can be used as part of a multimodal anesthetic regimen. A local study was performed to see if the current anesthetic practice correlates with the current recommendations and to evaluate the efficacy of the different techniques utilized. Method: 90 patients who underwent total hip or total knee replacements at Nevill Hall Hospital between February 2019 to July 2019 were reviewed. Data collected included the anesthetic technique, day one opiate use, pain score, and length of stay. The data was collected from anesthetic charts, and the pain team follows up forms. Analysis: The average of patients undergoing lower limb arthroplasty was 70. Of those 83% (n=75) received a spinal anaesthetic and 17% (n=15) received a general anaesthetic. For patients undergoing knee replacement under general anesthetic the average day, one pain score was 2.29 and 1.94 if a spinal anesthetic was performed. For hip replacements, the scores were 1.87 and 1.8, respectively. There was no statistical significance between these scores. Day 1 opiate usage was significantly higher in knee replacement patients who were given a general anesthetic (45.7mg IV morphine equivalent) vs. those who were operated on under spinal anesthetic (19.7mg). This difference was not noticeable in hip replacement patients. There was no significant difference in length of stay between the two anesthetic techniques. Discussion: There was no significant difference in the day one pain score between the patients who received a general or spinal anesthetic for either knee or hip replacements. The higher pain scores in the knee replacement group overall are consistent with this being a more painful procedure. This is a small patient population, which means any difference between the two groups is unlikely to be representative of a larger population. The pain scale has 4 points, which means it is difficult to identify a significant difference between pain scores. Conclusion: There is currently little standardization between the different anesthetic approaches utilized in Nevill Hall Hospital. This is likely due to the lack of adherence to a standardized anesthetic regimen. In accordance with ERAS recommends a standard anesthetic protocol is a core component. The results of this study and the guidance from the ERAS society will support the implementation of a new health board wide ERAS protocol.

Keywords: anaesthesia, orthopaedics, intensive care, patient centered decision making, treatment escalation

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Authors: Ying-Chang Yu, Yuan-Lung Lo

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Building envelope design is one of the most popular design fields of architectural profession in nowadays. The main design trend of such system is to highlight the designer's aesthetic intention from the outlook of building project. Due to the trend of current façade design, the building envelope contains more and more layers of components, such as double skin façade, photovoltaic panels, solar control system, or even ornamental components. These exterior components are designed for various functional purposes. Most researchers focus on how these exterior elements should be structurally sound secured. However, not many researchers consider these elements would help to improve the performance of façade system. When the exterior elements are deployed in large scale, it creates an additional layer outside of original façade system and acts like a porous interface which would interfere with the aerodynamic of façade surface in micro-scale. A standard façade performance consists with 'water penetration, air infiltration rate, operation force, and component deflection ratio', and these key performances are majorly driven by the 'Design Wind Load' coded in local regulation. A design wind load is usually determined by the maximum wind pressure which occurs on the surface due to the geometry or location of building in extreme conditions. This research was designed to identify the air damping phenomenon of micro turbulence caused by porous exterior layer leading to surface wind load reduction for improvement of façade system performance. A series of wind tunnel test on dynamic pressure sensor array covered by various scale of porous exterior skin was conducted to verify the effect of wind pressure reduction. The testing specimens were designed to simulate the typical building with two-meter extension offsetting from building surface. Multiple porous exterior skins were prepared to replicate various opening ratio of surface which may cause different level of damping effect. This research adopted 'Pitot static tube', 'Thermal anemometers', and 'Hot film probe' to collect the data of surface dynamic pressure behind porous skin. Turbulence and distributed resistance are the two main factors of aerodynamic which would reduce the actual wind pressure. From initiative observation, the reading of surface wind pressure was effectively reduced behind porous media. In such case, an actual building envelope system may be benefited by porous skin from the reduction of surface wind pressure, which may improve the performance of envelope system consequently.

Keywords: multi-layer facade, porous media, facade performance, turbulence and distributed resistance, wind tunnel test

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Authors: Anette Forssten Seiser, Ulf Blossing, Mats Ekholm

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The expectation on principals to manage, lead and develop their schools and teachers are high. However, principals are not left alone without guidelines. Policy texts, curricula and syllabuses guide the orientation of their leadership. Moreover, principals’ traits and experience as well as professional norms, are decisive. However, in this study we argue for the importance to deepen the knowledge of how the practice of leadership is shaped in the daily social working life with the teachers at the school. Teachers’ experiences and expectations of leadership influence the principal’s actions, sometimes perhaps contrary to what is emphasized in official texts like the central guidelines. The expectations of teachers make up the norms of the school and thus constitute the local school culture. The aim of this study is to deepen the knowledge of teachers’ expectations on their principals to manage, lead and develop their schools. Two questions are used to guide the study: 1) How do teachers’ and principals’ expectations differ in realistic situations? 2) How do teachers’ experience-based expectations differ from more ideal expectations? To investigate teachers’ expectations of their principals, we use a social psychological perspective framed within an organisational development perspective. A social role is defined by the fact that, within the framework of the role, different people who fulfil the same role exhibit greater similarities than differences in their actions. The way a social role is exercised depends on the expectations placed on the role’s position but also on the expectations of the function of the role. The way in which the social role is embodied in practice also depends on how the person fulfilling the role perceives and understands those expectations. Based on interviews with school principals a questionnaire was constructed. Nine possible real-life and critical incidents were described that are important when it comes to role shaping in the dynamics between teachers and principals. Teachers were asked to make a choice between three, four, or five possible and realistic courses of action for the principal. The teachers were also asked to make two choices between these different options in real-life situations, one ideal as if they were working as a principal themselves, and one experience based – how they estimated that their own principal would act in such a situation. The sample consist of two elementary schools in Sweden. School A consists of two principals and 38 teachers and school B of two principals and 22 teachers. The response rate among the teachers is 95 percent in school A and 86 percent in school B. All four principals answered our questions. The results show that the expectations of teachers and principals can be understood as variations of being harmonic or disharmonic. The harmonic expectations can be interpreted to lead to an attuned leadership, while the disharmonic expectations lead to a more tensed leadership. Harmonious expectations and an attuned leadership are prominent. The results are compared to earlier research on leadership. Attuned and more tensed leadership are discussed in relation to school development and future research.

Keywords: critical incidents, principal leadership, school culture, school development, teachers' expectations

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Authors: Ishrat Zakia Sultana

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The consistent persecution, ethnic cleansing, and genocide against the Rohingya in Burma resulted four major influxes of the Rohingya people to the neighboring country Bangladesh. After the latest influx of October 2016 and August 2017, the total number of Rohingya in Bangladesh stands somewhere between 900,000 to over one million, placing Bangladesh much ahead with the number of refugees compared to Dadaab and Kakuma in Kenya, Bidibidi in Uganda and Zaatari in Jordan. While Bangladesh received recognition and appreciation for receiving a huge number of the Rohingya, one of the fundamental human rights of the Rohingya – education – has never been fulfilled in Bangladesh. The Ministry of Disaster Management and Relief of the government of Bangladesh has been looking after the Rohingya and managing various programs for the Rohingya. On its website, the Ministry claims that it provides the basic supports/services to the Rohingya, including providing education. In practice, however, education for the Rohingya include only the provisions for registered Rohingya refugees – who are a very small number of populations among the entire Rohingya hosted in Bangladesh – and that is only up to grade 7 within the registered camps at Teknaf and Ukhia of Cox’s Bazar district of the country. There is no answer of the question, ‘What’s next’? Although refugees in Canada, Sudan, Turkey and other countries have been allowed to go to mainstream schools, Rohingya refugees in Bangladesh are not allowed to do so legally. Due to the lack of proof of nationality of the Rohingya, the government of Bangladesh imposes restrictions on their access to Bangladeshi schools. However, despite their vulnerability and statelessness, many Rohingyas are desperate to pursue education outside the camps and find their own way not only within Cox’s Bazar but also even in the capital city of the country. But they must hide their refugee identity to accomplish this. My research aims to explore how they manage to get admission amid government restrictions on their access to education in the mainstream institutions in Bangladesh. It will reveal how Rohingya people use adopted identity to get access to education in Bangladesh, and how they apply their own techniques to achieve their goals without having government approved identity. This research examined the strategies the Rohingya applied to manage documents related to their identity to ensure their admission to Bangladeshi education institutions – in schools, colleges, and universities. The research employed a qualitative approach. It used semi structured individual interviews and Focused Group Discussions (FGDs) with 20 male and female Rohingya refugees who are 18 years old and above, and have enrolled in Bangladeshi education institutions with adopted identity. Also I interviewed 5 local community members and policy makers to understand their perceptions and roles in this process. The findings of this research will allow the policy makers to rethink the outcomes of the restrictions on Rohingya’s education in Bangladesh, the ramifications of the denial of Rohingya’s access to education, and initiate policy dialogues on how to allow Rohingya refugees to pursue education in Bangladesh in legal way.

Keywords: Rohingya, Refugee, Bangladesh, Education

Procedia PDF Downloads 64

Authors: Dr. Jenit Gandhi, Dr. Manojith SS, Dr. Nakul GV, Dr. Sharath Honnani, Dr. Shaurav Ghosh, Dr. Neel Shetty, Dr. Nagabhushan JS, Dr. Manish Joshi

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Introduction: Acute pancreatitis is an inflammatory condition of the pancreas which begins in pancreatic acinar cells and triggers local inflammation that may progress to systemic inflammatory response (SIRS) and causing distant organ involvement and its function and ending up with multiple organ dysfunction syndromes (MODS). Aim: A comparative study in acute pancreatitis to find out the effectiveness of early addition of Ulinastatin to current standard care in Indian subjects . Methodology: A current prospective observational study is done during study period of 1year (Dec 2018 –Dec 2019) duration to evaluate the effect of early addition of Ulinastatin to the current standard treatment and its efficacy to reduce the early complication, analgesic requirement and duration of hospital stay in patients with Acute Pancreatitis. Results: In the control group 25 were males and 05 were females. In the test group 18 were males and 12 females. Majority was in the age group between 30 - 70 yrs of age with >50% in the 30-50yrs age group in both test and control groups. The VAS was median grade 3 in control group as compared to median grade 2 in test group , the pain was more in the initial 2 days in test group compared to 4 days in test group , the analgesic requirement was used for more in control group (median 6) to test group( median 3 days ). On follow up after 5 days for a period of 2 weeks none of the patients in the test group developed any complication. Where as in the control group 8 patients developed pleural effusion, 04-Pseudopancreatic cyst, 02 – patient developed portal vein and splenic vein thrombosis, 02 patients – ventilator with ARDS which were treated symptomatically whereas in test group 02 patient developed pleural effusions and 01 pseudo pancreatic cyst with splenic artery aneurysm, 01 – patient with AKI and MODS symptomatically treated. The duration of hospital stay for a median period of 4 days (2 – 7 days) in test group and 7 days (4 -10 days) in control group. All patients were able to return to normal work on an average of 5days compared 8days in control group, the difference was significant. Conclusion:The study concluded that early addition of Ulinastatin to current standard treatment of acute Pancreatitis is effective in reducing pain, early complication and duration of hospital stay in Indian subject

Keywords: Ulinastatin, VAS – visual analogue score , AKI – acute kidney injury , ARDS – acute respiratory distress syndrome

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Authors: Xiaoqiang Fu, Baihao Li

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In 1895, the failure of Sino-Japanese prompted the trend of comprehensive and systematic study of western pattern in China. In urban planning and construction, urban reform movement sprang up slowly, which aimed at renovating and reconstructing the traditional cities into modern cities similar to the concessions. During the movement, Chinese traditional city initiated a process of modern urban planning for its modernization. Meanwhile, the traditional planning morphology and system started to disintegrate, on the contrary, western form and technology had become the paradigm. Therefore, the improvement of existing cities had become the prototype of urban planning of early modern China. Currently, researches of the movement mainly concentrate on large cities, concessions, railway hub cities and some special cities resembling those. However, the systematic research about the large number of traditional small and medium-sized cities is still blank, up to now. This paper takes the improvement constructions of small and medium-sized cities in Southern region of Jiangsu Province as the research object. First of all, the criteria of small and medium-sized cities are based on the administrative levels of general office and cities at the county level. Secondly, the suitability of taking the Southern Jiangsu as the research object. The southern area of Jiangsu province called Southern Jiangsu for short, was the most economically developed region in Jiangsu, and also one of the most economically developed and the highest urbanization regions in China. As the most developed agricultural areas in ancient China, Southern Jiangsu formed a large number of traditional small and medium-sized cities. In early modern times, with the help of the Shanghai economic radiation, geographical advantage and powerful economic foundation, Southern Jiangsu became an important birthplace of Chinese national industry. Furthermore, the strong business atmosphere promoted the widespread urban improvement practices, which were incomparable of other regions. Meanwhile, the demonstration of Shanghai, Zhenjiang, Suzhou and other port cities became the improvement pattern of small and medium-sized city in Southern Jiangsu. This paper analyzes the reform movement of the small and medium-sized cities in Southern Jiangsu (1895-1927), including the subjects, objects, laws, technologies and the influence factors of politic and society, etc. At last, this paper reveals the formation mechanism and characteristics of urban improvement movement in early modern China. According to the paper, the improvement of small-medium city was a kind of gestation of the local city planning culture in early modern China，with a fusion of introduction and endophytism.

Keywords: early modern China, improvement of small-medium city, southern region of Jiangsu province, urban planning history of China

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Authors: Ryan Chalk, G. M. Shafiullah

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Climate change is a pertinent issue facing governments and societies around the world. The industrial revolution has resulted in a steady increase in the average global temperature. The mining and energy production industries have been significant contributors to this change prompting government to intervene by promoting low emission technology within these sectors. This paper initially reviews the energy problem in Australia and the mining sector with a focus on the energy requirements and production methods utilised in Western Australia (WA). Renewable energy in the form of utility-scale solar photovoltaics (PV) provides a solution to these problems by providing emission-free energy which can be used to supplement the existing natural gas turbines in operation at the proposed site. This research presents a custom renewable solution for the mining site considering the specific township network, local weather conditions, and seasonal load profiles. A summary of the required PV output is presented to supply slightly over 50% of the towns power requirements during the peak (summer) period, resulting in close to full coverage in the trench (winter) period. Dig Silent Power Factory Software has been used to simulate the characteristics of the existing infrastructure and produces results of integrating PV. Large scale PV penetration in the network introduce technical challenges, that includes; voltage deviation, increased harmonic distortion, increased available fault current and power factor. Results also show that cloud cover has a dramatic and unpredictable effect on the output of a PV system. The preliminary analyses conclude that mitigation strategies are needed to overcome voltage deviations, unacceptable levels of harmonics, excessive fault current and low power factor. Mitigation strategies are proposed to control these issues predominantly through the use of high quality, made for purpose inverters. Results show that use of inverters with harmonic filtering reduces the level of harmonic injections to an acceptable level according to Australian standards. Furthermore, the configuration of inverters to supply active and reactive power assist in mitigating low power factor problems. Use of FACTS devices; SVC and STATCOM also reduces the harmonics and improve the power factor of the network, and finally, energy storage helps to smooth the power supply.

Keywords: climate change, mitigation strategies, photovoltaic (PV), power quality

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Authors: Toslim Uddin Khan, Jesmin Akter, Mohiuddin Ahmed

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Menstrual hygiene management (MHM) and personal health-care practice is a critical issue to prevent morbidity and other reproductive health complications among adolescent girls in Bangladesh. Inadequate access to water, sanitation and hygiene (WASH) facilities lead to unhealthy MHM practices that resulted in poor reproductive health outcomes. It is evident from different studies that superstitions and misconception are more common in rural communities that limit young girls’ access to and understanding of the menstrual hygiene and self care practices. The state-of-the-art approach of Social Marketing Company (SMC) is proved to be instrumental in delivering reinforcing health messages, making public health and hygiene products available at the door steps of the community through community mobilization programs in rural Bangladesh. School health program is one of the flagship interventions of SMC to equip adolescent girls and boys with correct knowledge of health and hygiene practices among themselves, their families and peers. In Bangladeshi culture, adolescent girls often feel shy to ask fathers or male family members about buying sanitary napkin from local pharmacy and they seem to be reluctant to seek help regarding their menstrual problems. A recent study reveals that 48% adolescent girls are using sanitary napkins while majority of them are unaware of menstrual hygiene practices in Bangladesh. Under school adolescent program, SMC organizes health education sessions for adolescent girls from grade seven to ten using enter-educate approach with special focus on sexual and reproductive health and menstrual hygiene issues including delaying marriage and first pregnancy. In addition, 2500 rural women entrepreneurs branded as community sales agents are also involved in disseminating health messages and selling priority health products including sanitary napkin at the household level. These women entrepreneurs are serving as a source of sustainable supply of the sanitary napkins for the rural adolescent girls and thereby they are earning profit margins on the sales they make. A recent study on the impact of adolescent program activities reveals that majority (71%) of the school adolescent girls are currently using sanitary napkins. Health education equips and empowers adolescent girls with accurate knowledge about menstrual hygiene practices and self-care as well. Therefore, engagement of female entrepreneurs in school adolescent health program at the community level is one of the promising ways to improve menstrual hygiene practices leading to increased use of sanitary napkin in rural and semi-rural communities in Bangladesh.

Keywords: school adolescent program, social marketing, women entrepreneurs, menstrual hygiene management

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Authors: Zachary Cooper-Baldock, Paulo E. Santos, Russell S. A. Brinkworth, Karl Sammut

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- In recent years, large unmanned underwater vehicles such as the Boeing Voyager and Anduril Ghost Shark have been developed. These vessels can be structured to contain onboard internal payload bays. These payload bays can serve a variety of purposes – including the launch and recovery (LAR) of smaller underwater vehicles. The LAR of smaller vessels is extremely important, as it enables transportation over greater distances, increased time on station, data transmission and operational safety. The larger vessel and its payload bay structure complicate the LAR of UUVs in contrast to static docks that are affixed to the seafloor, as they actively impact the local flow field. These flow field impacts require analysis to determine if UUV vessels can be safely launched and recovered inside the motherships. This research seeks to determine the hydrodynamic forces exerted on a vertically over-actuated, small, unmanned underwater vehicle (OUUV) during an internal LAR manoeuvre and compare this to an under-actuated vessel (UUUV). In this manoeuvre, the OUUV is navigated through the stern wake region of the larger vessel to a set point within the internal payload bay. The manoeuvre is simulated using ANSYS Fluent computational fluid dynamics models, covering the entire recovery of the OUUV and UUUV. The analysis of the OUUV is compared against the UUUV to determine the differences in the exerted forces. Of particular interest are the drag, pressure, turbulence and flow field effects exerted as the OUUV is driven inside the payload bay of the larger vessel. The hydrodynamic forces and flow field disturbances are used to determine the feasibility of making such an approach. From the simulations, it was determined that there was no significant detrimental physical forces, particularly with regard to turbulence. The flow field effects exerted by the OUUV are significant. The vertical thrusters exert significant wake structures, but their orientation ensures the wake effects are exerted below the UUV, minimising the impact. It was also seen that OUUV experiences higher drag forces compared to the UUUV, which will correlate to an increased energy expenditure. This investigation found no key indicators that recovery via a mothership payload bay was not feasible. The turbulence, drag and pressure phenomenon were of a similar magnitude to existing static and towed dock structures.

Keywords: underwater vehicles, submarine, autonomous underwater vehicles, auv, computational fluid dynamics, flow fields, pressure, turbulence, drag

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Authors: Jahnu Bharadwaj

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In the third decade of the 19th century, the political landscape of the Brahmaputra valley changed at many levels. The establishment of East India Company’s authority in ‘Assam’ was complete with the Treaty of Yandaboo. The whole phenomenon of the annexation of Assam into the British Indian Empire led to several administrative reorganizations and reforms under the new regime. British colonial rule was distinguished by new systems and institutions of governance. This paper broadly looks at the historical proceedings of the introduction of the Rule of Law and a new legal structure in the region of ‘Assam’. With numerous archival data, this paper seeks to chiefly examine the trajectory of an important element in the new legal apparatus, i.e. the jury in the British criminal courts introduced in the newly annexed region. Right from the beginning of colonial legal innovations with the establishment of the panchayats and the parallel courts in Assam, the jury became an important element in the structure of the judicial system. In both civil and criminal courts, the jury was to be formed from the learned members of the ‘native’ society. In the working of the criminal court, the jury became significantly powerful and influential. The structure meant that the judge or the British authority eventually had no compulsion to obey the verdict of the jury. However, the structure also provided that the jury had a considerable say in matters of the court proceedings, and their verdict had significant weight. This study seeks to look at certain important criminal cases pertaining to the nineteenth century and the functioning of the jury in those cases. The power play at display between the British officials, judges and the members of the jury would be helpful in highlighting the important deliberations and politics that were in place in the functioning of the British criminal legal apparatus in colonial Assam. The working and the politics of the members of the jury in many cases exerted considerable influence in the court proceedings. The interesting negotiations of the British officials or judges also present us with vital insights. By reflecting on the difficulty that the British officials and judges felt with the considerable space for opinion and difference that was provided to important members of the local society, this paper seeks to locate, with evidence, the racial politics at play within the official formulations of the legal apparatus in the colonial rule in Assam. This study seeks to argue that despite the rhetorical claims of legal equality within the Empire, racial consideration and racial politics was a reality even in the making of the structure itself. This in a way helps to enrich our ideas about the racial elements at work in numerous layers sustaining the colonial regime.

Keywords: criminal courts, colonial regime, jury, race

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Authors: N. Rambabu, H. Gururaj, Reynold Washington, Oommen George

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Motivation: Under the USAID Strengthening Health Outcomes through Private Sector (SHOPS-TB) initiative, Karnataka Health Promotion Trust (KHPT) with technical support of Abt associates is implementing a TB prevention and care model in Karnataka State, South India. KHPT is the interface agency between the public and private sectors, and providers and the target community facilitating early TB case detection and enhancing treatment compliance through private health care providers (pHCP) engagement in RNTCP. The project coverage is 0.84 million urban poor from 663 slums in 12 districts of Karnataka. Problem Statement: India with the highest burden of global TB (26%) and two million cases annually, accounts for approximately one fifth of the global incidence. WHO estimates 300,000 people die from TB annually in India. India expanded the coverage of Directly Observed Treatment, Short-course chemotherapy (DOTS) to the entire country as early as 2006. However, the performance of RNTCP has not been uniform across states. While the national annual new smear-positive (NSP) case notification rate is 53, it is much lower at 47 in Karnataka. A third of TB patients in India reside in urban slums. Approach: Under SHOPS, KHPT actively engages with communities through key opinion leaders and community structures. Interpersonal communication, by Outreach workers through house-to-house visits and at aggregation points, is the primary method used for communication about TB and its management and to increase demand for sputum examination and DOTS. pHCP are mapped, trained and mentored by KHPT. ORWs also provide patient and family counseling on TB treatment, side effects and adherence, screen close contacts of index patients especially children under 6 years of age and screen co-morbidities including HIV, diabetes and malnutrition and risk factors including alcoholism, tobacco use, occupational hazards making appropriate accompanied or documented referrals. A treatment ‘buddy’ system for the patients involving close friends or family members, ICT-based support, DOTS Prerana (inspiration) groups of TB patients, family members and community, DOTS Mitra (friend) helpline services are also used for care and support services. Results: The intervention educated 39988 slum dwellers, referred 1731 chest symptomatics, tested 1061 patients and initiated 248 patients on anti-TB treatment within three months of intervention through continuous community engagement. Conclusions: The intervention’s potential to increase access to preferred health care providers, reduce patient and health system delays in diagnosis and initiation of treatment, improve health seeking behaviour and enhance compliance of pHCPs to standard treatment protocols is being monitored. Initial results are promising.

Keywords: DOTS, KHPT, health outcomes, public and private sector

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Authors: Aidan N. Smallwood, Celestine R. Weegenaar, Jack N. Evans

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The intensive care unit (ICU) is a particularly resource heavy environment, in terms of staff, drugs and equipment required. Whilst many areas of the hospital are attempting to cut down on plastic use and minimise their impact on the environment, this has proven challenging within the confines of intensive care. Concurrently, as globalization has progressed over recent decades, there has been a tendency towards centralised manufacturing with international distribution networks for products, often covering large distances. In this study, we have modelled the standard consumption of plastic single-use items over the course of the first 24-hours of an average individual patient’s stay in a 12 bed ICU in the United Kingdom (UK). We have identified the country of manufacture and calculated the minimum possible distance travelled by each item from factory to patient. We have assumed direct transport via the shortest possible straight line from country of origin to the UK and have not accounted for transport within either country. Assuming an intubated patient with invasive haemodynamic monitoring and central venous access, there are a total of 52 distincts, largely plastic, disposable products which would reasonably be required in the first 24-hours after admission. Each product type has only been counted once to account for multiple items being shipped as one package. Travel distances from origin were summed to give the total distance combined for all 52 products. The minimum possible total distance travelled from country of origin to the UK for all types of product was 273,353 km, equivalent to 6.82 circumnavigations of the globe, or 71% of the way to the moon. The mean distance travelled was 5,256 km, approximately the distance from London to Mecca. With individual packaging for each item, the total weight of consumed products was 4.121 kg. The CO2 produced shipping these items by air freight would equate to 30.1 kg, however doing the same by sea would produce 0.2 kg CO2. Extrapolating these results to the 211,932 UK annual ICU admissions (2018-2019), even with the underestimates of distance and weight of our assumptions, air freight would account for 6586 tons CO2 emitted annually, approximately 130 times that of sea freight. Given the drive towards cost saving within the UK health service, and the decline of the local manufacturing industry, buying from intercontinental manufacturers is inevitable However, transporting all consumables by sea where feasible would be environmentally beneficial, as well as being less costly than air freight. At present, the NHS supply chain purchases from medical device companies, and there is no freely available information as to the transport mode used to deliver the product to the UK. This must be made available to purchasers in order to give a fuller picture of life cycle impact and allow for informed decision making in this regard.

Keywords: CO2, intensive care, plastic, transport

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Authors: Jara Kaye S. Villanueva, M. Rosario Concepcion O. Ang

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For the past few years, Philippines has depended most of its energy source on oil, coal, and fossil fuel. According to the Department of Energy (DOE), the dominance of coal in the energy mix will continue until the year 2020. The expanding energy needs in the country have led to increasing efforts to promote and develop renewable energy. This research is a part of the government initiative in preparation for renewable energy development and expansion in the country. The Philippine Renewable Energy Resource Mapping from Light Detection and Ranging (LiDAR) Surveys is a three-year government project which aims to assess and quantify the renewable energy potential of the country and to put them into usable maps. This study focuses on the site suitability analysis of the four renewable energy sources – biomass (coconut, corn, rice, and sugarcane), hydro, solar, and wind energy. The site assessment is a key component in determining and assessing the most suitable locations for the construction of renewable energy power plants. This method maximizes the use of both the technical methods in resource assessment, as well as taking into account the environmental, social, and accessibility aspect in identifying potential sites by utilizing and integrating two different methods: the Multi-Criteria Decision Analysis (MCDA) method and Geographic Information System (GIS) tools. For the MCDA, Analytical Hierarchy Processing (AHP) is employed to determine the parameters needed for the suitability analysis. To structure these site suitability parameters, various experts from different fields were consulted – scientists, policy makers, environmentalists, and industrialists. The need to have a well-represented group of people to consult with is relevant to avoid bias in the output parameter of hierarchy levels and weight matrices. AHP pairwise matrix computation is utilized to derive weights per level out of the expert’s gathered feedback. Whereas from the threshold values derived from related literature, international studies, and government laws, the output values were then consulted with energy specialists from the DOE. Geospatial analysis using GIS tools translate this decision support outputs into visual maps. Particularly, this study uses Euclidean distance to compute for the distance values of each parameter, Fuzzy Membership algorithm which normalizes the output from the Euclidean Distance, and the Weighted Overlay tool for the aggregation of the layers. Using the Natural Breaks algorithm, the suitability ratings of each of the map are classified into 5 discrete categories of suitability index: (1) not suitable (2) least suitable, (3) suitable, (4) moderately suitable, and (5) highly suitable. In this method, the classes are grouped based on the best groups similar values wherein each subdivision are set from the rest based on the big difference in boundary values. Results show that in the entire Philippine area of responsibility, biomass has the highest suitability rating with rice as the most suitable at 75.76% suitability percentage, whereas wind has the least suitability percentage with score 10.28%. Solar and Hydro fall in the middle of the two, with suitability values 28.77% and 21.27%.

Keywords: site suitability, biomass energy, hydro energy, solar energy, wind energy, GIS

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Authors: S. Mohd Afzal, R. O'Connell

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Kaposi's sarcoma (KS) is the most common HIV-related cancer, and ocular manifestations constitute at least 25% of all KS cases. However, ocular presentations often occur in the context of systemic KS, and isolated lesions are rare. We report a unique case of ocular KS masquerading as subconjunctival haemorrhage, and only developing systemic manifestations after initiation of HIV treatment. Case: A 49-year old man with previous hypertensive stroke and newly diagnosed HIV infection presented with an acutely red left eye following repeated bouts of coughing. Given the convincing history of poorly controlled hypertension and cough, a diagnosis of subconjunctival haemorrhage was made. Over the next week, his ocular lesion began to improve and he subsequently started anti-retroviral therapy. Prior to receiving anti-retroviral therapy, his CD4+ lymphocyte count was 194 cells/mm3 with HIV viral load greater than 1 million/ml. This rapidly improved to a viral load of 150 copies/ml within 2 weeks of starting treatment. However, a few days after starting HIV treatment, his ocular lesion recurred. Ophthalmic examination was otherwise normal. He also developed widespread lymphadenopathy and multiple dark lesions on his torso. Histology and virology confirmed KS, systemically triggered by Immune Reconstitution Syndrome (KS-IRIS). The patient has since undergone chemotherapy successfully. Discussion: Kaposi's sarcoma is an atypical tumour caused by human herpesvirus 8 (HHV-8), also known as Kaposi’s sarcoma-associated herpesvirus (KSHV). In immunosuppressed patients, KSHV can also cause lymphoproliferative disorders such as primary effusion lymphoma and Castleman's disease (in our patient’s case, this was excluded through histological analysis of lymph nodes). KSHV is one of the seven currently known human oncoviruses, and its pathogenesis is poorly understood. Up to 13% of patients with HIV-related KS experience worsening of the disease after starting anti-retroviral treatment, due to a sudden increase in CD4 cell counts. Histology remains the diagnostic gold standard. Current British HIV Association (BHIVA) guidelines recommend treatment using anti-retroviral drugs, with either intralesional vinblastine for local disease or systemic chemotherapy for disseminated KS. Conclusion: This case is unique as ocular KS as initial presentation is rare and our patient's diagnosis was only made after systemic lesions were triggered by immune reconstitution. KS should be considered as an important differential diagnosis for red eyes in all patients at risk of acquiring HIV infection.

Keywords: human herpesvirus 8, human immunodeficiency virus, immune reconstitution syndrome, Kaposi’s sarcoma, Kaposi’s sarcoma-associated herpesvirus

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Authors: Kay Fielden, Eelin Tan, Lan Nguyen

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In this research project, data was gathered at a Covid 19 Conference held in June 2021 from industry leaders who discussed the impact of the global pandemic on the status of the New Zealand hospitality industry. Panel discussions on financials, human resources, health and safety, and recovery were conducted. The themes explored for the finance panel were customer demographics, hospitality sectors, financial practices, government impact, and cost of compliance. The aim was to see how the hospitality industry has responded to the global pandemic and the steps that have been taken for the industry to recover or sustain their business. The main research question for this qualitative study is: What are the factors that have impacted on finance for the hospitality industry in New Zealand due to Covid 19? For financials, literature has been gathered to study global effects, and this is being compared with the data gathered from the discussion panel through the lens of resilience theory. Resilience theory applied to the hospitality industry suggests that the challenges imposed by Covid 19 have been the catalyst for government initiatives, technical innovation, engaging local communities, and boosting confidence. Transformation arising from these ground shifts have been a move towards sustainability, wellbeing, more awareness of climate change, and community engagement. Initial findings suggest that there has been a shift in customer base that has prompted regional accommodation providers to realign offers and to become more flexible to attract and maintain this realigned customer base. Dynamic pricing structures have been required to meet changing customer demographics. Flexible staffing arrangements include sharing staff between different accommodation providers, owners with multiple properties adopting different staffing arrangements, maintaining a good working relationship with the bank, and conserving cash. Uncertain times necessitate changing revenue strategies to cope with external factors. Financial support offered by the government has cushioned the financial downturn for many in the hospitality industry, and managed isolation and quarantine (MIQ) arrangements have offered immediate financial relief for those hotels involved. However, there is concern over the long-term effects. Compliance with mandated health and safety requirements has meant that the hospitality industry has streamlined its approach to meeting those requirements and has invested in customer relations to keep paying customers informed of the health measures in place. Initial findings from this study lie within the resilience theory framework and are consistent with findings from the literature.

Keywords: global pandemic, hospitality industry, new Zealand, resilience

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Authors: Aziza Al-Sawafi

Abstract:

Introduction: The evidence of family interventions in schizophrenia is robust primarily in high-income settings. However, they have been adapted to other settings and cultures to improve effectiveness and acceptability. In Oman, there is limited integration of psychosocial interventions in the treatment of schizophrenia. Therefore, the adaptation of family intervention to the Omani culture may facilitate its uptake. Most service users in Oman live with their families outside the healthcare system, and nothing is known about their experience, needs, or resources. Furthermore, understanding caregivers' and mental health professionals' preferences, perceptions, and experience is a fundamental element in the process of intervention development. Therefore, this study aims to develop a culturally sensitive, feasible, and acceptable family intervention for relatives living with schizophrenia in Oman. Method: The Medical Research Council's framework for the evaluation of complex health care interventions provided the conceptual structure for the study. The development phase was carried out, which involved three stages: 1) systematically reviewing the available literature regarding culturally adapted family interventions in the Arab world 2) In-depth interviews with caregivers to explore their experience and perceived needs and preferences regarding intervention 3) A focus group study involving health professionals to explore the acceptability and feasibility of delivering the family intervention in the Omani context. Data synthesis determined the design of the proposed intervention according to the findings obtained from the previous stages. Results: Stage one: The systematic review found limited evidence of culturally-adapted family interventions in the Arab region. However, the cultural adaptation process was comprehensive, and the implementation was reported to be feasible and acceptable. Stage two: The experience of family caregivers illuminated four main themes: burden, stigma, violence, and family needs. Burdens of care included objective and subjective burdens, positive feelings, and coping mechanisms. Caregivers gave their opinion about the content and preference of the intervention from their personal experiences. Stage three: mental health professionals discussed the delivery system of the intervention from a clinical standpoint concerning issues and barriers to implementation. They recommended modifications to the components of the intervention to ensure its acceptability and feasibility in the local setting. Data synthesis was carried out, and the intervention was designed. Conclusion: This study provides evidence of the potential applicability and acceptability of a culturally sensitive family intervention for families of individuals with schizophrenia in Oman. However, more work needs to be done to test the feasibility of the study and overcome the practical challenges.

Keywords: cultural-adaptation, family intervention, Oman, schizophrenia

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Authors: Christi Jackson, Chuka Onaga

Abstract:

Introduction: We report a case of delayed diagnosis of extra-pulmonary INH-mono-resistant Tuberculosis (TB) in a South African patient with drug-resistant HIV. Case Presentation: A 36-year old male was initiated on 1st line (NNRTI-based) anti-retroviral therapy (ART) in September 2009 and switched to 2nd line (PI-based) ART in 2011, according to local guidelines. He was following up at the outpatient wellness unit of a public hospital, where he was diagnosed with Protease Inhibitor resistant HIV in March 2016. He had an HIV viral load (HIVVL) of 737000 copies/mL, CD4-count of 10 cells/µL and presented with complaints of productive cough, weight loss, chronic diarrhoea and a septic buttock wound. Several investigations were done on sputum, stool and pus samples but all were negative for TB. The patient was treated with antibiotics and the cough and the buttock wound improved. He was subsequently started on a 3rd-line ART regimen of Darunavir, Ritonavir, Etravirine, Raltegravir, Tenofovir and Emtricitabine in May 2016. He continued losing weight, became too weak to stand unsupported and started complaining of abdominal pain. Further investigations were done in September 2016, including a urine specimen for Line Probe Assay (LPA), which showed M. tuberculosis sensitive to Rifampicin but resistant to INH. A lymph node biopsy also showed histological confirmation of TB. Management and outcome: He was started on Rifabutin, Pyrazinamide and Ethambutol in September 2016, and Etravirine was discontinued. After 6 months on ART and 2 months on TB treatment, his HIVVL had dropped to 286 copies/mL, CD4 improved to 179 cells/µL and he showed clinical improvement. Pharmacy supply of his individualised drugs was unreliable and presented some challenges to continuity of treatment. He successfully completed his treatment in June 2017 while still maintaining virological suppression. Discussion: Several laboratory-related factors delayed the diagnosis of TB, including the unavailability of urine-lipoarabinomannan (LAM) and urine-GeneXpert (GXP) tests at this facility. Once the diagnosis was made, it presented a treatment dilemma due to the expected drug-drug interactions between his 3rd-line ART regimen and his INH-resistant TB regimen, and specialist input was required. Conclusion: TB is more difficult to diagnose in patients with severe immunosuppression, therefore additional tests like urine-LAM and urine-GXP can be helpful in expediting the diagnosis in these cases. Patients with non-standard drug regimens should always be discussed with a specialist in order to avoid potentially harmful drug-drug interactions.

Keywords: drug-resistance, HIV, line probe assay, tuberculosis

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Authors: Tünde Puskás, Anita Andersson

Abstract:

This study is part of a research project about whether religion is considered as part of Swedish cultural heritage in Swedish preschools. Our aim in this paper is to explore how a Swedish preschool balance between keeping the education non-confessional and at the same time teaching children about a particular tradition, Easter.The paper explores how in a Swedish preschool with a religious profile teachers balance between keeping education non-confessional and teaching about a tradition with religious roots. The point of departure for the theoretical frame of our study is that practical considerations in pedagogical situations are inherently dilemmatic. The dilemmas that are of interest for our study evolve around formalized, intellectual ideologies, such us multiculturalism and secularism that have an impact on everyday practice. Educational dilemmas may also arise in the intersections of the formalized ideology of non-confessionalism, prescribed in policy documents and the common sense understandings of what is included in what is understood as Swedish cultural heritage. In this paper, religion is treated as a human worldview that, similarly to secular ideologies, can be understood as a system of thought. We make use of Ninian Smart's theoretical framework according to which in modern Western world religious and secular ideologies, as human worldviews, can be studied from the same analytical framework. In order to be able to study the distinctive character of human worldviews Smart introduced a multi-dimensional model within which the different dimensions interact with each other in various ways and to different degrees. The data for this paper is drawn from fieldwork carried out in 2015-2016 in the form of video ethnography. The empirical material chosen consists of a video recording of a specific activity during which the preschool group took part in an Easter play performed in the local church. The analysis shows that the policy of non-confessionalism together with the idea that teaching covering religious issues must be purely informational leads in everyday practice to dilemmas about what is considered religious. At the same time what the adults actually do with religion fulfills six of seven dimensions common to religious traditions as outlined by Smart. What we can also conclude from the analysis is that whether it is religion or a cultural tradition that is thought through the performance the children watched in the church depends on how the concept of religion is defined. The analysis shows that the characters of the performance themselves understood religion as the doctrine of Jesus' resurrection from the dead. This narrow understanding of religion enabled them indirectly to teach about the traditions and narratives surrounding Easter while avoiding teaching religion as a belief system.

Keywords: non-confessional education, preschool, religion, tradition

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