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Authors: Linda D. F. Bambara, Marie Sawadogo

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Jatropha curcas (jatropha) is the plant that has been the most studied for biofuel production in West Africa. There exist however other plants such as Balanites aegyptiaca (balanites) that have been targeted as a potential feedstock for biofuel production. This biomass could be an alternative feedstock for the production of straight vegetable oil (SVO) at costs lower than jatropha-based SVO production costs. This study aims firstly to determine, through an MILP model, the optimal organization that minimizes the costs of the oilseeds supply of two biomass conversion units (BCU) exploiting respectively jatropha seeds and the balanitès seeds. Secondly, the study aims to carry out a comparative study of these costs obtained for each BCU. The model was then implemented on two theoretical cases studies built on the basis of the common practices in Burkina Faso and two scenarios were carried out for each case study. In Scenario 1, 3 pre-processing locations ("at the harvesting area", "at the gathering points", "at the BCU") are possible. In scenario 2, only one location ("at the BCU") is possible. For each biomass, the system studied is the upstream supply chain (harvesting, transport and pre-processing (drying, dehulling, depulping)), including cultivation (for jatropha). The model optimizes the area of land to be exploited based on the productivity of the studied plants and material losses that may occur during the harvesting and the supply of the BCU. It then defines the configuration of the logistics network allowing an optimal supply of the BCU taking into account the most common means of transport in West African rural areas. For the two scenarios, the results of the implementation showed that the total area exploited for balanites (1807 ha) is 4.7 times greater than the total area exploited for Jatropha (381 ha). In both case studies, the location of pre-processing “at the harvesting area” was always chosen for scenario1. As the balanites trees were not planted and because the first harvest of the jatropha seeds took place 4 years after planting, the cost price of the seeds at the BCU without the pre-processing costs was about 430 XOF/kg. This cost is 3 times higher than the balanites's one, which is 140 XOF/kg. After the first year of harvest, i.e. 5 years after planting, and assuming that the yield remains constant, the same cost price is about 200 XOF/kg for Jatropha. This cost is still 1.4 times greater than the balanites's one. The transport cost of the balanites seeds is about 120 XOF/kg. This cost is similar for the jatropha seeds. However, when the pre-processing is located at the BCU, i.e. for scenario2, the transport costs of the balanites seeds is 1200 XOF/kg. These costs are 6 times greater than the transport costs of jatropha which is 200 XOF/kg. These results show that the cost price of the balanites seeds at the BCU can be competitive compared to the jatropha's one if the pre-processing is located at the harvesting area.

Keywords: Balanites aegyptiaca, biomass conversion, Jatropha curcas, optimization, post-harvest operations

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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: O. D. Ohijeagbon, Oluseyi O. Ajayi, M. Ogbonnaya, Ahmeh Attabo

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This study analyzed the electricity generation potential from wind at seven sites spread across seven states of the North-Central region of Nigeria. Twenty-one years (1987 to 2007) wind speed data at a height of 10m were assessed from the Nigeria Meteorological Department, Oshodi. The data were subjected to different statistical tests and also compared with the two-parameter Weibull probability density function. The outcome shows that the monthly average wind speeds ranged between 2.2 m/s in November for Bida and 10.1 m/s in December for Jos. The yearly average ranged between 2.1m/s in 1987 for Bida and 11.8 m/s in 2002 for Jos. Also, the power density for each site was determined to range between 29.66 W/m2 for Bida and 864.96 W/m2 for Jos, Two parameters (k and c) of the Weibull distribution were found to range between 2.3 in Lokoja and 6.5 in Jos for k, while c ranged between 2.9 in Bida and 9.9m/s in Jos. These outcomes points to the fact that wind speeds at Jos, Minna, Ilorin, Makurdi and Abuja are compatible with the cut-in speeds of modern wind turbines and hence, may be economically feasible for wind-to-electricity at and above the height of 10 m. The study further assessed the potential and economic viability of standalone wind generation systems for off-grid rural communities located in each of the studied sites. A specific electric load profile was developed to suite hypothetic communities, each consisting of 200 homes, a school and a community health center. Assessment of the design that will optimally meet the daily load demand with a loss of load probability (LOLP) of 0.01 was performed, considering 2 stand-alone applications of wind and diesel. The diesel standalone system (DSS) was taken as the basis of comparison since the experimental locations have no connection to a distribution network. The HOMER® software optimizing tool was utilized to determine the optimal combination of system components that will yield the lowest life cycle cost. Sequel to the analysis for rural community utilization, a Distributed Generation (DG) analysis that considered the possibility of generating wind power in the MW range in order to take advantage of Nigeria’s tariff regime for embedded generation was carried out for each site. The DG design incorporated each community of 200 homes, freely catered for and offset from the excess electrical energy generated above the minimum requirement for sales to a nearby distribution grid. Wind DG systems were found suitable and viable in producing environmentally friendly energy in terms of life cycle cost and levelised value of producing energy at Jos ($0.14/kWh), Minna ($0.12/kWh), Ilorin ($0.09/kWh), Makurdi ($0.09/kWh), and Abuja ($0.04/kWh) at a particluar turbine hub height. These outputs reveal the value retrievable from the project after breakeven point as a function of energy consumed Based on the results, the study demonstrated that including renewable energy in the rural development plan will enhance fast upgrade of the rural communities.

Keywords: wind speed, wind power, distributed generation, cost per kilowatt-hour, clean energy, North-Central Nigeria

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Authors: Shazia Ali, Yves Mard, Éric Severin

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To the best of our knowledge, this is the first study to have analyzed the impact of a) firm-specific product-market power and b) industry competition on earnings management behavior of European firms in distress versus healthy years while controlling for firm-level characteristics. We predicted a significant relationship between firms’ product market power and earnings management tools and their trade-off under the moderation effect of financial distress. We found that the firm-level market power hereinafter referred to as MP (proxied by the industry-adjusted Lerner Index) is positively associated with both real and accrual earnings management. However, MP is associated with a higher level of real earnings management compared to accrual earnings management in distress years compared to healthy years. On the other hand, industry product market power (representing low competition and proxied by the inverse of the total number of firms in an industry hereinafter referred to as NUMB) and firms product market power (proxied by firm market share hereinafter referred to as MS) are associated with lower inflationary accruals and higher deflationary accruals respectively. On the other hand, they are found to be linked with higher real earnings management in distress versus healthy years. When we divided the sample into small and big firms based on their respective industry-year median total assets, we found that all three measures of industry competition (Industry Median Lerner Index (hereinafter referred to as IMLI), NUMB, and Herfindahl–Hirschman Index (hereinafter referred to as HHI) indicate that small firms in low-competitive industries in financial distress are more likely to inflate their earnings through discretionary accruals. While big firms in this situation are more likely to lower the use of both inflationary and deflationary discretionary accruals as indicated by IMLI and HHI and trade-off accruals earnings management for real earnings management as indicated by NUMB. Moreover, IMLI and HHI did not show any interesting results when we divided the sample based on the firm Lerner Index/Market Power. However, the distressed firms with high market power (MP>industry median) are found to engage in income-decreasing discretionary accruals in low-competitive industries (high NUMB). Whereas firms with low market power in the same industry use downward discretionary accruals but inflate income using real activities (abnCFO). Our findings are robust across alternate measures of discretionary accruals and financial distress, such as the Altman Z-Score. The finding of the study is valuable for accounting standard setters, competition authorities, policymakers, and investors alike to help in informed decision-making.

Keywords: financial distress, earnings management, market competition

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Authors: William C. Alexander

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The oscillating water column (OSC) wave energy converter (WEC) with deep water reactance (DWR) consists of a large hollow sphere filled with seawater at the base, referred to as the ‘stabilizer’, a hollow cylinder at the top of the device, with a said cylinder having a bottom open to the sea and a sealed top save for an orifice which leads to an air turbine, and a long, narrow rod connecting said stabilizer with said cylinder. A small amount of ballast at the bottom of the stabilizer and a small amount of floatation in the cylinder keeps the device upright in the sea. The floatation is set such that the mean water level is nominally halfway up the cylinder. The entire device is loosely moored to the seabed to keep it from drifting away. In the presence of ocean waves, seawater will move up and down within the cylinder, producing the ‘oscillating water column’. This gives rise to air pressure within the cylinder alternating between positive and negative gauge pressure, which in turn causes air to alternately leave and enter the cylinder through said top-cover situated orifice. An air turbine situated within or immediately adjacent to said orifice converts the oscillating airflow into electric power for transport to shore or elsewhere by electric power cable. Said oscillating air pressure produces large up and down forces on the cylinder. Said large forces are opposed through the rod to the large mass of water retained within the stabilizer, which is located deep enough to be mostly free of any wave influence and which provides the deepwater reactance. The cylinder and stabilizer form a spring-mass system which has a vertical (heave) resonant frequency. The diameter of the cylinder largely determines the power rating of the device, while the size (and water mass within) of the stabilizer determines said resonant frequency. Said frequency is chosen to be on the lower end of the wave frequency spectrum to maximize the average power output of the device over a large span of time (such as a year). The upper portion of the device (the cylinder) moves laterally (surge) with the waves. This motion is accommodated with minimal loading on the said rod by having the stabilizer shaped like a sphere, allowing the entire device to rotate about the center of the stabilizer without rotating the seawater within the stabilizer. A full-scale device of this type may have the following dimensions. The cylinder may be 16 meters in diameter and 30 meters high, the stabilizer 25 meters in diameter, and the rod 55 meters long. Simulations predict that this will produce 1,400 kW in waves of 3.5-meter height and 12 second period, with a relatively flat power curve between 5 and 16 second wave periods, as will be suitable for an open-ocean location. This is nominally 10 times higher power than similar-sized WEC spar buoys as reported in the literature, and the device is projected to have only 5% of the mass per unit power of other OWC converters.

Keywords: oscillating water column, wave energy converter, spar bouy, stabilizer

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Authors: Folajinmi Oluwasina, Towolawi Adetayo, Kate Ssamula, Penninah Iutung, Daniel Reijer

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Objective: Routine HIV screening has been promoted as an essential component of efforts to reduce incidence, morbidity, and mortality. The objectives of this study were to identify the optimal annual volume needed to realize the public health goals of HIV screening in the AIDS Healthcare Foundation supported hospitals and establish an implementation process to realize that optimal annual volume. Methods: Starting in 2011 a program was established to routinize HIV screening within communities and government hospitals. In 2016 Five-years of HIV screening data were reviewed to identify the optimal annual proportions of age-eligible patients screened to realize the public health goals of reducing new diagnoses and ending late-stage diagnosis (tracked as concurrent HIV/AIDS diagnosis). Analysis demonstrated that rates of new diagnoses level off when 42% of age-eligible patients were screened, providing a baseline for routine screening efforts; and concurrent HIV/AIDS diagnoses reached statistical zero at screening rates of 70%. Annual facility based targets were re-structured to meet these new target volumes. Restructuring efforts focused on right-sizing HIV screening programs to align and transition programs to integrated HIV screening within standard medical care and treatment. Results: Over one million patients were screened for HIV during the five years; 16, 033 new HIV diagnoses and access to care and treatment made successfully for 82 % (13,206), and concurrent diagnosis rates went from 32.26% to 25.27%. While screening rates increased by 104.7% over the 5-years, volume analysis demonstrated that rates need to further increase by 62.52% to reach desired 20% baseline and more than double to reach optimal annual screening volume. In 2011 facility targets for HIV screening were increased to reflect volume analysis, and in that third year, 12 of the 19 facilities reached or exceeded new baseline targets. Conclusions and Recommendation: Quantifying targets against routine HIV screening goals identified optimal annual screening volume and allowed facilities to scale their program size and allocate resources accordingly. The program transitioned from utilizing non-evidence based annual volume increases to establishing annual targets based on optimal volume analysis. This has allowed efforts to be evaluated on the ability to realize quantified goals related to the public health value of HIV screening. Optimal volume analysis helps to determine the size of an HIV screening program. It is a public health tool, not a tool to determine if an individual patient should receive screening.

Keywords: HIV screening, optimal volume, HIV diagnosis, routine

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Authors: Christi Jackson, Chuka Onaga

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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: Nadjet Mekaouche, Hanane Zitouni, Fatma Boudia, Habiba Fetati, A. Saleh, A. Lardjam, H. Geniaux, A. Coubret, H. Toumi

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Medicines have undeniably played a major role in prolonging shelf life and improving quality. The absolute efficacy of the drug remains a lever for innovation, its benefit/risk balance is not always assured and it does not always have the expected effects. Prior to marketing, knowledge about adverse drug reactions is incomplete. Once on the market, phase IV drug studies begin. For years, the drug was prescribed with less care to a large number of very heterogeneous patients and often in combination with other drugs. It is at this point that previously unknown adverse effects may appear, hence the need for the implementation of a pharmacovigilance system. Pharmacovigilance represents all methods for detecting, evaluating, informing and preventing the risks of adverse drug reactions. The most severe adverse events occur frequently in hospital and that a significant proportion of adverse events result in hospitalizations. In addition, the consequences of hospital adverse events in terms of length of stay, mortality and costs are considerable. It, therefore, appears necessary to develop ‘hospital pharmacovigilance’ aimed at reducing the incidence of adverse reactions in hospitals. The most widely used monitoring method in pharmacovigilance is spontaneous notification. However, underreporting of adverse drug reactions is common in many countries and is a major obstacle to pharmacovigilance assessment. It is in this context that this study aims to describe the experience of the pharmacovigilance service at the University Hospital of Oran (EHUO). This is a retrospective study extending from 2011 to 2017, carried out on archived records of declarations collected at the level of the EHUO Pharmacovigilance Department. Reporting was collected by two methods: ‘spontaneous notification’ and ‘active pharmacovigilance’ targeting certain clinical services. We counted 217 statements. It involved 56% female patients and 46% male patients. Age ranged from 5 to 78 years with an average of 46 years. The most common adverse reaction was drug toxidermy. For the drugs in question, they were essentially according to the ATC classification of anti-infectives followed by anticancer drugs. As regards the evolution of declarations by year, a low rate of notification was noted in 2011. That is why we decided to set up an active approach at the level of some services where a resident of reference attended the staffs every week. This has resulted in an increase in the number of reports. The declarations came essentially from the services where the active approach was installed. This highlights the need for ongoing communication between all relevant health actors to stimulate reporting and secure drug treatments.

Keywords: adverse drug reactions, hospital, pharmacovigilance, spontaneous notification

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Authors: Pedro Batista, André Vinha, Filipe Castelo, Bárbara Costa, Ricardo Sousa, Raquel Ricardo, André Pinto

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Background: Septic arthritis is a diagnosis that must be considered in any patient presenting with acute joint swelling and fever. Among the several risk factors for septic arthritis, such as age, rheumatoid arthritis, recent surgery, or skin infection, diabetes mellitus can sometimes be the main risk factor. Staphylococcus aureus is the most common pathogen isolated in septic arthritis; however, it is uncommon in monomicrobial necrotizing fasciitis. Objectives: A case report of concomitant septic arthritis and necrotizing fasciitis in a patient with undiagnosed diabetes based on clinical history. Study Design & Methods: We report a case of a 58-year-old Portuguese previously healthy man who presented to the emergency department with fever and left knee swelling and pain for two days. The blood work revealed ketonemia of 6.7 mmol/L and glycemia of 496 mg/dL. The vital signs were significant for a temperature of 38.5 ºC and 123 bpm of heart rate. The left knee had edema and inflammatory signs. Computed tomography of the left knee showed diffuse edema of the subcutaneous cellular tissue and soft tissue air bubbles. A diagnosis of septic arthritis and necrotising fasciitis was made. He was taken to the operating room for surgical debridement. The samples collected intraoperatively were sent for microbiological analysis, revealing infection by multi-sensitive Staphylococcus aureus. Given this result, the empiric flucloxacillin (500 mg IV) and clindamycin (1000 mg IV) were maintained for 3 weeks. On the seventh day of hospitalization, there was a significant improvement in subcutaneous and musculoskeletal tissues. After two weeks of hospitalization, there was no purulent content and partial closure of the wounds was possible. After 3 weeks, he was switched to oral antibiotics (flucloxacillin 500 mg). A week later, a urinary infection by Pseudomonas aeruginosa was diagnosed and ciprofloxacin 500 mg was administered for 7 days without complications. After 30 days of hospital admission, the patient was discharged home and recovered. Results: The final diagnosis of concomitant septic arthritis and necrotizing fasciitis was made based on the imaging findings, surgical exploration and microbiological tests results. Conclusions: Early antibiotic administration and surgical debridement are key in the management of septic arthritis and necrotizing fasciitis. Furthermore, risk factors control (euglycemic blood glucose levels) must always be taken into account given the crucial role in the patient's recovery.

Keywords: septic arthritis, Necrotizing fasciitis, diabetes, Staphylococcus Aureus

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Authors: Nirali Sanghavi, Julia Ash, Amy Wasserman

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Introduction: To the best of our knowledge, there is only one case report that found an association between leuprolide and scleroderma renal crisis (SRC). Leuprolide has been noted to cause acute renal failure in some patients. Given the close timing of the leuprolide injection and the worsening renal function in our patient, leuprolide likely caused exacerbation of lupus nephritis and SRC. Interestingly, our patient on long-term hydroxychloroquine (HCQ) with normal baseline cardiac function was found to have HCQ cardiomyopathy highlighting the need for close monitoring of HCQ toxicity. We know that some of the risk factors that are involved in HCQ induced cardiomyopathy are older age, females, increased dose and >10 years of HCQ use, and pre-existing cardiac and renal insufficiency. Case presentation: A 34-year-old African American woman with a history of overlap of systemic lupus erythematosus (SLE) and scleroderma features and class III lupus nephritis presented with severe headaches, elevated blood pressure (180/120 mmHg) and worsening creatinine levels (2.07 mg/dL). The headaches started 1 month ago after she started leuprolide injections for fibroids. She was being treated with mycophenolate mofetil 1 gm twice a day, belimumab weekly, HCQ 200mg, and prednisone 5 mg daily. She has been on HCQ since her teenage years. The examination was unremarkable except for proximal interphalangeal joint contractures in the right hand and sclerodactyly of bilateral hands, unchanged from baseline. Laboratory findings include urinalysis, which showed 3+ protein, 1+ blood, 6 red blood cells, and 14 white blood cells ruling out thrombotic microangiopathy. C3 was 32 mg/dL, C4 <5 mg/dL, and +dsDNA increased >1000. She was started on captopril and discharged once creatinine and blood pressure was controlled. She was readmitted with hypertension, hyperkalemia, worsening creatinine, nephrotic range proteinuria, complaints of chest pressure, and shortness of breath with pleuritic chest pain. Physical examination and lab findings were unchanged. She was treated with pulse dose methyl prednisone followed by taper and multiple anti-hypertensive agents, including captopril, for presumed lupus nephritis flare versus SRC. Renal biopsy was consistent with SRC and class IV lupus nephritis and was started on cyclophosphamide. While cardiac biopsy showed borderline myocarditis without necrosis and cytoplasmic vacuolization consistent with HCQ cardiomyopathy, hence HCQ was discontinued. Summary: It highlights a rare association of leuprolide causing exacerbation of lupus nephritis or SRC. Although rare, the current case reinforces the importance of close monitoring for HCQ toxicity in patients with renal insufficiency.

Keywords: leuprolide, lupus nephritis, scleroderma, SLE

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Authors: Tamar Grdzelishvili, Zaza Sinauridze

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Introduction: Preeclampsia is a complication of the second trimester of pregnancy, which is characterized by high morbidity and multiorgan damage. Many complex pathogenic mechanisms are now implicated to be responsible for this disease (1). Preeclampsia is one of the leading causes of maternal mortality worldwide. Statistics are enough to convince you of the seriousness of this pathology: about 100,000 women die of preeclampsia every year. It occurs in 3-14% (varies significantly depending on racial origin or ethnicity and geographical region) of pregnant women, in 75% of cases - in a mild form, and in 25% - in a severe form. During severe pre-eclampsia-eclampsia, perinatal mortality increases by 5 times and stillbirth by 9.6 times. Considering that the only way to treat the disease is to end the pregnancy, the main thing is timely diagnosis and prevention of the disease. Identification of high-risk pregnant women for PE and giving prophylaxis would reduce the incidence of preterm PE. First-trimester screening model developed by the Fetal Medicine Foundation (FMF), which uses the Bayes-theorem to combine maternal characteristics and medical history together with measurements of mean arterial pressure, uterine artery pulsatility index, and serum placental growth factor, has been proven to be effective and have superior screening performance to that of traditional risk factor-based approach for the prediction of PE (2) Methods: Retrospective single center screening study. The study population consisted of women from the Tbilisi maternity hospital “Pineo medical ecosystem” who met the following criteria: they spoke Georgian, English, or Russian and agreed to participate in the study after discussing informed consent and answering questions. Prior to the study, the informed consent forms approved by the Institutional Review Board were obtained from the study subjects. Early assessment of preeclampsia was performed between 11-13 weeks of pregnancy. The following were evaluated: anamnesis, dopplerography of the uterine artery, mean arterial blood pressure, and biochemical parameter: Pregnancy-associated plasma protein A (PAPP-A). Individual risk assessment was performed with performed by Fast Screen 3.0 software ThermoFisher scientific. Results: A total of 513 women were recruited and through the study, 51 women were diagnosed with preeclampsia (34.5% in the pregnant women with high risk, 6.5% in the pregnant women with low risk; P<0.000 1). Conclusions: First-trimester screening combining maternal factors with uterine artery Doppler, blood pressure, and pregnancy-associated plasma protein-A is useful to predict PE in a routine care setting. More patient studies are needed for final conclusions. The research is still ongoing.

Keywords: first-trimester, preeclampsia, screening, pregnancy-associated plasma protein

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Authors: Rajish Shil, Amal Alduhoori, Vipin Thomachan, Jamal Teir, Radhakrishnan Renganathan

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Background: Antiphospholipid antibody syndrome (APS) has a broad spectrum of thrombotic and non-thrombotic clinical manifestations. We present a case of APS presenting with seizure, stroke, and atrial mass. Case Description: A 38-year-old male presented with headache of 10 days duration and tonic-clonic seizure. The neurological examination was normal. Magnetic resonance imaging of brain showed small acute right cerebellar infarct. Magnetic resonance angiography of brain and neck showed a focal narrowing in the origin of the internal carotid artery bilaterally. Electroencephalogram was normal. He was started on aspirin, atorvastatin, and carbamazepine. Transthoracic and trans-esophageal echocardiography showed a pedunculated and lobular atrial mass, measuring 1 X 1.5 cm, which was freely mobile across mitral valve opening across the left ventricular inflow. Autoimmune screening showed positive Antiphospholipid antibodies in high titer (Cardiolipin IgG > 120 units/ml, B2 glycoprotein IgG 90 units/mL). Anti-nuclear antibody was negative. Erythrocyte sedimentation rate and C-reactive protein levels were normal. Platelet count was low (111 x 109/L). The patient underwent successful surgical removal of the mass, which looked like a thrombotic clot, and Histopathological analysis confirmed it as a fibrinous clot, with no evidence of tumor cells. The patient was started on full anticoagulation treatment and was followed up regularly in the clinic, where our patient did not have any further complications from the disease. Discussion: Our patient was diagnosed to have APS based on the features of high positive anticardiolipin antibody IgG and B2 glycoprotein IgG levels, Stroke, thrombocytopenia, and abnormal echo findings. Thrombotic vegetation can mimic an atrial myxoma on echo. Conclusion: APS can present with neurological and cardiac manifestations, and therefore a high index of suspicion is necessary for a diagnosis of the disease as it can affect both short and long term treatment plans and prognosis. Therefore, in patients presenting with neurological symptoms like seizures, weakness and radiological diagnosis of stroke in a young patient, where atrial masses could be thought to be the cause of stroke, they should be screened for any concomitant findings of thrombocytopenia and/or activated partial thromboplastin time prolongation, which should raise the suspicion of vasculitis, specifically APS to be the primary cause of the clinical presentation.

Keywords: antiphospholipid syndrome, seizures, atrial mass, stroke

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Authors: Alok Saini, Rajkumar Ghosh

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Water is nature's important resource for survival of all living things, but freshwater scarcity exists in some parts of world. This study has predicted that Gomti Nagar area (49.2 sq. km.) will harvest about 91110 ML of rainwater till 2051 (assuming constant and present annual rainfall). But 17.71 ML of rainwater was harvested from only 53 buildings in Gomti Nagar area in the year 2021. Water level will be increased (rise) by 13 cm in Gomti Nagar from such groundwater recharge. The total annual groundwater abstraction from Gomti Nagar area was 35332 ML (in 2021). Due to hydrogeological constraints and lower annual rainfall, groundwater recharge is less than groundwater abstraction. The recent scenario is only 0.07% of rainwater recharges by RTRWHs in Gomti Nagar. But if RTRWHs would be installed in all buildings then 12.39% of rainwater could recharge groundwater table in Gomti Nagar area. But if RTRWHs would be installed in all buildings then 12.39% of rainwater could recharge groundwater table in Gomti Nagar area. Gomti Nagar is situated in 'Zone–A' (water distribution area) and groundwater is the primary source of freshwater supply. Current scenario indicates only 0.07% of rainwater recharges by RTRWHs in Gomti Nagar. In Gomti Nagar, the difference between groundwater abstraction and recharge will be 735570 ML in 30 yrs. Statistically, all buildings at Gomti Nagar (new and renovated) could harvest 3037 ML of rainwater through RTRWHs annually. The most recent monsoonal recharge in Gomti Nagar was 10813 ML/yr. Harvested rainwater collected from RTRWHs can be used for rooftop irrigation, and residential kitchen and gardens (home grown fruit and vegetables). According to bylaws, RTRWH installations are required in both newly constructed and existing buildings plot areas of 300 sq. m or above. Harvested rainwater is of higher quality than contaminated groundwater. Harvested rainwater from RTRWHs can be considered water self-sufficient. Rooftop Rainwater Harvesting Systems (RTRWHs) are least expensive, eco-friendly, most sustainable, and alternative water resource for artificial recharge. This study also predicts about 3.9 m of water level rise in Gomti Nagar area till 2051, only when all buildings will install RTRWHs and harvest for groundwater recharging. As a result, this current study responds to an impact assessment study of RTRWHs implementation for the water scarcity problem in the Gomti Nagar area (1.36 sq.km.). This study suggests that common storage tanks (recharge wells) should be built for a group of at least ten (10) households and optimal amount of harvested rainwater will be stored annually. Artificial recharge from alternative water sources will be required to improve the declining water level trend and balance the groundwater table in this area. This over-exploitation of groundwater may lead to land subsidence, and development of vertical cracks.

Keywords: aquifer, aquitard, artificial recharge, bylaws, groundwater, monsoon, rainfall, rooftop rainwater harvesting system, RTRWHs water table, water level

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Authors: Saddam Hussain, Ghadeer Mohsen Albadrani

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Pakistan is one of the most vulnerable countries to climate change. Being a country where 23% of the country’s GDP relies on agriculture, this is a serious cause of concern. Introducing industrial hemp in Pakistan can help build climate resilience in the agricultural sector of the country, as hemp has recently emerged as a sustainable, eco-friendly, resource-efficient, and climate-resilient crop globally. Hemp has the potential to absorb huge amounts of CO₂, nourish the soil, and be used to create various biodegradable and eco-friendly products. Hemp is twice as effective as trees at absorbing and locking up carbon, with 1 hectare (2.5 acres) of hemp reckoned to absorb 8 to 22 tonnes of CO₂ a year, more than any woodland. Along with its high carbon-sequestration ability, it produces higher biomass and can be successfully grown as a cover crop. Hemp can grow in almost all soil conditions and does not require pesticides. It has fast-growing qualities and needs only 120 days to be ready for harvest. Compared with cotton, hemp requires 50% less water to grow and can produce three times higher fiber yield with a lower ecological footprint. Recently, the Government of Pakistan has allowed the cultivation of industrial hemp for industrial and medicinal purposes, making it possible for hemp to be reinserted into the country’s economy. Pakistan’s agro-climatic and edaphic conditions are well-suitable to produce industrial hemp, and its cultivation can bring economic benefits to the country. Pakistan can enter global markets as a new exporter of hemp products. The production of hemp in Pakistan can be most exciting to the workforce, especially for farmers participating in hemp markets. The minimum production cost of hemp makes it affordable to small holding farmers, especially those who need their cropping system to be as highly sustainable as possible. Dr. Saddam Hussain is leading the first pilot project of Industrial Hemp in Pakistan. In the past three years, he has been able to recruit high-impact research grants on industrial hemp as Principal Investigator. He has already screened the non-toxic hemp genotypes, tested the adaptability of exotic material in various agroecological conditions, formulated the production agronomy, and successfully developed the complete value chain. He has developed prototypes (fabric, denim, knitwear) using hemp fibre in collaboration with industrial partners and has optimized the indigenous fibre processing techniques. In this lecture, Dr. Hussain will talk on hemp agronomy and its complete fibre value chain. He will discuss the current progress, and will highlight the major challenges and future research direction on hemp research.

Keywords: industrial hemp, agricultural sustainability, agronomic evaluation, hemp value chain

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Authors: Kailash Chandra, Devanshu Gupta

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The Himalayan Mountains of India fall under two biogeographic zones Trans Himalaya (TH) and Himalaya and seven biotic provinces (TH-Ladakh Mountains, TH-Tibetan Plateau, TH-Sikkim, North-West Himalaya, West Himalaya, Central Himalaya, and East Himalaya). Because of the extreme environment and altitudinal variations, unique physiography, varied ecological conditions, and different vegetations, the Himalaya exhibit a rich assemblage of life, both flora, and fauna, further subjected to the impacts of climate change. To the authors’ best knowledge, there is no comprehensive account except for sporadic faunal investigations, to assess or interpret the insect diversity and their biogeographic distribution in Indian Himalaya (IH), one of the biodiversity hotspots. Therefore, in this paper, a compelling review of the extensive knowledge of insect diversity of IH is presented for the first time to the best of our knowledge. The inventory of the known insect species of IH was compiled from the exploration cum faunal-study data ready with the zoological survey of India, Kolkata as well as from the information published in the scientific literature till date. The species were listed with their valid names with their distribution in seven biotic provinces of IH. The insect fauna of IH represents about 38% of the identified insect diversity of India. The interpretation of data provided significant information in detecting possible gap areas in the taxonomic representation of different insect orders. Archaeognatha, Zygentoma, Ephemeroptera, Phasmida, Embioptera, Psocoptera, Phthiraptera, Strepsiptera, Megaloptera, Raphidioptera, Siphonaptera, and Mecoptera need revisions, and it is required to collect more samples from remote areas of the region. Scope for finding new taxa even in the most diverse orders, Coleoptera, Lepidoptera, Hymenoptera, Diptera, and Hemiptera cannot be overlooked. Exploration of cold deserts of Trans Himalaya and East Himalaya (Arunachal Pradesh) may result in a good number of new species from these regions. The most notable data was that many of the species recorded from Himalaya are still known from their type localities only, so there is an urgency to revisit and resurvey those collection localities for the evaluation of the status of those species. It is also required to assess and monitor the impact of climate change on the diversity of insects inhabiting in the fragile Himalayan ecosystem. DNA barcoding especially pests and biological control agents to solve the problems of identification in species complexes is also the need of the hour. In a nutshell, it can be concluded that the inventory of insects of this region is extensive but is far from final as every year hundreds of new species are described.

Keywords: catalog, climate change, diversity, DNA barcoding

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Authors: Giorgia Carratta

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Since the beginning of mass production, plastic items have been crucial in our daily lives. Thanks to their physical and chemical properties, plastic materials have proven almost irreplaceable in a number of economic sectors such as packaging, automotive, building and construction, textile, and many others. At the same time, the disruptive consequences of plastic pollution have been progressively brought to light in all environmental compartments. The overaccumulation of plastics in the environment, and its adverse effects on habitats, wildlife, and (most likely) human health, represents a call for action to decision-makers around the globe. From a regulatory perspective, plastic production is an unprecedented challenge at all levels of governance. At the international level, the design of new legal instruments, the amendment of existing ones, and the coordination among the several relevant policy areas requires considerable effort. Under the pressure of both increasing scientific evidence and a concerned public opinion, countries seem to slowly move towards the discussion of a new international ‘plastic treaty.’ However, whether, how, and with which scopes such instrument would be adopted is still to be seen. Additionally, governments are establishing regional-basedstrategies, prone to consider the specificities of the plastic issue in a certain geographical area. Thanks to the new Circular Economy Action Plan, approved in March 2020 by the European Commission, EU countries are slowly but steadily shifting to a carbon neutral, circular economy in the attempt to reduce the pressure on natural resources and, parallelly, facilitate sustainable economic growth. In this context, the EU Plastic Strategy is promising to change the way plastic is designed, produced, used, and treated after consumption. In fact, only in the EU27 Member States, almost 26 million tons of plastic waste are generated herein every year, whose 24,9% is still destined to landfill. Positive effects of the Strategy also include a more effective protection of our environment, especially the marine one, the reduction of greenhouse gas emissions, a reduced need for imported fossil energy sources, more sustainable production and consumption patterns. As promising as it may sound, the road ahead is still long. The need to implement these measures in domestic legislations makes their outcome difficult to predict at the moment. An analysis of the current international and European Union legal framework on plastic pollution, binding, and voluntary instruments included, could serve to detect ‘blind spots’ in the current governance as well as to facilitate the development of policy interventions along the plastic value chain, where it appears more needed.

Keywords: environmental law, European union, governance, plastic pollution, sustainability

Procedia PDF Downloads 109

Authors: Massimiliano Biagini, Marco Spinsanti, Gabriella De Angelis, Sara Tomei, Ilaria Ferlenghi, Maria Scarselli, Alessia Biolchi, Alessandro Muzzi, Brunella Brunelli, Silvana Savino, Marzia M. Giuliani, Isabel Delany, Paolo Costantino, Rino Rappuoli, Vega Masignani, Nathalie Norais

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The gram-negative bacterium Neisseria meningitidis serogroup B (MenB) is an exclusively human pathogen representing the major cause of meningitides and severe sepsis in infants and children but also in young adults. This pathogen is usually present in the 30% of healthy population that act as a reservoir, spreading it through saliva and respiratory fluids during coughing, sneezing, kissing. Among surface-exposed protein components of this diplococcus, factor H binding protein is a lipoprotein proved to be a protective antigen used as a component of the recently licensed Bexsero vaccine. fHbp is a highly variable meningococcal protein: to reflect its remarkable sequence variability, it has been classified in three variants (or two subfamilies), and with poor cross-protection among the different variants. Furthermore, the level of fHbp expression varies significantly among strains, and this has also been considered an important factor for predicting MenB strain susceptibility to anti-fHbp antisera. Different methods have been used to assess fHbp expression on meningococcal strains, however, all these methods use anti-fHbp antibodies, and for this reason, the results are affected by the different affinity that antibodies can have to different antigenic variants. To overcome the limitations of an antibody-based quantification, we developed a quantitative Mass Spectrometry (MS) approach. Selected Reaction Monitoring (SRM) recently emerged as a powerful MS tool for detecting and quantifying proteins in complex mixtures. SRM is based on the targeted detection of ProteoTypicPeptides (PTPs), which are unique signatures of a protein that can be easily detected and quantified by MS. This approach, proven to be highly sensitive, quantitatively accurate and highly reproducible, was used to quantify the absolute amount of fHbp antigen in total extracts derived from 105 clinical isolates, evenly distributed among the three main variant groups and selected to be representative of the fHbp circulating subvariants around the world. We extended the study at the genetic level investigating the correlation between the differential level of expression and polymorphisms present within the genes and their promoter sequences. The implications of fHbp expression on the susceptibility of the strain to killing by anti-fHbp antisera are also presented. To date this is the first comprehensive fHbp expression profiling in a large panel of Neisseria meningitidis clinical isolates driven by an antibody-independent MS-based methodology, opening the door to new applications in vaccine coverage prediction and reinforcing the molecular understanding of released vaccines.

Keywords: quantitative mass spectrometry, Neisseria meningitidis, vaccines, bexsero, molecular epidemiology

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Authors: Joo-Heon Lee, Ho-Won Jang, Hyung-Won Cho, Tae-Woong Kim

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Drought is a recurrent climatic feature that occurs in virtually every climatic zone around the world. Korea experiences the drought almost every year at the regional scale mainly during in the winter and spring seasons. Moreover, extremely severe droughts at a national scale also occurred at a frequency of six to seven years. Various drought indices had developed as tools to quantitatively monitor different types of droughts and are utilized in the field of drought analysis. Since drought is closely related with climatological and topographic characteristics of the drought prone areas, the basins where droughts are frequently occurred need separate drought preparedness and contingency plans. In this study, an analysis using statistical methods was carried out for the historical droughts occurred in the five major river basins in Korea so that drought characteristics can be quantitatively investigated. It was also aimed to provide information with which differentiated and customized drought preparedness plans can be established based on the basin level analysis results. Conventional methods which quantifies drought execute an evaluation by applying a various drought indices. However, the evaluation results for same drought event are different according to different analysis technique. Especially, evaluation of drought event differs depend on how we view the severity or duration of drought in the evaluation process. Therefore, it was intended to draw a drought history for the most severely affected five major river basins of Korea by investigating a magnitude of drought that can simultaneously consider severity, duration, and the damaged areas by applying drought run theory with the use of SPI (Standardized Precipitation Index) that can efficiently quantifies meteorological drought. Further, quantitative analysis for the historical extreme drought at various viewpoints such as average severity, duration, and magnitude of drought was attempted. At the same time, it was intended to quantitatively analyze the historical drought events by estimating the return period by derived SDF (severity-duration-frequency) curve for the five major river basins through parametric regional drought frequency analysis. Analysis results showed that the extremely severe drought years were in the years of 1962, 1988, 1994, and 2014 in the Han River basin. While, the extreme droughts were occurred in 1982 and 1988 in the Nakdong river basin, 1994 in the Geumg basin, 1988 and 1994 in Youngsan river basin, 1988, 1994, 1995, and 2000 in the Seomjin river basin. While, the extremely severe drought years at national level in the Korean Peninsula were occurred in 1988 and 1994. The most damaged drought were in 1981~1982 and 1994~1995 which lasted for longer than two years. The return period of the most severe drought at each river basin was turned out to be at a frequency of 50~100 years.

Keywords: drought magnitude, regional frequency analysis, SPI, SDF(severity-duration-frequency) curve

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Authors: Cory B. Lord

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Falls among the elderly population has become an area of concern in healthcare today. The negative impacts of falls lead to increased morbidity, mortality, and financial burdens for both patients and healthcare systems. Falls in the United States is reported at an annual rate of 36 million in those aged 65 and older. Each year, one out of four people in this age group will suffer a fall, with 20% of these falls causing injury. The setting for this Doctor of Nursing Practice (DNP) project was a memory care unit in an assisted living community, as these facilities house cognitively impaired older adults. These communities lack fall prevention programs; therefore, the need exists to add to the body of knowledge to positively impact this population. The objective of this project was to reduce fall rates through the implementation of the Center for Disease Control and Prevention (CDC) STEADI (stopping elderly accidents, deaths, and injuries) program. The DNP project performed was a quality improvement pilot study with a pre and post-test design. This program was implemented in the memory care setting over 12 weeks. The project included an educational session for staff and a fall risk assessment with appropriate resident referrals. The three aims of the DNP project were to reduce fall rates among the elderly aged 65 and older who reside in the memory care unit, increase staff knowledge of STEADI fall prevention measures after an educational session, and assess the willingness of memory care unit staff to adopt an evidence-based a fall prevention program. The Donabedian model was used as a guiding conceptual framework for this quality improvement pilot study. The fall rate data for 12 months before the intervention was evaluated and compared to post-intervention fall rates. The educational session comprised of a pre and post-test to assess staff knowledge of the fall prevention program and the willingness of staff to adopt the fall prevention program. The overarching goal was to reduce falls in the elderly population who live in memory care units. The results of the study showed, on average that the fall rate during the implementation period of STEADI (μ=6.79) was significantly lower when compared to the prior 12 months (μ= 9.50) (p=0.02, α = 0.05). The mean staff knowledge scores improved from pretest (μ=77.74%) to post-test (μ=87.42%) (p=0.00, α= 0.05) after the education session. The results of the willingness to adopt a fall prevention program were scored at 100%. In summation, implementing the STEADI fall prevention program can assist in reducing fall rates for residents aged 65 and older who reside in a memory care setting.

Keywords: dementia, elderly, falls, STEADI

Procedia PDF Downloads 135

Authors: Z. A. Ahmad Noor Syukri, A. J. Nawal Aswan, S. V. Wong

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The motorcycle has become one of the most common type of vehicles used on the road, particularly in the Asia region, including Malaysia, due to its size-convenience and affordable price. This study focuses only on crashes involving motorcycles with passenger cars consisting 43 real world crashes obtained from in-depth crash investigation process from June 2016 till July 2017. The study collected and analyzed vehicle and site parameters obtained during crash investigation and injury information acquired from the patient-treating hospital. The investigation team, consisting of two personnel, is stationed at the Emergency Department of the treatment facility, and was dispatched to the crash scene once receiving notification of the related crashes. The injury information retrieved was coded according to the level of severity using the Abbreviated Injury Scale (AIS) and classified into different body regions. The data revealed that weekend crashes were significantly higher for the night time period and the crash occurrence was the highest during morning hours (commuting to work period) for weekdays. Bad weather conditions play a minimal effect towards the occurrence of motorcycle – passenger vehicle crashes and nearly 90% involved motorcycles with single riders. Riders up to 25 years old are heavily involved in crashes with passenger vehicles (60%), followed by 26-55 year age group with 35%. Male riders were dominant in each of the age segments. The majority of the crashes involved side impacts, followed by rear impacts and cars outnumbered the rest of the passenger vehicle types in terms of crash involvement with motorcycles. The investigation data also revealed that passenger vehicles were the most at-fault counterpart (62%) when involved in crashes with motorcycles and most of the crashes involved situations whereby both of the vehicles are travelling in the same direction and one of the vehicles is in a turning maneuver. More than 80% of the involved motorcycle riders had sustained yellow severity level during triage process. The study also found that nearly 30% of the riders sustained injuries to the lower extremities, while MAIS level 3 injuries were recorded for all body regions except for thorax region. The result showed that crashes in which the motorcycles were found to be at fault were more likely to occur during night and raining conditions. These types of crashes were also found to be more likely to involve other types of passenger vehicles rather than cars and possess higher likelihood in resulting higher ISS (>6) value to the involved rider. To reduce motorcycle fatalities, it first has to understand the characteristics concerned and focus may be given on crashes involving passenger vehicles as the most dominant crash partner on Malaysian roads.

Keywords: motorcycle crash, passenger vehicle, in-depth crash investigation, injury mechanism

Procedia PDF Downloads 324

Authors: Diana Cunha, Catarina Coelho, Ana Paula Relvas, Elisabeth Kastenholz

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Context: Tourist experiences have a recognized impact on the well-being of individuals. However, studies on the specific benefits of tourist experiences for families are scattered across different disciplines. This study aims to systematically review the literature to synthesize the evidence on the benefits of tourist experiences for families. Research Aim: The main objective is to systematize the evidence in the literature regarding the benefits of tourist experiences for families. Methodology: A systematic literature review was conducted using Nvivo, analyzing 33 scientific studies obtained from various databases. The search terms used were "family"/ "couple" and "tourist experience". The studies included quantitative, qualitative, mixed methods, and literature reviews. All works prior to the year 2000 were excluded, and the search was restricted to full text. A language filter was also used, considering articles in Portuguese, English, and Spanish. For NVivo analysis, information was coded based on both deductive and inductive perspectives. To minimize the subjectivity of the selection and coding process, two of the authors discussed the process and agreed on criteria that would make the coding more objective. Once the coding process in NVivo was completed, the data relating to the identification/characterization of the works were exported to the Statistical Package for the Social Sciences (SPPS), to characterize the sample. Findings: The results highlight that tourist experiences have several benefits for family systems, including the strengthening of family and marital bonds, the creation of family memories, and overall well-being and life satisfaction. These benefits contribute to both immediate relationship quality improvement and long-term family identity construction and transgenerational transmission. Theoretical Importance: This study emphasizes the systemic nature of the effects and relationships within family systems. It also shows that no harm was reported within these experiences, with only some challenges related to positive outcomes. Data Collection and Analysis Procedures: The study collected data from 33 scientific studies published predominantly after 2013. The data were analyzed using Nvivo, employing a systematic review approach. Question Addressed: The study addresses the question of the benefits of tourist experiences for families and how these experiences contribute to family functioning and individual well-being. Conclusion: Tourist experiences provide opportunities for families to enhance their interpersonal relationships and create lasting memories. The findings suggest that formal interventions based on evidence could further enhance the potential benefits of these experiences and be a valuable preventive tool in therapeutic interventions.

Keywords: family systems, individual and family well-being, marital satisfaction, tourist experiences

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Authors: Michael Kenomore, Mohamed Hassan, Amjad Shah, Hom Dhakal

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Shale gas reservoirs have been of greater importance compared to shale oil reservoirs since 2009 and with the current nature of the oil market, understanding the technical and economic performance of shale gas reservoirs is of importance. Using the Barnett shale as a case study, an economic model was developed to quantify the effect of finding and development costs and gas prices on the basins in the Barnett shale using net present value as an evaluation parameter. A rate of return of 20% and a payback period of 60 months or less was used as the investment hurdle in the model. The Barnett was split into four basins (Strawn Basin, Ouachita Folded Belt, Forth-worth Syncline and Bend-arch Basin) with analysis conducted on each of the basin to provide a holistic outlook. The dataset consisted of only horizontal wells that started production from 2008 to at most 2015 with 1835 wells coming from the strawn basin, 137 wells from the Ouachita folded belt, 55 wells from the bend-arch basin and 724 wells from the forth-worth syncline. The data was analyzed initially on Microsoft Excel to determine the estimated ultimate recoverable (EUR). The range of EUR from each basin were loaded in the Palisade Risk software and a log normal distribution typical of Barnett shale wells was fitted to the dataset. Monte Carlo simulation was then carried out over a 1000 iterations to obtain a cumulative distribution plot showing the probabilistic distribution of EUR for each basin. From the cumulative distribution plot, the P10, P50 and P90 EUR values for each basin were used in the economic model. Gas production from an individual well with a EUR similar to the calculated EUR was chosen and rescaled to fit the calculated EUR values for each basin at the respective percentiles i.e. P10, P50 and P90. The rescaled production was entered into the economic model to determine the effect of the finding and development cost and gas price on the net present value (10% discount rate/year) as well as also determine the scenario that satisfied the proposed investment hurdle. The finding and development costs used in this paper (assumed to consist only of the drilling and completion costs) were £1 million, £2 million and £4 million while the gas price was varied from $2/MCF-$13/MCF based on Henry Hub spot prices from 2008-2015. One of the major findings in this study was that wells in the bend-arch basin were least economic, higher gas prices are needed in basins containing non-core counties and 90% of the Barnet shale wells were not economic at all finding and development costs irrespective of the gas price in all the basins. This study helps to determine the percentage of wells that are economic at different range of costs and gas prices, determine the basins that are most economic and the wells that satisfy the investment hurdle.

Keywords: shale gas, Barnett shale, unconventional gas, estimated ultimate recoverable

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Authors: Saori Iwatsuka

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In The Member of the Wedding, Carson McCullers starts with the words, “It happened,” without telling the reader what happens to a twelve-year-old protagonist, Frankie Adams. The reader feels confused and incomprehensible. However, he or she later realizes that the confusing phrase is connected to the scene where Frankie feels “the thing happened” after listening to the melodic lines of jazz and blues. Yet, the reader cannot really comprehend what happens to Frankie and feels puzzled till the end. And the story ends with Frankie’s words, “I am simply mad about . . .” Implying her queer desire for her new friend Mary Littlejohn, McCullers never tells the reader whom Frankie is mad about. Despite McCullers’s ambiguous way of depicting Frankie’s sexuality, recent critics and reviewers have come to discuss her sexuality as anti-heterosexual because Frankie expresses her hatred for Barney, whom she has had some type of sexual encounter, and feels wrong with her brother Jarvis’s wedding. After giving up her sexual desire for Jarvis’s bride, Janice, Frankie changes her name to Frances, becomes engrossed with Michelangelo, and enjoys reading Tennyson’s poetry with Mary. Michelangelo and Tennyson are well-known homosexual artists, which suggests that Frankie has an anti-heterosexual orientation. As McCullers does not precisely describe Frankie’s sexuality, the reader can only assume it by connecting fragmentary descriptions. However, this discussion is more clarified to show Frankie’s sexuality because analyzing the musical references of jazz and blues and interpreting them from a musicological viewpoint will illuminate it. In her works, McCullers frequently uses musical references and descriptions, which have a significant and psychological impact on the protagonists and portrays their bodily reactions to the impact to reveal what the reader cannot see on the surface. Thus, in this story, too, Frankie’s bodily reaction to music is portrayed to cue her feelings. After seeing the chimney swifts, known as monogamous birds, Frankie feels “a jazz sadness,” quivers her nerves and stiffens her heart. After listening to Berenice’s “dark jazz voice,” Frankie feels dizzy and throws a knife because Berenice’s voice jazzes (excites) her heart that beats in her head. Calming herself, she fantasizes that Jarvis, Jarvis’s bride, Janice, and herself are members of “the we of me.” Then in the evening, listening to the blues and jazz being played by a black horn player somewhere in her neighborhood, Frankie realizes “the thing happened” and discovers “a new feeling.” Following the musical references “jazz” and “blues” and examining them from the viewpoint of musicology and terminology leads the reader to explore what “it” is in “it happened” and what her “new feeling” is when “the thing happened” with the blues tune breaking off. Those discussions will illuminate Frankie’s sexuality. As McCullers does not clearly name her sexuality, this paper uses the word queer to express Frankie’s anti-sexual orientation.

Keywords: jazz and blues, musical references, queer sexuality, “we of me”

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Authors: Prema Basargekar

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Facilitating the subject ‘Entrepreneurship Education’ in higher education, such as management studies, can be exhilarating as well as challenging. It is a multi-disciplinary and ever-evolving subject. Capturing entrepreneurship as a phenomenon in a holistic manner is a daunting task as it requires covering various dimensions such as new ideas generation, entrepreneurial traits, business opportunities scanning, the role of policymakers, value creation, etc., to name a few. Implicit entrepreneurship theory and effectuation are two different theories that focus on engaging the participants to create content by using their own experiences, perceptions, and belief systems. It helps in understanding the phenomenon holistically. The assumption here is that all of us are part of the entrepreneurial ecosystem, and effective learning can come through active engagement and peer learning by all the participants together. The present study is an attempt to use these theories in the class assignment given to the students at the beginning of the course to build the course content and understand entrepreneurship as a phenomenon in a better way through peer learning. The assignment was given to three batches of MBA post-graduate students doing the program in one of the private business schools in India. The subject of ‘Entrepreneurship Management’ is facilitated in the third trimester of the first year. At the beginning of the course, the students were given the assignment to submit a brief write-up/ collage/picture/poem or in any other format about “What entrepreneurship means to you?” They were asked to give their candid opinions about entrepreneurship as a phenomenon as they perceive it. Nearly 156 students doing post-graduate MBA submitted the assignment. These assignments were further used to find answers to two research questions. – 1) Are students able to use divergent and innovative forms to express their opinions, such as poetry, illustrations, videos, etc.? 2) What are various dimensions of entrepreneurship which are emerging to understand the phenomenon in a better way? The study uses the Brawn and Clark framework of reflective thematic analysis for qualitative analysis. The study finds that students responded to this assignment enthusiastically and expressed their thoughts in multiple ways, such as poetry, illustration, personal narrative, videos, etc. The content analysis revealed that there could be seven dimensions to looking at entrepreneurship as a phenomenon. They are 1) entrepreneurial traits, 2) entrepreneurship as a journey, 3) value creation by entrepreneurs in terms of economic and social value, 4) entrepreneurial role models, 5) new business ideas and innovations, 6) personal entrepreneurial experiences and aspirations, and 7) entrepreneurial ecosystem. The study concludes that an implicit approach to facilitate entrepreneurship education helps in understanding it as a live phenomenon. It also encourages students to apply divergent and convergent thinking. It also helps in triggering new business ideas or stimulating the entrepreneurial aspirations of the students. The significance of the study lies in the application of implicit theories in the classroom to make higher education more engaging and effective.

Keywords: co-creation of content, divergent thinking, entrepreneurship education, implicit theory

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Authors: Chiu-Wen Chang, I-Yun Chang, Wei-Ting Chen, Hui-Ping Ho, Ruei-Hun Chang, Joh-Jong Huang

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Kaohsiung City is located in the tropical region where has Aedes aegypti and Aedes albopictus distributed; once the virus invades, it’s can easily trigger local epidemic. Besides, Kaohsiung City has a world-class airport and harbor, trade and tourism are close and frequently with every country, especially with the Southeast Asian countries which also suffer from dengue. Therefore, Kaohsiung City faces the difficult challenge of dengue every year. The objectives of this study was to enhance dengue clinical care, border management and vector surveillance in Kaohsiung City by establishing an larger scale, innovatively and more coordinated dengue prevention and control strategies in 2016, including (1) Integrated medical programs: facilitated 657 contract medical institutions, widely set up NS1 rapid test in clinics, enhanced triage and referrals system, dengue case daily-monitoring management (2) Border quarantine: comprehensive NS1 screening for foreign workers and fisheries when immigration, hospitalization and isolation for suspected cases, health education for high risk groups (foreign students, other tourists) (3) Mosquito control: Widely use Gravitrap to monitor mosquito density in environment, use NS1 rapid screening test to detect community dengue virus (4) Health education: create a dengue app for people to immediately inquire the risk map and nearby medical resources, routine health education to all districts to strengthen public’s dengue knowledge, neighborhood cleaning awards program. The results showed that after new integration of dengue prevention and control strategies fully implemented in Kaohsiung City, the number of confirmed cases in 2016 declined to 342 cases, the majority of these cases are the continuation epidemic in 2015; in fact, only two cases confirmed after the 2016 summer. Besides, the dengue mortality rate successfully decreased to 0% in 2016. Moreover, according to the reporting rate from medical institutions in 2014 and 2016, it dropped from 27.07% to 19.45% from medical center, and it decreased from 36.55% to 29.79% from regional hospital; however, the reporting rate of district hospital increased from 11.88% to 15.87% and also increased from 24.51% to 34.89% in general practice clinics. Obviously, it showed that under the action of strengthening medical management, it reduced the medical center’s notification ratio and improved the notification ratio of general clinics which achieved the great effect of dengue clinical management and dengue control.

Keywords: dengue control, integrated control strategies, clinical management, NS1

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Authors: Balarabe Z. Ahmad, Anne-Lorène Vernay

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The emergence of electricity in Nigeria was dated back to 1896. The power plants have the potential to generate 12,522 MW of electric power. Whereas current dispatch is about 4,000 MW, access to electrification is about 60%, with consumption at 0.14 MWh/capita. The government embarked on energy reforms to mitigate energy poverty. The reform targeted the provision of electricity access to 75% of the population by 2020 and 90% by 2030. Growth of total electricity demand by a factor of 5 by 2035 had been projected. This means that Nigeria will require almost 530 TWh of electricity which can be delivered through generators with a capacity of 65 GW. Analogously, the geographical location of Nigeria has placed it in an advantageous position as the source of solar energy; the availability of a high sunshine belt is obvious in the country. The implication is that the far North, where energy poverty is high, equally has about twice the solar radiation as against southern Nigeria. Hence, the chance of generating solar electricity is 66% possible at 11850 x 103 GWh per year, which is one hundred times the current electricity consumption rate in the country. Harvesting these huge potentials may be a mirage if the entrepreneurs in the solar panel business are left with the conventional business models that are not uncertainty resilient. Currently, business entities in RE in Nigeria are uncertain of; accessing the national grid, purchasing potentials of cooperating organizations, currency fluctuation and interest rate increases. Uncertainties such as the security of projects and government policy are issues entrepreneurs must navigate to remain sustainable in the solar panel industry in Nigeria. The aim of this paper is to identify how entrepreneurial firms consider uncertainties in developing workable business models for commercializing solar energy projects in Nigeria. In an attempt to develop a novel business model, the paper investigated how entrepreneurial firms assess and navigate uncertainties. The roles of key stakeholders in helping entrepreneurs to manage uncertainties in the Nigeria RE sector were probed in the ongoing study. The study explored empirical uncertainties that are peculiar to RE entrepreneurs in Nigeria. A mixed-mode of research was embraced using qualitative data from face-to-face interviews conducted on the Solar Energy Entrepreneurs and the experts drawn from key stakeholders. Content analysis of the interview was done using Atlas. It is a nine qualitative tool. The result suggested that all stakeholders are required to synergize in developing an uncertainty resilient business model. It was opined that the RE entrepreneurs need modifications in the business recommendations encapsulated in the energy policy in Nigeria to strengthen their capability in delivering solar energy solutions to the yawning Nigerians.

Keywords: uncertainties, entrepreneurial, business model, solar-panel

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Authors: E. Rommes, Els Toonen, Rahil Roodsaz, Suborna Camellia, Farhana Alam, Saad Khan, Jhalok Ranjon Talukder, Tanveer Hassan, Syeda Farjana Ahmed, Sabina Faiz Rashid

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In Bangladesh, a country in which adults (both parents and teachers) find it particularly hard to speak with youth about sexuality, adolescents seem to struggle with various insecurities about their sexual feelings, thoughts, behavior and physical characteristics. On the basis of a large number of interviews and focus groups with rural and urban Bangla adolescent girls and boys of lower and middle class as part of the large-scale three-year project ‘Breaking the Shame’, we have identified ten sexual themes or ‘myths’ that youth struggle with most. These encompass amongst others beliefs and insecurities on masturbation, discharge, same-sex behavior and feelings, the effects of watching porn and gender norms. We argue that the Internet is a particularly suitable medium to ‘debunk’ those myths, as youth can consult it anonymously and privately and so avoid social shame. Moreover, amongst the myths, we have identified two kinds which may need different debunking techniques. One kind of myth concerns scientifically uncontested, generally biological related information, such as the effects of having sex with a pregnant woman, questions on the effects of a penile or vaginal discharge or questions on the effects of masturbation. The second kind of myths concerns more diverse information sources and deals with e.g. religious or culturally specific norms, such as on the meaning and existence of homosexuality or gender appropriate norms of behavior in Bangladesh. For addressing both kinds of myths, expert information including a wealth of references to information resources needs to be provided, which the Internet is very suitable for. For the second kind of myths, adolescents also need to learn how to deal with sometimes conflicting norms and information sources, and they need to develop and reflect on their own opinions as part of their identity formation. On the basis of a literature review, we thus distinguish general information needs from identity formation needs, which includes the need to be able to relate information and opinions to one’s own opinions and situation. Hence, we argue that youth not only need abstract expert information to be able to debunk sexual myths, but also the option to discuss this information with other adolescents and compare their own situation and opinions with other peers, who in that way serve as ‘warm experts’ for each other. In this paper, we will describe the outcomes of our qualitative study above. In addition, we will present our findings of an intervention by presenting youth with general, uncontested information on the Internet with additional peer discussion options to compare the debunking effects on different kinds of myths.

Keywords: peer discussion, intervention, sexual myths, shame

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Authors: Taif Rocky, Uttam Saha, Mahobul Islam

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With a rapid urbanisation in Bangladesh, waste management remains one of the core challenges. Turning municipal waste into biogas for mass usage is a solution that Bangladesh needs to adopt urgently. Practical Action with its commitment to challenging poverty with technological justice has piloted such idea in Gaibandha. The initiative received immense success and drew the attention of policy makers and practitioners. We believe, biogas from waste can highly contribute to meet the growing demand for energy in the country at present and in the future. Practical Action has field based experience in promoting small scale and innovative technologies. We have proven track record in integrated solid waste management. We further utilized this experience to promote waste to biogas at end users’ level. In 2011, we have piloted a project on waste to biogas in Gaibandha, a northern secondary town of Bangladesh. With resource and support from UNICEF and with our own innovative funds we have established a complete chain of utilizing waste to the renewable energy source and organic fertilizer. Biogas is produced from municipal solid waste, which is properly collected, transported and segregated by private entrepreneurs. The project has two major focuses, diversification of biogas end use and establishing a public-private partnership business model. The project benefits include Recycling of Wastes, Improved institutional (municipal) capacity, Livelihood from improved services and Direct Income from the project. Project risks include Change of municipal leadership, Traditional mindset, Access to decision making, Land availability. We have observed several outcomes from the initiative. Up scaling such an initiative will certainly contribute for sustainable cleaner and healthier urban environment and urban poverty reduction. - It reduces the unsafe disposal of wastes which improve the cleanliness and environment of the town. -Make drainage system effective reducing the adverse impact of water logging or flooding. -Improve public health from better management of wastes. -Promotes usage of biogas replacing the use of firewood/coal which creates smoke and indoor air pollution in kitchens which have long term impact on health of women and children. -Reduce the greenhouse gas emission from the anaerobic recycling of wastes and contributes to sustainable urban environment. -Promote the concept of agroecology from the uses of bio slurry/compost which contributes to food security. -Creates green jobs from waste value chain which impacts on poverty alleviation of urban extreme poor. -Improve municipal governance from inclusive waste services and functional partnership with private sectors. -Contribute to the implementation of 3R (Reduce, Reuse, Recycle) Strategy and Employment Creation of extreme poor to achieve the target set in Vision 2021 by Government of Bangladesh.

Keywords: kitchen waste, secondary town, biogas, segregation

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Authors: Sarah Hazelwood, Janice Hay

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Methoxyflurane is an inhaled analgesic administered via a disposable inhaler, which has been used in Australia for 40 years for the management of pain in children & adults. However, there is a lack of data for methoxyflurane as a frontline analgesic medication within the emergency department (ED). This study will investigate the usefulness of methoxyflurane in a private inner-city ED. The study concluded that the inclusion of all key stakeholders in the prescribing, administering & use of this new process led to comprehensive uptake & vastly positive outcomes for consumer & health professionals. Method: A 12-week prospective pilot study was completed utilizing patients presenting to the ED in pain (numeric pain rating score > 4) that fit the requirement of methoxyflurane use (as outlined in the Australian Prescriber information package). Nurses completed a formatted spreadsheet for each interaction where methoxyflurane was used. Patient demographics, day, time, initial numeric pain score, analgesic response time, the reason for use, staff concern (free text), & patient feedback (free text), & discharge time was documented. When clinical concern was raised, the researcher retrieved & reviewed patient notes. Results: 140 methoxyflurane inhalers were used. 60% of patients were 31 years of age & over (n=82) with 16% aged 70+. The gender split; 51% male: 49% female. Trauma-related pain (57%) saw the highest use of administration, with the evening hours (1500-2259) seeing the greatest numbers used (39%). Tuesday, Thursday & Sunday shared the highest daily use throughout the study. A minimum numerical pain score of 4/10 (n=13, 9%), with the ranges of 5 - 7/10 (moderate pain) being given by almost 50% of patients. Only 3 instances of pain scores increased post use of methoxyflurane (all other entries showed pain score < initial rating). Patients & staff noted obvious analgesic response within 3 minutes (n= 96, 81%, of administration). Nurses documented a change in patient vital signs for 4 of the 15 patient-related concerns; the remaining concerns were due to “gagging” on the taste, or “having a coughing episode”; one patient tried to leave the department before the procedure was attended (very euphoric state). Upon review of the staff concerns – no adverse events occurred & return to therapeutic vitals occurred within 10 minutes. Length of stay for patients was compared with similar presentations (such as dislocated shoulder or ankle fracture) & saw an average 40-minute decrease in time to discharge. Methoxyflurane treatment was rated “positively” by > 80% of patients – with remaining feedback related to mild & transient concerns. Staff similarly noted a positive response to methoxyflurane as an analgesic & as an added tool for frontline analgesic purposes. Conclusion: Methoxyflurane should be used on suitable patient presentations requiring immediate, short term pain relief. As a highly portable, non-narcotic avenue to treat pain this study showed obvious therapeutic benefit, positive feedback, & a shorter length of stay in the ED. By partnering with key stake holders, this study determined methoxyflurane use decreased work load, decreased wait time to analgesia, and increased patient satisfaction.

Keywords: analgesia, benefits, emergency, methoxyflurane

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Authors: Nzereogu Stella Kosi, Igwe Ogbonnaya, Emeh Chukwuebuka Odinaka

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A comparative analysis of the expansion rate and soil erodibility of some gullies in Nnewi and Nnobi both of Nanka Formation were studied. The study involved an integration of field observations, geotechnical analysis, slope stability analysis, multivariate statistical analysis, gully expansion rate analysis, and determination of the soil erodibility factor (K) from Revised Universal Soil Loss Equation (RUSLE). Fifteen representative gullies were studied extensively, and results reveal that the geotechnical properties of the soil, topography, vegetation cover, rainfall intensity, and the anthropogenic activities in the study area were major factors propagating and influencing the erodibility of the soils. The specific gravity of the soils ranged from 2.45-2.66 and 2.54-2.78 for Nnewi and Nnobi, respectively. Grain size distribution analysis revealed that the soils are composed of gravel (5.77-17.67%), sand (79.90-91.01%), and fines (2.36-4.05%) for Nnewi and gravel (7.01-13.65%), sand (82.47-88.67%), and fines (3.78-5.02%) for Nnobi. The soils are moderately permeable with values ranging from 2.92 x 10-5 - 6.80 x 10-4 m/sec and 2.35 x 10-6 - 3.84 x 10⁻⁴m/sec for Nnewi and Nnobi respectively. All have low cohesion values ranging from 1–5kPa and 2-5kPa and internal friction angle ranging from 29-38° and 30-34° for Nnewi and Nnobi, respectively, which suggests that the soils have low shear strength and are susceptible to shear failure. Furthermore, the compaction test revealed that the soils were loose and easily erodible with values of maximum dry density (MDD) and optimum moisture content (OMC) ranging from 1.82-2.11g/cm³ and 8.20-17.81% for Nnewi and 1.98-2.13g/cm³ and 6.00-17.80% respectively. The plasticity index (PI) of the fines showed that they are nonplastic to low plastic soils and highly liquefiable with values ranging from 0-10% and 0-9% for Nnewi and Nnobi, respectively. Multivariate statistical analyses were used to establish relationship among the determined parameters. Slope stability analysis gave factor of safety (FoS) values in the range of 0.50-0.76 and 0.82-0.95 for saturated condition and 0.73-0.98 and 0.87-1.04 for unsaturated condition for both Nnewi and Nnobi, respectively indicating that the slopes are generally unstable to critically stable. The erosion expansion rate analysis for a fifteen-year period (2005-2020) revealed an average longitudinal expansion rate of 36.05m/yr, 10.76m/yr, and 183m/yr for Nnewi, Nnobi, and Nanka type gullies, respectively. The soil erodibility factor (K) are 8.57x10⁻² and 1.62x10-4 for Nnewi and Nnobi, respectively, indicating that the soils in Nnewi have higher erodibility potentials than those of Nnobi. From the study, both the Nnewi and Nnobi areas are highly prone to erosion. However, based on the relatively lower fine content of the soil, relatively lower topography, steeper slope angle, and sparsely vegetated terrain in Nnewi, soil erodibility and gully intensity are more profound in Nnewi than Nnobi.

Keywords: soil erodibility, gully expansion, nnewi-nnobi, slope stability, factor of safety

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