Search results for: central government constraint and incentive mechanism
Commenced in January 2007
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Edition: International
Paper Count: 9731

Search results for: central government constraint and incentive mechanism

551 Industrial Hemp Agronomy and Fibre Value Chain in Pakistan: Current Progress, Challenges, and Prospects

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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550 Active Victim Participation in the Criminal Justice System: The Indian Scenario

Authors: Narayani Sepaha

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In earlier days, the sufferer was burdened to prove the offence as well as to put the offender to punishment. The adversary system of legal procedure was characterized simply by two parties: the prosecution and the defence. With the onset of this system, firstly the judge started acting as a neutral arbitrator, and secondly, the state inadvertently started assuming the lead role and thereby relegated the victims to the position of oblivion. In this process, with the increasing role of police forces and the government, the victims got systematically excluded from the key stages of the case proceedings and were reduced to the stature of a prosecution witness. This paper tries to emphasise the increasing control over the various stages of the trial, by other stakeholders, leading to the marginalization of victims in the trial process. This monopolization has signalled the onset of an era of gross neglect of victims in the whole criminal justice system. This consciousness led some reformists to raise their concerns over the issue, during the early part of the 20th century. They started supporting the efforts which advocated giving prominence to the participation of victims in the trial process. This paved the way for the evolution of the science of victimology. Markedly the innovativeness to work out facts, seek opinions and statements of the victims and reassure that their voice is also heard has ensured the revival of their rightful roles in the justice delivery system. Many countries, like the US, have set an example by acknowledging the advantages of participation of victims in trials like in the proceedings of the Ariel Castro Kidnappings of Cleveland, Ohio and enacting laws for protecting their rights within the framework of the legal system to ensure speedy and righteous delivery of justice in some of the most complicated cases. An attempt has been made to flag that the accused have several rights in contrast to the near absence of separate laws for victims of crime, in India. It is sad to note that, even in the initial process of registering a crime the victims are subjected to the mercy of the officers in charge and thus begins the silent suffering of these victims, which continues throughout the process of their trial. The paper further contends, that the degree of victim participation in trials and its impact on the outcomes, can be debated and evaluated, but its potential to alter their position and make them regain their lost status cannot be ignored. Victim participation in trial proceedings will help the court in perceiving the facts of the case in a better manner and in arriving at a balanced view of the case. This will not only serve to protect the overall interest of the victims but will act to reinforce the faith in the criminal justice delivery system. It is pertinent to mention that there is an urgent need to review the accused centric prosecution system and introduce appropriate amendments so that the marginalization of victims comes to an end.

Keywords: victim participation, criminal justice, India, trial, marginalised

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549 Validation of Asymptotic Techniques to Predict Bistatic Radar Cross Section

Authors: M. Pienaar, J. W. Odendaal, J. C. Smit, J. Joubert

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Simulations are commonly used to predict the bistatic radar cross section (RCS) of military targets since characterization measurements can be expensive and time consuming. It is thus important to accurately predict the bistatic RCS of targets. Computational electromagnetic (CEM) methods can be used for bistatic RCS prediction. CEM methods are divided into full-wave and asymptotic methods. Full-wave methods are numerical approximations to the exact solution of Maxwell’s equations. These methods are very accurate but are computationally very intensive and time consuming. Asymptotic techniques make simplifying assumptions in solving Maxwell's equations and are thus less accurate but require less computational resources and time. Asymptotic techniques can thus be very valuable for the prediction of bistatic RCS of electrically large targets, due to the decreased computational requirements. This study extends previous work by validating the accuracy of asymptotic techniques to predict bistatic RCS through comparison with full-wave simulations as well as measurements. Validation is done with canonical structures as well as complex realistic aircraft models instead of only looking at a complex slicy structure. The slicy structure is a combination of canonical structures, including cylinders, corner reflectors and cubes. Validation is done over large bistatic angles and at different polarizations. Bistatic RCS measurements were conducted in a compact range, at the University of Pretoria, South Africa. The measurements were performed at different polarizations from 2 GHz to 6 GHz. Fixed bistatic angles of β = 30.8°, 45° and 90° were used. The measurements were calibrated with an active calibration target. The EM simulation tool FEKO was used to generate simulated results. The full-wave multi-level fast multipole method (MLFMM) simulated results together with the measured data were used as reference for validation. The accuracy of physical optics (PO) and geometrical optics (GO) was investigated. Differences relating to amplitude, lobing structure and null positions were observed between the asymptotic, full-wave and measured data. PO and GO were more accurate at angles close to the specular scattering directions and the accuracy seemed to decrease as the bistatic angle increased. At large bistatic angles PO did not perform well due to the shadow regions not being treated appropriately. PO also did not perform well for canonical structures where multi-bounce was the main scattering mechanism. PO and GO do not account for diffraction but these inaccuracies tended to decrease as the electrical size of objects increased. It was evident that both asymptotic techniques do not properly account for bistatic structural shadowing. Specular scattering was calculated accurately even if targets did not meet the electrically large criteria. It was evident that the bistatic RCS prediction performance of PO and GO depends on incident angle, frequency, target shape and observation angle. The improved computational efficiency of the asymptotic solvers yields a major advantage over full-wave solvers and measurements; however, there is still much room for improvement of the accuracy of these asymptotic techniques.

Keywords: asymptotic techniques, bistatic RCS, geometrical optics, physical optics

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548 Enhancing AI for Global Impact: Conversations on Improvement and Societal Benefits

Authors: C. P. Chukwuka, E. V. Chukwuka, F. Ukwadi

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This paper focuses on the advancement and societal impact of artificial intelligence (AI) systems. It explores the need for a theoretical framework in corporate governance, specifically in the context of 'hybrid' companies that have a mix of private and government ownership. The paper emphasizes the potential of AI to address challenges faced by these companies and highlights the importance of the less-explored state model in corporate governance. The aim of this research is to enhance AI systems for global impact and positive societal outcomes. It aims to explore the role of AI in refining corporate governance in hybrid companies and uncover nuanced insights into complex ownership structures. The methodology involves leveraging the capabilities of AI to address the challenges faced by hybrid companies in corporate governance. The researchers will analyze existing theoretical frameworks in corporate governance and integrate AI systems to improve problem-solving and understanding of intricate systems. The paper suggests that improved AI systems have the potential to shape a more informed and responsible corporate landscape. AI can uncover nuanced insights and navigate complex ownership structures in hybrid companies, leading to greater efficacy and positive societal outcomes. The theoretical importance of this research lies in the exploration of the role of AI in corporate governance, particularly in the context of hybrid companies. By integrating AI systems, the paper highlights the potential for improved problem-solving and understanding of intricate systems, contributing to a more informed and responsible corporate landscape. The data for this research will be collected from existing literature on corporate governance, specifically focusing on hybrid companies. Additionally, data on AI capabilities and their application in corporate governance will be collected. The collected data will be analyzed through a systematic review of existing theoretical frameworks in corporate governance. The researchers will also analyze the capabilities of AI systems and their potential application in addressing the challenges faced by hybrid companies. The findings will be synthesized and compared to identify patterns and potential improvements. The research concludes that AI systems have the potential to enhance corporate governance in hybrid companies, leading to greater efficacy and positive societal outcomes. By leveraging AI capabilities, nuanced insights can be uncovered, and complex ownership structures can be navigated, shaping a more informed and responsible corporate landscape. The findings highlight the importance of integrating AI in refining problem-solving and understanding intricate systems for global impact.

Keywords: advancement, artificial intelligence, challenges, societal impact

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547 Evaluating the Impact of Early Maternal Incarceration on Male Delinquent Behavior during Emerging Adulthood through the Mediating Mechanism of Mastery

Authors: Richard Abel

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In the United States, increased incarceration rates have caused many adolescents to feel the strain of parental absence. This absence is then manifest through adolescent feelings of parental rejection. Additionally, upon reentry maternal incarceration may be related to adolescents experienced perceived excessive disciple. It is possible parents engage in this manner of discipline attempting to prevent the child from taking the same path to incarceration as the parent. According to General Strain Theory, adolescents encountering strain are likely to experience negative emotions. The emotion that is most likely to lead to delinquency is anger through reduced inhibitions and motivation to act. Additionally, males are more likely to engage in delinquent behavior, regardless of experiencing strain. This is not the case for every male who experiences maternal incarceration, parental rejection, excessive discipline, or anger. There are protective factors that enable agency within individuals. One such protective factor is mastery, or the perception that one is in control of his or her own future. The model proposed in this research suggests maternal incarceration is associated with increased parental rejection and excessive discipline in males. Males experiencing parental rejection and excessive discipline are likely to experience increased anger, which is then associated with increases in delinquent behavior. This model explores whether agency, in the form of mastery, mediates the relationship between strains and negative emotions, or between negative emotions and delinquent behavior. The Kaplan Longitudinal and Multigenerational Study (KLAMS) dataset is uniquely situated to analyze this model providing longitudinal data collected from both parents and their offspring. Maternal incarceration is constructed using parental responses such that the mother was incarcerated after the child’s birth, and any incarceration that happened prior to birth is excluded. The remaining variables of the study are all constructed from varying waves of the adolescent survey. Parental rejection, along with control variables for age, race, parental socioeconomic status, neighborhood effects, delinquent peers, and prior delinquent behavior are all constructed using Wave I data. To increase causal inference, the negative emotion of anger and the mediating variable of mastery are measured during Wave II. Lastly, delinquent behavior is measured at Wave III. Results of the analysis show expected relationships such that adolescent males encountering maternal incarceration show increased perception of parental rejection and excessive discipline. Additionally, there is a positive relationship between parental rejection and excessive discipline at Wave I and feelings of anger at Wave II for males. For males experiencing either of these strains in Wave I, feelings of anger in Wave II are found to be associated with increased delinquent behavior in Wave III. Mastery was found to mediate the relationship between both parental rejection and excessive discipline and anger, but no such mediation occurs in the relationship between anger and delinquency, regardless of the strain being experienced. These findings suggest adolescent males who feel they are in control of their own lives are less likely to experience negative emotions produced by the occurrence of strain, thereby decreasing male engagement in delinquent behavior later in life.

Keywords: delinquency, mastery, maternal incarceration, strain

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546 The Affordable Housing Problems Of Elderly Households In The Istanbul Metropolitan Area

Authors: Elifsu Sahin

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In the world and in Turkey, approximately 1 in 10 people is 65 years of age or older. The age group of 65 and over is the fastest-growing age group since 1990. This demographic aging trend and demographic transformation have spread over a long period in Western Europe and North America, while in Turkey, they have occurred over a relatively short period. The aging of the population poses many challenges in terms of housing supply, housing satisfaction, and economic access to housing, due to factors such as a decrease in the number of people in households, low incomes, and increased time spent in housing and housing neighborhoods. On the other hand, since 2000, neoliberal economic policies and government policies have led to serious growth in the construction and housing sectors in Turkey. During this process, the housing market in Turkey generally produced housing for high-income groups and foreigners. Housing has become an investment instrument, and rising housing prices and rents have seriously reduced both the affordability of housing and households' chances of living in healthy housing. Housing has become a growing problem for vulnerable groups such as low- and middle-income households, students, refugees, and the elderly. Moreover, in recent years, international migration, pandemics, economic crises, inflation, and the expected Istanbul earthquake have raised housing prices and rent in Turkey as a whole, especially in Istanbul. The aim of the study is to investigate how elderly households that don't own homes deal with the economic accessibility of housing and other affordability-related housing problems in the Istanbul Metropolitan Area today, when housing becomes an investment instrument, the issue of social housing is not on the agenda, and households can be added to the market according to their ability to pay. A complex method was adopted in the research, using a combination of various statistical data and interview findings. Based on household income, in-depth interviews were conducted with 100 elderly households who don't own their own homes and were randomly selected in identified neighborhoods, analyzing the micro-area within the districts in the Istanbul Metropolitan Area, where middle- and low-income households are concentrated. The study found that more than 50% of the net income of elderly households was spent on rent and other housing expenses. Some of the households said that they restrict spending on food, health, and entertainment because of their housing expenses. Among the findings of the study is that households receive financial support from their children or move into their children’s house for economic reasons. Due to the decrease in household income, especially after the loss of a spouse, the single individual moves into their children’s house. Moreover, some of the interviewed households had to change their house and move to a smaller, lower-rent house on the urban periphery for economic reasons after retirement, especially after 2020, despite their unwillingness.

Keywords: affordable housing, elderly households, housing policy, istanbul metropolitan area

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545 Use of Proton Pump Inhibitors Medications during the First Years of Life and Late Complications

Authors: Kamelia Hamza

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Background: Proton pump inhibitors (PPIs) are the most prescribed drug classes for pediatric gastroesophageal reflux disease (GERD).Many patients are treated with these drugs for atypical manifestations attributed to gastroesophageal reflux (GER), even in the absence of proved causal relationship. There is an impression of increase use of PPI's treatment for reflux in "clalit health services," the largest health organization in Israel. In the recent years, the medicine is given without restriction, it's not limited to pediatric gastroenterologists only, but pediatricians and family doctors. The objective of this study is to evaluate the hypothesis that exposure to PPIs during the first year of life is associated with an increased risk of developing late adverse diseases: pneumonia, asthma, AGE, IBD, celiac disease, allergic disorders, obesity, attention deficit hyperactivity disorders (ADHD), autism spectrum disorders (ASD). Methods: The study is a retrospective case-control cohort study based on a computerized database of Clalit Health Services (CHS). It includes 9844 children born between 2002-2018 and reported to complain of at least one of the symptoms (reflux/ spitting up, irritability, feeding difficulties, colics). The study population included the study group (n=4922) of children exposed to PPIs at any time prior to the first year of life and a control group (n=4922) child not exposed to PPIs who were matched to each case of the study group on age, race, socioeconomic status, and year of birth. The prevalence of late complications/diseases in the study group was compared with the prevalence of late complications/diseases diagnosis between 2002-2020 in the control group. Odds ratios and 95% confidence intervals were calculated by using logistic regression models. Results: We found that compared to the control group, children exposed to PPIs in the first year of life had an increased risk of developing several late complications/ disorders: pneumonia, asthma, various allergies (urticaria, allergic rhinitis, or allergic conjunctivitis) OR, inhalant allergies, and food allergies. In addition, they showed an increased risk of being diagnosed with ADHD or ASD, but children exposed to PPIs in the first year of life had decrease the risk of obesity by 17% (OR 0.825, 95%CI 0.697-0.976). Conclusions: We found significant associations between the use of PPIs during the first year of life and subsequent development of late complications/diseases such as respiratory diseases, allergy diseases, ADHD, and ASD. More studies are needed to prove causality and determine the mechanism behind the effect of PPIs and the development of late complications.

Keywords: acid suppressing medications, proton pump inhibitors, histamine 2 blocker, late complications, gastroesophageal reflux, gastroesophageal reflux disease, acute gastroenteritis, community acquired pneumonia, asthma, allergic diseases, obesity, inflammatory bowel diseases, ulcerative colitis, crohn disease, attention deficit hyperactivity disorders, autism spectrum disorders

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544 Mechanical Response Investigation of Wafer Probing Test with Vertical Cobra Probe via the Experiment and Transient Dynamic Simulation

Authors: De-Shin Liu, Po-Chun Wen, Zhen-Wei Zhuang, Hsueh-Chih Liu, Pei-Chen Huang

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Wafer probing tests play an important role in semiconductor manufacturing procedures in accordance with the yield and reliability requirement of the wafer after the backend-of-the-line process. Accordingly, the stable physical and electrical contact between the probe and the tested wafer during wafer probing is regarded as an essential issue in identifying the known good die. The probe card can be integrated with multiple probe needles, which are classified as vertical, cantilever and micro-electro-mechanical systems type probe selections. Among all potential probe types, the vertical probe has several advantages as compared with other probe types, including maintainability, high probe density and feasibility for high-speed wafer testing. In the present study, the mechanical response of the wafer probing test with the vertical cobra probe on 720 μm thick silicon (Si) substrate with a 1.4 μm thick aluminum (Al) pad is investigated by the experiment and transient dynamic simulation approach. Because the deformation mechanism of the vertical cobra probe is determined by both bending and buckling mechanisms, the stable correlation between contact forces and overdrive (OD) length must be carefully verified. Moreover, the decent OD length with corresponding contact force contributed to piercing the native oxide layer of the Al pad and preventing the probing test-induced damage on the interconnect system. Accordingly, the scratch depth of the Al pad under various OD lengths is estimated by the atomic force microscope (AFM) and simulation work. In the wafer probing test configuration, the contact phenomenon between the probe needle and the tested object introduced large deformation and twisting of mesh gridding, causing the subsequent numerical divergence issue. For this reason, the arbitrary Lagrangian-Eulerian method is utilized in the present simulation work to conquer the aforementioned issue. The analytic results revealed a slight difference when the OD is considered as 40 μm, and the simulated is almost identical to the measured scratch depths of the Al pad under higher OD lengths up to 70 μm. This phenomenon can be attributed to the unstable contact of the probe at low OD length with the scratch depth below 30% of Al pad thickness, and the contact status will be being stable when the scratch depth over 30% of pad thickness. The splash of the Al pad is observed by the AFM, and the splashed Al debris accumulates on a specific side; this phenomenon is successfully simulated in the transient dynamic simulation. Thus, the preferred testing OD lengths are found as 45 μm to 70 μm, and the corresponding scratch depths on the Al pad are represented as 31.4% and 47.1% of Al pad thickness, respectively. The investigation approach demonstrated in this study contributed to analyzing the mechanical response of wafer probing test configuration under large strain conditions and assessed the geometric designs and material selections of probe needles to meet the requirement of high resolution and high-speed wafer-level probing test for thinned wafer application.

Keywords: wafer probing test, vertical probe, probe mark, mechanical response, FEA simulation

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543 Resolving Urban Mobility Issues through Network Restructuring of Urban Mass Transport

Authors: Aditya Purohit, Neha Bansal

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Unplanned urbanization and multidirectional sprawl of the cities have resulted in increased motorization and deteriorating transport conditions like traffic congestion, longer commuting, pollution, increased carbon footprint, and above all increased fatalities. In order to overcome these problems, various practices have been adopted including– promoting and implementing mass transport; traffic junction channelization; smart transport etc. However, these methods are found to be primarily focusing on vehicular mobility rather than people accessibility. With this research gap, this paper tries to resolve the mobility issues for Ahmedabad city in India, which being the economic capital Gujarat state has a huge commuter and visitor inflow. This research aims to resolve the traffic congestion and urban mobility issues focusing on Gujarat State Regional Transport Corporation (GSRTC) for the city of Ahmadabad by analyzing the existing operations and network structure of GSRTC followed by finding possibilities of integrating it with other modes of urban transport. The network restructuring (NR) methodology is used with appropriate variations, based on commuter demand and growth pattern of the city. To do these ‘scenarios’ based on priority issues (using 12 parameters) and their best possible solution, are established after route network analysis for 2700 population sample of 20 traffic junctions/nodes across the city. Approximately 5% sample (of passenger inflow) at each node is considered using random stratified sampling technique two scenarios are – Scenario 1: Resolving mobility issues by use of Special Purpose Vehicle (SPV) in joint venture to GSRTC and Private Operators for establishing feeder service, which shall provide a transfer service for passenger for movement from inner city area to identified peripheral terminals; and Scenario 2: Augmenting existing mass transport services such as BRTS and AMTS for using them as feeder service to the identified peripheral terminals. Each of these has now been analyzed for the best suitability/feasibility in network restructuring. A desire-line diagram is constructed using this analysis which indicated that on an average 62% of designated GSRTC routes are overlapping with mass transportation service routes of BRTS and AMTS in the city. This has resulted in duplication of bus services causing traffic congestion especially in the Central Bus Station (CBS). Terminating GSRTC services on the periphery of the city is found to be the best restructuring network proposal. This limits the GSRTC buses at city fringe area and prevents them from entering into the city core areas. These end-terminals of GSRTC are integrated with BRTS and AMTS services which help in segregating intra-state and inter-state bus services. The research concludes that absence of integrated multimodal transport network resulted in complexity of transport access to the commuters. As a further scope of research comparing and understanding of value of access time in total travel time and its implication on generalized cost on trip and how it varies city wise may be taken up.

Keywords: mass transportation, multi-modal integration, network restructuring, travel behavior, urban transport

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542 An Assessment of Involuntary Migration in India: Understanding Issues and Challenges

Authors: Rajni Singh, Rakesh Mishra, Mukunda Upadhyay

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India is among the nations born out of partition that led to one of the greatest forced migrations that marked the past century. The Indian subcontinent got partitioned into two nation-states, namely India and Pakistan. This led to an unexampled mass displacement of people accounting for about 20 million in the subcontinent as a whole. This exemplifies the socio-political version of displacement, but there are other identified reasons leading to human displacement viz., natural calamities, development projects and people-trafficking and smuggling. Although forced migrations are rare in incidence, they are mostly region-specific and a very less percentage of population appears to be affected by it. However, when this percentage is transcripted in terms of volume, the real impact created by such migration can be realized. Forced migration is thus an issue related to the lives of many people and requires to be addressed with proper intervention. Forced or involuntary migration decimates peoples' assets while taking from them their most basic resources and makes them migrate without planning and intention. This in most cases proves to be a burden on the destination resources. Thus, the question related to their security concerns arise profoundly with regard to the protection and safeguards to these migrants who need help at the place of destination. This brings the human security dimension of forced migration into picture. The present study is an analysis of a sample of 1501 persons by NSSO in India (National Sample Survey Organisation), which identifies three reasons for forced migration- natural disaster, social/political problem and displacement by development projects. It was observed that, of the total forced migrants, about 4/5th comprised of the internally displaced persons. However, there was a huge inflow of such migrants to the country from across the borders also, the major contributing countries being Bangladesh, Pakistan, Sri Lanka, Gulf countries and Nepal. Among the three reasons for involuntary migration, social and political problem is the most prominent in displacing huge masses of population; it is also the reason where the share of international migrants to that of internally displaced is higher compared to the other two factors /reasons. Second to political and social problems, natural calamities displaced a high portion of the involuntary migrants. The present paper examines the factors which increase people's vulnerability to forced migration. On perusing the background characteristics of the migrants it was seen that those who were economically weak and socially fragile are more susceptible to migration. Therefore, getting an insight about this fragile group of society is required so that government policies can benefit these in the most efficient and targeted manner.

Keywords: involuntary migration, displacement, natural disaster, social and political problem

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541 Establishing an Evidence-Based Trauma Informed Care Pathway for Survivors of Modern Slavery

Authors: I. Brezeanu, J. Mackrill, A. Cajo, C. Mogollon

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Modern Slavery is a serious crime, where often the victims are unable to leave their situation of exploitation, being controlled by threats, punishment, violence, coercion, and deception. In the UK, this term encompasses both Slavery and Human Trafficking. The number of potential victims who were referred to the National Referral Mechanism (NRM) increased exponentially in the past decade, passing from fewer than 700 potential victims referred in 2010 to more than 12.000 in 2021. Our study aims to explore how the concept of Trauma-Informed Care (TIC) approach can be adopted by services working with survivors of Modern Slavery and Trafficking (MST). Notably, in this paper, we will elaborate on how the complex needs of survivors are related to their traumatic experiences and what are the necessary steps and resources for implementing a Modern Slavery Trauma-Informed model. While there are relatively few services in the UK that have a deep understanding of the survivors’ and practitioners’ views of how trauma impacts their daily life, there is a strong need for developing services that are organised and delivered in ways that prevent retraumatisation and enable trauma survivors to engage safely with the right professionals at the right time, promoting healing through positive relationships. Such models, known as Trauma-Informed Approaches (TIAs), are seen as crucial to the empowerment of survivors, yet they remain a marginal implementation model by governments, law enforcement, judiciary, or care providers, who are frequently survivors’ first point of contact in the recovery process. In order to understand better how to provide best practice and to adopt the concept, this study is based on a multi-disciplinary approach, encompassing both theoretical perspectives and co-production. By combining qualitative and quantitative research and comparing different analysis of applied examples of TIC in the US and the UK, we gained important insights about the prevention and impact of trauma on survivors’ life. The articulation between more general expertise on Trauma-Informed Care developed by other institutions operating in the field, and the SJOG delivery, based on the Salvation Army’s Modern Slavery Victim Care and Coordination Contract (MSVCC) and the Care Quality Commission regulations, allowed to identify on one side what are the complex needs of survivors derived from their traumatic experiences, and on the other side, how could MST services prevent retraumatisation. Additional, two in-depth interviews with survivors, who receive support from one of our services at Olallo House in London, and a survey shared among all colleagues working with MST services completed the findings of the research with their personal experience and knowledge. Ultimately, we developed an evidence-based Trauma-Informed Care Pathway that aims to improve the wellbeing of survivors and to support them to live a meaningful life. The establishedpathway delivers three main outcomes belonging to the social determinants of health criteria – health and wellbeing, purpose and relationship, and covers key themes of the context of trauma, needs of individuals, and service support.

Keywords: trauma-informed care, modern slavery, human trafficking, trauma, retraumatisation

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540 Bio-Psycho-Social Consequences and Effects in Fall-Efficacy Scale in Seniors Using Exercise Intervention of Motor Learning According to Yoga Techniques

Authors: Milada Krejci, Martin Hill, Vaclav Hosek, Dobroslava Jandova, Jiri Kajzar, Pavel Blaha

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The paper declares effects of exercise intervention of the research project “Basic research of balance changes in seniors”, granted by the Czech Science Foundation. The objective of the presented study is to define predictors, which influence bio-psycho-social consequences and effects of balance ability in senior 65 years old and above. We focused on the Fall-Efficacy Scale changes evaluation in seniors. Comprehensive hypothesis of the project declares, that motion uncertainty (dyskinesia) can negatively affect the well-being of a senior in bio-psycho-social context. In total, random selection and testing of 100 seniors (30 males, 70 females) from Prague and Central Bohemian region was provided. The sample was divided by stratified random selection into experimental and control groups, who underwent input and output testing. For diagnostics the methods of Medical Anamnesis, Functional anthropological examinations, Tinetti Balance Assessment Tool, SF-36 Health Survey, Anamnestic comparative self-assessment scale were used. Intervention method called "Life in Balance" based on yoga techniques was applied in four-week cycle. Results of multivariate regression were verified by repeated measures ANOVA: subject factor, phase of intervention (between-subject factor), body fluid (within-subject factor) and phase of intervention × body fluid interaction). ANOVA was performed with a repetition involving the factors of subjects, experimental/control group, phase of intervention (independent variable), and x phase interaction followed by Bonferroni multiple comparison assays with a test strength of at least 0.8 on the probability level p < 0.05. In the paper results of the first-year investigation of the three years running project are analysed. Results of balance tests confirmed no significant difference between females and males in pre-test. Significant improvements in balance and walking ability were observed in experimental group in females comparing to males (F = 128.4, p < 0.001). In the females control group, there was no significant change in post- test, while in the female experimental group positive changes in posture and spine flexibility in post-tests were found. It seems that females even in senior age react better to incentives of intervention in balance and spine flexibility. On the base of results analyses, we can declare the significant improvement in social balance markers after intervention in the experimental group (F = 10.5, p < 0.001). In average, seniors are used to take four drugs daily. Number of drugs can contribute to allergy symptoms and balance problems. It can be concluded that static balance and walking ability of seniors according Tinetti Balance scale correlate significantly with psychic and social monitored markers.

Keywords: exercises, balance, seniors 65+, health, mental and social balance

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539 Phytoplankton Structure and Invasive Cyanobacterial Species of Polish Temperate Lakes: Their Associations with Environmental Parameters and Findings About Their Toxic Properties

Authors: Tumer Orhun Aykut, Robin Michael Crucitti-Thoo, Agnieszka Rudak, Iwona Jasser

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Due to eutrophication connected to the growing human population, intensive agriculture, industrialization, and reinforcement of global warming, freshwater resources are changing negatively in every region of the World. This change also concerns the replacement of native species by invasive ones that can spread in many ways. Biological invasions are a developing problem to ecosystem continuity and their presence is mostly common in freshwater bodies. The occurrence and potential invasion of the species depends on associations between abiotic and biotic variables. Due to climate change, many species can extend their range from low to high latitudes and differ in their geographic ranges. In addition, the hydrological issues strongly influence the physicochemical parameters and biological processes, especially the growth rates of species and bloom formation of Cyanobacteria. Among tropical invasive species noted in temperate Europe, Raphidiopsis raciborskii, Chrysosporum bergii, and Sphaerospermopsis aphanizomenoides are considered a serious threat. R. raciborskii being the most important one as it is already known as a highly invasive species in almost all around the World, is a freshwater, planktonic, filamentous, potentially toxic, and nitrogen-fixing Cyanobacteria. This study aimed to investigate the presence of invasive cyanobacterial species in temperate lakes in Northeastern Poland, reveal the composition of phytoplankton communities, determine the effect of environmental variables, and identify the toxic properties of invasive Cyanobacteria and other phytoplankton groups. Our study was conducted in twenty-five lakes in August 2023. The lakes represent a geographical gradient from central Poland to the Northeast and have different depths, sizes, and trophic statuses. According to performed analyses, the presence of R. raciborskii was recorded in five lakes: Szczęśliwickie (Warsaw), Mikołajskie, Rekąty, Sztynorckie (Masurian Lakeland), and further East, in Pobondzie (Suwałki Lakeland). On the other hand, C. bergii was found in three lakes: Rekąty (Masurian Lakeland), Żabinki, and Pobondzie (Suwałki Lakeland), while S. aphanizomenoides only in Pobondzie (Suwałki Lakeland). Maximum phytoplankton diversity was found in Lake Rekąty, a small and shallow lake mentioned above. The highest phytoplankton biomass was detected in highly eutrophic Lake Suskie, followed by Lake Sztynorckie. In this last lake, which is also strongly eutrophic, the highest biomass of R. raciborskii was found. Cyanophyceae had the highest biovolume and was followed by Chlorophyceae in the entire study. Numerous environmental parameters, including nutrients, were studied, and their relationships with the invasive species and the whole phytoplankton community will be presented. In addition, toxic properties of environmental DNA results from each lake will also be shown. In conclusion, investigated invasive cyanobacterial species were found in a few Northeastern Polish temperate lakes, but the number of individuals was quite low, so the biomass was quite low. It has been observed that the structure of phytoplankton changed based on lakes and environmental parameters.

Keywords: biological invasion, cyanobacteria, cyanotoxins, phytoplankton ecology, sanger sequencing

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538 Examining Smallholder Farmers’ Perceptions of Climate Change and Barriers to Strategic Adaptation in Todee District, Liberia

Authors: Joe Dorbor Wuokolo

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Thousands of smallholder farmers in Todee District, Montserrado county, are currently vulnerable to the negative impact of climate change. The district, which is the agricultural hot spot for the county, is faced with unfavorable changes in the daily temperature due to climate change. Farmers in the district have observed a dramatic change in the ratio of rainfall to sunshine, which has caused a chilling effect on their crop yields. However, there is a lack of documentation regarding how farmers perceive and respond to these changes and challenges. A study was conducted in the region to examine the perceptions of smallholder farmers regarding the negative impact of climate change, the adaptation strategies practice, and the barriers that hinder the process of advancing adaptation strategy. On purpose, a sample of 41 respondents from five towns was selected, including five town chiefs, five youth leaders, five women leaders, and sixteen community members. Women and youth leaders were specifically chosen to provide gender balance and enhance the quality of the investigation. Additionally, to validate the barriers farmers face during adaptation to climate change, this study interviewed eight experts from local and international organizations and government ministries and agencies involved in climate change and agricultural programs on what they perceived as the major barrier in both local and national level that impede farmers adaptation to climate change impact. SPSS was used to code the data, and descriptive statistics were used to analyze the data. The weighted average index (WAI) was used to rank adaptation strategies and the perceived importance of adaptation practices among farmers. On a scale from 0 to 3, 0 indicates the least important technique, and 3 indicates the most effective technique. In addition, the Problem Confrontation Index (PCI) was used to rank the barriers that prevented farmers from implementing adaptation measures. According to the findings, approximately 60% of all respondents considered the use of irrigation systems to be the most effective adaptation strategy, with drought-resistant varieties making up 30% of the total. Additionally, 80% of respondents placed a high value on drought-resistant varieties, while 63% percent placed it on irrigation practices. In addition, 78% of farmers ranked and indicated that unpredictability of the weather is the most significant barrier to their adaptation strategies, followed by the high cost of farm inputs and lack of access to financing facilities. 80% of respondents believe that the long-term changes in precipitation (rainfall) and temperature (hotness) are accelerating. This suggests that decision-makers should adopt policies and increase the capacity of smallholder farmers to adapt to the negative impact of climate change in order to ensure sustainable food production.

Keywords: adaptation strategies, climate change, farmers’ perception, smallholder farmers

Procedia PDF Downloads 71
537 Civilian and Military Responses to Domestic Security Threats: A Cross-Case Analysis of Belgium, France, and the United Kingdom

Authors: John Hardy

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The domestic security environment in Europe has changed dramatically in recent years. Since January 2015, a significant number of domestic security threats that emerged in Europe were located in Belgium, France and the United Kingdom. While some threats were detected in the planning phase, many also resulted in terrorist attacks. Authorities in all three countries instituted special or emergency measures to provide additional security to their populations. Each country combined an additional policing presence with a specific military operation to contribute to a comprehensive security response to domestic threats. This study presents a cross-case analysis of three countries’ civilian and military responses to domestic security threats in Europe. Each case study features a unique approach to combining civilian and military capabilities in similar domestic security operations during the same time period and threat environment. The research design focuses on five variables relevant to the relationship between civilian and military roles in each security response. These are the distinction between policing and military roles, the legal framework for the domestic deployment of military forces, prior experience in civil-military coordination, the institutional framework for threat assessments, and the level of public support for the domestic use of military forces. These variables examine the influence of domestic social, political, and legal factors on the design of combined civil-military operations in response to domestic security threats. Each case study focuses on a specific operation: Operation Vigilant Guard in Belgium, Operation Sentinel in France, and Operation Temperer in the United Kingdom. The results demonstrate that the level of distinction between policing and military roles and the existence of a clear and robust legal framework for the domestic use force by military personnel significantly influence the design and implementation of civilian and military roles in domestic security operations. The findings of this study indicate that Belgium, France and the United Kingdom experienced different design and implementation challenges for their domestic security operations. Belgium and France initially had less-developed legal frameworks for deploying the military in domestic security operations than the United Kingdom. This was offset by public support for enacting emergency measures and the strength of existing civil-military coordination mechanisms. The United Kingdom had a well-developed legal framework for integrating civilian and military capabilities in domestic security operations. However, its experiences in Ireland also made the government more sensitive to public perceptions regarding the domestic deployment of military forces.

Keywords: counter-terrorism, democracy, homeland security, intelligence, militarization, policing

Procedia PDF Downloads 118
536 Implementation of Performance Management and Development System: The Case of the Eastern Cape Provincial Department of Health, South Africa

Authors: Thanduxolo Elford Fana

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Rationale and Purpose: Performance management and development system are central to effective and efficient service delivery, especially in highly labour intensive sectors such as South African public health. Performance management and development systems seek to ensure that good employee performance is rewarded accordingly, while those who underperform are developed so that they can reach their full potential. An effective and efficiently implemented performance management system motivates and improves employee engagement. The purpose of this study is to examine the implementation of the performance management and development system and the challenges that are encountered during its implementation in the Eastern Cape Provincial Department of Health. Methods: A qualitative research approach and a case study design was adopted in this study. The primary data were collected through observations, focus group discussions with employees, a group interview with shop stewards, and in-depth interviews with supervisors and managers, from April 2019 to September 2019. There were 45 study participants. In-depth interviews were held with 10 managers at facility level, which included chief executive officer, chief medical officer, assistant director’s in human resources management, patient admin, operations, finance, and two area manager and two operation managers nursing. A group interview was conducted with five shop stewards and an in-depth interview with one shop steward from the group. Five focus group discussions were conducted with clinical and non-clinical staff. The focus group discussions were supplemented with an in-depth interview with one person from each group in order to counter the group effect. Observations included moderation committee, contracting, and assessment meetings. Findings: The study shows that the performance management and development system was not properly implemented. There was non-compliance to performance management and development system policy guidelines in terms of time lines for contracting, evaluation, payment of incentives to good performers, and management of poor performance. The study revealed that the system is ineffective in raising the performance of employees and unable to assist employees to grow. The performance bonuses were no longer paid to qualifying employees. The study also revealed that lack of capacity and commitment, poor communication, constant policy changes, financial constraints, weak and highly bureaucratic management structures, union interference were challenges that were encountered during the implementation of the performance management and development system. Lastly, employees and supervisors were rating themselves three irrespective of how well or bad they performed. Conclusion: Performance management is regarded as vital to improved performance of the health workforce and healthcare service delivery among populations. Effective implementation of performance management and development system depends on well-capacitated and unbiased management at facility levels. Therefore, there is an urgent need to improve communication, link performance management to rewards, and capacitate staff on performance management and development system, as it is key to improved public health sector outcomes or performance.

Keywords: challenges, implementation, performance management and development system, public hospital

Procedia PDF Downloads 119
535 Assessing P0.1 and Occlusion Pressures in Brain-Injured Patients on Pressure Support Ventilation: A Study Protocol

Authors: S. B. R. Slagmulder

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Monitoring inspiratory effort and dynamic lung stress in patients on pressure support ventilation in the ICU is important for protecting against self inflicted lung injury (P-SILI) and diaphragm dysfunction. Strategies to address the detrimental effects of respiratory drive and effort can lead to improved patient outcomes. Two non-invasive estimation methods, occlusion pressure (Pocc) and P0.1, have been proposed for achieving lung and diaphragm protective ventilation. However, their relationship and interpretation in neuro ICU patients is not well understood. P0.1 is the airway pressure measured during a 100-millisecond occlusion of the inspiratory port. It reflects the neural drive from the respiratory centers to the diaphragm and respiratory muscles, indicating the patient's respiratory drive during the initiation of each breath. Occlusion pressure, measured during a brief inspiratory pause against a closed airway, provides information about the inspiratory muscles' strength and the system's total resistance and compliance. Research Objective: Understanding the relationship between Pocc and P0.1 in brain-injured patients can provide insights into the interpretation of these values in pressure support ventilation. This knowledge can contribute to determining extubation readiness and optimizing ventilation strategies to improve patient outcomes. The central goal is to asses a study protocol for determining the relationship between Pocc and P0.1 in brain-injured patients on pressure support ventilation and their ability to predict successful extubation. Additionally, comparing these values between brain-damaged and non-brain-damaged patients may provide valuable insights. Key Areas of Inquiry: 1. How do Pocc and P0.1 values correlate within brain injury patients undergoing pressure support ventilation? 2. To what extent can Pocc and P0.1 values serve as predictive indicators for successful extubation in patients with brain injuries? 3. What differentiates the Pocc and P0.1 values between patients with brain injuries and those without? Methodology: P0.1 and occlusion pressures are standard measurements for pressure support ventilation patients, taken by attending doctors as per protocol. We utilize electronic patient records for existing data. Unpaired T-test will be conducted to compare P0.1 and Pocc values between both study groups. Associations between P0.1 and Pocc and other study variables, such as extubation, will be explored with simple regression and correlation analysis. Depending on how the data evolve, subgroup analysis will be performed for patients with and without extubation failure. Results: While it is anticipated that neuro patients may exhibit high respiratory drive, the linkage between such elevation, quantified by P0.1, and successful extubation remains unknown The analysis will focus on determining the ability of these values to predict successful extubation and their potential impact on ventilation strategies. Conclusion: Further research is pending to fully understand the potential of these indices and their impact on mechanical ventilation in different patient populations and clinical scenarios. Understanding these relationships can aid in determining extubation readiness and tailoring ventilation strategies to improve patient outcomes in this specific patient population. Additionally, it is vital to account for the influence of sedatives, neurological scores, and BMI on respiratory drive and occlusion pressures to ensure a comprehensive analysis.

Keywords: brain damage, diaphragm dysfunction, occlusion pressure, p0.1, respiratory drive

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534 Challenges of Strategies for Improving Sustainability in Urban Historical Context in Developing Countries: The Case of Shiraz Bein Al-Haramein

Authors: Amir Hossein Ashari, Sedighe Erfan Manesh

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One of the problems in developing countries is renovating the historical context and inducing behaviors appropriate to modern life to such a context. This study was conducted using field and library methods in 2012. Similar cases carried out in Iran and developing countries were compared to unveil the strengths and weaknesses of these projects. At present, in the historical context of Shiraz, the distance between two religious shrines of Shahcheragh (Ahmad ibn Musa) and Astaneh (Sayed Alaa al-Din Hossein), which are significant places in religious, cultural, social, and economic terms, is an area full of historic places called Bein Al-Haramein. Unfortunately, some of these places have been worn out and are not appropriate for common uses. The basic strategy of Bein Al-Haramein was to improve social development of Shiraz, to enhance the vitality and dynamism of the historical context of Bein Al-Haramein and to create tourist attractions in order to boost the city's economic and social stability. To this end, the project includes the huge Bein Al-Haramein Commercial Complex which is under construction now. To construct the complex, officials have decided to demolish places of historical value which can lead to irreparable consequences. Iranian urban design has always been based on three elements of bazaars, mosques and government facilities with bazaars being the organic connector of the other elements. Therefore, the best strategy in the above case is to provide for a commercial connection between the two poles. Although this strategy is included in the project, lack of attention to renovation principles in this area and complete destruction of the context will lead to its irreversible damage and will destroy its cultural and historical identity. In urban planning of this project, some important issues have been neglected including: preserving valuable buildings and special old features of the city, rebuilding worn buildings and context to attract trust and confidence of the people, developing new models according to changes, improving the structural position of old context with minimal degradation, attracting partnerships of residents and protecting their rights and finally using potential facilities of the old context. The best strategy for achieving sustainability in Bein Al-Haramein can be the one used in the distance between Santa Maria Novella and Santa Maria Del Fiore churches in historical context where while protecting the historic context and constructions, old buildings were renovated and given different commercial and service uses making them sustainable and dynamic places. Similarly, in Bein Al-Haramein, renovating old constructions and monuments and giving different commercial and other uses to them can help improve the economic and social sustainability of the area.

Keywords: Bein Al-Haramein, sustainability, historical context, historical context

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533 The Impression of Adaptive Capacity of the Rural Community in the Indian Himalayan Region: A Way Forward for Sustainable Livelihood Development

Authors: Rommila Chandra, Harshika Choudhary

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The value of integrated, participatory, and community based sustainable development strategies is eminent, but in practice, it still remains fragmentary and often leads to short-lived results. Despite the global presence of climate change, its impacts are felt differently by different communities based on their vulnerability. The developing countries have the low adaptive capacity and high dependence on environmental variables, making them highly susceptible to outmigration and poverty. We need to understand how to enable these approaches, taking into account the various governmental and non-governmental stakeholders functioning at different levels, to deliver long-term socio-economic and environmental well-being of local communities. The research assessed the financial and natural vulnerability of Himalayan networks, focusing on their potential to adapt to various changes, through accessing their perceived reactions and local knowledge. The evaluation was conducted by testing indices for vulnerability, with a major focus on indicators for adaptive capacity. Data for the analysis were collected from the villages around Govind National Park and Wildlife Sanctuary, located in the Indian Himalayan Region. The villages were stratified on the basis of connectivity via road, thus giving two kinds of human settlements connected and isolated. The study focused on understanding the complex relationship between outmigration and the socio-cultural sentiments of local people to not abandon their land, assessing their adaptive capacity for livelihood opportunities, and exploring their contribution that integrated participatory methodologies can play in delivering sustainable development. The result showed that the villages having better road connectivity, access to market, and basic amenities like health and education have a better understanding about the climatic shift, natural hazards, and a higher adaptive capacity for income generation in comparison to the isolated settlements in the hills. The participatory approach towards environmental conservation and sustainable use of natural resources were seen more towards the far-flung villages. The study helped to reduce the gap between local understanding and government policies by highlighting the ongoing adaptive practices and suggesting precautionary strategies for the community studied based on their local conditions, which differ on the basis of connectivity and state of development. Adaptive capacity in this study has been taken as the externally driven potential of different parameters, leading to a decrease in outmigration and upliftment of the human environment that could lead to sustainable livelihood development in the rural areas of Himalayas.

Keywords: adaptive capacity, Indian Himalayan region, participatory, sustainable livelihood development

Procedia PDF Downloads 99
532 Financial Burden of Occupational Slip and Fall Incidences in Taiwan

Authors: Kai Way Li, Lang Gan

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Slip &Fall are common in Taiwan. They could result in injuries and even fatalities. Official statistics indicate that more than 15% of all occupational incidences were slip/fall related. All the workers in Taiwan are required by the law to join the worker’s insurance program administered by the Bureau of Labor Insurance (BLI). The BLI is a government agency under the supervision of the Ministry of Labor. Workers claim with the BLI for insurance compensations when they suffer fatalities or injuries at work. Injuries statistics based on worker’s compensation claims were rarely studied. The objective of this study was to quantify the injury statistics and financial cost due to slip-fall incidences based on the BLI compensation records. Compensation records in the BLI during 2007 to 2013 were retrieved. All the original application forms, approval opinions, results for worker’s compensations were in hardcopy and were stored in the BLI warehouses. Xerox copies of the claims, excluding the personal information of the applicants (or the victim if passed away), were obtained. The content in the filing forms were coded in an Excel worksheet for further analyses. Descriptive statistics were performed to analyze the data. There were a total of 35,024 claims including 82 deaths, 878 disabilities, and 34,064 injuries/illnesses which were slip/fall related. It was found that the average losses for the death cases were 40 months. The total dollar amount for these cases paid was 86,913,195 NTD. For the disability cases, the average losses were 367.36 days. The total dollar amount for these cases paid was almost 2.6 times of those for the death cases (233,324,004 NTD). For the injury/illness cases, the average losses for the illness cases were 58.78 days. The total dollar amount for these cases paid was approximately 13 times of those of the death cases (1134,850,821 NTD). For the applicants/victims, 52.3% were males. There were more males than females for the deaths, disability, and injury/illness cases. Most (57.8%) of the female victims were between 45 to 59 years old. Most of the male victims (62.6%) were, on the other hand, between 25 to 39 years old. Most of the victims were in manufacturing industry (26.41%), next the construction industry (22.20%), and next the retail industry (13.69%). For the fatality cases, head injury was the main problem for immediate or eventual death (74.4%). For the disability case, foot (17.46%) and knee (9.05%) injuries were the leading problems. The compensation claims other than fatality and disability were mainly associated with injuries of the foot (18%), hand (12.87%), knee (10.42%), back (8.83%), and shoulder (6.77%). The slip/fall cases studied indicate that the ratios among the death, disability, and injury/illness counts were 1:10:415. The ratios of dollar amount paid by the BLI for the three categories were 1:2.6:13. Such results indicate the significance of slip-fall incidences resulting in different severity. Such information should be incorporated in to slip-fall prevention program in industry.

Keywords: epidemiology, slip and fall, social burden, workers’ compensation

Procedia PDF Downloads 307
531 Development of a Conceptual Framework for Supply Chain Management Strategies Maximizing Resilience in Volatile Business Environments: A Case of Ventilator Challenge UK

Authors: Elena Selezneva

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Over the last two decades, an unprecedented growth in uncertainty and volatility in all aspects of the business environment has caused major global supply chain disruptions and malfunctions. The effects of one failed company in a supply chain can ripple up and down the chain, causing a number of entities or an entire supply chain to collapse. The complicating factor is that an increasingly unstable and unpredictable business environment fuels the growing complexity of global supply chain networks. That makes supply chain operations extremely unpredictable and hard to manage with the established methods and strategies. It has caused the premature demise of many companies around the globe as they could not withstand or adapt to the storm of change. Solutions to this problem are not easy to come by. There is a lack of new empirically tested theories and practically viable supply chain resilience strategies. The mainstream organizational approach to managing supply chain resilience is rooted in well-established theories developed in the 1960-1980s. However, their effectiveness is questionable in currently extremely volatile business environments. The systems thinking approach offers an alternative view of supply chain resilience. Still, it is very much in the development stage. The aim of this explorative research is to investigate supply chain management strategies that are successful in taming complexity in volatile business environments and creating resilience in supply chains. The design of this research methodology was guided by an interpretivist paradigm. A literature review informed the selection of the systems thinking approach to supply chain resilience. Therefore, an explorative single case study of Ventilator Challenge UK was selected as a case study for its extremely resilient performance of its supply chain during a period of national crisis. Ventilator Challenge UK is intensive care ventilators supply project for the NHS. It ran for 3.5 months and finished in 2020. The participants moved on with their lives, and most of them are not employed by the same organizations anymore. Therefore, the study data includes documents, historical interviews, live interviews with participants, and social media postings. The data analysis was accomplished in two stages. First, data were thematically analyzed. In the second stage, pattern matching and pattern identification were used to identify themes that formed the findings of the research. The findings from the Ventilator Challenge UK case study supply management practices demonstrated all the features of an adaptive dynamic system. They cover all the elements of supply chain and employ an entire arsenal of adaptive dynamic system strategies enabling supply chain resilience. Also, it is not a simple sum of parts and strategies. Bonding elements and connections between the components of a supply chain and its environment enabled the amplification of resilience in the form of systemic emergence. Enablers are categorized into three subsystems: supply chain central strategy, supply chain operations, and supply chain communications. Together, these subsystems and their interconnections form the resilient supply chain system framework conceptualized by the author.

Keywords: enablers of supply chain resilience, supply chain resilience strategies, systemic approach in supply chain management, resilient supply chain system framework, ventilator challenge UK

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530 Rendering Religious References in English: Naguib Mahfouz in the Arabic as a Foreign Language Classroom

Authors: Shereen Yehia El Ezabi

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The transition from the advanced to the superior level of Arabic proficiency is widely known to pose considerable challenges for English speaking students of Arabic as a Foreign Language (AFL). Apart from the increasing complexity of the grammar at this juncture, together with the sprawling vocabulary, to name but two of those challenges, there is also the somewhat less studied hurdle along the way to superior level proficiency, namely, the seeming opacity of many aspects of Arab/ic culture to such learners. This presentation tackles one specific dimension of such issues: religious references in literary texts. It illustrates how carefully constructed translation activities may be used to expand and deepen students’ understanding and use of them. This is shown to be vital for making the leap to the desired competency, given that such elements, as reflected in customs, traditions, institutions, worldviews, and formulaic expressions lie at the very core of Arabic culture and, as such, pervade all modes and levels of Arabic discourse. A short story from the collection “Stories from Our Alley”, by preeminent novelist Naguib Mahfouz is selected for use in this context, being particularly replete with such religious references, of which religious expressions will form the focus of the presentation. As a miniature literary work, it provides an organic whole, so to speak, within which to explore with the class the most precise denotation, as well as the subtlest connotation of each expression in an effort to reach the ‘best’ English rendering. The term ‘best’ refers to approximating the meaning in its full complexity from the source text, in this case Arabic, to the target text, English, according to the concept of equivalence in translation theory. The presentation will show how such a process generates the sort of thorough discussion and close text analysis which allows students to gain valuable insight into this central idiom of Arabic. A variety of translation methods will be highlighted, gleaned from the presenter’s extensive work with advanced/superior students in the Center for Arabic Study Abroad (CASA) program at the American University in Cairo. These begin with the literal rendering of expressions, with the purpose of reinforcing vocabulary learning and practicing the rules of derivational morphology as they form each word, since the larger context remains that of an AFL class, as opposed to a translation skills program. However, departures from the literal approach are subsequently explored by degrees, moving along the spectrum of functional and pragmatic freer translations in order to transmit the ‘real’ meaning in readable English to the target audience- no matter how culture/religion specific the expression- while remaining faithful to the original. Samples from students’ work pre and post discussion will be shared, demonstrating how class consensus is formed as to the final English rendering, proposed as the closest match to the Arabic, and shown to be the result of the above activities. Finally, a few examples of translation work which students have gone on to publish will be shared to corroborate the effectiveness of this teaching practice.

Keywords: superior level proficiency in Arabic as a foreign language, teaching Arabic as a foreign language, teaching idiomatic expressions, translation in foreign language teaching

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529 Encapsulation of Venlafaxine-Dowex® Resinate: A Once Daily Multiple Unit Formulation

Authors: Salwa Mohamed Salah Eldin, Howida Kamal Ibrahim

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Introduction: Major depressive disorder affects high proportion of the world’s population presenting cost load in health care. Extended release venlafaxine is more convenient and could reduce discontinuation syndrome. The once daily dosing also reduces the potential for adverse events such as nausea due to reduced Cmax. Venlafaxine is an effective first-line agent in the treatment of depression. A once daily formulation was designed to enhance patient compliance. Complexing with a resin was suggested to improve loading of the water soluble drug. The formulated systems were thoroughly evaluated in vitro to prove superiority to previous trials and were compared to the commercial extended release product in experimental animals. Materials and Methods: Venlafaxine-resinates were prepared using Dowex®50WX4-400 and Dowex®50WX8-100 at drug to resin weight ratio of 1: 1. The prepared resinates were evaluated for their drug content, particle shape and surface properties and in vitro release profile in gradient pH. The release kinetics and mechanism were evaluated. Venlafaxine-Dowex® resinates were encapsulated using O/W solvent evaporation technique. Poly-ε-caprolactone, Poly(D, L-lactide-co-glycolide) ester, Poly(D, L-lactide) ester and Eudragit®RS100 were used as coating polymers alone and in combination. Drug-resinate microcapsules were evaluated for morphology, entrapment efficiency and in-vitro release profile. The selected formula was tested in rabbits using a randomized, single-dose, 2-way crossover study against Effexor-XR tablets under fasting condition. Results and Discussion: The equilibrium time was 30 min for Dowex®50WX4-400 and 90 min for Dowex®50WX8-100. The percentage drug loaded was 93.96 and 83.56% for both resins, respectively. Both drug-Dowex® resintes were efficient in sustaining venlafaxine release in comparison to the free drug (up to 8h.). Dowex®50WX4-400 based venlafaxine-resinate was selected for further encapsulation to optimize the release profile for once daily dosing and to lower the burst effect. The selected formula (coated with a mixture of Eudragit RS and PLGA in a ratio of 50/50) was chosen by applying a group of mathematical equations according to targeted values. It recorded the minimum burst effect, the maximum MDT (Mean dissolution time) and a Q24h (percentage drug released after 24 hours) between 95 and 100%. The 90% confidence intervals for the test/reference mean ratio of the log-transformed data of AUC0–24 and AUC0−∞ are within (0.8–1.25), which satisfies the bioequivalence criteria. Conclusion: The optimized formula could be a promising extended release form of the water soluble, short half lived venlafaxine. Being a multiple unit formulation, it lowers the probability of dose dumping and reduces the inter-subject variability in absorption.

Keywords: biodegradable polymers, cation-exchange resin, microencapsulation, venlafaxine hcl

Procedia PDF Downloads 384
528 Project Management and International Development: Competencies for International Assignment

Authors: M. P. Leroux, C. Coulombe

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Projects are popular vehicles through which international aid is delivered in developing countries. To achieve their objectives, many northern organizations develop projects with local partner organizations in the developing countries through technical assistance projects. International aid and international development projects precisely have long been criticized for poor results although billions are spent every year. Little empirical research in the field of project management has the focus on knowledge transfer in international development context. This paper focuses particularly on personal dimensions of international assignees participating in project within local team members in the host country. We propose to explore the possible links with a human resource management perspective in order to shed light on the less research problematic of knowledge transfer in development cooperation projects. The process leading to capacity building being far complex, involving multiple dimensions and far from being linear, we propose here to assess if traditional research on expatriate in multinational corporations pertain to the field of project management in developing countries. The following question is addressed: in the context of international development project cooperation, what personal determinants should the selection process focus when looking to fill a technical assistance position in a developing country? To answer that question, we first reviewed the literature on expatriate in the context of inter organizational knowledge transfer. Second, we proposed a theoretical framework combining perspectives of development studies and management to explore if parallels can be draw between traditional international assignment and technical assistance project assignment in developing countries. We conducted an exploratory study using case studies from technical assistance initiatives led in Haiti, a country in Central America. Data were collected from multiple sources following qualitative study research methods. Direct observations in the field were allowed by local leaders of six organization; individual interviews with present and past international assignees, individual interview with local team members, and focus groups were organized in order to triangulate information collected. Contrary from empirical research on knowledge transfer in multinational corporations, results tend to show that technical expertise rank well behind many others characteristics. Results tend to show the importance of soft skills, as a prerequisite to succeed in projects where local team have to collaborate. More importantly, international assignees who were talking knowledge sharing instead of knowledge transfer seemed to feel more satisfied at the end of their mandate than the others. Reciprocally, local team members who perceived to have participated in a project with an expat looking to share instead of aiming to transfer knowledge seemed to describe the results of project in more positive terms than the others. Results obtained from this exploratory study open the way for a promising research agenda in the field of project management. It emphasises the urgent need to achieve a better understanding on the complex set of soft skills project managers or project chiefs would benefit to develop, in particular, the ability to absorb knowledge and the willingness to share one’s knowledge.

Keywords: international assignee, international project cooperation, knowledge transfer, soft skills

Procedia PDF Downloads 127
527 Clinical Application of Measurement of Eyeball Movement for Diagnose of Autism

Authors: Ippei Torii, Kaoruko Ohtani, Takahito Niwa, Naohiro Ishii

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This paper shows developing an objectivity index using the measurement of subtle eyeball movement to diagnose autism. The developmentally disabled assessment varies, and the diagnosis depends on the subjective judgment of professionals. Therefore, a supplementary inspection method that will enable anyone to obtain the same quantitative judgment is needed. The diagnosis are made based on a comparison of the time of gazing an object in the conventional autistic study, but the results do not match. First, we divided the pupil into four parts from the center using measurements of subtle eyeball movement and comparing the number of pixels in the overlapping parts based on an afterimage. Then we developed the objective evaluation indicator to judge non-autistic and autistic people more clearly than conventional methods by analyzing the differences of subtle eyeball movements between the right and left eyes. Even when a person gazes at one point and his/her eyeballs always stay fixed at that point, their eyes perform subtle fixating movements (ie. tremors, drifting, microsaccades) to keep the retinal image clear. Particularly, the microsaccades link with nerves and reflect the mechanism that process the sight in a brain. We converted the differences between these movements into numbers. The process of the conversion is as followed: 1) Select the pixel indicating the subject's pupil from images of captured frames. 2) Set up a reference image, known as an afterimage, from the pixel indicating the subject's pupil. 3) Divide the pupil of the subject into four from the center in the acquired frame image. 4) Select the pixel in each divided part and count the number of the pixels of the overlapping part with the present pixel based on the afterimage. 5) Process the images with precision in 24 - 30fps from a camera and convert the amount of change in the pixels of the subtle movements of the right and left eyeballs in to numbers. The difference in the area of the amount of change occurs by measuring the difference between the afterimage in consecutive frames and the present frame. We set the amount of change to the quantity of the subtle eyeball movements. This method made it possible to detect a change of the eyeball vibration in numerical value. By comparing the numerical value between the right and left eyes, we found that there is a difference in how much they move. We compared the difference in these movements between non-autistc and autistic people and analyzed the result. Our research subjects consists of 8 children and 10 adults with autism, and 6 children and 18 adults with no disability. We measured the values through pasuit movements and fixations. We converted the difference in subtle movements between the right and left eyes into a graph and define it in multidimensional measure. Then we set the identification border with density function of the distribution, cumulative frequency function, and ROC curve. With this, we established an objective index to determine autism, normal, false positive, and false negative.

Keywords: subtle eyeball movement, autism, microsaccade, pursuit eye movements, ROC curve

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526 Assesment of Financial Performance: An Empirical Study of Crude Oil and Natural Gas Companies in India

Authors: Palash Bandyopadhyay

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Background and significance of the study: Crude oil and natural gas is of crucial importance due to its increasing demand in India. The demand has been increased because of change of lifestyle overtime. Since India has poor utilization of oil production capacity, constantly the import of it has been increased progressively day by day. This ultimately hit the foreign exchange reserves of India, however it negatively affect the Indian economy as well. The financial performance of crude oil and natural gas companies in India has been trimmed down year after year because of underutilization of production capacity, enhancement of demand, change in life style, and change in import bill and outflows of foreign currencies. In this background, the current study seeks to measure the financial performance of crude oil and natural gas companies of India in the post liberalization period. Keeping in view of this, this study assesses the financial performance in terms of liquidity management, solvency, efficiency, financial stability, and profitability of the companies under study. Methodology: This research work is encircled on yearly ratio data collected from Centre for Monitoring Indian Economy (CMIE) Prowess database for the periods between 1993-94 and 2012-13 with 20 observations using liquidity, solvency and efficiency indicators, profitability indicators and financial stability indicators of all the major crude oil and natural gas companies in India. In the course of analysis, descriptive statistics, correlation statistics, and linear regression test have been utilized. Major findings: Descriptive statistics indicate that liquidity position is satisfactory in case of three crude oil and natural gas companies (Oil and Natural Gas Companies Videsh Limited, Oil India Limited and Selan exploration and transportation Limited) out of selected companies under study but solvency position is satisfactory only for one company (Oil and Natural Gas Companies Videsh Limited). However, efficiency analysis points out that Oil and Natural Gas Companies Videsh Limited performs effectively the management of inventory, receivables, and payables, but the overall liquidity management is not well. Profitability position is very much satisfactory in case of all the companies except Tata Petrodyne Limited, but profitability management is not satisfactory for all the companies under study. Financial stability analysis shows that all the companies are more dependent on debt capital, which bears a financial risk. Correlation and regression test results illustrates that profitability is positively and negatively associated with liquidity, solvency, efficiency, and financial stability indicators. Concluding statement: Management of liquidity and profitability of crude oil and natural gas companies in India should have been improved through controlling unnecessary imports in spite of the heavy demand of crude oil and natural gas in India and proper utilization of domestic oil reserves. At the same time, Indian government has to concern about rupee depreciation and interest rates.

Keywords: financial performance, crude oil and natural gas companies, India, linear regression

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525 Presence, Distribution and Form of Calcium Oxalate Crystals in Relation to Age of Actinidia Deliciosa Leaves and Petioles

Authors: Muccifora S., Rinallo C., Bellani L.

Abstract:

Calcium (Ca²+) is an element essential to the plant being involved in plant growth and development. At high concentrations, it is toxic and can influence every stage, process and cellular activity of plant life. Given its toxicity, cells implement mechanisms to compartmentalize calcium in a vacuole, endoplasmic reticulum, mitochondria, plastids and cell wall. One of the most effective mechanisms to reduce the excess of calcium, thus avoiding cellular damage, is its complexation with oxalic acid to form calcium oxalate crystals that are no longer osmotically or physiologically active. However, the sequestered calcium can be mobilized when the plant needs it. Calcium crystals can be accumulated in the vacuole of specialized sink-cells called idioblasts, with different crystalline forms (druse, raphyde and styloid) of diverse physiological meanings. Actinidia deliciosa cv. Hayward presents raphydes and styloid localized in idioblasts in cells of photosynthetic and non-photosynthetic tissues. The purpose of this work was to understand if there is a relationship between the age of Actinidia leaves and the presence, distribution, dimension and shape of oxalate crystals by means of light, fluorescent, polarized and transmission electron microscopy. Three vines from female plants were chosen at the beginning of the season and used throughout the study. The leaves with petioles were collected at various stages of development from the bottom to the shoot of the plants monthly from April to July. The samples were taken in corresponding areas of the central and lateral parts of the leaves and of the basal portion of the petiole. The results showed that in the leaves, the number of raphyde idioblasts decreased with the progress of the growing season, while the styloid idioblasts increased progressively, becoming very numerous in the upper nodes of July. In June and in July samples, in the vacuoles of the highest nodes, a portion regular in shape strongly stained with rubeanic acid was present. Moreover, the chlortetracycline (CTC) staining for localization of free calcium marked the wall of the idioblasts and the wall of the cells near vascular bundles. In April petiole samples, moving towards the youngest nodes, the raphydes idioblast decreased in number and in the length of the single raphydes. Besides, crystals stained with rubeanic acid appeared in the vacuoles of some cells. In June samples, numerous raphyde idioblasts oriented parallel to vascular bundles were evident. Under the electron microscope, numerous idioblasts presented not homogeneous electrondense aggregates of material, in which a few crystals (styloids) in the form of regular holes were scattered. In July samples, an increase in the number of styloid idioblasts in the youngest nodes and little masses stained with CTC near styloids were observed. Peculiar cells stained with rubeanic acid were detected and hypothesized to be involved in the formation of the idioblasts. In conclusion, in Actinidia leaves and petioles, it seems to confirm the hypothesis that the formation of styloid idioblasts can be correlated to increasing calcium levels in growing tissues.

Keywords: calcium oxalate crystals, actinidia deliciosa, light and electron microscopy, idioblasts

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524 Endometrial Ablation and Resection Versus Hysterectomy for Heavy Menstrual Bleeding: A Systematic Review and Meta-Analysis of Effectiveness and Complications

Authors: Iliana Georganta, Clare Deehan, Marysia Thomson, Miriam McDonald, Kerrie McNulty, Anna Strachan, Elizabeth Anderson, Alyaa Mostafa

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Context: A meta-analysis of randomized controlled trials (RCTs) comparing hysterectomy versus endometrial ablation and resection in the management of heavy menstrual bleeding. Objective: To evaluate the clinical efficacy, satisfaction rates and adverse events of hysterectomy compared to more minimally invasive techniques in the treatment of HMB. Evidence Acquisition: A literature search was performed for all RCTs and quasi-RCTs comparing hysterectomy with either endometrial ablation endometrial resection of both. The search had no language restrictions and was last updated in June 2020 using MEDLINE, EMBASE, Cochrane Central Register of Clinical Trials, PubMed, Google Scholar, PsycINFO, Clinicaltrials.gov and Clinical trials. EU. In addition, a manual search of the abstract databases of the European Haemophilia Conference on women's health was performed and further studies were identified from references of acquired papers. The primary outcomes were patient-reported and objective reduction in heavy menstrual bleeding up to 2 years and after 2 years. Secondary outcomes included satisfaction rates, pain, adverse events short and long term, quality of life and sexual function, further surgery, duration of surgery and hospital stay and time to return to work and normal activities. Data were analysed using RevMan software. Evidence synthesis: 12 studies and a total of 2028 women were included (hysterectomy: n = 977 women vs endometrial ablation or resection: n = 1051 women). Hysterectomy was compared with endometrial ablation only in five studies (Lin, Dickersin, Sesti, Jain, Cooper) and endometrial resection only in five studies (Gannon, Schulpher, O’Connor, Crosignani, Zupi) and a mixture of the Ablation and Resection in two studies (Elmantwe, Pinion). Of the 1² studies, 10 reported women’s perception of bleeding symptoms as improved. Meta-analysis showed that women in the hysterectomy group were more likely to show improvement in bleeding symptoms when compared with endometrial ablation or resection up to 2-year follow-up (RR 0.75, 95% CI 0.71 to 0.79, I² = 95%). Objective outcomes of improvement in bleeding also favored hysterectomy. Patient satisfaction was higher after hysterectomy within the 2 years follow-up (RR: 0.90, 95%CI: 0.86 to 0.94, I²:58%), however, there was no significant difference between the two groups at more than 2 years follow up. Sepsis (RR: 0.03, 95% CI 0.002 to 0.56; 1 study), wound infection (RR: 0.05, 95% CI: 0.01 to 0.28, I²: 0%, 3 studies) and Urinary tract infection (UTI) (RR: 0.20, 95% CI: 0.10 to 0.42, I²: 0%, 4 studies) all favoured hysteroscopic techniques. Fluid overload (RR: 7.80, 95% CI: 2.16 to 28.16, I² :0%, 4 studies) and perforation (RR: 5.42, 95% CI: 1.25 to 23.45, I²: 0%, 4 studies) however favoured hysterectomy in the short term. Conclusions: This meta-analysis has demonstrated that endometrial ablation and endometrial resection are both viable options when compared with hysterectomy for the treatment of heavy menstrual bleeding. Hysteroscopic procedures had better outcomes in the short term with fewer adverse events including wound infection, UTI and sepsis. The hysterectomy performed better when measuring more long-term impacts such as recurrence of symptoms, overall satisfaction at two years and the need for further treatment or surgery.

Keywords: menorrhagia, hysterectomy, ablation, resection

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523 The Role of Oral and Intestinal Microbiota in European Badgers

Authors: Emma J. Dale, Christina D. Buesching, Kevin R. Theis, David W. Macdonald

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This study investigates the oral and intestinal microbiomes of wild-living European badgers (Meles meles) and will relate inter-individual differences to social contact networks, somatic and reproductive fitness, varying susceptibility to bovine tuberculous (bTB) and to the olfactory advertisement. Badgers are an interesting model for this research, as they have great variation in body condition, despite living in complex social networks and having access to the same resources. This variation in somatic fitness, in turn, affects breeding success, particularly in females. We postulate that microbiota have a central role to play in determining the successfulness of an individual. Our preliminary results, characterising the microbiota of individual badgers, indicate unique compositions of microbiota communities within social groups of badgers. This basal information will inform further questions related to the extent microbiota influence fitness. Hitherto, the potential role of microbiota has not been considered in determining host condition, but also other key fitness variables, namely; communication and resistance to disease. Badgers deposit their faeces in communal latrines, which play an important role in olfactory communication. Odour profiles of anal and subcaudal gland secretions are highly individual-specific and encode information about group-membership and fitness-relevant parameters, and their chemical composition is strongly dependent on symbiotic microbiota. As badgers sniff/ lick (using their Vomeronasal organ) and over-mark faecal deposits of conspecifics, these microbial communities can be expected to vary with social contact networks. However, this is particularly important in the context of bTB, where badgers are assumed to transmit bTB to cattle as well as conspecifics. Interestingly, we have found that some individuals are more susceptible to bTB than are others. As acquired immunity and thus potential susceptibility to infectious diseases are known to depend also on symbiotic microbiota in other members of the mustelids, a role of particularly oral microbiota can currently not be ruled out as a potential explanation for inter-individual differences in infection susceptibility of bTB in badgers. Tri annually badgers are caught in the context of a long-term population study that began in 1987. As all badgers receive an individual tattoo upon first capture, age, natal as well as previous and current social group-membership and other life history parameters are known for all animals. Swabs (subcaudal ‘scent gland’, anal, genital, nose, mouth and ear) and fecal samples will be taken from all individuals, stored at -80oC until processing. Microbial samples will be processed and identified at Wayne State University’s Theis (Host-Microbe Interactions) Lab, using High Throughput Sequencing (16S rRNA-encoding gene amplification and sequencing). Acknowledgments: Gas-Chromatography/ Mass-spectrometry (in the context of olfactory communication) analyses will be performed through an established collaboration with Dr. Veronica Tinnesand at Telemark University, Norway.

Keywords: communication, energetics, fitness, free-ranging animals, immunology

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522 Case Report on Anaesthesia for Ruptured Ectopic with Severe Pulmonary Hypertension in a Mute Patient

Authors: Pamela Chia, Tay Yoong Chuan

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Introduction: Severe pulmonary hypertension (PH) patients requiring non-cardiac surgery risk have increased mortality rates ranging. These patients are plagued with cardiorespiratory failure, dysrhythmias and anticoagulation potentially with concurrent sepsis and renal insufficiency, perioperative morbidity. We present a deaf-mute patient with severe idiopathic PH emergently prepared for ruptured ectopic laparotomy. Case Report: A 20 year-old female, 62kg (BMI 25 kg/m2) with severe idiopathic PH (2DE Ejection Fraction was 41%, Pulmonary Artery Systolic Pressure (PASP) 105 mmHg, Right ventricle strain and hypertrophy) and selective mutism was rushed in for emergency laparotomy after presenting to the emergency department for abdominal pain. The patient had an NYHA Class II with room air SpO2 93-95%. While awaiting lung transplant, the patient takes warfarin, Sildanefil, Macitentan and even Selexipag for rising PASP. At presentation, vital signs: BP 95/63, HR 119 SpO2 88% (room air). Despite decreasing haemoglobin 14 to 10g/dL, INR 2.59 was reversed with prothrombin concentrate, and Vitamin K. ECG revealed Right Bundle Branch Block with right ventricular strain and x-ray showed cardiomegaly, dilated Right Ventricle, Pulmonary Arteries, basal atelectasis. Arterial blood gas showed compensated metabolic acidosis pH 7.4 pCO2 32 pO2 53 HCO3 20 BE -4 SaO2 88%. The cardiothoracic surgeon concluded no role for Extracorporeal Membrane Oxygenation (ECMO). We inserted invasive arterial and central venous lines with blood transfusion via an 18G cannula before the patient underwent a midline laparotomy, haemostasis of ruptured ovarian cyst with 2.4L of clots under general anesthesia and FloTrac cardiac output monitoring. Rapid sequence induction was done with Midazolam/Propofol, remifentanil infusion, and rocuronium. The patient was maintained on Desflurane. Blood products and colloids were transfused for further 1.5L blood loss. Postoperatively, the patient was transferred to the intensive care unit and was extubated uneventfully 7hours later. The patient went home a week later. Discussion: Emergency hemostasis laparotomy in anticoagulated WHO Class I PH patient awaiting lung transplant with no ECMO backup poses tremendous stress on the deaf-mute patient and the anesthesiologist. Balancing hemodynamics avoiding hypotension while awaiting hemostasis in the presence of pulmonary arterial dilators and anticoagulation requires close titration of volatiles, which decreases RV contractility. We review the contraindicated anesthetic agents (ketamine, N2O), choice of vasopressors in hypotension to maintain Aortic-right ventricular pressure gradients and nitric oxide use perioperatively. Conclusion: Interdisciplinary communication with a deaf-mute moribund patient and anesthesia considerations pose many rare challenges worth sharing.

Keywords: pulmonary hypertension, case report, warfarin reversal, emergency surgery

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