Search results for: quality of services

Authors: Ali Alshahrani, Adel Almaai, Saad Garni

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Aim of the study: To explore duration and determinants of consultation time at a family medicine center. Methodology: This study was conducted at the Family Medicine Center in Ahad Rafidah City, at the southwestern part of Saudi Arabia. It was conducted on the working days of March 2013. Trained nurses helped in filling in the checklist. A total of 459 patients were included. A checklist was designed and used in this study. It included patient’s age, sex, diagnosis, type of visit, referral and its type, psychological problems and additional work-up. In addition, number of daily bookings, physician`s experience and consultation time. Results: More than half of patients (58.39%) had less than 10 minutes’ consultation (Mean+SD: 12.73+9.22 minutes). Patients treated by physicians with shortest experience (i.e., ≤5 years) had the longest consultation time while those who were treated with physicians with the longest experience (i.e., > 10 years) had the shortest consultation time (13.94±10.99 versus 10.79±7.28, p=0.011). Regarding patients’ diagnosis, those with chronic diseases had the longest consultation time (p<0.001). Patients who did not need referral had significantly shorter consultation time compared with those who had routine or urgent referral (11.91±8.42,14.60±9.03 and 22.42±14.81 minutes, respectively, p<0.001). Patients with associated psychological problems needed significantly longer consultation time than those without associated psychological problems (20.06±13.32 versus 12.45±8.93, p<0.001). Conclusions: The average length of consultation time at Ahad Rafidah Family Medicine Center is approximately 13 minutes. Less-experienced physicians tend to spend longer consultation times with patients. Referred patients, those with psychological problems, those with chronic diseases tend to have longer consultation time. Recommendations: Family physicians should be encouraged to keep their optimal consultation time. Booking an adequate number of patients per shift would allow the family physician to provide enough consultation time for each patient.

Keywords: consultation, quality, medicine, clinics

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Authors: Solomon Neway Jida, Jean-Francois Hetet, Pascal Chesse

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Vehicular emission is the key source of air pollution in the urban environment. This includes both fine particles (PM_2.5) and coarse particulate matters (PM₁₀). However, particulate matter emissions from road traffic comprise emissions from exhaust tailpipe and emissions due to wear and tear of the vehicle part such as brake, tire and clutch and re-suspension of dust (non-exhaust emission). This study estimates the share of the two sources of pollutant particle emissions from on-roadside vehicles in the Addis Ababa municipality, Ethiopia. To calculate its share, two methods were applied; the exhaust-tailpipe emissions were calculated using the Europeans emission inventory Tier II method and Tier I for the non-exhaust emissions (like vehicle tire wear, brake, and road surface wear). The results show that of the total traffic-related particulate emissions in the city, 63% emitted from vehicle exhaust and the remaining 37% from non-exhaust sources. The annual roads transport exhaust emission shares around 2394 tons of particles from all vehicle categories. However, from the total yearly non-exhaust particulate matter emissions’ contribution, tire and brake wear shared around 65% and 35% emanated by road-surface wear. Furthermore, vehicle tire and brake wear were responsible for annual 584.8 tons of coarse particles (PM₁₀) and 314.4 tons of fine particle matter (PM_2.5) emissions in the city whereas surface wear emissions were responsible for around 313.7 tons of PM₁₀ and 169.9 tons of PM_2.5 pollutant emissions in the city. This suggests that non-exhaust sources might be as significant as exhaust sources and have a considerable contribution to the impact on air quality.

Keywords: Addis Ababa, automotive emission, emission estimation, particulate matters

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Authors: Zsuzsanna Schnell - Francesca Ervas

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Background: the experimental pragmatic study confirms a basic tenet in the Relevance theoretical views in language philosophy. It draws up a developmental trajectory of the maxims, revealing the cognitive difficulty of their interpretation, their relative place to each other, and the order they may follow in development. A central claim of the present research is that social-cognitive skills play a significant role in inferential meaning construction. Children passing the False Belief Test are significantly more successful in tasks measuring the recognition of the infringement of conversational maxims. Aims and method: Preschoolers’ conversational skills and pragmatic competence is examined in view of their mentalization skills. In doing so it use a measure of linguistic tasks, containing 5 short scenarios for each Gricean maxim. it measure preschoolers’ ToM performance with a first- and a second order ToM task and compare participants’ ability to recognize the infringement of the Gricean maxims in view of their social cognitive skills. Results: Findings suggest that Theory of Mind has a predictive force of 75% concerning the ability to follow Gricean maxims efficiently. ToM proved to be a significant factor in predicting the group’s performance and success rates in 3 out of 4 maxim infringement recognition tasks: in the Quantity, Relevance and Manner conditions, but not in the Quality trial. Conclusions: the results confirm that children’s communicative competence in social contexts requires the development of higher-order social-cognitive reasoning, and reveal the cognitive effort needed for the recognition of the infringement of each maxim, yielding a continuum of their cognitive difficulty and trajectory of development.

Keywords: maxim infringement recognition, social cognition, Gricean maxims, developmental pragmatics

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Authors: Zhao Yu, Zhi-Nan Zhang

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More and more interactive devices are used in the transportation service system. Our mobile phones, on-board computers, and Head-Up Displays (HUDs) can all be used as the tools of the in-car service system. People can access smart systems with different terminals such as mobile phones, computers, pads and even their cars and watches. Different forms of terminals bring the different quality of interaction by the various human-computer Interaction modes. The new interactive devices require good ergonomics design at each stage of the whole design process. According to the theory of human factors and ergonomics, this paper compared three types of interactive devices by four driving tasks. Forty-eight drivers were chosen to experience these three interactive devices (mobile phones, on-board computers, and HUDs) by a simulate driving process. The subjects evaluated ergonomics performance and subjective workload after the process. And subjects were encouraged to support suggestions for improving the interactive device. The result shows that different interactive devices have different advantages in driving tasks, especially in non-driving tasks such as information and entertainment fields. Compared with mobile phones and onboard groups, the HUD groups had shorter response times in most tasks. The tasks of slow-up and the emergency braking are less accurate than the performance of a control group, which may because the haptic feedback of these two tasks is harder to distinguish than the visual information. Simulated driving is also helpful in improving the design of in-vehicle interactive devices. The paper summarizes the ergonomics characteristics of three in-vehicle interactive devices. And the research provides a reference for the future design of in-vehicle interactive devices through an ergonomic approach to ensure a good interaction relationship between the driver and the in-vehicle service system.

Keywords: human factors, industrial ergonomics, transportation system, usability, vehicle user interface

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Authors: Alok Kalra

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Consumers and practitioners (medical herbalists, pharmacists, and aromatherapists) with strong and increased awareness about health and environment demand organically grown medicinal and aromatic plants (MAPs) to offer a valued product. As the system does not permit the use of synthetic fertilizers the use of nutrient rich organic manures is extremely important. CSIR-CIMAP has developed a complete recycling package for managing distillation and agro-waste of medicinal and aromatic plants for production of superior quality vermicompost involving microbes capable of producing high amounts of humic acid. The major benefits being faster composting period and nutrient rich vermicompost; a nutrient advantage of about 100-150% over the most commonly used organic manure (FYM). At CSIR-CIMAP, strains of microbial inoculants with multiple activities especially strains useful both as biofertilizers and biofungicide and consortia of microbes possessing diverse functional activities have been developed. CSIR-CIMAP has also initiated a program where a large number of accessions are being screened for identifying organic proficient genotypes in mints, ashwagandha, geranium and safed musli. Some of the natural plant growth promoters like calliterpenones from the plant Callicarpa macrophylla has been tested successfully for induction of rooting in stem cuttings and improving growth and yield of various crops. Some of the microbes especially the endophytes have even been identified improving the active constituents of medicinal and aromatic plants. The above said scientific interventions making organic farming a charming proposition would be discussed in details.

Keywords: organic agriculture, microbial inoculants, organic fertilizers, natural plant growth promoters

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Authors: Jingqian Xiao

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The rapid wave of urbanization triggered by China’s economic growth over the past few decades has inevitably impacted the country’s educational landscape. Educational spaces in China shifted during the 1990s when, due to the government’s tax reforms, large numbers of rural schools were abolished or merged with urban schools, resulting in an “urbanization” of school content and values. While urbanized education is now the status quo, there is as yet no literature review, to our best knowledge, that comprehensively summarizes academic work on this phenomenon. Besides, most research on Chinese educational urbanization relies on basic policy deductions, and there is room for improvement in both the quality and quantity of empirical research on this topic. This paper, therefore, reviews relevant literature on educational urbanization in China from three interrelated factors that shape educational inequality between urban and rural China, namely the urbanization in educational space, school content, and educational values. Results find that the main discussion on Chinese educational urbanization often addresses how Chinese rural education can be improved by reforming the urbanization model to revitalize rural society. While the complete urbanization of Chinese education does not seem feasible, the rapidly changing nature of China’s development patterns and political landscape means the course of Chinese education may shift at any time. When the government does decide to fulfill its intentions to improve the countryside, many formerly dilapidated rural schools may be revived, but for the moment, both rural and urban education in China suffers from governmental neglect. In addition, the breakout of COVID-19, which led to a sudden spread of online education that reopened the gap between the educational conditions and the cultural capital of families in rural and urban areas, has also posed new challenges for China’s attempts to resolve conflicting interests between urban and rural schools and promote educational equality.

Keywords: Chinese education, educational inequality, rural and urban education, urbanization in education

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Authors: Yah-Ling Hung

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eHealth is undoubtedly emerging as a promising vehicle to provide information for individual self-care management. However, the accessing ability, reading strategies and navigating behavior between higher literacy users and lower literacy users are significantly different. Yet, ways to tailor audiences’ health literacy and develop appropriate eHealth to feed their need become a big challenge. The purpose of this study is to compare the educational effectiveness of eHealth to deliver health knowledge between higher literacy users and lower literacy users, thus establishing useful design strategies of eHealth for users with different level of health literacy. The study was implemented in four stages, the first of which developed a website as the testing media to introduce health care knowledge relating to children’s allergy. Secondly, a reliability and validity test was conducted to make sure that all of the questions in the questionnaire were good indicators. Thirdly, a pre-post knowledge test was conducted with 66 participants, 33 users with higher literacy and 33 users with lower literacy respectively. Finally, a usability evaluation survey was undertaken to explore the criteria used by users with different levels of health literacy to evaluate eHealth. The results demonstrated that the eHealth Intervention in both groups had a positive outcome. There was no significant difference between the effectiveness of eHealth intervention between users with higher literacy and users with lower literacy. However, the average mean of lower literacy group was marginally higher than the average mean of higher literacy group. The findings also showed that the criteria used to evaluate eHealth could be analyzed in terms of the quality of information, appearance, appeal and interaction, but the users with lower literacy have different evaluation criteria from those with higher literacy. This is an interdisciplinary research which proposes the sequential key steps that incorporate the planning, developing and accessing issues that need to be considered when designing eHealth for patients with varying degrees of health literacy.

Keywords: eHealth, health intervention, health literacy, usability evaluation

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Authors: A. Aljohani, D. Moore, D. D. Ahiaga-Dagbui

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Cost overruns are endemic in the delivery of construction projects. The problem is global. It occurs irrespective of type and size of the project, its location, procurement method or client. The size of overruns can be as high as 200% in some cases. Projects thus unfortunately often make the news headlines, not for their immense socio-economic contribution to society, but for being poorly procured. In Saudi Arabia, two-thirds of construction projects are publicly procured by the Saudi government, which has been invested Billions of dollars in infrastructure projects each year as part of an ambitious strategic development agenda to shift from mainly oil dependency to multi-source dependency. However, reports show that about 3,000 public projects face diverse issues related to time and cost overrun. As part of an on-going study to develop a framework for effective public procurement for the Saudi Arabian construction industry, this paper reports the initial findings of the causes of cost overruns in the context of the Gulf State. It also evaluates the interface between some of the front-end loading issues in public procurement in Saudi and their effects on project performance. A systematic review of the existing literature on construction cost overruns, with focus on the Saudi Arabian construction industry has been used. One of the initial findings is that a fixed-price contract is usually used by the client in an attempt to transfer all financial risks to the contractors. This has the unintended consequence of creating a turbulent environment for the delivery of the project which leads to project abandonment by contractors, poor quality of work and substantial rework. Further work is being undertaken to empirically verify the initial findings reported in this paper and their generalizability for the construction industry as a whole.

Keywords: cost overrun, public procurement, Saudi Arabia, construction projects

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Authors: Brigitte Mischler, Marget Hund, Hilfiker Roger, Clare Maguire

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Background: Brain injury is one of the main causes of permanent physical disability, and improving walking ability is one of the most important goals for patients. After inpatient rehabilitation, most do not receive long-term rehabilitation services. Physical activity is important for the health prevention of the musculoskeletal system, circulatory system and the psyche. Objective: This follow-up study measured physical activity in subacute patients after traumatic brain injury and stroke. The difference in the number of steps in the inpatient setting was compared to the number of steps 1 year after the event in the outpatient setting. Methods: This follow-up study is a cross-sectional observational study with 29 participants. The measurement of daily step count over a seven-day period one year after the event was evaluated with the StepWatch™ ankle sensor. The number of steps taken one year after the event in the outpatient setting was compared with the number of steps taken during the inpatient stay and evaluated if they reached the recommended target value. Correlations between steps-count and exit domain, FAC level, walking speed, light touch, joint position sense, cognition, and fear of falling were calculated. Results: The median (IQR) daily step count of all patients was 2512 (568.5, 4070.5). During follow-up, the number of steps improved to 3656(1710,5900). The average difference was 1159(-2825, 6840) steps per day. Participants who were unable to walk independently (FAC 1) improved from 336(5-705) to 1808(92, 5354) steps per day. Participants able to walk with assistance (FAC 2-3) walked 700(31-3080) and at follow-up 3528(243,6871). Independent walkers (FAC 4-5) walked 4093(2327-5868) and achieved 3878(777,7418) daily steps at follow-up. This value is significantly below the recommended guideline. Step-count at follow-up showed moderate to high and statistically significant correlations: positive for FAC score, positive for FIM total score, positive for walking speed, and negative for fear of falling. Conclusions: Only 17% of all participants achieved the recommended daily step count one year after the event. We need better inpatient and outpatient strategies to improve physical activity. In everyday clinical practice, pedometers and diaries with objectives should be used. A concrete weekly schedule should be drawn up together with the patient, relatives, or nursing staff after discharge. This should include daily self-training, which was instructed during the inpatient stay. A good connection to social life (professional connection or a daily task/activity) can be an important part of improving daily activity. Further research should evaluate strategies to increase daily step counts in inpatient settings as well as in outpatient settings.

Keywords: neurorehabilitation, stroke, traumatic brain injury, steps, stepcount

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Authors: Yousef Daneshvar Rouyandozagh, Ece. K. Açikgöz

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Conservation of historical urban patterns in the traditional neighborhoods is a part of creating integrated urban environments that are socially more sustainable. Urbanization reflects on life conditions and social, physical, economical characteristics of the society. In this regard, historical zones and traditional regions are affected by dramatic interventions on these characteristics. This article focuses on the Uch Dukkan neighborhood located in Ardabil City in Azarbaijani region of Iran, which has been up to such interventions that leaded its transformation from the past to the present. After introducing a brief inventory of the main elements of the historical zone and the neighborhood; this study explores the changes and transformations in different periods; and their impacts on the quality of the environment and its social sustainability. The survey conducted in the neighborhood as part of this research study revealed that the Uch Dukkan neighborhood and the unique architectural heritage that it possesses have become more inactive physically and functionally in a decade. This condition requires an exploration and comparison of the present and the expected transformations of the meaning of social space from the most private unit to the urban scale. From this token, it is argued that an architectural point of view that is based on space order; use and meaning of space as a social and cultural image, should not be ignored. Based on the interplay between social sustainability, collective memory, and the urban environment, study aims to make the invisible portion of ignorance clear, that ends up with a weakness in defining the collective meaning of the neighborhood as a historic urban district. It reveals that the spatial possessions of the neighborhood are valuable not only for their historical and physical characteristics, but also for their social memory that is to be remembered and constructed further.

Keywords: urban integrity, social sustainability, collective memory, social decay

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Authors: Chanya Inprasit, Ching-Liang Hsieh, Yi-Wen Lin

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Obesity (OB) is a hazardous global health problem that has been increasing in prevalence, more severely in last decade. It is the mainly resultant from the imbalance between food consumption and energy expenditure, which is concordant with a modern lifestyle, implying an increase in calories with poorer quality of food intake accompanied by a decrease in physical activities. Obesity does not concern the appearance only but is also a major factor contributing to poor physiology, psychology, society and economic issues. Moreover, OB induces low-grade inflammation in the body through the regulatory effect it enacts on the adipocyte function. Various alternative treatments were investigated for body weight control, including Acupoint Catgut Embedding (ACE). ACE is the implantation of absorbable catgut sutures at specific acupoints, displaying durable and potent stimulation and thereby reducing the treatment frequency. Our study utilized a mouse model to exclude any psychological factors of OB and ACE treatment. High-fat diet and body weight were measured once a week before subjects in ACE and Sham group received the ACE treatment or placebo treatment. We hypothesized that ACE can control body weight through the interaction of the TRPV1 pathways, as TRPV1 accordingly responds to inflammatory factors. The results of body weight variation show a significant decrease in body weight in ACE group compared with the baseline of control and Sham group. Meanwhile, converse results were explored in TRPV1 knockout mice, where a significant maintenance of normal body weight throughout the experiment period was observed. There was no significant difference in food consumption of each group. These finding indicated that TRPV1 pathways and its associated pathways may be involved in the maintenance of body weight, which can be controlled by ACE treatment of genetic manipulation.

Keywords: acupoint catgut embedding, obesity, hypothalamus, TRPV1

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Authors: Kristina Gordon

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One in three children in the United States is a victim of a maltreatment investigation, and about one in nine children has a substantiated investigation. Home visiting is one of several preventative strategies rooted in an early childhood approach that fosters maternal, infant, and early childhood health, protection, and growth. In the United States, 88% of states report administering home visiting programs or state-designed models. The purpose of this study was to conduct a systematic review on home visiting programs in the United States focused on the prevention of child abuse and neglect. This systematic review included 17 articles which found that most of the studies reported optimistic results. Common across studies was program content related to (1) typical child development, (2) parenting education, and (3) child physical health. Although several factors common to home visiting and parenting interventions have been identified, no research has examined the common components of manualized home visiting programs to prevent child maltreatment. Child maltreatment can be addressed with home visiting programs with evidence-based components and cultural adaptations that increase prevention by assisting families in tackling the risk factors they face. An innovative approach to child maltreatment prevention is bringing together at-risk families with the aging community. This innovative approach was prompted due to existing home visitation programs only focusing on improving skillsets and providing temporary relationships. This innovative approach can provide the opportunity for families to build a relationship with an aging individual who can share their wisdom, skills, compassion, love, and guidance, to support families in their well-being and decrease child maltreatment occurrence. Families would be identified if they experience any of the risk factors, including parental substance abuse, parental mental illness, domestic violence, and poverty. Families would also be identified as at risk if they lack supportive relationships such as grandparents or relatives. Families would be referred by local agencies such as medical clinics, hospitals, schools, etc., that have interactions with families regularly. The aging community would be recruited at local housing communities and community centers. An aging individual would be identified by the elderly community when there is a need or interest in a relationship by or for the individual. Cultural considerations would be made when assessing for compatibility between the families and aging individuals. The pilot program will consist of a small group of participants to allow manageable results to evaluate the efficacy of the program. The pilot will include pre-and post-surveys to evaluate the impact of the program. From the results, data would be created to determine the efficacy as well as the sufficiency of the details of the pilot. The pilot would also be evaluated on whether families were referred to Child Protective Services during the pilot as it relates to the goal of decreasing child maltreatment. The ideal findings will display a decrease in child maltreatment and an increase in family well-being for participants.

Keywords: child maltreatment, home visiting, neglect, preventative, abuse

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Authors: Shima Nikanjam, Badiossadat Hassanpour, Adi Irfan Che Ani

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The design process in architecture education is based upon the Learning-by-Doing method, which leads students to understand how to design by practicing rather than studying. First-year design studios, as starting educational stage, provide integrated knowledge and skills of design for newly jointed architecture students. Within the basic design studio environment, students are guided to transfer their abstract thoughts into visual concrete decisions under the supervision of design educators for the first time. Therefore, introductory design studios have predominant impacts on students’ operational thinking and designing. Architectural design thinking is quite different from students’ educational backgrounds and learning habits. This educational challenge at basic design studios creates a severe need to study the reality of design education at foundation year and define appropriate educational methods with convenient project types with the intention of enhancing architecture education quality. Material for this study has been gathered through long-term direct observation at a first year second semester design studio at the faculty of architecture at EMU (known as FARC 102), fall and spring academic semester 2014-15. Distribution of a questionnaire among case study students and interviews with third and fourth design studio students who passed through the same methods of education in the past 2 years and conducting interviews with instructors are other methodologies used in this research. The results of this study reveal a risk of a mismatch between the implemented teaching method, project type and scale in this particular level and students’ learning styles. Although the existence of such risk due to varieties in students’ profiles could be expected to some extent, recommendations can support educators to reach maximum compatibility.

Keywords: architecture education, basic design studio, educational method, forms creation skill

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Authors: Martin Mundo-Molina

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In Mexico, there are many small rural communities with serious water supply deficiencies. In Chiapas, Mexico, there are 19,972 poor rural communities, 15,712 of which have fewer than 100 inhabitants. The lack of a constant water supply is most severe in the highlands of Chiapas where the population is made up mainly of indigenous groups. The communities are on mountainous terrain with a widely dispersed population. These characteristics combine to make the provision of public utilities, such as water, electricity and sewerage, difficult with conventional means. The introduction of alternative, low-cost technologies represents means of supplying water such as through fog and rain catchment with zero greenhouse emissions. In this paper is presented the rainwater harvesting system (RWS) constructed in Yalentay, Chiapas Mexico. The RWS is able to store 1.2 M liters of water to provide drinking water to small rural indigenous communities of 500 people in the drought stage. Inside the system of rainwater harvesting there isn't photosynthesis in order to conserve water for long periods. The natural filters of the system of rainwater harvesting guarantee the drinking water for using to the community. The combination of potability and low cost makes rain collection a viable alternative for rural areas, weather permitting. The Mexican Institute of Water Technology and Chiapas University constructed a rainwater harvesting system in Yalentay Chiapas, it consists of four parts: 1. Roof of aluminum, for collecting rainwater, 2. Underground-cistern, divided in two tanks, 3. Filters, to improve the water quality and 4. The system of rainwater harvesting dignified the lives of people in Yalentay, saves energy, prevents the emission of greenhouse gases into the atmosphere, conserves natural resources such as water and air.

Keywords: appropriate technologies, climate change, greenhouse gases, rainwater harvesting

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Authors: Mushty Srividya

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Humans that inhabit a designed space consciously or unconsciously accept the spaces which have an impact on how they perceive, feel and act accordingly. Spaces that are more interactive and communicative with the human senses become more interesting. Interaction in architecture is the art of building relationships between the user and the spaces. Often spaces are form-based, function-based or aesthetically pleasing spaces but they are not interactive with the user which actually has a greater impact on how the user perceives the designed space and appreciate it. It is very necessary for a designer to understand and appreciate the human character and design accordingly, wherein the user gets the flexibility to explore and experience it for themselves rather than the designed space dictating the user how to perceive or feel in that space. In this interaction between designed spaces and the user, a designer needs to understand the spatial potential and user’s needs because the design language varies with varied situations in accordance with these factors. Designers often have the tendency to construct spaces with their perspectives, observations, and sense the space in their range of different angles rather than the users. It is, therefore, necessary to understand the potential of the space by understanding different factors and improve the quality of space with the help of creating better interactive spaces. For an interaction to occur between the user and space, there is a need for some medium. In this paper, light, color, and sound will be used as the mediums to understand and create interactions between the user and space, considering these to be the primary sources which would not require any physical touch in the space and would help in triggering the human senses. This paper involves in studying and understanding the impact of light, color and sound on different typologies of spaces on the user through different findings, articles, case studies and surveys and try to get links between these three mediums to create an interaction. This paper also deals with understanding in which medium takes an upper hand in a varied typology of spaces and identify different techniques which would create interactions between the user and space with the help of light, color, and sound.

Keywords: color, communicative spaces, human factors, interactive spaces, light, sound

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Authors: M. Soltani, K. Pakzad, A. Haghigh-Khiyabani, M. Alavi, R. Naderi, M. Castex

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Effect of probiotic Bactocell (Pediococcus acidilactici) as a supplementary diet was studied on post-larvae 12-15 of white leg shrimp (Litopenaeus vannamei) (150000 PL/0.5 h pond, average body weight=0.02 g) growth performance under farm condition for 102 days at water quality parameters consisting of temperature at 30.5-36οC, dissolved oxygen 4.1-6.6 mg/l, salinity 40-54 g/l, turbidity 35-110 cm, ammonia 0.1-0.8 mg/l and nitrite 0.1-0.9 mg/l. Also, the resistance level of the treated shrimps was assessed against a virulent strain of Vibrio paraheamolyticus as intramuscular injection route at 1.4 x 106 cells/shrimp. Significantly higher growth rate (11.3±1.54 g) and lower feed conversion ratio (1.1) were obtained in shrimps fed diets supplemented with Bactocell at 350 g/ tone feed compared to other treatments of 250 g Bactocell/ton feed (10.8±2 g, 1.3), 500 g Bactocell/ton feed (10.3±1.7 g, 1.3) and untreated control (10.1±2 g, 1.4). Also, thermal growth coefficient (0.057%) and protein efficiency ratio (2.13) were significantly improved in shrimps fed diets supplemented with Bactocell at 350 g/ton feed compare to other groups. Shrimps fed diet supplemented with Bactocell at 350 g/tone feed showed significantly higher protein content (72.56%) in their carcass composition than treatments of 250 g/ton feed (65.9%), 500 g/ton feed (67.5%) and control group (65.9%), while the carcass contents of moisture, lipid and ash in all shrimp groups were not significantly affected by different concentrations of Bactocell. No mortality occurred in the experimentally infected shrimps fed with Bactocell at 500 g/tone feed after 7 hours post-challenge with V. parahemolyticus. The mortality levels of 100%, 40%, 50% and 70% were obtained in shrimps fed with 0.0, 500 g/tone feed, 350 g/ton feed and 250 g/ton feed, respectively 14 hours post-infection. Also, the cumulative mortalities were achieved in 100%, 92% and 81% in shrimps few with Bactocell at 500 g/ton feed, 250 g/ton feed and 350 g/ton feed, respectively.

Keywords: litopenaeus vannamei, vibrio paraheamolyticus, pediococcus acidilactici, growth performance, bactocell

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Authors: Xuelian Qin

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Urban "organic renewal" based on the development of existing resources in high-density urban areas has become the mainstream of urban development in the new era. As an important stock resource of public space in high-density urban areas, promoting its value remodeling is an effective way to alleviate the shortage of public space resources. However, due to the lack of evaluation links in the process of underpass space renewal, a large number of underpass space resources have been left idle, facing the problems of low space conversion efficiency, lack of accuracy in development decision-making, and low adaptability of functional positioning to citizens' needs. Therefore, it is of great practical significance to construct the evaluation system of under-bridge space renewal potential and explore the renewal mode. In this paper, some of the under-bridge spaces in the main urban area of Chongqing are selected as the research object. Through the questionnaire interviews with the users of the built excellent space under the bridge, three types of six levels and twenty-two potential evaluation indexes of "objective demand factor, construction feasibility factor and construction suitability factor" are selected, including six levels of land resources, infrastructure, accessibility, safety, space quality and ecological environment. The analytical hierarchy process and expert scoring method are used to determine the index weight, construct the potential evaluation system of the space under the bridge in high-density urban areas of Chongqing, and explore the direction of renewal and utilization of its suitability. To provide feasible theoretical basis and scientific decision support for the use of under bridge space in the future.

Keywords: high density urban area, potential evaluation, space under bridge, updated using

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Authors: Daniel M. Muntean, Viorel Ungureanu

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More than half of the urban population in Romania lives today in residential buildings made out of large prefabricated reinforced concrete panels. Since their initial design was made in the 1960’s, these housing units are now being technically and morally outdated, consuming large amounts of energy for heating, cooling, ventilation and lighting, while failing to meet the needs of the contemporary life-style. Due to their widespread use, the design of a system that improves their energy efficiency would have a real impact, not only on the energy consumption of the residential sector, but also on the quality of life that it offers. Furthermore, with the transition of today’s existing power grid to a “smart grid”, buildings could become an active element for future electricity networks by contributing in micro-generation and energy storage. One of the most addressed issues today is to find locally adapted strategies that can be applied considering the 20-20-20 EU policy criteria and to offer sustainable and innovative solutions for the cost-optimal energy performance of buildings adapted on the existing local market. This paper presents a possible adaptive design scenario towards sustainable retrofitting of these housing units. The apartments are transformed in order to meet the current living requirements and additional extensions are placed on top of the building, replacing the unused roof space, acting not only as housing units, but as active solar energy collection systems. An adaptive building envelope is ensured in order to achieve overall air-tightness and an elevator system is introduced to facilitate access to the upper levels.

Keywords: adaptive building, energy efficiency, retrofitting, residential buildings, smart grid

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Authors: Maryam Ziaee

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This research proposes a new approach and provides an opportunity for manufacturing companies to produce large amounts of products that meet their prospective customers’ tastes, needs, and expectations and simultaneously enable manufacturers to increase their profit. Mass customization is the production of products or services to meet each individual customer’s desires to the greatest possible extent in high quantities and at reasonable prices. This process takes place at different levels such as the customization of goods’ design, assembly, sale, and delivery status, and classifies in several categories. The main focus of this study is on one class of mass customization, called optional customization, in which companies try to provide their customers with as many options as possible to customize their products. These options could range from the design phase to the manufacturing phase, or even methods of delivery. Mass customization values customers’ tastes, but it is only one side of clients’ satisfaction; on the other side is companies’ fast responsiveness delivery. It brings the concept of agility, which is the ability of a company to respond rapidly to changes in volatile markets in terms of volume and variety. Indeed, mass customization is not effectively feasible without integrating the concept of agility. To gain the customers’ satisfaction, the companies need to be quick in responding to their customers’ demands, thus highlighting the significance of agility. This research offers a different method that successfully integrates mass customization and fast production in manufacturing industries. This research is built upon the hypothesis that the success key to being agile in mass customization is to forecast demand, cooperate with suppliers, and control inventory. Therefore, the significance of the supply chain (SC) is more pertinent when it comes to this stage. Since SC behavior is dynamic and its behavior changes constantly, companies have to apply one of the predicting techniques to identify the changes associated with SC behavior to be able to respond properly to any unwelcome events. System dynamics utilized in this research is a simulation approach to provide a mathematical model among different variables to understand, control, and forecast SC behavior. The final stage is delayed differentiation, the production strategy considered in this research. In this approach, the main platform of products is produced and stocked and when the company receives an order from a customer, a specific customized feature is assigned to this platform and the customized products will be created. The main research question is to what extent applying system dynamics for the prediction of SC behavior improves the agility of mass customization. This research is built upon a qualitative approach to bring about richer, deeper, and more revealing results. The data is collected through interviews and is analyzed through NVivo software. This proposed model offers numerous benefits such as reduction in the number of product inventories and their storage costs, improvement in the resilience of companies’ responses to their clients’ needs and tastes, the increase of profits, and the optimization of productivity with the minimum level of lost sales.

Keywords: agility, manufacturing, resilience, supply chain

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Authors: Viveka Jackson, Erouscilla Joseph, Denise Beckles, Thomas Christopher

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Sulphur Dioxide (SO2) has been defined as a non-flammable, non-explosive, colourless gas, having a pungent, irritating odour, and is one of the main gases emitted from volcanoes. Sulphur dioxide has been recorded in concentrations hazardous to humans (0.25 – 0.5 ppm (~650 – 1300 μg/m3), downwind of many volcanoes and hence warrants constant air-quality monitoring around these sites. It has been linked to an increase in chronic respiratory disease attributed to long-term exposures and alteration in lung and other physiological functions attributed to short-term exposures. Sulphur Springs in Saint Lucia is a highly active geothermal area, located within the Soufrière Volcanic Centre, and is a park widely visited by tourists and locals. It is also a current source of continuous volcanic emissions via its many fumaroles and bubbling pools, warranting concern by residents and visitors to the park regarding the effects of exposure to these gases. In this study, we introduce a novel SO2 measurement system for the monitoring and quantification of ambient levels of airborne volcanic SO2 using low-cost technology. This work involves the extensive production of low-cost SO2 monitors/samplers, as well as field examination in tandem with standard commercial samplers (SO2 diffusion tubes). It also incorporates community involvement in the volcanic monitoring process as non-professional users of the instrument. We intend to present the preliminary monitoring results obtained from the low-cost samplers, to identify the areas in the Park exposed to high concentrations of ambient SO2, and to assess the feasibility of the instrument for non-professional use and application in volcanic settings

Keywords: ambient SO2, community-based monitoring, risk-reduction, sulphur springs, low-cost

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Authors: Seyedamir Makinejadsanij

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One of the most important factors in the production of quality steel is to know the exact weight of steel in the steelmaking area. In this study, a calculation method is presented to estimate the exact weight of the melt as well as the objects transported by the overhead crane. Iran Alloy Steel Company's steelmaking area has three 90-ton cranes, which are responsible for transferring the ladles and ladle caps between 34 areas in the melt shop. Each crane is equipped with a Disomat Tersus weighing system that calculates and displays real-time weight. The moving object has a variable weight due to swinging, and the weighing system has an error of about +-5%. This means that when the object is moving by a crane, which weighs about 80 tons, the device (Disomat Tersus system) calculates about 4 tons more or 4 tons less, and this is the biggest problem in calculating a real weight. The k-means algorithm is an unsupervised clustering method that was used here. The best result was obtained by considering 3 centers. Compared to the normal average(one) or two, four, five, and six centers, the best answer is with 3 centers, which is logically due to the elimination of noise above and below the real weight. Every day, the standard weight is moved with working cranes to test and calibrate cranes. The results are shown that the accuracy is about 40 kilos per 60 tons (standard weight). As a result, with this method, the accuracy of moving weight is calculated as 99.95%. K-means is used to calculate the exact mean of objects. The stopping criterion of the algorithm is also the number of 1000 repetitions or not moving the points between the clusters. As a result of the implementation of this system, the crane operator does not stop while moving objects and continues his activity regardless of weight calculations. Also, production speed increased, and human error decreased.

Keywords: k-means, overhead crane, melt weight, weight estimation, swing problem

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Authors: Eduzor Esther, Uhiara Ngozi, Ya’u Abubakar Umar, Anayo Jacob Gabriel, Umar Ahmed

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The study investigated the characteristic effect of treating okra seed and soybeans seed oil with crude enzymes extract from malted rice. The oils from okra seeds and soybeans were obtained by solvent extraction method using N-hexane solvent. Soybeans seeds had higher percentage oil yield than okra seed. 250ml of each oil was thoroughly mixed with 5ml of the malted rice extract at 400C for 5mins and then filtered and regarded as treated oil while another batch of 250ml of each oil was not mixed with the malted rice extract and regarded as untreated oil. All the oils were analyzed for specific gravity, refractive index, emulsification capacity, absortivity, TSS and viscosity. Treated okra seed and soybeans oil gave higher values for specific gravity, than the untreated oil for okra seed and soybeans oil respectively. The emulsification capacity values were also higher for treated oils, when compared to the untreated oil, for okra seed and soybeans oil respectively. Treated okra seed and soybeans oil also had higher range of values for absorptivity, than the untreated oil for okra seed and soybeans respectively. The ranges of T.S.S values of the treated oil were also higher, than those of the untreated oil for okra seed and soybeans respectively. The results of viscosity showed that the treated oil had higher values, than the untreated oil for okra seed and soybeans oil respectively. However, the results of refractive index showed that the untreated oils had higher values ranges of than the treated oils for okra seed and soybeans respectively. Treated oil show better quality in respect to the parameters analyst, except the refractive index which is slightly less but also is within the rangiest of standard, the oils are high in unsaturation especially okra oil when compared with soya beans oil. It is recommended that, treated oil of okra seeds and soya beans can serve better than many oils that presently in use such as ground nut oil, palm oil and cotton seeds oil.

Keywords: extract, malted, oil, okra, rice, seed, soybeans

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Authors: Nana Katsitadze, Tamar Atanelishvili, Mariam Kutateladze, Alexandre Tushishvili

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In the modern world, tourism has emerged as one of the most powerful economic sectors, and due to its high economic performance, it is attractive to the countries with various levels of economic development. The purpose of the present paper, dedicated to discussing the current problems of tourism development, is to find ways which will contribute to bringing more benefits to the country from the sector. Georgia has been successfully developing leisure tourism for the last ten years, and at the next stage of development business, tourism gains particular importance for Georgia as a means of mitigating the negative socio-economic effects caused by the seasonality of tourism and as a high-cost tourism market. Therefore, the object of the paper is to study the factors that contribute to the development of business tourism. The paper uses the research methods such as system analysis, synthesis, analogy, as well as historical, comparative, economic, and statistical methods of analysis. The information base for the research is made up of the statistics on the functioning of the tourism market of Georgia and foreign countries as well as official data provided by international organizations in the field of tourism. Based on the experience of business tourism around the world and identifying the successful start of business tourism development in Georgia and its causing factors, a business tourism development model for Georgia has been developed. The model might be useful as a methodological material for developing a business tourism development concept for the countries with limited financial resources but rich in tourism resources like Georgia. On the initial stage of development (in absence of conventional centers), the suggested concept of business tourism development involves organizing small and medium-sized meetings both in large cities and in regions by using high-class hotel infrastructure and event management services. Relocation of small meetings to the regions encourages inclusive development of the sector based on increasing the awareness of these regions as tourist sites as well as the increase in employment and sales of other tourism or consumer products. Business tourism increases the number of hotel visitors in the non-seasonal period and improves hotel performance indicators, which enhances the attractiveness of investing in the hotel business. According to the present concept of business tourism development, at the initial stage, development of business tourism is based on the existing markets, including internal market, neighboring markets and the markets of geographically relatively near countries and at the next stage, the concept involves generating tourists from other relatively distant target markets. As a result, by gaining experience in business tourism, enhancing professionalism, increasing awareness and stimulating infrastructure development, the country will prepare the basis to move to a higher stage of tourism development. In addition, the experience showed that for attracting large customers, peculiarities of the field require activation of state policy and active use of marketing mechanisms and tools of the state.

Keywords: hotel industry development, MICE model, MICE strategy, MICE tourism in Georgia

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Authors: Zahra Khazaeipour, Ehsan Ahmadipour, Vafa Rahimi-Movaghar, Fereshteh Ahmadipour

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Research Objectives: Chronic pain is one of the common problems associated with spinal cord injuries (SCI), which causes many complications. Therefore, this study intended to evaluate the relationship between pain and demographic, injury characteristics, socio-economic and social support in individuals with spinal cord Injury in Iran. Design: Descriptive cross-sectional study. Setting: Brain and Spinal Cord Injury Research Center (BASIR), Tehran University of Medical Sciences, Tehran, Iran, between 2012 and 2013. Participants: The participants were 140 individuals with SCI, 101 (72%) men and 39 (28%) women, with mean age of 29.4 ±7.9 years. Main Outcome Measure: The Persian version of the Brief Pain Inventory (BPI) was used to measure the pain, and the Multidimensional Scale of Perceived Social Support (MSPSS) was used to measure social support. Results: About 50.7% complained about having pain, which 79.3% had bilateral pain. The most common locations of pain were lower limbs and back. The most quality of pain was described as aching (41.4%), and tingling (32.9%). Patients with a medium level of education had the least pain compared to high and low level of education. SCI individuals with good economic situation reported higher frequency of having pain. There was no significant relationship between pain and social support. There was positive correlation between pain and impairment of mood, normal work, relations with other people and lack of sleep (P < 0.001). Conclusion: These findings revealed the importance of socioeconomic factors such as economic situation and educational level in understanding chronic pain in people with SCI and provide further support for the bio-psychosocial model. Hence, multidisciplinary evaluations and treatment strategies are advocated, including biomedical, psychological, and psycho-social interventions.

Keywords: pain, social support, socio-economic indicators, spinal cord injury

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Authors: Collen Tebogo Masilo, Erik Schmikl

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The demand for the DataMiner product by customers has presented a great challenge for the vendor in Skyline Communications in deploying its limited resources in the form of human resources, financial resources, and office space, to achieve high organisational performance in all its international operations. The rapid growth of the organisation has been unable to efficiently support its existing customers across the globe, and provide services to new customers, due to the limited number of approximately one hundred employees in its employ. The combined descriptive and explanatory case study research methods were selected as research design, making use of a survey questionnaire which was distributed to a sample of 100 respondents. A sample return of 89 respondents was achieved. The sampling method employed was non-probability sampling, using the convenient sampling method. Frequency analysis and correlation between the subscales (the four themes) were used for statistical analysis to interpret the data. The investigation was conducted into mechanisms that can be deployed to balance the high demand for products and the limited production capacity of the company’s Belgian operations across four aspects: demand management strategies, capacity management strategies, communication methods that can be used to align a sales management department, and reward systems in use to improve employee performance. The conclusions derived from the theme ‘demand management strategies’ are that the company is fully aware of the future market demand for its products. However, there seems to be no evidence that there is proper demand forecasting conducted within the organisation. The conclusions derived from the theme 'capacity management strategies' are that employees always have a lot of work to complete during office hours, and, also, employees seem to need help from colleagues with urgent tasks. This indicates that employees often work on unplanned tasks and multiple projects. Conclusions derived from the theme 'communication methods used to align sales management department with operations' are that communication is not good throughout the organisation. This means that information often stays with management, and does not reach non-management employees. This also means that there is a lack of smooth synergy as expected and a lack of good communication between the sales department and the projects office. This has a direct impact on the delivery of projects to customers by the operations department. The conclusions derived from the theme ‘employee reward systems’ are that employees are motivated, and feel that they add value in their current functions. There are currently no measures in place to identify unhappy employees, and there are also no proper reward systems in place which are linked to a performance management system. The research has made a contribution to the body of research by exploring the impact of the four sub-variables and their interaction on the challenges of organisational productivity, in particular where an organisation experiences a capacity problem during its growth stage during tough economic conditions. Recommendations were made which, if implemented by management, could further enhance the organisation’s sustained competitive operations.

Keywords: high demand for products, high organisational performance, limited production capacity, limited resources

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Authors: Hashim Isam Jameel Al-Safi, P. Ranjan Sarukkalige

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Climate change is likely to impact the Australian continent by changing the trends of rainfall, increasing temperature, and affecting the accessibility of water quantity and quality. This study investigates the possible impacts of future climate change on the hydrological system of the Harvey River catchment in Western Australia by using the conceptual modelling approach (HBV mode). Daily observations of rainfall and temperature and the long-term monthly mean potential evapotranspiration, from six weather stations, were available for the period (1961-2015). The observed streamflow data at Clifton Park gauging station for 33 years (1983-2015) in line with the observed climate variables were used to run, calibrate and validate the HBV-model prior to the simulation process. The calibrated model was then forced with the downscaled future climate signals from a multi-model ensemble of fifteen GCMs of the CMIP3 model under three emission scenarios (A2, A1B and B1) to simulate the future runoff at the catchment outlet. Two periods were selected to represent the future climate conditions including the mid (2046-2065) and late (2080-2099) of the 21^st century. A control run, with the reference climate period (1981-2000), was used to represent the current climate status. The modelling outcomes show an evident reduction in the mean annual streamflow during the mid of this century particularly for the A1B scenario relative to the control run. Toward the end of the century, all scenarios show a relatively high reduction trends in the mean annual streamflow, especially the A1B scenario, compared to the control run. The decline in the mean annual streamflow ranged between 4-15% during the mid of the current century and 9-42% by the end of the century.

Keywords: climate change impact, Harvey catchment, HBV model, hydrological modelling, GCMs, LARS-WG

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Authors: Bara' Al-Mistarehi

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Documentation and assessment of conservation state of an archaeological structure is a significant procedure in any management plan. However, it has always been a challenge to apply this with a low coast and safe methodology. It is also a time-demanding procedure. Therefore, a low cost, efficient methodology for documenting the state of a structure is needed. In the scope of this research, this paper will employ digital photogrammetry and laser scanner to one of highly significant structures in Germany, The Old Castle (German: Altes Schloss). The site is well known for its unique features. However, the castle suffers from serious deterioration threats because of the environmental conditions and the absence of continuous monitoring, maintenance and repair plans. Digital photogrammetry is a generally accepted technique for the collection of 3D representations of the environment. For this reason, this image-based technique has been extensively used to produce high quality 3D models of heritage sites and historical buildings for documentation and presentation purposes. Additionally, terrestrial laser scanners are used, which directly measure 3D surface coordinates based on the run-time of reflected light pulses. These systems feature high data acquisition rates, good accuracy and high spatial data density. Despite the potential of each single approach, in this research work maximum benefit is to be expected by a combination of data from both digital cameras and terrestrial laser scanners. Within the paper, the usage, application and advantages of the technique will be investigated in terms of building high realistic 3D textured model for some parts of the old castle. The model will be used as diagnosing tool of the conservation state of the castle and monitoring mean for future changes.

Keywords: Digital photogrammetry, Terrestrial laser scanners, 3D textured model, archaeological structure

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Authors: Muziwandile Luthuli

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Although numerous factors predicting adherence to antiretroviral therapy (ART) among people living with HIV/AIDS (PLWHA) have been broadly studied on both regional and global level, up-to-date adherence of patients to ART remains an overarching, dynamic and multifaceted problem that needs to be investigated over time and across various contexts. There is a rarity of empirical data in the literature on interactive mechanisms by which psychosocial factors influence adherence to ART among PLWHA within the South African context. Therefore, this study was designed to investigate the relationship between depression, HIV stigma, and adherence to ART among adult patients living with HIV at a tertiary hospital in Durban, South Africa, and the mediating roles of self-efficacy and social support. The health locus of control theory and the social support theory were the underlying theoretical frameworks for this study. Using a cross-sectional research design, a total of 201 male and female adult patients aged between 18-75 years receiving ART at a tertiary hospital in Durban, KwaZulu-Natal were sampled, using time location sampling (TLS). A self-administered questionnaire was employed to collect the data in this study. Data were analysed through SPSS version 27. Several statistical analyses were conducted in this study, namely univariate statistical analysis, correlational analysis, Pearson’s chi-square analysis, cross-tabulation analysis, binary logistic regression analysis, and mediational analysis. Univariate analysis indicated that the sample mean age was 39.28 years (SD=12.115), while most participants were females 71.0% (n=142), never married 74.2% (n=147), and most were also secondary school educated 48.3% (n=97), as well as unemployed 65.7% (n=132). The prevalence rate of participants who had high adherence to ART was 53.7% (n=108), and 46.3% (n=93) of participants had low adherence to ART. Chi-square analysis revealed that employment status was the only statistically significant socio-demographic influence of adherence to ART in this study (χ2 (3) = 8.745; p < .033). Chi-square analysis showed that there was a statistically significant difference found between depression and adherence to ART (χ2 (4) = 16.140; p < .003), while between HIV stigma and adherence to ART, no statistically significant difference was found (χ2 (1) = .323; p >.570). Binary logistic regression indicated that depression was statistically associated with adherence to ART (OR= .853; 95% CI, .789–.922, P < 001), while the association between self-efficacy and adherence to ART was statistically significant (OR= 1.04; 95% CI, 1.001– 1.078, P < .045) after controlling for the effect of depression. However, the findings showed that the effect of depression on adherence to ART was not significantly mediated by self-efficacy (Sobel test for indirect effect, Z= 1.01, P > 0.31). Binary logistic regression showed that the effect of HIV stigma on adherence to ART was not statistically significant (OR= .980; 95% CI, .937– 1.025, P > .374), but the effect of social support on adherence to ART was statistically significant, only after the effect of HIV stigma was controlled for (OR= 1.017; 95% CI, 1.000– 1.035, P < .046). This study promotes behavioral and social change effected through evidence-based interventions by emphasizing the need for additional research that investigates the interactive mechanisms by which psychosocial factors influence adherence to ART. Depression is a significant predictor of adherence to ART. Thus, to alleviate the psychosocial impact of depression on adherence to ART, effective interventions must be devised, along with special consideration of self-efficacy and social support. Therefore, this study is helpful in informing and effecting change in health policy and healthcare services through its findings

Keywords: ART adherence, depression, HIV/AIDS, PLWHA

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Authors: Hussain Sajid, Jung-Hun Shin, Kum-Won Cho

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Image super-resolution is the most common computer vision problem with many important applications. Generative adversarial networks (GANs) have promoted remarkable advances in single-image super-resolution (SR) by recovering photo-realistic images. However, high memory requirements of GAN-based SR (mainly generators) lead to performance degradation and increased energy consumption, making it difficult to implement it onto resource-constricted devices. To relieve such a problem, In this paper, we introduce an optimized and highly efficient architecture for SR-GAN (generator) model by utilizing model compression techniques such as Knowledge Distillation and pruning, which work together to reduce the storage requirement of the model also increase in their performance. Our method begins with distilling the knowledge from a large pre-trained model to a lightweight model using different loss functions. Then, iterative weight pruning is applied to the distilled model to remove less significant weights based on their magnitude, resulting in a sparser network. Knowledge Distillation reduces the model size by 40%; pruning then reduces it further by 18%. To accelerate the learning process, we employ the Horovod framework for distributed training on a cluster of 2 nodes, each with 8 GPUs, resulting in improved training performance and faster convergence. Experimental results on various benchmarks demonstrate that the proposed compressed model significantly outperforms state-of-the-art methods in terms of peak signal-to-noise ratio (PSNR), structural similarity index measure (SSIM), and image quality for x4 super-resolution tasks.

Keywords: single-image super-resolution, generative adversarial networks, knowledge distillation, pruning

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Authors: Sandra Cardoso, Gaspar Pais, Judite Neves, Sandra Cavaca, Fernando Araújo

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In 2021, Portugal has 63 emergency department (ED) visits per 100 people annually, the highest numbers in Europe. While EDs provide a critical service, high use is indicative of inappropriate and inefficient healthcare. In Portugal, all ED have the Manchester Triage System (MTS), a clinical risk management tool to enable that patients are seen in order of clinical priority. In 2023, more than 40% of the ED visits were of non-urgent conditions (blue and green), that could be better managed in primary health care (PHC), meaning wrong use of resources and lack of health literacy. From 2017, the country has a phone line, SNS24 (Contact Centre of the National Health Service), for triage, counseling, and referral service, 24 hours/7 days a week. The pilot project ‘Call before, save lives’ was implemented in the municipalities of Póvoa de Varzim and Vila do Conde (around 150.000 residents), in May 2023, by the executive board of the Portuguese Health Service, with the support of the Shared Services of the Ministry of Health, and local authorities. This geographical area has short travel times, 99% of the population a family doctor and the region is organized in a health local unit (HLU), integrating PHC and the local hospital. The purposes of this project included to increase awareness to contact SNS 24, before going to an ED, and non-urgent conditions oriented to a family doctor, reducing ED visits. The implementation of the project involved two phases, beginning with: i) development of campaigns using local influencers (fishmonger, model, fireman) through local institutions and media; ii) provision of telephone installed on site to contact SNS24; iii) establishment of open consultation in PHC; iv) promotion of the use of SNS24; v) creation of acute consultations at the hospital for complex chronic patients; and vi) direct referral for home hospitalization by PHC. The results of this project showed an excellent level of access to SNS24, an increase in the number of users referred to ED, with great satisfaction of users and professionals. The second phase, initiated in January 2024, for access to the ED, the need for prior referral was established as an admission rule, except for certain situations, as trauma patients. If the patient refuses, their registration in the ED and subsequent screening in accordance with the MTS must be ensured. When the patient is non-urgent, shall not be observed in the ED, provided that, according to his clinical condition, is guaranteed to be referred to PHC or to consultation/day hospital, through effective scheduling of an appointment for the same or the following day. In terms of results, 8 weeks after beginning of phase 2, we assist of a decrease in self-reported patients to ED from 59% to 15%, and a reduction of around 7% of ED visits. The key for this success was an effective public campaign that increases the knowledge of the right use of the health system, and capable of changing behaviors.

Keywords: contact centre of the national health service, emergency department visits, public campaign, health literacy, SNS24

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