Search results for: family planning and reproductive health

Authors: Galit Shiff, Yael Gilad

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The need to retrofit old buildings lies in the fact that buildings are responsible for the main energy use and CO₂ emission. Existing old structures are more dominant in their effect than new energy-efficient buildings. Nevertheless not every case of urban renewal that aims to replace old buildings with new neighbourhoods necessarily has a financial or sustainable justification. Façade design plays a vital role in the building's energy performance and the unit's comfort conditions. A retrofit façade residential methodology and feasibility applicative study has been carried out for the past four years, with two projects already fully renovated. The intention of this study is to serve as a case study for limited budget façade retrofit in Mediterranean climate urban areas. The two case study buildings are set in Israel. However, they are set in different local climatic conditions. One is in 'Sderot' in the south of the country, and one is in' Migdal Hahemek' in the north of the country. The building typology is similar. The budget of the projects is around $14,000 per unit and includes interventions at the buildings' envelope while tenants are living in. Extensive research and analysis of the existing conditions have been done. The building's components, materials and envelope sections were mapped, examined and compared to relevant updated standards. Solar radiation simulations for the buildings in their surroundings during winter and summer days were done. The energy rate of each unit, as well as the building as a whole, was calculated according to the Israeli Energy Code. The buildings’ facades were documented with the use of a thermal camera during different hours of the day. This information was superimposed with data about the electricity use and the thermal comfort that was collected from the residential units. Later in the process, similar tools were further used in order to compare the effectiveness of different design options and to evaluate the chosen solutions. Both projects showed that the most problematic units were the ones below the roof and the ones on top of the elevated entrance floor (pilotis). Old buildings tend to have poor insulation on those two horizontal surfaces which require treatment. Different radiation levels and wall sections in the two projects influenced the design strategies: In the southern project, there was an extreme difference in solar radiations levels between the main façade and the back elevation. Eventually, it was decided to invest in insulating the main south-west façade and the side façades, leaving the back north-east façade almost untouched. Lower levels of radiation in the northern project led to a different tactic: a combination of basic insulation on all façades, together with intense treatment on areas with problematic thermal behavior. While poor execution of construction details and bad installation of windows in the northern project required replacing them all, in the southern project it was found that it is more essential to shade the windows than replace them. Although the buildings and the construction typology was chosen for this study are similar, the research shows that there are large differences due to the location in different climatic zones and variation in local conditions. Therefore, in order to reach a systematic and cost-effective method of work, a more extensive catalogue database is needed. Such a catalogue will enable public housing companies in the Mediterranean climate to promote massive projects of renovating existing old buildings, drawing on minimal analysis and planning processes.

Keywords: facade, low budget, residential, retrofit

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Authors: Ammatu Alhassan

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Quality healthcare delivery is a crucial indicator in assessing the overall developmental status of a country. There are many limitations in the Ghanaian healthcare supply chain due to the lack of studies about the correlation between quality health service and the healthcare supply chain. Patients who visit various healthcare providers face unpleasant experiences such as delays in the availability of their medications. In this study, an assessment of the quality of services provided to Ghanaian outpatients who visit public healthcare providers was investigated to establish its effect on the healthcare supply chain using a conceptual model. The Donabedian’s structure, process, and outcome theory for service quality evaluation were used to analyse 20 Ghanaian hospitals. The data obtained was tested using the structural equation model (SEM). The findings from this research will help us to improve the overall quality of the Ghanaian healthcare supply chain. The model which will be developed will help us to understand better the linkage between quality healthcare and the healthcare supply chain as well as serving as a reference tool for future healthcare research in Ghana.

Keywords: Ghana, healthcare, outpatients, supply chain

Procedia PDF Downloads 190

Authors: Modupe O. Jimoh

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Waterfalls create an ambient environment for tourism and relaxation. They are also potential sources for water supply. Owu waterfall located at Isin Local Government, Kwara state, Nigeria is the highest waterfall in the West African region, yet none of its potential usefulness has been fully exploited. Water samples were taken from two sections of the fall and were analyzed for various water quality parameters. The results obtained include pH (6.71 ± 0.1), Biochemical oxygen demand (4.2 ± 0.5 mg/l), Chemical oxygen demand (3.07 ± 0.01 mg/l), Dissolved oxygen (6.59 ± 0.6 mg/l), Turbidity (4.43 ± 0.11 NTU), Total dissolved solids (8.2 ± 0.09 mg/l), Total suspended solids (18.25 ± 0.5 mg/l), Chloride ion (0.48 ± 0.08 mg/l), Calcium ion (0.82 ± 0.02 mg/l)), Magnesium ion (0.63 ± 0.03 mg/l) and Nitrate ion (1.25 ± 0.01 mg/l). The results were compared to the World Health Organisations standard for drinking water and the Nigerian standard for drinking water. From the comparison, it can be deduced that due to the Biochemical oxygen demand value, the water is not suitable for drinking unless it undergoes treatment. However, it is suitable for other classes of water usage.

Keywords: Owu falls, waterfall, water quality, water quality parameters, water use

Procedia PDF Downloads 185

Authors: Tiffany Riggleman, Andrea Schultheis, Kalyn Jannace, Jerika Taylor, Michelle Nordstrom, Paul F. Pasquina

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Introduction: Posttraumatic Stress (PTS) and Posttraumatic Stress Disorder (PTSD) remain significant problems for military and veteran communities. Symptoms of PTSD often include poor sleep, intrusive thoughts, difficulty concentrating, and trouble with emotional regulation. Unfortunately, despite its high prevalence, service members diagnosed with PTSD often do not seek help, usually because of the perceived stigma surrounding behavioral health care. To help address these challenges, non-pharmacological, therapeutic approaches are being developed to help improve care and enhance compliance. The Service Dog Training Program (SDTP), which involves teaching patients how to train puppies to become mobility service dogs, has been successfully implemented into PTS/PTSD care programs with anecdotal reports of improved outcomes. This study was designed to assess the biopsychosocial effects of SDTP from military beneficiaries with PTS symptoms. Methods: Individuals between the ages of 18 and 65 with PTS symptom were recruited to participate in this prospective study. Each subject completes 4 weeks of baseline testing, followed by 6 weeks of active service dog training (twice per week for one hour sessions) with a professional service dog trainer. Outcome measures included the Posttraumatic Stress Checklist for the DSM-5 (PCL-5), Generalized Anxiety Disorder questionnaire-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), social support/interaction, anthropometrics, blood/serum biomarkers, and qualitative interviews. Preliminary analysis of 17 participants examined mean scores on the GAD-7, PCL-5, and PHQ-9, pre- and post-SDTP, and changes were assessed using Wilcoxon Signed-Rank tests. Results: Post-SDTP, there was a statistically significant mean decrease in PCL-5 scores of 13.5 on an 80-point scale (p=0.03) and a significant mean decrease of 2.2 in PHQ-9 scores on a 27 point scale (p=0.04), suggestive of decreased PTSD and depression symptoms. While there was a decrease in mean GAD-7 scores post-SDTP, the difference was not significant (p=0.20). Recurring themes among results from the qualitative interviews include decreased pain, forgetting about stressors, improved sense of calm, increased confidence, improved communication, and establishing a connection with the service dog. Conclusion: Preliminary results of the first 17 participants in this study suggest that individuals who received SDTP had a statistically significant decrease in PTS symptom, as measured by the PCL-5 and PHQ-9. This ongoing study seeks to enroll a total of 156 military beneficiaries with PTS symptoms. Future analyses will include additional psychological outcomes, pain scores, blood/serum biomarkers, and other measures of the social aspects of PTSD, such as relationship satisfaction and sleep hygiene.

Keywords: post-concussive syndrome, posttraumatic stress, service dog, service dog training program, traumatic brain injury

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Authors: S. K. M. Basha

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Nallamalas one of the centres of Plant Diversity (CPD) (WWF&IUCN,1995) is located in the central eastern Ghats between latitudes 15.20’-16.30’N and Longitude 78.30-80.10E in Andhra Pradesh, extended to an area of 7640 Sq.Km. No Comprehensive work available for RET Plants in the study area, therefore the objective of the present paper is to document the RET Medicinal Plants of Nallamalias and their uses by the local people of the area. In India, one of the major resources to know about the number of plant species and their medicinal values is the groups who are habituated in near and deep forests. The most common groups in south Indian forests are Yanadis and Yerukulas. These two groups of people are residing in the forest, which is located very far from the modern society, towns and cities. They are following traditional methods obtained from their forefathers in all respects, including medication. They are the only source to know many medicinal plants in the areas where they reside and are also important to record the medicinal properties of various plant species which are not reported. The new reports may help in drug industry in order to develop pharmaceutical herbal medicine for human health. In the present study, nearly 150 rare species have been found to be used for various ailments. Out of these 23 species are critically endangered, over 25 are vulnerable and around 22 comes under the category of near threatened. Some important species like Christella dentate, Careya arborea are used for curing cough and cold. Piper attnuatum, piper nigrum are used for curing skin disease. Ipomoea mauritiana is used against male impotency.Glycosmis cochinensis, Entada perseatha are used as contraceptives. The roots of Andrographis nallamalayana and Acrocephalus indicus are used for leucorrhoea. While the stem barks of Gyrocarpus americanus is given orally for spider bite. Piper hymenophyllum leaves mixed with turmeric and gingerly oil is used externally for mouth ulcers in cattle. Piper nigrum fruits are used for skin diseases. Vernonia anthelmentica seeds are used for indigestion. It was widely distributed in this hills. Due to over exploitation this species was in declined condition. Sterculia urens which is a sorce of gum for tribal, due to over exploitation this species declaimed in these hills. Hence, there is an urgent need to conserve the medicinal plants and prevent their exploitation and extinction with the help of tribals. There is a need to adopt sustainable utilization, cultivation and micro propagation techniques. Medicinal plants are as potent and effective today as they were thousands of years ago. They are natures wonderful gift to mankind and are involved in India as a very rich ancient heritage of traditional systems medicine i.e., ayurveda, siddha and unani. Unfortunately, these traditions have been largely eroded because of lack of support and recognition as well as rapid destruction of natural habitats which has led to shrinkage of medicinal plants therefore the conservation of medicinal plants and the revitalization of local health traditions has been taken up on priority basis.

Keywords: RET plants CPD, IUCN, nallamalas, yanadis, yerukulas

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Authors: Marwa I. Shabayek, Ola A. Said, Hanan A. Attaia, Heba A. Awida

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Bladder carcinoma is an important worldwide health problem. Both cystoscopy and urine cytology used in detecting bladder cancer suffer from drawbacks where cystoscopy is an invasive method and urine cytology shows low sensitivity in low grade tumors. This study validates easier and less time-consuming techniques to evaluate the value of combined use of angiogenin and clusterin in comparison and combination with voided urine cytology in the detection of bladder cancer patients. This study includes malignant (bladder cancer patients, n= 50), benign (n=20), and healthy (n=20) groups. The studied groups were subjected to cystoscopic examination, detection of bilharzial antibodies, urine cytology, and estimation of urinary angiogenin and clusterin by ELISA. The overall sensitivity and specifcity were 66% and 75% for angiogenin, 70% and 82.5% for clusterin and 46% and 80% for voided urine cytology. Combined sensitivity of angiogenin and clusterin with urine cytology increased from 82 to 88%.

Keywords: angiogenin, bladder cancer, clusterin, cytology

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Authors: Oluwafunmibi Omotayo Fasanya, Augustine Kena Adjei

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Effective management of hypertension remains a critical public health challenge, particularly among racially and ethnically diverse populations. This study employs sophisticated statistical models to rigorously investigate the predictors of poor blood pressure (BP) control, with a specific focus on demographic, socioeconomic, and clinical risk factors. Leveraging a large sample of 19,253 adults drawn from the National Health and Nutrition Examination Survey (NHANES) across three distinct time periods (2013-2014, 2015-2016, and 2017-2020), we applied multivariable logistic regression and generalized estimating equations (GEE) to account for the clustered structure of the data and potential within-subject correlations. Our multivariable models identified significant associations between poor BP control and several key predictors, including race/ethnicity, age, gender, body mass index (BMI), prevalent diabetes, and chronic kidney disease (CKD). Non-Hispanic Black individuals consistently exhibited higher odds of poor BP control across all periods (OR = 1.99; 95% CI: 1.69, 2.36 for the overall sample; OR = 2.33; 95% CI: 1.79, 3.02 for 2017-2020). Younger age groups demonstrated substantially lower odds of poor BP control compared to individuals aged 75 and older (OR = 0.15; 95% CI: 0.11, 0.20 for ages 18-44). Men also had a higher likelihood of poor BP control relative to women (OR = 1.55; 95% CI: 1.31, 1.82), while BMI ≥35 kg/m² (OR = 1.76; 95% CI: 1.40, 2.20) and the presence of diabetes (OR = 2.20; 95% CI: 1.80, 2.68) were associated with increased odds of poor BP management. Further analysis using GEE models, accounting for temporal correlations and repeated measures, confirmed the robustness of these findings. Notably, individuals with chronic kidney disease displayed markedly elevated odds of poor BP control (OR = 3.72; 95% CI: 3.09, 4.48), with significant differences across the survey periods. Additionally, higher education levels and better self-reported diet quality were associated with improved BP control. College graduates exhibited a reduced likelihood of poor BP control (OR = 0.64; 95% CI: 0.46, 0.89), particularly in the 2015-2016 period (OR = 0.48; 95% CI: 0.28, 0.84). Similarly, excellent dietary habits were associated with significantly lower odds of poor BP control (OR = 0.64; 95% CI: 0.44, 0.94), underscoring the importance of lifestyle factors in hypertension management. In conclusion, our findings provide compelling evidence of the complex interplay between demographic, clinical, and socioeconomic factors in predicting poor BP control. The application of advanced statistical techniques such as GEE enhances the reliability of these results by addressing the correlated nature of repeated observations. This study highlights the need for targeted interventions that consider racial/ethnic disparities, clinical comorbidities, and lifestyle modifications in improving BP control outcomes.

Keywords: hypertension, blood pressure, NHANES, generalized estimating equations

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Authors: Anwar Ali Abdulla, Thekra Abdulaali Abed Al-Chaabawi, Anwar Kadhim Al-Saffar, Hussein Kadhim Al-Saffar

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Lactic acid bacteria are very significant to human health due to the production of some antimicrobial substances and ability to inhibit pathogenic bacteria. Furthermore, the bacteria are also used as starter culture in the production of various foods. The present study was focused on isolation and characterization of Lactobacillus acidophilus from yogurt and to demonstrate some of probiotic properties of these isolates. All isolates were phenotypically characterized including studying, biochemical, effect of sodium chloride and pH during growth, carbohydrates test and characterizing the antimicrobial activity of Lactobacillus acidophilus against pathogens. The present study demonstrates that Lactobacillus acidophilus produced a bacteriocin- like inhibitory substance with a broad spectrum of antimicrobial activity directed against pathogenic indicator organism suggesting its protective value against enteric pathogens.

Keywords: lactobacillus acidophilus, bacteriocin, antimicrobial activity, probiotic

Procedia PDF Downloads 542

Authors: Ubonrattan Phophatanachai, Phensri Thongphet, Weerawan Kerdtong

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The purposes of this study were to compare the ethical behavior regarding responsibility and polite manners of nursing students of Boromarajonani College of Nursing, Suratthani, Thailand before and after providing the activity session of ethical behavior development. The samples consisted of 103 sophomores in the academic year 2006. The tools were tested for reliability and content validity. The reliability of the Ethical Behavior Questionnaire measured by Cronbach’s alpha coefficient was 0.94. Data were analyzed using means, standard deviations, and dependent t-test. The findings were as follows: a) after the activity session, the mean scores of ethical behavior regarding responsibility and polite manners of nursing students increased from middle level to high level; b) mean scores of responsibilities and polite manners after the activity session were significantly higher than those before the session (t =28.36, p < .001; t =23.9, p < .001, respectively).

Keywords: development of ethical behavior, nursing students, health, nursing informatics

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Authors: João Coutinho-Rodrigues, Nuno Sousa, Luís Alçada-Almeida

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Transportation infrastructure systems are fundamental in modern society and economy. However, they need modernizing, maintaining, and reinforcing interventions which require large investments. In many countries, accumulated intervention delays arise from aging and intense use, being magnified by financial constraints of the past. The decision problem of managing the renewal of large backlogs is common to several types of important transportation infrastructures (e.g., railways, roads). This problem requires considering financial aspects as well as operational constraints under a multidimensional framework. The present research introduces a linear programming multiobjective model for managing railway infrastructure asset renewal. The model aims at minimizing three objectives: (i) yearly investment peak, by evenly spreading investment throughout multiple years; (ii) total cost, which includes extra maintenance costs incurred from renewal backlogs; (iii) priority delays related to work start postponements on the higher priority railway sections. Operational constraints ensure that passenger and freight services are not excessively delayed from having railway line sections under intervention. Achieving a balanced annual investment plan, without compromising the total financial effort or excessively postponing the execution of the priority works, was the motivation for pursuing the research which is now presented. The methodology, inspired by a real case study and tested with real data, reflects aspects of the practice of an infrastructure management company and is generalizable to different types of infrastructure (e.g., railways, highways). It was conceived for treating renewal interventions in infrastructure assets, which is a railway network may be rails, ballasts, sleepers, etc.; while a section is under intervention, trains must run at reduced speed, causing delays in services. The model cannot, therefore, allow for an accumulation of works on the same line, which may cause excessively large delays. Similarly, the lines do not all have the same socio-economic importance or service intensity, making it is necessary to prioritize the sections to be renewed. The model takes these issues into account, and its output is an optimized works schedule for the renewal project translatable in Gantt charts The infrastructure management company provided all the data for the first test case study and validated the parameterization. This case consists of several sections to be renewed, over 5 years and belonging to 17 lines. A large instance was also generated, reflecting a problem of a size similar to the USA railway network (considered the largest one in the world), so it is not expected that considerably larger problems appear in real life; an average of 25 years backlog and ten years of project horizon was considered. Despite the very large increase in the number of decision variables (200 times as large), the computational time cost did not increase very significantly. It is thus expectable that just about any real-life problem can be treated in a modern computer, regardless of size. The trade-off analysis shows that if the decision maker allows some increase in max yearly investment (i.e., degradation of objective ii), solutions improve considerably in the remaining two objectives.

Keywords: transport infrastructure, asset renewal, railway maintenance, multiobjective modeling

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Authors: Hadjer Boukhtache, Rachida Allem

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The objective of this work is to estimate the impact of polyphenols extracted from the fruits of Crataegus oxycantha on human nutrition and health by evaluating the antibacterial activity of this plant using the agar diffusion method. The polyphenol content was found to be 48.86 ± 1.96 mg GAE/g, while flavonoids accounted for 30.35 ± 2.91 mg QE/g. The methanolic, ethyl acetate and aqueous extracts of C. oxycantha demonstrated strong antibacterial activity against most of the tested bacterial strains. The results of this study highlighted the richness of the plant’s fruits in phenolic compounds. These compounds exhibited significant antibacterial activity, serving as an excellent biologically-derived bactericidal agent that could replace chemical treatments. Additionally, the fruits are rich in nutritional values that are recommended for human well-being. This study confirms the effectiveness of consuming these fruits in human diets and supports the rational use of this plant in traditional medicine.

Keywords: C. oxycantha, polyphenols, flavonoids, antibacterial activity, human nutrition

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Authors: K. Grigoryan, T. Jurcik

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Interpersonal and school-related factors, along with individual characteristics, can predict non-suicidal self-injures (NSSI). The objective of this review is to describe psychosocial variables associated with NSSI among adolescents. A better understanding of this phenomenon may facilitate the identification of potentially effective interventions for adolescents. Relevant empirical studies and reviews from clinical, cross-cultural, and social psychology, as well as cognitive psychology literature, were synthesized into two broad topics: social/interpersonal and individual factors. Variables related to the occurrence of NSSI are discussed, including social support, peer modeling, abuse, personality traits, sense of belongingness, self-compassion, and others. Based on these findings, specific clinical recommendations were identified that need to be further evaluated empirically. The systemic interventions recommended in this review may further promote research in circumventing this social and clinical problem.

Keywords: non-suicidal self-injury, psychosocial factors, mental health, adolescence

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Authors: Athul T.

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Kerala cities in India are grappling with an alarming rise in temperatures fueled by the Urban Heat Island (UHI) effect. This phenomenon, exacerbated by rapid urbanization and climate change, poses a significant threat to public health and environmental well-being. In response to this growing concern, this study investigates the potential of urban vegetation as a powerful mitigation strategy against UHI. The study delves into the intricate relationship between micro-climate changes, UHI intensity, and the strategic placement of greenery in alleviating these effects. Utilizing advanced simulation software, the most effective vegetation types and configurations for maximizing UHI reduction will be identified. By analyzing the current state of Kozhikode's urban vegetation and its influence on microclimates, this study aims to tailor actionable strategies for Kerala cities, potentially paving the way for a more sustainable and thermally comfortable urban future.

Keywords: urban heat island, climate change, micro climate, urban vegetation

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Authors: Abdulla Almulla, Wafaa Mahdi

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Building materials can make a significant contribution to the level of natural radioactivity in closed dwelling areas. Therefore, developing an expert system for monitoring the activity concentrations (ACs) of naturally occurring radioactive materials (NORMs) existing in building materials is useful for limiting the population’s exposure to gamma radiation emitted from those materials. The present work not only is aimed at examining the indoor radon concentration emitted by the building materials that are originated from various countries but are commercially available in Kuwait, but also is aimed at developing an expert system for monitoring the radiation emitted from these materials and classifying it as normal (acceptable) or dangerous (unacceptable). This system makes it possible to always monitor any radiological risks to human health. When detecting high doses of radiation, the system gives warning messages.

Keywords: building materials, NORMs, HNBRA, radionuclides, activity concentrations, expert systems

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Authors: Kulwinder Singh Mann

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The innovative features of information system, known as Radiology Information System (RIS), for electronic medical records has shown a good impact in the hospital. The objective is to help and make their work easier; such as for a physician to access the patient’s data and for a patient to check their bill transparently. The interoperability of RIS with the other intra-hospital information systems it interacts with, dealing with the compatibility and open architecture issues, are accomplished by two novel mechanisms. The first one is the particular message handling system that is applied for the exchange of information, according to the Health Level Seven (HL7) protocol’s specifications and serves the transfer of medical and administrative data among the RIS applications and data store unit. The second one implements the translation of information between the formats that HL7 and Digital Imaging and Communication in Medicine (DICOM) protocols specify, providing the communication between RIS and Picture and Archive Communication System (PACS) which is used for the increasing incorporation of modern medical imaging equipment.

Keywords: RIS, PACS, HIS, HL7, DICOM, messaging service, interoperability, digital images

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Authors: Zoltán Höhling, Sarah-Lu Oberschelp, Niklas Gilsdorf, Michael Wirsching, Andrea Kuhnert

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A majority of medical students at the University of Freiburg reported stress-related psychosomatic symptoms which are often associated with their studies. International research supports these findings, as medical students worldwide seem to be at special risk for mental health problems. In some countries and institutions, psychologically based interventions that assist medical students in coping with their stressors have been implemented. It turned out that anonymity is an important aspect here. Many students fear a potential damage of reputation when being associated with mental health problems, which may be due to a high level of competitiveness in classes. Therefore, we launched an online-platform where medical students could anonymously seek help and exchange their experiences with fellow students and experts. Medical students of all semesters have access to it through the university’s learning management system (called “ILIAS”). The informative part of the platform consists of exemplary videos showing medical students (actors) who act out scenes that demonstrate the antecedents of stress-related psychosomatic disorders. These videos are linked to different expert comments, describing the exhibited symptoms in an understandable and normalizing way. The (inter-)active part of the platform consists of self-help tools (such as meditation exercises or general tips for stress-coping) and an anonymous interactive forum where students can describe their stress-related problems and seek guidance from experts and/or share their experiences with fellow students. Besides creating an immediate proposal to help affected students, we expect that competitiveness between students might be diminished and bondage improved through mutual support between them. In the initial phase after the platform’s launch, it was accessed by a considerable number of medical students. On a closer look it appeared that platform sections like general information on psychosomatic-symptoms and self-treatment tools were accessed far more often than the online-forum during the first months after the platform launch. Although initial acceptance of the platform was relatively high, students showed a rather passive way of using our platform. While user statistics showed a clear demand for information on stress-related psychosomatic symptoms and its possible remedies, active engagement in the interactive online-forum was rare. We are currently advertising the platform intensively and trying to point out the assured anonymity of the platform and its interactive forum. Our plans, to assure students their anonymity through the use of an e-learning facility and promote active engagement in the online forum, did not (yet) turn out as expected. The reasons behind this may be manifold and based on either e-learning related issues or issues related to students’ individual needs. Students might, for example, question the assured anonymity due to a lack of trust in the technological functioning university’s learning management system. However, one may also conclude that reluctance to discuss stress-related psychosomatic symptoms with peer medical students may not be solely based on anonymity concerns, but could be rooted in more complex issues such as general mistrust between students.

Keywords: e-tutoring, stress-coping, student support, online forum

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Authors: Christoph Opperer

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The rapid urbanization of modern societies and the need for sustainable urban development demand innovative solutions that meet both individual and collective needs while addressing environmental concerns. To address these challenges, this paper presents a study that explores the potential of spatial and energetic/ecological optimization to enhance the performance of urban settlements, focusing on both architectural and urban scales. The study focuses on the application of biological principles and self-organization processes in urban planning and design, aiming to achieve a balance between ecological performance, architectural quality, and individual living conditions. The research adopts a case study approach, focusing on a 10-hectare brownfield site in the south of Vienna. The site is surrounded by a small-scale built environment as an appropriate starting point for the research and design process. However, the selected urban form is not a prerequisite for the proposed design methodology, as the findings can be applied to various urban forms and densities. The methodology used in this research involves dividing the overall building mass and program into individual small housing units. A computational model has been developed to optimize the distribution of these units, considering factors such as solar exposure/radiation, views, privacy, proximity to sources of disturbance (such as noise), and minimal internal circulation areas. The model also ensures that existing vegetation and buildings on the site are preserved and incorporated into the optimization and design process. The model allows for simultaneous optimization at two scales, architectural and urban design, which have traditionally been addressed sequentially. This holistic design approach leads to individual and collective benefits, resulting in urban environments that foster a balance between ecology and architectural quality. The results of the optimization process demonstrate a seemingly random distribution of housing units that, in fact, is a densified hybrid between traditional garden settlements and allotment settlements. This urban typology is selected due to its compatibility with the surrounding urban context, although the presented methodology can be extended to other forms of urban development and density levels. The benefits of this approach are threefold. First, it allows for the determination of ideal housing distribution that optimizes solar radiation for each building density level, essentially extending the concept of sustainable building to the urban scale. Second, the method enhances living quality by considering the orientation and positioning of individual functions within each housing unit, achieving optimal views and privacy. Third, the algorithm's flexibility and robustness facilitate the efficient implementation of urban development with various stakeholders, architects, and construction companies without compromising its performance. The core of the research is the application of global and local optimization strategies to create efficient design solutions. By considering both, the performance of individual units and the collective performance of the urban aggregation, we ensure an optimal balance between private and communal benefits. By promoting a holistic understanding of urban ecology and integrating advanced optimization strategies, our methodology offers a sustainable and efficient solution to the challenges of modern urbanization.

Keywords: sustainable development, self-organization, ecological performance, solar radiation and exposure, daylight, visibility, accessibility, spatial distribution, local and global optimization

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Authors: Pakize Ozlem Kurt Polat

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GMO (genetically modified organism) is the result of a laboratory process where genes from the DNA of one species are extracted and artificially forced into the genes of an unrelated plant or animal. This technology includes; nucleic acid hybridization, recombinant DNA, RNA, PCR, cell culture and gene cloning techniques. The studies are divided into three groups of properties transferred to the transgenic plant. Up to 59% herbicide resistance characteristic of the transfer, 28% resistance to insects and the virus seems to be related to quality characteristics of 13%. Transgenic crops are not included in the commercial production of each product; mostly commercial plant is soybean, maize, canola, and cotton. Day by day increasing GMO interest can be listed as follows; Use in the health area (Organ transplantation, gene therapy, vaccines and drug), Use in the industrial area (vitamins, monoclonal antibodies, vaccines, anti-cancer compounds, anti -oxidants, plastics, fibers, polyethers, human blood proteins, and are used to produce carotenoids, emulsifiers, sweeteners, enzymes , food preservatives structure is used as a flavor enhancer or color changer),Use in agriculture (Herbicide resistance, Resistance to insects, Viruses, bacteria, fungi resistance to disease, Extend shelf life, Improving quality, Drought , salinity, resistance to extreme conditions such as frost, Improve the nutritional value and quality), we explain all this methods step by step in this research. GMO has advantages and disadvantages, which we explain all of them clearly in full text, because of this topic, worldwide researchers have divided into two. Some researchers thought that the GMO has lots of disadvantages and not to be in use, some of the researchers has opposite thought. If we look the countries law about GMO, we should know Biosafety law for each country and union. For this Biosecurity reasons, the problems caused by the transgenic plants, including Turkey, to minimize 130 countries on 24 May 2000, ‘the United Nations Biosafety Protocol’ signed nudes. This protocol has been prepared in addition to Cartagena Biosafety Protocol entered into force on September 11, 2003. This protocol GMOs in general use by addressing the risks to human health, biodiversity and sustainable transboundary movement of all GMOs that may affect the prevention, transit covers were dealt and used. Under this protocol we have to know the, ‘US Regulations GMO’, ‘European Union Regulations GMO’, ‘Turkey Regulations GMO’. These three different protocols have different applications and rules. World population increasing day by day and agricultural fields getting smaller for this reason feeding human and animal we should improve agricultural product yield and quality. Scientists trying to solve this problem and one solution way is molecular biotechnology which is including the methods of GMO too. Before decide to support or against the GMO, should know the GMO protocols and it effects.

Keywords: biotechnology, GMO (genetically modified organism), molecular marker

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Authors: Baguma Daniel Kajura

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The study explores socio-economic factors, health related and individual factors that influence the breastfeeding habits of mothers and their effect on the nutritional status of their infants in the Rwenzori region of Western Uganda. A cross-sectional research design was adopted, and it involved the use of self-administered questionnaires, interview guides, and focused group discussion guides to assess the extent to which socio-demographic factors associated with breastfeeding practices influence child malnutrition. Using this design, data was collected from 276 mother-paired infants out of the selected 318 mother-paired infants over a period of ten days. Using a sample size formula by Kish Leslie for cross-sectional studies N= Zα2 P (1- P) / δ2, where N= sample size estimate of paired mother paired infants. P= assumed true population prevalence of mother–paired infants with malnutrition cases, P = 29.3%. 1-P = the probability of mother-paired infants not having malnutrition, so 1-P = 70.7% Zα = Standard normal deviation at 95% confidence interval corresponding to 1.96.δ = Absolute error between the estimated and true population prevalence of malnutrition of 5%. The calculated sample size N = 1.96 × 1.96 (0.293 × 0.707) /0,052= 318 mother paired infants. Demographic and socio-economic data for all mothers were entered into Microsoft Excel software and then exported to STATA 14 (StataCorp, 2015). Anthropometric measurements were taken for all children by the researcher and the trained assistants who physically weighed the children. The use of immunization card was used to attain the age of the child. The bivariate logistic regression analysis was used to assess the relationship between socio-demographic factors associated with breastfeeding practices and child malnutrition. The multivariable regression analysis was used to draw a conclusion on whether or not there are any true relationships between the socio-demographic factors associated with breastfeeding practices as independent variables and child stunting and underweight as dependent variables in relation to breastfeeding practices. Descriptive statistics on background characteristics of the mothers were generated and presented in frequency distribution tables. Frequencies and means were computed, and the results were presented using tables, then, we determined the distribution of stunting and underweight among infants by the socioeconomic and demographic factors. Findings reveal that children of mothers who used milk substitutes besides breastfeeding are over two times more likely to be stunted compared to those whose mothers exclusively breastfed them. Feeding children with milk substitutes instead of breastmilk predisposes them to both stunting and underweight. Children of mothers between 18 and 34 years of age are less likely to be underweight, as were those who were breastfed over ten times a day. The study further reveals that 55% of the children were underweight, and 49% were stunted. Of the underweight children, an equal number (58/151) were either mildly or moderately underweight (38%), and 23% (35/151) were severely underweight. Empowering community outreach programs by increasing knowledge and increased access to services on integrated management of child malnutrition is crucial to curbing child malnutrition in rural areas.

Keywords: infant and young child feeding, breastfeeding, child malnutrition, maternal health

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Authors: Paiboon Jeamponk, Tikamporn Thipsaeng

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This paper is aimed to investigate farmers’ level of awareness and behavior of chemical pesticide uses, by using a case study of Suan Luang Sub- District Municipality, Ampawa, Samut Songkram Province. Questionnaire was employed in this study with the farmers from 46 households to explore their level of awareness in chemical pesticide uses, while interview and observation were adopted in exploring their behavior of chemical pesticide uses. The findings reflected the farmers’ high level of awareness in chemical pesticide uses in the hazardous effects of the chemical to human and environmental health, while their behavior of chemical pesticide uses explained their awareness paid to the right way of using pesticides, for instance reading the direction on the label, keeping children and animals away from the area of pesticide mixing, covering body with clothes and wearing hat and mask, no smoking, eating or drinking during pesticide spray or standing in windward direction.

Keywords: awareness, behavior, pesticide, farmers

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Authors: Hafiz Arbab Sakandar, Sabahat Yaqub, Ayesha Sameen, Muhammad Imran, Sarfraz Ahmad

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Yoghurt is one of the famous nutritious fermented milk products which have myriad of positive health effects on human beings and curable against different intestinal diseases. This research was conducted to observe effects of different artificial sweeteners on the quality parameters of yoghurt with relation to storage. Some people are allergic to natural sweeteners so artificial sweetener will be helpful for them. Physical-chemical, Microbiology and various sensory evaluation tests were carried out with the interval of 7, 14, 21, and 28 days. It was outcome from this study that addition of artificial sweeteners in yoghurt has shown much harmful effects on the yoghurt microorganisms and other physicochemical parameters from quality point of view. Best results for acceptance were obtained when aspartame was added in yoghurt at level of 0.022 percent. In addition, growth of beneficial microorganisms in yoghurt was also improved as well as other sensory attributes were enhanced by the addition of aspartame.

Keywords: yoghurt, artificial sweetener, storage, quality parameters

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Authors: Michael Josef Schwerer

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Background: The identification of unknown victims from mass disasters, violent crimes, or terrorist attacks is frequently facilitated through information from missing persons lists, portrait photos, old or recent pictures showing unique characteristics of a person such as scars or tattoos, or simply reference samples from blood relatives for DNA analysis. In contrast, the identification or at least the characterization of an unknown perpetrator from criminal or terrorist actions remains challenging, particularly in the absence of material or data for comparison, such as fingerprints, which had been previously stored in criminal records. In scenarios that result in high levels of destruction of the perpetrator’s corpse, for instance, blast or fire events, the chance for a positive identification using standard techniques is further impaired. Objectives: This study shows the forensic genetic procedures in the Legal Medicine Service of the German Air Force for the identification of unknown individuals, including such cases in which reference samples are not available. Scenarios requiring such efforts predominantly involve aircraft crash investigations, which are routinely carried out by the German Air Force Centre of Aerospace Medicine as one of the Institution’s essential missions. Further, casework by military police or military intelligence is supported based on administrative cooperation. In the talk, data from study projects, as well as examples from real casework, will be demonstrated and discussed with the audience. Methods: Forensic genetic identification in our laboratories involves the analysis of Short Tandem Repeats and Single Nucleotide Polymorphisms in nuclear DNA along with mitochondrial DNA haplotyping. Extended DNA analysis involves phenotypic markers for skin, hair, and eye color together with the investigation of a person’s biogeographic ancestry. Assessment of the biological age of an individual employs CpG-island methylation analysis using bisulfite-converted DNA. Forensic Investigative Genealogy assessment allows the detection of an unknown person’s blood relatives in reference databases. Technically, end-point-PCR, real-time PCR, capillary electrophoresis, pyrosequencing as well as next generation sequencing using flow-cell-based and chip-based systems are used. Results and Discussion: Optimization of DNA extraction from various sources, including difficult matrixes like formalin-fixed, paraffin-embedded tissues, degraded specimens from decomposed bodies or from decedents exposed to blast or fire events, provides soil for successful PCR amplification and subsequent genetic profiling. For cases with extremely low yields of extracted DNA, whole genome preamplification protocols are successfully used, particularly regarding genetic phenotyping. Improved primer design for CpG-methylation analysis, together with validated sampling strategies for the analyzed substrates from, e.g., lymphocyte-rich organs, allows successful biological age estimation even in bodies with highly degraded tissue material. Conclusions: Successful identification of unknown individuals or at least their phenotypic characterization using pigmentation markers together with age-informative methylation profiles, possibly supplemented by family tree search employing Forensic Investigative Genealogy, can be provided in specialized laboratories. However, standard laboratory procedures must be adapted to work with difficult and highly degraded sample materials.

Keywords: identification, forensic genetics, phenotypic markers, CPG methylation, biological age estimation, forensic investigative genealogy

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Authors: Joseph Akyeh, Abdul Samed Muntaka, Emmanuel Anin, Dorcas Nuertey

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Purpose: This study develops and tests arguments that the relationship between technology alignment and supply chain performance is conditional upon levels of technology championing. Methodology: The proposed relationships are tested on a sample of 217 hospitals in a major sub-Saharan African economy. Findings: Findings from the study indicate that technology alignment has a positive and significant effect on supply chain performance. The study further finds that while technology championing strengthens the direct effects of technology alignment on supply chain performance. Theoretical Contributions: A theoretical contribution from this study is the finding that when technology alignment drives supply chain performance is more complex than previously thought it depends on whether or not technology alignment is first championed by top management. Originality: Though some studies have been conducted on technology alignment and health supply chain performance, to the best of the researcher’s knowledge, no previous study has examined the moderating role of technology championing the link between technology alignment and supply chain performance.

Keywords: technology alignment, supply chain performance, technology championing, structural equation modelling

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Authors: Scott Rawlings

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Victoria’s first State of the Bays report is an historic baseline study of the health of Port Phillip Bay and Western Port. The report includes 50 assessments of 36 indicators across a broad array of topics from the nitrogen cycle and water quality to key marine species and habitats. This paper discusses the processes for determining and assessing the indicators and comments on future priorities identified to maintain and improve the health of these water ways. Victoria’s population is now at six million, and growing at a rate of over 100,000 people per year - the highest increase in Australia – and the population of greater Melbourne is over four million. Port Phillip Bay and Western Port are vital marine assets at the centre of this growth and will require adaptive strategies if they are to remain in good condition and continue to deliver environmental, economic and social benefits. In 2014, it was in recognition of these pressures that the incoming Victorian Government committed to reporting on the state of the bays every five years. The inaugural State of the Bays report was issued by the independent Victorian Commissioner for Environmental Sustainability. The report brought together what is known about both bays, based on existing research. It was a baseline on which future reports will build and, over time, include more of Victoria’s marine environment. Port Phillip Bay and Western Port generally demonstrate healthy systems. Specific threats linked to population growth are a significant pressure. Impacts are more significant where human activity is more intense and where nutrients are transported to the bays around the mouths of creeks and drainage systems. The transport of high loads of nutrients and pollutants to the bays from peak rainfall events is likely to increase with climate change – as will sea level rise. Marine pests are also a threat. More than 100 introduced marine species have become established in Port Phillip Bay and can compete with native species, alter habitat, reduce important fish stocks and potentially disrupt nitrogen cycling processes. This study confirmed that our data collection regime is better within the Marine Protected Areas of Port Phillip Bay than in other parts. The State of the Bays report is a positive and practical example of what can be achieved through collaboration and cooperation between environmental reporters, Government agencies, academic institutions, data custodians, and NGOs. The State of the Bays 2016 provides an important foundation by identifying knowledge gaps and research priorities for future studies and reports on the bays. It builds a strong evidence base to effectively manage the bays and support an adaptive management framework. The Report proposes a set of indicators for future reporting that will support a step-change in our approach to monitoring and managing the bays – a shift from reporting only on what we do know, to reporting on what we need to know.

Keywords: coastal science, marine science, Port Phillip Bay, state of the environment, Western Port

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Authors: Sundru Manjulata Devi, Prakash M. Halami

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The immemorial use of fermented foods from vegetables, dairy and other biological sources are of great demand in India because of their health benefits. However, the diversity of Lactobacillus plantarum group (LPG) of vegetable origin has not been revealed yet, particularly with reference to their probiotic functionalities. In the present study, the different species of probiotic Lactobacillus plantarum group (LPG) i.e., L. plantarum subsp. plantarum MTCC 5422 (from fermented cereals), L. plantarum subsp. argentoratensis FG16 (from fermented bamboo shoot) and L. paraplantarum MTCC 9483 (from fermented gundruk) (as characterized by multiplex recA PCR assay) were considered to investigate their relative expression of MUB domains of mub gene (mucin binding protein) by Real time PCR. Initially, the allelic variation in the mub gene was assessed and found to encode three different variants (Type I, II and III). All the three types had 8, 9 and 10 MUB domains respectively (as analysed by Pfam database) and were found to be responsible for adhesion of bacteria to the host intestinal epithelial cells. These domains either get inserted or deleted during speciation or evolutionary events and lead to divergence. The reverse transcriptase qPCR analysis with mubLPF1+R1 primer pair supported variation in amplicon sizes with 300, 500 and 700 bp among different LPG strains. The relative expression of these MUB domains significantly unregulated in the presence of 1% mucin in overnight grown cultures. Simultaneously, the mub gene expressed efficiently by 7 fold in the culture L. paraplantarum MTCC 9483 with 10 MUB domains. An increase in the expression levels for L. plantarum subsp. plantarum MTCC 5422 and L. plantarum subsp. argentoratensis FG16 (MCC 2974) with 9 and 8 repetitive domains was around 4 and 2 fold, respectively. The detection and expression of an integrase (int) gene in the upstream region of mub gene reveals the excision and integration of these repetitive domains. Concurrently, an in vitro adhesion assay to mucin and exclusion of pathogens (such as Listeria monocytogenes and Micrococcus leuteus) was investigated and observed that the L. paraplantarum MTCC 9483 with more adhesion domains has more ability to adhere to mucin and inhibited the growth of pathogens. The production and expression of plantaricin-like bacteriocin (plnNC8 type) in MTCC 9483 suggests the pathogen inhibition. Hence, the expression of MUB domains can act as potential biomarkers in the screening of a novel probiotic LPG strain with adherence property. The present study provides a platform for an easy, rapid, less time consuming, low-cost methodology for the detection of potential probiotic bacteria. It was known that the traditional practices followed in the preparation of fermented bamboo shoots/gundruk/cereals of Indian foods contain different kinds of neutraceuticals for functional food and novel compounds with health promoting factors. In future, a detailed study of these food products can add more nutritive value, consumption and suitable for commercialization.

Keywords: adhesion gene, fermented foods, MUB domains, probiotics

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Authors: Habib Honari

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The purpose of this study is an investigation of the factors affecting entrepreneurship in sport from the point of view of experts in this field. This study is a descriptive analytic one and was conducted as a survey and statistical sample consisted of 64 subjects including top managers and sport management professors at physical education organization. Data is collected by research designed questionnaire. Its reliability (α=.95) is obtained after its validity confirmation (by professors). In this article the most important factors affecting sport entrepreneurship, both as an interdisciplinary field in the world, are studied. Initially, infrastructures are identified for entrepreneurial opportunities in sports and related problems become known so that identifying factors for social, cultural, and economical development to entrepreneurs will be a smooth path, because sport entrepreneurship, given its effective roles in business development, welfare, health development, and participation in various aspects of society, can also play a crucial role in the development of the country. Finally, some solutions for developing entrepreneurial sport are introduced.

Keywords: sport entrepreneurship, entrepreneurial opportunities, entrepreneurial barriers, interdisciplinary

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Authors: Shumaila Shakoor

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C. tubulosa is a rare parasitic plant. It is found to be endangered and it acquires nutrition by penetrating roots deep in host roots. It has momentous potential to fulfill local and national health needs. This specie became endangered due to its parasitic mode of life and lack of awareness. Investigation of distribution and habitat conditions of C. tubulosa from District Pakpattan is the objective of this study. To explore its habitat conditions and community ecology phytosociological survey of C. tubulosa in different habitats i.e roadsides and graveyards was carried out. It was found that C. tubulosa occurs successfully in different habitats like graveyards and roadsides with specific neighboring species. Soil analysis was carried out by taking soil samples from seven sites. Soil was analyzed for pH, EC, soil texture, OM, N %age, Ca, Mg, P and K, which shows that soil of C. tubulosa is rich in all these nutrients.

Keywords: organic matter, potassium, phosphorus, magnesium

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Authors: Yanhui Jia, Ning Guo, Juan Li, Yunkui Sun, Wei Yang, Tianping Zhang, Lin Ma, Wei Meng, Hai Geng

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The current statuses of lifetime test of LaB6 hollow cathode at the Lanzhou institute of physics (LIP), China, was described. 5A LaB6 hollow cathode was designed for LIPS-200 40mN Xenon ion thruster and it could be used for LHT-100 80 mN Hall thruster, too. Life test of the discharge and neutralizer modes of LHC-5 hollow cathode were stared in October 2011, and cumulative operation time reached 17,300 and 16,100 hours in April 2015, respectively. The life of cathode was designed more than 11,000 hours. Parameters of discharge and key structure dimensions were monitored in different stage of life test indicated that cathodes were health enough. The test will continue until the cathode cannot work or operation parameter is not in normally. The result of the endurance test of cathode demonstrated that the LaB6 hollow cathode is satisfied for the required of thruster in life and performance.

Keywords: LaB6, hollow cathode, thruster, lifetime test, electric propulsion

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Authors: Amna Tariq Shah

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Amid the pandemic, the contemporary landscape has experienced accelerated growth in small business activities and an expanding digital marketplace, further exacerbating the issue of non-compliance among self-employed individuals through aggressive tax planning and evasion. This research seeks to address these challenges by developing strategic tax policies that promote voluntary compliance and improve taxpayer facilitation. The study employs the innovative MINDSPACE framework to examine three psychosocial factors—tax communication, tax literacy, and shaming—to optimize policy responses, address administrative shortcomings, and ensure adequate revenue collection for public goods and services. Preliminary findings suggest that incomprehensible communication from tax authorities drives individuals to seek alternative, potentially biased sources of tax information, thereby exacerbating non-compliance. Furthermore, the study reveals low tax literacy among Australian and Pakistani respondents, with many struggling to navigate complex tax processes and comprehend tax laws. Consequently, policy recommendations include simplifying tax return filing and enhancing pre-populated tax returns. In terms of shaming, the research indicates that Australians, being an individualistic society, may not respond well to shaming techniques due to privacy concerns. In contrast, Pakistanis, as a collectivistic society, may be more receptive to naming and shaming approaches. The study employs a mixed-method approach, utilizing interviews and surveys to analyze the issue in both jurisdictions. The use of mixed methods allows for a more comprehensive understanding of tax compliance behavior, combining the depth of qualitative insights with the generalizability of quantitative data, ultimately leading to more robust and well-informed policy recommendations. By examining evidence from opposite jurisdictions, namely a developed country (Australia) and a developing country (Pakistan), the study's applicability is enhanced, providing perspectives from two disparate contexts that offer insights from opposite ends of the economic, cultural, and social spectra. The non-comparative case study methodology offers valuable insights into human behavior, which can be applied to other jurisdictions as well. The application of the MINDSPACE framework in this research is particularly significant, as it introduces a novel approach to tax compliance behavior analysis. By integrating insights from behavioral economics, the framework enables a comprehensive understanding of the psychological and social factors influencing taxpayer decision-making, facilitating the development of targeted and effective policy interventions. This research carries substantial importance as it addresses critical challenges in tax compliance and administration, with far-reaching implications for revenue collection and the provision of public goods and services. By investigating the psychosocial factors that influence taxpayer behavior and utilizing the MINDSPACE framework, the study contributes invaluable insights to the field of tax policy. These insights can inform policymakers and tax administrators in developing more effective tax policies that enhance taxpayer facilitation, address administrative obstacles, promote a more equitable and efficient tax system, and foster voluntary compliance, ultimately strengthening the financial foundation of governments and communities.

Keywords: individual tax compliance behavior, psychosocial factors, tax non-compliance, tax policy

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Authors: Chang Liu, Hanwen Zhang, Vikash Sharma, Don Eliseo Lucerno-Prisno III, Emmanuel Yujuico, Maulik Chokshi, Prashanthi Krishnakumar, Bach Xuan Tran, Giang Thu Vu, Kamilla Anna Pinter, Shenglan Tang

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Background and Aims: Globally, many health systems focus on hospital-based healthcare models targeting acute care and disease treatment, which are not effective in addressing the challenges of ageing populations, chronic conditions, multi-morbidities, and increasingly unhealthy lifestyles. Recently, integrated care programs on chronic diseases have been developed, piloted, and implemented to meet such challenges. However, integrated care programs in the Asia-Pacific region vary in the levels of integration from linkage to coordination to full integration. This study aims to identify and analyze existing cases of integrated care in the Asia-Pacific region and identify the facilitators and barriers in order to improve existing cases and inform future cases. Methods: The study is a comparative study, with a combination approach of desk-based research and key informant interviews. The selected countries included in this study represent a good mix of lower-middle income countries (the Philippines, India, Vietnam, and Fiji), upper-middle income country (China), and high-income country (Singapore) in the Asia-Pacific region. Existing integrated care programs were identified through the scoping review approach. Trigger, history, general design, beneficiaries, and objectors were summarized with barriers and facilitators of integrated care based on key informant interviews. Representative case(s) in each country were selected and comprehensively analyzed through deep-dive case studies. Results: A total of 87 existing integrated care programs on chronic diseases were found in all countries, with 44 in China, 21 in Singapore, 12 in India, 5 in Vietnam, 4 in the Philippines, and 1 in Fiji. 9 representative cases of integrated care were selected for in-depth description and analysis, with 2 in China, the Philippines, and Vietnam, and 1 in Singapore, India, and Fiji. Population aging and the rising chronic disease burden have been identified as key drivers for almost all the six countries. Among the six countries, Singapore has the longest history of integrated care, followed by Fiji, the Philippines, and China, while India and Vietnam have a shorter history of integrated care. Incentives, technologies, education, and performance evaluation would be crucial for developing strategies for implementing future programs and improve already existing programs. Conclusion: Integrated care is important for addressing challenges surrounding the delivery of long-term care. To date, there is an increasing trend of integrated care programs on chronic diseases in the Asia-Pacific region, and all six countries in our study set integrated care as a direction for their health systems transformation.

Keywords: integrated healthcare, integrated care delivery, chronic diseases, Asia-Pacific region

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