Search results for: sustainable health planning

Authors: Moustafa Osman Mohammed

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This paper introduces Luhmann’s autopoietic social systems starting with the original concept of autopoiesis by biologists and scientists, including the modification of general systems based on socialized medicine. A specific type of autopoietic system is explained in the three existing groups of the ecological phenomena: interaction, social and medical sciences. This hypothesis model, nevertheless, has a nonlinear interaction with its natural environment ‘interactional cycle’ for the exchange of photon energy with molecular without any changes in topology. The external forces in the systems environment might be concomitant with the natural fluctuations’ influence (e.g. radioactive radiation, electromagnetic waves). The cantilever sensor deploys insights to the future chip processor for prevention of social metabolic systems. Thus, the circuits with resonant electric and optical properties are prototyped on board as an intra–chip inter–chip transmission for producing electromagnetic energy approximately ranges from 1.7 mA at 3.3 V to service the detection in locomotion with the least significant power losses. Nowadays, therapeutic systems are assimilated materials from embryonic stem cells to aggregate multiple functions of the vessels nature de-cellular structure for replenishment. While, the interior actuators deploy base-pair complementarity of nucleotides for the symmetric arrangement in particular bacterial nanonetworks of the sequence cycle creating double-stranded DNA strings. The DNA strands must be sequenced, assembled, and decoded in order to reconstruct the original source reliably. The design of exterior actuators have the ability in sensing different variations in the corresponding patterns regarding beat-to-beat heart rate variability (HRV) for spatial autocorrelation of molecular communication, which consists of human electromagnetic, piezoelectric, electrostatic and electrothermal energy to monitor and transfer the dynamic changes of all the cantilevers simultaneously in real-time workspace with high precision. A prototype-enabled dynamic energy sensor has been investigated in the laboratory for inclusion of nanoscale devices in the architecture with a fuzzy logic control for detection of thermal and electrostatic changes with optoelectronic devices to interpret uncertainty associated with signal interference. Ultimately, the controversial aspect of molecular frictional properties is adjusted to each other and forms its unique spatial structure modules for providing the environment mutual contribution in the investigation of mass temperature changes due to pathogenic archival architecture of clusters.

Keywords: autopoiesis, nanoparticles, quantum photonics, portable energy, photonic structure, photodynamic therapeutic system

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Authors: Deepak Singh

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AI technology is rapidly being integrated into the healthcare system, bringing many ethical and social implications. This literature review examines the various aspects of this phenomenon, focusing on the ethical considerations of using AI in healthcare, such as how it might affect patient autonomy, privacy, and doctor-patient relationships. Furthermore, the review considers the potential social implications of AI in Healthcare, such as the potential for automation to reduce the availability of healthcare jobs and the potential to widen existing health inequalities. The literature suggests potential benefits and drawbacks to using AI in healthcare, and it is essential to consider the ethical and social implications before implementation. It is concluded that more research is needed to understand the full implications of using AI in healthcare and that ethical regulations must be in place to ensure patient safety and the technology's responsible use.

Keywords: AI, healthcare, telemedicine, telehealth, ethics, security, privacy, patient, rights, safety

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Authors: Tagel Gebrehiwot, Carolina Castilla

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Food insecurity and child malnutrition are among the most critical issues in Ethiopia. Accordingly, different reform programs have been carried to improve household food security. The Food Security Program (FSP) (among others) was introduced to combat the persistent food insecurity problem in the country. The FSP combines a safety net component called the Productive Safety Net Program (PSNP) started in 2005. The goal of PSNP is to offer multi-annual transfers, such as food, cash or a combination of both to chronically food insecure households to break the cycle of food aid. Food or cash transfers are the main elements of PSNP. The case for cash transfers builds on the Sen’s analysis of ‘entitlement to food’, where he argues that restoring access to food by improving demand is a more effective and sustainable response to food insecurity than food aid. Cash-based schemes offer a greater choice of use of the transfer and can allow a greater diversity of food choice. It has been proven that dietary diversity is positively associated with the key pillars of food security. Thus, dietary diversity is considered as a measure of household’s capacity to access a variety of food groups. Studies of dietary diversity among Ethiopian rural households are somewhat rare and there is still a dearth of evidence on the impact of PSNP on household dietary diversity. In this paper, we examine the impact of the Ethiopia’s PSNP on household dietary diversity and child nutrition using panel household surveys. We employed different methodologies for identification. We exploit the exogenous increase in kebeles’ PSNP budget to identify the effect of the change in the amount of money households received in transfers between 2012 and 2014 on the change in dietary diversity. We use three different approaches to identify this effect: two-stage least squares, reduced form IV, and generalized propensity score matching using a continuous treatment. The results indicate the increase in PSNP transfers between 2012 and 2014 had no effect on household dietary diversity. Estimates for different household dietary indicators reveal that the effect of the change in the cash transfer received by the household is statistically and economically insignificant. This finding is robust to different identification strategies and the inclusion of control variables that determine eligibility to become a PSNP beneficiary. To identify the effect of PSNP participation on children height-for-age and stunting we use a difference-in-difference approach. We use children between 2 and 5 in 2012 as a baseline because by then they have achieved long-term failure to grow. The treatment group comprises children ages 2 to 5 in 2014 in PSNP participant households. While changes in height-for-age take time, two years of additional transfers among children who were not born or under the age of 2-3 in 2012 have the potential to make a considerable impact on reducing the prevalence of stunting. The results indicate that participation in PSNP had no effect on child nutrition measured as height-for-age or probability of beings stunted, suggesting that PSNP should be designed in a more nutrition-sensitive way.

Keywords: continuous treatment, dietary diversity, impact, nutrition security

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Authors: Septiany Trisnaningtyas

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Purpose: This research aims to examine the factors affecting the profitability of pharmaceutical company during the Covid-19 Pandemic in Indonesia. A sharp decline in the number of patients coming to the hospital for treatment during the pandemic has an impact on the growth of the pharmaceutical sector and brought major changes in financial position and business performance. Pharmaceutical companies that provide products related to the Covid-19 pandemic can survive and continue to grow. This study investigates the factors affecting the profitability of pharmaceutical company during the Covid-19 Pandemic in Indonesia associated with the number of Covid-19 cases. Design/methodology/approach: This study uses panel-data regression models to evaluate the influence of the number of Covid-19 confirmed cases on profitability of ninelisted pharmaceuticalcompanies in Indonesia. This research is based on four independent variables that were empirically examined for their relationship with profitability. These variables are liquidity (current ratio), growth rate (sales growth), firm size (total sales), and market power (the Lerner index). Covid-19 case is used as moderating variable. Data of nine pharmaceutical companies listed on the Indonesia Stock Exchange covering the period of 2018–2021 were extracted from companies’ quarterly annual reports. Findings: In the period during Covid-19, company growth (sales growth) and market power (lerner index) have a positive and significant relationship to ROA and ROE. Total of confirmed Covid-19 cases has a positive and significant relationship to ROA and is proven to have a moderating effect between company’s growth (sales growth) to ROA and ROE and market power (Lerner index) to ROA. Research limitations/implications: Due to data availability, this study only includes data from nine listed pharmaceutical companies in Indonesian Stock exchange and quarterly annual reportscovering the period of 2018-2021. Originality/value: This study focuses onpharmaceutical companies in Indonesia during Covid-19 pandemic. Previous study analyzes the data from pharmaceutical companies’ annual reports since 2014 and focus on universal health coverage (national health insurance) implementation from the Indonesian government. This study analyzes the data using fixed effect panel-data regression models to evaluate the influence of Covid-19 confirmed cases on profitability. Pooled ordinary least squares regression and fixed effects were used to analyze the data in previous study. This study also investigate the moderating effect of Covid-19 confirmed cases to profitability in relevant with the pandemic situation.

Keywords: profitability, indonesia, pharmaceutical, Covid-19

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Authors: Ieva Jokubauskaite, Alvyra Slepetiene, Danute Karcauskiene, Inga Liaudanskiene, Kristina Amaleviciute

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Soil organic carbon (SOC) is the key soil quality and ecological stability indicator, therefore, carbon accumulation in stable forms not only supports and increases the organic matter content in the soil, but also has a positive effect on the quality of soil and the whole ecosystem. Soil liming is one of the most common ways to improve the carbon sequestration in the soil. Determination of the optimum intensity and combinations of liming in order to ensure the optimal carbon quantitative and qualitative parameters is one of the most important tasks of this work. The field experiments were carried out at the Vezaiciai Branch of Lithuanian Research Centre for Agriculture and Forestry (LRCAF) during the 2011–2013 period. The effect of liming with different intensity (at a rate 0.5 every 7 years and 2.0 every 3-4 years) was investigated in the topsoil of acid moraine loam Bathygleyic Dystric Glossic Retisol. Chemical analyses were carried out at the Chemical Research Laboratory of Institute of Agriculture, LRCAF. Soil samples for chemical analyses were taken from the topsoil after harvesting. SOC was determined by the Tyurin method modified by Nikitin, measuring with spectrometer Cary 50 (VARIAN) at 590 nm wavelength using glucose standards. SOC fractional composition was determined by Ponomareva and Plotnikova version of classical Tyurin method. Dissolved organic carbon (DOC) was analyzed using an ion chromatograph SKALAR in water extract at soil-water ratio 1:5. Spectral properties (E4/E6 ratio) of humic acids were determined by measuring the absorbance of humic and fulvic acids solutions at 465 and 665 nm. Our study showed a negative statistically significant effect of periodical liming (at 0.5 and 2.0 liming rates) on SOC content in the soil. The content of SOC was 1.45% in the unlimed treatment, while in periodically limed at 2.0 liming rate every 3–4 years it was approximately by 0.18 percentage points lower. It was revealed that liming significantly decreased the DOC concentration in the soil. The lowest concentration of DOC (0.156 g kg-1) was established in the most intensively limed (2.0 liming rate every 3–4 years) treatment. Soil liming exerted an increase of all humic acids and fulvic acid bounded with calcium fractions content in the topsoil. Soil liming resulted in the accumulation of valuable humic acids. Due to the applied liming, the HR/FR ratio, indicating the quality of humus increased to 1.08 compared with that in unlimed soil (0.81). Intensive soil liming promoted the formation of humic acids in which groups of carboxylic and phenolic compounds predominated. These humic acids are characterized by a higher degree of condensation of aromatic compounds and in this way determine the intensive organic matter humification processes in the soil. The results of this research provide us with the clear information on the characteristics of SOC change, which could be very useful to guide the climate policy and sustainable soil management.

Keywords: acid soil, carbon sequestration, long–term liming, soil organic carbon

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Authors: Tania Chalton

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In June 2013, an independent review of the Liverpool Care Pathway (LCP) identified a number of problems with the implementation of the LCP in the UK and recommended that it be replaced by individual care plans for each patient. As a result of the UK findings, in November 2013 the Ministry of Health (MOH) commissioned the Palliative Care Council to initiate a programme of work to investigate an appropriate approach for the care of people in their last days of life in New Zealand (NZ). The Last Days of Life Working Group commenced a process to develop national consensus on the care of people in their last days of life in April 2014. In order to develop its advice for the future provision of care to people in their last days of life, the Working Group (WG) established a comprehensive work programme and as a result has developed a series of working papers. Specific areas of focus included: An analysis of the UK Independent Review findings and an assessment of these findings to the NZ context. A stocktake of services providing care to people in their last days of life, including aged residential care (ARC); hospices; hospitals; and primary care. International and NZ literature reviews of evidence and best practice. Survey of family to understand the consumer perspective on the care of people in their last days of life. Key aspects of care that required further considerations for NZ were: Terminology: clarify terminology used in the last days of life and in relation to death and dying. Evidenced based: including specific review of evidence regarding, spiritual, culturally appropriate care as well as dementia care. Diagnosis of dying: need for both guidance around the diagnosis of dying and communication with family. Workforce issues: access to an appropriate workforce after hours. Nutrition and hydration: guidance around appropriate approaches to nutrition and hydration. Symptom and pain management: guidance around symptom management. Documentation: documentation of the person’s care which is robust enough for data collection and auditing requirements, not ‘tick box’ approach to care. Education and training: improved consistency and access to appropriate education and training. Leadership: A dedicated team or person to support and coordinate the introduction and implementation of any last days of life model of care. Quality indicators and data collection: model of care to enable auditing and regular reviews to ensure on-going quality improvement. Cultural and spiritual: address and incorporate any cultural and spiritual aspects. A final document was developed incorporating all the evidence which provides guidance to the health sector on best practice for people at end of life: “Principles and guidance for the last days of life: Te Ara Whakapiri”.

Keywords: end of life, guidelines, New Zealand, palliative care

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Authors: Hadiza Kabir Bako, Munir Abba Dandago

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The fright of food-borne diseases as a result of animal health across the globe is creating the need for origin confirmation, safety of food and method of identification of food produce within the supply chain. In this paper, we investigated two commercial and one backyard poultry farm; live poultry, poultry meat and egg. We propose various implementation options for the poultry traceability system with respect to trace and track, and food recall and withdrawal requirements. With the intention that farmers, Investors or Regulatory agencies would find it useful for the Nigerian poultry sector and we highlight the future needs and challenges that lie ahead in the two most significant system of poultry production in Nigeria: the commercial poultry and backyard breeding.

Keywords: farm, food safety, food traceability, poultry

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Authors: Erol Bayraktarov, Asya Ilgun, Thomas Schickl, Alexandre Campo, Nicolis Stamatios

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Traditional means of harvesting honey are often stressful for honeybees. Each time honey is collected a portion of the colony can die. In consequence, the colonies’ resilience to environmental stressors will decrease and this ultimately contributes to the global problem of honeybee colony losses. As part of the project HIVEOPOLIS, we design and build a different kind of beehive, incorporating technology to reduce negative impacts of beekeeping procedures, including honey harvesting. A first step in maintaining more sustainable honey harvesting practices is to design honey storage frames that can automate the honey collection procedures. This way, beekeepers save time, money, and labor by not having to open the hive and remove frames, and the honeybees' nest stays undisturbed.This system shows promising features, e.g., high reliability which could be a key advantage compared to current honey harvesting technologies.Our original concept of fractional honey harvesting has been to encourage the removal of honey only from "safe" locations and at levels that would leave the bees enough high-nutritional-value honey. In this abstract, we describe the current state of our honey harvester, its technology and areas to improve. The honey harvester works by separating the honeycomb cells away from the comb foundation; the movement and the elastic nature of honey supports this functionality. The honey sticks to the foundation, because of the surface tension forces amplified by the geometry. In the future, by monitoring the weight and therefore the capped honey cells on our honey harvester frames, we will be able to remove honey as soon as the weight measuring system reports that the comb is ready for harvesting. Higher viscosity honey or crystalized honey cause challenges in temperate locations when a smooth flow of honey is required. We use resistive heaters to soften the propolis and wax to unglue the moving parts during extraction. These heaters can also melt the honey slightly to the needed flow state. Precise control of these heaters allows us to operate the device for several purposes. We use ‘Nitinol’ springs that are activated by heat as an actuation method. Unlike conventional stepper or servo motors, which we also evaluated throughout development, the springs and heaters take up less space and reduce the overall system complexity. Honeybee acceptance was unknown until we actually inserted a device inside a hive. We not only observed bees walking on the artificial comb but also building wax, filling gaps with propolis and storing honey. This also shows that bees don’t mind living in spaces and hives built from 3D printed materials. We do not have data yet to prove that the plastic materials do not affect the chemical composition of the honey. We succeeded in automatically extracting stored honey from the device, demonstrating a useful extraction flow and overall effective operation this way.

Keywords: honey harvesting, honeybee, hiveopolis, nitinol

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Authors: Caroline Dickson

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While adolescence can be a challenging time, it may also be a time of opportunity. Whereas adolescents with a physical disability negotiate the adolescent developmental stage with similar issues to able-bodied adolescents, they additionally may encounter developmental problems which may impede their adulthood. In part due to the restricted opportunities disabled adolescents experience, they may experience difficulty with mastering this developmental stage. As is well documented, health and wellbeing are positively associated with participating in physical activity. However, the little research available suggested that Pacific adolescents generally are participating in less physical activity than adolescents of other ethnic groups. Objective/Study: The main aim of the study (from a larger mixed method study), was to explore physical activity participation in Pacific adolescent girls with a physical disability in relation to their physiological and psychological wellbeing. The qualitative descriptive study comprised of seven interviews with Pacific adolescent girls and their mothers in a family setting and also included the providers of services to Pacific girls with a physical disability. Including the providers of disability services allowed the researchers to identity a further understanding into challenges of participation for the Pacific adolescent girls and their families while the girls were attempting to participate in physical activity. The purpose of the talanoa (face-to-face interviews that were deemed informal) was to identify partaking and factors influencing participation in physical activity, whilst listening to the voices of the participants. The stories revealed the multitude of factors that influenced physical activity for the Pacific girls with a physical disability. Results: Findings from the qualitative descriptive study found that through physical activity, the Pacific adolescent girls with a physical disability experienced benefits from participation. The findings suggested that these girls wanted to participate in physical activity and clearly indicated the physical activities they preferred. Amongst the physiological and psychological benefits of the Pacific adolescents engaging in physical activity, the adolescents were able to develop positive social relationships, experience autonomy, and generally, their self-worth improved while building confidence. Nevertheless, the adolescents experienced a multitude of factors impeding their engagement in physical activity including cultural stigmas. Their participation was influenced by the interplay of a range of gender, cultural, age-related (adolescence) and socio-economic factors alongside policy and structurally related constraints. Conclusion: Physical activity has the potential to improve the general physiological and psychological health of all adolescents. It should be prioritised particularly in vulnerable populations where they may have limited access. As the Pacific adolescents with a physical activity are dependent on their families for physical activity participation, it is imperative the family be included and consulted. To increase participation, and reduce sedentary behaviours, factors influencing both participation and non-participation need to be considered.

Keywords: Pacific adolescent girls, physical activity, physical disability, qualitative descriptive study

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Authors: Farzaneh Sasanpour, Saeed Amini Varaki

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Resilience is an important goal for cities as urban areas face an increasing range of challenges in the 21st century; therefore, according to the characteristics of risks, adopting an approach that responds to sensitive conditions in the risk management process is the resilience of cities. In the meantime, most of the resilience assessments have dealt with natural hazards and less attention has been paid to pandemics.In the covid-19 pandemic, the country of Iran and especially the metropolis of Tehran, was not immune from the crisis caused by its effects and consequences and faced many challenges. One of the methods that can increase the resilience of Tehran's metropolis against possible crises in the future is future studies. This research is practical in terms of type. The general pattern of the research will be descriptive-analytical and from the point of view that it is trying to communicate between the components and provide urban resilience indicators with pandemic crises and explain the scenarios, its future studies method is exploratory. In order to extract and determine the key factors and driving forces effective on the resilience of Tehran's urban areas against pandemic crises (Covid-19), the method of structural analysis of mutual effects and Micmac software was used. Therefore, the primary factors and variables affecting the resilience of Tehran's urban areas were set in 5 main factors, including physical-infrastructural (transportation, spatial and physical organization, streets and roads, multi-purpose development) with 39 variables based on mutual effects analysis. Finally, key factors and variables in five main areas, including managerial-institutional with five variables; Technology (intelligence) with 3 variables; economic with 2 variables; socio-cultural with 3 variables; and physical infrastructure, were categorized with 7 variables. These factors and variables have been used as key factors and effective driving forces on the resilience of Tehran's urban areas against pandemic crises (Covid-19), in explaining and developing scenarios. In order to develop the scenarios for the resilience of Tehran's urban areas against pandemic crises (Covid-19), intuitive logic, scenario planning as one of the future research methods and the Global Business Network (GBN) model were used. Finally, four scenarios have been drawn and selected with a creative method using the metaphor of weather conditions, which is indicative of the general outline of the conditions of the metropolis of Tehran in that situation. Therefore, the scenarios of Tehran metropolis were obtained in the form of four scenarios: 1- solar scenario (optimal governance and management leading in smart technology) 2- cloud scenario (optimal governance and management following in intelligent technology) 3- dark scenario (optimal governance and management Unfavorable leader in intelligence technology) 4- Storm scenario (unfavorable governance and management of follower in intelligence technology). The solar scenario shows the best situation and the stormy scenario shows the worst situation for the Tehran metropolis. According to the findings obtained in this research, city managers can, in order to achieve a better tomorrow for the metropolis of Tehran, in all the factors and components of urban resilience against pandemic crises by using future research methods, a coherent picture with the long-term horizon of 2050, from the path Provide urban resilience movement and platforms for upgrading and increasing the capacity to deal with the crisis. To create the necessary platforms for the realization, development and evolution of the urban areas of Tehran in a way that guarantees long-term balance and stability in all dimensions and levels.

Keywords: future research, resilience, crisis, pandemic, covid-19, Tehran

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Authors: Mehdi Ghaemi

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In principle, foreign investment security is enshrined in International Investment Agreements (IIAs) and Bilateral Investment Treaties (BITs) in the form of protection standards such as the Full Protection and Security Standard (FPS). Accordingly, the host countries undertake to provide the necessary security for the economic activities of foreign investment. With the outbreak of coronavirus, the international community called COVID-19 a threat to international peace security, as well as to the public interest and national security of nations; and to deal with, they proposed several solutions, generally including quarantine, creating social distances, and restricting businesses. This article first studies the security of foreign investment in international investment law. In the following, it analyzes the consequences of the COVID-19 pandemic for foreign investment security so that if there is a threat to that security, solutions could be offered to reduce it.

Keywords: foreign investment, FPS standard, host country, public health, COVID-19

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Authors: Mohammed Al-Shalabi

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In recent years, the Internet of Things (IoT) has become an important technology for connecting various smart objects in many applications, especially in health monitoring applications. The IoT technology develops healthcare applications from traditional to personalized ones by making the treatment and monitoring of patients easier. Nowadays, especially during the COVID-19 pandemic, the necessity of enhancing healthcare monitoring applications to avoid the spreading of this pandemic is increased. In this paper, a mechanism is proposed to minimize direct contact with COVID-19 patients who need ventilators by using IoT technology. The proposed mechanism saves medical providers from COVID-19 infection and then minimizes the spreading of this disease.

Keywords: internet of things, healthcare monitoring, COVID-19, ventilators, thingspeak, clouds

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Authors: Qasim Khan, Furkan Ahmad, Asfar A. Khan, M. Saad Alam, Faiz Ahmad

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In this paper, partial discharge analysis is performed in cavities artificially created in insulation. The setup is according with Cigre-II Method. Circular Samples created from Perspex Sheet with different configuration with changing number of cavities. Assessment of insulation health can be performed by Partial Discharge measurement as this has been found to be important means of condition monitoring. The experiments are done using MPD 540, which is a modern partial discharge measurement system. By analyzing the PD activity obtained for various voids/cavities, it is observed that the PD voltages show variation for cavity’s diameter, depth even for its ratios. This can be employed for scrutiny of insulation system.

Keywords: partial discharges, condition monitoring, insulation defects, degradation and corrosion, PMMA

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Authors: Geetanjali Gill

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International non-governmental organizations (INGOs) and development assistance donors have been implementing education projects in Sub-Saharan Africa and the global South that respond to gender-based inequities and that attempt to transform socio-cultural norms for greater gender equality in schools and communities. These efforts are in line with the United Nations Sustainable Development Goal number four, quality education, and goal number five, gender equality. Some INGOs and donors have also championed the use of play-based pedagogies for improved and more gender equal education outcomes. The study used the qualitative methods of life history interviews and focus groups to gauge social norm change amongst male and female adolescents, families, and teachers in primary schools that have been using gender-responsive play-based pedagogies in Rwanda, Ghana, and Mozambique. School administrators and project managers from the INGO Right to Play International were consulted in the selection of two primary schools per country (in both rural and urban contexts), as well as the selection of ten male and ten female students in grades four to six in each school, using specific parameters of social norm adherence. The parents (or guardians) and grandparents of four male and four female students in each school who were determined to be ‘outliers’ in their adherence to social norms were also interviewed. Additionally, sex-specific focus groups were held with thirty-six teachers. The study found that gender-responsive play-based pedagogies positively impactedsocio-cultural norms that shape gender relations amongst adolescents, their families, and teachers. Female and male students who spoke about their beliefs about gender equality in the roles and educational and career aspirations of men/boys and women/girls made linkages to the play-based pedagogies and approaches used by their teachers. Also, the parents and grandparents of these students were aware of generational differences in gender norms, and many were accepting of changed gender norms. Teachers who were effectively implementing gender-responsive play-based pedagogies in their classrooms spoke about changes to their own gender norms and how they were able to influence the gender norms of parents and community members. Life history interviews were found to be well-suited for the examination of changes to socio-cultural norms and gender relations. However, an appropriate framing of questions and topics specific to each target group was instrumental for the collection of data on socio-cultural norms and gender. The findings of this study can spur further academic inquiry of linkages between gender norms and education outcomes. The findings are also relevant for the work of INGOs and donors in the global South and for the development of gender-responsive education policies and programs.

Keywords: education, gender equality, ghana, international development, life histories, mozambique, rwanda, socio-cultural norms, sub-saharan africa, qualitative research

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Authors: Prashant Neupane, Asmi Pandey, Mumna Ehsan, Katie Davies, Richard Lowsby

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Introduction/Background & aims: Safe and effective prescribing in hospitals, directly and indirectly, impacts the health of the patients. Even though digital prescribing in the National Health Service (NHS), UK has been used in lots of tertiary centers along with district general hospitals, a significant number of NHS trusts are still using paper prescribing. We came across lots of irregularities in our daily clinical practice when we are doing paper prescribing. The main aim of the study was to assess how safely and effectively are we prescribing at our hospital where there is no access to digital prescribing. Method/Summary of work: We conducted a prospective audit in the critical care department at Mid Cheshire Hopsitals NHS Foundation Trust in which 20 prescription charts from different patients were randomly selected over a period of 1 month. We assessed 16 multiple categories from each prescription chart and compared them to the standard trust guidelines on prescription. Results/Discussion: We collected data from 20 different prescription charts. 16 categories were evaluated within each prescription chart. The results showed there was an urgent need for improvement in 8 different sections. In 85% of the prescription chart, all the prescribers who prescribed the medications were not identified. Name, GMC number and signature were absent in the required prescriber identification section of the prescription chart. In 70% of prescription charts, either indication or review date of the antimicrobials was absent. Units of medication were not documented correctly in 65% and the allergic status of the patient was absent in 30% of the charts. The start date of medications was missing and alternations of the medications were not done properly in 35%of charts. The patient's name was not recorded in all desired sections of the chart in 50% of cases and cancellations of the medication were not done properly in 45% of the prescription charts. Conclusion(s): From the audit and data analysis, we assessed the areas in which we needed improvement in prescription writing in the Critical care department. However, during the meetings and conversations with the experts from the pharmacy department, we realized this audit is just a representation of the specialized department of the hospital where access to prescribing is limited to a certain number of prescribers. But if we consider bigger departments of the hospital where patient turnover is much more, the results could be much worse. The findings were discussed in the Critical care MDT meeting where suggestions regarding digital/electronic prescribing were discussed. A poster and presentation regarding safe and effective prescribing were done, awareness poster was prepared and attached alongside every bedside in critical care where it is visible to prescribers. We consider this as a temporary measure to improve the quality of prescribing, however, we strongly believe digital prescribing will help to a greater extent to control weak areas which are seen in paper prescribing.

Keywords: safe prescribing, NHS, digital prescribing, prescription chart

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Authors: C. Recchia, M. Bourel, B. Recchia

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Microorganisms (viruses, bacteria, fungi) are responsible for most communicable diseases, threatening human health. For domestic use, chemical agents are often criticized because of their potential dangerousness, and natural solutions are needed. Application of the “dry microfine steam” (DMS) technology was tested on a selection of common pathogens (SARS-CoV-2, enterovirus EV-71, human coronavirus 229E, E. coli, S. aureus, C. albicans), on different innate surfaces, for 5 to 10 seconds. Quantification of the remaining pathogens was performed, and the reduction rates ranged from 99.8% (S. aureus on plastic) to over 99.999%. DMS showed high efficacy in the elimination of common microorganisms and could be seen as a natural alternative to chemical agents to improve domestic hygiene.

Keywords: steam, SARS-CoV-2, bactericidal, virucidal, fungicidal, sterilization

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Authors: Tobias Huwer, Thomas Bobek, Gunter Spöcker

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Driving forces for enhancements in production are trends like digitalization and individualized production. Currently, such developments are restricted to assembly parts. Thus, complex freeform surfaces are not addressed in this context. The need for efficient use of resources and near-net-shape production will require individualized production of complex shaped workpieces. Due to variations between nominal model and actual geometry, this can lead to changes in operations in Computer-aided process planning (CAPP) to make CAPP manageable for an adaptive serial production. In this context, 3D CAD data can be a key to realizing that objective. Along with developments in the geometrical adaptation, a preceding inspection method based on CAD data is required to support the process planner by finding objective criteria to make decisions about the adaptive manufacturability of workpieces. Nowadays, this kind of decisions is depending on the experience-based knowledge of humans (e.g. process planners) and results in subjective decisions – leading to a variability of workpiece quality and potential failure in production. In this paper, we present an automatic part inspection method, based on design and measurement data, which evaluates actual geometries of single workpiece preforms. The aim is to automatically determine the suitability of the current shape for further machining, and to provide a basis for an objective decision about subsequent adaptive manufacturability. The proposed method is realized by a workflow-based approach, keeping in mind the requirements of industrial applications. Workflows are a well-known design method of standardized processes. Especially in applications like aerospace industry standardization and certification of processes are an important aspect. Function blocks, providing a standardized, event-driven abstraction to algorithms and data exchange, will be used for modeling and execution of inspection workflows. Each analysis step of the inspection, such as positioning of measurement data or checking of geometrical criteria, will be carried out by function blocks. One advantage of this approach is its flexibility to design workflows and to adapt algorithms specific to the application domain. In general, within the specified tolerance range it will be checked if a geometrical adaption is possible. The development of particular function blocks is predicated on workpiece specific information e.g. design data. Furthermore, for different product lifecycle phases, appropriate logics and decision criteria have to be considered. For example, tolerances for geometric deviations are different in type and size for new-part production compared to repair processes. In addition to function blocks, appropriate referencing systems are important. They need to support exact determination of position and orientation of the actual geometries to provide a basis for precise analysis. The presented approach provides an inspection methodology for adaptive and part-individual process chains. The analysis of each workpiece results in an inspection protocol and an objective decision about further manufacturability. A representative application domain is the product lifecycle of turbine blades containing a new-part production and a maintenance process. In both cases, a geometrical adaptation is required to calculate individual production data. In contrast to existing approaches, the proposed initial inspection method provides information to decide between different potential adaptive machining processes.

Keywords: adaptive, CAx, function blocks, turbomachinery

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Authors: Zaima Umar, Anas S. Qureshi, Adeel Sarfraz, Saqib Umar, Talha Umar, Muhammad Usman

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Ostrich has been a good source of food and income for people across the world. To get a better understanding of health and health-related problems, the knowledge of its digestive system is of utmost importance. The present study was conducted to determine the morphological and histometrical variations in the digestive system and associated glands of ostrich (Struthio camelus) as regard to the gender and progressive age. A total of 40 apparently healthy ostriches of both genders and two progressive age groups; young one (less than two year, group A); and adult (2-15 years, group B) in equal number were used in this study. Digestive organs including tongue, esophagus, proventriculus, gizzard, small and large intestines and associated glands like liver and pancreas were collected immediately after slaughtering the birds. The organs of the digestive system and associated glands of each group were studied grossly and histologically. Grossly colour, shape consistency, weight and various dimensions (length, width, and circumference) of organs of the digestive tract and associated glands were recorded. The mean (± SEM) of all gross anatomical parameters in group A were significantly (p ≤ 0.01) different from that of group B. For microscopic studies, 1-2 cm tissue samples of organs of the digestive system and associated glands were taken. The tissue was marked and fixed in the neutral buffer formaldehyde solution for histological studies. After fixation, the sections of 5-7 µm were cut and stained by haematoxylin and eosin stain. All the layers (epithelium, lamina propria, lamina muscularis, submucosa and tunica muscularis) were measured (µm) with the help of automated computer software Image J®. The results of this study provide valuable information on the gender and age-related histological and histometrical variations in the digestive organs of ostrich (Struthio camelus). The microscopic studies of different parts of the digestive system revealed highly significant differences (p ≤ 0.01) among the two groups. The esophagus was lined by non-keratinized stratified squamous epithelium. The duodenum, jejunum, and ileum showed similar histological structures. Statistical analysis revealed significant (p ≤ 0.05) increase in the thickness of different tunics of the gastrointestinal tract in adult birds (up to 15 years) as compared with young ones (less than two years). Therefore, it can be concluded that there is a gradual but consistent growth in the observed digestive organs mimicking that of other poultry species and may be helpful in determining the growth pattern in this bird. However, there is a need to record the changes at closer time intervals.

Keywords: ostrich, digestive system, histomorphometry, grossly

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Authors: M. Mueller, M. Kuehn, M. Voelker

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In small and medium-sized enterprises (SMEs), the challenge is to create a well-grounded and reliable basis for process analysis, optimization and planning due to a lack of data. SMEs have limited access to methods with which they can effectively and efficiently analyse processes and identify cause-and-effect relationships in order to generate the necessary database and derive optimization potential from it. The implementation of digitalization within the framework of Industry 4.0 thus becomes a particular necessity for SMEs. For these reasons, the abstract presents an analysis methodology that is subject to the objective of developing an SME-appropriate methodology for efficient, temporarily feasible data collection and evaluation in flexible production and logistics systems as a basis for process analysis and optimization. The overall methodology focuses on retrospective, event-based tracing and analysis of material flow objects. The technological basis consists of Bluetooth low energy (BLE)-based transmitters, so-called beacons, and smart mobile devices (SMD), e.g. smartphones as receivers, between which distance data can be measured and derived motion profiles. The distance is determined using the Received Signal Strength Indicator (RSSI), which is a measure of signal field strength between transmitter and receiver. The focus is the development of a software-based methodology for interpretation of relative movements of transmitters and receivers based on distance data. The main research is on selection and implementation of pattern recognition methods for automatic process recognition as well as methods for the visualization of relative distance data. Due to an existing categorization of the database regarding process types, classification methods (e.g. Support Vector Machine) from the field of supervised learning are used. The necessary data quality requires selection of suitable methods as well as filters for smoothing occurring signal variations of the RSSI, the integration of methods for determination of correction factors depending on possible signal interference sources (columns, pallets) as well as the configuration of the used technology. The parameter settings on which respective algorithms are based have a further significant influence on result quality of the classification methods, correction models and methods for visualizing the position profiles used. The accuracy of classification algorithms can be improved up to 30% by selected parameter variation; this has already been proven in studies. Similar potentials can be observed with parameter variation of methods and filters for signal smoothing. Thus, there is increased interest in obtaining detailed results on the influence of parameter and factor combinations on data quality in this area. The overall methodology is realized with a modular software architecture consisting of independently modules for data acquisition, data preparation and data storage. The demonstrator for initialization and data acquisition is available as mobile Java-based application. The data preparation, including methods for signal smoothing, are Python-based with the possibility to vary parameter settings and to store them in the database (SQLite). The evaluation is divided into two separate software modules with database connection: the achievement of an automated assignment of defined process classes to distance data using selected classification algorithms and the visualization as well as reporting in terms of a graphical user interface (GUI).

Keywords: event-based tracing, machine learning, process classification, parameter settings, RSSI, signal smoothing

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Authors: Bassam Shaikh, R. S. A. Jumain

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Game addiction has become an extremely important topic in psychology researchers, particularly in understanding and explaining why individuals become addicted (to video games). In previous studies, effect of online game addiction on social responsibilities, health problems, government action, and the behaviors of individuals to purchase and the causes of making individuals addicted on the video games has been discussed. Extending these concepts in marketing, it could be argued than the phenomenon could enlighten and extending our understanding on consumer loyalty. This study took the Grounded Theory approach, and found that motivation, satisfaction, fulfillments, exploration and achievements to be part of the important elements that builds consumer loyalty.

Keywords: grounded theory, consumer loyalty, video games, video game addiction

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Authors: Hamed Movahedi, Nicolas Bovet, Henning Friis Poulsen

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Following the advent of the Industrial Revolution, there has been a significant increase in the extraction and utilization of hydrocarbon and fossil fuel resources. However, a new era has emerged, characterized by a shift towards sustainable practices, namely the reduction of carbon emissions and the promotion of renewable energy generation. Given the substantial number of mature oil and gas wells that have been developed inside the petroleum reservoir domain, it is imperative to establish an environmental strategy and adopt appropriate measures to effectively seal and decommission these wells. In general, the cement plug serves as a material for plugging purposes. Nevertheless, there exist some scenarios in which the durability of such a plug is compromised, leading to the potential escape of hydrocarbons via fissures and fractures within cement plugs. Furthermore, cement is often not considered a practical solution for temporary plugging, particularly in the case of well sites that have the potential for future gas storage or CO2 injection. The Danish oil and gas industry has promising potential as a prospective candidate for future carbon dioxide (CO2) injection, hence contributing to the implementation of carbon capture strategies within Europe. The primary reservoir component consists of chalk, a rock characterized by limited permeability. This work focuses on the development and characterization of a novel hydrogel variant. The hydrogel is designed to be injected via a low-permeability reservoir and afterward undergoes a transformation into a high-viscosity gel. The primary objective of this research is to explore the potential of this hydrogel as a new solution for effectively plugging well flow. Initially, the synthesis of polyacrylamide was carried out using radical polymerization inside the confines of the reaction flask. Subsequently, with the application of the Hoffman rearrangement, the polymer chain undergoes partial amination, facilitating its subsequent reaction with the crosslinker and enabling the formation of a hydrogel in the subsequent stage. The organic crosslinker, glutaraldehyde, was employed in the experiment to facilitate the formation of a gel. This gel formation occurred when the polymeric solution was subjected to heat within a specified range of reservoir temperatures. Additionally, a rheological survey and gel time measurements were conducted on several polymeric solutions to determine the optimal concentration. The findings indicate that the gel duration is contingent upon the starting concentration and exhibits a range of 4 to 20 hours, hence allowing for manipulation to accommodate diverse injection strategies. Moreover, the findings indicate that the gel may be generated in environments characterized by acidity and high salinity. This property ensures the suitability of this substance for application in challenging reservoir conditions. The rheological investigation indicates that the polymeric solution exhibits the characteristics of a Herschel-Bulkley fluid with somewhat elevated yield stress prior to solidification.

Keywords: polyacrylamide, hofmann rearrangement, rheology, gel time

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Authors: Jason Gica, Yi-Hsieng Samuel Wu, Deng-Jye Yang, Yi-Chen Chen

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Mycotoxins, harmful secondary metabolites produced by certain fungi species, pose significant risks to animals and humans worldwide. Their stable properties lead to contamination during grain harvesting, transportation, and storage, as well as in processed food products. The prevalence of mycotoxin contamination has attracted significant attention due to its adverse impact on food safety and global trade. The secondary contamination pathway from animal products has been identified as an important route of exposure, posing health risks for livestock and humans consuming contaminated products. Pork, one of the highly consumed meat products in Taiwan according to the National Food Consumption Database, plays a critical role in the nation's diet and economy. Given its substantial consumption, pork processing products are a significant component of the food supply chain and a potential source of mycotoxin contamination. This study is paramount for formulating effective regulations and strategies to mitigate mycotoxin-related risks in the food supply chain. By establishing a reliable analytical method, this research contributes to safeguarding public health and enhancing the quality of pork processing products. The findings will serve as valuable guidance for policymakers, food industries, and consumers to ensure a safer food supply chain in the face of emerging mycotoxin challenges. An innovative and efficient analytical approach is proposed using Ultra-High Performance Liquid Chromatography coupled with Temperature Control Fluorescence Detector Light (UHPLC-TCFLD) to determine multiple mycotoxins in pork meat samples due to its exceptional capacity to detect multiple mycotoxins at the lowest levels of concentration, making it highly sensitive and reliable for comprehensive mycotoxin analysis. Additionally, its ability to simultaneously detect multiple mycotoxins in a single run significantly reduces the time and resources required for analysis, making it a cost-effective solution for monitoring mycotoxin contamination in pork processing products. The research aims to optimize the efficient mycotoxin QuEChERs extraction method and rigorously validate its accuracy and precision. The results will provide crucial insights into mycotoxin levels in pork processing products.

Keywords: multiple-mycotoxin analysis, pork processing products, QuEChERs, UHPLC-TCFLD, validation

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Authors: Abdullah S. Alghamdi, Khaled Alghamdi, Richard O. Jenkins, Parvez I. Haris

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Background: Physical activity is an important factor in the treatment and prevention of type 2 diabetes mellitus (T2DM). Reduction in HbA1c level, an important diabetes biomarker, was reported in patients who increased their daily physical activity. Although the ambient temperature was reported to be positively correlated to a negative impact on health and increase the incidences of diabetes, the exposure to bright sunlight was recently found to be associated with enhanced insulin sensitivity and improved beta-cell function. How Ramadan alters physical activity, and especially sunlight exposure, has not been adequately investigated. Aim: This study aimed to assess the physical activity and sun exposure of Saudis with T2DM over different periods (before, during, and after Ramadan) and related this to HbA1c levels. Methods: This study recruited 82 Saudis with T2DM, who chose to fast during Ramadan, from the Endocrine and Diabetic Centre of Al Iman General Hospital, Riyadh, Saudi Arabia. Ethical approvals for this study were obtained from De Montfort University and Saudi Ministry of Health. Physical activity and sun exposure were assessed by a self-administered questionnaire. Physical activity was estimated using the International Physical Activity Questionnaire (IPAQ), while the sun exposure was assessed by asking the patients about their hours per week of direct exposure to the sun, and daily hours spent outdoors. Blood samples were collected in each period for measuring HbA1c. Results: Low physical activity was observed in more than 60% of the patients, with no significant changes between periods. There were no significant variances between periods in the daily hours spent outdoors and the total number of weekly hours of direct exposure to the sun. The majority of patients reported only few hours of exposure to the sun (1h or less per week) and time spent outdoors (1h or less per day). The mean HbA1c significantly changed between periods (P = 0.001), with lowest level during Ramadan. There were significant differences in the mean HbA1c between the groups for the level of physical activity (P < 0.001), with significant lower mean HbA1c in the higher-level group. There were no significant variances in the mean of HbA1c between the groups for the daily hours spent outdoors. The mean HbA1c of the patients, who reported never in their total weekly hours of exposure to the sun, was significantly lower than the mean HbA1c of those who reported 1 hour or less (P = 0.001). Conclusion: Physical inactivity was prevalent among the study population with very little exposure to the sun or time spent outdoors. Higher level of physical activity was associated with lower mean HbA1c levels. Encouraging T2DM patients to achieve the recommended levels of physical activity may help them to obtain greater benefits of Ramadan fasting, such as reducing their HbA1c levels. The impact of low direct exposure to the sun and the time spent outdoors needs to be further investigated in both healthy and diabetic patients.

Keywords: diabetes, fasting, physical activity, sunlight, Ramadan

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Authors: Colin Schmidt, Adrien Lecossier, Pascal Crubleau, Philippe Blanchard, Simon Richir

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Introduction:The widespread availability of artificial intelligence, exemplified by Generative Pre-trained Transformers (GPT) relying on large language models (LLM), has caused a seismic shift in the realm of knowledge. Everyone now has the capacity to swiftly learn how these models can either serve them well or not. Today, conversational AI like ChatGPT is grounded in neural transformer models, a significant advance in natural language processing facilitated by the emergence of renowned LLMs constructed using neural transformer architecture. Inventiveness of an LLM : OpenAI's GPT-3 stands as a premier LLM, capable of handling a broad spectrum of natural language processing tasks without requiring fine-tuning, reliably producing text that reads as if authored by humans. However, even with an understanding of how LLMs respond to questions asked, there may be lurking behind OpenAI’s seemingly endless responses an inventive model yet to be uncovered. There may be some unforeseen reasoning emerging from the interconnection of neural networks here. Just as a Soviet researcher in the 1940s questioned the existence of Common factors in inventions, enabling an Under standing of how and according to what principles humans create them, it is equally legitimate today to explore whether solutions provided by LLMs to complex problems also share common denominators. Theory of Inventive Problem Solving (TRIZ) : We will revisit some fundamentals of TRIZ and how Genrich ALTSHULLER was inspired by the idea that inventions and innovations are essential means to solve societal problems. It's crucial to note that traditional problem-solving methods often fall short in discovering innovative solutions. The design team is frequently hampered by psychological barriers stemming from confinement within a highly specialized knowledge domain that is difficult to question. We presume ChatGPT Utilizes TRIZ 40. Hence, the objective of this research is to decipher the inventive model of LLMs, particularly that of ChatGPT, through a comparative study. This will enhance the efficiency of sustainable innovation processes and shed light on how the construction of a solution to a complex problem was devised. Description of the Experimental Protocol : To confirm or reject our main hypothesis that is to determine whether ChatGPT uses TRIZ, we will follow a stringent protocol that we will detail, drawing on insights from a panel of two TRIZ experts. Conclusion and Future Directions : In this endeavor, we sought to comprehend how an LLM like GPT addresses complex challenges. Our goal was to analyze the inventive model of responses provided by an LLM, specifically ChatGPT, by comparing it to an existing standard model: TRIZ 40. Of course, problem solving is our main focus in our endeavours.

Keywords: artificial intelligence, Triz, ChatGPT, inventiveness, problem-solving

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Authors: Anna Romanova, Mojtaba Mahmoodian, Morteza A. Alani

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Concrete sewer pipes are known to suffer from a process of hydrogen sulfide gas induced sulfuric acid corrosion. This leads to premature pipe degradation, performance failure and collapses which in turn may lead to property and health damage. The above work reports on a field study undertaken in working sewer manholes where the parameters of effluent temperature and pH as well as ambient temperature and concentration of hydrogen sulfide were continuously measured over a period of two months. Early results suggest that effluent pH has no direct effect on hydrogen sulfide build up; on average the effluent temperature is 3.5°C greater than the ambient temperature inside the manhole and also it was observed that hydrogen sulfate concentration increases with increasing temperature.

Keywords: concrete corrosion, hydrogen sulfide gas, temperature, sewer pipe

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Authors: Chiahsu Yang, Peiling Wu, Ted Ho

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From emphasizing economic development to stressing public happiness, the international community mainly hopes to be able to understand whether the quality of life for the public is becoming better. The Better Life Index (BLI) constructed by OECD uses living conditions and quality of life as starting points to cover 11 areas of life and to convey the state of the general public’s well-being. In light of the BLI framework, the Directorate General of Budget, Accounting and Statistics (DGBAS) of the Executive Yuan instituted the Gross National Happiness Index to understand the needs of the general public and to measure the progress of the aforementioned conditions in residents across the island. Whereas living conditions consist of income and wealth, jobs and earnings, and housing conditions, health status, work and life balance, education and skills, social connections, civic engagement and governance, environmental quality, personal security. The ICT area consists of health care, living environment, ICT-enabled communication, transportation, government, education, pleasure, purchasing, job & employment. In the wake of further science and technology development, rapid formation of information societies, and closer integration between lifestyles and information societies, the public’s well-being within information societies has indeed become a noteworthy topic. the Board of Science and Technology of the Executive Yuan use the OECD’s BLI as a reference in the establishment of the Taiwan-specific ICT-Enabled Better Life Index. Using this index, the government plans to examine whether the public’s quality of life is improving as well as measure the public’s satisfaction with current digital quality of life. This understanding will enable the government to gauge the degree of influence and impact that each dimension of digital services has on digital life happiness while also serving as an important reference for promoting digital service development. The content of the ICT Enabled Better Life Index. Information and communications technology (ICT) has been affecting people’s living styles, and further impact people’s quality of life (QoL). Even studies have shown that ICT access and usage have both positive and negative impact on life satisfaction and well-beings, many governments continue to invest in e-government programs to initiate their path to information society. This research is the few attempts to link the e-government benchmark to the subjective well-being perception, and further address the gap between user’s perception and existing hard data assessment, then propose a model to trace measurement results back to the original public policy in order for policy makers to justify their future proposals.

Keywords: information and communications technology, quality of life, satisfaction, well-being

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Authors: Le Jiang, Chua Jinxing

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Introduction: The recent outbreak of Ebola virus disease in the west Africa has drawn global concern. With a high fatality rate and direct human-to-human transmission, it has spread between countries and caused great damages for patients and family who are affected. Being the designated hospital to manage epidemic outbreak in Singapore, Tan Tock Seng Hospital (TTSH) is facing great challenges in preparation and managing of potential outbreak of emerging infectious disease such as Ebola virus disease. Aim: We conducted an infection control drill in TTSH emergency department to assess the readiness of healthcare and allied health workers in managing suspected Ebola patients. It also helps to review current Ebola clinical protocol and work instruction to ensure more smooth and safe practice in managing Ebola patients in TTSH emergency department. Result: General preparedness level of staffs involved in managing Ebola virus disease in TTSH emergency department is not adequate. Knowledge deficits of staffs on Ebola personal protective equipment gowning and degowning process increase the risk of potential cross contamination in patient care. Loopholes are also found in current clinical protocol, such as unclear instructions and inaccurate information, which need to be revised to promote better staff performance in patient management. Logistic issues such as equipment dysfunction and inadequate supplies can lead to ineffective communication among teams and causing harm to patients in emergency situation. Conclusion: The infection control drill identified the need for more well-structured and clear clinical protocols to be in place to promote participants performance. In addition to quality protocols and guidelines, systemic training and annual refresher for all staffs in the emergency department are essential to prepare staffs for the outbreak of Ebola virus disease. Collaboration and communication with allied health staffs are also crucial for smooth delivery of patient care and minimising the potential human suffering, properties loss or injuries caused by disease. Therefore, more clinical drills with collaboration among various departments involved are recommended to be conducted in the future to monitor and assess readiness of TTSH emergency department in managing Ebola virus disease.

Keywords: ebola, emergency department, infection control drill, Tan Tock Seng Hospital

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Authors: Kadri-Ann Kertsmik, Martin Talvik, Kimmo Lylykangas, Simo Ilomets, Targo Kalamees

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This study compares the building carbon footprint (CF) values for a case study of a private house located in a cold climate, using the Level(s) methodology. It provides a framework for measuring the environmental performance of buildings throughout their life cycle, taking into account various factors. The study presents the results of the three scenarios, comparing their carbon emissions and highlighting the benefits of circular material usage. The construction process was thoroughly documented, and all materials and components (including minuscule mechanical fasteners, each meter of cable, a kilogram of mortar, and the component of HVAC systems, among other things) delivered to the construction site were noted. Transportation distances of each delivery, the fuel consumption of construction machines, and electricity consumption for temporary heating and electrical tools were also monitored. Using the detailed data on material and energy resources, the CF was calculated for two scenarios: one where circular material usage was applied and another where virgin materials were used instead of reused ones. The results were compared with the CF calculated based on the building permit design model using the Level(s) methodology. To study the range of possible results in the early stage of CF assessment, the same building permit design was given to several experts. Results showed that embodied carbon values for a built scenario were significantly lower than the values predicted by the building permit stage as a result of more precise material quantities, as the calculation methodology is designed to overestimate the CF. Moreover, designers made an effort to reduce the building's CF by reusing certain materials such as ceramic tiles, lightweight concrete blocks, and timber during the construction process. However, in a cold climate context where operational energy (B6) continues to dominate, the total building CF value changes between the three scenarios were less significant. The calculation for the building permit project was performed by several experts, and CF results were in the same range. It alludes that, for the first estimation of preliminary building CF, using average values proves to be an appropriate method for the Estonian national carbon footprint estimation phase during building permit application. The study also identified several opportunities for reducing the carbon footprint of the building, such as reusing materials from other construction sites, preferring local material producers, and reducing wastage on site. The findings suggest that using circular materials can significantly reduce the carbon footprint of buildings. Overall, the study highlights the importance of using a comprehensive approach to measure the environmental performance of buildings, taking into account both the project and the actually built house. It also emphasises the need for ongoing monitoring for designing the building and construction site waste. The study also gives some examples of how to enable future circularity of building components and materials, e.g., building in layers, using wood as untreated, etc.

Keywords: carbon footprint, circular economy, sustainable construction, level(s) methodology

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Authors: S. Ivanova, K. Ivanov

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Bemitil (2-ethylthiobenzimidazole hydrobromide) is a synthetic adaptogen and actoprotector, with wide-ranging pharmacological activities such as nootropic, antihypoxic, antioxidant, immunostimulant. The intake of Bemitil increases mental and physical performance and could be applied under either normal or extreme conditions. Until 2017 Bemitil was not considered as doping and was used by professional athletes more than 30 years because of its high efficiency and safety. The drug was included in WADA monitoring programme for 2018, and most likely it would be included in WADA Prohibited List for 2019. Usually, a substance/method is included in WADA Prohibited List if it meets any two of the following three criteria: the potential to enhance or enhances sports performance/ potential health risk to the athlete/ violates the spirit of sport. Bemitil has high performance-enhancing potential, but it is also safe- it is controversial whether it should be considered as doping.

Keywords: doping, bemitil, sport, actoprotector

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Authors: Robert E. Kenney, Efrain Antunez, Samuel Nodal, Ameer Malik, Richard B. Aguilar

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Physician burnout has gained much attention during the COVID pandemic. After-hours workload, HCC coding, HEDIS metrics, and clinical documentation negatively impact career satisfaction. These and other influences have increased the rate of physicians leaving the workforce. In addition, roughly 1% of the entire physician workforce will be retiring earlier than expected based on pre-pandemic trends. The two Medical Specialties with the highest rates of burnout are Family Medicine and Primary Care. With a predicted shortage of primary care physicians looming, the need to address physician burnout is crucial. Commonly reported issues leading to clinician burnout are clerical documentation requirements, increased time working on Electronic Health Records (EHR) after hours, and a decrease in work-life balance. Clinicians experiencing burnout with physical and emotional exhaustion are at an increased likelihood of providing lower quality and less efficient patient care. This may include a lack of suitable clinical documentation, medication reconciliation, clinical assessment, and treatment plans. While the annual baseline turnover rates of physicians hover around 6-7%, the COVID pandemic profoundly disrupted the delivery of healthcare. A report found that 43% of physicians switched jobs during the initial two years of the COVID pandemic (2020 and 2021), tripling the expected average annual rate to 21.5 %/yr. During this same time, an average of 4% and 1.5% of physicians retired or left the workforce for a non-clinical career, respectively. The report notes that 35.2% made career changes for a better work-life balance and another 35% reported the reason as being unhappy with their administration’s response to the pandemic. A physician-led primary care-focused health organization, Cano Health (CH), based out of Florida, sought to preemptively address this problem by implementing several supportive measures. Working with >120 clinics and >280 PCPs from Miami to Tampa and Orlando, managing nearly 120,000 Medicare Advantage lives, CH implemented a number of changes to assist with the clinician’s workload. Supportive services such as after hour and home visits by APRNs, in-clinic care managers, and patient educators were implemented. In 2021, assistive Artificial Intelligence Software (AIS) was integrated into the EHR platform. This AIS converts free text within PDF files into a usable (copy-paste) format facilitating documentation. The software also systematically and chronologically organizes clinical data, including labs, medical records, consultations, diagnostic images, medications, etc., into an easy-to-use organ system or chronic disease state format. This reduced the excess time and documentation burden required to meet payor and CMS guidelines. A clinician Documentation Support team was employed to improve the billing/coding performance. The effects of these newly designed workflow interventions were measured via analysis of clinician turnover from CH’s hiring and termination reporting software. CH’s annualized average clinician turnover rate in 2020 and 2021 were 17.7% and 12.6%, respectively. This represents a 30% relative reduction in turnover rate compared to the reported national average of 21.5%. Retirement rates during both years were 0.1%, demonstrating a relative reduction of >95% compared to the national average (4%). This model successfully promoted the retention of clinicians in a Value-Based Care setting.

Keywords: clinician burnout, COVID-19, value-based care, burnout, clinician retirement

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