Search results for: efficiency assessment

Authors: Rowshan Mamtaz, Shuvo Ahmed, Imran Noor, Sumaiya Rahman, Prithvi Shams, Fahmida Gulshan

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Last few decades have witnessed a phenomenal rise in the use of electrical and electronic equipment globally in our everyday life. As these items reach the end of their lifecycle, they turn into e-wastes and contribute to the waste stream. Bangladesh, in conformity with the global trend and due to its ongoing rapid growth, is also using electronics-based appliances and equipment at an increasing rate. This has caused a corresponding increase in the generation of e-wastes. Bangladesh is a developing country; its overall waste management system, is not yet efficient, nor is it environmentally sustainable. Most of its solid wastes are disposed of in a crude way at dumping sites. Addition of e-wastes, which often contain toxic heavy metals, into its waste stream has made the situation more difficult and challenging. Assessment of generation of e-wastes is an important step towards addressing the challenges posed by e-wastes, setting targets, and identifying the best practices for their management. Understanding and proper management of e-wastes is a stated item of the Sustainable Development Goals (SDG) campaign, and Bangladesh is committed to fulfilling it. A better understanding and availability of reliable baseline data on e-wastes will help in preventing illegal dumping, promote recycling, and create jobs in the recycling sectors and thus facilitate sustainable e-waste management. With this objective in mind, the present study has attempted to estimate the amount of e-wastes and its future generation trend in Bangladesh. To achieve this, sales data on eight selected electrical and electronic products (TV, Refrigerator, Fan, Mobile phone, Computer, IT equipment, CFL (Compact Fluorescent Lamp) bulbs, and Air Conditioner) have been collected from different sources. Primary and secondary data on the collection, recycling, and disposal of the e-wastes have also been gathered by questionnaire survey, field visits, interviews, and formal and informal meetings with the stakeholders. Material Flow Analysis (MFA) method has been applied, and mathematical models have been developed in the present study to estimate e-waste amounts and their future trends up to the year 2035 for the eight selected electrical and electronic equipment. End of life (EOL) method is adopted in the estimation. Model inputs are products’ annual sale/import data, past and future sales data, and average life span. From the model outputs, it is estimated that the generation of e-wastes in Bangladesh in 2018 is 0.40 million tons and by 2035 the amount will be 4.62 million tons with an average annual growth rate of 20%. Among the eight selected products, the number of e-wastes generated from seven products are increasing whereas only one product, CFL bulb, showed a decreasing trend of waste generation. The average growth rate of e-waste from TV sets is the highest (28%) while those from Fans and IT equipment are the lowest (11%). Field surveys conducted in the e-waste recycling sector also revealed that every year around 0.0133 million tons of e-wastes enter into the recycling business in Bangladesh which may increase in the near future.

Keywords: Bangladesh, end of life, e-waste, material flow analysis

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Authors: Sthanu Mahadev, Wen Chan, Melanie Lim

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Anisotropy dominated continuous-fiber composite materials have garnered attention in numerous mechanical and aerospace structural applications. Tailored mechanical properties in advanced composites can exhibit superiority in terms of stiffness-to-weight ratio, strength-to-weight ratio, low-density characteristics, coupled with significant improvements in fatigue resistance as opposed to metal structure counterparts. Extensive research has demonstrated their core potential as more than just mere lightweight substitutes to conventional materials. Prior work done by Mahadev and Chan focused on formulating a modified composite shell theory based prognosis methodology for investigating the structural response of thin-walled circular cylindrical shell type composite configurations under in-plane mechanical loads respectively. The prime motivation to develop this theory stemmed from its capability to generate simple yet accurate closed-form analytical results that can efficiently characterize circular composite shell construction. It showcased the development of a novel mathematical framework to analytically identify the location of the centroid for thin-walled, open cross-section, curved composite shells that were characterized by circumferential arc angle, thickness-to-mean radius ratio, and total laminate thickness. Ply stress variations for curved cylindrical shells were analytically examined under the application of centric tensile and bending loading. This work presents a cost-effective, small-platform experimental methodology by taking advantage of the full-field measurement capability of digital image correlation (DIC) for an accurate assessment of key mechanical parameters such as in-plane mechanical stresses and strains, centroid location etc. Mechanical property measurement of advanced composite materials can become challenging due to their anisotropy and complex failure mechanisms. Full-field displacement measurements are well suited for characterizing the mechanical properties of composite materials because of the complexity of their deformation. This work encompasses the fabrication of a set of curved cylindrical shell coupons, the design and development of a novel test-fixture design and an innovative experimental methodology that demonstrates the capability to very accurately predict the location of centroid in such curved composite cylindrical strips via employing a DIC based strain measurement technique. Error percentage difference between experimental centroid measurements and previously estimated analytical centroid results are observed to be in good agreement. The developed analytical modified-shell theory provides the capability to understand the fundamental behavior of thin-walled cylindrical shells and offers the potential to generate novel avenues to understand the physics of such structures at a laminate level.

Keywords: anisotropy, composites, curved cylindrical shells, digital image correlation

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Authors: L. Chiriatti, H. Hafid, H. R. Mercado-Mendoza, K. L. Apedo, C. Fond, F. Feugeas

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Substituting natural aggregate with recycled aggregate coming from concrete demolition represents a promising alternative to face the issues of both the depletion of natural resources and the congestion of waste storage facilities. However, the crushing process of concrete demolition waste, currently in use to produce recycled concrete aggregate, does not allow the complete separation of natural aggregate from a variable amount of adhered mortar. Given the physicochemical characteristics of the latter, the introduction of recycled concrete aggregate into a concrete mix modifies, to a certain extent, both fresh and hardened concrete properties. As a consequence, the behavior of recycled reinforced concrete members could likely be influenced by the specificities of recycled concrete aggregates. Beyond the mechanical properties of concrete, and as a result of the composite character of reinforced concrete, the bond characteristics at the rebar/concrete interface have to be taken into account in an attempt to describe accurately the mechanical response of recycled reinforced concrete members. Hence, a comparative experimental campaign, including 16 pull-out tests, was carried out. Four concrete mixes with different recycled concrete aggregate content were tested. The main mechanical properties (compressive strength, tensile strength, Young’s modulus) of each concrete mix were measured through standard procedures. A single 14-mm-diameter ribbed rebar, representative of the diameters commonly used in the domain of civil engineering, was embedded into a 200-mm-side concrete cube. The resulting concrete cover is intended to ensure a pull-out type failure (i.e. exceedance of the rebar/concrete interface shear strength). A pull-out test carried out on the 100% recycled concrete specimen was enriched with exploratory acoustic emission measurements. Acoustic event location was performed by means of eight piezoelectric transducers distributed over the whole surface of the specimen. The resulting map was compared to existing data related to natural aggregate concrete. Damage distribution around the reinforcement and main features of the characteristic bond stress/free-end slip curve appeared to be similar to previous results obtained through comparable studies carried out on natural aggregate concrete. This seems to show that the usual bond mechanism sequence (‘chemical adhesion’, mechanical interlocking and friction) remains unchanged despite the addition of recycled concrete aggregate. However, the results also suggest that bond efficiency seems somewhat improved through the use of recycled concrete aggregate. This observation appears to be counter-intuitive with regard to the diminution of the main concrete mechanical properties with the recycled concrete aggregate content. As a consequence, the impact of recycled concrete aggregate content on bond characteristics seemingly represents an important factor which should be taken into account and likely to be further explored in order to determine flexural parameters such as deflection or crack distribution.

Keywords: acoustic emission monitoring, high-bond steel rebar, pull-out test, recycled aggregate concrete

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Authors: Arti Singh, Carolyn Jenkins, Oyedunni S. Arulogun, Mayowa O. Owolabi, Fred S. Sarfo, Bruce Ovbiagele, Enzinne Sylvia

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Background: Stroke, the leading cause of adult-onset disability and the second leading cause of death, is a major public health concern particularly pertinent in Sub-Saharan Africa (SSA), where nearly 80% of all global stroke mortalities occur. The Stroke Investigative Research and Education Network (SIREN) seeks to comprehensively characterize the genomic, sociocultural, economic, and behavioral risk factors for stroke and to build effective teams for research to address and decrease the burden of stroke and other non communicable diseases in SSA. One of the first steps to address this goal was to effectively engage the communities that suffer the high burden of disease in SSA. This study describes how the SIREN project engaged six sites in Ghana and Nigeria over the past three years, describing the community engagement activities that have arisen since inception. Aim: The aim of community engagement (CE) within SIREN is to elucidate information about knowledge, attitudes, beliefs, and practices (KABP) about stroke and its risk factors from individuals of African ancestry in SSA, and to educate the community about stroke and ways to decrease disabilities and deaths from stroke using socioculturally appropriate messaging and messengers. Methods: Community Advisory Board (CABs), Focus Group Discussions (FGDs) and community outreach programs. Results: 27 FGDs with 168 participants including community heads, religious leaders, health professionals and individuals with stroke among others, were conducted, and over 60 CE outreaches have been conducted within the SIREN performance sites. Over 5,900 individuals have received education on cardiovascular risk factors and about 5,000 have been screened for cardiovascular risk factors during the outreaches. FGDs and outreach programs indicate that knowledge of stroke, as well as risk factors and follow-up evidence-based care is limited and often late. Other findings include: 1) Most recognize hypertension as a major risk factor for stroke. 2) About 50% report that stroke is hereditary and about 20% do not know organs affected by stroke. 3) More than 95% willing to participate in genetic testing research and about 85% willing to pay for testing and recommend the test to others. 4) Almost all indicated that genetic testing could help health providers better treat stroke and help scientists better understand the causes of stroke. The CABs provided stakeholder input into SIREN activities and facilitated collaborations among investigators, community members and stakeholders. Conclusion: The CE core within SIREN is a first-of-its kind public outreach engagement initiative to evaluate and address perceptions about stroke and genomics by patients, caregivers, and local leaders in SSA and has implications as a model for assessment in other high-stroke risk populations. SIREN’s CE program uses best practices to build capacity for community-engaged research, accelerate integration of research findings into practice and strengthen dynamic community-academic partnerships within our communities. CE has had several major successes over the past three years including our multi-site collaboration examining the KABP about stroke (symptoms, risk factors, burden) and genetic testing across SSA.

Keywords: community advisory board, community engagement, focus groups, outreach, SSA, stroke

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Authors: Bagireanu Astrid, Bros-Williamson Julio, Duncheva Mila, Currie John

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The Architecture, Engineering, and Construction (AEC) sector plays a critical role in the global transition toward sustainable and net-zero built environments. However, the industry faces unique challenges in planning for net-zero while struggling with low productivity, cost overruns and overall resistance to change. Traditional practices fall short due to their inability to meet the requirements for systemic change, especially as governments increasingly demand transformative approaches. Working in silos and rigid hierarchies and a short-term, client-centric approach prioritising immediate gains over long-term benefit stands in stark contrast to the fundamental requirements for the realisation of net-zero objectives. These practices have limited capacity to effectively integrate AEC stakeholders and promote the essential knowledge sharing required to address the multifaceted challenges of achieving net-zero. In the context of built environment, procurement may be described as the method by which a project proceeds from inception to completion. Collaborative procurement methods under the Integrated Practices (IP) umbrella have the potential to align more closely with net-zero objectives. This paper explores the synergies between collaborative procurement principles and the pursuit of net zero in the AEC sector, drawing upon the shared values of cross-disciplinary collaboration, Early Supply Chain involvement (ESI), use of standards and frameworks, digital information management, strategic performance measurement, integrated decision-making principles and contractual alliancing. To investigate the role of collaborative procurement in advancing net-zero objectives, a structured research methodology was employed. First, the study focuses on a systematic review on the application of collaborative procurement principles in the AEC sphere. Next, a comprehensive analysis is conducted to identify common clusters of these principles across multiple procurement methods. An evaluative comparison between traditional procurement methods and collaborative procurement for achieving net-zero objectives is presented. Then, the study identifies the intersection between collaborative procurement principles and the net-zero requirements. Lastly, an exploration of key insights for AEC stakeholders focusing on the implications and practical applications of these findings is made. Directions for future development of this research are recommended. Adopting collaborative procurement principles can serve as a strategic framework for guiding the AEC sector towards realising net-zero. Synergising these approaches overcomes fragmentation, fosters knowledge sharing, and establishes a net-zero-centered ecosystem. In the context of the ongoing efforts to amplify project efficiency within the built environment, a critical realisation of their central role becomes imperative for AEC stakeholders. When effectively leveraged, collaborative procurement emerges as a powerful tool to surmount existing challenges in attaining net-zero objectives.

Keywords: collaborative procurement, net-zero, knowledge sharing, architecture, built environment

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Authors: M. A. C. S. Sampath Fernando, James M. Curran, Renate Meyer

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Model assessment, in the Bayesian context, involves evaluation of the goodness-of-fit and the comparison of several alternative candidate models for predictive accuracy and improvements. In posterior predictive checks, the data simulated under the fitted model is compared with the actual data. Predictive model accuracy is estimated using information criteria such as the Akaike information criterion (AIC), the Bayesian information criterion (BIC), the Deviance information criterion (DIC), and the Watanabe-Akaike information criterion (WAIC). The goal of an information criterion is to obtain an unbiased measure of out-of-sample prediction error. Since posterior checks use the data twice; once for model estimation and once for testing, a bias correction which penalises the model complexity is incorporated in these criteria. Cross-validation (CV) is another method used for examining out-of-sample prediction accuracy. Leave-one-out cross-validation (LOO-CV) is the most computationally expensive variant among the other CV methods, as it fits as many models as the number of observations. Importance sampling (IS), truncated importance sampling (TIS) and Pareto-smoothed importance sampling (PSIS) are generally used as approximations to the exact LOO-CV and utilise the existing MCMC results avoiding expensive computational issues. The reciprocals of the predictive densities calculated over posterior draws for each observation are treated as the raw importance weights. These are in turn used to calculate the approximate LOO-CV of the observation as a weighted average of posterior densities. In IS-LOO, the raw weights are directly used. In contrast, the larger weights are replaced by their modified truncated weights in calculating TIS-LOO and PSIS-LOO. Although, information criteria and LOO-CV are unable to reflect the goodness-of-fit in absolute sense, the differences can be used to measure the relative performance of the models of interest. However, the use of these measures is only valid under specific circumstances. This study has developed 11 models using normal, log-normal, gamma, and student’s t distributions to improve the PCR stutter prediction with forensic data. These models are comprised of four with profile-wide variances, four with locus specific variances, and three which are two-component mixture models. The mean stutter ratio in each model is modeled as a locus specific simple linear regression against a feature of the alleles under study known as the longest uninterrupted sequence (LUS). The use of AIC, BIC, DIC, and WAIC in model comparison has some practical limitations. Even though, IS-LOO, TIS-LOO, and PSIS-LOO are considered to be approximations of the exact LOO-CV, the study observed some drastic deviations in the results. However, there are some interesting relationships among the logarithms of pointwise predictive densities (lppd) calculated under WAIC and the LOO approximation methods. The estimated overall lppd is a relative measure that reflects the overall goodness-of-fit of the model. Parallel log-likelihood profiles for the models conditional on equal posterior variances in lppds were observed. This study illustrates the limitations of the information criteria in practical model comparison problems. In addition, the relationships among LOO-CV approximation methods and WAIC with their limitations are discussed. Finally, useful recommendations that may help in practical model comparisons with these methods are provided.

Keywords: cross-validation, importance sampling, information criteria, predictive accuracy

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Authors: Jennifer Kehinde, Claire O’Donnell, Annmarie Grealish

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Introduction: Breastfeeding has been shown to provide numerous health benefits for both infants and mothers. The decision to breastfeed is influenced by physiological, psychological, and emotional factors. However, the importance of equipping mothers with the necessary knowledge for successful breastfeeding practice cannot be ruled out. The decline in global breastfeeding rate can be linked to a lack of adequate breastfeeding education during the prenatal stage. This systematic review examined the effectiveness of prenatal breastfeeding education on breastfeeding uptake postpartum. Method: This review was undertaken and reported in conformity with the Preferred Reporting Items for Systemic Reviews and Meta-Analysis statement (PRISMA) and was registered on the international prospective register for systematic reviews (PROSPERO: CRD42020213853). A PICO analysis (population, intervention, comparison, outcome) was undertaken to inform the choice of keywords in the search strategy to formulate the review question, which was aimed at determining the effectiveness of prenatal breastfeeding educational programs in improving breastfeeding uptake following birth. A systematic search of five databases (Cumulative Index to Nursing and Allied Health Literature, Medline, Psych INFO, and Applied Social Sciences Index and Abstracts) was searched between January 2014 until July 2021 to identify eligible studies. Quality assessment and narrative synthesis were subsequently undertaken. Results: Fourteen studies were included. All 14 studies used different types of breastfeeding programs; eight used a combination of curriculum-based breastfeeding education programs, group prenatal breastfeeding counselling, and one-to-one breastfeeding educational programs, which were all delivered in person; four studies used web-based learning platforms to deliver breastfeeding education prenatally which were both delivered online and face to face over a period of 3 weeks to 2 months with follow-up periods ranging from 3 weeks to 6 months; one study delivered breastfeeding educational intervention using mother-to-mother breastfeeding support groups in promoting exclusive breastfeeding, and one study disseminated breastfeeding education to participants based on the theory of planned behaviour. The most effective interventions were those that included both theory and hands-on demonstrations. Results showed an increase in breastfeeding uptake, breastfeeding knowledge, an increase in a positive attitude to breastfeeding, and an increase in maternal breastfeeding self-efficacy among mothers who participated in breastfeeding educational programs during prenatal care. Conclusion: Prenatal breastfeeding education increases women’s knowledge of breastfeeding. Mothers who are knowledgeable about breastfeeding and hold a positive approach towards breastfeeding have the tendency to initiate breastfeeding and continue for a lengthened period. Findings demonstrate a general correlation between prenatal breastfeeding education and increased breastfeeding uptake postpartum. The high level of positive breastfeeding outcomes inherent in all the studies can be attributed to prenatal breastfeeding education. This review provides rigorous contemporary evidence that healthcare professionals and policymakers can apply when developing effective strategies to improve breastfeeding rates and ultimately improve the health outcomes of mothers and infants.

Keywords: breastfeeding, breastfeeding programs, breastfeeding self-efficacy, prenatal breastfeeding education

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Authors: Thanduxolo Elford Fana

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

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

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Authors: Gokulan Vethanayakam, Daniel Aston

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Introduction: The ReSPECT process supports healthcare professionals when making patient-centered decisions in the event of an emergency. It has been widely adopted by the NHS in England and allows patients to express thoughts and wishes about treatments and outcomes that they consider acceptable. It includes (but is not limited to) cardiopulmonary resuscitation decisions. ReSPECT conversations should ideally occur prior to ICU admission and should be documented in the eight sections of the nationally-standardised ReSPECT form. This audit evaluated the use of ReSPECT on a busy cardiothoracic ICU in an NHS Trust where established policies advocating its use exist. Methods: This audit was a retrospective review of ReSPECT forms for a sample of high-risk patients admitted to ICU at the Royal Papworth Hospital between January 2021 and March 2022. Patients all received one of the following interventions: Veno-Venous Extra-Corporeal Membrane Oxygenation (VV-ECMO) for severe respiratory failure (retrieved via the national ECMO service); cardiac or pulmonary transplantation-related surgical procedures (including organ transplants and Ventricular Assist Device (VAD) implantation); or elective non-transplant cardiac surgery. The quality of documentation on ReSPECT forms was evaluated using national standards and a graded ranking tool devised by the authors which was used to assess narrative aspects of the forms. Quality was ranked as A (excellent) to D (poor). Results: Of 230 patients (74 VV-ECMO, 104 transplant, 52 elective non-transplant surgery), 43 (18.7%) had a ReSPECT form and only one (0.43%) patient had a ReSPECT form completed prior to ICU admission. Of the 43 forms completed, 38 (88.4%) were completed due to the commencement of End of Life (EoL) care. No non-transplant surgical patients included in the audit had a ReSPECT form. There was documentation of balance of care (section 4a), CPR status (section 4c), capacity assessment (section 5), and patient involvement in completing the form (section 6a) on all 43 forms. Of the 34 patients assessed as lacking capacity to make decisions, only 22 (64.7%) had reasons documented. Other sections were variably completed; 29 (67.4%) forms had relevant background information included to a good standard (section 2a). Clinical guidance for the patient (section 4b) was given in 25 (58.1%), of which 11 stated the rationale that underpinned it. Seven forms (16.3%) contained information in an inappropriate section. In a comparison of ReSPECT forms completed ahead of an EoL trigger with those completed when EoL care began, there was a higher number of entries in section 3 (considering patient’s values/fears) that were assessed at grades A-B in the former group (p = 0.014), suggesting higher quality. Similarly, forms from the transplant group contained higher quality information in section 3 than those from the VV-ECMO group (p = 0.0005). Conclusions: Utilisation of the ReSPECT process in high-risk patients is yet to be well-adopted in this trust. Teams who meet patients before hospital admission for transplant or high-risk surgery should be encouraged to engage with the ReSPECT process at this point in the patient's journey. VV-ECMO retrieval teams should consider ReSPECT conversations with patients’ relatives at the time of retrieval.

Keywords: audit, critical care, end of life, ICU, ReSPECT, resuscitation

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Authors: Nezmin Kayedpour, Arash E. Samani, Siavash Asiaban, Jeroen M. De Kooning, Lieven Vandevelde, Guillaume Crevecoeur

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The growing adoption of renewable energy sources, such as wind power, in electricity generation is a significant step towards a sustainable and decarbonized future. However, the inherent intermittency and uncertainty of wind resources pose challenges to the reliable and stable operation of power grids. To address this, hydrogen storage systems have emerged as a promising and versatile technology to support grid balancing services in wind energy conversion systems. In this study, we propose a supplementary control design that enhances the performance of the hydrogen storage system by integrating wind turbine (WT) pitch and torque control systems. These control strategies aim to optimize the hydrogen production process, ensuring efficient utilization of wind energy while complying with grid requirements. The wind turbine pitch control system plays a crucial role in managing the turbine's aerodynamic performance. By adjusting the blade pitch angle, the turbine's rotational speed and power output can be regulated. Our proposed control design dynamically coordinates the pitch angle to match the wind turbine's power output with the optimal hydrogen production rate. This ensures that the electrolyzer receives a steady and optimal power supply, avoiding unnecessary strain on the system during high wind speeds and maximizing hydrogen production during low wind speeds. Moreover, the wind turbine torque control system is incorporated to facilitate efficient operation at varying wind speeds. The torque control system optimizes the energy capture from the wind while limiting mechanical stress on the turbine components. By harmonizing the torque control with hydrogen production requirements, the system maintains stable wind turbine operation, thereby enhancing the overall energy-to-hydrogen conversion efficiency. To enable grid-friendly operation, we introduce a cascaded controller that regulates the electrolyzer's electrical power-current in accordance with grid requirements. This controller ensures that the hydrogen production rate can be dynamically adjusted based on real-time grid demands, supporting grid balancing services effectively. By maintaining a close relationship between the wind turbine's power output and the electrolyzer's current, the hydrogen storage system can respond rapidly to grid fluctuations and contribute to enhanced grid stability. In this paper, we present a comprehensive analysis of the proposed supplementary control design's impact on the overall performance of the hydrogen storage system in wind energy conversion systems. Through detailed simulations and case studies, we assess the system's ability to provide grid balancing services, maximize wind energy utilization, and reduce greenhouse gas emissions.

Keywords: active power control, electrolyzer, grid balancing services, wind energy conversion systems

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Authors: Tatiane Benvenuti, Fernando Hamerski, Alexandre Giacobbo, Andrea M. Bernardes, Marco A. S. Rodrigues

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Population growth in urban areas has caused damages to the environment, a consequence of the uncontrolled dumping of domestic and industrial wastewater. The capacity of some plants to purify domestic and agricultural wastewater has been demonstrated by several studies. Since natural wetlands have the ability to transform, retain and remove nutrients, constructed wetlands have been used for wastewater treatment. They are widely recognized as an economical, efficient and environmentally acceptable means of treating many different types of wastewater. T. domingensis Pers. species have shown a good performance and low deployment cost to extract, detoxify and sequester pollutants. Constructed Floating Wetlands (CFWs) consist of emergent vegetation established upon a buoyant structure, floating on surface waters. The upper parts of the vegetation grow and remain primarily above the water level, while the roots extend down in the water column, developing an extensive under water-level root system. Thus, the vegetation grows hydroponically, performing direct nutrient uptake from the water column. Biofilm is attached on the roots and rhizomes, and as physical and biochemical processes take place, the system functions as a natural filter. The aim of this study is to diagnose the application of macrophytes in artificial floating in the treatment of domestic sewage in south Brazil. The T. domingensis Pers. plants were placed in a flotation system (polymer structure), in full scale, in a sewage treatment plant. The sewage feed rate was 67.4 m³.d⁻¹ ± 8.0, and the hydraulic retention time was 11.5 d ± 1.3. This CFW treat the sewage generated by 600 inhabitants, which corresponds to 12% of the population served by this municipal treatment plant. During 12 months, samples were collected every two weeks, in order to evaluate parameters as chemical oxygen demand (COD), biochemical oxygen demand in 5 days (BOD5), total Kjeldahl nitrogen (TKN), total phosphorus, total solids, and metals. The average removal of organic matter was around 55% for both COD and BOD5. For nutrients, TKN was reduced in 45.9% what was similar to the total phosphorus removal, while for total solids the reduction was 33%. For metals, aluminum, copper, and cadmium, besides in low concentrations, presented the highest percentage reduction, 82.7, 74.4 and 68.8% respectively. Chromium, iron, and manganese removal achieved values around 40-55%. The use of T. domingensis Pers. in artificial floating for sewage treatment is an effective and innovative alternative in Brazilian sewage treatment systems. The evaluation of additional parameters in the treatment system may give useful information in order to improve the removal efficiency and increase the quality of the water bodies.

Keywords: constructed wetland, floating system, sewage treatment, Typha domingensis Pers.

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Authors: D. Kekelidze, G. Tsotadze, G. Maisuradze, L. Akhalbedashvili, M. Chkhaidze

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Statement of Problem: The problem of solid wastes -dangerous sources of environmental pollution,is the urgent issue for Georgia as there are no waste-treatment and waste- incineration plants. Urban peripheral and rural areas, frequently along small rivers, are occupied by landfills without any permission. The study of the pollution of some environmental objects in the adjacent territories of solid waste landfill in Tbilisi carried out in 2020-2021, within the framework of project: “Ecological monitoring of the landfills surrounding areas and population health risk assessment”. Research objects: This research had goal to assess the ecological state of environmental objects (soil cover and surface water) in the territories, adjacent of solid waste landfill, on the base of changes heavy metals' (HM) concentration with distance from landfill. An open sanitary landfill for solid domestic waste in Tbilisi locates at suburb Lilo surrounded with densely populated villages. Content of following HM was determined in soil and river water samples: Pb, Cd, Cu, Zn, Ni, Co, Mn. Methodology: The HM content in samples was measured, using flame atomic absorption spectrophotometry (spectrophotometer of firm Perkin-Elmer AAnalyst 200) in accordance with ISO 11466 and GOST Р 53218-2008. Results and discussion: Data obtained confirmed migration of HM mainly in terms of the distance from the polygon that can be explained by their areal emissions and storage in open state, they could also get into the soil cover under the influence of wind and precipitation. Concentration of Pb, Cd, Cu, Zn always increases with approaching to landfill. High concentrations of Pb, Cd are characteristic of the soil covers of the adjacent territories around the landfill at a distance of 250, 500 meters.They create a dangerous zone, since they can later migrate into plants, enter in rivers and lakes. The higher concentrations, compared to the maximum permissible concentrations (MPC) for surface waters of Georgia, are observed for Pb, Cd. One of the reasons for the low concentration of HM in river water may be high turbidity – as is known, suspended particles are good natural sorbents that causes low concentration of dissolved forms. Concentration of Cu, Ni, Mn increases in winter, since in this season the rivers are switched to groundwater feeding. Conclusion: Soil covers of the areas adjacent to the landfill in Lilo are contaminated with HM. High concentrations in soils are characteristic of lead and cadmium. Elevated concentrations in comparison with the MPC for surface waters adopted in Georgia are also observed for Pb, Cd at checkpoints along and below (1000 m) of the landfill downstream. Data obtained confirm migration of HM to the adjacent territories of the landfill and to the Lochini River. Since the migration and toxicity of metals depends also on the presence of their mobile forms in water bodies, samples of bottom sediments should be taken too. Bottom sediments reflect a long-term picture of pollution, they accumulate HM and represent a constant source of secondary pollution of water bodies. The study of the physicochemical forms of metals is one of the priority areas for further research.

Keywords: landfill, pollution, heavy metals, migration

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Authors: Léa Caban, Lucile Soudani, Julien Berger, Armelle Nouviaire, Emilio Bastidas-Arteaga

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Improvement of the thermal performance of buildings is a high concern for the construction industry. With the increase in environmental issues, new types of construction materials are being developed. These include bio-based insulation materials. They capture carbon dioxide, can be produced locally, and have good thermal performance. However, their behavior with respect to moisture transfer is still facing some issues. With a high porosity, the mass transfer is more important in those materials than in mineral insulation ones. Therefore, they can be more sensitive to moisture disorders such as mold growth, condensation risks or decrease of the wall energy efficiency. For this reason, the initial moisture content on the construction site is a piece of crucial knowledge. Measuring moisture content in a laboratory is a mastered task. Diverse methods exist but the easiest and the reference one is gravimetric. A material is weighed dry and wet, and its moisture content is mathematically deduced. Non-destructive methods (NDT) are promising tools to determine in an easy and fast way the moisture content in a laboratory or on construction sites. However, the quality and reliability of the measures are influenced by several factors. Classical NDT portable devices usable on-site measure the capacity or the resistivity of materials. Water’s electrical properties are very different from those of construction materials, which is why the water content can be deduced from these measurements. However, most moisture meters are made to measure wooden materials, and some of them can be adapted for construction materials with calibration curves. Anyway, these devices are almost never calibrated for insulation materials. The main objective of this study is to determine the reliability of moisture meters in the measurement of biobased insulation materials. The determination of which one of the capacitive or resistive methods is the most accurate and which device gives the best result is made. Several biobased insulation materials are tested. Recycled cotton, two types of wood fibers of different densities (53 and 158 kg/m3) and a mix of linen, cotton, and hemp. It seems important to assess the behavior of a mineral material, so glass wool is also measured. An experimental campaign is performed in a laboratory. A gravimetric measurement of the materials is carried out for every level of moisture content. These levels are set using a climatic chamber and by setting the relative humidity level for a constant temperature. The mass-based moisture contents measured are considered as references values, and the results given by moisture meters are compared to them. A complete analysis of the uncertainty measurement is also done. These results are used to analyze the reliability of moisture meters depending on the materials and their water content. This makes it possible to determine whether the moisture meters are reliable, and which one is the most accurate. It will then be used for future measurements on construction sites to assess the initial hygrothermal state of insulation materials, on both new-build and renovation projects.

Keywords: capacitance method, electrical resistance method, insulation materials, moisture transfer, non-destructive testing

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Authors: Mohammad Moezzibadi, Isabelle Charpentier, Adrien Wanko, Robert Mosé

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The calibration of hydrodynamic parameters for subsurface constructed wetlands (CWs) is a sensitive process since highly non-linear equations are involved in unsaturated flow modeling. CW systems are engineered systems designed to favour natural treatment processes involving wetland vegetation, soil, and their microbial flora. Their significant efficiency at reducing the ecological impact of urban runoff has been recently proved in the field. Numerical flow modeling in a vertical variably saturated CW is here carried out by implementing the Richards model by means of a mixed hybrid finite element method (MHFEM), particularly well adapted to the simulation of heterogeneous media, and the van Genuchten-Mualem parametrization. For validation purposes, MHFEM results were compared to those of HYDRUS (a software based on a finite element discretization). As van Genuchten-Mualem soil hydrodynamic parameters depend on water content, their estimation is subject to considerable experimental and numerical studies. In particular, the sensitivity analysis performed with respect to the van Genuchten-Mualem parameters reveals a predominant influence of the shape parameters α, n and the saturated conductivity of the filter on the piezometric heads, during saturation and desaturation. Modeling issues arise when the soil reaches oven-dry conditions. A particular attention should also be brought to boundary condition modeling (surface ponding or evaporation) to be able to tackle different sequences of rainfall-runoff events. For proper parameter identification, large field datasets would be needed. As these are usually not available, notably due to the randomness of the storm events, we thus propose a simple, robust and low-cost numerical method for the inverse modeling of the soil hydrodynamic properties. Among the methods, the variational data assimilation technique introduced by Le Dimet and Talagrand is applied. To that end, a variational data assimilation technique is implemented by applying automatic differentiation (AD) to augment computer codes with derivative computations. Note that very little effort is needed to obtain the differentiated code using the on-line Tapenade AD engine. Field data are collected for a three-layered CW located in Strasbourg (Alsace, France) at the water edge of the urban water stream Ostwaldergraben, during several months. Identification experiments are conducted by comparing measured and computed piezometric head by means of the least square objective function. The temporal variability of hydrodynamic parameter is then assessed and analyzed.

Keywords: automatic differentiation, constructed wetland, inverse method, mixed hybrid FEM, sensitivity analysis

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Authors: Simran Baweja, Bhavika Kalal, Surajit Maity

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Photoinduced tautomerization reactions have been the centre of attention among scientific community over past several decades because of their significance in various biological systems. 7-azaindole (7AI) is considered as a model system for DNA base pairing and to understand the role of such tautomerization reactions in mutations. To the best of our knowledge, extensive studies have been carried on 7-azaindole and its solvent clusters exhibiting proton/ hydrogen transfer in both solution as well as gas phase. Derivatives of above molecule, like 2,7- and 2,6-diazaindoles are proposed to have even better photophysical properties due to the presence of -aza group on the 2nd position. However, there are a few studies in the solution phase which suggest the relevance of these molecules, but there are no experimental studies reported in the gas phase yet. In our current investigation, we present the first gas phase spectroscopic data of 2,7-diazaindole (2,7-DAI) and its solvent cluster (2,7-DAI-H2O). In this, we have employed state-of-the-art laser spectroscopic methods such as fluorescence excitation (LIF), dispersed fluorescence (DF), resonant two-photon ionization time of flight mass spectrometry (2C-R2PI), photoionization efficiency spectroscopy (PIE), IR-UV double resonance spectroscopy i.e. fluorescence-dip infrared spectroscopy (FDIR) and resonant ion-dip infrared spectroscopy (IDIR) to understand the electronic structure of the molecule. The origin band corresponding to S1 ← S0 transition of the bare 2,7-DAI is found to be positioned at 33910 cm-1 whereas the origin band corresponding to S1 ← S0 transition of the 2,7-DAI-H2O is positioned at 33074 cm-1. The red shifted transition in case of solvent cluster suggests the enhanced feasibility of excited state hydrogen/ proton transfer. The ionization potential for the 2,7-DAI molecule is found to be 8.92 eV, which is significantly higher that the previously reported 7AI (8.11 eV) molecule, making it a comparatively complex molecule to study. The ionization potential is reduced by 0.14 eV in case of 2,7-DAI-H2O (8.78 eV) cluster compared to that of 2,7-DAI. Moreover, on comparison with the available literature values of 7AI, we found the origin band of 2,7-DAI and 2,7-DAI-H2O to be red shifted by -729 and -280 cm-1 respectively. The ground and excited state N-H stretching frequencies of the 27DAI molecule were determined using fluorescence-dip infrared spectra (FDIR) and resonant ion dip infrared spectroscopy (IDIR), obtained at 3523 and 3467 cm-1, respectively. The lower value of vNH in the electronic excited state of 27DAI implies the higher acidity of the group compared to the ground state. Moreover, we have done extensive computational analysis, which suggests that the energy barrier in excited state reduces significantly as we increase the number of catalytic solvent molecules (S= H2O, NH3) as well as the polarity of solvent molecules. We found that the ammonia molecule is a better candidate for hydrogen transfer compared to water because of its higher gas-phase basicity. Further studies are underway to understand the excited state dynamics and photochemistry of such N-rich chromophores.

Keywords: photoinduced tautomerization reactions, gas phse spectroscopy, ), IR-UV double resonance spectroscopy, resonant two-photon ionization time of flight mass spectrometry (2C-R2PI)

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Authors: S. Nishat Fatima Rizvi, Tulika Chandra, Abbas Ali Mahdi, Devisha Agarwal

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Introduction: Blood components are an unexplored area prone to numerous discoveries which influence patient’s care. Experiments at different levels will further change the present concept of blood banking. Hyperlipidemia is a condition of elevated plasma level of low-density lipoprotein (LDL) as well as decreased plasma level of high-density lipoprotein (HDL). Studies show that platelets play a vital role in the progression of atherosclerosis and thrombosis, a major cause of death worldwide. They are activated by many triggers like elevated LDL in the blood resulting in aggregation and formation of plaques. Hyperlipidemic platelets are frequently transfused to patients with various disorders. Screening the random donor platelets for hyperlipidemia and correlating the condition with other donor criteria such as lipid rich diet, oral contraceptive pills intake, weight, alcohol intake, smoking, sedentary lifestyle, family history of heart diseases will lead to further deciding the exclusion criteria for donor selection. This will help in making the patients safe as well as the donor deferral criteria more stringent to improve the quality of blood supply. Technical evaluation and assessment will enable blood bankers to supply safe blood and improve the guidelines for blood safety. Thus, we try to study the correlation between hyperlipidemic platelets with platelets parameters, weight, and specific history of the donors. Methodology: This case control study included 100 blood samples of Blood donors, out of 100 only 30 samples were found to be hyperlipidemic and were included as cases, while rest were taken as controls. Lipid Profile were measured by fully automated analyzer (TRIGL:triglycerides),(LDL-C:LDL –Cholesterol plus 2nd generation),CHOL 2: Cholesterol Gen 2), HDL C 3: HDL-Cholesterol plus 3rdgeneration)-(Cobas C311-Roche Diagnostic).And Platelets parameters were analyzed by the Sysmex KX21 automated hematology analyzer. Results: A significant correlation was found amongst hyperlipidemic level in single time donor. In which 80% donors have history of heart disease, 66.66% donors have sedentary life style, 83.3% donors were smokers, 50% donors were alcoholic, and 63.33% donors had taken lipid rich diet. Active physical activity was found amongst 40% donors. We divided donors sample in two groups based on their body weight. In group 1, hyperlipidemic samples: Platelet Parameters were 75% in normal 25% abnormal in >70Kg weight while in 50-70Kg weight 90% were normal 10% were abnormal. In-group 2, Non Hyperlipidemic samples: platelet Parameters were 95% normal and 5% abnormal in >70Kg weight, while in 50-70Kg Weight, 66.66% normal and 33.33% abnormal. Conclusion: The findings indicate that Hyperlipidemic status of donors may affect the platelet parameters and can be distinguished on history by their weight, Smoking, Alcoholic intake, Sedentary lifestyle, Active physical activity, Lipid rich diet, Oral contraceptive pills intake, and Family history of heart disease. However further studies on a large sample size will affirm this finding.

Keywords: blood donors, hyperlipidemia, platelet, weight

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Authors: Virginia Guillén Cañas, Miren Agurtzane Ortiz-Jauregi, Sonia Ruiz De Azua, Naiara Ozamiz

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We want to focus on relationship of the communicational skills in several key aspects of medicine. The most relevant competencies of a health professional are an adequate communication capacity, which will influence the satisfaction of professionals and patients, therapeutic compliance, conflict prevention, clinical outcomes’ improvement and efficiency of health services. We define empathy as it as Sympathy and connection to others and capability to communicate this understanding. Some outcomes favoring empathy are female gender, younger age, and specialty choice. Third gender or third sex is a concept in which allows a person not to be categorized in a dual way but as a continuous variable, giving the choice of moving along it. This point of view recognizes three or more genders. The subject of Ethics and Clinical Communication is dedicated to sensitizing students about the importance and effectiveness of a good therapeutic relationship. We are also interested in other communicational aspects related to empathy as active listening, assertivity and basic and advanced Social Skills. Objectives: 1. To facilitate the approach of the student in the Medicine Degree to the reality of the medical profession 2. Analyze interesting outcome variables in communication 3. Interactive process to detect the areas of improvement in the learning process of the Physician throughout his professional career needs. Design: A comparative study with a cross-sectional approach was conducted in successive academic year cohorts of health professional students at a public Basque university. Four communicational aspects were evaluated through these questionnaires in Basque, Spanish and English: The active listening questionnaire, the TECA empathy questionnaire, the ACDA questionnaire and the EHS questionnaire Social Skills Scale. Types of interventions for improving skills: Interpersonal skills training intervention, Empathy intervention, Writing about experiential learning, Drama through role plays, Communicational skills training, Problem-based learning, Patient interviews ´videos, Empathy-focused training, Discussion. Results: It identified the need for a cross cultural adaptation and no gender distinction. The students enjoyed all the techniques in comparison to the usual master class. There was medium participation but these participative methodologies are not so usual in the university. According to empathy, men have a greater empathic capacity to fully understand women (p < 0.05) With regard to assertiveness there have been no differences between men and women in self-assertiveness but nevertheless women are more heteroassertive than men. Conclusions: These findings suggest that educational interventions with adequate feedback can be effective in maintaining and enhancing empathy in undergraduate medical students.

Keywords: physician's communicational skills, patient satisfaction, third gender, cross cultural adaptation

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Authors: Bruce Wrightsman

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Construction and design are inexorably linked. Traditional building methodologies, including those using wood, comprise a series of material layers differentiated and separated from each other. This results in the separation of two agencies of building envelope (skin) separate from the structure. However, from a material performance position reliant on additional materials, this is not an efficient strategy for the building. The merits of traditional platform framing are well known. However, its enormous effectiveness within wood-framed construction has seldom led to serious questioning and challenges in defining what it means to build. There are several downsides of using this method, which is less widely discussed. The first and perhaps biggest downside is waste. Second, its reliance on wood assemblies forming walls, floors and roofs conventionally nailed together through simple plate surfaces is structurally inefficient. It requires additional material through plates, blocking, nailers, etc., for stability that only adds to the material waste. In contrast, when we look back at the history of wood construction in airplane and boat manufacturing industries, we will see a significant transformation in the relationship of structure with skin. The history of boat construction transformed from indigenous wood practices of birch bark canoes to copper sheathing over wood to improve performance in the late 18th century and the evolution of merged assemblies that drives the industry today. In 1911, Swiss engineer Emile Ruchonnet designed the first wood monocoque structure for an airplane called the Cigare. The wing and tail assemblies consisted of thin, lightweight, and often fabric skin stretched tightly over a wood frame. This stressed skin has evolved into semi-monocoque construction, in which the skin merges with structural fins that take additional forces. It provides even greater strength with less material. The monocoque, which translates to ‘mono or single shell,’ is a structural system that supports loads and transfers them through an external enclosure system. They have largely existed outside the domain of architecture. However, this uniting of divergent systems has been demonstrated to be lighter, utilizing less material than traditional wood building practices. This paper will examine the role monocoque systems have played in the history of wood construction through lineage of boat and airplane building industries and its design potential for wood building systems in architecture through a case-study examination of a unique wood construction approach. The innovative approach uses a wood monocoque system comprised of interlocking small wood members to create thin shell assemblies for the walls, roof and floor, increasing structural efficiency and wasting less than 2% of the wood. The goal of the analysis is to expand the work of practice and the academy in order to foster deeper, more honest discourse regarding the limitations and impact of traditional wood framing.

Keywords: wood building systems, material histories, monocoque systems, construction waste

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Authors: Nadia Belu, Laurenţiu Mihai Ionescu, Agnieszka Misztal

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The automotive industry is one of the most important industries in the world that concerns not only the economy, but also the world culture. In the present financial and economic context, this field faces new challenges posed by the current crisis, companies must maintain product quality, deliver on time and at a competitive price in order to achieve customer satisfaction. Two of the most recommended techniques of quality management by specific standards of the automotive industry, in the product development, are Failure Mode and Effects Analysis (FMEA) and Control Plan. FMEA is a methodology for risk management and quality improvement aimed at identifying potential causes of failure of products and processes, their quantification by risk assessment, ranking of the problems identified according to their importance, to the determination and implementation of corrective actions related. The companies use Control Plans realized using the results from FMEA to evaluate a process or product for strengths and weaknesses and to prevent problems before they occur. The Control Plans represent written descriptions of the systems used to control and minimize product and process variation. In addition Control Plans specify the process monitoring and control methods (for example Special Controls) used to control Special Characteristics. In this paper we propose a computer-aided solution with Genetic Algorithms in order to reduce the drafting of reports: FMEA analysis and Control Plan required in the manufacture of the product launch and improved knowledge development teams for future projects. The solution allows to the design team to introduce data entry required to FMEA. The actual analysis is performed using Genetic Algorithms to find optimum between RPN risk factor and cost of production. A feature of Genetic Algorithms is that they are used as a means of finding solutions for multi criteria optimization problems. In our case, along with three specific FMEA risk factors is considered and reduce production cost. Analysis tool will generate final reports for all FMEA processes. The data obtained in FMEA reports are automatically integrated with other entered parameters in Control Plan. Implementation of the solution is in the form of an application running in an intranet on two servers: one containing analysis and plan generation engine and the other containing the database where the initial parameters and results are stored. The results can then be used as starting solutions in the synthesis of other projects. The solution was applied to welding processes, laser cutting and bending to manufacture chassis for buses. Advantages of the solution are efficient elaboration of documents in the current project by automatically generating reports FMEA and Control Plan using multiple criteria optimization of production and build a solid knowledge base for future projects. The solution which we propose is a cheap alternative to other solutions on the market using Open Source tools in implementation.

Keywords: automotive industry, FMEA, control plan, automotive technology

Procedia PDF Downloads 385

Authors: Ming-Chan Chung, Wen-Ming Huang, Yi-Chu Liu, Li-Hui Yang, Ming-Jyh Chen

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introduction: Hospital buildings require considerable energy, including air conditioning, lighting, elevators, heating, and medical equipment. Energy consumption in hospitals is expected to increase significantly due to innovative equipment and continuous development plans. Consequently, the environment and climate will be adversely affected. Hospitals should therefore consider transforming from their traditional role of saving lives to being at the forefront of global efforts to reduce carbon dioxide emissions. As healthcare providers, it is our responsibility to provide a high-quality environment while using as little energy as possible. Purpose / Methods: Compare the energy-saving benefits of solar photovoltaic systems and solar hot water systems. The proportion of electricity consumption effectively reduced after the installation of solar photovoltaic systems. To comprehensively assess the potential benefits of utilizing solar energy for both photovoltaic (PV) and solar thermal applications in hospitals, a solar PV system was installed covering a total area of 28.95 square meters in 2021. Approval was obtained from the Taiwan Power Company to integrate the system into the hospital's electrical infrastructure for self-use. To measure the performance of the system, a dedicated meter was installed to track monthly power generation, which was then converted into area output using an electric energy conversion factor. This research aims to compare the energy efficiency of solar PV systems and solar thermal systems. Results: Using the conversion formula between electrical and thermal energy, we can compare the energy output of solar heating systems and solar photovoltaic systems. The comparative study draws upon data from February 2021 to February 2023, wherein the solar heating system generated an average of 2.54 kWh of energy per panel per day, while the solar photovoltaic system produced 1.17 kWh of energy per panel per day, resulting in a difference of approximately 2.17 times between the two systems. Conclusions: After conducting statistical analysis and comparisons, it was found that solar thermal heating systems offer higher energy and greater benefits than solar photovoltaic systems. Furthermore, an examination of literature data and simulations of the energy and economic benefits of solar thermal water systems and solar-assisted heat pump systems revealed that solar thermal water systems have higher energy density values, shorter recovery periods, and lower power consumption than solar-assisted heat pump systems. Through monitoring and empirical research in this study, it has been concluded that a heat pump-assisted solar thermal water system represents a relatively superior energy-saving and carbon-reducing solution for medical institutions. Not only can this system help reduce overall electricity consumption and the use of fossil fuels, but it can also provide more effective heating solutions.

Keywords: sustainable development, energy conservation, carbon reduction, renewable energy, heat pump system

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Authors: M. Invigorito, G. Elia, M. Panelli

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Hybrid propulsion combines beneficial properties of both solid and liquid rockets, such as multiple restarts, throttability as well as simplicity and reduced costs. A nitrous oxide (N2O)/paraffin-based hybrid rocket engine demonstrator is currently under development at the Italian Aerospace Research Center (CIRA) within the national research program HYPROB, funded by the Italian Ministry of Research. Nitrous oxide belongs to the class of self-pressurizing propellants that exhibit a high vapor pressure at standard ambient temperature. This peculiar feature makes those fluids very attractive for space rocket applications because it avoids the use of complex pressurization systems, leading to great benefits in terms of weight savings and reliability. To avoid feed-system-coupled instabilities, the phase change is required to occur through the injectors. In this regard, the oxidizer is stored in liquid condition while target chamber pressures are designed to lie below vapor pressure. The consequent cavitation and flash vaporization constitute a remarkably complex phenomenology that arises great modelling challenges. Thus, it is clear that the design of the injection system is fundamental for the full exploitation of hybrid rocket engine throttability. The Analytical Hierarchy Process has been used to select the injection architecture as best compromise among different design criteria such as functionality, technology innovation and cost. The impossibility to use engineering simplified relations for the dimensioning of the injectors led to the needs of applying a numerical approach based on OpenFOAM®. The numerical tool has been validated with selected experimental data from literature. Quantitative, as well as qualitative comparisons are performed in terms of mass flow rate and pressure drop across the injector for several operating conditions. The results show satisfactory agreement with the experimental data. Modeling assumptions, together with their impact on numerical predictions are discussed in the paper. Once assessed the reliability of the numerical tool, the injection plate has been designed and sized to guarantee the required amount of oxidizer in the combustion chamber and therefore to assure high combustion efficiency. To this purpose, the plate has been designed with multiple injectors whose number and diameter have been selected in order to reach the requested mass flow rate for the two operating conditions of maximum and minimum thrust. The overall design has been finally verified through three-dimensional computations in cavitating non-reacting conditions and it has been verified that the proposed design solution is able to guarantee the requested values of mass flow rates.

Keywords: hybrid rocket, injection system design, OpenFOAM®, cavitation

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Authors: Tashinga Matindike

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By means of definition, digital artworks encompass an array of artistic productions that are expressed in a technological form as an essential part of a creative process. Examples include illustrations, photos, videos, sculptures, and installations. Within the context of the visual arts, the process of repatriation involves the return of once-appropriated goods. Archiving denotes the preservation of a commodity for storage purposes in order to nurture its continuity. The aforementioned definitions form the foundation of the academic framework and premise of the argument, which is outlined in this paper. This paper aims to define, discuss and decipher the complexities involved in digitising artworks, whilst explaining the benefits of the process, particularly within the South African context, which is rich in tangible and intangible traditional cultural material, objects, and performances. With the internet having been introduced to the African Continent in the early 1990s, this new form of technology, in its own right, initiated a high degree of efficiency, which also resulted in the progressive transformation of computer-generated visual output. Subsequently, this caused a revolutionary influence on the manner in which technological software was developed and uterlised in art-making. Digital technology and the digitisation of creative processes then opened up new avenues of collating and recording information. One of the first visual artists to make use of digital technology software in his creative productions was United States-based artist John Whitney. His inventive work contributed greatly to the onset and development of digital animation. Comparable by technique and originality, South African contemporary visual artists who make digital artworks, both locally and internationally, include David Goldblatt, Katherine Bull, Fritha Langerman, David Masoga, Zinhle Sethebe, Alicia Mcfadzean, Ivan Van Der Walt, Siobhan Twomey, and Fhatuwani Mukheli. In conclusion, the main objective of this paper is to address the following questions: In which ways has the South African art community of visual artists made use of and benefited from technology, in its digital form, as a means to further advance creativity? What are the positive changes that have resulted in art production in South Africa since the onset and use of digital technological software? How has digitisation changed the manner in which we record, interpret, and archive both written and visual information? What is the role of South African art institutions in the development of digital technology and its use in the field of visual art. What role does digitisation play in the process of the repatriation of artworks and artefacts. The methodology in terms of the research process of this paper takes on a multifacted form, inclusive of data analysis of information attained by means of qualitative and quantitative approaches.

Keywords: digital art, digitisation, technology, archiving, transformation and repatriation

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Authors: Venencia Albert, Arulselvi Subramanian, Hara Prasad Pati, Asok K. Mukhophadhyay

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Acute traumatic coagulopathy in an endogenous dysregulation of the intrinsic coagulation system in response to the injury, associated with three-fold risk of poor outcome, and is more amenable to corrective interventions, subsequent to early identification and management. Multiple definitions for stratification of the patients' risk for early acute coagulopathy have been proposed, with considerable variations in the defining criteria, including several trauma-scoring systems based on prehospital data. We aimed to develop a clinically relevant definition for acute coagulopathy of trauma based on conventional coagulation assays and to assess its efficacy in comparison to recently established prehospital prediction models. Methodology: Retrospective data of all trauma patients (n = 490) presented to our level I trauma center, in 2014, was extracted. Receiver operating characteristic curve analysis was done to establish cut-offs for conventional coagulation assays for identification of patients with acute traumatic coagulopathy was done. Prospectively data of (n = 100) adult trauma patients was collected and cohort was stratified by the established definition and classified as "coagulopathic" or "non-coagulopathic" and correlated with the Prediction of acute coagulopathy of trauma score and Trauma-Induced Coagulopathy Clinical Score for identifying trauma coagulopathy and subsequent risk for mortality. Results: Data of 490 trauma patients (average age 31.85±9.04; 86.7% males) was extracted. 53.3% had head injury, 26.6% had fractures, 7.5% had chest and abdominal injury. Acute traumatic coagulopathy was defined as international normalized ratio ≥ 1.19; prothrombin time ≥ 15.5 s; activated partial thromboplastin time ≥ 29 s. Of the 100 adult trauma patients (average age 36.5±14.2; 94% males), 63% had early coagulopathy based on our conventional coagulation assay definition. Overall prediction of acute coagulopathy of trauma score was 118.7±58.5 and trauma-induced coagulopathy clinical score was 3(0-8). Both the scores were higher in coagulopathic than non-coagulopathic patients (prediction of acute coagulopathy of trauma score 123.2±8.3 vs. 110.9±6.8, p-value = 0.31; trauma-induced coagulopathy clinical score 4(3-8) vs. 3(0-8), p-value = 0.89), but not statistically significant. Overall mortality was 41%. Mortality rate was significantly higher in coagulopathic than non-coagulopathic patients (75.5% vs. 54.2%, p-value = 0.04). High prediction of acute coagulopathy of trauma score also significantly associated with mortality (134.2±9.95 vs. 107.8±6.82, p-value = 0.02), whereas trauma-induced coagulopathy clinical score did not vary be survivors and non-survivors. Conclusion: Early coagulopathy was seen in 63% of trauma patients, which was significantly associated with mortality. Acute traumatic coagulopathy defined by conventional coagulation assays (international normalized ratio ≥ 1.19; prothrombin time ≥ 15.5 s; activated partial thromboplastin time ≥ 29 s) demonstrated good ability to identify coagulopathy and subsequent mortality, in comparison to the prehospital parameter-based scoring systems. Prediction of acute coagulopathy of trauma score may be more suited for predicting mortality rather than early coagulopathy. In emergency trauma situations, where immediate corrective measures need to be taken, complex multivariable scoring algorithms may cause delay, whereas coagulation parameters and conventional coagulation tests will give highly specific results.

Keywords: trauma, coagulopathy, prediction, model

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Authors: Omolola Ojetayo, Emmanuel Garuba, Obinna Ajunwa, Abiodun A. Onilude

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Introduction: Biofilm is a functional community of microorganisms that are associated with a surface or an interface. These adherent cells become embedded within an extracellular matrix composed of polymeric substances, i.e., biofilms refer to biological deposits consisting of both microbes and their extracellular products on biotic and abiotic surfaces. Despite their detrimental effects in medicine, biofilms as natural cell immobilization have found several applications in biotechnology, such as in the treatment of wastewater, bioremediation and biodegradation, desulfurization of gas, and conversion of agro-derived materials into alcohols and organic acids. The means of enhancing immobilized cells have been chemical-inductive, and this affects the medium composition and final product. Physical factors including electrical, magnetic, and electromagnetic flux have shown potential for enhancing biofilms depending on the bacterial species, nature, and intensity of emitted signals, the duration of exposure, and substratum used. However, the concept of cell immobilisation by electrical and magnetic induction is still underexplored. Methods: To assess the effects of physical factors on biofilm formation, six American typed culture collection (Acetobacter aceti ATCC15973, Pseudomonas aeruginosa ATCC9027, Serratia marcescens ATCC14756, Gluconobacter oxydans ATCC19357, Rhodobacter sphaeroides ATCC17023, and Bacillus subtilis ATCC6633) were used. Standard culture techniques for bacterial cells were adopted. Natural autoimmobilisation potentials of test bacteria were carried out by simple biofilms ring formation on tubes, while crystal violet binding assay techniques were adopted in the characterisation of biofilm quantity. Electroinduction of bacterial cells by direct current (DC) application in cell broth, static magnetic field exposure, and electromagnetic flux were carried out, and autoimmobilisation of cells in a biofilm pattern was determined on various substrata tested, including wood, glass, steel, polyvinylchloride (PVC) and polyethylene terephthalate. Biot Savart law was used in quantifying magnetic field intensity, and statistical analyses of data obtained were carried out using the analyses of variance (ANOVA) as well as other statistical tools. Results: Biofilm formation by the selected test bacteria was enhanced by the physical factors applied. Electromagnetic induction had the greatest effect on biofilm formation, with magnetic induction producing the least effect across all substrata used. Microbial cell-cell communication could be a possible means via which physical signals affected the cells in a polarisable manner. Conclusion: The enhancement of biofilm formation by bacteria using physical factors has shown that their inherent capability as a cell immobilization method can be further optimised for industrial applications. A possible relationship between the presence of voltage-dependent channels, mechanosensitive channels, and bacterial biofilms could shed more light on this phenomenon.

Keywords: bacteria, biofilm, cell immobilization, electromagnetic induction, substrata

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Authors: Martina I. Reinhold, Theresa Bacon-Baguley

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Background: Medical knowledge continuously evolves and to help health care providers to stay up-to-date, evidence-based medicine (EBM) has emerged as a model. The practice of EBM requires new skills of the health care provider, including directed literature searches, the critical evaluation of research studies, and the direct application of the findings to patient care. This paper describes the integration and evaluation of an evidence-based medicine course sequence into a Physician Assistant curriculum. This course sequence teaches students to manage and use the best clinical research evidence to competently practice medicine. A survey was developed to assess the outcomes of the EBM course sequence. Methodology: The cornerstone of the three-semester sequence of EBM are interactive small group discussions that are designed to introduce students to the most clinically applicable skills to identify, manage and use the best clinical research evidence to improve the health of their patients. During the three-semester sequence, the students are assigned each semester to participate in small group discussions that are facilitated by faculty with varying background and expertise. Prior to the start of the first EBM course in the winter semester, PA students complete a knowledge-based survey that was developed by the authors to assess the effectiveness of the course series. The survey consists of 53 Likert scale questions that address the nine objectives for the course series. At the end of the three semester course series, the same survey was given to all students in the program and the results from before, and after the sequence of EBM courses are compared. Specific attention is paid to overall performance of students in the nine course objectives. Results: We find that students from the Class of 2016 and 2017 consistently improve (as measured by percent correct responses on the survey tool) after the EBM course series (Class of 2016: Pre- 62% Post- 75%; Class of 2017: Pre- 61 % Post-70%). The biggest increase in knowledge was observed in the areas of finding and evaluating the evidence, with asking concise clinical questions (Class of 2016: Pre- 61% Post- 81%; Class of 2017: Pre- 61 % Post-75%) and searching the medical database (Class of 2016: Pre- 24% Post- 65%; Class of 2017: Pre- 35 % Post-66 %). Questions requiring students to analyze, evaluate and report on the available clinical evidence regarding diagnosis showed improvement, but to a lesser extend (Class of 2016: Pre- 56% Post- 77%; Class of 2017: Pre- 56 % Post-61%). Conclusions: Outcomes identified that students did gain skills which will allow them to apply EBM principles. In addition, the outcomes of the knowledge-based survey allowed the faculty to focus on areas needing improvement, specifically the translation of best evidence into patient care. To address this area, the clinical faculty developed case scenarios that were incorporated into the lecture and discussion sessions, allowing students to better connect the research studies with patient care. Students commented that ‘class discussion and case examples’ contributed most to their learning and that ‘it was helpful to learn how to develop research questions and how to analyze studies and their significance to a potential client’. As evident by the outcomes, the EBM courses achieved the goals of the course and were well received by the students. 

Keywords: evidence-based medicine, clinical education, assessment tool, physician assistant

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Authors: Hoda Manafian, Stephen Holland

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Problem statement: Rural areas in Iran are one of the most popular tourism destinations. Abyaneh Village is one of them with a long history behind it (more than 1500 years) which is a national heritage site and also is nominated as a world heritage site in UNESCO tentative list from 2007. There is a considerable foundation of religious-cultural heritage and also agricultural history and activities. However, this heritage site suffers from mass tourism which is beyond its social and physical carrying capacity, since the annual number of tourists exceed 500,000. While there are four adjacent villages around Abyaneh which can benefit from advantages of tourism. Local managers also can at the same time prorate the tourists’ flux of Abyaneh on those other villages especially in high-season. The other villages have some cultural and natural tourism attractions as well. Goal: The main goal of this study is to identify a feasible development strategy according to the current strengths, weaknesses, opportunities and threats of rural tourism in this area (Abyaneh Village and four adjacent villages). This development strategy can lead to sustainable management of these destinations. Method: To this end, we used SWOT analysis as a well-established tool for conducting a situational analysis to define a sustainable development strategy. The procedures included following steps: 1) Extracting variables of SWOT chart based on interviewing tourism experts (n=13), local elites (n=17) and personal observations of researcher. 2) Ranking the extracted variables from 1-5 by 13 tourism experts in Isfahan Cultural Heritage, Handcrafts and Tourism Organization (ICHTO). 3) Assigning weights to the ranked variables using Expert Choice Software and the method of Analytical Hierarchical Process (AHP). 4) Defining the Total Weighted Score (TWS) for each part of SWOT chart. 5) Identifying the strategic position according to the TWS 6) Selecting the best development strategy based on the defined position using the Strategic Position and Action Evaluation (SPACE) matrix. 7) Assessing the Probability of Strategic Success (PSS) for the preferred strategy using relevant formulas. 8) Defining two feasible alternatives for sustainable development. Results and recommendations: Cultural heritage attractions were first-ranked variable in strength chart and also lack of sufficient amenities for one-day tourists (catering, restrooms, parking, and accommodation) was firs-ranked weakness. The strategic position was in ST (Strength-Threat) quadrant which is a maxi-mini position. According this position we would suggest ‘Competitive Strategy’ as a development strategy which means relying on strengths in order to neutralization threats. The result of Probability of Strategic Success assessment which was 0.6 shows that this strategy could be successful. The preferred approach for competitive strategy could be rebranding the market of tourism in this area. Rebranding the market can be achieved by two main alternatives which are based on the current strengths and threats: 1) Defining a ‘Heritage Corridor’ from first adjacent village to Abyaneh as a final destination. 2) Focus on ‘educational tourism’ versus mass tourism and also green tourism by developing agritourism in that corridor.

Keywords: Abyaneh village, rural tourism, SWOT analysis, sustainable strategies

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Authors: Matthew Arnaouti, Michael Baird, Gabrielle Cahill, Tamara Worlton, Michelle Joseph

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Introduction: Over ten years after the 7.0 magnitude Earthquake struck the capital of Haiti, impacting over three million people and leading to the deaths of over two hundred thousand, the multinational humanitarian response remains the largest disaster relief effort to date. This study critically evaluates the multi-sector and multinational disaster response to the Earthquake, looking at how the lessons learned from this analysis can be applied to future disaster response efforts. We put particular emphasis on assessing the interaction between civilian and military sectors during this humanitarian relief effort, with the hopes of highlighting how concrete guidelines are essential to improve future responses. Methods: An extensive scoping review of the relevant literature was conducted - where library scientists conducted reproducible, verified systematic searches of multiple databases. Grey literature and hand searches were utilised to identify additional unclassified military documents, for inclusion in the study. More than 100 documents were included for data extraction and analysis. Key domains were identified, these included: Humanitarian and Military Response, Communication, Coordination, Resources, Needs Assessment and Pre-Existing Policy. Corresponding information and lessons-learned pertaining to these domains was then extracted - detailing the barriers and facilitators to an effective response. Results: Multiple themes were noted which stratified all identified domains - including the lack of adequate pre-existing policy, as well as extensive ambiguity of actors’ roles. This ambiguity was continually influenced by the complex role the United States military played in the disaster response. At a deeper level, the effects of neo-colonialism and concern about infringements on Haitian sovereignty played a substantial role at all levels: setting the pre-existing conditions and determining the redevelopment efforts that followed. Furthermore, external factors significantly impacted the response, particularly the loss of life within the political and security sectors. This was compounded by the destruction of important infrastructure systems - particularly electricity supplies and telecommunication networks, as well as air and seaport capabilities. Conclusions: This study stands as one of the first and most comprehensive evaluations, systematically analysing the civilian and military response - including their collaborative efforts. This study offers vital information for improving future combined responses and provides a significant opportunity for advancing knowledge in disaster relief efforts - which remains a more pressing issue than ever. The categories and domains formulated serve to highlight interdependent factors that should be applied in future disaster responses, with significant potential to aid the effective performance of humanitarian actors. Further studies will be grounded in these findings, particularly the need for greater inclusion of the Haitian perspective in the literature, through additional qualitative research studies.

Keywords: civilian and military collaboration, combined response, disaster, disaster response, earthquake, Haiti, humanitarian response

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Authors: Diego R. Boiarski, Camila M. Toigo, Thais M. Sobjak, Andrey F. P. Santos, Silvia Romao, Ana T. B. Guimaraes

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Anthropogenic activities promote changes in the community’s structures and decrease the species abundance of amphibians. Biological communities of fluvial systems are assemblies of organisms that have adapted to regional conditions, including the physical environment and food resources, and are further refined through interactions with other species. The aim of this study was to assess neurotoxic alterations and in the antioxidant system on tadpoles of Lithobates catesbeianus exposed to waters from Cascavel River, in the south of Brazil. A total of 420 L of water was collected from the Cascavel River, 140 L from each of the three different locations: Site 1 – headwater; Site 2 – stretch of the stream that runs through an urbanized area; Site 3 – a stretch from the rural area. Twelve tadpoles were acclimated in each aquarium (100 L of water) for seven days. The water from each aquarium was replaced with the ones sampled from the river, except the one from the control aquarium. After seven days, a portion of the liver was removed and conditioned for ChE, SOD, CAT and LPO analysis; other part of the tissue was conditioned for histological analysis. The statistical analysis performed was one-way ANOVA, followed by post-hoc Tukey-HSD test, and the multivariate principal components analysis. It was not observed any neurotoxic effect, but a slight increase in SOD activity and elevation of CAT activity in both urban and rural environment. A decrease in LPO reaction was detected, mainly among the tadpoles exposed to the waters from the rural area. The results of the present study demonstrate the alteration of the antioxidant system, as well as liver histopathologies in tadpoles exposed mainly to waters collected in urban and rural environments. These alterations may cause the reduction in the velocity of the metamorphosis process from the tadpoles. Further, were observed histological alterations, highlighting necrotic areas mainly among the animals exposed to urban waters. Those damages can lead to metabolic dysfunction, interfering with survival capacity, diminishing not only individual fitness but for the whole population. In the interpretation synthesis of all biomarkers, the cellular damage gradient is perceptible, characterized by the variables related to the antioxidant system, due to the flow direction of the stream. This result is indicative that along the course of the creek occurs dumping of organic material, which promoted an acute response upon tadpoles of L. catesbeianus. and it was also observed the difference in tissue damage between the experimental groups and the control group, the latter presenting histological alterations, but to a lesser degree than the animals exposed to the waters of the Cascavel river. These damages, caused by reactive oxygen species possibly resulting from the contamination by organic compounds, can lead the animals to a series of metabolic dysfunctions, interfering with its metamorphosis capacity. Interruption of metamorphosis may affect survival, which may impair its growth, development and reproduction, diminishing not only the fitness of each individual but in a long-term, to the entire population.

Keywords: American bullfrog, histopathology, oxidative stress, urban creeks pollution

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Authors: Banafsheh Nikmehr, Mohsen Bahrami, Yueqiang Song, Anuradha Koduru, Ayse K. Vuruskan, Hongkun Lu, Mallory Pitts, Tolga B. Mesen, Tamer M. Yalcinkaya

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The number of people who receive in vitro fertilization (IVF) treatment has increased on a startling trajectory over the past two decades. Despite advances in this field, particularly the introduction of intracytoplasmic sperm injection (ICSI) and the preimplantation genetic screening (PGS), the IVF success remains low. A major factor contributing to IVF failure is embryonic aneuploidy (abnormal chromosome content), which often results in miscarriage and birth defects. Although PGS is often used as the standard diagnostic tool to identify aneuploid embryos, it is an invasive approach that could affect the embryo development, and yet inaccessible to many patients due its high costs. As such, there is a clear need for a non-invasive cost-effective approach to identify euploid embryos for single embryo transfer (SET). The reported differences between morphokinetic behaviors of aneuploid and euploid embryos has shown promise to address this need. However, current literature is inconclusive and further research is urgently needed to translate current findings into clinical diagnostics. In this ongoing study, we found significant differences between morphokinetic behaviors of euploid and aneuploid embryos that provides important insights and reaffirms the promise of such behaviors for developing non-invasive methodologies. Methodology—A total of 242 embryos (euploid: 149, aneuploid: 93) from 74 patients who underwent IVF treatment in Carolinas Fertility Clinics in Winston-Salem, NC, were analyzed. All embryos were incubated in an EmbryoScope incubator. The patients were randomly selected from January 2019 to June 2021 with most patients having both euploid and aneuploid embryos. All embryos reached the blastocyst stage and had known PGS outcomes. The ploidy assessment was done by a third-party testing laboratory on day 5-7 embryo biopsies. The morphokinetic variables of each embryo were measured by the EmbryoViewer software (Uniesense FertiliTech) on time-lapse images using 7 focal depths. We compared the time to: pronuclei fading (tPNf), division to 2,3,…,9 cells (t2, t3,…,t9), start of embryo compaction (tSC), Morula formation (tM), start of blastocyst formation (tSC), blastocyst formation (tB), and blastocyst expansion (tEB), as well as intervals between them (e.g., c23 = t3 – t2). We used a mixed regression method for our statistical analyses to account for the correlation between multiple embryos per patient. Major Findings— The average age of the patients was 35.04 yrs. The average patient age associated with euploid and aneuploid embryos was not different (P = 0.6454). We found a significant difference in c45 = t5-t4 (P = 0.0298). Our results indicated this interval on average lasts significantly longer for aneuploid embryos - c45(aneuploid) = 11.93hr vs c45(euploid) = 7.97hr. In a separate analysis limited to embryos from the same patients (patients = 47, total embryos=200, euploid=112, aneuploid=88), we obtained the same results (P = 0.0316). The statistical power for this analysis exceeded 87%. No other variable was different between the two groups. Conclusion— Our results demonstrate the importance of morphokinetic variables as potential biomarkers that could aid in non-invasively characterizing euploid and aneuploid embryos. We seek to study a larger population of embryos and incorporate the embryo quality in future studies.

Keywords: IVF, embryo, euploidy, aneuploidy, morphokinteic

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Authors: Jennifer Kehinde, Claire O'donnell, Annmarie Grealish

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Introduction: Breastfeeding has been shown to provide numerous health benefits for both infants and mothers. The decision to breastfeed is influenced by physiological, psychological, and emotional factors. However, the importance of equipping mothers with the necessary knowledge for successful breastfeeding practice cannot be ruled out. The decline in global breastfeeding rate can be linked to lack of adequate breastfeeding education during prenatal stage.This systematic review examined the effectiveness of prenatal breastfeeding education on breastfeeding uptake postpartum. Method: This review was undertaken and reported in conformity with the Preferred Reporting Items for Systemic Reviews and Meta-Analysis statement (PRISMA) and was registered on the international prospective register for systematic reviews (PROSPERO: CRD42020213853). A PICO analysis (population, intervention, comparison, outcome) was undertaken to inform the choice of keywords in the search strategy to formulate the review question which was aimed at determining the effectiveness of prenatal breastfeeding educational programs at improving breastfeeding uptake following birth. A systematic search of five databases (Cumulative Index to Nursing and Allied Health Literature, Medline, Psych INFO, and Applied Social Sciences Index and Abstracts) were searched between January 2014 until July 2021 to identify eligible studies. Quality assessment and narrative synthesis were subsequently undertaken. Results: Fourteen studies were included. All 14 studies used different types of breastfeeding programs; eight used a combination of curriculum based breastfeeding education program, group prenatal breastfeeding counselling and one-to-one breastfeeding educational programs which were all delivered in person; four studies used web-based learning platforms to deliver breastfeeding education prenatally which were both delivered online and face to face over a period of 3 weeks to 2 months with follow-up periods ranging from 3 weeks to 6 months; one study delivered breastfeeding educational intervention using mother-to-mother breastfeeding support groups in promoting exclusive breastfeeding and one study disseminated breastfeeding education to participants based on the theory of planned behaviour. The most effective interventions were those that included both theory and hands-on demonstrations. Results showed an increase in breastfeeding uptake, breastfeeding knowledge, increase in positive attitude to breastfeeding and an increase in maternal breastfeeding self-efficacy among mothers who participated in breastfeeding educational programs during prenatal care. Conclusion: Prenatal breastfeeding education increases women’s knowledge of breastfeeding. Mothers who are knowledgeable about breastfeeding and hold a positive approach towards breastfeeding have the tendency to initiate breastfeeding and continue for a lengthened period. Findings demonstrates a general correlation between prenatal breastfeeding education and increased breastfeeding uptake postpartum. The high level of positive breastfeeding outcome inherent in all the studies can be attributed to prenatal breastfeeding education. This review provides rigorous contemporary evidence that healthcare professionals and policymakers can apply when developing effective strategies to improve breastfeeding rates and ultimately improve the health outcomes of mothers and infants.

Keywords: breastfeeding, breastfeeding programs, breastfeeding self-efficacy, prenatal breastfeedng education

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