Search results for: risk evaluation

Authors: Lilah Inzelberg, David Rand, Stanislav Steinberg, Moshe David Pur, Yael Hanein

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Human facial expressions carry important psychological and neurological information. Facial expressions involve the co-activation of diverse muscles. They depend strongly on personal affective interpretation and on social context and vary between spontaneous and voluntary activations. Smiling, as a special case, is among the most complex facial emotional expressions, involving no fewer than 7 different unilateral muscles. Despite their ubiquitous nature, smiles remain an elusive and debated topic. Smiles are associated with happiness and greeting on one hand and anger or disgust-masking on the other. Accordingly, while high-resolution recording of muscle activation patterns, in a non-interfering setting, offers exciting opportunities, it remains an unmet challenge, as contemporary surface facial electromyography (EMG) methodologies are cumbersome, restricted to the laboratory settings, and are limited in time and resolution. Here we present a wearable and non-invasive method for objective mapping of facial muscle activation and demonstrate its application in a natural setting. The technology is based on a recently developed dry and soft electrode array, specially designed for surface facial EMG technique. Eighteen healthy volunteers (31.58 ± 3.41 years, 13 females), participated in the study. Surface EMG arrays were adhered to participant left and right cheeks. Participants were instructed to imitate three facial expressions: closing the eyes, wrinkling the nose and smiling voluntary and to watch a funny video while their EMG signal is recorded. We focused on muscles associated with 'enjoyment', 'social' and 'masked' smiles; three categories with distinct social meanings. We developed a customized independent component analysis algorithm to construct the desired facial musculature mapping. First, identification of the Orbicularis oculi and the Levator labii superioris muscles was demonstrated from voluntary expressions. Second, recordings of voluntary and spontaneous smiles were used to locate the Zygomaticus major muscle activated in Duchenne and non-Duchenne smiles. Finally, recording with a wireless device in an unmodified natural work setting revealed expressions of neutral, positive and negative emotions in face-to-face interaction. The algorithm outlined here identifies the activation sources in a subject-specific manner, insensitive to electrode placement and anatomical diversity. Our high-resolution and cross-talk free mapping performances, along with excellent user convenience, open new opportunities for affective processing and objective evaluation of facial expressivity, objective psychological and neurological assessment as well as gaming, virtual reality, bio-feedback and brain-machine interface applications.

Keywords: affective expressions, affective processing, facial EMG, high-resolution electromyography, independent component analysis, wireless electrodes

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Authors: Phillip F. Blaauw, Anna M. Pretorius

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South Africa re-entered the international economy in the early 1990s, after Apartheid, at a time when globalisation was gathering momentum. Globalisation led to a more open economy, increased export volumes and a changed export mix. Manufacturing goods gained ground relative to mining products. After 21 years of democracy, South African researchers and policymakers need to evaluate the impact of international trade on the level of employment and compensation of employees in the South African manufacturing industry. This is important given the consistent and high levels of unemployment in South Africa. This paper has this evaluation as its aim. Two complimenting approaches are utilised. The 27 sub divisions of the South African manufacturing industry are classified according to capital/labour ratios. Possible trends in employment levels and employee compensation for these categories are then identified when comparing levels in 1995 to those in 2014. The supplementing empirical approach is cross-sectional and panel data regressions for the same period. The aim of the regression analysis is to explain the observed changes in employment and employee compensation levels between 1995 and 2014. The first part of the empirical approach revealed that over the 20-year period the intermediate capital intensive, labour intensive an ultra-labour intensive manufacturing industries all showed massive declines in overall employment. Only three of the 19 industries for these classifications showed marginal overall employment gains. The only meaningful gains were recorded in three of the eight capital intensive manufacturing industries. The overall performance of the South African manufacturing industry is therefore dismal at best. This scenario plays itself out for the skilled section of the intermediate capital intensive, labour intensive an ultra-labour intensive manufacturing industries as well. 18 out of the 19 industries displayed declines even for the skilled section of the labour force. The formal regression analysis supplements the above results. Real production growth is a statistically significant (95 per cent confidence level) explanatory variable of the overall employment level for the period under consideration, albeit with a small positive coefficient. The variables with the most significant negative relationship with changes in overall employment were the dummy variables for intermediate capital intensive and labour intensive manufacturing goods. Disaggregating overall changes in employment further in terms of skill levels revealed that skilled employment in particular responded negatively to increases in the ratio between imported and local inputs for manufacturing. The dummy variable for the labour intensive sectors remained negative and statistically significant, indicating that the labour intensive sectors of South African manufacturing remain vulnerable to the loss of employment opportunities. Whereas the first period (1995 to 2001) after the opening of the South African economy brought positive changes for skilled employment, continued increases in imported inputs displaced some of the skilled labour as well, putting further pressure on the South African economy with already high and persistent unemployment levels. Given the negative for the world commodity cycle and a stagnant local manufacturing sector, the challenge for policymakers is getting even more pronounced after South Africa’s political coming of age.

Keywords: capital/labour ratios, employment, employee compensation, manufacturing

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Authors: Azhar Naila, Steuer Benjamin

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Over-exploitation of resources and the burden on natural systems have provoked worldwide concerns about the potential resource as well as supply risks in the future. It has been estimated that the consumption of materials and resources will double by 2060, substantially mounting the amount of waste and emissions produced by individuals, organizations, and businesses, which necessitates sustainable technological innovations to address the problem. Therefore, there is a need to design products and services purposefully for material resource efficiency. This directs us toward the conceptualization and implementation of the ‘Circular Economy (CE),’ which has gained considerable attention among policymakers, researchers, and businesses in the past decade. A large amount of literature focuses on the concept of CE. However, contextual empirical research on the need to embrace CE in an emerging economy like Pakistan is still scarce, where the traditional economic model of take-make-dispose is quite common. Textile exports account for approximately 61% of Pakistan's total exports, and the industry provides employment for about 40% of the country's total industrial workforce. The industry provides job opportunities to above 10 million farmers, with cotton as the main crop of Pakistan. Consumers, companies, as well as the government have explored very limited CE potential in the country. This gap has motivated us to carry out the present study. The study is based on a mixed method approach, for which key informant interviews have been conducted to get insight into the present situation of the ecosystem readiness for the adoption of CE in 20 textile manufacturing industries. The subject study has been conducted on the following areas i) the level of understanding of the CE concept among key stakeholders in the textile manufacturing industry ii) Companies are pushing boundaries to invest in circularity-based initiatives, exploring the depths of risk-taking iii) the current national policy framework support the adoption of CE. Qualitative assessment has been undertaken using MAXQDA to analyze the data received after the key informant interviews. The data has been transcribed and coded for further analysis. The results show that most of the key stakeholders have a clear understanding of the concept, whereas few consider it to be only relevant to the end-of-life treatment of waste generated from the industry. Non-governmental organizations have been observed to be key players in creating awareness among the manufacturing industries. Maximum companies have shown their consent to invest in initiatives related to the adoption of CE. Whereas a few consider themselves far behind the race due to a lack of financial resources and support from responsible institutions. Mostly, the industries have an ambitious vision for integrating CE into the company’s policy but seem not to be ready to take any significant steps to nurture a culture for experimentation. However, the government is not playing any vital role in the transition towards CE; rather, they have been busy with the state’s uncertain political situation. Presently, Pakistan does not have any policy framework that supports the transition towards CE. Acknowledging the present landscape a well-informed CE transition is immediately required.

Keywords: circular economy, textile supply chain, textile manufacturing industries, resource efficiency, ecosystem readiness, multi-case study analysis

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Authors: M. Petunia Tsweleng

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Statement of the Problem: Research and aid organisations report that children and adolescents orphaned due to HIV and AIDS are particularly vulnerable as they are often exposed to negative effects of both HIV and AIDS and orphanhood. Without much-needed parental love, care, and support, these children and adolescents are at risk of poor developmental outcomes. A cursory look at the available literature on AIDS-orphaned adolescents, and the quality of caregiving relationships with caregivers, shows that this is a relatively under-researched terrain. This article is a review of the literature on caregiving relationships of adolescents orphaned due to AIDS and their current primary caregivers. It aims to inform community programmes and policymakers by providing insight into the qualities of these relationships. Methodology: A comprehensive search of both peer-reviewed and non-peer-reviewed literature was conducted through EBSCOhost, SpringLINK, PsycINFO, SAGE, PubMed, Elsevier ScienceDirect, JSTOR, Wiley Online Library databases, and Google Scholar. The combination of keywords used for the search were: (caregiving relationships); (orphans OR AIDS orphaned children OR AIDS orphaned adolescents); (primary caregivers); and (quality caregiving); (orphans); (HIV and AIDS). The search took place between 24 January and 28 February 2022. Both qualitative and quantitative research studies published between 2010 and 2020 were reviewed. However, only qualitative studies were selected in the end -as they presented more profound findings concerning orphan-caregiver relationships. The following three stages of meta-synthesis analysis were used to analyse data: refutational syntheses, reciprocal syntheses, and line of argument. Results: The search resulted in a total of 2090 titles, of which 750 were duplicates and therefore subtracted. The researcher reviewed all the titles and abstracts of the remaining 1340 articles. 329 articles were identified as relevant, and full texts were reviewed. Following the review of the full texts, 313 studies were excluded for relevance and 4 for methodology. Twelve articles representing 11 studies fulfilled the inclusion criteria and were selected. These studies, representing different countries across the globe, reported similar forms of hardships experienced by caregivers economically, psychosocially, and healthwise. However, the studies also show that the majority of caregivers found contentment in caring for orphans, particularly grandmother carers, and were thus enabled to provide love, care, and support despite hardships. This resulted in positive caregiving relationships -as orphans fared well emotionally and psychosocially. Some relationships, however, were found negative due to unhealed emotional wounds suffered by both caregivers and orphans and others due to the caregiver’s lack of interest in providing care. These findings were based on self-report data from both orphans and caregivers. Conclusion: Findings suggest that intervention efforts need to be intensified to: alleviate poverty in households that are affected by HIV and AIDS pandemic, strengthen the community psychosocial support programmes for orphans and their caregivers; and integrate clinical services with community programmes for the healing of emotional and psychological wounds. Contributions: Findings inform community programmes and policymakers by providing insight into the qualities of the mentioned relationships as well as identifying factors commonly associated with high-quality caregiving and poor-quality caregiving.

Keywords: systematic review, caregiving relationships, orphans and primary caregivers, AIDS

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Authors: Aşina Gülerarslan, M. Faik Özdengül

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The new economic, social and political world order has led to the emergence of a wide range of persuasion strategies and practices based on an ever expanding marketing axis that involves organizations, ideas and persons as well as products and services. It is seen that since the 1990's, a wide variety of competitive marketing ideas have been offered systematically to target audiences in the field of politics as in other fields. When the components of marketing are taken into consideration, all kinds of communication efforts involving “political leaders”, who are conceptualized as products in terms of political marketing, serve a process of social persuasion, which cannot be restricted to election periods only, and a manageable “image”. In this context, image, which is concerned with how the political product is perceived, involves not only the political discourses shared with the public but also all kinds of biographical information about the leader, the leader’s specific way of living and routines and his/her attitudes and behaviors in their private lives, and all these are regarded as components of the “product image”. While on the one hand the leader’s verbal or supra-verbal references serve the way the “spirit of the product” is perceived –just as in brand positioning- they also show their self-esteem levels, in other words how they perceive themselves on the other hand. Indeed, their self-esteem levels are evaluated in three fundamental categories in the “Functional Analysis”, namely parent, child and adult, and it is revealed that the words, tone of voice and body language a person uses makes it easy to understand at what self-esteem level that person is. In this context, words, tone of voice and body language, which provide important clues as to the “self” of the person, are also an indication of how political leaders evaluate both “themselves” and “the mass/audience” in the communication they establish with their audiences. When the matter is taken from the perspective of Turkey, the levels of self-esteem in the relationships that the political leaders establish with the masses are also important in revealing how our society is seen from the perspective of a specific leader. Since the leader is a part of the marketing strategy of a political party as a product, this evaluation is significant in terms of the forms of relationships between political institutions in our country with the society. In this study, the self-esteem level in the documentary entitled “Master’s Story”, where Recep Tayyip Erdoğan’s life history is told, is analyzed in the context of words, tone of voice and body language. Within the scope of the study, at what level of self-esteem Recep Tayyip Erdoğan was in the “Master’s Story”, a documentary broadcast on Beyaz TV, was investigated using the content analysis method. First, based on the Functional Analysis Literature, a transactional approach scale was created regarding parent, adult and child self-esteem levels. On the basis of this scale, the prime minister’s self-esteem level was determined in three basic groups, namely “tone of voice”, “the words he used” and “body language”. Descriptive analyses were made to the data within the framework of these criteria and at what self-esteem level the prime minister spoke throughout the documentary was revealed.

Keywords: political marketing, leader image, level of self-esteem, transactional approach

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Authors: Ananya Hazare, Ranjit Kamble

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Introduction: Patients with Cleft lip and palate (CL/P) can present with a maxillary retrution after cleft repair. Anterior Maxillary distraction osteogenesis (AMD) is a technique that provides simultaneous skeletal advancement and expansion of the soft tissues related to an anterior segment of the maxilla. This case presented is a case of AMD. The advantage of this technique is that the occlusion in the posterior segment can be maintained, and only the segment in cross bite is advanced for correction of the midfacial deficiency. The other alternative treatment is anterior movement by a Lefort 1 osteotomy. When a Lefort 1 osteotomy is compared with the Distraction osteogenesis or AMD, the disadvantages of the Le Fort 1 include a higher risk of morbidity, requirement of fixation, relapse tendency and unexpected changes in the nasal form. These complications were eliminated by AMD technique. This was followed by placement of the implant in the bone formed after AMD. Hence complete surgical, orthodontic and prosthodontics rehabilitation of the patient was done by an interdisciplinary approach. Methods: Patient presented with repaired UCL/P of the right side with midfacial retrusion. Intro-oral examination revealed a good occlusion in the posterior arch and anterior Crossbite from canine to canine. Patient's both maxillary lateral incisors were missing. The lower arch was well aligned with all teeth present. The study models when scored according to GOSLON yardstick received a score of 4. After pre-surgical orthodontic phase was completed an intraoral distractor was fabricated by modification of HYRAX expansion screw. After surgery, low subapical osteotomy cuts were placed and the distractor was fixed. The latency period of 5 days was observed after which the distraction was started. Distraction was done at a rate of 1 mm/day with a rhythm of 0.5mm in morning and 0.5mm in the evening. The total distraction of 12 mm was done. After a consolidation period, the distractor was removed, and retention by a removable partial denture was given. Radiographic examination confirmed mature bone formation in the distracted segment. Implants were placed and allowed to osseointegrate for approximately 4 months and were then loaded with abutments. Results: Total distraction done was 12mm and after relapse it was 8mm. After consolidation phase the radiographic examination revealed a B2 quality of bone according to the Misch's classification and sufficient height from the maxillary sinus. These findings were indicative for placement of implants in the distracted bone formed in premolar region. Implants were placed and after radiographic evidence of osseointegration was seen they were loaded with abutments. Thus resulting in a complete rehabilitation of a cleft patient by an interdisciplinary approach. Conclusion: Anterior maxillary distraction can be used as an alternative method instead of complete distraction osteogenesis or Lefort 1 advancement of maxilla in cases where the advancement needed is minimum. Use of HYRAX expansion screw modified as intra-oral distractor can be used in such cases, which significantly reduces the cost of treatment, as expensive distractors are not used. This technique is very useful and efficient in countries like India where the patient cannot afford expensive treatment options.

Keywords: cleft lip and palate, distraction osteogenesis, anterior maxillary distraction, orthodontics and dentofacial orthopaedics, hyrax expansion screw modification

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Authors: M. Eickermann, F. Ronellenfitsch, J. Junk

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Oilseed rape (Brassica napus L.) is one of the most important crops throughout Europe, but pressure due to pest insects and pathogens can reduce yield amount substantially. Therefore, the usage of pesticide applications is outstanding in this crop. In addition, climate change effects can interact with phenology of the host plant and their pests and can apply additional pressure on the yield. Next to the pollen beetle, Meligethes aeneus L., the seed-damaging pest insects, cabbage seed weevil (Ceutorhynchus obstrictus Marsham) and the brassica pod midge (Dasineura brassicae Winn.) are of main economic impact to the yield. While females of C. obstrictus are infesting oilseed rape by depositing single eggs into young pods, the females of D. brassicae are using this local damage in the pod for their own oviposition, while depositing batches of 20-30 eggs. Without a former infestation by the cabbage seed weevil, a significant yield reduction by the brassica pod midge can be denied. Based on long-term, multisided field experiments, a comprehensive data-set on pest migration to crops of B. napus has been built up in the last ten years. Five observational test sides, situated in different climatic regions in Luxembourg were controlled between February until the end of May twice a week. Pest migration was recorded by using yellow water pan-traps. Caught insects were identified in the laboratory according to species specific identification keys. By a combination of pest observations and corresponding meteorological observations, the set-up of models to predict the migration periods of the seed-damaging pests was possible. This approach is the basis for a computer-based decision support tool, to assist the farmer in identifying the appropriate time point of pesticide application. In addition, the derived algorithms of that decision support tool can be combined with climate change projections in order to assess the future potential threat caused by the seed-damaging pest species. Regional climate change effects for Luxembourg have been intensively studied in recent years. Significant changes to wetter winters and drier summers, as well as a prolongation of the vegetation period mainly caused by higher spring temperature, have also been reported. We used the COSMO-CLM model to perform a time slice experiment for Luxembourg with a spatial resolution of 1.3 km. Three ten year time slices were calculated: The reference time span (1991-2000), the near (2041-2050) and the far future (2091-2100). Our results projected a significant shift of pest migration to an earlier onset of the year. In addition, a prolongation of the possible migration period could be observed. Because D. brassiace is depending on the former oviposition activity by C. obstrictus to infest its host plant successfully, the future dependencies of both pest species will be assessed. Based on this approach the future risk potential of both seed-damaging pests is calculated and the status as pest species is characterized.

Keywords: CORDEX projections, decision support tool, Brassica napus, pests

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Authors: Echo Wang, Andrew Li

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Transparency could be defined as the voluntary release of information by institutions that is relevant to their own evaluation. Transparency based on information disclosure is recognised to be vital for the Third Sector, as civil society organisations are under pressure to become more transparent to answer the call for accountability. The growing importance of social enterprises as hybrid organisations emerging from the nexus of the public, the private and the Third Sector makes their transparency a topic worth exploring. However, transparency for social enterprises has not yet been studied: as a new form of organisation that combines non-profit missions with commercial means, it is unclear to both the practical and the academic world if the shift in operational logics from non-profit motives to for-profit pursuits has significantly altered their transparency. This is especially so in China, where informational governance and practices of information disclosure by local governments, industries and civil society are notably different from other countries. This study investigates the transparency-seeking behaviour of social enterprises in Greater China to understand what factors at the organisational level may affect their transparency, measured by their willingness to disclose financial information. We make use of the Survey on the Models and Development Status of Social Enterprises in the Greater China Region (MDSSGCR) conducted in 2015-2016. The sample consists of more than 300 social enterprises from the Mainland, Hong Kong and Taiwan. While most respondents have provided complete answers to most of the questions, there is tremendous variation in the respondents’ demonstrated level of transparency in answering those questions related to the financial aspects of their organisations, such as total revenue, net profit, source of revenue and expense. This has led to a lot of missing data on such variables. In this study, we take missing data as data. Specifically, we use missing values as a proxy for an organisation’s level of transparency. Our dependent variables are constructed from missing data on total revenue, net profit, source of revenue and cost breakdown. In addition, we also take into consideration the quality of answers in coding the dependent variables. For example, to be coded as being transparent, an organization must report the sources of at least 50% of its revenue. We have four groups of predictors of transparency, namely nature of organization, decision making body, funding channel and field of concentration. Furthermore, we control for an organisation’s stage of development, self-identity and region. The results show that social enterprises that are at their later stages of organisational development and are funded by financial means are significantly more transparent than others. There is also some evidence that social enterprises located in the Northeast region in China are less transparent than those located in other regions probably because of local political economy features. On the other hand, the nature of the organisation, the decision-making body and field of concentration do not systematically affect the level of transparency. This study provides in-depth empirical insights into the information disclosure behaviour of social enterprises under specific social context. It does not only reveal important characteristics of Third Sector development in China, but also contributes to the general understanding of hybrid institutions.

Keywords: China, information transparency, organisational behaviour, social enterprise

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Authors: S. H. Chew, Z. X. Eng, K. E. Chuah, T. Y. Lim, H. M. A. Yim

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In recent years, geotextile tube has been widely used in the hydraulic engineering and dewatering industry. To construct a stable containment bund with geotextile tubes, the sand slurry is always the preference infilling material. However, the shortage of sand supply posts a problem in Singapore to adopt this construction method in the actual construction of long containment bund. Hence, utilizing the soft dredged clay or the excavated soft clay as the infilling material of geotextile tubes has a great economic benefit. There are any technical issues with using this soft clayey material as infilling material, especially on the excessive settlement and stability concerns. To minimize the shape deformation and settlement of geotextile tube associated with the use of this soft clay infilling material, a modified innovative infilling material is proposed – lightly cemented soft clay. The preliminary laboratory studies have shown that the dewatering mechanism via geotextile material of the tube skin, and the introduction of cementitious chemical action of the lightly cemented soft clay will accelerate the consolidation and improve the shear strength of infill material. This study aims to extend the study by conducting a pilot test of the geotextile tube filled with lightly cemented clay. This study consists of testing on a series of miniature geo-tubes and two full-size geotextile tube. In the miniature geo-tube tests, a number of small scaled-down size of geotextile tubes were filled with cemented clay (at water content of 150%) with cement content of 0% to 8% (by weight). The shear strength development of the lightly cemented clay under dewatering mechanism was evaluated using a modified in-situ Cone Penetration Test (CPT) at 0 days, 3 days, 7 days and 28 days after the infilling. The undisturbed soil samples of lightly cemented infilled clay were also extracted at 3-days and 7-days for triaxial tests and evaluation of final water content. The results suggested that the geotextile tubes filled with un-cemented soft clay experienced very significant shape change over the days (as control test). However, geotextile mini-tubes filled with lightly cemented clay experienced only marginal shape changed, even that the strength development of this lightly cemented clay inside the tube may not show significant strength gain at the early stage. The shape stability is believed to be due to the confinement effect of the geotextile tube with clay at non-slurry state. Subsequently, a full-scale instrumented geotextile tube filled with lightly cemented clay was performed. The extensive results of strain gauges and pressure transducers installed on this full-size geotextile tube demonstrated a substantial mobilization of tensile forces on the geotextile skin corresponding to the filling activity and the subsequent dewatering stage. Shape change and the in-fill material strength development was also monitored. In summary, the construction of containment bund with geotextile tube filled with lightly cemented clay is found to be technically feasible and stable with the use of the sufficiently strong (i.e. adequate tensile strength) geotextile tube, the adequate control on the dosage of cement content, and suitable water content of infilling soft clay material.

Keywords: cemented clay, containment bund, dewatering, geotextile tube

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Authors: Md. Wasiul Islam, Md. Jamius Shams Sowrov

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The Sundarbans is the largest single tract of mangrove forest in the world. This is located in the southwest corner of Bangladesh. This is a unique ecosystem which is a great breeding and nursing ground for a great biodiversity. It supports the livelihood of about 3.5 million coastal dwellers and also protects the coastal belt and inland areas from various natural calamities. Historically, the management of the Sundarbans was controlled by the Bangladesh Forest Department following top-down approach without the involvement of local communities. Such fence and fining-based blue-print approach was not effective to protect the forest which caused Sundarbans to degrade severely in the recent past. Fifty percent of the total tree cover has been lost in the last 30 years. Therefore, local multi-stakeholder based bottom-up co-management approach was introduced at some of the parts of the Sundarbans in 2006 to improve the biodiversity status by enhancing the protection level of the forest. Various co-management organizations were introduced under co-management approach where the local community people could actively involve in various activities related to the management and welfare of the Sundarbans including the decision-making process to achieve the goal. From this backdrop, the objective of the study was to assess the performance of co-management organizations to facilitate sustainable management of the Sundarbans mangrove forests. The qualitative study followed face-to-face interview to collect data using two sets of semi-structured questionnaires. A total of 40 respondents participated in the research that was from eight villagers under two forest ranges. 32 representatives from the local communities as well as 8 official representatives involved in co-management approach were interviewed using snowball sampling technique. The study shows that the co-management approach improved governance system of the Sundarbans through active participation of the local community people and their interactions with the officials via the platform of co-management organizations. It facilitated accountability and transparency system to some extent through following some formal and informal rules and regulations. It also improved the power structure of the management process by fostering local empowerment process particularly the women. Moreover, people were able to learn from their interactions with and within the co-management organizations as well as interventions improved environmental awareness and promoted social learning. The respondents considered good governance as the most important factor for achieving the goal of sustainable management and biodiversity conservation of the Sundarbans. The success of co-management planning process also depends on the active and functional participation of different stakeholders including the local communities where co-management organizations were considered as the most functional platform. However, the governance system was also facing various challenges which resulted in barriers to the sustainable management of the Sundarbans mangrove forest. But still there were some members involved in illegal forest operations and created obstacles against sustainable management of the Sundarbans. Respondents recommended greater patronization from the government, financial and logistic incentives for alternative income generation opportunities with effective participatory monitoring and evaluation system to improve sustainable management of the Sundarbans.

Keywords: Bangladesh, co-management approach, co-management organizations, governance, Sundarbans, sustainable management

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Authors: Bandar A. Alkhayyal

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Modern supply chains are typically linear, transforming virgin raw materials into products for end consumers, who then discard them after use to landfills or incinerators. Nowadays, there are major efforts underway to create a circular economy to reduce non-renewable resource use and waste. One important aspect of these efforts is the development of Green Supply Chain (GSC) systems which enables a reverse flow of used products from consumers back to manufacturers, where they can be refurbished or remanufactured, to both economic and environmental benefit. This paper develops novel multi-objective optimization models to inform GSC system design at multiple levels: (1) strategic planning of facility location and transportation logistics; (2) tactical planning of optimal pricing; and (3) policy planning to account for potential valuation of GSC emissions. First, physical linear programming was applied to evaluate GSC facility placement by determining the quantities of end-of-life products for transport from candidate collection centers to remanufacturing facilities while satisfying cost and capacity criteria. Second, disassembly and remanufacturing processes have received little attention in industrial engineering and process cost modeling literature. The increasing scale of remanufacturing operations, worth nearly $50 billion annually in the United States alone, have made GSC pricing an important subject of research. A non-linear physical programming model for optimization of pricing policy for remanufactured products that maximizes total profit and minimizes product recovery costs were examined and solved. Finally, a deterministic equilibrium model was used to determine the effects of internalizing a cost of GSC greenhouse gas (GHG) emissions into optimization models. Changes in optimal facility use, transportation logistics, and pricing/profit margins were all investigated against a variable cost of carbon, using case study system created based on actual data from sites in the Boston area. As carbon costs increase, the optimal GSC system undergoes several distinct shifts in topology as it seeks new cost-minimal configurations. A comprehensive study of quantitative evaluation and performance of the model has been done using orthogonal arrays. Results were compared to top-down estimates from economic input-output life cycle assessment (EIO-LCA) models, to contrast remanufacturing GHG emission quantities with those from original equipment manufacturing operations. Introducing a carbon cost of $40/t CO2e increases modeled remanufacturing costs by 2.7% but also increases original equipment costs by 2.3%. The assembled work advances the theoretical modeling of optimal GSC systems and presents a rare case study of remanufactured appliances.

Keywords: circular economy, extended producer responsibility, greenhouse gas emissions, industrial ecology, low carbon logistics, green supply chains

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Authors: Pulakesh Das, Mukunda Dev Behera, Manchiraju Sri Ramachandra Murthy

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Large numbers of people living in and around the Hindu Kush Himalaya (HKH) region, depends on this diverse mountainous region for ecosystem services. Following the global trend, this region also experiencing rapid population growth, and demand for timber and agriculture land. The eight countries sharing the HKH region have different forest resources utilization and conservation policies that exert varying forces in the forest ecosystem. This created a variable spatial as well altitudinal gradient in rate of deforestation and corresponding forest patch fragmentation. The quantitative relationship between fragmentation and demography has not been established before for HKH vis-à-vis along elevation gradient. This current study was carried out to attribute the overall and different nature in landscape fragmentations along the altitudinal gradient with the demography of each sharing countries. We have used the tree canopy cover data derived from Landsat data to analyze the deforestation and afforestation rate, and corresponding landscape fragmentation observed during 2000 – 2010. Area-weighted mean radius of gyration (AMN radius of gyration) was computed owing to its advantage as spatial indicator of fragmentation over non-spatial fragmentation indices. Using the subtraction method, the change in fragmentation was computed during 2000 – 2010. Using the tree canopy cover data as a surrogate of forest cover, highest forest loss was observed in Myanmar followed by China, India, Bangladesh, Nepal, Pakistan, Bhutan, and Afghanistan. However, the sequence of fragmentation was different after the maximum fragmentation observed in Myanmar followed by India, China, Bangladesh, and Bhutan; whereas increase in fragmentation was seen following the sequence of as Nepal, Pakistan, and Afghanistan. Using SRTM-derived DEM, we observed higher rate of fragmentation up to 2400m that corroborated with high human population for the year 2000 and 2010. To derive the nature of fragmentation along the altitudinal gradients, the Statistica software was used, where the user defined function was utilized for regression applying the Gauss-Newton estimation method with 50 iterations. We observed overall logarithmic decrease in fragmentation change (area-weighted mean radius of gyration), forest cover loss and population growth during 2000-2010 along the elevation gradient with very high R2 values (i.e., 0.889, 0.895, 0.944 respectively). The observed negative logarithmic function with the major contribution in the initial elevation gradients suggest to gap filling afforestation in the lower altitudes to enhance the forest patch connectivity. Our finding on the pattern of forest fragmentation and human population across the elevation gradient in HKH region will have policy level implication for different nations and would help in characterizing hotspots of change. Availability of free satellite derived data products on forest cover and DEM, grid-data on demography, and utility of geospatial tools helped in quick evaluation of the forest fragmentation vis-a-vis human impact pattern along the elevation gradient in HKH.

Keywords: area-weighted mean radius of gyration, fragmentation, human impact, tree canopy cover

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Authors: Abdul Rehman, Bo Liu

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Axial flow turbines are commonly designed with high loads that generate strong secondary flows and result in high secondary losses. These losses contribute to almost 30% to 50% of the total losses. Non-axisymmetric endwall profiling is one of the passive control technique to reduce the secondary flow loss. In this paper, the non-axisymmetric endwall profile construction and optimization for the stator endwalls are presented to improve the efficiency of a high pressure turbine. The commercial code NUMECA Fine/ Design3D coupled with Fine/Turbo was used for the numerical investigation, design of experiments and the optimization. All the flow simulations were conducted by using steady RANS and Spalart-Allmaras as a turbulence model. The non-axisymmetric endwalls of stator hub and shroud were created by using the perturbation law based on Bezier Curves. Each cut having multiple control points was supposed to be created along the virtual streamlines in the blade channel. For the design of experiments, each sample was arbitrarily generated based on values automatically chosen for the control points defined during parameterization. The Optimization was achieved by using two algorithms i.e. the stochastic algorithm and gradient-based algorithm. For the stochastic algorithm, a genetic algorithm based on the artificial neural network was used as an optimization method in order to achieve the global optimum. The evaluation of the successive design iterations was performed using artificial neural network prior to the flow solver. For the second case, the conjugate gradient algorithm with a three dimensional CFD flow solver was used to systematically vary a free-form parameterization of the endwall. This method is efficient and less time to consume as it requires derivative information of the objective function. The objective function was to maximize the isentropic efficiency of the turbine by keeping the mass flow rate as constant. The performance was quantified by using a multi-objective function. Other than these two classifications of the optimization methods, there were four optimizations cases i.e. the hub only, the shroud only, and the combination of hub and shroud. For the fourth case, the shroud endwall was optimized by using the optimized hub endwall geometry. The hub optimization resulted in an increase in the efficiency due to more homogenous inlet conditions for the rotor. The adverse pressure gradient was reduced but the total pressure loss in the vicinity of the hub was increased. The shroud optimization resulted in an increase in efficiency, total pressure loss and entropy were reduced. The combination of hub and shroud did not show overwhelming results which were achieved for the individual cases of the hub and the shroud. This may be caused by fact that there were too many control variables. The fourth case of optimization showed the best result because optimized hub was used as an initial geometry to optimize the shroud. The efficiency was increased more than the individual cases of optimization with a mass flow rate equal to the baseline design of the turbine. The results of artificial neural network and conjugate gradient method were compared.

Keywords: artificial neural network, axial turbine, conjugate gradient method, non-axisymmetric endwall, optimization

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Authors: Rachael Andrews, Viktoria McMillan, Shuaib Nasser, Christopher M. Roberts

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Background and objective: The National Review of Asthma Deaths (NRAD) found that asthma management and care was inadequate in 26% of cases reviewed. Major shortfalls identified were adherence to national guidelines and standards and, particularly, the organisation of care, including supervision and monitoring in primary care, with 70% of cases reviewed having at least one avoidable factor in this area. 5.4 million people in the UK are diagnosed with and actively treated for asthma, and approximately 60,000 are admitted to hospital with acute exacerbations each year. The majority of people with asthma receive management and treatment solely in primary care. This has therefore created concern that many people within the UK are receiving sub-optimal asthma care resulting in unnecessary morbidity and risk of adverse outcome. NRAD concluded that a national asthma audit programme should be established to measure and improve processes, organisation, and outcomes of asthma care. Objective: To develop a primary care dataset enabling extraction of information from GP practices in Wales and providing robust data by which results and lessons could be drawn and drive service development and improvement. Methods: A multidisciplinary group of experts, including general practitioners, primary care organisation representatives, and asthma patients was formed and used as a source of governance and guidance. A review of asthma literature, guidance, and standards took place and was used to identify areas of asthma care which, if improved, would lead to better patient outcomes. Modified Delphi methodology was used to gain consensus from the expert group on which of the areas identified were to be prioritised, and an asthma patient and carer focus group held to seek views and feedback on areas of asthma care that were important to them. Areas of asthma care identified by both groups were mapped to asthma guidelines and standards to inform and develop primary and secondary care datasets covering both adult and pediatric care. Dataset development consisted of expert review and a targeted consultation process in order to seek broad stakeholder views and feedback. Results: Areas of asthma care identified as requiring prioritisation by the National Asthma Audit were: (i) Prescribing, (ii) Asthma diagnosis (iii) Asthma Reviews (iv) Personalised Asthma Action Plans (PAAPs) (v) Primary care follow-up after discharge from hospital (vi) Methodologies and primary care queries were developed to cover each of the areas of poor and variable asthma care identified and the queries designed to extract information directly from electronic patients’ records. Conclusion: This paper describes the methodological approach followed to develop primary care datasets for a National Asthma Audit. It sets out the principles behind the establishment of a National Asthma Audit programme in response to a national asthma mortality review and describes the development activities undertaken. Key process elements included: (i) mapping identified areas of poor and variable asthma care to national guidelines and standards, (ii) early engagement of experts, including clinicians and patients in the process, and (iii) targeted consultation of the queries to provide further insight into measures that were collectable, reproducible and relevant.

Keywords: asthma, primary care, general practice, dataset development

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Authors: Mirosław Krzemieniewski, Marcin Zieliński, Marcin Dębowski

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Electrokinetic disintegration is one of the high-voltage electric methods. The design of systems is exceptionally simple. Biomass flows through a system of pipes with alongside mounted electrodes that generate an electric field. Discharges in the electric field deform cell walls and lead to their successive perforation, thereby making their contents easily available to bacteria. The spark-over occurs between electrode surface and pipe jacket which is the second pole and closes the circuit. The value of voltage ranges from 10 to 100kV. Electrodes are supplied by normal “power grid” monophase electric current (230V, 50Hz). Next, the electric current changes into direct current of 24V in modules serving for particular electrodes, and this current directly feeds the electrodes. The installation is completely safe because the value of generated current does not exceed 250mA and because conductors are grounded. Therefore, there is no risk of electric shock posed to the personnel, even in the case of failure or incorrect connection. Low values of the electric current mean small energy consumption by the electrode which is extremely low – only 35W per electrode – compared to other methods of disintegration. Pipes with electrodes with diameter of DN150 are made of acid-proof steel and connected from both sides with 90º elbows ended with flanges. The available S and U types of pipes enable very convenient fitting with system construction in the existing installations and rooms or facilitate space management in new applications. The system of pipes for electrokinetic disintegration may be installed horizontally, vertically, askew, on special stands or also directly on the wall of a room. The number of pipes and electrodes is determined by operating conditions as well as the quantity of substrate, type of biomass, content of dry matter, method of disintegration (single or circulatory), mounting site etc. The most effective method involves pre-treatment of substrate that may be pumped through the disintegration system on the way to the fermentation tank or recirculated in a buffered intermediate tank (substrate mixing tank). Biomass structure destruction in the process of electrokinetic disintegration causes shortening of substrate retention time in the tank and acceleration of biogas production. A significant intensification of the fermentation process was observed in the systems operating in the technical scale, with the greatest increase in biogas production reaching 18%. The secondary, but highly significant for the energetic balance, effect is a tangible decrease of energy input by agitators in tanks. It is due to reduced viscosity of the biomass after disintegration, and may result in energy savings reaching even 20-30% of the earlier noted consumption. Other observed phenomena include reduction in the layer of surface scum, reduced sewage capability for foaming and successive decrease in the quantity of bottom sludge banks. Considering the above, the system for electrokinetic disintegration seems a very interesting and valuable solutions meeting the offer of specialist equipment for the processing of plant biomass, including Virginia fanpetals, before the process of methane fermentation.

Keywords: electrokinetic disintegration, biomass, biogas production, fermentation, Virginia fanpetals

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Authors: Mustafa Metin Donma, Orkide Donma

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Childhood obesity is an important clinical problem because it may lead to chronic diseases during the adulthood period of the individual. Obesity is a metabolic disease associated with low-grade inflammation. The liver occurs at the center of metabolic pathways. Adropin, fibroblast growth factor-21 (FGF-21), and fetuin-A are hepatokines. Due to the immense participation of the liver in glucose metabolism, these liver-derived factors may be associated with insulin resistance (IR), which is a phenomenon discussed within the scope of obesity problems. The aim of this study is to determine the concentrations of adropin, FGF-21, and fetuin-A in childhood obesity, to point out possible differences between the obesity groups, and to investigate possible associations among these three hepatokines in obese and morbidly obese children. A total of one hundred and thirty-two children were included in the study. Two obese groups were constituted. The groups were matched in terms of mean ± SD values of ages. Body mass index values of obese and morbidly obese groups were 25.0 ± 3.5 kg/m² and 29.8 ± 5.7 kg/m², respectively. Anthropometric measurements including waist circumference, hip circumference, head circumference, and neck circumference were recorded. Informed consent forms were taken from the parents of the participants. The ethics committee of the institution approved the study protocol. Blood samples were obtained after overnight fasting. Routine biochemical tests, including glucose- and lipid-related parameters, were performed. Concentrations of the hepatokines (adropin, FGF-21, fetuin A) were determined by enzyme-linked immunosorbent assay. Insulin resistance indices such as homeostasis model assessment for IR (HOMA-IR), alanine transaminase-to aspartate transaminase ratio (ALT/AST), diagnostic obesity notation model assessment laboratory index, diagnostic obesity notation model assessment metabolic syndrome index as well as obesity indices such as diagnostic obesity notation model assessment-II index, and fat mass index were calculated using the previously derived formulas. Statistical evaluation of the study data as well as findings of the study was performed by SPSS for Windows. Statistical difference was accepted significant when p is smaller than 0.05. Statistically significant differences were found for insulin, triglyceride, high-density lipoprotein cholesterol levels of the groups. A significant increase was observed for FGF-21 concentrations in the morbidly obese group. Higher adropin and fetuin-A concentrations were observed in the same group in comparison with the values detected in the obese group (p > 0.05). There was no statistically significant difference between the ALT/AST values of the groups. In all of the remaining IR and obesity indices, significantly increased values were calculated for morbidly obese children. Significant correlations were detected between HOMA-IR and each of the hepatokines. The highest one was the association with fetuin-A (r=0.373, p=0.001). In conclusion, increased levels observed in adropin, FGF-21, and fetuin-A have shown that these hepatokines possess increasing potential going from obese to morbid obese state. Out of the correlations found with the IR index, the most affected hepatokine was fetuin-A, the parameter possibly used as the indicator of the advanced obesity stage.

Keywords: adropin, fetuin A, fibroblast growth factor-21, insulin resistance, pediatric obesity

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Authors: Jessica Neri, Elena Faccio

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In Europe, except for Denmark and Malta, the legal gender change and the stages of the possible process of gender transition are bound to the diagnosis of a gender identity disorder. The requirement of the evaluation of a mental disorder might have many implications on trans people’s self-representations, interpersonal relations in different social contexts and the therapeutic relations with clinicians during the transition. Psychopathological language may contribute to define the individual’s reality from normative presuppositions with value implications related to the dominant cultural principles. In an effort to mark the boundaries between sanity and pathology, it concurs to the definition of the management procedures of the constructed diversities and deviances, legitimizing the operational practices of particular professional figures. The aim of this research concerns the analysis of the diagnostic category of gender dysphoria contained in the last edition of the Diagnostic and Statistical Manual of Mental Disorders. In particular, this study focuses on the relationship between the implicit and explicit assumptions related to the expressions of gender non-conformity, that sustain the language and the criteria characterizing the Manual, and the possible implications on people’s narratives of transition. In order to achieve this objective two main research methods were used: historical reconstruction of the diagnostic category in the different versions of the Manual and content analysis of that category in the present version. From the historical analysis, in the medical and psychiatric field gender non-conformity has been predominantly explicated by naturalistic perspectives, naming it ‘transsexualism’ and collocating it in the category of gender identity disorder. Currently, pathological judged experiences are represented by gender dysphoria, described in the DSM-5 as the distress that may accompany the incongruence between one's experienced or expressed gender and one's assigned gender, specifying that there must be ‘evidence’ of this. Implicit theories about gender binary, parallelism between gender identity, sex and sexuality and the understanding of the mental health and the subject’s agency as subordinated to the expert knowledge, can be found in the process of designation of the category. A lack of awareness of the historical, social and political aspects connected to the cultural and normative dimensions at the basis of these implicit theories, can be noticed and data given by culture and data given by supposed -biological or psychological- nature, are often confused. This reductionist interpretation of gender and its presumed diversities legitimize the clinician to assume the role of searching and orienting, in a correctional perspective, the biographical elements that correspond to him specific expectations, with no space for other possibilities and identity configurations for people in transition. This research may contribute to the current critical debate about the epistemological foundation of the psychodiagnosis, emphasizing the pragmatic effects on the individuals and on the psychological practice in its wider social context. This work also permits to underline the risks due to the lack of awareness of the processes of social construction of the diagnostic system and its essential role of defence of the values that hold up the symbolic universe of reference.

Keywords: diagnosis, gender dysphoria, narratives, social constructionism

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Authors: Panagiota Katsikouli, William Hamilton Byrne, Thomas Gammeltoft-Hansen, Tijs Slaats

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An individual who demonstrates a well-founded fear of persecution or faces real risk of being subjected to torture is eligible for asylum. In Danish law, the exact legal thresholds reflect those established by international conventions, notably the 1951 Refugee Convention and the 1950 European Convention for Human Rights. These international treaties, however, remain largely silent when it comes to how states should assess asylum claims. As a result, national authorities are typically left to determine an individual’s legal eligibility on a narrow basis consisting of an oral testimony, which may itself be hampered by several factors, including imprecise language interpretation, insecurity or lacking trust towards the authorities among applicants. The leaky ground, on which authorities must assess their subjective perceptions of asylum applicants' credibility, questions whether, in all cases, adjudicators make the correct decision. Moreover, the subjective element in these assessments raises questions on whether individual asylum cases could be afflicted by implicit biases or stereotyping amongst adjudicators. In fact, recent studies have uncovered significant correlations between decision outcomes and the experience and gender of the assigned judge, as well as correlations between asylum outcomes and entirely external events such as weather and political elections. In this study, we analyze a publicly available dataset containing approximately 8,000 summaries of asylum cases, initially rejected, and re-tried by the Refugee Appeals Board (RAB) in Denmark. First, we look for variations in the recognition rates, with regards to a number of applicants’ features: their country of origin/nationality, their identified gender, their identified religion, their ethnicity, whether torture was mentioned in their case and if so, whether it was supported or not, and the year the applicant entered Denmark. In order to extract those features from the text summaries, as well as the final decision of the RAB, we applied natural language processing and regular expressions, adjusting for the Danish language. We observed interesting variations in recognition rates related to the applicants’ country of origin, ethnicity, year of entry and the support or not of torture claims, whenever those were made in the case. The appearance (or not) of significant variations in the recognition rates, does not necessarily imply (or not) bias in the decision-making progress. None of the considered features, with the exception maybe of the torture claims, should be decisive factors for an asylum seeker’s fate. We therefore investigate whether the decision can be predicted on the basis of these features, and consequently, whether biases are likely to exist in the decisionmaking progress. We employed a number of machine learning classifiers, and found that when using the applicant’s country of origin, religion, ethnicity and year of entry with a random forest classifier, or a decision tree, the prediction accuracy is as high as 82% and 85% respectively. tentially predictive properties with regards to the outcome of an asylum case. Our analysis and findings call for further investigation on the predictability of the outcome, on a larger dataset of 17,000 cases, which is undergoing.

Keywords: asylum adjudications, automated decision-making, machine learning, text mining

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Authors: Hanna Mamo Ergando

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Climate change is already having a severe influence on agriculture, affecting crop yields, the nutritional content of main grains, and livestock productivity. Significant adaptation investments will be necessary to sustain existing yields and enhance production and food quality to fulfill demand. Climate-smart agriculture (CSA) provides numerous potentials in this regard, combining a focus on enhancing agricultural output and incomes while also strengthening resilience and responding to climate change. To improve agriculture production and productivity, the Ethiopian government has adopted and implemented a series of strategies, including the recent agricultural cluster farming that is practiced as an effort to change, improve, and transform subsistence farming to modern, productive, market-oriented, and climate-smart approach through farmers production cluster. Besides, greater attention and focus have been given to wheat production and productivity by the government, and wheat is the major crop grown in cluster farming. Therefore, the objective of this assessment was to examine various opportunities and challenges farmers face in a cluster farming system. A qualitative research approach was used to generate primary and secondary data. Respondents were chosen using the purposeful sampling technique. Accordingly, experts from the Federal Ministry of Agriculture, the Ethiopian Agricultural Transformation Institute, the Ethiopian Agricultural Research Institute, and the Ethiopian Environment Protection Authority were interviewed. The assessment result revealed that farming in clusters is an economically viable technique for sustaining small, resource-limited, and socially disadvantaged farmers' agricultural businesses. The method assists farmers in consolidating their products and delivering them in bulk to save on transportation costs while increasing income. Smallholders' negotiating power has improved as a result of cluster membership, as has knowledge and information spillover. The key challenges, on the other hand, were identified as a lack of timely provision of modern inputs, insufficient access to credit services, conflict of interest in crop selection, and a lack of output market for agro-processing firms. Furthermore, farmers in the cluster farming approach grow wheat year after year without crop rotation or diversification techniques. Mono-cropping has disadvantages because it raises the likelihood of disease and insect outbreaks. This practice may result in long-term consequences, including soil degradation, reduced biodiversity, and economic risk for farmers. Therefore, the government must devote more resources to addressing the issue of environmental sustainability. Farmers' access to complementary services that promote production and marketing efficiencies through infrastructure and institutional services has to be improved. In general, the assessment begins with some hint that leads to a deeper study into the efficiency of the strategy implementation, upholding existing policy, and scaling up good practices in a sustainable and environmentally viable manner.

Keywords: cluster farming, smallholder farmers, wheat, challenges, opportunities

Procedia PDF Downloads 153

Authors: Gabriel Malgaresi, Sara Borazjani, Hadi Madani, Pavel Bedrikovetsky

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Suspension-Colloidal flow in porous media occurs in numerous engineering fields, such as industrial water treatment, the disposal of industrial wastes into aquifers with the propagation of contaminants and low salinity water injection into petroleum reservoirs. The main effects are particle mobilization and captured by the porous rock, which can cause pore plugging and permeability reduction which is known as formation damage. Various factors such as fluid salinity, pH, temperature, and rock properties affect particle detachment. Formation damage is unfavorable specifically near injection and production wells. One way to control formation damage is pre-treatment of the rock with nanoparticles. Adsorption of nanoparticles on fines and rock surfaces alters zeta-potential of the surfaces and enhances the attachment force between the rock and fine particles. The main objective of this study is to develop a two-stage mathematical model for (1) flow and adsorption of nanoparticles on the rock in the pre-treatment stage and (2) fines migration and permeability reduction during the water production after the pre-treatment. The model accounts for adsorption and desorption of nanoparticles, fines migration, and kinetics of particle capture. The system of equations allows for the exact solution. The non-self-similar wave-interaction problem was solved by the Method of Characteristics. The analytical model is new in two ways: First, it accounts for the specific boundary and initial condition describing the injection of nanoparticle and production from the pre-treated porous media; second, it contains the effect of nanoparticle sorption hysteresis. The derived analytical model contains explicit formulae for the concentration fronts along with pressure drop. The solution is used to determine the optimal injection concentration of nanoparticle to avoid formation damage. The mathematical model was validated via an innovative laboratory program. The laboratory study includes two sets of core-flood experiments: (1) production of water without nanoparticle pre-treatment; (2) pre-treatment of a similar core with nanoparticles followed by water production. Positively-charged Alumina nanoparticles with the average particle size of 100 nm were used for the rock pre-treatment. The core was saturated with the nanoparticles and then flushed with low salinity water; pressure drop across the core and the outlet fine concentration was monitored and used for model validation. The results of the analytical modeling showed a significant reduction in the fine outlet concentration and formation damage. This observation was in great agreement with the results of core-flood data. The exact solution accurately describes fines particle breakthroughs and evaluates the positive effect of nanoparticles in formation damage. We show that the adsorbed concentration of nanoparticle highly affects the permeability of the porous media. For the laboratory case presented, the reduction of permeability after 1 PVI production in the pre-treated scenario is 50% lower than the reference case. The main outcome of this study is to provide a validated mathematical model to evaluate the effect of nanoparticles on formation damage.

Keywords: nano-particles, formation damage, permeability, fines migration

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Authors: A. G. Back

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Urban planning is a relevant tool to address, in a systemic way, several sectoral policies capable of linking the urban agenda with the reduction of socio-environmental risks. The Sao Paulo’s master plan (2014) presents innovations capable of promoting the transition to sustainability in the urban space, with a view to its regulatory instruments related to i) promotion of density in the axes of mass transport involving the mixture of commercial, residential, services, and leisure uses (principles related to the compact city); ii) vulnerabilities reduction based on housing policies including regular sources of funds for social housing and land reservation in urbanized areas; iii) reserve of green areas in the city to create parks and environmental regulations for new buildings focused on reducing the effects of heat island and improving urban drainage. However, its long-term implementation involves distributive conflicts and can undergo changes in different political, economic, and social contexts over time. Thus, the main objective of this paper is to identify and analyze the dynamics of conflicts of interest between social groups in the implementation of Sao Paulo’s urban development policy, particularly in relation to recent attempts at a (re) interpretation of the Master Plan guidelines, in view of the proposals for revision of the urban zoning law. In this sense, we seek to identify the demands, narratives of urban actors, including the real estate market, middle-class neighborhood associations ('not in my backyard' movements), and social housing rights movements. And we seek to analyze the power resources that these actors mobilize to influence the decision-making process, involving five categories: social capital, political access; discursive resource; media, juridical resource. The major findings of this research suggest that the interests and demands of the real estate market do not always prevail in urban regulation. After all, other actors also press for the definition of urban law with interests opposite to those of the real estate market. This is the case of associations of middle-class neighborhoods, which work to protect the characteristics of the locality, acting, in general, to prevent constructive and population densification in neighborhoods well located near the center, in São Paulo. One of the main demands of these “not in my backyard” movements is the delimitation of exclusively residential areas in the central region of the city, which is not only contrary to the interests of the real state market but also contrary to the principles of the compact city. On the other hand, social housing rights movements have also made progress in delimiting special areas of social interest in well-located and valued areas in the city dedicated to building social housing, also contrary to the interests of the real estate market. An urban development that follows the principles of the compact city must take into account the insertion of low-income populations in well-located regions; otherwise, such a development model may continue to push the less favored to the peripheries towards the preservation areas and/or risk areas.

Keywords: interest groups, Sao Paulo, sustainable urban development, urban policies implementation

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Authors: Mohammad Al-Refai, Majed Wakid

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Introduction: Soil-transmitted diseases (STD) are caused by intestinal worms that are transmitted via various routes into the human body resulting in various clinical manifestations. The intestinal worms causing these infections are known as soil transmitted helminths (STH), including Hook worms, Ascaris lumbricoides (A. lumbricoides), Trichuris trichiura (T. trichiura), and Strongyloides sterocoralis (S. sterocoralis). Objectives: The aim of this study was to investigate the prevalence of STH among newly arrived expatriate labors in Jeddah city, Saudi Arabia, using three different techniques (direct smears, sedimentation concentration, and real-time PCR). Methods: A total of 188 stool specimens were collected and investigated at the parasitology laboratory in the Special Infectious Agents Unit at King Fahd Medical Research Center, King Abdulaziz University in Jeddah, Saudi Arabia. Microscopic examination of wet mount preparations using normal saline and Lugols Iodine was carried out, followed by the formal ether sedimentation method. In addition, real-time PCR was used as a molecular tool to detect several STH and hookworm speciation. Results: Out of 188 stool specimens analyzed, in addition to STH parasite, several other types were detected. 9 samples (4.79%) were positive for Entamoeba coli, 7 samples (3.72%) for T. trichiura, 6 samples (3.19%) for Necator americanus, 4 samples (2.13%) for S. sterocoralis, 4 samples (2.13%) for A. lumbricoides, 4 samples (2.13%) for E. histolytica, 3 samples (1.60%) for Blastocystis hominis, 2 samples (1.06%) for Ancylostoma duodenale, 2 samples (1.06%) for Giardia lamblia, 1 sample (0.53%) for Iodamoeba buetschlii, 1 sample (0.53%) for Hymenolepis nana, 1 sample (0.53%) for Endolimax nana, and 1 sample (0.53%) for Heterophyes heterophyes. Out of the 35 infected cases, 26 revealed single infection, 8 with double infections, and only one triple infection of different STH species and other intestinal parasites. Higher rates of STH infections were detected among housemaids (11 cases) followed by drivers (7 cases) when compared to other occupations. According to educational level, illiterate participants represent the majority of infected workers (12 cases). The majority of workers' positive cases were from the Philippines. In comparison between laboratory techniques, out of the 188 samples screened for STH, real-time PCR was able to detect the DNA in (19/188) samples followed by Ritchie sedimentation technique (18/188), and direct wet smear (7/188). Conclusion: STH infections are a major public health issue to healthcare systems around the world. Communities must be educated on hygiene practices and the severity of such parasites to human health. As far as drivers and housemaids come to close contact with families, including children and elderlies. This may put family members at risk of developing serious side effects related to STH, especially as the majority of workers were illiterate, lacking the basic hygiene knowledge and practices. We recommend the official authority in Jeddah and around the kingdom of Saudi Arabia to revise the standard screening tests for newly arrived workers and enforce regular follow-up inspections to minimize the chances of the spread of STH from expatriate workers to the public.

Keywords: expatriate labors, Jeddah, prevalence, soil transmitted helminths

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Authors: Mehmet Salih Bayraktutan, Emre Tokmak

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Great Ararat Volcano is the highest peak in South Caucasus Volcanic Plateau. Uplifted by Quaternary basaltic pyroclastic and lava flows. Numerous volcanic cones formed along with the tensional fractures under N-S compressional geodynamic framework. Basaltic flows have fresh surface morphology give ages of 650-680 K years. Hyperstene andesites constitute a major mass of Greater Ararat gives ages of 450-490 K years. During the early eruption period, predominately pyroclastics, cinder, lapilly-ash volcanic bombs were extruded. Third-period eruptions dominantly basaltic lava flows. Andesitic domes aligned along with the NW-SE striking fractures. Hyalo basalt and hornblende basaltic lavas are the latest lava eruptions. Hyalo-basaltic eruptions occurred via parasitic cones distributed far from the center. Parasitic cones are most common at the foot of Mount covered by recent NW flowing basaltic lava. Some of the cones are distributed on a circular pattern. One of the most hazardous disasters recorded in Eastern Turkey was July 1840 Cehennem Canyon Flood. Volcanic activities seismically triggered resulted in melting of glacier cap, mixed with ash and pyroclastics, flowed down along the Valley. Mud rich Slush urged catastrophically northwards, crossed Ars River and damned Surmeli Basin, forming reservoir behind. Ararat volcanoes are located on NW-SE striking Agri Fault Zone. Right lateral extensional faults, along which a series of andesitic domes formed. Great Ararat, in general strato-type volcano. This huge structure, developed in two main parts with different topographic and morphological features. The large lower base covers a widespread area composed of predominantly pyroclastics, ignimbrites, aglomerates, thick pumice, perlite deposits. Approximately 1/3 of the Crest by height formed of this basement. And 2/3 of the upper part with a conic- shape composed of basaltic lava flows. The active tectonic structure consists of three different patterns. The first network is radially distributed fractures formed during the last stage of lava eruptions. The second group of active faults striking in NW direction, and continue in N30W strike, formes Igdir Fault Zone. The third set of faults, dipping in the northwest with 75-80 degrees, strikes NE- SW across the whole Mount, slicing Great Ararat into four segments. In the upper stage of Cehennem Canyon, this set cutting volcanic layers caused numerous Waterfalls, Rock Avalanches, Mud Flows along the canyon, threatens the Village of Yanidogan, at the apex of flood deposits. Great Ararat Region has high seismo-tectonic risk and by occurrence frequency and magnitude, which caused in history caused heavy disasters, at villages surrounding the Ararat Basement.

Keywords: Eastern Turkey, geohazard, great ararat volcano, seismo-tectonic features

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Authors: Prescilla Lambert, Christophe Roos, Mounim Lebrini

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For several years, the Caribbean islands and West Africa have had to deal with the massive arrival of the brown seaweed Sargassum. Overall, this macroalgae, which constitutes a habitat for a great diversity of marine organisms, is also an additional stress factor for the marine environment (e.g., coral reefs). In addition, the accumulation followed by the significant decomposition of the Sargassum spp. biomass on the coast leads to the release of toxic gases (H₂S and NH₃), which calls into question the functioning of the economic, health and tourist life of the island and the other interested territories. Originally, these algae are formed by the eutrophication of the oceans accentuated by global warming. Unfortunately, scientists predict a significant recurrence of these Sargassum strandings for years to come. It is therefore more than necessary to find solutions by putting in place a sustainable management plan for this phenomenon. Martinique, a small island in the Caribbean arc, is one of the many areas impacted by Sargassum seaweed strandings. Since 2011, there has been a constant increase in the degradation of the materials present in this region, largely due to toxic/corrosive gases released by the algae decomposition. In order to protect the structures and the vulnerable building materials while limiting the use of synthetic/petroleum based molecules as much as possible, research is being conducted on molecules of natural origin. Thus, thanks to the chemical composition, which comprise molecules with interesting properties, algae such as Sargassum could potentially help to solve many issues. Therefore, this study focuses on the green extraction and characterization of molecules from the species Sargassum fluitans and Sargassum natans present in Martinique. The secondary metabolites found in these extracts showed variability in yield rates due to local climatic conditions. The tests carried out shed light on the anticorrosive and antibacterial potential of the algae. These extracts can thus be described as natural inhibitors. The effect of variation in inhibitor concentrations was tested in electrochemistry using electrochemical impedance spectroscopy and polarization curves. The analysis of electrochemical results obtained by direct immersion in the extracts and self-assembled molecular layers (SAMs) for Sargassum fluitans III, Sargassum natans I and VIII species was conclusive in acid and alkaline environments. The excellent results obtained reveal an inhibitory efficacy of 88% at 50mg/L for the crude extract of Sargassum fluitans III and efficacies greater than 97% for the chemical families of Sargassum fluitans III. Similarly, microbiological tests also suggest a bactericidal character. Results for Sargassum fluitans III crude extract show a minimum inhibitory concentration (MIC) of 0.005 mg/mL on Gram-negative bacteria and a MIC greater than 0.6 mg/mL on Gram-positive bacteria. These results make it possible to consider the management of local and international issues while valuing a biomass rich in biodegradable molecules. The next step in this study will therefore be the evaluation of the toxicity of Sargassum spp..

Keywords: Sargassum, secondary metabolites, anticorrosive, antibacterial, natural inhibitors

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Authors: Riadh Zorgati, Thomas Triboulet

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In quite diverse application areas such as astronomy, medical imaging, geophysics or nondestructive evaluation, many problems related to calibration, fitting or estimation of a large number of input parameters of a model from a small amount of output noisy data, can be cast as inverse problems. Due to noisy data corruption, insufficient data and model errors, most inverse problems are ill-posed in a Hadamard sense, i.e. existence, uniqueness and stability of the solution are not guaranteed. A wide class of inverse problems in physics relates to the Fredholm equation of the first kind. The ill-posedness of such inverse problem results, after discretization, in a very ill-conditioned linear system of equations, the condition number of the associated matrix can typically range from 109 to 1018. This condition number plays the role of an amplifier of uncertainties on data during inversion and then, renders the inverse problem difficult to handle numerically. Similar problems appear in other areas such as numerical optimization when using interior points algorithms for solving linear programs leads to face ill-conditioned systems of linear equations. Devising efficient solution approaches for such system of equations is therefore of great practical interest. Efficient iterative algorithms are proposed for solving a system of linear equations. The approach is based on a preconditioning of the initial matrix of the system with an approximation of a generalized inverse leading to a stochastic preconditioned matrix. This approach, valid for non-negative matrices, is first extended to hermitian, semi-definite positive matrices and then generalized to any complex rectangular matrices. The main results obtained are as follows: 1) We are able to build a generalized inverse of any complex rectangular matrix which satisfies the convergence condition requested in iterative algorithms for solving a system of linear equations. This completes the (short) list of generalized inverse having this property, after Kaczmarz and Cimmino matrices. Theoretical results on both the characterization of the type of generalized inverse obtained and the convergence are derived. 2) Thanks to its properties, this matrix can be efficiently used in different solving schemes as Richardson-Tanabe or preconditioned conjugate gradients. 3) By using Lp norms, we propose generalized Kaczmarz’s type matrices. We also show how Cimmino's matrix can be considered as a particular case consisting in choosing the Euclidian norm in an asymmetrical structure. 4) Regarding numerical results obtained on some pathological well-known test-cases (Hilbert, Nakasaka, …), some of the proposed algorithms are empirically shown to be more efficient on ill-conditioned problems and more robust to error propagation than the known classical techniques we have tested (Gauss, Moore-Penrose inverse, minimum residue, conjugate gradients, Kaczmarz, Cimmino). We end on a very early prospective application of our approach based on stochastic matrices aiming at computing some parameters (such as the extreme values, the mean, the variance, …) of the solution of a linear system prior to its resolution. Such an approach, if it were to be efficient, would be a source of information on the solution of a system of linear equations.

Keywords: conditioning, generalized inverse, linear system, norms, stochastic matrix

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Authors: Irene Kalemaki, Ioanna Garefi

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Social Innovation Education (SIE) is a new educational approach that aims to empower students to take action for a more democratic and sustainable society. Conceptually and pedagogically wise, it is situated at the intersection of Enterprise Education and Citizenship Education as it aspires to i) combine action with activism, ii) personal development with collective efficacy, iii) entrepreneurial mindsets with democratic values and iv) individual competences with collective competences. This paper abstract presents the work of the NEMESIS project, funded by H2020, that aims to design, test and validate the first consolidated approach for embedding Social Innovation Education in schools of primary and secondary education. During the academic year 2018-2019, eight schools from five European countries experimented with different approaches and methodologies to incorporate SIE in their settings. This paper reports briefly on these attempts and discusses the wider educational philosophy underlying these interventions with a particular focus on analyzing the learning outcomes and impact on students. That said, this paper doesn’t only report on the theoretical and practical underpinnings of SIE, but most importantly, it provides evidence on the impact of SIE on students. In terms of methodology, the study took place from September 2018 to July 2019 in eight schools from Greece, Spain, Portugal, France, and the UK involving directly 56 teachers, 1030 students and 69 community stakeholders. Focus groups, semi-structured interviews, classroom observations as well as students' written narratives were used to extract data on the impact of SIE on students. The overall design of the evaluation activities was informed by a realist approach, which enabled us to go beyond “what happened” and towards understanding “why it happened”. Research findings suggested that SIE can benefit students in terms of their emotional, cognitive, behavioral and agentic engagement. Specifically, the emotional engagement of students was increased because through SIE interventions; students voice was heard, valued, and acted upon. This made students feel important to their school, increasing their sense of belonging, confidence and level of autonomy. As regards cognitive engagement, both students and teachers reported positive outcomes as SIE enabled students to take ownership of their ideas to drive their projects forward and thus felt more motivated to perform in class because it felt personal, important and relevant to them. In terms of behavioral engagement, the inclusive environment and the collective relationships that were reinforced through the SIE interventions had a direct positive impact on behaviors among peers. Finally, with regard to agentic engagement, it has been observed that students became very proactive which was connected to the strong sense of ownership and enthusiasm developed during collective efforts to deliver real-life social innovations. Concluding, from a practical and policy point of view these research findings could encourage the inclusion of SIE in schools, while from a research point of view, they could contribute to the scientific discourse providing evidence and clarity on the emergent field of SIE.

Keywords: education, engagement, social innovation, students

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Authors: Siddharudha B. Patil

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Cotton is a premier commercial fibre crop of India subjected to ravages of insect pests. Sucking pests viz thrips, Thrips tabaci,(lind) leaf hopper Amrsca devastance,(dist) miridbug, Poppiocapsidea beseratense (Dist) and bollworms continue to inflict damage Bt Cotton right from seeding stage. Their infestation impact cotton yield to an extent of 30-40 percent. Chemical control is still adoptable as one of the techniques for combating these pests. Presently, growers have many challenges in selecting effective chemicals which fit in with an integrated pest management. Spinetoram has broad spectrum with excellent insecticidal activity against both sucking pests and bollworms. Hence, it is expected to make a great contribution to stable production and quality improvement of agricultural products. Spinetoram is a derivative of biologically active substances (Spinosyns) produced by soil actinomycetes, Saccharopolypara spinosa which is semi synthetic active ingredient representing Spinosyn chemical class of insecticide and has demonstrated higher level of efficacy with reduced risk on beneficial arthropods. The efforts were made in the present study to test the efficacy of Spinetoram against sucking pests and bollworms in comparison with other insecticides in Bt Cotton under field condition. Field experiment was laid out during 2013-14 and 2014-15 at Agricultural Research station Dharwad (Karnataka-India) in a randomized block design comprising eight treatments and three replications. Bt cotton genotype, Bunny BG-II was sown in a plot size of 5.4 m x5.4 m. Recommend agronomical practices were followed. The Spinetoram 12% SC alone and incombination with sulfaxaflore with varied dosages against pest complex was tested. Performance was compared with Spinosad 45% SC and thiamethoxam 25% WG. The results of consecutive seasons revealed that nonsignificant difference in thrips and leafhopper population and varied significantly after 3 days of imposition. Among the treatments, combiproduct, Spinetoram 10%WG + Sulfoxaflor 30% WG@ 140 gai/ha registered lowest population of thrips (3.91/3 leaves) and leaf hoppers (1.08/3 leaves) followed by its lower dosages viz 120 gai/ha (4.86/3 leaves and 1.14/3 leaves of thrips and leaf hoppers, respectively) and 100 gai/ha (6.02 and 1.23./3 leaves of thrips and leaf hoppers respectively) being at par, significantly superior to rest of the treatments. On the contrary, the population of thrips, leaf hopper and miridbugs in untreated control was on higher side. Similarly the higher dosage of Spinetoram 10% WG+ Sulfoxaflor 30% WG (140 gai/ha) proved its bioefficacy by registering lowest miridbug incidence of 1.70/25 squares, followed by its lower dosage (1.78 and 1.83/25 squares respectively) Further observation made on bollworms incidence revealed that the higher dosage of Spinetoram 10% WG+Sulfoxaflor 30% WG (140 gai/ha) registered lowest percentage of boll damage (7.22%), more number of good opened bolls (36.89/plant) and higher seed cotton yield (19.45q/ha) followed by rest of its lower dosages, Spinetoram 12% SC alone and Spinosad 45% SC being at par significantly superior to rest of the treatments. However, significantly higher boll damage (15.13%) and lower seed cotton yield (14.45 q/ha) was registered in untreated control. Thus Spinetoram10% WG+Sulfoxaflor 30% WG can be a promising option for pest management in Bt Cotton.

Keywords: Spinetoram10% WG+Sulfoxaflor 30% WG, sucking pests, bollworms, Bt cotton, management

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Authors: Dahna Alkahtani, Faryal Suraya, Fadah Alanazi

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Background: Buccal mucosal graft for urethral augmentation has surpassed other grafting options, and is now considered the standard of choice for substitution Urethroplasty. The graft has gained its popularity due to its excellent short and long-term results, easy harvesting as well as its ability in withstanding wet environments. However, although Buccal mucosal grafts are an excellent option, it is not free of complications, potential intraoral complications are bleeding, pain, swelling, injury to the nerve resulting in numbness, lip deviation or retraction. Objectives: The current study aims to evaluate the intraoral complications of buccal mucosa grafts harvested from one cheek, and used in Augmentation Urethroplasty. Methodology: The study was conducted retrospectively using the medical records of patients who underwent open augmentation urethroplasty with a buccal mucosa graft at King Khalid University Hospital, Saudi Arabia. Data collection of demographics included the type of graft used, presence or absence of strictures and its etiological factors. Pre-operative and post-operative evaluations were carried out on the subjects including the medical history, physical examination, uroflowmetry, retrograde urethrography, voiding cystourethrography and urine cultures were also noted. Further, the quality of life and complications of the procedure including the presence or occurrence of bleeding within 3-days post-procedure, the severity of pain, oral swelling after grafting, length of return to normal daily diet, painful surgical site, intake of painkillers, presence or absence of speech disturbance, numbness in the cheeks and lips were documented. Results: Thirty-two male subjects with ages ranging from 15 years to 72 years were included in the current study. Following the procedure, a hundred percent of the subjects returned to their normal daily diet by the sixth postoperative day. Further, the majority of the patients reported experiencing mild pain accounting for 61.3%, and 90.3% of the subjects reported using painkillers to control the pain. Surgical wound Pain was reportedly more common at the perineal site as 48.4% of the subjects experienced it; on the other hand, 41.9% of the patients experienced pain in the oral mucosa. The presence of speech disorders, as assessed through medical history, was found to be present in 3.2% of patients. The presence of numbness in the cheeks and lips was found in 3.2% of patients. Other complications such as parotid duct injury, delayed wound healing, non-healing wound and suture granuloma were rare as 90.3% of the subjects denied experiencing any of them, there were nonetheless reports of parotid duct injury by 6.5% of the patients, and non-healing wound by the 3.2% of patients. Conclusion: Buccal Mucosa Graft in Augmentation Urethroplasty is an ideal source of allograft, although not entirely painless; it is considerably safe with minimal intra-oral complication and undetectable strain on the patients’ quality of life.

Keywords: augmentation, buccal, graft, oral

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Authors: Ana Rodrigues, Maria Cadilhe, Filipa Ferreira, Claudia Pereira, Marta Santos

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Professional paths must be understood in the multiplicity of their possible configurations. While some actors tend to represent their path as a harmonious succession of positions in the life cycle, most recognize the existence of unforeseen and uncontrollable bifurcations, caused, for example, by a work accident or by going through a period of unemployment. Considering the intensified challenges posed by the ongoing societal changes (e.g., technological and demographic), and looking at the Portuguese context, where the unemployment rate continues to be more evident in certain age groups, like in individuals aged 45 years or over, it is essential to support those adults by providing strategies capable of supporting them during professional transitions, being this a joint responsibility of governments, employers, workers, educational institutions, among others. Concerned about those issues, Porto City Council launched the challenge of designing and implementing a Lifelong Career Guidance program, which was answered with the presentation of a customized conceptual and operational model: groWing|Lifelong Career Guidance. A pilot project targeting working-age adults (35 or older) who were unemployed was carried out, aiming to support them to reconstruct their professional paths, through the recovery of their past experiences and through a reflection about dimensions such as skills, interests, constraints, and labor market. A research action approach was used to assess the proposed model, namely the perceived relevance of the theme and of the project, by adults themselves (N=44), employment professionals (N=15) and local companies (N=15), in an integrated manner. A set of activities were carried out: a train the trainer course and a monitoring session with employment professionals; collective and individual sessions with adults, including a monitoring session as well; and a workshop with local companies. Support materials for individual/collective reflection about professional paths were created and adjusted for each involved agent. An evaluation model was co-build by different stakeholders. Assessment was carried through a form created for the purpose, completed at the end of the different activities, which allowed us to collect quantitative and qualitative data. Statistical analysis was carried through SPSS software. Results showed that the participants, as well as the employment professionals and the companies involved, considered both the topic and the project as extremely relevant. Also, adults saw the project as an opportunity to reflect on their paths and become aware of the opportunities and the necessary conditions to achieve their goals; the professionals highlighted the support given by an integrated methodology and the existence of tools to assist the process; companies valued the opportunity to think about the topic and the possible initiatives they could implement within the company to diversify their recruitment pool. The results allow us to conclude that, in the local context under study, there is an alignment between different agents regarding the pertinence of supporting adults with work experience in professional transitions, seeing the project as a relevant strategy to address this issue, which justifies that it can be extended in time and to other working-age adults in the future.

Keywords: professional paths, research action, turning points, lifelong career guidance, relevance

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Authors: Rishana Bilimoria, Selina Tang, Sajni Shah, Marianne Henien, Christopher Sproat

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Temporomandibular disorders (TMD) may affect up to a third of the general population, and there is evidence demonstrating the majority of Myofascial TMD cases improve after education and conservative measures. In 2015 our department implemented a modified care pathway for myofascial TMD patients in an attempt to improve the patient journey. This involved the use of an interactive group therapy approach to deliver education, reinforce conservative measures and promote self-management. Patient reported experience measures from the new group clinic revealed 71% patient satisfaction. This service is efficient in improving aspects of health status while reducing health-care costs and redistributing clinical time. Since its’ establishment, 52 hours of clinical time, resources and funding have been redirected effectively. This Quality Improvement Project was initiated because it was felt that this new service was being underutilised by our surgical teams. The ‘Plan-Do-Study-Act cycle’ (PDSA) framework was employed to analyse utilisation of the service: The ‘plan’ stage involved outlining our aims: to raise awareness amongst clinicians of the unified care pathway and to increase referral to this clinic. The ‘do’ stage involved collecting data from a sample of 96 patients over 4 month period to ascertain the proportion of Myofascial TMD patients who were correctly referred to the designated clinic. ‘Suitable’ patients who weren’t referred were identified. The ‘Study’ phase involved analysis of results, which revealed that 77% of suitable patients weren’t referred to the designated clinic. They were reviewed on other clinics, which are often overbooked, or managed by junior staff members. This correlated with our original prediction. Barriers to referral included: lack of awareness of the clinic, individual consultant treatment preferences and patient, reluctance to be referred to a ‘group’ clinic. The ‘Act’ stage involved presenting our findings to the team at a clinical governance meeting. This included demonstration of the clinical effectiveness of the care-pathway and explaining the referral route and criteria. In light of the evaluation results, it was decided to keep the group clinic and maximize utilisation. The second cycle of data collection following these changes revealed that of 66 Myofascial TMD patients over a 4 month period, only 9% of suitable patients were not seen via the designated pathway; therefore this QIP was successful in meeting the set objectives. Overall, employing the PDSA cycle in this QIP resulted in appropriate utilisation of the modified care pathway for patients with myofascial TMD in Guy’s Oral Surgery Department. In turn, this leads to high patient satisfaction with the service and effectively redirected 52 hours of clinical time. It permitted adoption of a collaborative working style with oral surgery colleagues to investigate problems, identify solutions, and collectively raise standards of clinical care to ensure we adopt a unified care pathway in secondary care management of Myofascial TMD patients.

Keywords: myofascial, quality Improvement, PDSA, TMD

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