Search results for: nurses resilience
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 1365

Search results for: nurses resilience

225 Enhancing Nursing Students’ Communication Using TeamSTEPPS to Improve Patient Safety

Authors: Stefanie Santorsola, Natasha Frank

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Improving healthcare safety necessitates examining current trends and beliefs about safety and devising strategies to improve. Errors in healthcare continue to increase and be experienced by patients, which is preventable and directly correlated to a breakdown in healthcare communication. TeamSTEPPS is an evidence-based process designed to improve the quality and safety of healthcare by improving communication and team processes. Communication is at the core of effective team collaboration and is vital for patient safety. TeamSTEPPS offers insights and strategies for improving communication and teamwork and reducing preventable errors to create a safer healthcare environment for patients. The academic, clinical, and educational environment for nursing students is vital in preparing them for professional practice by providing them with foundational knowledge and abilities. This environment provides them with a prime opportunity to learn about errors and the importance of effective communication to enhance patient safety, as nursing students are often unprepared to deal with errors. Proactively introducing and discussing errors through a supportive culture during the nursing student’s academic beginnings has the potential to carry key concepts into practice to improve and enhance patient safety. TeamSTEPPS has been used globally and has collectively positively impacted improvements in patient safety and teamwork. A workshop study was introduced in winter 2023 of registered practical nurses (RPN) students bridging to the baccalaureate nursing program; the majority of the RPNs in the bridging program were actively employed in a variety of healthcare facilities during the semester. The workshop study did receive academic institution ethics board approval, and participants signed a consent form prior to participating in the study. The premise of the workshop was to introduce TeamSTEPPS and a variety of strategies to these students and have students keep a reflective journal to incorporate the presented communication strategies in their practicum setting and keep a reflective journal on the effect and outcomes of the strategies in the healthcare setting. Findings from the workshop study supported the objective of the project, resulting in students verbalizing notable improvements in team functioning in the healthcare environment resulting from the incorporation of enhanced communication strategies from TeamSTEPPS that they were introduced to in the workshop study. Implication for educational institutions is the potential of further advancing the safety literacy and abilities of nursing students in preparing them for entering the workforce and improving safety for patients.

Keywords: teamstepps, education, patient safety, communication

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224 Climate Species Lists: A Combination of Methods for Urban Areas

Authors: Andrea Gion Saluz, Tal Hertig, Axel Heinrich, Stefan Stevanovic

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Higher temperatures, seasonal changes in precipitation, and extreme weather events are increasingly affecting trees. To counteract the increasing challenges of urban trees, strategies are increasingly being sought to preserve existing tree populations on the one hand and to prepare for the coming years on the other. One such strategy lies in strategic climate tree species selection. The search is on for species or varieties that can cope with the new climatic conditions. Many efforts in German-speaking countries deal with this in detail, such as the tree lists of the German Conference of Garden Authorities (GALK), the project Stadtgrün 2021, or the instruments of the Climate Species Matrix by Prof. Dr. Roloff. In this context, different methods for a correct species selection are offered. One possibility is to select certain physiological attributes that indicate the climate resilience of a species. To calculate the dissimilarity of the present climate of different geographic regions in relation to the future climate of any city, a weighted (standardized) Euclidean distance (SED) for seasonal climate values is calculated for each region of the Earth. The calculation was performed in the QGIS geographic information system, using global raster datasets on monthly climate values in the 1981-2010 standard period. Data from a European forest inventory were used to identify tree species growing in the calculated analogue climate regions. The inventory used is the compilation of georeferenced point data at a 1 km grid resolution on the occurrence of tree species in 21 European countries. In this project, the results of the methodological application are shown for the city of Zurich for the year 2060. In the first step, analog climate regions based on projected climate values for the measuring station Kirche Fluntern (ZH) were searched for. In a further step, the methods mentioned above were applied to generate tree species lists for the city of Zurich. These lists were then qualitatively evaluated with respect to the suitability of the different tree species for the Zurich area to generate a cleaned and thus usable list of possible future tree species.

Keywords: climate change, climate region, climate tree, urban tree

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223 Integration of Technology into Nursing Education: A Collaboration between College of Nursing and University Research Center

Authors: Lori Lioce, Gary Maddux, Norven Goddard, Ishella Fogle, Bernard Schroer

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This paper presents the integration of technologies into nursing education. The collaborative effort includes the College of Nursing (CoN) at the University of Alabama in Huntsville (UAH) and the UAH Systems Management and Production Center (SMAP). The faculty at the CoN conducts needs assessments to identify education and training requirements. A team of CoN faculty and SMAP engineers then prioritize these requirements and establish improvement/development teams. The development teams consist of nurses to evaluate the models and to provide feedback and of undergraduate engineering students and their senior staff mentors from SMAP. The SMAP engineering staff develops and creates the physical models using 3D printing, silicone molds and specialized molding mixtures and techniques. The collaboration has focused on developing teaching and training, or clinical, simulators. In addition, the onset of the Covid-19 pandemic has intensified this relationship, as 3D modeling shifted to supplied personal protection equipment (PPE) to local health care providers. A secondary collaboration has been introducing students to clinical benchmarking through the UAH Center for Management and Economic Research. As a result of these successful collaborations the Model Exchange & Development of Nursing & Engineering Technology (MEDNET) has been established. MEDNET seeks to extend and expand the linkage between engineering and nursing to K-12 schools, technical schools and medical facilities in the region to the resources available from the CoN and SMAP. As an example, stereolithography (STL) files of the 3D printed models, along with the specifications to fabricate models, are available on the MEDNET website. Ten 3D printed models have been developed and are currently in use by the CoN. The following additional training simulators are currently under development:1) suture pads, 2) gelatin wound models and 3) printed wound tattoos. Specification sheets have been written for these simulations that describe the use, fabrication procedures and parts list. These specifications are available for viewing and download on MEDNET. Included in this paper are 1) descriptions of CoN, SMAP and MEDNET, 2) collaborative process used in product improvement/development, 3) 3D printed models of training and teaching simulators, 4) training simulators under development with specification sheets, 5) family care practice benchmarking, 6) integrating the simulators into the nursing curriculum, 7) utilizing MEDNET as a pandemic response, and 8) conclusions and lessons learned.

Keywords: 3D printing, nursing education, simulation, trainers

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222 Pressures of a Pandemic on the Perinatal Women: Experiences of Welsh Women

Authors: Filiz Celik, Rachel Harrad, Rob Keasley, Paul Bennett

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The COVID-19 pandemic has posed a significant challenge to many, with some groups with particular vulnerability to adverse psychological impacts. These include those disadvantaged by mental ill health, either pre-existing or occurring during pregnancy or post-partum. Using a qualitative approach, the research aimed to identify the challenges posed by COVID-19 to women, their infants and families during the perinatal period and to suggest what further support can help alleviate the adverse mental health impact of COVID-19. 21 expectant and new mothers who were currently receiving support via a peri-natal mental health service participated in semi-structured interviews. In these interviews, participants explored the impact of changes in social circumstances and healthcare providers as a result of COVID-19 restrictions, with the resultant audio recordings transcribed and analyzed using Reflexive Thematic Analysis (RTA). Based on these accounts, it was concluded that women, their partners and potentially their infants experienced heightened peri-natal distress, and their experience at this time increased their risk for future mental health problems. Women described emerging as more vulnerable, owing to their role as primary caregivers during the perinatal period and also explained how social isolation and limited access to services meant protective buffers against mental health deterioration were reduced and the resources they needed in order to develop resilience were weakened. Although partners were invited to take part in the research, a sizeable volume of data could not be generated to fully assess the impact of the pandemic on a partner’s mental well-being. However, women expressed concerns about the paternal mental health of partners and husbands which invites us to be further vigilant to paternal mental health and associated experiences. Overall, these interviews serve to highlight and provide a voice to these women and their families who describe experiencing disadvantage at an already vulnerable time in their lives, as well as illustrating the need for services to prioritize the needs of this population when acute events strike, be those future pandemics or other disasters.

Keywords: patient experience, perinatal mental health, covid-19 pandemic, heightened anxiety, birth trauma, post-natal well-being

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221 Household Earthquake Absorptive Capacity Impact on Food Security: A Case Study in Rural Costa Rica

Authors: Laura Rodríguez Amaya

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The impact of natural disasters on food security can be devastating, especially in rural settings where livelihoods are closely tied to their productive assets. In hazards studies, absorptive capacity is seen as a threshold that impacts the degree of people’s recovery after a natural disaster. Increasing our understanding of households’ capacity to absorb natural disaster shocks can provide the international community with viable measurements for assessing at-risk communities’ resilience to food insecurities. The purpose of this study is to identify the most important factors in determining a household’s capacity to absorb the impact of a natural disaster. This is an empirical study conducted in six communities in Costa Rica affected by earthquakes. The Earthquake Impact Index was developed for the selection of the communities in this study. The households coded as total loss in the selected communities constituted the sampling frame from which the sample population was drawn. Because of the study area geographically dispersion over a large surface, the stratified clustered sampling hybrid technique was selected. Of the 302 households identified as total loss in the six communities, a total of 126 households were surveyed, constituting 42 percent of the sampling frame. A list of indicators compiled based on theoretical and exploratory grounds for the absorptive capacity construct served to guide the survey development. These indicators were included in the following variables: (1) use of informal safety nets, (2) Coping Strategy, (3) Physical Connectivity, and (4) Infrastructure Damage. A multivariate data analysis was conducted using Statistical Package for Social Sciences (SPSS). The results show that informal safety nets such as family and friends assistance exerted the greatest influence on the ability of households to absorb the impact of earthquakes. In conclusion, communities that experienced the highest environmental impact and human loss got disconnected from the social networks needed to absorb the shock’s impact. This resulted in higher levels of household food insecurity.

Keywords: absorptive capacity, earthquake, food security, rural

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220 Resourcing for Post-Disaster Housing Reconstruction: The Case of Cyclone Sidr and Aila in Bangladesh

Authors: Zahidul Islam

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This study investigates the effectiveness of resourcing in post-disaster housing reconstruction with reference to Cyclones Sidr and Aila in Bangladesh. Through evaluating three key theories- Build Back Better approach, Balance Scorecard approach and Dynamic Competency theories, the synthesis of literature, and empirical fieldwork, this research develops a dynamic theoretical framework that moves the trajectory of post-disaster housing reconstruction towards the reconstruction of more resilient houses. The ultimate goal of any post-disaster housing reconstruction project is to provide quality houses and to achieve high levels of satisfaction for beneficiaries. However, post-disaster reconstruction projects often fail in their stated objectives; only 10-20% housing needs are met, with most houses constructed on a temporary rather than permanent basis. A number of scholars have argued that access to resources can significantly increase the capacity and capability of disaster victims to rebuild their lives, including the construction of new homes. This study draws on structured interviews of 285 villagers affected by cyclones to investigate the effectiveness of resourcing in rebuilding houses after Cyclone Sidr in 2007 and Cyclone Aila in 2009. Furthermore, semi-structured interviews were conducted with 20 key stakeholders in UNDP, Oxfam, government officials, and national and international NGOs. The results of this study show that recovery rate of cyclone resilient houses that can withstand cyclone is very low and majority of the population are still vulnerable. Furthermore, hierarchical regression of survey data and thematic analyses of qualitative data indicate that access to resources, level of education, quality of building materials and income generating activities of the respondents are critical for effective post-disaster recovery. Conversely, resource availability, lack of coordination among participant organisations, corruption and lack of access to appropriate land constituted significant obstacles to livelihood recovery. Finally, this study makes significant theoretical contributions to theories of post-disaster recovery by introducing new variables and measures for evaluating the quality and effectiveness of post-disaster housing.

Keywords: disaster, resourcing, housing, resilience

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219 Sorghum Resilience and Sustainability under Limiting and Non-limiting Conditions of Water and Nitrogen

Authors: Muhammad Tanveer Altaf, Mehmet Bedir, Waqas Liaqat, Gönül Cömertpay, Volkan Çatalkaya, Celaluddin Barutçular, Nergiz Çoban, Ibrahim Cerit, Muhammad Azhar Nadeem, Tolga Karaköy, Faheem Shehzad Baloch

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Food production needs to be almost double by 2050 in order to feed around 9 billion people around the Globe. Plant production mostly relies on fertilizers, which also have one of the main roles in environmental pollution. In addition to this, climatic conditions are unpredictable, and the earth is expected to face severe drought conditions in the future. Therefore, water and fertilizers, especially nitrogen are considered as main constraints for future food security. To face these challenges, developing integrative approaches for germplasm characterization and selecting the resilient genotypes performing under limiting conditions is very crucial for effective breeding to meet the food requirement under climatic change scenarios. This study is part of the European Research Area Network (ERANET) project for the characterization of the diversity panel of 172 sorghum accessions and six hybrids as control cultivars under limiting (+N/-H2O, -N/+H2O) and non-limiting conditions (+N+H2O). This study was planned to characterize the sorghum diversity in relation to resource Use Efficiency (RUE), with special attention on harnessing the interaction between genotype and environment (GxE) from a physiological and agronomic perspective. Experiments were conducted at Adana, a Mediterranean climate, with augmented design, and data on various agronomic and physiological parameters were recorded. Plentiful diversity was observed in the sorghum diversity panel and significant variations were seen among the limiting water and nitrogen conditions in comparison with the control experiment. Potential genotypes with the best performance are identified under limiting conditions. Whole genome resequencing was performed for whole germplasm under investigation for diversity analysis. GWAS analysis will be performed using genotypic and phenotypic data and linked markers will be identified. The results of this study will show the adaptation and improvement of sorghum under climate change conditions for future food security.

Keywords: germplasm, sorghum, drought, nitrogen, resources use efficiency, sequencing

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218 A Theoretical Framework of Patient Autonomy in a High-Tech Care Context

Authors: Catharina Lindberg, Cecilia Fagerstrom, Ania Willman

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Patients in high-tech care environments are usually dependent on both formal/informal caregivers and technology, highlighting their vulnerability and challenging their autonomy. Autonomy presumes that a person has education, experience, self-discipline and decision-making capacity. Reference to autonomy in relation to patients in high-tech care environments could, therefore, be considered paradoxical, as in most cases these persons have impaired physical and/or metacognitive capacity. Therefore, to understand the prerequisites for patients to experience autonomy in high-tech care environments and to support them, there is a need to enhance knowledge and understanding of the concept of patient autonomy in this care context. The development of concepts and theories in a practice discipline such as nursing helps to improve both nursing care and nursing education. Theoretical development is important when clarifying a discipline, hence, a theoretical framework could be of use to nurses in high-tech care environments to support and defend the patient’s autonomy. A meta-synthesis was performed with the intention to be interpretative and not aggregative in nature. An amalgamation was made of the results from three previous studies, carried out by members of the same research group, focusing on the phenomenon of patient autonomy from a patient perspective within a caring context. Three basic approaches to theory development: derivation, synthesis, and analysis provided an operational structure that permitted the researchers to move back and forth between these approaches during their work in developing a theoretical framework. The results from the synthesis delineated that patient autonomy in a high-tech care context is: To be in control though trust, co-determination, and transition in everyday life. The theoretical framework contains several components creating the prerequisites for patient autonomy. Assumptions and propositional statements that guide theory development was also outlined, as were guiding principles for use in day-to-day nursing care. Four strategies used by patients to remain or obtain patient autonomy in high-tech care environments were revealed: the strategy of control, the strategy of partnership, the strategy of trust, and the strategy of transition. This study suggests an extended knowledge base founded on theoretical reasoning about patient autonomy, providing an understanding of the strategies used by patients to achieve autonomy in the role of patient, in high-tech care environments. When possessing knowledge about the patient perspective of autonomy, the nurse/carer can avoid adopting a paternalistic or maternalistic approach. Instead, the patient can be considered to be a partner in care, allowing care to be provided that supports him/her in remaining/becoming an autonomous person in the role of patient.

Keywords: autonomy, caring, concept development, high-tech care, theory development

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217 Modified Fuzzy Delphi Method to Incorporate Healthcare Stakeholders’ Perspectives in Selecting Quality Improvement Projects’ Criteria

Authors: Alia Aldarmaki, Ahmad Elshennawy

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There is a global shift in healthcare systems’ emphasizing engaging different stakeholders in selecting quality improvement initiatives and incorporating their preferences to improve the healthcare efficiency and outcomes. Although experts bring scientific knowledge based on the scientific model and their personal experience, other stakeholders can bring new insights and information into the decision-making process. This study attempts to explore the impact of incorporating different stakeholders’ preference in identifying the most significant criteria that should be considered in healthcare for electing the improvement projects. A Framework based on a modified Fuzzy Delphi Method (FDM) was built. In addition to, the subject matter experts, doctors/physicians, nurses, administrators, and managers groups contribute to the selection process. The research identifies potential criteria for evaluating projects in healthcare, then utilizes FDM to capture expertise knowledge. The first round in FDM is intended to validate the identified list of criteria from experts; which includes collecting additional criteria from experts that the literature might have overlooked. When an acceptable level of consensus has been reached, a second round is conducted to obtain experts’ and other related stakeholders’ opinions on the appropriate weight of each criterion’s importance using linguistic variables. FDM analyses eliminate or retain the criteria to produce a final list of the critical criteria to select improvement projects in healthcare. Finally, reliability and validity were investigated using Cronbach’s alpha and factor analysis, respectively. Two case studies were carried out in a public hospital in the United Arab Emirates to test the framework. Both cases demonstrate that even though there were common criteria between the experts and the stakeholders, still stakeholders’ perceptions bring additional critical criteria into the evaluation process, which can impact the outcomes. Experts selected criteria related to strategical and managerial aspects, while the other participants preferred criteria related to social aspects such as health and safety and patients’ satisfaction. The health and safety criterion had the highest important weight in both cases. The analysis showed that Cronbach’s alpha value is 0.977 and all criteria have factor loading greater than 0.3. In conclusion, the inclusion of stakeholders’ perspectives is intended to enhance stakeholders’ engagement, improve transparency throughout the decision process, and take robust decisions.

Keywords: Fuzzy Delphi Method, fuzzy number, healthcare, stakeholders

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216 A Multiple Perspectives Approach on the Well-Being of Students with Autism Spectrum Disorder

Authors: Joanne Danker, Iva Strnadová, Therese Cumming

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As a consequence of the increased evidence of the bi-directional relationship between student well-being and positive educational outcomes, there has been a surge in the number of research studies dedicated to understanding the notion of student well-being and the ways to enhance it. In spite of these efforts, the concept of student well-being remains elusive. Additionally, studies on student well-being mainly consulted adults' perspectives and failed to take into account students' views, which if considered, could contribute to a clearer understanding of the complex concept of student well-being. Furthermore, there is a lack of studies focusing on the well-being of students with autism spectrum disorder (ASD), and these students continue to fare worse in post-school outcomes as compared to students without disabilities, indicating a significant gap in the current research literature. Findings from research conducted on students without disabilities may not be applicable to students with ASD as their educational experiences may differ due to the characteristics associated with ASD. Thus, the purpose of this study was to explore how students with ASD, their parents, and teachers conceptualise student well-being. It also aims to identify the barriers and assets of the well-being of these students. To collect data, 19 teachers and 11 parents participated in interviews while 16 high school students with ASD were involved in a photovoice project regarding their well-being in school. Grounded theory approaches such as open and axial coding, memo-writing, diagramming, and making constant comparisons were adopted to analyse the data. All three groups of participants conceptualised student well-being as a multidimensional construct consisting of several domains. These domains were relationships, engagement, positive/negative emotions, and accomplishment. Three categories of barriers were identified. These were environmental, attitudes and behaviours of others, and impact of characteristics associated with ASD. The identified internal assets that could contribute to student well-being were acceptance, resilience, self-regulation, and ability to work with others. External assets were knowledgeable and inclusive school community, and having access to various school programs and resources. It is crucial that schools and policymakers provide ample resources and programs to adequately support the development of each identified domain of student well-being. This could in turn enhance student well-being and lead to more successful educational outcomes for students with ASD.

Keywords: autism spectrum disorder, grounded theory approach, school experiences, student well-being

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215 Food Sharing App and the Ubuntu Ssharing Economy: Accessing the Impact of Technology of Food Waste Reduction

Authors: Gabriel Sunday Ayayia

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Food waste remains a critical global challenge with significant environmental, economic, and ethical implications. In an era where food waste and food insecurity coexist, innovative technology-driven solutions have emerged, aiming to bridge the gap between surplus food and those in need. Simultaneously, disparities in food access persist, exacerbating issues of hunger and malnutrition. Emerging food-sharing apps offer a promising avenue to mitigate these problems but require further examination within the context of the Ubuntu sharing economy. This study seeks to understand the impact of food-sharing apps, guided by the principles of Ubuntu, on reducing food waste and enhancing food access. The study examines how specific food-sharing apps within the Ubuntu sharing economy could contribute to fostering community resilience and reducing food waste. Ubuntu underscores the idea that we are all responsible for the well-being of our community members. In the context of food waste, this means that individuals and businesses have a collective responsibility to ensure that surplus food is shared rather than wasted. Food-sharing apps align with this principle by facilitating the sharing of excess food with those in need, transforming waste into a communal resource. This research employs a mixed-methods approach of both quantitative analysis and qualitative inquiry. Large-scale surveys will be conducted to assess user behavior, attitudes, and experiences with food-sharing apps, focusing on the frequency of use, motivations, and perceived impacts. Qualitative interviews with app users, community organizers, and stakeholders will explore the Ubuntu-inspired aspects of food-sharing apps and their influence on reducing food waste and improving food access. Quantitative data will be analyzed using statistical techniques, while qualitative data will undergo thematic analysis to identify key patterns and insights. This research addresses a critical gap in the literature by examining the role of food-sharing apps in reducing food waste and enhancing food access, particularly within the Ubuntu sharing economy framework. Findings will offer valuable insights for policymakers, technology developers, and communities seeking to leverage technology to create a more just and sustainable food system.

Keywords: sharing economy, food waste reduction, technology, community- based approach

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214 Santo Niño in Canada: Religion, Migration, and the Filipino Underside

Authors: Alison Marshall

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“Santo Niño in Canada – Religion, Migration, and the Filipino Underside” seeks to explore the intersection of religion, migration and the Filipino underside through research participant narratives, archival research, and fieldwork on the cult of Santo Niño in Canada. Santo Niño is the single most revered saint in Filipino religiosity. According to popular lore, the original statue of Santo Niño was brought to the Philippines by Portuguese explorer Ferdinand Magellan in 1521, who claimed the islands on behalf of Spain. While Santo Niño is meant to be a manifestation of Jesus as a child, in Filipino thought and culture he very much resembles pre-Hispanic spirits, as well as patron saints introduced by the Spanish. Santo Niño shrines appear in churches, restaurants, businesses, and homes throughout the diaspora suggesting that he was much more than a Catholic image. He represents a deity who often shares a business or home shrine with non-Christian statues such as lucky cats, the Buddha, Guanyin, and Guangong, and sometimes the Chinese God of the Earth. He represents how Christian culture has been refashioned through indigenous, Chinese, Malay, and Indonesian influences. He embodies the religious superstructure that defines Christian piety and habits. On the one hand, he stands for Jesus, a pious son of God, and yet, on the other hand, he can be a simple vindictive child who punishes those who ignore him. Santo Niño is a complex character linked to the past before Christianity. As Filipinos engage with Santo Niño in Canada, they connect to him as Jesus, the son of God. They are also connecting to a childlike figure who sometimes uses his spiritual power to punish. A hybrid figure who comes came into being at the beginning of the Spanish colonial moment, he is maintained throughout the American one and continues to be a powerful reminder of Filipino identity and resilience when people leave the Philippines for migrant work. As this paper argues, Santo Niño beliefs, practices, and stories unite people in the diaspora regardless of language, gender, or nation. Santo Niño enables one to think about and understand what it means to be Filipino and living migrant lives in the diaspora today. In this way, the cult of Santo Niño expresses both Catholic orthodoxy and the heterodox Filipino underside that includes the use of magical amulets, healing, visions, and spirit mediumship.

Keywords: ethnography, migration, Philippines, religion

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213 Restoring Urban South Africa through a Sustainable Green Infrastructure Approach

Authors: Z. Goosen, E. J. Cilliers

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Referring to the entire green network within urban environments, at all spatial scales, green infrastructure is considered as an important constituent of sustainable development within urban areas through planning for a healthy environment and simultaneously improving quality of life for the people. Green infrastructure has made its appearance internationally in terms of the infrastructural urban environment focussing on ecological systems and sustaining society while building with nature. Within South Africa, the terminology of green infrastructure has, however, not continuously been entertained, mainly due to more pressing realities and challenges faced within urban areas of South Africa that include but are not limited to basic service provision, financial constraints and a lack of guiding policies and frameworks. But the notion of green infrastructure planning has changes, creating a newfound movement within urban areas of South Africa encouraging green infrastructure for urban resilience. Although green infrastructure is not an entirely new concept within the local context of South Africa, the benefits thereof constantly needs to be identified in order to measure the value of green infrastructure. Consequently challenges faces within urban areas of South Africa, in terms of human and nature, could be restored through focussing on a sustainable green infrastructure approach. This study does not focus on the pressing challenges and realities faced within urban areas of South Africa but rather aims solely on improving a green infrastructure approach within urban areas of South Africa. At the outset, the study will commence by introducing the concept of a green infrastructure approach by means of a local and international comparison. This will ensure an improved conceptual understanding of green infrastructure within a local South African context. The green infrastructure concept will be elaborated on through the inclusion of South African case study evaluations. The selected case studies will illustrate existing green infrastructure implementation within South Africa along with the benefits provided through the implementation thereof in terms of human (the people) and nature (the natural environment). As green infrastructure within South Africa continues to remain a fairly new concept with moderate levels of implementation thereof, room for improving on the approach in terms of implementation and maintenance exist. For this reason, the study will conclude with alternative green infrastructure suggestions and approaches to possibly be enforced within South Africa, led by international best practices.

Keywords: green infrastructure, international best practices, sustainability, urban South Africa

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212 A Multidimensional Indicator-Based Framework to Assess the Sustainability of Productive Green Roofs: A Case Study in Madrid

Authors: Francesca Maria Melucci, Marco Panettieri, Rocco Roma

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Cities are at the forefront of achieving the sustainable development goals set out in the Sustainable Development Goals of Agenda 2030. For these reasons, increasing attention has been given to the creation of resilient, sustainable, inclusive and green cities and finding solutions to these problems is one of the greatest challenges faced by researchers today. In particular urban green infrastructures, including green roofs, play a key role in tackling environmental, social and economic problems. The starting point was an extensive literature review on 1. research developments on the benefits (environmental, economic and social) and implications of green roofs; 2. sustainability assessment and applied methodologies; 3. specific indicators to measure impacts on urban sustainability. Through this review, the appropriate qualitative and quantitative characteristics that are part of the complex 'green roof' system were identified, as studies that holistically capture its multifunctional nature are still lacking. So, this paper aims to find a method to improve community participation in green roof initiatives and support local governance processes in developing efficient proposals to achieve better sustainability and resilience of cities. To this aim, the multidimensional indicator-based framework, presented by Tapia in 2021, has been tested for the first time in the case of a green roof in the city of Madrid. The framework's set of indicators was implemented with other indicators such as those of waste management and circularity (OECD Inventory of Circular Economy indicators) and sustainability performance. The specific indicators to be used in the case study were decided after a consultation phase with relevant stakeholders. Data on the community's willingness to participate in green roof implementation initiatives were collected through interviews and online surveys with a heterogeneous sample of citizens. The results of the application of the framework suggest how the different aspects of sustainability influence the choice of a green roof and provide input on the main mechanisms involved in citizens' willingness to participate in such initiatives.

Keywords: urban agriculture, green roof, urban sustainability, indicators, multi-criteria analysis

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211 The Role of Strategic Metals in Cr-Al-Pt-V Composition of Protective Bond Coats

Authors: A. M. Pashayev, A. S. Samedov, T. B. Usubaliyev, N. Sh. Yusifov

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Different types of coating technologies are widely used for gas turbine blades. Thermal barrier coatings, consisting of ceramic top coat, thermally grown oxide and a metallic bond coat are used in applications for thermal protection of hot section components in gas turbine engines. Operational characteristics and longevity of high-temperature turbine blades substantially depend on a right choice of composition of the protective thermal barrier coatings. At a choice of composition of a coating and content of the basic elements it is necessary to consider following factors, as minimum distinctions of coefficients of thermal expansions of elements, level of working temperatures and composition of the oxidizing environment, defining the conditions for the formation of protective layers, intensity of diffusive processes and degradation speed of protective properties of elements, extent of influence on the fatigue durability of details during operation, using of elements with high characteristics of thermal stability and satisfactory resilience of gas corrosion, density, hardness, thermal conduction and other physical characteristics. Forecasting and a choice of a thermal barrier coating composition, all above factors at the same time cannot be considered, as some of these characteristics are defined by experimental studies. The implemented studies and investigations show that one of the main failures of coatings used on gas turbine blades is related to not fully taking the physical-chemical features of elements into consideration during the determination of the composition of alloys. It leads to the formation of more difficult spatial structure, composition which also changes chaotically in some interval of concentration that doesn't promote thermal and structural firmness of a coating. For the purpose of increasing the thermal and structural resistant of gas turbine blade coatings is offered a new approach to forecasting of composition on the basis of analysis of physical-chemical characteristics of alloys taking into account the size factor, electron configuration, type of crystal lattices and Darken-Gurry method. As a result, of calculations and experimental investigations is offered the new four-component metallic bond coat on the basis of chrome for the gas turbine blades.

Keywords: gas turbine blades, thermal barrier coating, metallic bond coat, strategic metals, physical-chemical features

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210 Assessing Acceptability and Preference of Printed Posters on COVID-19 Related Stigma: A Post-Test Study Among HIV-Focused Health Workers in Greater Accra Region of Ghana

Authors: Jerry Fiave, Dacosta Aboagye, Stephen Ayisi-Addo, Mabel Kissiwah Asafo, Felix Osei-Sarpong, Ebenezer Kye-Mensah, Renee Opare-Otoo

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Background: Acceptability and preference of social and behaviour change (SBC) materials by target audiences is an important determinant of effective health communication outcomes. In Ghana, however, pre-test and post-test studies on acceptability and preference of specific SBC materials for specific audiences are rare. The aim of this study was therefore to assess the acceptability and preference of printed posters on COVID-19 related stigma as suitable SBC materials for health workers to influence behaviours that promote uptake of HIV-focused services. Methods: A total of 218 health workers who provide HIV-focused services were purposively sampled in 16 polyclinics where the posters were distributed in the Greater Accra region of Ghana. Data was collected in March 2021 using an adapted self-administered questionnaire in Google forms deployed via WhatsApp to participants. The data were imported into SPSS version 27 where chi-square test and regression analyses were performed to establish association as well as strength of association between variables respectively. Results: A total of 142 participants (physicians, nurses, midwives, lab scientists, health promoters, diseases control officers) made up of 85(60%) females and 57(40%) males responded to the questionnaire, giving a response rate of 65.14%. Only 88 (61.97%) of the respondents were exposed to the posters. The majority of those exposed said the posters were informative [82(93.18%)], relevant [85(96.59%)] and attractive [83(94.32%)]. They [82(93.20%)] also rated the material as acceptable with no statistically significant association between category of health worker and acceptability of the posters (X =1.631, df=5, p=0.898). However, participants’ most preferred forms of material on COVID-19 related stigma were social media [38(26.76%)], television [33(23.24%)], SMS [19(13.38%)], and radio [18(12.70%)]. Clinical health workers were 4.88 times more likely to prefer online or electronic versions of SBC materials than nonclinical health workers [AOR= 4.88 (95% CI= 0.31-0.98), p=0.034]. Conclusions: Printed posters on COVID-19 related stigma are acceptable SBC materials in communicating behaviour change messages that target health workers in promoting uptake of HIV-focused services. Posters are however, not among the most preferred materials for health workers. It is therefore recommended that material assessment studies are conducted to inform the development of acceptable and preferred materials for target audiences.

Keywords: acceptability, AIDS, HIV, posters, preference, SBC, stigma, social and behaviour change communication

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209 Influencing Factors for Job Satisfaction and Turnover Intention of Surgical Team in the Operating Rooms

Authors: Shu Jiuan Chen, Shu Fen Wu, I. Ling Tsai, Chia Yu Chen, Yen Lin Liu, Chen-Fuh Lam

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Background: Increased emotional stress in workplace and depressed job satisfaction may significantly affect the turnover intention and career life of personnel. However, very limited studies have reported the factors influencing the turnover intention of the surgical team members in the operating rooms, where extraordinary stress is normally exit in this isolated medical care unit. Therefore, this study aimed to determine the environmental and personal characteristic factors that might be associated with job satisfaction and turnover intention in the non-physician staff who work in the operating rooms. Methods: This was a cross-sectional, descriptive study performed in a metropolitan teaching hospital in southern Taiwan between May 2017 to July 2017. A structured self-administered questionnaire, modified from the Practice Environment Scale of the Nursing Work Index (PES-NWI), Occupational Stress Indicator-2 (OSI-2) and Maslach Burnout Inventory (MBI) manual was collected from the operating room nurses, nurse anesthetists, surgeon assistants, orderly and other non-physician staff. Numerical and categorical data were analyzed using unpaired t-test and Chi-square test, as appropriate (SPSS, version 20.0). Results: A total of 167 effective questionnaires were collected from 200 eligible, non-physician personnel who worked in the operating room (response rate 83.5%). The overall satisfaction of all responders was 45.64 ± 7.17. In comparison to those who had more than 4-year working experience in the operating rooms, the junior staff ( ≤ 4-year experience) reported to have significantly higher satisfaction in workplace environment and job contentment, as well as lower intention to quit (t = 6.325, P =0.000). Among the different specialties of surgical team members, nurse anesthetists were associated with significantly lower levels of job satisfaction (P=0.043) and intention to stay (x² = 8.127, P < 0.05). Multivariate regression analysis demonstrates job title, seniority, working shifts and job satisfaction are the significant independent predicting factors for quit jobs. Conclusion: The results of this study highlight that increased work seniorities ( > 4-year working experience) are associated with significantly lower job satisfaction, and they are also more likely to leave their current job. Increased workload in supervising the juniors without appropriate job compensation (such as promotions in job title and work shifts) may precipitate their intention to quit. Since the senior staffs are usually the leaders and core members in the operating rooms, the retention of this fundamental manpower is essential to ensure the safety and efficacy of surgical interventions in the operating rooms.

Keywords: surgical team, job satisfaction, resignation intention, operating room

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208 Rural Livelihood under a Changing Climate Pattern in the Zio District of Togo, West Africa

Authors: Martial Amou

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This study was carried out to assess the situation of households’ livelihood under a changing climate pattern in the Zio district of Togo, West Africa. The study examined three important aspects: (i) assessment of households’ livelihood situation under a changing climate pattern, (ii) farmers’ perception and understanding of local climate change, (iii) determinants of adaptation strategies undertaken in cropping pattern to climate change. To this end, secondary sources of data, and survey data collected from 235 farmers in four villages in the study area were used. Adapted conceptual framework from Sustainable Livelihood Framework of DFID, two steps Binary Logistic Regression Model and descriptive statistics were used in this study as methodological approaches. Based on Sustainable Livelihood Approach (SLA), various factors revolving around the livelihoods of the rural community were grouped into social, natural, physical, human, and financial capital. Thus, the study came up that households’ livelihood situation represented by the overall livelihood index in the study area (34%) is below the standard average households’ livelihood security index (50%). The natural capital was found as the poorest asset (13%) and this will severely affect the sustainability of livelihood in the long run. The result from descriptive statistics and the first step regression (selection model) indicated that most of the farmers in the study area have clear understanding of climate change even though they do not have any idea about greenhouse gases as the main cause behind the issue. From the second step regression (output model) result, education, farming experience, access to credit, access to extension services, cropland size, membership of a social group, distance to the nearest input market, were found to be the significant determinants of adaptation measures undertaken in cropping pattern by farmers in the study area. Based on the result of this study, recommendations are made to farmers, policy makers, institutions, and development service providers in order to better target interventions which build, promote or facilitate the adoption of adaptation measures with potential to build resilience to climate change and then improve rural livelihood.

Keywords: climate change, rural livelihood, cropping pattern, adaptation, Zio District

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207 Study on Runoff Allocation Responsibilities of Different Land Uses in a Single Catchment Area

Authors: Chuan-Ming Tung, Jin-Cheng Fu, Chia-En Feng

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In recent years, the rapid development of urban land in Taiwan has led to the constant increase of the areas of impervious surface, which has increased the risk of waterlogging during heavy rainfall. Therefore, in recent years, promoting runoff allocation responsibilities has often been used as a means of reducing regional flooding. In this study, the single catchment area covering both urban and rural land as the study area is discussed. Based on Storm Water Management Model, urban and rural land in a single catchment area was explored to develop the runoff allocation responsibilities according to their respective control regulation on land use. The impacts of runoff increment and reduction in sub-catchment area were studied to understand the impact of highly developed urban land on the reduction of flood risk of rural land at the back end. The results showed that the rainfall with 1 hour short delay of 2 years, 5 years, 10 years, and 25 years return period. If the study area was fully developed, the peak discharge at the outlet would increase by 24.46% -22.97% without runoff allocation responsibilities. The front-end urban land would increase runoff from back-end of rural land by 76.19% -46.51%. However, if runoff allocation responsibilities were carried out in the study area, the peak discharge could be reduced by 58.38-63.08%, which could make the front-end to reduce 54.05% -23.81% of the peak flow to the back-end. In addition, the researchers found that if it was seen from the perspective of runoff allocation responsibilities of per unit area, the residential area of urban land would benefit from the relevant laws and regulations of the urban system, which would have a better effect of reducing flood than the residential land in rural land. For rural land, the development scale of residential land was generally small, which made the effect of flood reduction better than that of industrial land. Agricultural land requires a large area of land, resulting in the lowest share of the flow per unit area. From the point of the planners, this study suggests that for the rural land around the city, its responsibility should be assigned to share the runoff. And setting up rain water storage facilities in the same way as urban land, can also take stock of agricultural land resources to increase the ridge of field for flood storage, in order to improve regional disaster reduction capacity and resilience.

Keywords: runoff allocation responsibilities, land use, flood mitigation, SWMM

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206 Digital Immunity System for Healthcare Data Security

Authors: Nihar Bheda

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Protecting digital assets such as networks, systems, and data from advanced cyber threats is the aim of Digital Immunity Systems (DIS), which are a subset of cybersecurity. With features like continuous monitoring, coordinated reactions, and long-term adaptation, DIS seeks to mimic biological immunity. This minimizes downtime by automatically identifying and eliminating threats. Traditional security measures, such as firewalls and antivirus software, are insufficient for enterprises, such as healthcare providers, given the rapid evolution of cyber threats. The number of medical record breaches that have occurred in recent years is proof that attackers are finding healthcare data to be an increasingly valuable target. However, obstacles to enhancing security include outdated systems, financial limitations, and a lack of knowledge. DIS is an advancement in cyber defenses designed specifically for healthcare settings. Protection akin to an "immune system" is produced by core capabilities such as anomaly detection, access controls, and policy enforcement. Coordination of responses across IT infrastructure to contain attacks is made possible by automation and orchestration. Massive amounts of data are analyzed by AI and machine learning to find new threats. After an incident, self-healing enables services to resume quickly. The implementation of DIS is consistent with the healthcare industry's urgent requirement for resilient data security in light of evolving risks and strict guidelines. With resilient systems, it can help organizations lower business risk, minimize the effects of breaches, and preserve patient care continuity. DIS will be essential for protecting a variety of environments, including cloud computing and the Internet of medical devices, as healthcare providers quickly adopt new technologies. DIS lowers traditional security overhead for IT departments and offers automated protection, even though it requires an initial investment. In the near future, DIS may prove to be essential for small clinics, blood banks, imaging centers, large hospitals, and other healthcare organizations. Cyber resilience can become attainable for the whole healthcare ecosystem with customized DIS implementations.

Keywords: digital immunity system, cybersecurity, healthcare data, emerging technology

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205 Tapping Traditional Environmental Knowledge: Lessons for Disaster Policy Formulation in India

Authors: Aparna Sengupta

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The paper seeks to find answers to the question as to why India’s disaster management policies have been unable to deliver the desired results. Are the shortcomings in policy formulation, effective policy implementation or timely prevention mechanisms? Or is there a fundamental issue of policy formulation which sparsely takes into account the cultural specificities and uniqueness, technological know-how, educational, religious and attitudinal capacities of the target population into consideration? India was slow in legislating disaster policies but more than that the reason for lesser success of disaster polices seems to be the gap between policy and the people. We not only keep hearing about the failure of governmental efforts but also how the local communities deal far more efficaciously with disasters utilizing their traditional knowledge. The 2004 Indian Ocean tsunami which killed 250,000 people (approx.) could not kill the tribal communities who saved themselves due to their age-old traditional knowledge. This large scale disaster, considered as a landmark event in history of disasters in the twenty-first century, can be attributed in bringing and confirming the importance of Traditional Environmental Knowledge in managing disasters. This brings forth the importance of cultural and traditional know-how in dealing with natural disasters and one is forced to question as to why shouldn’t traditional environmental knowledge (TEK) be taken into consideration while formulating India’s disaster resilience policies? Though at the international level, many scholars have explored the connectedness of disaster to cultural dimensions and several research examined how culture acts as a stimuli in perceiving disasters and their management (Clifford, 1956; Mcluckie, 1970; Koentjaraningrat, 1985; Peacock, 1997; Elliot et.al, 2006; Aruntoi, 2008; Kulatunga, 2010). But in the Indian context, this field of inquiry i.e. linking disaster policies with tradition and generational understanding has seldom received attention of the government, decision- making authorities, disaster managers and even in the academia. The present study attempts to fill this gap in research and scholarship by presenting an historical analysis of disaster and its cognition by cultural communities in India. The paper seeks to interlink the cultural comprehension of Indian tribal communities with scientific-technology towards more constructive disaster policies in India.

Keywords: culture, disasters, local communities, traditional knowledge

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204 Tackling Inequalities in Regional Health Care: Accompanying an Inter-Sectoral Cooperation Project between University Medicine and Regional Care Structures

Authors: Susanne Ferschl, Peter Holzmüller, Elisabeth Wacker

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Ageing populations, advances in medical sciences and digitalization, diversity and social disparities, as well as the increasing need for skilled healthcare professionals, are challenging healthcare systems around the globe. To address these challenges, future healthcare systems need to center on human needs taking into account the living environments that shape individuals’ knowledge of and opportunities to access healthcare. Moreover, health should be considered as a common good and an integral part of securing livelihoods for all people. Therefore, the adoption of a systems approach, as well as inter-disciplinary and inter-sectoral cooperation among healthcare providers, are essential. Additionally, the active engagement of target groups in the planning and design of healthcare structures is indispensable to understand and respect individuals’ health and livelihood needs. We will present the research project b4 – identifying needs | building bridges | developing health care in the social space, which is situated within this reasoning and accompanies the cross-sectoral cooperation project Brückenschlag (building bridges) in a Bavarian district. Brückenschlag seeks to explore effective ways of health care linking university medicine (Maximalversorgung | maximum care) with regional inpatient, outpatient, rehabilitative, and preventive care structures (Regionalversorgung | regional care). To create advantages for both (potential) patients and the involved cooperation partners, project b4 qualitatively assesses needs and motivations among professionals, population groups, and political stakeholders at individual and collective levels. Besides providing an overview of the project structure as well as of regional population and healthcare characteristics, the first results of qualitative interviews conducted with different health experts will be presented. Interviewed experts include managers of participating hospitals, nurses, medical specialists working in the hospital and registered doctors operating in practices in rural areas. At the end of the project life and based on the identified factors relevant to the success -and also for failure- of participatory cooperation in health care, the project aims at informing other districts embarking on similar systems-oriented and human-centered healthcare projects. Individuals’ health care needs in dependence on the social space in which they live will guide the development of recommendations.

Keywords: cross-sectoral collaboration in health care, human-centered health care, regional health care, individual and structural health conditions

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203 Improving Screening and Treatment of Binge Eating Disorders in Pediatric Weight Management Clinic through a Quality Improvement Framework

Authors: Cristina Fernandez, Felix Amparano, John Tumberger, Stephani Stancil, Sarah Hampl, Brooke Sweeney, Amy R. Beck, Helena H Laroche, Jared Tucker, Eileen Chaves, Sara Gould, Matthew Lindquist, Lora Edwards, Renee Arensberg, Meredith Dreyer, Jazmine Cedeno, Alleen Cummins, Jennifer Lisondra, Katie Cox, Kelsey Dean, Rachel Perera, Nicholas A. Clark

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Background: Adolescents with obesity are at higher risk of disordered eating than the general population. Detection of eating disorders (ED) is difficult. Screening questionnaires may aid in early detection of ED. Our team’s prior efforts focused on increasing ED screening rates to ≥90% using a validated 10-question adolescent binge eating disorder screening questionnaire (ADO-BED). This aim was achieved. We then aimed to improve treatment plan initiation of patients ≥12 years of age who screen positive for BED within our WMC from 33% to 70% within 12 months. Methods: Our WMC is within a tertiary-care, free-standing children’s hospital. A3, an improvement framework, was used. A multidisciplinary team (physicians, nurses, registered dietitians, psychologists, and exercise physiologists) was created. The outcome measure was documentation of treatment plan initiation of those who screen positive (goal 70%). The process measure was ADO-BED screening rate of WMC patients (goal ≥90%). Plan-Do-Study-Act (PDSA) cycle 1 included provider education on current literature and treatment plan initiation based upon ADO-BED responses. PDSA 2 involved increasing documentation of treatment plan and retrain process to providers. Pre-defined treatment plans were: 1) repeat screen in 3-6 months, 2) resources provided only, or 3) comprehensive multidisciplinary weight management team evaluation. Run charts monitored impact over time. Results: Within 9 months, 166 patients were seen in WMC. Process measure showed sustained performance above goal (mean 98%). Outcome measure showed special cause improvement from mean of 33% to 100% (n=31). Of treatment plans provided, 45% received Plan 1, 4% Plan 2, and 46% Plan 3. Conclusion: Through a multidisciplinary improvement team approach, we maintained sustained ADO-BED screening performance, and, prior to our 12-month timeline, achieved our project aim. Our efforts may serve as a model for other multidisciplinary WMCs. Next steps may include expanding project scope to other WM programs.

Keywords: obesity, pediatrics, clinic, eating disorder

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202 Implementation of an Accessible State-Wide Trauma Education Program

Authors: Christine Lassen, Elizabeth Leonard, Matthew Oliver

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The management of trauma is often complex and outcomes dependent on clinical expertise, effective teamwork, and a supported trauma system. The implementation of a statewide trauma education program should be accessible to all clinicians who manage trauma, but this can be challenging due to diverse individual needs, trauma service needs and geography. The NSW Institute of Trauma and Injury Management (ITIM) is a government funded body, responsible for coordinating and supporting the NSW Trauma System. The aim of this presentation is to describe how education initiatives have been implemented across the state. Simulation: In 2006, ITIM developed a Trauma Team Training Course - aimed to educate clinicians on the technical and non-technical skills required to manage trauma. The course is now independently coordinated by trauma services across the state at major trauma centres as well as in regional and rural hospitals. ITIM is currently in the process of re-evaluating and updating the Trauma Team Training Course to allow for the development of new resources and simulation scenarios. Trauma Education Evenings: In 2013, ITIM supported major trauma services to develop trauma education evenings which allowed the provision of free education to staff within the area health service and local area. The success of these local events expanded to regional hospitals. A total of 75 trauma education evenings have been conducted within NSW, with over 10,000 attendees. Wed-Based Resources: Recently, ITIM commenced free live streaming of the trauma education evenings which have now had over 3000 live views. The Trauma App developed in 2015 provides trauma clinicians with a centralised portal for trauma information and works on smartphones and tablets that integrate with the ITIM website. This supports pre-hospital and bedside clinical decisions and allows for trauma care to be more standardised, evidence-based, timely, and appropriate. Online e-Learning modules have been developed to assist clinicians, reduce unwarranted clinical variation and provide up to date evidence based education. The modules incorporate clinically focused education content with summative and formative assessments. Conclusion: Since 2005, ITIM has helped to facilitate the development of trauma education programs for doctors, nurses, pre-hospital and allied health clinicians. ITIM has been actively involved in more than 100 specialized trauma education programs, seminars and clinical workshops - attended by over 12,000 staff. The provision of state-wide trauma education is a challenging task requiring collaboration amongst numerous agencies working towards a common goal – to provide easily accessible trauma education.

Keywords: education, simulation, team-training, trauma

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201 Healthcare Professionals' Perspectives on Warfarin Therapy at Lao-Luxembourg Heart Centre, Mahosot Hospital, Lao PDR

Authors: Vanlounni Sibounheuang, Wanarat Anusornsangiam, Pattarin Kittiboonyakun, Chanthanom Manithip

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In worldwide, one of the most common use of oral anticoagulant is warfarin. Its margin between therapeutic inhibition of clot formation and bleeding complications is narrow. Mahosot Hospital, warfarin clinic had not been established yet. The descriptive study was conducted by investigating drug-related problems of outpatients using warfarin, the value of the international normalized ratio (INR) higher than normal ranges (25.40 % of the total 272 outpatients) were mostly identified at Lao-Luxembourg Heart Centre, Mahosot Hospital, Lao PDR. This result led to the present study conducting qualitative interviews in order to help establish a warfarin clinic at Mahosot Hospital for the better outcomes of patients using warfarin. The purpose of this study was to explore perspectives of healthcare professional providing services for outpatients using warfarin. The face to face, in-depth interviews were undertaken among nine healthcare professionals (doctor=3, nurse=3, pharmacist=3) working at out-patient clinic, Lao-Luxembourg Heart Centre, Mahosot Hospital, Lao PDR. The interview guides were developed, and they were validated by the experts in the fields of qualitative research. Each interview lasted approximately 20 minutes. Three major themes emerged; healthcare professional’s experiences of current practice problems with warfarin therapy, healthcare professionals’ views of medical problems related to patients using warfarin, and healthcare professionals’ perspectives on ways of service improvement. All healthcare professionals had the same views that it’s difficult to achieve INR goal for individual patients because of some important patient barriers especially lack of knowledge about to use warfarin properly and safety, patients not regularly follow-up due to problems with transportations and financial support. Doctors and nurses agreed to have a pharmacist running a routine warfarin clinic and provided counselling to individual patients on the following points: how to take drug properly and safety, drug-drug and food-drug interactions, common side effects and how to manage them, lifestyle modifications. From the interviews, some important components of the establishment of a warfarin clinic included financial support, increased human resources, improved the system of keeping patients’ medical records, short course training for pharmacists. This study indicated the acceptance of healthcare professionals on the important roles of pharmacists and the feasibility of setting up warfarin clinic by working together with the multidisciplinary health care team in order to help improve health outcomes of patients using warfarin at Mahosot Hospital, Lao PDR.

Keywords: perspectives, healthcare professional, warfarin therapy, Mahosot Hospital

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200 Finding a Redefinition of the Relationship between Rural and Urban Knowledge

Authors: Bianca Maria Rulli, Lenny Valentino Schiaretti

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The considerable recent urbanization has increasingly sharpened environmental and social problems all over the world. During the recent years, many answers to the alarming attitudes in modern cities have emerged: a drastic reduction in the rate of growth is becoming essential for future generations and small scale economies are considered more adaptive and sustainable. According to the concept of degrowth, cities should consider surpassing the centralization of urban living by redefining the relationship between rural and urban knowledge; growing food in cities fundamentally contributes to the increase of social and ecological resilience. Through an innovative approach, this research combines the benefits of urban agriculture (increase of biological diversity, shorter and thus more efficient supply chains, food security) and temporary land use. They stimulate collaborative practices to satisfy the changing needs of communities and stakeholders. The concept proposes a coherent strategy to create a sustainable development of urban spaces, introducing a productive green-network to link specific areas in the city. By shifting the current relationship between architecture and landscape, the former process of ground consumption is deeply revised. Temporary modules can be used as concrete tools to create temporal areas of innovation, transforming vacant or marginal spaces into potential laboratories for the development of the city. The only permanent ground traces, such as foundations, are minimized in order to allow future land re-use. The aim is to describe a new mindset regarding the quality of space in the metropolis which allows, in a completely flexible way, to bring back the green and the urban farming into the cities. The wide possibilities of the research are analyzed in two different case-studies. The first is a regeneration/connection project designated for social housing, the second concerns the use of temporary modules to answer to the potential needs of social structures. The intention of the productive green-network is to link the different vacant spaces to each other as well as to the entire urban fabric. This also generates a potential improvement of the current situation of underprivileged and disadvantaged persons.

Keywords: degrowth, green network, land use, temporary building, urban farming

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199 An Exploratory Case Study of the Transference of Skills and Dispositions Used by a Newly Qualified Teacher

Authors: Lynn Machin

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Using the lens of a theoretical framework relating to learning to learn the intention of the case study was to explore how transferable the teaching and learning skills of a newly qualified teacher (post-compulsory education) were when used in an overseas, unfamiliar and challenging post-compulsory educational environment. Particularly, the research sought to explore how this newly qualified teacher made use of the skills developed during their teacher training and to ascertain if, and what, other skills were necessary in order for them to have a positive influence on their learners and for them to be able to thrive within a different country and learning milieu. This case study looks at the experience of a trainee teacher who recently qualified in the UK to teach in post compulsory education (i.e. post 16 education). Rather than gaining employment in a UK based academy or college of further education this newly qualified teacher secured her first employment as a teacher in a province in China. Moreover, the newly qualified teacher had limited travel experience and had never travelled to Asia. She was one of the quieter and more reserved members on the one year teacher training course and was the least likely of the group to have made the decision to work abroad. How transferable the pedagogical skills that she had gained during her training would be when used in a culturally different and therefore (to her, challenging) environment was a key focus of the study. Another key focus was to explore the dispositions being used by the newly qualified teacher in order for her to teach and to thrive in an overseas educational environment. The methodological approach used for this study was both interpretative and qualitative. Associated methods were: Observation: observing the wider and operational practice of the newly qualified teacher over a five day period, and their need, ability and willingness to be reflective, resilient, reciprocal and resourceful. Interview: semi-structured interview with the newly qualified teacher following the observation of her practice. Findings from this case study illuminate the modifications made by the newly qualified teacher to her bank of teaching and learning strategies as well as the essentiality of dispositions used by her to know how to learn and also, crucially, to be ready and willing to do so. Such dispositions include being resilient, resourceful, reciprocal and reflective; necessary in order to adapt to the emerging challenges encountered by the teacher during their first months of employment in China. It is concluded that developing the skills to teach is essential for good teaching and learning practices. Having dispositions that enable teachers to work in ever changing conditions and surroundings is, this paper argues, essential for transferability and longevity of use of these skills.

Keywords: learning, post-compulsory, resilience, transferable

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198 Effects of Macroprudential Policies on BankLending and Risks

Authors: Stefanie Behncke

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This paper analyses the effects of different macroprudential policy measures that have recently been implemented in Switzerland. Among them is the activation and the increase of the countercyclical capital buffer (CCB) and a tightening of loan-to-value (LTV) requirements. These measures were introduced to limit systemic risks in the Swiss mortgage and real estate markets. They were meant to affect mortgage growth, mortgage risks, and banks’ capital buffers. Evaluation of their quantitative effects provides insights for Swiss policymakers when reassessing their policy. It is also informative for policymakers in other countries who plan to introduce macroprudential instruments. We estimate the effects of the different macroprudential measures with a Differences-in-Differences estimator. Banks differ with respect to the relative importance of mortgages in their portfolio, their riskiness, and their capital buffers. Thus, some of the banks were more affected than others by the CCB, while others were more affected by the LTV requirements. Our analysis is made possible by an unusually informative bank panel data set. It combines data on newly issued mortgage loans and quantitative risk indicators such as LTV and loan-to-income (LTI) ratios with supervisory information on banks’ capital and liquidity situation and balance sheets. Our results suggest that the LTV cap of 90% was most effective. The proportion of new mortgages with a high LTV ratio was significantly reduced. This result does not only apply to the 90% LTV, but also to other threshold values (e.g. 80%, 75%) suggesting that the entire upper part of the LTV distribution was affected. Other outcomes such as the LTI distribution, the growth rates of mortgages and other credits, however, were not significantly affected. Regarding the activation and the increase of the CCB, we do not find any significant effects: neither LTV/LTI risk parameters nor mortgage and other credit growth rates were significantly reduced. This result may reflect that the size of the CCB (1% of relevant residential real estate risk-weighted assets at activation, respectively 2% at the increase) was not sufficiently high enough to trigger a distinct reaction between the banks most likely to be affected by the CCB and those serving as controls. Still, it might be have been effective in increasing the resilience in the overall banking system. From a policy perspective, these results suggest that targeted macroprudential policy measures can contribute to financial stability. In line with findings by others, caps on LTV reduced risk taking in Switzerland. To fully assess the effectiveness of the CCB, further experience is needed.

Keywords: banks, financial stability, macroprudential policy, mortgages

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197 Islamic Finance and Trade Promotion in the African Continental Free Trade Area: An Exploratory Study

Authors: Shehu Usman Rano Aliyu

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Despite the significance of finance as a major trade lubricant, evidence in the literature alludes to its scarcity and increasing cost, especially in developing countries where small and medium-scale enterprises are worst affected. The creation of the African Continental Free Trade Area (AFCFTA) in 2018, an organ of the African Union (AU), was meant to serve as a beacon for deepening economic integration through the removal of trade barriers inhibiting intra-African trade and movement of persons, among others. Hence, this research explores the role Islamic trade finance (ITF) could play in spurring intra- and inter-African trade. The study involves six countries; Egypt, Kenya, Malaysia, Morocco, Nigeria, and Saudi Arabia, and employs survey research, a total of 430 sample data, and SmartPLS Structural Equation Modelling (SEM) techniques in its analyses. We find strong evidence that Shari’ah, legal and regulatory compliance issues of the ITF institutions rhythm with the internal, national, and international compliance requirements equally as the unique instruments applied in ITF. In addition, ITF was found to be largely driven by global economic and political stability, socially responsible finance, ethical and moral considerations, risk-sharing, and resilience of the global Islamic finance industry. Further, SMEs, Governments, and Importers are the major beneficiary sectors. By and large, AfCFTA’s protocols align with the principles of ITF and are therefore suited for the proliferation of Islamic finance in the continent. And, while AML/KYC and BASEL requirements, compliance to AAOIFI and IFSB standards, paucity of Shari'ah experts, threats to global security, and increasing global economic uncertainty pose as major impediments, the future of ITF would be shaped by a greater need for institutional and policy support, global economic cum political stability, robust regulatory framework, and digital technology/fintech. The study calls for the licensing of more ITF institutions in the continent, participation of multilateral institutions in ITF, and harmonization of Shariah standards.

Keywords: AfCFTA, islamic trade finance, murabaha, letter of credit, forwarding

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196 Predictability of Thermal Response in Housing: A Case Study in Australia, Adelaide

Authors: Mina Rouhollahi, J. Boland

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Changes in cities’ heat balance due to rapid urbanization and the urban heat island (UHI) have increased energy demands for space cooling and have resulted in uncomfortable living conditions for urban residents. Climate resilience and comfortable living spaces can be addressed through well-designed urban development. The sustainable housing can be more effective in controlling high levels of urban heat. In Australia, to mitigate the effects of UHIs and summer heat waves, one solution to sustainable housing has been the trend to compact housing design and the construction of energy efficient dwellings. This paper analyses whether current housing configurations and orientations are effective in avoiding increased demands for air conditioning and having an energy efficient residential neighborhood. A significant amount of energy is consumed to ensure thermal comfort in houses. This paper reports on the modelling of heat transfer within the homes using the measurements of radiation, convection and conduction between exterior/interior wall surfaces and outdoor/indoor environment respectively. The simulation was tested on selected 7.5-star energy efficient houses constructed of typical material elements and insulation in Adelaide, Australia. The chosen design dwellings were analyzed in extremely hot weather through one year. The data were obtained via a thermal circuit to accurately model the fundamental heat transfer mechanisms on both boundaries of the house and through the multi-layered wall configurations. The formulation of the Lumped capacitance model was considered in discrete time steps by adopting a non-linear model method. The simulation results focused on the effects of orientation of the solar radiation on the dynamic thermal characteristics of the houses orientations. A high star rating did not necessarily coincide with a decrease in peak demands for cooling. A more effective approach to avoid increasing the demands for air conditioning and energy may be to integrate solar–climatic data to evaluate the performance of energy efficient houses.

Keywords: energy-efficient residential building, heat transfer, neighborhood orientation, solar–climatic data

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