Search results for: long term services and supports

Authors: Natalie Hoyer

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Usually, steel structures are designed for the upper region of the steel toughness-temperature curve. To address the reduced toughness properties in the temperature transition range, additional safety assessments based on fracture mechanics are necessary. These assessments enable the appropriate selection of steel materials to prevent brittle fracture. In this context, recommendations were established in 2011 to regulate the appropriate selection of steel grades for bridge bearing components. However, these recommendations are no longer fully aligned with more recent insights: Designing bridge bearings and their components in accordance with DIN EN 1337 and the relevant sections of DIN EN 1993 has led to an increasing trend of using large plate thicknesses, especially for long-span bridges. However, these plate thicknesses surpass the application limits specified in the national appendix of DIN EN 1993-2. Furthermore, compliance with the regulations outlined in DIN EN 1993-1-10 regarding material toughness and through-thickness properties requires some further modifications. Therefore, these standards cannot be directly applied to the material selection for bearings without additional information. In addition, recent findings indicate that certain bridge bearing components are subjected to high fatigue loads, necessitating consideration in structural design, material selection, and calculations. To address this issue, the German Center for Rail Traffic Research initiated a research project aimed at developing a proposal to enhance the existing standards. This proposal seeks to establish guidelines for the selection of steel materials for bridge bearings to prevent brittle fracture, particularly for thick plates and components exposed to specific fatigue loads. The results derived from theoretical analyses, including finite element simulations and analytical calculations, are verified through component testing on a large-scale. During these large-scale tests, where a brittle failure is deliberately induced in a bearing component, an artificially generated defect is introduced into the specimen at the predetermined hotspot. Subsequently, a dynamic load is imposed until the crack initiation process transpires, replicating realistic conditions akin to a sharp notch resembling a fatigue crack. To stop the action of the dynamic load in time, it is important to precisely determine the point at which the crack size transitions from stable crack growth to unstable crack growth. To achieve this, the potential drop measurement method is employed. The proposed paper informs about the choice of measurement method (alternating current potential drop (ACPD) or direct current potential drop (DCPD)), presents results from correlations with created FE models, and may proposes a new approach to introduce beach marks into the fracture surface within the framework of potential drop measurement.

Keywords: beach marking, bridge bearing design, brittle fracture, design for fatigue, potential drop

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Authors: M. P. Leroux, C. Coulombe

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Projects are popular vehicles through which international aid is delivered in developing countries. To achieve their objectives, many northern organizations develop projects with local partner organizations in the developing countries through technical assistance projects. International aid and international development projects precisely have long been criticized for poor results although billions are spent every year. Little empirical research in the field of project management has the focus on knowledge transfer in international development context. This paper focuses particularly on personal dimensions of international assignees participating in project within local team members in the host country. We propose to explore the possible links with a human resource management perspective in order to shed light on the less research problematic of knowledge transfer in development cooperation projects. The process leading to capacity building being far complex, involving multiple dimensions and far from being linear, we propose here to assess if traditional research on expatriate in multinational corporations pertain to the field of project management in developing countries. The following question is addressed: in the context of international development project cooperation, what personal determinants should the selection process focus when looking to fill a technical assistance position in a developing country? To answer that question, we first reviewed the literature on expatriate in the context of inter organizational knowledge transfer. Second, we proposed a theoretical framework combining perspectives of development studies and management to explore if parallels can be draw between traditional international assignment and technical assistance project assignment in developing countries. We conducted an exploratory study using case studies from technical assistance initiatives led in Haiti, a country in Central America. Data were collected from multiple sources following qualitative study research methods. Direct observations in the field were allowed by local leaders of six organization; individual interviews with present and past international assignees, individual interview with local team members, and focus groups were organized in order to triangulate information collected. Contrary from empirical research on knowledge transfer in multinational corporations, results tend to show that technical expertise rank well behind many others characteristics. Results tend to show the importance of soft skills, as a prerequisite to succeed in projects where local team have to collaborate. More importantly, international assignees who were talking knowledge sharing instead of knowledge transfer seemed to feel more satisfied at the end of their mandate than the others. Reciprocally, local team members who perceived to have participated in a project with an expat looking to share instead of aiming to transfer knowledge seemed to describe the results of project in more positive terms than the others. Results obtained from this exploratory study open the way for a promising research agenda in the field of project management. It emphasises the urgent need to achieve a better understanding on the complex set of soft skills project managers or project chiefs would benefit to develop, in particular, the ability to absorb knowledge and the willingness to share one’s knowledge.

Keywords: international assignee, international project cooperation, knowledge transfer, soft skills

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Authors: Hao Huang

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INTRODUCTION: The Association of American Colleges and Universities (AACU) recommends the development of ‘high-impact practices,’ in an effort to increase rates of student retention and student engagement at undergraduate institutions. To achieve these goals, the Scripps College Humanities Institute and HI Fellows Seminar not only featured distinguished academics presenting their scholarship about current immigration policy and its consequences in the USA and around the world but integrated socially significant community leaders and creative activists/artivists in public talks, student workshops and collaborative art events. Students participated in experiential learning that involved guest personal presentations and discussions, oral history interviews that applied standard oral history methodologies, detailed cultural documentation, collaborative artistic interventions, and weekly posts in Internet Digital Learning Environment Sakai collaborative course forums and regular responses to other students’ comments. Our teaching pedagogies addressed the four learning styles outlined in Kolb’s Learning Style Inventory. PROJECT DESCRIPTION: Over the academic year 2017-18, the Scripps College Humanities Institute and HI Fellows Seminar presented a Fall 2017 topic, ‘The World at Our Doorsteps: Immigration and Deportation in Los Angeles’. Our purpose was to address how current federal government anti-immigration measures have affected many students of color, some of whom are immigrants, many of whom are related to and are friends with people who are impacted by the attitudes as well as the practices of the U.S. Citizenship and Immigration Services. In Spring 2018, we followed with the topic, ‘Exclusive Nationalisms: Global Migration and Immigration’. This addresses the rise of white supremacists who have ascended to position of power worldwide, in America, Europe, Russia, and xenophobic nationalisms in China, Myanmar and the Philippines. Recent scholarship has suggested the existence of categories of refugees beyond the political or social, who fit into the more inclusive category of migrants. ASSESSMENT METHODOLOGIES: Assessment methodologies not only included qualitative student interviews and quantitative student evaluations in standard rubric format, but also Outcome Assessments, Formative Evaluations, and Outside Guest Teacher feedback. These indicated that the most effective educational practices involved collaborative inquiry in undergraduate research, community-based learning, and capstone projects. Assessments of E-portfolios, written and oral coursework, and final creative projects with associated 10-12 page analytic paper revealed that students developed their understanding of how government and social organizations work; they developed communication skills that enhanced working with others from different backgrounds; they developed their ability to thoughtfully evaluate their course performance by adopting reflective practices; they gained analytic and interpretive skills that encouraged self-confidence and self- initiative not only academically, but also with regards to independent projects. CONCLUSION: Most importantly, the Scripps Humanities Institute experiential learning project spurred on real-world actions by our students, such as a public symposium on how to cope with bigots, a student tutoring program for immigrant staff children, student negotiations with the administration to establish meaningful, sustainable diversity and inclusion programs on-campus. Activism is not only to be taught to and for our students– it has to be enacted by our students.

Keywords: immigration, migration, human rights, learning assessment

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

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

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

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Authors: Al. Tsertsvadze. L. Ebralidze, I. Matchutadze. D. Berashvili, A. Bakuridze

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Peatlands are landscape elements, they are formed over a very long period by physical, chemical, biologic, and geologic processes. In the moderate zone of Caucasus, the Kolkheti lowlands are distinguished by the diversity of relictual plants, a high degree of endemism, orographic, climate, landscape, and other characteristics of high levels of biodiversity. The unique properties of the Kolkheti region lead to the formation of special, so-called, endemic peat peloids. The composition and properties of peloids strongly depend on peat-forming plants. Peat is considered a unique complex of raw materials, which can be used in different fields of the industry: agriculture, metallurgy, energy, biotechnology, chemical industry, health care. They are formed in permanent wetland areas. As a result of decay, higher plants remain in the anaerobic area, with the participation of microorganisms. Peat mass absorbs soil and groundwater. Peloids are predominantly rich with humic substances, which are characterized by high biological activity. Humic acids stimulate enzymatic activity, regenerative processes, and have anti-inflammatory activity. Objects of the research were Kolkheti peat peloids (Ispani, Anaklia, Churia, Chirukhi, Peranga) possessing different formation phases. Due to specific physical and chemical properties of research objects, the aim of the research was to develop analytical methods in order to study the chemical composition of the objects. The research was held using modern instrumental methods of analysis: Ultraviolet-visible spectroscopy and Infrared spectroscopy, Scanning Electron Microscopy, Centrifuge, dry oven, Ultraturax, pH meter, fluorescence spectrometer, Gas chromatography-mass spectrometry (GC-MS/MS), Gas chromatography. Based on the research ration between organic and inorganic substances, the spectrum of micro and macro elements, also the content of minerals was determined. The content of organic nitrogen was determined using the Kjeldahl method. The total composition of amino acids was studied by a spectrophotometric method using standard solutions of glutamic and aspartic acids. Fatty acid was determined using GC (Gas chromatography). Based on the obtained results, we can conclude that the method is valid to identify fatty acids in the research objects. The content of organic substances in the research objects was held using GC-MS. Using modern instrumental methods of analysis, the chemical composition of research objects was studied. Each research object is predominantly reached with a broad spectrum of organic (fatty acids, amino acids, carbocyclic and heterocyclic compounds, organic acids and their esters, steroids) and inorganic (micro and macro elements, minerals) substances. Modified methods used in the presented research may be utilized for the evaluation of cosmetological balneological and pharmaceutical means prepared on the base of Kolkheti's Sphagnum Peat Peloids.

Keywords: modern analytical methods, natural resources, peat, chemistry

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Authors: Rodrigo Arnaldo Scarpel

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Trend following is a widely accepted investment strategy that adopts a rule-based trading mechanism that rather than striving to predict market direction or on information gathering to decide when to buy and when to sell a stock. Thus, in trend following one must respond to market’s movements that has recently happen and what is currently happening, rather than on what will happen. Optimally, in trend following strategy, is to catch a bull market at its early stage, ride the trend, and liquidate the position at the first evidence of the subsequent bear market. For applying the trend following strategy one needs to find the trend and identify trade signals. In order to avoid false signals, i.e., identify fluctuations of short, mid and long terms and to separate noise from real changes in the trend, most academic works rely on moving averages and other technical analysis indicators, such as the moving average convergence divergence (MACD) and the relative strength index (RSI) to uncover intelligible stock trading rules following trend following strategy philosophy. Recently, some works has applied machine learning techniques for trade rules discovery. In those works, the process of rule construction is based on evolutionary learning which aims to adapt the rules to the current environment and searches for the global optimum rules in the search space. In this work, instead of focusing on the usage of machine learning techniques for creating trading rules, a time series trend classification employing a semi-supervised approach was used to early identify both the beginning and the end of upward and downward trends. Such classification model can be employed to identify trade signals and the decision-making procedure is that if an up-trend (down-trend) is identified, a buy (sell) signal is generated. Semi-supervised learning is used for model training when only part of the data is labeled and Semi-supervised classification aims to train a classifier from both the labeled and unlabeled data, such that it is better than the supervised classifier trained only on the labeled data. For illustrating the proposed approach, it was employed daily trade information, including the open, high, low and closing values and volume from January 1, 2000 to December 31, 2022, of the São Paulo Exchange Composite index (IBOVESPA). Through this time period it was visually identified consistent changes in price, upwards or downwards, for assigning labels and leaving the rest of the days (when there is not a consistent change in price) unlabeled. For training the classification model, a pseudo-label semi-supervised learning strategy was used employing different technical analysis indicators. In this learning strategy, the core is to use unlabeled data to generate a pseudo-label for supervised training. For evaluating the achieved results, it was considered the annualized return and excess return, the Sortino and the Sharpe indicators. Through the evaluated time period, the obtained results were very consistent and can be considered promising for generating the intended trading signals.

Keywords: evolutionary learning, semi-supervised classification, time series data, trading signals generation

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Authors: Hoda Manafian, Stephen Holland

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

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

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Authors: Bhupendra Kumar Poudel, Sadhana Amatya, Tirtha Maiya Shrestha, Bharatmani Pokhrel, Mohan Prasad Amatya

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Background: H. salicifolia is a dense, branched, multipurpose, deciduous, nitrogen fixing, thorny willow-like small to moderate tree, restricted to the Himalaya. Among the two species of Nepal (Hippophae salicifolia and H. tibetana), it has been traditionally used as food additive, anticancer (bark), and treating toothache, tooth inflammation (anti-inflammatory) and radiation injury; while people of Western Nepal have largely undermined its veiled treasure by using it for fuel, wood and soil stabilization only. Therefore, the main objective of this study was to explore biological properties (analgesic, antidiabetic, cytotoxic and anti-inflammatory properties of this plant. Methodology: The transverse section of leaves and stems were viewed under microscope. Extracts obtained from soxhlation subjected to tests for phytochemical and biological studies. Rats (used to study antidiabetic and anti-inflammatory properties) and mice (used to study analgesic, CNS depressant, muscle relaxant and locomotor properties) were assumed to be normally distributed; then ANOVA and post hoc tukey test was used to find significance. The data obtained were analyzed by SPSS 17 and Excel 2007. Results and Conclusion: Pharmacognostical analysis revealed the presence of long stellate trichomes, double layered vascular bundle 5-6 in number and double layered compact sclerenchyma. The preliminary phytochemical screening of the extracts was found to exhibit the positive reaction tests for glycoside, steroid, tannin, flavonoid, saponin, coumarin and reducing sugar. The brine shrimp lethality bioassay tested in 1000, 100 and 10 ppm revealed cytotoxic activity inherent in methanol, water, chloroform and ethyl acetate extracts with LC50 (μg/ml) values of 61.42, 99.77, 292.72 and 277.84 respectively. The cytotoxic activity may be due to presence of tannins in the constituents. Antimicrobial screening of the extracts by cup diffusion method using Staphylococcus aereus, Escherichia coli and Pseudomonas aeruginosa against standard antibiotics (oxacillin, gentamycin and amikacin respectively) portrayed no activity against the microorganisms tested. The methanol extract of the stems and leaves showed various pharmacological properties: and antidiabetic, anti-inflammatory, analgesic [chemical writhing method], CNS depressant, muscle relaxant and locomotor activities in a dose-dependent fashion, indicating the possibility of the presence of different constituents in the stems and leaves responsible for these biological activities. All the effects when analyzed by post hoc tukey test were found to be significant at 95% confidence level. The antidiabetic activity was presumed to be due to flavonoids present in extract. Therefore, it can be concluded that this plant’s secondary metabolites possessed strong antidiabetic, anti-inflammatory and cytotoxic activity which could be isolated for further investigation.

Keywords: Hippophae salicifolia, constituents, antidiabetic, inflammatory, brine shrimp

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Authors: Ashik Sarder

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Bangladesh is a disaster-prone and one of the most vulnerable countries to climate change. The country has a long coastal area which is frequently being affected by several types of natural disasters due to climate change. The disasters have impacts on the life and livelihood of different natural resources depending on communities living in the coastal areas. The Malo is a Hindu religious traditional fishing community living at Sarafpur Union of Dumuria Upazila of Khulna district of south-west coastal Bangladesh. Fishing is the only means of their livelihood and the community has been engaged in fishing practices inherently in rivers, estuaries, and sea for more than 300 years. and they are totally dependent on this traditional occupation. But, in recent year’s climate change has negative impacts on their only livelihood option. The study aims to examine the impacts of climate change on the livelihood of Malo fishing community in south-west coastal Bangladesh, identify the adaptation strategies undertaken and practiced by Malo fishing community to cope with climate change and sustain their livelihood and explore the changing adaptation strategies undertaken by Malo fishing community and others. The study has been conducted from both qualitative and quantitative perspectives. Data has been collected from both primary and secondary sources. The primary data has been collected in the participatory observation approach following both qualitative and quantitative method. The primary source of data includes village census, face-to-face interview and in-depth case studies using structured questionnaire. The secondary source of the literature includes different national and international documents, policy papers, books and articles; related websites and peer-viewed documents on climate change, vulnerability, adaptation, livelihood, and fisheries. The study has identified different practices of adaption to climate change by Malo fishing community and others in the selected area. Three types of adaption practices have been identified. Firstly, the indigenous adaptation practices by Malo fishing community to cope with climate change have been identified. These identified adaptation practices by Malo fishing community include; ensuring drinking water and sanitation facilities, planting trees to tackle impacts of cyclone, excavating dumps to preserve the valuable assets, growing vegetables and rearing domestic livestock to earn surplus money, taking loans for ensuring continuation of present livelihood and migrating to near city or towns for better livelihood options. Secondly, adaptation initiatives undertaken by the government have provided limited facility to this vulnerable fishing community and made them benefited. And thirdly, some adaptation initiatives commenced by few non-government and community-based organizations have also made the Malo fishing community as beneficiaries. The study has suggested recommendations for Malo fishing community to overcome the challenges and impacts of climate change for retaining their traditional fishing livelihood. The accumulated recommendations would be very useful for the researchers, academicians, policy-makers of Government and non-government organizations to conduct more researches and take initiatives for Malo fishing community to make them more capable to sustain their fishing livelihood.

Keywords: climate change, livelihood, adaptation, anthropology, vulnerability

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Authors: Irfan Anjum Manarvi, Fawzi Aljassir

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Human bones have been a keen area of research over a long time in the field of biomechanical engineering. Medical professionals, as well as engineering academics and researchers, have investigated various bones by using medical, mechanical, and materials approaches to discover the available body of knowledge. Their major focus has been to establish properties of these and ultimately develop processes and tools either to prevent fracture or recover its damage. Literature shows that mechanical professionals conducted a variety of tests for hardness, deformation, and strain field measurement to arrive at their findings. However, they considered these results accuracy to be insufficient due to various limitations of tools, test equipment, difficulties in the availability of human bones. They proposed the need for further studies to first overcome inaccuracies in measurement methods, testing machines, and experimental errors and then carry out experimental or theoretical studies. Finite Element analysis is a technique which was developed for the aerospace industry due to the complexity of design and materials. But over a period of time, it has found its applications in many other industries due to accuracy and flexibility in selection of materials and types of loading that could be theoretically applied to an object under study. In the past few decades, the field of biomechanical engineering has also started to see its applicability. However, the work done in the area of Tarsals, metatarsals and phalanges using this technique is very limited. Therefore, present research has been focused on using this technique for analysis of these critical bones of the human body. This technique requires a 3-dimensional geometric computer model of the object to be analyzed. In the present research, a 3d laser scanner was used for accurate geometric scans of individual tarsals, metatarsals, and phalanges from a typical human foot to make these computer geometric models. These were then imported into a Finite Element Analysis software and a length refining process was carried out prior to analysis to ensure the computer models were true representatives of actual bone. This was followed by analysis of each bone individually. A number of constraints and load conditions were applied to observe the stress and strain distributions in these bones under the conditions of compression and tensile loads or their combination. Results were collected for deformations in various axis, and stress and strain distributions were observed to identify critical locations where fracture could occur. A comparative analysis of failure properties of all the three types of bones was carried out to establish which of these could fail earlier which is presented in this research. Results of this investigation could be used for further experimental studies by the academics and researchers, as well as industrial engineers, for development of various foot protection devices or tools for surgical operations and recovery treatment of these bones. Researchers could build up on these models to carryout analysis of a complete human foot through Finite Element analysis under various loading conditions such as walking, marching, running, and landing after a jump etc.

Keywords: tarsals, metatarsals, phalanges, 3D scanning, finite element analysis

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Authors: Pamela Tancsik

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The stage production in 2018, titled ‘From‘Marikana to Mahagonny’, began with a prologue in the form of the award-winning documentary ‘Miners Shot Down' by Rehad Desai, followed by Brecht/Weill’s song play or scenic cantata ‘Mahagonny’, premièred in Baden-Baden 1927. The central directorial concept of the DUT musical production ‘From Marikana to Mahagonny’ was to show a connection between the socio-political alienation of mineworkers in present-day South Africa and Brecht’s alienation effect in his scenic cantata ‘Mahagonny’. Marikana is a mining town about 50 km west of South Africa’s capital Pretoria. Mahagonny is a fantasy name for a utopian mining town in the United States. The characters, setting, and lyrics refer to America with of songs like ‘Benares’ and ‘Moon of Alabama’ and the use of typical American inventions such as dollars, saloons, and the telephone. The six singing characters in ‘Mahagonny’ all have typical American names: Charlie, Billy, Bobby, Jimmy, and the two girls they meet later are called Jessie and Bessie. The four men set off to seek Mahagonny. For them, it is the ultimate dream destination promising the fulfilment of all their desires, such as girls, alcohol, and dollars – in short, materialistic goals. Instead of finding a paradise, they experience how money and the practice of exploitive capitalism, and the lack of any moral and humanity is destroying their lives. In the end, Mahagonny gets demolished by a hurricane, an event which happened in 1926 in the United States. ‘God’ in person arrives disillusioned and bitter, complaining about violent and immoral mankind. In the end, he sends them all to hell. Charlie, Billy, Bobby, and Jimmy reply that this punishment does not mean anything to them because they have already been in hell for a long time – hell on earth is a reality, so the threat of hell after life is meaningless. Human life was also taken during the stand-off between striking mineworkers and the South African police on 16 August 2012. Miners from the Lonmin Platinum Mine went on an illegal strike, equipped with bush knives and spears. They were striking because their living conditions had never improved; they still lived in muddy shacks with no running water and electricity. Wages were as low as R4,000 (South African Rands), equivalent to just over 200 Euro per month. By August 2012, the negotiations between Lonmin management and the mineworkers’ unions, asking for a minimum wage of R12,500 per month, had failed. Police were sent in by the Government, and when the miners did not withdraw, the police shot at them. 34 were killed, some by bullets in their backs while running away and trying to hide behind rocks. In the musical play ‘From Marikana to Mahagonny’ audiences in South Africa are confronted with a documentary about Marikana, followed by Brecht/Weill’s scenic cantata, highlighting the tragic parallels between the Mahagonny story and characters from 1927 America and the Lonmin workers today in South Africa, showing that in 95 years, capitalism has not changed.

Keywords: alienation, brecht/Weill, mahagonny, marikana/South Africa, musical theatre

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Authors: Jennifer Wheeldon, Nick de Viggiani, Nikki Cotterill

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Background: Urinary and fecal incontinence affect a significant proportion of older adults aged 65 and over who permanently reside in residential and nursing home facilities. Incontinence symptoms have been linked to comorbidities, an increased risk of infection and reduced quality of life and mental wellbeing of residents. However, continence care provision can often be poor, further compromising the health and wellbeing of this vulnerable population. Objectives: To identify experiences and perceptions of continence care provision in older adult residential care settings and to identify factors that help or hinder good continence care provision. Settings included both residential care homes and nursing homes for older adults. Methods: A qualitative evidence synthesis using systematic review methodology established the current evidence-base. Data from 20 qualitative and mixed-method studies was appraised and synthesized. Following the review process, 10* qualitative interviews with staff working in older adult residential care settings were conducted across six* sites, which included registered managers, registered nurses and nursing/care assistants/aides. Purposive sampling recruited individuals from across England. Both evidence synthesis and interview data was analyzed thematically, both manually and with NVivo software. Results: The evidence synthesis revealed complex barriers and facilitators for continence care provision at three influencing levels: macro (structural and societal external influences), meso (organizational and institutional influences) and micro (day-to-day actions of individuals impacting service delivery). Macro-level barriers included negative stigmas relating to incontinence, aging and working in the older adult social care sector, restriction of continence care resources such as containment products (i.e. pads), short staffing in care facilities, shortfalls in the professional education and training of care home staff and the complex health and social care needs of older adult residents. Meso-level barriers included task-centered organizational cultures, ageist institutional perspectives regarding old age and incontinence symptoms, inadequate care home management and poor communication and teamwork among care staff. Micro-level barriers included poor knowledge and negative attitudes of care home staff and residents regarding incontinence symptoms and symptom management and treatment. Facilitators at the micro-level included proactive and inclusive leadership skills of individuals in management roles. Conclusions: The findings of the evidence synthesis study help to outline the complexities of continence care provision in older adult care homes facilities. Macro, meso and micro level influences demonstrate problematic and interrelated barriers across international contexts, indicating that improving continence care in this setting is extremely challenging due to the multiple levels at which care provision and services are impacted. Both international and national older adult social care policy-makers, researchers and service providers must recognize this complexity, and any intervention seeking to improve continence care in older adult care home settings must be planned accordingly and appreciatively of the complex and interrelated influences. It is anticipated that the findings of the qualitative interviews will shed further light on the national context of continence care provision specific to England; data collection is ongoing*. * Sample size is envisaged to be between 20-30 participants from multiple sites by Spring 2023.

Keywords: continence care, residential and nursing homes, evidence synthesis, qualitative

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Authors: Ani Kojoyan

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Linguistic studies have been investigating a connection between gender and linguistic development since 1970s. Scholars claim that gender differences in first and second language learning are socially constructed. Recent studies to language learning and gender reveal that second language acquisition is also a social phenomenon directly influencing one’s gender identity. Those responsible for designing language learning-teaching materials should be encouraged to understand the importance of and address the gender sensitivity accurately in textbooks. Writing or compiling a textbook is not an easy task; it requires strong academic abilities, patience, and experience. For a long period of time Armenia has been involved in the compilation process of a number of foreign language textbooks. However, there have been very few discussions or evaluations of those textbooks which will allow specialists to theorize that practice. The present paper focuses on the analysis of gender sensitivity issues and policy aspects involved in an EFL textbook. For the research the following material has been considered – “A Basic English Grammar: Morphology”, first printed in 2011. The selection of the material is not accidental. First, the mentioned textbook has been widely used in university teaching over years. Secondly, in Armenia “A Basic English Grammar: Morphology” has considered one of the most successful English grammar textbooks in a university teaching environment and served a source-book for other authors to compile and design their textbooks. The present paper aims to find out whether an EFL textbook is gendered in the Armenian teaching environment, and whether the textbook compilers are aware of gendered messages while compiling educational materials. It also aims at investigating students’ attitude toward the gendered messages in those materials. And finally, it also aims at increasing the gender sensitivity among book compilers and educators in various educational settings. For this study qualitative and quantitative research methods of analyses have been applied, the quantitative – in terms of carrying out surveys among students (45 university students, 18-25 age group), and the qualitative one – by discourse analysis of the material and conducting in-depth and semi-structured interviews with the Armenian compilers of the textbook (interviews with 3 authors). The study is based on passive and active observations and teaching experience done in a university classroom environment in 2014-2015, 2015-2016. The findings suggest that the discussed and analyzed teaching materials (145 extracts and examples) include traditional examples of intensive use of language and role-modelling, particularly, men are mostly portrayed as active, progressive, aggressive, whereas women are often depicted as passive and weak. These modeled often serve as a ‘reliable basis’ for reinforcing the traditional roles that have been projected on female and male students. The survey results also show that such materials contribute directly to shaping learners’ social attitudes and expectations around issues of gender. The applied techniques and discussed issues can be generalized and applied to other foreign language textbook compilation processes, since those principles, regardless of a language, are mostly the same.

Keywords: EFL textbooks, gender policy, gender sensitivity, qualitative and quantitative research methods

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Authors: Daniel Rowe, Christopher R. Vogel, Richard H. J. Willden

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The University of Oxford’s recirculating water flume is a combined wave and current test tank with a 1 m depth, 1.1 m width, and 10 m long working section, and is capable of flow speeds up to 1 ms−1 . This study documents the hydrodynamic characteristics of the facility in preparation for experimental testing of horizontal axis tidal stream turbine models. The turbine to be tested has a rotor diameter of 0.6 m and is a modified version of one of two model-scale turbines tested in previous experimental campaigns. An Acoustic Doppler Velocimeter (ADV) was used to measure the flow at high temporal resolution at various locations throughout the flume, enabling the spatial uniformity and turbulence flow parameters to be investigated. The mean velocity profiles exhibited high levels of spatial uniformity at the design speed of the flume, 0.6 ms−1 , with variations in the three-dimensional velocity components on the order of ±1% at the 95% confidence level, along with a modest streamwise acceleration through the measurement domain, a target 5 m working section of the flume. A high degree of uniformity was also apparent for the turbulence intensity, with values ranging between 1-2% across the intended swept area of the turbine rotor. The integral scales of turbulence exhibited a far higher degree of variation throughout the water column, particularly in the streamwise and vertical scales. This behaviour is believed to be due to the high signal noise content leading to decorrelation in the sampling records. To achieve more realistic levels of vertical velocity shear in the flume, a simple procedure to practically generate target vertical shear profiles in open-channel flows is described. Here, the authors arranged a series of non-uniformly spaced parallel bars placed across the width of the flume and normal to the onset flow. By adjusting the resistance grading across the height of the working section, the downstream profiles could be modified accordingly, characterised by changes in the velocity profile power law exponent, 1/n. Considering the significant temporal variation in a tidal channel, the choice of the exponent denominator, n = 6 and n = 9, effectively provides an achievable range around the much-cited value of n = 7 observed at many tidal sites. The resulting flow profiles, which we intend to use in future turbine tests, have been characterised in detail. The results indicate non-uniform vertical shear across the survey area and reveal substantial corner flows, arising from the differential shear between the target vertical and cross-stream shear profiles throughout the measurement domain. In vertically sheared flow, the rotor-equivalent turbulence intensity ranges between 3.0-3.8% throughout the measurement domain for both bar arrangements, while the streamwise integral length scale grows from a characteristic dimension on the order of the bar width, similar to the flow downstream of a turbulence-generating grid. The experimental tests are well-defined and repeatable and serve as a reference for other researchers who wish to undertake similar investigations.

Keywords: acoustic doppler Velocimeter, experimental hydrodynamics, open-channel flow, shear profiles, tidal stream turbines

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Authors: Warren Jared, Bekker Jeremy, Salazar Guy, Jackman Katelyn, Linford Lauren

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Introduction: Positive Psychology research has burgeoned in the past 20 years; however, relatively few evidence-based resources to cultivate positive psychology skills are widely available to the general public. The positive psychology resources at www.mybestself101.org were developed to assist individuals in cultivating well-being using a variety of techniques, including gratitude, purpose, mindfulness, self-compassion, savoring, personal growth, and supportive relationships. These resources are empirically based and are built to be accessible to a broad audience. Key Objectives: This presentation highlights results from two recent randomized intervention studies of specific MBS101 learning modules. A key objective of this research is to empirically assess the efficacy and usability of these online resources. Another objective of this research is to encourage the broad dissemination of online positive psychology resources; thus, recommendations for further research and dissemination will be discussed. Methods: In both interventions, we recruited adult participants using social media advertisements. The participants completed several well-being and positive psychology construct-specific measures (savoring and self-compassion measures) at baseline and post-intervention. Participants in the experimental condition were also given a feedback questionnaire to gather qualitative data on how participants viewed the modules. Participants in the self-compassion study were randomly split between an experimental group, who received the treatment, and a control group, who were placed on a waitlist. There was no control group for the savoring study. Participants were instructed to read content on the module and practice savoring or self-compassion strategies listed in the module for a minimum of twenty minutes a day for 21 days. The intervention was semi-structured, as participants were free to choose which module activities they would complete from a menu of research-based strategies. Participants tracked which activities they completed and how long they spent on the modules each day. Results: In the savoring study, participants increased in savoring ability as indicated by multiple measures. In addition, participants increased in well-being from pre- to post-treatment. In the self-compassion study, repeated measures mixed model analyses revealed that compared to waitlist controls, participants who used the MBS101 self-compassion module experienced significant improvements in self-compassion, well-being, and body image with effect sizes ranging from medium to large. Attrition was 10.5% for the self-compassion study and 71% for the savoring study. Overall, participants indicated that the modules were generally helpful, and they particularly appreciated the specific strategy menus. Participants requested more structured course activities, more interactive content, and more practice activities overall. Recommendations: Mybestself101.org is an applied positive psychology research program that shows promise as a model for effectively disseminating evidence-based positive psychology resources that are both engaging and easily accessible. Considerable research is still needed, both to test the efficacy and usability of the modules currently available and to improve them based on participant feedback. Feedback received from participants in the randomized controlled trial led to the development of an expanded, 30-day online course called The Gift of Self-Compassion and an online mindfulness course currently in development called Mindfulness For Humans.

Keywords: positive psychology, intervention, online resources, self-compassion, dissemination, online curriculum

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Authors: Hilal T. Sasmazel, Seda Surucu

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Skin tissue engineering is a promising field for the treatment of skin defects using scaffolds. This approach involves the use of living cells and biomaterials to restore, maintain, or regenerate tissues and organs in the body by providing; (i) larger surface area for cell attachment, (ii) proper porosity for cell colonization and cell to cell interaction, and (iii) 3-dimensionality at macroscopic scale. Recent studies on this area mainly focus on fabrication of scaffolds that can closely mimic the natural extracellular matrix (ECM) for creation of tissue specific niche-like environment at the subcellular scale. Scaffolds designed as ECM-like architectures incorporating into the host with minimal scarring/pain and facilitate angiogenesis. This study is related to combining of synthetic PCL and natural chitosan polymers to form 3D PCL/Chitosan core-shell structures for skin tissue engineering applications. Amongst the polymers used in tissue engineering, natural polymer chitosan and synthetic polymer poly(ε-caprolactone) (PCL) are widely preferred in the literature. Chitosan has been among researchers for a very long time because of its superior biocompatibility and structural resemblance to the glycosaminoglycan of bone tissue. However, the low mechanical flexibility and limited biodegradability properties reveals the necessity of using this polymer in a composite structure. On the other hand, PCL is a versatile polymer due to its low melting point (60°C), ease of processability, degradability with non-enzymatic processes (hydrolysis) and good mechanical properties. Nevertheless, there are also several disadvantages of PCL such as its hydrophobic structure, limited bio-interaction and susceptibility to bacterial biodegradation. Therefore, it became crucial to use both of these polymers together as a hybrid material in order to overcome the disadvantages of both polymers and combine advantages of those. The scaffolds here were fabricated by using electrospinning technique and the characterizations of the samples were done by contact angle (CA) measurements, scanning electron microscopy (SEM), transmission electron microscopy (TEM) and X-Ray Photoelectron spectroscopy (XPS). Additionally, gas permeability test, mechanical test, thickness measurement and PBS absorption and shrinkage tests were performed for all type of scaffolds (PCL, chitosan and PCL/chitosan core-shell). By using ImageJ launcher software program (USA) from SEM photographs the average inter-fiber diameter values were calculated as 0.717±0.198 µm for PCL, 0.660±0.070 µm for chitosan and 0.412±0.339 µm for PCL/chitosan core-shell structures. Additionally, the average inter-fiber pore size values exhibited decrease of 66.91% and 61.90% for the PCL and chitosan structures respectively, compare to PCL/chitosan core-shell structures. TEM images proved that homogenous and continuous bead free core-shell fibers were obtained. XPS analysis of the PCL/chitosan core-shell structures exhibited the characteristic peaks of PCL and chitosan polymers. Measured average gas permeability value of produced PCL/chitosan core-shell structure was determined 2315±3.4 g.m-2.day-1. In the future, cell-material interactions of those developed PCL/chitosan core-shell structures will be carried out with L929 ATCC CCL-1 mouse fibroblast cell line. Standard MTT assay and microscopic imaging methods will be used for the investigation of the cell attachment, proliferation and growth capacities of the developed materials.

Keywords: chitosan, coaxial electrospinning, core-shell, PCL, tissue scaffold

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Authors: Z. Gharaee

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Recognizing actions performed by others is important in our daily lives since it is necessary for communicating with others in a proper way. We perceive an action by observing the kinematics of motions involved in the performance. We use our experience and concepts to make a correct recognition of the actions. Although building the action concepts is a life-long process, which is repeated throughout life, we are very efficient in applying our learned concepts in analyzing motions and recognizing actions. Experiments on the subjects observing the actions performed by an actor show that an action is recognized after only about two hundred milliseconds of observation. In this study, hierarchical action recognition architecture is proposed by using growing grid layers. The first-layer growing grid receives the pre-processed data of consecutive 3D postures of joint positions and applies some heuristics during the growth phase to allocate areas of the map by inserting new neurons. As a result of training the first-layer growing grid, action pattern vectors are generated by connecting the elicited activations of the learned map. The ordered vector representation layer receives action pattern vectors to create time-invariant vectors of key elicited activations. Time-invariant vectors are sent to second-layer growing grid for categorization. This grid creates the clusters representing the actions. Finally, one-layer neural network developed by a delta rule labels the action categories in the last layer. System performance has been evaluated in an experiment with the publicly available MSR-Action3D dataset. There are actions performed by using different parts of human body: Hand Clap, Two Hands Wave, Side Boxing, Bend, Forward Kick, Side Kick, Jogging, Tennis Serve, Golf Swing, Pick Up and Throw. The growing grid architecture was trained by applying several random selections of generalization test data fed to the system during on average 100 epochs for each training of the first-layer growing grid and around 75 epochs for each training of the second-layer growing grid. The average generalization test accuracy is 92.6%. A comparison analysis between the performance of growing grid architecture and self-organizing map (SOM) architecture in terms of accuracy and learning speed show that the growing grid architecture is superior to the SOM architecture in action recognition task. The SOM architecture completes learning the same dataset of actions in around 150 epochs for each training of the first-layer SOM while it takes 1200 epochs for each training of the second-layer SOM and it achieves the average recognition accuracy of 90% for generalization test data. In summary, using the growing grid network preserves the fundamental features of SOMs, such as topographic organization of neurons, lateral interactions, the abilities of unsupervised learning and representing high dimensional input space in the lower dimensional maps. The architecture also benefits from an automatic size setting mechanism resulting in higher flexibility and robustness. Moreover, by utilizing growing grids the system automatically obtains a prior knowledge of input space during the growth phase and applies this information to expand the map by inserting new neurons wherever there is high representational demand.

Keywords: action recognition, growing grid, hierarchical architecture, neural networks, system performance

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Authors: Armin Nabaei, M. Omair Ahmad, M. N. S. Swamy

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Many facial expression and emotion recognition methods in the traditional approaches of using LDA, PCA, and EBGM have been proposed. In recent years deep learning models have provided a unique platform addressing by automatically extracting the features for the detection of facial expression and emotions. However, deep networks require large training datasets to extract automatic features effectively. In this work, we propose an efficient emotion detection algorithm using face images when only small datasets are available for training. We design a deep network whose feature extraction capability is enhanced by utilizing several parallel modules between the input and output of the network, each focusing on the extraction of different types of coarse features with fined grained details to break the symmetry of produced information. In fact, we leverage long range dependencies, which is one of the main drawback of CNNs. We develop this work by introducing a Dynamic Soft-Margin SoftMax.The conventional SoftMax suffers from reaching to gold labels very soon, which take the model to over-fitting. Because it’s not able to determine adequately discriminant feature vectors for some variant class labels. We reduced the risk of over-fitting by using a dynamic shape of input tensor instead of static in SoftMax layer with specifying a desired Soft- Margin. In fact, it acts as a controller to how hard the model should work to push dissimilar embedding vectors apart. For the proposed Categorical Loss, by the objective of compacting the same class labels and separating different class labels in the normalized log domain.We select penalty for those predictions with high divergence from ground-truth labels.So, we shorten correct feature vectors and enlarge false prediction tensors, it means we assign more weights for those classes with conjunction to each other (namely, “hard labels to learn”). By doing this work, we constrain the model to generate more discriminate feature vectors for variant class labels. Finally, for the proposed optimizer, our focus is on solving weak convergence of Adam optimizer for a non-convex problem. Our noteworthy optimizer is working by an alternative updating gradient procedure with an exponential weighted moving average function for faster convergence and exploiting a weight decay method to help drastically reducing the learning rate near optima to reach the dominant local minimum. We demonstrate the superiority of our proposed work by surpassing the first rank of three widely used Facial Expression Recognition datasets with 93.30% on FER-2013, and 16% improvement compare to the first rank after 10 years, reaching to 90.73% on RAF-DB, and 100% k-fold average accuracy for CK+ dataset, and shown to provide a top performance to that provided by other networks, which require much larger training datasets.

Keywords: computer vision, facial expression recognition, machine learning, algorithms, depp learning, neural networks

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Authors: Shpetim Rezniqi

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Financial Policies in the process of global crisis the current crisis has swept the world with special emphasis, most developed countries, those countries which have most gross -product world and you have a high level of living.Even those who are not experts can describe the consequences of the crisis to see the reality that is seen, but how far will it go this crisis is impossible to predict. Even the biggest experts have conjecture and large divergence, but agree on one thing: - The devastating effects of this crisis will be more severe than ever before and can not be predicted.Long time, the world was dominated economic theory of free market laws. With the belief that the market is the regulator of all economic problems. The market, as river water will flow to find the best and will find the necessary solution best. Therefore much less state market barriers, less state intervention and market itself is an economic self-regulation. Free market economy became the model of global economic development and progress, it transcends national barriers and became the law of the development of the entire world economy. Globalization and global market freedom were principles of development and international cooperation. All international organizations like the World Bank, states powerful economic, development and cooperation principles laid free market economy and the elimination of state intervention. The less state intervention much more freedom of action was this market- leading international principle. We live in an era of financial tragic. Financial markets and banking in particular economies are in a state of thy good, US stock markets fell about 40%, in other words, this time, was one of the darkest moments 5 since 1920. Prior to her rank can only "collapse" of the stock of Wall Street in 1929, technological collapse of 2000, the crisis of 1973 after the Yom Kippur war, while the price of oil quadrupled and famous collapse of 1937 / '38, when Europe was beginning World war II In 2000, even though it seems like the end of the world was the corner, the world economy survived almost intact. Of course, that was small recessions in the United States, Europe, or Japan. Much more difficult the situation was at crisis 30s, or 70s, however, succeeded the world. Regarding the recent financial crisis, it has all the signs to be much sharper and with more consequences. The decline in stock prices is more a byproduct of what is really happening. Financial markets began dance of death with the credit crisis, which came as a result of the large increase in real estate prices and household debt. It is these last two phenomena can be matched very well with the gains of the '20s, a period during which people spent fists as if there was no tomorrow. All is not away from the mouth of the word recession, that fact no longer a sudden and abrupt. But as much as the financial markets melt, the greater is the risk of a problematic economy for years to come. Thus, for example, the banking crisis in Japan proved to be much more severe than initially expected, partly because the assets which were based more loans had, especially the land that falling in value. The price of land in Japan is about 15 years that continues to fall. (ADRI Nurellari-Published in the newspaper "Classifieds"). At this moment, it is still difficult to çmosh to what extent the crisis has affected the economy and what would be the consequences of the crisis. What we know is that many banks will need more time to reduce the award of credit, but banks have this primary function, this means huge loss.

Keywords: globalisation, finance, crisis, recomandation, bank, credits

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Authors: S. C. Lin, M. S. Wu

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Japanese Scholar Manabu Sato has been advocating the Learning Community, which changed Japanese fundamental education during the last three decades. It was also called a “Quiet Revolution.” Manabu Sato criticized that traditional education only focused on individual competition, exams, teacher-centered instruction, and memorization. The students lacked leaning motivation. Therefore, Manabu Sato proclaimed that learning should be a sustainable process of “constantly weaving the relationship and the meanings” by having dialogues with learning materials, with peers, and with oneself. For a long time, secondary school education in Taiwan has been focused on exams and emphasized reciting and memorizing. The incident of “giving up learning” happened to some students. Manabu Sato’s learning community program has been implemented very successfully in Japan. It is worth exploring if learning community can resolve the issue of “Escape from learning” phenomenon among secondary school students in Taiwan. This study was the first year of a two-year project. This project applied a program theory-driven approach to evaluating the impact of teachers’ professional development interventions on students’ learning by using a mix of methods, qualitative inquiry, and quasi-experimental design. The current study was to show the results of using the method of theory-driven approach to program planning to design and evaluate a teachers’ professional development program (TPDP). The Manabu Sato’s learning community theory was applied to structure all components of a 54-hour workshop. The participants consisted of seven secondary school science teachers from two schools. The research procedure was comprised of: 1) Defining the problem and assessing participants’ needs; 2) Selecting the Theoretical Framework; 3) Determining theory-based goals and objectives; 4) Designing the TPDP intervention; 5) Implementing the TPDP intervention; 6) Evaluating the TPDP intervention. Data was collected from a number of different sources, including TPDP checklist, activity responses of workshop, LC subject matter test, teachers’ e-portfolio, course design documents, and teachers’ belief survey. The major findings indicated that program design was suitable to participants. More than 70% of the participants were satisfied with program implementation. They revealed that TPDP was beneficial to their instruction and promoted their professional capacities. However, due to heavy teaching loadings during the project some participants were unable to attend all workshops. To resolve this problem, the author provided options to them by watching DVD or reading articles offered by the research team. This study also established a communication platform for participants to share their thoughts and learning experiences. The TPDP had marked impacts on participants’ teaching beliefs. They believe that learning should be a sustainable process of “constantly weaving the relationship and the meanings” by having dialogues with learning materials, with peers, and with oneself. Having learned from TPDP, they applied a “learner-centered” approach and instructional strategies to design their courses, such as learning by doing, collaborative learning, and reflective learning. To conclude, participants’ beliefs, knowledge, and skills were promoted by the program instructions.

Keywords: program theory-driven approach, learning community, teacher professional development program, program evaluation

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Authors: Andreas Schweiger, Matthias Gnigler, Elisabeth Wieder, Michael Grobbauer

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Especially in the alpine region, available areas for new residential development are limited. One possible solution is to exploit the potential of existing settlements. Urban redensification, especially the addition of floors to existing buildings, requires efficient, lightweight constructions with short construction times. This topic is being addressed in the five-year Alpine Building Centre. The focus of this cooperation between Salzburg University of Applied Sciences and RSA GH Studio iSPACE is on transdisciplinary research in the fields of building and energy technology, building envelopes and geoinformation, as well as the transfer of research results to industry. One development objective is a system of wood panel system construction with a high degree of prefabrication to optimize the construction quality, the construction time and the applicability for small and medium-sized enterprises. The system serves as a reliable working basis for mastering the complex building task of redensification. The technical solution is the development of an open system in timber frame and solid wood construction, which is suitable for a maximum two-story addition of residential buildings. The applicability of the system is mainly influenced by the existing building stock. Therefore, timber frame and solid timber construction are combined where necessary to bridge large spans of the existing structure while keeping the dead weight as low as possible. Escape routes are usually constructed in reinforced concrete and are located outside the system boundary. Thus, within the framework of the legal and normative requirements of timber construction, a hybrid construction method for redensification created. Component structure, load-bearing structure and detail constructions are developed in accordance with the relevant requirements. The results are directly applicable in individual cases, with the exception of the required verifications. In order to verify the practical suitability of the developed system, stakeholder workshops are held on the one hand, and the system is applied in the planning of a two-storey extension on the other hand. A company-independent construction standard offers the possibility of cooperation and bundling of capacities in order to be able to handle larger construction volumes in collaboration with several companies. Numerous further developments can take place on the basis of the system, which is under open license. The construction system will support planners and contractors from design to execution. In this context, open means publicly published and freely usable and modifiable for own use as long as the authorship and deviations are mentioned. The companies are provided with a system manual, which contains the system description and an application manual. This manual will facilitate the selection of the correct component cross-sections for the specific construction projects by means of all component and detail specifications. This presentation highlights the initial situation, the motivation, the approach, but especially the technical solution as well as the possibilities for the application. After an explanation of the objectives and working methods, the component and detail specifications are presented as work results and their application.

Keywords: redensification, SME, urban development, wood building system

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Authors: Natalie Hoyer

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Bridges in both roadway and railway systems depend on bearings to ensure extended service life and functionality. These bearings enable proper load distribution from the superstructure to the substructure while permitting controlled movement of the superstructure. The design of bridge bearings, according to Eurocode DIN EN 1337 and the relevant sections of DIN EN 1993, increasingly requires the use of thick plates, especially for long-span bridges. However, these plate thicknesses exceed the limits specified in the national appendix of DIN EN 1993-2. Furthermore, compliance with DIN EN 1993-1-10 regulations regarding material toughness and through-thickness properties necessitates further modifications. Consequently, these standards cannot be directly applied to the selection of bearing materials without supplementary guidance and design rules. In this context, a recommendation was developed in 2011 to regulate the selection of appropriate steel grades for bearing components. Prior to the initiation of the research project underlying this contribution, this recommendation had only been available as a technical bulletin. Since July 2023, it has been integrated into guideline 804 of the German railway. However, recent findings indicate that certain bridge-bearing components are exposed to high fatigue loads, which necessitate consideration in structural design, material selection, and calculations. Therefore, the German Centre for Rail Traffic Research called a research project with the objective of defining a proposal to expand the current standards in order to implement a sufficient choice of steel material for bridge bearings to avoid brittle fracture, even for thick plates and components subjected to specific fatigue loads. The results obtained from theoretical considerations, such as finite element simulations and analytical calculations, are validated through large-scale component tests. Additionally, experimental observations are used to calibrate the calculation models and modify the input parameters of the design concept. Within the large-scale component tests, a brittle failure is artificially induced in a bearing component. For this purpose, an artificially generated initial defect is introduced at the previously defined hotspot into the specimen using spark erosion. Then, a dynamic load is applied until the crack initiation process occurs to achieve realistic conditions in the form of a sharp notch similar to a fatigue crack. This initiation process continues until the crack length reaches a predetermined size. Afterward, the actual test begins, which requires cooling the specimen with liquid nitrogen until a temperature is reached where brittle fracture failure is expected. In the next step, the component is subjected to a quasi-static tensile test until failure occurs in the form of a brittle failure. The proposed paper will present the latest research findings, including the results of the conducted component tests and the derived definition of the initial crack size in bridge bearings.

Keywords: bridge bearings, brittle fracture, fatigue, initial crack size, large-scale tests

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Authors: Emily Moore, Andrew Gaukroger, Matthew Solan, Lucy Bailey, Alexandra Boxall, Andrew Carne, Chintu Gadamsetty, Charlotte Morley, Katy Western, Iwona Kolodziejczyk

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Introduction: Rupture of the Achilles tendon is common and has a long recovery period. Most cases are managed non-operatively. Foot and Ankle Surgeons advise an ultrasound scan to check the gap between the torn ends. A large gap (with the ankle in equinus) is a relative indication for surgery. The definitive decision regarding surgical versus non-operative management can only be made once an ultrasound scan is undertaken and the patient is subsequently reviewed by a Foot and Ankle surgeon. To get to this point, the patient journey involves several hospital departments. In nearby trusts, patients reattend for a scan and go to the plaster room both before and after the ultrasound for removal and re-application of the cast. At a third visit to the hospital, the surgeon and patient discuss options for definitive treatment. It may take 2-3 weeks from the initial Emergency Department visit before the final treatment decision is made. This “wasted time” is ultimately added to the recovery period for the patient. In this hospital, Achilles rupture patients are seen in a weekly multidisciplinary OneStop Heel Pain clinic. This pathway was already efficient but subject to occasional frustrating delays if a key staff member was absent. A new pathway was introduced with the goal to reduce delays to a definitive treatment plan. Method: A retrospective series of Achilles tendon ruptures managed according to the 2019 protocol was identified. Time taken from the Emergency Department to have both an ultrasound scan and specialist Foot and Ankle surgical review were calculated. 30 consecutive patients were treated with our new pathway and prospectively followed. The time taken for a scan and for specialist review were compared to the 30 consecutive cases from the 2019 (pre-COVID) cohort. The new pathway includes 1. A new contoured splint applied to the front of the injured limb held with a bandage. This can be removed and replaced (unlike a plaster cast) in the ultrasound department, removing the need for plaster room visits. 2. Urgent triage to a Foot and Ankle specialist. 3. Ultrasound scan for assessment of rupture gap and deep vein thrombosis check. 4. Early decision regarding surgery. Transfer to weight bearing in a prosthetic boot in equinuswithout waiting for the once-a-week clinic. 5. Extended oral VTE prophylaxis. Results: The time taken for a patient to have both an ultrasound scan and specialist review fell > 50%. All patients in the new pathway reached a definitive treatment decision within one week. There were no significant differences in patient demographics or rates of surgical vs non-operative treatment. The mean time from Emergency Department visit to specialist review and ultrasound scan fell from 8.7 days (old protocol) to 2.9 days (new pathway). The maximum time for this fell from 23 days (old protocol) to 6 days (new pathway). Conclusion: Teamwork and innovation have improved the experience for patients with an Achilles tendon rupture. The new pathway brings many advantages - reduced time in the Emergency Department, fewer hospital visits, less time using crutches and reduced overall recovery time.

Keywords: orthopaedics, achilles rupture, ultrasound, innovation

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Authors: N. Naz, A. D. Domenico, M. N. Huda

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Soft Robotics is a rapidly growing multidisciplinary field where robots are fabricated using highly deformable materials motivated by bioinspired designs. The high dexterity and adaptability to the external environments during contact make soft robots ideal for applications such as gripping delicate objects, locomotion, and biomedical devices. The actuation system of soft robots mainly includes fluidic, tendon-driven, and smart material actuation. Among them, Soft Pneumatic Actuator, also known as SPA, remains the most popular choice due to its flexibility, safety, easy implementation, and cost-effectiveness. However, at present, most of the fabrication of SPA is still based on traditional molding and casting techniques where the mold is 3d printed into which silicone rubber is cast and consolidated. This conventional method is time-consuming and involves intensive manual labour with the limitation of repeatability and accuracy in design. Recent advancements in direct 3d printing of different soft materials can significantly reduce the repetitive manual task with an ability to fabricate complex geometries and multicomponent designs in a single manufacturing step. The aim of this research work is to design and analyse the Soft Pneumatic Actuator (SPA) utilizing both conventional casting and modern direct 3d printing technologies. The mold of the SPA for traditional casting is 3d printed using fused deposition modeling (FDM) with the polylactic acid (PLA) thermoplastic wire. Hyperelastic soft materials such as Ecoflex-0030/0050 are cast into the mold and consolidated using a lab oven. The bending behaviour is observed experimentally with different pressures of air compressor to ensure uniform bending without any failure. For direct 3D-printing of SPA fused deposition modeling (FDM) with thermoplastic polyurethane (TPU) and stereolithography (SLA) with an elastic resin are used. The actuator is modeled using the finite element method (FEM) to analyse the nonlinear bending behaviour, stress concentration and strain distribution of different hyperelastic materials after pressurization. FEM analysis is carried out using Ansys Workbench software with a Yeon-2nd order hyperelastic material model. FEM includes long-shape deformation, contact between surfaces, and gravity influences. For mesh generation, quadratic tetrahedron, hybrid, and constant pressure mesh are used. SPA is connected to a baseplate that is in connection with the air compressor. A fixed boundary is applied on the baseplate, and static pressure is applied orthogonally to all surfaces of the internal chambers and channels with a closed continuum model. The simulated results from FEM are compared with the experimental results. The experiments are performed in a laboratory set-up where the developed SPA is connected to a compressed air source with a pressure gauge. A comparison study based on performance analysis is done between FDM and SLA printed SPA with the molded counterparts. Furthermore, the molded and 3d printed SPA has been used to develop a three-finger soft pneumatic gripper and has been tested for handling delicate objects.

Keywords: finite element method, fused deposition modeling, hyperelastic, soft pneumatic actuator

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Authors: M. Fry, L. Fitzpatrick, Julie Considine, R. Z. Shaban, Kate Curtis

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Introduction: The vast majority of older Australians lives independently and are self-managing at home, despite a growing number living with a chronic illness that requires health intervention. Evidence shows that between 50% and 80% of people presenting to the emergency department (ED) are in pain. Australian EDs manage 7.2 million attendances every year and 1.4 million of these are people aged 65 years or more. Research shows that 28% of ED patients aged 65 years or more have Cognitive impairment (CI) associated with dementia, delirium and neurological conditions. Background: Traditional ED service delivery may not be suitable for older people who present with multiple, complex and ongoing illnesses. Likewise, ED clinical staff often perceive that their role should be focused more on immediate and potential lifethreatening illness and conditions which are episodic in nature. Therefore, the needs of older people and their family/carers may not be adequately addressed in the context of an ED presentation. Aim: We aimed to explore the utilisation and characteristics of older people presenting to four metropolitan EDs. Method: The findings being presented are part of a program of research exploring pain management practices for older persons with long bone fractures. The study was conducted across four metropolitan emergency departments of older patients (65years and over) and involved a 12-month randomised medical record audit (n=255). Results: ED presentations across four ED sites in 2012 numbered 168021, with 44778 (26.6%) patients aged 65 and over. Of the 44778 patients, the average age was 79.1 years (SD 8.54). There were more females 23932 (53.5%). The majority (26925: 85.0%) of older persons self-referred to the ED and lived independently. The majority arrived by ambulance (n=18553: 41.4%) and were allocated triage category was 3 (n=19,507:43.65%) or Triage category 4 at (n=15,389: 34.43%). The top five triage symptom presentations involved pain (n=8088; 18.25%), dyspnoea (n=4735; 10.7%), falls (n=4032; 9.1%), other (n=3984; 9.0%), cardiac (n=2987; 6.7%). The top five system based diagnostic presentations involved musculoskeletal (n=8902; 20.1%), cardiac (n=6704:15.0%), respiratory (n=4933; 11.0%), neurological (n=4909; 11.0%), gastroenterology (n=4321; 9.7%). On review of one tertiary hospital database the vital signs on average at time triage: Systolic Blood Pressure 143.6mmHg. Heart Rate 83.4 beats/minute; Respiratory Rate 18.5 breaths/ minute; Oxygen saturation 97.0% and Tympanic temperature 36.7 and Blood Glucose Level 7.4mmols/litre. The majority presented with a Glasgow Coma Score of 14 or higher. On average the older person stayed in the ED 4:56 (SD 3:28minutes).The average time to be seen was 39 minutes (SD 48 minutes). The majority of older persons were admitted (n=27562: 61.5%), did not wait for treatment (n= 8879: 0.02%) discharged home (n=16256: 36.0%). Conclusion: The vast majority of older persons are living independently, although many require admission on arrival to the ED. Many arrived in pain and with musculoskeletal injuries and or conditions. New models of care need to be considered, which may better support self-management and independent living of the older person and the National Emergency Access Targets.

Keywords: chronic, older person, aged care, emergency department

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Authors: Inês Amorim Leitão, Loes van Shaick, António Dinis Ferreira, Violette Geissen

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Plastic pollution is a growing concern worldwide: plastics are commercialized in large quantities and it takes a long time for them to degrade. When in the environment, plastic is fragmented into microplastics (<5mm), which have been found in all environmental compartments at different locations. Microplastics contribute to the environmental pollution in water, air and soil and are linked to human health problems. The progressive increase of population living in cities led to the aggravation of the pollution problem worldwide, especially in urban environments. Urban areas represent a strong source of pollution, through the roads, industrial production, wastewater, landfills, etc. It is expected that pollutants such as microplastics are transported diffusely from the sources through different pathways such as wind and rain. Therefore, it is very complex to quantify, control and treat these pollutants, designated current problematic issues by the European Commission. Green areas are pointed out by experts as natural filters for contaminants in cities, through their capacity of retention by vegetation. These spaces have thus the capacity to control the load of pollutants transported. This study investigates the spatial distribution of microplastics in urban soils of different land uses, their transport through atmospheric deposition, wind erosion, runoff and streams, as well as their deposition in vegetation like grass and tree leaves in urban environment. Coimbra, a medium large city located in the central Portugal, is the case-study. All the soil, sediments, water and vegetation samples were collected in Coimbra and were later analyzed in the Wageningen University & Research laboratory. Microplastics were extracted through the density separation using Sodium Phosphate as solution (~1.4 g cm−3) and filtration methods, visualized under a stereo microscope and identified using the u-FTIR method. Microplastic particles were found in all the different samples. In terms of soils, higher concentrations of microplastics were found in green parks, followed by landfills and industrial places, and the lowest concentrations in forests and pasture land-uses. Atmospheric deposition and streams after rainfall events seems to represent the strongest pathways of microplastics. Tree leaves can retain microplastics on their surfaces. Small leaves such as needle leaves seem to present higher amounts of microplastics per leaf area than bigger leaves. Rainfall episodes seem to reduce the concentration of microplastics on leaves surface, which suggests the wash of microplastics down to lower levels of the tree or to the soil. When in soil, different types of microplastics could be transported to the atmosphere through wind erosion. Grass seems to present high concentrations of microplastics, and the enlargement of the grass cover leads to a reduction of the amount of microplastics in soil, but also of the microplastics moved from the ground to the atmosphere by wind erosion. This study proof that vegetation can help to control the transport and dispersion of microplastics. In order to control the entry and the concentration of microplastics in the environment, especially in cities, it is essential to defining and evaluating nature-based land-use scenarios, considering the role of green urban areas in filtering small particles.

Keywords: microplastics, cities, sources, pathways, vegetation

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Authors: Wen-Yang Hu, Ranli Lu, Mark Maienschein-Cline, Danping Hu, Larisa Nonn, Toshi Shioda, Gail S. Prins

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Background: Genetic mutations are highly associated with increased prostate cancer risk. In addition to whole genome sequencing, somatic mutations can be identified by aligning transcriptome sequences to the human genome. Here we analyzed bulk RNAseq and single cell RNAseq data of human prostate cancer cells and their matched non-cancer cells in benign regions from 4 individual patients. Methods: Sequencing raw reads were aligned to the reference genome hg38 using STAR. Variants were annotated using Annovar with respect to overlap gene annotation information, effect on gene and protein sequence, and SIFT annotation of nonsynonymous variant effect. We determined cancer-specific novel alleles by comparing variant calls in cancer cells to matched benign cells from the same individual by selecting unique alleles that were only detected in the cancer samples. Results: In bulk RNAseq data from 3 patients, the most common variants were the noncoding mutations at UTR3/UTR5, and the major variant types were single-nucleotide polymorphisms (SNP) including frameshift mutations. C>T transversion is the most frequently presented substitution of SNP. A total of 222 genes carrying unique exonic or UTR variants were revealed in cancer cells across 3 patients but not in benign cells. Among them, transcriptome levels of 7 genes (CITED2, YOD1, MCM4, HNRNPA2B1, KIF20B, DPYSL2, NR4A1) were significantly up or down regulated in cancer stem cells. Out of the 222 commonly mutated genes in cancer, 19 have nonsynonymous variants and 11 are damaged genes with variants including SIFT, frameshifts, stop gain/loss, and insertions/deletions (indels). Two damaged genes, activating transcription factor 6 (ATF6) and histone demethylase KDM3A are of particular interest; the former is a survival factor for certain cancer cells while the later positively activates androgen receptor target genes in prostate cancer. Further, single cell RNAseq data of cancer cells and their matched non-cancer benign cells from both primary 2D and 3D tumoroid cultures were analyzed. Similar to the bulk RNAseq data, single cell RNAseq in cancer demonstrated that the exonic mutations are less common than noncoding variants, with SNPs including frameshift mutations the most frequently presented types in cancer. Compared to cancer stem cell enriched-3D tumoroids, 2D cancer cells carried 3-times higher variants, 8-times more coding mutations and 10-times more nonsynonymous SNP. Finally, in both 2D primary and 3D tumoroid cultures, cancer stem cells exhibited fewer coding mutations and noncoding SNP or insertions/deletions than non-stem cancer cells. Summary: Our study demonstrates the usefulness of bulk and single cell RNAseaq data in identifying somatic mutations in prostate cancer, providing an alternative method in screening candidate genes for prostate cancer diagnosis and potential therapeutic targets. Cancer stem cells carry fewer somatic mutations than non-stem cancer cells due to their inherited immortal stand DNA from parental stem cells that explains their long-lived characteristics.

Keywords: prostate cancer, stem cell, genomic mutation, RNAseq

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Authors: Natia Jalagonia, Tinatin Kuchukhidze

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Polymer electrolytes (PE) play an important part in electrochemical devices such as batteries and fuel cells. To achieve optimal performance, the PE must maintain a high ionic conductivity and mechanical stability at both high and low relative humidity. The polymer electrolyte also needs to have excellent chemical stability for long and robustness. According to the prevailing theory, ionic conduction in polymer electrolytes is facilitated by the large-scale segmental motion of the polymer backbone, and primarily occurs in the amorphous regions of the polymer electrolyte. Crystallinity restricts polymer backbone segmental motion and significantly reduces conductivity. Consequently, polymer electrolytes with high conductivity at room temperature have been sought through polymers which have highly flexible backbones and have largely amorphous morphology. The interest in polymer electrolytes was increased also by potential applications of solid polymer electrolytes in high energy density solid state batteries, gas sensors and electrochromic windows. Conductivity of 10-3 S/cm is commonly regarded as a necessary minimum value for practical applications in batteries. At present, polyethylene oxide (PEO)-based systems are most thoroughly investigated, reaching room temperature conductivities of 10-7 S/cm in some cross-linked salt in polymer systems based on amorphous PEO-polypropylene oxide copolymers.. It is widely accepted that amorphous polymers with low glass transition temperatures Tg and a high segmental mobility are important prerequisites for high ionic conductivities. Another necessary condition for high ionic conductivity is a high salt solubility in the polymer, which is most often achieved by donors such as ether oxygen or imide groups on the main chain or on the side groups of the PE. It is well established also that lithium ion coordination takes place predominantly in the amorphous domain, and that the segmental mobility of the polymer is an important factor in determining the ionic mobility. Great attention was pointed to PEO-based amorphous electrolyte obtained by synthesis of comb-like polymers, by attaching short ethylene oxide unit sequences to an existing amorphous polymer backbone. The aim of presented work is to obtain of solid polymer electrolyte membranes using PMHS as a matrix. For this purpose the hydrosilylation reactions of α,ω-bis(trimethylsiloxy)methyl¬hydrosiloxane with allyl triethylene-glycol mo¬nomethyl ether and vinyltriethoxysilane at 1:28:7 ratio of initial com¬pounds in the presence of Karstedt’s catalyst, platinum hydrochloric acid (0.1 M solution in THF) and platinum on the carbon catalyst in 50% solution of anhydrous toluene have been studied. The synthesized olygomers are vitreous liquid products, which are well soluble in organic solvents with specific viscosity ηsp ≈ 0.05 - 0.06. The synthesized olygomers were analysed with FTIR, 1H, 13C, 29Si NMR spectroscopy. Synthesized polysiloxanes were investigated with wide-angle X-ray, gel-permeation chromatography, and DSC analyses. Via sol-gel processes of doped with lithium trifluoromethylsulfonate (triflate) or lithium bis¬(trifluoromethylsulfonyl)¬imide polymer systems solid polymer electrolyte membranes have been obtained. The dependence of ionic conductivity as a function of temperature and salt concentration was investigated and the activation energies of conductivity for all obtained compounds are calculated

Keywords: synthesis, PMHS, membrane, electrolyte

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Authors: Miria Gambardella

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The influence of solidarity demonstrations towards the Zapatista National Liberation Army has been constantly present over the years, both locally and internationally, guaranteeing visibility to the cause, shaping the movement’s choices, and influencing its hopes of impact worldwide. Most of the coffee produced by the autonomous cooperatives from Chiapas is exported, therefore making coffee trade the main income from international solidarity networks. The question arises about the implications of the relations established between the communities in resistance in Southeastern Mexico and international solidarity movements, specifically on the strategies adopted to conciliate army's demands for autonomy and economic asymmetries between Zapatista cooperatives producing coffee and European collectives who hold purchasing power. In order to deepen the inquiry on those topics, a year-long multi-site investigation was carried out. The first six months of fieldwork were based in Barcelona, where Zapatista coffee was first traded in Spain and where one of the historical and most important European solidarity groups can be found. The last six months of fieldwork were carried out directly in Chiapas, in contact with coffee producers, Zapatista political authorities, international activists as well as vendors, and the rest of the network implicated in coffee production, roasting, and sale. The investigation was based on qualitative research methods, including participatory observation, focus groups, and semi-structured interviews. The analysis did not only focus on retracing the steps of the market chain as if it could be considered a linear and unilateral process, but it rather aimed at exploring actors’ reciprocal perceptions, roles, and dynamics of power. Demonstrations of solidarity and the money circulation they imply aim at changing the system in place and building alternatives, among other things, on the economic level. This work analyzes the formulation of discourse and the organization of solidarity activities that aim at building opportunities for action within a highly politicized economic sphere to which access must be regularly legitimized. The meaning conveyed by coffee is constructed on a symbolic level by the attribution of moral criteria to transactions. The latter participate in the construction of imaginaries that circulate through solidarity movements with the Zapatista rebellion. Commercial exchanges linked to solidarity networks turned out to represent much more than monetary transactions. The social, cultural, and political spheres are invested by ethics, which penetrates all aspects of militant action. It is at this level that the boundaries of different collective actors connect, contaminating each other: merely following the money flow would have been limiting in order to account for a reality within which imaginary is one of the main currencies. The notions of “trust”, “dignity” and “reciprocity” are repeatedly mobilized to negotiate discontinuous and multidirectional flows in the attempt to balance and justify commercial relations in a politicized context that characterizes its own identity through demonizing “market economy” and its dehumanizing powers.

Keywords: coffee trade, economic anthropology, international cooperation, Zapatista National Liberation Army

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Authors: Lolwa Alansari, Hanen Mrabet, Kholoud Khaled, Abdelhamid Azhaghdani, Sufia Athar, Aska Kaima, Zaineb Mhamdia, Zubaria Altaf, Almunzer Zakaria, Tamara Alshadafat

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Introduction: The Obstetrics and Gynecology Emergency Department at Alwakra Hospital has faced significant challenges, which have been further worsened by the impact of the COVID-19 pandemic. These challenges involve issues such as overcrowding, extended wait times, and a notable surge in demand for emergency care services. Moreover, prolonged waiting times have emerged as a primary factor contributing to situations where patients leave without receiving attention, known as left without being seen (LWBS), and unexpectedly abscond. Addressing the issue of insufficient patient mobility in the obstetrics and gynecology emergency department has brought about substantial improvements in patient care, healthcare administration, and overall departmental efficiency. These changes have not only alleviated overcrowding but have also elevated the quality of emergency care, resulting in higher patient satisfaction, better outcomes, and operational rewards. Methodology: The COVID-19 pandemic has served as a catalyst for substantial transformations in the obstetrics and gynecology emergency, aligning seamlessly with the strategic direction of Hamad Medical Corporation (HMC). The fundamental aim of this initiative is to revolutionize the operational efficiency of the OB-GYN ED. To accomplish this mission, a range of transformations has been initiated, focusing on essential areas such as digitizing systems, optimizing resource allocation, enhancing budget efficiency, and reducing overall costs. The project utilized the Plan-Do-Study-Act (PDSA) model, involving a diverse team collecting baseline data and introducing throughput improvements. Post-implementation data and feedback were analysed, leading to the integration of effective interventions into standard procedures. These interventions included optimized space utilization, real-time communication, bedside registration, technology integration, pre-triage screening, enhanced communication and patient education, consultant presence, and a culture of continuous improvement. These strategies significantly reduced waiting times, enhancing both patient care and operational efficiency. Results: Results demonstrated a substantial reduction in overall average waiting time, dropping from 35 to approximately 14 minutes by August 2023. The wait times for priority 1 cases have been reduced from 22 to 0 minutes, and for priority 2 cases, the wait times have been reduced from 32 to approximately 13.6 minutes. The proportion of patients spending less than 8 hours in the OB ED observation beds rose from 74% in January 2022 to over 98% in 2023. Notably, there was a remarkable decrease in LWBS and absconded patient rates from 2020 to 2023. Conclusion: The project initiated a profound change in the department's operational environment. Efficiency became deeply embedded in the unit's culture, promoting teamwork among staff that went beyond the project's original focus and had a positive influence on operations in other departments. This effectiveness not only made processes more efficient but also resulted in significant cost reductions for the hospital. These cost savings were achieved by reducing wait times, which in turn led to fewer prolonged patient stays and reduced the need for additional treatments. These continuous improvement initiatives have now become an integral part of the Obstetrics and Gynecology Division's standard operating procedures, ensuring that the positive changes brought about by the project persist and evolve over time.

Keywords: overcrowding, waiting time, person centered care, quality initiatives

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