Search results for: Bradley Storm
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 217

Search results for: Bradley Storm

127 Association Between Disability and Obesity Status Among US Adults: Findings From 2019-2021 National Health Interview Survey (NHIS)

Authors: Chimuanya Osuji, Kido Uyamasi, Morgan Bradley

Abstract:

Introduction: Obesity is a major risk factor for many chronic diseases, with higher rates occurring among certain populations. Even though disparities in obesity rates exist for those with disabilities, few studies have assessed the association between disability and obesity status. This study aims to examine the association between type of disability and obesity status among US adults during the Covid-19 pandemic (2019-2021). Methods: Data for this cross-sectional study was obtained from the 2019, 2020 and 2021 NHIS. Multinomial logistic regressions were used to assess the relationship between each type of disability and obesity status (reference= normal/underweight). Each model adjusted for demographic, health status and health-related quality of life variables. Statistical analyses were conducted using SAS version 9.4. Results: Of the 82,632 US adults who completed the NHIS in 2019, 2020, and 2021. 8.9% (n= 7,354) reported at least 1 disability-related condition. Respondents reported having a disability across vision (1.5%), hearing (1.5%), mobility (5.3%), communication (0.8%), cognition (2.4%) and self-care (1.1%) domains. After adjusting for covariates, adults with at least 1 disability-related condition were about 30% more likely to have moderate-severe obesity (AOR=1.3; 95% CI=1.11, 1.53). Mobility was the only disability category positively associated with mild obesity (AOR=1.16; 95% CI=1.01, 1.35) and moderate/severe obesity (AOR=1.6; 95% CI=1.35, 1.89). Individuals with vision disability were about 35% less likely to have mild obesity (AOR=0.66; 95% CI=0.51, 0.86) and moderate-severe obesity (AOR=0.66; 95% CI= 0.48, 0.9). Individuals with hearing disability were 28% less likely to have mild obesity (AOR=0.72; 95% CI= 0.56, 0.94). Individuals with communication disability were about 30% less likely to be overweight (AOR=0.66; 95% CI=0.47, 0.93) and 50% less likely to have mild obesity (AOR=0.45; 95% CI= 0.29, 0.71). Individuals with cognitive disability were about 25% less likely to have mild obesity and about 35% less likely to have moderate-severe obesity. Individuals with self-care disability were about 30% less likely to be overweight. Conclusion: Mobility-related disabilities are significantly associated with obesity status among adults residing in the United States. Researchers and policy makers should implement obesity intervention methods that can address the gap in obesity prevalence rates among those with and without disabilities.

Keywords: cognition, disability, mobility, obesity

Procedia PDF Downloads 44
126 Wave of Islamic Fintech: Revolutionizing Malaysia's Islamic Banking and Finance Regulatory Landscape

Authors: Ho Wen Hui, Azwina Wati Abdull Manaf, Asfarina Kartika Mohd Shakri

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The global trend of Fintech had taken the Malaysian shore by storm in recent years, thus making the studies and observations of its impacts more critical than ever. Additionally, Fintech has grown to become an unavoidable subject in the Islamic Banking and Finance (IBF) industry. In relation to that, this paper seeks to analyze the development of Fintech parallel with the IBF industry and its connection to Islamic economics. While the scarcity of studies on this area is apparent, it is found that there is a need to regulate the development of the Fintech Industry and its effects while analyzing the ramifications and positive effects of Fintech towards parties involved in IBF industry. This paper objectively studies the phenomenon of Islamic Fintech around the world as a whole as well as more specifically in Malaysia. The paper will then explore on the existing regulatory instruments in Malaysia, study their boundaries as well as limitations and contribute on possible reform to regulate Islamic Fintech in this jurisdiction. It is aimed that this paper will prompt and encourage more thorough studies to be conducted on the topic of Fintech which would subsequently contribute to a positive growth of the IBF industry worldwide.

Keywords: financial technology, FinTech, Islamic banking & finance, regulation

Procedia PDF Downloads 205
125 Land Use Sensitivity Map for the Extreme Flood Events in the Kelantan River Basin

Authors: Nader Saadatkhah, Jafar Rahnamarad, Shattri Mansor, Zailani Khuzaimah, Arnis Asmat, Nor Aizam Adnan, Siti Noradzah Adam

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Kelantan river basin as a flood prone area at the east coast of the peninsular Malaysia has suffered several flood and mudflow events in the recent years. The current research attempted to assess the land cover changes impact in the Kelantan river basin focused on the runoff contributions from different land cover classes and the potential impact of land cover changes on runoff generation. In this regards, the hydrological regional modeling of rainfall induced runoff event as the improved transient rainfall infiltration and grid based regional model (Improved-TRIGRS) was employed to compute rate of infiltration, and subsequently changes in the discharge volume in this study. The effects of land use changes on peak flow and runoff volume was investigated using storm rainfall events during the last three decades.

Keywords: improved-TRIGRS model, land cover changes, Kelantan river basin, flood event

Procedia PDF Downloads 388
124 Association of Geomagnetic Storms with Coronal Mass Ejections during 1997-2012

Authors: O. P. Tripathi, P. L. Verma

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Coronal Mass Ejections (CMEs) are mostly reached on Earth from 1 to 5 days from the Sun. As a consequence, slow CMEs are accelerated toward the speed of solar wind and fast CMEs are decelerated toward the speed of the solar wind. Coronal mass ejections (CMEs) are bursts of solar material i.e. clouds of plasma and magnetic fields that shoot off the sun’s surface. Other solar events include solar wind streams that come from the coronal holes on the Sun and solar energetic particles that are primarily released by CMEs. We have studied geomagnetic storms (DST ≤ - 80nT) during 1997-2012 with halo and partial halo coronal mass ejections and found that 73.28% CMEs (halo and partial halo coronal mass ejections) are associated with geomagnetic storms. The association rate of halo and partial halo coronal mass ejections are found 67.06% and 32.94% with geomagnetic storms respectively. We have also determined positive co-relation between magnitude of geomagnetic storms and speed of coronal mass ejection with correlation co-efficient 0.23.

Keywords: geomagnetic storms, coronal mass ejections (CMEs), disturbance storm time (Dst), interplanetary magnetic field (IMF)

Procedia PDF Downloads 480
123 Comparison of On-Site Stormwater Detention Policies in Australian and Brazilian Cities

Authors: Pedro P. Drumond, James E. Ball, Priscilla M. Moura, Márcia M. L. P. Coelho

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In recent decades, On-site Stormwater Detention (OSD) systems have been implemented in many cities around the world. In Brazil, urban drainage source control policies were created in the 1990’s and were mainly based on OSD. The concept of this technique is to promote the detention of additional stormwater runoff caused by impervious areas, in order to maintain pre-urbanization peak flow levels. In Australia OSD, was first adopted in the early 1980’s by the Ku-ring-gai Council in Sydney’s northern suburbs and Wollongong City Council. Many papers on the topic were published at that time. However, source control techniques related to stormwater quality have become to the forefront and OSD has been relegated to the background. In order to evaluate the effectiveness of the current regulations regarding OSD, the existing policies were compared in Australian cities, a country considered experienced in the use of this technique, and in Brazilian cities where OSD adoption has been increasing. The cities selected for analysis were Wollongong and Belo Horizonte, the first municipalities to adopt OSD in their respective countries, and Sydney and Porto Alegre, cities where these policies are local references. The Australian and Brazilian cities are located in Southern Hemisphere of the planet and similar rainfall intensities can be observed, especially in storm bursts greater than 15 minutes. Regarding technical criteria, Brazilian cities have a site-based approach, analyzing only on-site system drainage. This approach is criticized for not evaluating impacts on urban drainage systems and in rare cases may cause the increase of peak flows downstream. The city of Wollongong and most of the Sydney Councils adopted a catchment-based approach, requiring the use of Permissible Site Discharge (PSD) and Site Storage Requirements (SSR) values based on analysis of entire catchments via hydrograph-producing computer models. Based on the premise that OSD should be designed to dampen storms of 100 years Average Recurrence Interval (ARI) storm, the values of PSD and SSR in these four municipalities were compared. In general, Brazilian cities presented low values of PSD and high values of SSR. This can be explained by site-based approach and the low runoff coefficient value adopted for pre-development conditions. The results clearly show the differences between approaches and methodologies adopted in OSD designs among Brazilian and Australian municipalities, especially with regard to PSD values, being on opposite sides of the scale. However, lack of research regarding the real performance of constructed OSD does not allow for determining which is best. It is necessary to investigate OSD performance in a real situation, assessing the damping provided throughout its useful life, maintenance issues, debris blockage problems and the parameters related to rain-flow methods. Acknowledgments: The authors wish to thank CNPq - Conselho Nacional de Desenvolvimento Científico e Tecnológico (Chamada Universal – MCTI/CNPq Nº 14/2014), FAPEMIG - Fundação de Amparo à Pesquisa do Estado de Minas Gerais, and CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior for their financial support.

Keywords: on-site stormwater detention, source control, stormwater, urban drainage

Procedia PDF Downloads 160
122 Ocular Manifestations of Recent Viral Pandemics: A Literature Review

Authors: Mohammad J. J. Taha, Mohammad T. Abuawwad, Warda A. Alrubasy, Shams Khalid Sameer, Taleb Alsafi, Yaqeen Al-Bustanji, Luai Abu-Ismail, Abdulqadir J. Nashwan

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Viral pandemics often take the world by storm, urging the medical community to prioritize the most evident systemic manifestations, often causing ocular manifestations to go unnoticed. This literature review aims to highlight the ocular complications of monkeypox, SARS-CoV-2, MERS, ebola, H1N1, and zika viruses as the most recent viral pandemics. Since the emergence of the newly resurfacing monkeypox and the novel SARS-CoV-2, research aiming to uncover the effects of these pandemics began right away. Moreover, it also discusses the ocular complications of the vaccines and treatments that were used in the scope of the viral pandemics. To add, this work discussed the role of the eye as an important route of viral transmission, and thereafter, the American Academy of Ophthalmology (AAO) recommendations to reduce the incidence of viral transmission were mentioned. Finally, this paper aims to outline a platform for researchers who are interested in further investigating eye-related viral manifestations.

Keywords: ophthalmology, monkeypox, ebola, zika, MERS, H1N1, influenza, COVID-19

Procedia PDF Downloads 107
121 A Weighted K-Medoids Clustering Algorithm for Effective Stability in Vehicular Ad Hoc Networks

Authors: Rejab Hajlaoui, Tarek Moulahi, Hervé Guyennet

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In a highway scenario, the vehicle speed can exceed 120 kmph. Therefore, any vehicle can enter or leave the network within a very short time. This mobility adversely affects the network connectivity and decreases the life time of all established links. To ensure an effective stability in vehicular ad hoc networks with minimum broadcasting storm, we have developed a weighted algorithm based on the k-medoids clustering algorithm (WKCA). Indeed, the number of clusters and the initial cluster heads will not be selected randomly as usual, but considering the available transmission range and the environment size. Then, to ensure optimal assignment of nodes to clusters in both k-medoids phases, the combined weight of any node will be computed according to additional metrics including direction, relative speed and proximity. Empirical results prove that in addition to the convergence speed that characterizes the k-medoids algorithm, our proposed model performs well both AODV-Clustering and OLSR-Clustering protocols under different densities and velocities in term of end-to-end delay, packet delivery ratio, and throughput.

Keywords: communication, clustering algorithm, k-medoids, sensor, vehicular ad hoc network

Procedia PDF Downloads 212
120 Runoff Estimates of Rapidly Urbanizing Indian Cities: An Integrated Modeling Approach

Authors: Rupesh S. Gundewar, Kanchan C. Khare

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Runoff contribution from urban areas is generally from manmade structures and few natural contributors. The manmade structures are buildings; roads and other paved areas whereas natural contributors are groundwater and overland flows etc. Runoff alleviation is done by manmade as well as natural storages. Manmade storages are storage tanks or other storage structures such as soakways or soak pits which are more common in western and European countries. Natural storages are catchment slope, infiltration, catchment length, channel rerouting, drainage density, depression storage etc. A literature survey on the manmade and natural storages/inflow has presented percentage contribution of each individually. Sanders et.al. in their research have reported that a vegetation canopy reduces runoff by 7% to 12%. Nassif et el in their research have reported that catchment slope has an impact of 16% on bare standard soil and 24% on grassed soil on rainfall runoff. Infiltration being a pervious/impervious ratio dependent parameter is catchment specific. But a literature survey has presented a range of 15% to 30% loss of rainfall runoff in various catchment study areas. Catchment length and channel rerouting too play a considerable role in reduction of rainfall runoff. Ground infiltration inflow adds to the runoff where the groundwater table is very shallow and soil saturates even in a lower intensity storm. An approximate percent contribution through this inflow and surface inflow contributes to about 2% of total runoff volume. Considering the various contributing factors in runoff it has been observed during a literature survey that integrated modelling approach needs to be considered. The traditional storm water network models are able to predict to a fair/acceptable degree of accuracy provided no interaction with receiving water (river, sea, canal etc), ground infiltration, treatment works etc. are assumed. When such interactions are significant then it becomes difficult to reproduce the actual flood extent using the traditional discrete modelling approach. As a result the correct flooding situation is very rarely addressed accurately. Since the development of spatially distributed hydrologic model the predictions have become more accurate at the cost of requiring more accurate spatial information.The integrated approach provides a greater understanding of performance of the entire catchment. It enables to identify the source of flow in the system, understand how it is conveyed and also its impact on the receiving body. It also confirms important pain points, hydraulic controls and the source of flooding which could not be easily understood with discrete modelling approach. This also enables the decision makers to identify solutions which can be spread throughout the catchment rather than being concentrated at single point where the problem exists. Thus it can be concluded from the literature survey that the representation of urban details can be a key differentiator to the successful understanding of flooding issue. The intent of this study is to accurately predict the runoff from impermeable areas from urban area in India. A representative area has been selected for which data was available and predictions have been made which are corroborated with the actual measured data.

Keywords: runoff, urbanization, impermeable response, flooding

Procedia PDF Downloads 233
119 Dynamics of the Moving Ship at Complex and Sudden Impact of External Forces

Authors: Bo Liu, Liangtian Gao, Idrees Qasim

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The impact of the storm leads to accidents even in the case of vessels that meet the computed safety criteria for stability. That is why, in order to clarify the causes of the accident and shipwreck, it is necessary to study the dynamics of the ship under the complex sudden impact of external forces. The task is to determine the movement and landing of the ship in the complex and sudden impact of external forces, i.e. when the ship's load changes over a relatively short period of time. For the solution, a technique was used to study the ship's dynamics, which is based on the compilation of a system of differential equations of motion. A coordinate system was adopted for the equation of motion of the hull and the determination of external forces. As a numerical method of integration, the 4th order Runge-Kutta method was chosen. The results of the calculation show that dynamic deviations were lower for high-altitude vessels. The study of the movement of the hull under a difficult situation is performed: receiving of cargo, impact of a flurry of wind and subsequent displacement of the cargo. The risk of overturning and flooding was assessed.

Keywords: dynamics, statics, roll, trim, vertical displacement, dynamic load, tilt

Procedia PDF Downloads 196
118 Mitigating Urban Flooding through Spatial Planning Interventions: A Case of Bhopal City

Authors: Rama Umesh Pandey, Jyoti Yadav

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Flooding is one of the waterborne disasters that causes extensive destruction in urban areas. Developing countries are at a higher risk of such damage and more than half of the global flooding events take place in Asian countries including India. Urban flooding is more of a human-induced disaster rather than natural. This is highly influenced by the anthropogenic factors, besides metrological and hydrological causes. Unplanned urbanization and poor management of cities enhance the impact manifold and cause huge loss of life and property in urban areas. It is an irony that urban areas have been facing water scarcity in summers and flooding during monsoon. This paper is an attempt to highlight the factors responsible for flooding in a city especially from an urban planning perspective and to suggest mitigating measures through spatial planning interventions. Analysis has been done in two stages; first is to assess the impacts of previous flooding events and second to analyze the factors responsible for flooding at macro and micro level in cities. Bhopal, a city in Central India having nearly two million population, has been selected for the study. The city has been experiencing flooding during heavy rains in monsoon. The factors responsible for urban flooding were identified through literature review as well as various case studies from different cities across the world and India. The factors thus identified were analyzed for both macro and micro level influences. For macro level, the previous flooding events that have caused huge destructions were analyzed and the most affected areas in Bhopal city were identified. Since the identified area was falling within the catchment of a drain so the catchment area was delineated for the study. The factors analyzed were: rainfall pattern to calculate the return period using Weibull’s formula; imperviousness through mapping in ArcGIS; runoff discharge by using Rational method. The catchment was divided into micro watersheds and the micro watershed having maximum impervious surfaces was selected to analyze the coverage and effect of physical infrastructure such as: storm water management; sewerage system; solid waste management practices. The area was further analyzed to assess the extent of violation of ‘building byelaws’ and ‘development control regulations’ and encroachment over the natural water streams. Through analysis, the study has revealed that the main issues have been: lack of sewerage system; inadequate storm water drains; inefficient solid waste management in the study area; violation of building byelaws through extending building structures ether on to the drain or on the road; encroachments by slum dwellers along or on to the drain reducing the width and capacity of the drain. Other factors include faulty culvert’s design resulting in back water effect. Roads are at higher level than the plinth of houses which creates submersion of their ground floors. The study recommends spatial planning interventions for mitigating urban flooding and strategies for management of excess rain water during monsoon season. Recommendations have also been made for efficient land use management to mitigate water logging in areas vulnerable to flooding.

Keywords: mitigating strategies, spatial planning interventions, urban flooding, violation of development control regulations

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117 Application of Global Predictive Real Time Control Strategy to Improve Flooding Prevention Performance of Urban Stormwater Basins

Authors: Shadab Shishegar, Sophie Duchesne, Genevieve Pelletier

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Sustainability as one of the key elements of Smart cities, can be realized by employing Real Time Control Strategies for city’s infrastructures. Nowadays Stormwater management systems play an important role in mitigating the impacts of urbanization on natural hydrological cycle. These systems can be managed in such a way that they meet the smart cities standards. In fact, there is a huge potential for sustainable management of urban stormwater and also its adaptability to global challenges like climate change. Hence, a dynamically managed system that can adapt itself to instability of the environmental conditions is desirable. A Global Predictive Real Time Control approach is proposed in this paper to optimize the performance of stormwater management basins in terms of flooding prevention. To do so, a mathematical optimization model is developed then solved using Genetic Algorithm (GA). Results show an improved performance at system-level for the stormwater basins in comparison to static strategy.

Keywords: environmental sustainability, optimization, real time control, storm water management

Procedia PDF Downloads 156
116 An Ecological Systems Approach to Risk and Protective Factors of Sibling Conflict for Children in the United Kingdom

Authors: C. A. Bradley, D. Patsios, D. Berridge

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This paper presents evidence to better understand the risk and protective factors related to sibling conflict and the patterns of association between sibling conflict and negative adjustment outcomes by incorporating additional familial and societal factors within statistical models of risk and adjustment. It was conducted through the secondary analysis of a large representative cross-sectional dataset of children in the UK. The original study includes proxy interviews for young children and self-report interviews for adolescents. The study applies an ecological systems framework for the analyses. Hierarchical regression models assess risk and protective factors and adjustment outcomes associated with sibling conflict. Interactions reveal differential effect between contextual risk factors and the social context of influence. The general pattern of findings suggested that, although factors affecting likelihood of experiencing sibling conflict were often determined by child age, some remained consistent across childhood. These factors were often conditional on each other, reinforcing the importance of an ecological framework. Across both age-groups, sibling conflict was associated with siblings closer in age; male sibling groups; most advantaged socio-economic group; and exposure to community violence, such as witnessing violent assault or robbery. The study develops the evidence base on the influence of ethnicity and socio-economic group on sibling conflict by exploring interactions between social context. It also identifies key new areas of influence – such as family structure, disability, and community violence in exacerbating or reducing risk of conflict. The study found negative associations between sibling conflict and young children’s mental well-being and adolescents' mental well-being and anti-social behaviour, but also more context specific associations – such as sibling conflict moderating the negative impact of adversity and high risk experiences for young children such as parental violence toward the child.

Keywords: adjustment, conflict, ecological systems, family systems, risk and protective factors, sibling

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115 The Use of Non-Parametric Bootstrap in Computing of Microbial Risk Assessment from Lettuce Consumption Irrigated with Contaminated Water by Sanitary Sewage in Infulene Valley

Authors: Mario Tauzene Afonso Matangue, Ivan Andres Sanchez Ortiz

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The Metropolitan area of Maputo (Mozambique Capital City) is located in semi-arid zone (800 mm annual rainfall) with 1101170 million inhabitants. On the west side, there are the flatlands of Infulene where the Mulauze River flows towards to the Indian Ocean, receiving at this site, the storm water contaminated with sanitary sewage from Maputo, transported through a concrete open channel. In Infulene, local communities grow salads crops such as tomato, onion, garlic, lettuce, and cabbage, which are then commercialized and consumed in several markets in Maputo City. Lettuce is the most daily consumed salad crop in different meals, generally in fast-foods, breakfasts, lunches, and dinners. However, the risk of infection by several pathogens due to the consumption of lettuce, using the Quantitative Microbial Risk Assessment (QMRA) tools, is still unknown since there are few studies or publications concerning to this matter in Mozambique. This work is aimed at determining the annual risk arising from the consumption of lettuce grown in Infulene valley, in Maputo, using QMRA tools. The exposure model was constructed upon the volume of contaminated water remaining in the lettuce leaves, the empirical relations between the number of pathogens and the indicator of microorganisms (E. coli), the consumption of lettuce (g) and reduction of pathogens (days). The reference pathogens were Vibrio cholerae, Cryptosporidium, norovirus, and Ascaris. The water quality samples (E. coli) were collected in the storm water channel from January 2016 to December 2018, comprising 65 samples, and the urban lettuce consumption data were collected through inquiry in Maputo Metropolis covering 350 persons. A non-parametric bootstrap was performed involving 10,000 iterations over the collected dataset, namely, water quality (E. coli) and lettuce consumption. The dose-response models were: Exponential for Cryptosporidium, Kummer Confluent hypergeomtric function (1F1) for Vibrio and Ascaris Gaussian hypergeometric function (2F1-(a,b;c;z) for norovirus. The annual infection risk estimates were performed using R 3.6.0 (CoreTeam) software by Monte Carlo (Latin hypercubes), a sampling technique involving 10,000 iterations. The annual infection risks values expressed by Median and the 95th percentile, per person per year (pppy) arising from the consumption of lettuce are as follows: Vibrio cholerae (1.00, 1.00), Cryptosporidium (3.91x10⁻³, 9.72x 10⁻³), nororvirus (5.22x10⁻¹, 9.99x10⁻¹) and Ascaris (2.59x10⁻¹, 9.65x10⁻¹). Thus, the consumption of the lettuce would result in greater risks than the tolerable levels ( < 10⁻³ pppy or 10⁻⁶ DALY) for all pathogens, and the Vibrio cholerae is the most virulent pathogens, according to the hit-single models followed by the Ascaris lumbricoides and norovirus. The sensitivity analysis carried out in this work pointed out that in the whole QMRA, the most important input variable was the reduction of pathogens (Spearman rank value was 0.69) between harvest and consumption followed by water quality (Spearman rank value was 0.69). The decision-makers (Mozambique Government) must strengthen the prevention measures related to pathogens reduction in lettuce (i.e., washing) and engage in wastewater treatment engineering.

Keywords: annual infections risk, lettuce, non-parametric bootstrapping, quantitative microbial risk assessment tools

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114 Assessment of Causes of Building Collapse in Nigeria

Authors: Olufemi Oyedele

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Building collapse (BC) in Nigeria is becoming a regular occurrence, each recording great casualties in the number of lives and materials lost. Building collapse is a situation where building which has been completed and occupied, completed but not occupied or under construction, collapses on its own due to action or inaction of man or due to natural event like earthquake, storm, flooding, tsunami or wildfire. It is different from building demolition. There are various causes of building collapse and each case requires expert judgment to decide the cause of its collapse. Rate of building collapse is a reflection of the level of organization and control of building activities and degree of sophistication of the construction professionals in a country. This study explored the use of case study by examining the causes of six (6) collapsed buildings (CB) across Nigeria. Samples of materials from the sites of the collapsed buildings were taken for testing and analysis, while critical observations were made at the sites to note the conditions of the ground (building base). The study found out that majority of the building collapses in Nigeria were due to poor workmanship, sub-standard building materials, followed by bad building base and poor design. The National Building Code 2006 is not effective due to lack of enforcement and the Physical Development Departments of states and Federal Capital Territory are just mere agents of corruption allowing all types of construction without building approvals.

Keywords: building collapse, concrete tests, differential settlement, integrity test, quality control

Procedia PDF Downloads 497
113 Understanding Help Seeking among Black Women with Clinically Significant Posttraumatic Stress Symptoms

Authors: Glenda Wrenn, Juliet Muzere, Meldra Hall, Allyson Belton, Kisha Holden, Chanita Hughes-Halbert, Martha Kent, Bekh Bradley

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Understanding the help seeking decision making process and experiences of health disparity populations with posttraumatic stress disorder (PTSD) is central to development of trauma-informed, culturally centered, and patient focused services. Yet, little is known about the decision making process among adult Black women who are non-treatment seekers as they are, by definition, not engaged in services. Methods: Audiotaped interviews were conducted with 30 African American adult women with clinically significant PTSD symptoms who were engaged in primary care, but not in treatment for PTSD despite symptom burden. A qualitative interview guide was used to elucidate key themes. Independent coding of themes mapped to theory and identification of emergent themes were conducted using qualitative methods. An existing quantitative dataset was analyzed to contextualize responses and provide a descriptive summary of the sample. Results: Emergent themes revealed that active mental avoidance, the intermittent nature of distress, ambivalence, and self-identified resilience as undermining to help seeking decisions. Participants were stuck within the help-seeking phase of ‘recognition’ of illness and retained a sense of “it is my decision” despite endorsing significant social and environmental negative influencers. Participants distinguished ‘help acceptance’ from ‘help seeking’ with greater willingness to accept help and importance placed on being of help to others. Conclusions: Elucidation of the decision-making process from the perspective of non-treatment seekers has implications for outreach and treatment within models of integrated and specialty systems care. The salience of responses to trauma symptoms and stagnation in the help seeking recognition phase are findings relevant to integrated care service design and community engagement.

Keywords: culture, help-seeking, integrated care, PTSD

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112 Study and Modeling of Flood Watershed in Arid and Semi Arid Regions of Algeria

Authors: Belagoune Fares, Boutoutaou Djamel

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The study on floods in Algeria established by the National Agency of Water Resources (ANRH) shows that the country is confronted with the phenomenon of very destructive floods and floods especially in arid and semiarid regions. Flooding of rivers in these areas is less known. They are characterized by their sudden duration (rain showers, thunderstorm).The duration of the flood is of the order of minutes to hours. The human and material damage caused by these floods were still high. The study area encompasses three watersheds in semi-arid and arid south and Algeria. THERE are pools of Chott-Melghir (68,751 km2), highland Constantine-07 (9578 km2) and El Hodna-05 basin (25,843 km2). The total area of this zone is about 104,500km2.Studies of protection against floods and design studies of hydraulic structures (spillway, storm basin, etc.) require the raw data which is often unknown in several places particularly at ungauged wadis of these areas. This makes it very difficult to schedules and managers working in the field of hydraulic studies. The objective of this study and propose a methodology for determining flows in the absence of observations in the semi-arid and arid south eastern Algeria. The objective of the study is to propose a methodology for these areas of flood calculation for ungauged rivers.

Keywords: flood, watershed, specific flow, coefficient of variation, arid

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111 A Study on the Safety Evaluation of Pier According to the Water Level Change by the Monte-Carlo Method

Authors: Minho Kwon, Jeonghee Lim, Yeongseok Jeong, Donghoon Shin, Kiyoung Kim

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Recently, global warming phenomenon has led to natural disasters caused by global environmental changes, and due to abnormal weather events, the frequency and intensity of heavy rain storm typhoons are increasing. Therefore, it is imperative to prepare for future heavy rain storms and typhoons. This study selects arbitrary target bridges and performs numerical analysis to evaluate the safety of bridge piers in the event that the water level changes. The numerical model is based on two-dimensional surface elements. Actual reinforced concrete was simulated by modeling concrete to include reinforcements, and a contact boundary model was applied between the ground and the concrete. The water level applied to the piers was considered at 18 levels between 7.5 m and 16.1 m. The elastic modulus, compressive strength, tensile strength, and yield strength of the reinforced concrete were calculated using 250 random combinations and numerical analysis was carried out for each water level. In the results of analysis, the bridge exceeded the stated limit at 15.0 m. At the maximum water level of 16.1m, the concrete’s failure rate was 35.2%, but the probability that the reinforcement would fail was 61.2%.

Keywords: Monte-Carlo method, pier, water level change, limit state

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110 How the Current Opioid Crisis Differs from the Heroin Epidemic of the 1960s-1970s: An Analysis of Drugs and Demographics

Authors: Donna L. Roberts

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Heroin has appeared on the drug scene before. Yet the current opioid crisis differs in significant ways. In order to address the grave challenges, this epidemic poses, the unique precipitating and sustaining conditions must be thoroughly examined. This research explored the various aspects of the political, economic, and social conditions that created a 'perfect storm' for the evolution and maintenance of the current opioid crisis. Specifically, the epidemiology, demographics, and progression of addiction inherent in the current crisis were compared to the patterns of past opioid use. Additionally, the role of pharmaceutical companies and prescribing physicians, the nature and pharmaceutical properties of the available substances and the changing socioeconomic climate were considered. Results indicated that the current crisis differs significantly with respect to its evolution, magnitude, prevalence, and widespread societal effects. Precipitated by a proliferation of prescription medication and sustained by the availability of cheaper, more potent street drugs, including new versions of synthetic opioids, the current crisis presents unprecedented challenges affecting a wider and more diverse segment of society. The unique aspects of this epidemic demand unique approaches to addressing the problem. Understanding these differences is a key step in working toward a practical and enduring solution.

Keywords: addiction, drug abuse, opioids, opioid crisis

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109 An Inflammatory Mediated Hypothesis of COVID-19 Psychosis

Authors: Hilary P. Stevenson, Alexander J. Hayek, Amie Dereczyk

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In this case report, we provide an example of an asymptomatic COVID-19 positive patient who presented with new-onset psychosis with severe paranoid delusions. He was seen in our ED after ingesting isopropyl alcohol which he reported was an attempt to escape presumed attackers, which at the time was logical to the patient. The patient’s family had COVID-19 symptoms that corresponded to those typically observed from the Omicron variant. The patient was treated successfully, within ten days, with Risperdal twice-daily dosing resulting in the resolution of the patient’s delusions and improved insight regarding the events that led to his hospitalization. In this work, we examine possible contributing factors to new-onset psychosis in the context of COVID-19, a phenomenon that is becoming increasingly notable in the literature. One area of importance is the already established inflammatory hypothesis of psychosis in which defects in the innate immune system, which result in its overactivation, may play a role in a typical first-episode psychosis, in addition to subsequent episodes. Given that COVID-19 is known to cause derangements in the innate immune system, such as cytokine storm reactions, this link may be critical in further understanding the etiologies of new-onset COVID-19 psychosis and its risk factors. Also included in this work is a brief review of antipsychotic interventions that have been described in the literature to date for the first episode of COVID-19-related psychosis. This will explore the potential of some antipsychotics to innately diminish the production of pro-inflammatory cytokines, further enhancing their usefulness in COVID-19 first-episode psychosis patients.

Keywords: COVID-19, first break psychosis, inflammatory hypothesis of psychosis, Risperdal

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108 Protecting the Health of Astronauts: Enhancing Occupational Health Monitoring and Surveillance for Former NASA Astronauts to Understand Long-Term Outcomes of Spaceflight-Related Exposures

Authors: Meredith Rossi, Lesley Lee, Mary Wear, Mary Van Baalen, Bradley Rhodes

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The astronaut community is unique, and may be disproportionately exposed to occupational hazards not commonly seen in other communities. The extent to which the demands of the astronaut occupation and exposure to spaceflight-related hazards affect the health of the astronaut population over the life course is not completely known. A better understanding of the individual, population, and mission impacts of astronaut occupational exposures is critical to providing clinical care, targeting occupational surveillance efforts, and planning for future space exploration. The ability to characterize the risk of latent health conditions is a significant component of this understanding. Provision of health screening services to active and former astronauts ensures individual, mission, and community health and safety. Currently, the NASA-Johnson Space Center (JSC) Flight Medicine Clinic (FMC) provides extensive medical monitoring to active astronauts throughout their careers. Upon retirement, astronauts may voluntarily return to the JSC FMC for an annual preventive exam. However, current retiree monitoring includes only selected screening tests, representing an opportunity for augmentation. The potential long-term health effects of spaceflight demand an expanded framework of testing for former astronauts. The need is two-fold: screening tests widely recommended for other aging populations are necessary to rule out conditions resulting from the natural aging process (e.g., colonoscopy, mammography); and expanded monitoring will increase NASA’s ability to better characterize conditions resulting from astronaut occupational exposures. To meet this need, NASA has begun an extensive exploration of the overall approach, cost, and policy implications of expanding the medical monitoring of former NASA astronauts under the Astronaut Occupational Health program. Increasing the breadth of monitoring services will ultimately enrich the existing evidence base of occupational health risks to astronauts. Such an expansion would therefore improve the understanding of the health of the astronaut population as a whole, and the ability to identify, mitigate, and manage such risks in preparation for deep space exploration missions.

Keywords: astronaut, long-term health, NASA, occupational health, surveillance

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107 Agricultural Water Consumption Estimation in the Helmand Basin

Authors: Mahdi Akbari, Ali Torabi Haghighi

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Hamun Lakes, located in the Helmand Basin, consisting of four water bodies, were the greatest (>8500 km2) freshwater bodies in Iran plateau but have almost entirely desiccated over the last 20 years. The desiccation of the lakes caused dust storm in the region which has huge economic and health consequences on the inhabitants. The flow of the Hirmand (or Helmand) River, the most important feeding river, has decreased from 4 to 1.9 km3 downstream due to anthropogenic activities. In this basin, water is mainly consumed for farming. Due to the lack of in-situ data in the basin, this research utilizes remote-sensing data to show how croplands and consequently consumed water in the agricultural sector have changed. Based on Landsat NDVI, we suggest using a threshold of around 0.35-0.4 to detect croplands in the basin. Croplands of this basin has doubled since 1990, especially in the downstream of the Kajaki Dam (the biggest dam of the basin). Using PML V2 Actual Evapotranspiration (AET) data and considering irrigation efficiency (≈0.3), we estimate that the consumed water (CW) for farming. We found that CW has increased from 2.5 to over 7.5 km3 from 2002 to 2017 in this basin. Also, the annual average Potential Evapotranspiration (PET) of the basin has had a negative trend in the recent years, although the AET over croplands has an increasing trend. In this research, using remote sensing data, we covered lack of data in the studied area and highlighted anthropogenic activities in the upstream which led to the lakes desiccation in the downstream.

Keywords: Afghanistan-Iran transboundary Basin, Iran-Afghanistan water treaty, water use, lake desiccation

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106 Study of the Benefit Analysis Using Vertical Farming Method in Urban Renewal within the Older City of Taichung

Authors: Hsu Kuo-Wei, Tan Roon Fang, Chao Jen-chih

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Cities face environmental challenges, including over-urbanization issues, air and water quality issues, lack of green space, excess heat capture, polluted storm water runoff and lack of ecological biodiversity. The vertical farming holds the condition of technology addressing these issues by enabling more food to be produced with finite less resources use and space. Most of the existing research regarding to technology Industry of agriculture between plant factory and vertical greening, which with high costs and high-technology. Relative research developed a sustainable model for construction and operation of the vertical farm in urban housing which aims to revolutionize our daily life of food production and urban development. However, those researches focused on quantitative analysis. This study utilized relative research for key variables of benefits of vertical farming. In the second stage, utilizes Fuzzy Delphi Method to obtain the critical factors of benefits of vertical farming using in Urban Renewal by interviewing the foregoing experts. Then, Analytic Hierarchy Process is applied to find the importance degree of each criterion as the measurable indices of the vertical farming method in urban renewal within the older city of Taichung.

Keywords: urban renewal, vertical farming, urban agriculture, benefit analysis, the older city of Taichung

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105 Tide Contribution in the Flood Event of Jeddah City: Mathematical Modelling and Different Field Measurements of the Groundwater Rise

Authors: Aïssa Rezzoug

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This paper is aimed to bring new elements that demonstrate the tide caused the groundwater to rise in the shoreline band, on which the urban areas occurs, especially in the western coastal cities of the Kingdom of Saudi Arabia like Jeddah. The reason for the last events of Jeddah inundation was the groundwater rise in the city coupled at the same time to a strong precipitation event. This paper will illustrate the tide participation in increasing the groundwater level significantly. It shows that the reason for internal groundwater recharge within the urban area is not only the excess of the water supply coming from surrounding areas, due to the human activity, with lack of sufficient and efficient sewage system, but also due to tide effect. The research study follows a quantitative method to assess groundwater level rise risks through many in-situ measurements and mathematical modelling. The proposed approach highlights groundwater level, in the urban areas of the city on the shoreline band, reaching the high tide level without considering any input from precipitation. Despite the small tide in the Red Sea compared to other oceanic coasts, the groundwater level is considerably enhanced by the tide from the seaside and by the freshwater table from the landside of the city. In these conditions, the groundwater level becomes high in the city and prevents the soil to evacuate quickly enough the surface flow caused by the storm event, as it was observed in the last historical flood catastrophe of Jeddah in 2009.

Keywords: flood, groundwater rise, Jeddah, tide

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104 Early Intervention for Preschool Children of Parents with Mental Illness: The Evaluation of a Resource for Service Providers

Authors: Stella Laletas, Andrea Reupert, Melinda Goodyear, Bradley Morgan

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Background: Many people with a mental illness have young children. Research has shown that early childhood is a particularly vulnerable time for children whose parents have a mental illness. Moreover, repeated research has demonstrated the effectiveness of a multiagency approach to family focused practice for improving parental functioning and preventing adverse outcomes in children whose parents have a mental illness, particularly in the early years of a child’s life. However, there is a paucity of professional development resources for professionals who work with families where a parent has a mental illness and has young children. Significance of the study: This study will make a contribution to addressing knowledge gaps around resource development and workforce needs for early childhood and mental health professionals working with young children where a parent has a mental illness. Objective: This presentation describes a newly developed resource, 'Pathways of Care', specifically designed for early childhood educators and mental health workers, alongside pilot evaluation data regarding its effectiveness. ‘Pathways of Care’ aims to promote collaborative practice and present early identification and referral processes for workers in this sector. The resource was developed by the Children of Parents with a Mental Illness (COPMI) National Initiative which is funded by the Australian Government. Method: Using a mixed method design, the effectiveness of the training resource is also presented. Fifteen workers completed the Family Focus Mental Health Practice Questionnaire pre and post using the resource, to measure confidence and practice change; semi-structured interviews were also conducted with eight of these same workers to further explore the utility of the resource. Findings: The findings indicated the resource was effective in increasing knowledge and confidence, particularly for new and/or inexperienced staff. Examples of how the resource was used in practice by various professions emerged from the interview data. Conclusions: Collaborative practice, early identification and intervention in early childhood can potentially play a key role in altering the life trajectory of children who are at risk. This information has important implications for workforce development and staff training in both the early childhood and mental health sectors. Implications for policy and future research are discussed.

Keywords: parents with mental ilnesses, early intervention, evaluation, preschool children

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103 Reservoir Inflow Prediction for Pump Station Using Upstream Sewer Depth Data

Authors: Osung Im, Neha Yadav, Eui Hoon Lee, Joong Hoon Kim

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Artificial Neural Network (ANN) approach is commonly used in lots of fields for forecasting. In water resources engineering, forecast of water level or inflow of reservoir is useful for various kind of purposes. Due to advantages of ANN, many papers were written for inflow prediction in river networks, but in this study, ANN is used in urban sewer networks. The growth of severe rain storm in Korea has increased flood damage severely, and the precipitation distribution is getting more erratic. Therefore, effective pump operation in pump station is an essential task for the reduction in urban area. If real time inflow of pump station reservoir can be predicted, it is possible to operate pump effectively for reducing the flood damage. This study used ANN model for pump station reservoir inflow prediction using upstream sewer depth data. For this study, rainfall events, sewer depth, and inflow into Banpo pump station reservoir between years of 2013-2014 were considered. Feed – Forward Back Propagation (FFBF), Cascade – Forward Back Propagation (CFBP), Elman Back Propagation (EBP) and Nonlinear Autoregressive Exogenous (NARX) were used as ANN model for prediction. A comparison of results with ANN model suggests that ANN is a powerful tool for inflow prediction using the sewer depth data.

Keywords: artificial neural network, forecasting, reservoir inflow, sewer depth

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102 Prognostic Value of C-Reactive Protein (CRP) in SARS-CoV-2 Infection: A Simplified Biomarker of COVID-19 Severity in Sub-Saharan Africa

Authors: Teklay Gebrecherkos, Mahmud Abdulkader, Tobias Rinke De Wit, Britta C. Urban, Feyissa Chala, Yazezew Kebede, Dawit Welday

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Background: C-reactive protein (CRP) levels are a reliable surrogate for interleukin-6 bioactivity that plays a pivotal role in the pathogenesis of cytokine storm associated with severe COVID-19. There is a lack of data on the role of CRP as a determinant of COVID-19 severity status in the African context. Methods: We determined the longitudinal kinetics of CRP levels on 78 RT-PCR-confirmed COVID-19 patients (49 non-severe and 29 severe cases) and 50 PCR-negative controls. Results: COVID-19 patients had overall significantly elevated CRP at baseline when compared to PCR-negative controls [median 11.1 (IQR: 2.0-127.8) mg/L vs. 0.9 (IQR: 0.5-1.9) mg/L; p=0.0004)]. Moreover, severe COVID-19 patients had significantly higher median CRP levels than non-severe cases [166.1 (IQR: 48.6-332.5) mg/L vs. 2.4 (IQR: 1.2-7.6) mg/L; p<0.00001)]. In addition, persistently elevated levels of CRP were exhibited among those with comorbidities and higher age groups. Area under receiver operating characteristic curve (AUC) analysis of CRP levels distinguished PCR-confirmed COVID-19 patients from the ones with PCR-negative non-COVID-19 individuals, with an AUC value of 0.77 (95% CI: 0.68-0.84; p=0.001). Moreover, it clearly distinguished severe from non-severe COVID-19 patients, with an AUC value of 0.83 (95% CI: 0.73-0.91). After adjusting for age and the presence of comorbidities, CRP levels above 30 mg/L were significantly associated with an increased risk of developing severe COVID-19 (adjusted relative risk 3.99 (95%CI: 1.35-11.82; p=0.013). Conclusions: Determining CRP levels in COVID-19 patients in African settings may provide a simple, prompt, and inexpensive assessment of the severity status at baseline and monitoring of treatment outcomes.

Keywords: CRP, COVID-19, SARS-CoV-2, biomarker

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101 Estimation of the Effectiveness of Tasik Kemajuan and Tasik Inovasi as Flood Detention Pond at UTHM Campus

Authors: Noor Aliza Binti Ahmad, Azra Munirah Mat Daud, Sabariah Musa, Mohamad Azhar MK

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Flooding is a common natural disaster in Malaysia triggered by heavy rainfall. Urbanization that increases the construction of paved areas, subsequently raise surface runoff and reduce time of concentration. It increases flood magnitude and so that leads to greater flood problems as what has happened at Universiti Tun Hussein Onn Malaysia (UTHM) area in December 2006 and earlier 2007. Tasik Kemajuan and Tasik Inovasi were constructed as recreation ponds and have also functioned as flood ponds. Unfortunately, the flood problem still occurs persistently. Thus, the effectiveness of Tasik Kemajuan and Tasik Inovasi in reducing the flood problems need to be investigated and the causes of flood events at UTHM Campus need to be evaluated. The results from this study show that the conditions of Tasik Kemajuan and Tasik Inovasi are effective in reducing the flood water levels. It also can be concluded that increasing water level in both lakes in UTHM Campus are significantly influenced by presence of the grass and rubbish. During dry condition, the flow rates with three different days are 59.38m3/s, 60.71m3/s and 59.08m3/s and while for wet condition in two different days are 89.59 m3/s and 86.61m3/s. In conclusion, this system should be improved to prevent future flooding either widened or reduced drainage floor, and also perform maintenance on the plants that live around the lake.

Keywords: drainage system, flood detention, lakes, storm water

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100 Genome Sequencing, Assembly and Annotation of Gelidium Pristoides from Kenton-on-Sea, South Africa

Authors: Sandisiwe Mangali, Graeme Bradley

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Genome is complete set of the organism's hereditary information encoded as either deoxyribonucleic acid or ribonucleic acid in most viruses. The three different types of genomes are nuclear, mitochondrial and the plastid genome and their sequences which are uncovered by genome sequencing are known as an archive for all genetic information and enable researchers to understand the composition of a genome, regulation of gene expression and also provide information on how the whole genome works. These sequences enable researchers to explore the population structure, genetic variations, and recent demographic events in threatened species. Particularly, genome sequencing refers to a process of figuring out the exact arrangement of the basic nucleotide bases of a genome and the process through which all the afore-mentioned genomes are sequenced is referred to as whole or complete genome sequencing. Gelidium pristoides is South African endemic Rhodophyta species which has been harvested in the Eastern Cape since the 1950s for its high economic value which is one motivation for its sequencing. Its endemism further motivates its sequencing for conservation biology as endemic species are more vulnerable to anthropogenic activities endangering a species. As sequencing, mapping and annotating the Gelidium pristoides genome is the aim of this study. To accomplish this aim, the genomic DNA was extracted and quantified using the Nucleospin Plank Kit, Qubit 2.0 and Nanodrop. Thereafter, the Ion Plus Fragment Library was used for preparation of a 600bp library which was then sequenced through the Ion S5 sequencing platform for two runs. The produced reads were then quality-controlled and assembled through the SPAdes assembler with default parameters and the genome assembly was quality assessed through the QUAST software. From this assembly, the plastid and the mitochondrial genomes were then sampled out using Gelidiales organellar genomes as search queries and ordered according to them using the Geneious software. The Qubit and the Nanodrop instruments revealed an A260/A280 and A230/A260 values of 1.81 and 1.52 respectively. A total of 30792074 reads were obtained and produced a total of 94140 contigs with resulted into a sequence length of 217.06 Mbp with N50 value of 3072 bp and GC content of 41.72%. A total length of 179281bp and 25734 bp was obtained for plastid and mitochondrial respectively. Genomic data allows a clear understanding of the genomic constituent of an organism and is valuable as foundation information for studies of individual genes and resolving the evolutionary relationships between organisms including Rhodophytes and other seaweeds.

Keywords: Gelidium pristoides, genome, genome sequencing and assembly, Ion S5 sequencing platform

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99 Analysys of Some Solutions to Protect the Tombolo of Giens

Authors: Yves Lacroix, Van Van Than, Didier Léandri, Pierre Liardet

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The western Tombolo of the Giens peninsula in southern France, known as Almanarre beach, is subject to coastal erosion. We are trying to use computer simulation in order to propose solutions to stop this erosion. Our aim was first to determine the main factors for this erosion and successfully apply a coupled hydro-sedimentological numerical model based on observations and measurements that have been performed on the site for decades. We have gathered all available information and data about waves, winds, currents, tides, bathymetry, coastal line, and sediments concerning the site. These have been divided into two sets: one devoted to calibrating a numerical model using Mike 21 software, the other to serve as a reference in order to numerically compare the present situation to what it could be if we implemented different types of underwater constructions. This paper presents the first part of the study: selecting and melting different sources into a coherent data basis, identifying the main erosion factors, and calibrating the coupled software model against the selected reference period. Our results bring calibration of the numerical model with good fitting coefficients. They also show that the winter South-Western storm events conjugated to depressive weather conditions constitute a major factor of erosion, mainly due to wave impact in the northern part of the Almanarre beach. Together, current and wind impact is shown negligible.

Keywords: Almanarre beach, coastal erosion, hydro-sedimentological, numerical model

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98 An Engineered Epidemic: Big Pharma's Role in the Opioid Crisis

Authors: Donna L. Roberts

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2019 marked 23 years since Purdue Pharma launched its flagship drug, OxyContin, that unleashed an unprecedented epidemic touching both celebrities and common citizens, metropolitan, suburbia and rural areas and all levels of socioeconomic status. From rural Appalachia to East LA individuals, families and communities have been devastated by a trajectory of addiction that often began with the legitimate prescription of a pain killer for anything from a tooth extraction to a sports injury to recovery from surgery or chronic arthritis. Far from being a serendipitous progression of events, the proliferation of this new breed of 'miracle drug' was instead a carefully crafted marketing program aimed at both the medical community and common citizens. This research represents and in-depth investigation of the evolution of the marketing, distribution and promotion of prescription opioids by pharmaceutical companies and its relationship to the propagation of the opioid crisis. Specifically, key components of Purdue Pharma’s aggressive marketing campaign, including its bonus system and sales incentives, were analyzed in the context of the sociopolitical environment that essential created the proverbial 'perfect storm' for the changing manner in which pain is treated in the U.S. The analyses of these series of events clearly indicate their role in first, the increase in prescription of opioids for non-terminal pain relief and subsequently, the incidence of related addiction, overdose, and death. Through this examination of the conditions that facilitated and maintained this drug crisis, perhaps we can begin to chart a course toward its resolution.

Keywords: addiction, opioid, opioid crisis, Purdue Pharma

Procedia PDF Downloads 100