Search results for: modern hair loass treatments

Authors: Hellen L. De Castro e Silva, Ana A. Robles Aguilar, Erik Meers

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Digestates are residual by-products, rich in nutrients and trace elements, which can be used as organic fertilisers on soils. However, due to the non-digestibility of these elements and reduced dry matter during the anaerobic digestion process, metal concentrations are higher in digestates than in feedstocks, which might hamper their use as fertilisers according to the threshold values of some country policies. Furthermore, there is uncertainty regarding the required assimilated amount of these elements by some crops, which might result in their bioaccumulation. Therefore, further processing of the digestate to obtain safe fertilizing products has been recommended. This research aims to analyze the effect of applying the hydrothermal carbonization process to manure-derived digestates as a thermal treatment to reduce the bioavailability of heavy metals in mono and co-digestates derived from pig manure and maize from contaminated land in France. This study examined pig manure collected from a novel stable system (VeDoWs, province of East Flanders, Belgium) that separates the collection of pig urine and feces, resulting in a solid fraction of manure with high up-concentration of heavy metals and nutrients. Mono-digestion and co-digestion processes were conducted in semi-continuous reactors for 45 days at mesophilic conditions, in which the digestates were dried at 105 °C for 24 hours. Then, hydrothermal carbonization was applied to a 1:10 solid/water ratio to guarantee controlled experimental conditions in different temperatures (180, 200, and 220 °C) and residence times (2 h and 4 h). During the process, the pressure was generated autogenously, and the reactor was cooled down after completing the treatments. The solid and liquid phases were separated through vacuum filtration, in which the solid phase of each treatment -hydrochar- was dried and ground for chemical characterization. Different fractions (exchangeable / adsorbed fraction - F1, carbonates-bound fraction - F2, organic matter-bound fraction - F3, and residual fraction – F4) of some heavy metals (Cd, Cr, Ni, and Cr) have been determined in digestates and derived hydrochars using the modified Community Bureau of Reference (BCR) sequential extraction procedure. The main results indicated a difference in the heavy metals fractionation between digestates and their derived hydrochars; however, the hydrothermal carbonization operating conditions didn’t have remarkable effects on heavy metals partitioning between the hydrochars of the proposed treatments. Based on the estimated potential ecological risk assessment, there was one level decrease (considerate to moderate) when comparing the HMs partitioning in digestates and derived hydrochars.

Keywords: heavy metals, bioavailability, hydrothermal treatment, bio-based fertilisers, agriculture

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Authors: Saikat Majumdar, D. C. Kalita

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The Agriculture sector plays an important role in the rural economy of India. It is the backbone of our Indian economy and is the dominant sector in terms of employment and livelihood. Agriculture still contributes significantly to export earnings and is an important source of raw materials as well as of demand for many industrial products particularly fertilizers, pesticides, agricultural implements and a variety of consumer goods, etc. The performance of the agricultural sector influences the growth of Indian economy. According to the 2011 Agricultural Census of India, an estimated 61.5 percentage of rural populations are dependent on agriculture. Proper Agricultural infrastructure has the potential to transform the existing traditional agriculture into a most modern, commercial and dynamic farming system in India through its diffusion of technology. The rate of adoption of modern technology reflects the progress of development in agricultural sector. The adoption of any improved agricultural technology is also dependent on the development of road infrastructure or road network. The present study was consisting of 300 sample farmers out which 150 samples was taken from the developed area and rest 150 samples was taken from underdeveloped area. The samples farmers under develop and underdeveloped areas were collected by using Multistage Random Sampling procedure. In the first stage, North 24 Parganas District have been selected purposively. Then from the district, one developed and one underdeveloped block was selected randomly. In the third phase, 10 villages have been selected randomly from each block. Finally, from each village 15 sample farmers was selected randomly. The extents of adoption of technology in different areas were calculated through various parameters. These are percentage area under High Yielding Variety Cereals, percentage area under High Yielding Variety pulses, area under hybrids vegetables, irrigated area, mechanically operated area, amount spent on fertilizer and pesticides, etc. in both developed and underdeveloped areas of North 24 Parganas District, West Bengal. The percentage area under High Yielding Variety Cereals in the developed and underdeveloped areas was 34.86 and 22.59. 42.07 percentages and 31.46 percentages for High Yielding Variety pulses respectively. In the case the area under irrigation it was 57.66 and 35.71 percent while for the mechanically operated area it was 10.60 and 3.13 percent respectively in developed and underdeveloped areas of North 24 Parganas district, West Bengal. It clearly showed that the extent of adoption of technology was significantly higher in the developed area over underdeveloped area. Better road network system helps the farmers in increasing his farm income, farm assets, cropping intensity, marketed surplus and the rate of adoption of new technology. With this background, an attempt is made in this paper to study the impact of Agricultural Infrastructure on the adoption of modern technology in agriculture in North 24 Parganas District, West Bengal.

Keywords: agricultural infrastructure, adoption of technology, farm income, road network

Procedia PDF Downloads 101

Authors: Łukasz Bis

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The author is going to discuss virtual reality and its importance for new didactic methods. It has been known for years that experience-based education gives much better results in terms of long-term memory than theoretical study. However, practice is expensive - virtual reality allows the use of an empirical approach to learning, with minimized production costs. The author defines what makes a given VR experience appropriate (adequate) for the didactic and cognitive process. The article is a kind of a list of guidelines and their importance for the VR experience under development.

Keywords: virtual reality, education, universal design, guideline

Procedia PDF Downloads 106

Authors: Anastasios Manos, Despina Elisabeth Filippidou

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Introduction: Historical buildings are an inte-gral part of the cultural heritage of every place, and beyond the obvious need for protection against risks, they have specific requirements regarding the handling of hazards and disasters such as fire, floods, earthquakes, etc. Ensuring high levels of protection and safety for these buildings is impera-tive for two distinct but interconnected reasons: a) they themselves constitute cultural heritage, and b) they are often used as museums/cultural spaces, necessitating the protection of both human life (vis-itors and workers) and the cultural treasures they house. However, these buildings present serious constraints in implementing the necessary measures to protect them from destruction due to their unique architecture, construction methods, and/or the structural materials used in the past, which have created an existing condition that is sometimes challenging to reshape and operate within the framework of modern regulations and protection measures. One of the most devastating risks that threaten historical buildings is fire. Catastrophic fires demonstrate the need for timely evaluation of fire safety measures in historical buildings. Recog-nizing the criticality of protecting historical build-ings from the risk of fire, the Confederation of Fire Protection Associations in Europe (CFPA E) issued specific guidelines in 2013 (CFPA-E Guideline No 30:2013 F) for the fire protection of historical buildings at the European level. However, until now, few actions have been implemented towards leveraging modern technologies in the field of con-struction and maintenance of buildings, such as Building Information Modeling (BIM) and the Inter-net of Things (IoT), for the protection of historical buildings from risks like fires, floods, etc. The pro-ject BIM4Cult has bee developed in order to fill this gap. It is a tool for timely assessing and monitoring of the fire safety level of historical buildings using BIM and IoT technologies in an integrated manner. The tool serves as a decision support expert system for improving the fire safety of historical buildings by continuously monitoring, controlling and as-sessing critical risk factors for fire.

Keywords: Iot, fire, BIM, expert system

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Authors: A. Azizi, M. Toubane, L. Chetibi

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Differential scanning calorimetry (DSC) is a widely used technique for the study of phase transformations, particularly in the study of precipitation. The kinetic of the precipitation and dissolution is always related to the concept of activation energy Ea. The determination of the activation energy gives important information about the kinetic of the precipitation reaction. In this work, we were interested in the study of the isothermal and non-isothermal treatments on the decomposition of the supersaturated solid solution in the alloy AZ91 (Mg-9 Al-Zn 1-0.2 Mn. mass fraction %), using Differential Calorimetric method. Through this method, the samples were heat treated up to 425° C, using different rates. To calculate the apparent activation energies associated with the formation of precipitated phases, we used different isoconversional methods. This study was supported by other analysis: X-ray diffraction and microhardness measurements.

Keywords: calorimetric, activation energy, AZ91 alloys, microstructural evolution

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Authors: Darshan Lal

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The paper describes the concept of Information literacy. It is a critical component of this information age. Information literacy is the vital process in modern changing world. Information Literacy initiatives in India was also discussed. Paper also discussed Information literacy programmes for LIS professionals. Information literacy makes person capable to recognize when information is needed and how to locate, evaluate and use effectively of the needed information.

Keywords: information literacy, information communication technology (ICT), information literacy programmes

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Authors: Hsiang-Ru Lin

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Cholesterol plays an essential role in the regulation of the progression of numerous important diseases including atherosclerosis and Alzheimer disease so the generation of suitable cholesterol-lowering reagents is urgent to develop. Liver X receptor (LXR) is a ligand-activated transcription factor whose natural ligands are cholesterols, oxysterols and glucose. Once being activated, LXR can transactivate the transcription action of various genes including CYP7A1, ABCA1, and SREBP1c, involved in the lipid metabolism, glucose metabolism and inflammatory pathway. Essentially, the upregulation of ABCA1 facilitates cholesterol efflux from the cells and attenuates the production of beta-amyloid (ABeta) 42 in brain so LXR is a promising target to develop the cholesterol-lowering reagents and preventative treatment of Alzheimer disease. Engelhardia roxburghiana is a deciduous tree growing in India, China, and Taiwan. However, its chemical composition is only reported to exhibit antitubercular and anti-inflammatory effects. In this study, four compounds, engelheptanoxides A, C, engelhardiol A, and B isolated from the root of Engelhardia roxburghiana were evaluated for their agonistic activity against LXR by the transient transfection reporter assays in the HepG2 cells. Furthermore, their interactive modes with LXR ligand binding pocket were generated by molecular modeling programs. By using the cell-based biological assays, engelheptanoxides A, C, engelhardiol A, and B showing no cytotoxic effect against the proliferation of HepG2 cells, exerted obvious LXR agonistic effects with similar activity as T0901317, a novel synthetic LXR agonist. Further modeling studies including docking and SAR (structure-activity relationship) showed that these compounds can locate in LXR ligand binding pocket in the similar manner as T0901317. Thus, LXR is one of nuclear receptors targeted by pharmaceutical industry for developing treatments of Alzheimer and atherosclerosis diseases. Importantly, the cell-based assays, together with molecular modeling studies suggesting a plausible binding mode, demonstrate that engelheptanoxides A, C, engelhardiol A, and B function as LXR agonists. This is the first report to demonstrate that the extract of Engelhardia roxburghiana contains LXR agonists. As such, these active components of Engelhardia roxburghiana or subsequent analogs may show important therapeutic effects through selective modulation of the LXR pathway.

Keywords: Liver X receptor (LXR), Engelhardia roxburghiana, CYP7A1, ABCA1, SREBP1c, HepG2 cells

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Authors: Ardiansyah I. Ryan, Ashsholih K. R., Fathurrohman G. R., Kurniadi M. R., Huda P. A

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The burden of brain-related disease is very high. There are a lot of brain-related diseases with limited treatment result and thus raise the burden more. The Parkinson Disease (PD), Mental Health Problem, or Paralysis of extremities treatments had risen concern, as the patients for those diseases usually had a low quality of life and low chance to recover fully. There are also many other brain or related neural diseases with the similar condition, mainly the treatments for those conditions are still limited as our understanding of the brain function is insufficient. Brain Implant Technology had given hope to help in treating this condition. In this paper, we examine the current update of the brain implant technology. Neurotechnology is growing very rapidly worldwide. The United States Food and Drug Administration (FDA) has approved the use of Deep Brain Stimulation (DBS) as a brain implant in humans. As for neural implant both the cochlear implant and retinal implant are approved by FDA too. All of them had shown a promising result. DBS worked by stimulating a specific region in the brain with electricity. This device is planted surgically into a very specific region of the brain. This device consists of 3 main parts: Lead (thin wire inserted into the brain), neurostimulator (pacemaker-like device, planted surgically in the chest) and an external controller (to turn on/off the device by patient/programmer). FDA had approved DBS for the treatment of PD, Pain Management, Epilepsy and Obsessive Compulsive Disorder (OCD). The target treatment of DBS in PD is to reduce the tremor and dystonia symptoms. DBS has been showing the promising result in animal and limited human trial for other conditions such as Alzheimer, Mental Health Problem (Major Depression, Tourette Syndrome), etc. Every surgery has risks of complications, although in DBS the chance is very low. DBS itself had a very satisfying result as long as the subject criteria to be implanted this device based on indication and strictly selection. Other than DBS, there are several brain implant devices that still under development. It was included (not limited to) implant to treat paralysis (In Spinal Cord Injury/Amyotrophic Lateral Sclerosis), enhance brain memory, reduce obesity, treat mental health problem and treat epilepsy. The potential of neurotechnology is unlimited. When brain function and brain implant were fully developed, it may be one of the major breakthroughs in human history like when human find ‘fire’ for the first time. Support from every sector for further research is very needed to develop and unveil the true potential of this technology.

Keywords: brain implant, deep brain stimulation (DBS), deep brain stimulation, Parkinson

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Authors: Moloud Torkandam

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Any cities must be designed and built in a way that minimizes their need for fossil fuel. Undoubtedly, the necessity of accepting this principle in the previous eras is undeniable with respect to the mode of constructions. Perhaps only due to the great diversity of materials and new technologies in the contemporary era, such a principle in buildings has been forgotten. The question of optimizing energy consumption in buildings has attracted a great deal of attention in many countries and, in this way, they have been able to cut down the consumption of energy up to 30 percent. The energy consumption is remarkably higher than global standards in our country, and the most important reason is the undesirable state of buildings from the standpoint of energy consumption. In addition to providing the means to protect the natural and fuel resources for the future generations, reducing the use of fossil energies may also bring about desirable outcomes such as the decrease in greenhouse gases (whose emissions cause global warming, the melting of polar ice, the rise in sea level and the climatic changes of the planet earth), the decrease in the destructive effects of contamination in residential complexes and especially urban environments and preparation for national self-sufficiency and the country’s independence and preserving national capitals. This research realize that in this modern day and age, living sustainably is a pre-requisite for ensuring a bright future and high quality of life. In acquiring this living standard, we will maintain the functions and ability of our environment to serve and sustain our livelihoods. Electricity is now an integral part of modern life, a basic necessity. In the provision of electricity, we are committed to respecting the environment by reducing the use of fossil fuels through the use of proven technologies that use local renewable and natural resources as its energy source. As far as this research concerned it is completely necessary to work on different type of energy producing such as solar and CPVT system.

Keywords: energy, photovoltaic, termal system, solar energy, CPVT

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Authors: Farhat Imtiaz, Umar Farooq

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In this work, we developed a computational model to predict ply level failure in impacted composite laminates. Data obtained from physical testing from flat and round nose impacts of 8-, 16-, 24-ply laminates were considered. Routine inspections of the tested laminates were carried out to approximate ply by ply inflicted damage incurred. Plots consisting of load–time, load–deflection, and energy–time history were drawn to approximate the inflicted damages. Impact test generated unwanted data logged due to restrictions on testing and logging systems were also filtered. Conventional filters (built-in, statistical, and numerical) reliably predicted load thresholds for relatively thin laminates such as eight and sixteen ply panels. However, for relatively thick laminates such as twenty-four ply laminates impacted by flat nose impact generated clipped data which can just be de-noised using oscillatory algorithms. The literature search reveals that modern oscillatory data filtering and extrapolation algorithms have scarcely been utilized. This investigation reports applications of filtering and extrapolation of the clipped data utilising fast Fourier Convolution algorithm to predict load thresholds. Some of the results were related to the impact-induced damage areas identified with Ultrasonic C-scans and found to be in acceptable agreement. Based on consistent findings, utilizing of modern data filtering and extrapolation algorithms to data logged by the existing machines has efficiently enhanced data interpretations without resorting to extra resources. The algorithms could be useful for impact-induced damage approximations of similar cases.

Keywords: fibre reinforced laminates, fast Fourier algorithms, mechanical testing, data filtering and extrapolation

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Authors: Shahram Naghizadeh Raeisi, Ali Alghooneh, Seyed Jalal Razavi Zahedkolaei

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Herein, a shelf stable (no refrigeration required) UHT processed, aseptically packaged whey protein drink was formulated by using a new strategy in microparticulate process. Applying thermal and two-dimensional mechanical treatments simultaneously, a modified protein (MWPC-80) was produced. Then the physical, thermal and thermodynamic properties of MWPC-80 were assessed using particle size analysis, dynamic temperature sweep (DTS), and differential scanning calorimetric (DSC) tests. Finally, using MWPC-80, a new RTD beverage was formulated, and shelf stability was assessed for three months at ambient temperature (25 °C). Non-isothermal dynamic temperature sweep was performed, and the results were analyzed by a combination of classic rate equation, Arrhenius equation, and time-temperature relationship. Generally, results showed that temperature dependency of the modified sample was significantly (Pvalue<0.05) less than the control one contained WPC-80. The changes in elastic modulus of the MWPC did not show any critical point at all the processed stages, whereas, the control sample showed two critical points during heating (82.5 °C) and cooling (71.10 °C) stages. Thermal properties of samples (WPC-80 & MWPC-80) were assessed using DSC with 4 °C /min heating speed at 20-90 °C heating range. Results did not show any thermal peak in MWPC DSC curve, which suggested high thermal resistance. On the other hands, WPC-80 sample showed a significant thermal peak with thermodynamic properties of ∆G:942.52 Kj/mol ∆H:857.04 Kj/mole and ∆S:-1.22Kj/mole°K. Dynamic light scattering was performed and results showed 0.7 µm and 15 nm average particle size for MWPC-80 and WPC-80 samples, respectively. Moreover, particle size distribution of MWPC-80 and WPC-80 were Gaussian-Lutresian and normal, respectively. After verification of microparticulation process by DTS, PSD and DSC analyses, a 10% why protein beverage (10% w/w/ MWPC-80, 0.6% w/w vanilla flavoring agent, 0.1% masking flavor, 0.05% stevia natural sweetener and 0.25% citrate buffer) was formulated and UHT treatment was performed at 137 °C and 4 s. Shelf life study did not show any jellification or precipitation of MWPC-80 contained beverage during three months storage at ambient temperature, whereas, WPC-80 contained beverage showed significant precipitation and jellification after thermal processing, even at 3% w/w concentration. Consumer knowledge on nutritional advantages of whey protein increased the request for using this protein in different food systems especially RTD beverages. These results could make a huge difference in this industry.

Keywords: high protein whey beverage, micropartiqulation, two-dimentional mechanical treatments, thermodynamic properties

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Authors: A. Danbaba

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Samurai Sudoku consists of five Sudoku square designs each having nine treatments in each row (column or sub-block) only once such the five Sudoku designs overlaps. Two or more Samurai designs can be joint together to give an extended Samurai design. In addition, two Samurai designs, each containing five Sudoku square designs, are mutually orthogonal (Graeco). If we superimpose two Samurai designs and obtained a pair of Latin and Greek letters in each row (column or sub-block) of the five Sudoku designs only once, then we have Graeco Samurai design. In this paper, simple method of constructing Samurai designs and mutually orthogonal Samurai design are proposed. In addition, linear models and methods of data analysis for the designs are proposed.

Keywords: samurai design, graeco samurai design, sudoku design, row or column swap

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Authors: Amir Razmjou, Elika Karbassi Yazdi

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Several direct lithium extraction (DLE) technologies have been developed for Li extraction from different brines. Although laboratory studies showed that they can technically recover Li to 90%, challenges still remain in developing a sustainable process that can serve as a foundation for the lithium dependent low-carbon economy. There is a continuing quest for DLE technologies that do not need extensive pre-treatments, fewer materials, and have simplified extraction processes with high Li selectivity. Here, an overview of DLE technologies will be provided with an emphasis on the basic principles of the materials’ design for the development of membranes with nanochannels and nanopores with Li ion selectivity. We have used a variety of building blocks such as nano-clay, organic frameworks, Graphene/oxide, MXene, etc., to fabricate the membranes. Molecular dynamic simulation (MD) and density functional theory (DFT) were used to reveal new mechanisms by which high Li selectivity was obtained.

Keywords: lithium recovery, membrane, lithium selectivity, decarbonization

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Authors: Sujit Kumar

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Historicity of inter-caste relations can be traced in the early stages of evolution of rural community in the Indian society. These have witnessed vicissitudes during long drawn interactions between caste groups. Inter-caste relations evolved in a more organized form in the guise of Jajmani system. This is a system of permanent and hereditary inter-caste relations and gives a kaleidoscopic view of socio-economic relations among various caste groupings. Universality of its prevalence in rural India for centuries is well recognized and documented. But it has been undergoing metamorphic change in some regions and changing at a slower pace in the others during post-independence period. An empirical study was conducted with the objectives to know whether Jajmani system is in vogue in the rural areas and type and intensity of socio-economic ties among different caste categories and to find out the change in inter-caste relations, if any owing to industrialization and modernization. Information was elicited from 225 respondents using interview schedule designed for this purpose. It is discernible that in majority of cases, inter-caste social relations which find better expression on the occasions like marriage, death, birth and festivals etc. among Brahmins and lower castes vis-à-vis other caste categories have grown weak. The data further unearth that economic relations as maintained on the occasions of marriage, sacred thread ceremony, mundan sacrament, birthday, death, yajna, katha, routine hair cut, manufacture and repair of various iron, earthen, wooden and leather articles between members of higher castes (general category) and lower castes (scheduled castes) are moderate but weak in case of Other Backward Classes vis-à-vis all other caste categories. Overwhelming majority of informants believe that decline in hereditary occupations, depreciation of old products and services and their availability from the market being made by industry are main reasons in descending order for change in inter caste relations. Modernization, westernization, industrialization, transportation and communications, growing materialism and consumerism together have brought change in relations among caste groups affecting about a billion population inhabiting rural India.

Keywords: inter-caste, Jajmani, sacrament, Yajna

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Authors: Mariya Yeldhos, G. Hema, Sowmya Narayanan, L. Dhiviyalakshmi

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Insomnia is one of the most prevalent psychological disorders worldwide. Some of the deficiencies of the current treatments of insomnia are: side effects in the case of sleeping pills and high costs in the case of psychotherapeutic treatment. In this paper, we propose a device which provides a combination of audio visual entrainment and acupressure based compression therapy for insomnia. This device provides drug-free treatment of insomnia through a user friendly and portable device that enables relaxation of brain and muscles, with certain advantages such as low cost, and wide accessibility to a large number of people. Tools adapted towards the treatment of insomnia: -Audio -Continuous exposure to binaural beats of a particular frequency of audible range -Visual -Flash of LED light -Acupressure points -GB-20 -GV-16 -B-10

Keywords: insomnia, acupressure, entrainment, audio-visual entrainment

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Authors: Khemakhem Nahed, Hammami Fatma, Trabelsi Houaida, Neji Sourour, Sellami Hayet, Makni Fattouma, Turki Hamida, Ayadi Ali

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Dermatophytoses are considered a public health problem and represent 10% of dermatological consultations in our region. Their epidemiology is influenced by various factors, such as lifestyle, human migration patterns, changes in the environment and the host relationship. The understanding of epidemiology has a major impact on their prevention and treatment. The aim of the study is to determine the prevalence pattern of aetiological agents and to describe the clinical characteristics of dermatophytoses between 1999 and 2019. Out of 65 059 subjects suspected to have superficial mycoses, 36 220 (55.67%) were affected with dermatophytoses. The mean age was 40.1 years (range: 10 days to 99 years). The sex ratio was 0.8. Our patients were from urban regions in 80.9% of cases. The most common type of infection was onychomycosis (42.64%), followed by tinea pedis (20.8%), intertrigo (18.3%), tinea corporis (8.48%) and tinea capitis (7.87%). The most isolated dermatophyte was Trichophyton rubrum (76.5%), followed by T. mentagrophytes complex (6.3%), Microsporum canis (5.8%), T. violaceum (5.3%), T. verrucosum (0.83%) and Epidermophyton floccosum (0.3%). Zoophilic agents have become more prevalent and their frequency has been increased from 6.46% in 1999 to 13% in 2019. It is interesting to note that M. canis has been on the rise since 2010 and it was the first etiological agent of tinea capitis (48%), while infections caused by T. violaceum continued to decrease from 1999 (16.2%) to 2019 (4.7%). Other dermatophytes have been rarely isolated: T. tonsurans (9 cases), T. schoenleinii (3 cases), T. soudanense (2 cases), M. fulvum (1 case), M. audouinii (1 case) and M. ferrugineum (2 cases).T. mentagrophytes var. quinckeanum was isolated from an inflammatory tinea capitis lesion in an a-3-year-old girl. T. mentagrophytes var. erinacei was isolated from the first case of tinea manuum, in-a-10-year-old girl. The same fungus was isolated from the hair and scales of the hedgehog. Our study showed significant changes in the dermatophytes spectrum in our region. The prevalence of zoophilic species increased in recent years due to people's behavioral changes with the adoption of pets and animal husbandry in urban settings. Molecular methods are often crucial that help us to refine the identification strains of dermatophytes and to identify their origin of the contamination.

Keywords: dermatophytoses, PCR-sequencing, spectrum, Sfax, Tunisia

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Authors: Zafar Tabrez, Nizamuddin Khan

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Agriculture in India in the pre-green revolution period was mostly controlled by terrain, climate and edaphic factors. But after the introduction of innovative factors and technological inputs, green revolution occurred and agricultural scene witnessed great change. In the development of India’s agriculture, speedy, and extensive introduction of technological change is one of the crucial factors. The technological change consists of adoption of farming techniques such as use of fertilisers, pesticides and fungicides, improved variety of seeds, modern agricultural implements, improved irrigation facilities, contour bunding for the conservation of moisture and soil, which are developed through research and calculated to bring about diversification and increase of production and greater economic return to the farmers. The green revolution in India took place during late 60s, equipped with technological inputs like high yielding varieties seeds, assured irrigation as well as modern machines and implements. Initially the revolution started in Punjab, Haryana and western Uttar Pradesh. With the efforts of government, agricultural planners, as well as policy makers, the modern technocratic agricultural development scheme was also implemented and introduced in backward and marginal regions of the country later on. Agriculture sector occupies the centre stage of India’s social security and overall economic welfare. The country has attained self-sufficiency in food grain production and also has sufficient buffer stock. Our first Prime Minister, Jawaharlal Nehru said ‘everything else can wait but not agriculture’. There is still a continuous change in the technological inputs and cropping patterns. Keeping these points in view, author attempts to investigate extensively the mechanization of agriculture and the change by selecting western Trans-Ghaghara plain as a case study and block a unit of the study. It includes the districts of Gonda, Balrampur, Bahraich and Shravasti which incorporate 44 blocks. It is based on secondary sources of data by blocks for the year 1997 and 2007. It may be observed that there is a wide range of variations and the change in farm mechanization, i.e., agricultural machineries such as ploughs, wooden and iron, advanced harrow and cultivator, advanced thrasher machine, sprayers, advanced sowing instrument, and tractors etc. It may be further noted that due to continuous decline in size of land holdings and outflux of people for the same nature of works or to be employed in non-agricultural sectors, the magnitude and direction of agricultural systems are affected in the study area which is one of the marginalized regions of Uttar Pradesh, India.

Keywords: agriculture, technological inputs, farm mechanization, food production, cropping pattern

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Authors: Nayif Alrasheedi, Sultan Almutairi

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Field-wide, a water supply wells’ downhole corrosion inhibition program is being applied to maintain downhole component integrity and keep the fluid corrosivity below 5 MPY. Batch treatment is currently used to inject the oil field chemical. This work is a case study consisting of analytical procedures used to optimize the frequency of the good corrosion inhibition treatments. During the study, a corrosion cell was fitted with a special three-electrode configuration for electrochemical measurements, electrochemical linear polarization, corrosion monitoring, and microbial analysis. This study revealed that the current practice is not able to mitigate material corrosion in the downhole system for more than three months.

Keywords: downhole corrosion inhibition, electrochemical measurements, electrochemical linear polarization, corrosion monitoring

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Authors: Ashish Thakur

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This technical paper was written in view of focusing the biomaterials and its various applications in modern industries. Author tires to elaborate not only the medical, infect plenty of application in other industries. The scope of the research area covers the wide range of physical, biological and chemical sciences that underpin the design of biomaterials and the clinical disciplines in which they are used. A biomaterial is now defined as a substance that has been engineered to take a form which, alone or as part of a complex system, is used to direct, by control of interactions with components of living systems, the course of any therapeutic or diagnostic procedure. Biomaterials are invariably in contact with living tissues. Thus, interactions between the surface of a synthetic material and biological environment must be well understood. This paper reviews the benefits and challenges associated with surface modification of the metals in biomedical applications. The paper also elaborates how the surface characteristics of metallic biomaterials, such as surface chemistry, topography, surface charge, and wettability, influence the protein adsorption and subsequent cell behavior in terms of adhesion, proliferation, and differentiation at the biomaterial–tissue interface. The chapter also highlights various techniques required for surface modification and coating of metallic biomaterials, including physicochemical and biochemical surface treatments and calcium phosphate and oxide coatings. In this review, the attention is focused on the biomaterial-associated infections, from which the need for anti-infective biomaterials originates. Biomaterial-associated infections differ markedly for epidemiology, aetiology and severity, depending mainly on the anatomic site, on the time of biomaterial application, and on the depth of the tissues harbouring the prosthesis. Here, the diversity and complexity of the different scenarios where medical devices are currently utilised are explored, providing an overview of the emblematic applicative fields and of the requirements for anti-infective biomaterials. In addition to this, chapter introduces nanomedicine and the use of both natural and synthetic polymeric biomaterials, focuses on specific current polymeric nanomedicine applications and research, and concludes with the challenges of nanomedicine research. Infection is currently regarded as the most severe and devastating complication associated to the use of biomaterials. Osteoporosis is a worldwide disease with a very high prevalence in humans older than 50. The main clinical consequences are bone fractures, which often lead to patient disability or even death. A number of commercial biomaterials are currently used to treat osteoporotic bone fractures, but most of these have not been specifically designed for that purpose. Many drug- or cell-loaded biomaterials have been proposed in research laboratories, but very few have received approval for commercial use. Polymeric nanomaterial-based therapeutics plays a key role in the field of medicine in treatment areas such as drug delivery, tissue engineering, cancer, diabetes, and neurodegenerative diseases. Advantages in the use of polymers over other materials for nanomedicine include increased functionality, design flexibility, improved processability, and, in some cases, biocompatibility.

Keywords: nanomedicine, tissue, infections, biomaterials

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Authors: Kumar Y., Suman D., Sumathi

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Introduction: Burns to the face account for between one-fourth and one-third of all burns. The loss of an eyebrow due to a burn or infection can have negative physical and psychological consequences for patients because eyebrows have a critical functional and aesthetic role on the face. Plastic surgeons face unique challenges in reconstructing eyebrows due to their complex anatomy and variations within genders. As a general rule, there are three techniques for reconstructing the eyebrow: superficial temporal artery island flap, a composite graft from the scalp, and mini or micro follicular grafts from the scalp. In situations where a sufficient amount of subcutaneous tissue is not available and the defect is big such as the case of burns, flaps like the superficial temporal artery scalp flap remain reliable options. In 2018, a 17-year-old female patient presented to the department of Burns Plastic and reconstructive Surgery of Guru Teg Bahadur Hospital, Delhi, India. A scald-burn injury to the face occurred two years before admission, resulting in bilateral eyebrow loss. We reconstructed the bilateral eyebrows using bilateral scalp island flaps based on the posterior branch of the superficial temporal artery. The reconstructed eyebrows successfully assumed a desirable shape and exhibited a natural appearance, which was consistent with preoperative expectations and the patient stated that she was more comfortable with her social relationships. Among the current treatment procedures, the superficial temporal artery island flap continues to be a versatile option for reconstructing the eyebrows after alopecia, especially in cases of burns. Results: During the 30 days follow-up period, the scalp island flap remained vascularised with normal hair growth, without complications. The reconstructed eyebrows successfully assumed a desirable shape and exhibited a natural appearance; the patient stated that she was more comfortable with her social relationships. Conclusion: In this case report, we demonstrated how scalp island flaps pedicled by the superficial temporal artery could be performed very safely and reliably to create new eyebrows.

Keywords: alopecia, burns, eyebrow, flap, superficial temporal artery

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Authors: Justin P. Pool, Haruyo Yoshida

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This research focuses on the effects of creating an English as a foreign language curriculum that combines online learning and classroom teaching in a complementary manner. Through pre- and post-test results, teacher observation, and learner reflection, it will be shown that learners can benefit from online programs focusing on receptive skills if combined with a communicative classroom environment that encourages learners to develop their productive skills. Much research has lamented the fact that many modern mobile assisted language learning apps do not take advantage of the affordances of modern technology by focusing only on receptive skills rather than inviting learners to interact with one another and develop communities of practice. This research takes into account the realities of the state of such apps and focuses on how to best create a curriculum that complements apps which focus on receptive skills. The research involved 15 adult learners working for a business in Japan simultaneously engaging in 1) a commercial online English language learning application that focused on reading, listening, grammar, and vocabulary and 2) a 15-week class focused on communicative language teaching, presentation skills, and mitigation of error aversion tendencies. Participants of the study experienced large gains on a standardized test, increased motivation and willingness to communicate, and asserted that they felt more confident regarding English communication. Moreover, learners continued to study independently at higher rates after the study than they had before the onset of the program. This paper will include the details of the program, reveal the improvement in test scores, share learner reflections, and critically view current evaluation models for mobile assisted language learning applications.

Keywords: adult learners, communicative language teaching, mobile assisted language learning, motivation

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Authors: D. Lopes, I. I. R. Baptista, R. F. Vieira, J. Vaz, H. Varela, O. M. Freitas, V. F. Domingues, R. Jorge, C. Delerue-Matos, S. A. Figueiredo

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Deodorization is nowadays a need in wastewater treatment plants. Nitrogen and sulphur compounds, volatile fatty acids, aldehydes and ketones are responsible for the unpleasant odours, being ammonia, hydrogen sulphide and mercaptans the most common pollutants. Although chemical treatments of the air extracted are efficient, these are more expensive than biological treatments, namely due the use of chemical reagents (commonly sulphuric acid, sodium hypochlorite and sodium hydroxide). Biofiltration offers the advantage of avoiding the use of reagents (only in some cases, nutrients are added in order to increase the treatment efficiency) and can be considered a sustainable process when the packing medium used is of natural origin. In this work the application of some natural materials locally available was studied both at laboratory and pilot scale, in a real wastewater treatment plant. The materials selected for this study were indigenous Portuguese forest materials derived from eucalyptus and pinewood, such as woodchips and bark, and coconut fiber was also used for comparison purposes. Their physico-chemical characterization was performed: density, moisture, pH, buffer and water retention capacity. Laboratory studies involved batch adsorption studies for ammonia and hydrogen sulphide removal and evaluation of microbiological activity. Four pilot-scale biofilters (1 cubic meter volume) were installed at a local wastewater treatment plant treating odours from the effluent receiving chamber. Each biofilter contained a different packing material consisting of mixtures of eucalyptus bark, pine woodchips and coconut fiber, with added buffering agents and nutrients. The odour treatment efficiency was monitored over time, as well as other operating parameters. The operation at pilot scale suggested that between the processes involved in biofiltration - adsorption, absorption and biodegradation - the first dominates at the beginning, while the biofilm is developing. When the biofilm is completely established, and the adsorption capacity of the material is reached, biodegradation becomes the most relevant odour removal mechanism. High odour and hydrogen sulphide removal efficiencies were achieved throughout the testing period (over 6 months), confirming the suitability of the materials selected, and mixtures thereof prepared, for biofiltration applications.

Keywords: ammonia hydrogen sulphide and removal, biofiltration, natural materials, odour control in wastewater treatment plants

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Authors: Naif A. Haddad

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Greek, Hellenistic and Roman theatre heritage are exposed to multiple risks at varied times or simultaneously. There is no single reason why a theatre building becomes ‘at risk’, as each case has different circumstances which have led to the theatre building decay. There are complicated processes of destruction and distress that show divergence in theatre building materials' decay. Theatre modern use for cultural performances causes much of the risks concerning the physical structure and authenticity of theatre sites. In addition, there are some deterioration and deformations due to previous poor quality restorations and interventions through related excavation and conservation programmes as also risks to authenticity due to new additions. For preventive conservation, theatre natural and anthropogenic risks management can provide a framework for decision making. These risks to ancient theatre heritage may stem from exposure to one or more risk or synergy of many factors. We, therefore, need to link the theatre natural risks to the risks that come from anthropogenic factors associated with social and economic development. However, this requires a holistic approach, and systematic methodology for understanding these risks from various sources while incorporating specific actions, planning and strategies for each specific risk. Elaborating on recent relevant studies, and ERATO and ATHENA EU projects for ancient theaters and odea and general surveys, this paper attempts to discuss the main aspects of the ancient Greek, Hellenistic and Roman theatres risk related issues. Relevant case studies shall also be discussed and investigated to examine frameworks for risk mitigation, and related guidelines and recommendations that provide a systematic approach for sustainable management and planning in relation mainly to ‘compatible use’ of theatre sites.

Keywords: cultural heritage management, European ancient theatres projects, Anthropogenic risks mitigation, sustainable management and planning, preventive conservation, modern use, compatible use

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Authors: Katarina Revocati Mteule

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The background of this research arises from global demands for fair business opportunities. As one of responses to these demands, nations embarked on reforms in commercial laws. In 1990s Tanzania resorted to economic transformation through liberalization to attract more investments included reform in commercial laws enforcement. This research scrutinizes the effectiveness of reforms in Tanzania in comparison with Canada and Singapore and the role of technology. The methodology to be used is doctrinal legal research mixed with international comparative legal research. It involves comparative analysis of library, online, and internet resources as well as Case Laws and Statutory Laws. Tanzania, Canada and Singapore are sampled comparators basing on their distinct level of economic development. The criteria of analysis includes the nature of reforms, type of technology, technological infrastructure and human resource technical competence in each country. As the world progresses towards reforms in commercial laws, improvements in law, policy, and regulatory frameworks are paramount. Specifically, commercial laws are essential in contract enforcement and dispute resolution and how it copes with modern technologies is a concern. Harnessing the best technology is necessary to cope with the modernity in world businesses. In line with this, Tanzania is improving its business environment, including law enforcement mechanisms that are supportive to investments. Reforms such as specialized commercial law enforcement coupled with alternative dispute resolutions such as arbitration, mediation, and reconciliation are emphasized. Court technology as one of the reform tools given high priority. This research evaluates the progress and the effectiveness of the reforms in Commercial Laws towards friendly business environment in Tanzania in comparison with Canada and Singapore. The experience of Tanzania is compared with Canada and Singapore to see what to improve for each country to enhance quick and fair enforcement of commercial law. The research proposes necessary global standards of procedures and in national laws to offer a business-friendly environment and the use of appropriate technology. Solutions are proposed in tackling the challenges of delays in enforcing Commercial Laws such as case management, funding, legal and procedural hindrances, laxity among staff, and abuse of Court process among litigants, all in line with modern technology. It is the finding of the research that proper use of technology has managed to reduce case backlogs and time taken to resolve a commercial dispute, to increase court integrity by minimizing human contacts in commercial law enforcement which may lead to solicitation of favors and saving of parties’ time due to online service. Among the three countries, each one is facing a distinct challenge due to the level of poverty and remoteness from online service. How solutions are found in one country is a lesson to another. To conclude, this paper is suggesting solutions for improving the commercial law enforcement mechanisms in line with modern technology. The call for technological transformation is essential for the enforcement of commercial laws.

Keywords: commercial law, enforcement, technology

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Authors: G. J. Fan, T. T. Lee, M. H. Chen, T. F. Shiao, B. Yu, C. F. Lee

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Rice straw with poor feed quality and spent mushroom substrate are both the most abundant agricultural residues in Taiwan. Edible mushrooms from white rot fungi possess lignocellulase activity. It was expected to improve the feeding value of rice straw for ruminant by solid-state fermentation pretreatment using spent mushroom substrate. Six varieties or subspecies of spent edible mushrooms (Pleurotus ostreatus (blue or white color), P. sajor-caju, P. citrinopileatus, P. eryngii and Ganoderma lucidium) substrate were evaluated in solid-state fermentation process with rice straw for 8 wks. Quality improvement of fermented rice straw was determined by its in vitro digestibility, lignocellulose degradability, and cell wall breakdown checked by scanning electron microscope. Results turned out that Pleurotus ostreatus (white color) and P. sajor-caju had the better lignocellulose degradation effect than the others and was chosen for advance in vivo study. Rice straw fermented with spent Pleurotus ostreatus or Pleurotus sajor-caju mushroom substrate 8 wks was prepared for growing and lactating feeding trials of dairy goat, respectively. Pangolagrass hay at 15% diet dry matter was the control diet. Fermented or original rice straw was added to substitute pangolagrass hay in both feeding trials. A total of 30 head of Alpine castrated ram were assigned into three groups for 11 weeks, 5 pens (2 head/pen) each group. A total of 21 head of Saanen and Alpine goats were assigned into three treatments and individually fed in two repeat lactating trials with 28-d each. In castrated ram study, results showed that fermented rice straw by spent Pleurotus ostreatus mushroom substrate attributed the higher daily dry matter intakes (DMI, 1.53 vs. 1.20 kg) and body weight gain (138 vs. 101 g) than goats fed original rice straw. DMI (2.25 vs. 1.81 kg) and milk yield (3.31 vs. 3.02 kg) of lactating goats fed control pangolagrass diet and fermented rice straw by spent Pleurotus sajor-caju mushroom substrate were also higher than those fed original rice straw diet (P < 0.05). Milk compositions, milk fat, protein, total solid and lactose, were similar among treatments. In conclusion, solid-state fermentation by spent Pleurotus ostreatus or Pleurotus sajor-caju mushroom substrate could effectively improve the feeding value of rice straw. Fermented rice straw is a good alternative fiber feed resource for growing and lactating dairy goats and 15% in diet dry matter is recommended.

Keywords: feeding value, fermented rice straw, growing and lactating dairy goat, spent Pleurotus ostreatus and Pleurotus sajor-caju mushroom substrate

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Authors: Jagruti Barot

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The textile industry plays a major role in the economy of India and on the other side of the coin it is the major source for water pollution. As azo dyes is the largest dye class they are extensively used in many fields such as textile industry, leather tanning industry, paper production, food, colour photography, pharmaceuticals and medicine, cosmetic, hair colourings, wood staining, agricultural, biological and chemical research etc. In addition to these, they can have acute and/or chronic effects on organisms depending on their concentration and length of exposure when they discharged as effluent in the environment. The aim of this study was to assess the genotoxic and histotoxic potentials of environmentally relevant concentrations of RR 120 on Catla catla, important edible freshwater fingerlings. For this, healthy Catla catla fingerlings were procured from the Government Fish Farm and acclimatized in 100 L capacity and continuously aerated glass aquarium in laboratory for 15 days. According to APHA some physic-chemical parameters were measured and maintained such as temperature, pH, dissolve oxygen, alkalinity, total hardness. Water along with excreta had been changed every 24 hrs. All fingerlings were fed artificial food palates once a day @ body weight. After 15 days fingerlings were grouped in 5 (10 in each) and exposed to various concentrations of RR 120 (Control, 10, 20, 30 and 40 mg/L) and samples (peripheral blood and gills, kidney) were collected and analyzed at 96 hrs. of interval. All results were compared with the control. Micronuclei (MN), nuclear buds (NB), fragmented-apoptotic (FA) and bi-nucleated (BN) cells in blood cells and in tissues (gills and kidney cells) were observed. Prominent histopathological alterations were noticed in gills such as aneurism, hyperplasia, degenerated central axis, lifting of gill epithelium, curved secondary gill lamellae etc. Similarly kidney showed some detrimental changes like shrunken glomeruli with increased periglomerular space, degenerated renal tubules etc. Both haematological and histopathological changes clearly reveal the toxic potential of RR 120. This work concludes that water pollution assessment can be done by these two biomarkers which provide baseline to the further chromosomal or molecular work.

Keywords: micronuclei, genotoxicity, RR 120, Catla catla

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Authors: Olasunkanmi Olapeju

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A large chunk of global population are not yet connected to water borne faecal management systems that rely on flush mechanisms and sewers networks that are linked with a central treatment plant. Only about 10% of sub-Saharan African countries are connected to central sewage systems. In Nigeria, majority of the population do not only depend on on-plot sanitation systems, a huge chunk do not also have access to safe and improved toilets. Apart from the organizational challenges and technical capacity, the other major factors that account for why faecal waste management is yet unimproved in developing countries are faulty planning frameworks that fail to maintain balance between urbanization dynamics and infrastructures, and misconceptions about what modern sanitation is all about. In most cases, the quest to implement developmental patterns that integrate modern sewers based sanitation systems have huge financial and political costs. Faecal waste management in poor countries largely lacks the needed political attention and budgetary prioritization. Yet, the on-plot sanitation systems being mainly relied upon the need to be managed in a manner that is sustainable and healthy, pending when development would embrace a more sustainable off-site central sewage system. This study is aimed at investigating existing strategies for managing on-plot sanitation systems’ faecal waste in Ogun state, Nigeria, with the aim of recommending sustainable sanitation management systems. The study adopted the convergent parallel variant of the mixed-mode technique, which involves the adoption of both quantitative and qualitative method of data collection. Adopting a four-level multi-stage approach, which is inclusive of all political divisions in the study area, a total of 330 questionnaires were respectively administered in the study area. Moreover, the qualitative data adopted the purposive approach in scoping down to 33 key informants. SPSS software (Version 22.0) was employed for descriptively analysis. The study shows that about 52% of households adopt the non-recovery management (NRM) means of burying their latrines with sand sludge shrinkage with chemicals such as carbides. The dominance of the non-recovery management means seriously constrains the quest for faecal resource recovery. Essentially, the management techniques adopted by households depend largely on the technology of their sanitary containments, emptying means available, the ability of households to pay for the cost of emptying, and the social acceptability of the reusability of faecal waste, which determines faecal resource recoverability. The study suggests that there is a need for municipal authorities in the study area to urgently intervene in the sanitation sector and consider it a key element of the planning process. There is a need for a comprehensive plan that would ensure a seamless transition to the adoption of a modern sanitation management system.

Keywords: faecal, management, planning, waste, sanitation, sustainability

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Authors: Fathi Kallel, Saida Khachira, Mohamed Ben Slima, Ahmed Ben Hamida

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Speckle noise is a main characteristic of cardiac ultrasound images, it corresponding to grainy appearance that degrades the image quality. For this reason, the ultrasound images are difficult to use automatically in clinical use, then treatments are required for this type of images. Then a filtering procedure of these images is necessary to eliminate the speckle noise and to improve the quality of ultrasound images which will be then segmented to extract the necessary forms that exist. In this paper, we present the importance of the pre-treatment step for segmentation. This work is applied to cardiac ultrasound images. In a first step, a comparative study of speckle filtering method will be presented and then we use a segmentation algorithm to locate and extract cardiac structures.

Keywords: medical image processing, ultrasound images, Speckle noise, image enhancement, speckle filtering, segmentation, snakes

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Authors: Judith Partouche-Sebban, Saeedeh Rezaee Vessal

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Because of the rising number of new cases of cancer, especially among women, it is more than essential to better understand how women experience cancer in order to bring them adapted to support and care and enhance their well-being and patient experience. Cancer stands for a traumatic experience in which the diagnosis, its medical treatments, and the related side effects lead to deep physical and psychological changes that may arouse considerable stress and anxiety. In order to reduce these negative emotions, women tend to use various defense mechanisms, among which denial has been defined as the most frequent mechanism used by breast cancer patients. This study aims to better understand the consequences of the experience of cancer and their link with the adoption of a denial strategy. The empirical research was done among female cancer survivors in France. Since the topic of this study is relatively unexplored, a qualitative methodology and open-ended interviews were employed. In total, 25 semi-directive interviews were conducted with a female with different cancers, different stages of treatment, and different ages. A systematic inductive method was performed to analyze data. The content analysis enabled to highlight three different denial-related behaviors among women with cancer, which serve a self-protective function. First, women who expressed high levels of anxiety confessed they tended to completely deny the existence of their cancer immediately after the diagnosis of their illness. These women mainly exhibit many fears and a deep distrust toward the medical context and professionals. This coping mechanism is defined by the patient as being unconscious. Second, other women deliberately decided to deny partial information about their cancer, whether this information is related to the stages of the illness, the emotional consequences, or the behavioral consequences of the illness. These women use this strategy as a way to avoid the reality of the illness and its impact on the different aspects of their life as if cancer does not exist. Third, some women tend to reinterpret and give meaning to their cancer as a way to reduce its impact on their life. To this end, they may use magical thinking or positive reframing, or reinterpretation. Because denial may lead to delays in medical treatments, this topic deserves a deep investigation, especially in the context of oncology. As denial is defined as a specific defense mechanism, this study contributes to the existing literature in service marketing which focuses on emotions and emotional regulation in healthcare services which is a crucial issue. Moreover, this study has several managerial implications for healthcare professionals who interact with patients in order to implement better care and support for the patients.

Keywords: cancer, coping mechanisms, denial, healthcare services

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Authors: D. M. Lewis, L. Frisby, U. Stead

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Objective: Many patients are receiving invasive treatments in acute care or are dying in hospital without having had comprehensive goals of care conversations. Some of these treatments may not align with the patient’s wishes, may be futile, and may cause unnecessary suffering. While many staff may recognize the benefits of engaging patients and families in Serious Illness Conversations (a goal of care framework developed by Ariadne Labs in Boston), few staff feel confident and/or competent in having these conversations in acute care. Another barrier to having these conversations may be due to a lack of incorporation in the current workflow. An educational exercise, titled the Two Question Challenge, was initiated on four medical units across two Vancouver Coastal Health (VCH) hospitals in attempt to engage the entire interdisciplinary team in asking patients and families questions around goals of care and to improve the documentation of these expressed wishes and preferences. Methods: Four acute care units across two separate hospitals participated in the Two Question Challenge. On each unit, over the course of two eight-hour shifts, all members of the interdisciplinary team were asked to select at least two questions from a selection of nine goals of care questions. They were asked to pose these questions of a patient or family member throughout their shift and then asked to document their conversations in a centralized Advance Care Planning/Goals of Care discussion record in the patient’s chart. A visual representation of conversation outcomes was created to demonstrate to staff and patients the breadth of conversations that took place throughout the challenge. Staff and patients were interviewed about their experiences throughout the challenge. Two palliative approach leads remained present on the units throughout the challenge to support, guide, or role model these conversations. Results: Across four acute care medical units, 47 interdisciplinary staff participated in the Two Question Challenge, including nursing, allied health, and a physician. A total of 88 questions were asked of patients, or their families around goals of care and 50 newly documented goals of care conversations were charted. Two code statuses were changed as a result of the conversations. Patients voiced an appreciation for these conversations and staff were able to successfully incorporate these questions into their daily care. Conclusion: The Two Question Challenge proved to be an effective way of having teams explore the goals of care of patients and families in an acute care setting. Staff felt that they gained confidence and competence. Both staff and patients found these conversations to be meaningful and impactful and felt they were notably different from their usual interactions. Documentation of these conversations in a centralized location that is easily accessible to all care providers increased significantly. Application of the Two Question Challenge in non-medical units or other care settings, such as long-term care facilities or community health units, should be explored in the future.

Keywords: advance care planning, goals of care, interdisciplinary, palliative approach, serious illness conversations

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