Search results for: landscape design strategies

Authors: A. W. J. Wong, I. H. Ibrahim

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Increasing urbanisation has driven building designers to incorporate natural ventilation in the designs of sustainable buildings. This project utilises Computational Fluid Dynamics (CFD) to investigate the natural ventilation of an academic building, SIT@SP, using an assessment criterion based on daily mean temperature and mean velocity. The areas of interest are the pedestrian level of first and fourth levels of the building. A reference case recommended by the Architectural Institute of Japan was used to validate the simulation model. The validated simulation model was then used for coupled simulations on SIT@SP and neighbouring geometries, under two wind speeds. Both steady and transient simulations were used to identify differences in results. Steady and transient results are agreeable with the transient simulation identifying peak velocities during flow development. Under a lower wind speed, the first level was sufficiently ventilated while the fourth level was not. The first level has excessive wind velocities in the higher wind speed and the fourth level was adequately ventilated. Fourth level flow velocity was consistently lower than those of the first level. This is attributed to either simulation model error or poor building design. SIT@SP is concluded to have a sufficiently ventilated first level and insufficiently ventilated fourth level. Future works for this project extend to modifying the urban geometry, simulation model improvements, evaluation using other assessment metrics and extending the area of interest to the entire building.

Keywords: buildings, CFD Simulations, natural ventilation, urban airflow

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Authors: Nureni O. Adeboye, Dawud A. Agunbiade

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This research attempts to investigate the effects of heteroscedasticity and periodicity in a Panel Data Regression Model (PDRM) by extending previous works on balanced panel data estimation within the context of fitting PDRM for Banks audit fee. The estimation of such model was achieved through the derivation of Joint Lagrange Multiplier (LM) test for homoscedasticity and zero-serial correlation, a conditional LM test for zero serial correlation given heteroscedasticity of varying degrees as well as conditional LM test for homoscedasticity given first order positive serial correlation via a two-way error component model. Monte Carlo simulations were carried out for 81 different variations, of which its design assumed a uniform distribution under a linear heteroscedasticity function. Each of the variation was iterated 1000 times and the assessment of the three estimators considered are based on Variance, Absolute bias (ABIAS), Mean square error (MSE) and the Root Mean Square (RMSE) of parameters estimates. Eighteen different models at different specified conditions were fitted, and the best-fitted model is that of within estimator when heteroscedasticity is severe at either zero or positive serial correlation value. LM test results showed that the tests have good size and power as all the three tests are significant at 5% for the specified linear form of heteroscedasticity function which established the facts that Banks operations are severely heteroscedastic in nature with little or no periodicity effects.

Keywords: audit fee lagrange multiplier test, heteroscedasticity, lagrange multiplier test, Monte-Carlo scheme, periodicity

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Authors: Lucia Salvioni, Pietro Giorgio Lovaglio, Valerio Leoni, Miriam Colombo, Luisa Fiandra

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The involvement of plasmatic surfactant protein-D (SP-D) in pulmonary diseases has been long investigated, and over the last two years, more interest has been directed to determine its role as a marker of COVID-19. In this direction, several studies aimed to correlate pulmonary surfactant proteins with the clinical manifestations of the virus indicated SP-D as a prognostic biomarker of COVID-19 pneumonia severity. The present work has performed a retrospective study on a relatively large cohort of patients of Hospital Pio XI of Desio (Lombardia, Italy) with the aim to assess differences in the hematic SP-D concentrations among COVID-19 patients and healthy donors and the role of SP-D as a prognostic marker of severity and/or of mortality risk. The obtained results showed a significant difference in the mean of log SP-D levels between COVID-19 patients and healthy donors, so as between dead and survived patients. SP-D values were significantly higher for both hospitalized COVID-19 and dead patients, with threshold values of 150 and 250 ng/mL, respectively. SP-D levels at admission and increasing differences among follow-up and admission values resulted in the strongest significant risk factors of mortality. Therefore, this study demonstrated the role of SP-D as a predictive marker of SARS-CoV-2 infection and its outcome. A significant correlation of SP-D with patient mortality indicated that it is also a prognostic factor in terms of mortality, and its early detection should be considered to design adequate preventive treatments for COVID-19 patients.

Keywords: SARS-CoV-2 infection, COVID-19, surfactant protein-D (SP-D), mortality, biomarker

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Authors: Saidu I. R., Shittu S. S.

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As the trend of personal devices accessing corporate data continues to rise through Bring Your Own Device (BYOD) practices, organizations recognize the potential cost reduction and productivity gains. However, the associated security risks pose a significant threat to these benefits. Often, organizations adopt BYOD environments without fully considering the vulnerabilities introduced by human factors in this context. This study presents an enhanced assessment model that evaluates the security posture of employees in BYOD environments using cyber hygiene principles. The framework assesses users' adherence to best practices and guidelines for maintaining a secure computing environment, employing scales and the Euclidean distance formula. By utilizing this algorithm, the study measures the distance between users' security practices and the organization's optimal security policies. To facilitate user evaluation, a simple and intuitive interface for automated assessment is developed. To validate the effectiveness of the proposed framework, design science research methods are employed, and empirical assessments are conducted using five artifacts to analyze user suitability in BYOD environments. By addressing the human factor vulnerabilities through the assessment of cyber hygiene practices, this study aims to enhance the overall security of BYOD environments and enable organizations to leverage the advantages of this evolving trend while mitigating potential risks.

Keywords: security, BYOD, vulnerability, risk, cyber hygiene

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Authors: Hesam Khajehsaeid, Naeimeh Alagheband

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Magnetorheological fluids (MRF) are a category of smart materials. They exhibit a reversible change from a Newtonian-like fluid to a semi-solid state upon application of an external magnetic field. In contrast to ordinary fluids, MRFs can tolerate shear stresses up to a threshold value called yield stress which strongly depends on the strength of the magnetic field, magnetic particles volume fraction and temperature. Even beyond the yield, a magnetic field can increase MR fluid viscosity up to several orders. As yield stress is an important parameter in the design of MR devices, in this work, the effects of magnetic field intensity and magnetic particle concentration on the yield stress of MRFs are investigated. Four MRF samples with different particle concentrations are developed and tested through flow-ramp analysis to obtain the flow curves at a range of magnetic field intensity as well as shear rate. The viscosity of the fluids is determined by means of the flow curves. The results are then used to determine the yield stresses by means of the steady stress sweep method. The yield stresses are then determined by means of a modified form of the dipole model as well as empirical models. The exponential distribution function is used to describe the orientation of particle chains in the dipole model under the action of the external magnetic field. Moreover, the modified dipole model results in a reasonable distribution of chains compared to previous similar models.

Keywords: magnetorheological fluids, yield stress, particles concentration, dipole model

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Authors: Farah Vierra

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Following the 2016 US presidential election and the advancement of the Brexit referendum, the concept of “post-truth,” defined by the Oxford Dictionary as “relating to or denoting circumstances in which objective facts are less influential in shaping public opinion than appeals to emotion and personal belief,” came into prominent use in public, political and educational circles. What this essentially entails is that in this age, individuals are increasingly confronted with subjective perpetuations of truth in their discourse spheres that are informed by beliefs and opinions as opposed to any form of coherence to the reality of those to who this truth claims concern. In principle, a subjective delineation of truth is progressive and liberating – especially considering its potential to provide marginalised groups in the diverse communities of our globalised world with the voice to articulate truths that are representative of themselves and their experiences. However, any form of human flourishing that seems to be promised here collapses as the tenets of subjective truths initially in place to liberate have been distorted through post-truth to allow individuals to purport selective and individualistic truth claims that further oppress and silence certain groups within society without due accountability. The evidence of this is prevalent through the conception of terms such as "alternative facts" and "fake news" that we observe individuals declare when their problematic truth claims are being questioned. Considering the pervasiveness of post-truth and the ethical issues that accompany it, educators and scholars alike have increasingly noted the need to adapt educational practices and pedagogies to account for the diminishing objectivity of truth in the twenty-first century, especially because students, as digital natives, find themselves in the firing line of post-truth; engulfed in digital societies that proliferate post-truth through the surge of truth claims allowed in various media sites. In an attempt to equip students with the vital skills to navigate the post-truth age and oppose its proliferation of social injustices, English educators find themselves having to contend with a complex question: how can the teaching of English equip students with the ability to critically and ethically scrutinise truth claims whilst also mediating the subjectivity of truth in a manner that does not undermine the voices of diverse communities. In order to address this question, this paper will first examine the challenges that confront students as a result of post-truth. Following this, the paper will elucidate the role English education can play in helping students overcome the complex demands of the post-truth age. Scholars have consistently touted the affordances of literary texts in providing students with imagined spaces to explore societal issues through a critical discernment of language and an ethical engagement with its narrative developments. Therefore, this paper will explain and demonstrate how literary texts, when used alongside a critical-ethical post-truth pedagogy that equips students with interpretive strategies informed by literary traditions such as literary and ethical criticism, can be effective in helping students develop the pertinent skills to comprehensively examine truth claims and overcome the challenges of the post-truth age.

Keywords: post-truth, pedagogy, ethics, english, education

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Authors: Mustafa Abu Ghalia, Mohammed Seddik

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The design and development of a new class of biomaterial has gained particular interest in producing polymer scaffold for biomedical applications. Improving mechanical properties, biological and controlling pores scaffold are important factors to provide appropriate biomaterial for implement in soft tissue repair and regeneration. In this study, poly-ε-caprolactone (PCL) /polyethylene glycol (PEG) copolymer (80/20) incorporated with CNF scaffolds were made employing solvent casting and particulate leaching methods. Four mass percentages of CNF (1, 2.5, 5, and 10 wt.%) were integrated into the copolymer through a silane coupling agent. Mechanical properties were determined using Tensile Tester data acquisition to investigate the effect of porosity, pore size, and CNF contents. Tensile strength obtained for PCL/PEG- 5 wt.% CNF was 16 MPa, which drastically decreased after creating a porous structure to 7.1 MPa. The optimum parameters of the results were found to be 5 wt.% for CNF, 240 μm for pore size, and 83% for porosity. Scanning electron microscopy (SEM) micrograph reveals that consistent pore size and regular pore shape were accomplished after the addition of CNF-5 wt. % into PCL/PEG. The results of mass loss of PCL/PEG reinforced-CNF 1% have clearly enhanced to double values compared with PCL/PEG copolymer and three times with PCL/PEG scaffold-CNF 1%. In addition, all PCL/PEG reinforced and scaffold- CNF were partially disintegrated under composting conditions confirming their biodegradable behavior. This also provides a possible solution for the end life of these biomaterials.

Keywords: PCL/PEG, cellulose nanofibers, tissue engineering, biodegradation, compost polymers

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Authors: Tessy Treesa Jose, Sripathy M. Bhat

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Nursing is recognized as a stressful occupation and has indicated a probable high prevalence of distress. It is a helping profession requiring a high degree of commitment and involvement. If stress is intense, continuous and repeated, it becomes a negative phenomenon or "distress," which can lead to physical illness and psychological disorders. The frequency of common psychosomatic symptoms including sleeping problems, tension headache, chronic fatigue, palpitation etc. may be an indicator of nurses’ work-related stress level. Objectives of the study were to determine psychiatric morbidity among nurses and to find its association with selected variables. The study population consisted of 1040 registered nurses working in selected medical college hospitals and government hospitals of Udupi and Mangalore districts. Descriptive survey design was used to conduct the study. Subjects were selected by using purposive sampling. Data were gathered by administering background proforma and General Health questionnaire. Severe distress was experienced by 0.9% of nurses and 5.6% had some evidence of distress. Subjects who did not have any distress were 93.5%. No significant association between psychiatric morbidity in nurses and demographic variables was observed. With regard to work variables significant association is observed between psychiatric morbidity and total years of experience (z=10.67, p=0.03) and experience in current area of work (z=9.43, p=0.02).

Keywords: psychiatric morbidity, nurse, selected hospitals, working

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Authors: Jennifer Kehinde, Claire O’Donnell, Annmarie Grealish

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Introduction: Breastfeeding has been shown to provide numerous health benefits for both infants and mothers. The decision to breastfeed is influenced by physiological, psychological, and emotional factors. However, the importance of equipping mothers with the necessary knowledge for successful breastfeeding practice cannot be ruled out. The decline in global breastfeeding rate can be linked to a lack of adequate breastfeeding education during the prenatal stage. This systematic review examined the effectiveness of prenatal breastfeeding education on breastfeeding uptake postpartum. Method: This review was undertaken and reported in conformity with the Preferred Reporting Items for Systemic Reviews and Meta-Analysis statement (PRISMA) and was registered on the international prospective register for systematic reviews (PROSPERO: CRD42020213853). A PICO analysis (population, intervention, comparison, outcome) was undertaken to inform the choice of keywords in the search strategy to formulate the review question, which was aimed at determining the effectiveness of prenatal breastfeeding educational programs in improving breastfeeding uptake following birth. A systematic search of five databases (Cumulative Index to Nursing and Allied Health Literature, Medline, Psych INFO, and Applied Social Sciences Index and Abstracts) was searched between January 2014 until July 2021 to identify eligible studies. Quality assessment and narrative synthesis were subsequently undertaken. Results: Fourteen studies were included. All 14 studies used different types of breastfeeding programs; eight used a combination of curriculum-based breastfeeding education programs, group prenatal breastfeeding counselling, and one-to-one breastfeeding educational programs, which were all delivered in person; four studies used web-based learning platforms to deliver breastfeeding education prenatally which were both delivered online and face to face over a period of 3 weeks to 2 months with follow-up periods ranging from 3 weeks to 6 months; one study delivered breastfeeding educational intervention using mother-to-mother breastfeeding support groups in promoting exclusive breastfeeding, and one study disseminated breastfeeding education to participants based on the theory of planned behaviour. The most effective interventions were those that included both theory and hands-on demonstrations. Results showed an increase in breastfeeding uptake, breastfeeding knowledge, an increase in a positive attitude to breastfeeding, and an increase in maternal breastfeeding self-efficacy among mothers who participated in breastfeeding educational programs during prenatal care. Conclusion: Prenatal breastfeeding education increases women’s knowledge of breastfeeding. Mothers who are knowledgeable about breastfeeding and hold a positive approach towards breastfeeding have the tendency to initiate breastfeeding and continue for a lengthened period. Findings demonstrate a general correlation between prenatal breastfeeding education and increased breastfeeding uptake postpartum. The high level of positive breastfeeding outcomes inherent in all the studies can be attributed to prenatal breastfeeding education. This review provides rigorous contemporary evidence that healthcare professionals and policymakers can apply when developing effective strategies to improve breastfeeding rates and ultimately improve the health outcomes of mothers and infants.

Keywords: breastfeeding, breastfeeding programs, breastfeeding self-efficacy, prenatal breastfeeding education

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Authors: Mary Anthony Oguike, Ilouno, Amaduruonye

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A completely randomized design experiment with 3 treatments was conducted to study the effects of garlic on intestine characteristics, haematology and serum biochemistry of Marshal broilers. Thirty three (33) broiler chicks were randomly allotted to each treatment designated T1, T2 and T3. The birds in each treatment were replicated 3 times with 11 broilers per replicate. They were fed diets supplemented with garlic at 0, 1.5 and 2.5 % /kg feed for t1, T2 and T3, respectively with T1 as control. Data were collected on intestine parameters, serum biochemical parameters and haematological indices. The results showed significant (P>0.05) dose-dependent decrease in intestine weight and caeca microbial load of the broilers. The intestine of broilers in the treatments showed normal histological architecture in all the treatments. The red blood cell (RBC), white blood cell (WBC), haemoglobin (Hb) and other haematological indices showed no significant differences (P<0.05) among the treatments. Cholesterol, globulin, glucose and alanin aminotransferase (ALT) were significantly different (P<0.05) among the treatment groups. Serum biochemical parameters such as, total protein albumin, bilirubin and others were not significant among the treatments. All the blood parameters studied fall within the normal range for broilers. Garlic supplementation in the diets of broilers did not have any detrimental effects on the treated birds since their serum biochemistry and haematology fall within the normal range for broilers birds. The microbial examination of intestine and caeca, as well as the histopathological studies of the intestine confirmed antimicrobial properties of garlic.

Keywords: broiler, biochemistry and haematology, garlic, intestine

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Authors: Adino Andaregie, Isao Takagi, Hirohisa Shimura, Mitsuko Chikasada, Shinjiro Sato, Solomon Addisu

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Context: The prevalence of undernutrition in developing countries like Ethiopia has become a significant issue. In this regard, finding alternative nutritional supplements seems to be a practical solution. Spirulina, a highly nutritious microalgae, offers a valuable option as it is a rich source of various essential nutrients. The study aimed to establish the factors affecting urban Ethiopian consumers' consumption intention of Spirulina-fortified bread. Research Aim: The primary purpose of this research is to identify the behavioral and socioeconomic factors impacting the intention of urban Ethiopian consumers to eat Spirulina-fortified bread. Methodology: The research utilized a quantitative approach wherein a structured questionnaire was created and distributed among 361 urban consumers via an online platform. The theory of planned behavior (TPB) was used as a conceptual framework, and confirmatory factor analysis (CFA) and structural equation modelling (SEM) were employed for data analysis. Findings: The study results revealed that attitude towards the supplement, subjective norms, and perceived behavioral control were the critical factors influencing the consumption intention of Spirulina-fortified bread. Moreover, age, physical exercise, and prior knowledge of Spirulina as a food ingredient were also found to have a significant influence. Theoretical Importance: The study contributes towards the understanding of consumer behavior and factors affecting the purchase intentions of Spirulina-fortified bread in urban Ethiopia. The use of TPB as a theoretical framework adds a vital aspect to the study as it provides helpful insights into the factors affecting intentions towards this functional food. Data Collection and Analysis Procedures: The data collection process involved the creation of a structured questionnaire, which was distributed online to urban Ethiopian consumers. Once data was collected, CFA and SEM were utilized to analyze the data and identify the factors impacting consumer behavior. Questions Addressed: The study aimed to address the following questions: (1) What are the behavioral and socioeconomic factors impacting urban Ethiopian consumers' consumption intention of Spirulina-fortified bread? (2) To what extent do attitude towards the supplement, subjective norms, and perceived behavioral control affect the purchase intention of Spirulina-fortified bread? (3) What role does age, education, income, physical exercise, and prior knowledge of Spirulina as a food ingredient play in the purchase intention of Spirulina-fortified bread among urban Ethiopian consumers? Conclusion: The study concludes that attitude towards the supplement, subjective norms, and perceived behavioral control are significant factors influencing urban Ethiopian consumers’ consumption intention of Spirulina-fortified bread. Moreover, age, education, income, physical exercise, and prior knowledge of Spirulina as a food ingredient also play a significant role in determining purchase intentions. The findings provide valuable insights for developing effective marketing strategies for Spirulina-fortified functional foods targeted at different consumer segments.

Keywords: spirulina, consumption, factors, intention, consumers, behavior

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Authors: Castells Pau, Poetsch Christophe

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The effect of gust and turbulence encounters on aircraft is a wide field of study which allows different approaches, from high-fidelity multidisciplinary simulations to more simplified models adapted to industrial applications. The typical main goal is to predict the gust loads on the aircraft in order to ensure a safe design and achieve certification. Another topic widely studied is the gust loads reduction through an active control law. The impact of gusts on aircraft handling qualities is of interest as well in the analysis of in-service events so as to evaluate the aircraft response and the performance of the flight control laws. Traditionally, gust loads and handling qualities are addressed separately with different models adapted to the specific needs of each discipline. In this paper, an assessment of the differences between both models is presented and a strategy to better account for the physics of gust encounters in a typical flight dynamics model is proposed based on the model used for gust loads analysis. The applied corrections aim to capture the gust unsteady aerodynamics and propagation as well as the effect of dynamic flexibility at low frequencies. Results from the gust loads model at different flight conditions and measures from real events are used for validation. An assessment of a possible extension of steady aerodynamic nonlinearities to low frequency range is also addressed. The proposed corrections provide meaningful means to evaluate the performance and possible adjustments of the flight control laws.

Keywords: flight dynamics, gust loads, handling qualities, unsteady aerodynamics

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Authors: José M. Carmona, Diana Puigserver, Jofre Herrero

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Chlorinated solvents belong to the group of nonaqueous phase liquids (DNAPL) and have been involved in many contamination episodes. They are carcinogenic and recalcitrant pollutants that may be found in granular aquifers as: i) pools accumulated on low hydraulic conductivity layers; ii) immobile residual phase retained at the pore-scale by capillary forces; iii) dissolved phase in groundwater; iv) sorbed by particulate organic matter; and v) stored into the matrix of low hydraulic conductivity layers where they penetrated by molecular diffusion. The transition zone between granular aquifers and basal aquitards constitute the lowermost part of the aquifer and presents numerous fine-grained interbedded layers that give rise to significant textural contrasts. These layers condition the transport and fate of contaminants and lead to differences from the rest of the aquifer, given that: i) hydraulic conductivity of these layers is lower; ii) DNAPL tends to accumulate on them; iii) groundwater flow is slower in the transition zone and consequently pool dissolution is much slower; iv) sorbed concentrations are higher in the fine-grained layers because of their higher content in organic matter; v) a significant mass of pollutant penetrates into the matrix of these layers; and vi) this contaminant mass back-diffuses after remediation and the aquifer becomes contaminated again. Thus, contamination sources of chlorinated solvents are extremely more recalcitrant in transition zones, which has far-reaching implications for the environment. The aim of this study is to analyze the spatial and temporal differences in the evolution of biogeochemical processes in the transition zone and in the rest of the aquifer. For this, an unconfined aquifer with a transition zone in the lower part was selected at Vilafant (NE Spain). This aquifer was contaminated by perchloroethylene (PCE) in the 80’s. Distribution of PCE and other chloroethenes in groundwater and porewater was analyzed in: a) conventional piezometers along the plume and in two multilevel wells at the source of contamination; and b) porewater of fine grained materials from cores recovered when drilled the two multilevel wells. Currently, the highest concentrations continue to be recorded in the source area in the transition zone. By contrast, the lowest concentrations in this area correspond to the central part of the aquifer, where flow velocities are higher and a greater washing of the residual phase initially retained has occurred. The major findings of the study were: i) PCE metabolites were detected in the transition zone, where conditions were more reducing than in the rest of the aquifer; ii) however, reductive dechlorination was partial since only the formation of cis-dicholoroethylene (DCE) was reached; iii) In the central part of the aquifer, where conditions were predominantly oxidizing, the presence of nitrate significantly hindered the reductive declination of PCE. The remediation strategies to be implemented should be directed to enhance dissolution of the source, especially in the transition zone, where it is more recalcitrant. For example, by combining chemical and bioremediation methods, already tested at the laboratory scale with groundwater and sediments of this site.

Keywords: chlorinated solvents, chloroethenes, DNAPL, partial reductive dechlorination, PCE, transition zone to basal aquitard

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Authors: Alexis D'Agostino, Celeste Sununtunasuk, Jack Fiedler

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Background: Iron-folic acid (IFA) supplementation during antenatal care (ANC) has existed in many countries for decades. Despite this, low national coverage persists and women do not often consume appropriate amounts during pregnancy. USAID’s SPRING Project investigated pregnant women’s access to, and consumption of, IFA tablets through ANC. Cross-country analysis provided a global picture of the state of IFA-supplementation, while country-specific results noted key contextual issues, including geography, wealth, and ANC attendance. The analysis can help countries prioritize strategies for systematic performance improvements within one of the most common micronutrient supplementation programs aimed at reducing maternal anemia. Methodology: Using falter point analysis on Demographic and Health Survey (DHS) data collected from 162,958 women across 22 countries, SPRING identified four sequential falter points (ANC attendance, IFA receipt or purchase, IFA consumption, and number of tablets taken) where pregnant women fell out of the IFA distribution structure. SPRING analyzed data on IFA intake from DHS surveys with women of reproductive age. SPRING disaggregated these data by ANC participation during the most recent pregnancy, residency, and women’s socio-economic status. Results: Average sufficient IFA tablet use across all countries was only eight percent. Even in the best performing countries, only about one-third of pregnant women consumed 180 or more IFA tablets during their most recent pregnancy. ANC attendance was an important falter point for a quarter of women across all countries (with highest falter rates in Democratic Republic of the Congo, Nigeria, and Niger). Further analysis reveals patterns, with some countries having high ANC coverage but low IFA provision during ANC (DRC and Haiti), others having high ANC coverage and IFA provision but few women taking any tablets (Nigeria and Liberia), and countries that perform well in ANC, supplies, and initial consumption but where very few women consume the recommended 180 tablets (Malawi and Cambodia). Country-level analysis identifies further patterns of supplementation. In Indonesia, for example, only 62% of women in the poorest quintile took even one IFA tablet, while 86% of the wealthiest women did. This association between socioeconomic status and IFA intake held across nearly all countries where these data are available and was also visible in rural/urban comparisons. Analysis of ANC attendance data also suggests that higher numbers of ANC visits are associated with higher tablet intake. Conclusions: While it is difficult to disentangle which specific aspects of supply or demand cause the low rates of consumption, this tool allows policy-makers to identify major bottlenecks to scaling-up IFA supplementation during ANC. In turn, each falter point provides possible explanations of program performance and helps strategically identify areas for improved IFA supplementation. For example, improving the delivery of IFA supplementation in Ethiopia relies on increasing access to ANC, but also on identifying and addressing program gaps in IFA supply management and health workers’ practices in order to provide quality ANC services. While every country requires a customized approach to improving IFA supplementation, the multi-country analysis conducted by SPRING is a helpful first step in identifying country bottlenecks and prioritizing interventions.

Keywords: iron and folic acid, supplementation, antenatal care, micronutrient

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Authors: Estela Díaz

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This article aims to make three contributions. First, build on the literature on ethical decision-making literature by exploring factors that influence the intention of adopting veganism. Second, study the superiority of extended models of the Theory of Planned Behavior (TPB) for understanding the process involved in forming the intention of adopting veganism. Third, analyze the moderating effect of gender on TPB given that attitudes and behavior towards animals are gender-sensitive. No study, to our knowledge, has examined these questions. Veganism is not a diet but a political and moral stand that exclude, for moral reasons, the use of animals. Although there is a growing interest in studying veganism, it continues being overlooked in empirical research, especially within the domain of social psychology. TPB has been widely used to study a broad range of human behaviors, including moral issues. Nonetheless, TPB has rarely been applied to examine ethical decisions about animals and, even less, to veganism. Hence, the validity of TPB in predicting the intention of adopting veganism remains unanswered. A total of 476 non-vegan Spanish university students (55.6% female; the mean age was 23.26 years, SD= 6.1) responded to online and pencil-and-paper self-reported questionnaire based on previous studies. TPB extended models incorporated two background factors: ‘general attitudes towards humanlike-attributes ascribed to animals’ (AHA) (capacity for reason/emotions/suffer, moral consideration, and affect-towards-animals); and ‘general attitudes towards 11 uses of animals’ (AUA). SPSS 22 and SmartPLS 3.0 were used for statistical analyses. This study constructed a second-order reflective-formative model and took the multi-group analysis (MGA) approach to study gender effects. Six models of TPB (the standard and five competing) were tested. No a priori hypotheses were formulated. The results gave partial support to TPB. Attitudes (ATTV) (β = .207, p < .001), subjective norms (SNV) (β = .323, p < .001), and perceived control behavior (PCB) (β = .149, p < .001) had a significant direct effect on intentions (INTV). This model accounted for 27,9% of the variance in intention (R2Adj = .275) and had a small predictive relevance (Q2 = .261). However, findings from this study reveal that contrary to what TPB generally proposes, the effect of the background factors on intentions was not fully mediated by the proximal constructs of intentions. For instance, in the final model (Model#6), both factors had significant multiple indirect effect on INTV (β = .074, 95% C = .030, .126 [AHA:INTV]; β = .101, 95% C = .055, .155 [AUA:INTV]) and significant direct effect on INTV (β = .175, p < .001 [AHA:INTV]; β = .100, p = .003 [AUA:INTV]). Furthermore, the addition of direct paths from background factors to intentions improved the explained variance in intention (R2 = .324; R2Adj = .317) and the predictive relevance (Q2 = .300) over the base-model. This supports existing literature on the superiority of enhanced TPB models to predict ethical issues; which suggests that moral behavior may add additional complexity to decision-making. Regarding gender effect, MGA showed that gender only moderated the influence of AHA on ATTV (e.g., βWomen−βMen = .296, p < .001 [Model #6]). However, other observed gender differences (e.g. the explained variance of the model for intentions were always higher for men that for women, for instance, R2Women = .298; R2Men = .394 [Model #6]) deserve further considerations, especially for developing more effective communication strategies.

Keywords: veganism, Theory of Planned Behavior, background factors, gender moderation

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Authors: Ese Urhie, Olabisi Popoola, Obindah Gershon, Olabanji Ewetan

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Modern agriculture involves the use of improved tools and equipment (instead of crude and ineffective tools) like tractors, hand operated planters, hand operated fertilizer drills and combined harvesters - which increase agricultural productivity. Farmers in Nigeria still have huge potentials to enhance their productivity. The study argues that the increase in agricultural output due to increased productivity, orchestrated by modern agriculture will promote forward linkages and opportunities in the processing sub-sector; both the manufacturing of machines and the processing of raw materials. Depending on existing incentives, foreign investment could be attracted to augment local investment in the sector. The availability of raw materials in large quantity – which prices are competitive – will attract investment in other industries. In addition, potentials for backward linkages will also be created. In a nutshell, adopting the unbalanced growth theory in favour of the agricultural sector could engender industrialization in a country with untapped potentials. The paper highlights the numerous potentials of modern agriculture that are yet to be tapped in Nigeria and also provides a theoretical analysis of how the realization of such potentials could promote industrialization in the country. The study adopts the Lewis’ theory of structural–change model and Hirschman’s theory of unbalanced growth in the design of the analytical framework. The framework will be useful in empirical studies that will guide policy formulation.

Keywords: modern agriculture, industrialization, structural change model, unbalanced growth

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Authors: Reham H. Diab, Amira A. A. Abdallah, Eman A. Embaby

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Background: The effectiveness of bracing on preventing spino-pelvic alignment deterioration in idiopathic scoliosis has been extensively studied especially in the frontal plane. Yet, there is lack of knowledge regarding the effect of soft braces on spino-pelvic alignment in the sagittal plane. Achieving harmonious sagittal plane spino-pelvic balance is critical for the preservation of physiologic posture and spinal health. Purpose: This study examined the kyphotic angle, lordotic angle and pelvic inclination in the sagittal plane and trunk imbalance in the frontal plane before and after a six-month rehabilitation period. Methods: Nineteen patients with idiopathic scoliosis participated in the study. They were divided into two groups; experimental and control. The experimental group (group I) used the SpineCor brace in addition to a rehabilitation exercise program while the control group (group II) had the exercise program only. The mean ±SD age, weight and height were 16.89±2.15 vs. 15.3±2.5 years; 59.78±6.85 vs. 62.5±8.33 Kg and 162.78±5.76 vs. 159±5.72 cm for group I vs. group II. Data were collected using for metric Π system. Results: Mixed design MANOVA showed that there were significant (p < 0.05) decreases in all the tested variables after the six-month period compared with “before” in both groups. Moreover, there was a significant decrease in the kyphotic angle in group I compared with group II after the six-month period. Interpretation and conclusion: SpineCor brace is beneficial in reducing spino-pelvic alignment deterioration in both sagittal and frontal planes.

Keywords: adolescent idiopathic scoliosis, SpineCor, spino-pelvic alignment, biomechanics

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Authors: Kritika Kulhari, Aparna Sahu

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Test anxiety results from concerns about failure in examinations or evaluative situations. Attentional biases are known to pronounce the symptomatic expression of test anxiety. In recent times, the inattentional blindness (IB) paradigm has shown promise as an attention bias modification treatment (ABMT) for anxiety by overcoming practice and expectancy effects which preexisting paradigms fail to counter. The IB paradigm assesses the inability of an individual to attend to a stimulus that appears suddenly while indulging in a perceptual discrimination task. The present study incorporated an IB task with three critical items (book, face, and triangle) appearing randomly in the perceptual discrimination task. Attentional biases were assessed as detection and identification of the critical item. The sample (N = 50) consisted of low test anxiety (LTA) and high test anxiety (HTA) groups based on the reactions to tests scale scores. Test threat manipulation was done with pre- and post-test assessment of test anxiety using the State Test Anxiety Inventory. A mixed factorial design with gender, test anxiety, presence or absence of test threat, and critical items was conducted to assess their effects on attentional biases. Results showed only a significant main effect for test anxiety on detection with higher accuracy of detection of the critical item for the LTA group. The study presents promising results in the realm of ABMT for test anxiety.

Keywords: attentional bias, attentional bias modification treatment, inattentional blindness, test anxiety

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Authors: Kadiri Kayode Ibrahim

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Small and Medium Enterprises (SMEs) play significant roles in the economic development of Nigeria. However, the performance of these SMEs is influenced by various factors, including cultural factors. Keffi Local Government Area (LGA) in Nasarawa State, Nigeria, has a large number of registered SMEs. Understanding the impact of cultural factors on the performance of these SMEs in Keffi LGA is essential for their growth and sustainability. Therefore, this study aims to investigate the effect of cultural factors on the performance of selected SMEs in Keffi LGA, Nasarawa State. A cross-sectional survey research design was used to collect data from 165 purposefully selected SME owners out of the 283 registered SMEs in Keffi LGA. The data was collected using a questionnaire divided into three sections, and analysed using descriptive and ordinary least square regression (OLS). The results indicate that socio-cultural factors and ethical values have a positive and significant effect on the performance of SMEs in Keffi LGA, while attitude has a negative and significant effect on the performance of SMEs in Keffi LGA. Therefore, the study recommends that SMEs in Keffi LGA should understand the socio-cultural elements of their operating environment, adopt socio-cultural factors as elements to guide their planning and strategizing and take into consideration the ethical values of the business environment when offering new products or services. Additionally, SME Managers should take cognisance of people’s attitudes and use them to gauge their activities and ensure they support the overall performance of the business.

Keywords: cultural, factors, performance, SMEs

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Authors: Mona Misfer Alshardan, Djamal Ziani

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Enterprise resource planning (ERP) systems are the organizations tickets to the global market. With the implementation of ERP, organizations can manage and coordinate all functions, processes, resources and data from different departments by a single software. However, many organizations consider the cost of traditional ERP to be expensive and look for alternative affordable solutions within their budget. One of these alternative solutions is providing ERP over a software as a service (SaaS) model. This alternative could be considered as a cost effective solution compared to the traditional ERP system. A key feature of any SaaS system is the multi-tenancy architecture where multiple customers (tenants) share the system software. However, different organizations have different requirements. Thus, the SaaS developers accommodate each tenant’s unique requirements by allowing tenant-level customization or configuration. While customization requires source code changes and in most cases a programming experience, the configuration process allows users to change many features within a predefined scope in an easy and controlled manner. The literature provides many techniques to accomplish the configuration process in different SaaS systems. However, the nature and complexity of SaaS ERP needs more attention to the details regarding the configuration process which is merely described in previous researches. Thus, this research is built on strong knowledge regarding the configuration in SaaS to define specifically the configuration borders in SaaS ERP and to design a configuration service with the consideration of the different configuration aspects. The proposed architecture will ensure the easiness of the configuration process by using wizard technology. Also, the privacy and performance are guaranteed by adopting the databases isolation technique.

Keywords: configuration, software as a service, multi-tenancy, ERP

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Authors: Durga Prasad Neupane

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This study investigates the impacts of homestay tourism on the traditional lifestyle and culture of the indigenous Tharu people in Nepal. It explores how this form of tourism has influenced the lives of Tharu individuals and their community as a whole. The study delves into the effects of tourism on various aspects, including language, socio-economic development, and cultural promotion and revival. Employing a qualitative approach and a case study design, the study gathers in-depth and comprehensive data on the impacts of homestay tourism on the Amaltari Tharu community. Building rapport with respondents, including homestay management committees, Tharu homestay owners, and non-Tharu residents, is achieved through various channels like personal interactions, phone conversations, and repeated visits. The research further combines document analysis with in-depth interviews to glean diverse perspectives and insights. The study's findings reveal that while homestay tourism presents challenges, it also holds significant potential for promoting and revitalizing the Tharu culture. Tourism has not only fostered the flourishing of Tharu traditions but has also contributed to improved educational opportunities within the community. However, the study recognizes the influence of globalization in driving changes to Tharu customs and rituals, potentially leading to a new form of cultural colonization. In this context, homestay tourism emerges as a crucial tool for preserving and revitalizing the unique ethnic identity and traditions of the Amaltari Tharu community.

Keywords: homestay, tourism, Tharu culture, cultural revival, linguistic variations

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Authors: Cora Fernandez Dacosta, John A. Posada, Andrea Ramirez

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The biodegradable family of polymers polyhydroxyalkanoates are interesting substitutes for convectional fossil-based plastics. However, the manufacturing and environmental impacts associated with their production via intracellular bacterial fermentation are strongly dependent on the raw material used and on energy consumption during the extraction process, limiting their potential for commercialization. Industrial wastewater is studied in this paper as a promising alternative feedstock for waste valorization. Based on results from laboratory and pilot-scale experiments, a conceptual process design, techno-economic analysis and life cycle assessment are developed for the large-scale production of the most common type of polyhydroxyalkanoate, polyhydroxbutyrate. Intracellular polyhydroxybutyrate is obtained via fermentation of microbial community present in industrial wastewater and the downstream processing is based on chemical digestion with surfactant and hypochlorite. The economic potential and environmental performance results help identifying bottlenecks and best opportunities to scale-up the process prior to industrial implementation. The outcome of this research indicates that the fermentation of wastewater towards PHB presents advantages compared to traditional PHAs production from sugars because the null environmental burdens and financial costs of the raw material in the bioplastic production process. Nevertheless, process optimization is still required to compete with the petrochemicals counterparts.

Keywords: circular economy, life cycle assessment, polyhydroxyalkanoates, waste valorization

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Authors: B. W. Kenny, D.Mansour, K. G. Mansour, J. Attia, B. Meads

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There is currently insufficient evidence to make a conclusive statement about safety while immobilized in a short arm cast. There is a paucity of published literature on this topic. The purpose of this study is to specifically evaluate short arm casts and their effect on driving abilities, particularly steering and avoidance of obstacles. The ability to drive safely is extrapolated from this data. In this study, a randomised, controlled, crossover design was used to assess 30 subjects randomised into 2 groups. A Logitech force feedback steering column and simulated driving program with a standardised road course was used. Objective outcome measures were the number of times subjects drove off the track, the number of crashes, time to lap completion and subjective assessment on whether wearing a short arm plaster cast impeded their steering. Recruited subjects had no upper limb pathology. The side of the applied plaster cast was randomised. The mean lap completion time reduced with repetition, the difference being statistically significant. There was no significant difference in mean number of times subjects in casts drove off the track (3 with vs. 3.07 without casts), average number of crashes (1.27 vs 0.97). Steering ability was not reduced whilst a subject was immobilised in a short arm Plaster of Paris cast, despite subject’s own impressions that their steering was impeded. This may help guide doctors in their advice to patients regarding driving in these casts.

Keywords: upper limb, arm injury, plaster cast, splint, driving, automobile, bone fracture

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Authors: M. Bredice, M. B. Forleo, L. Quici

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Coastal tourism is currently facing huge challenges on how to balance environmental problems and tourist activities. Recent literature shows a growing interest in the issue of sustainable tourism from a so-called civilized tourists’ perspective by investigating opinions, perceptions, and behaviors. This study investigates the opinions of youth on what makes them responsible tourists and the ability of coastal marine areas to support tourism in future scenarios. A sample of 778 Italians attending the last year of high school was interviewed. Descriptive statistics, tests, and cluster analyses are applied to highlight the distribution of opinions among youth, detect significant differences based on demographic characteristics, and make segmentation of the different profiles based on students’ opinions and behaviors. Preliminary results show that students are largely convinced (62%) that by 2050 the quality of coastal environments could limit seaside tourism, while 10% of them believe that the problem can be solved simply by changing the tourist destination. Besides the cost of the holiday, the most relevant aspect respondents consider when choosing a marine destination is the presence of tourist attractions followed by the quality of the marine-coastal environment, the specificity of the local gastronomy and cultural traditions, and finally, the activities offered to guests such as sports and events. The reduction of waste and lower air emissions are considered the most important environmental areas in which marine-coastal tourism activities can contribute to preserving the quality of seas and coasts. Areas in which, as a tourist, they believe possible to give a personal contribution were (responses “very much” and “somewhat”); do not throw litter in the sea and on the beach (84%), do not buy single-use plastic products (66%), do not use soap or shampoo when showering in beaches (53%), do not have bonfires (47%), do not damage dunes (46%), and do not remove natural materials (e.g., sand, shells) from the beach (46%). About 6% of the sample stated that they were not interested in contributing to the aforementioned activities, while another 7% replied that they could not contribute at all. Finally, 80% of the sample has never participated in voluntary environmental initiatives or citizen science projects; moreover, about 64% of the students have never participated in events organized by environmental associations in marine or coastal areas. Regarding the test analysis -based on Kruskal-Wallis and Mann and Whitney tests - gender, region, and studying area of students reveals significance in terms of variables expressing knowledge and interest in sustainability topics and sustainable tourism behaviors. The classification of the education field is significant for a great number of variables, among which those related to several sustainable behaviors that respondents declare to be able to contribute as tourists. The ongoing cluster analysis will reveal different profiles in the sample and relevant variables. Based on preliminary results, implications are envisaged in the fields of education, policy, and business strategies for sustainable scenarios. Under these perspectives, the study has the potential to contribute to the conference debate about marine and coastal sustainable development and management.

Keywords: cluster analysis, education, knowledge, young people

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Authors: Deepak Loura

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Climate change is considered one of the major environmental problems of the 21st century and a lasting change in the statistical distribution of weather patterns over periods ranging from decades to millions of years. Agriculture and climate change are internally correlated with each other in various aspects, as the threat of varying global climate has greatly driven the attention of scientists, as these variations are imparting a negative impact on global crop production and compromising food security worldwide. The fast pace of development and industrialization and indiscriminate destruction of the natural environment, more so in the last century, have altered the concentration of atmospheric gases that lead to global warming. Carbon dioxide (CO₂), methane (CH₄), and nitrous oxide (NO) are important biogenic greenhouse gases (GHGs) from the agricultural sector contributing to global warming and their concentration is increasing alarmingly. Agricultural productivity can be affected by climate change in 2 ways: first, directly, by affecting plant growth development and yield due to changes in rainfall/precipitation and temperature and/or CO₂ levels, and second, indirectly, there may be considerable impact on agricultural land use due to snow melt, availability of irrigation, frequency and intensity of inter- and intra-seasonal droughts and floods, soil organic matter transformations, soil erosion, distribution and frequency of infestation by insect pests, diseases or weeds, the decline in arable areas (due to submergence of coastal lands), and availability of energy. An increase in atmospheric CO₂ promotes the growth and productivity of C3 plants. On the other hand, an increase in temperature, can reduce crop duration, increase crop respiration rates, affect the equilibrium between crops and pests, hasten nutrient mineralization in soils, decrease fertilizer- use efficiencies, and increase evapotranspiration among others. All these could considerably affect crop yield in long run. Climate resilient agriculture consisting of adaptation, mitigation, and other agriculture practices can potentially enhance the capacity of the system to withstand climate-related disturbances by resisting damage and recovering quickly. Climate resilient agriculture turns the climate change threats that have to be tackled into new business opportunities for the sector in different regions and therefore provides a triple win: mitigation, adaptation, and economic growth. Improving the soil organic carbon stock of soil is integral to any strategy towards adapting to and mitigating the abrupt climate change, advancing food security, and improving the environment. Soil carbon sequestration is one of the major mitigation strategies to achieve climate-resilient agriculture. Climate-smart agriculture is the only way to lower the negative impact of climate variations on crop adaptation before it might affect global crop production drastically. To cope with these extreme changes, future development needs to make adjustments in technology, management practices, and legislation. Adaptation and mitigation are twin approaches to bringing resilience to climate change in agriculture.

Keywords: climate change, global warming, crop production, climate resilient agriculture

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Authors: Atousa Khodadadyan, Ali Rostami

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The objective of off-site construction manufacturing is to utilise the workforce and machinery in a controlled environment without external interference for higher productivity and quality. The usage of prefabricated components can save up to 14% of the total energy consumption in comparison with the equivalent number of cast-in-place ones. Despite the benefits of prefabrication construction, its current project practices encompass technical and managerial issues. Building design, precast components’ production, logistics, and prefabrication installation processes are still mostly discontinued and fragmented. Furthermore, collaboration among prefabrication manufacturers, transportation parties, and on-site assemblers rely on real-time information such as the status of precast components, delivery progress, and the location of components. From the technical point of view, in this industry, geometric variability is still prevalent, which can be caused during the transportation or production of components. These issues indicate that there are still many aspects of prefabricated construction that can be developed using disruptive technologies. Practical real-time risk analysis can be used to address these issues as well as the management of safety, quality, and construction environment issues. On the other hand, the lack of research about risk assessment and the absence of standards and tools hinder risk management modeling in prefabricated construction. It is essential to note that no risk management standard has been established explicitly for prefabricated construction projects, and most software packages do not provide tailor-made functions for this type of projects.

Keywords: project risk management, risk analysis, risk modelling, prefabricated construction projects

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Authors: Malik Shoeb Ahmad

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The aim of the present study is to carry out investigations on Class F fly ash obtained from NTPC thermal power plant, Dadri, U.P. (India) and electroplating waste sludge from Aligarh, U.P. (India) along with geofibre for its subsequent utilization in various geotechnical and highway engineering applications. The experimental studies such as California bearing ratio (CBR) tests were carried out to evaluate the strength of plain fly ash as well as fly ash-waste sludge mix reinforced with geofibre, as the CBR value is the vital parameters used in the design of flexible and rigid pavements. Results of the study show that the strength of the mix is highly dependent on the curing period and the sludge and geofibre content. The CBR values were determined for mix containing fly ash (83.5-93.5%), waste sludge (5-15%) and 1-2% geofibre. However, out of the various combinations of mixes the CBR value of the mix 88.5%FA+10%S+1.5%GF at 28 days of curing was found to be 53.52% when compared with the strength of plain fly ash. It has been observed that the fibre inclusion increases the strength of the plain fly ash and fly ash-waste sludge specimens by changing their brittle to ductile behavior. The TCLP leaching test was also conducted to determine the heavy metal concentration in the optimized mix. The results of TCLP test show that the heavy metal concentration in the mix 88.5%FA+10%S+1.5%G at 28 days of curing reduced substantially from 24 to 98% when compared with the concentration of heavy metals in the waste sludge collected from source. It has also been observed that the pH of the leachate of this mix is between 9-11, which ensures the proper stabilization of the heavy metals present in the mix. Hence, this study will certainly help in mass scale utilization of two industrial wastes viz., electroplating waste and fly ash, which are causing pollution to the environment to a great extent.

Keywords: Dadri fly ash, geofibre, electroplating waste sludge, CBR, TCLP

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Authors: Arthur C. Tsai, Chii-Shyang Kuo, Vincent S. C. Chien, Michelle Liou, Philip E. Cheng

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Meditation enhances mental abilities and it is an antidote to anxiety. However, very little is known about brain mechanisms and cortico-subcortical interactions underlying meditation-induced anxiety relief. In this study, the changes of phase-amplitude coupling (PAC) in which the amplitude of the beta frequency band were modulated in phase with delta rhythm were investigated after eight-week of meditation training. The study hypothesized that through a concentrate but relaxed mental training the delta-beta coupling in the frontal regions is attenuated. The delta-beta coupling analysis was applied to within and between maximally-independent component sources returned from the extended infomax independent components analysis (ICA) algorithm on the continuous EEG data during mediation. A unique meditative concentration task through relaxing body and mind was used with a constant level of moderate mental effort, so as to approach an ‘emptiness’ meditative state. A pre-test/post-test control group design was used in this study. To evaluate cross-frequency phase-amplitude coupling of component sources, the modulation index (MI) with statistics to calculate circular phase statistics were estimated. Our findings reveal that a significant delta-beta decoupling was observed in a set of frontal regions bilaterally. In addition, beta frequency band of prefrontal component were amplitude modulated in phase with the delta rhythm of medial frontal component.

Keywords: phase-amplitude coupling, ICA, meditation, EEG

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Authors: Badar Khalid Hakim Alshabibi

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This study aims to examine the determinants of corporate board diligence in the listed firm in Sultanate of Oman, using four corporate board characteristics, the board size, board independence, board gender diversity, and nationality diversity. Design/methodology/approach: Using a sample comprised of all companies listed in the Muscat Securities Exchange over a ten-year period (2009–2019), the study applies Pooled OLS regression to examine the determinants of corporate board diligence. Findings: Drawing from the agency theory and institutional theory, the results reveal that the number of independent board members had statistical significance, suggesting that board independence can improve corporate board diligence, though board size and nationality diversity were found to have a negative association with corporate board diligence. There is no evidence, however, that board gender diversity improves corporate board diligence. Practical implications: The study provides insights for both the investors and regulatory authorities in developing economies. For the investors to be aware about the corporate board characteristics which enhance board monitoring, and for the regulatory authorities to consider revising the corporate governance codes which enhance the quality of governance practices. Originality/value: The study provides new evidence documenting the determinants of corporate board diligence in a developing country such as the Sultanate of Oman, which has a high potential for growth and attracting foreign investment, as stated in Oman vision 2040. In addition, this paper is the first to examine the association between corporate board diligence and corporate board diversity aspects.

Keywords: board diligence, board monitoring, board composition, board diversity, oman

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Authors: A. Abubakar, A. Parsa, S. Walker

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Despite advances made in the diagnosis and management of drug-sensitive tuberculosis (TB) over the past decades, treatment of multidrug-resistant tuberculosis (MDR-TB) remains challenging and complex particularly in high burden countries including Nigeria. Treatment of MDR-TB is cost-prohibitive with success rate generally lower compared to drug-sensitive TB and if care is not taken it may become the dominant form of TB in future with many treatment uncertainties and substantial morbidity and mortality. Addressing these challenges requires collaborative efforts thorough sustained researches to evaluate the current treatment guidelines, particularly in high burden countries and prevent progression of resistance. To our best knowledge, there has been no research exploring the acceptability, effectiveness, and cost-effectiveness of community-based-MDR-TB treatment model in Nigeria, which is among the high burden countries. The previous similar qualitative study looks at the home-based management of MDR-TB in rural Uganda. This research aimed to explore patient’s views and acceptability of community-based-MDR-TB treatment model and to evaluate and compare the effectiveness and cost-effectiveness of community-based versus hospital-based MDR-TB treatment model of care from the Nigerian perspective. Knowledge of patient’s views and acceptability of community-based-MDR-TB treatment approach would help in designing future treatment recommendations and in health policymaking. Accordingly, knowledge of effectiveness and cost-effectiveness are part of the evidence needed to inform a decision about whether and how to scale up MDR-TB treatment, particularly in a poor resource setting with limited knowledge of TB. Mixed methods using qualitative and quantitative approach were employed. Qualitative data were obtained using in-depth semi-structured interviews with 21 MDR-TB patients in Nigeria to explore their views and acceptability of community-based MDR-TB treatment model. Qualitative data collection followed an iterative process which allowed adaptation of topic guides until data saturation. In-depth interviews were analyzed using thematic analysis. Quantitative data on treatment outcomes were obtained from medical records of MDR-TB patients to determine the effectiveness and direct and indirect costs were obtained from the patients using validated questionnaire and health system costs from the donor agencies to determine the cost-effectiveness difference between community and hospital-based model from the Nigerian perspective. Findings: Some themes have emerged from the patient’s perspectives indicating preference and high acceptability of community-based-MDR-TB treatment model by the patients and mixed feelings about the risk of MDR-TB transmission within the community due to poor infection control. The result of the modeling from the quantitative data is still on course. Community-based MDR-TB care was seen as the acceptable and most preferred model of care by the majority of the participants because of its convenience which in turn enhanced recovery, enables social interaction and offer more psychosocial benefits as well as averted productivity loss. However, there is a need to strengthen this model of care thorough enhanced strategies that ensure guidelines compliance and infection control in order to prevent the progression of resistance and curtail community transmission.

Keywords: acceptability, cost-effectiveness, multidrug-resistant TB treatment, community and hospital approach

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