Search results for: climate change risk perception

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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Authors: Pirta Palola, Richard Bailey, Lisa Wedding

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Societies and economies worldwide fundamentally depend on natural capital. Alarmingly, natural capital assets are quickly depreciating, posing an existential challenge for humanity. The development of robust natural capital accounting systems is essential for transitioning towards sustainable economic systems and ensuring sound management of capital assets. However, the accurate, equitable and comprehensive estimation of natural capital asset stocks and their accounting values still faces multiple challenges. In particular, the representation of socio-cultural values held by groups or communities has arguably been limited, as to date, the valuation of natural capital assets has primarily been based on monetary valuation methods and assumptions of individual rationality. People relate to and value the natural environment in multiple ways, and no single valuation method can provide a sufficiently comprehensive image of the range of values associated with the environment. Indeed, calls have been made to improve the representation of multiple types of value (instrumental, intrinsic, and relational) and diverse ontological and epistemological perspectives in environmental valuation. This study addresses this need by establishing a novel valuation framework, Environmental Value Functions (EVF), that allows for the integration of multiple types of value in natural capital accounting systems. The EVF framework is based on the estimation and application of value functions, each of which describes the relationship between the value and quantity (or quality) of an ecosystem component of interest. In this framework, values are estimated in terms of change relative to the current level instead of calculating absolute values. Furthermore, EVF was developed to also support non-marginalist conceptualizations of value: it is likely that some environmental values cannot be conceptualized in terms of marginal changes. For example, ecological resilience value may, in some cases, be best understood as a binary: it either exists (1) or is lost (0). In such cases, a logistic value function may be used as the discriminator. Uncertainty in the value function parameterization can be considered through, for example, Monte Carlo sampling analysis. The use of EVF is illustrated with two conceptual examples. For the first time, EVF offers a clear framework and concrete methodology for the representation of multiple types of value in natural capital accounting systems, simultaneously enabling 1) the complementary use and integration of multiple valuation methods (monetary and non-monetary); 2) the synthesis of information from diverse knowledge systems; 3) the recognition of value incommensurability; 4) marginalist and non-marginalist value analysis. Furthermore, with this advancement, the coupling of EVF and ecosystem modeling can offer novel insights to the study of spatial-temporal dynamics in natural capital asset values. For example, value time series can be produced, allowing for the prediction and analysis of volatility, long-term trends, and temporal trade-offs. This approach can provide essential information to help guide the transition to a sustainable economy.

Keywords: economics of biodiversity, environmental valuation, natural capital, value function

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Authors: D. Kekelidze, G. Tsotadze, G. Maisuradze, L. Akhalbedashvili, M. Chkhaidze

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Statement of Problem: The problem of solid wastes -dangerous sources of environmental pollution,is the urgent issue for Georgia as there are no waste-treatment and waste- incineration plants. Urban peripheral and rural areas, frequently along small rivers, are occupied by landfills without any permission. The study of the pollution of some environmental objects in the adjacent territories of solid waste landfill in Tbilisi carried out in 2020-2021, within the framework of project: “Ecological monitoring of the landfills surrounding areas and population health risk assessment”. Research objects: This research had goal to assess the ecological state of environmental objects (soil cover and surface water) in the territories, adjacent of solid waste landfill, on the base of changes heavy metals' (HM) concentration with distance from landfill. An open sanitary landfill for solid domestic waste in Tbilisi locates at suburb Lilo surrounded with densely populated villages. Content of following HM was determined in soil and river water samples: Pb, Cd, Cu, Zn, Ni, Co, Mn. Methodology: The HM content in samples was measured, using flame atomic absorption spectrophotometry (spectrophotometer of firm Perkin-Elmer AAnalyst 200) in accordance with ISO 11466 and GOST Р 53218-2008. Results and discussion: Data obtained confirmed migration of HM mainly in terms of the distance from the polygon that can be explained by their areal emissions and storage in open state, they could also get into the soil cover under the influence of wind and precipitation. Concentration of Pb, Cd, Cu, Zn always increases with approaching to landfill. High concentrations of Pb, Cd are characteristic of the soil covers of the adjacent territories around the landfill at a distance of 250, 500 meters.They create a dangerous zone, since they can later migrate into plants, enter in rivers and lakes. The higher concentrations, compared to the maximum permissible concentrations (MPC) for surface waters of Georgia, are observed for Pb, Cd. One of the reasons for the low concentration of HM in river water may be high turbidity – as is known, suspended particles are good natural sorbents that causes low concentration of dissolved forms. Concentration of Cu, Ni, Mn increases in winter, since in this season the rivers are switched to groundwater feeding. Conclusion: Soil covers of the areas adjacent to the landfill in Lilo are contaminated with HM. High concentrations in soils are characteristic of lead and cadmium. Elevated concentrations in comparison with the MPC for surface waters adopted in Georgia are also observed for Pb, Cd at checkpoints along and below (1000 m) of the landfill downstream. Data obtained confirm migration of HM to the adjacent territories of the landfill and to the Lochini River. Since the migration and toxicity of metals depends also on the presence of their mobile forms in water bodies, samples of bottom sediments should be taken too. Bottom sediments reflect a long-term picture of pollution, they accumulate HM and represent a constant source of secondary pollution of water bodies. The study of the physicochemical forms of metals is one of the priority areas for further research.

Keywords: landfill, pollution, heavy metals, migration

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Authors: B. Sudhakara Reddy

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This study provides a snapshot of the sustainability of selected Indian cities by employing 70 indicators in four dimensions to develop an overall city sustainability index. In recent years, the concept of ‘urban sustainability’ has become prominent due to its complexity. Urban areas propel growth and at the same time poses a lot of ecological, social and infrastructural problems and risks. In case of developing countries, the high population density of and the continuous in-migration run the highest risk in natural and man-made disasters. These issues combined with the inability of policy makers in providing basic services makes the cities unsustainable. To assess whether any given policy is moving towards or against urban sustainability it is necessary to consider the relationships among its various dimensions. Hence, in recent years, while preparing the sustainability index, an integral approach involving indicators of different dimensions such as ‘economic’, ‘environmental’ and 'social' is being used. It is also important for urban planners, social analysts and other related institutions to identify and understand the relationships in this complex system. The objective of the paper is to develop a city performance index (CPI) to measure and evaluate the urban regions in terms of sustainable performances. The objectives include: i) Objective assessment of a city’s performance, ii) setting achievable goals iii) prioritise relevant indicators for improvement, iv) learning from leaders, iv) assessment of the effectiveness of programmes that results in achieving high indicator values, v) Strengthening of stakeholder participation. Using the benchmark approach, a conceptual framework is developed for evaluating 25 Indian cities. We develop City Sustainability index (CSI) in order to rank cities according to their level of sustainability. The CSI is composed of four dimensions: Economic, Environment, Social, and Institutional. Each dimension is further composed of multiple indicators: (1) Economic that considers growth, access to electricity, and telephone availability; (2) environmental that includes waste water treatment, carbon emissions, (3) social that includes, equity, infant mortality, and 4) institutional that includes, voting share of population, urban regeneration policies. The CSI, consisting of four dimensions disaggregate into 12 categories and ultimately into 70 indicators. The data are obtained from public and non-governmental organizations, and also from city officials and experts. By ranking a sample of diverse cities on a set of specific dimensions the study can serve as a baseline of current conditions and a marker for referencing future results. The benchmarks and indices presented in the study provide a unique resource for the government and the city authorities to learn about the positive and negative attributes of a city and prepare plans for a sustainable urban development. As a result of our conceptual framework, the set of criteria we suggest is somewhat different to any already in the literature. The scope of our analysis is intended to be broad. Although illustrated with specific examples, it should be apparent that the principles identified are relevant to any monitoring that is used to inform decisions involving decision variables. These indicators are policy-relevant and, hence they are useful tool for decision-makers and researchers.

Keywords: benchmark, city, indicator, performance, sustainability

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Authors: Amirhosein Moonesi Shabestary, Eckhard Krepper, Dirk Lucas

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The current PhD project comprises CFD-modeling and simulation of condensation and heat transfer inside horizontal pipes. Condensation plays an important role in emergency cooling systems of reactors. The emergency cooling system consists of inclined horizontal pipes which are immersed in a tank of subcooled water. In the case of an accident the water level in the core is decreasing, steam comes in the emergency pipes, and due to the subcooled water around the pipe, this steam will start to condense. These horizontal pipes act as a strong heat sink which is responsible for a quick depressurization of the reactor core when any accident happens. This project is defined in order to model all these processes which happening in the emergency cooling systems. The most focus of the project is on detection of different morphologies such as annular flow, stratified flow, slug flow and plug flow. This project is an ongoing project which has been started 1 year ago in Helmholtz Zentrum Dresden Rossendorf (HZDR), Fluid Dynamics department. In HZDR most in cooperation with ANSYS different models are developed for modeling multiphase flows. Inhomogeneous MUSIG model considers the bubble size distribution and is used for modeling small-scaled dispersed gas phase. AIAD (Algebraic Interfacial Area Density Model) is developed for detection of the local morphology and corresponding switch between them. The recent model is GENTOP combines both concepts. GENTOP is able to simulate co-existing large-scaled (continuous) and small-scaled (polydispersed) structures. All these models are validated for adiabatic cases without any phase change. Therefore, the start point of the current PhD project is using the available models and trying to integrate phase transition and wall condensing models into them. In order to simplify the idea of condensation inside horizontal tubes, 3 steps have been defined. The first step is the investigation of condensation inside a horizontal tube by considering only direct contact condensation (DCC) and neglect wall condensation. Therefore, the inlet of the pipe is considered to be annular flow. In this step, AIAD model is used in order to detect the interface. The second step is the extension of the model to consider wall condensation as well which is closer to the reality. In this step, the inlet is pure steam, and due to the wall condensation, a liquid film occurs near the wall which leads to annular flow. The last step will be modeling of different morphologies which are occurring inside the tube during the condensation via using GENTOP model. By using GENTOP, the dispersed phase is able to be considered and simulated. Finally, the results of the simulations will be validated by experimental data which will be available also in HZDR.

Keywords: wall condensation, direct contact condensation, AIAD model, morphology detection

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Authors: Dr. Luigi Iannacci

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This research critically explores the current educational landscape with respect to special education and dominant deficit/medical model discourses that continue to forward unresponsive problematic approaches to teaching students with disabilities. Asset-oriented perspectives and social/critical models of disability are defined and explicated in order to offer alternatives to these dominant discourses. To that end, a framework that draws on Brian Camborne’s conditions of learning and applications of his work in relation to instruction conceptualize learning conditions and their significance to students with special needs. Methodologically, the research is designed as Critical Narrative Inquiry (CNI). Critical incidents, interviews, documents, artefacts etc. are drawn on and narratively constructed to explore how disability is presently configured in language, discourses, pedagogies and interactions with students deemed disabled. This data was collected using ethnographic methods and as such, through participant-observer field work that occurred directly in classrooms. This narrative approach aims to make sense of complex classroom interactions and ways of reconceptualizing approaches to students with special needs. CNI is situated in the critical paradigm and primarily concerned with culture, language and participation as issues of power in need of critique with the intent of change in the direction of social justice. Research findings highlight the ways in which Cambourne’s learning conditions, such as demonstration, approximation, engagement, responsibility, immersion, expectation, employment (transfer, use), provide a clear understanding of what is central to and constitutes a responsive and inclusive this instructional frame. Examples of what each of these conditions look like in practice are therefore offered in order to concretely demonstrate the ways in which various pedagogical choices and questions can enable classroom spaces to be responsive to the assets and challenges students with special needs have and experience. These particular approaches are also illustrated through an exploration of multiliteracies theory and pedagogy and what this research and approach allows educators to draw on, facilitate and foster in terms of the ways in which students with special needs can make sense of and demonstrate their understanding of skills, content and knowledge. The contextual information, theory, research and instructional frame focused on throughout this inquiry ultimately demonstrate what inclusive classroom spaces and practice can look like. These perspectives and conceptualizations are in stark contrast to dominant deficit driven approaches that ensure current pedagogically impoverished teaching focused on narrow, limited and limiting understandings of special needs learners and their ways of knowing and acquiring/demonstrating knowledge.

Keywords: asset-oriented approach, social/critical model of disability, conditions for learning and teaching, students with special needs

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Authors: Soheila Sadeghi

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Infrastructure projects often encounter contract variations that can significantly deviate from the original tender estimates, leading to cost overruns, schedule delays, and financial implications. This research aims to quantitatively assess the impact of changes in contract variations on project performance by conducting an in-depth analysis of a comprehensive dataset from the Regional Airport Car Park project. The dataset includes tender budget, contract quantities, rates, claims, and revenue data, providing a unique opportunity to investigate the effects of variations on project outcomes. The study focuses on 21 specific variations identified in the dataset, which represent changes or additions to the project scope. The research methodology involves establishing a baseline for the project's planned cost and scope by examining the tender budget and contract quantities. Each variation is then analyzed in detail, comparing the actual quantities and rates against the tender estimates to determine their impact on project cost and schedule. The claims data is utilized to track the progress of work and identify deviations from the planned schedule. The study employs statistical analysis using R to examine the dataset, including tender budget, contract quantities, rates, claims, and revenue data. Time series analysis is applied to the claims data to track progress and detect variations from the planned schedule. Regression analysis is utilized to investigate the relationship between variations and project performance indicators, such as cost overruns and schedule delays. The research findings highlight the significance of effective variation management in construction projects. The analysis reveals that variations can have a substantial impact on project cost, schedule, and financial outcomes. The study identifies specific variations that had the most significant influence on the Regional Airport Car Park project's performance, such as PV03 (additional fill, road base gravel, spray seal, and asphalt), PV06 (extension to the commercial car park), and PV07 (additional box out and general fill). These variations contributed to increased costs, schedule delays, and changes in the project's revenue profile. The study also examines the effectiveness of project management practices in managing variations and mitigating their impact. The research suggests that proactive risk management, thorough scope definition, and effective communication among project stakeholders can help minimize the negative consequences of variations. The findings emphasize the importance of establishing clear procedures for identifying, assessing, and managing variations throughout the project lifecycle. The outcomes of this research contribute to the body of knowledge in construction project management by demonstrating the value of analyzing tender, contract, claims, and revenue data in variation impact assessment. However, the research acknowledges the limitations imposed by the dataset, particularly the absence of detailed contract and tender documents. This constraint restricts the depth of analysis possible in investigating the root causes and full extent of variations' impact on the project. Future research could build upon this study by incorporating more comprehensive data sources to further explore the dynamics of variations in construction projects.

Keywords: contract variation impact, quantitative analysis, project performance, claims analysis

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Authors: Drago Bratkovic, Curtis Gravance, David Ketteridge, Ravi Krishnan, Michael Imperiale

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The mucopolysaccharidoses (MPSs) are a group of lysosomal storage diseases that have a common defect in the catabolism of glycosaminoglycans (GAGs). MPS I is the most common of the MPS diseases. Manifestations of MPS I include coarsening of facial features, corneal clouding, developmental delay, short stature, skeletal manifestations, hearing loss, cardiac valve disease, hepatosplenomegaly, and umbilical and inguinal hernias. Treatments for MPS I restore or activate the missing or deficient enzyme in the case of enzyme replacement therapy (ERT) and haematopoietic stem cell transplantation (HSCT). Pentosan polysulfate sodium (PPS) is a potential treatment to improve bone and joint manifestations of MPS I. The mechanisms of action of PPS that are relevant to the treatment of MPS I are the ability to: (i) Reduce systemic and accumulated GAG, (ii) Reduce inflammatory effects via the inhibition of NF-kB, resulting in the reduction in pro-inflammatory mediators. (iii) Reduce the expression of the pain mediator nerve growth factor in osteocytes from degenerating joints. (iv) Inhibit the cartilage degrading enzymes related to joint dysfunction in MPS I. PPS is being evaluated as an adjunctive therapy to ERT and/or HSCT in an open-label, single-centre, phase 2 study. Patients are ≥ 5 years of age with a diagnosis of MPS I and previously received HSCT and/or ERT. Three white, female, patients with MPS I-Hurler, ages 14, 15, and 19 years, and one, white male patient aged 15 years are enrolled. All were diagnosed at ≤2 years of age. All patients received HSCT ≤ 6 months after diagnosis. Two of the patients were treated with ERT prior to HSCT, and 1 patient received ERT commencing 3 months prior to HSCT. Two patients received 0.75mg/kg and 2 patients received 1.5mg/kg of PPS. PPS was well tolerated at doses of 0.75 and 1.5 mg/kg to 47 weeks of continuous dosing. Of the 19 adverse events (AEs), 2 were related to PPS. One AE was moderate (pre-syncope) and 1 was mild (injection site bruising), experienced in the same patient. All AEs were reported as mild or moderate. There have been no SAEs. One subject experienced a COVID-19 infection and PPS was interrupted. The MPS I signature GAG fragments, sulfated disaccharide and UA-HNAc S, tended to decrease in 3 patients from baseline through Week 25. Week 25 GAG data are pending for the 4th patient. Overall, most biomarkers (inflammatory, cartilage degeneration, and bone turnover) evaluated in the 3 patients with 25-week assessments have indicated either no change or a reduction in levels compared to baseline. In 3 patients, there was a trend toward improvement in the 2MWT from baseline to Week 48 with > 100% increase in 1 patient (01-201). In the 3 patients that had Week 48 assessments, patients and proxies reported improvement in PGIC, including “worthwhile difference” (n=1), or “made all the difference” (n=2).

Keywords: MPS I, pentosan polysulfate sodium, clinical study, 2MWT, QoL

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Authors: Andi Setiawan, Annisa Ulfah Pristya

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Indonesian rubber plant area reached 2.9 million hectares with productivity reached 1.38 million. High rubber productivity is directly proportional to the amount of waste produced rubber processing industry. Rubber industry would produce a negative impact on the rubber industry in the form of environmental pollution caused by waste that has not been treated optimally. Rubber industrial wastewater containing high-nitrogen compounds (nitrate and ammonia) and phosphate compounds which cause water pollution and odor problems due to the high ammonia content. On the other hand, demand for NPK fertilizers in Indonesia continues to increase from year to year and in need of ammonia and phosphate as raw material. Based on domestic demand, it takes a year to 400,000 tons of ammonia and Indonesia imports 200,000 tons of ammonia per year valued at IDR 4.2 trillion. As well, the lack of phosphoric acid to be imported from Jordan, Morocco, South Africa, the Philippines, and India as many as 225 thousand tons per year. During this time, the process of wastewater treatment is generally done with a rubber on the tank to contain the waste and then precipitated, filtered and the rest released into the environment. However, this method is inefficient and thus require high energy costs because through many stages before producing clean water that can be discharged into the river. On the other hand, Indonesia has the potential of pineapple fruit can be harvested throughout the year in all of Indonesia. In 2010, production reached 1,406,445 tons of pineapple in Indonesia or about 9.36 percent of the total fruit production in Indonesia. Increased productivity is directly proportional to the amount of pineapple waste pineapple leaves are kept continuous and usually just dumped in the ground or disposed of with other waste at the final disposal. Through Eco-Nanofiltration Membrane-Based Fiber Pineapple leaves Waste so that environmental problems can be solved efficiently. Nanofiltration is a process that uses pressure as a driving force that can be either convection or diffusion of each molecule. Nanofiltration membranes that can split water to nano size so as to separate the waste processed residual economic value that N and P were higher as a raw material for the manufacture of NPK fertilizer to overcome the crisis in Indonesia. The raw materials were used to manufacture Eco-Nanofiltration Membrane is cellulose from pineapple fiber which processed into cellulose acetate which is biodegradable and only requires a change of the membrane every 6 months. Expected output target is Green eco-technology so with nanofiltration membranes not only treat waste rubber industry in an effective, efficient and environmentally friendly but also lowers the cost of waste treatment compared to conventional methods.

Keywords: biodegradable, cellulose diacetate, fertilizers, pineapple, rubber

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Authors: Rami Hashish, Manon Limousis-Gayda, Caitlin H. McCleery

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Introduction: A leading cause of emergency room visits among youth (in the United States), is sports-related traumatic brain injuries. Mild traumatic brain injuries (mTBIs), also called concussions, are caused by linear and/or angular acceleration experienced at the head and represent an increasing societal burden. Due to the developing nature of the brain in youth, there is a great risk for long-term neuropsychological deficiencies following a concussion. Accordingly, the purpose of this paper is to investigate incidence rates of concussion across gender for the five most common youth sports in the United States. These include basketball, track and field, soccer, baseball (boys), softball (girls), football (boys), and volleyball (girls). Methods: A PubMed search was performed for four search themes combined. The first theme identified the outcomes (concussion, brain injuries, mild traumatic brain injury, etc.). The second theme identified the sport (American football, soccer, basketball, softball, volleyball, track, and field, etc.). The third theme identified the population (adolescence, children, youth, boys, girls). The last theme identified the study design (prevalence, frequency, incidence, prospective). Ultimately, 473 studies were surveyed, with 15 fulfilling the criteria: prospective study presenting original data and incidence of concussion in the relevant youth sport. The following data were extracted from the selected studies: population age, total study population, total athletic exposures (AE) and incidence rate per 1000 athletic exposures (IR/1000). Two One-Way ANOVA and a Tukey’s post hoc test were conducted using SPSS. Results: From the 15 selected studies, statistical analysis revealed the incidence of concussion per 1000 AEs across the considered sports ranged from 0.014 (girl’s track and field) to 0.780 (boy’s football). Average IR/1000 across all sports was 0.483 and 0.268 for boys and girls, respectively; this difference in IR was found to be statistically significant (p=0.013). Tukey’s post hoc test showed that football had significantly higher IR/1000 than boys’ basketball (p=0.022), soccer (p=0.033) and track and field (p=0.026). No statistical difference was found for concussion incidence between girls’ sports. Removal of football was found to lower the IR/1000 for boys without a statistical difference (p=0.101) compared to girls. Discussion: Football was the only sport showing a statistically significant difference in concussion incidence rate relative to other sports (within gender). Males were overall more likely to be concussed than females when football was included (1.8x), whereas concussion was more likely for females when football was excluded. While the significantly higher rate of concussion in football is not surprising because of the nature and rules of the sport, it is concerning that research has shown higher incidence of concussion in practices than games. Interestingly, findings indicate that girls’ sports are more concussive overall when football is removed. This appears to counter the common notion that boys’ sports are more physically taxing and dangerous. Future research should focus on understanding the concussive mechanisms of injury in each sport to enable effective rule changes.

Keywords: gender, football, soccer, traumatic brain injury

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Authors: Toktam mehrabani

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Textiles, fashion, and architecture, though seemingly disparate fields, share a deep and evolving relationship. This paper explores the intersection of these disciplines, examining how the tactile, structural, and aesthetic qualities of textiles have influenced both fashion and architecture over time. By investigating historical and contemporary examples, this paper seeks to unravel the ways in which textiles and fashion have not only shaped architectural design but have also acted as a bridge between functionality, art, and human experience in the built environment.Textiles have been integral to human culture since the dawn of civilization. Their presence transcends mere functionality, serving as a medium for artistic expression, cultural identity, and social commentary. Fashion, derived from textiles, has long been associated with personal identity and societal trends, while architecture reflects human needs, environmental context, and cultural values. This paper posits that the relationship between textiles, fashion, and architecture is more interconnected than often perceived, with each influencing and inspiring the other across time. Textiles in Architectural Design: From ancient draperies in temples to tapestries in castles, textiles have adorned structures, softening rigid spaces and adding layers of warmth and luxury. Fabric screens and curtains have also served functional purposes, such as controlling light, acoustics, and temperature. Fashion as Architectural Expression: Renaissance and Baroque fashion used exaggerated forms, corsetry, and layers to mirror the grandiosity of architectural styles of the time. Clothing acted as wearable architecture, with structured garments mirroring the strong lines and curves of buildings..Structural Textiles in Architecture: In the 21st century, textiles are no longer just decorative; they have become integral to architectural innovation. Materials like tensile fabrics and smart textiles are used in creating flexible, lightweight structures. Iconic examples include Frei Otto’s work with tensile membranes, seen in the Munich Olympic Stadium.Technological advancements have drastically transformed the relationship between textiles, fashion, and architecture. Digital tools like 3D printing and laser cutting allow designers in both fields to push the limits of form and structure. Smart textiles that react to environmental stimuli are being explored for use in both wearable technology and adaptable architecture, such as facades that change in response to weather conditions. Textiles, fashion, and architecture are inextricably linked through their shared exploration of form, structure, and expression. This interdisciplinary relationship continues to evolve, driven by technological advancements and a growing emphasis on sustainability. As fashion becomes more architectural in its construction and architecture more fluid in its forms, the lines between these disciplines blur, offering new possibilities for creativity and functionality in both wearable and built environments.

Keywords: textiles in architecture, fashion and architecture, textile architecture, structural textiles, wearable architecture, architectural fashion

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Authors: Andreas Lind, Aitor Iriondo Pascual, Dan Hogberg, Lars Hanson

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Factory setup lifecycles are most often described and prepared in CAD environments; the preparation is based on experience and inputs from several cross-disciplinary processes. Early in the factory setup preparation, a so-called block layout is created. The intention is to describe a high-level view of the intended factory setup and to claim area reservations and allocations. Factory areas are then blocked, i.e., targeted to be used for specific intended resources and processes, later redefined with detailed factory setup layouts. Each detailed layout is based on the block layout and inputs from cross-disciplinary preparation processes, such as manufacturing sequence, productivity, workers’ workplace requirements, and resource setup preparation. However, this activity is often not carried out with all variables considered simultaneously, which might entail a risk of sub-optimizing the detailed layout based on manual decisions. Therefore, this work aims to realize a digital method for assembly manufacturing layout planning where productivity, area utilization, and ergonomics can be considered simultaneously in a cross-disciplinary manner. The purpose of the digital method is to support engineers in finding optimized designs of detailed layouts for assembly manufacturing factories, thereby facilitating better decisions regarding setups of future factories. Input datasets are company-specific descriptions of required dimensions for specific area reservations, such as defined dimensions of a worker’s workplace, material façades, aisles, and the sequence to realize the product assembly manufacturing process. To test and iteratively develop the digital method, a demonstrator has been developed with an adaptation of existing software that simulates and proposes optimized designs of detailed layouts. Since the method is to consider productivity, ergonomics, area utilization, and constraints from the automatically generated block layout, a multi-objective optimization approach is utilized. In the demonstrator, the input data are sent to the simulation software industrial path solutions (IPS). Based on the input and Lua scripts, the IPS software generates a block layout in compliance with the company’s defined dimensions of area reservations. Communication is then established between the IPS and the software EPP (Ergonomics in Productivity Platform), including intended resource descriptions, assembly manufacturing process, and manikin (digital human) resources. Using multi-objective optimization approaches, the EPP software then calculates layout proposals that are sent iteratively and simulated and rendered in IPS, following the rules and regulations defined in the block layout as well as productivity and ergonomics constraints and objectives. The software demonstrator is promising. The software can handle several parameters to optimize the detailed layout simultaneously and can put forward several proposals. It can optimize multiple parameters or weight the parameters to fine-tune the optimal result of the detailed layout. The intention of the demonstrator is to make the preparation between cross-disciplinary silos transparent and achieve a common preparation of the assembly manufacturing factory setup, thereby facilitating better decisions.

Keywords: factory setup, multi-objective, optimization, simulation

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Authors: Anna Slupik, Anna Mosiolek, Sebastian Wojtowicz, Dariusz Bialoszewski

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Introduction: Whole-body vibration (WBV) uses high frequency mechanical stimuli generated by a vibration plate and transmitted through bone, muscle and connective tissues to the whole body. Research has shown that long-term vibration-plate training improves neuromuscular facilitation, especially in afferent neural pathways, responsible for the conduction of vibration and proprioceptive stimuli, muscle function, balance and proprioception. Some researchers suggest that the vibration stimulus briefly inhibits the conduction of afferent signals from proprioceptors and can interfere with the maintenance of body balance. The aim of this study was to evaluate the influence of a single set of exercises associated with whole-body vibration on the joint position sense and body balance. Material and methods: The study enrolled 55 people aged 19-24 years. These individuals were randomly divided into a test group (30 persons) and a control group (25 persons). Both groups performed the same set of exercises on a vibration plate. The following vibration parameters: frequency of 20Hz and amplitude of 3mm, were used in the test group. The control group performed exercises on the vibration plate while it was off. All participants were instructed to perform six dynamic exercises lasting 30 seconds each with a 60-second period of rest between them. The exercises involved large muscle groups of the trunk, pelvis and lower limbs. Measurements were carried out before and immediately after exercise. Joint position sense (JPS) was measured in the knee joint for the starting position at 45° in an open kinematic chain. JPS error was measured using a digital inclinometer. Balance was assessed in a standing position with both feet on the ground with the eyes open and closed (each test lasting 30 sec). Balance was assessed using Matscan with FootMat 7.0 SAM software. The surface of the ellipse of confidence and front-back as well as right-left swing were measured to assess balance. Statistical analysis was performed using Statistica 10.0 PL software. Results: There were no significant differences between the groups, both before and after the exercise (p> 0.05). JPS did not change in both the test (10.7° vs. 8.4°) and control groups (9.0° vs. 8.4°). No significant differences were shown in any of the test parameters during balance tests with the eyes open or closed in both the test and control groups (p> 0.05). Conclusions. 1. Deterioration in proprioception or balance was not observed immediately after the vibration stimulus. This suggests that vibration-induced blockage of proprioceptive stimuli conduction can have only a short-lasting effect that occurs only as long as a vibration stimulus is present. 2. Short-term use of vibration in treatment does not impair proprioception and seems to be safe for patients with proprioceptive impairment. 3. These results need to be supplemented with an assessment of proprioception during the application of vibration stimuli. Additionally, the impact of vibration parameters used in the exercises should be evaluated.

Keywords: balance, joint position sense, proprioception, whole body vibration

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Authors: Pamela Chia, Tay Yoong Chuan

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Introduction: Severe pulmonary hypertension (PH) patients requiring non-cardiac surgery risk have increased mortality rates ranging. These patients are plagued with cardiorespiratory failure, dysrhythmias and anticoagulation potentially with concurrent sepsis and renal insufficiency, perioperative morbidity. We present a deaf-mute patient with severe idiopathic PH emergently prepared for ruptured ectopic laparotomy. Case Report: A 20 year-old female, 62kg (BMI 25 kg/m2) with severe idiopathic PH (2DE Ejection Fraction was 41%, Pulmonary Artery Systolic Pressure (PASP) 105 mmHg, Right ventricle strain and hypertrophy) and selective mutism was rushed in for emergency laparotomy after presenting to the emergency department for abdominal pain. The patient had an NYHA Class II with room air SpO2 93-95%. While awaiting lung transplant, the patient takes warfarin, Sildanefil, Macitentan and even Selexipag for rising PASP. At presentation, vital signs: BP 95/63, HR 119 SpO2 88% (room air). Despite decreasing haemoglobin 14 to 10g/dL, INR 2.59 was reversed with prothrombin concentrate, and Vitamin K. ECG revealed Right Bundle Branch Block with right ventricular strain and x-ray showed cardiomegaly, dilated Right Ventricle, Pulmonary Arteries, basal atelectasis. Arterial blood gas showed compensated metabolic acidosis pH 7.4 pCO2 32 pO2 53 HCO3 20 BE -4 SaO2 88%. The cardiothoracic surgeon concluded no role for Extracorporeal Membrane Oxygenation (ECMO). We inserted invasive arterial and central venous lines with blood transfusion via an 18G cannula before the patient underwent a midline laparotomy, haemostasis of ruptured ovarian cyst with 2.4L of clots under general anesthesia and FloTrac cardiac output monitoring. Rapid sequence induction was done with Midazolam/Propofol, remifentanil infusion, and rocuronium. The patient was maintained on Desflurane. Blood products and colloids were transfused for further 1.5L blood loss. Postoperatively, the patient was transferred to the intensive care unit and was extubated uneventfully 7hours later. The patient went home a week later. Discussion: Emergency hemostasis laparotomy in anticoagulated WHO Class I PH patient awaiting lung transplant with no ECMO backup poses tremendous stress on the deaf-mute patient and the anesthesiologist. Balancing hemodynamics avoiding hypotension while awaiting hemostasis in the presence of pulmonary arterial dilators and anticoagulation requires close titration of volatiles, which decreases RV contractility. We review the contraindicated anesthetic agents (ketamine, N2O), choice of vasopressors in hypotension to maintain Aortic-right ventricular pressure gradients and nitric oxide use perioperatively. Conclusion: Interdisciplinary communication with a deaf-mute moribund patient and anesthesia considerations pose many rare challenges worth sharing.

Keywords: pulmonary hypertension, case report, warfarin reversal, emergency surgery

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Authors: Oyvind Nordvik, Peder O. L. Heggdal, Jonas Brannstrom, Flemming Vassbotn, Anne Kari Aarstad, Hans Jorgen Aarstad

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Background: Hearing Loss (HL) is a condition that may affect people in all stages of life, but the prevalence increases with age, mostly because of age-related HL, generally referred to as presbyacusis. As human speech is related to relatively high frequencies, even a limited hearing loss at high frequencies may cause impaired speech intelligibility. Being diagnosed with, treated for and living with a chronic condition such as HL, must for many be a disabling and stressful condition that put ones coping resources to test. Stress is a natural part of life and most people will experience stressful events or periods. Chronic diseases, such as HL, are risk factor for distress in individuals, causing anxiety and lowered mood. How an individual cope with HL may be closely connected to the level of distress he or she is experiencing and to personality, which can be defined as those characteristics of a person that account for consistent patterns of feelings, thinking, and behavior. Thus, as to distress in life, such as illness or disease, available coping strategies may be more important than the challenge itself. The same line of arguments applies to level of experienced health-related quality of life (HRQoL). Aim: The aim of this study was to investigate the relationship between distress, HRQoL, reported hearing loss, personality and coping in patients with HL. Method: 158 adult (aged 18-78 years) patients with HL, referred for hearing aid (HA) fitting at Haukeland University Hospital in western Norway, participated in the study. Both first-time users, as well as patients referred for HA renewals were included. First-time users had been pre-examined by an ENT-specialist. The questionnaires were answered before the actual HA fitting procedure. The pure-tone average (PTA; frequencies 0.5, 1, 2, and 4 kHz) was determined for each ear. The Eysenck personality inventory, neuroticism and lie scales, the Theoretically Originated Measure of the Cognitive Activation Theory of Stress (TOMCATS) measuring active coping, hopelessness and helplessness, as well as distress (General Health Questionnaire (GHQ) - 12 items) and the EORTC Quality of Life Questionnaire general part were answered. In addition, we used a revised and shortened version of the Abbreviated Profile of Hearing Aid Benefit (APHAB) as a measure of patient-reported hearing loss. Results: Significant correlations were determined between APHAB (weak), HRQoL scores (strong), distress scores (strong) on the one side and personality and choice of coping scores on the other side. As measured by stepwise regression analyses, the distress and HRQoL scores were scored secondary to the obtained personality and coping scores. The APHAB scores were as determined by regression analyses scored secondary to PTA (best ear), level of neuroticism and lie score. Conclusion: We found that reported employed coping style, distress/HRQoL and personality are closely connected to each other in this patient group. Patient-reported HL was associated to hearing level and personality. There is need for further investigations on these questions, and how these associations may influence the clinical context.

Keywords: coping, distress, hearing loss, personality

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Authors: Lukasz Grabowski, Marcin Szlachetka, Tytus Tulwin

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The main task of the engine cooling system is to maintain its average operating temperatures within strictly defined limits. Too high or too low average temperatures result in accelerated wear or even damage to the engine or its individual components. In order to avoid local overheating or significant temperature gradients, leading to high stresses in the component, the aim is to ensure an even flow of air. In the case of analyses related to heat exchange, one of the main problems is the comparison of temperature fields because standard measuring instruments such as thermocouples or thermistors only provide information about the course of temperature at a given point. Thermal imaging tests can be helpful in this case. With appropriate camera settings and taking into account environmental conditions, we are able to obtain accurate temperature fields in the form of thermograms. Emission of heat from the engine to the engine compartment is an important issue when designing a cooling system. Also, in the case of liquid cooling, the main sources of heat in the form of emissions from the engine block, cylinders, etc. should be identified. It is important to redesign the engine compartment ventilation system. Ensuring proper cooling of aircraft reciprocating engine is difficult not only because of variable operating range but mainly because of different cooling conditions related to the change of speed or altitude of flight. Engine temperature also has a direct and significant impact on the properties of engine oil, which under the influence of this parameter changes, in particular, its viscosity. Too low or too high, its value can be a result of fast wear of engine parts. One of the ways to determine the temperatures occurring on individual parts of the engine is the use of thermal imaging measurements. The article presents the results of preliminary thermal imaging tests of aircraft piston diesel engine with a maximum power of about 100 HP. In order to perform the heat emission tests of the tested engine, the ThermaCAM S65 thermovision monitoring system from FLIR (Forward-Looking Infrared) together with the ThermaCAM Researcher Professional software was used. The measurements were carried out after the engine warm up. The engine speed was 5300 rpm The measurements were taken for the following environmental parameters: air temperature: 17 °C, ambient pressure: 1004 hPa, relative humidity: 38%. The temperatures distribution on the engine cylinder and on the exhaust manifold were analysed. Thermal imaging tests made it possible to relate the results of simulation tests to the real object by measuring the rib temperature of the cylinders. The results obtained are necessary to develop a CFD (Computational Fluid Dynamics) model of heat emission from the engine bay. The project/research was financed in the framework of the project Lublin University of Technology-Regional Excellence Initiative, funded by the Polish Ministry of Science and Higher Education (contract no. 030/RID/2018/19).

Keywords: aircraft, piston engine, heat, emission

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Authors: Theoni Soublis

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The COVID-19 pandemic created a severe interruption in teaching and learning in K-12 schools. It is essential that educational researchers, teachers, and administrators understand the long term effects that COVID-19 had on a variety of stakeholders in education. This investigation aims to analyze the research since the beginning of the pandemic that focuses specifically on teacher retention, resilience, and training. The results of this investigation will help to inform future research in order to better understand how the institution of education can continue to be prepared and to better prepare for future significant shifts in the modalities of instruction. The results of this analysis will directly impact the field of education as it will broaden the scope of understanding regarding how COVID- 19 impacted teaching and learning. The themes that will emerge from the data analysis will directly inform policy makers, administrators, and researchers about how to best implement training and curriculum design in order to support teacher effectiveness this in the classroom. Educational researchers have written about how teacher morale plummeted and how many teachers reported early burnout and higher stress levels. Teachers’ stress and anxiety soared during the COVID-19 pandemic, but so has their resilience and dedication to the field of education. This research aims to understand how public-school teachers overcame teaching obstacles presented to them during COVID-19. Research has been conducted to identify a variety of information regarding the impact the pandemic has had on K-12 teachers, students, and families. This research aims to understand how teachers continued to pursue their teaching objectives without significant training of effective online instruction methods. Not many educators even heard of the video conferencing platform Zoom before the spring of 2020. Researchers are interested in understanding how teachers used their expertise, prior knowledge, and training to institute immediate and effective online learning environments, what types of relationships did teachers build with students while teaching 100% remotely, and how did relationships change with students while teaching remotely? Furthermore, did the teacher-student relationship propel teacher resolve to be successful while teaching during a pandemic. Recent world events have significantly impacted the field of public-school teaching. The pandemic forced teachers to shift their paradigm about how to maintain high academic expectations, meet state curriculum standards, and assess students learning gains to make data-informed decisions while simultaneously adapting modes of instruction through multiple outlets with little to no training on remote, synchronous, asynchronous, virtual, and hybrid teaching. While it would be very interesting to study how teaching positively impacted students learning during the pandemic, I am more interested in understanding how teaches stayed the course and maintained their mental health while dealing with the stress and pressure of teaching during COVID-19.

Keywords: teacher retention, COVID-19, teacher education, teacher moral

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Authors: Maria Cardova

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Aim and objectives: The purpose of this studywas to explore to what extent the deprivation statusinfluenced children’s physical activity, dietary behaviour, and health outcomes such as weight status. Background: The United Kingdom’s childhood obesity rates are currently ranked among the highest in Europe. North West England deals with highest rates of childhood obesity. Data from the UK Millennium Cohort Study suggested a deprivation gradient to childhood obesity in England, with obesity rates being the highest in the most deprived areas. Traditionally, it has been individual conception of health, but the contemporary stance is that health behaviours affecting obesity are influenced by a broad range of factors operating at multiple levels. According to socio-ecological model of health behaviour, differences in obesity rates and health outcomes are likely explained by differences in lifestyle behaviours including physical activity and diet behaviours. However, higher rates of obesity among deprived children are not due to physical inactivity, in fact, most socially disadvantaged children are the most physically active. Poor diet including high consumption of fast food and sugar-sweetened beverages and low consumption of fruit and vegetables was found to be the most prevalent among adolescents living in poverty. Methods: This study adopted quantitative approach. It consisted of combination of basic demographic data, anthropometry, and questionnaires. Children (N = 165, mean age = 10.04 years; 53.33% female; 46.66% male) completed survey packs during school day including KIDSCREEN, Youth Activity Profile, Beverage and Snack Questionnaire, and Child Body Image Scale questionnaires as well as had anthropometric measurements taken including Body mass index, waist circumference, weight, and height. Children’s deprivation status was based on the English Indices of Multiple Deprivation scores of the school they attended. Results: Children from more deprived areas had higher weight status, waist circumference. Deprivation status had also effect on some dimensions of the KIDSCREEN questionnaire, such as that those from more deprived areas felt less socially accepted and bullied by their peers, had worse feelings about themselves such as body image, and more difficulty with school and learning. Children from more deprived areas reported higher rates of physical activity and also differences in snack and fruit and vegetable intake than their more affluent peers. Conclusion: Results demonstrated that, children living in the most-deprived areas appear to be at greater risk of unfavourable health-related variables and behaviours and are exposed to home and neighbourhood environments that are less conducive to health-promoting behaviours compared to their peers from less deprived areas. These findings indicate that children living in highly deprived areas represent an important group for future interventions designed to promote health-behaviours that would impact on the quality of life of the child and other health variables such as weight status.

Keywords: children, dietary behaviour, health, obesity, physical Activity, weight Status

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Authors: Habiba Nahzat, Karen Crow, Lisa Manuel, Maria Huijbregts

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Background and Rationale: The World Health Organization (WHO) declared COVID-19 a pandemic on March 11, 2020. Shortly after, the Ontario provincial and Toronto municipal governments also released multiple directives that led to the mass closure of businesses both in the public and private sectors. Recent research has identified connections between Intimate Partner Violence (IPV) and COVID-19 related stressors - especially because of lockdown and social isolation measures. Psychological impacts of lengthy seclusion coupled with disconnection from extended family and diminished support services can take a toll on families at risk and may increase mental health issues and the prevalence of IPV. Research Question: Thus, the purpose of the study was to understand the perspective of the Violence Against Women (VAW) program staff on the impact of the COVID-19 pandemic; we especially wanted to understand staff views of restrictions on clients’ counseling experiences and the ability to access services in general. The study also aimed to examine VAW program staff experiences regarding remote work and explore how the pandemic restriction measures affected the ability of their program operations to support their clients and each other. Method: A cross-sectional, descriptive qualitative study was conducted with a purposive sample of 9 VAW program staff – eight VAW counselors and one VAW manager. Prior to data collection, program staff collaborated in the development of the study purpose, interview questions and methodology. Ethics approval was obtained from the sponsoring organization’s Research Ethics Board. In-depth individual interviews were conducted with study participants using a semi-structured interview questionnaire. Brief demographic information was also collected prior to the interview. Descriptive statistics were used to analyze quantitative data and qualitative data was analyzed by thematic content analysis. Results: Findings from this study indicate that the COVID-19 pandemic restrictions had an adverse impact on clients seeking VAW services based on VAW staff perspectives. Program staff reported a perceived increase in abuse among women, especially in emotional and financial abuse and experiences of isolation and trauma. Findings further highlight the challenges women experienced when trying to access services in general as well as counseling and legal services. This was perceived to be more prominent among newcomers and marginalized women. The study also revealed client and staff challenges when participating in virtual counseling, their innovations and clients’ creativity in accessing needed counseling and how staff over time adapted to providing virtual support during the pandemic. Conclusion and Next Steps: This study builds upon existing evidence on the impact of COVID-19 restrictions on VAW and may inform future research to better understand the association between the COVID-19 pandemic restrictions and VAW on a broader scale and to inform and support possible short-term and long-term changes in the client experience and counselling practice.

Keywords: COVID-19, pandemic, virtual, violence against women (VAW)

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Authors: Teresa Rushe, Nicole Devlin, Tara O Neill

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In this study, we sought to examine associations between childhood experiences of community and collective violence and psychological functioning in young people who grew up in post-conflict Northern Ireland. We hypothesized that those who grew up with such experiences would demonstrate internalizing and externalizing difficulties in early adulthood and, furthermore, that these difficulties would be mediated by adverse childhood experiences occurring within the home environment. As part of the Northern Ireland Childhood Adversity Study, we recruited 213 young people aged 18-25 years (108 males) who grew up in the post-conflict society of Northern Ireland using purposive sampling. Participants completed a digital questionnaire to measure adverse childhood experiences as well as aspects of psychological functioning. We employed the Adverse Childhood Experience -International Questionnaire (ACE-IQ¬) adaptation of the original Adverse Childhood Experiences Questionnaire (ACE) as it additionally measured aspects of witnessing community violence (e.g., seeing someone being beaten/killed, fights) and experiences of collective violence (e.g., war, terrorism, police, or gangs’ battles exposure) during the first 18 years of life. 51% of our sample reported experiences of community and/or collective violence (N=108). Compared to young people with no such experiences (N=105), they also reported significantly more adverse experiences indicative of household dysfunction (e.g., family substance misuse, mental illness or domestic violence in the family, incarceration of a family member) but not more experiences of abuse or neglect. As expected, young people who grew up with the community and/or collective violence reported significantly higher anxiety and depression scores and were more likely to engage in acts of deliberate self-harm (internalizing symptoms). They also started drinking and taking drugs at a younger age and were significantly more likely to have been in trouble with the police (externalizing symptoms). When the type of violence exposure was separated by whether the violence was witnessed (community violence) or more directly experienced (collective violence), we found community and collective violence to have similar effects on externalizing symptoms, but for internalizing symptoms, we found evidence of a differential effect. Collective violence was associated with depressive symptoms, whereas witnessing community violence was associated with anxiety-type symptoms and deliberate self-harm. However, when experiences of household dysfunction were entered into the models predicting anxiety, depression, and deliberate self-harm, none of the main effects remained significant. This suggests internalizing type symptoms are mediated by immediate family-level experiences. By contrast, significant community and collective violence effects on externalizing behaviours: younger initiation of alcohol use, younger initiation of drug use, and getting into trouble with the police persisted after controlling for family-level factors and thus are directly associated with growing up with the community and collective violence. Given the cross-sectional nature of our study, we cannot comment on the direction of the effect. However, post-hoc correlational analyses revealed associations between externalising behaviours and personal factors, including greater risk-taking and young age at puberty. The implications of the findings will be discussed in relation to interventions for young people and families living with the community and collective violence.

Keywords: community and collective violence, adverse childhood experiences, youth, psychological wellbeing

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Authors: Sally Abu Sabaa, Lindsey Gutt

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In an attempt to use education as a way of raising a socially responsible and engaged global citizen, the YU-Bridge program, the largest and fastest pathway program of its kind in North America, has embarked on the journey of integrating general themes from the UN’s sustainable developmental goals (SDGs) in its English for Academic Purposes (EAP) curriculum. The purpose of this initiative was to redefine the general philosophy of education in the middle of a pandemic and align with York University’s University Academic Plan that was released in summer 2020 framed around the SDGs. The YUB program attracts international students from all over the world but mainly from China, and its goal is to enable students to achieve the minimum language requirement to join their undergraduate courses at York University. However, along with measuring outcomes, objectives, and the students’ GPA, instructors and academics are always seeking innovation of the YUB curriculum to adapt to the ever growing challenges of academics in the university context, in order to focus more on subject matter that students will be exposed to in their undergraduate studies. However, with the sudden change that has happened globally with the advance of the COVID-19 pandemic, and other natural disasters like the increase in forest fires and floods, rethinking the philosophy and goal of education was a must. Accordingly, the SDGs became the solid pillars upon which we, academics and administrators of the program, could build a new curriculum and shift our perspective from simply ESL education to education with moral and ethical goals. The preliminary implementation of this initiative was supported by an institutional-wide consultation with EAP instructors who have diverse experiences, disciplines, and interests. Along with brainstorming sessions and mini-pilot projects preceding the integration of the SDGs in the YUB-EAP curriculum, those meetings led to creating a general outline of a curriculum and an assessment framework that has the SDGs at its core with the medium of ESL used for language instruction. Accordingly, a community of knowledge exchange was spontaneously created and facilitated by instructors. This has led to knowledge, resources, and teaching pedagogies being shared and examined further. In addition, experiences and reactions of students are being shared, leading to constructive discussions about opportunities and challenges with the integration of the SDGs. The discussions have branched out to discussions about cultural and political barriers along with a thirst for knowledge and engagement, which has resulted in increased engagement not only on the part of the students but the instructors as well. Later in the program, two surveys will be conducted: one for the students and one for the instructors to measure the level of engagement of each in this initiative as well as to elicit suggestions for further development. This paper will describe this fundamental step into using ESL methodology as a mode of disseminating essential ethical and socially correct knowledge for all learners in the 21st Century, the students’ reactions, and the teachers’ involvement and reflections.

Keywords: EAP, curriculum, education, global citizen

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Authors: Ernest Moles, Patricia Urbán, María Belén Jiménez-Díaz, Sara Viera-Morilla, Iñigo Angulo-Barturen, Maria Antònia Busquets, Xavier Fernàndez-Busquets

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Bearing in mind the absence of an effective vaccine against malaria and its severe clinical manifestations causing nearly half a million deaths every year, this disease represents nowadays a major threat to life. Besides, the basic rationale followed by currently marketed antimalarial approaches is based on the administration of drugs on their own, promoting the emergence of drug-resistant parasites owing to the limitation in delivering drug payloads into the parasitized erythrocyte high enough to kill the intracellular pathogen while minimizing the risk of causing toxic side effects to the patient. Such dichotomy has been successfully addressed through the specific delivery of immunoliposome (iLP)-encapsulated antimalarials to Plasmodium falciparum-infected red blood cells (pRBCs). Unfortunately, this strategy has not progressed towards clinical applications, whereas in vitro assays rarely reach drug efficacy improvements above 10-fold. Here, we show that encapsulation efficiencies reaching >96% can be achieved for the weakly basic drugs chloroquine (CQ) and primaquine using the pH gradient active loading method in liposomes composed of neutrally charged, saturated phospholipids. Targeting antibodies are best conjugated through their primary amino groups, adjusting chemical crosslinker concentration to retain significant antigen recognition. Antigens from non-parasitized RBCs have also been considered as targets for the intracellular delivery of drugs not affecting the erythrocytic metabolism. Using this strategy, we have obtained unprecedented nanocarrier targeting to early intraerythrocytic stages of the malaria parasite for which there is a lack of specific extracellular molecular tags. Polyethylene glycol-coated liposomes conjugated with monoclonal antibodies specific for the erythrocyte surface protein glycophorin A (anti-GPA iLP) were capable of targeting 100% RBCs and pRBCs at the low concentration of 0.5 μM total lipid in the culture, with >95% of added iLPs retained into the cells. When exposed for only 15 min to P. falciparum in vitro cultures synchronized at early stages, free CQ had no significant effect over parasite viability up to 200 nM drug, whereas iLP-encapsulated 50 nM CQ completely arrested its growth. Furthermore, when assayed in vivo in P. falciparum-infected humanized mice, anti-GPA iLPs cleared the pathogen below detectable levels at a CQ dose of 0.5 mg/kg. In comparison, free CQ administered at 1.75 mg/kg was, at most, 40-fold less efficient. Our data suggest that this significant improvement in drug antimalarial efficacy is in part due to a prophylactic effect of CQ found by the pathogen in its host cell right at the very moment of invasion.

Keywords: immunoliposomal nanoparticles, malaria, prophylactic-therapeutic polyvalent activity, targeted drug delivery

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Authors: Esther Gumboh

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The police play a critical role in society and are an integral aspect of the rule of law. Equally, respect for human rights is an integral part of professional policing. In view of the vast powers that the police enjoy and the attendant risk of abuse and resulting human rights violations, the need for police accountability and civilian police oversight is internationally and regionally recognised. Policing oversight springs from the duty to investigate human rights violations. Those implicated in perpetrating or covering up violations must be disciplined or prosecuted to ensure effective accountability. Police accountability is particularly important in Malawi given the dark history of policing in the country during the 30-year dictatorial era under President Kamuzu Banda. Described as one of the most repressive regimes in Africa, the Banda administration was characterised by gross state-sponsored violence, repressive policing and human rights violations. Indeed, the police were involved in various forms of human rights abuse including arbitrary arrests and unlawful detentions, torture, and excessive use of force in conducting arrests and public order policing. This situation flourished within a culture of police impunity bolstered in part by the absence of clear oversight mechanisms for police accountability. In turn, there was immense public mistrust of the police. Unsurprisingly, the criminal justice system was one of the priority areas for reform when Malawi adopted its first democratic Constitution in 1994. Section 153 of the Constitution envisions a police service that is, for all intents and purposes, there to provide for the protection of public safety and the rights of persons in Malawi according to the prescriptions of the Constitution and any other law. This position reflects the view that the duty to protect and promote human rights is not incompatible with effective policing. Despite this, the police continue to engage in questionable behaviour in public order policing, excessive use of force, deaths in police custody, ill-treatment, torture and other forms of abuse including sexual abuse. Perpetrators of abuses are occasionally punished, but investigations are often delayed, abandoned, or remain inconclusive. Police accountability remains largely elusive. Commendably, the law does subject the police to significant oversight both internally and externally. However, until 2010, Malawi lacked a wholly independent civilian oversight mechanism specifically mandated to monitor the activities of the Malawi Police Service and held it accountable. This void has since been filled by the Independent Complaints Commission established under the Police Act. This is a positive development that reiterates Malawi’s commitment to the investigation of human rights violations by the police and to ending police impunity. This contribution examines the legal framework for this Commission to project the effectiveness of the Commission. While the framework looks promising on various fronts, there are potential challenges that lie ahead. Malawi must pre-emptively deal with these challenges carefully if the Commission is to have any practical significance in transforming police accountability in the country. Drawing on lessons from other jurisdictions like South Africa, the paper makes recommendations for legislative reform to strengthen the Commission’s framework.

Keywords: civilian policing oversight, Malawi, police, police accountability, policing, policing oversight

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Authors: Roberta Pecoraro, Elena Maria Scalisi

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Engineered Nanoparticles (ENPs) and Nanomaterials (ENMs) concern an active research area and a sector in full expansion. They have physical-chemical characteristics and small size that improve their performance compared to common materials. Due to the increase in their production and their subsequent release into the environment, new strategies are emerging to assess risk of nanomaterials. NPs can be released into the environment through aquatic systems by human activities and exert toxicity on living organisms. We evaluated the potential toxic effect of cerium oxide (CeO2) nanoparticles because it’s used in different fields due to its peculiar properties. In order to assess nanoparticles toxicity, Fish Embryo Toxicity (FET) test was performed. Powders of CeO2 NPs supplied by the CNR-IMM of Catania are indicated as CeO2 type 1 (as-prepared) and CeO2 type 2 (modified), while CeO2 type 3 (commercial) is supplied by Sigma-Aldrich. Starting from a stock solution (0.001g/10 ml dilution water) of each type of CeO2 NPs, the other concentration solutions were obtained adding 1 ml of the stock solution to 9 ml of dilution water, leading to three different solutions of concentration (10-4, 10-5, 10-6 g/ml). All the solutions have been sonicated to avoid natural tendency of NPs to aggregate and sediment. FET test was performed according to the OECD guidelines for testing chemicals using our internal protocol procedure. A number of eight selected fertilized eggs were placed in each becher filled with 5 ml of each concentration of the three types of CeO2 NPs; control samples were incubated only with dilution water. Replication was performed for each concentration. During the exposure period, we observed four endpoints (embryo coagulation, lack of formation of somites, failure to lift the yolk bag, no heartbeat) by a stereomicroscope every 24 hours. Immunohistochemical analysis on treated larvae was performed to evaluate the expression of metallothioneins (MTs), Heat Shock Proteins 70 (HSP70) and 7-ethoxyresorufin-O-diethylase (EROD). Our results have not shown evident alterations on embryonic development because all embryos completed the development and the hatching of the eggs, started around the 48th hour after exposure, took place within the last observation at 72 hours. A good reactivity, both in the embryos and in the newly hatched larvae, was found. The presence of heartbeat has also been observed in embryos with reduced mobility confirming their viability. A higher expression of EROD biomarker was observed in the larvae exposed to the three types of CeO2, showing a clear difference with the control. A weak positivity was found for MTs biomarker in treated larvae as well as in the control. HSP70 are expressed homogeneously in all the type of nanoparticles tested but not too much greater than control. Our results are in agreement with other studies in the literature, in which the exposure of Danio rerio larvae to other metal oxide nanoparticles does not show adverse effects on survival and hatching time. Further studies are necessary to clarify the role of these NPs and also to solve conflicting opinions.

Keywords: Danio rerio, endpoints, fish embryo toxicity test, metallic nanoparticles

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Authors: Lillian M. Seo, Curtis L. Petersen, Ryan J. Halter, David Kotz, John A. Batsis

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Background: Resistance-based exercises effectively enhance muscle strength, which is especially important in older populations as it reduces the risk of disability. Our group developed a Bluetooth-enabled handle for resistance exercise bands that wirelessly transmits relative force data through low-energy Bluetooth to a local smartphone or similar device. The system has the potential to measure home-based exercise interventions, allowing health professionals to monitor compliance. Its feasibility has already been demonstrated in both clinical and field-based settings, but it remained unclear whether the system’s usability persisted upon repeated use. The current study sought to assess the usability of this system and its users’ satisfaction with repeated use by deploying the device among younger adults to gather formative information that can ultimately improve the device’s design for older adults. Methods: A usability study was conducted in which 32 participants used the above system. Participants executed 10 repetitions of four commonly performed exercises: bicep flexion, shoulder abduction, elbow extension, and triceps extension. Each completed three exercise sessions, separated by at least 24 hours to minimize muscle fatigue. At its conclusion, subjects completed an adapted version of the usefulness, satisfaction, and ease (USE) questionnaire – assessing the system across four domains: usability, satisfaction, ease of use, and ease of learning. The 20-item questionnaire examined how strongly a participant agrees with positive statements about the device on a seven-point Likert scale, with one representing ‘strongly disagree’ and seven representing ‘strongly agree.’ Participants’ data were aggregated to calculate mean response values for each question and domain, effectively assessing the device’s performance across different facets of the user experience. Summary force data were visualized using a custom web application. Finally, an optional prompt at the end of the questionnaire allowed for written comments and feedback from participants to elicit qualitative indicators of usability. Results: Of the n=32 participants, 13 (41%) were female; their mean age was 32.4 ± 11.8 years, and no participants had a physical impairment. No usability questions received a mean score < 5 of seven. The four domains’ mean scores were: usefulness 5.66 ± 0.35; satisfaction 6.23 ± 0.06; ease of use 6.25 ± 0.43; and ease of learning 6.50 ± 0.19. Representative quotes of the open-ended feedback include: ‘A non-rigid strap-style handle might be useful for some exercises,’ and, ‘Would need different bands for each exercise as they use different muscle groups with different strength levels.’ General impressions were favorable, supporting the expectation that the device would be a useful tool in exercise interventions. Conclusions: A simple usability assessment of a Bluetooth-enabled resistance exercise band supports a consistent and positive user experience among young adults. This study provides adequate formative data, assuring the next steps can be taken to continue testing and development for the target population of older adults.

Keywords: Bluetooth, exercise, mobile health, mHealth, usability

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Authors: Lopamudra D. Satpathy, Bani Chatterjee, Jitendra Mahakud

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The rapid economic growth in terms of output and investment necessitates a substantial growth of Total Factor Productivity (TFP) of firms which is an indicator of an economy’s technological change. The strong empirical relationship between financial sector development and economic growth clearly indicates that firms financing decisions do affect their levels of output via their investment decisions. Hence it establishes a linkage between the financial factors and productivity growth of the firms. To achieve the smooth and continuous economic growth over time, it is imperative to understand the financial channel that serves as one of the vital channels. The theoretical or logical argument behind this linkage is that when the internal financial capital is not sufficient enough for the investment, the firms always rely upon the external sources of finance. But due to the frictions and existence of information asymmetric behavior, it is always costlier for the firms to raise the external capital from the market, which in turn affect their investment sentiment and productivity. This kind of financial position of the firms puts heavy pressure on their productive activities. Keeping in view this theoretical background, the present study has tried to analyze the role of both external and internal financial factors (leverage, cash flow and liquidity) on the determination of total factor productivity of the firms of manufacturing industry and its sub-industries, maintaining a set of firm specific variables as control variables (size, age and disembodied technological intensity). An estimate of total factor productivity of the Indian manufacturing industry and sub-industries is computed using a semi-parametric approach, i.e., Levinsohn- Petrin method. It establishes the relationship between financial factors and productivity growth of 652 firms using a dynamic panel GMM method covering the time period between 1997-98 and 2012-13. From the econometric analyses, it has been found that the internal cash flow has a positive and significant impact on the productivity of overall manufacturing sector. The other financial factors like leverage and liquidity also play the significant role in the determination of total factor productivity of the Indian manufacturing sector. The significant role of internal cash flow on determination of firm-level productivity suggests that access to external finance is not available to Indian companies easily. Further, the negative impact of leverage on productivity could be due to the less developed bond market in India. These findings have certain implications for the policy makers to take various policy reforms to develop the external bond market and easily workout through which the financially constrained companies will be able to raise the financial capital in a cost-effective manner and would be able to influence their investments in the highly productive activities, which would help for the acceleration of economic growth.

Keywords: dynamic panel, financial factors, manufacturing sector, total factor productivity

Procedia PDF Downloads 331

Authors: Jeanne Leblond, Warren Viricel, Amira Mbarek

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Although several products have reached the market, gene therapeutics are still in their first stages and require optimization. It is possible to improve their lacking efficiency by the use of carefully engineered vectors, able to carry the genetic material through each of the biological barriers they need to cross. In particular, getting inside the cell is a major challenge, because these hydrophilic nucleic acids have to cross the lipid-rich plasmatic and/or endosomal membrane, before being degraded into lysosomes. It takes less than one hour for newly endocytosed liposomes to reach highly acidic lysosomes, meaning that the degradation of the carried gene occurs rapidly, thus limiting the transfection efficiency. We propose to use a new pH-sensitive lipid able to change its conformation upon protonation at endosomal pH values, leading to the disruption of the lipidic bilayer and thus to the fast release of the nucleic acids into the cytosol. It is expected that this new pH-sensitive mechanism promote endosomal escape of the gene, thereby its transfection efficiency. The main challenge of this work was to design a preparation presenting fast-responding lipidic bilayer destabilization properties at endosomal pH 5 while remaining stable at blood pH value and during storage. A series of pH-sensitive lipids able to perform a conformational switch upon acidification were designed and synthesized. Liposomes containing these switchable lipids, as well as co-lipids were prepared and characterized. The liposomes were stable at 4°C and pH 7.4 for several months. Incubation with siRNA led to the full entrapment of nucleic acids as soon as the positive/negative charge ratio was superior to 2. The best liposomal formulation demonstrated a silencing efficiency up to 10% on HeLa cells, very similar to a commercial agent, with a lowest toxicity than the commercial agent. Using flow cytometry and microscopy assays, we demonstrated that drop of pH was required for the transfection efficiency, since bafilomycin blocked the transfection efficiency. Additional evidence was brought by the synthesis of a negative control lipid, which was unable to switch its conformation, and consequently exhibited no transfection ability. Mechanistic studies revealed that the uptake was mediated through endocytosis, by clathrin and caveolae pathways, as reported for previous lipid nanoparticle systems. This potent system was used for the treatment of hypercholesterolemia. The switchable lipids were able to knockdown PCSK9 expression on human hepatocytes (Huh-7). Its efficiency is currently evaluated on in vivo mice model of PCSK9 KO mice. In summary, we designed and optimized a new cationic pH-sensitive lipid for gene delivery. Its transfection efficiency is similar to the best available commercial agent, without the usually associated toxicity. The promising results lead to its use for the treatment of hypercholesterolemia on a mice model. Anticancer applications and pulmonary chronic disease are also currently investigated.

Keywords: liposomes, siRNA, pH-sensitive, molecular switch

Procedia PDF Downloads 203

Authors: Akiko Ohta, Masahiro Minami, Yusra Qadir, Jennifer York

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The Home Instruction for Parents of Preschool Youngsters (HIPPY) is a home instruction program for mothers of children 3 to 5 years old. Using role-play as a method of teaching, the participating mothers work with their home visitors and learn how to deliver the HIPPY curriculum to their children. Applying HIPPY, Reviving Hope and Home for High-risk Refugee Mothers Program (RHH) was created to provide more personalized peer support and to respond to ongoing settlement challenges for isolated and vulnerable Government Assisted Refugee (GAR) mothers. GARs often have greater needs and vulnerabilities than other refugee groups. While the support is available, they often face various challenges and barriers in starting their new lives in Canada, such as inadequate housing, low first-language literacy levels, low competency in English or French, and social isolation. The pilot project was operated by Mothers Matter Centre (MMC) from January 2019 to March 2021 in partnership with the Immigrant Services Society of BC (ISSofBC). The formative evaluation was conducted by a research team at Simon Fraser University. In order to provide more suitable support for GAR mothers, RHH intended to offer more flexibility in HIPPY delivery, supported by a home visitor, to meet the need of refugee mothers facing various conditions and challenges; to have a pool of financial resources to be used for the RHH families when necessitated during the program period; to have another designated staff member, called a community navigator, assigned to facilitate the support system for the RHH families in their settlement; to have a portable device available for each RHH mother to navigate settlement support resources; and to provide other variations of the HIPPY curriculum as an option for the RHH mothers, including a curriculum targeting pre-HIPPY age children. Reflections on each program component was collected from RHH mothers and staff members of MMC and ISSofBC, including frontline workers and management staff, through individual interviews and focus group discussions. Each of the RHH program components was analyzed and evaluated by applying Moore’s four domains framework to identify key information and generate new knowledge (data). To capture RHH mothers’ program experience more in depth based on their own reflections, the photovoice method was used. Some photos taken by the mothers will be shared to illustrate their RHH experience as part of their life stories. Over the period of the program, this evaluation observed how RHH mothers became more confident in various domains, such as communicating with others, taking public transportations alone, and teaching their own child(ren). One of the major factors behind the success was their home visitors’ flexibility and creativity to create a more meaningful and tailored approach for each mother, depending on her background and personal situation. The role of the community navigator was tested out and improved during the program period. The community navigators took the key role to assess the needs of the RHH families and connect them with community resources. Both the home visitors and community navigators were immigrant mothers themselves and owing to their dedicated care for the RHH mothers; they were able to gain trust and work closely and efficiently with RHH mothers.

Keywords: refugee mothers, settlement support, program evaluation, Canada

Procedia PDF Downloads 171

Authors: Ran Goldblatt, Nicholas Jones, Jennifer Mannix, Brad Bottoms

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Accurate, complete, and up-to-date geospatial information is the foundation of successful disaster management. When the 2010 Haiti Earthquake struck, accurate and timely information on the distribution of critical infrastructure was essential for the disaster response community for effective search and rescue operations. Existing geospatial datasets such as Google Maps did not have comprehensive coverage of these features. In the days following the earthquake, many organizations released high-resolution satellite imagery, catalyzing a worldwide effort to map Haiti and support the recovery operations. Of these organizations, OpenStreetMap (OSM), a collaborative project to create a free editable map of the world, used the imagery to support volunteers to digitize roads, buildings, and other features, creating the most detailed map of Haiti in existence in just a few weeks. However, large portions of the island are still not fully covered by OSM. There is an increasing need for a tool to automatically identify which areas in Haiti, as well as in other countries vulnerable to disasters, that are not fully mapped. The objective of this project is to leverage different types of remote sensing measurements, together with machine learning approaches, in order to identify geographical areas where OSM coverage of building footprints is incomplete. Several remote sensing measures and derived products were assessed as potential predictors of OSM building footprints coverage, including: intensity of light emitted at night (based on VIIRS measurements), spectral indices derived from Sentinel-2 satellite (normalized difference vegetation index (NDVI), normalized difference built-up index (NDBI), soil-adjusted vegetation index (SAVI), urban index (UI)), surface texture (based on Sentinel-1 SAR measurements)), elevation and slope. Additional remote sensing derived products, such as Hansen Global Forest Change, DLR`s Global Urban Footprint (GUF), and World Settlement Footprint (WSF), were also evaluated as predictors, as well as OSM street and road network (including junctions). Using a supervised classification with a random forest classifier resulted in the prediction of 89% of the variation of OSM building footprint area in a given cell. These predictions allowed for the identification of cells that are predicted to be covered but are actually not mapped yet. With these results, this methodology could be adapted to any location to assist with preparing for future disastrous events and assure that essential geospatial information is available to support the response and recovery efforts during and following major disasters.

Keywords: disaster management, Haiti, machine learning, OpenStreetMap, remote sensing

Procedia PDF Downloads 122

Authors: V. Rekha, Rama Pal

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The study examines the degree and magnitude of wealth-based inequalities in child health and its determinants in India. Despite making strides in economic growth, India has failed to secure a better nutritional status for all the children. The country currently faces the double burden of malnutrition as well as the problems of overweight and obesity. Child malnutrition, obesity, unsafe water, sanitation among others are identified as the risk factors for Non-Communicable Diseases (NCDs). Eliminating malnutrition in all its forms will catalyse improved health and economic outcomes. The assessment of the distributive dimension of child health across various segments of the population is essential for effective policy intervention. The study utilises the fourth round of District Level Health Survey for 2012-13 to analyse the inequalities among children in the age group 0-14 years in Maharashtra, a state in the western region of India with a population of 11.24 crores which constitutes 9.3 percent of the total population of India. The study considers the extent of health inequality by state, districts, sector, age-groups, and gender. The z-scores of four child health outcome variables are computed to assess the nutritional status of pre-school and school children using WHO reference. The descriptive statistics, concentration curves, concentration indices, correlation matrix, logistic regression have been used to analyse the data. The results indicate that magnitude of inequality is higher in Maharashtra and child health inequalities manifest primarily among the weaker sections of society. The concentration curves show that there exists a pro-poor inequality in child malnutrition measured by stunting, wasting, underweight, anaemia and a pro-rich overweight inequality. The inequalities in anaemia are observably lower due to the widespread prevalence. Rural areas exhibit a higher incidence of malnutrition, but greater inequality is observed in the urban areas. Overall, the wealth-based inequalities do not vary significantly between age groups. It appears that there is no gender discrimination at the state level. Further, rural-urban differentials in gender show that boys from the rural area and girls living in the urban region experience higher disparities in health. The relative distribution of undernutrition across districts in Maharashtra reveals that malnutrition is rampant and considerable heterogeneity also exists. A negative correlation is established between malnutrition prevalence and human development indicators. The findings of logistic regression analysis reveal that lower economic status of the household is associated with a higher probability of being malnourished. The study recognises household wealth, education of the parent, child gender, and household size as factors significantly related to malnutrition. The results suggest that among the supply-side variables, child-oriented government programmes might be beneficial in tackling nutrition deficit. In order to bridge the health inequality gap, the government needs to target the schemes better and should expand the coverage of services.

Keywords: child health, inequality, malnutrition, obesity

Procedia PDF Downloads 145