Search results for: quality of learning

Authors: Jaroslav Knapek, Kamila Vavrova, Tomas Kralik, Tereza Humesova

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The treatment and disposal of sewage sludge is one of the most important and critical problems of waste water treatment plants. Currently, 180 thousand tonnes of sludge dry matter are produced in the Czech Republic, which corresponds to approximately 17.8 kg of stabilized sludge dry matter / year per inhabitant of the Czech Republic. Due to the fact that sewage sludge contains a large amount of substances that are not beneficial for human health, the conditions for sludge management will be significantly tightened in the Czech Republic since 2023. One of the tested methods of sludge liquidation is the production of alternative fuel from sludge from sewage treatment plants and paper production. The paper presents an analysis of economic efficiency of alternative fuel production from sludge and its use for fluidized bed boiler with nominal consumption of 5 t of fuel per hour. The evaluation methodology includes the entire logistics chain from sludge extraction, through mechanical moisture reduction to about 40%, transport to the pelletizing line, moisture drying for pelleting and pelleting itself. For economic analysis of sludge pellet production, a time horizon of 10 years corresponding to the expected lifetime of the critical components of the pelletizing line is chosen. The economic analysis of pelleting projects is based on a detailed analysis of reference pelleting technologies suitable for sludge pelleting. The analysis of the economic efficiency of pellet is based on the simulation of cash flows associated with the implementation of the project over the life of the project. For the entered value of return on the invested capital, the price of the resulting product (in EUR / GJ or in EUR / t) is searched to ensure that the net present value of the project is zero over the project lifetime. The investor then realizes the return on the investment in the amount of the discount used to calculate the net present value. The calculations take place in a real business environment (taxes, tax depreciation, inflation, etc.) and the inputs work with market prices. At the same time, the opportunity cost principle is respected; waste disposal for alternative fuels includes the saved costs of waste disposal. The methodology also respects the emission allowances saved due to the displacement of coal by alternative (bio) fuel. Preliminary results of testing of pellet production from sludge show that after suitable modifications of the pelletizer it is possible to produce sufficiently high quality pellets from sludge. A mixture of sludge and paper waste has proved to be a more suitable material for pelleting. At the same time, preliminary results of the analysis of the economic efficiency of this sludge disposal method show that, despite the relatively low calorific value of the fuel produced (about 10-11 MJ / kg), this sludge disposal method is economically competitive. This work has been supported by the Czech Technology Agency within the project TN01000048 Biorefining as circulation technology.

Keywords: Alternative fuel, Economic analysis, Pelleting, Sewage sludge

Procedia PDF Downloads 136

Authors: Zuyong Chen, Jianghao Wu, Yanlai Zhang

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Flapping-wing micro aerial vehicle (FMAV) is a new type of aircraft by mimicking the flying behavior to that of small birds or insects. Comparing to the traditional fixed wing or rotor-type aircraft, FMAV only needs to control the motion of flapping wings, by changing the size and direction of lift to control the flight attitude. Therefore, its transmission system should be designed very compact. Lightweight design can effectively extend its endurance time, while engineering experience alone is difficult to simultaneously meet the requirements of FMAV for structural strength and quality. Current researches still lack the guidance of considering nonlinear factors of 3D printing material when carrying out topology optimization, especially for the tiny FMAV transmission system. The coupling of non-linear material properties and non-linear contact behaviors of FMAV transmission system is a great challenge to the reliability of the topology optimization result. In this paper, topology optimization design based on FEA solver package Altair Optistruct for the transmission system of FMAV manufactured by 3D Printing was carried out. Firstly, the isotropic constitutive behavior of the Ultraviolet (UV) Cureable Resin used to fabricate the structure of FMAV was evaluated and confirmed through tensile test. Secondly, a numerical computation model describing the mechanical behavior of FMAV transmission structure was established and verified by experiments. Then topology optimization modeling method considering non-linear factors were presented, and optimization results were verified by dynamic simulation and experiments. Finally, detail discussions of different load status and constraints were carried out to explore the leading factors affecting the optimization results. The contributions drawn from this article helpful for guiding the lightweight design of FMAV are summarizing as follow; first, a dynamic simulation modeling method used to obtain the load status is presented. Second, verification method of optimized results considering non-linear factors is introduced. Third, based on or can achieve a better weight reduction effect and improve the computational efficiency rather than taking multi-states into account. Fourth, basing on makes for improving the ability to resist bending deformation. Fifth, constraint of displacement helps to improve the structural stiffness of optimized result. Results and engineering guidance in this paper may shed lights on the structural optimization and light-weight design for future advanced FMAV.

Keywords: flapping-wing micro aerial vehicle, 3d printing, topology optimization, finite element analysis, experiment

Procedia PDF Downloads 170

Authors: Dila Ram Bhandari

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Throughout the 20th century, new governments were created where identities such as ethnic, religious, linguistic, caste, communal, tribal, and others played a part in the development of constitutions and the legal system of victim and criminal justice. Acute issues with extremism, poverty, environmental degradation, cybercrimes, human rights violations, crime against, and victimization of both individuals and groups have recently plagued South Asian nations. Everyday massive number of crimes are steadfast, these frequent crimes have made the lives of common citizens restless. Crimes are one of the major threats to society and also for civilization. Crime is a bone of contention that can create a societal disturbance. The old-style crime solving practices are unable to live up to the requirement of existing crime situations. Crime analysis is one of the most important activities of the majority of intelligent and law enforcement organizations all over the world. The South Asia region lacks such a regional coordination mechanism, unlike central Asia of Asia Pacific regions, to facilitate criminal intelligence sharing and operational coordination related to organized crime, including illicit drug trafficking and money laundering. There have been numerous conversations in recent years about using data mining technology to combat crime and terrorism. The Data Detective program from Sentient as a software company, uses data mining techniques to support the police (Sentient, 2017). The goals of this internship are to test out several predictive model solutions and choose the most effective and promising one. First, extensive literature reviews on data mining, crime analysis, and crime data mining were conducted. Sentient offered a 7-year archive of crime statistics that were daily aggregated to produce a univariate dataset. Moreover, a daily incidence type aggregation was performed to produce a multivariate dataset. Each solution's forecast period lasted seven days. Statistical models and neural network models were the two main groups into which the experiments were split. For the crime data, neural networks fared better than statistical models. This study gives a general review of the applied statistics and neural network models. A detailed image of each model's performance on the available data and generalizability is provided by a comparative analysis of all the models on a comparable dataset. Obviously, the studies demonstrated that, in comparison to other models, Gated Recurrent Units (GRU) produced greater prediction. The crime records of 2005-2019 which was collected from Nepal Police headquarter and analysed by R programming. In conclusion, gated recurrent unit implementation could give benefit to police in predicting crime. Hence, time series analysis using GRU could be a prospective additional feature in Data Detective.

Keywords: time series analysis, forecasting, ARIMA, machine learning

Procedia PDF Downloads 166

Authors: A. Kourou, A. Ioakeimidou, S. Hadjiefthymiades, V. Abramea

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During the last decades, the task of engaging governments, communities and citizens to reduce risk and vulnerability of the populations has made variable progress. Experience has demonstrated that lack of awareness, education and preparedness may result in significant material and other losses both on the onset of the disaster. Schools play a vital role in the community and are important elements of values and culture of the society. A proper school education not only teaches children, but also is a key factor in the promotion of a safety culture into the wider community. In Greece School Earthquake Safety Initiative has been undertaken by Earthquake Planning and Protection Ogranization with specific actions (seminars, lectures, guidelines, educational material, campaigns, national or EU projects, drills etc.). The objective of this initiative is to develop disaster-resilient school communities through awareness, self-help, cooperation and education. School preparedness requires the participation of Principals, teachers, students, parents, and competent authorities. Preparation and earthquake readiness involves: a) learning what should be done before, during, and after earthquake; b) doing or preparing to do these things now, before the next earthquake; and c) developing teachers’ and students’ skills to cope efficiently in case of an earthquake. In the above given framework this paper presents the results of a survey aimed to identify the level of education and preparedness of school community in Greece. More specifically, the survey questionnaire investigates issues regarding earthquake protection actions, appropriate attitudes and behaviors during an earthquake and existence of contingency plans at elementary and secondary schools. The questionnaires were administered to Principals and teachers from different regions of the country that attend the EPPO national training project 'Earthquake Safety at Schools'. A closed-form questionnaire was developed for the survey, which contained questions regarding the following: a) knowledge of self protective actions b) existence of emergency planning at home and c) existence of emergency planning at school (hazard mitigation actions, evacuation plan, and performance of drills). Survey results revealed that a high percentage of teachers have taken the appropriate preparedness measures concerning non-structural hazards at schools, emergency school plan and simulation drills every year. In order to improve the action-planning for ongoing school disaster risk reduction, the implementation of earthquake drills, the involvement of students with disabilities and the evaluation of school emergency plans, EPPO participates in E-PreS project. The main objective of this project is to create smart tools which define, simulate and evaluate all hazards emergency steps customized to the unique district and school. The project comes up with a holistic methodology using real-time evaluation involving different categories of actors, districts, steps and metrics. The project is supported by EU Civil Protection Financial Instrument with a duration of two years. Coordinator is the Kapodistrian University of Athens and partners are from four countries; Greece, Italy, Romania and Bulgaria.

Keywords: drills, earthquake, emergency plans, E-PreS project

Procedia PDF Downloads 236

Authors: Alan Walsh, Peter Walker

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Differences in commercial, professional and personal cultural traditions between western consultants and project sponsors in the Gulf Cooperation Council (GCC) region are potentially significant in the workplace, and this can impact on project outcomes. These cultural differences can, for example, result in conflict amongst senior managers, which can negatively impact the megaproject. New entrants to the GCC often experience ‘culture shock’ as they attempt to integrate into their unfamiliar environments. Megaprojects are unique ventures with individual project characteristics, which need to be considered when managing their associated risks. Megaproject research to date has mostly ignored the significance of the absence of cultural congruence in the GCC, which is surprising considering that there are large volumes of megaprojects in various stages of construction in the GCC. An initial step to dealing with cultural issues is to acknowledge culture as a significant risk factor (SRF). This paper seeks to understand the criticality for western consultants to address these risks. It considers the cultural barriers that exist between GCC sponsors and western consultants and examines the cultural distance between the key actors. Initial findings suggest the presence to a certain extent of ethnocentricity. Other cultural clashes arise out of a lack of appreciation of the customs, practices and traditions of ‘the Other’, such as the need for avoiding public humiliation and the hierarchal significance rankings. The concept and significance of cultural shock as part of the integration process for new arrivals are considered. Culture shock describes the state of anxiety and frustration resulting from the immersion in a culture distinctly different from one's own. There are potentially substantial project risks associated with underestimating the process of cultural integration. This paper examines two distinct but intertwined issues: the societal and professional culture differences associated with expatriate assignments. A case study examines the cultural congruences between GCC sponsors and American, British and German consultants, over a ten-year cycle. This provides indicators as to which nationalities encountered the most profound cultural issues and the nature of these. GCC megaprojects are typically intensive fast track demanding ventures, where consultant turnover is high. The study finds that building trust-filled relationships is key to successful project team integration and therefore, to successful megaproject execution. Findings indicate that both professional and social inclusion processes have steep learning curves. Traditional risk management practice is to approach any uncertainty in a structured way to mitigate the potential impact on project outcomes. This research highlights cultural risk as a significant factor in the management of GCC megaprojects. These risks arising from high staff turnover typically include loss of project knowledge, delays to the project, cost and disruption in replacing staff. This paper calls for cultural risk to be recognised as an SRF, as the first step to developing risk management strategies, and to reduce staff turnover for western consultants in GCC megaprojects.

Keywords: western consultants in megaprojects, national culture impacts on GCC megaprojects, significant risk factors in megaprojects, professional culture in megaprojects

Procedia PDF Downloads 136

Authors: Ozlem Uguz, Ali Demirci, Hanzade Haykiri-Acma, Serdar Yaman

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Lignitic coal holds its position as Turkey’s most important indigenous energy source to generate energy in thermal power plants. Hence, efficient and environmental-friendly use of lignite in electricity generation is of great importance. Thus, clean coal technologies have been planned to mitigate emissions and provide more efficient burning in power plants. In this context, oxygen enriched combustion (oxy-combustion) is regarded as one of the clean coal technologies, which based on burning with oxygen concentrations higher than that in air. As it is known that the most of the Turkish coals are low rank with high mineral matter content, unburnt carbon trapped in ash is, unfortunately, high, and it leads significant losses in the overall efficiencies of the thermal plants. Besides, the necessity of burning huge amounts of these low calorific value lignites to get the desired amount of energy also results in the formation of large amounts of ash that is rich in unburnt carbon. Oxygen enriched combustion technology enables to increase the burning efficiency through the complete burning of almost all of the carbon content of the fuel. This also contributes to the protection of air quality and emission levels drop reasonably. The aim of this study is to investigate the unburnt carbon content and the burning reactivities of several different lignite samples under oxygen enriched conditions. For this reason, the combined effects of temperature and oxygen/nitrogen ratios in the burning atmosphere were investigated and interpreted. To do this, Turkish lignite samples from Adıyaman-Gölbaşı and Kütahya-Tunçbilek regions were characterized first by proximate and ultimate analyses and the burning profiles were derived using DTA (Differential Thermal Analysis) curves. Then, these lignites were subjected to slow burning process in a horizontal tube furnace at different temperatures (200ºC, 400ºC, 600ºC for Adıyaman-Gölbaşı lignite and 200ºC, 450ºC, 800ºC for Kütahya-Tunçbilek lignite) under atmospheres having O₂+N₂ proportions of 21%O₂+79%N₂, 30%O₂+70%N₂, 40%O₂+60%N₂, and 50%O₂+50%N₂. These burning temperatures were specified based on the burning profiles derived from the DTA curves. The residues obtained from these burning tests were also analyzed by proximate and ultimate analyses to detect the unburnt carbon content along with the unused energy potential. Reactivity of these lignites was calculated using several methodologies. Burning yield under air condition (21%O₂+79%N₂) was used a benchmark value to compare the effectiveness of oxygen enriched conditions. It was concluded that oxygen enriched combustion method enhanced the combustion efficiency and lowered the unburnt carbon content of ash. Combustion of low-rank coals under oxygen enriched conditions was found to be a promising way to improve the efficiency of the lignite-firing energy systems. However, cost-benefit analysis should be considered for a better justification of this method since the use of more oxygen brings an unignorable additional cost.

Keywords: coal, energy, oxygen enriched combustion, reactivity

Procedia PDF Downloads 275

Authors: Yulia V. Krasavtseva, Tatiana V. Kornilova

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Risk-taking behaviors are not only dictated by cognitive components but also involve emotional aspects. Anticipatory emotions, involving both cognitive and affective mechanisms, are involved in decision-making in general, and risk-taking in particular. Affective reactions are prompted when an expectation or prediction is either validated or invalidated in the achieved result. This study aimed to combine predictions, anticipatory emotions, affective reactions, and personality traits in the context of risk-taking behaviors. An experimental online method Emotion and Prediction In a Casino (EPIC) was used, based on a casino-like roulette game. In a series of choices, the participant is presented with progressively riskier roulette combinations, where the potential sums of wins and losses increase with each choice and the participant is given a choice: to 'walk away' with the current sum of money or to 'play' the displayed roulette, thus accepting the implicit risk. Before and after the result is displayed, participants also rate their emotions, using the Self-Assessment Mannequin [Bradley, Lang, 1994], picking a picture, representing the intensity of pleasure, arousal, and dominance. The following personality measures were used: 1) Personal Decision-Making Factors [Kornilova, 2003] assessing risk and rationality; 2) I7 – Impulsivity Questionnaire [Kornilova, 1995] assessing impulsiveness, risk readiness, and empathy and 3) Subjective Risk Intelligence Scale [Craparo et al., 2018] assessing negative attitude toward uncertainty, emotional stress vulnerability, imaginative capability, and problem-solving self-efficacy. Two groups of participants took part in the study: 1) 98 university students (Mage=19.71, SD=3.25; 72% female) and 2) 94 online participants (Mage=28.25, SD=8.25; 89% female). Online participants were recruited via social media. Students with high rationality rated their pleasure and dominance before and after choices as lower (ρ from -2.6 to -2.7, p < 0.05). Those with high levels of impulsivity rated their arousal lower before finding out their result (ρ from 2.5 - 3.7, p < 0.05), while also rating their dominance as low (ρ from -3 to -3.7, p < 0.05). Students prone to risk-rated their pleasure and arousal before and after higher (ρ from 2.5 - 3.6, p < 0.05). High empathy was positively correlated with arousal after learning the result. High emotional stress vulnerability positively correlates with arousal and pleasure after the choice (ρ from 3.9 - 5.7, p < 0.05). Negative attitude to uncertainty is correlated with high anticipatory and reactive arousal (ρ from 2.7 - 5.7, p < 0.05). High imaginative capability correlates negatively with anticipatory and reactive dominance (ρ from - 3.4 to - 4.3, p < 0.05). Pleasure (.492), arousal (.590), and dominance (.551) before and after the result were positively correlated. Higher predictions positively correlated with reactive pleasure and arousal. In a riskier scenario (6/8 chances to win), anticipatory arousal was negatively correlated with the pleasure emotion (-.326) and vice versa (-.265). Correlations occur regardless of the roulette outcome. In conclusion, risk-taking behaviors are linked not only to personality traits but also to anticipatory emotions and affect in a modeled casino setting. Acknowledgment: The study was supported by the Russian Foundation for Basic Research, project 19-29-07069.

Keywords: anticipatory emotions, casino game, risk taking, impulsiveness

Procedia PDF Downloads 133

Authors: Constantinos S. Mammas, Andreas Lazaris, Adamantia S. Mamma-Graham, Georgia Kostopanagiotou, Chryssa Lemonidou, John Mantas, Eustratios Patsouris

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The process to build a better safety culture, methods of error analysis, and preventive measures, starts with an understanding of the effects when human factors engineering refer to remote microscopic diagnosis in surgery and specially in organ transplantation for the evaluation of the grafts. Α high percentage of solid organs arrive at the recipient hospitals and are considered as injured or improper for transplantation in the UK. Digital microscopy adds information on a microscopic level about the grafts (G) in Organ Transplant (OT), and may lead to a change in their management. Such a method will reduce the possibility that a diseased G will arrive at the recipient hospital for implantation. Aim: The aim of this study is to analyze the ergonomics of digital microscopy (DM) based on virtual slides, on telemedicine systems (TS) for tele-pathological evaluation (TPE) of the grafts (G) in organ transplantation (OT). Material and Methods: By experimental simulation, the ergonomics of DM for microscopic TPE of renal graft (RG), liver graft (LG) and pancreatic graft (PG) tissues is analyzed. In fact, this corresponded to the ergonomics of digital microscopy for TPE in OT by applying virtual slide (VS) system for graft tissue image capture, for remote diagnoses of possible microscopic inflammatory and/or neoplastic lesions. Experimentation included the development of an OTE-TS similar experimental telemedicine system (Exp.-TS) for simulating the integrated VS based microscopic TPE of RG, LG and PG Simulation of DM on TS based TPE performed by 2 specialists on a total of 238 human renal graft (RG), 172 liver graft (LG) and 108 pancreatic graft (PG) tissues digital microscopic images for inflammatory and neoplastic lesions on four electronic spaces of the four used TS. Results: Statistical analysis of specialist‘s answers about the ability to accurately diagnose the diseased RG, LG and PG tissues on the electronic space among four TS (A,B,C,D) showed that DM on TS for TPE in OT is elaborated perfectly on the ES of a desktop, followed by the ES of the applied Exp.-TS. Tablet and mobile-phone ES seem significantly risky for the application of DM in OT (p<.001). Conclusion: To make the largest reduction in errors and adverse events referring to the quality of the grafts, it will take application of human factors engineering to procurement, design, audit, and awareness-raising activities. Consequently, it will take an investment in new training, people, and other changes to management activities for DM in OT. The simulating VS based TPE with DM of RG, LG and PG tissues after retrieval, seem feasible and reliable and dependable on the size of the electronic space of the applied TS, for remote prevention of diseased grafts from being retrieved and/or sent to the recipient hospital and for post-grafting and pre-transplant planning.

Keywords: digital microscopy, organ transplantation, tele-pathology, virtual slides

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Authors: Paritosh Goel

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The conservation of historic buildings and historic Centre’s over recent years has become fully encompassed in the planning of built-up areas and their management following climate changes. The approach of the world of restoration, in the Indian context on integrated urban regeneration and its strategic potential for a smarter, more sustainable and socially inclusive urban development introduces, for urban transformations in general (historical centers and otherwise), the theme of sustainability. From this viewpoint, it envisages, as a primary objective, a real “green, ecological or environmental” requalification of the city through interventions within the main categories of sustainability: mobility, energy efficiency, use of sources of renewable energy, urban metabolism (waste, water, territory, etc.) and natural environment. With this the concept of a “resilient city” is also introduced, which can adapt through progressive transformations to situations of change which may not be predictable, behavior that the historical city has always been able to express. Urban planning on the other hand, has increasingly focused on analyses oriented towards the taxonomic description of social/economic and perceptive parameters. It is connected with human behavior, mobility and the characterization of the consumption of resources, in terms of quantity even before quality to inform the city design process, which for ancient fabrics, and mainly affects the public space also in its social dimension. An exact definition of the term “smart city” is still essentially elusive, since we can attribute three dimensions to the term: a) That of a virtual city, evolved based on digital networks and web networks b) That of a physical construction determined by urban planning based on infrastructural innovation, which in the case of historic Centre’s implies regeneration that stimulates and sometimes changes the existing fabric; c) That of a political and social/economic project guided by a dynamic process that provides new behavior and requirements of the city communities that orients the future planning of cities also through participation in their management. This paper is a preliminary research into the connections between these three dimensions applied to the specific case of the fabric of ancient cities with the aim of obtaining a scientific theory and methodology to apply to the regeneration of Indian historical Centre’s. The Smart city scheme if contextualize with heritage of the city it can be an initiative which intends to provide a transdisciplinary approach between various research networks (natural sciences, socio-economics sciences and humanities, technological disciplines, digital infrastructures) which are united in order to improve the design, livability and understanding of urban environment and high historical/cultural performance levels.

Keywords: historical cities regeneration, sustainable restoration, urban planning, smart cities, cultural heritage development strategies

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Authors: Neha Gupta, Sonika Verma, Seema Puri, Nikhil Tandon, Narendra K. Arora

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The concurrent increasing prevalence of underweight and overweight/obesity among children with changing lifestyle and the rapid transitioning society has necessitated the need for a unifying/multi-level approach to understand the determinants of the problem. The present community-based cross-sectional research study was conducted to assess the associations between lifestyle behavior and food environment of the child at household, neighborhood, and school with the BMI of children (6-12 year old) (n=612) residing in three rural clusters of Palwal district, Haryana. The study used innovative and robust methods for assessing the lifestyle and various components of food environment in the study. The three rural clusters selected for the study were located at three different locations according to their access to highways in the SOMAARTH surveillance site. These clusters were significantly different from each other in terms of their socio-demographic and socio-economic profile, living conditions, environmental hygiene, health seeking behavior and retail density. Despite of being different, the quality of living conditions and environmental hygiene was poor across three clusters. The children had higher intakes of dietary energy and sugars; one-fifth share of the energy being derived from unhealthy foods, engagement in high levels of physical activity and significantly different food environment at home, neighborhood and school level. However, despite having a high energy intake, 22.5% of the recruited children were thin/severe thin, and 3% were overweight/obese as per their BMI-for-age categories. The analysis was done using multi-variate logistic regression at three-tier hierarchy including individual, household and community level. The factors significantly explained the variability in governing the risk of getting thin/severe thin among children in rural area (p-value: 0.0001; Adjusted R2: 0.156) included age (>10years) (OR: 2.1; 95% CI: 1.0-4.4), the interaction between minority category and poor SES of the household (OR: 4.4; 95% CI: 1.6-12.1), availability of sweets (OR: 0.9; 95% CI: 0.8-0.99) and cereals (OR: 0.9; 95% CI: 0.8-1.0) in the household and poor street condition (proxy indicator of the hygiene and cleanliness in the neighborhood) (OR: 0.3; 95% CI: 0.1-1.1). The homogeneity of other factors at neighborhood and school level food environment diluted the heterogeneity in the lifestyles and home environment of the recruited children and their households. However, it is evident that when various individual factors interplay at multiple levels amplifies the risk of undernutrition in a rural community. Conclusion: These rural areas in Haryana are undergoing developmental, economic and societal transition. In correspondence, no improvements in the nutritional status of children have happened. Easy access to the unhealthy foods has become a paradox.

Keywords: transition, food environment, lifestyle, undernutrition, overnutrition

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Authors: Urvi Panwar, Kanchan Mishra, Kanjaksha Ghosh, ShankerLal Kothari

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Background: Day-by-day the increasing prevalence of neurodegenerative diseases have become a global issue to manage them by medical sciences. The adult neural stem cells are rare and require an invasive and painful procedure to obtain it from central nervous system. Mesenchymal stem cell (MSCs) therapies have shown remarkable application in treatment of various cell injuries and cell loss. MSCs can be derived from various sources like adult tissues, human bone marrow, umbilical cord blood and cord tissue. MSCs have similar proliferation and differentiation capability, but the human umbilical cord-derived mesenchymal stem cells (hUCMSCs) are proved to be more beneficial with respect to cell procurement, differentiation to other cells, preservation, and transplantation. Material and method: Human umbilical cord is easily obtainable and non-controversial comparative to bone marrow and other adult tissues. The umbilical cord can be collected after delivery of baby, and its tissue can be cultured using explant culture method. Cell culture medium such as DMEMF12+10% FBS and DMEMF12+Neural growth factors (bFGF, human noggin, B27) with antibiotics (Streptomycin/Gentamycin) were used to culture and differentiate mesenchymal stem cells into neural cells, respectively. The characterisations of MSCs were done with Flow Cytometer for surface markers CD90, CD73 and CD105 and colony forming unit assay. The differentiated various neural cells will be characterised by fluorescence markers for neurons, astrocytes, and oligodendrocytes; quantitative PCR for genes Nestin and NeuroD1 and Western blotting technique for gap43 protein. Result and discussion: The high quality and number of MSCs were isolated from human umbilical cord via explant culture method. The obtained MSCs were differentiated into neural cells like neurons, astrocytes and oligodendrocytes. The differentiated neural cells can be used to treat neural injuries and neural cell loss by delivering cells by non-invasive administration via cerebrospinal fluid (CSF) or blood. Moreover, the MSCs can also be directly delivered to different injured sites where they differentiate into neural cells. Therefore, human umbilical cord is demonstrated to be an inexpensive and easily available source for MSCs. Moreover, the hUCMSCs can be a potential source for neural cell therapies and neural cell regeneration for neural cell injuries and neural cell loss. This new way of research will be helpful to treat and manage neural cell damages and neurodegenerative diseases like Alzheimer and Parkinson. Still the study has a long way to go but it is a promising approach for many neural disorders for which at present no satisfactory management is available.

Keywords: bone marrow, cell therapy, explant culture method, flow cytometer, human umbilical cord, mesenchymal stem cells, neurodegenerative diseases, neuroprotective, regeneration

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Authors: Shelley Y. Hawkins

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Introduction/Background: As technology has grown exponentially in healthcare, nurse educators must prepare Advanced Practice Registered Nurse (APRN) graduates with the knowledge and skills in information systems/technology to support and improve patient care and health care systems. APRN’s are expected to lead in caring for populations who lack accessibility and availability through the use of technology, specifically telehealth. The capacity to effectively and efficiently use technology in patient care delivery is clearly delineated in the American Association of Colleges of Nursing (AACN) Doctor of Nursing Practice (DNP) and Master of Science in Nursing (MSN) Essentials. However, APRN’s have minimal, or no, exposure to formalized telehealth education and lack necessary technical skills needed to incorporate telehealth into their patient care. APRN’s must successfully master the technology using telehealth/telemedicine, electronic health records, health information technology, and clinical decision support systems to advance health. Furthermore, APRN’s must be prepared to lead the coordination and collaboration with other healthcare providers in their use and application. Aim/Goal/Purpose: The purpose of this presentation is to establish and operationalize telehealth-focused educational partnerships between one University School of Nursing and two health care systems in order to enhance the preparation of APRN NP students for practice, teaching, and/or scholarly endeavors. Methods: The proposed project was initially presented by the project director to selected multidisciplinary stakeholders including leadership, home telehealth personnel, primary care providers, and decision support systems within two major health care systems to garner their support for acceptance and implementation. Concurrently, backing was obtained from key university-affiliated colleagues including the Director of Simulation and Innovative Learning Lab and Coordinator of the Health Care Informatics Program. Technology experts skilled in design and production in web applications and electronic modules were secured from two local based technology companies. Results: Two telehealth-focused APRN Program academic/practice partnerships have been established. Students have opportunities to engage in clinically based telehealth experiences focused on: (1) providing patient care while incorporating various technology with a specific emphasis on telehealth; (2) conducting research and/or evidence-based practice projects in order to further develop the scientific foundation regarding incorporation of telehealth with patient care; and (3) participating in the production of patient-level educational materials related to specific topical areas. Conclusions: Evidence-based APRN student telehealth clinical experiences will assist in preparing graduates who can effectively incorporate telehealth into their clinical practice. Greater access for diverse populations will be available as a result of the telehealth service model as well as better care and better outcomes at lower costs. Furthermore, APRN’s will provide the necessary leadership and coordination through interprofessional practice by transforming health care through new innovative care models using information systems and technology.

Keywords: academic/practice partnerships, advanced practice nursing, nursing education, telehealth

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Authors: Kathrin F. Schneider, Luis Xavier Unda Galarza

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In our modern world, few are the areas that are not permeated by digitalization: we use digital tools for work, study, entertainment, and daily life. Since technology changes rapidly, skills must adapt to the new reality, which gives a dynamic dimension to the set of skills necessary for people's academic, professional, and personal success. The concept of 21st-century digital skills, which includes skills such as collaboration, communication, digital literacy, citizenship, problem-solving, critical thinking, interpersonal skills, creativity, and productivity, have been widely discussed in the literature. Digital transformation has opened many economic opportunities for entrepreneurs for the development of their products, financing possibilities, and product distribution. One of the biggest advantages is the reduction in cost for the entrepreneur, which has opened doors not only for the entrepreneur or the entrepreneurial team but also for corporations through intrapreneurship. The development of students' general literacy level and their digital competencies is crucial for improving the effectiveness and efficiency of the learning process, as well as for students' adaptation to the constantly changing labor market. The digital economy allows a free substantial increase in the supply share of conditional and also innovative products; this is mainly achieved through 5 ways to reduce costs according to the conventional digital economy: search costs, replication, transport, tracking, and verification. Digital entrepreneurship worldwide benefits from such achievements. There is an expansion and democratization of entrepreneurship thanks to the use of digital technologies. The digital transformation that has been taking place in recent years is more challenging for developing countries, as they have fewer resources available to carry out this transformation while offering all the necessary support in terms of cybersecurity and educating their people. The degree of digitization (use of digital technology) in a country and the levels of digital literacy of its people often depend on the economic level and situation of the country. Telefónica's Digital Life Index (TIDL) scores are strongly correlated with country wealth, reflecting the greater resources that richer countries can contribute to promoting "Digital Life". According to the Digitization Index, Ecuador is in the group of "emerging countries", while Chile, Colombia, Brazil, Argentina, and Uruguay are in the group of "countries in transition". According to Herrera Espinoza et al. (2022), there are startups or digital ventures in Ecuador, especially in certain niches, but many of the ventures do not exceed six months of creation because they arise out of necessity and not out of the opportunity. However, there is a lack of relevant research, especially empirical research, to have a clearer vision. Through a self-report questionnaire, the digital skills of students will be measured in an Ecuadorian private university, according to the skills identified as the six 21st-century skills. The results will be put to the test against the variable of the intention to start a digital venture measured using the theory of planned behavior (TPB). The main hypothesis is that high digital competence is positively correlated with the intention to start digital entrepreneurship.

Keywords: new literacies, digital transformation, 21st century skills, theory of planned behavior, digital entrepreneurship

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Authors: Muhammad Fayyaz Nazir, Ellen Wayenberg, Shahzadaah Faahed Qureshi

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Introduction: The study is based on the Contextual Interaction Theory (CIT) constructs to explore the role of policy actors in implementing the COVID-19 Disease Prevention and Control (DP&C) Policy. The study analyzes the role of healthcare workers' contextual factors, such as cognition, motives, and resources, and their interactions in implementing Social Distancing (SD). In this way, we test a two actors policy implementation theory, i.e., the CIT in a three-actor context. Methods: Data was collected through document analysis and semi-structured interviews. For a qualitative study design, interviews were conducted with questions on cognition, motives, and resources from the healthcare workers involved in implementing SD in the local context in Multan – Pakistan. The possible interactions resulting from contextual factors of the policy actors – healthcare workers were identified through framework analysis protocol guided by CIT and supported by trustworthiness criterion and data saturation. Results: This inquiry resulted in theory application, addition, and enrichment. The theoretical application in the three actor's contexts illustrates the different levels of motives, cognition, and resources of healthcare workers – senior administrators, managers, and healthcare professionals. The senior administrators working in National Command and Operations Center (NCOC), Provincial Technical Committees (PTCs), and Districts Covid Teams (DCTs) were playing their role with high motivation. They were fully informed about the policy and moderately resourceful. The policy implementors: healthcare managers working on implementing the SD within their respective hospitals were playing their role with high motivation and were fully informed about the policy. However, they lacked the required resources to implement SD. The target medical and allied healthcare professionals were moderately motivated but lack of resources and information. The interaction resulted in cooperation and the need for learning to manage the future healthcare crisis. However, the lack of resources created opposition to the implementation of SD. Objectives of the Study: The study aimed to apply a two actors theory in a multi actors context. We take this as an opportunity to qualitatively test the theory in a novel situation of the Covid-19 pandemic and make way for its quantitative application by designing a survey instrument so that implementation researchers can apply CIT through multivariate analyses or higher-order statistical modeling. Conclusion: Applying two actors' implementation theory in exploring a complex case of healthcare intervention in three actors context is a unique work that has never been done before, up to the best of our knowledge. So, the work will contribute to the policy implementation studies by applying, extending, and enriching an implementation theory in a novel case of the Covi-19 pandemic, ultimately fulfilling the gap in implementation literature. Policy institutions and other low or middle-income countries can learn from this research and improve SD implementation by working on the variables with weak significance levels.

Keywords: COVID-19, disease prevention and control policy, implementation, policy actors, social distancing

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Authors: Madhura Bapat, Uma Krishnan

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Exploring the redefinition of masculinity through the experiences of male Indian classical dancers, this qualitative research focuses on their perceived quality of life, psychosocial challenges, and coping strategies. This study aims to explore the mental health nuances of male Indian classical dancers through an in-depth understanding of their lived experiences with dance. The benefits and personal journeys of dancers, particularly in Indian classical forms, reveal insights into culture, gender, and societal expectations. Men in Indian classical dance frequently encounter stigma due to prevailing gender norms in the arts and society. Acknowledgment of these experiences is key to understanding issues of identity, mental wellness, and communal acceptance of male Indian classical dancers in the Indian dance scenario. This study follows an interpretive phenomenological approach to follow the lived experiences of male Indian classical dancers. Male Indian classical dancers were selected using criterion-based sampling. The participants are male, fluent in English and pursue Indian classical dance styles professionally, like Kathak, Bharatanatyam, Chhau, etc. Six participants were recruited for personal, semi-structured, in-depth interviews. A focus group discussion with four participants was conducted to explore the stigma surrounding their roles. The data were analyzed using interpretive phenomenological analysis (IPA), revealing superordinate themes of (1) identity fragmentation and negotiation in gendered social contexts; (2) gendered constraints and artistic expression; (3) psychosocial distress and mental health challenges; (4) coping mechanisms and resilience; and (5) stigmatization and social integration dynamics. Male Indian classical dancers grapple with identity formation, navigating a paradox of self-perception, artistic identity, and societal expectation. They reported experiencing emasculation, compromising artistic expression, and struggling with gender norms and gendered training constraints. They have faced name-calling, bullying, taunting, slandering, and discrimination. These experiences have led to psychological challenges and distress. However, the paradox continues as male dancers use adaptive coping strategies despite the adversities that intertwine self-perception, societal pressures, and their passion for dance. This research sheds light on the intersection of gender, mental health, and art. These findings provide a strong foundation for making changes in the dance community for acceptance of male dancers, policy making for better job opportunities for male dancers and mental health services to be provided to help them deal with distress. The study offers valuable insights into how male classical dancers navigate stigma and mental health challenges in gendered social contexts, contributing to a deeper understanding of identity formation in the arts.

Keywords: gendered experiences, Indian classical dance, male dancers, mental health, stigma

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Authors: Julio Jesus Salazar, Manuel Andres Jesus De Lama

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There are very few models that serve to analyze the use of water in the socio-economic process. On the supply side, the joint use of groundwater has been considered in addition to the simple limits on the availability of surface water. In addition, we have worked on waterlogging and the effects on water quality (mainly salinity). In this paper, a 'complex' water economy is examined; one in which demands grow differentially not only within but also between sectors, and one in which there are limited opportunities to increase consumptive use. In particular, high-value growth, the growth of the production of irrigated crops of high value within the basins of the case study, together with the rapidly growing urban areas, provides a rich context to examine the general problem of water management at the basin level. At the same time, the long-term aridity of nature has made the eco-environment in the basins located on the coast of Peru very vulnerable, and the exploitation and immediate use of water resources have further deteriorated the situation. The presented methodology is the optimization with embedded simulation. The wide basin simulation of flow and water balances and crop growth are embedded with the optimization of water allocation, reservoir operation, and irrigation scheduling. The modeling framework is developed from a network of river basins that includes multiple nodes of origin (reservoirs, aquifers, water courses, etc.) and multiple demand sites along the river, including places of consumptive use for agricultural, municipal and industrial, and uses of running water on the coast of Peru. The economic benefits associated with water use are evaluated for different demand management instruments, including water rights, based on the production and benefit functions of water use in the urban agricultural and industrial sectors. This work represents a new effort to analyze the use of water at the regional level and to evaluate the modernization of the integrated management of water resources and socio-economic territorial development in Peru. It will also allow the establishment of policies to improve the process of implementation of the integrated management and development of water resources. The input-output analysis is essential to present a theory about the production process, which is based on a particular type of production function. Also, this work presents the Computable General Equilibrium (CGE) version of the economic model for water resource policy analysis, which was specifically designed for analyzing large-scale water management. As to the platform for CGE simulation, GEMPACK, a flexible system for solving CGE models, is used for formulating and solving CGE model through the percentage-change approach. GEMPACK automates the process of translating the model specification into a model solution program.

Keywords: water economy, simulation, modeling, integration

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Authors: Sophie-Bo Heinkel, Andrea Rechenburg, Thomas Kistemann

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The current status of wellbeing and life satisfaction of subsistence farmers in a wetland in Uganda and the contributing role of place attachment has been assessed. The aim of this study is to shed light on environmental factors supporting wellbeing in a wetland setting. Furthermore, it has been assessed, how the emotional bonding to the wetland as ‘place’ influences the peoples’ wellbeing and life satisfaction. The results shed light on the human-environment-relationship. A survey was carried out in three communities in urban and rural areas in a wetland basin in Uganda. A sample (n=235) provided information about the attachment to the wetland, the participants’ relation to the place of their residence and their emotional wellbeing. The Wellbeing Index (WHO-5) was assessed as well as the Perceived Stress Scale (PSS-10) and Rosenberg’s Self-Esteem scale (RSE). Furthermore, the Satisfaction With Life Scale (SWLS) was applied as well as the Place Attachment Inventory (PAI), which consists of the two intertwined dimensions of place identity and place dependence. Beside this, binary indicators as ‘feeling save’ and ‘feeling comfortable’ and ‘enjoying to live at the place of residence’ have been assessed. A bivariate correlation analysis revealed a high interconnectivity between all metric scales. Especially, the subscale ‘place identity’ showed significances with all other scales. A cluster analysis revealed three groups, which differed in the perception of place-related indicators and their attachment to the wetland as well as the status of wellbeing. First, a cluster whose majority is dissatisfied with their lives, but mainly had a good status of emotional well-being. This group does not feel attached to the wetland and lives in a town. Comparably less persons of this group feel safe and comfortable at their place of residence. In the second cluster, persons feel highly attached to the wetland and identify with it. This group was characterized by the high number of persons preferring their current place of residence and do not consider moving. All persons feel well and satisfied with their lives. The third group of persons is mainly living in rural areas and feels highly attached to the wetland. They are satisfied with their lives, but only a small minority is in a good emotional state of wellbeing. The emotional attachment to a place influences life satisfaction and, indirectly, the emotional wellbeing. In the present study it could be shown that subsistence farmers are attached to the wetland, as it is the source of their livelihood. While those living in areas with a good infrastructure are less dependent on the wetland and, therefore, less attached to. This feeling also was mirrored in the perception of a place as being safe and comfortable. The identification with a place is crucial for the feeling of being at “home”. Subsistence farmers feel attached to the ecosystem, but they also might be exposed to environmental and social stressors influencing their short-term emotional wellbeing. The provision of place identity is an ecosystem service provided by wetlands, which supports the status of wellbeing in human beings.

Keywords: mental health, positive environments, quality of life, wellbeing

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Authors: Thao Nguyen, Maximiliano Hyon, Sany Rajagukguk, Anna Melkonyan

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Introduction: Type 2 Diabetes is a well-established risk factor for severe SARS-CoV-2 infection. Uncontrolled hyperglycemia in patients with established or newly diagnosed diabetes is associated with poor outcomes, including increased mortality and hospital length of stay. Objectives: Our study aims to compare three different glycemic management strategies and their association with clinical outcomes in patients hospitalized for moderate to severe SARS-CoV-2 infection. Identifying optimal glycemic management strategies will improve the quality of patient care and improve their outcomes. Method: This is a retrospective observational study on patients hospitalized at Adventist Health White Memorial with severe SARS-CoV-2 infection from 11/1/2020 to 02/28/2021. The following inclusion criteria were used: positive SARS-CoV-2 PCR test, age >18 yrs old, diabetes or random glucose >200 mg/dL on admission, oxygen requirement >4L/min, and treatment with glucocorticoids. Our exclusion criteria included: ICU admission within 24 hours, discharge within five days, death within five days, and pregnancy. The patients were divided into three glycemic management groups: Group 1, managed solely by the Primary Team, Group 2, by Pharmacy; and Group 3, by Endocrinologist. Primary outcomes were average glucose on Day 5, change in glucose between Days 3 and 5, and average insulin dose on Day 5 among groups. Secondary outcomes would be upgraded to ICU, inpatient mortality, and hospital length of stay. For statistics, we used IBM® SPSS, version 28, 2022. Results: Most studied patients were Hispanic, older than 60, and obese (BMI >30). It was the first CV-19 surge with the Delta variant in an unvaccinated population. Mortality was markedly high (> 40%) with longer LOS (> 13 days) and a high ICU transfer rate (18%). Most patients had markedly elevated inflammatory markers (CRP, Ferritin, and D-Dimer). These, in combination with glucocorticoids, resulted in severe hyperglycemia that was difficult to control. Average glucose on Day 5 was not significantly different between groups primary vs. pharmacy vs. endocrine (220.5 ± 63.4 vs. 240.9 ± 71.1 vs. 208.6 ± 61.7 ; P = 0.105). Change in glucose from days 3 to 5 was not significantly different between groups but trended towards favoring the endocrinologist group (-26.6±73.6 vs. 3.8±69.5 vs. -32.2±84.1; P= 0.052). TDD insulin was not significantly different between groups but trended towards higher TDD for the endocrinologist group (34.6 ± 26.1 vs. 35.2 ± 26.4 vs. 50.5 ± 50.9; P=0.054). The endocrinologist group used significantly more preprandial insulin compared to other groups (91.7% vs. 39.1% vs. 65.9% ; P < 0.001). The pharmacy used more basal insulin than other groups (95.1% vs. 79.5% vs. 79.2; P = 0.047). There were no differences among groups in the clinical outcomes: LOS, ICU upgrade, or mortality. Multivariate regression analysis controlled for age, sex, BMI, HbA1c level, renal function, liver function, CRP, d-dimer, and ferritin showed no difference in outcomes among groups. Conclusion: Given high-risk factors in our population, despite efforts from the glycemic management teams, it’s unsurprising no differences in clinical outcomes in mortality and length of stay.

Keywords: glycemic management, strategies, hospitalized, SARS-CoV-2, outcomes

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Authors: Eman Hegazy, Stefan Anderberg, Joakim Krook

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Urban water infrastructure is crucial for efficient and reliable water supply in growing cities. With the growth of cities, the need for maintenance and renewal of these systems increases but often goes unfulfilled due to a variety of reasons, such as limited funding, political priorities, or lack of public awareness. Neglecting the renewal needs of these systems can lead to frequent malfunctions and reduced quality and reliability of water supply, as well as increased costs and health and environmental hazards. It is important for cities to prioritize investment in water infrastructure and develop long-term plans to address renewal needs. Drawing general conclusions about the rate of renewal of urban water infrastructure systems at an international or national level can be challenging due to the influence of local management decisions. In many countries, the responsibility for water infrastructure management lies with the municipal authorities, who are responsible for making decisions about the allocation of resources for repair, maintenance, and renewal. These decisions can vary widely based on factors such as local finances, political priorities, and public perception of the importance of water infrastructure. As a result, it is difficult to make generalizations about the rate of renewal across different countries or regions. In Sweden, the situation is not different, and the information from Svenskt Vatten indicates that the rate of renewal varies across municipalities and can be insufficient, leading to a buildup of maintenance and renewal needs. This study aims to examine the adequacy of the rate of renewal of urban water infrastructure in Linköping case city in Sweden. Using a case study framework, the study will assess the current status of the urban water system and the need for renewal. The study will also consider the role of factors such as proper identification processes, limited funding, competing for political priorities, and local management decisions in contributing to insufficient renewal. The study investigates the following questions: (1) What is the current status of water and sewerage networks in terms of length, age distribution, and material composition, estimated total water leakage in the network per year, damages, leaks, and outages occur per year, both overall and by district? (2) What are the main causes of these damages, leaks, and interruptions, and how are they related to lack of maintenance and renewal? (3) What is the current status of renewal work for the water and sewerage networks, including the renewal rate and changes over time, recent renewal material composition, and the budget allocation for renewal and emergency repairs? (4) What factors influence the need for renewal and what conditions should be considered in the assessment? The findings of the study provide insights into the challenges facing urban water infrastructure and identify strategies for improving the rate of renewal to ensure a reliable and sustainable water supply.

Keywords: case study, infrastructure, management, renewal need, Sweden

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Authors: Laura N. Bolivar T.

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The tourism importance for regional development is mainly highlighted by the collaborative, cooperating and competitive relationships of the involved agents. The fostering of associativity processes, in particular, the cluster approach emphasizes the beneficial outcomes from the concentration of enterprises, where innovation and entrepreneurship flourish and shape the dynamics for tourism empowerment. Considering the department of Huila, it is located in the south-west of Colombia and holds the biggest coffee production in the country, although it barely contributes to the national GDP. Hence, its economic development strategy is looking for more dynamism and Huila could be consolidated as a leading destination for cultural, ecological and heritage tourism, if at least the public policy making processes for the tourism management of La Tatacoa Desert, San Agustin Park and Bambuco’s National Festival, were implemented in a more efficient manner. In this order of ideas, this study attempts to address the potential restrictions and beneficial factors for the consolidation of the tourism sector of Huila-Colombia as a cluster and how could it impact its regional development. Therefore, a set of theoretical frameworks such as the Tourism Routes Approach, the Tourism Breeding Environment, the Community-based Tourism Method, among others, but also a collection of international experiences describing tourism clustering processes and most outstanding problematics, is analyzed to draw up learning points, structure of proceedings and success-driven factors to be contrasted with the local characteristics in Huila, as the region under study. This characterization involves primary and secondary information collection methods and comprises the South American and Colombian context together with the identification of involved actors and their roles, main interactions among them, major tourism products and their infrastructure, the visitors’ perspective on the situation and a recap of the related needs and benefits regarding the host community. Considering the umbrella concepts, the theoretical and the empirical approaches, and their comparison with the local specificities of the tourism sector in Huila, an array of shortcomings is analytically constructed and a series of guidelines are proposed as a way to overcome them and simultaneously, raise economic development and positively impact Huila’s well-being. This non-exhaustive bundle of guidelines is focused on fostering cooperating linkages in the actors’ network, dealing with Information and Communication Technologies’ innovations, reinforcing the supporting infrastructure, promoting the destinations considering the less known places as well, designing an information system enabling the tourism network to assess the situation based on reliable data, increasing competitiveness, developing participative public policy-making processes and empowering the host community about the touristic richness. According to this, cluster dynamics would drive the tourism sector to meet articulation and joint effort, then involved agents and local particularities would be adequately assisted to cope with the current changing environment of globalization and competition.

Keywords: innovative strategy, local development, network of tourism actors, tourism cluster

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Authors: F. O’Dowd, G. Murphy, M. Roche, E. Shudell, F. Keane, M. O’Kane

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Intoduction: Apremilast (Otezla®) is an oral phosphodiesterase-4 (PDE4) inhibitor indicated for treatment of adult patients with moderate to severe plaque psoriasis who have contraindications to have failed or intolerant of standard systemic therapy and/or phototherapy; and adult patients with active psoriatic arthritis. Apremilast influences intracellular regulation of inflammatory mediators. Two randomized, placebo-controlled trials evaluating apremilast in 1426 patients with moderate to severe plague psoriasis (ESTEEM 1 and 2) demonstrated that the commonest adverse reactions (AE’s) leading to discontinuation were nausea (1.6%), diarrhoea (1.0%), and headaches (0.8%). The overall proportion of subjects discontinuing due to adverse reactions was 6.1%. At week 16 these trials demonstrated significant more apremilast-treated patients (33.1%) achieved the primary end point PASI-75 than placebo (5.3%). We began prescribing apremilast in July 2015. Aim: To evaluate efficacy and tolerability of apremilast in an Irish teaching hospital psoriasis population. Methods: A proforma documenting clinical evaluation parameters, prior treatment experience and AE’s; was completed prospectively on all patients commenced on apremilast since July 2015 – July 2017. Data was collected at week 0,6,12,24,36 and week 52 with 20/71 patients having passed week 52. Efficacy was assessed using Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI). AE’s documented included GI effects, infections, changes in weight and mood. Retrospective chart review and telephone review was utilised for missing data. Results: A total of 71 adult subjects (38 male, 33 female; age range 23-57), with moderate to severe psoriasis, were evaluated. Prior treatment: 37/71 (52%) were systemic/biologic/phototherapy naïve; 14/71 (20%) has prior phototherapy alone;20/71 (28%) had previous systemic/biologic exposure; 12/71 (17%) had both psoriasis and psoriatic arthritis. PASI responses: mean baseline PASI was 10.1 and DLQI was 15.Week 6: N=71, n=15 (21%) achieved PASI 75. Week 12: N= 48, n=6 (13%) achieved a PASI 100%; n=16 (34.5%) achieved a PASI 75. Week 24: N=40, n=10 (25%) achieved a PASI 100; n=15 (37.5%) achieved a PASI 75. Week 52: N= 20, n=4 (20%) achieved a PASI 100; n= 16 (80%) achieved a PASI 75. (N= number of pts having passed the time point indicated, n= number of pts (out of N) achieving PASI or DLQI responses at that time). DLQI responses: week 24: N= 40, n=30 (75%) achieved a DLQI score of 0; n=5 (12.5%) achieved a DLQI score of 1; n=1 (2.5%) achieved a DLQI score of 10 (due to lack of efficacy). Adverse Events: The proportion of patients that discontinued treatment due to AE’s was n=7 (9.8%). One patient experienced nausea alleviated by dose reduction; another developed significant dysgeusia for certain foods, both continued therapy. Two patients lost 2-3 kg. Conclusion: Initial Irish patient experience of Apremilast appears comparable to that observed in trials with good efficacy and tolerability.

Keywords: Apremilast, introduction, Ireland, clinical audit

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Authors: Irene Kalemaki, Ioanna Garefi

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Social Innovation Education (SIE) is a new educational approach that aims to empower students to take action for a more democratic and sustainable society. Conceptually and pedagogically wise, it is situated at the intersection of Enterprise Education and Citizenship Education as it aspires to i) combine action with activism, ii) personal development with collective efficacy, iii) entrepreneurial mindsets with democratic values and iv) individual competences with collective competences. This paper abstract presents the work of the NEMESIS project, funded by H2020, that aims to design, test and validate the first consolidated approach for embedding Social Innovation Education in schools of primary and secondary education. During the academic year 2018-2019, eight schools from five European countries experimented with different approaches and methodologies to incorporate SIE in their settings. This paper reports briefly on these attempts and discusses the wider educational philosophy underlying these interventions with a particular focus on analyzing the learning outcomes and impact on students. That said, this paper doesn’t only report on the theoretical and practical underpinnings of SIE, but most importantly, it provides evidence on the impact of SIE on students. In terms of methodology, the study took place from September 2018 to July 2019 in eight schools from Greece, Spain, Portugal, France, and the UK involving directly 56 teachers, 1030 students and 69 community stakeholders. Focus groups, semi-structured interviews, classroom observations as well as students' written narratives were used to extract data on the impact of SIE on students. The overall design of the evaluation activities was informed by a realist approach, which enabled us to go beyond “what happened” and towards understanding “why it happened”. Research findings suggested that SIE can benefit students in terms of their emotional, cognitive, behavioral and agentic engagement. Specifically, the emotional engagement of students was increased because through SIE interventions; students voice was heard, valued, and acted upon. This made students feel important to their school, increasing their sense of belonging, confidence and level of autonomy. As regards cognitive engagement, both students and teachers reported positive outcomes as SIE enabled students to take ownership of their ideas to drive their projects forward and thus felt more motivated to perform in class because it felt personal, important and relevant to them. In terms of behavioral engagement, the inclusive environment and the collective relationships that were reinforced through the SIE interventions had a direct positive impact on behaviors among peers. Finally, with regard to agentic engagement, it has been observed that students became very proactive which was connected to the strong sense of ownership and enthusiasm developed during collective efforts to deliver real-life social innovations. Concluding, from a practical and policy point of view these research findings could encourage the inclusion of SIE in schools, while from a research point of view, they could contribute to the scientific discourse providing evidence and clarity on the emergent field of SIE.

Keywords: education, engagement, social innovation, students

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Authors: Innocent Atuhe, Babra Nalwadda, Grace Mulyowa, Annabella Habinka Ejiri

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Background: Atopic Dermatitis (AD) is one of the most prevalent and growing chronic inflammatory skin diseases in African prisons. AD care is limited in African due to a lack of information about the disease amongst primary care workers, limited access to dermatologists, lack of proper training of healthcare workers, and shortage of appropriate treatments. We designed and implemented the Prisons Telederma project based on the recommendations of the International Society of Atopic Dermatitis. We aimed at; i) increase awareness and understanding of teledermatology among prison health workers and ii) improve treatment outcomes of prisoners with atopic dermatitis through increased access to and utilization of consultant dermatologists through teledermatology in Uganda prisons. Approach: We used Store-and-forward Teledermatology (SAF-TD) to increase access to dermatologist-led care for prisoners and prison staff with AD. We conducted five days of training for prison health workers using an adapted WHO training guide on recognizing neglected tropical diseases through changes on the skin together with an adapted American Academy of Dermatology (AAD) Childhood AD Basic Dermatology Curriculum designed to help trainees develop a clinical approach to the evaluation and initial management of patients with AD. This training was followed by blended e-learning, webinars facilitated by consultant Dermatologists with local knowledge of medication and local practices, apps adjusted for pigmented skin, WhatsApp group discussions, and sharing pigmented skin AD pictures and treatment via zoom meetings. We hired a team of Ugandan Senior Consultant dermatologists to draft an iconographic atlas of the main dermatoses in pigmented African skin and shared this atlas with prison health staff for use as a job aid. We had planned to use MySkinSelfie mobile phone application to take and share skin pictures of prisoners with AD with Consultant Dermatologists, who would review the pictures and prescribe appropriate treatment. Unfortunately, the National Health Service withdrew the app from the market due to technical issues. We monitored and evaluated treatment outcomes using the Patient-Oriented Eczema Measure (POEM) tool. We held four advocacy meetings to persuade relevant stakeholders to increase supplies and availability of first-line AD treatments such as emollients in prison health facilities. Results: We have the very first iconographic atlas of the main dermatoses in pigmented African skin. We increased; i) the proportion of prison health staff with adequate knowledge of AD and teledermatology from 20% to 80%; ii) the proportion of prisoners with AD reporting improvement in disease severity (POEM scores) from 25% to 35% in one year; iii) increased proportion of prisoners with AD seen by consultant dermatologist through teledermatology from 0% to 20% in one year and iv)Increased the availability of AD recommended treatments in prisons health facilities from 5% to 10% in one year. Our study contributes to the use, evaluation, and verification of the use of teledermatology to increase access to specialist dermatology services to the most hard to reach areas and vulnerable populations such as that of prisoners.

Keywords: teledermatology, prisoners, reaching, un-reachable

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Authors: Dariusz M. Trzmielak, William Bradley Zehner, Elin Oftedal, Ilona Lipka-Matusiak

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The use of new technologies should create new value for all stakeholders in the healthcare system. The article focuses on demonstrating that technologies or products typically enable new functionality, a higher standard of service, or a higher level of knowledge and competence for clinicians. It also highlights the key benefits that can be achieved through the use of artificial intelligence, such as relieving clinicians of many tasks and enabling the expansion and greater specialisation of healthcare services. The comparative analysis allowed the authors to create a classification of new technologies in e-health according to health needs and benefits for patients, doctors, and healthcare systems, i.e., the main stakeholders in the implementation of new technologies and products in healthcare. The added value of the development of new technologies in healthcare is diagnosed. The work is both theoretical and practical in nature. The primary research methods are bibliographic analysis and analysis of research data and market potential of new solutions for healthcare organisations. The bibliographic analysis is complemented by the author's case studies of implemented technologies, mostly based on artificial intelligence or telemedicine. In the past, patients were often passive recipients, the end point of the service delivery system, rather than stakeholders in the system. One of the dangers of powerful new technologies is that patients may become even more marginalised. Healthcare will be provided and delivered in an increasingly administrative, programmed way. The doctor may also become a robot, carrying out programmed activities - using 'non-human services'. An alternative approach is to put the patient at the centre, using technologies, products, and services that allow them to design and control technologies based on their own needs. An important contribution to the discussion is to open up the different dimensions of the user (carer and patient) and to make them aware of healthcare units implementing new technologies. The authors of this article outline the importance of three types of patients in the successful implementation of new medical solutions. The impact of implemented technologies is analysed based on: 1) "Informed users", who are able to use the technology based on a better understanding of it; 2) "Engaged users" who play an active role in the broader healthcare system as a result of the technology; 3) "Innovative users" who bring their own ideas to the table based on a deeper understanding of healthcare issues. The authors' research hypothesis is that the distinction between informed, engaged, and innovative users has an impact on the perceived and actual quality of healthcare services. The analysis is based on case studies of new solutions implemented in different medical centres. In addition, based on the observations of the Polish author, who is a manager at the largest medical research institute in Poland, with analytical input from American and Norwegian partners, the added value of the implementations for patients, clinicians, and the healthcare system will be demonstrated.

Keywords: innovation, management, medicine, e-health, artificial intelligence

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Authors: Irina-Emily Hansen, Ola Jon Mork

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The European economic growth strategy and supporting it framework for research and innovation highlight the importance of nurturing new open innovation in order to strengthen Europe’s competitiveness. One of the main approaches to enhance innovation in European society is the Triple Helix model that centres on science- industry collaboration where the universities are assigned the managerial role. In spite of the defined collaboration strategy, the collaboration between academics and in-dustry in Europe has still many challenges. Many of them are explained by culture difference: academic culture aims towards scientific knowledge, while businesses are oriented towards pro-duction and profitable results; also execution of collaborative projects is seen differently by part-ners involved. That proves that traditional management strategies applied to collaboration between researchers and businesses are not effective. There is a need for dynamic strategies that can support the interaction between researchers and industry intensifying knowledge co-creation and contributing to development of national innovation system (NIS) by incorporating individual, organizational and inter-organizational learning. In order to find a good subject to follow, the researchers of a given paper have investigated one of the most rapidly developing knowledge-based, innovation society, Singapore. Singapore does not dispose much land- or sea- resources that normally provide income for any country. Therefore, Singapore was forced to think differently and build society on resources that are available: talented people and knowledge. Singapore has during the last twenty years developed attracting high rated university camps, research institutions and leading industrial companies from all over the world. This article elucidates and elaborates Singapore’s national innovation strategies from Knowledge Management perspective. The research is done on the variety of organizations that enable and support knowledge development in this state: governmental research and development (R&D) centers in universities, private talent incubators for entrepreneurs, and industrial companies with own R&D departments. The research methods are based on presentations, documents, and visits at a number of universities, research institutes, innovation parks, governmental institutions, industrial companies and innovation exhibitions in Singapore. In addition, a literature review of science articles is made regarding the topic. The first finding is that objectives of collaboration between researchers, entrepreneurs and industry in Singapore correspond primary goals of the state: knowledge- and economy growth. There are common objectives for all stakeholders on all national levels. The second finding is that Singapore has enabled system on a national level that supports innovation the entire way from fostering or capturing the new knowledge, providing knowledge exchange and co-creation to application of it in real-life. The conclusion is that innovation means not only new idea, but also the enabling mechanism for its execution and the marked-oriented approach in order that new knowledge can be absorbed in society. The future research can be done with regards to application of Singapore knowledge management strategy in innovation to European countries.

Keywords: knowledge management strategy, national innovation system, research industry and business collaboration, knowledge enabling

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Authors: Leigh G. Hayden, Susan E. Shepley, Cristina Passarelli, William Tingo

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Introduction: Sensory interventions are popular therapeutic and recreational approaches for people living with all stages of dementia. However, it is unknown which sensory interventions are used to achieve which outcomes across all subtypes of dementia. Methods: To address this gap, we conducted a scoping review of sensory interventions for people living with dementia. We conducted a search of the literature for any article published in English from 1 January 1990 to 1 June 2019, on any sensory or multisensory intervention targeted to people living with any kind of dementia, which reported on patient health outcomes. We did not include complex interventions where only a small aspect was related to sensory stimulation. We searched the databases Medline, CINHAL, and Psych Articles using our institutional discovery layer. We conducted all screening in duplicate to reduce Type 1 and Type 2 errors. The data from all included papers were extracted by one team member, and audited by another, to ensure consistency of extraction and completeness of data. Results: Our initial search captured 7654 articles, and the removal of duplicates (n=5329), those that didn’t pass title and abstract screening (n=1840) and those that didn’t pass full-text screening (n=281) resulted in 174 articles included. The countries with the highest publication in this area were the United States (n=59), the United Kingdom (n=26) and Australia (n=15). The most common type of interventions were music therapy (n=36), multisensory rooms (n=27) and multisensory therapies (n=25). Seven articles were published in the 1990’s, 55 in the 2000’s, and the remainder since 2010 (n=112). Discussion: Multisensory rooms have been present in the literature since the early 1990’s. However, more recently, nature/garden therapy, art therapy, and light therapy have emerged since 2008 in the literature, an indication of the increasingly diverse scholarship in the area. The least popular type of intervention is a traditional food intervention. Taste as a sensory intervention is generally avoided for safety reasons, however it shows potential for increasing quality of life. Agitation, behavior, and mood are common outcomes for all sensory interventions. However, light therapy commonly targets sleep. The majority (n=110) of studies have very small sample sizes (n=20 or less), an indicator of the lack of robust data in the field. Additional small-scale studies of the known sensory interventions will likely do little to advance the field. However, there is a need for multi-armed studies which directly compare sensory interventions, and more studies which investigate the use of layering sensory interventions (for example, adding an aromatherapy component to a lighting intervention). In addition, large scale studies which enroll people at early stages of dementia will help us better understand the potential of sensory and multisensory interventions to slow the progression of the disease.

Keywords: sensory interventions, dementia, scoping review

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Authors: Rana Parween, Rob Marchant

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With the continued loss of global biodiversity despite the application of modern conservation techniques, it has become crucial to investigate non-conventional methods. Accelerated destruction of ecosystems due to altered land use, climate change, cultural and social change, necessitates the exploration of society-biodiversity attitudes and links. While the loss of species and their extinction is a well-known and well-documented process that attracts much-needed attention from researchers, academics, government and non-governmental organizations, the loss of traditional ecological knowledge and practices is more insidious and goes unnoticed. The growing availability of 'indirect experiences' such as the internet and media are leading to a disaffection towards nature and the 'Extinction of Experience'. Exacerbated by the lack of documentation of traditional practices and skills, there is the possibility for the 'extinction' of traditional practices and skills before they are fully recognized and captured. India, as a mega-biodiverse country, is also known for its historical conservation strategies entwined in traditional beliefs. Indigenous communities hold skillsets, knowledge, and traditions that have accumulated over multiple generations and may play an important role in conserving biodiversity today. This study explores the differences in knowledge and attitudes towards conserving biodiversity, of three different stakeholder groups living around Jim Corbett National Park, based on their age, traditions, and association with the protected area. A triangulation designed multi-strategy investigation collected qualitative and quantitative data through a questionnaire survey of village elders, the general public, and forest officers. Following an inductive approach to analyzing qualitative data, the thematic content analysis was followed. All coding and analysis were completed using NVivo 11. Although the village elders and some general public had vast amounts of traditional knowledge, most of it was related to animal husbandry and the medicinal value of plants. Village elders were unfamiliar with the concept of the term ‘biodiversity’ albeit their way of life and attitudes ensured that they care for the ecosystem without having the scientific basis underpinning biodiversity conservation. Inherently, village elders were keen to conserve nature; the superimposition of governmental policies without any tangible benefit or consultation was seen as detrimental. Alienating villagers and consequently the village elders who are the reservoirs of traditional knowledge would not only be damaging to the social network of the area but would also disdain years of tried and tested techniques held by the elders. Forest officers advocated for biodiversity and conservation education for women and children. Women, across all groups, when questioned about nature conservation, showed more interest in learning and participation. Biodiversity not only has an ethical and cultural value, but also plays a role in ecosystem function and, thus, provides ecosystem services and supports livelihoods. Therefore, underpinning and using traditional knowledge and incorporating them into programs of biodiversity conservation should be explored with a sense of urgency.

Keywords: biological diversity, mega-biodiverse countries, traditional ecological knowledge, society-biodiversity links

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Authors: Juliane Spaak

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A life-cycle assessment was performed, looking at seven retrofit projects in New Zealand using LCAQuickV3.5. The study found that retrofits save up to 80% of embodied carbon emissions for the structural elements compared to a new building. In other words, it is only a 20% carbon investment to transform and extend a building’s life. In addition, the systems were evaluated by looking at environmental impacts over the design life of these buildings and resilience using FEMA P58 and PACT software. With the increasing interest in Zero Carbon targets, significant changes in the building and construction sector are required. Emissions for buildings arise from both embodied carbon and operations. Based on the significant advancements in building energy technology, the focus is moving more toward embodied carbon, a large portion of which is associated with the structure. Since older buildings make up most of the real estate stock of our cities around the world, their reuse through structural retrofit and wider refurbishment plays an important role in extending the life of a building’s embodied carbon. New Zealand’s building owners and engineers have learned a lot about seismic issues following a decade of significant earthquakes. Recent earthquakes have brought to light the necessity to move away from constructing code-minimum structures that are designed for life safety but are frequently ‘disposable’ after a moderate earthquake event, especially in relation to a structure’s ability to minimize damage. This means weaker buildings sit as ‘carbon liabilities’, with considerably more carbon likely to be expended remediating damage after a shake. Renovating and retrofitting older assets plays a big part in reducing the carbon profile of the buildings sector, as breathing new life into a building’s structure is vastly more sustainable than the highest quality ‘green’ new builds, which are inherently more carbon-intensive. The demolition of viable older buildings (often including heritage buildings) is increasingly at odds with society’s desire for a lower carbon economy. Bringing seismic resilience and carbon best practice together in decision-making can open the door to commercially attractive outcomes, with retrofits that include structural and sustainability upgrades transforming the asset’s revenue generation. Across the global real estate market, tenants are increasingly demanding the buildings they occupy be resilient and aligned with their own climate targets. The relationship between seismic performance and ‘sustainable design’ has yet to fully mature, yet in a wider context is of profound consequence. A whole-of-life carbon perspective on a building means designing for the likely natural hazards within the asset’s expected lifespan, be that earthquake, storms, damage, bushfires, fires, and so on, ¬with financial mitigation (e.g., insurance) part, but not all, of the picture.

Keywords: retrofit, sustainability, earthquake, reuse, carbon, resilient

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Authors: Geday Elias, Montaigne Etienne, Padilla Martine, Tollossa Degefa

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Smallholder farmers’ participation in agricultural value chain identified as a pathway to get out of poverty trap in Ethiopia. The smallholder dairy activities have a huge potential in poverty reduction through enhancing income, achieving food and nutritional security in the country. However, much less is known about the effects of smallholder’s participation in milk value chain on household food security and nutrition. This paper therefore, aims at evaluating the effects of smallholders’ participation in milk value chain on household food security taking in to account the four pillars of food security measurements (availability, access, utilization and stability). Using a semi-structured interview, a cross sectional farm household data collected from a randomly selected sample of 333 households (170 in Amhara and 163 in Oromia regions).Binary logit and propensity score matching( PSM) models are employed to examine the mechanisms through which smallholder’s participation in the milk value chain affects household food security where crop production, per capita calorie intakes, diet diversity score, and food insecurity access scale are used to measure food availability, access, utilization and stability respectively. Our findings reveal from 333 households, only 34.5% of smallholder farmers are participated in the milk value chain. Limited access to inputs and services, limited access to inputs markets and high transaction costs are key constraints for smallholders’ limited access to the milk value chain. To estimate the true average participation effects of milk value chain for participated households, the outcome variables (food security) of farm households who participated in milk value chain are compared with the outcome variables if the farm households had not participated. The PSM analysis reveals smallholder’s participation in milk value chain has a significant positive effect on household income, food security and nutrition. Smallholder farmers who are participated in milk chain are better by 15 quintals crops production and 73 percent of per capita calorie intakes in food availability and access respectively than smallholder farmers who are not participated in the market. Similarly, the participated households are better in dietary quality by 112 percents than non-participated households. Finally, smallholders’ who are participated in milk value chain are better in reducing household vulnerability to food insecurity by an average of 130 percent than non participated households. The results also shows income earned from milk value chain participation contributed to reduce capital’s constraints of the participated households’ by higher farm income and total household income by 5164 ETB and 14265 ETB respectively. This study therefore, confirms the potential role of smallholders’ participation in food value chain to get out of poverty trap through improving rural household income, food security and nutrition. Therefore, identified the determinants of smallholder participation in milk value chain and the participation effects on food security in the study areas are worth considering as a positive knock for policymakers and development agents to tackle the poverty trap in the study area in particular and in the country in general.

Keywords: effects, food security and nutrition, milk, participation, smallholders, value chain

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Authors: Moletsane Makgotso, Mogakabe Elijah, Marrengane Zinhle

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South Africa’s water resources quality is becoming more and more weakened by eutrophication, which deteriorates its usability. Thirty five percent of fresh water resources are eutrophic to hypertrophic, including grossly-enriched reservoirs that go beyond the globally-accepted definition of hypertrophy. Failing infrastructure adds to the problem of contaminated urban runoff which encompasses an important fraction of flows to inland reservoirs, particularly in the non-coastal, economic heartland of the country. Eutrophication threatens the provision of potable and irrigation water in the country because of the dependence on fresh water resources. Eutrophicated water reservoirs increase water treatment costs, leads to unsuitability for recreational purposes and health risks to human and animal livelihood due to algal proliferation. Eutrophication is caused by high concentrations of phosphorus and nitrogen in water bodies. In South Africa, Microsystis and Anabaena are widely distributed cyanobacteria, with Microcystis being the most dominant bloom-forming cyanobacterial species associated with toxin production. Two impoundments were selected, namely the Klipvoor and Leeukraal dams as they are mainly used for fishing, recreational, agricultural and to some extent, potable water purposes. The total oxidized nitrogen and total phosphorus concentration were determined as causative nutrients for eutrophication. Chlorophyll a and total microcystins, as well as the identification of cyanobacteria was conducted as indicators of cyanobacterial infestation. The orthophosphate concentration was determined by subjecting the samples to digestion and filtration followed by spectrophotometric analysis of total phosphates and dissolved phosphates using Aquakem kits. The total oxidized nitrates analysis was conducted by initially conducting filtration followed by spectrophotometric analysis. Chlorophyll a was quantified spectrophotometrically by measuring the absorbance of before and after acidification. Microcystins were detected using the Quantiplate Microcystin Kit, as well as microscopic identification of cyanobacterial species. The Klipvoor dam was found to be hypertrophic throughout the study period as the mean Chlorophyll a concentration was 269.4µg/l which exceeds the mean value for the hypertrophic state. The mean Total Phosphorus concentration was >0.130mg/l, and the total microcystin concentration was > 2.5µg/l throughout the study. The most predominant algal species were found to be the Microcystis. The Leeukraal dam was found to be mesotrophic with the potential of it becoming eutrophic as the mean concentration for chlorophyll a was 18.49 µg/l with the mean Total Phosphorus > 0.130mg/l and the Total Microcystin concentration < 0.16µg/l. The cyanobacterial species identified in Leeukraal have been classified as those that do not pose a potential risk to any impoundment. Microcystis was present throughout the sampling period and dominant during the warmer seasons. The high nutrient concentrations led to the dominance of Microcystis that resulted in high levels of microcystins rendering the impoundments, particularly Klipvoor undesirable for utilisation.

Keywords: nitrogen, phosphorus, cyanobacteria, microcystins

Procedia PDF Downloads 287