Search results for: health information exchanges
784 The Recorded Interaction Task: A Validation Study of a New Observational Tool to Assess Mother-Infant Bonding
Authors: Hannah Edwards, Femke T. A. Buisman-Pijlman, Adrian Esterman, Craig Phillips, Sandra Orgeig, Andrea Gordon
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Mother-infant bonding is a term which refers to the early emotional connectedness between a mother and her infant. Strong mother-infant bonding promotes higher quality mother and infant interactions including prolonged breastfeeding, secure attachment and increased sensitive parenting and maternal responsiveness. Strengthening of all such interactions leads to improved social behavior, and emotional and cognitive development throughout childhood, adolescence and adulthood. The positive outcomes observed following strong mother-infant bonding emphasize the need to screen new mothers for disrupted mother-infant bonding, and in turn the need for a robust, valid tool to assess mother-infant bonding. A recent scoping review conducted by the research team identified four tools to assess mother-infant bonding, all of which employed self-rating scales. Thus, whilst these tools demonstrated both adequate validity and reliability, they rely on self-reported information from the mother. As such this may reflect a mother’s perception of bonding with their infant, rather than their actual behavior. Therefore, a new tool to assess mother-infant bonding has been developed. The Recorded Interaction Task (RIT) addresses shortcomings of previous tools by employing observational methods to assess bonding. The RIT focusses on the common interaction between mother and infant of changing a nappy, at the target age of 2-6 months, which is visually recorded and then later assessed. Thirteen maternal and seven infant behaviors are scored on the RIT Observation Scoring Sheet, and a final combined score of mother-infant bonding is determined. The aim of the current study was to assess the content validity and inter-rater reliability of the RIT. A panel of six experts with specialized expertise in bonding and infant behavior were consulted. Experts were provided with the RIT Observation Scoring Sheet, a visual recording of a nappy change interaction, and a feedback form. Experts scored the mother and infant interaction on the RIT Observation Scoring Sheet and completed the feedback form which collected their opinions on the validity of each item on the RIT Observation Scoring Sheet and the RIT as a whole. Twelve of the 20 items on the RIT Observation Scoring Sheet were scored ‘Valid’ by all (n=6) or most (n=5) experts. Two items received a ‘Not valid’ score from one expert. The remainder of the items received a mixture of ‘Valid’ and ‘Potentially Valid’ scores. Few changes were made to the RIT Observation Scoring Sheet following expert feedback, including rewording of items for clarity and the exclusion of an item focusing on behavior deemed not relevant for the target infant age. The overall ICC for single rater absolute agreement was 0.48 (95% CI 0.28 – 0.71). Experts (n=6) ratings were less consistent for infant behavior (ICC 0.27 (-0.01 – 0.82)) compared to mother behavior (ICC 0.55 (0.28 – 0.80)). Whilst previous tools employ self-report methods to assess mother-infant bonding, the RIT utilizes observational methods. The current study highlights adequate content validity and moderate inter-rater reliability of the RIT, supporting its use in future research. A convergent validity study comparing the RIT against an existing tool is currently being undertaken to confirm these results.Keywords: content validity, inter-rater reliability, mother-infant bonding, observational tool, recorded interaction task
Procedia PDF Downloads 180783 The Renewed Constitutional Roots of Agricultural Law in Hungary in Line with Sustainability
Authors: Gergely Horvath
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The study analyzes the special provisions of the highest level of national agricultural legislation in the Fundamental Law of Hungary (25 April 2011) with descriptive, analytic and comparative methods. The agriculturally relevant articles of the constitution are very important, because –in spite of their high level of abstraction– they can determine and serve the practice comprehensively and effectively. That is why the objective of the research is to interpret the concrete sentences and phrases in connection with agriculture compared with the methods of some other relevant constitutions (historical-grammatical interpretation). The major findings of the study focus on searching for the appropriate provisions and approach capable of solving the problems of sustainable food production. The real challenge agricultural law must face with in the future is protecting or conserving its background and subjects: the environment, the ecosystem services and all the 'roots' of food production. In effect, agricultural law is the legal aspect of the production of 'our daily bread' from farm to table. However, it also must guarantee the safe daily food for our children and for all our descendants. In connection with sustainability, this unique, value-oriented constitution of an agrarian country even deals with uncustomary questions in this level of legislation like GMOs (by banning the production of genetically modified crops). The starting point is that the principle of public good (principium boni communis) must be the leading notion of the norm, which is an idea partly outside the law. The public interest is reflected by the agricultural law mainly in the concept of public health (in connection with food security) and the security of supply with healthy food. The construed Article P claims the general protection of our natural resources as a requirement. The enumeration of the specific natural resources 'which all form part of the common national heritage' also means the conservation of the grounds of sustainable agriculture. The reference of the arable land represents the subfield of law of the protection of land (and soil conservation), that of the water resources represents the subfield of water protection, the reference of forests and the biological diversity visualize the specialty of nature conservation, which is an essential support for agrobiodiversity. The mentioned protected objects constituting the nation's common heritage metonymically melt with their protective regimes, strengthening them and forming constitutional references of law. This regimes also mean the protection of the natural foundations of the life of the living and also the future generations, in the name of intra- and intergenerational equity.Keywords: agricultural law, constitutional values, natural resources, sustainability
Procedia PDF Downloads 166782 Plastic Pollution: Analysis of the Current Legal Framework and Perspectives on Future Governance
Authors: Giorgia Carratta
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Since the beginning of mass production, plastic items have been crucial in our daily lives. Thanks to their physical and chemical properties, plastic materials have proven almost irreplaceable in a number of economic sectors such as packaging, automotive, building and construction, textile, and many others. At the same time, the disruptive consequences of plastic pollution have been progressively brought to light in all environmental compartments. The overaccumulation of plastics in the environment, and its adverse effects on habitats, wildlife, and (most likely) human health, represents a call for action to decision-makers around the globe. From a regulatory perspective, plastic production is an unprecedented challenge at all levels of governance. At the international level, the design of new legal instruments, the amendment of existing ones, and the coordination among the several relevant policy areas requires considerable effort. Under the pressure of both increasing scientific evidence and a concerned public opinion, countries seem to slowly move towards the discussion of a new international ‘plastic treaty.’ However, whether, how, and with which scopes such instrument would be adopted is still to be seen. Additionally, governments are establishing regional-basedstrategies, prone to consider the specificities of the plastic issue in a certain geographical area. Thanks to the new Circular Economy Action Plan, approved in March 2020 by the European Commission, EU countries are slowly but steadily shifting to a carbon neutral, circular economy in the attempt to reduce the pressure on natural resources and, parallelly, facilitate sustainable economic growth. In this context, the EU Plastic Strategy is promising to change the way plastic is designed, produced, used, and treated after consumption. In fact, only in the EU27 Member States, almost 26 million tons of plastic waste are generated herein every year, whose 24,9% is still destined to landfill. Positive effects of the Strategy also include a more effective protection of our environment, especially the marine one, the reduction of greenhouse gas emissions, a reduced need for imported fossil energy sources, more sustainable production and consumption patterns. As promising as it may sound, the road ahead is still long. The need to implement these measures in domestic legislations makes their outcome difficult to predict at the moment. An analysis of the current international and European Union legal framework on plastic pollution, binding, and voluntary instruments included, could serve to detect ‘blind spots’ in the current governance as well as to facilitate the development of policy interventions along the plastic value chain, where it appears more needed.Keywords: environmental law, European union, governance, plastic pollution, sustainability
Procedia PDF Downloads 107781 Interdisciplinary Evaluations of Children with Autism Spectrum Disorder in a Telehealth Arena
Authors: Janice Keener, Christine Houlihan
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Over the last several years, there has been an increase in children identified as having Autism Spectrum Disorder (ASD). Specialists across several disciplines: mental health and medical professionals have been tasked with ensuring accurate and timely evaluations for children with suspected ASD. Due to the nature of the ASD symptom presentation, an interdisciplinary assessment and treatment approach best addresses the needs of the whole child. During the unprecedented COVID-19 Pandemic, clinicians were faced with how to continue with interdisciplinary assessments in a telehealth arena. Instruments that were previously used to assess ASD in-person were no longer appropriate measures to use due to the safety restrictions. For example, The Autism Diagnostic Observation Schedule requires examiners and children to be in very close proximity of each other and if masks or face shields are worn, they render the evaluation invalid. Similar issues arose with the various cognitive measures that are used to assess children such as the Weschler Tests of Intelligence and the Differential Ability Scale. Thus the need arose to identify measures that are able to be safely and accurately administered using safety guidelines. The incidence of ASD continues to rise over time. Currently, the Center for Disease Control estimates that 1 in 59 children meet the criteria for a diagnosis of ASD. The reasons for this increase are likely multifold, including changes in diagnostic criteria, public awareness of the condition, and other environmental and genetic factors. The rise in the incidence of ASD has led to a greater need for diagnostic and treatment services across the United States. The uncertainty of the diagnostic process can lead to an increased level of stress for families of children with suspected ASD. Along with this increase, there is a need for diagnostic clarity to avoid both under and over-identification of this condition. Interdisciplinary assessment is ideal for children with suspected ASD, as it allows for an assessment of the whole child over the course of time and across multiple settings. Clinicians such as Psychologists and Developmental Pediatricians play important roles in the initial evaluation of autism spectrum disorder. An ASD assessment may consist of several types of measures such as standardized checklists, structured interviews, and direct assessments such as the ADOS-2 are just a few examples. With the advent of telehealth clinicians were asked to continue to provide meaningful interdisciplinary assessments via an electronic platform and, in a sense, going to the family home and evaluating the clinical symptom presentation remotely and confidently making an accurate diagnosis. This poster presentation will review the benefits, limitations, and interpretation of these various instruments. The role of other medical professionals will also be addressed, including medical providers, speech pathology, and occupational therapy.Keywords: Autism Spectrum Disorder Assessments, Interdisciplinary Evaluations , Tele-Assessment with Autism Spectrum Disorder, Diagnosis of Autism Spectrum Disorder
Procedia PDF Downloads 208780 The Comparison of Bird’s Population between Naturally Regenerated Acacia Forest with Adjacent Secondary Indigenous Forest in Universiti Malaysia Sabah
Authors: Jephte Sompud, Emily A. Gilbert, Andy Russel Mojiol, Cynthia B. Sompud, Alim Biun
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Naturally regenerated acacia forest and secondary indigenous forest forms some of the urban forests in Sabah. Naturally regenerated acacia trees are usually seen along the road that exists as forest islands. Acacia tree is not an indigenous tree species in Sabah that was introduced in the 1960’s as fire breakers that eventually became one of the preferred trees for forest plantation for paper and pulp production. Due to its adaptability to survive even in impoverished soils and poor-irrigated land, this species has rapidly spread throughout Sabah through natural regeneration. Currently, there is a lack of study to investigate the bird population in the naturally regenerated acacia forest. This study is important because it shed some light on the role of naturally regenerated acacia forest on bird’s population, as bird is known to be a good bioindicator forest health. The aim of this study was to document the bird’s population in naturally regenerated acacia forest with that adjacent secondary indigenous forest. The study site for this study was at Universiti Malaysia Sabah (UMS) Campus. Two forest types in the campus were chosen as a study site, of which were naturally regenerated Acacia Forest and adjacent secondary indigenous forest, located at the UMS Hill. A total of 21 sampling days were conducted in each of the forest types. The method used during this study was solely mist nets with three pockets. Whenever a bird is caught, it is extracted from the net to be identified and measurements were recorded in a standard data sheet. Mist netting was conducted from 6 morning until 5 evening. This study was conducted between February to August 2014. Birds that were caught were ring banded to initiate a long-term study on the understory bird’s population in the Campus The data was analyzed using descriptive analysis, diversity indices, and t-test. The bird population diversity at naturally regenerated Acacia forest with those at the secondary indigenous forest was calculated using two common indices, of which were Shannon-Wiener and Simpson diversity index. There were 18 families with 33 species that were recorded from both sites. The number of species recorded at the naturally regenerated acacia forest was 26 species while at the secondary indigenous forest were 19 species. The Shannon diversity index for Naturally Regenerated Acacia Forest and secondary indigenous forests were 2.87 and 2.46. The results show that there was very significantly higher species diversity at the Naturally Regenerated Acacia Forest as opposed to the secondary indigenous forest (p<0.001). This suggests that Naturally Regenerated Acacia forest plays an important role in urban bird conservation. It is recommended that Naturally Regenerated Acacia Forests should be considered as an established urban forest conservation area as they do play a role in biodiversity conservation. More future studies in Naturally Regenerated Acacia Forest should be encouraged to determine the status and value of biodiversity conservation of this ecosystem.Keywords: naturally regenerated acacia forest, bird population diversity, Universiti Malaysia Sabah, biodiversity conservation
Procedia PDF Downloads 427779 A Meta-Analysis of School-Based Suicide Prevention for Adolescents and Meta-Regressions of Contextual and Intervention Factors
Authors: E. H. Walsh, J. McMahon, M. P. Herring
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Post-primary school-based suicide prevention (PSSP) is a valuable avenue to reduce suicidal behaviours in adolescents. The aims of this meta-analysis and meta-regression were 1) to quantify the effect of PSSP interventions on adolescent suicide ideation (SI) and suicide attempts (SA), and 2) to explore how intervention effects may vary based on important contextual and intervention factors. This study provides further support to the benefits of PSSP by demonstrating lower suicide outcomes in over 30,000 adolescents following PSSP and mental health interventions and tentatively suggests that intervention effectiveness may potentially vary based on intervention factors. The protocol for this study is registered on PROSPERO (ID=CRD42020168883). Population, intervention, comparison, outcomes, and study design (PICOs) defined eligible studies as cluster randomised studies (n=12) containing PSSP and measuring suicide outcomes. Aggregate electronic database EBSCO host, Web of Science, and Cochrane Central Register of Controlled Trials databases were searched. Cochrane bias tools for cluster randomised studies demonstrated that half of the studies were rated as low risk of bias. The Egger’s Regression Test adapted for multi-level modelling indicated that publication bias was not an issue (all ps > .05). Crude and corresponding adjusted pooled log odds ratios (OR) were computed using the Metafor package in R, yielding 12 SA and 19 SI effects. Multi-level random-effects models accounting for dependencies of effects from the same study revealed that in crude models, compared to controls, interventions were significantly associated with 13% (OR=0.87, 95% confidence interval (CI), [0.78,0.96], Q18 =15.41, p=0.63) and 34% (OR=0.66, 95%CI [0.47,0.91], Q10=16.31, p=0.13) lower odds of SI and SA, respectively. Adjusted models showed similar odds reductions of 15% (OR=0.85, 95%CI[0.75,0.95], Q18=10.04, p=0.93) and 28% (OR=0.72, 95%CI[0.59,0.87], Q10=10.46, p=0.49) for SI and SA, respectively. Within-cluster heterogeneity ranged from no heterogeneity to low heterogeneity for SA across crude and adjusted models (0-9%). No heterogeneity was identified for SI across crude and adjusted models (0%). Pre-specified univariate moderator analyses were not significant for SA (all ps < 0.05). Variations in average pooled SA odds reductions across categories of various intervention characteristics were observed (all ps < 0.05), which preliminarily suggests that the effectiveness of interventions may potentially vary across intervention factors. These findings have practical implications for researchers, clinicians, educators, and decision-makers. Further investigation of important logical, theoretical, and empirical moderators on PSSP intervention effectiveness is recommended to establish how and when PSSP interventions best reduce adolescent suicidal behaviour.Keywords: adolescents, contextual factors, post-primary school-based suicide prevention, suicide ideation, suicide attempts
Procedia PDF Downloads 102778 Assessing P0.1 and Occlusion Pressures in Brain-Injured Patients on Pressure Support Ventilation: A Study Protocol
Authors: S. B. R. Slagmulder
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Monitoring inspiratory effort and dynamic lung stress in patients on pressure support ventilation in the ICU is important for protecting against self inflicted lung injury (P-SILI) and diaphragm dysfunction. Strategies to address the detrimental effects of respiratory drive and effort can lead to improved patient outcomes. Two non-invasive estimation methods, occlusion pressure (Pocc) and P0.1, have been proposed for achieving lung and diaphragm protective ventilation. However, their relationship and interpretation in neuro ICU patients is not well understood. P0.1 is the airway pressure measured during a 100-millisecond occlusion of the inspiratory port. It reflects the neural drive from the respiratory centers to the diaphragm and respiratory muscles, indicating the patient's respiratory drive during the initiation of each breath. Occlusion pressure, measured during a brief inspiratory pause against a closed airway, provides information about the inspiratory muscles' strength and the system's total resistance and compliance. Research Objective: Understanding the relationship between Pocc and P0.1 in brain-injured patients can provide insights into the interpretation of these values in pressure support ventilation. This knowledge can contribute to determining extubation readiness and optimizing ventilation strategies to improve patient outcomes. The central goal is to asses a study protocol for determining the relationship between Pocc and P0.1 in brain-injured patients on pressure support ventilation and their ability to predict successful extubation. Additionally, comparing these values between brain-damaged and non-brain-damaged patients may provide valuable insights. Key Areas of Inquiry: 1. How do Pocc and P0.1 values correlate within brain injury patients undergoing pressure support ventilation? 2. To what extent can Pocc and P0.1 values serve as predictive indicators for successful extubation in patients with brain injuries? 3. What differentiates the Pocc and P0.1 values between patients with brain injuries and those without? Methodology: P0.1 and occlusion pressures are standard measurements for pressure support ventilation patients, taken by attending doctors as per protocol. We utilize electronic patient records for existing data. Unpaired T-test will be conducted to compare P0.1 and Pocc values between both study groups. Associations between P0.1 and Pocc and other study variables, such as extubation, will be explored with simple regression and correlation analysis. Depending on how the data evolve, subgroup analysis will be performed for patients with and without extubation failure. Results: While it is anticipated that neuro patients may exhibit high respiratory drive, the linkage between such elevation, quantified by P0.1, and successful extubation remains unknown The analysis will focus on determining the ability of these values to predict successful extubation and their potential impact on ventilation strategies. Conclusion: Further research is pending to fully understand the potential of these indices and their impact on mechanical ventilation in different patient populations and clinical scenarios. Understanding these relationships can aid in determining extubation readiness and tailoring ventilation strategies to improve patient outcomes in this specific patient population. Additionally, it is vital to account for the influence of sedatives, neurological scores, and BMI on respiratory drive and occlusion pressures to ensure a comprehensive analysis.Keywords: brain damage, diaphragm dysfunction, occlusion pressure, p0.1, respiratory drive
Procedia PDF Downloads 68777 Investigating Selected Traditional African Medicinal Plants for Anti-fibrotic Potential: Identification and Characterization of Bioactive Compounds Through Fourier-Transform Infrared Spectroscopy and Gas Chromatography-Mass Spectrometry Analysis
Authors: G. V. Manzane, S. J. Modise
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Uterine fibroids, also known as leiomyomas or myomas, are non-cancerous growths that develop in the muscular wall of the uterus during the reproductive years. The cause of uterine fibroids includes hormonal, genetic, growth factors, and extracellular matrix factors. Common symptoms of uterine fibroids include heavy and prolonged menstrual bleeding which can lead to a high risk of anemia, lower abdominal pains, pelvic pressure, infertility, and pregnancy loss. The growth of this tumor is a concern because of its negative impact on women’s health and the increase in their economic burden. Traditional medicinal plants have long been used in Africa for their potential therapeutic effects against various ailments. In this study, we aimed to identify and characterize bioactive compounds from selected African medicinal plants with potential anti-fibrotic properties using Fourier-transform infrared spectroscopy (FTIR) and gas chromatography-mass spectrometry (GCMS) analysis. Two medicinal plant species known for their traditional use in fibrosis-related conditions were selected for investigation. Aqueous extracts were prepared from the plant materials, and FTIR analysis was conducted to determine the functional groups present in the extracts. GCMS analysis was performed to identify the chemical constituents of the extracts. The FTIR analysis revealed the presence of various functional groups, such as phenols, flavonoids, terpenoids, and alkaloids, known for their potential therapeutic activities. These functional groups are associated with antioxidant, anti-inflammatory, and anti-fibrotic properties. The GCMS analysis identified several bioactive compounds, including flavonoids, alkaloids, terpenoids, and phenolic compounds, which are known for their pharmacological activities. The discovery of bioactive compounds in African medicinal plants that exhibit anti-fibrotic effects, opens up promising avenues for further research and development of potential treatments for fibrosis. This suggests the potential of these plants as a valuable source of novel therapeutic agents for treating fibrosis-related conditions. In conclusion, our study identified and characterized bioactive compounds from selected African medicinal plants using FTIR and GCMS analysis. The presence of compounds with known antifibrotic properties suggests that these plants hold promise as a potential source of natural products for the development of novel anti-fibrotic therapies.Keywords: uterine fibroids, african medicinal plants, bioactive compounds, identify and characterized
Procedia PDF Downloads 98776 The Affordable Housing Problems of Elderly Households in the Istanbul Metropolitan Area
Authors: Elifsu Sahin
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In the world and in Turkey, approximately 1 in 10 people is 65 years of age or older. The age group of 65 and over is the fastest-growing age group since 1990. This demographic aging trend and demographic transformation have spread over a long period in Western Europe and North America, while in Turkey, they have occurred over a relatively short period. The aging of the population poses many challenges in terms of housing supply, housing satisfaction, and economic access to housing, due to factors such as a decrease in the number of people in households, low incomes, and increased time spent in housing and housing neighborhoods. On the other hand, since 2000, neoliberal economic policies and government policies have led to serious growth in the construction and housing sectors in Turkey. During this process, the housing market in Turkey generally produced housing for high-income groups and foreigners. Housing has become an investment instrument, and rising housing prices and rents have seriously reduced both the affordability of housing and households' chances of living in healthy housing. Housing has become a growing problem for vulnerable groups such as low- and middle-income households, students, refugees, and the elderly. Moreover, in recent years, international migration, pandemics, economic crises, inflation, and the expected Istanbul earthquake have raised housing prices and rent in Turkey as a whole, especially in Istanbul. The aim of the study is to investigate how elderly households that don't own homes deal with the economic accessibility of housing and other affordability-related housing problems in the Istanbul Metropolitan Area today, when housing becomes an investment instrument, the issue of social housing is not on the agenda, and households can be added to the market according to their ability to pay. A complex method was adopted in the research, using a combination of various statistical data and interview findings. Based on household income, in-depth interviews were conducted with 100 elderly households who don't own their own homes and were randomly selected in identified neighborhoods, analyzing the micro-area within the districts in the Istanbul Metropolitan Area, where middle- and low-income households are concentrated. The study found that more than 50% of the net income of elderly households was spent on rent and other housing expenses. Some of the households said that they restrict spending on food, health, and entertainment because of their housing expenses. Among the findings of the study is that households receive financial support from their children or move into their children’s house for economic reasons. Due to the decrease in household income, especially after the loss of a spouse, the single individual moves into their children’s house. Moreover, some of the interviewed households had to change their house and move to a smaller, lower-rent house on the urban periphery for economic reasons after retirement, especially after 2020, despite their unwillingness.Keywords: affordable housing, elderly households, housing policy, istanbul metropolitan area
Procedia PDF Downloads 33775 Multi-Criteria Geographic Information System Analysis of the Costs and Environmental Impacts of Improved Overland Tourist Access to Kaieteur National Park, Guyana
Authors: Mark R. Leipnik, Dahlia Durga, Linda Johnson-Bhola
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Kaieteur is the most iconic National Park in the rainforest-clad nation of Guyana in South America. However, the magnificent 226-meter-high waterfall at its center is virtually inaccessible by surface transportation, and the occasional charter flights to the small airstrip in the park are too expensive for many tourists and residents. Thus, the largest waterfall in all of Amazonia, where the Potaro River plunges over a single free drop twice as high as Victoria Falls, remains preserved in splendid isolation inside a 57,000-hectare National Park established by the British in 1929, in the deepest recesses of a remote jungle canyon. Kaieteur Falls are largely unseen firsthand, but images of the falls are depicted on the Guyanese twenty dollar note, in every Guyanese tourist promotion, and on many items in the national capital of Georgetown. Georgetown is only 223-241 kilometers away from the falls. The lack of a single mileage figure demonstrates there is no single overland route. Any journey, except by air, involves changes of vehicles, a ferry ride, and a boat ride up a jungle river. It also entails hiking for many hours to view the falls. Surface access from Georgetown (or any city) is thus a 3-5 day-long adventure; even in the dry season, during the two wet seasons, travel is a particularly sticky proposition. This journey was made overland by the paper's co-author Dahlia Durga. This paper focuses on potential ways to improve overland tourist access to Kaieteur National Park from Georgetown. This is primarily a GIS-based analysis, using multiple criteria to determine the least cost means of creating all-weather road access to the area near the base of the falls while minimizing distance and elevation changes. Critically, it also involves minimizing the number of new bridges required to be built while utilizing the one existing ferry crossings of a major river. Cost estimates are based on data from road and bridge construction engineers operating currently in the interior of Guyana. The paper contains original maps generated with ArcGIS of the potential routes for such an overland connection, including the one deemed optimal. Other factors, such as the impact on endangered species habitats and Indigenous populations, are considered. This proposed infrastructure development is taking place at a time when Guyana is undergoing the largest boom in its history due to revenues from offshore oil and gas development. Thus, better access to the most important tourist attraction in the country is likely to happen eventually in some manner. But the questions of the most environmentally sustainable and least costly alternatives for such access remain. This paper addresses those questions and others related to access to this magnificent natural treasure and the tradeoffs such access will have on the preservation of the currently pristine natural environment of Kaieteur Falls.Keywords: nature tourism, GIS, Amazonia, national parks
Procedia PDF Downloads 165774 Self-Care and Emotional Wellbeing of Nurses Using Playback Theatre and Expressive Arts
Authors: Radhika Jain
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The nursing community in India face unique challenges ranging from lack of adequate career progression, low social status attached to the profession, poor nurse-to-patient ratio leading to heavy workload resulting in stress and burnout, lack of general recognition and the responsibility of often having to deal with the ire of the patients and their families. This study explores how a combination of Playback Theatre and Expressive Arts could be used as a very powerful tool to understand the concerns, and consequently as a self-care tool to bring about the sense of well-being and emotional awareness for the nurses. For the purpose of this study, Playback Theatre was used as an entry tool to understand the thoughts, feelings and concerns. Playback theatre is a unique improvisational form of theatre developed by Jonathan Fox and Jo Salas in 1975, in which audience share their own stories from their lives and the performers play them back through a range of improv techniques such as metaphor, poetry, music and movement. Playback Theatre helped in first warming them up to the idea of sharing and then gave them the confidence of a safe space to collectively go deeper into their emotional experiences. As the next step, structured sessions of Expressive Arts were conducted with the same set of nurses, for them to work on the issues and concerns they have (and which they shared during the Playback performance). These sessions were to enable longer engagements as many of the concerns expressed were related to perceptions and beliefs that have been ingrained over a period of time and hence it needs a longer engagement to be worked on in detail. The Expressive Art sessions helped in this regard. Expressive arts therapy combines psychology and the creative process to promote emotional growth and healing. The study was conducted at two places: one a geriatric centre and the other, a palliative care centre. The study revealed that concerns and challenges would not be identical across the nursing community or across similar types of health care organizations but would be specific to each organization or centre as the circumstances and set-up at each place would be different. At the geriatric centre, stress and burnout emerged as the main concerns while at the palliative care centre, the main concern that came up was around the difficulty the nurses faced in expressing emotions and in communicating their feelings. The objective analysis of the results of the study indicated how longer-term engagements using Expressive Arts as the modality helped the nurses have better awareness of their emotions and helped them develop tools of self-care tools while also tapping into their emotions to express and experience. The process of eliciting the main concerns from the nurses using a Playback Theatre performance and then following that with subsequent sessions of expressive arts helped the nurses in the way nurses approached their job and the reduced level of overwhelm that they felt.Keywords: palliative care, nurses, self-care, expressive arts, playback theatre
Procedia PDF Downloads 120773 The Effects of Stoke's Drag, Electrostatic Force and Charge on Penetration of Nanoparticles through N95 Respirators
Authors: Jacob Schwartz, Maxim Durach, Aniruddha Mitra, Abbas Rashidi, Glen Sage, Atin Adhikari
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NIOSH (National Institute for Occupational Safety and Health) approved N95 respirators are commonly used by workers in construction sites where there is a large amount of dust being produced from sawing, grinding, blasting, welding, etc., both electrostatically charged and not. A significant portion of airborne particles in construction sites could be nanoparticles created beside coarse particles. The penetration of the particles through the masks may differ depending on the size and charge of the individual particle. In field experiments relevant to this current study, we found that nanoparticles of medium size ranges are penetrating more frequently than nanoparticles of smaller and larger sizes. For example, penetration percentages of nanoparticles of 11.5 – 27.4 nm into a sealed N95 respirator on a manikin head ranged from 0.59 to 6.59%, whereas nanoparticles of 36.5 – 86.6 nm ranged from 7.34 to 16.04%. The possible causes behind this increased penetration of mid-size nanoparticles through mask filters are not yet explored. The objective of this study is to identify causes behind this unusual behavior of mid-size nanoparticles. We have considered such physical factors as Boltzmann distribution of the particles in thermal equilibrium with the air, kinetic energy of the particles at impact on the mask, Stoke’s drag force, and electrostatic forces in the mask stopping the particles. When the particles collide with the mask, only the particles that have enough kinetic energy to overcome the energy loss due to the electrostatic forces and the Stokes’ drag in the mask can pass through the mask. To understand this process, the following assumptions were made: (1) the effect of Stoke’s drag depends on the particles’ velocity at entry into the mask; (2) the electrostatic force is proportional to the charge on the particles, which in turn is proportional to the surface area of the particles; (3) the general dependence on electrostatic charge and thickness means that for stronger electrostatic resistance in the masks and thicker the masks’ fiber layers the penetration of particles is reduced, which is a sensible conclusion. In sampling situations where one mask was soaked in alcohol eliminating electrostatic interaction the penetration was much larger in the mid-range than the same mask with electrostatic interaction. The smaller nanoparticles showed almost zero penetration most likely because of the small kinetic energy, while the larger sized nanoparticles showed almost negligible penetration most likely due to the interaction of the particle with its own drag force. If there is no electrostatic force the fraction for larger particles grows. But if the electrostatic force is added the fraction for larger particles goes down, so diminished penetration for larger particles should be due to increased electrostatic repulsion, may be due to increased surface area and therefore larger charge on average. We have also explored the effect of ambient temperature on nanoparticle penetrations and determined that the dependence of the penetration of particles on the temperature is weak in the range of temperatures in the measurements 37-42°C, since the factor changes in the range from 3.17 10-3K-1 to 3.22 10-3K-1.Keywords: respiratory protection, industrial hygiene, aerosol, electrostatic force
Procedia PDF Downloads 194772 CLEAN Jakarta Waste Bank Project: Alternative Solution in Urban Solid Waste Management by Community Based Total Sanitation (CBTS) Approach
Authors: Mita Sirait
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Everyday Jakarta produces 7,000 tons of solid waste and only about 5,200 tons delivered to landfill out of the city by 720 trucks, the rest are left yet manageable, as reported by Government of Clean Sector. CLEAN Jakarta Project is aimed at empowering community to achieve healthy environment for children and families in urban slum in Semper Barat and Penjaringan sub-district of North Jakarta that consisted of 20,584 people. The project applies Community Based Total Sanitation, an approach to empowering community to achieve total hygiene and sanitation behaviour by triggering activities. As regulated by Ministry of Health, it has 5 pillars: (1) open defecation free, (2) hand-washing with soaps, (3) drinking-water treatment, (4) solid-waste management and (5) waste-water management; and 3 strategic components: 1) demand creation, 2) supply creation and 3) enabling environment. Demand creation is generated by triggering community’s reaction to their daily sanitation habits by exposing them to their surrounding where they can see faeces, waste and other environmental pollutant to stimulate disgusting, embarrassing and responsibility sense. Triggered people then challenged to commit to improving their hygiene practice such as to stop littering and start waste separation. In order to support this commitment, and for supply creation component, the project initiated waste bank with community working group. It facilitated capacity-building trainings, waste bank system formulation and meetings with local authorities to solicit land permit and waste bank decree. As it is of a general banking system, waste bank has customer service, teller, manager, legal paper and provides saving book and money transaction. In 8 months, two waste banks have established with 148 customers, 17 million rupiah cash, and about 9 million of stored recyclables. Approximately 2.5 tons of 15-35 types of recyclable are managed in both waste banks per week. On enabling environment, the project has initiated sanitation working group in community and multi sectors government level, and advocated both parties. The former is expected to promote behaviour change and monitoring in the community, while the latter is expected to support sanitation with regulations, strategies, appraisal and awards; to coordinate partnering and networking, and to replicate best practices to other areas.Keywords: urban community, waste management, Jakarta, community based total sanitation (CBTS)
Procedia PDF Downloads 294771 Brittle Fracture Tests on Steel Bridge Bearings: Application of the Potential Drop Method
Authors: Natalie Hoyer
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Usually, steel structures are designed for the upper region of the steel toughness-temperature curve. To address the reduced toughness properties in the temperature transition range, additional safety assessments based on fracture mechanics are necessary. These assessments enable the appropriate selection of steel materials to prevent brittle fracture. In this context, recommendations were established in 2011 to regulate the appropriate selection of steel grades for bridge bearing components. However, these recommendations are no longer fully aligned with more recent insights: Designing bridge bearings and their components in accordance with DIN EN 1337 and the relevant sections of DIN EN 1993 has led to an increasing trend of using large plate thicknesses, especially for long-span bridges. However, these plate thicknesses surpass the application limits specified in the national appendix of DIN EN 1993-2. Furthermore, compliance with the regulations outlined in DIN EN 1993-1-10 regarding material toughness and through-thickness properties requires some further modifications. Therefore, these standards cannot be directly applied to the material selection for bearings without additional information. In addition, recent findings indicate that certain bridge bearing components are subjected to high fatigue loads, necessitating consideration in structural design, material selection, and calculations. To address this issue, the German Center for Rail Traffic Research initiated a research project aimed at developing a proposal to enhance the existing standards. This proposal seeks to establish guidelines for the selection of steel materials for bridge bearings to prevent brittle fracture, particularly for thick plates and components exposed to specific fatigue loads. The results derived from theoretical analyses, including finite element simulations and analytical calculations, are verified through component testing on a large-scale. During these large-scale tests, where a brittle failure is deliberately induced in a bearing component, an artificially generated defect is introduced into the specimen at the predetermined hotspot. Subsequently, a dynamic load is imposed until the crack initiation process transpires, replicating realistic conditions akin to a sharp notch resembling a fatigue crack. To stop the action of the dynamic load in time, it is important to precisely determine the point at which the crack size transitions from stable crack growth to unstable crack growth. To achieve this, the potential drop measurement method is employed. The proposed paper informs about the choice of measurement method (alternating current potential drop (ACPD) or direct current potential drop (DCPD)), presents results from correlations with created FE models, and may proposes a new approach to introduce beach marks into the fracture surface within the framework of potential drop measurement.Keywords: beach marking, bridge bearing design, brittle fracture, design for fatigue, potential drop
Procedia PDF Downloads 42770 Project Management and International Development: Competencies for International Assignment
Authors: M. P. Leroux, C. Coulombe
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Projects are popular vehicles through which international aid is delivered in developing countries. To achieve their objectives, many northern organizations develop projects with local partner organizations in the developing countries through technical assistance projects. International aid and international development projects precisely have long been criticized for poor results although billions are spent every year. Little empirical research in the field of project management has the focus on knowledge transfer in international development context. This paper focuses particularly on personal dimensions of international assignees participating in project within local team members in the host country. We propose to explore the possible links with a human resource management perspective in order to shed light on the less research problematic of knowledge transfer in development cooperation projects. The process leading to capacity building being far complex, involving multiple dimensions and far from being linear, we propose here to assess if traditional research on expatriate in multinational corporations pertain to the field of project management in developing countries. The following question is addressed: in the context of international development project cooperation, what personal determinants should the selection process focus when looking to fill a technical assistance position in a developing country? To answer that question, we first reviewed the literature on expatriate in the context of inter organizational knowledge transfer. Second, we proposed a theoretical framework combining perspectives of development studies and management to explore if parallels can be draw between traditional international assignment and technical assistance project assignment in developing countries. We conducted an exploratory study using case studies from technical assistance initiatives led in Haiti, a country in Central America. Data were collected from multiple sources following qualitative study research methods. Direct observations in the field were allowed by local leaders of six organization; individual interviews with present and past international assignees, individual interview with local team members, and focus groups were organized in order to triangulate information collected. Contrary from empirical research on knowledge transfer in multinational corporations, results tend to show that technical expertise rank well behind many others characteristics. Results tend to show the importance of soft skills, as a prerequisite to succeed in projects where local team have to collaborate. More importantly, international assignees who were talking knowledge sharing instead of knowledge transfer seemed to feel more satisfied at the end of their mandate than the others. Reciprocally, local team members who perceived to have participated in a project with an expat looking to share instead of aiming to transfer knowledge seemed to describe the results of project in more positive terms than the others. Results obtained from this exploratory study open the way for a promising research agenda in the field of project management. It emphasises the urgent need to achieve a better understanding on the complex set of soft skills project managers or project chiefs would benefit to develop, in particular, the ability to absorb knowledge and the willingness to share one’s knowledge.Keywords: international assignee, international project cooperation, knowledge transfer, soft skills
Procedia PDF Downloads 142769 Curcumin Nanomedicine: A Breakthrough Approach for Enhanced Lung Cancer Therapy
Authors: Shiva Shakori Poshteh
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Lung cancer is a highly prevalent and devastating disease, representing a significant global health concern with profound implications for healthcare systems and society. Its high incidence, mortality rates, and late-stage diagnosis contribute to its formidable nature. To address these challenges, nanoparticle-based drug delivery has emerged as a promising therapeutic strategy. Curcumin (CUR), a natural compound derived from turmeric, has garnered attention as a potential nanomedicine for lung cancer treatment. Nanoparticle formulations of CUR offer several advantages, including improved drug delivery efficiency, enhanced stability, controlled release kinetics, and targeted delivery to lung cancer cells. CUR exhibits a diverse array of effects on cancer cells. It induces apoptosis by upregulating pro-apoptotic proteins, such as Bax and Bak, and downregulating anti-apoptotic proteins, such as Bcl-2. Additionally, CUR inhibits cell proliferation by modulating key signaling pathways involved in cancer progression. It suppresses the PI3K/Akt pathway, crucial for cell survival and growth, and attenuates the mTOR pathway, which regulates protein synthesis and cell proliferation. CUR also interferes with the MAPK pathway, which controls cell proliferation and survival, and modulates the Wnt/β-catenin pathway, which plays a role in cell proliferation and tumor development. Moreover, CUR exhibits potent antioxidant activity, reducing oxidative stress and protecting cells from DNA damage. Utilizing CUR as a standalone treatment is limited by poor bioavailability, lack of targeting, and degradation susceptibility. Nanoparticle-based delivery systems can overcome these challenges. They enhance CUR’s bioavailability, protect it from degradation, and improve absorption. Further, Nanoparticles enable targeted delivery to lung cancer cells through surface modifications or ligand-based targeting, ensuring sustained release of CUR to prolong therapeutic effects, reduce administration frequency, and facilitate penetration through the tumor microenvironment, thereby enhancing CUR’s access to cancer cells. Thus, nanoparticle-based CUR delivery systems promise to improve lung cancer treatment outcomes. This article provides an overview of lung cancer, explores CUR nanoparticles as a treatment approach, discusses the benefits and challenges of nanoparticle-based drug delivery, and highlights prospects for CUR nanoparticles in lung cancer treatment. Future research aims to optimize these delivery systems for improved efficacy and patient prognosis in lung cancer.Keywords: lung cancer, curcumin, nanomedicine, nanoparticle-based drug delivery
Procedia PDF Downloads 72768 A Qualitative Exploration of the Beliefs and Experiences of HIV-Related Self-Stigma Amongst Young Adults Living with HIV in Zimbabwe
Authors: Camille Rich, Nadine Ferris France, Ann Nolan, Webster Mavhu, Vongai Munatsi
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Background and Aim: Zimbabwe has one of the highest HIV rates in the world, with a 12.7% adult prevalence rate. Young adults are a key group affected by HIV, and one-third of all new infections in Zimbabwe are amongst people ages 18-24 years. Stigma remains one of the main barriers to managing and reducing the HIV crisis, especially for young adults. There are several types of stigma, including enacted stigma, the outward discrimination towards someone and self-stigma, the negative self-judgments one has towards themselves. Self-stigma can have severe consequences, including feelings of worthlessness, shame, suicidal thoughts, and avoidance of medical help. This can have detrimental effects on those living with HIV. However, the unique beliefs and impacts of self-stigma amongst key groups living with HIV have not yet been explored. Therefore, the focus of this study is on the beliefs and experiences of HIV-related self-stigma, as experienced by young adults living in Harare, Zimbabwe. Research Methods: A qualitative approach was taken for this study, using sixteen semi-structured interviews with young adults (18-24 years) who are living with HIV in Harare. Participants were conveniently and purposefully sampled as members of Africa, an organization dedicated to young people living with HIV. Interviews were conducted over Zoom due to the COVID-19 pandemic, recorded and then coded using the software NVivo. The data was analyzed using both inductive and deductive Thematic Analysis to find common themes. Results: All of the participants experienced HIV-related self-stigma, and both beliefs and experiences were explored. These negative self-perceptions included beliefs of worthlessness, hopelessness, and negative body image. The young adults described believing they were not good enough to be around HIV negative people or that they could never be loved due to their HIV status. Developing self-stigmatizing thoughts came from internalizing negative cultural values, stereotypes about people living with HIV, and adverse experiences. Three main themes of self-stigmatizing experiences emerged: disclosure difficulties, relationship complications, and being isolated. Fear of telling someone their status, rejection in a relationship, and being excluded by others due to their HIV status contributed to their self-stigma. These experiences caused feelings of loneliness, sadness, shame, fear, and low self-worth. Conclusions: This study explored the beliefs and experiences of HIV-related self-stigma of these young adults. The emergence of negative self-perceptions demonstrated deep-rooted beliefs of HIV-related self-stigma that adversely impact the participants. The negative self-perceptions and self-stigmatizing experiences caused the participants to feel worthless, hopeless, shameful, and alone-negatively impacting their physical and mental health, personal relationships, and sense of self-identity. These results can now be used to pursue interventions to target the specific beliefs and experiences of young adults living with HIV and reduce the adverse consequences of self-stigma.Keywords: beliefs, HIV, self-stigma, stigma, Zimbabwe
Procedia PDF Downloads 115767 A Visualization Classification Method for Identifying the Decayed Citrus Fruit Infected by Fungi Based on Hyperspectral Imaging
Authors: Jiangbo Li, Wenqian Huang
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Early detection of fungal infection in citrus fruit is one of the major problems in the postharvest commercialization process. The automatic and nondestructive detection of infected fruits is still a challenge for the citrus industry. At present, the visual inspection of rotten citrus fruits is commonly performed by workers through the ultraviolet induction fluorescence technology or manual sorting in citrus packinghouses to remove fruit subject with fungal infection. However, the former entails a number of problems because exposing people to this kind of lighting is potentially hazardous to human health, and the latter is very inefficient. Orange is used as a research object. This study would focus on this problem and proposed an effective method based on Vis-NIR hyperspectral imaging in the wavelength range of 400-1000 nm with a spectroscopic resolution of 2.8 nm. In this work, three normalization approaches are applied prior to analysis to reduce the effect of sample curvature on spectral profiles, and it is found that mean normalization was the most effective pretreatment for decreasing spectral variability due to curvature. Then, principal component analysis (PCA) was applied to a dataset composing of average spectra from decayed and normal tissue to reduce the dimensionality of data and observe the ability of Vis-NIR hyper-spectra to discriminate data from two classes. In this case, it was observed that normal and decayed spectra were separable along the resultant first principal component (PC1) axis. Subsequently, five wavelengths (band) centered at 577, 702, 751, 808, and 923 nm were selected as the characteristic wavelengths by analyzing the loadings of PC1. A multispectral combination image was generated based on five selected characteristic wavelength images. Based on the obtained multispectral combination image, the intensity slicing pseudocolor image processing method is used to generate a 2-D visual classification image that would enhance the contrast between normal and decayed tissue. Finally, an image segmentation algorithm for detection of decayed fruit was developed based on the pseudocolor image coupled with a simple thresholding method. For the investigated 238 independent set samples including infected fruits infected by Penicillium digitatum and normal fruits, the total success rate is 100% and 97.5%, respectively, and, the proposed algorithm also used to identify the orange infected by penicillium italicum with a 100% identification accuracy, indicating that the proposed multispectral algorithm here is an effective method and it is potential to be applied in citrus industry.Keywords: citrus fruit, early rotten, fungal infection, hyperspectral imaging
Procedia PDF Downloads 299766 Creating Standards to Define the Role of Employment Specialists: A Case Study
Authors: Joseph Ippolito, David Megenhardt
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In the United States, displaced workers, the unemployed and those seeking to build additional work skills are provided employment training and job placement services through a system of One-Stop Career Centers that are sponsored by the country’s 593 local Workforce Boards. During the period 2010-2015, these centers served roughly 8 million individuals each year. The quality of services provided at these centers rests upon professional employment specialists who work closely with clients to identify their job interests, to connect them to appropriate training opportunities, to match them with needed supportive social services and to guide them to eventual employment. Despite the crucial role these Employment Specialists play, currently there are no broadly accepted standards that establish what these individuals are expected to do in the workplace, nor are there indicators to assess how well an individual performs these responsibilities. Education Development Center (EDC) and the United Labor Agency (ULA) have partnered to create a foundation upon which curriculum can be developed that addresses the skills, knowledge and behaviors that Employment Specialists must master in order to serve their clients effectively. EDC is a non-profit, education research and development organization that designs, implements, and evaluates programs to improve education, health and economic opportunity worldwide. ULA is the social action arm of organized labor in Greater Cleveland, Ohio. ULA currently operates One-Stop Career Centers in both Cleveland and Pittsburgh, Pennsylvania. This case study outlines efforts taken to create standards that define the work of Employment Specialists and to establish indicators that can guide assessment of work performance. The methodology involved in the study has engaged a panel of expert Employment Specialists in rigorous, structured dialogues that analyze and identify the characteristics that enable them to be effective in their jobs. It has also drawn upon and integrated reviews of the panel’s work by more than 100 other Employment Specialists across the country. The results of this process are two documents that provide resources for developing training curriculum for future Employment Specialists, namely: an occupational profile of an Employment Specialist that offers a detailed articulation of the skills, knowledge and behaviors that enable individuals to be successful at this job, and; a collection of performance based indicators, aligned to the profile, which illustrate what the work responsibilities of an Employment Specialist 'look like' a four levels of effectiveness ranging from novice to expert. The method of occupational analysis used by the study has application across a broad number of fields.Keywords: assessment, employability, job standards, workforce development
Procedia PDF Downloads 234765 Deep Learning-Based Classification of 3D CT Scans with Real Clinical Data; Impact of Image format
Authors: Maryam Fallahpoor, Biswajeet Pradhan
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Background: Artificial intelligence (AI) serves as a valuable tool in mitigating the scarcity of human resources required for the evaluation and categorization of vast quantities of medical imaging data. When AI operates with optimal precision, it minimizes the demand for human interpretations and, thereby, reduces the burden on radiologists. Among various AI approaches, deep learning (DL) stands out as it obviates the need for feature extraction, a process that can impede classification, especially with intricate datasets. The advent of DL models has ushered in a new era in medical imaging, particularly in the context of COVID-19 detection. Traditional 2D imaging techniques exhibit limitations when applied to volumetric data, such as Computed Tomography (CT) scans. Medical images predominantly exist in one of two formats: neuroimaging informatics technology initiative (NIfTI) and digital imaging and communications in medicine (DICOM). Purpose: This study aims to employ DL for the classification of COVID-19-infected pulmonary patients and normal cases based on 3D CT scans while investigating the impact of image format. Material and Methods: The dataset used for model training and testing consisted of 1245 patients from IranMehr Hospital. All scans shared a matrix size of 512 × 512, although they exhibited varying slice numbers. Consequently, after loading the DICOM CT scans, image resampling and interpolation were performed to standardize the slice count. All images underwent cropping and resampling, resulting in uniform dimensions of 128 × 128 × 60. Resolution uniformity was achieved through resampling to 1 mm × 1 mm × 1 mm, and image intensities were confined to the range of (−1000, 400) Hounsfield units (HU). For classification purposes, positive pulmonary COVID-19 involvement was designated as 1, while normal images were assigned a value of 0. Subsequently, a U-net-based lung segmentation module was applied to obtain 3D segmented lung regions. The pre-processing stage included normalization, zero-centering, and shuffling. Four distinct 3D CNN models (ResNet152, ResNet50, DensNet169, and DensNet201) were employed in this study. Results: The findings revealed that the segmentation technique yielded superior results for DICOM images, which could be attributed to the potential loss of information during the conversion of original DICOM images to NIFTI format. Notably, ResNet152 and ResNet50 exhibited the highest accuracy at 90.0%, and the same models achieved the best F1 score at 87%. ResNet152 also secured the highest Area under the Curve (AUC) at 0.932. Regarding sensitivity and specificity, DensNet201 achieved the highest values at 93% and 96%, respectively. Conclusion: This study underscores the capacity of deep learning to classify COVID-19 pulmonary involvement using real 3D hospital data. The results underscore the significance of employing DICOM format 3D CT images alongside appropriate pre-processing techniques when training DL models for COVID-19 detection. This approach enhances the accuracy and reliability of diagnostic systems for COVID-19 detection.Keywords: deep learning, COVID-19 detection, NIFTI format, DICOM format
Procedia PDF Downloads 88764 Mastopexy with the "Dermoglandular Autоaugmentation" Method. Increased Stability of the Result. Personalized Technique
Authors: Maksim Barsakov
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Introduction. In modern plastic surgery, there are a large number of breast lift techniques.Due to the spreading information about the "side effects" of silicone implants, interest in implant-free mastopexy is increasing year after year. However, despite the variety of techniques, patients sometimes do not get full satisfaction from the results of mastopexy because of the unexpressed filling of the upper pole, extended anchoring postoperative scars and sometimes because of obtaining an aesthetically unattractive breast shape. The stability of the result after mastopexy depends on many factors, including postoperative rehabilitation. Stability of weight and hormonal background, stretchability of tissues. The high recurrence rate of ptosis and short-term aesthetic effect of mastopexy indicate the urgency of improving surgical techniques and increasing the stabilization of breast tissue. Purpose of the study. To develop and introduce into practice a technique of mastopexy based on the use of a modified Ribeiro flap, as well as elements of tissue movement and fixation designed to increase the stability of postoperative mastopexy. In addition, to give indications for the application of this surgical technique. Materials and Methods. it operated on 103 patients aged 18 to 53 years from 2019 to 2023 according to the reported method. These were patients with primary mastopexy, secondary mastopexy, and also patient with implant removal and one-stage mastopexy. The patients were followed up for 12 months to assess the stability of the result. Results and their discussion. Observing the patients, we noted greater stability of the breast shape and upper pole filling compared to the conventional classical methods. We did not have to resort to anchoring scars. In 90 percent of cases, a inverted T-shape scar was used. In 10 percent, the J-scar was used. The quantitative distribution of complications identified among the operated patients is as follows: worsened healing of the junction of vertical and horizontal sutures at the period of 1-1.5 months after surgery - 15 patients; at treatment with ointment method healing was observed in 7-30 days; permanent loss of NAC sensitivity - 0 patients; vascular disorders in the area of NAC/areola necrosis - 0 patients; marginal necrosis of the areola-2 patients. independent healing within 3-4 weeks without aesthetic defects. Aesthetically unacceptable mature scars-3 patients; partial liponecrosis of the autoflap unilaterally - 1 patient. recurrence of ptosis - 1 patient (after weight loss of 12 kg). In the late postoperative period, 2 patients became pregnant, gave birth, and no lactation problems were observed. Conclusion. Thus, in the world of plastic surgery methods of breast lift continue to improve, which is especially relevant in modern times, due to the increased attention to this operation. The author's proposed method of mastopexy with glandular autoflap allows obtaining in most cases a stable result, a fuller breast shape, avoiding the presence of extended anchoring scars, and also preserves the possibility of lactation. The author of this article has obtained a patent for invention for this method of mastopexy.Keywords: mastopexy, mammoplasty, autoflap, personal technique
Procedia PDF Downloads 36763 A Study of the Prevalence of Trichinellosis in Domestic and Wild Animals for the Region of Sofia, Bulgaria
Authors: Valeria Dilcheva, Svetlozara Petkova, Ivelin Vladov
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Nemathodes of the genus Trichinella are zoonotic parasites with a cosmopolitan distribution. More than 100 species of mammals, birds and reptiles are involved in the natural cycle of this nematode. At present, T. spiralis, T. pseudospiralis, and T. britovi have been found in Bulgaria. The existence of natural wildlife and domestic reservoirs of Trichinella spp. can be a serious threat to human health. Three trichinella isolates caused human trichinella infection outbreaks from three regions of Sofia City Province were used for the research: sample No. 1 - Ratus norvegicus, sample No. 2 – domestic pig (Sus scrofa domestica), sample No. 3 - domestic pig (Sus scrofa domestica). Trichinella larvae of the studied species were isolated via digestive method (pepsin, hydrochloric acid, water) at 37ºC by standard procedure and were determined by gender (male and female) based on their morphological characteristics. As a reference trichinella species were used: T. spiralis, T. pseudospiralis, T. nativa and T. britovi. Single male and female larvae of the three isolates were crossed with single male and female larvae of the reference trichinella species as well as reciprocally. As a result of cross-breeding, offspring of muscular larvae with T. spiralis and T. britovi were obtained, while in experiments with T. pseudospiralis and T. nativa, trichinella larvae were not found in the laboratory mice. The results obtained in the control groups indicate that the trichinella larvae used from the isolates and the four trichinella species are infective. Also, the infective ability of the F1 offspring from the successful cross-breeding between isolates and reference species was investigated. Through the data obtained in the experiment was found that isolates No. 1 and No. 2 belong to the species T. spiralis, and isolate No. 3 belongs to the species T. britovi. The results were confirmed by PCR and real-time PCR analysis. Thus the presence and circulation of the species T. spiralis and T. britovi in Bulgaria was confirmed. Probably the rodents (rats) are involved in the distribution of T. spiralis in urban environment. The species T. britovi found in a domestic pig speaks of some contact with wild animals for which T. britovi is characteristic. The probable reason is that a large number of farmers in Bulgaria practice the free-range breeding of domestic pigs. Part of the farmers also used as food for domestic pigs waste products from the game (foxes, jackals, bears, wolves) and probably thus the infection was obtained. The distribution range of trichinella species in Bulgaria is not strictly outlined. It is believed that T. spiralis is most common in domestic animals and T. britovi and T. pseudospiralis are characteristic of wildlife. To answer the question whether wild and synanthropic animals are infected with the same or different trichinella species, which species predominate in nature and what their distribution among different hosts is, further research is required.Keywords: cross-breeding, Sofia, trichinellosis, Trichinella britovi, Trichinella spiralis
Procedia PDF Downloads 189762 Semiconductor Properties of Natural Phosphate Application to Photodegradation of Basic Dyes in Single and Binary Systems
Authors: Y. Roumila, D. Meziani, R. Bagtache, K. Abdmeziem, M. Trari
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Heterogeneous photocatalysis over semiconductors has proved its effectiveness in the treatment of wastewaters since it works under soft conditions. It has emerged as a promising technique, giving rise to less toxic effluents and offering the opportunity of using sunlight as a sustainable and renewable source of energy. Many compounds have been used as photocatalysts. Though synthesized ones are intensively used, they remain expensive, and their synthesis involves special conditions. We thus thought of implementing a natural material, a phosphate ore, due to its low cost and great availability. Our work is devoted to the removal of hazardous organic pollutants, which cause several environmental problems and health risks. Among them, dye pollutants occupy a large place. This work relates to the study of the photodegradation of methyl violet (MV) and rhodamine B (RhB), in single and binary systems, under UV light and sunlight irradiation. Methyl violet is a triarylmethane dye, while RhB is a heteropolyaromatic dye belonging to the Xanthene family. In the first part of this work, the natural compound was characterized using several physicochemical and photo-electrochemical (PEC) techniques: X-Ray diffraction, chemical, and thermal analyses scanning electron microscopy, UV-Vis diffuse reflectance measurements, and FTIR spectroscopy. The electrochemical and photoelectrochemical studies were performed with a Voltalab PGZ 301 potentiostat/galvanostat at room temperature. The structure of the phosphate material was well characterized. The photo-electrochemical (PEC) properties are crucial for drawing the energy band diagram, in order to suggest the formation of radicals and the reactions involved in the dyes photo-oxidation mechanism. The PEC characterization of the natural phosphate was investigated in neutral solution (Na₂SO₄, 0.5 M). The study revealed the semiconducting behavior of the phosphate rock. Indeed, the thermal evolution of the electrical conductivity was well fitted by an exponential type law, and the electrical conductivity increases with raising the temperature. The Mott–Schottky plot and current-potential J(V) curves recorded in the dark and under illumination clearly indicate n-type behavior. From the results of photocatalysis, in single solutions, the changes in MV and RhB absorbance in the function of time show that practically all of the MV was removed after 240 mn irradiation. For RhB, the complete degradation was achieved after 330 mn. This is due to its complex and resistant structure. In binary systems, it is only after 120 mn that RhB begins to be slowly removed, while about 60% of MV is already degraded. Once nearly all of the content of MV in the solution has disappeared (after about 250 mn), the remaining RhB is degraded rapidly. This behaviour is different from that observed in single solutions where both dyes are degraded since the first minutes of irradiation.Keywords: environment, organic pollutant, phosphate ore, photodegradation
Procedia PDF Downloads 132761 Biodegradation Effects onto Source Identification of Diesel Fuel Contaminated Soils
Authors: Colin S. Chen, Chien-Jung Tien, Hsin-Jan Huang
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For weathering studies, the change of chemical constituents by biodegradation effect in diesel-contaminated soils are important factors to be considered, especially when there is a prolonged period of weathering processes. The objective was to evaluate biodegradation effects onto hydrocarbon fingerprinting and distribution patterns of diesel fuels, fuel source screening and differentiation, source-specific marker compounds, and diagnostic ratios of diesel fuel constituents by laboratory and field studies. Biodegradation processes of diesel contaminated soils were evaluated by experiments lasting for 15 and 12 months, respectively. The degradation of diesel fuel in top soils was affected by organic carbon content and biomass of microorganisms in soils. Higher depletion of total petroleum hydrocarbon (TPH), n-alkanes, and polynuclear aromatic hydrocarbons (PAHs) and their alkyl homologues was observed in soils containing higher organic carbon content and biomass. Decreased ratio of selected isoprenoids (i.e., pristane (Pr) and phytane (Ph)) including n-C17/pristane and n-C18/phytane was observed. The ratio of pristane/phytane was remained consistent for a longer period of time. At the end of the experimental period, a decrease of pristane/phytane was observed. Biomarker compounds of bicyclic sesquiterpanes (BS) were less susceptible to the effects of biodegradation. The ratios of characteristic factors such as C15 sesquiterpane/ 8β(H)-drimane (BS3/BS5), C15 sesquiterpane/ 8β(H)-drimane (BS4/BS5), 8β(H)-drimane/8β(H)-homodrimane (BS5/BS10), and C15 sesquiterpane/8β(H)-homodrimane (BS3/BS10) could be adopted for source identification of diesel fuels in top soil. However, for biodegradation processes lasted for six months but shorter than nine months, only BS3/BS5 and BS3/BS10 could be distinguished in two diesel fuels. In subsoil experiments (contaminated soil located 50 cm below), the ratios of characteristic factors including BS3/BS5, BS4/BS5, and BS5/BS10 were valid for source identification of two diesel fuels for nine month biodegradation. At the early stage of contamination, biomass of soil decreased significantly. However, 6 and 7 dominant species were found in soils in top soil experiments, respectively. With less oxygen and nutrients in subsoil, less biomass of microorganisms was observed in subsoils. Only 2 and 4 diesel-degrading species of microorganisms were identified in two soils, respectively. Parameters of double ratio such as fluorene/C1-fluorene: C2-phenanthrene/C3-phenanthrene (C0F/C1F:C2P/C3P) in both top and subsoil, C2-naphthalene/C2-phenanthrene: C1-phenanthrene/C3-phenanthrene (C2N/C2P:C1P/C3P), and C1-phenanthrene/C1-fluorene: C3-naphthalene/C3-phenanthrene (C1P/C1F:C3N/C3P) in subsoil could serve as forensic indicators in diesel contaminated sites. BS3/BS10:BS4/BS5 could be used in 6 to 9 months of biodegradation processes. Results of principal component analysis (PCA) indicated that source identification of diesel fuels in top soil could only be perofrmed for weathering process less than 6 months. For subsoil, identification can be conducted for weathering process less than 9 months. Ratio of isoprenoids (pristane and phytane) and PAHs might be affected by biodegradation in spilled sites. The ratios of bicyclic sesquiterpanes could serve as forensic indicators in diesel-contaminated soils. Finally, source identification was attemped for samples collected from different fuel contaminated sites by using the unique pattern of sesquiterpanes. It was anticipated that the information generated from this study would be adopted by decision makers to evaluate the liability of cleanup in diesel contaminated sites.Keywords: biodegradation, diagnostic ratio, diesel fuel, environmental forensics
Procedia PDF Downloads 228760 Generative Design of Acoustical Diffuser and Absorber Elements Using Large-Scale Additive Manufacturing
Authors: Saqib Aziz, Brad Alexander, Christoph Gengnagel, Stefan Weinzierl
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This paper explores a generative design, simulation, and optimization workflow for the integration of acoustical diffuser and/or absorber geometry with embedded coupled Helmholtz-resonators for full-scale 3D printed building components. Large-scale additive manufacturing in conjunction with algorithmic CAD design tools enables a vast amount of control when creating geometry. This is advantageous regarding the increasing demands of comfort standards for indoor spaces and the use of more resourceful and sustainable construction methods and materials. The presented methodology highlights these new technological advancements and offers a multimodal and integrative design solution with the potential for an immediate application in the AEC-Industry. In principle, the methodology can be applied to a wide range of structural elements that can be manufactured by additive manufacturing processes. The current paper focuses on a case study of an application for a biaxial load-bearing beam grillage made of reinforced concrete, which allows for a variety of applications through the combination of additive prefabricated semi-finished parts and in-situ concrete supplementation. The semi-prefabricated parts or formwork bodies form the basic framework of the supporting structure and at the same time have acoustic absorption and diffusion properties that are precisely acoustically programmed for the space underneath the structure. To this end, a hybrid validation strategy is being explored using a digital and cross-platform simulation environment, verified with physical prototyping. The iterative workflow starts with the generation of a parametric design model for the acoustical geometry using the algorithmic visual scripting editor Grasshopper3D inside the building information modeling (BIM) software Revit. Various geometric attributes (i.e., bottleneck and cavity dimensions) of the resonator are parameterized and fed to a numerical optimization algorithm which can modify the geometry with the goal of increasing absorption at resonance and increasing the bandwidth of the effective absorption range. Using Rhino.Inside and LiveLink for Revit, the generative model was imported directly into the Multiphysics simulation environment COMSOL. The geometry was further modified and prepared for simulation in a semi-automated process. The incident and scattered pressure fields were simulated from which the surface normal absorption coefficients were calculated. This reciprocal process was repeated to further optimize the geometric parameters. Subsequently the numerical models were compared to a set of 3D concrete printed physical twin models, which were tested in a .25 m x .25 m impedance tube. The empirical results served to improve the starting parameter settings of the initial numerical model. The geometry resulting from the numerical optimization was finally returned to grasshopper for further implementation in an interdisciplinary study.Keywords: acoustical design, additive manufacturing, computational design, multimodal optimization
Procedia PDF Downloads 157759 Application of Response Surface Methodology to Assess the Impact of Aqueous and Particulate Phosphorous on Diazotrophic and Non-Diazotrophic Cyanobacteria Associated with Harmful Algal Blooms
Authors: Elizabeth Crafton, Donald Ott, Teresa Cutright
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Harmful algal blooms (HABs), more notably cyanobacteria-dominated HABs, compromise water quality, jeopardize access to drinking water and are a risk to public health and safety. HABs are representative of ecosystem imbalance largely caused by environmental changes, such as eutrophication, that are associated with the globally expanding human population. Cyanobacteria-dominated HABs are anticipated to increase in frequency, magnitude, and are predicted to plague a larger geographical area as a result of climate change. The weather pattern is important as storm-driven, pulse-input of nutrients have been correlated to cyanobacteria-dominated HABs. The mobilization of aqueous and particulate nutrients and the response of the phytoplankton community is an important relationship in this complex phenomenon. This relationship is most apparent in high-impact areas of adequate sunlight, > 20ᵒC, excessive nutrients and quiescent water that corresponds to ideal growth of HABs. Typically the impact of particulate phosphorus is dismissed as an insignificant contribution; which is true for areas that are not considered high-impact. The objective of this study was to assess the impact of a simulated storm-driven, pulse-input of reactive phosphorus and the response of three different cyanobacteria assemblages (~5,000 cells/mL). The aqueous and particulate sources of phosphorus and changes in HAB were tracked weekly for 4 weeks. The first cyanobacteria composition consisted of Planktothrix sp., Microcystis sp., Aphanizomenon sp., and Anabaena sp., with 70% of the total population being non-diazotrophic and 30% being diazotrophic. The second was comprised of Anabaena sp., Planktothrix sp., and Microcystis sp., with 87% diazotrophic and 13% non-diazotrophic. The third composition has yet to be determined as these experiments are ongoing. Preliminary results suggest that both aqueous and particulate sources are contributors of total reactive phosphorus in high-impact areas. The results further highlight shifts in the cyanobacteria assemblage after the simulated pulse-input. In the controls, the reactors dosed with aqueous reactive phosphorus maintained a constant concentration for the duration of the experiment; whereas, the reactors that were dosed with aqueous reactive phosphorus and contained soil decreased from 1.73 mg/L to 0.25 mg/L of reactive phosphorus from time zero to 7 days; this was higher than the blank (0.11 mg/L). Suggesting a binding of aqueous reactive phosphorus to sediment, which is further supported by the positive correlation observed between total reactive phosphorus concentration and turbidity. The experiments are nearly completed and a full statistical analysis will be completed of the results prior to the conference.Keywords: Anabaena, cyanobacteria, harmful algal blooms, Microcystis, phosphorous, response surface methodology
Procedia PDF Downloads 167758 The Impression of Adaptive Capacity of the Rural Community in the Indian Himalayan Region: A Way Forward for Sustainable Livelihood Development
Authors: Rommila Chandra, Harshika Choudhary
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The value of integrated, participatory, and community based sustainable development strategies is eminent, but in practice, it still remains fragmentary and often leads to short-lived results. Despite the global presence of climate change, its impacts are felt differently by different communities based on their vulnerability. The developing countries have the low adaptive capacity and high dependence on environmental variables, making them highly susceptible to outmigration and poverty. We need to understand how to enable these approaches, taking into account the various governmental and non-governmental stakeholders functioning at different levels, to deliver long-term socio-economic and environmental well-being of local communities. The research assessed the financial and natural vulnerability of Himalayan networks, focusing on their potential to adapt to various changes, through accessing their perceived reactions and local knowledge. The evaluation was conducted by testing indices for vulnerability, with a major focus on indicators for adaptive capacity. Data for the analysis were collected from the villages around Govind National Park and Wildlife Sanctuary, located in the Indian Himalayan Region. The villages were stratified on the basis of connectivity via road, thus giving two kinds of human settlements connected and isolated. The study focused on understanding the complex relationship between outmigration and the socio-cultural sentiments of local people to not abandon their land, assessing their adaptive capacity for livelihood opportunities, and exploring their contribution that integrated participatory methodologies can play in delivering sustainable development. The result showed that the villages having better road connectivity, access to market, and basic amenities like health and education have a better understanding about the climatic shift, natural hazards, and a higher adaptive capacity for income generation in comparison to the isolated settlements in the hills. The participatory approach towards environmental conservation and sustainable use of natural resources were seen more towards the far-flung villages. The study helped to reduce the gap between local understanding and government policies by highlighting the ongoing adaptive practices and suggesting precautionary strategies for the community studied based on their local conditions, which differ on the basis of connectivity and state of development. Adaptive capacity in this study has been taken as the externally driven potential of different parameters, leading to a decrease in outmigration and upliftment of the human environment that could lead to sustainable livelihood development in the rural areas of Himalayas.Keywords: adaptive capacity, Indian Himalayan region, participatory, sustainable livelihood development
Procedia PDF Downloads 118757 Rethinking the Languages for Specific Purposes Syllabus in the 21st Century: Topic-Centered or Skills-Centered
Authors: A. Knezović
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21st century has transformed the labor market landscape in a way of posing new and different demands on university graduates as well as university lecturers, which means that the knowledge and academic skills students acquire in the course of their studies should be applicable and transferable from the higher education context to their future professional careers. Given the context of the Languages for Specific Purposes (LSP) classroom, the teachers’ objective is not only to teach the language itself, but also to prepare students to use that language as a medium to develop generic skills and competences. These include media and information literacy, critical and creative thinking, problem-solving and analytical skills, effective written and oral communication, as well as collaborative work and social skills, all of which are necessary to make university graduates more competitive in everyday professional environments. On the other hand, due to limitations of time and large numbers of students in classes, the frequently topic-centered syllabus of LSP courses places considerable focus on acquiring the subject matter and specialist vocabulary instead of sufficient development of skills and competences required by students’ prospective employers. This paper intends to explore some of those issues as viewed both by LSP lecturers and by business professionals in their respective surveys. The surveys were conducted among more than 50 LSP lecturers at higher education institutions in Croatia, more than 40 HR professionals and more than 60 university graduates with degrees in economics and/or business working in management positions in mainly large and medium-sized companies in Croatia. Various elements of LSP course content have been taken into consideration in this research, including reading and listening comprehension of specialist texts, acquisition of specialist vocabulary and grammatical structures, as well as presentation and negotiation skills. The ability to hold meetings, conduct business correspondence, write reports, academic texts, case studies and take part in debates were also taken into consideration, as well as informal business communication, business etiquette and core courses delivered in a foreign language. The results of the surveys conducted among LSP lecturers will be analyzed with reference to what extent those elements are included in their courses and how consistently and thoroughly they are evaluated according to their course requirements. Their opinions will be compared to the results of the surveys conducted among professionals from a range of industries in Croatia so as to examine how useful and important they perceive the same elements of the LSP course content in their working environments. Such comparative analysis will thus show to what extent the syllabi of LSP courses meet the demands of the employment market when it comes to the students’ language skills and competences, as well as transferable skills. Finally, the findings will also be compared to the observations based on practical teaching experience and the relevant sources that have been used in this research. In conclusion, the ideas and observations in this paper are merely open-ended questions that do not have conclusive answers, but might prompt LSP lecturers to re-evaluate the content and objectives of their course syllabi.Keywords: languages for specific purposes (LSP), language skills, topic-centred syllabus, transferable skills
Procedia PDF Downloads 308756 Poly(Acrylamide-Co-Itaconic Acid) Nanocomposite Hydrogels and Its Use in the Removal of Lead in Aqueous Solution
Authors: Majid Farsadrouh Rashti, Alireza Mohammadinejad, Amir Shafiee Kisomi
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Lead (Pb²⁺), a cation, is a prime constituent of the majority of the industrial effluents such as mining, smelting and coal combustion, Pb-based painting and Pb containing pipes in water supply systems, paper and pulp refineries, printing, paints and pigments, explosive manufacturing, storage batteries, alloy and steel industries. The maximum permissible limit of lead in the water used for drinking and domesticating purpose is 0.01 mg/L as advised by Bureau of Indian Standards, BIS. This becomes the acceptable 'safe' level of lead(II) ions in water beyond which, the water becomes unfit for human use and consumption, and is potential enough to lead health problems and epidemics leading to kidney failure, neuronal disorders, and reproductive infertility. Superabsorbent hydrogels are loosely crosslinked hydrophilic polymers that in contact with aqueous solution can easily water and swell to several times to their initial volume without dissolving in aqueous medium. Superabsorbents are kind of hydrogels capable to swell and absorb a large amount of water in their three-dimensional networks. While the shapes of hydrogels do not change extensively during swelling, because of tremendously swelling capacity of superabsorbent, their shape will broadly change.Because of their superb response to changing environmental conditions including temperature pH, and solvent composition, superabsorbents have been attracting in numerous industrial applications. For instance, water retention property and subsequently. Natural-based superabsorbent hydrogels have attracted much attention in medical pharmaceutical, baby diapers, agriculture, and horticulture because of their non-toxicity, biocompatibility, and biodegradability. Novel superabsorbent hydrogel nanocomposites were prepared by graft copolymerization of acrylamide and itaconic acid in the presence of nanoclay (laponite), using methylene bisacrylamide (MBA) and potassium persulfate, former as a crosslinking agent and the second as an initiator. The superabsorbent hydrogel nanocomposites structure was characterized by FTIR spectroscopy, SEM and TGA Spectroscopy adsorption of metal ions on poly (AAm-co-IA). The equilibrium swelling values of copolymer was determined by gravimetric method. During the adsorption of metal ions on polymer, residual metal ion concentration in the solution and the solution pH were measured. The effects of the clay content of the hydrogel on its metal ions uptake behavior were studied. The NC hydrogels may be considered as a good candidate for environmental applications to retain more water and to remove heavy metals.Keywords: adsorption, hydrogel, nanocomposite, super adsorbent
Procedia PDF Downloads 187755 Regional Review of Outcome of Cervical Smears Reported with Cytological Features of Non Cervical Glandular Neoplasia
Authors: Uma Krishnamoorthy, Vivienne Beavers, Janet Marshall
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Introduction: Cervical cytology showing features raising the suspicion of non cervical glandular neoplasia are reported as code 0 under the United Kingdom National Health Service Cervical screening programme ( NHSCSP). As the suspicion is regarding non cervical neoplasia, smear is reported as normal and patient informed that cervical screening result is normal. GP receives copy of results where it states further referral is indicated in small font within text of report. Background: There were several incidents of delayed diagnosis of endometrial cancer in Lancashire which prompted this Northwest Regional review to enable an understanding of underlying pathology outcome of code zero smears to raise awareness and also to review whether further action on wording of smear results was indicated to prevent such delay. Methodology: All Smears reported at the Manchester cytology centre who process cytology for Lancashire population from March 2013 to March 2014 were reviewed and histological diagnosis outcome of women in whom smear was reported as code zero was reviewed retrospectively . Results: Total smears reported by the cytology centre during this period was approximately 109400. Reports issued with result code 0 among this during this time period was 49.Results revealed that among three fourth (37) of women with code zero smear (N=49), evidence of underlying pathology of non cervical origin was confirmed. Of this, 73 % (36) were due to endometrial pathology with 49 % (24) endometrial carcinoma, 12 % (6)polyp, 4 % atypical endometrial hyperplasia (2), 6 % endometrial hyperplasia without atypia (3), and 2 % adenomyosis (1 case) and 2 % ( 1 case) due to ovarian adenocarcinoma. Conclusion: This review demonstrated that more than half (51 %) of women with a code 0 smear report were diagnosed with underlying carcinoma and 75 % had a confirmed underlying pathology contributory to code 0 smear findings. Recommendations and Action Plan: A local rapid access referral and management pathway for this group of women was implemented as a result of this in our unit. The findings and Pathway were shared with other regional units served by the cytology centre through the Pan Lancashire cervical screening board and through the Cytology centre. Locally, the smear report wording was updated to include a rubber stamp/ print in "Red Bold letters" stating that " URGENT REFERRAL TO GYNAECOLOGY IS INDICATED". Findings were also shared through the Pan Lancashire board with National cervical screening programme board, and revisions to wording of code zero smear reports to highlight the need for Urgent referral has now been agreed at National level to be implemented.Keywords: code zero smears, endometrial cancer, non cervical glandular neoplasia, ovarian cancer
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