Search results for: advanced maternal age
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 2659

Search results for: advanced maternal age

2509 On Dynamic Chaotic S-BOX Based Advanced Encryption Standard Algorithm for Image Encryption

Authors: Ajish Sreedharan

Abstract:

Security in transmission and storage of digital images has its importance in today’s image communications and confidential video conferencing. Due to the increasing use of images in industrial process, it is essential to protect the confidential image data from unauthorized access. Advanced Encryption Standard (AES) is a well known block cipher that has several advantages in data encryption. However, it is not suitable for real-time applications. This paper presents modifications to the Advanced Encryption Standard to reflect a high level security and better image encryption. The modifications are done by adjusting the ShiftRow Transformation and using On Dynamic chaotic S-BOX. In AES the Substitute bytes, Shift row and Mix columns by themselves would provide no security because they do not use the key. In Dynamic chaotic S-BOX Based AES the Substitute bytes provide security because the S-Box is constructed from the key. Experimental results verify and prove that the proposed modification to image cryptosystem is highly secure from the cryptographic viewpoint. The results also prove that with a comparison to original AES encryption algorithm the modified algorithm gives better encryption results in terms of security against statistical attacks.

Keywords: advanced encryption standard (AES), on dynamic chaotic S-BOX, image encryption, security analysis, ShiftRow transformation

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2508 Prevalence and Associated Factors of Stunting among 6-59 Months Children in Pastoral Community of Korahay Zone, Somali Regional State, Ethiopia 2016

Authors: Sisay Shine, Frew Tadesse, Zemenu Shiferaw, Lema Mideksa

Abstract:

Background: Stunting is one of the most important public health problems in Ethiopia with an estimated 44.4% of children less than five years of age are stunted. Thus, this study aimed to assess prevalence and associated factors of stunting among 6-59 months children in pastoral community of Korahay Zone, Somali Regional State, Ethiopia. Objective of the study: To assess prevalence and associated factors of stunting among 6-59 months children in pastoral community of Korahay Zone, Somali Regional State, Ethiopia, 2016. Methods: Community based cross sectional study design was done among 770 children in pastoral community of Korahay Zone. Systematic sampling techniques were used to select households and took child mother pair from each selected households. Data was collected using pre-tested and structured questionnaire. Odds ratio with 95% confidence interval was used to assess level of significance. Result: Prevalence of stunting among 6-59 months age children was 31.9%. Sex (AOR: 1.47, 95%CI 1.02, 2.11), age (AOR: 2.10, 95%CI 1.16, 3.80), maternal education (AOR: 3.42, 95%CI 1.58, 7.41), maternal occupation (AOR: 3.10, 95%CI 1.85, 5.19), monthly income (AOR: 1.47, 95%CI 1.03, 2.09), PNC visits (AOR: 1.59, 95%CI 1.07, 2.37), source of water (AOR: 3.41, 95%CI 1.96, 5.93), toilet availability (AOR: 1.71, 95%CI 1.13, 2.58), first milk feeding (AOR: 3.37, 95%CI 2.27, 5.02) and bottle feeding (AOR: 2.07, 95%CI 1.34, 3.18) were significant predictors of stunting. Conclusion and recommendations: Prevalence of stunting among 6-59 months children was high 31.9%. Lack maternal education, not feeding first milk, unsafe water supply, absence toilet availability and bottle feeding can increase the risk of stunting. So, educating mothers on child feeding practice, sanitation and important of first milk can reduce stunting.

Keywords: dietary, environmental, healthcare, socio-demographic, stunting

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2507 Maternal Care Practices on Nutritional Status of Pre School Children in Dass Local Government Area of Bauchi State, Nigeria

Authors: Adebusoye Michael, Okunola Olayinka, Owolabi Abdulateef, Jacob Anayo

Abstract:

Introduction: Child undernutrition remains one of Africa’s most fundamental challenges for improved human development because the time and capacities of caregivers are limited; far too many children are unable to access effectively amenities they need for a healthy life. Methods and procedures: This cross-sectional, descriptive study evaluated the maternal care practices on nutritional status of pre-school children, 150 mothers were selected by systematic random sampling in Dass L.G.A., Bauchi-State, Nigeria. Information on relevant parameters were collected by questionaire, analysed by various indices of descriptive statistics using SPSS version 16.0.Spearman’s rank correlation was used to test for associations between the variables. Results: Thirty-five (23.3%) of the respondents were aged 21-25 years. Thirty-three (28.0%) had secondary education, while forty-nine (32.7%) were full housewives. Majority 79(52.7) earned NI,000- N10,000 monthly versus 10(6.7%) who earned N11,000- N20,000.113(75.3%) married while 7(4.7%) of respondents were separated. Sixty-one (40.7%) practiced exclusive breastfeeding within six months. Only seventy-one (47.3%) initiated breastfeeding between 7 and 13 months. Five (3.3%) of children were mildly underweight while nine (6.0%) were severely stunted. Conclusion: The outcome suggested that working time of mothers is a major determinant on their child nutritional status. However, there is a significant relationship on the working time of mothers, income level and educational level of mothers to the nutritional status of their children (P<0.05). Recommendation: Good policy programmes should aim at eradicating poverty, better child care practices that would reduce malnutrition among under-five children.

Keywords: maternal care, nutritional status, preschool children, Dass L.G.A.

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2506 Association between Anemia and Maternal Depression during Pregnancy: Systematic Review

Authors: Gebeyaw Molla Wondim, Damen Haile Mariam, Wubegzier Mekonnen, Catherine Arsenault

Abstract:

Introduction: Maternal depression is a common psychological disorder that mostly occurs during pregnancy and after childbirth. It affects approximately one in four women worldwide. There is inconsistent evidence regarding the association between anemia and maternal depression. The objective of this systematic review was to examine the association between anemia and depression during pregnancy. Method: A comprehensive search of articles published before March 8, 2024, was conducted in seven databases such as PubMed, Scopus, Web of Science, PsycINFO, CINAHL, Cochrane Library, and Google Scholar. The Boolean operators “AND” or “OR” and “NOT” were used to connect the MeSH terms and keywords. Rayyan software was used to screen articles for final retrieval, and the PRISMA diagram was used to show the article selection process. Data extraction and risk bias assessment were done by two reviewers independently. JBI critical appraisal tool was used to assess the methodological quality of the retrieved articles. Heterogenicity was assessed through visual inspection of the extracted result, and narrative analysis was used to synthesize the result. Result: A total of 2,413 articles were obtained from seven electronic databases. Among these articles, a total of 2,398 were removed due to duplication (702 articles), by title and abstract selection criteria (1,678 articles), and by full-text review (18 articles). Finally, in this systematic review, 15 articles with a total of 628,781 pregnant women were included: seven articles were cohort studies, two were case-control, and six studies were cross-sectional. All included studies were published between 2013 and 2022. Studies conducted in the United States, South Korea, Finland, and one in South India found no significant association between anemia and maternal depression during pregnancy. On the other hand, studies conducted in Australia, Canada, Finland, Israel, Turkey, Vietnam, Ethiopia, and South India showed a significant association between anemia and depression during pregnancy. Conclusion: The overall finding of the systematic review shows the burden of anemia and antenatal depression is much higher among pregnant women in developing countries. Around three-fourths of the studies show that anemia is positively associated with antenatal depression. Almost all studies conducted in LMICs show anemia positively associated with antenatal depression.

Keywords: pregnant, women, anemia, depression

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2505 Family Income and Parental Behavior: Maternal Personality as a Moderator

Authors: Robert H. Bradley, Robert F. Corwyn

Abstract:

There is abundant research showing that socio-economic status is implicated in parenting. However, additional factors such as family context, parent personality, parenting history and child behavior also help determine how parents enact the role of caregiver. Each of these factors not only helps determine how a parent will act in a given situation, but each can serve to moderate the influence of the other factors. Personality has long been studied as a factor that influences parental behavior, but it has almost never been considered as a moderator of family contextual factors. For this study, relations between three maternal personality characteristics (agreeableness, extraversion, neuroticism) and four aspects of parenting (harshness, sensitivity, stimulation, learning materials) were examined when children were 6 months, 36 months, and 54 months old and again at 5th grade. Relations between these three aspects of personality and the overall home environment were also examined. A key concern was whether maternal personality characteristics moderated relations between household income and the four aspects of parenting and between household income and the overall home environment. The data for this study were taken from the NICHD Study of Early Child Care and Youth Development (NICHD SECCYD). The total sample consisted of 1364 families living in ten different sites in the United States. However, the samples analyzed included only those with complete data on all four parenting outcomes (i.e., sensitivity, harshness, stimulation, and provision of learning materials), income, maternal education and all three measures of personality (i.e., agreeableness, neuroticism, extraversion) at each age examined. Results from hierarchical regression analysis showed that mothers high in agreeableness were more likely to demonstrate sensitivity and stimulation as well as provide more learning materials to their children but were less likely to manifest harshness. Maternal agreeableness also consistently moderated the effects of low income on parental behavior. Mothers high in extraversion were more likely to provide stimulation and learning materials, with extraversion serving as a moderator of low income on both. By contrast, mothers high in neuroticism were less likely to demonstrate positive aspects of parenting and more likely to manifest negative aspects (e.g., harshness). Neuroticism also served to moderate the influence of low income on parenting, especially for stimulation and learning materials. The most consistent effects of parent personality were on the overall home environment, with significant main and interaction effects observed in 11 of the 12 models tested. These findings suggest that it may behoove professional who work with parents living in adverse circumstances to consider parental personality in helping to better target prevention or intervention efforts aimed at supporting parental efforts to act in ways that benefit children.

Keywords: home environment, household income, learning materials, personality, sensitivity, stimulation

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2504 Investigating the Use of Advanced Manufacturing Technologies in the Assembly Type Manufacturing Companies in Trinidad and Tobago

Authors: Nadine Sangster, Akil James, Rondell Duke, Aaron Ameerali, Terrence Lalla

Abstract:

The market place of the 21st century is evolving into one of merging national markets, fragmented consumer markets, and rapidly changing product technologies. The use of new technologies has become vital to the manufacturing industry for their survival and sustainability. This work focused on the assembly type industry in a small developing country and aimed at identifying the use of advanced manufacturing technologies and their impact on this sector of the manufacturing industry. It was found that some technologies were being used and that they had improved the effectiveness of those companies but there was still quite a bit of room for improvements. Some of the recommendations included benchmarking against international standards, the adoption of a “made in TT” campaign and the effective utilisation of the technologies to improve manufacturing effectiveness and thus improve competitive advantages and strategies.

Keywords: advanced manufacturing technology, Trinidad and Tobago, manufacturing, industrial engineering

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2503 Advanced Manufacturing Technology Adoption and Organizational Structure

Authors: George Nyori Makari

Abstract:

Data on 92 industrial organizations point to the existence of relationships between advanced manufacturing technology (AMT) adoption and some aspects of organizational structure, including the number of specialized sub-units, the number of levels of authority, span of control, degree of role programming specification, degree of communication programming specification and the degree of output programming. Primary finding is that as the investments and integration of AMTs increases, the more likely the foregoing aspects of structure increase. The findings hold with size and a number of other organizational variables controlled. The results indicate that a company’s capacity to assimilate technology depends on its organizational capabilities. The study encapsulates the need for companies to increase their organizational capabilities during investment and integration of AMTs.

Keywords: advanced manufacturing technology, adoption, organizational structure, Kenya

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2502 Role of Ologen in Previously Failed Trabeculectomy in Advanced Glaucoma

Authors: Reetika Sharma, Lalit Tejwani, Himanshu Shekhar, Arun Singhvi

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Purpose: Advanced Glaucoma with Failed trab is not an uncommon sight in glaucoma clinic, and such cases usually tend to present with high intraocular pressure (IOP) and advanced cupping, or even glaucomatous atrophy stage. Re-surgery is needed for such cases, and wound modulation poses a major challenge in these cases. We share our experience in this case series with the use of Ologen (collagen matrix implant) along with MMC 0.04% used in surgery. The purpose of the study was to evaluate the efficacy and outcome of collagen matrix implant in re-trabeculectomy in advanced glaucoma cases. Methodology: Eleven eyes of 11 patients (one eye of one patient) underwent re-trabeculectomy surgery with MMC and Ologen. Ologen implant was used in sub scleral and subconjunctival space, as a spacer and wound modulator. In five cases, triple modulation with implant soaked in anti-VEGF was used. Results: All patients had cupping more than 0.9, and one case was GOA. All cases were on maximal medication at presentation and majority were on systemic anti-glaucoma therapy also. Post-surgery, follow-up ranged from 13 – 34 months, and all cases had a follow longer than the gap between previous surgery (which was failed) and re-trab. One case needed AC reformation and one needling was done. Phaco was done at same sitting in four cases. All cases had their IOP lowered post surgery, and vision was maintained in all, however one case was considered as failed re-surgery case. Topical medication was needed in seven cases post-surgery also. Conclusion: Ologen as adjuvant should be considered in all re-trab cases and all high risk and advanced cases, and triple modulation can be next step in these cases. Aggressive IOP control and non- reluctance to continue topical medications post second surgery should be considered in such cases, to give them best possible vision.

Keywords: failed trabeculectomy, ologen, trabeculectomy, advanced glaucoma

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2501 Maternal Parenting Style and Moral Development of Primary School Students: Evidence from Pakistan

Authors: Ghulam Zahra

Abstract:

Parenting style affects the morality of their children. There is plenty of evidence to support the effect of parenting styles on the morality of their children. Therefore, this research is considered essential and suitable. Thus, the main objective of this study was to assess the correlation between the parenting style of mothers and the moral development of primary school students. The population consisted of all primary school students enrolled in the province of Punjab. The sample was comprised of twelve hundred thirty-nine primary school students. One questionnaire was adapted to explore the parenting styles of mothers and to assess the level of students’ level of morality; a moral development scale was adopted. The conclusions showed that there was a significant correlation exist among authoritarian parenting style, permissive parenting, and moral developments. Based on findings, it is recommended that parents should follow a warm style of parenting for the sake of the moral development of their children.

Keywords: maternal parenting style, moral development, authoritative parenting, authoritarian parenting, permissive parenting

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2500 A Qualitative Case Study Exploring Zambian Mathematics Teachers' Content Knowledge of Functions

Authors: Priestly Malambo, Sonja Van Putten, Hanlie Botha, Gerrit Stols

Abstract:

The relevance of what is content is taught in tertiary teacher training has long been in question. This study attempts to understand how advanced mathematics courses equip student teachers to teach functions at secondary school level. This paper reports on an investigation that was conducted in an African university, where preservice teachers were purposefully selected for participation in individual semi-structured interviews after completing a test on functions as taught at secondary school. They were asked to justify their reasoning in the test and to explain functions in a way that might bring about understanding of the topic in someone who did not know how functions work. These were final year preservice mathematics teachers who had studied advanced mathematics courses for three years. More than 50% of the students were not able to explain concepts or to justify their reasoning about secondary school functions in a coherent way. The results of this study suggest that the study of advanced mathematics does not automatically enable students to teach secondary school functions, and that, although these students were able to do advanced mathematics, they were unable to explain the working of functions in a way that would allow them to teach this topic successfully.

Keywords: secondary school, mathematical reasoning, student-teachers, functions

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2499 The Development of Nursing Model for Pregnant Women to Prevention of Early Postpartum Hemorrhage

Authors: Wadsana Sarakarn, Pimonpan Charoensri, Baliya Chaiyara

Abstract:

Objectives: To study the outcomes of the developed nursing model to prevent early postpartum hemorrhage (PPH). Materials and Methods: The analytical study was conducted in Sunpasitthiprasong Hospital during October 1st, 2015, until May 31st, 2017. After review the prevalence, risk factors, and outcomes of postpartum hemorrhage of the parturient who gave birth in Sunpasitthiprasong Hospital, the nursing model was developed under research regulation of Kemmis&McTaggart using 4 steps of operating procedures: 1) analyzing problem situation and gathering 2) creating the plan 3) noticing and performing 4) reflecting the result of the operation. The nursing model consisted of the screening tools for risk factors associated with PPH, the clinical nursing practice guideline (CNPG), and the collecting bag for measuring postpartum blood loss. Primary outcome was early postpartum hemorrhage. Secondary outcomes were postpartum hysterectomy, maternal mortality, personnel’s practice, knowledge, and satisfaction of the nursing model. The data were analyzed by using content analysis for qualitative data and descriptive statistics for quantitative data. Results: Before using the nursing model, the prevalence of early postpartum hemorrhage was under estimated (2.97%). There were 5 cases of postpartum hysterectomy and 2 cases of maternal death due to postpartum hemorrhage. During the study period, there was 22.7% prevalence of postpartum hemorrhage among 220 pregnant women who were vaginally delivered at Sunpasitthiprasong Hospital. No maternal death or postpartum hysterectomy was reported after using the nursing model. Among 16 registered nurses at the delivery room who evaluated using of the nursing model, they reported the high level of practice, knowledge, and satisfaction Conclusion: The nursing model for the prevention of early PPH is effective to decrease early PPH and other serious complications.

Keywords: the development of a nursing model, prevention of postpartum hemorrhage, pregnant women, postpartum hemorrhage

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2498 Advanced Nurse Practitioners in Clinical Practice - a Leadership Challenge

Authors: Mette Kjerholt, Thora Grothe Thomsen, Connie Bøttcher Berthelsen, Bibi Hølge Hazelton

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Academic nursing is a relatively new phenomenon in Denmark. Leadership and management training in nursing does not prepare Danish nurse leaders to become leaders for nurses with academic background, and some leaders may feel estranged with including this kind of nursing staff in clinical settings. Currently there is a debate regarding what academic nurses can contribute with in clinical practice, and some managers express concern regarding whether this will lead to less focus on clinical practice and more focus on theoretical issues that may not seem so relevant in a busy everyday clinical setting. The paper will present the experiences of integrating three advanced nurse practitioners with Ph.D. degrees (ANP) in three different clinical departments at a regional hospital in Denmark with no prior experiences with such profiles among its staff.

Keywords: leadership, advanced nurse practitioners, clinical practice, academic nursing

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2497 Design and Performance Analysis of Advanced B-Spline Algorithm for Image Resolution Enhancement

Authors: M. Z. Kurian, M. V. Chidananda Murthy, H. S. Guruprasad

Abstract:

An approach to super-resolve the low-resolution (LR) image is presented in this paper which is very useful in multimedia communication, medical image enhancement and satellite image enhancement to have a clear view of the information in the image. The proposed Advanced B-Spline method generates a high-resolution (HR) image from single LR image and tries to retain the higher frequency components such as edges in the image. This method uses B-Spline technique and Crispening. This work is evaluated qualitatively and quantitatively using Mean Square Error (MSE) and Peak Signal to Noise Ratio (PSNR). The method is also suitable for real-time applications. Different combinations of decimation and super-resolution algorithms in the presence of different noise and noise factors are tested.

Keywords: advanced b-spline, image super-resolution, mean square error (MSE), peak signal to noise ratio (PSNR), resolution down converter

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2496 Expression of Selected miRNAs in Placenta of the Intrauterine Restricted Growth Fetuses in Cattle

Authors: Karolina Rutkowska, Hubert Pausch, Jolanta Oprzadek, Krzysztof Flisikowski

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The placenta is one of the most important organs that plays a crucial role in the fetal growth and development. Placenta dysfunction is one of the primary cause of the intrauterine growth restriction (IUGR). Cattle have the cotyledonary placenta which consists of two anatomical parts: fetal and maternal. In the case of cattle during the first months of pregnancy, it is very easy to separate maternal caruncle from fetal cotyledon tissue, easier in fact than removing an ordinary glove from one's hand. Which in fact make easier to conduct tissue-specific molecular studies. Typically, animal models for the study of IUGR are created using surgical methods and malnutrition of the pregnant mother or in the case of mice by genetic modifications. However, proposed cattle model with MIMT1Del/WT deletion is unique because it was created without any surgical methods what significantly distinguish it from the other animal models. The primary objective of the study was to identify differential expression of selected miRNAs in the placenta from normal and intrauterine growth restricted fetuses. There was examined the expression of miRNA in the fetal and maternal part of the placenta from 24 fetuses (12 samples from the fetal part of the placenta and 12 samples from maternal part of the placenta). In the study, there was done miRNAs sequencing in the placenta of MIMT1Del/WT fetuses and MIMT1WT/WT fetuses. Then, there were selected miRNAs that are involved in fetal growth and development. Analysis of miRNAs expression was conducted on ABI7500 machine. miRNAs expression was analyzed by reverse-transcription polymerase chain reaction (RT-PCR). As the reference gene was used SNORD47. The results were expressed as 2ΔΔCt: ΔΔCt = (Ctij − CtSNORD47j) − (Cti1 − CtSNORD471). Where Ctij and CtSNORD47j are the Ct values for gene i and for SNORD47 in a sample (named j); Cti1 and CtSNORD471 are the Ct values in sample 1. Differences between groups were evaluated with analysis of variance by using One-Way ANOVA. Bonferroni’s tests were used for interpretation of the data. All normalised miRNA expression values are expressed on a value of natural logarithm. The data were expressed as least squares mean with standard errors. Significance was declared when P < 0.05. The study shows that miRNAs expression depends on the part of the placenta where they origin (fetal or maternal) and on the genotype of the animal. miRNAs offer a particularly new approach to study IUGR. Corresponding tissue samples were collected according to the standard veterinary protocols according to the European Union Normative for Care and Use of Experimental Animals. All animal experiments were approved by the Animal Ethics Committee of the State Provincial Office of Southern Finland (ESAVI-2010-08583/YM-23).

Keywords: placenta, intrauterine growth restriction, miRNA, cattle

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2495 Quality of Care for the Maternal Complications at Selected Primary and Secondary Health Facilities of Bangladesh: Lessons Learned from a Formative Research

Authors: Mohiuddin Ahsanul Kabir Chowdhury, Nafisa Lira Huq, Afroza Khanom, Rafiqul Islam, Abdullah Nurus Salam Khan, Farhana Karim, Nabila Zaka, Shams El Arifeen, Sk. Masum Billah

Abstract:

After having astounding achievements in reducing maternal mortality and achieving the target for Millennium Development Goal (MDG) 5, the Government of Bangladesh has set new target to reduce Maternal Mortality Ratio (MMR) to 70 per 100,000 live births aligning with targets of Sustainable Development Goals (SDGs). Aversion of deaths from maternal complication by ensuring quality health care could be an important path to accelerate the rate of reduction of MMR. This formative research was aimed at exploring the provision of quality maternal health services at different level of health facilities. The study was conducted in 1 district hospital (DH) and 4 Upazila health complexes (UHC) of Kurigram district of Bangladesh, utilizing both quantitative and qualitative research methods. We conducted 14 key informant interviews with facility managers and 20 in-depth interviews with health care providers and support staff. Besides, we observed 387 normal deliveries from which we found 17 cases of post partum haemorrhage (PPH) and 2 cases of eclampsia during the data collection period extended from July-September 2016. The quantitative data were analyzed by using descriptive statistics, and the qualitative component underwent thematic analysis with the broad themes of facility readiness for maternal complication management, and management of complications. Inadequacy in human resources has been identified as the most important bottleneck to provide quality care to manage maternal complications. The DH had a particular paucity of human resources in medical officer cadre where about 61% posts were unfilled. On the other hand, in the UHCs the positions mostly empty were obstetricians (75%, paediatricians (75%), staff nurses (65%), and anaesthetists (100%). The workload on the existing staff is increased because of the persistence of vacant posts. Unavailability of anesthetists and consultants does not permit the health care providers (HCP) of lower cadres to perform emergency operative procedures and forces them to refer the patients although referral system is not well organized in rural Bangladesh. Insufficient bed capacity, inadequate training, shortage of emergency medicines etc. are other hindrance factors for facility readiness. Among the 387 observed delivery case, 17 (4.4%) were identified as PPH cases, and only 2 cases were found as eclampsia/pre-eclampsia. The majority of the patients were treated with uterine message (16 out of 17, 94.1%) and injectable Oxytocin (14 out of 17, 82.4%). The providers of DH mentioned that they can manage the PPH because of having provision for diagnostic and blood transfusion services, although not as 24/7 services. Regarding management of eclampsia/pre-eclampsia, HCPs provided Diazepam, MgSO4, and other anti-hypertensives. The UHCs did not have MgSO4 at stock even, and one facility manager admitted that they treat eclampsia with Diazepam only. The nurses of the UHCs were found to be afraid to handle eclampsia cases. The upcoming interventions must ensure refresher training of service providers, continuous availability of essential medicine and equipment needed for complication management, availability of skilled health workforce, availability of functioning blood transfusion unit and pairing of consultants and anaesthetists to reach the newly set targets altogether.

Keywords: Bangladesh, health facilities, maternal complications, quality of care

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2494 Delivery of Contraceptive and Maternal Health Commodities with Drones in the Most Remote Areas of Madagascar

Authors: Josiane Yaguibou, Ngoy Kishimba, Issiaka V. Coulibaly, Sabrina Pestilli, Falinirina Razanalison, Hantanirina Andremanisa

Abstract:

Background: Madagascar has one of the least developed road networks in the world with a majority of its national and local roads being earth roads and in poor condition. In addition, the country is affected by frequent natural disasters that further affect the road conditions limiting the accessibility to some parts of the country. In 2021 and 2022, 2.21 million people were affected by drought in the Grand Sud region, and by cyclones and floods in the coastal regions, with disruptions of the health system including last mile distribution of lifesaving maternal health commodities and reproductive health commodities in the health facilities. Program intervention: The intervention uses drone technology to deliver maternal health and family planning commodities in hard-to-reach health facilities in the Grand Sud and Sud-Est of Madagascar, the regions more affected by natural disasters. Methodology The intervention was developed in two phases. A first phase, conducted in the Grand Sud, used drones leased from a private company to deliver commodities in isolated health facilities. Based on the lesson learnt and encouraging results of the first phase, in the second phase (2023) the intervention has been extended to the Sud Est regions with the purchase of drones and the recruitment of pilots to reduce costs and ensure sustainability. Key findings: The drones ensure deliveries of lifesaving commodities in the Grand Sud of Madagascar. In 2023, 297 deliveries in commodities in forty hard-to-reach health facilities have been carried out. Drone technology reduced delivery times from the usual 3 - 7 days necessary by road or boat to only a few hours. Program Implications: The use of innovative drone technology demonstrated to be successful in the Madagascar context to reduce dramatically the distribution time of commodities in hard-to-reach health facilities and avoid stockouts of life-saving medicines. When the intervention reaches full scale with the completion of the second phase and the extension in the Sud-Est, 150 hard-to-reach facilities will receive drone deliveries, avoiding stockouts and improving the quality of maternal health and family planning services offered to 1,4 million people in targeted areas.

Keywords: commodities, drones, last-mile distribution, lifesaving supplies

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2493 Treatment of Sanitary Landfill Leachate by Advanced Oxidation Techniques

Authors: R. Kerbachi , Y. Medkour, F. Sahnoune

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The integrated waste management is an important aspect in the implementation of sustainable development. Leachate generated by sanitary landfills is a high-strength wastewater that is likely to contain large amounts of organic and inorganic matter, with humic substances, as well as ammonia nitrogen, heavy metals, chlorinated organic and inorganic salts. Untreated leachates create a great potential for harm to the environment, they can permeate ground water or mix with surface water and contribute to the pollution of soil, ground water, and surface water. In Algeria, the treatment of landfill leachate is the weakest link in the solid waste management. This study focuses on the evaluation of the pollution load carried by leachate produced in a former sanitary landfill located to the west of Algiers and the implementation of advanced oxidation treatment (advanced oxidation process, AOP), Fenton, electro-Fenton etc. The characterization of these leachates shows that they have a high organic load, mineral and nitrogen. Measured COD reaches very high values of the order of 5000 to 20,000 mg O2 / L. On this non-biodegradable leachate, treatment tests have been carried out by the methods of coagulation-flocculation, Fenton oxidation, electrocoagulation and electro-Fenton. The removal efficiencies of pollution obtained for each of these modes of treatment are respectively 69, 80, 84 and 97%. The study shows that advanced oxidation processes are very suitable for the treatment of poorly biodegradable leachate.

Keywords: advanced oxidation processes, electrocoagulation, electro-Fenton, leachates treatment, sanitary landfill

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2492 A Robust Software for Advanced Analysis of Space Steel Frames

Authors: Viet-Hung Truong, Seung-Eock Kim

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This paper presents a robust software package for practical advanced analysis of space steel framed structures. The pre- and post-processors of the presented software package are coded in the C++ programming language while the solver is written by using the FORTRAN programming language. A user-friendly graphical interface of the presented software is developed to facilitate the modeling process and result interpretation of the problem. The solver employs the stability functions for capturing the second-order effects to minimize modeling and computational time. Both the plastic-hinge and fiber-hinge beam-column elements are available in the presented software. The generalized displacement control method is adopted to solve the nonlinear equilibrium equations.

Keywords: advanced analysis, beam-column, fiber-hinge, plastic hinge, steel frame

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2491 Multi-dimensional Approach to Resilience and Support in Advanced School-based Mental Health Service Delivery (MARS-SMHSD) Framework Development for Low-Resource Areas

Authors: Wan You Ning

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Addressing the rising prevalence of mental health issues among youths, the Multi-dimensional Approach to Resilience and Support in Advanced School-based Mental Health Service Delivery (MARS-ASMHSD) framework proposes the implementation of advanced mental health services in low-resource areas to further instil mental health resilience among students in a school-based setting. Recognizing the unsustainability of direct service delivery due to rapidly growing demands and costs, the MARS-ASMHSD framework endorses the deinstitutionalization of mental healthcare and explores a tiered, multi-dimensional approach in mental healthcare provision, establishing advanced school-based mental health service delivery. The framework is developed based on sustainable and credible evidence-based practices and modifications of existing mental health service deliveries in Asia, including Singapore, Thailand, Malaysia, Japan, and Taiwan. Dissemination of the framework model for implementation will enable a more progressive and advanced school-based mental health service delivery in low-resource areas. Through the evaluation of the mental health landscape and the role of stakeholders in the respective countries, the paper concludes with a multi-dimensional framework model for implementation in low-resource areas. A mixed-method independent research study is conducted to facilitate the framework's development.

Keywords: mental health, youths, school-based services, framework development

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2490 Exploring Spiritual Needs of Taiwanese Inpatients with Advanced Cancer and Their Family Caregivers

Authors: Szu Mei Hsiao

Abstract:

This study explores the spiritual needs of inpatients with advanced cancer and their family caregivers in one southern regional teaching hospital in Taiwan and elucidates the differences and similarities of spiritual needs between them. Little research reports the different phases of spiritual needs and the potential impact of Chinese cultural values on the spiritual needs. Qualitative inquiry was used. Twenty-one patients with advanced cancer and twenty-two family caregivers were recruited. During hospitalization, all participants identified spiritual needs both the palliative phase and the dying phase: (a) the need to foster faith/confidence and hope for medicine and/or God; (b) to understand the meaning and values of life; (c) to experience more reciprocal human love and forgiveness; and (d) to obey God’s/Heaven will. Furthermore, the differences of spiritual needs between patients with advanced cancer and their family caregivers are as follows: (a) family caregivers emphasized the need to inform relatives and say goodbye in order to die peacefully; (b) patients highlighted a need to maintain a certain physical appearance in order to preserve their dignity; nurture one’s willpower; learn about the experiences of cancer survivors; and identify one’s own life experience for understanding the meaning and values of life. Moreover, the dissimilarity of spiritual needs is that the patients pointed out the need to understand God’s will during the palliative treatment phase. However, the family caregivers identified the need to forgive each other, and inform relatives and say goodbye to patients in the dying phase. This research has shown that the needs of meaning/values of life and facing death peacefully are different between two groups. Health professionals will be encouraged to detect and to develop individualized care strategies to meet spiritual needs.

Keywords: advanced cancer, Chinese culture, family caregivers, qualitative research, spiritual needs

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2489 Exploring the Vocabulary and Grammar Advantage of US American over British English Speakers at Age 2;0

Authors: Janine Just, Kerstin Meints

Abstract:

The research aims to compare vocabulary size and grammatical development between US American English- and British English-speaking children at age 2;0. As there is evidence that precocious children with large vocabularies develop grammar skills earlier than their typically developing peers, it was investigated if this also holds true across varieties of English. Thus, if US American children start to produce words earlier than their British counterparts, this could mean that US children are also at an advantage in the early developmental stages of acquiring grammar. This research employs a British English adaptation of the MacArthur-Bates CDI Words and Sentences (Lincoln Toddler CDI) to compare vocabulary and also grammar scores with the updated US Toddler CDI norms. At first, the Lincoln TCDI was assessed for its concurrent validity with the Preschool Language Scale (PLS-5 UK). This showed high correlations for the vocabulary and grammar subscales between the tests. In addition, the frequency of the Toddler CDI’s words was also compared using American and British English corpora of adult spoken and written language. A paired-samples t-test found a significant difference in word frequency between the British and the American CDI demonstrating that the TCDI’s words were indeed of higher frequency in British English. We then compared language and grammar scores between US (N = 135) and British children (N = 96). A two-way between groups ANOVA examined if the two samples differed in terms of SES (i.e. maternal education) by investigating the impact of SES and country on vocabulary and sentence complexity. The two samples did not differ in terms of maternal education as the interaction effects between SES and country were not significant. In most cases, scores were not significantly different between US and British children, for example, for overall word production and most grammatical subscales (i.e. use of words, over- regularizations, complex sentences, word combinations). However, in-depth analysis showed that US children were significantly better than British children at using some noun categories (i.e. people, objects, places) and several categories marking early grammatical development (i.e. pronouns, prepositions, quantifiers, helping words). However, the effect sizes were small. Significant differences for grammar were found for irregular word forms and progressive tense suffixes. US children were more advanced in their use of these grammatical categories, but the effect sizes were small. In sum, while differences exist in terms of vocabulary and grammar ability, favouring US children, effect sizes were small. It can be concluded that most British children are ‘catching up’ with their US American peers at age 2;0. Implications of this research will be discussed.

Keywords: first language acquisition, grammar, parent report instrument, vocabulary

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2488 Redirection of Cytokine Production Patterns by Dydrogesterone, an Orally-Administered Progestogen

Authors: Raj Raghupathy

Abstract:

Recurrent Spontaneous Miscarriage (RSM) is a common form of pregnancy loss, 50% of which are due to ‘unexplained’ causes. Evidence exists to suggest that RSM may be caused by immunologic factors such as cytokines which are critical molecules of the immune system, with an impressive array of capabilities. An association appears to exist between Th2-type reactivity (mediated by Th2 or anti-inflammatory cytokines) and normal, successful pregnancy, and between unexplained RSM and Th1 cytokine dominance. If pro-inflammatory cytokines are indeed associated with pregnancy loss, the suppression of these cytokines, and thus the ‘redirection’ of maternal reactivity, may help prevent cytokine-mediated pregnancy loss. The objective of this study was to explore the possibility of modulating cytokine production using Dydrogesterone (Duphaston®), an orally-administered progestogen. Peripheral blood mononuclear cells from 34 women with a history of at least 3 unexplained recurrent miscarriages were stimulated in vitro with a mitogen (to elicit cytokine production) in the presence and absence of dydrogesterone. Levels of selected pro- and anti-inflammatory cytokines produced by peripheral blood mononuclear cells were measured after exposure to these progestogens. Dydrogesterone down-regulates the production of pro-inflammatory cytokines and up-regulates the production of anti-inflammatory cytokines. The ratios of Th2 to Th1 cytokines are markedly elevated in the presence of dydrogesterone, indicating a shift from potentially harmful maternal Th1 reactivity to a more pregnancy-conducive Th2 profile. We used a progesterone receptor antagonist to show that this cytokine-modulating effect of dydrogesterone is mediated via the progesterone receptor. Dydrogesterone also induces the production of the Progesterone-Induced Blocking Factor (PIBF); lymphocytes exposed to PIBF produce higher levels of Th2 cytokines, affecting a Th1 → Th2 cytokine shift which could be favourable to the success of pregnancy. We conclude that modulation of maternal cytokine production profiles is possible with dydrogesterone which has the merits that it can be administered orally and that it is safe.

Keywords: cytokines, dydrogesterone, progesterone, recurrent spontaneous miscarriage

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2487 Determinants of Child Anthropometric Indicators: A Case Study of Mali in 2015

Authors: Davod Ahmadigheidari

Abstract:

The main objective of this study was to explore prevalence of anthropometric indicators as well the factors associated with the anthropometric indications in Mali. Data on 2015, downloaded from the website of Unicef, were analyzed. A total of 16,467 women (ages 15-49 years) and 16,467 children (ages 0-59 months) were selected for the sample. Different statistical analyses, such as descriptive, crosstabs and binary logistic regression form the basis of this study. Child anthropometric indicators (i.e., wasting, stunting, underweight and BMI for age) were used as the dependent variables. SPSS Syntax from WHO was used to create anthropometric indicators. Different factors, such as child’s sex, child’s age groups, child’s diseases symptoms (i.e., diarrhea, cough and fever), maternal education, household wealth index and area of residence were used as independent variables. Results showed more than forty percent of Malian households were in nutritional crises (stunting (42%) and underweight (34%). Findings from logistic regression analyses indicated that low score of wealth index, low maternal education and experience of diarrhea in last two weeks increase the probability of child malnutrition.

Keywords: Mali, wasting, stunting, underweight, BMI for age and wealth index

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2486 Multiple Organ Manifestation in Neonatal Lupus Erythematous: Report of Two Cases

Authors: A. Lubis, R. Widayanti, Z. Hikmah, A. Endaryanto, A. Harsono, A. Harianto, R. Etika, D. K. Handayani, M. Sampurna

Abstract:

Neonatal lupus erythematous (NLE) is a rare disease marked by clinical characteristic and specific maternal autoantibody. Many cutaneous, cardiac, liver, and hematological manifestations could happen with affect of one organ or multiple. In this case, both babies were premature, low birth weight (LBW), small for gestational age (SGA) and born through caesarean section from a systemic lupus erythematous (SLE) mother. In the first case, we found a baby girl with dyspnea and grunting. Chest X ray showed respiratory distress syndrome (RDS) great I and echocardiography showed small atrial septal defect (ASD) and ventricular septal defect (VSD). She also developed anemia, thrombocytopenia, elevated C-reactive protein, hypoalbuminemia, increasing coagulation factors, hyperbilirubinemia, and positive blood culture of Klebsiella pneumonia. Anti-Ro/SSA and Anti-nRNP/sm were positive. Intravenous fluid, antibiotic, transfusion of blood, thrombocyte concentrate, and fresh frozen plasma were given. The second baby, male presented with necrotic tissue on the left ear and skin rashes, erythematous macula, athropic scarring, hyperpigmentation on all of his body with various size and facial haemorrhage. He also suffered from thrombocytopenia, mild elevated transaminase enzyme, hyperbilirubinemia, anti-Ro/SSA was positive. Intravenous fluid, methyprednisolone, intravenous immunoglobulin (IVIG), blood, and thrombocyte concentrate transfution were given. Two cases of neonatal lupus erythematous had been presented. Diagnosis based on clinical presentation and maternal auto antibody on neonate. Organ involvement in NLE can occur as single or multiple manifestations.

Keywords: neonatus lupus erythematous, maternal autoantibody, clinical characteristic, multiple organ manifestation

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2485 Potential Impacts of Maternal Nutrition and Selection for Residual Feed Intake on Metabolism and Fertility Parameters in Angus Bulls

Authors: Aidin Foroutan, David S. Wishart, Leluo L. Guan, Carolyn Fitzsimmons

Abstract:

Maximizing efficiency and growth potential of beef cattle requires not only genetic selection (i.e. residual feed intake (RFI)) but also adequate nutrition throughout all stages of growth and development. Nutrient restriction during gestation has been shown to negatively affect post-natal growth and development as well as fertility of the offspring. This, when combined with RFI may affect progeny traits. This study aims to investigate the impact of selection for divergent genetic potential for RFI and maternal nutrition during early- to mid-gestation, on bull calf traits such as fertility and muscle development using multiple ‘omics’ approaches. Comparisons were made between High-diet vs. Low-diet and between High-RFI vs. Low-RFI animals. An epigenetics experiment on semen samples identified 891 biomarkers associated with growth and development. A gene expression study on Longissimus thoracis muscle, semimembranosus muscle, liver, and testis identified 4 genes associated with muscle development and immunity of which Myocyte enhancer factor 2A [MEF2A; induces myogenesis and control muscle differentiation] was the only differentially expressed gene identified in all four tissues. An initial metabolomics experiment on serum samples using nuclear magnetic resonance (NMR) identified 4 metabolite biomarkers related to energy and protein metabolism. Once all the biomarkers are identified, bioinformatics approaches will be used to create a database covering all the ‘omics’ data collected from this project. This database will be broadened by adding other information obtained from relevant literature reviews. Association analyses with these data sets will be performed to reveal key biological pathways affected by RFI and maternal nutrition. Through these association studies between the genome and metabolome, it is expected that candidate biomarker genes and metabolites for feed efficiency, fertility, and/or muscle development are identified. If these gene/metabolite biomarkers are validated in a larger animal population, they could potentially be used in breeding programs to select superior animals. It is also expected that this work will lead to the development of an online tool that could be used to predict future traits of interest in an animal given its measurable ‘omics’ traits.

Keywords: biomarker, maternal nutrition, omics, residual feed intake

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2484 Completion of the Modified World Health Organization (WHO) Partograph during Labour in Public Health Institutions of Addis Ababa, Ethiopia

Authors: Engida Yisma, Berhanu Dessalegn, Ayalew Astatkie, Nebreed Fesseha

Abstract:

Background: The World Health Organization (WHO) recommends using the partograph to follow labour and delivery, with the objective to improve health care and reduce maternal and foetal morbidity and death. Methods: A retrospective document review was undertaken to assess the completion of the modified WHO partograph during labour in public health institutions of Addis Ababa, Ethiopia. A total of 420 of the modified WHO partographs used to monitor mothers in labour from five public health institutions that provide maternity care were reviewed. A structured checklist was used to gather the required data. The collected data were analyzed using SPSS version 16.0. Frequency distributions, cross-tabulations and a graph were used to describe the results of the study. Results: All facilities were using the modified WHO partograph. The correct completion of the partograph was very low. From 420 partographs reviewed across all the five health facilities, foetal heart rate was recorded into the recommended standard in 129(30.7%) of the partographs, while 138 (32.9%) of cervical dilatation and 87 (20.70%) of uterine contractions were recorded to the recommended standard. The study did not document descent of the presenting part in 353 (84%). Moulding in 364 (86.7%) of the partographs reviewed was not recorded. Documentation of state of the liquor was 113(26.9%), while the maternal blood pressure was recorded to standard only in 78(18.6%) of the partographs reviewed. Conclusions: This study showed a poor completion of the modified WHO partographs during labour in public health institutions of Addis Ababa, Ethiopia. The findings may reflect poor management of labour and indicate the need for pre-service and periodic on-job training of health workers on the proper completion of the partograph. Regular supportive supervision, provision of guidelines and mandatory health facility policy are also needed in support of a collaborative effort to reduce maternal and perinatal deaths.

Keywords: modified WHO partograph, completion, public health institutions, Addis Ababa, Ethiopia

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2483 Environmental and Safety Studies for Advanced Fuel Cycle Fusion Energy Systems: The ESSENTIAL Approach

Authors: Massimo Zucchetti

Abstract:

In the US, the SPARC-ARC projects of compact tokamaks are being developed: both are aimed at the technological demonstration of fusion power reactors with cutting-edge technology but following different design approaches. However, they show more similarities than differences in the fuel cycle, safety, radiation protection, environmental, waste and decommissioning aspects: all reactors, either experimental or demonstration ones, have to fulfill certain "essential" requirements to pass from virtual to real machines, to be built in the real world. The paper will discuss these "essential" requirements. Some of the relevant activities in these fields, carried out by our research group (ESSENTIAL group), will be briefly reported, with the aim of showing some methodology aspects that have been developed and might be of wider interest. Also, a non-competitive comparison between our results for different projects will be included when useful. The question of advanced D-He3 fuel cycles to be used for those machines will be addressed briefly. In the past, the IGNITOR project of a compact high-magnetic field D-T ignition experiment was found to be able to sustain limited D-He3 plasmas, while the Candor project was a more decisive step toward D-He3 fusion reactors. The following topics will be treated: Waste management and radioactive safety studies for advanced fusion power plants; development of compact high-field advanced fusion reactors; behavior of nuclear materials under irradiation: neutron-induced radioactivity due to side DT reactions, radiation damage; accident analysis; reactor siting.

Keywords: advanced fuel fusion reactors, deuterium-helium3, high-field tokamaks, fusion safety

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2482 Evaluation of Washing Performance of Household Wastewater Purified by Advanced Oxidation Process

Authors: Nazlı Çetindağ, Pelin Yılmaz Çetiner, Metin Mert İlgün, Emine Birci, Gizemnur Yıldız Uysal, Özcan Hatipoğlu, Ehsan Tuzcuoğlu, Gökhan Sır

Abstract:

Stressing the importance of water conservation, emphasizing the need for efficient management of household water, and underlining the significance of alternative solutions are important. In this context, advanced solutions based on technologies such as the advanced oxidation process have emerged as promising methods for treating household wastewater. Evaluating household water usage holds critical importance for the sustainability of water resources. Researchers and experts are examining various technological approaches to effectively treat and reclaim water for reuse. In this framework, the advanced oxidation process has proven to be an effective method for the removal of various organic and inorganic pollutants in the treatment of household wastewater. In this study, performance will be evaluated by comparing it with the reference case. This international criterion simulates the washing of home textile products, determining various performance parameters. The specially designed stain strips, including sebum, carbon black, blood, cocoa, and red wine, used in experiments, represent various household stains. These stain types were carefully selected to represent challenging stain scenarios, ensuring a realistic assessment of washing performance. Experiments conducted under different temperatures and program conditions successfully demonstrate the practical applicability of the advanced oxidation process for treating household wastewater. It is important to note that both adherence to standards and the use of real-life stain types contribute to the broad applicability of the findings. In conclusion, this study strongly supports the effectiveness of treating household wastewater with the advanced oxidation process in terms of washing performance under both standard and practical application conditions. The study underlines the importance of alternative solutions for sustainable water resource management and highlights the potential of the advanced oxidation process in the treatment of household water, contributing significantly to optimizing water usage and developing sustainable water management solutions.

Keywords: advanced oxidation process, household water usage, household appliance waste water, modelling, water reuse

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2481 The Effect of Aerobics Course on Fitness Ability of the University Students

Authors: Hui-Fang Lee, Hsuan-Jung Hsieh, Wen-Chi Lu, Meng-Chu Liu

Abstract:

The purpose of the study was to examine abnormal BMI students of Chien Hsin University of Science and Technology, implement teaching aerobics course through elementary and advanced curriculum design, dietary education and three-day dietary record, analyze participant fitness improvement, an 10-week course as well as pre-test and post-test were carried out to evaluate the effect of the aerobics course on the fitness ability. The actual participate elementary and advanced courses each of 40 people, with low participation deduction course unfinished fitness testing, access to elementary curriculum valid samples 35 (87.5%) people, advanced courses valid samples 38(95%) people, 16 students participated in two consecutive courses. The fitness activities included sit-bending, one-minute sit-ups, standing long jump, and three minutes to board the stage. Analysis and comparison to the average three-day dietary record difference, an independent samples t-test was conducted to analyze the differences in the four activities between pre-test and post-test. The results showed that the elementary course had significant effects on females’ sit-bending and one minute sit-ups, the females also had high fat intake in three-day dietary record. The advanced course had significant effects on males’ sit-bending and on females’ BMI, sit-bending and standing long jump, males and females in three-day dietary record carbohydrate intake slightly low, slightly higher protein and fat intake. In conclusion, aerobics course teaching, dietary education and three-day, dietary record implementation can significantly enhance the physical fitness indicators, and continued to participate in advanced courses better. In the practice of sport should be the future course planning elementary and advanced courses, while introducing dietary education, achieve concrete results in improving physical fitness.

Keywords: physical fitness, aerobics course, dietary education, three-day dietary record

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2480 GIS Based Spatial Modeling for Selecting New Hospital Sites Using APH, Entropy-MAUT and CRITIC-MAUT: A Study in Rural West Bengal, India

Authors: Alokananda Ghosh, Shraban Sarkar

Abstract:

The study aims to identify suitable sites for new hospitals with critical obstetric care facilities in Birbhum, one of the vulnerable and underserved districts of Eastern India, considering six main and 14 sub-criteria, using GIS-based Analytic Hierarchy Process (AHP) and Multi-Attribute Utility Theory (MAUT) approach. The criteria were identified through field surveys and previous literature. After collecting expert decisions, a pairwise comparison matrix was prepared using the Saaty scale to calculate the weights through AHP. On the contrary, objective weighting methods, i.e., Entropy and Criteria Importance through Interaction Correlation (CRITIC), were used to perform the MAUT. Finally, suitability maps were prepared by weighted sum analysis. Sensitivity analyses of AHP were performed to explore the effect of dominant criteria. Results from AHP reveal that ‘maternal death in transit’ followed by ‘accessibility and connectivity’, ‘maternal health care service (MHCS) coverage gap’ were three important criteria with comparatively higher weighted values. Whereas ‘accessibility and connectivity’ and ‘maternal death in transit’ were observed to have more imprint in entropy and CRITIC, respectively. While comparing the predictive suitable classes of these three models with the layer of existing hospitals, except Entropy-MAUT, the other two are pointing towards the left-over underserved areas of existing facilities. Only 43%-67% of existing hospitals were in the moderate to lower suitable class. Therefore, the results of the predictive models might bring valuable input in future planning.

Keywords: hospital site suitability, analytic hierarchy process, multi-attribute utility theory, entropy, criteria importance through interaction correlation, multi-criteria decision analysis

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