Search results for: Aga Khan foundation

Authors: Farhana Karim, Abdullah N. S. Khan, Mohiuddin A. K. Chowdhury, Nabila Zaka, Alexander Manu, Shams El Arifeen, Sk Masum Billah

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Breastfeeding, an integral part of newborn care, can reduce 55-87% of all-cause neonatal mortality and morbidity. Early initiation of breastfeeding within 1 hour of birth can avert 22% of newborn mortality. Only 45% of world’s newborns and 42% of newborns in South-Asia are put to the breast within one hour of birth. In Bangladesh, only a half of the mothers practice early initiation of breastfeeding which is less likely to be practiced if the baby is born in a health facility. This study aims to generate strong evidence for early initiation of breastfeeding practices in the government health facilities and to explore the associated factors influencing the practice. The study was conducted in selected health facilities in three neighbouring districts of Northern Bangladesh. Total 249 normal vaginal delivery cases were observed for 24 hours since the time of birth. The outcome variable was initiation of breastfeeding within 1 hour while the explanatory variables included type of health facility, privacy, presence of support person, stage of labour at admission, need for augmentation of labour, complications during delivery, need for episiotomy, spontaneous cry of the newborn, skin-to-skin contact with mother, post-natal contact with the service provider, receiving a post-natal examination and counselling on breastfeeding during postnatal contact. The simple descriptive statistics were employed to see the distribution of samples according to socio-demographic characteristics. Kruskal-Wallis test was carried out for testing the equality of medians among two or more categories of each variable and P-value is reported. A series of simple logistic regressions were conducted with all the potential explanatory variables to identify the determining factors for breastfeeding within 1 hour in a health facility. Finally, multiple logistic regression was conducted including the variables found significant at bi-variate analyses. Almost 90% participants initiated breastfeeding at the health facility and median time to initiate breastfeeding was 38 minutes. However, delivering in a sub-district hospital significantly delayed the breastfeeding initiation in comparison to delivering in a district hospital. Maintenance of adequate privacy and presence of separate staff for taking care of newborn significantly reduced the time in early breastfeeding initiation. Initiation time was found longer if the mother had an augmented labour, obstetric complications, and the newborn needed resuscitation. However, the initiation time was significantly early if the baby was put skin-to-skin on mother’s abdomen and received a postnatal examination by a provider. After controlling for the potential confounders, the odds of initiating breastfeeding within one hour of birth is higher if mother gives birth in a district hospital (AOR 3.0: 95% CI 1.5, 6.2), privacy is well-maintained (AOR 2.3: 95% CI 1.1, 4.5), babies cry spontaneously (AOR 7.7: 95% CI 3.3, 17.8), babies are put to skin-to-skin contact with mother (AOR 4.6: 95% CI 1.9, 11.2) and if the baby is examined by a provider in the facility (AOR 4.4: 95% CI 1.4, 14.2). The evidence generated by this study will hopefully direct the policymakers to identify and prioritize the scopes for creating and supporting early initiation of breastfeeding in the health facilities.

Keywords: Bangladesh, early initiation of breastfeeding, health facility, normal vaginal delivery, skin to skin contact

Procedia PDF Downloads 124

Authors: Lyndsee Baumann-Birkbeck, Sohil A. Khan, Shailendra Anoopkumar-Dukie, Gary D. Grant

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Technology-enhanced education tools are being rapidly integrated into health programs globally. These tools provide an interactive platform for students and can be used to deliver topics in various modes including games and simulations. Simulations are of particular interest to healthcare education, where they are employed to enhance clinical knowledge and help to bridge the gap between theory and practice. Simulations will often assess competencies for practical tasks, yet limited research examines the effects of simulation on student perceptions of their learning. The aim of this study was to determine the effects of an interactive virtual patient simulation for pharmacology education and clinical practice on student knowledge, skills and confidence. Ethics approval for the study was obtained from Griffith University Research Ethics Committee (PHM/11/14/HREC). The simulation was intended to replicate the pharmacy environment and patient interaction. The content was designed to enhance knowledge of proton-pump inhibitor pharmacology, role in therapeutics and safe supply to patients. The tool was deployed into a third-year clinical pharmacology and therapeutics course. A number of core practice areas were examined including the competency domains of questioning, counselling, referral and product provision. Baseline measures of student self-reported knowledge, skills and confidence were taken prior to the simulation using a specifically designed questionnaire. A more extensive questionnaire was deployed following the virtual patient simulation, which also included measures of student engagement with the activity. A quiz assessing student factual and conceptual knowledge of proton-pump inhibitor pharmacology and related counselling information was also included in both questionnaires. Sixty-one students (response rate >95%) from two cohorts (2014 and 2015) participated in the study. Chi-square analyses were performed and data analysed using Fishers exact test. Results demonstrate that student knowledge, skills and confidence within the competency domains of questioning, counselling, referral and product provision, show improvement following the implementation of the virtual patient simulation. Statistically significant (p<0.05) improvement occurred in ten of the possible twelve self-reported measurement areas. Greatest magnitude of improvement occurred in the area of counselling (student confidence p<0.0001). Student confidence in all domains (questioning, counselling, referral and product provision) showed a marked increase. Student performance in the quiz also improved, demonstrating a 10% improvement overall for pharmacology knowledge and clinical practice following the simulation. Overall, 85% of students reported the simulation to be engaging and 93% of students felt the virtual patient simulation enhanced learning. The data suggests that the interactive virtual patient simulation developed for clinical pharmacology and therapeutics education enhanced students knowledge, skill and confidence, with respect to the competency domains of questioning, counselling, referral and product provision. These self-reported measures appear to translate to learning outcomes, as demonstrated by the improved student performance in the quiz assessment item. Future research of education using virtual simulation should seek to incorporate modern quantitative measures of student learning and engagement, such as eye tracking.

Keywords: clinical simulation, education, pharmacology, simulation, virtual learning

Procedia PDF Downloads 303

Authors: Ghita Benayad

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Asset allocation, which affects the long-term profitability of portfolios by distributing assets to fulfill a range of investment objectives, is the cornerstone of investment management in the dynamic and complicated world of financial markets. This paper offers a technique for optimizing strategic asset allocation with the goal of improving portfolio performance by addressing the inherent complexity and uncertainty of the market through the use of Principal Component Analysis (PCA) in a multi-objective modeling framework. The study's first section starts with a critical evaluation of conventional asset allocation techniques, highlighting how poorly they are able to capture the intricate relationships between assets and the volatile nature of the market. In order to overcome these challenges, the project suggests a PCA-driven methodology that isolates important characteristics influencing asset returns by decreasing the dimensionality of the investment universe. This decrease provides a stronger basis for asset allocation decisions by facilitating a clearer understanding of market structures and behaviors. Using a multi-objective optimization model, the project builds on this foundation by taking into account a number of performance metrics at once, including risk minimization, return maximization, and the accomplishment of predetermined investment goals like regulatory compliance or sustainability standards. This model provides a more comprehensive understanding of investor preferences and portfolio performance in comparison to conventional single-objective optimization techniques. While applying the PCA-driven multi-objective optimization model to historical market data, aiming to construct portfolios better under different market situations. As compared to portfolios produced from conventional asset allocation methodologies, the results show that portfolios optimized using the proposed method display improved risk-adjusted returns, more resilience to market downturns, and better alignment with specified investment objectives. The study also looks at the implications of this PCA technique for portfolio management, including the prospect that it might give investors a more advanced framework for navigating financial markets. The findings suggest that by combining PCA with multi-objective optimization, investors may obtain a more strategic and informed asset allocation that is responsive to both market conditions and individual investment preferences. In conclusion, this capstone project improves the field of financial engineering by creating a sophisticated asset allocation optimization model that integrates PCA with multi-objective optimization. In addition to raising concerns about the condition of asset allocation today, the proposed method of portfolio management opens up new avenues for research and application in the area of investment techniques.

Keywords: asset allocation, portfolio optimization, principle component analysis, multi-objective modelling, financial market

Procedia PDF Downloads 22

Authors: Anubhav Kumar Dwivedi, Arshad Khan, S. N. Tripathi, Manish Joshi, Gaurav Mishra, Dinesh Nath, Naveen Tiwari, B. K. Sapra

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In a nuclear reactor accident scenario, a large number of fission products may release to the piping system of the primary heat transport. The released fission products, mostly in the form of the aerosol, get deposited on the inner surface of the piping system mainly due to gravitational settling and thermophoretic deposition. The removal processes in the complex piping system are controlled to a large extent by the thermal-hydraulic conditions like temperature, pressure, and flow rates. These parameters generally vary with time and therefore must be carefully monitored to predict the aerosol behavior in the piping system. The removal process of aerosol depends on the size of particles that determines how many particles get deposit or travel across the bends and reach to the other end of the piping system. The released aerosol gets deposited onto the inner surface of the piping system by various mechanisms like gravitational settling, Brownian diffusion, thermophoretic deposition, and by other deposition mechanisms. To quantify the correct estimate of deposition, the identification and understanding of the aforementioned deposition mechanisms are of great importance. These mechanisms are significantly affected by different flow and thermodynamic conditions. Thermophoresis also plays a significant role in particle deposition. In the present study, a series of experiments were performed in the piping system of the National Aerosol Test Facility (NATF), BARC using metal aerosols (zinc) in dry environments to study the spatial distribution of particles mass and number concentration, and their depletion due to various removal mechanisms in the piping system. The experiments were performed at two different carrier gas flow rates. The commercial CFD software FLUENT is used to determine the distribution of temperature, velocity, pressure, and turbulence quantities in the piping system. In addition to the in-built models for turbulence, heat transfer and flow in the commercial CFD code (FLUENT), a new sub-model PBM (population balance model) is used to describe the coagulation process and to compute the number concentration along with the size distribution at different sections of the piping. In the sub-model coagulation kernels are incorporated through user-defined function (UDF). The experimental results are compared with the CFD modeled results. It is found that most of the Zn particles (more than 35 %) deposit near the inlet of the plenum chamber and a low deposition is obtained in piping sections. The MMAD decreases along the length of the test assembly, which shows that large particles get deposited or removed in the course of flow, and only fine particles travel to the end of the piping system. The effect of a bend is also observed, and it is found that the relative loss in mass concentration at bends is more in case of a high flow rate. The simulation results show that the thermophoresis and depositional effects are more dominating for the small and larger sizes as compared to the intermediate particles size. Both SEM and XRD analysis of the collected samples show the samples are highly agglomerated non-spherical and composed mainly of ZnO. The coupled model framed in this work could be used as an important tool for predicting size distribution and concentration of some other aerosol released during a reactor accident scenario.

Keywords: aerosol, CFD, deposition, coagulation

Procedia PDF Downloads 121

Authors: Rahul Patel, S. P. Dave, M. V Shah

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Ahmedabad is a rapidly growing city in western India that is experiencing significant urbanization and industrialization. With projections indicating that it will become a metropolitan city in the near future, various construction activities are taking place, making soil testing a crucial requirement before construction can commence. To achieve this, construction companies and contractors need to periodically conduct soil testing. This study focuses on the process of creating a spatial database that is digitally formatted and integrated with geotechnical data and a Geographic Information System (GIS). Building a comprehensive geotechnical Geo-database involves three essential steps. Firstly, borehole data is collected from reputable sources. Secondly, the accuracy and redundancy of the data are verified. Finally, the geotechnical information is standardized and organized for integration into the database. Once the Geo-database is complete, it is integrated with GIS. This integration allows users to visualize, analyze, and interpret geotechnical information spatially. Using a Topographic to Raster interpolation process in GIS, estimated values are assigned to all locations based on sampled geotechnical data values. The study area was contoured for SPT N-Values, Soil Classification, Φ-Values, and Bearing Capacity (T/m2). Various interpolation techniques were cross-validated to ensure information accuracy. The GIS map generated by this study enables the calculation of SPT N-Values, Φ-Values, and bearing capacities for different footing widths and various depths. This approach highlights the potential of GIS in providing an efficient solution to complex phenomena that would otherwise be tedious to achieve through other means. Not only does GIS offer greater accuracy, but it also generates valuable information that can be used as input for correlation analysis. Furthermore, this system serves as a decision support tool for geotechnical engineers. The information generated by this study can be utilized by engineers to make informed decisions during construction activities. For instance, they can use the data to optimize foundation designs and improve site selection. In conclusion, the rapid growth experienced by Ahmedabad requires extensive construction activities, necessitating soil testing. This study focused on the process of creating a comprehensive geotechnical database integrated with GIS. The database was developed by collecting borehole data from reputable sources, verifying its accuracy and redundancy, and organizing the information for integration. The GIS map generated by this study is an efficient solution that offers greater accuracy and generates valuable information that can be used as input for correlation analysis. It also serves as a decision support tool for geotechnical engineers, allowing them to make informed decisions during construction activities.

Keywords: arcGIS, borehole data, geographic information system (GIS), geo-database, interpolation, SPT N-value, soil classification, φ-value, bearing capacity

Procedia PDF Downloads 44

Authors: Akhentoolove Corbin, Leta De Jonge, Charmaine De Jonge

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Introduction: Various writers have promoted the adoption of the 4th R in the education curricula (relationships, respect, reasoning, religion, computing, science, art, conflict management, music) and the 5th R (responsibility). They argue that the traditional 3 Rs are not adequate for the modern environment and the requirements for students to become functional citizens in society. In particular, the developing countries of the anglophone Caribbean (most of which are tiny islands) are susceptible to the dangers and complexities of climate change and global economic volatility. These proposed additions to the 3Rs do have some justification, but this research considers Resilience as even more important and relevant in a world that is faced with the negative prospects of climate change, poverty, discrimination, and economic volatility. It is argued that the foundation for resilient citizens, workers, and workplaces, must be built in the elementary and secondary/middle schools and then through the tertiary level, to achieve an outcome of more resilient students. Government, business, and society require widespread resilience to be capable of ‘bouncing back’ and be more adaptable, transformational, and sustainable. Methodology: The paper utilises a mixed-methods approach incorporating a questionnaire and interviews to determine participants’ opinions on the importance and relevance of resilience in the schools’ curricula and to government, business, and society. The target groups are as follows: educators at all levels, education administrators, members of the business sector, public sector, and 3rd sector. The research specifically targets the anglophone Caribbean developing countries (Barbados, Guyana, Jamaica, Trinidad, St. Lucia, and St Vincent, and the Grenadines). The research utilises SPSS for data analysis. Major Findings: The preliminary findings suggest that the majority of participants support the adoption of resilience as a 4th R in the curricula of the elementary, secondary/middle schools, and tertiary level in the anglophone Caribbean. The final results will allow the researchers to reveal more specific details on any variations among the islands in the sample andto engage in an in-depth discussion of the relevance and importance of resilience as the 4th R. Conclusion: Results seem to suggest that the education system should adopt the 4th R of resilience so that educators working in collaboration with the family and community/village can develop young citizens who are more resilient and capable of manifesting the behaviours and attitudes associated with ‘bouncing back,’ adaptability, transformation, and sustainability. These findings may be useful for education decision-makers and governments in these Caribbean islands, who have the authority and responsibility for the development of education policy, laws, and regulations.

Keywords: education, resilient students, adaptable, transformational, resilient citizens, workplaces, government

Procedia PDF Downloads 44

Authors: Jian Wu

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Since a few years, some French companies have integrated CRS (corporate social responsibility) criteria in their variable remuneration plans to ‘restore a good working atmosphere’ and ‘preserve the natural environment’. These CSR criteria are based on concerns on environment protection, social aspects, and corporate governance. In June 2012, a report on this practice has been made jointly by ORSE (which means Observatory on CSR in French) and PricewaterhouseCoopers. Facing this initiative from the business world, we need to examine whether it has a real economic utility. We adopt a theoretical approach for our study. First, we examine the debate between the ‘orthodox’ point of view in economics and the CSR school of thought. The classical economic model asserts that in a capitalist economy, exists a certain ‘invisible hand’ which helps to resolve all problems. When companies seek to maximize their profits, they are also fulfilling, de facto, their duties towards society. As a result, the only social responsibility that firms should have is profit-searching while respecting the minimum legal requirement. However, the CSR school considers that, as long as the economy system is not perfect, there is no ‘invisible hand’ which can arrange all in a good order. This means that we cannot count on any ‘divine force’ which makes corporations responsible regarding to society. Something more needs to be done in addition to firms’ economic and legal obligations. Then, we reply on some financial theories and empirical evident to examine the sound foundation of CSR. Three theories developed in corporate governance can be used. Stakeholder theory tells us that corporations owe a duty to all of their stakeholders including stockholders, employees, clients, suppliers, government, environment, and society. Social contract theory tells us that there are some tacit ‘social contracts’ between a company and society itself. A firm has to respect these contracts if it does not want to be punished in the form of fine, resource constraints, or bad reputation. Legitime theory tells us that corporations have to ‘legitimize’ their actions toward society if they want to continue to operate in good conditions. As regards empirical results, we present a literature review on the relationship between the CSR performance and the financial performance of a firm. We note that, due to difficulties in defining these performances, this relationship remains still ambiguous despite numerous research works realized in the field. Finally, we are curious to know whether the integration of CSR criteria in variable remuneration plans – which is practiced so far in big companies – should be extended to other ones. After investigation, we note that two groups of firms have the greatest need. The first one involves industrial sectors whose activities have a direct impact on the environment, such as petroleum and transport companies. The second one involves companies which are under pressures in terms of return to deal with international competition.

Keywords: corporate social responsibility, corporate governance, variable remuneration, stakeholder theory

Procedia PDF Downloads 165

Authors: Samanta Kietytė

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The object of this study is the verbal derivatives stemming from the Lithuanian prefix per-. The prefix under examination can be classified as prepositional, having descended from the preposition per, thereby sharing the same prototypical meaning – denoting movement OVER. These frequently co-occur within sentences (1). The aim of this paper is to conduct a semantic analysis of the prefix per- and to propose a possible radial network of its meanings. In essence, the aim is to identify the interrelationships existing between its meanings. 1) Jis peršoko per tvorą/ 3SG.NOM.M jump.PST.3 over fence.ACC.SG. /ʻHe jumped over the fenceʼ. The foundation of this work lies in the methodological and theoretical framework of cognitive linguistics. The prototypical meaning of prefixes consistently embodies spatial dimensions that can be described through image schemas. This entails the identification of the trajectory, the landmark, and the relation between them in the situation described by the prefixed verb. The meanings of linguistic units are not perceived as arbitrary, but rather, they are interconnected through semantic motivation. According to this perspective, a singular meaning within linguistic units is considered as prototypical, while additional meanings are descended (not necessarily directly) from it. For example, one of the per- meanings TRANSFER (2) is derived from the prototypical meaning OVER. 2) Prašau persiųsti vadovo laišką man./ Ask.PRS.1 forward.INF manager.GEN.SG email.ACC.SG 1.SG.DAT/ ʻPlease forward the manager‘s email to meʼ. Certain semantic relations are explained by the conceptual metaphor and metonymy theory. For instances, when prefixed verb has a meaning WIN (3) it is related to the prototypical meaning. In this case, the prefixed verb describes situations of winning in various ways. In the prototypical meaning, the trajector moves higher than the landmark, and winning is metaphorically perceived as being higher. 3) Sūnus peraugo tėvą./ Son.NOM.SG outgrow.PST.3 father.ACC.SG/ ʻThe son has outgrown the fatherʼ. The data utilized for this study was collected from the 2014 grammatically annotated text "Lithuanian Web (LithuanianWaC v2)", consisting of 63,645,700 words. Given that the corpus is grammatically lemmatized, the list of the 793 items was obtained using the wordlist function and specifying that verbs starting with per were searched. The list included not only prefixed verbs but also other verbs whose roots have the same letter sequences as prefixes. Also, words with misspellings, without diacritical marks, and words listed for lemmatization errors were rejected, and a total of 475 derivatives were left for further analysis. The semantic analysis revealed that there are 12 distinct meanings of the prefix per-. The spatial meanings were extracted by determining what a trajector is, what a landmark is, and what the relation between them is. The connection between non-spatial meanings and spatial ones occurs through semantic motivation established by identifying elements that correspond to the trajector and landmark. The analysis reveals that there are no strict boundaries among these meanings, instead showing a continuum that encompasses a central core and a peripheral association with their internal structure, i.e., some derivatives are more prototypical of a particular meaning than others.

Keywords: word-formation, cognitive semantics, metaphor, radial networks, prototype theory, prefix

Procedia PDF Downloads 38

Authors: Nadia Noor, Farida Faisal

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Horizontal hostility has been identified as a special type of workplace violence and refers to the aggressive behavior inflicted by women towards other women due to gender issues or towards minority group members due to minority issues. Many women, while they want eagerly to succeed and invest invigorated efforts to achieve success, harbor negative feelings for other women to succeed in their career. This phenomenon has been known as Horizontal Violence, Horizontal Hostility, Lateral Violence, Indirect Aggression, or The Tall Poppy Syndrome in Australian culture. Tall Poppy is referred to as a visibly successful individual who attracts envy or hostility due to distinctive characteristics. Therefore, horizontal hostility provides theoretical foundation to examine fierce competition among females than males for their limited access to top level management positions. In Pakistan, gender discrimination persists due to male dominance in the society and women do not enjoy basic equality rights in all aspects of life. They are oppressed at social and organizational level. As Government has been trying to enhance women participation through providing more employment opportunities, provision of peaceful workplace is mandatory that will enable aspiring females to achieve objectives of career success. This research study will help to understand antecedents, dimensions and outcomes of horizontal hostility that hinder career success of competitive females. The present paper is a review paper and various forms of horizontal hostility have been discussed in detail. Different psychological and organizational level drivers of horizontal hostility have been explored through literature. Psychological drivers include oppression, lack of empowerment, learned helplessness and low self-esteem. Organizational level drivers include sticky floor, glass ceiling, toxic work environment and leadership role. Horizontal hostility among working women results in psychological and physical outcomes including stress, low motivation, poor job performance and intention to leave. The study recommends provision of healthy and peaceful work environment that will enable competent women to achieve objectives of career success. In this regard, concrete actions and effective steps are required to promote gender equality at social and organizational level. The need is to ensure the enforcement of legal frameworks by government agencies in order to provide healthy working environment to women by reducing harassment and violence against them. Organizations must eradicate drivers of horizontal hostility and provide women peaceful work environment. In order to develop coping skills, training and mentoring must be provided to them.

Keywords: gender discrimination, glass ceiling, horizontal hostility, oppression

Procedia PDF Downloads 117

Authors: Ryan A. Black, Stacey A. McCaffrey

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Over the past few decades, great strides have been made towards improving the science in the measurement of psychological constructs. Item Response Theory (IRT) has been the foundation upon which statistical models have been derived to increase both precision and accuracy in psychological measurement. These models are now being used widely to develop and refine tests intended to measure an individual's level of academic achievement, aptitude, and intelligence. Recently, the field of clinical psychology has adopted IRT models to measure psychopathological phenomena such as depression, anxiety, and addiction. Because advances in IRT measurement models are being made so rapidly across various fields, it has become quite challenging for psychologists and other behavioral scientists to keep abreast of the most recent developments, much less learn how to employ and decide which models are the most appropriate to use in their line of work. In the same vein, IRT measurement models vary greatly in complexity in several interrelated ways including but not limited to the number of item-specific parameters estimated in a given model, the function which links the expected response and the predictor, response option formats, as well as dimensionality. As a result, inferior methods (a.k.a. Classical Test Theory methods) continue to be employed in efforts to measure psychological constructs, despite evidence showing that IRT methods yield more precise and accurate measurement. To increase the use of IRT methods, this study endeavors to provide a comprehensive overview of binary IRT models; that is, measurement models employed on test data consisting of binary response options (e.g., correct/incorrect, true/false, agree/disagree). Specifically, this study will cover the most basic binary IRT model, known as the 1-parameter logistic (1-PL) model dating back to over 50 years ago, up until the most recent complex, 4-parameter logistic (4-PL) model. Binary IRT models will be defined mathematically and the interpretation of each parameter will be provided. Next, all four binary IRT models will be employed on two sets of data: 1. Simulated data of N=500,000 subjects who responded to four dichotomous items and 2. A pilot analysis of real-world data collected from a sample of approximately 770 subjects who responded to four self-report dichotomous items pertaining to emotional consequences to alcohol use. Real-world data were based on responses collected on items administered to subjects as part of a scale-development study (NIDA Grant No. R44 DA023322). IRT analyses conducted on both the simulated data and analyses of real-world pilot will provide a clear demonstration of how to construct, evaluate, and compare binary IRT measurement models. All analyses will be performed using the new IRT procedure in SAS 9.4. SAS code to generate simulated data and analyses will be available upon request to allow for replication of results.

Keywords: instrument development, item response theory, latent trait theory, psychometrics

Procedia PDF Downloads 329

Authors: Fong-Zuo Lee, Jihn-Sung Lai, Yung-Bin Lin, Xiaoqin Liu, Kuo-Chun Chang, Zhi-Xian Yang, Wen-Dar Guo, Jian-Hao Hong

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In recent years, climate change is a major factor to increase rainfall intensity and extreme rainfall frequency. The increased rainfall intensity and extreme rainfall frequency will increase the probability of flash flood with abundant sediment transport in a river basin. The floods caused by heavy rainfall may cause damages to the bridge, embankment, hydraulic works, and the other disasters. Therefore, the foundation scouring of bridge pier, embankment and spur dike caused by floods has been a severe problem in the worldwide. This severe problem has happened in many East Asian countries such as Taiwan and Japan because of these areas are suffered in typhoons, earthquakes, and flood events every year. Results from the complex interaction between fluid flow patterns caused by hydraulic works and the sediment transportation leading to the formation of river morphology, it is extremely difficult to develop a reliable and durable sensor to measure river bed degradation and bridge pier scouring. Therefore, an innovative scour monitoring sensor using vibration-based Micro-Electro Mechanical Systems (MEMS) was developed. This vibration-based MEMS sensor was packaged inside a stainless sphere with the proper protection of the full-filled resin, which can measure free vibration signals to detect scouring/deposition processes at the bridge pier. In addition, a friendly operational system includes rainfall runoff model, one-dimensional and two-dimensional numerical model, and the applicability of sediment transport equation and local scour formulas of bridge pier are included in this research. The friendly operational system carries out the simulation results of flood events that includes the elevation changes of river bed erosion near the specified bridge pier and the erosion depth around bridge piers. In addition, the system is developed with easy operation and integrated interface, the system can supplies users to calibrate and verify numerical model and display simulation results through the interface comparing to the scour monitoring sensors. To achieve the forecast of the erosion depth of river bed and main bridge pier in the study area, the system also connects the rainfall forecast data from Taiwan Typhoon and Flood Research Institute. The results can be provided available information for the management unit of river and bridge engineering in advance.

Keywords: flash flood, river bed degradation, bridge pier scouring, a friendly operational system

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Authors: Jinhui Bak, Bumjin Kim

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The purpose of this study is to analyze how the scientific and mathematical fields (STEM) and liberal arts (A) work together in the STEAM program. In the future STEAM programs that have been designed and developed, the humanities will act not just as a 'tool' for science technology and mathematics, but as a 'core' content to have an equivalent status. STEAM was first introduced to the Republic of Korea in 2011 when the Ministry of Education emphasized fostering creative convergence talent. Many programs have since been developed under the name STEAM, but with the majority of programs focusing on technology education, arts and humanities are considered secondary. As a result, arts is most likely to be accepted as an option that can be excluded from the teachers who run the STEAM program. If what we ultimately pursue through STEAM education is in fostering STEAM literacy, we should no longer turn arts into a tooling area for STEM. Based on this consciousness, this study analyzed over 160 STEAM programs in middle and high schools, which were produced and distributed by the Ministry of Education and the Korea Science and Technology Foundation from 2012 to 2017. The framework of analyses referenced two criteria presented in the related prior studies: normative convergence and technological convergence. In addition, we divide Arts into fine arts and liberal arts and focused on Korean Language Course which is in liberal arts and analyzed what kind of curriculum standards were selected, and what kind of process the Korean language department participated in teaching and learning. In this study, to ensure the reliability of the analysis results, we have chosen to cross-check the individual analysis results of the two researchers and only if they are consistent. We also conducted a reliability check on the analysis results of three middle and high school teachers involved in the STEAM education program. Analyzing 10 programs selected randomly from the analyzed programs, Cronbach's α .853 showed a reliable level. The results of this study are summarized as follows. First, the convergence ratio of the liberal arts was lowest in the department of moral at 14.58%. Second, the normative convergence is 28.19%, which is lower than that of the technological convergence. Third, the language and achievement criteria selected for the program were limited to functional areas such as listening, talking, reading and writing. This means that the convergence of Korean language departments is made only by the necessary tools to communicate opinions or promote scientific products. In this study, we intend to compare these results with the STEAM programs in the United States and abroad to explore what elements or key concepts are required for the achievement criteria for Korean language and curriculum. This is meaningful in that the humanities field (A), including Korean, provides basic data that can be fused into 'equivalent qualifications' with science (S), technical engineering (TE) and mathematics (M).

Keywords: Korean STEAM Programme, liberal arts, STEAM curriculum, STEAM Literacy, STEM

Procedia PDF Downloads 129

Authors: Reeden Bicomong

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Ecotourism activities, though geared towards conservation efforts, still put pressures against the natural state of the environment. Influx of visitors that goes beyond carrying capacity of the ecotourism site, the wastes generated, greenhouse gas emissions, are just few of the potential negative impacts of a not well-managed ecotourism activities. According to Girard and Nocca (2017) tourism produces many negative impacts because it is configured according to the model of linear economy, operating on a linear model of take, make and dispose (Ellen MacArthur Foundation 2015). With the influx of tourists in an ecotourism area, more wastes are generated, and if unregulated, natural state of the environment will be at risk. It is in this light that a study on waste analysis and classification study in five different ecotourism sites of Samal Island, Philippines was conducted. The major objective of the study was to analyze the amount and content of wastes generated from ecotourism sites in Samal Island, Philippines and make recommendations based on the circular economy perspective. Five ecotourism sites in Samal Island, Philippines was identified such as Hagimit Falls, Sanipaan Vanishing Shoal, Taklobo Giant Clams, Monfort Bat Cave, and Tagbaobo Community Based Ecotourism. Ocular inspection of each ecotourism site was conducted. Likewise, key informant interview of ecotourism operators and staff was done. Wastes generated from these ecotourism sites were analyzed and characterized to come up with recommendations that are based on the concept of circular economy. Wastes generated were classified into biodegradables, recyclables, residuals and special wastes. Regression analysis was conducted to determine if increase in number of visitors would equate to increase in the amount of wastes generated. Ocular inspection indicated that all of the five ecotourism sites have their own system of waste collection. All of the sites inspected were found to be conducting waste separation at source since there are different types of garbage bins for all of the four classification of wastes such as biodegradables, recyclables, residuals and special wastes. Furthermore, all five ecotourism sites practice composting of biodegradable wastes and recycling of recyclables. Therefore, only residuals are being collected by the municipal waste collectors. Key informant interview revealed that all five ecotourism sites offer mostly nature based activities such as swimming, diving, site seeing, bat watching, rice farming experiences and community living. Among the five ecotourism sites, Sanipaan Vanishing Shoal has the highest average number of visitors in a weekly basis. At the same time, in the wastes assessment study conducted, Sanipaan has the highest amount of wastes generated. Further results of wastes analysis revealed that biodegradables constitute majority of the wastes generated in all of the five selected ecotourism sites. Meanwhile, special wastes proved to be the least generated as there was no amount of this type was observed during the three consecutive weeks WACS was conducted.

Keywords: Circular economy, ecotourism, sustainable development, WACS

Procedia PDF Downloads 184

Authors: Yumei Han, Naiqing Song, Xiaoping Yang, Yuping Han

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This study explores the conceptualization of key competencies that children are expected to develop in three year preschools (age 3-6) and the assessment practices of such key competencies in China. Assessment of children development has been put into the central place of early childhood education quality evaluation system in China. In the context of students key competencies development centered education reform in China, defining and selecting key competencies of children in preschools are of great significance in that they would lay a solid foundation for children’s lifelong learning path, and they would lead to curriculum and instruction reform, teacher development reform as well as quality evaluation reform in the early childhood education area. Based on sense making theory and framework, this study adopted multiple stakeholders’ (early childhood educators, parents, evaluation administrators, scholars in the early childhood education field) perspectives and grass root voices to conceptualize and operationalize key competencies for children in preschools in Southwest China. On the ground of children development theories, Chinese and international literature related to children development and key competencies, and key competencies frameworks by UNESCO, OECD and other nations, the authors designed a two-phase sequential mixed method study to address three main questions: (a) How is early childhood key competency defined or labeled from literature and from different stakeholders’ views? (b) Based on the definitions explicated in the literature and the surveys on different stakeholders, what domains and components are regarded to constitute the key competency framework of children in three-year preschools in China? (c) How have early childhood key competencies been assessed and measured, and how such assessment and measurement contribute to enhancing early childhood development quality? On the first phase, a series of focus group surveys were conducted among different types of stakeholders around the research questions. Moreover, on the second phase, based on the coding of the participants’ answers, together with literature synthesis findings, a questionnaire survey was designed and conducted to select most commonly expected components of preschool children’s key competencies. Semi-structured open questions were also included in the questionnaire for the participants to add on competencies beyond the checklist. Rudimentary findings show agreeable concerns on the significance and necessity of conceptualization and assessment of key competencies for children in preschools, and a key competencies framework composed of 7 domains and 25 indicators was constructed. Meanwhile, the findings also show issues in the current assessment practices of children’s competencies, such as lack of effective assessment tools, lack of teacher capacity in applying the tools to evaluating children and advancing children development accordingly. Finally, the authors put forth suggestions and implications for China and international communities in terms of restructuring early childhood key competencies framework, and promoting child development centered reform in early childhood education quality evaluation and development.

Keywords: assessment, conceptualization, early childhood education quality in China, key competencies

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Authors: Eva Filová, Jana Daňková, Věra Sovková, Matej Daniel

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Titanium alloys are biocompatible metals that are widely used in clinical practice as load bearing implants. The chemical modification may influence cell adhesion, proliferation, and differentiation as well as stiffness of the material. The aim of the study was to evaluate the adhesion, growth and differentiation of pig mesenchymal stem cells on the novel beta titanium alloy Ti36Nb6Ta compared to standard medical titanium alloy Ti6Al4V. Discs of Ti36Nb6Ta and Ti6Al4V alloy were sterilized by ethanol, put in 48-well plates, and seeded by pig mesenchymal stem cells at the density of 60×103/cm2 and cultured in Minimum essential medium (Sigma) supplemented with 10% fetal bovine serum and penicillin/streptomycin. Cell viability was evaluated using MTS assay (CellTiter 96® AQueous One Solution Cell Proliferation Assay;Promega), cell proliferation using Quant-iT™ ds DNA Assay Kit (Life Technologies). Cells were stained immunohistochemically using monoclonal antibody beta-actin, and secondary antibody conjugated with AlexaFluor®488 and subsequently the spread area of cells was measured. Cell differentiation was evaluated by alkaline phosphatase assay using p-nitrophenyl phosphate (pNPP) as a substrate; the reaction was stopped by NaOH, and the absorbance was measured at 405 nm. Osteocalcin, specific bone marker was stained immunohistochemically and subsequently visualized using confocal microscopy; the fluorescence intensity was analyzed and quantified. Moreover, gene expression of osteogenic markers osteocalcin and type I collagen was evaluated by real-time reverse transcription-PCR (qRT-PCR). For statistical evaluation, One-way ANOVA followed by Student-Newman-Keuls Method was used. For qRT-PCR, the nonparametric Kruskal-Wallis Test and Dunn's Multiple Comparison Test were used. The absorbance in MTS assay was significantly higher on titanium alloy Ti6Al4V compared to beta titanium alloy Ti36Nb6Ta on days 7 and 14. Mesenchymal stem cells were well spread on both alloys, but no difference in spread area was found. No differences in alkaline phosphatase assay, fluorescence intensity of osteocalcin as well as the expression of type I collagen, and osteocalcin genes were observed. Higher expression of type I collagen compared to osteocalcin was observed for cells on both alloys. Both beta titanium alloy Ti36Nb6Ta and titanium alloy Ti6Al4V Ti36Nb6Ta supported mesenchymal stem cellsˈ adhesion, proliferation and osteogenic differentiation. Novel beta titanium alloys Ti36Nb6Ta is a promising material for bone implantation. The project was supported by the Czech Science Foundation: grant No. 16-14758S, the Grant Agency of the Charles University, grant No. 1246314 and by the Ministry of Education, Youth and Sports NPU I: LO1309.

Keywords: beta titanium, cell growth, mesenchymal stem cells, titanium alloy, implant

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Authors: Hamza Saeed, Khurram Iqbal Ahmad Khan

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Effective information management is crucial for any construction project and its success. Primary areas of information generation are either the construction site or the design office. There are different types of information required at different stages of construction involving various stakeholders creating complexity. There is a need for effective management of information flows to reduce uncertainty creating complexity. Nature provides a unique perspective in terms of dealing with complexity, in particular, information complexity. System dynamics methodology provides tools and techniques to address complexity. It involves modeling and simulation techniques that help address complexity. Nature has been dealing with complex systems since its creation 4.5 billion years ago. It has perfected its system by evolution, resilience towards sudden changes, and extinction of unadaptable and outdated species that are no longer fit for the environment. Nature has been accommodating the changing factors and handling complexity forever. Humans have started to look at their natural counterparts for inspiration and solutions for their problems. This brings forth the possibility of using a biomimetics approach to improve the management practices used in the construction sector. Ants inhabit different habitats. Cataglyphis and Pogonomyrmex live in deserts, Leafcutter ants reside in rainforests, and Pharaoh ants are native to urban developments of tropical areas. Detailed studies have been done on fifty species out of fourteen thousand discovered. They provide the opportunity to study the interactions in diverse environments to generate collective behavior. Animals evolve to better adapt to their environment. The collective behavior of ants emerges from feedback through interactions among individuals, based on a combination of three basic factors: The patchiness of resources in time and space, operating cost, environmental stability, and the threat of rupture. If resources appear in patches through time and space, the response is accelerating and non-linear, and if resources are scattered, the response follows a linear pattern. If the acquisition of energy through food is faster than energy spent to get it, the default is to continue with an activity unless it is halted for some reason. If the energy spent is rather higher than getting it, the default changes to stay put unless activated. Finally, if the environment is stable and the threat of rupture is low, the activation and amplification rate is slow but steady. Otherwise, it is fast and sporadic. To further study the effects and to eliminate the environmental bias, the behavior of four different ant species were studied, namely Red Harvester ants (Pogonomyrmex Barbatus), Argentine ants (Linepithema Humile), Turtle ants (Cephalotes Goniodontus), Leafcutter ants (Genus: Atta). This study aims to improve the information system in the construction sector by providing a guideline inspired by nature with a systems-thinking approach, using system dynamics as a tool. Identified factors and their interdependencies were analyzed in the form of a causal loop diagram (CLD), and construction industry professionals were interviewed based on the developed CLD, which was validated with significance response. These factors and interdependencies in the natural system corresponds with the man-made systems, providing a guideline for effective use and flow of information.

Keywords: biomimetics, complex systems, construction management, information management, system dynamics

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Authors: Abdullah Nurus Salam Khan, Farhana Karim, Mohiuddin Ahsanul Kabir Chowdhury, S. Masum Billah, Nabila Zaka, Alexander Manu, Shams El Arifeen

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Globally, pre-eclampsia (PE) and ante-partum haemorrhage (APH) are two major causes of maternal mortality. Prompt identification and management of these conditions depend on competency of the birth attendants. Since these conditions are infrequent to be observed, clinical vignette based assessment could identify the extent of health worker’s competence in managing emergency obstetric care (EmOC). During June-August 2016, competence of 39 medical officers (MO) and 95 nurses working in obstetric ward of 15 government health facilities (3 district hospital, 12 sub-district hospital) was measured using clinical vignettes on PE and APH. The vignettes resulted in three outcome measures: total vignette scores, scores for diagnosis component, and scores for management component. T-test was conducted to compare mean vignette scores and linear regression was conducted to measure the strength and association of vignette scores with different cadres of health workers, facility’s readiness for EmOC and average annual utilization of normal deliveries after adjusting for type of health facility, health workers’ work experience, training status on managing maternal complication. For each of the seven component of EmOC items (administration of injectable antibiotics, oxytocic and anticonvulsant; manual removal of retained placenta, retained products of conception; blood transfusion and caesarean delivery), if any was practised in the facility within last 6 months, a point was added and cumulative EmOC readiness score (range: 0-7) was generated for each facility. The yearly utilization of delivery cases were identified by taking the average of all normal deliveries conducted during three years (2013-2015) preceding the survey. About 31% of MO and all nurses were female. Mean ( ± sd) age of the nurses were higher than the MO (40.0 ± 6.9 vs. 32.2 ± 6.1 years) and also longer mean( ± sd) working experience (8.9 ± 7.9 vs. 1.9 ± 3.9 years). About 80% health workers received any training on managing maternal complication, however, only 7% received any refresher’s training within last 12 months. The overall vignette score was 8.8 (range: 0-19), which was significantly higher among MO than nurses (10.7 vs. 8.1, p < 0.001) and the score was not associated with health facility types, training status and years of experience of the providers. Vignette score for management component (range: 0-9) increased with higher annual average number of deliveries in their respective working facility (adjusted β-coefficient 0.16, CI 0.03-0.28, p=0.01) and increased with each unit increase in EmOC readiness score (adjusted β-coefficient 0.44, CI 0.04-0.8, p=0.03). The diagnosis component of vignette score was not associated with any of the factors except it was higher among the MO than the nurses (adjusted β-coefficient 1.2, CI 0.13-2.18, p=0.03). Lack of competence in diagnosing and managing obstetric complication by the nurses than the MO is of concern especially when majority of normal deliveries are conducted by the nurses. Better EmOC preparedness of the facility and higher utilization of normal deliveries resulted in higher vignette score for the management component; implying the impact of experiential learning through higher case management. Focus should be given on improving the facility readiness for EmOC and providing the health workers periodic refresher’s training to make them more competent in managing obstetric cases.

Keywords: Bangladesh, emergency obstetric care, clinical vignette, competence of health workers

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

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

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

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Authors: Georgi Y. Georgiev, Matthew Brouillet

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This research applies the power of agent-based modeling to a pivotal question at the intersection of biology, computer science, physics, and complex systems theory about the self-organization processes in open, complex, non-equilibrium thermodynamic systems. Central to this investigation is the principle of Maximum Entropy Production (MEP). This principle suggests that such systems evolve toward states that optimize entropy production, leading to the formation of structured environments. It is hypothesized that guided by the least action principle, open thermodynamic systems identify and follow the shortest paths to transmit energy and matter, resulting in maximal entropy production, internal structure formation, and a decrease in internal entropy. Concurrently, it is predicted that there will be an increase in system information as more information is required to describe the developing structure. To test this, an agent-based model is developed simulating an ant colony's formation of a path between a food source and its nest. Utilizing the Netlogo software for modeling and Python for data analysis and visualization, self-organization is quantified by calculating the decrease in system entropy based on the potential states and distribution of the ants within the simulated environment. External entropy production is also evaluated for information increase and efficiency improvements in the system's action. Simulations demonstrated that the system begins at maximal entropy, which decreases as the ants form paths over time. A range of system behaviors contingent upon the number of ants are observed. Notably, no path formation occurred with fewer than five ants, whereas clear paths were established by 200 ants, and saturation of path formation and entropy state was reached at populations exceeding 1000 ants. This analytical approach identified the inflection point marking the transition from disorder to order and computed the slope at this point. Combined with extrapolation to the final path entropy, these parameters yield important insights into the eventual entropy state of the system and the timeframe for its establishment, enabling the estimation of the self-organization rate. This study provides a novel perspective on the exploration of self-organization in thermodynamic systems, establishing a correlation between internal entropy decrease rate and external entropy production rate. Moreover, it presents a flexible framework for assessing the impact of external factors like changes in world size, path obstacles, and friction. Overall, this research offers a robust, replicable model for studying self-organization processes in any open thermodynamic system. As such, it provides a foundation for further in-depth exploration of the complex behaviors of these systems and contributes to the development of more efficient self-organizing systems across various scientific fields.

Keywords: complexity, self-organization, agent based modelling, efficiency

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Authors: Francesca Nardi, Kashish Aneja, Katherine Ginsbach

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The COVID-19 pandemic has demonstrated both a need for evidence-based and rights-based public health policy and how challenging it can be to make effective decisions with limited information, evidence, and data. The O’Neill Institute, in conjunction with several partners, has been working since the beginning of the pandemic to collect, analyze, and distribute critical data on public health policies enacted in response to COVID-19 around the world in the COVID-19 Law Lab. Well-designed laws and policies can help build strong health systems, implement necessary measures to combat viral transmission, enforce actions that promote public health and safety for everyone, and on the individual level have a direct impact on health outcomes. Poorly designed laws and policies, on the other hand, can fail to achieve the intended results and/or obstruct the realization of fundamental human rights, further disease spread, or cause unintended collateral harms. When done properly, laws can provide the foundation that brings clarity to complexity, embrace nuance, and identifies gaps of uncertainty. However, laws can also shape the societal factors that make disease possible. Law is inseparable from the rest of society, and COVID-19 has exposed just how much laws and policies intersects all facets of society. In the COVID-19 context, evidence-based and well-informed law and policy decisions—made at the right time and in the right place—can and have meant the difference between life or death for many. Having a solid evidentiary base of legal information can promote the understanding of what works well and where, and it can drive resources and action to where they are needed most. We know that legal mechanisms can enable nations to reduce inequities and prepare for emerging threats, like novel pathogens that result in deadly disease outbreaks or antibiotic resistance. The collection and analysis of data on these legal mechanisms is a critical step towards ensuring that legal interventions and legal landscapes are effectively incorporated into more traditional kinds of health science data analyses. The COVID-19 Law Labs see a unique opportunity to collect and analyze this kind of non-traditional data to inform policy using laws and policies from across the globe and across diseases. This global view is critical to assessing the efficacy of policies in a wide range of cultural, economic, and demographic circumstances. The COVID-19 Law Lab is not just a collection of legal texts relating to COVID-19; it is a dataset of concise and actionable legal information that can be used by health researchers, social scientists, academics, human rights advocates, law and policymakers, government decision-makers, and others for cross-disciplinary quantitative and qualitative analysis to identify best practices from this outbreak, and previous ones, to be better prepared for potential future public health events.

Keywords: public health law, surveillance, policy, legal, data

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Authors: Samuele Ghignoli, Valentina de Lorenzi, Gianmarco Ferri, Stefano Luin, Francesco Cardarelli

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Insulin and glucagon are the two essential hormones for maintaining proper blood glucose homeostasis, which is disrupted in Diabetes. A constantly growing research interest has been focused on the study of the subcellular structures involved in hormone secretion, namely insulin- and glucagon-containing granules, and on the mechanisms regulating their behaviour. Yet, while several successful attempts were reported describing the dynamic properties of insulin granules, little is known about their counterparts in α cells, the glucagon-containing granules. To fill this gap, we used αTC1 clone 9 cells as a model of α cells and ZIGIR as a fluorescent Zinc chelator for granule labelling. We started by using spatiotemporal fluorescence correlation spectroscopy in the form of imaging-derived mean square displacement (iMSD) analysis. This afforded quantitative information on the average dynamical and structural properties of glucagon granules having insulin granules as a benchmark. Interestingly, the iMSD sensitivity to average granule size allowed us to confirm that glucagon granules are smaller than insulin ones (~1.4 folds, further validated by STORM imaging). To investigate possible heterogeneities in granule dynamic properties, we moved from correlation spectroscopy to single particle tracking (SPT). We developed a MATLAB script to localize and track single granules with high spatial resolution. This enabled us to classify the glucagon granules, based on their dynamic properties, as ‘blocked’ (i.e., trajectories corresponding to immobile granules), ‘confined/diffusive’ (i.e., trajectories corresponding to slowly moving granules in a defined region of the cell), or ‘drifted’ (i.e., trajectories corresponding to fast-moving granules). In cell-culturing control conditions, results show this average distribution: 32.9 ± 9.3% blocked, 59.6 ± 9.3% conf/diff, and 7.4 ± 3.2% drifted. This benchmarking provided us with a foundation for investigating selected experimental conditions of interest, such as the glucagon-granule relationship with the cytoskeleton. For instance, if Nocodazole (10 μM) is used for microtubule depolymerization, the percentage of drifted motion collapses to 3.5 ± 1.7% while immobile granules increase to 56.0 ± 10.7% (remaining 40.4 ± 10.2% of conf/diff). This result confirms the clear link between glucagon-granule motion and cytoskeleton structures, a first step towards understanding the intracellular behaviour of this subcellular compartment. The information collected might now serve to support future investigations on glucagon granules in physiology and disease. Acknowledgment: This work has received funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (grant agreement No 866127, project CAPTUR3D).

Keywords: glucagon granules, single particle tracking, correlation spectroscopy, ZIGIR

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Authors: Bagireanu Astrid, Bros-Williamson Julio, Duncheva Mila, Currie John

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Digital Twins (DT) are an innovative concept of cyber-physical integration of data between an asset and its virtual replica. They have originated in established industries such as manufacturing and aviation and have garnered increasing attention as a potentially transformative technology within the built environment. With the potential to support decision-making, real-time simulations, forecasting abilities and managing operations, DT do not fall under a singular scope. This makes defining and leveraging the potential uses of DT a potential missed opportunity. Despite its recognised potential in established industries, literature on DT in the built environment remains limited. Inadequate attention has been given to the implementation of DT in construction projects, as opposed to its operational stage applications. Additionally, the absence of a standardised definition has resulted in inconsistent interpretations of DT in both industry and academia. There is a need to consolidate research to foster a unified understanding of the DT. Such consolidation is indispensable to ensure that future research is undertaken with a solid foundation. This paper aims to present a comprehensive systematic literature review on the role of DT in the built environment. To accomplish this objective, a review and thematic analysis was conducted, encompassing relevant papers from the last five years. The identified papers are categorised based on their specific areas of focus, and the content of these papers was translated into a through classification of DT. In characterising DT and the associated data processes identified, this systematic literature review has identified 6 DT opportunities specifically relevant to the built environment: Facilitating collaborative procurement methods, Supporting net-zero and decarbonization goals, Supporting Modern Methods of Construction (MMC) and off-site manufacturing (OSM), Providing increased transparency and stakeholders collaboration, Supporting complex decision making (real-time simulations and forecasting abilities) and Seamless integration with Internet of Things (IoT), data analytics and other DT. Finally, a discussion of each area of research is provided. A table of definitions of DT across the reviewed literature is provided, seeking to delineate the current state of DT implementation in the built environment context. Gaps in knowledge are identified, as well as research challenges and opportunities for further advancements in the implementation of DT within the built environment. This paper critically assesses the existing literature to identify the potential of DT applications, aiming to harness the transformative capabilities of data in the built environment. By fostering a unified comprehension of DT, this paper contributes to advancing the effective adoption and utilisation of this technology, accelerating progress towards the realisation of smart cities, decarbonisation, and other envisioned roles for DT in the construction domain.

Keywords: built environment, design, digital twins, literature review

Procedia PDF Downloads 48

Authors: Imdad Ullah Khan, Yongseok Yoon, Kyeung Uk Choi, Kwang Rae Jo, Namyul Kim, Eunbee Lee, Wan Hee Kim, Oh-Kyeong Kweon

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The primary spinal cord injury (SCI) causes mechanical damage to the neurons and blood vessels. It leads to secondary SCI, which activates multiple pathological pathways, which expand neuronal damage at the injury site. It is characterized by vascular disruption, ischemia, excitotoxicity, oxidation, inflammation, and apoptotic cell death. It causes nerve demyelination and disruption of axons, which perpetuate a loss of impulse conduction through the injured spinal cord. It also leads to the production of myelin inhibitory molecules, which with a concomitant formation of an astroglial scar, impede axonal regeneration. The pivotal role regarding the neuronal necrosis is played by oxidation and inflammation. During an early stage of spinal cord injury, there occurs an abundant expression of reactive oxygen species (ROS) due to defective mitochondrial metabolism and abundant migration of phagocytes (macrophages, neutrophils). ROS cause lipid peroxidation of the cell membrane, and cell death. Abundant migration of neutrophils, macrophages, and lymphocytes collectively produce pro-inflammatory cytokines such as tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), interleukin-1beta (IL-1β), matrix metalloproteinase, superoxide dismutase, and myeloperoxidases which synergize neuronal apoptosis. Therefore, it is crucial to control inflammation and oxidation injury to minimize the nerve cell death during secondary spinal cord injury. Therefore, in response to oxidation and inflammation, heme oxygenase-1 (HO-1) is induced by the resident cells to ameliorate the milieu. In the meanwhile, neurotrophic factors are induced to promote neuroregeneration. However, it seems that anti-stress enzyme (HO-1) and neurotrophic factor (BDNF) do not significantly combat the pathological events during secondary spinal cord injury. Therefore, optimum healing can be induced if anti-inflammatory and neurotrophic factors are administered in a higher amount through an exogenous source. During the first experiment, the inflammation and neuroregeneration were selectively targeted. HO-1 expressing MSCs (HO-1 MSCs) and BDNF expressing MSCs (BDNF MSC) were co-transplanted in one group (combination group) of dogs with subacute spinal cord injury to selectively control the expression of inflammatory cytokines by HO-1 and induce neuroregeneration by BDNF. We compared the combination group with the HO-1 MSCs group, BDNF MSCs group, and GFP MSCs group. We found that the combination group showed significant improvement in functional recovery. It showed increased expression of neural markers and growth-associated proteins (GAP-43) than in other groups, which depicts enhanced neuroregeneration/neural sparing due to reduced expression of pro-inflammatory cytokines such as TNF-alpha, IL-6 and COX-2; and increased expression of anti-inflammatory markers such as IL-10 and HO-1. Histopathological study revealed reduced intra-parenchymal fibrosis in the injured spinal cord segment in the combination group than in other groups. Thus it was concluded that selectively targeting the inflammation and neuronal growth with the combined use of HO-1 MSCs and BDNF MSCs more favorably promote healing of the SCI. HO-1 MSCs play a role in controlling the inflammation, which favors the BDNF induced neuroregeneration at the injured spinal cord segment of dogs.

Keywords: HO-1 MSCs, BDNF MSCs, neuroregeneration, inflammation, anti-inflammation, spinal cord injury, dogs

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Authors: Ekatereine Abashidze, Nino Nazarashvili, Dali Gaganidze, Oleg Gorgadze, Mariam Aznarashvili, Eter Gvritishvili

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Potato is one of the leading agricultural crops in Georgia. Georgia produces early and late potato varieties in almost all regions. Potato production is equal to 25,000 ha and its average yield is 20-25 t/ha. Among the plant pests that limit potato production and quality, the potato cyst nematodes (Globodera pallida (Stone) Behrens and Globodera rostochiensis (Wollenveber) Behrens) are harmful around the world. PCN is among the most difficult plant pests to control. Cysts protected by a durable wall can survive for over 30 years . Control of PCN (G. pallida and G. rostochiensis) is regulated by Council Directive 2007/33/EE C. There was no legislative regulation of these pests in Georgia before 2016. By Resolution #302 from July 1, 2016, developed within the action plan of the DCFTA (Deep and Comprehensive Free Trade Area) the Government of Georgia established control over potato cyst nematodes. The Agreement about the legal acts approximation to EU legislation concerns the approval of rules of PCN control and research of these pests. Taking into consideration the above mentioned, it is necessary to study PCN (G. pallida and G. rostochiensis) in the potato-growing areas of Georgia. The aim of this research is to conduct survey of potato cyst nematodes (Globodera rostochiensis and G. pallida) in two geographically distinct regions of Georgia - Samtskhe - Javakheti and Svanetii and to identify the species G. Rostochiensis and G. Pallida by the morphological - morphometric and molecular methods. Soil samples were taken in each village, in a zig-zag pattern on the potato fields of the private sector, using the Metlitsky method. Samples were taken also from infested potato plant roots. To extract nematode cysts from soil samples Fanwick can be used according to standard methods by EPPO. Cysts were measured under a stereoscopic microscope (Leica M50). Identification of the nematod species was carried out according to morphological and morphometric characteristics of the cysts and larvae using appropriate protocols EPPO. For molecular identification, a multiplex PCR test was performed by the universal ITS5 and cyst nematodes’ (G. pallida, G. rostochiensis) specific primers. To identify the species of potato cyst nematodes (PCN) in two regions (Samtskhe-Javakheti and Svaneti) were taken 200 samples, among them: 80 samples in Samtskhe-Javakheti region and 120 in Svaneti region. Cysts of Globiodera spp. were revealed in 50 samples obtained from Samtskhe-Javakheti and 80 samples from Svaneti regions. Morphological, morphometric and molecular analysis of two forms of PCN found in investigated regions of Georgia shows that one form of PCN belongs to G. rostoshiensi; the second form is the different species of Globodera sp.t is the subject of future research. Despite the different geographic locations, larvae and cysts of G. rostoshiensi were found in both regions. But cysts and larvae of G. pallida were not reported. Acknowledgement: The research has been supported by the Shota Rustaveli National Scientific Foundation of Georgia: Project # FR17_235.

Keywords: cyst nematode, globodera rostochiensis, globodera pallida, morphologic-morphometric measurement

Procedia PDF Downloads 182

Authors: Rayanne Branco Dos Santos Lima, Lorena Pinheiro Barbosa, Kamila Ferreira Lima, Victor Manuel Tegoma Ruiz, Monyka Brito Lima Dos Santos, Maria Wendiane Gueiros Gaspar, Luzia Camila Coelho Ferreira, Leandro Cardozo Dos Santos Brito, Deyse Maria Alves Rocha

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Introduction: The lack of regulation of the baby's sleep-wake pattern in the first years of life affects the health of thousands of women. Maternal sleep deprivation can trigger or aggravate psychosomatic problems such as depression, anxiety and stress that can directly influence maternal safety, with consequences for the baby's and mother's sleep. Such conditions can affect the family's quality of life and child development. Objective: To correlate maternal security with maternal state anxiety scores and the mother's and baby's total sleep time. Method: Cross-sectional study carried out with 96 mothers of babies aged 10 to 24 months, accompanied by nursing professionals linked to a Federal University in Northeast Brazil. Study variables were maternal security, maternal state anxiety scores, infant latency and sleep time, and total nocturnal sleep time of mother and infant. Maternal safety was calculated using a four-point Likert scale (1=not at all safe, 2=somewhat safe, 3=very safe, 4=completely safe). Maternal anxiety was measured by State-Trait Anxiety Inventory, state-anxiety subscale whose scores vary from 20 to 80 points, and the higher the score, the higher the anxiety levels. Scores below 33 are considered mild; from 33 to 49, moderate and above 49, high. As for the total nocturnal sleep time, values between 7-9 hours of sleep were considered adequate for mothers, and values between 9-12 hours for the baby, according to the guidelines of the National Sleep Foundation. For the sleep latency time, a time equal to or less than 20 min was considered adequate. It is noteworthy that the latency time and the time of night sleep of the mother and the baby were obtained by the mother's subjective report. To correlate the data, Spearman's correlation was used in the statistical package R version 3.6.3. Results: 96 women and babies participated, aged 22 to 38 years (mean 30.8) and 10 to 24 months (mean 14.7), respectively. The average of maternal security was 2.89 (unsafe); Mean maternal state anxiety scores were 43.75 (moderate anxiety). The babies' average sleep latency time was 39.6 min (>20 min). The mean sleep times of the mother and baby were, respectively, 6h and 42min and 8h and 19min, both less than the recommended nocturnal sleep time. Maternal security was positively correlated with maternal state anxiety scores (rh=266, p=0.009) and negatively correlated with infant sleep latency (rh= -0.30. P=0.003). Baby sleep time was positively correlated with maternal sleep time. (rh 0.46, p<0.001). Conclusion: The more secure the mothers considered themselves, the higher the anxiety scores and the shorter the baby's sleep latency. Also, the longer the baby sleeps, the longer the mother sleeps. Thus, interventions are needed to promote the quality and efficiency of sleep for both mother and baby.

Keywords: sleep, anxiety, infant, mother-child relations

Procedia PDF Downloads 74

Authors: Soumi Banerjee

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In this research paper we will go deep into understanding Benedict Anderson’s definition of the nation as an imagined community and we will analyze why and how national identities were created through long and complex processes, and how there can exist strong emotional bonds between people within an imagined community, given the fact that these people have never known each other personally, but will still feel some form of imagined unity. Such identity construction on the part of an individual or within societies are always in some sense in a state of flux as imagined communities are ever changing, which provides us with the ontological foundation for reaching on this paper. This sort of identity crisis among individuals living in the Western world, who are in search for psychological comfort and security, illustrates a possible need for spatially dislocated, ontologically insecure and vulnerable individuals to have a secure identity. To create such an identity there has to be something to build upon, which could be achieved through what may be termed as ‘homesteading’. This could in short, and in my interpretation of Kinnvall and Nesbitt’s concept, be described as a search for security that involves a search for ‘home’, where home acts as a secure place, which one can build an identity around. The next half of the paper will then look into how populism and identity have played an increasingly important role in the political elections in the so-called western democracies of the world, using the U.S. as an example. Notions of ‘us and them’, the people and the elites will be looked into and analyzed through a social constructivist theoretical lens. Here we will analyze how such narratives about identity and the nation state affects people, their personality development and identity in different ways by studying the U.S. President Donald Trump’s speeches and analyze if and how he used different identity creating narratives for gaining political and popular support. The reason to choose narrative analysis as a method in this research paper is to use the narratives as a device to understand how the perceived notions of 'us and them' can initiate huge identity crisis with a community or a nation-state. This is a relevant subject as results and developments such as rising populist rightwing movements are being felt in a number of European states, with the so-called Brexit vote in the U.K. and the election of Donald Trump as president are two of the prime examples. This paper will then attempt to argue that these mechanisms are strengthened and gaining significance in situations when humans in an economic, social or ontologically vulnerable position, imagined or otherwise, in a general and broad meaning perceive themselves to be under pressure, and a sense of insecurity is rising. These insecurities and sense of being under threat have been on the rise in many of the Western states that are otherwise usually perceived to be some of the safest, democratically stable and prosperous states in the world, which makes it of interest to study what has changed, and help provide some part of the explanation as to how creating a ‘them’ in the discourse of national identity can cause massive security crisis.

Keywords: identity crisis, migration, ontological security(in), nation-states

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Authors: Sudha Arlikatti, Laura Siebeneck, Simon A. Andrew

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The objective of this research is to measure organizational resiliency through five attributes namely, rapidity, redundancy, resourcefulness, and robustness and to provide recommendations for resiliency building in flood risk communities. The research was conducted in Thailand following the severe floods of 2011 triggered by Tropical Storm Nock-ten. The floods lasted over eight months starting in June 2011 affecting 65 of the country’s 76 provinces and over 12 million people. Funding from a US National Science Foundation grant was used to collect ephemeral data in rural (Ayutthaya), suburban (Pathum Thani), and urban (Bangkok) provinces of Thailand. Semi-structured face-to-face interviews were conducted in Thai with 44 contacts from public, private, and non-profit organizations including universities, schools, automobile companies, vendors, tourist agencies, monks from temples, faith based organizations, and government agencies. Multiple triangulations were used to analyze the data by identifying selective themes from the qualitative data, validated with quantitative data and news media reports. This helped to obtain a more comprehensive view of how organizations in different geographic settings varied in their understanding of what enhanced or hindered their resilience and consequently their speed and capacities to respond. The findings suggest that the urban province of Bangkok scored highest in resourcefulness, rapidity of response, robustness, and ability to rebound. This is not surprising considering that it is the country’s capital and the seat of government, economic, military and tourism sectors. However, contrary to expectations all 44 respondents noted that the rural province of Ayutthaya was the fastest to recover amongst the three. Its organizations scored high on redundancy and rapidity of response due to the strength of social networks, a flood disaster sub-culture due to annual flooding, and the help provided by monks from and faith based organizations. Organizations in the suburban community of Pathum Thani scored lowest on rapidity of response and resourcefulness due to limited and ambiguous warnings, lack of prior flood experience and controversies that government flood protection works like sandbagging favored the capital city of Bangkok over them. Such a micro-level examination of organizational resilience in rural, suburban and urban areas in a country through mixed methods studies has its merits in getting a nuanced understanding of the importance of disaster subcultures and religious norms for resilience. This can help refocus attention on the strengths of social networks and social capital, for flood mitigation.

Keywords: disaster subculture, flood response, organizational resilience, Thailand floods, religious beliefs and response, social capital and disasters

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Authors: Jacqueline A. G. Sachett, Cláudia S. Nogueira, Diana C. P. Lima, Jessica T. S. Oliveira, Guilherme K. M. Salazar, Lílian K. Aguiar

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The Polo Amazon Telehealth offers several tools for professionals working in Primary Health Care as a second formative opinion, teleconsulting and training between the different areas, whether medicine, dentistry, nursing, physiotherapy, among others. These activities have a monthly schedule of free access to the municipalities of Amazonas registered. With this premise, and in partnership with the University of the State of Amazonas (UEA), is promoting the practice of the triad; teaching-research-extension in order to collaborate with the enrichment and acquisition of knowledge through educational practices carried out through teleconferences. Therefore, nursing is to join efforts and inserts as a collaborator of this project running, contributing to the education and training of these professionals who are part of the health system in full Amazon. The aim of this study is to report the experience of academic of Amazonas State University nursing course, about the experience in the extension project underway in Polo Telemedicine Amazon. This was a descriptive study, the experience report type, about the experience of nursing academic UEA, by extension 'Telenursing: teleconsulting and second formative opinion for FHS professionals in the state of Amazonas' project, held in Polo Telemedicine Amazon, through an agreement with the UEA and funded by the Foundation of Amazonas Research from July / 2012 to July / 2016. Initially developed active search of members of the Family Health Strategy professionals, in order to provide training and training teams to use the virtual clinic, as well as the virtual environment is the focus of this tool design. The election period was an aggravating factor for the implementation of teleconsulting proposal, due to change of managers in each municipality, requiring the stoppage until they assume their positions. From this definition, we established the need for new training. The first video conference took place on 03.14.2013 for learning and training in the use of Virtual Learning Environment and Virtual Clinic, with the participation of municipalities of Novo Aripuanã, São Paulo de Olivença and Manacapuru. During the whole project was carried out literature about what is being done and produced at the national level about the subject. By the time the telenursing project has received twenty-five (25) consultancy requests. The consultants sent by nursing professionals, all have been answered to date. Faced with the lived experience, particularly in video conferencing, face to cause difficulties issues, such as the fluctuation in the number of participants in activities, difficulty of participants to reconcile the opening hours of the units with the schedule of video conferencing, transmission difficulties and changes schedule. It was concluded that the establishment of connection between the Telehealth points is one of the main factors for the implementation of Telenursing and that this feature is still new for nursing. However, effective training and updating, may provide to these professional category subsidies to quality health care in the Amazon.

Keywords: Amazon, teleconsulting, telehealth, telenursing

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Authors: Young Ik Suh, Sanghak Lee, Tae Wook Chung

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In recent year, cultural diversity has acquired increasing attentions in our society due to the cultural pluralism and globalization. With the emphasis of diversity in our society, higher education has played a significant role in preparing people to be successful in a diverse world. A number of colleges and universities provide various diversity-related courses that enhance students to recognize the importance of diversity and multiculturalism. However, little research has been conducted with diversity environments in physical activity and sports-related courses to appreciate students’ attitudes toward multiculturalism. Physical activity courses can be regarded as an essential and complementary part of general education. As well, playing and watching certain sports plays a critical role to foster mutual understanding between different races and to help social integration for minority communities. Therefore, it is expected that the appropriate diverse environments in physical activity courses may have a positive impact to the understandings of different cultures and races. The primary purpose of this study is to examine attitudes toward cultural diversity in a physical activity course among undergraduate students. In building on the scholarly foundation in this area, this study applies the established survey scale (e.g., Pluralism and Diversity Attitude Assessment [PADAA]) developed by Stanley (1996) and previous literature related to cultural diversity. The PADAA includes 19 questions. The following two research hypotheses were proposed. H1: Students who take a diversity-related physical course (i.e., Taekwondo) will provide positive attitude changes toward their cultural diversity. H2: Students who take a general physical activity course (i.e., Weight Training) will provide no significant attitude changes toward their cultural diversity. To test the research hypotheses, subjects will be selected from the both Taekwondo and Weight Training class at University of West Georgia. In the Taekwondo class, students will learn the history, meaning, basic terminology, and physical skills, which is a Korean martial art and the national sport of Korea. In the Weight Training class, students will not be exposed to any cultural diversity topics. Regarding data analysis, Doubly Multivariate Analysis of Covariance (Doubly MANCOVA), 2 (time period: pre and after) X 2 (diversity-related content exposure: Taekwondo and Weight Training), will be conducted on attitudes toward the cultural diversity with control variables such as gender and age. The findings of this study will add to the body of literature in cultural diversity because this will be the first known attempt to explain the college students’ attitudes toward cultural diversity in a physical activity courses. The expected results will state that the physical activity course focusing on diversity issues will have a positive impact on college students’ attitude toward cultural diversity. This finding will indicate that Universities need to create diverse programs (e.g., study abroad, exchange program, second language courses) and environments so that students can have positive interactions with other groups of races and different cultures. It is also expected that the positive perceptions and attitudes toward cultural diversity will break down cultural barriers and make students be ready for meeting several challenges in a multicultural and global society.

Keywords: cultural diversity, physical activity course, attitude, Taekwondo

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Authors: T. Arkle, D. Pournaras, S. Lam, B. Kumar

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Introduction: Fundoplication is widely recognised as the best surgical option for gastro-oesophageal reflux disease (GORD) in the general population. However, there is controversy surrounding the use of conventional fundoplication in obese patients. Whilst the intra-operative failure of fundoplication, including wrap disruption, is reportedly higher in obese individuals, the more significant issue surrounds symptom recurrence post-surgery. Could a bariatric procedure be considered in obese patients for weight management, to treat the GORD, and to also reduce the risk of recurrence? Roux-en-Y gastric bypass, a widely performed bariatric procedure, has been shown to be highly successful both in controlling GORD symptoms and in weight management in obese patients. Furthermore, NICE has published clear guidelines on eligibility for bariatric surgery, with the main criteria being type 3 obesity or type 2 obesity with the presence of significant co-morbidities that would improve with weight loss. This study aims to identify the proportion of patients who undergo conventional fundoplication for GORD and/or hiatus hernia, which would have been eligible for bariatric surgery referral according to NICE guidelines. Methods: All patients who underwent fundoplication procedures for GORD and/or hiatus hernia repair at a single NHS foundation trust over a 10-year period will be identified using the Trust’s health records database. Pre-operative patient records will be used to find BMI and the presence of significant co-morbidities at the time of consideration for surgery. This information will be compared to NICE guidelines to determine potential eligibility for the bariatric surgical referral at the time of initial surgical intervention. Results: A total of 321 patients underwent fundoplication procedures between January 2011 and December 2020; 133 (41.4%) had available data for BMI or to allow BMI to be estimated. Of those 133, 40 patients (30%) had a BMI greater than 30kg/m², and 7 (5.3%) had BMI >35kg/m². One patient (0.75%) had a BMI >40 and would therefore be automatically eligible according to NICE guidelines. 4 further patients had significant co-morbidities, such as hypertension and osteoarthritis, which likely be improved by weight management surgery and therefore also indicated eligibility for referral. Overall, 3.75% (5/133) of patients undergoing conventional fundoplication procedures would have been eligible for bariatric surgical referral, these patients were all female, and the average age was 60.4 years. Conclusions: Based on this Trust’s experience, around 4% of obese patients undergoing fundoplication would have been eligible for bariatric surgical intervention. Based on current evidence, in class 2/3 obese patients, there is likely to have been a notable proportion with recurrent disease, potentially requiring further intervention. These patient’s may have benefitted more through undergoing bariatric surgery, for example a Roux-en-Y gastric bypass, addressing both their obesity and GORD. Use of patient written notes to obtain BMI data for the 188 patients with missing BMI data and further analysis to determine outcomes following fundoplication in all patients, assessing for incidence of recurrent disease, will be undertaken to strengthen conclusions.

Keywords: bariatric surgery, GORD, Nissen fundoplication, nice guidelines

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