Search results for: airport emergency plan
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 2817

Search results for: airport emergency plan

927 Transmission of Intergenerational Trauma: Protecting Those who Still Suffer from Pain of their Ancestors’ Trauma

Authors: Bonnie Pollak

Abstract:

As the world continues to suffer grievous injuries, future generations will suffer from trauma that was inflicted on innocent victims. Trauma can result from refugees fleeing their homes, exposure to warfare, loss of loved ones, and lack of shelter and basic necessities. The Holocaust continues to cause pain even though WWII ended nearly 80 years ago. One cannot forget the inhumane treatment and murder of relatives. The pain and trauma may continue for generations. The purpose of the Final Solution was to eliminate Jews in totality. Though Hitler’s plan was not successful, he managed to cause trauma that will continue with no end date in sight. “The Effects of Trauma and Secondary Trauma,” Trauma can cause life-long challenges, eating disorders, cardiovascular disease, cancer, sleeping difficulties, fear of going outside, guilt, separation problems, and epigenetic changes. Secondary Trauma, witnessing a loved one in danger or hearing about the danger, can cause similar symptoms as seen in primary trauma. The transmission of trauma was demonstrated in children of Holocaust survivors and in communities where oppression was commonplace. We are witnessing a repeat of widescale death and horrific injuries today in Ukraine and in other parts of the world, where concern for pain and trauma is not acknowledged by perpetrators. Lessons from the Holocaust can be applied to help others who have been traumatized by widescale terrorism resulting in death of loved ones, loss of home and shelter, food and other life-sustaining measures. The world must help victims by providing basic necessities but also by using trauma-informed care, focusing on strength and resilience, and helping individuals to feel pride in their identity.

Keywords: transmission of intergenerational trauma, impact on religious beliefs and practices, 2nd generation, identity

Procedia PDF Downloads 82
926 ILearn, a Pathway to Progress

Authors: Reni Francis

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Learning has transcended the classroom boundaries to create a learner centric, interactive, and integrative teaching learning environment. This study analysed the impact of iLearn on the teaching, learning, and evaluation among 100 teacher trainees. The objectives were to cater to the different learning styles of the teacher trainees, to incorporate innovative teaching learning activities, to assist in peer tutoring, to implement different evaluation processes. i: Identifying the learning styles among the teacher trainees through VARK Learning style checklist was followed by planning the teaching-learning process to meet the learning styles of the teacher trainees. L: Leveraging innovations in teaching- learning by planning and creating modules incorporating innovative teaching learning and hence the concept based year plan was prepared. E: Engage learning through constructivism using different teaching methodology to engage the teacher trainees in the learning process through Workshop, Round Robin, Gallery walk, Co-Operative learning, Think-Pair-Share, EDMODO, Course Networking, Concept Map, Brainstorming Sessions, Video Clippings. A: Assessing the learning through an Open Book assignment, Closed book assignment, and Multiple Choice Questions and Seminar presentation. R: Remediation through peer tutoring through Mentor-mentee approach in the tutorial groups, Group work, Library Hours. N: Norming new standards. This was done in the form of extended remediation and tutorials to understand the need of the teacher trainee and support them for further achievements in learning through Face to face interaction, Supervised Study Circle, Mobile (Device) learning. The findings of the study revealed the positive impact of iLearn towards student achievement and enhanced social skills.

Keywords: academic achievement, innovative strategy, learning styles, social skills

Procedia PDF Downloads 335
925 Evaluating News in Press about Konya in Context of City Image

Authors: Nur Gorkemli, Basak Solmaz

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With globalization, competition between cities increased and therefore cities started to give more importance to be a more differentiated one among thousands of their competitors. In order to become a more livable place and appeal more tourists, more investors, more students and more people cities give importance to marketing and branding activities. City image is very important concept for building a city brand. Cinemas, books, news or information about cities create 'city image' in peoples’ minds. Every city has their own peculiarities and changing their neutral or negative image to a positive way will bring advantages to them in national and even in international arena. Konya, which is a city in central Anatolia, has been an important city since very early times in human kind. It has the ruins of one of the first settlements existed approximately 9.000 years ago. Moreover, it was the capital of Selcuk Empire before Ottoman period and also a very important city during Ottoman Empire. With this historical richness, the city has important structures and works of art from those periods. Moreover, the city is also very well-known in the world with one of the greatest philosopher, poet, theologian, and Sufi mystic Mevlana Jelaleddin Rumi, who lived most of his life in Konya. Every year nearly two million people from various cities and countries visit Mevlana Museum. With all these potentials, Turkish Ministry of Culture and Tourism chose Konya to be a branded city in its 2023 action plan. For branding activities, understanding city image has a crucial role. Moreover, news about cities has a great potential on building a 'city image' in minds. This study is aimed at interpreting Konya’s image by categorizing Konya’s news existed in three national newspapers, which has the highest circulation in Turkey. Content analysis method will be used in this study.

Keywords: city branding, city image, newspaper analysis, Konya

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924 Policy Analysis and Program Evaluation: Need to Designate a Navigable Spatial Identity for Slums Dwellers in India to Maximize Accessibility and Policy Impact

Authors: Resham Badri

Abstract:

Cities today are unable to justify equitable distribution of theirsocio- economic and infrastructural benefits to the marginalized urban poor, and the emergence of a pressing pandemic like COVID-19 has amplified its impact. Lack of identity, vulnerability, and inaccessibility contribute to exclusion. Owing to systemic gaps in institutional processes, urban development policiesfail to represent and cater to the urban poor. This paper aims to be a roadmap for the Indian Government to understand the significance of the designation of a navigable spatial identity to slum dwellers in the form of a digital address, which can form the fundamental basis of identification to enable accessibility to not only basic servicesbut also other utilities. Capitalizing on such a granular and technology backed approach shall allow to target and reach out to the urban poor strategically andaid effective urban governance. This paper adopts a three-pronged approach;(i) Policy analysis- understanding gaps in existing urban policies of India, such as the Pradhan Mantri Awas Yojana, Swachh Bharat Mission, and Adhaar Card policy, (ii) Program Evaluation- analyzing a case study, where slum dwellers in Kolhapur city in India have been provided with navigable addresses using Google Plus Codes and have gained access to basic services, vaccinations, and other emergency deliveries in COVID-19 times, (iii) Policy recommendation. This designation of a navigable spatial identity has tremendous potential to form the foundation on which policies can further base their data collection and service delivery processes to not only provide basic services but also other infrastructural and social welfare initiatives. Hence, a massive window of opportunity lies in addressing the unaddressed to elevate their living standards and respond to their basic needs.

Keywords: policy analysis, urban poor, navigable spatial identity, accessibility

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923 A Case Report on Diaphragm Disease of Small Bowel Following Usage of Non-Steroidal Anti-Inflammatory Drugs

Authors: Shivani Kuttuva, Bridget Fergie, Andrew Mishreki, Shovkat Mir, Fintan Bergin

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Diaphragm disease (DD) of the small bowel is a condition wherein the bowel lumen is divided into a series of short compartments by multiple circumferential membranes of mucosa and submucosa, leading to pinhole lumen and subsequent obstruction. It is a rare condition commonly attributed to non-steroidal anti-inflammatory drugs (NSAIDs) usage. Herein we present a 31-yr-old-female with a history of NSAIDs usage for one year following neurosurgery, who presented with recurrent idiopathic small bowel obstruction, recalcitrant anaemia, and impaction of capsule endoscope on investigating for anaemia. The capsule endoscopy images demonstrated multiple circumferential strictures with ulcers at its tip and villous atrophy in the proximal bowel, suggestive of NSAIDs related damage. However, due to the lack of awareness of the detrimental effects of NSAIDs on bowel mucosa distal to the duodenum, the underlying aetiology of this clinical presentation remained a mystery for a significant duration. The patient had to undergo repeated laparotomies in order to relieve the symptoms of recurring acute small bowel obstruction. Upon examining the resected specimen under microscopy, the histopathological hallmark of expanded, fibrotic, and congested submucosa was picked up, leading to the confirmation of diaphragm disease. Thus, this case report aims to widen the awareness among clinicians and aid surgeons in devising a management plan for young individuals presenting with recurring episodes of obstruction due to Diaphragm disease.

Keywords: capsule endoscopy, diaphragm disease, NSAIDs, recurrent small bowel obstruction

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922 Prevalence of Shift Work Disorders among Mongolian Nurses

Authors: Davaakhuu Vandannyam, Amarsaikhan Dashtseren, Oyungoo Badamdorj

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Background: Shift work and extended working hours are increasing in many industries and organization's in the world. Over a 24 hour period, the circadian clock regulates sleep/wake patterns, body temperature, hormone levels, digestion and many other functions. Depending on the time of day or night, the human body is programmed for periods of wakefulness and sleep, high and low body temperature, high and low digestive activity and so on. Shift work is highly prevalent in industrialized societies (>20%) but, when it includes night work, it has pronounced negative effects on sleep, subjective and physiological sleepiness, performance, accident risk, as well as on health outcomes such as cardiovascular disease and certain forms of cancer. Method: In this cross-sectional field study, 634 shift work and day work nurses from a plant were involved, with participation rate of 100% (634 nurses). The general health questionnaire (GHQ-28) and RLS, ESS, ISI, FSS were used to evaluate the level of insomnia, sleepiness, fatigue and restless legs syndrome, respectively. Results: As a result of research on some indicators of health risks caused from work shift, it was proven that prevalence of restless legs syndrome was at 5.5% and 25.9% are in risk of becoming sick, 42.3% are in fatigue, 3.5% in high stage of insomnia and 27.4% are sleepy on duty. Insomnia of nurses mainly affected from long-hour shift, dissatisfaction, workload, lose of focus and use of coffee. There is sleepiness lies in the workplace due to number of shifts, unsatisfactory performance and emergency calls between shifts. It has been determined that risk of sickness influenced by number of shifts in a month and long hour shift, dissatisfaction and use of coffee and divisions are causing restless legs syndrome. Conclusions: Among the nurses, it was found that the prevalence of insomnia is 31.6%, sleepiness 27.4%, fatigue 42.3%, restless legs syndrome 35% and stress 25.9%. These factors of shift work affecting health tend to go up as working hours increase and more common among shift work nurses.

Keywords: shiftwork, insomnia, sleepiness, restless

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921 Implementation of Enhanced Recovery after Surgery (ERAS) Protocols in Laparoscopic Sleeve Gastrectomy (LSG); A Systematic Review and Meta-analysis

Authors: Misbah Nizamani, Saira Malik

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Introduction: Bariatric surgery is the most effective treatment for patients suffering from morbid obesity. Laparoscopic sleeve gastrectomy (LSG) accounts for over 50% of total bariatric procedures. The aim of our meta-analysis is to investigate the effectiveness and safety of Enhanced Recovery After Surgery (ERAS) protocols for patients undergoing laparoscopic sleeve gastrectomy. Method: To gather data, we searched PubMed, Google Scholar, ScienceDirect, and Cochrane Central. Eligible studies were randomized controlled trials and cohort studies involving adult patients (≥18 years) undergoing bariatric surgeries, i.e., Laparoscopic sleeve gastrectomy. Outcome measures included LOS, postoperative narcotic usage, postoperative pain score, postoperative nausea and vomiting, postoperative complications and mortality, emergency department visits and readmission rates. RevMan version 5.4 was used to analyze outcomes. Results: Three RCTs and three cohorts with 1522 patients were included in this study. ERAS group and control group were compared for eight outcomes. LOS was reduced significantly in the intervention group (p=0.00001), readmission rates had borderline differences (p=0.35) and higher postoperative complications in the control group, but the result was non-significant (p=0.68), whereas postoperative pain score was significantly reduced (p=0.005). Total MME requirements became significant after performing sensitivity analysis (p= 0.0004). Postoperative mortality could not be analyzed on account of invalid data showing 0% mortality in two cohort studies. Conclusion: This systemic review indicated the effectiveness of the application of ERAS protocols in LSG in reducing the length of stay, post-operative pain and total MME requirements postoperatively, indicating the feasibility and assurance of its application.

Keywords: eras protocol, sleeve gastrectomy, bariatric surgery, enhanced recovery after surgery

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920 Transboundary Pollution after Natural Disasters: Scenario Analyses for Uranium at Kyrgyzstan-Uzbekistan Border

Authors: Fengqing Li, Petra Schneider

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Failure of tailings management facilities (TMF) of radioactive residues is an enormous challenge worldwide and can result in major catastrophes. Particularly in transboundary regions, such failure is most likely to lead to international conflict. This risk occurs in Kyrgyzstan and Uzbekistan, where the current major challenge is the quantification of impacts due to pollution from uranium legacy sites and especially the impact on river basins after natural hazards (i.e., landslides). By means of GoldSim, a probabilistic simulation model, the amount of tailing material that flows into the river networks of Mailuu Suu in Kyrgyzstan after pond failure was simulated for three scenarios, namely 10%, 20%, and 30% of material inputs. Based on Muskingum-Cunge flood routing procedure, the peak value of uranium flood wave along the river network was simulated. Among the 23 TMF, 19 ponds are close to the river networks. The spatiotemporal distributions of uranium along the river networks were then simulated for all the 19 ponds under three scenarios. Taking the TP7 which is 30 km far from the Kyrgyzstan-Uzbekistan border as one example, the uranium concentration decreased continuously along the longitudinal gradient of the river network, the concentration of uranium was observed at the border after 45 min of the pond failure and the highest value was detected after 69 min. The highest concentration of uranium at the border were 16.5, 33, and 47.5 mg/L under scenarios of 10%, 20%, and 30% of material inputs, respectively. In comparison to the guideline value of uranium in drinking water (i.e., 30 µg/L) provided by the World Health Organization, the observed concentrations of uranium at the border were 550‒1583 times higher. In order to mitigate the transboundary impact of a radioactive pollutant release, an integrated framework consisting of three major strategies were proposed. Among, the short-term strategy can be used in case of emergency event, the medium-term strategy allows both countries handling the TMF efficiently based on the benefit-sharing concept, and the long-term strategy intends to rehabilitate the site through the relocation of all TMF.

Keywords: Central Asia, contaminant transport modelling, radioactive residue, transboundary conflict

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919 Drought Resilient Water Supply for Livelihood: Establishment of Groundwater Treatment Plant at Construction Sites in Taichung City

Authors: Shang-Hsin Ou, Yang-Chun Lin, Ke-Hao Cheng

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The year 2021 marked a historic drought in Taiwan, posing unprecedented challenges due to record-low rainfall and inadequate reservoir storage. The central region experienced water scarcity, leading to the implementation of "Groundwater Utilization at Construction Sites" for drought-resilient livelihood water supply. This study focuses on the establishment process of temporary groundwater treatment plants at construction sites in Taichung City, serving as a reference for future emergency response and the utilization of construction site groundwater. To identify suitable sites for groundwater reuse projects, site selection operations were carried out based on relevant water quality regulations and assessment principles. Subsequently, the planning and design of temporary water treatment plants were conducted, considering the water quality, quantity, and on-site conditions of groundwater wells associated with construction projects. The study consolidates the major water treatment facilities at each site and addresses encountered challenges during the establishment process. Practical insights gained from operating temporary groundwater treatment plants are presented, including improvements related to stable water quality, water quantity, equipment operation, and hydraulic control. In light of possible future droughts, this study provides an outlook and recommendations to expedite and improve the setup of groundwater treatment plants at construction sites. This includes considering on-site water abstraction, treatment, and distribution conditions. The study's results aim to offer practical guidelines for effectively establishing and managing such treatment plants, while offering experiences and recommendations for other regions facing similar emergencies, water shortages, and drought situations. These endeavors contribute to ensuring sustainable water supply for drought-resilient livelihoods and maintaining societal stability.

Keywords: drought resilience, groundwater treatment, construction site, water supply

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918 Material Vitalism’s Potential Role in Informing EU Construction and Demolition Waste Policy

Authors: Cameron Jones

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Emissions, produced by landfill waste from demolished obsolete buildings, have a damaging effect on both the Earth’s climate and human health. The philosophical theory of material vitalism - the potential for materials to react and emit harmful pollutants - therefore defines this construction and demolition waste (CDW) as having vitality. The European Union’s ‘Circular Economic Action Plan’ (CEAP) aims to mitigate the effects of CDW by prioritising the circularity of building materials. This dissertation examines how the philosophical theory of material vitalism can make an environmentally responsible contribution to CDW policy. The CEAP and Silvertown Quays development are used as case studies for the application of vitalism to policy revision. The study concludes that vitalism has a positive role to play in informing CDW policy, although its contribution is stronger in some areas. This is established by first appraising the aspects that relate to the obsolescence of buildings outlined in the EU’s existing CDW policies. Next, these policy directives are compared with the CE principles employed in the Silvertown Quays development. Subsequently, a keyword analysis model is used to categorise the language used in the CEAP, demonstrating how socio-political approaches to the CE and strategies to address resource scarcity could be strengthened to represent the EU’s policy aspirations more effectively. Recommendations are then made on how material vitalism could be utilised to strengthen legislation, arguing that a notable contribution can be made in most policy areas. Finally, theoretical testing of the impact of these revisions to policy on the case study development identified some practicalities for consideration in improving waste management outcomes.

Keywords: vitalism, construction waste, obsolescence, political ecology, exceptionalism

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917 Causes of Pokir in the Budgeting Process: Case Study in the Province of Jakarta, Indonesia

Authors: Tri Nopiyanto, Rahardhyani Dwiannisa, Arief Ismaryanto

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One main issue for a certain region in order to achieve development is if the government that consists of the executive, legislative and judicial board are able to work together. However, there are certain conditions that these boards are the sources of conflict, especially between the executive and legislative board. One of the example of the conflict is between the Local Government and Legislative Board (DPRD) in the Province of Jakarta in 2015. The cause of this conflict is because of the occurrence of pokir (pokok pikiran or ideas of budgeting). Pokir is driven by a budgeting plan that is arranged by DPRD that is supposed to be sourced from the aspiration of the people and delivered 5 months before the legalization of Local Government Budget (APBD), but the current condition in Jakarta is that pokir is a project by DPRD members itself and delivered just 3 days before the legalization in order to facilitate the interests of the members of the legislative. This paper discusses how pokir happens and what factors caused it. This paper uses political budgeting theory by Andy Norton and Diane Elson to analyze the issue. The method used in this paper is qualitative to collect the data and solve the problem of this research. The methods involved are in depth interview, experimental questionnaire, and literature studies. Results of this research are that Pokir occurs because of the distribution of power among DPRD members, between parties, executive, and legislative board. Beside that, Pokir also occurs because of the lack of the people’s participation in budgeting process and monitoring. Other than that, this paper also found that pokir also happens because of the budgeting system that is not able to provide a clean budgeting process, so it enables the creation of certain slots to add pokir into the budgets. Pokir also affects the development of Jakarta that goes through stagnation. This research recommends the implementation of e-budgeting to prevent the occurrence of pokir itself in the Province of Jakarta.

Keywords: legislative and executive board, Jakarta, political budgeting, Pokir

Procedia PDF Downloads 245
916 Comparison of the Existing Damage Indices in Steel Moment-Resisting Frame Structures

Authors: Hamid Kazemi, Abbasali Sadeghi

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Assessment of seismic behavior of frame structures is just done for evaluating life and financial damages or lost. The new structural seismic behavior assessment methods have been proposed, so it is necessary to define a formulation as a damage index, which the damage amount has been quantified and qualified. In this paper, four new steel moment-resisting frames with intermediate ductility and different height (2, 5, 8, and 12-story) with regular geometry and simple rectangular plan were supposed and designed. The three existing groups’ damage indices were studied, each group consisting of local index (Drift, Maximum Roof Displacement, Banon Failure, Kinematic, Banon Normalized Cumulative Rotation, Cumulative Plastic Rotation and Ductility), global index (Roufaiel and Meyer, Papadopoulos, Sozen, Rosenblueth, Ductility and Base Shear), and story (Banon Failure and Inter-story Rotation). The necessary parameters for these damage indices have been calculated under the effect of far-fault ground motion records by Non-linear Dynamic Time History Analysis. Finally, prioritization of damage indices is defined based on more conservative values in terms of more damageability rate. The results show that the selected damage index has an important effect on estimation of the damage state. Also, failure, drift, and Rosenblueth damage indices are more conservative indices respectively for local, story and global damage indices.

Keywords: damage index, far-fault ground motion records, non-linear time history analysis, SeismoStruct software, steel moment-resisting frame

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915 A Review of Protocols and Guidelines Addressing the Exposure of Occupants to Electromagnetic Field (EMF) Radiation in Buildings

Authors: Shabnam Monadizadeh, Charles Kibert, Jiaxuan Li, Janghoon Woo, Ashish Asutosh, Samira Roostaei, Maryam Kouhirostami

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A significant share of the technology that has emerged over the past several decades produces electromagnetic field (EMF) radiation. Communications devices, household appliances, industrial equipment, and medical devices all produce EMF radiation with a variety of frequencies, strengths, and ranges. Some EMF radiation, such as Extremely Low Frequency (ELF), Radio Frequency (RF), and the ionizing range have been shown to have harmful effects on human health. Depending on the frequency and strength of the radiation, EMF radiation can have health effects at the cellular level as well as at brain, nervous, and cardiovascular levels. Health authorities have enacted regulations locally and globally to set critical values to limit the adverse effects of EMF radiation. By introducing a more comprehensive field of EMF radiation study and practice, architects and designers can design for a safer electromagnetic (EM) indoor environment, and, as building and construction specialists, will be able to monitor and reduce EM radiation. This paper identifies the nature of EMF radiation in the built environment, the various EMF radiation sources, and its human health effects. It addresses European and US regulations for EMF radiation in buildings and provides a preliminary action plan. The challenges of developing measurement protocols for the various EMF radiation frequency ranges and determining the effects of EMF radiation on building occupants are discussed. This paper argues that a mature method for measuring EMF radiation in building environments and linking these measurements to human health impacts occupant health should be developed to provide adequate safeguards for human occupants of buildings for future research.

Keywords: biological affection, electromagnetic field, building regulation, human health, healthy building, clean construction

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914 Traumatic Spinal Cord Injury; Incidence, Prognosis and the Time-Course of Clinical Outcomes: A 12 Year Review from a Tertiary Hospital in Korea

Authors: Jeounghee Kim

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Objective: To describe the incidence of complication, according to the stage of Traumatic Spinal Cord Injury (TSCI) which was treated at Asan Medical Center (AMC), Korea. Hereafter, it should be developed in nursing management protocol of traumatic SCI. Methods. Retrospectively reviewed hospital records about the patients who were admitted AMC Patients with traumatic spinal cord injury until January 2005 and December 2016 were analyzed (n=97). AMC is a single institution of 2,700 beds where patients with trauma and severe trauma can be treated. Patients who were admitted to the emergency room due to spinal cord injury and who underwent intensive care unit, general ward, and rehabilitation ward. To identify long-term complications, we excluded patients who were operated on to other hospitals after surgery. Complications such as respiratory(pneumonia, atelectasis, pulmonary embolism, and others), cardiovascular (hypotension), urinary (autonomic dysreflexia, urinary tract infection (UTI), neurogenic bladder, and others), and skin systems (pressure ulcers) from the time of admission were examined through medical records and images. Results: SCI was graded according to ASIA scale. The initial grade was checked at admission. (grade A 55(56.7%), grade B 14(14.4)%, grade C 11(11.3%), grade D 15(15.5%), and grade E 2(2.1%). The grade was rechecked when the patient was discharged after treatment. (grade A 43(44.3%), grade B 15(15.5%), grade C 12(12.4%), grade D 21(21.6%), and grade E 6(6.2%). The most common complication after SCI was UTI 24cases (mean 36.5day), sore 24cases (40.5day), and Pneumonia which was 23 cases after 10days averagely. The other complications after SCI were neuropathic pain 19 cases, surgical site infection 4 cases. 53.6% of patient who had SCI were educated about intermittent catheterization at discharge from hospital. The mean hospital stay of all SCI patients was 61days. Conclusion: The Complications after traumatic SCI were developed at various stages from acute phase to chronic phase. Nurses need to understand fully the time-course of complication in traumatic SCI to provide evidence-based practice.

Keywords: spinal cord injury, complication, nursing, rehabilitation

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913 Mercury Contamination of Wetland Caused by Wastewater from Chlor-Alkali Industry

Authors: Mitsuo Yoshida

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A significant mercury contamination of soil/sediment was unveiled by an environmental monitoring program in a wetland along La Plata River, west to Montevideo City, Uruguay. The mercury contamination was caused by industrial wastewater discharged from a chlor-alkali plant using a mercury-cell process. The contamination level is above 60 mg/kg in soil/sediment. Most of mercury (Hg) in the environment is inorganic, but some fractions are converted by bacteria to methylmercury (MeHg), a toxic organic compound. MeHg biologically accumulates through a food-chain and become serious public health risk. In order to clarify the contaminated part for countermeasure operation, an intervention value of mercury contamination of sediment/soil was defined as 15 mg/kg (total Hg) by the authority. According to the intervention value, mercury contaminated area in the La Plata site is approximately 48,280 m² and estimated total volume of contaminated sediments/soils was around 18,750 m³. The countermeasures to contaminated zone were proposed in two stages; (i) mitigation of risks for public health and (ii) site remediation. The first stage is an installation of fens and net around the contamination zone, for mitigating risks of exposure, inhalation, and intake. The food chain among wetland-river ecosystem was also interrupted by the installation of net and fens. The state of mercury contamination in La Plata site and plan of countermeasure was disclosed to local people and the public, and consensus on setting off-limit area was successfully achieved. Mass media also contribute to share the information on the contamination site. The cost for countermeasures was borne by the industry under the polluter-pay-principle.

Keywords: chlor-alkali plant, mercury contamination, polluter pay principle, Uruguay, wetland

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912 A Learning Package on Medical Cannabis for Nurses

Authors: Kulveer Sandhu

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Background: In 1999, the Government of Canada legalized the use of cannabis for the therapeutic purpose (CTP); however, its users remain highly vulnerable to stigma and are judged by care providers and nonusers of cannabis. Findings from a literature review suggest health care providers (HCPs), including nurses in palliative care settings, lack knowledge about medical cannabis. For this reason, it is important to enhance HCPs’awarenessand knowledge of medical cannabis. Significance of the Project: Nurses are the first point of contact and spend more time with patients than other care providers; it is, therefore, important for them to be informed about CTPto provide quality and equitable care for medical cannabis users. Although nurses and other HCPs want information on CTP, the topic is rarely included in their educational curriculum. The purpose of this project is to create an evidence informed Package designed to increase knowledge among palliative care nurses about CTP. The information package will empower palliative nurses to help palliative patients make informed decisions about their treatment plan. Method: The information package will include a basic overview of the endocannabinoid system, common cannabis plants and products, and methods of consumption, as well as information to help nurses better understand consumption and harm reduction. The package will also include a set of cannabis fact sheets for nurses. Each fact sheet will comprise a high-level overview with graphics followed by a description of medical cannabis with links and references. At the end of the learning package, there are five self-reflection questions that allow nurses to examine their personal values, attitudes, and practices regarding medical cannabis. These questions will help each nurse understand their personal approach towards CTP and its users.

Keywords: medical cannabis, improve knowledge, cannabis for therapeutic purpose (CTP), patient experience, palliative care

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911 Future Sustainable Mobility for Colorado

Authors: Paolo Grazioli

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In this paper, we present the main results achieved during an eight-week international design project on Colorado Future Sustainable Mobilitycarried out at Metropolitan State University of Denver. The project was born with the intention to seize the opportunity created by the Colorado government’s plan to promote e-bikes mobility by creating a large network of dedicated tracks. The project was supported by local entrepreneurs who offered financial and professional support. The main goal of the project was to engage design students with the skills to design a user-centered, original vehicle that would satisfy the unarticulated practical and emotional needs of “Gen Z” users by creating a fun, useful, and reliablelife companion that would helps users carry out their everyday tasks in a practical and enjoyable way. The project was carried out with the intention of proving the importance of the combination of creative methods with practical design methodologies towards the creation of an innovative yet immediately manufacturable product for a more sustainable future. The final results demonstrate the students' capability to create innovative and yet manufacturable products and, especially, their ability to create a new design paradigm for future sustainable mobility products. The design solutions explored n the project include collaborative learning and human-interaction design for future mobility. The findings of the research led students to the fabrication of two working prototypes that will be tested in Colorado and developed for manufacturing in the year 2024. The project showed that collaborative design and project-based teaching improve the quality of the outcome and can lead to the creation of real life, innovative products directly from the classroom to the market.

Keywords: sustainable transportation design, interface design, collaborative design, user -centered design research, design prototyping

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910 A Literature Review about Responsible Third Cycle Supervision

Authors: Johanna Lundqvist

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Third cycle supervision is a multifaceted and complex task for supervisors in higher education. It progresses over several years and is affected by several proximal and distal factors. It can result in positive learning outcomes for doctoral students and high-quality publications. However, not all doctoral students thrive during their doctoral studies; nor do they all complete their studies. This is problematic for both the individuals themselves as well as society at large: doctoral students are valuable and important in current research, future research and higher education. The aim of this literature review is to elucidate what responsible third cycle supervision can include and be in practice. The question posed is as follows: according to recent literature, what is it that characterises responsible third cycle supervision in which doctoral students can thrive and develop their research knowledge and skills? A literature review was conducted, and the data gathered from the literature regarding responsible third cycle supervision was analysed by means of a thematic analysis. The analysis was inspired by the notion of responsible inclusion outlined by David Mitchell. In this study, the term literature refers to research articles and regulations. The results (preliminary) show that responsible third cycle supervision is associated with a number of interplaying factors (themes). These are as follows: committed supervisors and doctoral students; a clear vision and research problem; an individual study plan; adequate resources; interaction processes and constructive feedback; creativity; cultural awareness; respect and research ethics; systematic quality work and improvement efforts; focus on overall third cycle learning goals; and focus on research presentations and publications. Thus, responsible third cycle supervision can occur if these factors are realized in practice. This literature review is of relevance to evaluators, researchers, and management in higher education, as well as third cycle supervisors.

Keywords: doctoral student, higher education, third cycle supervisors, third cycle programmes

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909 Field Prognostic Factors on Discharge Prediction of Traumatic Brain Injuries

Authors: Mohammad Javad Behzadnia, Amir Bahador Boroumand

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Introduction: Limited facility situations require allocating the most available resources for most casualties. Accordingly, Traumatic Brain Injury (TBI) is the one that may need to transport the patient as soon as possible. In a mass casualty event, deciding when the facilities are restricted is hard. The Extended Glasgow Outcome Score (GOSE) has been introduced to assess the global outcome after brain injuries. Therefore, we aimed to evaluate the prognostic factors associated with GOSE. Materials and Methods: In a multicenter cross-sectional study conducted on 144 patients with TBI admitted to trauma emergency centers. All the patients with isolated TBI who were mentally and physically healthy before the trauma entered the study. The patient’s information was evaluated, including demographic characteristics, duration of hospital stays, mechanical ventilation on admission laboratory measurements, and on-admission vital signs. We recorded the patients’ TBI-related symptoms and brain computed tomography (CT) scan findings. Results: GOSE assessments showed an increasing trend by the comparison of on-discharge (7.47 ± 1.30), within a month (7.51 ± 1.30), and within three months (7.58 ± 1.21) evaluations (P < 0.001). On discharge, GOSE was positively correlated with Glasgow Coma Scale (GCS) (r = 0.729, P < 0.001) and motor GCS (r = 0.812, P < 0.001), and inversely with age (r = −0.261, P = 0.002), hospitalization period (r = −0.678, P < 0.001), pulse rate (r = −0.256, P = 0.002) and white blood cell (WBC). Among imaging signs and trauma-related symptoms in univariate analysis, intracranial hemorrhage (ICH), interventricular hemorrhage (IVH) (P = 0.006), subarachnoid hemorrhage (SAH) (P = 0.06; marginally at P < 0.1), subdural hemorrhage (SDH) (P = 0.032), and epidural hemorrhage (EDH) (P = 0.037) were significantly associated with GOSE at discharge in multivariable analysis. Conclusion: Our study showed some predictive factors that could help to decide which casualty should transport earlier to a trauma center. According to the current study findings, GCS, pulse rate, WBC, and among imaging signs and trauma-related symptoms, ICH, IVH, SAH, SDH, and EDH are significant independent predictors of GOSE at discharge in TBI patients.

Keywords: field, Glasgow outcome score, prediction, traumatic brain injury.

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908 Implementing 3D Printing for 3D Digital Modeling in the Classroom

Authors: Saritdikhun Somasa

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3D printing fabrication has empowered many artists in many fields. Artists who work in stop motion, 3D modeling, toy design, product design, sculpture, and fine arts become one-stop shop operations–where they can design, prototype, and distribute their designs for commercial or fine art purposes. The author has developed a digital sculpting course that fosters digital software, peripheral hardware, and 3D printing with traditional sculpting concept techniques to address the complexities of this multifaceted process, allowing the students to produce complex 3d-printed work. The author will detail the preparation and planning for pre- to post-process 3D printing elements, including software, materials, space, equipment, tools, and schedule consideration for small to medium figurine design statues in a semester-long class. In addition, the author provides insight into teaching challenges in the non-studio space that requires students to work intensively on post-printed models to assemble parts, finish, and refine the 3D printed surface. Even though this paper focuses on the 3D printing processes and techniques for small to medium design statue projects for the Digital Media program, the author hopes the paper will benefit other fields of study such as craft practices, product design, and fine-arts programs. Other schools that might implement 3D printing and fabrication in their programs will find helpful information in this paper, such as a teaching plan, choices of equipment and materials, adaptation for non-studio spaces, and putting together a complete and well-resolved project for students.

Keywords: 3D digital modeling, 3D digital sculpting, 3D modeling, 3D printing, 3D digital fabrication

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907 Investigate the Side Effects of Patients With Severe COVID-19 and Choose the Appropriate Medication Regimens to Deal With Them

Authors: Rasha Ahmadi

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In December 2019, a coronavirus, currently identified as SARS-CoV-2, produced a series of acute atypical respiratory illnesses in Wuhan, Hubei Province, China. The sickness induced by this virus was named COVID-19. The virus is transmittable between humans and has caused pandemics worldwide. The number of death tolls continues to climb and a huge number of countries have been obliged to perform social isolation and lockdown. Lack of focused therapy continues to be a problem. Epidemiological research showed that senior patients were more susceptible to severe diseases, whereas children tend to have milder symptoms. In this study, we focus on other possible side effects of COVID-19 and more detailed treatment strategies. Using bioinformatics analysis, we first isolated the gene expression profile of patients with severe COVID-19 from the GEO database. Patients' blood samples were used in the GSE183071 dataset. We then categorized the genes with high and low expression. In the next step, we uploaded the genes separately to the Enrichr database and evaluated our data for signs and symptoms as well as related medication regimens. The results showed that 138 genes with high expression and 108 genes with low expression were observed differentially in the severe COVID-19 VS control group. Symptoms and diseases such as embolism and thrombosis of the abdominal aorta, ankylosing spondylitis, suicidal ideation or attempt, regional enteritis were observed in genes with high expression and in genes with low expression of acute and subacute forms of ischemic heart, CNS infection and poliomyelitis, synovitis and tenosynovitis. Following the detection of diseases and possible signs and symptoms, Carmustine, Bithionol, Leflunomide were evaluated more significantly for high-expression genes and Chlorambucil, Ifosfamide, Hydroxyurea, Bisphenol for low-expression genes. In general, examining the different and invisible aspects of COVID-19 and identifying possible treatments can help us significantly in the emergency and hospitalization of patients.

Keywords: phenotypes, drug regimens, gene expression profiles, bioinformatics analysis, severe COVID-19

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906 An Exploration of Cross-culture Consumer Behaviour - The Characteristics of Chinese Consumers’ Decision Making in Europe

Authors: Yongsheng Guo, Xiaoxian Zhu, Mandella Osei-Assibey Bonsu

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This study explores the effects of national culture on consumer behaviour by identifying the characteristics of Chinese consumers’ decision making in Europe. It offers a better understanding of how cultural factors affect consumers’ behaviour, and how consumers make decisions in other nations with different culture. It adopted a grounded theory approach and conducted twenty-four in-depth interviews. Grounded theory models are developed to link the causal conditions, process and consequences. Results reveal that some cultural factors including conservatism, emotionality, acquaintance community, long-term orientation and principles affect Chinese consumers when making purchase decisions in Europe. Most Chinese consumers plan and prepare their expenditure and stay in Europe as cultural learners, and purchase durable products or assets as investment, and share their experiences within a community. This study identified potential problems such as political and social environment, complex procedures, and restrictions. This study found that external factors influence on internal factors and then internal characters determine consumer behaviour. This study proposes that cultural traits developed in convergence evolution through social selection and Chinese consumers persist most characters but adapt some perceptions and actions overtime in other countries. This study suggests that cultural marketing could be adopted by companies to reflect consumers’ preferences. Agencies, shops, and the authorities could take actions to reduce the complexity and restrictions.

Keywords: national culture, consumer behaviour, decision making, cultural marketing

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905 Thermal Instability in Solid under Irradiation

Authors: P. Selyshchev

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Construction materials for nuclear facilities are operated under extreme thermal and radiation conditions. First of all, they are nuclear fuel, fuel assemblies, and reactor vessel. It places high demands on the control of their state, stability of their state, and their operating conditions. An irradiated material is a typical example of an open non-equilibrium system with nonlinear feedbacks between its elements. Fluxes of energy, matter and entropy maintain states which are far away from thermal equilibrium. The links that arise under irradiation are inherently nonlinear. They form the mechanisms of feed-backs that can lead to instability. Due to this instability the temperature of the sample, heat transfer, and the defect density can exceed the steady-state value in several times. This can lead to change of typical operation and an accident. Therefore, it is necessary to take into account the thermal instability to avoid the emergency situation. The point is that non-thermal energy can be accumulated in materials because irradiation produces defects (first of all these are vacancies and interstitial atoms), which are metastable. The stored energy is about energy of defect formation. Thus, an annealing of the defects is accompanied by releasing of non-thermal stored energy into thermal one. Temperature of the material grows. Increase of temperature results in acceleration of defect annealing. Density of the defects drops and temperature grows more and more quickly. The positive feed-back is formed and self-reinforcing annealing of radiation defects develops. To describe these phenomena a theoretical approach to thermal instability is developed via formalism of complex systems. We consider system of nonlinear differential equations for different components of microstructure and temperature. The qualitative analysis of this non-linear dynamical system is carried out. Conditions for development of instability have been obtained. Points of bifurcation have been found. Convenient way to represent obtained results is a set of phase portraits. It has been shown that different regimes of material state under irradiation can develop. Thus degradation of irradiated material can be limited by means of choice appropriate kind of evolution of materials under irradiation.

Keywords: irradiation, material, non-equilibrium state, nonlinear feed-back, thermal instability

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904 Pandemic-Era WIC Participation in Delaware, U.S.: Participants' Experiences and Challenges

Authors: McKenna Halverson, Allison Karpyn

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Introduction: The COVID-19 pandemic posed unprecedented challenges for families with young children in the United States. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), a federal nutrition assistance program that provides low-income mothers and young children with access to healthy foods (e.g., infant formula, milk, and peanut butter), mitigated some financial challenges for families. However, the U.S. experienced a national infant formula shortage and rising inflation rates during the pandemic, which likely impacted WIC participants’ shopping experiences and well-being. As such, this study aimed to characterize how the COVID-19 pandemic and related events impacted Delaware WIC participants’ in-store benefit redemption experiences and overall well-being. Method: The authors conducted semi-structured interviews with 51 WIC participants in Wilmington, Delaware. Survey measures included demographic questions and open-ended questions regarding participants’ experiences with WIC benefit redemption during the COVID-19 pandemic. Data were analyzed using a hybrid inductive and deductive coding approach. Findings: The COVID-19 pandemic significantly impacted WIC participants’ shopping experiences and well-being. Specifically, participants were forced to alter their shopping behaviors to account for rising food prices (e.g., used coupons, bought less food, used food banks). Additionally, WIC participants experienced significant distress during the national infant formula shortage resulting from difficulty finding formula to feed their children. Participants also struggled with in-store benefit redemption due to inconsistencies in shelf labelling, the WIC app, and low stock of WIC foods. These findings highlight the need to reexamine WIC operations and emergency food response policy in the United States during times of crisis to optimize public health and ensure federal nutrition assistance programs meeting the needs of low-income families with young children.

Keywords: benefit redemption, COVID-19 pandemic, infant formula shortage, inflation, shopping, WIC

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903 Woodfuels as Alternative Source of Energy in Rural and Urban Areas in the Philippines

Authors: R. T. Aggangan

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Woodfuels continue to be a major component of the energy supply mix of the Philippines due to increasing demand for energy that are not adequately met by decreasing supply and increasing prices of fuel oil such as liquefied petroleum gas (LPG) and kerosene. The Development Academy of the Philippines projects the demand of woodfuels in 2016 as 28.3 million metric tons in the household sector and about 105.4 million metric tons combined supply potentials of both forest and non-forest lands. However, the Revised Master Plan for Forestry Development projects a demand of about 50 million cu meters of fuelwood in 2016 but the capability to supply from local sources is only about 28 million cu meters indicating a 44 % deficiency. Household demand constitutes 82% while industries demand is 18%. Domestic household demand for energy is for cooking needs while the industrial demand is for steam power generation, curing barns of tobacco: brick, ceramics and pot making; bakery; lime production; and small scale food processing. Factors that favour increased use of wood-based energy include the relatively low prices (increasing oil-based fuel prices), availability of efficient wood-based energy utilization technology, increasing supply, and increasing population that cannot afford conventional fuels. Moreover, innovations in combustion technology and cogeneration of heat and power from biomass for modern applications favour biomass energy development. This paper recommends policies and strategic directions for the development of the woodfuel industry with the twin goals of sustainably supplying the energy requirements of households and industry.

Keywords: biomass energy development, fuelwood, households and industry, innovations in combustion technology, supply and demand

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902 Numerical Modeling of a Molten Salt Power Tower Configuration Adaptable for Harsh Winter Climate

Authors: Huiqiang Yang, Domingo Santana

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This paper proposes a novel configuration which introduces a natural draft dry cooling tower system in a molten salt power tower. A three-dimensional numerical modeling was developed based on the novel configuration. A plan of building 20 new concentrating solar power plants has been announced by Chinese government in September 2016, and among these 20 new plants, most of them are located in regions with long winter and harsh winter climate. The innovative configuration proposed includes an external receiver concrete tower at the center, a natural draft dry cooling tower which is surrounding the external receiver concrete tower and whose shell is fixed on the external receiver concrete tower, and a power block (including a steam generation system, a steam turbine system and hot/cold molten salt tanks, and water treatment systems) is covered by the roof of the natural draft dry cooling tower. Heat exchanger bundles are vertically installed at the furthest edge of the power block. In such a way, all power block equipment operates under suitable environmental conditions through whole year operation. The monthly performance of the novel configuration is simulated as compared to a standard one. The results show that the novel configuration is much more efficient in each separate month in a typical meteorological year. Moreover, all systems inside the power block have less thermal losses at low ambient temperatures, especially in harsh winter climate. It is also worthwhile mentioning that a photovoltaic power plant can be installed on the roof of the cooling tower to reduce the parasites of the molten salt power tower.

Keywords: molten salt power tower, natural draft dry cooling, commercial scale, power block, harsh winter climate

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901 Microwave Single Photon Source Using Landau-Zener Transitions

Authors: Siddhi Khaire, Samarth Hawaldar, Baladitya Suri

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As efforts towards quantum communication advance, the need for single photon sources becomes imminent. Due to the extremely low energy of a single microwave photon, efforts to build single photon sources and detectors in the microwave range are relatively recent. We plan to use a Cooper Pair Box (CPB) that has a ‘sweet-spot’ where the two energy levels have minimal separation. Moreover, these qubits have fairly large anharmonicity making them close to ideal two-level systems. If the external gate voltage of these qubits is varied rapidly while passing through the sweet-spot, due to Landau-Zener effect, the qubit can be excited almost deterministically. The rapid change of the gate control voltage through the sweet spot induces a non-adiabatic population transfer from the ground to the excited state. The qubit eventually decays into the emission line emitting a single photon. The advantage of this setup is that the qubit can be excited without any coherent microwave excitation, thereby effectively increasing the usable source efficiency due to the absence of control pulse microwave photons. Since the probability of a Landau-Zener transition can be made almost close to unity by the appropriate design of parameters, this source behaves as an on-demand source of single microwave photons. The large anharmonicity of the CPB also ensures that only one excited state is involved in the transition and multiple photon output is highly improbable. Such a system has so far not been implemented and would find many applications in the areas of quantum optics, quantum computation as well as quantum communication.

Keywords: quantum computing, quantum communication, quantum optics, superconducting qubits, flux qubit, charge qubit, microwave single photon source, quantum information processing

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900 Computational Assistance of the Research, Using Dynamic Vector Logistics of Processes for Critical Infrastructure Subjects Continuity

Authors: Urbánek Jiří J., Krahulec Josef, Urbánek Jiří F., Johanidesová Jitka

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These Computational assistance for the research and modelling of critical infrastructure subjects continuity deal with this paper. It enables us the using of prevailing operation system MS Office (SmartArt...) for mathematical models, using DYVELOP (Dynamic Vector Logistics of Processes) method. It serves for crisis situations investigation and modelling within the organizations of critical infrastructure. In the first part of the paper, it will be introduced entities, operators and actors of DYVELOP method. It uses just three operators of Boolean algebra and four types of the entities: the Environments, the Process Systems, the Cases and the Controlling. The Process Systems (PrS) have five “brothers”: Management PrS, Transformation PrS, Logistic PrS, Event PrS and Operation PrS. The Cases have three “sisters”: Process Cell Case, Use Case and Activity Case. They all need for the controlling of their functions special Ctrl actors, except ENV – it can do without Ctrl. Model´s maps are named the Blazons and they are able mathematically - graphically express the relationships among entities, actors and processes. In the second part of this paper, the rich blazons of DYVELOP method will be used for the discovering and modelling of the cycling cases and their phases. The blazons need live PowerPoint presentation for better comprehension of this paper mission. The crisis management of energetic crisis infrastructure organization is obliged to use the cycles for successful coping of crisis situations. Several times cycling of these cases is a necessary condition for the encompassment of the both the emergency event and the mitigation of organization´s damages. Uninterrupted and continuous cycling process bring for crisis management fruitfulness and it is a good indicator and controlling actor of organizational continuity and its sustainable development advanced possibilities. The research reliable rules are derived for the safety and reliable continuity of energetic critical infrastructure organization in the crisis situation.

Keywords: blazons, computational assistance, DYVELOP method, critical infrastructure

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899 Nutritionists' Perspective on the Conception of a Telenutrition Platform for Diabetes Care: Qualitative Study

Authors: Choumous Mannoubi, Dahlia Kairy, Brigitte Vachon

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The use of technology allows clinicians to provide an individualized approach in a cost-effective manner and to reach a broader client base more easily. Such interventions can be effective in ensuring self-management and follow-up of people with diabetes, reducing the risk of complications by improving accessibility to care services, and better adherence to health recommendations. Consideration of users' opinions and fears to inform the design and implementation stages of these telehealth services seems to be essential to improve their acceptance and usability. The objective of this study is to describe the telepractice of nutritionists supporting the therapeutic management of diabetic patients and document the functional requirements of nutritionists for the design of a tele-nutrition platform. To best identify the requirements and constraints of nutritionists, we conducted individual semi-structured interviews with 10 nutritionists who offered tele-nutrition services. Using a qualitative design with a descriptive approach based on the Nutrition Care Process Model (mNCP) framework, we explored in depth the state of nutritionists' telepractice in public and private health care settings, as well as their requirements for teleconsultation. Qualitative analyses revealed that nutritionists primarily used telephone calls during the COVID 19 pandemic to provide teleconsultations. Nutritionists identified the following important features for the design of a tele-nutrition platform: it should support interprofessional collaboration, allow for the development and monitoring of a care plan, integrate with the existing IT environment, be easy to use, accommodate different levels of patient literacy, and allow for easy sharing of educational materials to support nutrition education.

Keywords: telehealth, nutrition, diabetes, telenutrition, teleconsultation, telemonitoring

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898 Telephonic Communication in Palliative Care for Better Management of Terminal Cancer Patients in Rural India: An NGO Based Approach

Authors: Aditya Manna, L. K. Khanra, S. K. Sarkar

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Aim: Due to financial incapability and the absence of manpower-poor families often fail to carry their advanced cancer patients to the nodal centers. This pilot study will explore whether communication by mobile phone can lessen this burden. Method: Initially a plan was generated regarding management of an advanced cancer patient in a nodal center at District Head Quarter. Subsequently every two week a trained social worker attached to the nodal center will follow up and give necessary advice and emotional support to the patients and their families through their registered mobile phone number. Patient’s family were also encouraged to communicate with the team by phone in case of fresh complain and urgency in between. Results: Since initiation in January 2013, 193 cancer patients were contacted by mobile phone every two weeks to enquire about their difficulties. In 76% of the situation trained social workers could give necessary advice by phone regarding management of their physical symptoms. Moreover, patient’s family was really overwhelmed by the emotional support offered by the team over the phone. Only 24% of cancer patients have to attend the nodal center for expert advice from Palliative Care specialists. Conclusion: This novel approach helped: (a) In providing regular physical and emotional support to the patients and their families. (b) In significantly reducing the financial and manpower problems of carrying patients to the nodal units. (c) In improving the quality of life of patients by continuous guidance. More and more team members can take help of this new strategy for better communication and uninterrupted care.

Keywords: palliative care, terminal care, home based palliative care, rural india

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