Search results for: remote healthcare

Authors: Sara Tokhi Arab, Rozo Noguchi, Tofeal Ahamed

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Drought is a natural disaster that occurs in a region due to a lack of precipitation and high temperatures over a continuous period or in a single season as a consequence of climate change. Precipitation deficits and prolonged high temperatures mostly affect the agricultural sector, water resources, socioeconomics, and the environment. Consequently, it causes agricultural product loss, food shortage, famines, migration, and natural resources degradation in a region. Agriculture is the first sector affected by drought. Therefore, it is important to develop an agricultural drought risk and loss assessment to mitigate the drought impact in the agriculture sector. In this context, the main purpose of this study was to assess yield loss using composite drought indices in the drought-affected vineyards. In this study, the CDI was developed for the years 2016 to 2020 by comprising five indices: the vegetation condition index (VCI), temperature condition index (TCI), deviation of NDVI from the long-term mean (NDVI DEV), normalized difference moisture index (NDMI) and precipitation condition index (PCI). Moreover, the quantitative principal component analysis (PCA) approach was used to assign a weight for each input parameter, and then the weights of all the indices were combined into one composite drought index. Finally, Bayesian regularized artificial neural networks (BRANNs) were used to evaluate the yield variation in each affected vineyard. The composite drought index result indicated the moderate to severe droughts were observed across the Kabul Province during 2016 and 2018. Moreover, the results showed that there was no vineyard in extreme drought conditions. Therefore, we only considered the severe and moderated condition. According to the BRANNs results R=0.87 and R=0.94 in severe drought conditions for the years of 2016 and 2018 and the R= 0.85 and R=0.91 in moderate drought conditions for the years of 2016 and 2018, respectively. In the Kabul Province within the two years drought periods, there was a significate deficit in the vineyards. According to the findings, 2018 had the highest rate of loss almost -7 ton/ha. However, in 2016 the loss rates were about – 1.2 ton/ha. This research will support stakeholders to identify drought affect vineyards and support farmers during severe drought.

Keywords: grapes, composite drought index, yield loss, satellite remote sensing

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Authors: Bisola Olumegbon

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Globally, there were about 229 million cases of malaria in 2022. The sub-Saharan African region accounted for 92% of the reported cases and 94% of deaths. Nigeria had the highest number of malaria cases and deaths, representing 27% of global cases. This scholarly project was a case study guided by the political determinants of health. Triangulation of data using thematic analysis was used to identify the political determinants of malaria in Nigeria and to understand how the concept of interaction contributes to the persistence of the disease. The analysis involved a deductive and inductive approach based on the literature review and the evidence of political determinants gathered in the data. Participants’ in-depth interviews were used to collect data from frontline personnel. Data triangulation was done using thematic analysis, a method used to identify patterns and themes in qualitative data. The study findings revealed a correlation between political determinants of health and malaria management efforts in Nigeria. Some influencing factors included voting challenges, inadequate funding, lack of health priority from the government, noncompliance among patients, and hurdles to effective communication. The findings suggest a need to deliberately increase dedication to the political agenda, provide sufficient financial resources, enhance communication, and active community involvement to address the persistent malaria endemic effectively. Further study is recommended to identify interventions to address identified factors of political determinants of health to reduce malaria in Nigeria. Such intervention must involve collaboration with diverse stakeholders such as policymakers, healthcare professionals, community leaders, and researchers.

Keywords: malaria, malaria management, health worker, stakeholders, political determinant of health

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Authors: Bagher Bayat, Wouter Verhoef, Behnaz Arabi, Christiaan Van der Tol

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The aim of this study was to follow the canopy reflectance patterns in response to soil water deficit and to detect trends of changes in biophysical and biochemical parameters of grass (Poa pratensis species). We used visual interpretation, imaging spectroscopy and radiative transfer model inversion to monitor the gradual manifestation of water stress effects in a laboratory setting. Plots of 21 cm x 14.5 cm surface area with Poa pratensis plants that formed a closed canopy were subjected to water stress for 50 days. In a regular weekly schedule, canopy reflectance was measured. In addition, Leaf Area Index (LAI), Chlorophyll (a+b) content (Cab) and Leaf Water Content (Cw) were measured at regular time intervals. The 1-D bidirectional canopy reflectance model SAIL, coupled with the leaf optical properties model PROSPECT, was inverted using hyperspectral measurements by means of an iterative optimization method to retrieve vegetation biophysical and biochemical parameters. The relationships between retrieved LAI, Cab, Cw, and Cs (Senescent material) with soil moisture content were established in two separated groups; stress and non-stressed. To differentiate the water stress condition from the non-stressed condition, a threshold was defined that was based on the laboratory produced Soil Water Characteristic (SWC) curve. All parameters retrieved by model inversion using canopy spectral data showed good correlation with soil water content in the water stress condition. These parameters co-varied with soil moisture content under the stress condition (Chl: R2= 0.91, Cw: R2= 0.97, Cs: R2= 0.88 and LAI: R2=0.48) at the canopy level. To validate the results, the relationship between vegetation parameters that were measured in the laboratory and soil moisture content was established. The results were totally in agreement with the modeling outputs and confirmed the results produced by radiative transfer model inversion and spectroscopy. Since water stress changes all parts of the spectrum, we concluded that analysis of the reflectance spectrum in the VIS-NIR-MIR region is a promising tool for monitoring water stress impacts on vegetation.

Keywords: hyperspectral remote sensing, model inversion, vegetation responses, water stress

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Authors: Raj Mukta Sundaram

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The location of Ayodhya is distinctly described along river Sarayu in the epic Ramayan. On the contrary, even elaborate descriptions of Lanka and its environs are still proving elusive to human ingenuity to find a direct correlation on the ground. His-torically, there were hardly any attempts to locate Lanka, but some speculations have been made very recently, of which Sri Lanka has gained widespread public ac-ceptance for obvious reasons, such as Sri and Lanka. This belief is almost secured by the impression of Ram Setu on the satellite images, which has led the government to initiate a scientific mission to determine its age. In fact, other viewpoints believe Lanka to be somewhere far-flung along the equator, and another has long proclaimed it to be in central regions of India, but both are diminished by contemporary belief. This study emanates from the fact that Sri Lanka has no correlation to epic, and more importantly, satellite images are deceptive. So the objectives are twofold - firstly, to interpret the text from a holistic approach by analyzing the ecosystem, settlements, geological as-pects, and most importantly, the timeline of key events. Secondly, it explains the pit-falls in the rationale behind contemporary belief. At the outset, it categorically rejects the notion of Ram Setu, which, in geological terms, is merely a part of the continental shelf developed millions of years ago. It also refutes the misconception created by the word “Sri,” which is, in fact, an official name adopted by the country in the seventies with no correlation whatsoever with the events of Ramayana. Likewise, the study ar-gues for the establishment of a prosperous kingdom on a remote island with adverse climatic conditions for any civilization at that time. Eventually, the study demonstrates that travel time for the distances covered by Lord Rama does not corroborate with the description in the epic. It all leads to one conclusion that Lanka cannot be in Sri Lanka. Rather, it needs to be somewhere in the central-eastern parts of India. That region jus-tifies the environs and timelines for the journeys undertaken by Lord Rama, besides the fact that the tribes of the region show strong allegiance to Ravana. The study strongly recommends looking into the central-east region of India for the golden abode of a demon king and rejuvenating tourism of a scenic and culturally rich region hitherto marred by disturbances.

Keywords: spatial analysis, Ramayan, heritage, tourism

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Authors: Lorho Mary Maheo, Arundhati Maibam Devi

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Background: Maternal and child health (MCH) cares are the health services provided to mothers and children. It includes the health promotion, preventive, curative and rehabilitation health care for mothers and children. Materials and method: The present study sample comprises of 208 women within the age range 15-69 years from two remote villages of Tamenglong District in Manipur. They were randomly chosen for assessing their health as well as the child’s health adopting an interview schedule method. Results: The findings of the study revealed that majority (80%) of the women have their first conception in their first year of married life. A decadal change has been observed with regard to the last pregnancy i.e., antenatal check-up, place of delivery as well as the service provider. However, irrespective of age of the women, home delivery is still preferred though very few are locally trained. Pre- and post-delivery resting period vary depending on the busy schedule of the agricultural works as the population under study is basically agriculturist. Postnatal care remains to be traditional as they are strongly associated with cultural beliefs and practices that continue to prevail in the studied community. Breast feeding practices such as colostrums given, initiation of breastfeeding, weaning was all taken into account.  Immunization of children has not reached the expected target owing to a variety of reasons. Maternal health care also includes use of birth control measures. The health status of women would invariably improve if family planning is meaningfully adopted. Only 10.1% of the women adopted the modern birth control implying its deep-rooted value attached to the children. Based on the self-assessment report on their health treatment a good number of the respondents resorted to self-medication even to the extent of buying allopathic medicine without a doctor’s prescription. One important finding from the study is the importance attributed to the traditional health care system which is easily affordable and accessible to the villagers. Conclusion: The overall condition of maternal and child care is way behind till now as no adequate/proper health services are available.

Keywords: antenatal, breastfeeding, child health, maternal, Tamenglong District

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Authors: Phoutsathaphone Sibounheuang, Phayom Sookaneknun Olson, Chanuttha Ploylearmsang, Santiparp Sookaneknun, Chanthanom Manithip

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Patient satisfaction is an outcome that can be measured and used to improve diabetes care and management. There are limited instruments for assessing patient satisfaction covering the whole process of diabetes management. In this study, the questionnaire was developed with items pooled from a systematic review of qualitative studies of patients’ and healthcare providers’ perspectives in diabetes management. The questionnaire consists of 11 domains with 45 items. The Thai version was translated to Lao and then checked by back-translating it into Thai. We tested the questionnaire on 150 diabetes patients in Thailand and 150 in Lao People Democratic Republic (PDR). Validity was performed by factor analysis and Pearson correlation. Internal consistency reliability was estimated by calculating Cronbach’s alpha. The study was approved by the Mahasarakham University Ethics Committee, and the National Ethics Committee for Health Research, Lao PDR. The Thai and Lao versions showed the construct validity by principal component analysis. This consisted of 11 domains which account for 71.23% of the variance (Thai version) and 71.66% of the variance (Lao version) in the total patient satisfaction scores. The Kaiser-Meyer-Olkin (KMO) measures were 0.85 for the Thai version and 0.75 for the Lao version. The Bartlett tests of sphericity of both versions were significant (p < 0.001). The factor loadings of all items in both versions were > 0.40. The convergent validity of the Thai and Lao versions was 93.63% and 79.54% respectively. The discriminant validity for the Thai and Lao versions was 92.68% and 88.68% respectively. Cronbach’s alpha was 0.95 in both versions. The Patient Satisfaction Questionnaire (PSQ) in both versions had acceptable properties. This study has yielded evidence supporting the validity and reliability of both versions.

Keywords: construct validity, diabetes management, patient satisfaction, questionnaire development, reliability

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Authors: Manahil Alfuraydan, Jodie Croxall, Lisa Hurt, Mike Kerr, Sinead Brophy

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Autism Spectrum Disorder (ASD) is a developmental condition characterised by impairment in terms of social communication, social interaction, and a repetitive or restricted pattern of interest, behaviour, and activity. There is a significant delay between seeking help and a confirmed diagnosis of ASD. This may result in delay in receiving early intervention services, which are critical for positive outcomes. The long wait times also cause stress for the individuals and their families. Telehealth potentially offers a way of improving the diagnostic pathway for ASD. This review of the literature aims to examine which telehealth approaches have been used in the diagnosis and assessment of autism in children and adults, whether they are feasible and acceptable, and how they compare with face-to-face diagnosis and assessment methods. A comprehensive search of following databases- MEDLINE, CINAHL Plus with Full text, Business Sources Complete, Web of Science, Scopus, PsycINFO and trail and systematic review databases including Cochrane Library, Health Technology Assessment, Database of Abstracts and Reviews of Effectiveness and NHS Economic Evaluation was conducted, combining the terms of autism and telehealth from 2000 to 2018. A total of 10 studies were identified for inclusion in the review. This review of the literature found there to be two methods of using telehealth: (a) video conferencing to enable teams in different areas to consult with the families and to assess the child/adult in real time and (b) a video upload to a web portal that enables the clinical assessment of behaviours in the family home. The findings were positive, finding there to be high agreement in terms of the diagnosis between remote methods and face to face methods and with high levels of satisfaction among the families and clinicians. This field is in the very early stages, and so only studies with small sample size were identified, but the findings suggest that there is potential for telehealth methods to improve assessment and diagnosis of autism used in conjunction with existing methods, especially for those with clear autism traits and adults with autism. Larger randomised controlled trials of this technology are warranted.

Keywords: assessment, autism spectrum disorder, diagnosis, telehealth

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Authors: Zandi Ahmad, Sokhanguei Yahya, Saboonchi Reza

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Objective: The new and modern lifestyle, especially in the twenty-first century and lack of movement in spinal structure have made patients and the physicians in the field of health and also other insurance companies in the developed and developing countries worry more than before about the abnormalities of spinal column- this great healthcare problem. The high prevalence of spinal column in all age groups -from children to adults- and in all professions have led the researchers to the idea of giving an opportunity to all those who worry about the dangers threatening the spinal column. Therefore, one of the corrective methods for these patients is using SEAS exercises. Materials and Methods: This study aims at investigating the effect of one-period of SEAS exercises on some spinal biomechanical and postural parameters in the students with idiopathic scoliosis. According to the nature of the study and research objectives as well as the data collection methods, the current research is a semi-empirical survey. The research population is comprised of students with idiopathic scoliosis. A total number of 30 students were selected using available sampling and divided into two groups of control and SEAS exercises. Scoliometer was used for data collection. Descriptive statistics were used to categorize the findings. Kolmogorov-Smirnov statistical models were used to confirm that the distribution of the data is normal and T-test was used for effectiveness. Hypothesis testing was done using SPSS21. Conclusion: Results show that SEAS exercises have a significant effect in Adam’s Test. Therefore, according to the obtained results, SEAS exercises can be used to recover idiopathic scoliosis among the students. Further studies in larger samples and treatment, periods as well as more follow-up investigations appear to be essential to prove these effects.

Keywords: SEAS exercises, idiopathic scoliosis, Adam’s test, exercise

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Authors: Nuruddeen Abubakar Adamu

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Background: Global health nursing describes health-related work across borders and focuses more on the differences between the nurses’ role between countries and identified why nursing care in particular country differs from another. It also helps in analyzing the health issues and concerns that transcend national borders class, race, ethnicity and culture. The primary objective of this study is to introduce the concept of global health nursing. And the article also argues for the need for global health nursing. Methods This review assesses available evidence, both published and unpublished, on issues relating to the global health nursing and the nurse's role in global health. The review is qualitative based. Results: Globalization, modern technologies, travel, migration and changes in diseases trend globally has made the nursing role to become more diverse and less traditional. These issues change the nurse’s role in the healthcare industry to become enormous and very challenging. This article considers response to issues of emerging global health nursing concept, challenges, purposes, global health nursing activities in both developed and developing countries and the nurse's role globally in maternal-newborn health; preparedness for advocacy in global health within a framework of social justice, equity; and health system strengthening globally. Conclusion: Global health nursing goes beyond the intervention to care for a patient with a particular health problem but, however health is interconnected to political, economic and social context and therefore this explains the need of a multi-professional and multi-sectoral approach to achieve the goal of global health and the need for global health nursing. Global health equity can be promoted and if the profile of nursing and nurses will be raised and enable nurses to be aware of global health issues so as to enable them to work to their full maximum potential, to attain greater health outcome and wellness.

Keywords: global health nursing, double burden of diseases, globalization, health equity

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Authors: Harshadkumar Rajgor, Jeff Butterworth

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Background: Barretts oesophagus increases the risk of developing oesophageal adenocarcinoma. Over the last 40 years, there has been a 6 fold increase in the incidence of oesophageal adenocarcinoma in the western world and the incidence rates are increasing at a greater rate than cancers of the colon, breast and lung. Endoscopic mucosal resection (EMR) is a relatively new technique being used by 2 centres in the greater midlands cancer network. EMR can be used for curative or staging purposes, for high-grade dysplasia’s and T1 tumours of the oesophagus. EMR is also suitable for those who are deemed high risk for oesophagectomy. EMR has a recurrence rate of 21% according to the Wiesbaden data. Method: A retrospective study of prospectively collected data was carried out involving 24 patients who had EMR for curative or staging purposes. Complications of residual or recurrent disease following EMR that required further treatment were investigated. Results: In 54% of cases residual or recurrent disease was suspected. 96% of patients were given clear and concise information regarding their diagnosis of high-grade dysplasia or T1 tumours. All 24 patients consulted the same specialist healthcare team. Conclusion: EMR is a safe and effective treatment for patients who have high-grade dysplasia and T1NO tumours. In 54% of cases residual or recurrent disease was suspected. Initially, only single resections were undertaken. Multiple resections are now being carried out to reduce the risk of recurrence. Complications from EMR remain low in this series and consisted of a single episode of post procedural bleeding.

Keywords: endoscopic mucosal resection, oesophageal dysplasia, T1 tumours, cancer network

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Authors: Nicole Banton

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The maternal and infant mortality rate of Blacks is three times that of Whites in the US. Research indicates that breastfeeding lowers both. In this paper, the researcher examines how the ideas that Black/African American mothers had about breastfeeding before, during, and after pregnancy (postpartum) affected whether or not they initiated breastfeeding. The researcher used snowball sampling to recruit thirty African-American mothers from the Orlando area. At the time of her interview, each mother had at least one child who was at least three years old. Through in-depth face-to-face interviews, the researcher investigated how mothers’ healthcare providers affected their decision-making about infant feeding, as well as how the type of birth that she had (e.g., preterm, vaginal, c-section, full term) affected her actual versus idealized infant feeding practice. Through our discussions, we explored how pre-pregnancy perceptions, birth and postpartum experiences, social support, and the discourses surrounding motherhood within an African-American context affected the perceptions and experiences that the mothers in the study had with their infant feeding practice(s). Findings suggest that the pregnancy and birth experiences of the mothers in the study influenced whether or not they breastfed exclusively, combined breastfeeding and infant formula use, or used infant formula exclusively. Specifically, the interplay of invocation of agency (the ability to control their bodies before, during, and after birth), birth outcomes, and the interaction that the mothers in this study had with resources, human and material, had the highest impact on the initiation, duration, and attitude toward breastfeeding.

Keywords: African American mothers, maternal health, breastfeeding, birth, midwives, obstetricians, hospital birth, breast pumps, formula use, infant feeding, lactation consultant, postpartum, vaginal birth, c-section, familial support, social support, work, pregnancy

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Authors: Seyed Ali Hossein Zahraei, Iman Dianat

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The role of midwives and healthcare providers in applying pain relief methods to female patients is very important. different therapies like hydropathy, flavorer remedies, and respiratory techniques for pain relief do not work properly as what we expected. Lack of recognition of the physiological property of birth, despite findings that coming will attenuate the consequences of hurting, suggests the necessity for bigger awareness among expectant oldsters, educators, and health professionals of the potential of coming as a way of pain relief. Method: In our method we have 5 steps to achieve activation of oxytocin and dopamine pathways in order to reduce pain in all possible fields and reasons instead of using other treatments such as chemical painkillers. Step 1: First of all the patient should start by rubbing the clitoris up and down till occurring first clitoral orgasm. Step 2: Without stop rubing clitoris the patient must continue stimulate the clitoris in different way like circular motion in clock pathway until occurring second clitoral orgasm. Step 3: Immedietly the patient can change the position from clitoris to urethral opening where vestibular glands located. In this step the patient nock the urethral area very slowly without pressure and just like touching the area till feeling want to pee. But because of activation of sympathic nerves the gi tract is inactive. Step 4: In this step the patient should apply more pressure and change the motion to circular on urethral area in which the pee sensation increase but actually it is vestibular gland fluid. The patient should release it in small amount in this step. Step 5: The last step is combination of clitoral and urethral stimulation in up and down motion that cause more pee feeling and after clitoral orgasm occurred the amount of released fluid can be about 400ml.

Keywords: female, natural, method, pain

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Authors: T. Holecki, J. Wozniak-Holecka, K. Sobczyk

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Development, implementation, and evaluation of the effects of health policy programs, resulting from the identified health needs and health status of residents, is the own task of all local government units in Poland. This is due to the obligation to provide access to healthcare services to all residents and the implementation of tasks in the field of health promotion based on specific legal acts. Until the end of 2016 local governments financed health policy programs only with their own funds. Currently, there are additional resources available from the public health insurance subsidising up to 80% of health policy programs costs in cities with a population under 5 thousand people and up to 40% in bigger cities. Changes in legal provisions do not translate automatically to increased involvement of local government units in the implementation of public health tasks. The main objective of the study was to assess the actual impact of the new legal regulation on financing local health policy programs on the engagement of local administration in this area of public health activity. To achieve this aim, we analyzed difference in the number of local governments developing and implementing health policy programs before and after the new law came into force. The aim of the study was also to estimate the level of expenditures incurred by self-government units and the National Health Fund to cover the costs of health policy programs. In the first stage of the project, legal acts concerning the subject of research and financial data published by the National Health Fund were analyzed. The material for the second, main stage of the study was the detailed financial data obtained from the National Health Fund and data obtained from local government units. The results present the situation in Poland in territorial terms, divided into 16 voivodships.

Keywords: health care system, health policy programs, local self-governments, public health

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Authors: Jonah Kenei, Elisha Opiyo

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Electronic health records, as a repository of patient information, is nowadays the most commonly used technology to record, store and review patient clinical records and perform other clinical tasks. However, the accurate identification and retrieval of relevant information from clinical records is a difficult task due to the unstructured nature of clinical documents, characterized in particular by a lack of clear structure. Therefore, medical practice is facing a challenge thanks to the rapid growth of health information in electronic health records (EHRs), mostly in narrative text form. As a result, it's becoming important to effectively manage the growing amount of data for a single patient. As a result, there is currently a requirement to visualize electronic health records (EHRs) in a way that aids physicians in clinical tasks and medical decision-making. Leveraging text visualization techniques to unstructured clinical narrative texts is a new area of research that aims to provide better information extraction and retrieval to support clinical decision support in scenarios where data generated continues to grow. Clinical datasets in electronic health records (EHR) offer a lot of potential for training accurate statistical models to classify facets of information which can then be used to improve patient care and outcomes. However, in many clinical note datasets, the unstructured nature of clinical texts is a common problem. This paper examines the very issue of getting raw clinical texts and mapping them into meaningful structures that can support healthcare professionals utilizing narrative texts. Our work is the result of a collaborative design process that was aided by empirical data collected through formal usability testing.

Keywords: classification, electronic health records, narrative texts, visualization

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Authors: Theresa Veach, Erin Crisp

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It has been shown that traditional students flourish as a function of several factors including level of academic challenge, student/faculty interactions, active/collaborative learning, enriching educational experiences, and supportive campus environment. With the increase in demand for remote or online courses, factors that result in academic flourishing in the virtual classroom have become more crucial to understand than ever before. This study seeks to give insight into those factors that impact student learning, overall student wellbeing, and flourishing among college students enrolled in an online program. 4160 unique students participated in the completion of End of Course Survey (EOC) before final grades were released. Quantitative results from the survey are used by program directors as a measure of student satisfaction with both the curriculum and the faculty. In addition, students also submitted narrative comments in an open comment field. No prompts were given for the comment field on the survey. The purpose of this analysis was to report on the qualitative data available with the goal of gaining insight into what matters to students. Survey results from July 1st, 2016 to December 1st, 2016 were compiled into spreadsheet data sets. The analysis approach used involved both key word and phrase searches and reading results to identify patterns in responses and to tally the frequency of those patterns. In total, just over 25,000 comments were included in the analysis. Preliminary results indicate that it is the professor-student relationship, frequency of feedback and overall engagement of both instructors and students that are indicators of flourishing in college programs offered in an online format. This qualitative study supports the notion that college students flourish with regard to 1) education, 2) overall student well-being and 3) program satisfaction when overall engagement of both the instructor and the student is high. Ways to increase engagement in the online college environment were also explored. These include 1) increasing student participation by providing more project-based assignments, 2) interacting with students in meaningful ways that are both high in frequency and in personal content, and 3) allowing students to apply newly acquired knowledge in ways that are meaningful to current life circumstances and future goals.

Keywords: college, engagement, flourishing, online

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Authors: Aisha Al-Baroud

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The United Nations Compensation Commission (UNCC), Kuwait National Focal Point (KNFP) and Kuwait Oil Company (KOC) cooperated in a joint project to undertake comprehensive and collaborative efforts to remediate 26 million m3 of crude oil contaminated soil that had resulted from the Gulf War in 1990/1991. These efforts are referred to as the Kuwait Environmental Remediation Program (KERP). KOC has developed a Total Remediation Solution (TRS) for KERP, which will guide the Remediation projects, comprises of alternative remedial solutions with treatment techniques inclusive of limited landfills for non-treatable soil materials disposal, and relies on treating certain ranges of Total Petroleum Hydrocarbon (TPH) contamination with the most appropriate remediation techniques. The KERP Remediation projects will be implemented within the KOC’s oilfields in North and South East Kuwait. The objectives of this remediation project is to clear land for field development and treat all the oil contaminated features (dry oil lakes, wet oil lakes, and oil contaminated piles) through TRS plan to optimize the treatment processes and minimize the volume of contaminated materials to be placed into landfills. The treatment strategy will comprise of Excavation and Transportation (E&T) of oil contaminated soils from contaminated land to remote treatment areas and to use appropriate remediation technologies or a combination of treatment technologies to achieve remediation target criteria (RTC). KOC has awarded five mega projects to achieve the same and is currently in the execution phase. As a part of the company’s commitment to environment and for the fulfillment of the mandatory HSSEMS procedures, all the Remediation contractors needs to report waste generation data from the various project activities on a monthly basis. Data on waste generation is collected in order to implement cost-efficient and sustainable waste management operations. Data analytics approaches can be built on the top of the data to produce more detailed, and in-time waste generation information for the basis of waste management and collection. The results obtained highlight the potential of advanced data analytic approaches in producing more detailed waste generation information for planning and optimization of waste collection and recycling.

Keywords: waste, tencnolgies, KERP, data, soil

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Authors: Martina I. Reinhold, Theresa Bacon-Baguley

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A core challenge of physician assistant education is preparing professionals for lifelong learning. While this conventionally has encompassed scientific advances, students must also embrace new care delivery models and technologies. Telemedicine, the provision of care via two-way audio and video, is an example of a technological advance reforming health care. During a three-semester sequence of Hospital Community Experiences, physician assistant students were assigned experiences with Answer Health on Demand, a telemedicine collaborative. Preceding the experiences, the agency lectured on the application of telemedicine. Students were then introduced to the technology and partnered with a provider. Prior to observing the patient-provider interaction, patient consent was obtained. Afterwards, students completed a reflection paper on lessons learned and the potential impact of telemedicine on their careers. Thematic analysis was completed on the students’ reflection papers (n=13). Preceding the lecture and experience, over 75% of students (10/13) were unaware of telemedicine. Several stated they were 'skeptical' about the effectiveness of 'impersonal' health care appointments. After the experience, all students remarked that telemedicine will play a large role in the future of healthcare and will provide benefits by improving access in rural areas, decreasing wait time, and saving cost. More importantly, 30% of students (4/13) commented that telemedicine is a technology they can see themselves using in their future practice. Initial results indicate that collaborative interaction between students and telemedicine providers enhanced student learning and exposed students to technological advances in the delivery of care. Further, results indicate that students perceived telemedicine more favorably as a viable delivery method after the experience.

Keywords: collaboration, physician assistant education, teaching innovative health care delivery method, telemedicine

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Authors: Swanand Pathak, Kiran R. Giri, Reena R. Giri, Kamlesh Palandurkar, Sangita Totade, Rajesh Jha, S. S. Patel

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Background: Population burden, illiteracy, availability of few doctors for larger group of population leads to many unanswered questions left in a patient’s mind. Incomplete information results into noncompliance, therapeutic failure, and adverse drug reactions (ADR). It is very important to establish a system which will provide noncommercial, independent, unbiased source of medicine information. Medicines Info OPD is a concept and step towards safe and appropriate use of medicines. Objective: (1) to assess the present status of knowledge about the medicines in the patients and its correlation with education; (2) to assess the medicine information dispensing modalities, their use and sufficiency from the patients view point; (3) to assess the overall need for Medicines Information OPD in present scenario. Materials and Methods: A pre-validated questionnaire based study was conducted amongst 500 patients of tertiary health care hospital. The questionnaire consisted of specific questions regarding understanding of prescription, knowledge about adverse drug reaction, view about self-medication and opinion regarding the need of Medicines Info OPD. Results: Significantly large proportion of patients opined that doctors do not have sufficient time in current Indian healthcare to explain the prescription and they are not aware of adverse drug reactions, expiry date or use the package inserts etc. Conclusion: Clinically relevant, up to date, user specific, independent, objective and unbiased Medicines Info OPD is essential for appropriate drug use and can help in a big way to common public to address many problems faced by them.

Keywords: information, prescription, unbiased, clinically relevant

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Authors: Peeyush Verma, Anil Kumar, Anju Rawlley, Chanchal Mehra

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India's school-going population is largely served by an educational system that is, in most rural parts, stuck with methods that emphasize rote learning, endless examinations, and monotonous classroom activities. Rural government schools are generally seen as having poor infrastructure, poor support system and low motivation for teaching as well as learning. It was experienced during the survey of this project that there is lesser motivation of rural boys and girls to attend their schools and still less likely chances to study science, tabooed as “difficult”. An experiment was conducted with the help of Rural Knowledge Network Project through Department of Science and Technology, Govt of India in five remote villages of Sehore District in Madhya Pradesh (India) during 2012-2015. These schools are located about 50-70 Km away from Bhopal, the capital of Madhya Pradesh and can distinctively qualify as average rural schools. Three tier methodology was adapted to unfold the experiment. In first tier randomly selected boys and girls from these schools were taken to a daylong visit to the Regional Science Centre located in Bhopal. In second tier, randomly selected half of those who visited earlier were again taken to the Science Centre to make models of Science. And in third tier, all the boys and girls studying science were exposed to video lectures and study material through web. The results have shown an interesting face towards learning science among youths in rural schools through peer learning or incremental learning. The students who had little or no interest in learning science became good learners and queries started pouring in from the neighbourhood village as well as a few parents requested to take their wards in the project to learn science. The paper presented is a case study of the experiment conducted in five rural schools of Sehore District. It reflects upon the methodology of developing awareness and interest among students and finally engaging them in popularising science through peer-to-peer learning using incremental learning elements. The students, who had a poor perception about science initially, had changed their attitude towards learning science during the project period. The results of this case, however, cannot be generalised unless replicated in the same setting elsewhere.

Keywords: popularisation of science, science temper, incremental learning, peer-to-peer learning

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Authors: Seynabou Toure, Oumar Diop, Kidiyo Kpalma, Amadou S. Maiga

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Color and texture are the two most determinant elements for perception and recognition of the objects in an image. For this reason, color and texture analysis find a large field of application, for example in image classification and segmentation. But, the pioneering work in texture analysis was conducted on grayscale images, thus discarding color information. Many grey-level texture descriptors have been proposed and successfully used in numerous domains for image classification: face recognition, industrial inspections, food science medical imaging among others. Taking into account color in the definition of these descriptors makes it possible to better characterize images. Color texture is thus the subject of recent work, and the analysis of color texture images is increasingly attracting interest in the scientific community. In optical remote sensing systems, sensors measure separately different parts of the electromagnetic spectrum; the visible ones and even those that are invisible to the human eye. The amounts of light reflected by the earth in spectral bands are then transformed into grayscale images. The primary natural colors Red (R) Green (G) and Blue (B) are then used in mixtures of different spectral bands in order to produce RGB images. Thus, good color texture discrimination can be achieved using RGB under controlled illumination conditions. Some previous works investigate the effect of using different color space for color texture classification. However, the selection of the best performing color space in land-sea segmentation is an open question. Its resolution may bring considerable improvements in certain applications like coastline detection, where the detection result is strongly dependent on the performance of the land-sea segmentation. The aim of this paper is to present the results of a study conducted on different color spaces in order to show the best-performing color space for land-sea segmentation. In this sense, an experimental analysis is carried out using five different color spaces (RGB, XYZ, Lab, HSV, YCbCr). For each color space, the Haar wavelet decomposition is used to extract different color texture features. These color texture features are then used for Fusion of Over Segmentation (FOOS) based classification; this allows segmentation of the land part from the sea one. By analyzing the different results of this study, the HSV color space is found as the best classification performance while using color and texture features; which is perfectly coherent with the results presented in the literature.

Keywords: classification, coastline, color, sea-land segmentation

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Authors: Mohammed Flaih Alotaibi, Rasheed Ahemad Shaik, Mohammed Z. Nasrullah

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Diabetic foot ulcers are the foremost global healthcare burden. Hyperglycemia in diabetics is incriminating in impeding wound healing and it can allow for more severe medical issues. The study was intended to establish a nanoconjugate of cordycepin-melittin (COR-MEL) and evaluate its healing effects in wounded diabetic rats. Diabetes induced by injecting streptozotocin intraperitoneally (50 mg/kg, body weight). Therefore, animals were classified into various groups; diabetic untreated, vehicle-treated, COR alone, MEL alone, and COR-MEL nanoconjugate treated, respectively. Animals with diabetes were exposed to excision and treated with Vehicle, COR, MEL, or COR-MEL nanoconjugate topically. After 14 days, the wounded skin was sliced and subjected to histological and biochemical assessments. The formulated nanoconjugate has a particle size of 253.5± 17.4 nm by a polydispersity index of 0.36 ± 0.05, and a zeta potential of 1.72 ± 0.3 mV. The study demonstrated an accelerated wound contraction in COR-MEL-treated diabetic rats, which was further validated by histological analysis. The nanoconjugate further exhibited antioxidant activities by inhibiting the accumulation of malondialdehyde and exhaustion of superoxide dismutase and glutathione peroxidase enzymatic activities. The nanoconjugate further demonstrated an enhanced anti-inflammatory activity by retarding the expression of proinflammatory cytokines (IL-6 and TNF-α). Additionally, the nanoconjugate exhibits a strong expression of growth factors (TGF-β1, VEGF-A, and PDGFR-β), indicating enrichment of proliferation. Likewise, nanoconjugate increased the concentration of hydroxyproline as well as the mRNA expression of collagen, type I, alpha 1. Thus, it is concluded that the nanoconjugate possesses a potent wound-healing activity in diabetic rats via antioxidant, anti-inflammatory, and pro-angiogenetic mechanisms.

Keywords: diabetic wounds, cordycepin, melittin, nanoconjugate, wound healing

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Authors: Florian Lienert, Peter Costa, Caroline Aurensan, Elaine Melander

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Introduction: Rabies pre-exposure prophylaxis (PrEP) can be given before travel and simplifies post-exposure prophylaxis (PEP). We studied the knowledge about rabies, the uptake of PrEP, and reasons for deciding for or against PrEP in at-risk travelers. We also examined how healthcare professionals (HCPs) counsel on rabies prevention. Methods: On behalf of Bavarian Nordic, Ipsos MORI conducted two online surveys in the USA. Fieldwork from February 24th to April 23rd, 2021, 689 participants aged 18-85 years, visited one of 91 endemic rabies countries in the past 3 years for at least one week, involved in at least 1 of 7 at-risk activities, heard of rabies, positive towards vaccination and chose to take part (surveyed travelers). Secondly, 76 HCPs, with responsibility for advising/ making decisions about vaccination requirements for their patients, personally recommend or prescribe vaccines for rabies, positive towards vaccination and chose to take part (surveyed HCPs). Results: A minority (36%) of surveyed travelers classified rabies as a life-threatening disease. A third of surveyed HCPs (37%) did not discuss rabies vaccination with at-risk travelers, 18% discussed only PEP, 23% only PrEP and 22% both. A minority (21%) of surveyed travelers reported having received rabies vaccination since they were 18. Among those participants (n=145), the most common reasons for deciding to get PrEP were for their own peace of mind (35%) and following an HCP recommendation (32%). Of those who decided not to receive the rabies vaccine (n=319), the most common reasons were that they did not think their risk of rabies was sufficient (23%) and that the HCP did not suggest it (23%). Conclusions: The survey demonstrated knowledge gaps around rabies and low PrEP coverage among surveyed travelers. It also highlighted the role of HCP recommendations and showed that most HCPs did not discuss PrEP with at-risk travelers.

Keywords: rabies, pre-exposure prophylaxis, travel, travel health, post-travel care, rabies treatment, vaccine, post-exposure, prophylaxis, at-risk, education, PrEP, PEP

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Authors: Mohd Ayyub Khan, Nadeem Akhtar

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Due to recent advances in wireless communication technologies and hand-held devices, there is a huge demand for video-based applications such as video surveillance, video conferencing, remote surgery, Digital Video Broadcast (DVB), IPTV, online learning courses, YouTube, WhatsApp, Instagram, Facebook, Interactive Video Games. However, the raw videos posses very high bandwidth which makes the compression a must before its transmission over the wireless channels. The High Efficiency Video Codec (HEVC) (also called H.265) is latest state-of-the-art video coding standard developed by the Joint effort of ITU-T and ISO/IEC teams. HEVC is targeted for high resolution videos such as 4K or 8K resolutions that can fulfil the recent demands for video services. The compression ratio achieved by the HEVC is twice as compared to its predecessor H.264/AVC for same quality level. The compression efficiency is generally increased by removing more correlation between the frames/pixels using complex techniques such as extensive intra and inter prediction techniques. As more correlation is removed, the chances of interdependency among coded bits increases. Thus, bit errors may have large effect on the reconstructed video. Sometimes even single bit error can lead to catastrophic failure of the reconstructed video. In this paper, we study the performance of HEVC bitstream over additive white Gaussian noise (AWGN) channel. Moreover, HEVC over Quadrature Amplitude Modulation (QAM) combined with forward error correction (FEC) schemes are also explored over the noisy channel. The video will be encoded using HEVC, and the coded bitstream is channel coded to provide some redundancies. The channel coded bitstream is then modulated using QAM and transmitted over AWGN channel. At the receiver, the symbols are demodulated and channel decoded to obtain the video bitstream. The bitstream is then used to reconstruct the video using HEVC decoder. It is observed that as the signal to noise ratio of channel is decreased the quality of the reconstructed video decreases drastically. Using proper FEC codes, the quality of the video can be restored up to certain extent. Thus, the performance analysis of HEVC presented in this paper may assist in designing the optimized code rate of FEC such that the quality of the reconstructed video is maximized over wireless channels.

Keywords: AWGN, forward error correction, HEVC, video coding, QAM

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Authors: Giulia I. Pintea

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The Roma people are a nomadic ethnic group native to India, and they are one of the most prevalent minorities in Europe. In the past, Roma were enslaved and they were imprisoned in concentration camps during the Holocaust; today, Roma are subject to hate crimes and are denied access to healthcare, education, and proper housing. The aim of this project is to analyze how the public perception of the Roma people may be influenced by antiziganist and pro-Roma institutions in Europe. In order to carry out this project, we used social network analysis to build two large social networks: The antiziganist network, which is composed of institutions that oppress and racialize Roma, and the pro-Roma network, which is composed of institutions that advocate for and protect Roma rights. Measures of centrality, density, and modularity were obtained to determine which of the two social networks is exerting the greatest influence on the public’s perception of Roma in European societies. Furthermore, data on hate crimes on Roma were gathered from the Organization for Security and Cooperation in Europe (OSCE). We analyzed the trends in hate crimes on Roma for several European countries for 2009-2015 in order to see whether or not there have been changes in the public’s perception of Roma, thus helping us evaluate which of the two social networks has been more influential. Overall, the results suggest that there is a greater and faster exchange of information in the pro-Roma network. However, when taking the hate crimes into account, the impact of the pro-Roma institutions is ambiguous, due to differing patterns among European countries, suggesting that the impact of the pro-Roma network is inconsistent. Despite antiziganist institutions having a slower flow of information, the hate crime patterns also suggest that the antiziganist network has a higher impact on certain countries, which may be due to institutions outside the political sphere boosting the spread of antiziganist ideas and information to the European public.

Keywords: applied mathematics, oppression, Roma people, social network analysis

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Authors: Sanjay Sinha, Mohd Umair Khan

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The level of income inequality in India has been worrisome as the World Inequality Report termed it as a “poor and unequal country, with an affluent elite”. As important as income is to understand inequality and deprivation, it is just one dimension. But the historical roots and current realities of inequality and deprivation in India lies in many of the non-income dimensions such as housing, nutrition, education, agency, sense of inclusion etc. which are often ignored, especially in solution-oriented research. The level of inequality and deprivation among the tribal is one such case. There is a corpus of literature establishing that the tribal communities in India are disadvantageous on various grounds. Given their rural geography, issues of access and quality of basic facilities such as education and healthcare are often unaddressed. COVID-19 has further exacerbated this challenge and climate change will make it even more worrying. With this background, a succinct measurement tool at the village level is necessary to design short to medium-term actions with reference to risk mitigation for tribal communities. This research paper examines the level of inequality and deprivation among the tribal communities in the rural areas of Andhra Pradesh state of India using a Multidimensional Inequality and Deprivation Index based on the Alkire-Foster methodology. The methodology is theoretically grounded in the capability approach propounded by Amartya Sen, emphasizing on achieving the “beings and doings” (functionings) an individual reason to value. In the index, the authors have five domains, including Livelihood, Food Security, Education, Health and Housing and these domains are divided into sixteen indicators. This assessment is followed by domain-wise short-term and long-term solutions.

Keywords: Andhra Pradesh, Alkire-Foster methodology, deprivation, inequality, multidimensionality, poverty, tribal

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Authors: Zerubabel Mihret

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Background: Work-related stress is a pattern of reactions to work demands unmatched by worker’s knowledge, skills, or abilities. Healthcare institutions are considered high-risk and intensive work areas for work-related stress. However, there is the nonexistence of clear and strong data about the magnitude of work-related stress on sanitation workers in hospitals in Ethiopia. The aim of this study was to determine the magnitude of work-related stress among sanitation workers in public hospitals during COVID-19 in Addis Ababa, Ethiopia. Methods: Institution-based cross-sectional study was conducted from October 2021 to February 2022 among 494 sanitation workers who were selected from 4 hospitals. HSE (Health and Safety Executive of UK) standard data collection tool was used, and an interviewer-administered questionnaire was used to collect the data using KOBO collect application. The collected data were cleaned and analyzed using SPSS version 20.0. Both binary and multivariable logistic regression analyses were done to identify important factors having an association with work-related stress. Variables with p-value ≤ 0.25 in the bivariate analysis were entered into the multivariable logistic regression model. A statistically significant level was declared at a p-value ≤ 0.05. Results: This study revealed that the magnitude of work-related stress among sanitation workers was 49.2% (95% CI 45-54). Significant proportions (72.7%) of sanitation workers were dissatisfied with their current job. Sex, age, experience, and chewing khat were significantly associated with work-related stress. Conclusion: Work-related stress is significantly high among sanitation workers. Sex, age, experience, and chewing khat were identified as factors associated with work-related stress. Intervention program focusing on the prevention and control of stress is desired by hospitals.

Keywords: work-related stress, sanitation workers, Likert scale, public hospitals, Ethiopia

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Authors: Malik Abid Hussain Khokhar, Muhammad Naveed Tahir, Muhammad Amin

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Energy demand has been increased manifold due to increasing population, urban sprawl and rapid socio-economic improvements. Low water capacity in dams for continuation of hydrological power, land cover and land use are the key parameters which are creating problems for more energy production. Overall installed hydropower capacity of Pakistan is more than 35000 MW whereas Pakistan is producing up to 17000 MW and the requirement is more than 22000 that is resulting shortfall of 5000 - 7000 MW. Therefore, there is a dire need to develop small hydropower to fulfill the up-coming requirements. In this regards, excessive rainfall, snow nurtured fast flowing perennial tributaries and streams in northern mountain regions of Pakistan offer a gigantic scope of hydropower potential throughout the year. Rivers flowing in KP (Khyber Pakhtunkhwa) province, GB (Gilgit Baltistan) and AJK (Azad Jammu & Kashmir) possess sufficient water availability for rapid energy growth. In the backdrop of such scenario, small hydropower plants are believed very suitable measures for more green environment and power sustainable option for the development of such regions. Aim of this study is to estimate hydropower potential sites for small hydropower plants and stream distribution as per steam network available in the available basins in the study area. The proposed methodology will focus on features to meet the objectives i.e. site selection of maximum hydropower potential for hydroelectric generation using well emerging GIS tool SWAT as hydrological run-off model on the Neelum, Kunhar and the Dor Rivers’ basins. For validation of the results, NDWI will be computed to show water concentration in the study area while overlaying on geospatial enhanced DEM. This study will represent analysis of basins, watershed, stream links, and flow directions with slope elevation for hydropower potential to produce increasing demand of electricity by installing small hydropower stations. Later on, this study will be benefitted for other adjacent regions for further estimation of site selection for installation of such small power plants as well.

Keywords: energy, stream network, basins, SWAT, evapotranspiration

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Authors: Jakob Renko, Deja Praprotnik, Kristina Martinovič, Igor Karnjuš

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Introduction: Catheter-related bloodstream infections are a major burden for healthcare and patients. Although infections of this type cannot be completely avoided, they can be reduced by taking preventive measures. The aim of this study is to review and analyze the existing literature on preventive interventions to prevent central venous catheters (CVC) infections. Methods: A systematic literature review was carried out. The international databases CINAHL, Medline, PubMed, and Web of Science were searched using the search strategy: "catheter-related infections" AND "intensive care units" AND "prevention" AND "central venous catheter." Articles that met the inclusion and exclusion criteria were included in the study. The literature search flow is illustrated by the PRISMA diagram. The descriptive research method was used to analyze the data. Results: Out of 554 search results, 22 surveys were included in the final analysis. We identified seven relevant preventive measures to prevent CVC infections: washing the whole body with chlorhexidine gluconate (CHG) solution, disinfecting the CVC entry site with CHG solution, use of CHG or silver dressings, alcohol protective caps, CVC care education, selecting appropriate catheter and multicomponent care bundles. Discussion and conclusions: Both single interventions and multicomponent care bundles have been shown to be currently effective measures to prevent CVC infections in adult patients in the ICU. None of the measures identified stood out in terms of their effectiveness. Prevention work to reduce CVC infections in the ICU is a complex process that requires the simultaneous consideration of several factors.

Keywords: central venous access, critically ill patients, hospital-acquired complications, prevention

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Authors: Qiuyu Chen, Bin Long, Junxi Yang

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Located in the southwest of the "roof of the world", Tibet is the origin center of Tibetan Culture.Lhasa, Shigatse and Gyantse are three famous historical and cultural cities in Tibet. They have always been prominent political, economic and cultural cities, and have accumulated the unique aesthetic orientation and value consciousness of Tibet's urban construction. "Archetype" usually refers to the theoretical origin of things, which is the collective unconscious precipitation. The archetype theory fundamentally explores the dialectical relationship between image expression, original form and behavior mode. By abstracting and describing typical phenomena or imagery of the archetype object can observe the essence of objects, explore ways in which object phenomena arise. Applying archetype theory to the field of urban planning helps to gain insight, evaluation, and restructuring of the complex and ever-changing internal structural units of cities. According to existing field investigations, it has been found that Dzong, Temple, Linka and traditional residential systems are important structural units that constitute the urban space of Lhasa, Shigatse and Gyantse. This article applies the thinking method of archetype theory, starting from the imagery expression of urban spatial pattern, using technologies such as ArcGIS, Depthmap, and Computer Vision to descriptively identify the spatial representation and plane relationship of three cities through remote sensing images and historical maps. Based on historical records, the spatial characteristics of cities in different historical periods are interpreted in a hierarchical manner, attempting to clarify the origin of the formation and evolution of urban pattern imagery from the perspectives of geopolitical environment, social structure, religious theory, etc, and expose the growth laws and key driving forces of cities. The research results can provide technical and material support for important behaviors such as urban restoration, spatial intervention, and promoting transformation in the region.

Keywords: archetype theory, urban spatial imagery, original form and pattern, behavioral driving force, Tibet

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Authors: Christine Maleesha Withanachchi, Eithne Heffernan, Derek Hoare

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Background: Social isolation (SI} is a major consequence of hearing loss (HL}. Isolation can lead to serious health problems (e.g., dementia and depression). Hearing Aids (HA) is the primary intervention for HL. However, these are less effective in social situations. Interventions are needed for SI in adults with hearing loss (AHL). Objectives: Investigated the relationship between HL and SI. Explored the views of AHL and hearing healthcare professionals (HHP) towards interventions for isolation. Methods: Individual and group semi-structured interviews were conducted. Interviews were conducted at the Nottingham Institute of Health Research (NIHR) Biomedical Research Centre (BRC). Six AHL and seven HHP were recruited via maximum variation sampling. The interview transcripts were analyzed using inductive thematic analysis. Results: Social impacts of HL: Most participants described that HL hurt them. This was in the form of social withdrawal, strain on relationships, and identity loss. Downstream effects of HL: Most audiologists acknowledged that isolation from HL could lead to depression. HL can also lead to exhaustion and unemployment. Impact of stigma: There are negative connotations around HL and HA (e.g. old age) and there is difficulty talking about isolation. The complexity of SI: There can be difficulty separating SI due to HL from SI due to other contributing factors (e.g. comorbidities). Potential intervention for isolation: Participants were unfamiliar with interventions for isolation and few, if any, were targeted for AHL specifically. Most participants thought an intervention should be patient-centered and run by an AHL in the community. Opinions differed regarding whether it should hear specific or generic. Implementation of intervention: Challenges to the implementation of an intervention for SI exist due to the sensitivity of the subject. Conclusions: This study demonstrated that SI is a major consequence of HL and uncovered novel findings related to its interventions. Uptake of interventions offered to AHL to reduce loneliness and social isolation is expected to be better if led by AHL in the community as opposed to HHP led interventions in the hospital or clinic settings.

Keywords: adults with hearing loss, hearing aids, interventions, social isolation

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