Search results for: healthcare sectors
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 2708

Search results for: healthcare sectors

788 Optimization of a High-Growth Investment Portfolio for the South African Market Using Predictive Analytics

Authors: Mia Françoise

Abstract:

This report aims to develop a strategy for assisting short-term investors to benefit from the current economic climate in South Africa by utilizing technical analysis techniques and predictive analytics. As part of this research, value investing and technical analysis principles will be combined to maximize returns for South African investors while optimizing volatility. As an emerging market, South Africa offers many opportunities for high growth in sectors where other developed countries cannot grow at the same rate. Investing in South African companies with significant growth potential can be extremely rewarding. Although the risk involved is more significant in countries with less developed markets and infrastructure, there is more room for growth in these countries. According to recent research, the offshore market is expected to outperform the local market over the long term; however, short-term investments in the local market will likely be more profitable, as the Johannesburg Stock Exchange is predicted to outperform the S&P500 over the short term. The instabilities in the economy contribute to increased market volatility, which can benefit investors if appropriately utilized. Price prediction and portfolio optimization comprise the two primary components of this methodology. As part of this process, statistics and other predictive modeling techniques will be used to predict the future performance of stocks listed on the Johannesburg Stock Exchange. Following predictive data analysis, Modern Portfolio Theory, based on Markowitz's Mean-Variance Theorem, will be applied to optimize the allocation of assets within an investment portfolio. By combining different assets within an investment portfolio, this optimization method produces a portfolio with an optimal ratio of expected risk to expected return. This methodology aims to provide a short-term investment with a stock portfolio that offers the best risk-to-return profile for stocks listed on the JSE by combining price prediction and portfolio optimization.

Keywords: financial stocks, optimized asset allocation, prediction modelling, South Africa

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787 Evaluating the Effectiveness of Combined Psychiatric and Psychotherapeutic Care versus Psychotherapy Alone in the Treatment of Depression and Anxiety in Cancer Patients

Authors: Nathen A. Spitz, Dennis Martin Kivlighan III, Arwa Aburizik

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Background and Purpose: Presently, there is a paucity of naturalistic studies that directly compare the effectiveness of psychotherapy versus concurrent psychotherapy and psychiatric care for the treatment of depression and anxiety in cancer patients. Informed by previous clinical trials examining the efficacy of concurrent approaches, this study sought to test the hypothesis that a combined approach would result in the greatest reduction of depression and anxiety symptoms. Methods: Data for this study consisted of 433 adult cancer patients, with 252 receiving only psychotherapy and 181 receiving concurrent psychotherapy and psychiatric care at the University of Iowa Hospitals and Clinics. Longitudinal PHQ9 and GAD7 data were analyzed between both groups using latent growth curve analyses. Results: After controlling for treatment length and provider effects, results indicated that concurrent care was more effective than psychotherapy alone for depressive symptoms (γ₁₂ = -0.12, p = .037). Specifically, the simple slope for concurrent care was -0.25 (p = .022), and the simple slope for psychotherapy alone was -0.13 (p = .006), suggesting that patients receiving concurrent care experienced a greater reduction in depressive symptoms compared to patients receiving psychotherapy alone. In contrast, there were no significant differences between psychotherapy alone and concurrent psychotherapy and psychiatric care in the reduction of anxious symptoms. Conclusions: Overall, as both psychotherapy and psychiatric care may address unique aspects of mental health conditions, in addition to potentially providing synergetic support to each other, a combinatorial approach to mental healthcare for cancer patients may improve outcomes.

Keywords: psychiatry, psychology, psycho-oncology, combined care, psychotherapy, behavioral psychology

Procedia PDF Downloads 103
786 Application of Metric Dimension of Graph in Unraveling the Complexity of Hyperacusis

Authors: Hassan Ibrahim

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The prevalence of hyperacusis, an auditory condition characterized by heightened sensitivity to sounds, continues to rise, posing challenges for effective diagnosis and intervention. It is believed that this work deepens will deepens the understanding of hyperacusis etiology by employing graph theory as a novel analytical framework. We constructed a comprehensive graph wherein nodes represent various factors associated with hyperacusis, including aging, head or neck trauma, infection/virus, depression, migraines, ear infection, anxiety, and other potential contributors. Relationships between factors are modeled as edges, allowing us to visualize and quantify the interactions within the etiological landscape of hyperacusis. it employ the concept of the metric dimension of a connected graph to identify key nodes (landmarks) that serve as critical influencers in the interconnected web of hyperacusis causes. This approach offers a unique perspective on the relative importance and centrality of different factors, shedding light on the complex interplay between physiological, psychological, and environmental determinants. Visualization techniques were also employed to enhance the interpretation and facilitate the identification of the central nodes. This research contributes to the growing body of knowledge surrounding hyperacusis by offering a network-centric perspective on its multifaceted causes. The outcomes hold the potential to inform clinical practices, guiding healthcare professionals in prioritizing interventions and personalized treatment plans based on the identified landmarks within the etiological network. Through the integration of graph theory into hyperacusis research, the complexity of this auditory condition was unraveled and pave the way for more effective approaches to its management.

Keywords: auditory condition, connected graph, hyperacusis, metric dimension

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785 Modulation of the Interphase in a Glass Epoxy System: Influence of the Sizing Chemistry on Adhesion and Interfacial Properties

Authors: S. Assengone Otogo Be, A. Fahs, L. Belec, T. A. Nguyen Tien, G. Louarn, J-F. Chailan

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Glass fiber-reinforced composite materials have gradually developed in all sectors ranging from consumer products to aerospace applications. However, the weak point is most often the fiber/matrix interface, which can reduce the durability of the composite material. To solve this problem, it is essential to control the interphase and improve our understanding of the adhesion mechanism at the fibre/matrix interface. The interphase properties depend on the nature of the sizing applied on the surface of the glass fibers during their manufacture in order to protect them, facilitate their handling, and ensure fibre/matrix adhesion. The sizing composition, and in particular the nature of the coupling agent and the film-former affects the mechanical properties and the durability of composites. The aim of our study is, therefore, to develop and study composite materials with simplified sizing systems in order to understand how the main constituents modify the mechanical properties and the durability of composites from the nanometric to the macroscopic scale. Two model systems were elaborated: an epoxy matrix reinforced with simplified-sized glass fibres and an epoxy coating applied on glass substrates treated with the same sizings as fibres. For the sizing composition, two configurations were chosen. The first configuration possesses a chemical reactivity to link the glass and the matrix, and the second sizing contains non-reactive agents. The chemistry of the sized glass substrates and fibers was analyzed by FT-IR and XPS spectroscopies. The surface morphology was characterized by SEM and AFM microscopies. The observation of the surface samples reveals the presence of sizings which morphology depends on their chemistry. The evaluation of adhesion of coated substrates and composite materials show good interfacial properties for the reactive configuration. However, the non-reactive configuration exhibits an adhesive rupture at the interface of glass/epoxy for both systems. The interfaces and interphases between the matrix and the substrates are characterized at different scales. Correlations are made between the initial properties of the sizings and the mechanical performances of the model composites.

Keywords: adhesion, interface, interphase, materials composite, simplified sizing systems, surface properties

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784 The KAPSARC Energy Policy Database: Introducing a Quantified Library of China's Energy Policies

Authors: Philipp Galkin

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Government policy is a critical factor in the understanding of energy markets. Regardless, it is rarely approached systematically from a research perspective. Gaining a precise understanding of what policies exist, their intended outcomes, geographical extent, duration, evolution, etc. would enable the research community to answer a variety of questions that, for now, are either oversimplified or ignored. Policy, on its surface, also seems a rather unstructured and qualitative undertaking. There may be quantitative components, but incorporating the concept of policy analysis into quantitative analysis remains a challenge. The KAPSARC Energy Policy Database (KEPD) is intended to address these two energy policy research limitations. Our approach is to represent policies within a quantitative library of the specific policy measures contained within a set of legal documents. Each of these measures is recorded into the database as a single entry characterized by a set of qualitative and quantitative attributes. Initially, we have focused on the major laws at the national level that regulate coal in China. However, KAPSARC is engaged in various efforts to apply this methodology to other energy policy domains. To ensure scalability and sustainability of our project, we are exploring semantic processing using automated computer algorithms. Automated coding can provide a more convenient input data for human coders and serve as a quality control option. Our initial findings suggest that the methodology utilized in KEPD could be applied to any set of energy policies. It also provides a convenient tool to facilitate understanding in the energy policy realm enabling the researcher to quickly identify, summarize, and digest policy documents and specific policy measures. The KEPD captures a wide range of information about each individual policy contained within a single policy document. This enables a variety of analyses, such as structural comparison of policy documents, tracing policy evolution, stakeholder analysis, and exploring interdependencies of policies and their attributes with exogenous datasets using statistical tools. The usability and broad range of research implications suggest a need for the continued expansion of the KEPD to encompass a larger scope of policy documents across geographies and energy sectors.

Keywords: China, energy policy, policy analysis, policy database

Procedia PDF Downloads 311
783 Harmonic Assessment and Mitigation in Medical Diagonesis Equipment

Authors: S. S. Adamu, H. S. Muhammad, D. S. Shuaibu

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Poor power quality in electrical power systems can lead to medical equipment at healthcare centres to malfunction and present wrong medical diagnosis. Equipment such as X-rays, computerized axial tomography, etc. can pollute the system due to their high level of harmonics production, which may cause a number of undesirable effects like heating, equipment damages and electromagnetic interferences. The conventional approach of mitigation uses passive inductor/capacitor (LC) filters, which has some drawbacks such as, large sizes, resonance problems and fixed compensation behaviours. The current trends of solutions generally employ active power filters using suitable control algorithms. This work focuses on assessing the level of Total Harmonic Distortion (THD) on medical facilities and various ways of mitigation, using radiology unit of an existing hospital as a case study. The measurement of the harmonics is conducted with a power quality analyzer at the point of common coupling (PCC). The levels of measured THD are found to be higher than the IEEE 519-1992 standard limits. The system is then modelled as a harmonic current source using MATLAB/SIMULINK. To mitigate the unwanted harmonic currents a shunt active filter is developed using synchronous detection algorithm to extract the fundamental component of the source currents. Fuzzy logic controller is then developed to control the filter. The THD without the active power filter are validated using the measured values. The THD with the developed filter show that the harmonics are now within the recommended limits.

Keywords: power quality, total harmonics distortion, shunt active filters, fuzzy logic

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782 One or More Building Information Modeling Managers in France: The Confusion of the Kind

Authors: S. Blanchard, D. Beladjine, K. Beddiar

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Since 2015, the arrival of BIM in the building sector in France has turned the corporation world upside down. Not only constructive practices have been impacted, but also the uses and the men who have undergone important changes. Thus, the new collaborative mode generated by the BIM and the digital model has challenged the supremacy of some construction actors because the process involves working together taking into account the needs of other contributors. New BIM tools have emerged and actors in the act of building must take ownership of them. It is in this context that under the impetus of a European directive and the French government's encouragement of new missions and job profiles have. Moreover, concurrent engineering requires that each actor can advance at the same time as the others, at the whim of the information that reaches him, and the information he has to transmit. However, in the French legal system around public procurement, things are not planned in this direction. Also, a consequent evolution must take place to adapt to the methodology. The new missions generated by the BIM in France require a good mastery of the tools and the process. Also, to meet the objectives of the BIM approach, it is possible to define a typical job profile around the BIM, adapted to the various sectors concerned. The multitude of job offers using the same terms with very different objectives and the complexity of the proposed missions motivated by our approach. In order to reinforce exchanges with professionals or specialists, we carried out a statistical study to answer this problem. Five topics are discussed around the business area: the BIM in the company, the function (business), software used and BIM missions practiced (39 items). About 1400 professionals were interviewed. These people work in companies (micro businesses, SMEs, and Groups) of construction, engineering offices or, architectural agencies. 77% of respondents have the status of employees. All participants are graduated in their trade, the majority having level 1. Most people have less than a year of experience in BIM, but some have 10 years. The results of our survey help to understand why it is not possible to define a single type of BIM Manager. Indeed, the specificities of the companies are so numerous and complex and the missions so varied, that there is not a single model for a function. On the other hand, it was possible to define 3 main professions around the BIM (Manager, Coordinator and Modeler) and 3 main missions for the BIM Manager (deployment of the method, assistance to project management and management of a project).

Keywords: BIM manager, BIM modeler, BIM coordinator, project management

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781 Test Procedures for Assessing the Peel Strength and Cleavage Resistance of Adhesively Bonded Joints with Elastic Adhesives under Detrimental Service Conditions

Authors: Johannes Barlang

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Adhesive bonding plays a pivotal role in various industrial applications, ranging from automotive manufacturing to aerospace engineering. The peel strength of adhesives, a critical parameter reflecting the ability of an adhesive to withstand external forces, is crucial for ensuring the integrity and durability of bonded joints. This study provides a synopsis of the methodologies, influencing factors, and significance of peel testing in the evaluation of adhesive performance. Peel testing involves the measurement of the force required to separate two bonded substrates under controlled conditions. This study systematically reviews the different testing techniques commonly applied in peel testing, including the widely used 180-degree peel test and the T-peel test. Emphasis is placed on the importance of selecting an appropriate testing method based on the specific characteristics of the adhesive and the application requirements. The influencing factors on peel strength are multifaceted, encompassing adhesive properties, substrate characteristics, environmental conditions, and test parameters. Through an in-depth analysis, this study explores how factors such as adhesive formulation, surface preparation, temperature, and peel rate can significantly impact the peel strength of adhesively bonded joints. Understanding these factors is essential for optimizing adhesive selection and application processes in real-world scenarios. Furthermore, the study highlights the role of peel testing in quality control and assurance, aiding manufacturers in maintaining consistent adhesive performance and ensuring the reliability of bonded structures. The correlation between peel strength and long-term durability is discussed, shedding light on the predictive capabilities of peel testing in assessing the service life of adhesive bonds. In conclusion, this study underscores the significance of peel testing as a fundamental tool for characterizing adhesive performance. By delving into testing methodologies, influencing factors, and practical implications, this study contributes to the broader understanding of adhesive behavior and fosters advancements in adhesive technology across diverse industrial sectors.

Keywords: adhesively bonded joints, cleavage resistance, elastic adhesives, peel strength

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780 Building Information Modeling Acting as Protagonist and Link between the Virtual Environment and the Real-World for Efficiency in Building Production

Authors: Cristiane R. Magalhaes

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Advances in Information and Communication Technologies (ICT) have led to changes in different sectors particularly in architecture, engineering, construction, and operation (AECO) industry. In this context, the advent of BIM (Building Information Modeling) has brought a number of opportunities in the field of the digital architectural design process bringing integrated design concepts that impact on the development, elaboration, coordination, and management of ventures. The project scope has begun to contemplate, from its original stage, the third dimension, by means of virtual environments (VEs), composed of models containing different specialties, substituting the two-dimensional products. The possibility to simulate the construction process of a venture in a VE starts at the beginning of the design process offering, through new technologies, many possibilities beyond geometrical digital modeling. This is a significant change and relates not only to form, but also to how information is appropriated in architectural and engineering models and exchanged among professionals. In order to achieve the main objective of this work, the Design Science Research Method will be adopted to elaborate an artifact containing strategies for the application and use of ICTs from BIM flows, with pre-construction cut-off to the execution of the building. This article intends to discuss and investigate how BIM can be extended to the site acting as a protagonist and link between the Virtual Environments and the Real-World, as well as its contribution to the integration of the value chain and the consequent increase of efficiency in the production of the building. The virtualization of the design process has reached high levels of development through the use of BIM. Therefore it is essential that the lessons learned with the virtual models be transposed to the actual building production increasing precision and efficiency. Thus, this paper discusses how the Fourth Industrial Revolution has impacted on property developments and how BIM could be the propellant acting as the main fuel and link between the virtual environment and the real production for the structuring of flows, information management and efficiency in this process. The results obtained are partial and not definite up to the date of this publication. This research is part of a doctoral thesis development, which focuses on the discussion of the impact of digital transformation in the construction of residential buildings in Brazil.

Keywords: building information modeling, building production, digital transformation, ICT

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779 An Assessment of Potentials, Challenges, and Opportunities of Ethiopian Cultural Centers for Tourism Product Development

Authors: Berie Abebe Getahun

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The tourism sector has been identified by the Ethiopian government as one of the priority economic sectors and planned to make Ethiopia among the top five African destinations by 2020. It is obvious international tourism demand for Ethiopia lags behind other African countries like South Africa, Egypt, Morocco, Tanzania, and Kenya. Meanwhile, the number of international tourists’ arrival to Ethiopia increases continuously. The main purpose of this study was to find out potentials, challenges, and opportunities of Ethiopian Cultural Center for tourism product development. Therefore, an attempt has been made to identify potentials over which tourism product development can be enhanced, and opportunities that promote tourism product development in Ethiopia. To achieve this objective, data have been collected by using observation, interview and focus group discussion with selected informants working the ministry of tourism and culture. The collected data has been analyzed by transcribing materials, and by using thematic analysis method based on the research objective. Likewise, the analyzed data has been discussed in the context of prevailing literature. As revealed in finding, Ethiopian cultural center has untapped potential for tourism product development that includes: meetings, incentives, conferences, events, availability of concerned stakeholders and demand of visitors. On the other hand, lack of awareness about tourism product development, financial constraints, skilled manpower, absence of tour guiding service and interpretation of heritages have been identified as the major challenges that hindering tourism product development in the cultural center. Moreover, the growth of domestic tourism, distinctive presence and rich culture of Ethiopia, and policy of Ethiopia that promotes the growth and preservation of indigenous cultures are deemed important opportunities for tourism product development in the country. And lastly, conducting a research based on tourism product development, reviewing the existing marketing and promotion strategies, training manpower, working harmoniously with the concerned stakeholders, and a careful examination of opportunities present in order to best utilize resources were implications drawn for future intervention.

Keywords: challenges and opportunities of tourism, Ethiopian tourism potential, tourism product, tourism product development

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778 Feasibility Study for Implementation of Geothermal Energy Technology as a Means of Thermal Energy Supply for Medium Size Community Building

Authors: Sreto Boljevic

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Heating systems based on geothermal energy sources are becoming increasingly popular among commercial/community buildings as management of these buildings looks for a more efficient and environmentally friendly way to manage the heating system. The thermal energy supply of most European commercial/community buildings at present is provided mainly by energy extracted from natural gas. In order to reduce greenhouse gas emissions and achieve climate change targets set by the EU, restructuring in the area of thermal energy supply is essential. At present, heating and cooling account for approx... 50% of the EU primary energy supply. Due to its physical characteristics, thermal energy cannot be distributed or exchange over long distances, contrary to electricity and gas energy carriers. Compared to electricity and the gas sectors, heating remains a generally black box, with large unknowns to a researcher and policymaker. Ain literature number of documents address policies for promoting renewable energy technology to facilitate heating for residential/community/commercial buildings and assess the balance between heat supply and heat savings. Ground source heat pump (GSHP) technology has been an extremely attractive alternative to traditional electric and fossil fuel space heating equipment used to supply thermal energy for residential/community/commercial buildings. The main purpose of this paper is to create an algorithm using an analytical approach that could enable a feasibility study regarding the implementation of GSHP technology in community building with existing fossil-fueled heating systems. The main results obtained by the algorithm will enable building management and GSHP system designers to define the optimal size of the system regarding technical, environmental, and economic impacts of the system implementation, including payback period time. In addition, an algorithm is created to be utilized for a feasibility study for many different types of buildings. The algorithm is tested on a building that was built in 1930 and is used as a church located in Cork city. The heating of the building is currently provided by a 105kW gas boiler.

Keywords: GSHP, greenhouse gas emission, low-enthalpy, renewable energy

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777 Responsibility of States in Air Traffic Management: Need for International Unification

Authors: Nandini Paliwal

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Since aviation industry is one of the fastest growing sectors of the world economy, states depend on the air transport industry to maintain or stimulate economic growth. It significantly promotes and contributes to the economic well-being of every nation as well as world in general. Because of the continuous and rapid growth in civil aviation, it is inevitably leading to congested skies, flight delays and most alarmingly, a decrease in the safety of air navigation facilities. Safety is one of the most important concerns of aviation industry that has been unanimously recognised across the whole world. The available capacity of the air navigation system is not sufficient for the demand that is being generated. It has been indicated by forecast that the current growth in air traffic has the potential of causing delays in 20% of flights by 2020 unless changes are brought in the current system. Therefore, a safe, orderly and expeditious air navigation system is needed at the national and global levels, which, requires the implementation of an air traffic management (hereinafter referred as ‘ATM’) system to ensure an optimum flow of air traffic by utilising and enhancing capabilities provided by technical advances. The objective of this paper is to analyse the applicability of national regulations in case of liability arising out of air traffic management services and whether the current legal regime is sufficient to cover multilateral agreements including the Single European Sky regulations. In doing so, the paper will examine the international framework mainly the Article 28 of the Chicago Convention and its relevant annexes to determine the responsibility of states for providing air navigation services. Then, the paper will discuss the difference between the concept of responsibility and liability under the air law regime and how states might claim sovereign immunity for the functions of air traffic management. Thereafter, the paper will focus on the cross border agreements including the bilateral and multilateral agreements. In the end, the paper will address the scheme of Single European Sky and the need for an international convention dealing with the liability of air navigation service providers. The paper will conclude with some suggestions for unification of the laws at an international level dealing with liability of air navigation service providers and the requirement of enhanced co-operation among states in order to keep pace with technological advances.

Keywords: air traffic management, safety, single European sky, co-operation

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776 Sector-Wide Collaboration to Reduce Food Waste

Authors: Carolyn Cameron

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Stop Food Waste Australia is working with the industry to co-design sector action plans to prevent and reduce food waste across the supply chain. We are a public-private partnership, funded in 2021 by the Australian national government under the 2017 National Food Waste Strategy. Our partnership has representatives from all levels of government, industry associations from farm to fork, and food rescue groups. Like many countries, Australia has adopted the Sustainable Development Goal (SDG) target of 12.3 to halve food waste by 2030. A seminal 2021 study, the National Food Waste Feasibility Report, developed a robust national baseline, illustrating hotspots in commodities and across the supply chain. This research found that the consumption stages – households, food service, and institutions - account for over half of all food waste, and 22% of food produced never leaves the farm gate. Importantly the study found it is feasible for Australia to meet SDG 12.3, but it will require unprecedented action by governments, industry, and the community. Sector Action Plans (Plan) are one of the four main initiatives of Stop Food Waste Australia, including a voluntary commitment, a coordinated food waste communications hub, and robust monitoring and reporting framework. These plans provide a systems-based approach to reducing food loss and waste while realising multiple benefits for supply chain partners and other collaborators. Each plan is being co-designed with the key stakeholders most able to directly control or influence the root cause(s) of food waste hotspots and to take action to reduce or eliminate food waste in their value chain.  The initiatives in the Plans are fit-for-purpose, reflecting current knowledge and recognising priorities may refocus over time. To date, sector action plans have been developed with the Food Rescue, Cold Chain, Bread and Bakery, and Dairy Sectors. Work is currently underway on Meat and Horticulture, and we are also developing supply-chain stage plans for food services and institutions. The study will provide an overview of Australia’s food waste baseline and challenges, the important role of sector action plans in reducing food waste, and case studies of implementation outcomes.

Keywords: co-design, horticulture, sector action plans, voluntary

Procedia PDF Downloads 115
775 Export and Import Indicators of Georgian Agri-food Products during the Pandemic: Challenges and Opportunities

Authors: Eteri Kharaishvili

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Introduction. The paper analyzes the main indicators of export and import of Georgian agri-food products; identifies positive and negative trends under the pandemic; based on the revealed problemssubstantiates the need formodernization ofin agri-food sector. It is argued that low production and productivity rates of food products negatively impact achieving the optimal export-to-import ratio; therefore, it leads toincreaseddependence on other countries andreduces the level of food security. Research objectives. The objective of the research is to identify the key challenges based on the analysis of export-import indicators of Georgian food products during the pandemic period and develop recommendations on the possibilities of post-pandemic perspectives. Research methods. Various theoretical and methodological research tools are used in the paper; in particular, a desk research is carried out on the research topic; endogenous and exogenous variables affecting export and import are determined through factor analysis; SWOT and PESTEL analysis are used to identify development opportunities; selection and groupingof data, identification of similarities and differences is carried outby using analysis, synthesis, sampling, induction and other methods; a qualitative study is conducted based on a survey of agri-food experts and exporters for clarifying the factors that impede export-import flows. Contributions. The factors that impede the export of Georgian agri-food products in the short run under COVID-19 pandemic are identified. These are: reduced income of farmers, delays in the supply of raw materials and supplies to the agri-food sectorfrom the neighboring industries, as well as in harvesting, processing, marketing, transportation, and other sectors; increased indirect costs, etc. The factors that impede the export in the long run areas follows loss of public confidence in the industry, risk of losing positions in traditional markets, etc. Conclusions are made on the problems in the field of export and import of Georgian agri-food products in terms of the pandemic; development opportunities are evaluated based on the analysis of the agri-food sector potential. Recommendations on the development opportunities for export and import of Georgian agri-food products in the post-pandemic period are proposed.

Keywords: agri-food products, export, and import, pandemic period, hindering factor, development potential

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774 Improving Health Care and Patient Safety at the ICU by Using Innovative Medical Devices and ICT Tools: Examples from Bangladesh

Authors: Mannan Mridha, Mohammad S. Islam

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Innovative medical technologies offer more effective medical care, with less risk to patient and healthcare personnel. Medical technology and devices when properly used provide better data, precise monitoring and less invasive treatments and can be more targeted and often less costly. The Intensive Care Unit (ICU) equipped with patient monitoring, respiratory and cardiac support, pain management, emergency resuscitation and life support devices is particularly prone to medical errors for various reasons. Many people in the developing countries now wonder whether their visit to hospital might harm rather than help them. This is because; clinicians in the developing countries are required to maintain an increasing workload with limited resources and absence of well-functioning safety system. A team of experts from the medical, biomedical and clinical engineering in Sweden and Bangladesh have worked together to study the incidents, adverse events at the ICU in Bangladesh. The study included both public and private hospitals to provide a better understanding for physical structure, organization and practice in operating processes of care, and the occurrence of adverse outcomes the errors, risks and accidents related to medical devices at the ICU, and to develop a ICT based support system in order to reduce hazards and errors and thus improve the quality of performance, care and cost effectiveness at the ICU. Concrete recommendations and guidelines have been made for preparing appropriate ICT related tools and methods for improving the routine for use of medical devices, reporting and analyzing of the incidents at the ICU in order to reduce the number of undetected and unsolved incidents and thus improve the patient safety.

Keywords: intensive care units, medical errors, medical devices, patient care and safety

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773 Effects of Fe Addition and Process Parameters on the Wear and Corrosion Characteristics of Icosahedral Al-Cu-Fe Coatings on Ti-6Al-4V Alloy

Authors: Olawale S. Fatoba, Stephen A. Akinlabi, Esther T. Akinlabi, Rezvan Gharehbaghi

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The performance of material surface under wear and corrosion environments cannot be fulfilled by the conventional surface modifications and coatings. Therefore, different industrial sectors need an alternative technique for enhanced surface properties. Titanium and its alloys possess poor tribological properties which limit their use in certain industries. This paper focuses on the effect of hybrid coatings Al-Cu-Fe on a grade five titanium alloy using laser metal deposition (LMD) process. Icosahedral Al-Cu-Fe as quasicrystals is a relatively new class of materials which exhibit unusual atomic structure and useful physical and chemical properties. A 3kW continuous wave ytterbium laser system (YLS) attached to a KUKA robot which controls the movement of the cladding process was utilized for the fabrication of the coatings. The titanium cladded surfaces were investigated for its hardness, corrosion and tribological behaviour at different laser processing conditions. The samples were cut to corrosion coupons, and immersed into 3.65% NaCl solution at 28oC using Electrochemical Impedance Spectroscopy (EIS) and Linear Polarization (LP) techniques. The cross-sectional view of the samples was analysed. It was found that the geometrical properties of the deposits such as width, height and the Heat Affected Zone (HAZ) of each sample remarkably increased with increasing laser power due to the laser-material interaction. It was observed that there are higher number of aluminum and titanium presented in the formation of the composite. The indentation testing reveals that for both scanning speed of 0.8 m/min and 1m/min, the mean hardness value decreases with increasing laser power. The low coefficient of friction, excellent wear resistance and high microhardness were attributed to the formation of hard intermetallic compounds (TiCu, Ti2Cu, Ti3Al, Al3Ti) produced through the in situ metallurgical reactions during the LMD process. The load-bearing capability of the substrate was improved due to the excellent wear resistance of the coatings. The cladded layer showed a uniform crack free surface due to optimized laser process parameters which led to the refinement of the coatings.

Keywords: Al-Cu-Fe coating, corrosion, intermetallics, laser metal deposition, Ti-6Al-4V alloy, wear resistance

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772 Industry 4.0 Adoption, Control Mechanism and Sustainable Performance of Healthcare Supply Chains under Disruptive Impact

Authors: Edward Nartey

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Although the boundaries of sustainable performance and growth in the field of service supply chains (SCs) have been broadened by scholars in recent years, research on the impact and promises of Industry 4.0 Destructive Technologies (IDTs) on sustainability performance under disruptive events is still scarce. To mitigate disruptions in the SC and improve efficiency by identifying areas for cost savings, organizations have resorted to investments in digitalization, automation, and control mechanisms in recent years. However, little is known about the sustainability implications for IDT adoption and controls in service SCs, especially during disruptive events. To investigate this paradox, survey data were sought from 223 public health managers across Ghana and analyzed via covariance-based structural equations modelling. The results showed that both formal and informal control have a positive and significant relationship with IDT adoption. In addition, formal control has a significant and positive relationship with environmental and economic sustainability but an insignificant relationship with social sustainability. Furthermore, informal control positively impacts economic performance but has an insignificant relationship with social and environmental sustainability. While the findings highlight the prevalence of the IDTs being initiated by Ghanaian public health institutions (PHIs), this study concludes that the installed control systems in these organizations are inadequate for promoting sustainable SC behaviors under destructive events. Thus, in crisis situations, PHIs need to redesign their control systems to facilitate IDT integration towards sustainability issues in SCs.

Keywords: industry 4.0 destructive technologies, formal control, informal control, sustainable supply chain performance, public health organizations

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771 Aten Years Rabies Data Exposure and Death Surveillance Data Analysis in Tigray Region, Ethiopia, 2023

Authors: Woldegerima G. Medhin, Tadele Araya

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Background: Rabies is acute viral encephalitis affecting mainly carnivores and insectivorous but can affect any mammal. Case fatality rate is 100% once clinical signs appear. Rabies has a worldwide distribution in continental regions of Asia and Africa. Globally, rabies is responsible for more than 61000 human deaths annually. An estimation of human mortality rabies in Asia and Africa annually exceed 35172 and 21476 respectively. Ethiopia approximately 2900 people were estimated to die of rabies annually, Tigary region approximately 98 people were estimated to die annually. The aim of this study is to analyze trends, describe, and evaluate the ten years rabies data in Tigray, Ethiopia. Methods: We conducted descriptive epidemiological study from 15-30 February, 2023 of rabies exposure and death in humans by reviewing the health management information system report from Tigray Regional Health Bureau and vaccination coverage of dog population from 2013 to 2022. We used case definition, suspected cases are those bitten by the dogs displaying clinical signs consistent with rabies and confirmed cases were deaths from rabies at time of the exposure. Results: A total 21031 dog bites and 375 deaths report of rabies and 18222 post exposure treatments for humans in Tigray region were used. A suspected rabies patients had shown an increasing trend from 2013 to 2015 and 2018 to 2019. Overall mortality rate was 19/1000 in Tigray. Majority of suspected patients (45%) were age <15 years old. An estimated by Agriculture Bureau of Tigray Region about 12000 owned and 2500 stray dogs are available in the region, but yearly dog vaccination remains low (50%). Conclusion: Rabies is a public health problem in Tigray region. It is highly recommended to vaccinate individually owned dogs and concerned sectors should eliminate stray dogs. Surveillance system should strengthen for estimating the real magnitude, launch preventive and control measures.

Keywords: rabies, Virus, transmision, prevalence

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

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

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

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

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769 Application of Observational Medical Outcomes Partnership-Common Data Model (OMOP-CDM) Database in Nursing Health Problems with Prostate Cancer-a Pilot Study

Authors: Hung Lin-Zin, Lai Mei-Yen

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Prostate cancer is the most commonly diagnosed male cancer in the U.S. The prevalence is around 1 in 8. The etiology of prostate cancer is still unknown, but some predisposing factors, such as age, black race, family history, and obesity, may increase the risk of the disease. In 2020, a total of 7,178 Taiwanese people were nearly diagnosed with prostate cancer, accounting for 5.88% of all cancer cases, and the incidence rate ranked fifth among men. In that year, the total number of deaths from prostate cancer was 1,730, accounting for 3.45% of all cancer deaths, and the death rate ranked 6th among men, accounting for 94.34% of the cases of male reproductive organs. Looking for domestic and foreign literature on the use of OMOP (Observational Medical Outcomes Partnership, hereinafter referred to as OMOP) database analysis, there are currently nearly a hundred literature published related to nursing-related health problems and nursing measures built in the OMOP general data model database of medical institutions are extremely rare. The OMOP common data model construction analysis platform is a system developed by the FDA in 2007, using a common data model (common data model, CDM) to analyze and monitor healthcare data. It is important to build up relevant nursing information from the OMOP- CDM database to assist our daily practice. Therefore, we choose prostate cancer patients who are our popular care objects and use the OMOP- CDM database to explore the common associated health problems. With the assistance of OMOP-CDM database analysis, we can expect early diagnosis and prevention of prostate cancer patients' comorbidities to improve patient care.

Keywords: OMOP, nursing diagnosis, health problem, prostate cancer

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768 Optimal Approach for Siewert Type Ⅱ Adenocarcinoma of the Esophagogastric Junction: A Systematic Review and Metanalysis

Authors: Maatouk Mohamed, Nouira Mariem

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Background and aims: Healthcare-associated infections (HAI) represent a major public health problem worldwide. They represent one of the most serious adverse events in health care. The objectives of our study were to estimate the prevalence of HAI at the Charles Nicolle Hospital (CNH) and to identify the main associated factors as well as to estimate the frequency of antibiotic use. Methods: It was a cross sectional study at the CNH with a unique passage per department (OctoberDecember 2018). All patients present at the wards for more than 48 hours were included. All patients from outpatient consultations, emergency and dialysis departments were not included. The site definitions of infections proposed by the Centers for Disease Control and Prevention (CDC) were used. Only clinically and/or microbiologically confirmed active HAIs were included. Results: A total of 318 patients were included with a mean age of 52 years and a sex ratio (Female/Male) of 1.05. A total of 41 patients had one or more active HAIs, corresponding to a prevalence of 13.1% (95% CI: 9.3%-16.9%). The most frequent sites infections were urinary tract infections and pneumonia. Multivariate analysis among adult patients (>=18 years) (n=261), revealed that infection on admission (p=0.01), alcoholism (p=0.01), high blood pressure (p=0.008), having at least one invasive device inserted (p=0.004), and history of recent surgery (p=0.03), increased significantly the risk of HAIs. More than 1 of 3 patients (35.4%) were under antibiotics on the day of the survey, of which more than half (57.4%) were under 2 or more types of antibiotics. Conclusion: The prevalence of HAIs and antibiotic prescriptions at the CNH were considerably high. An infection prevention and control committee, as well as the development of an Antibiotic stewardship program with continuous monitoring using repeated prevalence surveys must be implemented to limit the frequency of these infections effectively.

Keywords: tumors, oesophagectomy, esophagogastric junction, systematic review

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767 Surface-Enhanced Raman Spectroscopy on Gold Nanoparticles in the Kidney Disease

Authors: Leonardo C. Pacheco-Londoño, Nataly J Galan-Freyle, Lisandro Pacheco-Lugo, Antonio Acosta-Hoyos, Elkin Navarro, Gustavo Aroca-Martinez, Karin Rondón-Payares, Alberto C. Espinosa-Garavito, Samuel P. Hernández-Rivera

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At the Life Science Research Center at Simon Bolivar University, a primary focus is the diagnosis of various diseases, and the use of gold nanoparticles (Au-NPs) in diverse biomedical applications is continually expanding. In the present study, Au-NPs were employed as substrates for Surface-Enhanced Raman Spectroscopy (SERS) aimed at diagnosing kidney diseases arising from Lupus Nephritis (LN), preeclampsia (PC), and Hypertension (H). Discrimination models were developed for distinguishing patients with and without kidney diseases based on the SERS signals from urine samples by partial least squares-discriminant analysis (PLS-DA). A comparative study of the Raman signals across the three conditions was conducted, leading to the identification of potential metabolite signals. Model performance was assessed through cross-validation and external validation, determining parameters like sensitivity and specificity. Additionally, a secondary analysis was performed using machine learning (ML) models, wherein different ML algorithms were evaluated for their efficiency. Models’ validation was carried out using cross-validation and external validation, and other parameters were determined, such as sensitivity and specificity; the models showed average values of 0.9 for both parameters. Additionally, it is not possible to highlight this collaborative effort involved two university research centers and two healthcare institutions, ensuring ethical treatment and informed consent of patient samples.

Keywords: SERS, Raman, PLS-DA, kidney diseases

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766 A Case Study of the Political Determinant of Health on the Public Health Crisis of Malaria in Nigeria

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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765 Hydrodynamic and Water Quality Modelling to Support Alternative Fuels Maritime Operations Incident Planning & Impact Assessments

Authors: Chow Jeng Hei, Pavel Tkalich, Low Kai Sheng Bryan

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Due to the growing demand for sustainability in the maritime industry, there has been a significant increase in focus on alternative fuels such as biofuels, liquefied natural gas (LNG), hydrogen, methanol and ammonia to reduce the carbon footprint of vessels. Alternative fuels offer efficient transportability and significantly reduce carbon dioxide emissions, a critical factor in combating global warming. In an era where the world is determined to tackle climate change, the utilization of methanol is projected to witness a consistent rise in demand, even during downturns in the oil and gas industry. Since 2022, there has been an increase in methanol loading and discharging operations for industrial use in Singapore. These operations were conducted across various storage tank terminals at Jurong Island of varying capacities, which are also used to store alternative fuels for bunkering requirements. The key objective of this research is to support the green shipping industries in the transformation to new fuels such as methanol and ammonia, especially in evolving the capability to inform risk assessment and management of spills. In the unlikely event of accidental spills, a highly reliable forecasting system must be in place to provide mitigation measures and ahead planning. The outcomes of this research would lead to an enhanced metocean prediction capability and, together with advanced sensing, will continuously build up a robust digital twin of the bunkering operating environment. Outputs from the developments will contribute to management strategies for alternative marine fuel spills, including best practices, safety challenges and crisis management. The outputs can also benefit key port operators and the various bunkering, petrochemicals, shipping, protection and indemnity, and emergency response sectors. The forecasted datasets provide a forecast of the expected atmosphere and hydrodynamic conditions prior to bunkering exercises, enabling a better understanding of the metocean conditions ahead and allowing for more refined spill incident management planning

Keywords: clean fuels, hydrodynamics, coastal engineering, impact assessments

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764 Economic Policy to Stimulate Industrial Development in Georgia

Authors: Gulnaz Erkomaishvili

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The article analyzes the modern level of industrial production in Georgia, shows the export-import of industrial products and evaluates the results of the activities of institutions implementing industrial policy. The research showed us that the level of development of industry in the country and its export potential are quite low. The article concludes that in the modern phase of industrial development, the country should choose a model focused on technological development and maximum growth of export potential. Objectives. The aim of the research is to develop an economic policy that promotes the development of industry and to look for ways to implement it effectively. Methodologies This paper uses general and specific methods, in particular, analysis, synthesis, induction, deduction, scientific abstraction, comparative and statistical methods, as well as experts’ evaluation. In-depth interviews with experts were conducted to determine quantitative and qualitative indicators; Publications of the National Statistics Office of Georgia are used to determine the regularity between analytical and statistical estimations. Also, theoretical and applied research of international organizations and scientist-economists are used. Contributions Based on the identified challenges in the area of industry, recommendations for the implementation of an active industrial policy in short and long term periods were developed. In particular: the government's priority orientation of industrial development; paying special attention to the processing industry sectors that Georgia has the potential to produce; supporting the development of scientific fields; Determination of certain benefits for those investors who invest money in industrial production; State partnership with the private sector, manifested in the fight against bureaucracy, corruption and crime, creating favorable business conditions for entrepreneurs; Coordination between education - science - production should be implemented in the country. Much attention should be paid to basic scientific research, which does not require purely commercial returns in the short term, science should become a real productive force; Special importance should be given to the creation of an environment that will support the expansion of export-oriented production; Overcoming barriers to entry into export markets.

Keywords: industry, sectoral structure of industry, exsport-import of industrial products, industrial policy

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763 Development of Patient Satisfaction Questionnaire for Diabetes Management in Thailand and Lao People Democratic Republic

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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762 Effect of One-Period of SEAS Exercises on Some Spinal Biomechanical and Postural Parameters in the Students with Idiopathic Scoliosis

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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761 Towards the Concept of Global Health Nursing

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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760 Why is the Recurrence Rate of Residual or Recurrent Disease Following Endoscopic Mucosal Resection (EMR) of the Oesophageal Dysplasia’s and T1 Tumours Higher in the Greater Midlands Cancer Network?

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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759 The Birth Connection: An Examination of the Relationship between Her Birth Event and Infant Feeding among African American Mothers

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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