Search results for: hospital waste

Authors: Yohana Fessehazion

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Mercury is a prominent example of a heavy metal contaminant in the environment, and it has been extensively investigated for its potential health risk in humans and other organisms. In South Africa, massive mercury contamination happened in1980s when the England-based mercury reclamation processing plant relocated to Cato Ridge, KwaZulu-Natal Province, and discharged mercury waste into the Mngceweni River. This mercury waste discharge resulted in high mercury concentration that exceeded the acceptable levels in Mngceweni River, Umgeni River, and human hair of the nearby villagers. This environmental issue raised the alarm, and over the years, several environmental assessments were reported the dire environmental crises resulting from the Thor Chemicals (now known as Metallica Chemicals) and urged the immediate removal of the around 3,000 tons of mercury waste stored in the factory storage facility over two decades. Recently theft of some containers with the toxic substance from the Thor Chemicals warehouse and the subsequent fire that ravaged the facility furtherly put the factory on the spot escalating the urgency of left behind deadly mercury waste removal. This project aims to investigate the mercury contamination leaking from an old Thor Chemicals mercury processing plant. The focus will be on sediments, water, terrestrial plants, and aquatic weeds such as the prominent water hyacinth weeds in the nearby water systems of Mngceweni River, Umgeni River, and Inanda Dam as a bio-indicator and phytoremediator for mercury pollution. Samples will be collected in spring around October when the condition is favourable for microbial activity to methylate mercury incorporated in sediments and blooming season for some aquatic weeds, particularly water hyacinth. Samples of soil, sediment, water, terrestrial plant, and aquatic weed will be collected per sample site from the point of source (Thor Chemicals), Mngceweni River, Umgeni River, and the Inanda Dam. One-way analysis of variance (ANOVA) tests will be conducted to determine any significant differences in the Hg concentration among all sampling sites, followed by Least Significant Difference post hoc test to determine if mercury contamination varies with the gradient distance from the source point of pollution. The flow injection atomic spectrometry (FIAS) analysis will also be used to compare the mercury sequestration between the different plant tissues (roots and stems). The principal component analysis is also envisaged for use to determine the relationship between the source of mercury pollution and any of the sampling points (Umgeni and Mngceweni Rivers and the Inanda Dam). All the Hg values will be expressed in µg/L or µg/g in order to compare the result with the previous studies and regulatory standards. Sediments are expected to have relatively higher levels of Hg compared to the soils, and aquatic macrophytes, water hyacinth weeds are expected to accumulate a higher concentration of mercury than terrestrial plants and crops.

Keywords: mercury, phytoremediation, Thor chemicals, water hyacinth

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Authors: Ahmadreza Bagheri, Seyyed S. Eftekhari, Shervin Rashidinia

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Background: Various stress tests have been proposed yet to assess patients with suspected coronary artery disease. However, their diagnostic properties in terms of sensitivity, specificity, and accuracy are variable and their applicability remained somewhat vague. The aim of this study is to validate per-vessel diagnostic properties of 3 types of stress myocardial perfusion scintigraphy in gated SPECT (Single-Photon Emission Computed Tomography) using either exercise or pharmacological stress testing with dipyridamole or dobutamine. Materials and Methods: Hospital records of 314 patients who referred to Imam Khomeini hospital of Tehran between September 2015 and January 2017 were completely reviewed in this study. All patients underwent coronary angiography within 3 months after stress myocardial perfusion scan. Eventually, the results were analyzed in per-vessel basis to find the proper modality for each involved vessel or scanned site. Results: The mean age of patients was 62.15 ± 4.94 years (30-85) and 35.03% were women. The overall sensitivity, specificity, and accuracy were calculated as 56.59%, 54.24%, and 55.09%, respectively. These values were 56.43% and 53.25%, 54.46% and 47.36%, 56.75% and 54.83% for dipyridamole and exercise, respectively. Ischemia of the anterior wall through exercise stress testing has the highest diagnostic accuracy in detecting LAD (Left Anterior Descending artery) involvement. Inferior wall hypokinesia and anterolateral wall ischemia during exercise stress testing have the highest diagnostic accuracy in detecting RCA (Right Coronary Artery) and LCX artery (Left Circumflex Artery) stenosis, respectively. Conclusion: Stress myocardial perfusion scan should be carried out on the basis of the findings of the preliminary investigations on suspicion of a specific coronary artery or involved myocardial wall.

Keywords: dipyridamole, dobutamine, single-photon emission computed tomography, stress myocardial perfusion scintigraphy

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Authors: Jyh-Cherng Chen, Yi-Jie Lin

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This study tries to reuse the fly ash of municipal solid waste incinerator (MSWI) for the synthesis of zeolites. The fly ashes were treated with NaOH alkali fusion at different temperatures for 40 mins and then synthesized the zeolites with hydrothermal method at 105oC for different operation times. The effects of different operation conditions and the optimum synthesis parameters were explored. The specific surface area, surface morphology, species identification, adsorption capacity, and the reuse potentials of the synthesized zeolites were analyzed and evaluated. Experimental results showed that the optimum operation conditions for the synthesis of zeolite from the mixed fly ash were Si/Al=20, alkali/ash=1.5, alkali fusion reaction with NaOH at 800oC for 40 mins, hydrolysis with L/S=200 at 105oC for 24 hr, and hydrothermal synthesis at 105oC for 48 hr. The largest specific surface area of synthesized zeolite could be increased to 943.05m2/g. The influence of different operation parameters on the synthesis of zeolite from mixed fly ash followed the sequence of Si/Al > hydrolysis L/S> hydrothermal time > alkali fusion temperature > alkali/ash ratio. The XRD patterns of synthesized zeolites were identified to be similar with the ZSM-23 zeolite. The adsorption capacities of synthesized zeolite for pollutants were increased as rising the specific surface area of synthesized zeolite. In summary, MSWI fly ash can be treated and reused to synthesize the zeolite with high specific surface area by the alkali fusion and hydrothermal method. The zeolite can be reuse for the adsorption of various pollutants. They have great potential for development.

Keywords: alkali fusion, hydrothermal, fly ash, zeolite

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Authors: Muhammad Saleem Akhtar, Mushtaq Hussain Lashari, Ejaz Ahmad, Tanveer Ahmad, Laeeq Akbar Lodhi, Ijaz Ahmad, Masood Akhtar

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The objective of this study was to determine the effect of bull exposure continuously or intermittently or its excretory products after calving on postpartum interval to estrus, in Nili-Ravi buffalo. Forty-eight buffaloes of Nili-Ravi breed were allocated one of the four treatments in a totally randomized plan using a 4 x 1 factorial design. The four treatment groups were BEC (Bull Exposed Continuously), BEI (Bull Exposed Intermittently), EPB (Excretory Products of Bull) and BNE (Bull Not Exposed). BEC; buffaloes (n = 12) were exposed continuously to the physical presence of a bull whereas in BEI; buffaloes (n = 12) were exposed intermittently to the physical presence of bull. EPB; buffaloes (n = 12) were exposed to discharge waste (urine and feces) of bull and BNE buffaloes (n = 12) were not exposed to a bull or discharge waste of bulls. Buffaloes were exposed on day 15 after parturition. Day 15 postpartum represented d 0 for each treatment. The postpartum interval from calving to first behavioural estrus was 66.88 days in BEC, 75.12 days in BEI, 77.28 days in EPB and 76.5 days in BNE treatments. Postpartum interval to first behavioural estrus was shorter in BEC than BEI, EPB, and BNE treatments. There was no significant difference in postpartum interval to estrus between BEI, EPB and BNE treatments. In present study, the percentage of buffaloes showing estrus during experimental period was 75.0%, 66.66%, 66.66% and 58.33% in BEC, BEI, EPB and BNE treatments, respectively. The mean serum progesterone concentration did not differ significantly between BEC and other (BEI, EPB, and BNE) treatments. It was concluded that presence of bull has positive effect in reducing calving interval in Nili Ravi buffalo.

Keywords: calving interval, biostimulation, buffalo, bull exposure

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Authors: Antonia Harold-Barry, Eugene Dempsey

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Background: The objective is to examine the survival and outcome of infants born under 26 weeks gestation in an Irish tertiary maternity hospital from 2007-2016 and to describe the survival and neurodevelopmental outcomes of these extremely preterm infants. Method: The population is 132 infants born at 23, 24, and 25 weeks in Cork University Maternity Hospital from 2007 to 2016. Ethical approval was granted by the Cork Clinical Research Ethics Committee. Patient details were obtained from the Vermont Oxford and Badger Networks. Survival rates and Bayley scores were calculated to assess neurodevelopmental outcomes. Statistical analysis with SPSS included frequencies, distributions, and comparisons between data from 2007-2011 and 2012-2016. Results: Overall survival rate was 63%. Of the surviving babies, 61% had Bayley scores calculated. Survival stood at 39% for delivery at 23 weeks, 50% at 24 weeks, and 83% at 25 weeks. The 2012 to 2016 cohort has shown further increases in survival, with 50% of babies at 23 weeks, 58% at 24 weeks, and 89% at 25 weeks. Corresponding figures for 2007-2011 are 20%, 39%, and 75%. Gestational age and incidence of periventricular leukomalacia were statistically significant, with a p-value of 0.022. Gestational age and delivery room deaths had a p-value of 0.025, as did gestational age and birth weight. A comparison of the two cohorts (2007-2011 and 2012-2016) with the administration of antenatal steroids showed a statistically significant p-value of 0.044. Conclusion: There is less morbidity and mortality in infants born at 25 than at 23 or 24 weeks. Survival of extremely premature infants has increased significantly over the past ten years. Survival rates with normal neurodevelopmental outcomes are comparable with international standards and reflect positive changes in attitude and practices in neonatal intensive care. This study will inform parents about the potential outcomes of extreme prematurity and policy regarding the management of extreme prematurity.

Keywords: extreme of viability, neurodevelopmental outcome, periventricular leukomalacia, prematurity

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Authors: Rieski Prihastuti, Meliana Depo, Trisno A. Wibowo, Misinem

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On October 19, 2017, Yogyakarta Islamic Hospital reported 38 garment employees with nausea, vomiting, headache, abdominal pain, and diarrhea after they had lunch on October 18, 2017, to Sleman District Health Office. Objectives of this study were to ensure the outbreak and identify source and route of transmission. Case-control study was conducted to analyze food items that caused the outbreak. A case was defined as a person who got symptoms such as abdominal pain, diarrhea, nausea with/without vomiting, fever, and headache after they had lunch on October 18, 2017. Samples included leftover lunch box, vomit, tap water and drinking water had been sent to the laboratory. Data were analyzed descriptively as frequency table and analyzed by using chi-square in bivariate analysis. All of 196 garment employee was included in this study. The common symptoms of this outbreak were abdominal pain (84.4%), diarrhea (72.8%), nausea (61.6%), headache (52.8%), vomiting (12.8%), and fever (6.4%) with median incubation period 13 hours (range 1-34 hours). Highest attack rate and odds ratio was found in grilled chicken (Attack Rate 58,49%) with Odds Ratio 11,023 (Confidence Interval 95% 1.383 - 87.859; p value 0,005). Almost all samples showed mold, except drinking water. Based on its sign and symptoms, also incubation period, diarrheal Bacillus cereus and Clostridium perfringens were suspected to be the causative agent of the outbreak. Limitation of this study was improper sample handling and no sample of food handler and stools in the food caterer. Outbreak investigation training needed to be given to the hospital worker, and monitoring should be done to the food caterer to prevent another outbreak.

Keywords: disease outbreak, foodborne disease, food poisoning, outbreak

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Authors: Ram Sharan Mehta, Sanjeev Sharma

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Introduction: Haemodialysis (HD) is a mechanical process of removing waste products from the blood and replacing essential substances in patients with renal failure. First artificial kidney developed in Netherlands in 1943 AD First successful treatment of CRF reported in 1960AD, life-saving treatment begins for CRF in 1972 AD. In 1973 AD Medicare took over financial responsibility for many clients and after that method become popular. BP Koirala institute of health science is the only center outside the Kathmandu, where HD service is available. In BPKIHS PD started in Jan.1998, HD started in August 2002 till September 2003 about 278 patients received HD. Day by day the number of HD patients is increasing in BPKIHS as with institutional growth. No such type of study was conducted in past hence there is lack of valid & reliable baseline data. Hence, the investigators were interested to conduct the study on " Profile of the Renal Failure patients under Haemodialysis at B.P. Koirala Institute of Health Sciences Nepal". Objectives: The objectives of the study were: to find out the Socio-demographic characteristics of the patients, to explore the knowledge of the patients regarding disease process and Haemodialysis and to identify the problems encountered by the patients. Methods: It is a hospital-based exploratory study. The population of the study was the clients under HD and the sampling method was purposive. Fifty-four patients undergone HD during the period of 17 July 2012 to 16 July 2013 of complete one year were included in the study. Structured interview schedule was used for collect data after obtaining validity and reliability. Results: Total 54 subjects had undergone for HD, having age range of 5-75 years and majority of them were male (74%) and Hindu (93 %). Thirty-one percent illiterate, 28% had agriculture their occupation, 80% of them were from very poor community, and about 30% subjects were unaware about the disease they suffering. Majority of subjects reported that they had no complications during dialysis (61%), where as 20% reported nausea and vomiting, 9% Hypotension, 4% headache and 2%chest pain during dialysis. Conclusions: CRF leading to HD is a long battle for patients, required to make major and continuous adjustment, both physiologically and psychologically. The study suggests that non-compliance with HD regimen were common. The socio-demographic and knowledge profile will help in the management and early prevention of disease and evaluate aspects that will influence care and patients can select mode of treatment themselves properly.

Keywords: profile, haemodialysis, Nepal, patients, treatment

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Authors: M. Mathuthu, N. N. Gaxela, R. Y. Olobatoke

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A study was carried out to assess the heavy metal and radionuclide concentrations of water from the waste water treatment plant in Mafikeng Local Municipality to evaluate treatment efficiency. Ten water samples were collected from various stages of water treatment which included sewage delivered to the plant, the two treatment stages and the effluent and also the community. The samples were analyzed for heavy metal content using Inductive Coupled Plasma Mass Spectrometer. Gross α/β activity concentration in water samples was evaluated by Liquid Scintillation Counting whereas the concentration of individual radionuclides was measured by gamma spectroscopy. The results showed marked reduction in the levels of heavy metal concentration from 3 µg/L (As)–670 µg/L (Na) in sewage into the plant to 2 µg/L (As)–170 µg/L (Fe) in the effluent. Beta activity was not detected in water samples except in the in-coming sewage, the concentration of which was within reference limits. However, the gross α activity in all the water samples (7.7-8.02 Bq/L) exceeded the 0.1 Bq/L limit set by World Health Organization (WHO). Gamma spectroscopy analysis revealed very high concentrations of 235U and 226Ra in water samples, with the lowest concentrations (9.35 and 5.44 Bq/L respectively) in the in-coming sewage and highest concentrations (73.8 and 47 Bq/L respectively) in the community water suggesting contamination along water processing line. All the values were considerably higher than the limits of South Africa Target Water Quality Range and WHO. However, the estimated total doses of the two radionuclides for the analyzed water samples (10.62 - 45.40 µSv yr-1) were all well below the reference level of the committed effective dose of 100 µSv yr-1 recommended by WHO.

Keywords: gross α/β activity, heavy metals, radionuclides, 235U, 226Ra, water sample

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Authors: Michelle Hartanto, Risheka Suthantirakumar

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Introduction Staff redeployment, increased numbers of acutely unwell patients requiring resuscitation decision-making conversations, visiting restrictions, and varying guidance regarding resuscitation for patients with COVID-19 disrupted clinicians’ management of resuscitation and escalation decision-making processes. While it was generally accepted that the COVID-19 pandemic disturbed numerous aspects of the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) process in the United Kingdom, a process which establishes a patient’s CPR status and treatment escalation plans, the impact of the pandemic on clinicians’ attitudes towards these resuscitation and decision-making conversations was unknown. This was the first study to examine the impact of the COVID-19 pandemic on clinicians’ knowledge, skills, and attitudes towards the ReSPECT process. Methods A cross-sectional survey of clinicians at one acute teaching hospital in the UK was conducted. A questionnaire with a defined five-point Likert scale was distributed and clinicians were asked to recall their pre-pandemic views on ReSPECT and report their current views at the time of survey distribution (May 2020, end of the first COVID-19 wave in the UK). Responses were received from 171 clinicians, and self-reported views before and during the pandemic were compared. Results Clinicians reported they found managing ReSPECT conversations more challenging during the pandemic, especially when conducted over the telephone with relatives, and they experienced an increase in negative emotions before, during, and after conducting ReSPECT conversations. Our findings identified that due to the pandemic there was now a need for clinicians to receive training and support in conducting resuscitation and escalation decision-making conversations over the telephone with relatives and managing these processes.

Keywords: cardiopulmonary resuscitation, COVID-19 pandemic, DNACPR discussion, education, recommended summary plan for emergency care and treatment, resuscitation order

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Authors: Hamda M. Al-Ali

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The ultimate aim of space exploration has been centralized around the possibility of life on other planets in the solar system. This aim is driven by the detrimental effects that climate change could potentially have on human survival on Earth in the future. This drives humans to search for feasible solutions to increase environmental and economical sustainability on Earth and to evaluate and explore the ability of human survival on other planets such as Mars. To do that, frequent space missions are required to meet the ambitious human goals. This means that reliable and affordable access to space is required, which could be largely achieved through the use of reusable spacecrafts. Therefore, materials and resources must be used wisely to meet the increasing demand. Space missions are currently extremely expensive to operate. However, reusing materials hence spacecrafts, can potentially reduce overall mission costs as well as the negative impact on both space and Earth environments. This is because reusing materials leads to less waste generated per mission, and therefore fewer landfill sites are required. Reusing materials reduces resource consumption, material production, and the need for processing new and replacement spacecraft and launch vehicle parts. Consequently, this will ease and facilitate human access to outer space as it will reduce the demand for scarce resources, which will boost material efficiency in the space industry. Material efficiency expresses the extent to which resources are consumed in the production cycle and how the waste produced by the industrial process is minimized. The strategies proposed in this paper to boost material efficiency in the space sector are the introduction of key performance indicators that are able to measure material efficiency as well as the introduction of clearly defined policies and legislation that can be easily implemented within the general practices in the space industry. Another strategy to improve material efficiency is by amplifying energy and resource efficiency through reusing materials. The circularity of various spacecraft materials such as Kevlar, steel, and aluminum alloys could be maximized through reusing them directly or after galvanizing them with another layer of material to act as a protective coat. This research paper has an aim to investigate and discuss how to improve material efficiency in space missions considering circular economy concepts so that space and Earth become more economically and environmentally sustainable. The circular economy is a transition from a make-use-waste linear model to a closed-loop socio-economic model, which is regenerative and restorative in nature. The implementation of a circular economy will reduce waste and pollution through maximizing material efficiency, ensuring that businesses can thrive and sustain. Further research into the extent to which reusable launch vehicles reduce space mission costs have been discussed, along with the environmental and economic implications it could have on the space sector and the environment. This has been examined through research and in-depth literature review of published reports, books, scientific articles, and journals. Keywords such as material efficiency, circular economy, reusable launch vehicles and spacecraft materials were used to search for relevant literature.

Keywords: circular economy, key performance indicator, material efficiency, reusable launch vehicles, spacecraft materials

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Authors: N. Boontian

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Biological conversion of biomass to methane has received increasing attention in recent years. Grasses have been explored for their potential anaerobic digestion to methane. In this review, extensive literature data have been tabulated and classified. The influences of several parameters on the potential of these feedstocks to produce methane are presented. Lignocellulosic biomass represents a mostly unused source for biogas and ethanol production. Many factors, including lignin content, crystallinity of cellulose, and particle size, limit the digestibility of the hemicellulose and cellulose present in the lignocellulosic biomass. Pretreatments have used to improve the digestibility of the lignocellulosic biomass. Each pretreatment has its own effects on cellulose, hemicellulose and lignin, the three main components of lignocellulosic biomass. Solid-state anaerobic digestion (SS-AD) generally occurs at solid concentrations higher than 15%. In contrast, liquid anaerobic digestion (AD) handles feedstocks with solid concentrations between 0.5% and 15%. Animal manure, sewage sludge, and food waste are generally treated by liquid AD, while organic fractions of municipal solid waste (OFMSW) and lignocellulosic biomass such as crop residues and energy crops can be processed through SS-AD. An increase in operating temperature can improve both the biogas yield and the production efficiency, other practices such as using AD digestate or leachate as an inoculant or decreasing the solid content may increase biogas yield but have negative impact on production efficiency. Focus is placed on substrate pretreatment in anaerobic digestion (AD) as a means of increasing biogas yields using today’s diversified substrate sources.

Keywords: anaerobic digestion, lignocellulosic biomass, methane production, optimization, pretreatment

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Authors: Angelis P. Barlampas

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Purpose or Learning Objective It is well known that previous examinations play a major role in futural diagnosis, thus avoiding unnecessary new exams that cost in time and money both for the patient and the health system. A case is presented in which past patient’s results, in combination with the least needed new tests, give an easy final diagnosis. Methods or Background A middle aged man visited the emergency department complaining of hard controlled, persisting fever for the last few days. Laboratory tests showed an elevated number of white blood cells with neutrophil shift and abnormal CRP. The patient was admitted to hospital a month ago for continuing lungs symptomatology after a recent covid-19 infection. Results or Findings Computed tomography scanning showed a solid mass with spiculating margins in right lower lobe. After intravenous iodine contrast administration, there was mildly peripheral enhancement and eccentric non enhancing area. A pneumonic cancer was suspected. Comparison with the patient’s latest computed tomography revealed no mass in the area of interest but only signs of recent post covid-19 lung parenchyma abnormalities. Any new mass that appears in a month’s time span can not be a cancer but a benign lesion. It was obvious that an abscess was the most suitable explanation. The patient was admitted to hospital, and antibiotic therapy was given, with very good results. After a few days, the patient was afebrile and in good condition. Conclusion In this case , a PET scan or a biopsy was avoided, thanks to the patient’s medical history and the availability of previous examinations. It is worthy encouraging the patients to keep their medical records and organizing more efficiently the health system with the current technology of archiving the medical examinations, too.

Keywords: covid-19, chest ct, cancer, abscess, fever

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Authors: Abbas Ahmed Albu Shaqraa

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The concept of a safe environment and low greenhouse gas emissions is a common concern especially in the construction industry. The produced carbon dioxide (CO2) emissions are nearly a ton in producing only one ton of Portland cement, which is the primary ingredient of concrete. Current studies had investigated the utilization of several waste materials in producing a cement free concrete. The geopolymer concrete is a green material that results from the reaction of aluminosilicate material with an alkaline liquid. A summary of several recent researches in geopolymer concrete will be presented in this manuscript. In addition, the offered presented review considers the use of several waste materials including fly ash, granulated blast furnace slag, cement kiln dust, kaolin, metakaolin, and limestone powder as binding materials in making geopolymer concrete. Moreover, the mechanical, chemical and thermal properties of geopolymer concrete will be reviewed. In addition, the geopolymer concrete applications and limitations will be discussed as well. The results showed a high early compressive strength gain in geopolymer concrete when dry- heating or steam curing was performed. Also, it was stated that the outstanding acidic resistance of the geopolymer concrete made it possible to be used where the ordinary Portland cement concrete was doubtable. Thus, the commercial geopolymer concrete pipes were favored for sewer system in case of high acidic conditions. Furthermore, it was reported that the geopolymer concrete could stand up to 1200 °C in fire without losing its strength integrity whereas the Portland cement concrete was losing its function upon heating to some 100s °C only. However, the geopolymer concrete still considered as an emerging field and occupied mainly by the precast industries.

Keywords: geopolymer concrete, Portland cement concrete, alkaline liquid, compressive strength

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Authors: Bhaven N. Tandel, Athira Rajeev

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Sequencing batch reactor process is a suspended growth process operating under non-steady state conditions which utilizes a fill and draw reactor with complete mixing during the batch reaction step (after filling) and where the subsequent steps of aeration and clarification occur in the same tank. All sequencing batch reactor systems have five steps in common, which are carried out in sequence as follows, (1) fill (2) react (3) settle (sedimentation/clarification) (4) draw (decant) and (5) idle. The study was carried out in a sequencing batch reactor of dimensions 44cmx30cmx70cm with a working volume of 40 L. Mechanical stirrer of 100 rpm was used to provide continuous mixing in the react period and oxygen was supplied by fish tank aerators. The duration of a complete cycle of sequencing batch reactor was 8 hours. The cycle period was divided into different phases in sequence as follows-0.25 hours fill phase, 6 hours react period, 1 hour settling phase, 0.5 hours decant period and 0.25 hours idle phase. The study consisted of two runs, run 1 and run 2. Run 1 consisted of 6 hours aerobic react period and run 2 consisted of 3 hours aerobic react period followed by 3 hours anoxic react period. The influent wastewater used for the study had COD, BOD, NH3-N and TKN concentrations of 308.03±48.94 mg/L, 100.36±22.05 mg/L, 14.12±1.18 mg/L, and 24.72±2.21 mg/L respectively. Run 1 had an average COD removal efficiency of 41.28%, BOD removal efficiency of 56.25%, NH3-N removal efficiency of 86.19% and TKN removal efficiency of 54.4%. Run 2 had an average COD removal efficiency of 63.19%, BOD removal efficiency of 73.85%, NH3-N removal efficiency of 90.74% and TKN removal efficiency of 65.25%. It was observed that run 2 gave better performance than run 1 in the removal of COD, BOD and TKN.

Keywords: municipal waste water, aerobic, anoxic, sequencing batch reactor

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Authors: R. Padmini, G. V. Manoj Kumar

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Structural insulated panels (SIPs) are a high-performance building system for residential and light commercial construction. The panels consist of an insulating foam core sandwiched between two structural facings, typically oriented strand board (OSB). SIPs are manufactured under factory controlled conditions and can be fabricated to fit nearly any building design. The result is a building system that is extremely strong, energy efficient and cost effective. Building with SIPs will save you time, money and labor. Building with SIPs generally costs about the same as building with wood frame construction when you factor in the labor savings resulting from shorter construction time and less job-site waste. Other savings are realized because smaller heating and cooling systems are required with SIP construction. Structural insulated panels (SIPs) are one of the most airtight and well-insulated building systems available, making them an inherently green product. An airtight SIP building will use less energy to heat and cool, allow for better control over indoor environmental conditions, and reduce construction waste. Green buildings use less energy, reducing carbon dioxide emissions and playing an important role in combating global climate change. Buildings also use a tremendous amount of natural resources to construct and operate. Constructing green buildings that use these resources more efficiently, while minimizing pollution that can harm renewable natural resources, is crucial to a sustainable future.

Keywords: high performance, under factory controlled, wood frame, carbon dioxide emissions, natural resources

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Authors: Christina Drosou, Konstantina E. Kyriakopoulou, Andreas Bimpilas, Dimitrios Tsimogiannis, Magdalini C. Krokida

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Rationale: Agiorgitiko is one of the most widely-grown and commercially well-established red wine varieties in Greece. Each year viticulture industry produces a large amount of waste consisting of grape skins and seeds (pomace) during a short period. Grapes contain polyphenolic compounds which are partially transferred to wine during winemaking. Therefore, winery wastes could be an alternative cheap source for obtaining such compounds with important antioxidant activity. Specifically, red grape waste contains anthocyanins and flavonols which are characterized by multiple biological activities, including cardioprotective, anti-inflammatory, anti-carcinogenic, antiviral and antibacterial properties attributed mainly to their antioxidant activity. Ultrasound assisted extraction (UAE) is considered an effective way to recover phenolic compounds, since it combines the advantage of mechanical effect with low temperature. Moreover, green solvents can be used in order to recover extracts intended for used in the food and nutraceutical industry. Apart from the extraction, pre-treatment process like drying can play an important role on the preservation of the grape pomace and the enhancement of its antioxidant capacity. Objective: The aim of this study is to recover natural extracts from winery waste with high antioxidant capacity using green solvents so they can be exploited and utilized as enhancers in food or nutraceuticals. Methods: Agiorgitiko grape pomace was dehydrated by air drying (AD) and accelerated solar drying (ASD) in order to explore the effect of the pre-treatment on the recovery of bioactive compounds. UAE was applied in untreated and dried samples using water and water: ethanol (1:1) as solvents. The total antioxidant potential and phenolic content of the extracts was determined using the 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical scavenging assay and Folin-Ciocalteu method, respectively. Finally, the profile of anthocyanins and flavonols was specified using HPLC-DAD analysis. The efficiency of processes was determined in terms of extraction yield, antioxidant activity, phenolic content and the anthocyanins and flavovols profile. Results & Discussion: The experiments indicated that the pre-treatment was essential for the recovery of highly nutritious compounds from the pomace as long as the extracts samples showed higher phenolic content and antioxidant capacity. Water: ethanol (1:1) was considered a more effective solvent on the recovery of phenolic compounds. Moreover, ASD grape pomace extracted with the solvent system exhibited the highest antioxidant activity (IC50=0.36±0.01mg/mL) and phenolic content (TPC=172.68±0.01mgGAE/g dry extract), followed by AD and untreated pomace. The major compounds recovered were malvidin3-O-glucoside and quercetin3-O-glucoside according to the HPLC analysis. Conclusions: Winery waste can be exploited for the recovery of nutritious compounds using green solvents such as water or ethanol. The pretreatment of the pomace can significantly affect the concentration of phenolic compounds, while UAE is considered a highly effective extraction process.

Keywords: agiorgitico grape pomace, antioxidants, phenolic compounds, ultrasound assisted extraction

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Authors: Antonio Marco Miotti, Antonella Ruffatto, Giampaola Basso, Antonio Madia, Giulia Zavatta, Emanuela Salvatico, Emanuela Zilli

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A National Action Plan to fight antimicrobial resistance was launched in Italy in 2017. In order to reduce inappropriate exposure to antibiotics and infections from multi-drug resistant bacteria, it is essential to set up a structured system of surveillance and monitoring of the implementation of National Action Plan standards, including antimicrobial consumption, with a special focus on quinolones, third generation cephalosporins and carbapenems. A quantitative estimate of antibiotic consumption (defined daily dose - DDD - consumption per 100 days of hospitalization) has been provided by the Pharmaceutical Service to the Hospital of Cittadella, ULSS 6 Euganea – Health Trust (District of Padua) for the years 2019 (before the pandemic), 2020 and 2021 for all classes of antibiotics. Multidisciplinary meetings have been organized monthly by the local Antimicrobial Stewardship Group. Between 2019 and 2021, an increase in the consumption of carbapenems in the Intensive Care Unit (from 12.2 to 18.2 DDD, + 49.2%) and a decrease in Medical wards (from 5.3 to 2.6 DDD, - 50.9%) was reported; a decrease in the consumption of quinolones in Intensive Care Unit (from 17.2 to 10.8 DDD, - 37.2%), Medical wards (from 10.5 to 6.6 DDD, - 37.1%) and Surgical wards (from 10.2 to 9.3 DDD, - 8.8%) was highlighted; an increase in the consumption of third generation cephalosporins in Medical wards (from 18.1 to 22.6 DDD, + 24,1%) was reported. Finally, after an increase in the consumption of macrolides between 2020 and 2019, in 2021, a decrease was reported in the Intensive Care Unit (DDD: 8.0 in 2019, 18.0 in 2020, 6.4 in 2021) and Medical wards (DDD: 9.0 in 2019, 13.7 in 2020, 10.9 in 2021). Constant monitoring of antimicrobial consumption and timely identifying of warning situations that may need a specific intervention are the cornerstone of Antimicrobial Stewardship programs, together with analysing data on bacterial resistance rates and infections from multi-drug resistant bacteria.

Keywords: carbapenems, quinolones, antimicrobial, stewardship

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Authors: Chibuzo Okoye Daniels, Gillian Glegg, Lynda Rodwell

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Marine debris from fishing nets to medical equipment to food packaging that play major roles in boosting the economy and protecting human health is now more than an environmental problem that can be solved by legislation, law enforcement and technical solutions. It has also been identified as a cultural problem that can only be addressed by identifying instruments that can be used to change human attitudes and behaviors. This may be through management approaches, education and involvement of all sectors/interests, including the public. To contribute to the sustainable development of coastal Nigeria, two case study areas (Ikoyi and Victoria Islands of Lagos State) were used to evaluate the socio-economic impacts of marine debris problem in coastal Nigeria. The following methods were used: (1) semi-structured interviews with key stakeholders and businesses on beaches, waterfronts and waterways within the study areas and (2) observational study of beaches, waterfronts and waterways within the study areas. The results of the study have shown that marine debris is a cultural and multi-sectoral problem that poses great threat not only to the environmental sustainability of the study areas but also to the wellbeing of its citizens and the economy of coastal Nigeria. Current solid waste and marine debris management practices are inefficient due to inadequate knowledge of how to tackle the problem. To ensure environmental sustainability in coastal Nigeria and avoid waste of scarce financial resources, adequate, appropriate and cost effective solutions to the marine debris problem need to be identified and effectively transferred for implementation in the study areas.

Keywords: sustainability, coastal Nigeria, study areas, aquaculture

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Authors: Ming-Chan Chung, Wen-Ming Huang, Yi-Chu Liu, Li-Hui Yang, Ming-Jyh Chen

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introduction: Hospital buildings require considerable energy, including air conditioning, lighting, elevators, heating, and medical equipment. Energy consumption in hospitals is expected to increase significantly due to innovative equipment and continuous development plans. Consequently, the environment and climate will be adversely affected. Hospitals should therefore consider transforming from their traditional role of saving lives to being at the forefront of global efforts to reduce carbon dioxide emissions. As healthcare providers, it is our responsibility to provide a high-quality environment while using as little energy as possible. Purpose / Methods: Compare the energy-saving benefits of solar photovoltaic systems and solar hot water systems. The proportion of electricity consumption effectively reduced after the installation of solar photovoltaic systems. To comprehensively assess the potential benefits of utilizing solar energy for both photovoltaic (PV) and solar thermal applications in hospitals, a solar PV system was installed covering a total area of 28.95 square meters in 2021. Approval was obtained from the Taiwan Power Company to integrate the system into the hospital's electrical infrastructure for self-use. To measure the performance of the system, a dedicated meter was installed to track monthly power generation, which was then converted into area output using an electric energy conversion factor. This research aims to compare the energy efficiency of solar PV systems and solar thermal systems. Results: Using the conversion formula between electrical and thermal energy, we can compare the energy output of solar heating systems and solar photovoltaic systems. The comparative study draws upon data from February 2021 to February 2023, wherein the solar heating system generated an average of 2.54 kWh of energy per panel per day, while the solar photovoltaic system produced 1.17 kWh of energy per panel per day, resulting in a difference of approximately 2.17 times between the two systems. Conclusions: After conducting statistical analysis and comparisons, it was found that solar thermal heating systems offer higher energy and greater benefits than solar photovoltaic systems. Furthermore, an examination of literature data and simulations of the energy and economic benefits of solar thermal water systems and solar-assisted heat pump systems revealed that solar thermal water systems have higher energy density values, shorter recovery periods, and lower power consumption than solar-assisted heat pump systems. Through monitoring and empirical research in this study, it has been concluded that a heat pump-assisted solar thermal water system represents a relatively superior energy-saving and carbon-reducing solution for medical institutions. Not only can this system help reduce overall electricity consumption and the use of fossil fuels, but it can also provide more effective heating solutions.

Keywords: sustainable development, energy conservation, carbon reduction, renewable energy, heat pump system

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Authors: Suphap Sikkhaphan, Muwanga Zake, Johnnie Wycliffe Frank

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The purposes of the study included a) investigating the authentic and transformational leadership model of the directors of tambon health promoting hospitals b) evaluating the relation between the authentic and transformation leadership of the directors of tambon health promoting hospitals and the effectiveness of their hospitals and c) assessing the invariance test of the authentic and transformation leadership of the directors of tambon health promoting hospitals. All 400 southern tambon health promoting hospital directors were enrolled into the study. Half were males (200), and another half were females (200). They were sampled via a stratified method. A research tool was a questionnaire paper containing 4 different sections. The Alpha-Cronbach’s Coefficient was equally to .98. Descriptive analysis was used for demographic data, and inferential statistics was used for the relation and invariance tests of authentic and transformational leadership of the directors of tambon health promoting hospitals. The findings revealed overall the authentic and transformation leadership model of the directors of tambon health promoting hospitals has the relation to the effectiveness of the hospitals. Only the factor of “strong community support” was statistically significantly related to the authentic leadership (p < .05). However, there were four latent variables statistically related to the transformational leadership including, competency and work climate, management system, network cooperation, and strong community support (p = .01). Regarding the relation between the authentic and transformation leadership of the directors of tambon health promoting hospitals and the effectiveness of their hospitals, four casual variables of authentic leadership were not related to those latent variables. In contrast, all four latent variables of transformational leadership has statistically significantly related to the effectiveness of tambon health promoting hospitals (p = .001). Furthermore, only management system variable was significantly related to those casual variables of the authentic leadership (p < .05). Regarding the invariance test, the result found no statistical significance of the authentic and transformational leadership model of the directors of tambon health promoting hospitals, especially between male and female genders (p > .05).

Keywords: authentic leadership, transformational leadership, tambon health promoting hospital

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Authors: N. Z. van Hierden, Q. Yu, F. Gauvin

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Cement manufacturing is, because of its production process, among the highest contributors to CO₂ emissions worldwide. As cement is one of the major components in 3D printed concrete, achieving sustainability and carbon neutrality can be particularly challenging. To improve the sustainability of 3D printed materials, different CO₂-reducing strategies can be used, each one with a distinct level of impact and complexity. In this work, we focus on the development of these sustainable mixtures and finding alternatives. Promising alternatives for cement and clinker replacement include the use of recycled building materials, amongst which (calcined) bricks and roof tiles. To study the potential of recycled clay-based building materials, the application of calcinated clay itself is studied as well. Compared to cement, the calcination temperature of clay-based materials is significantly lower, resulting in reduced CO₂ output. Reusing these materials is therefore a promising solution for utilizing waste streams while simultaneously reducing the cement content in 3D concrete mixtures. In addition, waste streams can be locally sourced, thereby reducing the emitted CO₂ during transportation. In this research, various alternative binders are examined, such as calcined clay blends (LC3) from recycled tiles and bricks, or locally obtained clay resources. Using various experiments, a high potential for mix designs including these resources has been shown with respect to material strength, while sustaining decent printability and buildability. Therefore, the defined strategies are promising and can lead to a more sustainable, low-CO₂ mixture suitable for 3D printing while using accessible materials.

Keywords: cement replacement, 3DPC, circular building materials, calcined clay, CO₂ reduction

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Authors: Muna Al-Tarshi, Dobretsov Sergey, Wenresti Gallardo

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Marine litter pollution is a global concern that has wide-ranging ecological, societal, and economic implications, along with potential health risks for humans. In Oman, inadequate solid waste management has led to the accumulation of litter in mangrove ecosystems. However, there is a dearth of information on marine litter and microplastic pollution in Omani mangroves, impeding the formulation of effective mitigation strategies. To address this knowledge gap, we conducted a comprehensive assessment of marine litter and microplastics in mangrove sediments in the Sea of Oman. Our study measured the average abundance of marine litter, which ranged from 0.83±1.03 to 19.42±8.52 items/m2. Notably, plastics constituted the majority of litter, accounting for 73-96% of all items, with soft plastics being the most prevalent. Furthermore, we investigated microplastic concentrations in the sediments, finding levels ranging from 6 to 256 pieces /kg. Among the studied areas, afforested mangroves in Al-Sawadi exhibited the highest average abundance of microplastics (27.52±5.32 pieces/ kg), while the Marine Protected Area Al Qurum had the lowest average abundance (0.60±1.12 pieces /kg). These findings significantly contribute to our understanding of marine litter and microplastic pollution in Omani mangroves. They provide valuable baseline data for future monitoring initiatives and the development of targeted management strategies. Urgent action is needed to implement effective waste management practices and interventions to protect the ecological integrity of mangrove ecosystems in Oman and mitigate the risks associated with marine litter and microplastics.

Keywords: microplastics, anthropogenic marine litter, ftir, polymer, khawr, mangrove, sediment

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Authors: Massimo Zucchetti

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

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

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Authors: Thomas D. Collin, Rachel Cunningham, Bruce Jefferson, Raffaella Villa

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Fats, oils and grease (FOG) are by-products of food preparation and cooking processes. FOG enters wastewater systems through a variety of sources such as households, food service establishments, and industrial food facilities. Over time, if no source control is in place, FOG builds up on pipe walls, leading to blockages, and potentially to sewer overflows which are a major risk to the Environment and Human Health. UK water utilities spend millions of pounds annually trying to control FOG. Despite UK legislation specifying that discharge of such material is against the law, it is often complicated for water companies to identify and prosecute offenders. Hence, it leads to uncertainties regarding the attitude to take in terms of FOG management. Research is needed to seize the full potential of implementing current practices. The aim of this research was to undertake a comprehensive study to document the extent of FOG problems in sewer lines and reinforce existing knowledge. Data were collected to develop a model estimating quantities of FOG available for recovery within Thames Water wastewater catchments. Geographical Information System (GIS) software was used in conjunction to integrate data with a geographical component. FOG was responsible for at least 1/3 of sewer blockages in Thames Water waste area. A waste-based approach was developed through an extensive review to estimate the potential for FOG collection and recovery. Three main sources were identified: residential, commercial and industrial. Commercial properties were identified as one of the major FOG producers. The total potential FOG generated was estimated for the 354 wastewater catchments. Additionally, raw and settled sewage were sampled and analysed for FOG (as hexane extractable material) monthly at 20 sewage treatment works (STW) for three years. A good correlation was found with the sampled FOG and population equivalent (PE). On average, a difference of 43.03% was found between the estimated FOG (waste-based approach) and sampled FOG (raw sewage sampling). It was suggested that the approach undertaken could overestimate the FOG available, the sampling could only capture a fraction of FOG arriving at STW, and/or the difference could account for FOG accumulating in sewer lines. Furthermore, it was estimated that on average FOG could contribute up to 12.99% of the primary sludge removed. The model was further used to investigate the relationship between estimated FOG and number of blockages. The higher the FOG potential, the higher the number of FOG-related blockages is. The GIS-based tool was used to identify critical areas (i.e. high FOG potential and high number of FOG blockages). As reported in the literature, FOG was one of the main causes of sewer blockages. By identifying critical areas (i.e. high FOG potential and high number of FOG blockages) the model further explored the potential for source-control in terms of ‘sewer relief’ and waste recovery. Hence, it helped targeting where benefits from implementation of management strategies could be the highest. However, FOG is still likely to persist throughout the networks, and further research is needed to assess downstream impacts (i.e. at STW).

Keywords: fat, FOG, GIS, grease, oil, sewer blockages, sewer networks

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Authors: Sayan Munshi, Subrajit Banerjee, Indrani Chakraborty

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Tourism is a prime sector in the economic development of many countries in particular the Indian sub-continent. Tourism is considered an integral pillar in the Make in India Program under the Government of India. The statistics of tourism in India had evolved from a past with the formation of History. The sector had shown dynamic changes in the statistics since 1980. With the evolving tourism along with destinations, this sector has been converted into the prime industry, as it not only impacts the destination but on the other hand supports the periphery of the destination. Tourism boost revenue and creates varied economic possibilities for the residents. Due to the influx of tourism in the cities, a load on the infrastructure and services can be observed, specifically in the Physical Infrastructure sectors. Due to the floating population in the designated tourism core of the Urban / Peri-Urban area, issues pertaining to Solid waste management and Transportation are highly observed. Thus, a need for capacity building arises for the infrastructure impacted by tourism, which may result in the upgradation of the lifestyle of the city and its permanent users. As tourism of a region has a dependency on the infrastructure, the paper here focuses on the relationship between tourism potential of a region and the infrastructural determinants of the city or region and hence to derive a structural equation supporting the relationship, further determine a coefficient and suggest the domain of in need of upgradation or retrofitting possibilities. The outcome of the paper is to suggest possible recommendations towards the formation of policies on an urban level to support the tourism potential of the region.

Keywords: urban planning, tourism planning, infrastructure, transportation, solid waste management

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Authors: Ru-Yu Lien, Shih-Hsin Hung, Shu-Fen Lu, Shu-I Chin, Wen-Ju Yang, Wan Ming-Shang, Chien-Ying Wang

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Background: Upon recovery from critical condition, patients are normally transferred from the intensive care units (ICUs) to the general wards. However, transferring patients to a new environment causes stressful experiences for both patients and their families. Therefore, there is a necessity to communicate with the patients and their families to reduce psychological stress and unplanned return. Methods: This study was performed in the general ICUs from January 1, 2021, to December 31, 2021, in Taipei Veteran General Hospital. The patients who were evaluated by doctors and liaison nurses transferred to the general wards were selected as the research objects and ranked by the Critical Care Transition Program (CCTP). The plan was applied to 40 patients in a study group and usual care support for a control group of 40 patients. The psychological condition of patients was evaluated by a migration stress scale and a hospital anxiety and depression scale. In addition, the rate of return to ICU was also measured. Results: A total of 63 patients out of 80 (78.8%) experienced moderate to severe degrees of anxiety, and 42 patients (52.6%) experienced moderate to severe degrees of depression before being transferred. The difference between anxiety and depression changed more after the transfer; moreover, when a transition program was applied, it was lower than without a transition program. The return to ICU rate in the study group was lower than in the usual transition group, with an adjusted odds ratio of 0.21 (95% confidence interval: 0.05-0.888, P=0.034). Conclusion: Our study found that the transfer program could reduce the anxiety and depression of patients and the associated stress on their families during the transition from ICU. Before being transferred out of ICU, the healthcare providers need to assess the needs of patients to set the goals of the care plan and perform patient-centered decision-making with multidisciplinary support.

Keywords: ICU, critical care transition program, healthcare, transition program

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Authors: Ming-Juei Chang, Hui-Ing Ma, Tsung-Hsueh Lu

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Introduction: Because of the advance of medical care (e.g., ventilation techniques and gastrostomy feeding), more and more children with CP can live to adulthood. However, little is known about the use of health care services from children to adults who have CP. The patterns of utilization of ambulatory care are heavily influenced by insurance coverage and primary care gatekeeper regulation. The purpose of this study was to examine patterns of ambulatory care utilization among individuals with CP in Taiwan, a country with universal coverage and no gatekeeper regulation. Methods: A representative sample of one million patients (about 1/23 of total population) covered by Taiwan’s National Health Insurance was used to analyze the ambulatory care utilization in individuals with CP. Data were analyzed by 3 different age groups (children, youth and adults) during 2000 to 2003. Participants were identified by the presence of CP diagnosis made by pediatricians or physicians of physical and rehabilitation medicine and stated at least three times in claims data. Results: Annual rates of outpatient physician visits were 31680 for children, 16492 for youth, and 28617 for adults with CP (per 1000 persons). Individuals with CP received over 50% of their outpatient care from hospital outpatient department. Higher use of specialist physician services was found in children (54.7%) than in the other two age groups (28.4% in youth and 18.8% in adults). Diseases of respiratory system were the most frequent diagnoses for visits in both children and youth with CP. Diseases of the circulatory system were the main reasons (24.3%) that adults with CP visited hospital outpatient care department or clinics. Conclusion: This study showed different patterns of ambulatory care utilization among different age groups. It appears that youth and adults with CP continue to have complex health issues and rely heavily on the health care system. Additional studies are needed to determine the factors which influence ambulatory care utilization among individuals with CP.

Keywords: cerebral palsy, health services, lifespan, universal coverage

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Authors: Karolina Porada

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Over the last 40 years, there has been a trend in landscape architecture which supporters do not perceive the role of pro-ecological or postmodern solutions in the design of public green spaces as an essential goal, shifting their attention to the 'sculptural' shaping of areas with the use of slopes, hills, embankments, and other forms of terrain. This group of designers can be considered avant-garde, which in its activities refers to land art. Initial research shows that such applications are particularly frequent in places of former post-industrial sites and landfills, utilizing materials such as debris and post-mining waste in their construction. Due to the high degradation of the environment surrounding modern man, the brownfields are a challenge and a field of interest for the representatives of landscape architecture avant-garde, who through their projects try to recover lost lands by means of transformations supported by engineering and ecological knowledge to create places where nature can develop again. The analysis of a dozen or so facilities made it possible to come up with an important conclusion: apart from the cultural aspects (including artistic activities), the green areas formally referring to the land are important in the process of remediation of post-industrial sites and waste recycling (e. g. from construction sites). In these processes, there is also a potential for applying the concept of Natural Based Solutions, i.e. solutions allowing for the natural development of the site in such a way as to use it to cope with environmental problems, such as e.g.  air pollution, soil phytoremediation and climate change. The paper presents examples of modern parks, whose compositions are based on shaping the surface of the terrain in a way referring to the land art, at the same time providing an example of brownfields reuse and application of waste recycling.  For the purposes of object analysis, research methods such as historical-interpretation studies, case studies, qualitative research or the method of logical argumentation were used. The obtained results provide information about the role that landscape architecture can have in the process of remediation of degraded areas, at the same time guaranteeing the benefits, such as the shaping of landscapes attractive in terms of visual appearance, low costs of implementation, and improvement of the natural environment quality.

Keywords: brownfields, contemporary parks, landscape architecture, remediation

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Authors: Policarpio Jr. Joves

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Physicians in most teaching hospitals are commonly promoted into managerial roles, yet their training is mostly in clinical and scientific skills but not in leadership competencies. When they shift into roles of physician leadership, the majority hold on to their primary identity of physicians. These conflicting roles affect their identity and eventually their work. The physician leaders also face additional challenges related to academics which include incorporation of new knowledge into the existing curriculum, use of technology in the delivery of teaching, the need to train medical students outside of hospital wards, etc. The study aims to explore how physician leaders in teaching hospitals of private medical schools enact their leadership roles and how they face the challenges as physician leaders. The study setting shall be teaching hospitals of three private medical schools situated in the National Capital Region, Philippines. A multiple case study design shall be adopted in this research. Physicians shall be eligible to participate in the study if they are practicing clinicians limited to the five major clinical specialty: Internal Medicine, Pediatrics, Family Medicine, Surgery, Obstetrics and Gynecology. They must be teaching in the College of Medicine prior to their appointments as physician leaders in both medical school and teaching hospital. Semi-structured face-to-face interviews shall be utilized as a means of data collection, with open-ended questions, enabling physician leaders to present narratives about their identity, role enactment, conflicts, reaction of colleagues, and the challenges encountered in their day-to-day work as physician leaders. Interviews shall be combined with observations and review of records to gain more insights into how the physician leaders are 'doing' management. Within-case analysis shall be done initially followed by a thematic analysis across the cases, referred to as cross–case analysis or cross-case synthesis.

Keywords: academic leaders, academic managers, physician leaders, physician managers

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Authors: Sara Alhabli, Eman Elashiry, Osama Felemban, Abdullah Almushayt, Faisal Dardeer, Ahmed Mohammad, Fajr Orri, Nada Bamashmous

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Background: In December of 2019, the coronavirus (SARS-CoV-2) first appeared and quickly spread to become a worldwide pandemic. This study aimed to evaluate the prevalence and types of pediatric dental emergencies during the COVID-19 lockdown in Jeddah, Saudi Arabia, at the University Dental Hospital (UDH) of King Abdulaziz University (KAU) and identified the management provided for these dental emergency visits. Materials and Methods: Data collection was done retrospectively from electronic dental records for children aged 0-18 that attended the UDH emergency clinic during the period from March 1st, 2020, to September 30th, 2020. An electronic form formulated specifically for this study was used to collect the required data from electronic patient records, including demographic data, emergency classification, management, and referrals. Results: A total of 3146 patients were seen at the emergency clinics during this period, of which 661 were children (21%). Types of emergency conditions included 0.8% emergency cases, 34% urgent, and 65.2% non-urgent conditions. Severe dental pain (73.1%) and abscesses (20%) were the most common urgent dental conditions. Most non-urgent conditions presented for initial or periodic visits, recalls, or routine radiographs (74%). Treatments rarely involved restorations, with 8% among urgent conditions and 5.4% among non-urgent conditions. Antibiotics were only prescribed to 6.9% of urgent conditions. Conclusions: The largest group of children presenting at the emergency dental clinics were found to be children with non-urgent conditions. Tele dentistry can be a solution to avoid large numbers of non-urgent patients presenting to emergency clinics. Additionally, dental care for non-urgent conditions during the pandemic should focus more on procedures with less aerosol generation.

Keywords: COVID-19 pandemic, dental emergencies, oral health, pediatric dentistry, children

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