Search results for: road injury
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 1997

Search results for: road injury

17 The Politics of Identity and Retributive Genocidal Massacre against Chena Amhara under International Humanitarian Law

Authors: Gashaw Sisay Zenebe

Abstract:

Northern-Ethiopian conflict that broke out on 04 November 2020 between the central government and TPLF caused destruction beyond imagination in all aspects; millions of people have been killed, including civilians, mainly women, and children. Civilians have been indiscriminately attacked simply because of their ethnic or religious identity. Warrying parties committed serious crimes of international concern opposite to International Humanitarian Law (IHL). A House of People Representatives (HPR) declared that the terrorist Tigrean Defense Force (TDF), encompassing all segments of its people, waged war against North Gondar through human flooding. On Aug 30, 2021, after midnight, TDF launched a surprise attack against Chena People who had been drunk and deep slept due to the annual festivity. Unlike the lowlands, however, ENDF conjoined the local people to fight TDF in these Highland areas. This research examines identity politics and the consequential genocidal massacre of Chena, including its human and physical destructions that occurred as a result of the armed conflict. As such, the study could benefit international entities by helping them develop a better understanding of what happened in Chena and trigger interest in engaging in ensuring the accountability and enforcement of IHL in the future. Preserving fresh evidence will also serve as a starting point on the road to achieving justice either nationally or internationally. To study the Chena case evaluated against IHL rules, a combination of qualitative and doctrinal research methodology has been employed. The study basically follows a unique sampling case study which has used primary data tools such as observation, interview, key-informant interview, FGD, and battle-field notes. To supplement, however, secondary sources, including books, journal articles, domestic laws, international conventions, reports, and media broadcasts, were used to give meaning to what happened on the ground in light of international law. The study proved that the war was taking place to separate Tigray from Ethiopia. While undertaking military operations to achieve this goal, mass killings, genocidal acts, and war crimes were committed over Chena and approximate sites in the Dabat district of North Gondar. Thus, hundreds of people lost their lives to the brutalities of mass killings, hundreds of people were subjected to a forcible disappearance, and tens of thousands of people were forced into displacement. Furthermore, harsh beatings, forced labor, slavery, torture, rape, and gang rape have been reported, and generally, people are subjected to pass cruel, inhuman, and degrading treatment and punishment. Also, what is so unique is that animals were indiscriminately killed completely, making the environment unsafe for human survival because of pollution and bad smells and the consequent diseases such as Cholera, Flu, and Diarrhea. In addition to TDF, ENDF’s shelling has caused destruction to farmers’ houses & claimed lives. According to humanitarian principles, acts that can establish MACs and war crimes were perpetrated. Generally, the war in this direction has shown an absolute disrespect for international law norms.

Keywords: genocide, war crimes, Tigray Defense Force, Chena, IHL

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16 Geovisualization of Human Mobility Patterns in Los Angeles Using Twitter Data

Authors: Linna Li

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The capability to move around places is doubtless very important for individuals to maintain good health and social functions. People’s activities in space and time have long been a research topic in behavioral and socio-economic studies, particularly focusing on the highly dynamic urban environment. By analyzing groups of people who share similar activity patterns, many socio-economic and socio-demographic problems and their relationships with individual behavior preferences can be revealed. Los Angeles, known for its large population, ethnic diversity, cultural mixing, and entertainment industry, faces great transportation challenges such as traffic congestion, parking difficulties, and long commuting. Understanding people’s travel behavior and movement patterns in this metropolis sheds light on potential solutions to complex problems regarding urban mobility. This project visualizes people’s trajectories in Greater Los Angeles (L.A.) Area over a period of two months using Twitter data. A Python script was used to collect georeferenced tweets within the Greater L.A. Area including Ventura, San Bernardino, Riverside, Los Angeles, and Orange counties. Information associated with tweets includes text, time, location, and user ID. Information associated with users includes name, the number of followers, etc. Both aggregated and individual activity patterns are demonstrated using various geovisualization techniques. Locations of individual Twitter users were aggregated to create a surface of activity hot spots at different time instants using kernel density estimation, which shows the dynamic flow of people’s movement throughout the metropolis in a twenty-four-hour cycle. In the 3D geovisualization interface, the z-axis indicates time that covers 24 hours, and the x-y plane shows the geographic space of the city. Any two points on the z axis can be selected for displaying activity density surface within a particular time period. In addition, daily trajectories of Twitter users were created using space-time paths that show the continuous movement of individuals throughout the day. When a personal trajectory is overlaid on top of ancillary layers including land use and road networks in 3D visualization, the vivid representation of a realistic view of the urban environment boosts situational awareness of the map reader. A comparison of the same individual’s paths on different days shows some regular patterns on weekdays for some Twitter users, but for some other users, their daily trajectories are more irregular and sporadic. This research makes contributions in two major areas: geovisualization of spatial footprints to understand travel behavior using the big data approach and dynamic representation of activity space in the Greater Los Angeles Area. Unlike traditional travel surveys, social media (e.g., Twitter) provides an inexpensive way of data collection on spatio-temporal footprints. The visualization techniques used in this project are also valuable for analyzing other spatio-temporal data in the exploratory stage, thus leading to informed decisions about generating and testing hypotheses for further investigation. The next step of this research is to separate users into different groups based on gender/ethnic origin and compare their daily trajectory patterns.

Keywords: geovisualization, human mobility pattern, Los Angeles, social media

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15 Unidentified Remains with Extensive Bone Disease without a Clear Diagnosis

Authors: Patricia Shirley Almeida Prado, Selma Paixão Argollo, Maria De Fátima Teixeira Guimarães, Leticia Matos Sobrinho

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Skeletal differential diagnosis is essential in forensic anthropology in order to differentiate skeletal trauma from normal osseous variation and pathological processes. Thus, part of forensic anthropological field is differentiate skeletal criminal injuries from the normal skeletal variation (bone fusion or nonunion, transitional vertebrae and other non-metric traits), non-traumatic skeletal pathology (myositis ossificans, arthritis, bone metastasis, osteomyelitis) from traumatic skeletal pathology (myositis ossificans traumatic) avoiding misdiagnosis. This case shows the importance of effective pathological diagnosis in order to accelerate the identification process of skeletonized human remains. THE CASE: An unidentified skeletal remains at the medico legal institute Nina Rodrigues-Salvador, of a male young adult (29 to 40 years estimated) showing a massive heterotopic ossification on its right tibia at upper epiphysis and adjacent articular femur surface; an extensive ossification on the right clavicle (at the sternal extremity) also presenting an heterotopic ossification at right scapulae (upper third of scapulae lateral margin and infraglenoid tubercule) and at the head of right humerus at the shoulder joint area. Curiously, this case also shows an unusual porosity in certain vertebrae´s body and in some tarsal and carpal bones. Likewise, his left fifth metacarpal bones (right and left) showed a healed fracture which led both bones distorted. Based on identification, of pathological conditions in human skeletal remains literature and protocols these alterations can be misdiagnosed and this skeleton may present more than one pathological process. The anthropological forensic lab at Medico-legal Institute Nina Rodrigues in Salvador (Brazil) adopts international protocols to ancestry, sex, age and stature estimations, also implemented well-established conventions to identify pathological disease and skeletal alterations. The most compatible diagnosis for this case is hematogenous osteomyelitis due to following findings: 1: the healed fracture pattern at the clavicle showing a cloaca which is a pathognomonic for osteomyelitis; 2: the metacarpals healed fracture does not present cloaca although they developed a periosteal formation. 3: the superior articular surface of the right tibia shows an extensive inflammatory healing process that extends to adjacent femur articular surface showing some cloaca at tibia bone disease. 4: the uncommon porosities may result from hematogenous infectious process. The fractures probably have occurred in a different moments based on the healing process; the tibia injury is more extensive and has not been reorganized, while metacarpals and clavicle fracture is properly healed. We suggest that the clavicle and tibia´s fractures were infected by an existing infectious disease (syphilis, tuberculosis, brucellosis) or an existing syndrome (Gorham’s disease), which led to the development of osteomyelitis. This hypothesis is supported by the fact that different bones are affected in diverse levels. Like the metacarpals that do not show the cloaca, but then a periosteal new bone formation; then the unusual porosities do not show a classical osteoarthritic processes findings as the marginal osteophyte, pitting and new bone formation, they just show an erosive process without bone formation or osteophyte. To confirm and prove our hypothesis we are working on different clinical approaches like DNA, histopathology and other image exams to find the correct diagnostic.

Keywords: bone disease, forensic anthropology, hematogenous osteomyelitis, human identification, human remains

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14 Correlation of Unsuited and Suited 5ᵗʰ Female Hybrid III Anthropometric Test Device Model under Multi-Axial Simulated Orion Abort and Landing Conditions

Authors: Christian J. Kennett, Mark A. Baldwin

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As several companies are working towards returning American astronauts back to space on US-made spacecraft, NASA developed a human flight certification-by-test and analysis approach due to the cost-prohibitive nature of extensive testing. This process relies heavily on the quality of analytical models to accurately predict crew injury potential specific to each spacecraft and under dynamic environments not tested. As the prime contractor on the Orion spacecraft, Lockheed Martin was tasked with quantifying the correlation of analytical anthropometric test devices (ATDs), also known as crash test dummies, against test measurements under representative impact conditions. Multiple dynamic impact sled tests were conducted to characterize Hybrid III 5th ATD lumbar, head, and neck responses with and without a modified shuttle-era advanced crew escape suit (ACES) under simulated Orion landing and abort conditions. Each ATD was restrained via a 5-point harness in a mockup Orion seat fixed to a dynamic impact sled at the Wright Patterson Air Force Base (WPAFB) Biodynamics Laboratory in the horizontal impact accelerator (HIA). ATDs were subject to multiple impact magnitudes, half-sine pulse rise times, and XZ - ‘eyeballs out/down’ or Z-axis ‘eyeballs down’ orientations for landing or an X-axis ‘eyeballs in’ orientation for abort. Several helmet constraint devices were evaluated during suited testing. Unique finite element models (FEMs) were developed of the unsuited and suited sled test configurations using an analytical 5th ATD model developed by LSTC (Livermore, CA) and deformable representations of the seat, suit, helmet constraint countermeasures, and body restraints. Explicit FE analyses were conducted using the non-linear solver LS-DYNA. Head linear and rotational acceleration, head rotational velocity, upper neck force and moment, and lumbar force time histories were compared between test and analysis using the enhanced error assessment of response time histories (EEARTH) composite score index. The EEARTH rating paired with the correlation and analysis (CORA) corridor rating provided a composite ISO score that was used to asses model correlation accuracy. NASA occupant protection subject matter experts established an ISO score of 0.5 or greater as the minimum expectation for correlating analytical and experimental ATD responses. Unsuited 5th ATD head X, Z, and resultant linear accelerations, head Y rotational accelerations and velocities, neck X and Z forces, and lumbar Z forces all showed consistent ISO scores above 0.5 in the XZ impact orientation, regardless of peak g-level or rise time. Upper neck Y moments were near or above the 0.5 score for most of the XZ cases. Similar trends were found in the XZ and Z-axis suited tests despite the addition of several different countermeasures for restraining the helmet. For the X-axis ‘eyeballs in’ loading direction, only resultant head linear acceleration and lumbar Z-axis force produced ISO scores above 0.5 whether unsuited or suited. The analytical LSTC 5th ATD model showed good correlation across multiple head, neck, and lumbar responses in both the unsuited and suited configurations when loaded in the XZ ‘eyeballs out/down’ direction. Upper neck moments were consistently the most difficult to predict, regardless of impact direction or test configuration.

Keywords: impact biomechanics, manned spaceflight, model correlation, multi-axial loading

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13 Feasibility and Acceptability of an Emergency Department Digital Pain Self-Management Intervention: An Randomized Controlled Trial Pilot Study

Authors: Alexandria Carey, Angela Starkweather, Ann Horgas, Hwayoung Cho, Jason Beneciuk

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Background/Significance: Over 3.4 million acute axial low back pain (aLBP) cases are treated annually in the United States (US) emergency departments (ED). ED patients with aLBP receive varying verbal and written discharge routine care (RC), leading to ineffective patient self-management. Ineffective self-management increase chronic low back pain (cLPB) transition risks, a chief cause of worldwide disability, with associated costs >$60 million annually. This research addresses this significant problem by evaluating an ED digital pain self-management intervention (EDPSI) focused on improving self-management through improved knowledge retainment, skills, and self-efficacy (confidence) (KSC) thus reducing aLBP to cLBP transition in ED patients discharged with aLBP. The research has significant potential to increase self-efficacy, one of the most potent mechanisms of behavior change and improve health outcomes. Focusing on accessibility and usability, the intervention may reduce discharge disparities in aLBP self-management, especially with low health literacy. Study Questions: This research will answer the following questions: 1) Will an EDPSI focused on improving KSC progress patient self-management behaviors and health status?; 2) Is the EDPSI sustainable to improve pain severity, interference, and pain recurrence?; 3) Will an EDPSI reduce aLBP to cLBP transition in patients discharged with aLBP? Aims: The pilot randomized-controlled trial (RCT) study’s objectives assess the effects of a 12-week digital self-management discharge tool in patients with aLBP. We aim to 1) Primarily assess the feasibility [recruitment, enrollment, and retention], and [intervention] acceptability, and sustainability of EDPSI on participant’s pain self-management; 2) Determine the effectiveness and sustainability of EDPSI on pain severity/interference among participants. 3) Explore patient preferences, health literacy, and changes among participants experiencing the transition to cLBP. We anticipate that EDPSI intervention will increase likelihood of achieving self-management milestones and significantly improve pain-related symptoms in aLBP. Methods: The study uses a two-group pilot RCT to enroll 30 individuals who have been seen in the ED with aLBP. Participants are randomized into RC (n=15) or RC + EDPSI (n=15) and receive follow-up surveys for 12-weeks post-intervention. EDPSI innovative content focuses on 1) highlighting discharge education; 2) provides self-management treatment options; 3) actor demonstration of ergonomics, range of motion movements, safety, and sleep; 4) complementary alternative medicine (CAM) options including acupuncture, yoga, and Pilates; 5) combination therapies including thermal application, spinal manipulation, and PT treatments. The intervention group receives Booster sessions via Zoom to assess and reinforce their knowledge retention of techniques and provide return demonstration reinforcing ergonomics, in weeks two and eight. Outcome Measures: All participants are followed for 12-weeks, assessing pain severity/ interference using the Brief Pain Inventory short-form (BPI-sf) survey, self-management (measuring KSC) using the short 13-item Patient Activation Measure (PAM), and self-efficacy using the Pain Self-Efficacy Questionnaire (PSEQ) weeks 1, 6, and 12. Feasibility is measured by recruitment, enrollment, and retention percentages. Acceptability and education satisfaction are measured using the Education-Preference and Satisfaction Questionnaire (EPSQ) post-intervention. Self-management sustainment is measured including PSEQ, PAM, and patient satisfaction and healthcare utilization (PSHU) requesting patient overall satisfaction, additional healthcare utilization, and pain management related to continued back pain or complications post-injury.

Keywords: digital, pain self-management, education, tool

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12 Policies for Circular Bioeconomy in Portugal: Barriers and Constraints

Authors: Ana Fonseca, Ana Gouveia, Edgar Ramalho, Rita Henriques, Filipa Figueiredo, João Nunes

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Due to persistent climate pressures, there is a need to find a resilient economic system that is regenerative in nature. Bioeconomy offers the possibility of replacing non-renewable and non-biodegradable materials derived from fossil fuels with ones that are renewable and biodegradable, while a Circular Economy aims at sustainable and resource-efficient operations. The term "Circular Bioeconomy", which can be summarized as all activities that transform biomass for its use in various product streams, expresses the interaction between these two ideas. Portugal has a very favourable context to promote a Circular Bioeconomy due to its variety of climates and ecosystems, availability of biologically based resources, location, and geomorphology. Recently, there have been political and legislative efforts to develop the Portuguese Circular Bioeconomy. The Action Plan for a Sustainable Bioeconomy, approved in 2021, is composed of five axes of intervention, ranging from sustainable production and the use of regionally based biological resources to the development of a circular and sustainable bioindustry through research and innovation. However, as some statistics show, Portugal is still far from achieving circularity. According to Eurostat, Portugal has circularity rates of 2.8%, which is the second lowest among the member states of the European Union. Some challenges contribute to this scenario, including sectorial heterogeneity and fragmentation, prevalence of small producers, lack of attractiveness for younger generations, and absence of implementation of collaborative solutions amongst producers and along value chains.Regarding the Portuguese industrial sector, there is a tendency towards complex bureaucratic processes, which leads to economic and financial obstacles and an unclear national strategy. Together with the limited number of incentives the country has to offer to those that pretend to abandon the linear economic model, many entrepreneurs are hesitant to invest the capital needed to make their companies more circular. Absence of disaggregated, georeferenced, and reliable information regarding the actual availability of biological resources is also a major issue. Low literacy on bioeconomy among many of the sectoral agents and in society in general directly impacts the decisions of production and final consumption. The WinBio project seeks to outline a strategic approach for the management of weaknesses/opportunities in the technology transfer process, given the reality of the territory, through road mapping and national and international benchmarking. The developed work included the identification and analysis of agents in the interior region of Portugal, natural endogenous resources, products, and processes associated with potential development. Specific flow of biological wastes, possible value chains, and the potential for replacing critical raw materials with bio-based products was accessed, taking into consideration other countries with a matured bioeconomy. The study found food industry, agriculture, forestry, and fisheries generate huge amounts of waste streams, which in turn provide an opportunity for the establishment of local bio-industries powered by this biomass. The project identified biological resources with potential for replication and applicability in the Portuguese context. The richness of natural resources and potentials known in the interior region of Portugal is a major key to developing the Circular Economy and sustainability of the country.

Keywords: circular bioeconomy, interior region of portugal, regional development., public policy

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11 Revolutionizing Oil Palm Replanting: Geospatial Terrace Design for High-precision Ground Implementation Compared to Conventional Methods

Authors: Nursuhaili Najwa Masrol, Nur Hafizah Mohammed, Nur Nadhirah Rusyda Rosnan, Vijaya Subramaniam, Sim Choon Cheak

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Replanting in oil palm cultivation is vital to enable the introduction of planting materials and provides an opportunity to improve the road, drainage, terrace design, and planting density. Oil palm replanting is fundamentally necessary every 25 years. The adoption of the digital replanting blueprint is imperative as it can assist the Malaysia Oil Palm industry in addressing challenges such as labour shortages and limited expertise related to replanting tasks. Effective replanting planning should commence at least 6 months prior to the actual replanting process. Therefore, this study will help to plan and design the replanting blueprint with high-precision translation on the ground. With the advancement of geospatial technology, it is now feasible to engage in thoroughly researched planning, which can help maximize the potential yield. A blueprint designed before replanting is to enhance management’s ability to optimize the planting program, address manpower issues, or even increase productivity. In terrace planting blueprints, geographic tools have been utilized to design the roads, drainages, terraces, and planting points based on the ARM standards. These designs are mapped with location information and undergo statistical analysis. The geospatial approach is essential in precision agriculture and ensuring an accurate translation of design to the ground by implementing high-accuracy technologies. In this study, geospatial and remote sensing technologies played a vital role. LiDAR data was employed to determine the Digital Elevation Model (DEM), enabling the precise selection of terraces, while ortho imagery was used for validation purposes. Throughout the designing process, Geographical Information System (GIS) tools were extensively utilized. To assess the design’s reliability on the ground compared with the current conventional method, high-precision GPS instruments like EOS Arrow Gold and HIPER VR GNSS were used, with both offering accuracy levels between 0.3 cm and 0.5cm. Nearest Distance Analysis was generated to compare the design with actual planting on the ground. The analysis revealed that it could not be applied to the roads due to discrepancies between actual roads and the blueprint design, which resulted in minimal variance. In contrast, the terraces closely adhered to the GPS markings, with the most variance distance being less than 0.5 meters compared to actual terraces constructed. Considering the required slope degrees for terrace planting, which must be greater than 6 degrees, the study found that approximately 65% of the terracing was constructed at a 12-degree slope, while over 50% of the terracing was constructed at slopes exceeding the minimum degrees. Utilizing blueprint replanting promising strategies for optimizing land utilization in agriculture. This approach harnesses technology and meticulous planning to yield advantages, including increased efficiency, enhanced sustainability, and cost reduction. From this study, practical implementation of this technique can lead to tangible and significant improvements in agricultural sectors. In boosting further efficiencies, future initiatives will require more sophisticated techniques and the incorporation of precision GPS devices for upcoming blueprint replanting projects besides strategic progression aims to guarantee the precision of both blueprint design stages and its subsequent implementation on the field. Looking ahead, automating digital blueprints are necessary to reduce time, workforce, and costs in commercial production.

Keywords: replanting, geospatial, precision agriculture, blueprint

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10 Circular Tool and Dynamic Approach to Grow the Entrepreneurship of Macroeconomic Metabolism

Authors: Maria Areias, Diogo Simões, Ana Figueiredo, Anishur Rahman, Filipa Figueiredo, João Nunes

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It is expected that close to 7 billion people will live in urban areas by 2050. In order to improve the sustainability of the territories and its transition towards circular economy, it’s necessary to understand its metabolism and promote and guide the entrepreneurship answer. The study of a macroeconomic metabolism involves the quantification of the inputs, outputs and storage of energy, water, materials and wastes for an urban region. This quantification and analysis representing one opportunity for the promotion of green entrepreneurship. There are several methods to assess the environmental impacts of an urban territory, such as human and environmental risk assessment (HERA), life cycle assessment (LCA), ecological footprint assessment (EF), material flow analysis (MFA), physical input-output table (PIOT), ecological network analysis (ENA), multicriteria decision analysis (MCDA) among others. However, no consensus exists about which of those assessment methods are best to analyze the sustainability of these complex systems. Taking into account the weaknesses and needs identified, the CiiM - Circular Innovation Inter-Municipality project aims to define an uniform and globally accepted methodology through the integration of various methodologies and dynamic approaches to increase the efficiency of macroeconomic metabolisms and promoting entrepreneurship in a circular economy. The pilot territory considered in CiiM project has a total area of 969,428 ha, comprising a total of 897,256 inhabitants (about 41% of the population of the Center Region). The main economic activities in the pilot territory, which contribute to a gross domestic product of 14.4 billion euros, are: social support activities for the elderly; construction of buildings; road transport of goods, retailing in supermarkets and hypermarkets; mass production of other garments; inpatient health facilities; and the manufacture of other components and accessories for motor vehicles. The region's business network is mostly constituted of micro and small companies (similar to the Central Region of Portugal), with a total of 53,708 companies identified in the CIM Region of Coimbra (39 large companies), 28,146 in the CIM Viseu Dão Lafões (22 large companies) and 24,953 in CIM Beiras and Serra da Estrela (13 large companies). For the construction of the database was taking into account data available at the National Institute of Statistics (INE), General Directorate of Energy and Geology (DGEG), Eurostat, Pordata, Strategy and Planning Office (GEP), Portuguese Environment Agency (APA), Commission for Coordination and Regional Development (CCDR) and Inter-municipal Community (CIM), as well as dedicated databases. In addition to the collection of statistical data, it was necessary to identify and characterize the different stakeholder groups in the pilot territory that are relevant to the different metabolism components under analysis. The CIIM project also adds the potential of a Geographic Information System (GIS) so that it is be possible to obtain geospatial results of the territorial metabolisms (rural and urban) of the pilot region. This platform will be a powerful visualization tool of flows of products/services that occur within the region and will support the stakeholders, improving their circular performance and identifying new business ideas and symbiotic partnerships.

Keywords: circular economy tools, life cycle assessment macroeconomic metabolism, multicriteria decision analysis, decision support tools, circular entrepreneurship, industrial and regional symbiosis

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9 Contactless Heart Rate Measurement System based on FMCW Radar and LSTM for Automotive Applications

Authors: Asma Omri, Iheb Sifaoui, Sofiane Sayahi, Hichem Besbes

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Future vehicle systems demand advanced capabilities, notably in-cabin life detection and driver monitoring systems, with a particular emphasis on drowsiness detection. To meet these requirements, several techniques employ artificial intelligence methods based on real-time vital sign measurements. In parallel, Frequency-Modulated Continuous-Wave (FMCW) radar technology has garnered considerable attention in the domains of healthcare and biomedical engineering for non-invasive vital sign monitoring. FMCW radar offers a multitude of advantages, including its non-intrusive nature, continuous monitoring capacity, and its ability to penetrate through clothing. In this paper, we propose a system utilizing the AWR6843AOP radar from Texas Instruments (TI) to extract precise vital sign information. The radar allows us to estimate Ballistocardiogram (BCG) signals, which capture the mechanical movements of the body, particularly the ballistic forces generated by heartbeats and respiration. These signals are rich sources of information about the cardiac cycle, rendering them suitable for heart rate estimation. The process begins with real-time subject positioning, followed by clutter removal, computation of Doppler phase differences, and the use of various filtering methods to accurately capture subtle physiological movements. To address the challenges associated with FMCW radar-based vital sign monitoring, including motion artifacts due to subjects' movement or radar micro-vibrations, Long Short-Term Memory (LSTM) networks are implemented. LSTM's adaptability to different heart rate patterns and ability to handle real-time data make it suitable for continuous monitoring applications. Several crucial steps were taken, including feature extraction (involving amplitude, time intervals, and signal morphology), sequence modeling, heart rate estimation through the analysis of detected cardiac cycles and their temporal relationships, and performance evaluation using metrics such as Root Mean Square Error (RMSE) and correlation with reference heart rate measurements. For dataset construction and LSTM training, a comprehensive data collection system was established, integrating the AWR6843AOP radar, a Heart Rate Belt, and a smart watch for ground truth measurements. Rigorous synchronization of these devices ensured data accuracy. Twenty participants engaged in various scenarios, encompassing indoor and real-world conditions within a moving vehicle equipped with the radar system. Static and dynamic subject’s conditions were considered. The heart rate estimation through LSTM outperforms traditional signal processing techniques that rely on filtering, Fast Fourier Transform (FFT), and thresholding. It delivers an average accuracy of approximately 91% with an RMSE of 1.01 beat per minute (bpm). In conclusion, this paper underscores the promising potential of FMCW radar technology integrated with artificial intelligence algorithms in the context of automotive applications. This innovation not only enhances road safety but also paves the way for its integration into the automotive ecosystem to improve driver well-being and overall vehicular safety.

Keywords: ballistocardiogram, FMCW Radar, vital sign monitoring, LSTM

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8 A Risk-Based Comprehensive Framework for the Assessment of the Security of Multi-Modal Transport Systems

Authors: Mireille Elhajj, Washington Ochieng, Deeph Chana

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The challenges of the rapid growth in the demand for transport has traditionally been seen within the context of the problems of congestion, air quality, climate change, safety, and affordability. However, there are increasing threats including those related to crime such as cyber-attacks that threaten the security of the transport of people and goods. To the best of the authors’ knowledge, this paper presents for the first time, a comprehensive framework for the assessment of the current and future security issues of multi-modal transport systems. The approach or method proposed is based on a structured framework starting with a detailed specification of the transport asset map (transport system architecture), followed by the identification of vulnerabilities. The asset map and vulnerabilities are used to identify the various approaches for exploitation of the vulnerabilities, leading to the creation of a set of threat scenarios. The threat scenarios are then transformed into risks and their categories, and include insights for their mitigation. The consideration of the mitigation space is holistic and includes the formulation of appropriate policies and tactics and/or technical interventions. The quality of the framework is ensured through a structured and logical process that identifies the stakeholders, reviews the relevant documents including policies and identifies gaps, incorporates targeted surveys to augment the reviews, and uses subject matter experts for validation. The approach to categorising security risks is an extension of the current methods that are typically employed. Specifically, the partitioning of risks into either physical or cyber categories is too limited for developing mitigation policies and tactics/interventions for transport systems where an interplay between physical and cyber processes is very often the norm. This interplay is rapidly taking on increasing significance for security as the emergence of cyber-physical technologies, are shaping the future of all transport modes. Examples include: Connected Autonomous Vehicles (CAVs) in road transport; the European Rail Traffic Management System (ERTMS) in rail transport; Automatic Identification System (AIS) in maritime transport; advanced Communications, Navigation and Surveillance (CNS) technologies in air transport; and the Internet of Things (IoT). The framework adopts a risk categorisation scheme that considers risks as falling within the following threat→impact relationships: Physical→Physical, Cyber→Cyber, Cyber→Physical, and Physical→Cyber). Thus the framework enables a more complete risk picture to be developed for today’s transport systems and, more importantly, is readily extendable to account for emerging trends in the sector that will define future transport systems. The framework facilitates the audit and retro-fitting of mitigations in current transport operations and the analysis of security management options for the next generation of Transport enabling strategic aspirations such as systems with security-by-design and co-design of safety and security to be achieved. An initial application of the framework to transport systems has shown that intra-modal consideration of security measures is sub-optimal and that a holistic and multi-modal approach that also addresses the intersections/transition points of such networks is required as their vulnerability is high. This is in-line with traveler-centric transport service provision, widely accepted as the future of mobility services. In summary, a risk-based framework is proposed for use by the stakeholders to comprehensively and holistically assess the security of transport systems. It requires a detailed understanding of the transport architecture to enable a detailed vulnerabilities analysis to be undertaken, creates threat scenarios and transforms them into risks which form the basis for the formulation of interventions.

Keywords: mitigations, risk, transport, security, vulnerabilities

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7 Consumer Preferences for Low-Carbon Futures: A Structural Equation Model Based on the Domestic Hydrogen Acceptance Framework

Authors: Joel A. Gordon, Nazmiye Balta-Ozkan, Seyed Ali Nabavi

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Hydrogen-fueled technologies are rapidly advancing as a critical component of the low-carbon energy transition. In countries historically reliant on natural gas for home heating, such as the UK, hydrogen may prove fundamental for decarbonizing the residential sector, alongside other technologies such as heat pumps and district heat networks. While the UK government is set to take a long-term policy decision on the role of domestic hydrogen by 2026, there are considerable uncertainties regarding consumer preferences for ‘hydrogen homes’ (i.e., hydrogen-fueled appliances for space heating, hot water, and cooking. In comparison to other hydrogen energy technologies, such as road transport applications, to date, few studies have engaged with the social acceptance aspects of the domestic hydrogen transition, resulting in a stark knowledge deficit and pronounced risk to policymaking efforts. In response, this study aims to safeguard against undesirable policy measures by revealing the underlying relationships between the factors of domestic hydrogen acceptance and their respective dimensions: attitudinal, socio-political, community, market, and behavioral acceptance. The study employs an online survey (n=~2100) to gauge how different UK householders perceive the proposition of switching from natural gas to hydrogen-fueled appliances. In addition to accounting for housing characteristics (i.e., housing tenure, property type and number of occupants per dwelling) and several other socio-structural variables (e.g. age, gender, and location), the study explores the impacts of consumer heterogeneity on hydrogen acceptance by recruiting respondents from across five distinct groups: (1) fuel poor householders, (2) technology engaged householders, (3) environmentally engaged householders, (4) technology and environmentally engaged householders, and (5) a baseline group (n=~700) which filters out each of the smaller targeted groups (n=~350). This research design reflects the notion that supporting a socially fair and efficient transition to hydrogen will require parallel engagement with potential early adopters and demographic groups impacted by fuel poverty while also accounting strongly for public attitudes towards net zero. Employing a second-order multigroup confirmatory factor analysis (CFA) in Mplus, the proposed hydrogen acceptance model is tested to fit the data through a partial least squares (PLS) approach. In addition to testing differences between and within groups, the findings provide policymakers with critical insights regarding the significance of knowledge and awareness, safety perceptions, perceived community impacts, cost factors, and trust in key actors and stakeholders as potential explanatory factors of hydrogen acceptance. Preliminary results suggest that knowledge and awareness of hydrogen are positively associated with support for domestic hydrogen at the household, community, and national levels. However, with the exception of technology and/or environmentally engaged citizens, much of the population remains unfamiliar with hydrogen and somewhat skeptical of its application in homes. Knowledge and awareness present as critical to facilitating positive safety perceptions, alongside higher levels of trust and more favorable expectations for community benefits, appliance performance, and potential cost savings. Based on these preliminary findings, policymakers should be put on red alert about diffusing hydrogen into the public consciousness in alignment with energy security, fuel poverty, and net-zero agendas.

Keywords: hydrogen homes, social acceptance, consumer heterogeneity, heat decarbonization

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6 Analysis of Composite Health Risk Indicators Built at a Regional Scale and Fine Resolution to Detect Hotspot Areas

Authors: Julien Caudeville, Muriel Ismert

Abstract:

Analyzing the relationship between environment and health has become a major preoccupation for public health as evidenced by the emergence of the French national plans for health and environment. These plans have identified the following two priorities: (1) to identify and manage geographic areas, where hotspot exposures are suspected to generate a potential hazard to human health; (2) to reduce exposure inequalities. At a regional scale and fine resolution of exposure outcome prerequisite, environmental monitoring networks are not sufficient to characterize the multidimensionality of the exposure concept. In an attempt to increase representativeness of spatial exposure assessment approaches, risk composite indicators could be built using additional available databases and theoretical framework approaches to combine factor risks. To achieve those objectives, combining data process and transfer modeling with a spatial approach is a fundamental prerequisite that implies the need to first overcome different scientific limitations: to define interest variables and indicators that could be built to associate and describe the global source-effect chain; to link and process data from different sources and different spatial supports; to develop adapted methods in order to improve spatial data representativeness and resolution. A GIS-based modeling platform for quantifying human exposure to chemical substances (PLAINE: environmental inequalities analysis platform) was used to build health risk indicators within the Lorraine region (France). Those indicators combined chemical substances (in soil, air and water) and noise risk factors. Tools have been developed using modeling, spatial analysis and geostatistic methods to build and discretize interest variables from different supports and resolutions on a 1 km2 regular grid within the Lorraine region. By example, surface soil concentrations have been estimated by developing a Kriging method able to integrate surface and point spatial supports. Then, an exposure model developed by INERIS was used to assess the transfer from soil to individual exposure through ingestion pathways. We used distance from polluted soil site to build a proxy for contaminated site. Air indicator combined modeled concentrations and estimated emissions to take in account 30 polluants in the analysis. For water, drinking water concentrations were compared to drinking water standards to build a score spatialized using a distribution unit serve map. The Lden (day-evening-night) indicator was used to map noise around road infrastructures. Aggregation of the different factor risks was made using different methodologies to discuss weighting and aggregation procedures impact on the effectiveness of risk maps to take decisions for safeguarding citizen health. Results permit to identify pollutant sources, determinants of exposure, and potential hotspots areas. A diagnostic tool was developed for stakeholders to visualize and analyze the composite indicators in an operational and accurate manner. The designed support system will be used in many applications and contexts: (1) mapping environmental disparities throughout the Lorraine region; (2) identifying vulnerable population and determinants of exposure to set priorities and target for pollution prevention, regulation and remediation; (3) providing exposure database to quantify relationships between environmental indicators and cancer mortality data provided by French Regional Health Observatories.

Keywords: health risk, environment, composite indicator, hotspot areas

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5 Experimental Study on Granulated Steel Slag as an Alternative to River Sand

Authors: K. Raghu, M. N. Vathhsala, Naveen Aradya, Sharth

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River sand is the most preferred fine aggregate for mortar and concrete. River sand is a product of natural weathering of rocks over a period of millions of years and is mined from river beds. Sand mining has disastrous environmental consequences. The excessive mining of river bed is creating an ecological imbalance. This has lead to have restrictions imposed by ministry of environment on sand mining. Driven by the acute need for sand, stone dust or manufactured sand prepared from the crushing and screening of coarse aggregate is being used as sand in the recent past. However manufactured sand is also a natural material and has quarrying and quality issues. To reduce the burden on the environment, alternative materials to be used as fine aggregates are being extensively investigated all over the world. Looking to the quantum of requirements, quality and properties there has been a global consensus on a material – Granulated slags. Granulated slag has been proven as a suitable material for replacing natural sand / crushed fine aggregates. In developed countries, the use of granulated slag as fine aggregate to replace natural sand is well established and is in regular practice. In the present paper Granulated slag has been experimented for usage in mortar. Slags are the main by-products generated during iron and steel production in the steel industry. Over the past decades, the steel production has increased and, consequently, the higher volumes of by-products and residues generated which have driven to the reuse of these materials in an increasingly efficient way. In recent years new technologies have been developed to improve the recovery rates of slags. Increase of slags recovery and use in different fields of applications like cement making, construction and fertilizers help in preserving natural resources. In addition to the environment protection, these practices produced economic benefits, by providing sustainable solutions that can allow the steel industry to achieve its ambitious targets of “zero waste” in coming years. Slags are generated at two different stages of steel production, iron making and steel making known as BF(Blast Furnace) slag and steel slag respectively. The slagging agent or fluxes, such as lime stone, dolomite and quartzite added into BF or steel making furnaces in order to remove impurities from ore, scrap and other ferrous charges during smelting. The slag formation is the result of a complex series of physical and chemical reactions between the non-metallic charge(lime stone, dolomite, fluxes), the energy sources(coal, coke, oxygen, etc.) and refractory materials. Because of the high temperatures (about 15000 C) during their generation, slags do not contain any organic substances. Due to the fact that slags are lighter than the liquid metal, they float and get easily removed. The slags protect the metal bath from atmosphere and maintain temperature through a kind of liquid formation. These slags are in liquid state and solidified in air after dumping in the pit or granulated by impinging water systems. Generally, BF slags are granulated and used in cement making due to its high cementious properties, and steel slags are mostly dumped due to unfavourable physio-chemical conditions. The increasing dump of steel slag not only occupies a plenty of land but also wastes resources and can potentially have an impact on the environment due to water pollution. Since BF slag contains little Fe and can be used directly. BF slag has found a wide application, such as cement production, road construction, Civil Engineering work, fertilizer production, landfill daily cover, soil reclamation, prior to its application outside the iron and steel making process.

Keywords: steel slag, river sand, granulated slag, environmental

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4 Northern Nigeria Vaccine Direct Delivery System

Authors: Evelyn Castle, Adam Thompson

Abstract:

Background: In 2013, the Kano State Primary Health Care Management Board redesigned its Routine immunization supply chain from diffused pull to direct delivery push. It addressed issues around stockouts and reduced time spent by health facility staff collecting, and reporting on vaccine usage. The health care board sought the help of a 3PL for twice-monthly deliveries from its cold store to 484 facilities across 44 local governments. eHA’s Health Delivery Systems group formed a 3PL to serve 326 of these new facilities in partnership with the State. We focused on designing and implementing a technology system throughout. Basic methodologies: GIS Mapping: - Planning the delivery of vaccines to hundreds of health facilities requires detailed route planning for delivery vehicles. Mapping the road networks across Kano and Bauchi with a custom routing tool provided information for the optimization of deliveries. Reducing the number of kilometers driven each round by 20%, - reducing cost and delivery time. Direct Delivery Information System: - Vaccine Direct Deliveries are facilitated through pre-round planning (driven by health facility database, extensive GIS, and inventory workflow rules), manager and driver control panel customizing delivery routines and reporting, progress dashboard, schedules/routes, packing lists, delivery reports, and driver data collection applications. Move: Last Mile Logistics Management System: - MOVE has improved vaccine supply information management to be timely, accurate and actionable. Provides stock management workflow support, alerts management for cold chain exceptions/stock outs, and on-device analytics for health and supply chain staff. Software was built to be offline-first with user-validated interface and experience. Deployed to hundreds of vaccine storage site the improved information tools helps facilitate the process of system redesign and change management. Findings: - Stock-outs reduced from 90% to 33% - Redesigned current health systems and managing vaccine supply for 68% of Kano’s wards. - Near real time reporting and data availability to track stock. - Paperwork burdens of health staff have been dramatically reduced. - Medicine available when the community needs it. - Consistent vaccination dates for children under one to prevent polio, yellow fever, tetanus. - Higher immunization rates = Lower infection rates. - Hundreds of millions of Naira worth of vaccines successfully transported. - Fortnightly service to 326 facilities in 326 wards across 30 Local Government areas. - 6,031 cumulative deliveries. - Over 3.44 million doses transported. - Minimum travel distance covered in a round of delivery is 2000 kms & maximum of 6297 kms. - 153,409 kms travelled by 6 drivers. - 500 facilities in 326 wards. - Data captured and synchronized for the first time. - Data driven decision making now possible. Conclusion: eHA’s Vaccine Direct delivery has met challenges in Kano and Bauchi State and provided a reliable delivery service of vaccinations that ensure t health facilities can run vaccination clinics for children under one. eHA uses innovative technology that delivers vaccines from Northern Nigerian zonal stores straight to healthcare facilities. Helped healthcare workers spend less time managing supplies and more time delivering care, and will be rolled out nationally across Nigeria.

Keywords: direct delivery information system, health delivery system, GIS mapping, Northern Nigeria, vaccines

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3 Cycleloop Personal Rapid Transit: An Exploratory Study for Last Mile Connectivity in Urban Transport

Authors: Suresh Salla

Abstract:

In this paper, author explores for most sustainable last mile transport mode addressing present problems of traffic congestion, jams, pollution and travel stress. Development of energy-efficient sustainable integrated transport system(s) is/are must to make our cities more livable. Emphasis on autonomous, connected, electric, sharing system for effective utilization of systems (vehicles and public infrastructure) is on the rise. Many surface mobility innovations like PBS, Ride hailing, ride sharing, etc. are, although workable but if we analyze holistically, add to the already congested roads, difficult to ride in hostile weather, causes pollution and poses commuter stress. Sustainability of transportation is evaluated with respect to public adoption, average speed, energy consumption, and pollution. Why public prefer certain mode over others? How commute time plays a role in mode selection or shift? What are the factors play-ing role in energy consumption and pollution? Based on the study, it is clear that public prefer a transport mode which is exhaustive (i.e., less need for interchange – network is widespread) and intensive (i.e., less waiting time - vehicles are available at frequent intervals) and convenient with latest technologies. Average speed is dependent on stops, number of intersections, signals, clear route availability, etc. It is clear from Physics that higher the kerb weight of a vehicle; higher is the operational energy consumption. Higher kerb weight also demands heavier infrastructure. Pollution is dependent on source of energy, efficiency of vehicle, average speed. Mode can be made exhaustive when the unit infrastructure cost is less and can be offered intensively when the vehicle cost is less. Reliable and seamless integrated mobility till last ¼ mile (Five Minute Walk-FMW) is a must to encourage sustainable public transportation. Study shows that average speed and reliability of dedicated modes (like Metro, PRT, BRT, etc.) is high compared to road vehicles. Electric vehicles and more so battery-less or 3rd rail vehicles reduce pollution. One potential mode can be Cycleloop PRT, where commuter rides e-cycle in a dedicated path – elevated, at grade or underground. e-Bike with kerb weight per rider at 15 kg being 1/50th of car or 1/10th of other PRT systems makes it sustainable mode. Cycleloop tube will be light, sleek and scalable and can be modular erected, either on modified street lamp-posts or can be hanged/suspended between the two stations. Embarking and dis-embarking points or offline stations can be at an interval which suits FMW to mass public transit. In terms of convenience, guided e-Bike can be made self-balancing thus encouraging driverless on-demand vehicles. e-Bike equipped with smart electronics and drive controls can intelligently respond to field sensors and autonomously move reacting to Central Controller. Smart switching allows travel from origin to destination without interchange of cycles. DC Powered Batteryless e-cycle with voluntary manual pedaling makes it sustainable and provides health benefits. Tandem e-bike, smart switching and Platoon operations algorithm options provide superior through-put of the Cycleloop. Thus Cycleloop PRT will be exhaustive, intensive, convenient, reliable, speedy, sustainable, safe, pollution-free and healthy alternative mode for last mile connectivity in cities.

Keywords: cycleloop PRT, five-minute walk, lean modular infrastructure, self-balanced intelligent e-cycle

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2 Acute Severe Hyponatremia in Patient with Psychogenic Polydipsia, Learning Disability and Epilepsy

Authors: Anisa Suraya Ab Razak, Izza Hayat

Abstract:

Introduction: The diagnosis and management of severe hyponatremia in neuropsychiatric patients present a significant challenge to physicians. Several factors contribute, including diagnostic shadowing and attributing abnormal behavior to intellectual disability or psychiatric conditions. Hyponatraemia is the commonest electrolyte abnormality in the inpatient population, ranging from mild/asymptomatic, moderate to severe levels with life-threatening symptoms such as seizures, coma and death. There are several documented fatal case reports in the literature of severe hyponatremia secondary to psychogenic polydipsia, often diagnosed only in autopsy. This paper presents a case study of acute severe hyponatremia in a neuropsychiatric patient with early diagnosis and admission to intensive care. Case study: A 21-year old Caucasian male with known epilepsy and learning disability was admitted from residential living with generalized tonic-clonic self-terminating seizures after refusing medications for several weeks. Evidence of superficial head injury was detected on physical examination. His laboratory data demonstrated mild hyponatremia (125 mmol/L). Computed tomography imaging of his brain demonstrated no acute bleed or space-occupying lesion. He exhibited abnormal behavior - restlessness, drinking water from bathroom taps, inability to engage, paranoia, and hypersexuality. No collateral history was available to establish his baseline behavior. He was loaded with intravenous sodium valproate and leveritircaetam. Three hours later, he developed vomiting and a generalized tonic-clonic seizure lasting forty seconds. He remained drowsy for several hours and regained minimal recovery of consciousness. A repeat set of blood tests demonstrated profound hyponatremia (117 mmol/L). Outcomes: He was referred to intensive care for peripheral intravenous infusion of 2.7% sodium chloride solution with two-hourly laboratory monitoring of sodium concentration. Laboratory monitoring identified dangerously rapid correction of serum sodium concentration, and hypertonic saline was switched to a 5% dextrose solution to reduce the risk of acute large-volume fluid shifts from the cerebral intracellular compartment to the extracellular compartment. He underwent urethral catheterization and produced 8 liters of urine over 24 hours. Serum sodium concentration remained stable after 24 hours of correction fluids. His GCS recovered to baseline after 48 hours with improvement in behavior -he engaged with healthcare professionals, understood the importance of taking medications, admitted to illicit drug use and drinking massive amounts of water. He was transferred from high-dependency care to ward level and was initiated on multiple trials of anti-epileptics before achieving seizure-free days two weeks after resolution of acute hyponatremia. Conclusion: Psychogenic polydipsia is often found in young patients with intellectual disability or psychiatric disorders. Patients drink large volumes of water daily ranging from ten to forty liters, resulting in acute severe hyponatremia with mortality rates as high as 20%. Poor outcomes are due to challenges faced by physicians in making an early diagnosis and treating acute hyponatremia safely. A low index of suspicion of water intoxication is required in this population, including patients with known epilepsy. Monitoring urine output proved to be clinically effective in aiding diagnosis. Early referral and admission to intensive care should be considered for safe correction of sodium concentration while minimizing risk of fatal complications e.g. central pontine myelinolysis.

Keywords: epilepsy, psychogenic polydipsia, seizure, severe hyponatremia

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1 Supply Side Readiness for Universal Health Coverage: Assessing the Availability and Depth of Essential Health Package in Rural, Remote and Conflict Prone District

Authors: Veenapani Rajeev Verma

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Context: Assessing facility readiness is paramount as it can indicate capacity of facilities to provide essential care for resilience to health challenges. In the context of decentralization, estimation of supply side readiness indices at sub national level is imperative for effective evidence based policy but remains a colossal challenge due to lack of dependable and representative data sources. Setting: District Poonch of Jammu and Kashmir was selected for this study. It is remote, rural district with unprecedented topographical barriers and is identified as high priority by government. It is also a fragile area as is bounded by Line of Control with Pakistan bearing the brunt of cease fire violations, military skirmishes and sporadic militant attacks. Hilly geographical terrain, rudimentary/absence of road network and impoverishment are quintessential to this area. Objectives: Objective of the study is to a) Evaluate the service readiness of health facilities and create a concise index subsuming plethora of discrete indicators and b) Ascertain supply side barriers in service provisioning via stakeholder’s analysis. Study also strives to expand analytical domain unravelling context and area specific intricacies associated with service delivery. Methodology: Mixed method approach was employed to triangulate quantitative analysis with qualitative nuances. Facility survey encompassing 90 Subcentres, 44 Primary health centres, 3 Community health centres and 1 District hospital was conducted to gauge general service availability and service specific availability (depth of coverage). Compendium of checklist was designed using Indian Public Health Standards (IPHS) in form of standard core questionnaire and scorecard generated for each facility. Information was collected across dimensions of amenities, equipment, medicines, laboratory and infection control protocols as proposed in WHO’s Service Availability and Readiness Assesment (SARA). Two stage polychoric principal component analysis employed to generate a parsimonious index by coalescing an array of tracer indicators. OLS regression method used to determine factors explaining composite index generated from PCA. Stakeholder analysis was conducted to discern qualitative information. Myriad of techniques like observations, key informant interviews and focus group discussions using semi structured questionnaires on both leaders and laggards were administered for critical stakeholder’s analysis. Results: General readiness score of health facilities was found to be 0.48. Results indicated poorest readiness for subcentres and PHC’s (first point of contact) with composite score of 0.47 and 0.41 respectively. For primary care facilities; principal component was characterized by basic newborn care as well as preparedness for delivery. Results revealed availability of equipment and surgical preparedness having lowest score (0.46 and 0.47) for facilities providing secondary care. Presence of contractual staff, more than 1 hr walk to facility, facilities in zone A (most vulnerable) to cross border shelling and facilities inaccessible due to snowfall and thick jungles was negatively associated with readiness index. Nonchalant staff attitude, unavailability of staff quarters, leakages and constraint in supply chain of drugs and consumables were other impediments identified. Conclusions/Policy Implications: It is pertinent to first strengthen primary care facilities in this setting. Complex dimensions such as geographic barriers, user and provider behavior is not under precinct of this methodology.

Keywords: effective coverage, principal component analysis, readiness index, universal health coverage

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