Search results for: Jonathan Heng

Authors: Vinodhini Elangovan, Jen Heng Pek

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Background: An ectopic pregnancy is defined as any pregnancy implanted outside of the endometrial cavity. Cornual pregnancy, a rare variety of ectopic pregnancies, is seen in about 2-4% of ectopic pregnancies. It develops in the interstitial portion of the fallopian tube and invades through the uterine wall. This case describes a third-trimester cornual pregnancy that resulted in a uterine rupture. Case: A 38-year old Chinese lady was brought to the Emergency Department (ED) as a standby case for hypotension. She was 30+6 weeks pregnant (Gravida 3, Parous 1). Her past obstetric history included a live birth delivered via lower segment Caesarean section due to non-reassuring fetal status in 2002 and a miscarriage in 2012. She developed generalized abdominal pain. There was no per vaginal bleeding or leaking liquor. There was also no fever, nausea, vomiting, constipation, diarrhea, or urinary symptoms. On arrival in the ED, she was pale, diaphoretic, and lethargic. She had generalized tenderness with guarding and rebound over her abdomen. Point of care ultrasound was performed and showed a large amount of intra-abdominal free fluid, and the fetal heart rate was 170 beats per minute. The point of care hemoglobin was 7.1 g/dL, and lactate was 6.8 mmol/L. The patient’s blood pressure dropped precipitously to 50/36 mmHg, and her heart rate went up to 141 beats per minute. The clinical impression was profound shock secondary to uterine rupture. Intra-operatively, there was extensive haemoperitoneum, and the fetus was seen in the abdominal cavity. The fetus was delivered immediately and handed to the neonatal team. On exploration of the uterus, the point of rupture was at the left cornual region where the placenta was attached to. Discussion: Cornual pregnancies are difficult to diagnose pre-operatively with low ultrasonographic sensitivity and hence are commonly confused with normal intrauterine pregnancies. They pose a higher risk of rupture and hemorrhage compared to other types of ectopic pregnancies. In very rare circumstances, interstitial pregnancies can result in a viable fetus. Uterine rupture resulting in hemorrhagic shock is a true obstetric emergency that can result in significant morbidity and mortality for the patient and the fetus, and early diagnosis in the emergency department is crucial. The patient in this case presented with known risk factors of multiparity, advanced maternal age, and previous lower segment cesarean section, which increased the suspicion of uterine rupture. Ultrasound assessment may be beneficial to any patient who presents with symptoms and a history of uterine surgery to assess the possibility of uterine dehiscence or rupture. Management of a patient suspected of uterine rupture should be systematic in the emergency department and follow an ABC approach. Conclusion: This case demonstrates the importance for an emergency physician to maintain the suspicion for ectopic pregnancy even at advanced gestational ages. It also highlights how even though all emergency physicians may not be qualified to do a detailed pelvic ultrasound, it is essential for them to be competent with a point of care ultrasound to make a prompt diagnosis of conditions such as uterine rupture.

Keywords: cornual ectopic , ectopic pregnancy, emergency medicine, obstetric emergencies

Procedia PDF Downloads 129

Authors: Josh Felton

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There’s a common misconception that sports is an escape from the reality of life, and that it is what disconnects us from the agendas of tomorrow. While this may be true for a select few, there’s more to sports than just competition and banter. The bearing and impact society has on the sports we know and love has always existed and is greater than ever. However, to many in the national media, it is almost seen as a taboo subject. Whether one realizes it or not, sports and society intersect at every turn and it’s not a coincidence. In collaboration with the Woodrow Wilson Fellowship at Johns Hopkins University, a video and podcast series titled Intersection of sports and society (ISS), dedicated to studying some of the most polarizing and some of the least recognized issues in the world of sports that have a powerful social bearing on every demographic will debut in the Summer of 2023. Issues like race, gender, and sexuality, as well as how they have been challenged and addressed historically in the sports realm will be discussed to a great extent in the series. With the collaboration of many authors, researchers, and former athletes, the podcast will be a platform for them to not only share their discoveries but to have an extensive dialogue on the impact their work and current events have had on the issues. Set to be released in the summer of 2023, the series will have a list of great researchers and authors, headlined by New York Times writer and best-selling author Jonathan Abrams, who in 2017, published a book titled Boys Among Men: How the Prep-to-Pro Generation Redefined the NBA and Sparked a Basketball Revolution. His expertise on the matters of the high school and collegiate sports will be reflected in a very important conversation on the evolution of the high school-to-professional route, the historic exploitation of black student athletes by the NCAA, and how the new rules allowing for greater freedom of choice for young athletes has benefitted minority athletes coming from impoverished backgrounds. This episode is just a preview of a list of important topics that to the author’s best knowledge aren't typically discussed by the national media. Many more topics include women’s sports representation, the struggle for achieving fair minority representation in NFL coaching and front office positions, the story of race and baseball within the Boston Red Sox organization, and what the rise of the black quarterback means for America. Many people fail to realize how the sports we all know and love have any social bearing on them and the athletes who play them. The hope with this project is to shed light on the social relevance that exists in the realm of sports, where we have for years failed to see and acknowledge a connection between sports and society.

Keywords: sports, society, race, gender

Procedia PDF Downloads 107

Authors: Liane J. Ioannou, Jonathan Serpell, Joanne Dean, Cino Bendinelli, Jenny Gough, Dean Lisewski, Julie Miller, Win Meyer-Rochow, Stan Sidhu, Duncan Topliss, David Walters, John Zalcberg, Susannah Ahern

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Background: The occurrence of thyroid cancer is increasing throughout the developed world, including Australia and New Zealand, and since the 1990s has become the fastest increasing malignancy. Following the success of a number of institutional databases that monitor outcomes after thyroid surgery, the Australian and New Zealand Endocrine Surgeons (ANZES) agreed to auspice the development of a bi-national thyroid cancer registry. Objectives: To establish a bi-national population-based clinical quality registry with the aim of monitoring and improving the quality of care provided to patients diagnosed with thyroid cancer in Australia and New Zealand. Patients and Methods: The Australian and New Zealand Thyroid Cancer Registry (ANZTCR) captures clinical data for all patients, over the age of 18 years, diagnosed with thyroid cancer, confirmed by histopathology report, that have been diagnosed, assessed or treated at a contributing hospital. Data is collected by endocrine surgeons using a web-based interface, REDCap, primarily via direct data entry. Results: A multi-disciplinary Steering Committee was formed, and with operational support from Monash University the ANZTCR was established in early 2017. The pilot phase of the registry is currently operating in Victoria, New South Wales, Queensland, Western Australia and South Australia, with over 30 sites expected to come on board across Australia and New Zealand in 2018. A modified-Delphi process was undertaken to determine the key quality indicators to be reported by the registry, and a minimum dataset was developed comprising information regarding thyroid cancer diagnosis, pathology, surgery, and 30-day follow up. Conclusion: There are very few established thyroid cancer registries internationally, yet clinical quality registries have shown valuable outcomes and patient benefits in other cancers. The establishment of the ANZTCR provides the opportunity for Australia and New Zealand to further understand the current practice in the treatment of thyroid cancer and reasons for variation in outcomes. The engagement of endocrine surgeons in supporting this initiative is crucial. While the pilot registry has a focus on early clinical outcomes, it is anticipated that future collection of longer-term outcome data particularly for patients with the poor prognostic disease will add significant further value to the registry.

Keywords: thyroid cancer, clinical registry, population health, quality improvement

Procedia PDF Downloads 192

Authors: Riofrio Jonathan, Fernandez Guillermo

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Renewable energy represented around 80% of the energy matrix for power generation in Ecuador during 2020, so the deployment of current public policies is focused on taking advantage of the high presence of renewable sources to carry out several electrification projects. These projects are part of the portfolio sent to the United Nations Framework on Climate Change (UNFCCC) as a commitment to reduce greenhouse gas emissions (GHG) in the established national determined contribution (NDC). In this sense, the Ecuadorian Organic Energy Efficiency Law (LOEE) published in 2019 promotes E-mobility as one of the main milestones. In fact, it states that the new vehicles for urban and interurban usage must be E-buses since 2025. As a result, and for a successful implementation of this technological change in a national context, it is important to deploy land surveys focused on technical and geographical areas to keep the quality of services in both the electricity and transport sectors. Therefore, this research presents a technological and energy comparison between a conventional diesel bus and its equivalent E-bus. Both vehicles fulfill all the technical requirements to ride in the study-case city, which is Ambato in the province of Tungurahua-Ecuador. In addition, the analysis includes the development of a model for the energy estimation of both technologies that are especially applied in a highland city such as Ambato. The altimetry of the most important bus routes in the city varies from 2557 to 3200 m.a.s.l., respectively, for the lowest and highest points. These operation conditions provide a grade of novelty to this paper. Complementary, the technical specifications of diesel buses are defined following the common features of buses registered in Ambato. On the other hand, the specifications for E-buses come from the most common units introduced in Latin America because there is not enough evidence in similar cities at the moment. The achieved results will be good input data for decision-makers since electric demand forecast, energy savings, costs, and greenhouse gases emissions are computed. Indeed, GHG is important because it allows reporting the transparency framework that it is part of the Paris Agreement. Finally, the presented results correspond to stage I of the called project “Analysis and Prospective of Electromobility in Ecuador and Energy Mix towards 2030” supported by Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ).

Keywords: high altitude cities, energy planning, NDC, e-buses, e-mobility

Procedia PDF Downloads 151

Authors: Raveendranath Veeramani, Sunil Jonathan Holla, Parkash Chand, Sunil Chumber

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Gray’s Anatomy for Students has been a well-appreciated book among undergraduate students of anatomy in Asia. However, the current curricular requirements of anatomy require a more focused and organized approach. The editors of the first South Asia edition of Gray’s Anatomy for Students hereby highlight the modifications and importance of this edition. There is an emphasis on active learning by making the clinical relevance of anatomy explicit. Learning anatomy in context has been fostered by the association between anatomists and clinicians in keeping with the emerging integrated curriculum of the 21st century. The language has been simplified to aid students who have studied in the vernacular. The original illustrations have been retained, and few illustrations have been added. There are more figure numbers mentioned in the text to encourage students to refer to the illustrations while learning. The text has been made more student-friendly by adding generalizations, classifications and summaries. There are useful review materials at the beginning of the chapters which include digital resources for self-study. There are updates on imaging techniques to encourage students to appreciate the importance of essential knowledge of the relevant anatomy to interpret images, due emphasis has been laid on dissection. Additional importance has been given to the cranial nerves, by describing their relevant details with several additional illustrations and flowcharts. This new edition includes innovative features such as set inductions, outlines for subchapters and flowcharts to facilitate learning. Set inductions are mostly clinical scenarios to create interest in the need to study anatomy for healthcare professions. The outlines are a modern multimodal facilitating approach towards various topics to empower students to explore content and direct their learning and include learning objectives and material for review. The components of the outline encourage the student to be aware of the need to create solutions to clinical problems. The outlines help students direct their learning to recall facts, demonstrate and analyze relationships, use reason to explain concepts, appreciate the significance of structures and their relationships and apply anatomical knowledge. The 'structures to be identified in a dissection' are given as Level I, II and III which represent the 'must know, desirable to know and nice to know' content respectively. The flowcharts have been added to get an overview of the course of a structure, recapitulate important details about structures, and as an aid to recall. There has been a great effort to balance the need to have content that would enable students to understand concepts as well as get the basic material for the current condensed curriculum.

Keywords: Grays anatomy, South Asia, human anatomy, students anatomy

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Authors: Jonathan Turner, Julie Doyle, Laura O’Philbin, Dympna O’Sullivan

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People living with dementia should be at the centre of decision-making regarding goals for daily living. These goals include basic activities (dressing, hygiene, and mobility), advanced activities (finances, transportation, and shopping), and meaningful activities that promote well-being (pastimes and intellectual pursuits). However, there is limited involvement of people living with dementia in the design of technology to support their goals. A project is described that is co-designing intelligent computer-based support for, and with, people affected by dementia and their carers. The technology will support self-management, empower participation in shared decision-making with carers and help people living with dementia remain healthy and independent in their homes for longer. It includes information from the patient’s care plan, which documents medications, contacts, and the patient's wishes on end-of-life care. Importantly for this work, the plan can outline activities that should be maintained or worked towards, such as exercise or social contact. The authors discuss how to integrate care goal information from such a care plan with data collected from passive sensors in the patient’s home in order to deliver individualized planning and interventions for persons with dementia. A number of scientific challenges are addressed: First, to co-design with dementia patients and their carers computerized support for shared decision-making about their care while allowing the patient to share the care plan. Second, to develop a new and open monitoring framework with which to configure sensor technologies to collect data about whether goals and actions specified for a person in their care plan are being achieved. This is developed top-down by associating care quality types and metrics elicited from the co-design activities with types of data that can be collected within the home, from passive and active sensors, and from the patient’s feedback collected through a simple co-designed interface. These activities and data will be mapped to appropriate sensors and technological infrastructure with which to collect the data. Third, the application of machine learning models to analyze data collected via the sensing devices in order to investigate whether and to what extent activities outlined via the care plan are being achieved. The models will capture longitudinal data to track disease progression over time; as the disease progresses and captured data show that activities outlined in the care plan are not being achieved, the care plan may recommend alternative activities. Disease progression may also require care changes, and a data-driven approach can capture changes in a condition more quickly and allow care plans to evolve and be updated.

Keywords: care goals, decision-making, dementia, self-care, sensors

Procedia PDF Downloads 169

Authors: Sudikshya Bhandari, Jonathan K. London

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Barpak in northern Nepal represents a unique identity expressed through the local rituals, values, lifeways and the styles of vernacular architecture. The traditional residential buildings and construction practices adopted by the dominant ethnic groups: Ghales and Gurungs, reflect environmental, social, cultural and economic concerns. However, most of these buildings did not survive the Gorkha earthquake in 2015 that made many residents skeptical about their strength to resist future disasters. This led Barpak residents to prefer modern housing designs primarily for the strength but additionally for convenience and access to earthquake relief funds. Post-earthquake reconstruction has transformed the cohesive community, developed over hundreds of years into a haphazard settlement with the imposition of externally-driven building models. Housing guidelines provided for the community reconstruction and earthquake resilience have been used as a singular template, similar to other communities on different geographical locations. The design and construction of these buildings do not take into account the local, historical, environmental, social, cultural and economic context of Barpak. In addition to the physical transformation of houses and the settlement, the consequences continue to develop challenges to sustainability. This paper identifies the major challenges for environmental sustainability with the construction of new houses in post-earthquake Barpak. Mixed methods such as interviews, focus groups, site observation, and documentation, and analysis of housing and neighborhood design have been used for data collection. The discernible changing situation of this settlement due to the new housing has included reduced climatic adaptation and thermal comfort, increased consumption of agricultural land and water, minimized use of local building materials, and an increase in energy demand. The research has identified that reconstruction housing practices happening in Barpak, while responding to crucial needs for disaster recovery and resilience, are also leading this community towards an unsustainable future. This study has also integrated environmental, social, cultural and economic parameters into an assessment framework that could be used to develop place-based design guidelines in the context of other post-earthquake reconstruction efforts. This framework seeks to minimize the unintended repercussions of unsustainable reconstruction interventions, support the vitality of vernacular architecture and traditional lifeways and respond to context-based needs in coordination with residents.

Keywords: earthquake, environment, reconstruction, sustainability

Procedia PDF Downloads 115

Authors: Zeyu Zhou, Ziyu Zhao, Xiaochen Yang, Ling AI, Heng Zhai, Stuart Holmes

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As a promising sustainable alternative to traditional fossil fuels, fuel cell technology is highly favoured due to its enhanced working efficiency and reduced emissions. In the context of high-temperature fuel cells (operating above 100 °C), the most commonly used proton exchange membrane (PEM) is the Polybenzimidazole (PBI) doped phosphoric acid (PA) membrane. Grafting is a promising strategy to advance PA-doped PBI PEM technology. The existing grafting modification on PBI PEMs mainly focuses on grafting phosphate-containing or alkaline groups onto the PBI molecular chains. However, quaternary ammonium-based grafting approaches face a common challenge. To initiate the N-alkylation reaction, deacidifying agents such as NaH, NaOH, KOH, K2CO3, etc., can lead to ionic crosslinking between the quaternary ammonium group and PBI. Polyvinylpyrrolidone (PVP) is another widely used polymer, the N-heterocycle groups within PVP endow it with a significant ability to absorb PA. Recently, PVP has attracted substantial attention in the field of fuel cells due to its reduced environmental impact and impressive fuel cell performance. However, due to the the poor compatibility of PVP in PBI, few research apply PVP in PA-doped PBI PEMs. This work introduces an innovative strategy to graft PVP onto PBI to form a network-like polymer. Due to the absence of quaternary ammonium groups, PVP does not pose issues related to crosslinking with PBI. Moreover, the nitrogen-containing functional groups on PVP provide PBI with a robust phosphoric acid retention ability. The nuclear magnetic resonance (NMR) hydrogen spectrum analysis results indicate the successful completion of the grafting reaction where N-alkylation reactions happen on both sides of the grafting agent 1,4-bis(chloromethyl)benzene. On one side, the reaction takes place with the hydrogen atoms on the imidazole groups of PBI, while on the other side, it reacts with the terminal amino group of PVP. The XPS results provide additional evidence from the perspective of the element. On synthesized PBI-g-PVP surfaces, there is an absence of chlorine (chlorine in grafting agent 1,4-bis(chloromethyl)benzene is substituted) element but a presence of sulfur element (sulfur element in terminal amino PVP appears in PBI), which demonstrates the occurrence of the grafting reaction and PVP is successfully grafted onto PBI. Prepare these modified membranes into MEA. It was found that during the fuel cell operation, all the grafted membranes showed substantial improvement in maximum current density and peak power density compared to unmodified one. For PBI-g-PVP 30, with a grafting degree of 22.4%, the peak power density reaches 1312 mW cm⁻², marking a 59.6% enhancement compared to the pristine PBI membrane. The improvement is caused by the improved PA binding ability of the membrane after grafting. The AST test result shows that the grafting membranes have better long-term durability and performance than unmodified membranes attributed to the presence of added PA binding sites, which can effectively prevent the PA leaching caused by proton migration. In conclusion, the test results indicate that grafting PVP onto PBI is a promising strategy which can effectively improve the fuel cell performance.

Keywords: fuel cell, grafting modification, PA doping ability, PVP

Procedia PDF Downloads 79

Authors: Amirul Adlan, Robert A McCulloch, Neil Jenkins, MIchael Parry, Jonathan Stevenson, Lee Jeys

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Background and Objectives: The current antibiotic prophylaxis for oncological patients is based upon evidence from primary arthroplasty despite significant differences in both patient group and procedure. The aim of this study was to compare the microbiology organisms responsible for PJI in patients who underwent two-stage revision for infected primary knee replacement with those of infected oncological endoprostheses of the lower limb in a single institution. This will subsequently guide decision making regarding antibiotic prophylaxis at primary implantation for oncological procedures and empirical antibiotics for infected revision procedures (where the infecting organism(s) are unknown). Patient and Methods: 118 patients were treated with two-stage revision surgery for infected knee arthroplasty and lower limb endoprostheses between 1999 and 2019. 74 patients had two-stage revision for PJI of knee arthroplasty, and 44 had two-stage revision of lower limb endoprostheses. There were 68 males and 50 females. The mean age for the knee arthroplasty cohort and lower limb endoprostheses cohort were 70.2 years (50-89) and 36.1 years (12-78), respectively (p<0.01). Patient host and extremity criteria were categorised according to the MSIS Host and Extremity Staging System. Patient microbiological culture, the incidence of polymicrobial infection and multi-drug resistance (MDR) were analysed and recorded. Results: Polymicrobial infection was reported in 16% (12 patients) from knee arthroplasty PJI and 14.5% (8 patients) in endoprostheses PJI (p=0.783). There was a significantly higher incidence of MDR in endoprostheses PJI, isolated in 36.4% of cultures, compared to knee arthroplasty PJI (17.2%) (p=0.01). Gram-positive organisms were isolated in more than 80% of cultures from both cohorts. Coagulase-negative Staphylococcus (CoNS) was the commonest gram-positive organism, and Escherichia coli was the commonest Gram-negative organism in both groups. According to the MSIS staging system, the host and extremity grade of knee arthroplasty PJI cohort were significantly better than endoprostheses PJI(p<0.05). Conclusion: Empirical antibiotic management of PJI in orthopaedic oncology is based upon PJI in arthroplasty despite differences in both host and microbiology. Our results show a significant increase in MDR pathogens within the oncological group despite CoNS being the most common infective organism in both groups. Endoprosthetic patients presented with poorer host and extremity criteria. These factors should be considered when managing this complex patient group, emphasising the importance of broad-spectrum antibiotic prophylaxis and preoperative sampling to ensure appropriate perioperative antibiotic cover.

Keywords: microbiology, periprosthetic Joint infection, knee arthroplasty, endoprostheses

Procedia PDF Downloads 115

Authors: Mark Ashton Newman, Richard Blagrove, Jonathan Folland

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The force-velocity profile of an individual has been shown to influence success in ballistic movements, independent of the individuals' maximal power output; therefore, effective and accurate evaluation of an individual’s F-V characteristics and not solely maximal power output is important. The relatively narrow range of loads typically utilised during force-velocity profiling protocols due to the difficulty in obtaining force data at high velocities may bring into question the accuracy of the F-V slope along with predictions pertaining to the maximum force that the system can produce at a velocity of null (F₀) and the theoretical maximum velocity against no load (V₀). As such, the reliability of the slope of the force-velocity profile, as well as V₀, has been shown to be relatively poor in comparison to F₀ and maximal power, and it has been recommended to assess velocity at loads closer to both F₀ and V₀. The aim of the present study was to assess the relative and absolute reliability of an instrumented novel leg press machine which enables the assessment of force and velocity data at loads equivalent to ≤ 10% of one repetition maximum (1RM) through to 1RM during a ballistic leg press movement. The reliability of maximal and mean force, velocity, and power, as well as the respective force-velocity and power-velocity relationships and the linearity of the force-velocity relationship, were evaluated. Sixteen male strength-trained individuals (23.6 ± 4.1 years; 177.1 ± 7.0 cm; 80.0 ± 10.8 kg) attended four sessions; during the initial visit, participants were familiarised with the leg press, modified to include a mounted force plate (Type SP3949, Force Logic, Berkshire, UK) and a Micro-Epsilon WDS-2500-P96 linear positional transducer (LPT) (Micro-Epsilon, Merseyside, UK). Peak isometric force (IsoMax) and a dynamic 1RM, both from a starting position of 81% leg length, were recorded for the dominant leg. Visits two to four saw the participants carry out the leg press movement at loads equivalent to ≤ 10%, 30%, 50%, 70%, and 90% 1RM. IsoMax was recorded during each testing visit prior to dynamic F-V profiling repetitions. The novel leg press machine used in the present study appears to be a reliable tool for measuring F and V-related variables across a range of loads, including velocities closer to V₀ when compared to some of the findings within the published literature. Both linear and polynomial models demonstrated good to excellent levels of reliability for SFV and F₀ respectively, with reliability for V₀ being good using a linear model but poor using a 2nd order polynomial model. As such, a polynomial regression model may be most appropriate when using a similar unilateral leg press setup to predict maximal force production capabilities due to only a 5% difference between F₀ and obtained IsoMax values with a linear model being best suited to predict V₀.

Keywords: force-velocity, leg-press, power-velocity, profiling, reliability

Procedia PDF Downloads 58

Authors: Radhika Jain

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The nursing community in India face unique challenges ranging from lack of adequate career progression, low social status attached to the profession, poor nurse-to-patient ratio leading to heavy workload resulting in stress and burnout, lack of general recognition and the responsibility of often having to deal with the ire of the patients and their families. This study explores how a combination of Playback Theatre and Expressive Arts could be used as a very powerful tool to understand the concerns, and consequently as a self-care tool to bring about the sense of well-being and emotional awareness for the nurses. For the purpose of this study, Playback Theatre was used as an entry tool to understand the thoughts, feelings and concerns. Playback theatre is a unique improvisational form of theatre developed by Jonathan Fox and Jo Salas in 1975, in which audience share their own stories from their lives and the performers play them back through a range of improv techniques such as metaphor, poetry, music and movement. Playback Theatre helped in first warming them up to the idea of sharing and then gave them the confidence of a safe space to collectively go deeper into their emotional experiences. As the next step, structured sessions of Expressive Arts were conducted with the same set of nurses, for them to work on the issues and concerns they have (and which they shared during the Playback performance). These sessions were to enable longer engagements as many of the concerns expressed were related to perceptions and beliefs that have been ingrained over a period of time and hence it needs a longer engagement to be worked on in detail. The Expressive Art sessions helped in this regard. Expressive arts therapy combines psychology and the creative process to promote emotional growth and healing. The study was conducted at two places: one a geriatric centre and the other, a palliative care centre. The study revealed that concerns and challenges would not be identical across the nursing community or across similar types of health care organizations but would be specific to each organization or centre as the circumstances and set-up at each place would be different. At the geriatric centre, stress and burnout emerged as the main concerns while at the palliative care centre, the main concern that came up was around the difficulty the nurses faced in expressing emotions and in communicating their feelings. The objective analysis of the results of the study indicated how longer-term engagements using Expressive Arts as the modality helped the nurses have better awareness of their emotions and helped them develop tools of self-care tools while also tapping into their emotions to express and experience. The process of eliciting the main concerns from the nurses using a Playback Theatre performance and then following that with subsequent sessions of expressive arts helped the nurses in the way nurses approached their job and the reduced level of overwhelm that they felt.

Keywords: palliative care, nurses, self-care, expressive arts, playback theatre

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Authors: Jonathan Munyoro, Takawira Machimbidza, Stephen Mutula

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The study investigates the current status of Intellectual Property (IP) information services in Zimbabwe's university libraries. Specifically, the study assesses the current IP information services offered in Zimbabwe’s university libraries, identifies challenges to the development of comprehensive IP information services in Zimbabwe’s university libraries, and suggests solutions for the development of IP information services in Zimbabwe’s university libraries. The study is born out of a realisation that research on IP information services in university libraries has received little attention, especially in developing country contexts, despite the fact that there are calls for heightened participation of university libraries in IP information services. In Zimbabwe, the launch of the National Intellectual Property Policy and Implementation Strategy 2018-2022 and the introduction of the Education 5.0 concept are set to significantly change the IP landscape in the country. Education 5.0 places more emphasis on innovation and industrialisation (in addition to teaching, community service, and research), and has the potential to shift the focus and level of IP output produced in higher and tertiary education institutions beyond copyrights and more towards commercially exploited patents, utility models, and industrial designs. The growing importance of IP commercialisation in universities creates a need for appropriate IP information services to assist students, academics, researchers, administrators, start-ups, entrepreneurs, and inventors. The critical challenge for university libraries is to reposition themselves and remain relevant in the new trajectory. Designing specialised information services to support increased IP generation and commercialisation appears to be an opportunity for university libraries to stay relevant in the knowledge economy. However, IP information services in Zimbabwe’s universities appear to be incomplete and focused mostly on assisting with research publications and copyright-related activities. Research on the existing status of IP services in university libraries in Zimbabwe is therefore necessary to help identify gaps and provide solutions in order to stimulate the growth of new forms of such services. The study employed a quantitative approach. An online questionnaire was administered to 57 academic librarians from 15 university libraries. Findings show that the current focus of the surveyed institutions is on providing scientific research support services (15); disseminating/sharing university research output (14); and copyright activities (12). More specialised IP information services such as IP education and training, patent information services, IP consulting services, IP online service platforms, and web-based IP information services are largely unavailable in Zimbabwean university libraries. Results reveal that the underlying challenge in the development of IP information services in Zimbabwe's university libraries is insufficient IP knowledge among academic librarians, which is exacerbated by inadequate IP management frameworks in university institutions. The study proposes a framework for the entrenchment of IP information services in Zimbabwe's university libraries.

Keywords: academic libraries, information services, intellectual property, IP knowledge, university libraries, Zimbabwe

Procedia PDF Downloads 156

Authors: Iris Vural Gursel, Jonathan Moncada, Ernst Worrell, Andrea Ramirez

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In order to achieve the transition from a fossil to bio-based economy, biomass needs to replace fossil resources in meeting the world’s energy and chemical needs. This calls for development of biorefinery systems allowing cost-efficient conversion of biomass to chemicals. In biorefinery systems, feedstock is converted to key intermediates called platforms which are converted to wide range of marketable products. The C6 sugars platform stands out due to its unique versatility as precursor for multiple valuable products. Among the different potential routes from C6 sugars to bio-based chemicals, 1,3-butadiene and ε-caprolactam appear to be of great interest. Butadiene is an important chemical for the production of synthetic rubbers, while caprolactam is used in production of nylon-6. In this study, ex-ante techno-economic performance of 1,3-butadiene and ε-caprolactam routes from C6 sugars were assessed. The aim is to provide insight from an early stage of development into the potential of these new technologies, and the bottlenecks and key cost-drivers. Two cases for each product line were analyzed to take into consideration the effect of possible changes on the overall performance of both butadiene and caprolactam production. Conceptual process design for the processes was developed using Aspen Plus based on currently available data from laboratory experiments. Then, operating and capital costs were estimated and an economic assessment was carried out using Net Present Value (NPV) as indicator. Finally, sensitivity analyses on processing capacity and prices was done to take into account possible variations. Results indicate that both processes perform similarly from an energy intensity point of view ranging between 34-50 MJ per kg of main product. However, in terms of processing yield (kg of product per kg of C6 sugar), caprolactam shows higher yield by a factor 1.6-3.6 compared to butadiene. For butadiene production, with the economic parameters used in this study, for both cases studied, a negative NPV (-642 and -647 M€) was attained indicating economic infeasibility. For the caprolactam production, one of the cases also showed economic infeasibility (-229 M€), but the case with the higher caprolactam yield resulted in a positive NPV (67 M€). Sensitivity analysis indicated that the economic performance of caprolactam production can be improved with the increase in capacity (higher C6 sugars intake) reflecting benefits of the economies of scale. Furthermore, humins valorization for heat and power production was considered and found to have a positive effect. Butadiene production was found sensitive to the price of feedstock C6 sugars and product butadiene. However, even at 100% variation of the two parameters, butadiene production remained economically infeasible. Overall, the caprolactam production line shows higher economic potential in comparison to that of butadiene. The results are useful in guiding experimental research and providing direction for further development of bio-based chemicals.

Keywords: bio-based chemicals, biorefinery, C6 sugars, economic analysis, process modelling

Procedia PDF Downloads 152

Authors: Jonathan A. Noble

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‘Origins’ is an exhibition designed and installed by MMA Design Studio, at the 2023 Venice Biennale. The instillation formed part of the ‘Dangerous Liaisons’ group exhibition at the Arsenale building. An immersive experience was created for those who visited, where video projection and the bodies of visitors interacted with the scene. Designed by South African architect, Mphethi Morojele – founder and owner of MMA – the primary inspiration for ‘Origins’ was the recent discovery by Professor Karim Sadr in 2019, of a substantial Tswana settlement. Situated in present day Suikerbosrand Nature Reserve, some 45km south of Johannesburg, this precolonial city named Kweneng, has been dated back to the fifteenth century. This remarkable discovery was achieved thanks to advanced aerial, LiDAR scanning technology, which was used to capture the traces of Kweneng, spanning a terrain of some 10km long and 2km wide. Discovered by light (LiDAR) and exhibited through light, Origins presents a simulated experience of Kweneng. The presentation of Kweneng was achieved primarily though video, with a circular projection onto the floor of an animated LiDAR data sequence, and onto the walls a filmed dance sequence choreographed to embody the architectural, spatial and symbolic significance of Kweneng. This paper documents the design process that was involved in the conceptualization, development and final realization of this noteworthy exhibition, with an elucidation upon key social and cultural questions pertaining to precolonial heritage, reimagined histories and postcolonial identity. Periods of change and of social awakening sometimes spark an interest in questions of origin, of cultural lineage and belonging – and which certainly is the case for contemporary, post-Apartheid South Africa. Researching this paper has required primary study of MMA Design Studio’s project archive, including various proposals and other design related documents, conceptual design sketches, architectural drawings and photographs. This material is supported by the authors first-hand interviews with Morejele and others who were involved, especially with respect to the choreography of the interpretive dance, LiDAR visualization techniques and video production that informed the simulated, immersive experience at the exhibition. Presenting a ‘dangerous liaison’ between architecture and dance, Origins looks into the distant past to frame contemporary questions pertaining to intangible heritage, animism and embodiment through architecture and dance – considerations which are required “to survive the future”, says Morojele.

Keywords: architecture and dance, Kweneng, MMA design studio, origins, Venice Biennale

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Authors: Akinola Helen Olufunke, Soetan Olatunbosun Jonathan, Adeleye Oludamola

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Introduction: Antibiotic resistance has grown significantly, which is a major cause for concern. There have not been many significant developments in antibiotics over the past few decades, and practically all of the ones that are currently in use are losing effectiveness against pathogenic germs. Researchers are starting to focus more on the physiologically active compounds found in plants, particularly phytobiotics in poultry production. Consumption of chicken products is among the greatest in the country, but numerous nations, including Nigeria, use excessive amounts of necessary antibiotics in poultry farming, endangering the safety of such goods (through antimicrobial residues). Drug resistance has become a widespread issue as a result of the risky use of antibiotics in the chicken production industry. In order to replace antibiotics, biotic or natural products like phytobiotics (also known as botanicals or phytogenics) have drawn a lot of interest. Phytobiotics or their components are thought to be a relatively recent category of natural herbs that have acquired acceptance and favor among chicken farmers. The addition of several phytobiotic additions to poultry feed has demonstrated its capacity to improve both the broiler and layer populations' productivity. Design: Experimental research design and cross-sectional study was carried out at every 300 purposively selected farming household in the six-geopolitical zone in Nigeria. Data Analysis: A semi-structured questionnaire was administered to each farmer, and quantitative data were analyzed using Statistical Package for Social Science (SPSS) while the Chi-square test was used to analyze factors mitigating the use of Phytobiotics. Result: The result shows that the benefits associated with the use of phytobiotics are contributed to growth promotion in chickens and enhancement of productive performance of broiler and layer, which could be attributed to their antioxidant activity. The result further revealed that factors mitigating the use of phytobiotics were lack of knowledge in the use of phytobiotics, overdose or underdose usage, and seasonal availability of the phytobiotics. Others are the educational level of the farmers, intrinsic motivation, income poultry farming experience, price of phytobiotics based additives feeds, and intensity of extension agents in visiting them. Conclusion: The difficulties associated with using phytobiotics in chicken farms limit their willingness to boost productivity. The study found that most farmers were ignorant, which prevented them from handling this notion and turning their poultry into a viable enterprise while also allowing them to be creative. They believed that packing phytobiotics-based additive feed was expensive, and lastly, the seasonal availability of some phytobiotics. Recommendation: Further research in phytobiotics use in Nigeria should be carried out in order to establish its efficiency, safety, and awareness.

Keywords: mitigating, antibiotics, phytobiotics, poultry farming

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Authors: Areej K. Al-Jwaid, Dmitiry Berllio, Andrew Cundy, Irina Savina, Jonathan L. Caplin

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Phenol is a toxic compound that is widely distributed in the environment including the atmosphere, water and soil, due to the release of effluents from the petrochemical and pharmaceutical industries, coking plants and oil refineries. Moreover, a range of daily products, using phenol as a raw material, may find their way into the environment without prior treatment. The toxicity of phenol effects both human and environment health, and various physio-chemical methods to remediate phenol contamination have been used. While these techniques are effective, their complexity and high cost had led to search for alternative strategies to reduce and eliminate high concentrations of phenolic compounds in the environment. Biological treatments are preferable because they are environmentally friendly and cheaper than physico-chemical approaches. Some microorganisms such as Pseudomonas sp., Rhodococus sp., Acinetobacter sp. and Bacillus sp. have shown a high ability to degrade phenolic compounds to provide a sole source of energy. Immobilisation process utilising various materials have been used to protect and enhance the viability of cells, and to provide structural support for the bacterial cells. The aim of this study is to develop a new approach to the bioremediation of phenol based on an immobilisation strategy that can be used in wastewater. In this study, two bacterial species known to be phenol degrading bacteria (Pseudomonas mendocina and Rhodococus koreensis) were purchased from National Collection of Industrial, Food and Marine Bacteria (NCIMB). The two species and mixture of them were immobilised to produce macro porous crosslinked cell cryogels samples by using four types of cross-linker polymer solutions in a cryogelation process. The samples were used in a batch culture to degrade phenol at an initial concentration of 50mg/L at pH 7.5±0.3 and a temperature of 30°C. The four types of polymer solution - i. glutaraldehyde (GA), ii. Polyvinyl alcohol with glutaraldehyde (PVA+GA), iii. Polyvinyl alcohol–aldehyde (PVA-al) and iv. Polyetheleneimine–aldehyde (PEI-al), were used at different concentrations, ranging from 0.5 to 1.5% to crosslink the cells. The results of SEM and rheology analysis indicated that cell-cryogel samples crosslinked with the four cross-linker polymers formed monolithic macro porous cryogels. The samples were evaluated for their ability to degrade phenol. Macro porous cell–cryogels crosslinked with GA and PVA+GA showed an ability to degrade phenol for only one week, while the other samples crosslinked with a combination of PVA-al + PEI-al at two different concentrations have shown higher stability and viability to reuse to degrade phenol at concentration (50 mg/L) for five weeks. The initial results of using crosslinked cell cryogel samples to degrade phenol indicate that is a promising tool for bioremediation strategies especially to eliminate and remove the high concentration of phenol in wastewater.

Keywords: bioremediation, crosslinked cells, immobilisation, phenol degradation

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Authors: Sandra Smieszek, Jonathan Haines

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Introduction: Numerous research efforts have focused on searching for ‘longevity genes’. However, attempting to decipher the genetic component of the longevous phenotype have resulted in limited success and the mechanisms governing longevity remain to be explained. We conducted a genome-wide homozygosity analysis (GWHA) of the founder population of the Amish community in central Ohio. While genome-wide association studies using unrelated individuals have revealed many interesting longevity associated variants, these variants are typically of small effect and cannot explain the observed patterns of heritability for this complex trait. The Amish provide a large cohort of extended kinships allowing for in depth analysis via family-based approach excellent population due to its. Heritability of longevity increases with age with significant genetic contribution being seen in individuals living beyond 60 years of age. In our present analysis we show that the heritability of longevity is estimated to be increasing with age particularly on the paternal side. Methods: The present analysis integrated both phenotypic and genotypic data and led to the discovery of a series of variants, distinct for stratified populations across ages and distinct for paternal and maternal cohorts. Specifically 5437 subjects were analyzed and a subset of 893 successfully genotyped individuals was used to assess CHIP heritability. We have conducted the homozygosity analysis to examine if homozygosity is associated with increased risk of living beyond 90. We analyzed AMISH cohort genotyped for 614,957 SNPs. Results: We delineated 10 significant regions of homozygosity (ROH) specific for the age group of interest (>90). Of particular interest was ROH on chromosome 13, P < 0.0001. The lead SNPs rs7318486 and rs9645914 point to COL4A2 and our lead SNP. COL25A1 encodes one of the six subunits of type IV collagen, the C-terminal portion of the protein, known as canstatin, is an inhibitor of angiogenesis and tumor growth. COL4A2 mutations have been reported with a broader spectrum of cerebrovascular, renal, ophthalmological, cardiac, and muscular abnormalities. The second region of interest points to IRS2. Furthermore we built a classifier using the obtained SNPs from the significant ROH region with 0.945 AUC giving ability to discriminate between those living beyond to 90 years of age and beyond. Conclusion: In conclusion our results suggest that a history of longevity does indeed contribute to increasing the odds of individual longevity. Preliminary results are consistent with conjecture that heritability of longevity is substantial when we start looking at oldest fifth and smaller percentiles of survival specifically in males. We will validate all the candidate variants in independent cohorts of centenarians, to test whether they are robustly associated with human longevity. The identified regions of interest via ROH analysis could be of profound importance for the understanding of genetic underpinnings of longevity.

Keywords: regions of homozygosity, longevity, SNP, Amish

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Authors: Ling Ai, Ziyu Zhao, Zeyu Zhou, Xiaochen Yang, Heng Zhai, Stuart Holmes

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Optimizing the catalyst layer structure is crucial for enhancing the performance of proton exchange membrane fuel cells (PEMFCs) with low Platinum (Pt) loading. Current works focused on the utilization, durability, and site activity of Pt particles on support, and performance enhancement has been achieved by loading Pt onto porous support with different morphology, such as graphene, carbon fiber, and carbon black. Some schemes have also incorporated cost considerations to achieve lower Pt loading. However, the design of the catalyst layer (CL) structure in the membrane electrode assembly (MEA) must consider the interactions between the layers. Addressing the crucial aspects of water management, low contact resistance, and the establishment of effective three-phase boundary for MEA, multi-walled carbon nanotubes (MWCNTs) are promising CL support due to their intrinsically high hydrophobicity, high axial electrical conductivity, and potential for ordered alignment. However, the drawbacks of MWCNTs, such as strong agglomeration, wall surface chemical inertness, and unopened ends, are unfavorable for Pt nanoparticle loading, which is detrimental to MEA processing and leads to inhomogeneous CL surfaces. This further deteriorates the utilization of Pt and increases the contact resistance. Robust chemical oxidation or nitrogen doping can introduce polar functional groups onto the surface of MWCNTs, facilitating the creation of open tube ends and inducing defects in tube walls. This improves dispersibility and load capacity but reduces length and conductivity. Consequently, a trade-off exists between maintaining the intrinsic properties and the degree of functionalization of MWCNTs. In this work, MWCNTs were modified based on the operational requirements of the MEA from the viewpoint of interlayer interactions, including the search for the optimal degree of oxidation, N-doping, and micro-arrangement. MWCNT were functionalized by oxidizing, N-doping, as well as micro-alignment to achieve lower contact resistance between CL and proton exchange membrane (PEM), better hydrophobicity, and enhanced performance. Furthermore, this work expects to construct a more continuously distributed three-phase boundary by aligning MWCNT to form a locally ordered structure, which is essential for the efficient utilization of Pt active sites. Different from other chemical oxidation schemes that used HNO3:H2SO4 (1:3) mixed acid to strongly oxidize MWCNT, this scheme adopted pure HNO3 to partially oxidize MWCNT at a lower reflux temperature (80 ℃) and a shorter treatment time (0 to 10 h) to preserve the morphology and intrinsic conductivity of MWCNT. The maximum power density of 979.81 mw cm-2 was achieved by Pt loading on 6h MWCNT oxidation time (Pt-MWCNT6h). This represented a 59.53% improvement over the commercial Pt/C catalyst of 614.17 (mw cm-2). In addition, due to the stronger electrical conductivity, the charge transfer resistance of Pt-MWCNT6h in the electrochemical impedance spectroscopy (EIS) test was 0.09 Ohm cm-2, which was 48.86% lower than that of Pt/C. This study will discuss the developed catalysts and their efficacy in a working fuel cell system. This research will validate the impact of low-functionalization modification of MWCNTs on the performance of PEMFC, which simplifies the preparation challenges of CL and contributing for the widespread commercial application of PEMFCs on a larger scale.

Keywords: carbon nanotubes, electrocatalyst, membrane electrode assembly, proton exchange membrane fuel cell

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Authors: Richard Okyere Boadu, Godwin Adzakpah, Nathan Kumasenu Mensah, Kwame Adu Okyere Boadu, Jonathan Kissi, Christiana Dziyaba, Rosemary Bermaa Abrefa

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Information and communication technology (ICT) has significantly advanced global healthcare, with electronic health (e-Health) applications improving health records and delivery. These innovations, including electronic health records, strengthen healthcare systems. The study investigates healthcare professionals' perceptions of health information applications and their associated factors in the Cape Coast Metropolis of Ghana's health facilities. Methods: We used a descriptive cross-sectional study design to collect data from 632 healthcare professionals (HCPs), in the three purposively selected health facilities in the Cape Coast municipality of Ghana in July 2022. Shapiro-Wilk test was used to check the normality of dependent variables. Descriptive statistics were used to report means with corresponding standard deviations for continuous variables. Proportions were also reported for categorical variables. Bivariate regression analysis was conducted to determine the factors influencing the Benefits of Information Technology (BoIT); Barriers to Information Technology Use (BITU); and Motives of Information Technology Use (MoITU) in healthcare delivery. Stata SE version 15 was used for the analysis. A p-value of less than 0.05 served as the basis for considering a statistically significant accepting hypothesis. Results: Healthcare professionals (HCPs) generally perceived moderate benefits (Mean score (M)=5.67) from information technology (IT) in healthcare. However, they slightly agreed that barriers like insufficient computers (M=5.11), frequent system downtime (M=5.09), low system performance (M=5.04), and inadequate staff training (M=4.88) hindered IT utilization. Respondents slightly agreed that training (M=5.56), technical support (M=5.46), and changes in work procedures (M=5.10) motivated their IT use. Bivariate regression analysis revealed significant influences of education, working experience, healthcare profession, and IT training on attitudes towards IT utilization in healthcare delivery (BoIT, BITU, and MoITU). Additionally, the age of healthcare providers, education, and working experience significantly influenced BITU. Ultimately, age, education, working experience, healthcare profession, and IT training significantly influenced MoITU in healthcare delivery. Conclusions: Healthcare professionals acknowledge moderate benefits of IT in healthcare but encounter barriers like inadequate resources and training. Motives for IT use include staff training and support. Bivariate regression analysis shows education, working experience, profession, and IT training significantly influence attitudes toward IT adoption. Targeted interventions and policies can enhance IT utilization in the Cape Coast Metropolis, Ghana.

Keywords: health information application, utilization of information application, information technology use, healthcare

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Authors: Maria Hadjisoteriou, Yiorgos Hadjichristou

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This paper aims to explore and provoke a debate, through the work of the design studio, “living where the immaterial matters” of the architecture department of the University of Nicosia, on the role that the “immaterial matter” can play in enhancing innovative sustainable architecture and viewing the cities as sustainable organisms that always grow and alter. The blurring, juxtaposing binary of immaterial and matter, as the theoretical backbone of the Unit is counterbalanced by the practicalities of the contested sites of the last divided capital Nicosia with its ambiguous green line and the ghost city of Famagusta in the island of Cyprus. Jonathan Hill argues that the ‘immaterial is as important to architecture as the material concluding that ‘Immaterial–Material’ weaves the two together, so that they are in conjunction not opposition’. This understanding of the relationship of the immaterial vs material set the premises and the departing point of our argument, and talks about new recipes for creating hybrid public space that can lead to the unpredictability of a complex and interactive, sustainable city. We hierarchized the human experience as a priority. We distinguish the notion of space and place referring to Heidegger’s ‘building dwelling thinking’: ‘a distinction between space and place, where spaces gain authority not from ‘space’ appreciated mathematically but ‘place’ appreciated through human experience’. Following the above, architecture and the city are seen as one organism. The notions of boundaries, porous borders, fluidity, mobility, and spaces of flows are the lenses of the investigation of the unit’s methodology, leading to the notion of a new hybrid urban environment, where the main constituent elements are in a flux relationship. The material and the immaterial flows of the town are seen interrelated and interwoven with the material buildings and their immaterial contents, yielding to new sustainable human built environments. The above premises consequently led to choices of controversial sites. Indisputably a provoking site was the ghost town of Famagusta where the time froze back in 1974. Inspired by the fact that the nature took over the a literally dormant, decaying city, a sustainable rebirthing was seen as an opportunity where both nature and built environment, material and immaterial are interwoven in a new emergent urban environment. Similarly, we saw the dividing ‘green line’ of Nicosia completely failing to prevent the trespassing of images, sounds and whispers, smells and symbols that define the two prevailing cultures and becoming a porous creative entity which tends to start reuniting instead of separating , generating sustainable cultures and built environments. The authors would like to contribute to the debate by introducing a question about a new recipe of cooking the built environment. Can we talk about a new ‘urban recipe’: ‘cooking architecture and city’ to deliver an ever changing urban sustainable organism, whose identity will mainly depend on the interrelationship of the immaterial and material constituents?

Keywords: blurring zones, porous borders, spaces of flow, urban recipe

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Authors: Jonathan Sahu, Jill Aylott

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Individuals with Autism, Intellectual and Developmental disabilities (AIDD) are one of the most vulnerable groups in society, hampered not only by their own limitations to understand and interact with the wider society, but also societal limitations in perception and understanding. Communication to express their needs and wishes is fundamental to enable such individuals to live and prosper in society. This research project was designed as an organisational case study, in a large secondary health care hospital within the National Health Service (NHS), to assess the quality of care provided to people with AIDD and to review the role of advocacy to reduce health inequalities in these individuals. Methods: The research methodology adopted was as an “insider researcher”. Data collection included both quantitative and qualitative data i.e. a mixed method approach. A semi-structured interview schedule was designed and used to obtain qualitative and quantitative primary data from a wide range of interdisciplinary frontline health care workers to assess their understanding and awareness of systems, processes and evidence based practice to offer a quality service to people with AIDD. Secondary data were obtained from sources within the organisation, in keeping with “Case Study” as a primary method, and organisational performance data were then compared against national benchmarking standards. Further data sources were accessed to help evaluate the effectiveness of different types of advocacy that were present in the organisation. This was gauged by measures of user and carer experience in the form of retrospective survey analysis, incidents and complaints. Results: Secondary data demonstrate near compliance of the Organisation with the current national benchmarking standard (Monitor Compliance Framework). However, primary data demonstrate poor knowledge of the Mental Capacity Act 2005, poor knowledge of organisational systems, processes and evidence based practice applied for people with AIDD. In addition there was poor knowledge and awareness of frontline health care workers of advocacy and advocacy schemes for this group. Conclusions: A significant amount of work needs to be undertaken to improve the quality of care delivered to individuals with AIDD. An operational strategy promoting the widespread dissemination of information may not be the best approach to deliver quality care and optimal patient experience and patient advocacy. In addition, a more robust set of standards, with appropriate metrics, needs to be developed to assess organisational performance which will stand the test of professional and public scrutiny.

Keywords: advocacy, autism, health inequalities, intellectual developmental disabilities, quality of care

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Authors: Sudikshya Bhandari, Jonathan K. London

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The earthquake of April 2015 was one of the biggest disasters in the history of Nepal. The epicenter was located near Barpak, north of the Gorkha district. Before the disaster, this settlement was a compact and homogeneous settlement manifesting its uniqueness through the social and cultural activities, and a distinct vernacular architecture. Narrow alleys with stone paved streets, buildings with slate roofs, and common spaces between the houses made this settlement socially, culturally, and environmentally cohesive. With the presence of micro hydro power plants, local economic activities enabled the local community to exist and thrive. Agriculture and animal rearing are the sources of livelihood for the majority of families, along with the booming homestays (where local people welcome guests to their home, as a business) and local shops. Most of these activities are difficult to find as the houses have been destroyed with the earthquake and the process of reconstruction has been transforming the outlook of the settlement. This study characterized the drastic transformation in Barpak post-earthquake, and analyzed the consequences of the reconstruction process. In addition, it contributes to comprehending a broader representation about unsustainability created by the lack of contextual post-disaster development. Since the research is based in a specific area, a case study approach was used. Sample houses were selected on the basis of ethnicity and house typology. Mixed methods such as key informant and semi structured interviews, focus groups, observations and photographs are used for the collection of data. The research focus is predominantly on the physical change of the house typology from vernacular to externally adopted designs. This transformation of the house entails socio-cultural changes such as social fragmentation with differences among the rich and the poor and decreases in the social connectivity within families and neighborhood. Families have found that new houses require more maintenance and resources that have increased their economic expenses. The study also found that the reconstructed houses are not thermally comfortable in the cold climate of Barpak, leading to the increased use of different sources of heating like electric heaters and more firewood. Lack of storage spaces for crops and livestock have discouraged them to pursue traditional means of livelihood and depend more on buying food from stores, ultimately making it less economical for most of the families. The transformation of space leading to the economic, social and cultural changes demonstrates the unsustainability of Barpak. Conclusions from the study suggest place based and inclusive planning and policy formations that include locals as partners, identifying the possible ways to minimize the impact and implement these recommendations into the future policy and planning scenarios.

Keywords: earthquake, Nepal, reconstruction, settlement, transformation

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Authors: Samuel Sii, David Homewood, Brendan Dittmer, Tony Nzembela, Jonathan O’Brien, Niall Corcoran, Dinesh Agarwal

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Introduction: Innovation is key to the advancement of medicine and improvement in patient care. This is particularly true in surgery, where pioneering techniques have transformed operative management from a historically highly risky peri-morbid and disfiguring to the contemporary low-risk, sterile and minimally invasive treatment modality. There is a delicate balance between enabling innovation and minimizing patient harm. Publication and discussion of novel surgical techniques allow for independent expert review. Recent journals have increasingly stringent requirements for publications and often require larger case volumes for novel techniques to be published. This potentially impairs the initial publication of novel techniques and slows innovation. The historical perspective provides a better understanding of how requirements for the publication of new techniques have evolved over time. This is essential in overcoming challenges in developing novel techniques. Aims and Objectives: We explore how novel techniques in Urology have been published over the past 200 years. Our objective is to describe the trend and publication requirements of novel urological techniques, both historical and present. Methods: We assessed all major urological operations using multipronged historical analysis. An initial literature search was carried out through PubMed and Google Scholar for original literature descriptions, followed by reference tracing. The first publication of each pioneering urological procedure was recorded. Data collected includes the year of publication, description of the procedure, number of cases and outcomes. Results: 65 papers describing pioneering techniques in Urology were identified. These comprised of 2 experimental studies, 17 case reports and 46 case series. These papers described various pioneering urological techniques in urological oncology, reconstructive urology and endourology. We found that, historically, techniques were published with smaller case numbers. Often, the surgical technique itself was a greater focus of the publication than patient outcome data. These techniques were often adopted prior to larger publications. In contrast, the risks and benefits of recent novel techniques are often well-defined prior to adoption. This historical perspective is important as recent journals have requirements for larger case series and data outcomes. This potentially impairs the initial publication of novel techniques and slows innovation. Conclusion: A better understanding of historical publications and their effect on the adoption of urological techniques into common practice could assist the current generation of Urologists in formulating a safe, efficacious process in promoting surgical innovation and the development of novel surgical techniques. We propose the reassessment of requirements for the publication of novel operative techniques by splitting technical perspectives and data-orientated case series. Existing frameworks such as IDEAL and ASERNIP-S should be integrated into current processes when investigating and developing new surgical techniques to ensure efficacious and safe innovation within surgery is encouraged.

Keywords: urology, surgical innovation, novel surgical techniques, publications

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Authors: Tarek Saadawi, Rosario Gennaro, Jonathan Akeley

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There is rapidly growing demand for professionals to fill positions in Cybersecurity. This is recognized as a national priority both by government agencies and the private sector. Cybersecurity is a very wide technical area which encompasses all measures that can be taken in an electronic system to prevent criminal or unauthorized use of data and resources. This requires defending computers, servers, networks, and their users from any kind of malicious attacks. The need to address this challenge has been recognized globally but is particularly acute in the New York metropolitan area, home to some of the largest financial institutions in the world, which are prime targets of cyberattacks. In New York State alone, there are currently around 57,000 jobs in the Cybersecurity industry, with more than 23,000 unfilled positions. The Cybersecurity Program at City College is a collaboration between the Departments of Computer Science and Electrical Engineering. In Fall 2020, The City College of New York matriculated its first students in theCybersecurity Master of Science program. The program was designed to fill gaps in the previous offerings and evolved out ofan established partnership with Facebook on Cybersecurity Education. City College has designed a program where courses, curricula, syllabi, materials, labs, etc., are developed in cooperation and coordination with industry whenever possible, ensuring that students graduating from the program will have the necessary background to seamlessly segue into industry jobs. The Cybersecurity Program has created multiple pathways for prospective students to obtain the necessary prerequisites to apply in order to build a more diverse student population. The program can also be pursued on a part-time basis which makes it available to working professionals. Since City College’s Cybersecurity M.S. program was established to equip students with the advanced technical skills needed to thrive in a high-demand, rapidly-evolving field, it incorporates a range of pedagogical formats. From its outset, the Cybersecurity program has sought to provide both the theoretical foundations necessary for meaningful work in the field along with labs and applied learning projects aligned with skillsets required by industry. The efforts have involved collaboration with outside organizations and with visiting professors designing new courses on topics such as Adversarial AI, Data Privacy, Secure Cloud Computing, and blockchain. Although the program was initially designed with a single asynchronous course in the curriculum with the rest of the classes designed to be offered in-person, the advent of the COVID-19 pandemic necessitated a move to fullyonline learning. The shift to online learning has provided lessons for future development by providing examples of some inherent advantages to the medium in addition to its drawbacks. This talk will address the structure of the newly-implemented Cybersecurity Master’s Program and discuss the innovations, challenges, and possible future directions.

Keywords: cybersecurity, new york, city college, graduate degree, master of science

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Authors: Yiorgos Hadjichristou

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The paper will focus on the strategic development deriving from the evolution of the traditional courtyard spatial organization towards a new, contemporary sustainable way of living. New sustainable approaches that engulf the social issues, the notion of place, the understanding of weather architecture blended together with the bioclimatic behaviour will be seen through a series of experimental case studies in the island of Cyprus, inspired and originated from its traditional wisdom, ranging from small scale of living to urban interventions. Weather and nature will be seen as co-architectural authors with architects as intelligently claimed by Jonathan Hill in his Weather Architecture discourse. Furthermore, following Pallasmaa’s understanding, the building will be seen not as an end itself and the elements of an architectural experience as having a verb form rather than being nouns. This will further enhance the notion of merging the subject-human and the object-building as discussed by Julio Bermudez. This eventually will enable to generate the discussion of the understanding of the building constructed according to the specifics of place and inhabitants, shaped by its physical and human topography as referred by Adam Sharr in relation to Heidegger’s thinking. The specificities of the divided island and the dealing with sites that are in vicinity with the diving Green Line will further trigger explorations dealing with the regeneration issues and the social sustainability offering unprecedented opportunities for innovative sustainable ways of living. The above premises will lead us to develop innovative strategies for a profound, both technical and social sustainability, which fruitfully yields to innovative living built environments, responding to the ever changing environmental and social needs. As a starting point, a case study in Kaimakli in Nicosia a refurbishment with an extension of a traditional house, already engulfs all the traditional/ vernacular wisdom of the bioclimatic architecture. It aims at capturing not only its direct and quite obvious bioclimatic features, but rather to evolve them by adjusting the whole house in a contemporary living environment. In order to succeed this, evolutions of traditional architectural elements and spatial conditions are integrated in a way that does not only respond to some certain weather conditions, but they integrate and blend the weather within the built environment. A series of innovations aiming at maximum flexibility is proposed. The house can finally be transformed into a winter enclosure, while for the most part of the year it turns into a ‘camping’ living environment. Parallel to experimental interventions in existing traditional units, we will proceed examining the implementation of the same developed methodology in designing living units and complexes. Malleable courtyard organizations that attempt to blend the traditional wisdom with the contemporary needs for living, the weather and nature with the built environment will be seen tested in both horizontal and vertical developments. A new social identity of people, directly involved and interacting with the weather and climatic conditions will be seen as the result of balancing the social with the technological sustainability, the immaterial and the material aspects of the built environment.

Keywords: building as a verb, contemporary living, traditional bioclimatic wisdom, weather architecture

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Authors: Jonathan D. Recchi

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Introduction: Workplace violence is a major concern for nurses throughout the United States and is a rising occupational health hazard that has been exacerbated by both the Covid-19 pandemic and increasing patient and family member incivility. De-escalation training has been found to be an evidence-based tool for emergency department nurses to help avoid or mitigate high-risk situations that could lead to workplace violence. Many healthcare organizations either do not provide de-escalation training to their staff or only provide it sparingly, such as during new employee orientation. There is limited research in the literature on the psychological benefits of de-escalation training. Purpose: The purpose of this study is to determine if there are psychological and organizational advantages to providing emergency department nurses with de-escalation training. Equipping emergency department nurses with skills that are essential to de-escalate violent or potentially violent patients may help prevent physical, mental, and/or psychological damage to the nurse because of violence and/or threatening acts. The hypothesis is that providing de-scalation training to emergency department nurses will lead to increased nurse confidence in dealing with aggressive patients, increased resiliency, increased professional quality of life, and increased intention to stay with their current organization. This study aims to show that organizations would benefit from providing de-escalation training to all nurses operating in high-risk areas on a regular basis. Significance: Showing psychological benefits to providing evidence-based de-escalation training can provide healthcare organizations with the ability to retain a more resilient and prepared workforce. Method: This study uses a pre-experimental cross-sectional pre-/post-test design using a convenience sample of emergency department registered nurses employed across Jefferson Health Northeast (Jefferson Torresdale, Jefferson Bucks, and Jefferson Frankford. Inclusion criteria include registered nurses who work full or part-time, with 51% or more of their clinical time spent in direct clinical care. Excluded from participation are registered nurses in orientation, per-diem nurses, temporary and/or travel nurses, nurses who spend less than 51% of their time in direct patient care, and nurses who have received de-escalation training within the past two years. This study uses the Connor-Davidson Resilience Scale 10 (CD-RISC-10), the Clinician Confidence in Coping with Patient Aggression Scale, the Press Ganey Intention To Stay question, and the Professional Quality of Life Scale. Results: A Paired t-Test will be used to analyze the mean scores of the three scales and one question pre and post-intervention to determine if there is a statistically significant difference in RN resiliency, confidence in coping with patient aggression, intention to stay, and professional quality of life. Discussion and Conclusions: Upon completion, the outcomes of this intervention will show the importance of providing evidence-based de-escalation training to all nurses operating within the emergency department.

Keywords: de-escalation, nursing, emergency department, workplace violence

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Authors: Rebecca Sager, Gary Adler, Damon Mayrl, Jonathan Cooley

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The United States’ unique constitutional structure and religious roots have fostered the flourishing of local communities through the close interaction of church and state. Today, these local relationships play out in these circumstances, including increased religious diversity and changing jurisprudence to more accommodating church-state interaction. This project seeks to understand the meanings of church-state interaction among diverse religious leaders in a variety of local settings. Using data from interviews with over 200 religious leaders in six states in the US, we examine how religious groups interact with various non-elected and elected government officials. We have interviewed local religious actors in eight communities characterized by the difference in location and religious homogeneity. These include a small city within a major metropolitan area, several religiously diverse cities in various areas across the country, a small college town with religious diversity set in a religiously-homogenous rural area, and a small farming community with minimal religious diversity. We identified three types of religious actors in each of our geographic areas: congregations, religious non-profit organizations, and clergy coalitions. Given the well-known difficulties in identifying religious organizations, we used the following to construct a local population list from which to sample: the Association of Religion Data Archives ProPublica’s Nonprofit Explorer, Guidestar, and the Internal Revenue Service Exempt Business Master File. Our sample for selecting interviewees were stratified by three criteria: religious tradition (Christian v. non-Christian), sectarian orientation (Mainline/Catholic v. Evangelical Protestant), and organizational form (congregation vs. other). Each interview included the elicitation of local church-state interactions experienced by the organization and organizational members, the enumeration of information sources for navigating church-state interactions, and the personal and community background of interviewees. We coded interviews to identify the cognitive schema of “church” and “state,” the models of legitimate relations between the two, and discretion rules for managing interaction and avoiding conflict. We also enumerate arenas in which and issues for which local state officials are engaged. In this paper, we focus on Korean religious groups and examine how their interactions differ from other congregations, including other immigrant congregations. These churches were particularly common in one large metropolitan area. We find that Korean churches are much more likely to be concerned about any governmental interactions and have fewer connections than non-Korean churches leading to more disconnection from their communities. We argue that due to their status as new immigrant churches without a lot of community ties for many members and being in a large city, Korean churches were particularly concerned about too much interaction with any type of government officials, even ones that could be potentially helpful. While other immigrant churches were somewhat willing to work with government groups, such as Latino-based Catholic groups, Korean churches were the least likely to want to create these connections. Understanding these churches and how immigrant church identity varies and creates different types of interaction is crucial to understanding how church/state interaction can be more meaningful over space and place.

Keywords: religion, congregations, government, politics

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Authors: Jonathan Kissi, Baozhen Dai, Wisdom W. K. Pomegbe, Abdul-Basit Kassim

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Protecting patient’s digital information is a growing concern for healthcare institutions as people nowadays perpetually live their lives through telemedicine services. These telemedicine services have been confronted with several determinants that hinder their successful implementations, especially in developing countries. Identifying such determinants that influence the acceptance of telemedicine services is also a problem for healthcare professionals. Despite the tremendous increase in telemedicine services, its adoption, and use has been quite slow in some healthcare settings. Generally, it is accepted in today’s globalizing world that the success of telemedicine services relies on users’ satisfaction. Satisfying health professionals and patients are one of the crucial objectives of telemedicine success. This study seeks to investigate the determinants that influence health professionals’ intention to utilize telemedicine services in clinical activities in a sub-Saharan African country in West Africa (Ghana). A hybridized model comprising of health adoption models, including technology acceptance theory, diffusion of innovation theory, and protection of motivation theory, were used to investigate these quandaries. The study was carried out in four government health institutions that apply and regulate telemedicine services in their clinical activities. A structured questionnaire was developed and used for data collection. Purposive and convenience sampling methods were used in the selection of healthcare professionals from different medical fields for the study. The collected data were analyzed based on structural equation modeling (SEM) approach. All selected constructs showed a significant relationship with health professional’s behavioral intention in the direction expected from prior literature including perceived usefulness, perceived ease of use, management strategies, financial sustainability, communication channels, patients security threat, patients privacy risk, self efficacy, actual service use, user satisfaction, and telemedicine services systems securities threat. Surprisingly, user characteristics and response efficacy of health professionals were not significant in the hybridized model. The findings and insights from this research show that health professionals are pragmatic when making choices for technology applications and also their willingness to use telemedicine services. They are, however, anxious about its threats and coping appraisals. The identified significant constructs in the study may help to increase efficiency, quality of services, quality patient care delivery, and satisfactory user satisfaction among healthcare professionals. The implantation and effective utilization of telemedicine services in the selected hospitals will aid as a strategy to eradicate hardships in healthcare services delivery. The service will help attain universal health access coverage to all populace. This study contributes to empirical knowledge by identifying the vital factors influencing health professionals’ behavioral intentions to adopt telemedicine services. The study will also help stakeholders of healthcare to formulate better policies towards telemedicine service usage.

Keywords: telemedicine service, perceived usefulness, perceived ease of use, management strategies, security threats

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Authors: Felix Lankester, Alicia Davis, Safari Kinung'hi, Catherine Bunga, Shayo Alkara, Imam Mzimbiri, Jonathan Yoder, Sarah Cleaveland, Guy H. Palmer

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Achieving the London Declaration goal of a 90% reduction in neglected tropical diseases (NTDs) by 2030 requires cost-effective strategies that attain high and comprehensive coverage. The first objective of this trial was to assess the impact on cost and coverage of employing a novel integrative One Health approach linking two NTD control programs: mass drug administration (MDA) for soil-transmitted helminths in humans (STH) and mass dog rabies vaccination (MDRV). The second objective was to compare the coverage achieved by the MDA, a community-wide deworming intervention, with that of the existing national primary school-based deworming program (NSDP), with particular focus on the proportion of primary school-age children reached and their school enrolment status. Our approach was unconventional because, in line with the One Health approach to disease control, it coupled the responsibilities and resources of the Ministries responsible for human and animal health into one program with the shared aim of preventing multiple NTDs. The trial was carried out in hard-to-reach pastoral communities comprising 24 villages of the Ngorongoro District, Tanzania, randomly allocated to either Arm A (MDA and MDRV), Arm B (MDA only) or Arm C (MDRV only). Objective one: The percentage of people in each target village that received treatment through MDA in Arms A and B was 63% and 65%, respectively (χ2 = 1, p = 0.32). The percentage of dogs vaccinated in Arm A and C was 70% and 81%, respectively (χ2 =9, p = 0.003). It took 33% less time for a single person and a dog to attend the integrated delivery than two separate events. Cost per dose (including delivery) was lower under the integrated strategy, with delivery of deworming and rabies vaccination reduced by $0.13 (54%) and $0.85 (19%) per dose, respectively. Despite a slight reduction in the proportion of village dogs vaccinated in the integrated event, both the integrated and non-integrated strategies achieved the target threshold of 70% required to eliminate rabies. Objective two: The percentages of primary school age children enrolled in school that was reached by this trial (73%) and the existing NSDP (80%) were not significantly different (F = 0.9, p = 0.36). However, of the primary school age children treated in this trial, 46% were not enrolled in school. Furthermore, 86% of the people treated would have been outside the reach of the NSDP because they were not primary school age or were primary school age children not enrolled in school. The comparable reach, the substantial reductions in cost per dose delivered and the decrease in participants’ time support this integrated One Health approach to control multiple NTDs. Further, the recorded level of non-enrolment at primary school suggests that, in remote areas, school-based delivery strategies could miss a large fraction of school-age children and that programs that focus delivery solely at the level of the primary school will miss a substantial proportion of both primary school age children as well as other individuals from the community. We have shown that these populations can be effectively reached through extramural programs.

Keywords: canine mediated human rabies, integrated health interventions, mass drug administration, neglected tropical disease, One Health, soil-transmitted helminths

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Authors: Chinasa U. Imo, Queen Chikwendu, Jonathan Ajuma, Mario Banuelos

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Background: Sociocultural norms primarily influence the health-seeking behavior of populations in rural communities. In the Nkporo community, Abia State, Nigeria, their sociocultural perception of diseases runs counter to biomedical definitions, wherein they rely heavily on traditional medicine and practices. In a state where birth asphyxia and sepsis account for the significant causes of death for neonates, malaria leads to the causes of other mortalities, followed by common preventable diseases such as diarrhea, pneumonia, acute respiratory tract infection, malnutrition, and HIV/AIDS. Most local mothers attribute their health conditions and that of their children to witchcraft attacks, the hand of God, and ancestral underlining. This influences how they see antenatal and postnatal care, choice of place of accessing care and birth delivery, response to children's illnesses, immunization, and nutrition. Method: To implement a community health improvement program, we adopted an asset-based community development model to address health's normative and social determinants. The first step was to use a qualitative approach to conduct a community health needs baseline assessment, involving focus group discussions with twenty-five (25) youths aged 18-25, semi-structured interviews with ten (10) officers-in-charge of primary health centers, eight (8) ward health committee members, and nine (9) community leaders. Secondly, we designed an intervention program. Going forward, we will proceed with implementing and evaluating this program. Result: The priority needs identified by the communities were malaria, lack of clean drinking water, and the need for behavioral change information. The study also highlighted the significant influence of youths on their peers, family, and community as caregivers and information interpreters. Based on the findings, the NGO SieDi-Hub collaborated with the Abia State Ministry of Health, the State Primary Healthcare Agency, and Empower Next Generations to design a one-year "Community Health Youth Champions Pilot Program." Twenty (20) youths in the community were trained and equipped to champion a participatory approach to bridging the gap between access and delivery of primary healthcare, to adjust sociocultural norms to improve health equity for people in Nkporo community – with limited education, lack of access to health information, and quality healthcare facilities using an innovative community-led improvement approach. Conclusion: Youths play a vital role in achieving health equity, being a vulnerable population with significant influence. To ensure effective primary healthcare, strategies must include cultural humility. The asset-based community development model offers valuable tools, and this article will share ongoing lessons from the intervention's behavioral change strategies with young people.

Keywords: asset-based community development, community health, primary health systems strengthening, youth empowerment

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