Search results for: long term venous access
Commenced in January 2007
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Edition: International
Paper Count: 10438

Search results for: long term venous access

8368 A Quantitative Case Study Analysis of Store Format Contributors to U.S. County Obesity Prevalence in Virginia

Authors: Bailey Houghtaling, Sarah Misyak

Abstract:

Food access; the availability, affordability, convenience, and desirability of food and beverage products within communities, is influential on consumers’ purchasing and consumption decisions. These variables may contribute to lower dietary quality scores and a higher obesity prevalence documented among rural and disadvantaged populations in the United States (U.S.). Current research assessing linkages between food access and obesity outcomes has primarily focused on distance to a traditional grocery/supermarket store as a measure of optimality. However, low-income consumers especially, including U.S. Department of Agriculture’s Supplemental Nutrition Assistance Program (SNAP) participants, seem to utilize non-traditional food store formats with greater frequency for household dietary needs. Non-traditional formats have been associated with less nutritious food and beverage options and consumer purchases that are high in saturated fats, added sugars, and sodium. Authors’ formative research indicated differences by U.S. region and rurality in the distribution of traditional and non-traditional SNAP-authorized food store formats. Therefore, using Virginia as a case study, the purpose of this research was to determine if a relationship between store format, rurality, and obesity exists. This research applied SNAP-authorized food store data (food access points for SNAP as well as non-SNAP consumers) and obesity prevalence data by Virginia county using publicly available databases: (1) SNAP Retailer Locator, and; (2) U.S. County Health Rankings. The alpha level was set a priori at 0.05. All Virginia SNAP-authorized stores (n=6,461) were coded by format – grocery, drug, mass merchandiser, club, convenience, dollar, supercenter, specialty, farmers market, independent grocer, and non-food store. Simple linear regression was applied primarily to assess the relationship between store format and obesity. Thereafter, multiple variables were added to the regression to account for potential moderating relationships (e.g., county income, rurality). Convenience, dollar, non-food or restaurant, mass merchandiser, farmers market, and independent grocer formats were significantly, positively related to obesity prevalence. Upon controlling for urban-rural status and income, results indicated the following formats to be significantly related to county obesity prevalence with a small, positive effect: convenience (p=0.010), accounting for 0.3% of the variance in obesity prevalence; dollar (p=0.005; 0.5% of the variance), and; non-food (p=0.030; 1.3% of the variance) formats. These results align with current literature on consumer behavior at non-traditional formats. For example, consumers’ food and beverage purchases at convenience and dollar stores are documented to be high in saturated fats, added sugars, and sodium. Further, non-food stores (i.e., quick-serve restaurants) often contribute to a large portion of U.S. consumers’ dietary intake and thus poor dietary quality scores. Current food access research investigates grocery/supermarket access and obesity outcomes. These results suggest more research is needed that focuses on non-traditional food store formats. Nutrition interventions within convenience, dollar, and non-food stores, for example, that aim to enhance not only healthy food access but the affordability, convenience, and desirability of nutritious food and beverage options may impact obesity rates in Virginia. More research is warranted utilizing the presented investigative framework in other U.S. and global regions to explore the role and the potential of non-traditional food store formats to prevent and reduce obesity.

Keywords: food access, food store format, non-traditional food stores, obesity prevalence

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8367 Impact of Organizational Culture and Strategic Leadership on Organizational Resilience

Authors: Anyia Nduka, Aslan Bin Amad Senin

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Organizational culture, strategic leadership and organizational resilience have gained significant attention in recent years. This study aims to examine the relationship between these factors and their combined influence on an organization's ability to adapt and thrive in the face of challenges and disruptions. A mixed-methods approach, combining quantitative survey data and qualitative interviews with leaders and employees from cohort organizations within the industry. The quantitative phase involves measuring organizational culture, strategic leadership behaviours, and organizational resilience using standardized scales. This study highlighted the significance of organizational culture and strategic leadership in building and sustaining organizational resilience. Preliminary findings suggest a strong positive relationship between a resilient organizational culture and strategic leadership practices. Secondly, Organizations can enhance their capacity to respond to disruptions, exploit opportunities, and achieve long-term success in a rapidly changing business environment. Furthermore, the qualitative analysis reveals several key themes that elucidate the link between organizational culture, strategic leadership, and resilience. This study contributes to the growing body of knowledge on organizational resilience and strategic leadership, providing insights and practical implications for leaders and practitioners seeking to strengthen their organizations' resilience capabilities. Further research is needed to explore the specific mechanisms and contextual factors that influence the relationship between these variables in different organizational contexts and industries.

Keywords: organizational culture, strategic leadership, organizational resilience, leadership

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8366 Electric Arc Furnaces as a Source of Voltage Fluctuations in the Power System

Authors: Zbigniew Olczykowski

Abstract:

The paper presents the impact of work on the electric arc furnace power grid. The arc furnace operating will be modeled at different power conditions of steelworks. The paper will describe how to determine the increase in voltage fluctuations caused by working in parallel arc furnaces. The analysis of indicators characterizing the quality of electricity recorded during several cycles of measurement made at the same time at three points grid, with different power and different short-circuit rated voltage, will be carried out. The measurements analysis presented in this paper were conducted in the mains of one of the Polish steel. The indicators characterizing the quality of electricity was recorded during several cycles of measurement while making measurements at three points of different power network short-circuit power and various voltage ratings. Measurements of power quality indices included the one-week measurement cycles in accordance with the EN-50160. Data analysis will include the results obtained during the simultaneous measurement of three-point grid. This will determine the actual propagation of interference generated by the device. Based on the model studies and measurements of quality indices of electricity we will establish the effect of a specific arc on the mains. The short-circuit power network’s minimum value will also be estimated, this is necessary to limit the voltage fluctuations generated by arc furnaces.

Keywords: arc furnaces, long-term flicker, measurement and modeling of power quality, voltage fluctuations

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8365 Simulation of Hydrogenated Boron Nitride Nanotube’s Mechanical Properties for Radiation Shielding Applications

Authors: Joseph E. Estevez, Mahdi Ghazizadeh, James G. Ryan, Ajit D. Kelkar

Abstract:

Radiation shielding is an obstacle in long duration space exploration. Boron Nitride Nanotubes (BNNTs) have attracted attention as an additive to radiation shielding material due to B10’s large neutron capture cross section. The B10 has an effective neutron capture cross section suitable for low energy neutrons ranging from 10-5 to 104 eV and hydrogen is effective at slowing down high energy neutrons. Hydrogenated BNNTs are potentially an ideal nanofiller for radiation shielding composites. We use Molecular Dynamics (MD) Simulation via Material Studios Accelrys 6.0 to model the Young’s Modulus of Hydrogenated BNNTs. An extrapolation technique was employed to determine the Young’s Modulus due to the deformation of the nanostructure at its theoretical density. A linear regression was used to extrapolate the data to the theoretical density of 2.62g/cm3. Simulation data shows that the hydrogenated BNNTs will experience a 11% decrease in the Young’s Modulus for (6,6) BNNTs and 8.5% decrease for (8,8) BNNTs compared to non-hydrogenated BNNT’s. Hydrogenated BNNTs are a viable option as a nanofiller for radiation shielding nanocomposite materials for long range and long duration space exploration.

Keywords: boron nitride nanotube, radiation shielding, young modulus, atomistic modeling

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8364 Utilization, Barriers and Determinants of Emergency Medical Services in Mekelle City, Tigray, Ethiopia: A Community-Based Cross-Sectional Study

Authors: Goitom Molalign Takele, Tsegalem Hailemariam Ballo, Kiros Belay Gebrekidan, Birhan Gebresilassie Gebregiorgis

Abstract:

Background: Emergency medical services (EMS) are services that provide out-of-hospital emergency medical care to injured or ill peoples, and transporting to definitive care. EMS is an integral part of the emergency medical system and has been associated with decreased morbidity and mortality related to emergency cases. The aim of this study was to assess the utilization, barriers, and determinants of EMS in Mekelle, Ethiopia. Methods: A community-based cross-sectional study was conducted in selected sub-cities of Mekelle. A multistage sampling method was employed to recruit study participants, and data were collected by trained data collectors using an interviewer-administered questionnaire. Multivariate logistic regression analysis was used to examine the statistical association of the determinants of EMS utilization. Results: Half (50.5%) of the respondents had experienced or witnessed an emergency incident in the past year. The common means of transportations used were Bajaj’s (39.2%) and ambulances (22.7%). Majority (88.1%) of the respondents did not knew the EMS access phone number of an ambulance. As their preferred mode of transportation in case of emergency conditions, 42.2% of the participants reported an ambulance, followed by Bajaj 33.7%. Where participants who had gynecologic emergencies were 9.4 times (AOR=9.4, 95% CI: 1.04, 85, p=0.046), and those who knew any ambulance numbers were 3.6 times (AOR=3.6, 95% CI: 1.22, 10.8, p=0.02) more likely to use ambulance services in case of emergencies. Conclusion: The ambulance utilization level in Mekelle city was low and victims of emergency conditions were being transported mainly using public transports such as Bajaj’s and taxis. Even though the perception of the public towards EMS services is favorable, lack of awareness of EMS access, and lack of integrated EMS system in the city are the barriers that may have contributed to the low utilization. Actions to improve EMS access and integrating the system are warranted to promote the services utilization.

Keywords: emergency medical services, utilization, Mekelle, barriers

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8363 Challenges in Developing a World Class Sustainable Food Organization

Authors: Baskar Kotte

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Many organizations are constantly striving to implement numerous techniques for long-term sustainability, for food related organizations it is imperative to conceptualize the critical concepts which constitute food safety sustainability. This presentation provides three critical pillars to develop a sustainable organization. Financial sustainability, regulatory sustainability and excellence standards sustainability are the three components which practiced and implemented effectively with process performance metrics defined objectives and targets lead to sustainable and safe food organizations. The participants take away a well-developed concept diagram with all elements impacting sustainability. Proven disciplined path which worked to achieve desired results is presented for effective implementation. Effective implementation of this proven disciplined path positions organizations to achieve world class status with bottomline improvement. Additionally, this presentation highlights critical terms, principles and implementation difficulties related to using the proven disciplined path. This presentation is beneficial for business leaders, food safety compliance managers, food safety practitioners, financial managers, Lean & Six sigma continual improvement managers, BRC/SQF/ IFS / FSSC 22000 practitioners and food manufacturing personnel.

Keywords: food safety, sustainability, regulatory, lean, six sigma, bottom-line improvement disciplined path

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8362 Real-Time Web Map Service Based on Solar-Powered Unmanned Aerial Vehicle

Authors: Sunghun Jung

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The existing web map service providers contract with the satellite operators to update their maps by paying an astronomical amount of money, but the cost could be minimized by operating a cheap and small UAV. In contrast to the satellites, we only need to replace aged battery packs from time to time for the usage of UAVs. Utilizing both a regular camera and an infrared camera mounted on a small, solar-powered, long-endurance, and hoverable UAV, daytime ground surface photographs, and nighttime infrared photographs will be continuously and repeatedly uploaded to the web map server and overlapped with the existing ground surface photographs in real-time. The real-time web map service using a small, solar-powered, long-endurance, and hoverable UAV can also be applied to the surveillance missions, in particular, to detect border area intruders. The improved real-time image stitching algorithm is developed for the graphic map data overlapping. Also, a small home server will be developed to manage the huge size of incoming map data. The map photographs taken at tens or hundreds of kilometers by a UAV would improve the map graphic resolution compared to the map photographs taken at thousands of kilometers by satellites since the satellite photographs are limited by weather conditions.

Keywords: long-endurance, real-time web map service (RWMS), solar-powered, unmanned aerial vehicle (UAV)

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8361 Frequency Analysis of Minimum Ecological Flow and Gage Height in Indus River Using Maximum Likelihood Estimation

Authors: Tasir Khan, Yejuan Wan, Kalim Ullah

Abstract:

Hydrological frequency analysis has been conducted to estimate the minimum flow elevation of the Indus River in Pakistan to protect the ecosystem. The Maximum likelihood estimation (MLE) technique is used to estimate the best-fitted distribution for Minimum Ecological Flows at nine stations of the Indus River in Pakistan. The four selected distributions, Generalized Extreme Value (GEV) distribution, Generalized Logistics (GLO) distribution, Generalized Pareto (GPA) distribution, and Pearson type 3 (PE3) are fitted in all sites, usually used in hydro frequency analysis. Compare the performance of these distributions by using the goodness of fit tests, such as the Kolmogorov Smirnov test, Anderson darling test, and chi-square test. The study concludes that the Maximum Likelihood Estimation (MLE) method recommended that GEV and GPA are the most suitable distributions which can be effectively applied to all the proposed sites. The quantiles are estimated for the return periods from 5 to 1000 years by using MLE, estimations methods. The MLE is the robust method for larger sample sizes. The results of these analyses can be used for water resources research, including water quality management, designing irrigation systems, determining downstream flow requirements for hydropower, and the impact of long-term drought on the country's aquatic system.

Keywords: minimum ecological flow, frequency distribution, indus river, maximum likelihood estimation

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8360 Correlation to Predict Thermal Performance According to Working Fluids of Vertical Closed-Loop Pulsating Heat Pipe

Authors: Niti Kammuang-lue, Kritsada On-ai, Phrut Sakulchangsatjatai, Pradit Terdtoon

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The objectives of this paper are to investigate effects of dimensionless numbers on thermal performance of the vertical closed-loop pulsating heat pipe (VCLPHP) and to establish a correlation to predict the thermal performance of the VCLPHP. The CLPHPs were made of long copper capillary tubes with inner diameters of 1.50, 1.78, and 2.16mm and bent into 26 turns. Then, both ends were connected together to form a loop. The evaporator, adiabatic, and condenser sections length were equal to 50 and 150 mm. R123, R141b, acetone, ethanol, and water were chosen as variable working fluids with constant filling ratio of 50% by total volume. Inlet temperature of heating medium and adiabatic section temperature was constantly controlled at 80 and 50oC, respectively. Thermal performance was represented in a term of Kutateladze number (Ku). It can be concluded that when Prandtl number of liquid working fluid (Prl), and Karman number (Ka) increases, thermal performance increases. On contrary, when Bond number (Bo), Jacob number (Ja), and Aspect ratio (Le/Di) increases, thermal performance decreases. Moreover, the correlation to predict more precise thermal performance has been successfully established by analyzing on all dimensionless numbers that have effect on the thermal performance of the VCLPHP.

Keywords: vertical closed-loop pulsating heat pipe, working fluid, thermal performance, dimensionless parameter

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8359 A Vaccination Program to Control an Outbreak of Acute Hepatitis A among MSM in Taiwan, 2016

Authors: Ying-Jung Hsieh, Angela S. Huang, Chu-Ming Chiu, Yu-Min Chou, Chin-Hui Yang

Abstract:

Background and Objectives: Hepatitis A is primarily acquired by the fecal-oral route through person-to-person contact or ingestion of contaminated food or water. During 2010 to 2014, an average of 83 cases of locally-acquired disease was reported to Taiwan’s notifiable disease system. Taiwan Centers for Disease Control (TCDC) identified an outbreak of acute hepatitis A which began in June 2015. Of the 126 cases reported in 2015, 103 (82%) cases were reported during June–December and 95 cases (92%) of them were male. The average age of all male cases was 31 years (median, 29 years; range, 15–76 years). Among the 95 male cases, 49 (52%) were also infected with HIV, and all reported to have had sex with other men. To control this outbreak, TCDC launched a free hepatitis A vaccination program in January 2016 for close contacts of confirmed hepatitis A cases, including family members, sexual partners, and household contacts. Effect of the vaccination program was evaluated. Methods: All cases of hepatitis A reported to the National Notifiable Disease Surveillance System were included. A case of hepatitis A was defined as a locally-acquired disease in a person who had acute clinical symptoms include fever, malaise, loss of appetite, nausea or abdominal discomfort compatible with hepatitis, and tested positive for anti-HAV IgM during June 2015 to June 2016 in Taiwan. The rate of case accumulation was calculated using a simple regression model. Results: During January–June 2016, there were 466 cases of hepatitis A reported; of the 243 (52%) who were also infected with HIV, 232 (95%) had a history of having sex with men. Of the 346 cases that were followed up, 259 (75%) provided information on contacts but only 14 (5%) of them provided the name of their sexual partners. Among the 602 contacts reported, 349 (58%) were family members, 14 (2%) were sexual partners, and 239 (40%) were other household contacts. Among the 602 contacts eligible for free hepatitis A vaccination, 440 (73%) received the vaccine. There were 87 (25%) cases that refused to disclose their close contacts. The average case accumulation rate during January–June 2016 was 21.7 cases per month, which was 6.8 times compared to the average case accumulation rate during June–December 2015 of 3.2 cases per month. Conclusions: Despite vaccination program aimed to provide free hepatitis A vaccine to close contacts of hepatitis A patients, the outbreak continued and even gained momentum in transmission. Refusal by hepatitis A patients to provide names of their close contacts and rejection of contacts to take the hepatitis A vaccine may have contributed to the poor effect of the program. Targeted vaccination efforts of all MSM may be needed to control the outbreak among this population in the short term. In the long term, universal vaccination program is needed to prevent the infection of hepatitis A.

Keywords: hepatitis A, HIV, men who have sex with men, vaccination

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8358 Identification of Hedgerows in the Agricultural Landscapes of Mugada within Bartın Province, Turkey

Authors: Yeliz Sarı Nayim, B. Niyami Nayim

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Biotopes such as forest areas rich in biodiversity, wetlands, hedgerows and woodlands play important ecological roles in agricultural landscapes. Of these semi-natural areas and features, hedgerows are the most common landscape elements. Their most significant features are that they serve as a barrier between the agricultural lands, serve as shelter, add aesthetical value to the landscape and contribute significantly to the wildlife and biodiversity. Hedgerows surrounding agricultural landscapes also provide an important habitat for pollinators which are important for agricultural production. This study looks into the identification of hedgerows in agricultural lands in the Mugada rural area within Bartın province, Turkey. From field data and-and satellite images, it is clear that in this area, especially around rural settlements, large forest areas have been cleared for settlement and agriculture. A network of hedgerows is also apparent, which might potentially play an important role in the otherwise open agricultural landscape. We found that these hedgerows serve as an ecological and biological corridor, linking forest ecosystems. Forest patches of different sizes and creating a habitat network across the landscape. Some examples of this will be presented. The overall conclusion from the study is that ecologically, biologically and aesthetically important hedge biotopes should be maintained in the long term in agricultural landscapes such as this. Some suggestions are given for how they could be managed sustainably into the future.

Keywords: agricultural biotopes, Hedgerows, landscape ecology, Turkey

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8357 Variability of Surface Air Temperature in Sri Lanka and Its Relation to El Nino Southern Oscillation and Indian Ocean Dipole

Authors: Athdath Waduge Susantha Janaka Kumara, Xiefei Zhi, Zin Mie Mie Sein

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Understanding the air temperature variability is crucially important for disaster risk reduction and management. In this study, we used 15 synoptic meteorological stations to assess the spatiotemporal variability of air temperature over Sri Lanka during 1972–2021. The empirical orthogonal function (EOF), Principal component analysis (PCA), Mann-Kendall test, power spectrum analysis and correlation coefficient analysis were used to investigate the long-term trends of air temperature and their possible relation to sea surface temperature (SST) over the region. The results indicate that an increasing trend in air temperature was observed with the abrupt climate change noted in the year 1994. The spatial distribution of EOF1 (63.5%) shows the positive and negative loading dipole patterns from south to northeast, while EOF2 (23.4%) explains warmer (colder) in some parts of central (south and east) areas. The power spectrum of PC1 (PC2) indicates that there is a significant period of 3-4 years (quasi-2 years). Moreover, Indian Ocean Dipole (IOD) provides a strong positive correlation with the air temperature of Sri Lanka, while the EL Nino Southern Oscillation (ENSO) presents a weak negative correlation. Therefore, IOD events led to higher temperatures in the region. This study’s findings can help disaster risk reduction and management in the country.

Keywords: air temperature, interannaul variability, ENSO, IOD

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8356 An Analytical Study on Rotational Capacity of Beam-Column Joints in Unit Modular Frames

Authors: Kyung-Suk Choi, Hyung-Joon Kim

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Modular structural systems are constructed using a method that they are assembled with prefabricated unit modular frames on-site. This provides a benefit that can significantly reduce building construction time. Their structural design is usually carried out under the assumption that the load-carrying mechanism is similar to that of a traditional steel moment-resisting system. However, both systems are different in terms of beam-column connection details which may strongly influence the lateral structural behavior. Specially, the presence of access holes in a beam-column joint of a unit modular frame could cause undesirable failure during strong earthquakes. Therefore, this study carried out finite element analyses (FEM) of unit modular frames to investigate the cyclic behavior of beam-column joints with the structural influence of access holes. Analysis results show that the unit modular frames present stable cyclic response with large deformation capacities, and their joints are classified into semi-rigid connections.

Keywords: unit modular frame, steel moment connection, nonlinear analytical model, moment-rotation relation

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8355 Food and Agricultural Waste Management for Sustainable Agriculture

Authors: Shubhangi Salokhe

Abstract:

Agriculture encompasses crop and livestock production, forestry, and fisheries for food and non-food products. Farmers combine land, water, commercial inputs, labor, and their management skills into practices and systems that produce food and fibre. Harvesting of agricultural produce is either followed by the processing of fresh produce or storage for later consumption. All these activities result in a vast generation of waste in terms of crop residue or food waste. So, a large amount of agricultural waste is produced every year. Waste arising from food and agricultural sectors has the potential for vast applications. So, agricultural waste management is an essential component of sustainable agriculture. The major portion of the waste comes from the residues of crops on farms, food processing, livestock, aquaculture, and agro-industry waste. Therefore, management of these agricultural wastes is an important task, and it requires robust strategic planning. It can contribute to three pillars of sustainable agriculture development. It protects the environment (environmental pillar), enhances the livelihoods of farmers (economic pillar), and can contribute to increasing the sustainability of the agricultural sector (social pillar). This paper addresses the essential technological aspects, possible solutions, and sound policy concerns to accomplish long-term way out of agriculture waste management and to minimize the negative impact of waste on the environment. The author has developed a sustainable agriculture waste management model for improving the sustainability of agriculture.

Keywords: agriculture, development, management, waste

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8354 Optimizing Heavy-Duty Green Hydrogen Refueling Stations: A Techno-Economic Analysis of Turbo-Expander Integration

Authors: Christelle Rabbat, Carole Vouebou, Sary Awad, Alan Jean-Marie

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Hydrogen has been proven to be a viable alternative to standard fuels as it is easy to produce and only generates water vapour and zero carbon emissions. However, despite the hydrogen benefits, the widespread adoption of hydrogen fuel cell vehicles and internal combustion engine vehicles is impeded by several challenges. The lack of refueling infrastructures remains one of the main hindering factors due to the high costs associated with their design, construction, and operation. Besides, the lack of hydrogen vehicles on the road diminishes the economic viability of investing in refueling infrastructure. Simultaneously, the absence of accessible refueling stations discourages consumers from adopting hydrogen vehicles, perpetuating a cycle of limited market uptake. To address these challenges, the implementation of adequate policies incentivizing the use of hydrogen vehicles and the reduction of the investment and operation costs of hydrogen refueling stations (HRS) are essential to put both investors and customers at ease. Even though the transition to hydrogen cars has been rather slow, public transportation companies have shown a keen interest in this highly promising fuel. Besides, their hydrogen demand is easier to predict and regulate than personal vehicles. Due to the reduced complexity of designing a suitable hydrogen supply chain for public vehicles, this sub-sector could be a great starting point to facilitate the adoption of hydrogen vehicles. Consequently, this study will focus on designing a chain of on-site green HRS for the public transportation network in Nantes Metropole leveraging the latest relevant technological advances aiming to reduce the costs while ensuring reliability, safety, and ease of access. To reduce the cost of HRS and encourage their widespread adoption, a network of 7 H35-T40 HRS has been designed, replacing the conventional J-T valves with turbo-expanders. Each station in the network has a daily capacity of 1,920 kg. Thus, the HRS network can produce up to 12.5 tH2 per day. The detailed cost analysis has revealed a CAPEX per station of 16.6 M euros leading to a network CAPEX of 116.2 M euros. The proposed station siting prioritized Nantes metropole’s 5 bus depots and included 2 city-centre locations. Thanks to the turbo-expander technology, the cooling capacity of the proposed HRS is 19% lower than that of a conventional station equipped with J-T valves, resulting in significant CAPEX savings estimated at 708,560 € per station, thus nearly 5 million euros for the whole HRS network. Besides, the turbo-expander power generation ranges from 7.7 to 112 kW. Thus, the power produced can be used within the station or sold as electricity to the main grid, which would, in turn, maximize the station’s profit. Despite the substantial initial investment required, the environmental benefits, cost savings, and energy efficiencies realized through the transition to hydrogen fuel cell buses and the deployment of HRS equipped with turbo-expanders offer considerable advantages for both TAN and Nantes Metropole. These initiatives underscore their enduring commitment to fostering green mobility and combatting climate change in the long term.

Keywords: green hydrogen, refueling stations, turbo-expander, heavy-duty vehicles

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8353 Post-occupancy Evaluation of Greenway Based on Multi-source data : A Case Study of Jincheng Greenway in Chengdu

Authors: Qin Zhu

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Under the development concept of Park City, Tianfu Greenway system, as the basic and pre-configuration element of Chengdu Global Park construction, connects urban open space with linear and circular structures and undertakes and exerts the ecological, cultural and recreational functions of the park system. Chengdu greenway construction is in full swing. In the process of greenway planning and construction, the landscape effect of greenway on urban quality improvement is more valued, and the long-term impact of crowd experience on the sustainable development of greenway is often ignored. Therefore, it is very important to test the effectiveness of greenway construction from the perspective of users. Taking Jincheng Greenway in Chengdu as an example, this paper attempts to introduce multi-source data to construct a post-occupancy evaluation model of greenway and adopts behavior mapping method, questionnaire survey method, web text analysis and IPA analysis method to comprehensively evaluate the user 's behavior characteristics and satisfaction. According to the evaluation results, we can grasp the actual behavior rules and comprehensive needs of users so that the experience of building greenways can be fed back in time and provide guidance for the optimization and improvement of built greenways and the planning and construction of future greenways.

Keywords: multi-source data, greenway, IPA analysis, post -occupancy evaluation (POE)

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8352 Examining the Relationship Between Traditional Property Rights and Online Intellectual Property Rights in the Digital Age

Authors: Luljeta Plakolli-Kasumi

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In the digital age, the relationship between traditional property rights and online intellectual property rights is becoming increasingly complex. On the one hand, the internet and advancements in technology have allowed for the widespread distribution and use of digital content, making it easier for individuals and businesses to access and share information. On the other hand, the rise of digital piracy and illegal file-sharing has led to increased concerns about the protection of intellectual property rights. This paper aims to examine the relationship between traditional property rights and online intellectual property rights in the digital age by analyzing the current legal frameworks, key challenges and controversies that arise, and potential solutions for addressing these issues. The paper will look at how traditional property rights concepts such as ownership and possession are being applied in the online context and how they intersect with new and evolving forms of intellectual property such as digital downloads, streaming services, and online content creation. It will also discuss the tension between the need for strong intellectual property protection to encourage creativity and innovation and the public interest in promoting access to information and knowledge. Ultimately, the paper will explore how the legal system can adapt to better balance the interests of property owners, creators, and users in the digital age.

Keywords: intellectual property, traditional property, digital age, digital content

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8351 Impact of Gender Difference on Crop Productivity: The Case of Decha Woreda, Ethiopia

Authors: Getinet Gezahegn Gebre

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The study examined the impact of gender differences on Crop productivity in Decha woreda of southwest Kafa zone, located 140 Km from Jimma Town and 460 km southwest of Addis Ababa, between Bonga town and Omo River. The specific objectives were to assess the extent to which the agricultural production system is gender oriented, to examine access and control over productive resources, and to estimate men’s and women’s productivity in agriculture. Cross-sectional data collected from a total of 140 respondents were used in this study, whereby 65 were female-headed and 75 were male-headed households. The data were analyzed by using Statistical Package for Social Science (SPSS). Descriptive statistics such as frequency, mean, percentage, t-test and chi-square were used to summarize and compare the information between the two groups. Moreover, Cobb-Douglas(CD) production function was used to estimate the productivity difference in agriculture between male and female-headed households. Results of the study showed that male-headed households (MHH) own more productive resources such as land, livestock, labor and other agricultural inputs as compared to female-headed households (FHH). Moreover, the estimate of CD production function shows that livestock, herbicide use, land size and male labor were statistically significant for MHH, while livestock, land size, herbicides use and female labor were significant variables for FHH. The crop productivity difference between MHH and FHH was about 68.83% in the study area. However, if FHH had equal access to the inputs as MHH, the gross value of the output would be higher by 23.58% for FHH. This might suggest that FHH would be more productive than MHH if they had equal access to inputs as MHH. Based on the results obtained, the following policy implication can be drawn: accessing FHH to inputs that increase the productivity of agriculture, such as herbicides, livestock and male labor; increasing the productivity of land; and introducing technologies that reduce the time and energy of women, especially for enset processing.

Keywords: gender difference, crop productivity, GDP, efficiency

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8350 Women’s Perceptions of DMPA-SC Self-Injection in Malawi

Authors: Mandayachepa C. Nyando, Lauren Suchman, Innocencia Mtalimanja, Address Malata, Tamanda Jumbe, Martha Kamanga, Peter Waiswa

Abstract:

Background: Subcutaneous depot medroxyprogesterone acetate (DMPA-SC) is a new innovation in contraceptive methods that allow users to inject themselves with a hormonal contraceptive in their own homes. Self-injection (SI) of DMPA-SC has the potential to improve the accessibility of family planning to women who want it and who are capable of injecting themselves. Malawi started implementing this new innovation in 2018. SI was incorporated into the DMPA-SC delivery strategy from its outset. Methodology: This study involved two districts in Malawi where DMPA-SC SI was rolled out: Mulanje and Ntchisi. We used a qualitative cross-sectional study design where 60 in-depth interviews were conducted with women of reproductive age group stratified as 15-45 age band. These included women who were SI users, non-users, and any woman who was on any contraceptive methods. The women participants were tape-recorded, and data were transcribed and then analysed using Dedoose software, where themes were categorised into mother and child themes. Results: Women perceived DMPA SC SI as uniquely private, convenient, and less painful when self-injected. In terms of privacy, women in Mulanje and Ntchisi especially appreciated that self-injecting allowed them to use covertly from partners. Some men do not allow their spouses to use modern contraceptive methods; hence women prefer to use them covertly. “… but I first reach out to men because the strongest power is answered by men (MJ015).” In addition, women reported that SI offers privacy from family/community and less contact with healthcare providers. These aspects of privacy were especially valued in areas where there is a high degree of mistrust around family planning and among those who feel judged or antagonized purchasing contraception, such as young unmarried women. Women also valued the convenience SI provided in terms of their ability to save time by injecting themselves at home rather than visiting a healthcare provider and having more reliable access to contraception, particularly in the face of stockouts. SI allows for stocking up on doses to accommodate shifting work schedules in case of future stockouts or hard times, such as the period of COVID-19, where there was a limitation in the movement of the people. Conclusion: Our findings suggest that SI may meet the needs of many women in Malawi as long as the barriers are eliminated. The barriers women mentioned include fear of self-inject and proper storage of the DMPA SC SI, and these barriers can be eliminated by proper training. The findings also set the scene for policy revision and direction at a national level and integrate the approach with national family planning strategies in Malawi. Findings provide insights that may guide future implementation strategies, strengthen non-clinic family planning access programs and stimulate continued research.

Keywords: family planning, Malawi, Sayana press, self-injection

Procedia PDF Downloads 61
8349 Capacity Oversizing for Infrastructure Sharing Synergies: A Game Theoretic Analysis

Authors: Robin Molinier

Abstract:

Industrial symbiosis (I.S) rely on two basic modes of cooperation between organizations that are infrastructure/service sharing and resource substitution (the use of waste materials, fatal energy and recirculated utilities for production). The former consists in the intensification of use of an asset and thus requires to compare the incremental investment cost to be incurred and the stand-alone cost faced by each potential participant to satisfy its own requirements. In order to investigate the way such a cooperation mode can be implemented we formulate a game theoretic model integrating the grassroot investment decision and the ex-post access pricing problem. In the first period two actors set cooperatively (resp. non-cooperatively) a level of common (resp. individual) infrastructure capacity oversizing to attract ex-post a potential entrant with a plug-and-play offer (available capacity, tariff). The entrant’s requirement is randomly distributed and known only after investments took place. Capacity cost exhibits sub-additive property so that there is room for profitable overcapacity setting in the first period under some conditions that we derive. The entrant willingness-to-pay for the access to the infrastructure is driven by both her standalone cost and the complement cost to be incurred in case she chooses to access an infrastructure whose the available capacity is lower than her requirement level. The expected complement cost function is thus derived, and we show that it is decreasing, convex and shaped by the entrant’s requirements distribution function. For both uniform and triangular distributions optimal capacity level is obtained in the cooperative setting and equilibrium levels are determined in the non-cooperative case. Regarding the latter, we show that competition is deterred by the first period investor with the highest requirement level. Using the non-cooperative game outcomes which gives lower bounds for the profit sharing problem in the cooperative one we solve the whole game and describe situations supporting sharing agreements.

Keywords: capacity, cooperation, industrial symbiosis, pricing

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8348 Expand Rabies Post-Exposure Prophylaxis to Where It Is Needed the Most

Authors: Henry Wilde, Thiravat Hemachudha

Abstract:

Human rabies deaths are underreported worldwide at 55,000 annual cases; more than of dengue and Japanese encephalitis. Almost half are children. A recent study from the Philippines of nearly 2,000 rabies deaths revealed that none of had received incomplete or no post exposure prophylaxis. Coming from a canine rabies endemic country, this is not unique. There are two major barriers to reducing human rabies deaths: 1) the large number of unvaccinated dogs and 2) post-exposure prophylaxis (PEP) that is not available, incomplete, not affordable, or not within reach for bite victims travel means. Only the first barrier, inadequate vaccination of dogs, is now being seriously addressed. It is also often not done effectively or sustainably. Rabies PEP has evolved as a complex, prolonged process, usually delegated to centers in larger cities. It is virtually unavailable in villages or small communities where most dog bites occur, victims are poor and usually unable to travel a long distance multiple times to receive PEP. Reseacrh that led to better understanding of the pathophysiology of rabies and immune responses to potent vaccines and immunoglobulin have allowed shortening and making PEP more evidence based. This knowledge needs to be adopted and applied so that PEP can be rendered safely and affordably where needed the most: by village health care workers who have long performed more complex services after appropriate training. Recent research makes this an important and long neglected goal that is now within our means to implement.

Keywords: rabies, post-exposure prophylaxis, availability, immunoglobulin

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8347 Telemedicine for Telerehabilitation in Areas Affected by Social Conflicts in Colombia

Authors: Lilia Edit Aparicio Pico, Paulo Cesar Coronado Sánchez, Roberto Ferro Escobar

Abstract:

This paper presents the implementation of telemedicine services for physiotherapy, occupational therapy, and speech therapy rehabilitation, utilizing telebroadcasting of audiovisual content to enhance comprehensive patient recovery in rural areas of San Vicente del Caguán municipality, characterized by high levels of social conflict in Colombia. The region faces challenges such as dysfunctional problems, physical rehabilitation needs, and a high prevalence of hearing diseases, leading to neglect and substandard health services. Limited access to healthcare due to communication barriers and transportation difficulties exacerbates these issues. To address these challenges, a research initiative was undertaken to leverage information and communication technologies (ICTs) to improve healthcare quality and accessibility for this vulnerable population. The primary objective was to develop a tele-rehabilitation system to provide asynchronous online therapies and teleconsultation services for patient follow-up during the recovery process. The project comprises two components: Communication systems and human development. A technological component involving the establishment of a wireless network connecting rural centers and the development of a mobile application for video-based therapy delivery. Communications systems will be provided by a radio link that utilizes internet provided by the Colombian government, located in the municipality of San Vicente del Caguán to connect two rural centers (Pozos and Tres Esquinas) and a mobile application for managing videos for asynchronous broadcasting in sidewalks and patients' homes. This component constitutes an operational model integrating information and telecommunications technologies. The second component involves pedagogical and human development. The primary focus is on the patient, where performance indicators and the efficiency of therapy support were evaluated for the assessment and monitoring of telerehabilitation results in physical, occupational, and speech therapy. They wanted to implement a wireless network to ensure audiovisual content transmission for tele-rehabilitation, design audiovisual content for tele-rehabilitation based on services provided by the ESE Hospital San Rafael in physiotherapy, occupational therapy, and speech therapy, develop a software application for fixed and mobile devices enabling access to tele-rehabilitation audiovisual content for healthcare personnel and patients and finally to evaluate the technological solution's contribution to the ESE Hospital San Rafael community. The research comprised four phases: wireless network implementation, audiovisual content design, software application development, and evaluation of the technological solution's impact. Key findings include the successful implementation of virtual teletherapy, both synchronously and asynchronously, and the assessment of technological performance indicators, patient evolution, timeliness, acceptance, and service quality of tele-rehabilitation therapies. The study demonstrated improved service coverage, increased care supply, enhanced access to timely therapies for patients, and positive acceptance of teletherapy modalities. Additionally, the project generated new knowledge for potential replication in other regions and proposed strategies for short- and medium-term improvement of service quality and care indicators

Keywords: e-health, medical informatics, telemedicine, telerehabilitation, virtual therapy

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8346 The Interactive Effects of Leadership on Safety

Authors: Jane E. Mullen, Kevin Kelloway, Ann Rhéaume-Brüning

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The purpose of this study is to examine the effects of perceived leader word-action alignment on subordinate extra-role safety behavior. Using survey data gathered from a sample of nurses employed in health care facilities located in Eastern Canada (n = 192), the effects of perceived word-action alignment (measured as the cross product of leaders speaking positively about safety and acting safely) on nurse safety participation was examined. Moderated regression analysis resulted in the significant (p < .01) prediction of nurse safety participation by the interaction term. Analysis of the simple slopes comprising the interaction term suggests that positively speaking about safety only predicted safety participation when leaders were also perceived by subordinates as acting safely. The results provide empirical support for the importance of the perceived alignment between leaders’ words, or espoused safety values and priorities, and their actions. Practical implications for safety leadership training are discussed.

Keywords: leadership, safety participation, safety performance, safety training

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8345 Factors Affecting Customer Loyalty in the Independent Surveyor Service Industry in Indonesia

Authors: Sufrin Hannan, Budi Suharjo, Rita Nurmalina, Kirbrandoko

Abstract:

The challenge for independent surveyor service companies now is growing with increasing uncertainty in business. Protection from the government for domestic independent surveyor industry from competitor attack, such as entering the global surveyors to Indonesia also no longer exists. Therefore, building customer loyalty becomes very important to create a long-term relationship between an independent surveyor with its customers. This study aims to develop a model that can be used to build customer loyalty by looking at various factors that determine customer loyalty, especially on independent surveyors for coal inspection in Indonesia. The development of this model uses the relationship marketing approach. Testing of the hypothesis is done by testing the variables that determine customer loyalty, either directly or indirectly, which amounted to 10 variables. The data were collected from 200 questionnaires filled by independent surveyor company decision makers from 51 exporting companies and coal trading companies in Indonesia and analyzed using Structural Equation Model (SEM). The results show that customer loyalty of independent surveyors is influenced by customer satisfaction, trust, switching-barrier, and relationship-bond. Research on customer satisfaction shows that customer satisfaction is influenced by the perceived quality and perceived value, while perceived quality is influenced by reliability, assurance, responsiveness, and empathy.

Keywords: relationship marketing, customer loyalty, customer satisfaction, switching barriers, relationship bonds

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8344 Research and Innovation Centre

Authors: Krasimir Ivanov, Tonyo Tonev, Nguyen Nguyen, Alexander Peltekov, Anyo Mitkov

Abstract:

Maize is among the most economically important crops and at the same time one of the most sensitive to soil deficiency in zinc. In this paper, the impact of the foliar zinc application in the form of zinc hydroxy nitrate suspension on the micro and macro elements partitioning in maize leaves and grain was studied during spring maize season, 2017. The impact of the foliar zinc fertilization on the grain yield and quality was estimated too. The experiment was performed by the randomized block design with 8 variants in 3 replications. Seven suspension solutions whit different Zn concentration were used, including ZnO suspension and zinc hydroxyl nitrate alone or nixed with other nutrients. Fertilization and irrigation were the same for all variants. The Zn content and the content of selected micro (Cu, Fe) and macro (Ca, Mg, P and K) elements in maize leaves were determined two weeks after the first spraying (5-6 sheets), two weeks after the second spraying (9-10 sheets) and after harvesting. It was concluded that the synthesized zinc hydroxy nitrate demonstrates potential as the long-term foliar fertilizer. A significant (p < 0.05) effect of zinc accumulation in maize leaves by foliar zinc application during the first growth stage was found, followed by its reutilization to other plants organs during the second growth stage. Significant export of Cu, P, and K from lower and middle leaves was observed. The content of Ca and Mg remains constant in the whole longevity period, while the content of Fe decreases sharply.

Keywords: foliar fertilization, zinc hydroxy nitrate, maize, zinc

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8343 Young People and Their Parents Accessing Their Digital Health Data via a Patient Portal: The Ethical and Legal Implications

Authors: Pippa Sipanoun, Jo Wray, Kate Oulton, Faith Gibson

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Background: With rapidly evolving digital health innovation, there is a need for digital health transformation that is accessible and sustainable, that demonstrates utility for all stakeholders while maintaining data safety. Great Ormond Street Hospital for Children aimed to future-proof the hospital by transitioning to an electronic patient record (EPR) system with a tethered patient portal (MyGOSH) in April 2019. MyGOSH patient portal enables patients 12 years or older (with their parent's consent) to access their digital health data. This includes access to results, documentation, and appointments that facilitate communication with their care team. As part of the Going Digital Study conducted between 2018-2021, data were collected from a sample of all relevant stakeholders before and after EPR and MyGOSH implementation. Data collection reach was wide and included the hospital legal and ethics teams. Aims: This study aims to understand the ethical and legal implications of young people and their parents accessing their digital health data. Methods: A focus group was conducted. Recruited participants were members of the Great Ormond Street Hospital Paediatric Bioethics Centre. Participants included expert and lay members from the Committee from a variety of professional or academic disciplines. Written informed consent was provided by all participants (n=7). The focus group was recorded, transcribed verbatim, and analyzed using thematic analysis. Results: Six themes were identified: access, competence and capacity - granting access to the system; inequalities in access resulting in inequities; burden, uncertainty and responding to change - managing expectations; documenting, risks and data safety; engagement, empowerment and understanding – how to use and manage personal information; legal considerations and obligations. Discussion: If healthcare professionals are to empower young people to be more engaged in their care, the importance of including them in decisions about their health is paramount, especially when they are approaching the age of becoming the consenter for treatment. Complexities exist in assessing competence or capacity when granting system access, when disclosing sensitive information, and maintaining confidentiality. Difficulties are also present in managing clinician burden, managing user expectations whilst providing an equitable service, and data management that meets professional and legal requirements. Conclusion: EPR and tethered-portal implementation at Great Ormond Street Hospital for Children was not only timely, due to the need for a rapid transition to remote consultations during the COVID-19 pandemic, which would not have been possible had EPR/MyGOSH not been implemented, but also integral to the digital health revolution required in healthcare today. This study is highly relevant in understanding the complexities around young people and their parents accessing their digital health data and, although the focus of this research related to portal use and access, the findings translate to young people in the wider digital health context. Ongoing support is required for all relevant stakeholders following MyGOSH patient portal implementation to navigate the ethical and legal complexities. Continued commitment is needed to balance the benefits and burdens, promote inclusion and equity, and ensure portal utility for patient benefit, whilst maintaining an individualized approach to care.

Keywords: patient portal, young people and their parents, ethical, legal

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8342 Smallholder’s Agricultural Water Management Technology Adoption, Adoption Intensity and Their Determinants: The Case of Meda Welabu Woreda, Oromia, Ethiopia

Authors: Naod Mekonnen Anega

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The very objective of this paper was to empirically identify technology tailored determinants to the adoption and adoption intensity (extent of use) of agricultural water management technologies in Meda Welabu Woreda, Oromia regional state, Ethiopia. Meda Welabu Woreda which is one of the administrative Woredas of the Oromia regional state was selected purposively as this Woreda is one of the Woredas in the region where small scale irrigation practices and the use of agricultural water management technologies can be found among smallholders. Using the existence water management practices (use of water management technologies) and land use pattern as a criterion Genale Mekchira Kebele is selected to undergo the study. A total of 200 smallholders were selected from the Kebele using the technique developed by Krejeie and Morgan. The study employed the Logit and Tobit models to estimate and identify the economic, social, geographical, household, institutional, psychological, technological factors that determine adoption and adoption intensity of water management technologies. The study revealed that while 55 of the sampled households are adopters of agricultural water management technology the rest 140 were non adopters of the technologies. Among the adopters included in the sample 97% are using river diversion technology (traditional) with traditional canal while the rest 7% percent are using pond with treadle pump technology. The Logit estimation reveled that while adoption of river diversion is positively and significantly affected by membership to local institutions, active labor force, income, access to credit and land ownership, adoption of treadle pump technology is positively and significantly affected by family size, education level, access to credit, extension contact, income, access to market, and slope. The Logit estimation also revealed that whereas, group action requirement, distance to farm, and size of active labor force negative and significantly influenced adoption of river diversion, age and perception has negatively and significantly influenced adoption decision of treadle pump technology. On the other hand, the Tobit estimation reveled that while adoption intensity (extent of use) of agricultural water management is positively and significantly affected by education, credit, and extension contact, access to credit, access to market and income. This study revealed that technology tailored study on adoption of Agricultural water management technologies (AWMTs) should be considered to indentify and scale up best agricultural water management practices. In fact, in countries like Ethiopia, where there is difference in social, economic, cultural, environmental and agro ecological conditions even within the same Kebele technology tailored study that fit the condition of each Kebele would help to identify and scale up best practices in agricultural water management.

Keywords: water management technology, adoption, adoption intensity, smallholders, technology tailored approach

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8341 Socioterritorial Inequalities in a Region of Chile. Beyond the Geography

Authors: Javier Donoso-Bravo, Camila Cortés-Zambrano

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In this paper, we analyze socioterritorial inequalities in the region of Valparaiso (Chile) using secondary data to account for these inequalities drawing on economic, social, educational, and environmental dimensions regarding the thirty-six municipalities of the region. We looked over a wide-ranging set of secondary data from public sources regarding economic activities, poverty, employment, income, years of education, post-secondary education access, green areas, access to potable water, and others. We found sharp socioterritorial inequalities especially based on the economic performance in each territory. Analysis show, on the one hand, the existence of a dual and unorganized development model in some territories with a strong economic activity -especially in the areas of finance, real estate, mining, and vineyards- but, at the same time, with poor social indicators. On the other hand, most of the territories show a dispersed model with very little dynamic economic activities and very poor social development. Finally, we discuss how socioterritorial inequalities in the region of Valparaiso reflect the level of globalization of the economic activities carried on in every territory.

Keywords: socioterritorial inequalities, development model, Chile, secondary data, Region of Valparaiso

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8340 Mountain Photo Sphere: An Android Application of Mountain Hiking Street View

Authors: Yanto Budisusanto, Aulia Rachmawati

Abstract:

Land navigation technology that is being developed is Google Street View to provide 360° street views, enabling the user to know the road conditions physically with the photo display. For climbers, especially beginners, detail information of climbing terrain is needed so climbers can prepare supplies and strategies before climbing. Therefore, we built a mountaineer guide application named Mountain Photo Sphere. This application displays a 360̊ panoramic view of mountain hiking trail and important points along the hiking path and its surrounding conditions. By combining panoramic photos 360̊ and tracking paths from coordinate data, a virtual tour will be formed. It is built using Java language and Android Studio. The hiking trail map composed by Google Maps API (Gaining access to google maps), Google GEO API (Gaining access to google maps), and OpenStreetMap API (Getting map files to be accessed offline on the Application). This application can be accessed offline so that climbers can use the application during climbing activities.

Keywords: google street view, panoramic photo 360°, mountain hiking, mountain photo sphere

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8339 Control of an Outbreak of Vancomycin-Resistant Enterococci in a Tunisian Teaching Hospital

Authors: Hela Ghali, Sihem Ben Fredj, Mohamed Ben Rejeb, Sawssen Layouni, Salwa Khefacha, Lamine Dhidah, Houyem Said Laatiri

Abstract:

Background: Antimicrobial resistance is a growing threat to public health and motivates to improve prevention and control programs both at international (WHO) and national levels. Despite their low pathogenicity, vancomycin-resistant enterococci (VRE) are common nosocomial pathogens in several countries. The high potential for transmission of VRE between patients and the threat to send its resistance genes to other bacteria such as staphylococcus aureus already resistant to meticilin, justify strict control measures. Indeed, in Europe, the proportion of Enterococcus faecium responsible for invasive infections, varies from 1% to 35% in 2011 and less than 5% were resistant to vancomycin. In addition, it represents the second cause of urinary tract and wound infections and the third cause of nosocomial bacteremia in the United States. The nosocomial outbreaks of VRE have been mainly described in intensive care services, hematology-oncology and haemodialysis. An epidemic of VRE has affected our hospital and the objective of this work is to describe the measures put in place. Materials/Methods: Following the alert given by the service of plastic surgery concerning a patient carrier of VRE, a team of the prevention and healthcare security service (doctor + technician) made an investigation. A review of files was conducted to draw the synoptic table and the table of cases. Results: By contacting the microbiology laboratory, we have identified four other cases of VRE and who were hospitalized in Medical resuscitation department (2 cases, one of them was transferred to the Physical rehabilitation department), and Nephrology department (2 cases). The visit has allowed to detect several malfunctions in professional practice. A crisis cell has allowed to validate, coordinate and implement control measures following the recommendations of the Technical Center of nosocomial infections. In fact, the process was to technically isolate cases in their sector of hospitalization, to restrict the use of antibiotics, to strength measures of basic hygiene, and to make a screening by rectal swab for both cases and contacts (other patients and health staff). These measures have helped to control the situation and no other case has been reported for a month. 2 new cases have been detected in the intensive care unit after a month. However, these are short-term strategies, and other measures in the medium and long term should be taken into account in order to face similar outbreaks. Conclusion: The efforts to control the outbreak were not efficient since 2 new cases have been reported after a month. Therefore, a continuous monitoring in order to detect new cases earlier is crucial to minimize the dissemination of VRE.

Keywords: hospitals, nosocomial infection, outbreak, vancomycin-resistant enterococci

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