Search results for: principles of total quality management

Authors: Ogunremi Beatrice, Oluwole David Adebayo

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Public secondary school students are face with some challenges from the parents, government and teachers in school. Some of the challenges that arises from the parents are lack of attention and adequate communication. From the government are unavailability of useful instructional materials, competent and professionally trained teachers for each subject the students do in school. The challenges that arise from the teachers most often are mismanagement of time, inability to understand the capacity of the student and lack class management and follow up. This study investigated self-regulation, emotional intelligence, self-efficacy and goal orientation as predictors of school engagement among public secondary school students in Ibadan. A structured questionnaire was administered on 258 students from six mixed secondary schools in Ibadan. Pearson Product Moment Correlation method was used for data analysis. Four hypothesis were raised and answered, the results showed there is positive and significant relationships between school engagement among public secondary school students and each of the independent variable: Self-regulation, Emotional intelligence, Self-efficacy, Goal orientation. On the basis of these findings, it was recommended that the parents have to encourage their children on how to be goal oriented ,build their self-efficacy skill, to be self-regulated and emotionally intelligent in order to be effective in school and be able to increase their intellectual ability.

Keywords: emotional intelligence, self-efficacy, goal orientation, school engagement, self-regulation

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Authors: Anna Bak-Klimek, Emily Spencer, Siew Lee, Karen Campbell, Wendy McInally

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Background & Significance: Over half of Teenagers and Young Adults (TYAs) say that they experience psychological distress after cancer diagnosis and TYAs with cancer are at higher risk of developing distress compared to other age groups. Despite this there are no age-appropriate interventions to help TYAs manage distress and there is a lack of conceptual understanding of what causes distress in this population group. This makes it difficult to design a targeted, developmentally appropriate intervention. This review aims to identify the key determinants of distress in TYAs affected by cancer and to propose an integrative model of cancer-related distress for TYAs. Method: A literature search was performed in Cochrane Database of Systematic Reviews, MEDLINE, PsycINFO, CINAHL, EMBASE and PsycArticles in May-June, 2022. Quantitative literature was systematically reviewed on the relationship between psychological distress experienced by TYAs affected by cancer and a wide range of factors i.e. individual (demographic, psychological, developmental, and clinical factors) and contextual (social/environmental) factors. Evidence was synthesized and correlates were categorized using the Biopsychosocial Model. The full protocol is available from PROSPERO (CRD42022322069) Results: Thirty eligible quantitative studies met criteria for the review. A total of twenty-six studies were cross-sectional, three were longitudinal and one study was a case control study. The evidence on the relationship between the socio-demographic, illness and treatment-related factors and psychological distress is inconsistent and unclear. There is however consistent evidence on the link between psychological factors and psychological distress. For instance, the use of cognitive and defence coping, negative meta-cognitive beliefs, less optimism, a lack of sense of meaning and lower resilience levels were significantly associated with higher psychological distress. Furthermore, developmental factors such as poor self-image, identity issues and perceived conflict were strongly associated with higher distress levels. Conclusions: The current review suggests that psychological and developmental factors such as ineffective coping strategies, poor self-image and identity issues may play a key role in the development of psychological distress in TYAs affected by cancer. The review proposes a Positive Developmental Psychology Model of Distress for Teenagers and Young Adults affected by cancer. The review highlights that implementation of psychological interventions that foster optimism, improve resilience and address self-image may result in reduced distress in TYA’s with cancer.

Keywords: cancer, determinant, psychological distress, teenager and young adult, theoretical model

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Authors: Elif Tugce Aksun Tumerkan

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Fluorescent proteins (FPs) have become very popular since green fluorescent protein discovered from crystal jellyfish. It is known that Anthozoa species have a wide range of chromophore organisms, and the initial crystal structure for non-fluorescent chromophores obtained from the reef-building coral has been determined. There are also differently coloured pigments in non-bioluminescent Anthozoa zooxanthellate and azooxanthellate which are frequently members of the GFP-like protein family. The development of fluorescent proteins (FPs) and their applications is an outstanding example of basic science leading to practical biotechnological and medical applications. Fluorescent proteins have several applications in science and are used as important indicators in molecular biology and cell-based research. With rising interest in cell biology, FPs have used as biosensor indicators and probes in pharmacology and cell biology. Using fluorescent proteins in genetically encoded metabolite sensors has many advantages than chemical probes for metabolites such as easily introduced into any cell or organism in any sub-cellular localization and giving chance to fixing to fluoresce of different colours or characteristics. There are different factors effects to signalling mechanism when they used as a biosensor. While there are wide ranges of research have been done on the significance and applications of fluorescent proteins, the cell signalling response of FPs and target cell are less well understood. In this study, it was aimed to clarify the response of adaptive mechanisms of coral species such as pH, temperature and symbiotic relationship and target cells properties on the signalling capacity. Corals are a rich natural source of fluorescent proteins that change with environmental conditions such as light, heat stress and injury. Adaptation mechanism of coral species to these types of environmental variations is important factor due to FPs properties have affected by this mechanism. Since fluorescent proteins obtained from nature, their own ecological property like the symbiotic relationship is observed very commonly in coral species and living conditions have the impact on FPs efficiency. Target cell properties also have an effect on signalling and visualization. The dynamicity of detector that used for reading fluorescence and the level of background fluorescence are key parameters for the quality of the fluorescent signal. Among the factors, it can be concluded that coral species adaptive characteristics have the strongest effect on FPs signalling capacity.

Keywords: biosensor, cell biology, environmental conditions, fluorescent protein, sea anemone

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Authors: Kwabena Asare, Ezekiel N. N. Nortey, Felix O. Mettle

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Modelling of extreme events has always been of interest in fields such as hydrology and meteorology. However, after the recent global financial crises, appropriate models for modelling of such rare events leading to these crises have become quite essential in the finance and risk management fields. This paper models the extreme values of the Ghana Stock Exchange All-Shares indices (2000-2010) by applying the Extreme Value Theory to fit a model to the tails of the daily stock returns data. A conditional approach of the EVT was preferred and hence an ARMA-GARCH model was fitted to the data to correct for the effects of autocorrelation and conditional heteroscedastic terms present in the returns series, before EVT method was applied. The Peak Over Threshold (POT) approach of the EVT, which fits a Generalized Pareto Distribution (GPD) model to excesses above a certain selected threshold, was employed. Maximum likelihood estimates of the model parameters were obtained and the model’s goodness of fit was assessed graphically using Q-Q, P-P and density plots. The findings indicate that the GPD provides an adequate fit to the data of excesses. The size of the extreme daily Ghanaian stock market movements were then computed using the Value at Risk (VaR) and Expected Shortfall (ES) risk measures at some high quantiles, based on the fitted GPD model.

Keywords: extreme value theory, expected shortfall, generalized pareto distribution, peak over threshold, value at risk

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Authors: Shasha Lv, Zhengcao Li

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Due to the CMOS compatibility, silicon-based field emission (FE) devices as potential electron sources have attracted much attention. The geometrical arrangement and dimensional features of aligned silicon nanowires (SiNWs) have a determining influence on the FE properties. We discuss a multistep template replication process of Ag-assisted chemical etching combined with polystyrene (PS) spheres to fabricate highly periodic and well-aligned silicon nanowires, then their diameter, aspect ratio and density were further controlled via dry oxidation and post chemical treatment. The FE properties related to proximity and aspect ratio were systematically studied. A remarkable improvement of FE propertiy was observed with the average nanowires tip interspace increasing from 80 to 820 nm. On the basis of adjusting SiNWs dimensions and morphology, addition of a secondary material whose properties complement the SiNWs could yield a combined characteristic. Three different nanoheterostructures were fabricated to control the FE performance, they are: NiSi/Si core-shell structures, ZnO/Si nanotrees, and Graphene/SiNWs. We successfully fabricated the high-quality NiSi/Si heterostructured nanowires with excellent conformality. First, nickle nanoparticles were deposited onto SiNWs, then rapid thermal annealing process were utilized to form NiSi shell. In addition, we demonstrate a new and simple method for creating 3D nanotree-like ZnO/Si nanocomposites with a spatially branched hierarchical structure. Compared with the as-prepared SiNRs and ZnO NWs, the high-density ZnO NWs on SiNRs have exhibited predominant FE characteristics, and the FE enhancement factors were attributed to band bending effect and geometrical morphology. The FE efficiency from flat sheet structure of graphene is low. We discussed an effective approach towards full control over the diameter of uniform SiNWs to adjust the protrusions of large-scale graphene sheet deposited on SiNWs. The FE performance regarding the uniformity and dimensional control of graphene protrusions supported on SiNWs was systematically clarified. Therefore, the hybrid SiNWs/graphene structures with protrusions provide a promising class of field emission cathodes.

Keywords: field emission, silicon nanowires, heterostructures, controllable synthesis

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Authors: Ariyaratna Athugala

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Mass media play a significant role in democratic societies. The Political Economy of the Mass Media postulates that elite media interlock with other institutional sectors in ownership, and editorial management effectively circumscribing their ability to remain analytically detached from other dominant institutional sectors. The production of meaning in news discourse is not valued neutral, but part of a larger process of presenting a hegemonic understanding of the world to audiences as the “production of consent.” The horse race model argues that “the raw material of news” pressures six bands that ultimately shape the news audiences receive. The six bands are as follows: Crown piece (raw material), brow band (professionalism), throat latch (gatekeeper), a bit (construction), nose band (perception), and reins (ownership). dThe horse race model suggests that media ultimately serve to “manufacture consent” for a range of self-serving elite opinion options. These bands determine what events are deemed newsworthy, how they are covered, where they are placed within the media and how much coverage they receive. Highly descriptive in nature, the horse race model of communication is concerned with the question of whether media can be seen to play a hegemonic role in the society oriented towards legitimization, hegemonic pressures and ideological construction.

Keywords: hegemonic pressures, horse race, ideological construction, six bands

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Authors: Shizra Waris, Bilal Shoaib, Munib Ahmad

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Background; The using of clinical decision support systems (CDSSs) may recover unceasing disease organization, which requires regular visits to multiple health professionals, treatment monitoring, disease control, and patient behavior modification. The objective of this survey is to determine if these CDSSs improve the processes of unceasing care including diagnosis, treatment, and monitoring of diseases. Though artificial intelligence is not a new idea it has been widely documented as a new technology in computer science. Numerous areas such as education business, medical and developed have made use of artificial intelligence Methods: The survey covers articles extracted from relevant databases. It uses search terms related to information technology and viral hepatitis which are published between 2000 and 2016. Results: Overall, 80% of studies asserted the profit provided by information technology (IT); 75% of learning asserted the benefits concerned with medical domain;25% of studies do not clearly define the added benefits due IT. The CDSS current state requires many improvements to hold up the management of liver diseases such as HCV, liver fibrosis, and cirrhosis. Conclusion: We concluded that the planned model gives earlier and more correct calculation of hepatitis B and it works as promising tool for calculating of custom hepatitis B from the clinical laboratory data.

Keywords: detection, hapataties, observation, disesese

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Authors: Y. N. Fung, R. Liu, T. M. Choi

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Over the past decades, previous studies have explored different consumers’ attitudes towards sustainable fashion and how these attitudes affect consumer behaviors. Researchers have attempted to provide solutions for product suppliers (e.g., retailers, designers, developers, and manufacturers) through studying consumers’ attitudes towards sustainable fashion. However, based on the studies of consumer attitudes, investigations on the sales and market share of sustainable sportswear products remain under-explored. Gaps may exist between the consumers’ expectations and the developed sustainable sportswear products. In this study, a novel study has been carried out to examine the attitude gaps existing between the sustainable sportswear suppliers’ (SSSs) and the sustainable sportswear consumers (SSCs). This study firstly identifies the key attitudes towards sustainable sportswear product development. It analyses how sustainable attitudes affect the products being developed, as well as the effects of the attitude’s difference between the SSSs and the SSCs on the consumers’ satisfaction towards sportswear product consumption. A gap analysis research framework is adopted with the use of collected questionnaire survey data. The results indicate that a significant difference exists between SSSs and SSCs’ attitudes towards sustainable design, manufacture, product features, and branding. Based on in-depth interviews, the major causes of the difference in attitudes are studied to provide managerial insights for sustainable sportswear product management and business development.

Keywords: sustainability, sportswear, attitude, gap analysis, suppliers, consumers

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Authors: Rudolph Carl Barrientos, Juwaln Diego Descallar, Rainer James Palmiano

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Household Appliance Scheduling Systems (HASS) coupled with a Time-of-Use (TOU) pricing scheme, a form of Demand Side Management (DSM), is not widely utilized in the Philippines’ residential electricity sector. This paper’s goal is to encourage distribution utilities (DUs) to adopt HASS and TOU by analyzing the effect of household schedulers on the electricity price and load profile in a residential environment. To establish this, a city based on an implemented survey is generated using Monte Carlo Analysis (MCA). Then, a Binary Particle Swarm Optimization (BPSO) algorithm-based HASS is developed considering user satisfaction, electricity budget, appliance prioritization, energy storage systems, solar power, and electric vehicles. The simulations were assessed under varying levels of user compliance. Results showed that the average electricity cost, peak demand, and peak-to-average ratio (PAR) of the city load profile were all reduced. Therefore, the deployment of the HASS and TOU pricing scheme is beneficial for both stakeholders.

Keywords: appliance scheduling, DSM, TOU, BPSO, city-wide simulation, electric vehicle, appliance prioritization, energy storage system, solar power

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Authors: Zülfiye Bıkmaz, Aytolan Yıldırım

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This study was planned as a descriptive regressive study in order to determine the relationship between the competency levels of working nurses, the levels of competency expected by nursing students, the critical thinking disposition of nurses, their perceived autonomy levels, and certain socio demographic characteristics. It is also a methodological study with regard to the intercultural adaptation of the Nursing Competence Scale (NCS) in both working and student samples. The sample of the study group of nurses at a university hospital for at least 6 months working properly and consists of 443 people filled out questionnaires. The student group, consisting of 543 individuals from the 4 public university nursing 3rd and 4th grade students. Data collection tools consisted of a questionnaire prepared in order to define the socio demographic, economic, and personal characteristics of the participants, the ‘Nursing Competency Scale’, the ‘Autonomy Subscale of the Sociotropy – Autonomy Scale’, and the ‘California Critical Thinking Disposition Inventory’. In data evaluation, descriptive statistics, nonparametric tests, Rasch analysis and correlation and regression tests were used. The language validity of the ‘NCS’ was performed by translation and back translation, and the context validity of the scale was performed with expert views. The scale, which was formed into its final structure, was applied in a pilot application from a group consisting of graduate and student nurses. The time constancy of the test was obtained by analysis testing retesting method. In order to reduce the time problems with the two half reliability method was used. The Cronbach Alfa coefficient of the scale was found to be 0.980 for the nurse group and 0.986 for the student group. Statistically meaningful relationships between competence and critical thinking and variables such as age, gender, marital status, family structure, having had critical thinking training, education level, class of the students, service worked in, employment style and position, and employment duration were found. Statistically meaningful relationships between autonomy and certain variables of the student group such as year, employment status, decision making style regarding self, total duration of employment, employment style, and education status were found. As a result, it was determined that the NCS which was adapted interculturally was a valid and reliable measurement tool and was found to be associated with autonomy and critical thinking.

Keywords: nurse, nursing student, competence, autonomy, critical thinking, Rasch analysis

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Authors: Natalia Alzate-Carvajal, Diego A. Acevedo-Guzman, Victor Meza-Laguna, Mario H. Farias, Luis A. Perez-Rey, Edgar Abarca-Morales, Victor A. Garcia-Ramirez, Vladimir A. Basiuk, Elena V. Basiuk

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Direct covalent functionalization of prefabricated free-standing graphene oxide paper (GOP) is considered as the only approach suitable for systematic tuning of thermal, mechanical and electronic characteristics of this important class of carbon nanomaterials. At the same time, the traditional liquid-phase functionalization protocols can compromise physical integrity of the paper-like material up to its total disintegration. To avoid such undesirable effects, we explored the possibility of employing an alternative, solvent-free strategy for facile and nondestructive functionalization of GOP with two representative aliphatic amines, 1-octadecylamine (ODA) and 1,12-diaminododecane (DAD), as well as with two aromatic amines, 1-aminopyrene (AP) and 1,5-diaminonaphthalene (DAN). The functionalization was performed under moderate heating at 150-180 °C in vacuum. Under such conditions, it proceeds through both amidation and epoxy ring opening reactions. Comparative characterization of pristine and amine-functionalized GOP mats was carried out by using Fourier-transform infrared, Raman, and X-ray photoelectron spectroscopy (XPS), thermogravimetric (TGA) and differential thermal analysis, scanning electron and atomic force microscopy (SEM and AFM, respectively). Besides that, we compared the stability in water, wettability, electrical conductivity and elastic (Young's) modulus of GOP mats before and after amine functionalization. The highest content of organic species was obtained in the case of GOP-ODA, followed by GOP-DAD, GOP-AP and GOP-DAN samples. The covalent functionalization increased mechanical and thermal stability of GOP, as well as its electrical conductivity. The magnitude of each effect depends on the particular chemical structure of amine employed, which allows for tuning a given GOP property. Morphological characterization by using SEM showed that, compared to pristine graphene oxide paper, amine-modified GOP mats become relatively ordered layered assemblies, in which individual GO sheets are organized in a near-parallel pattern. Financial support from the National Autonomous University of Mexico (grants DGAPA-IN101118 and IN200516) and from the National Council of Science and Technology of Mexico (CONACYT, grant 250655) is greatly appreciated. The authors also thank David A. Domínguez (CNyN of UNAM) for XPS measurements and Dr. Edgar Alvarez-Zauco (Faculty of Science of UNAM) for the opportunity to use TGA equipment.

Keywords: amines, covalent functionalization, gas-phase, graphene oxide paper

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Authors: Z. I Jeeva

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The establishment of municipalities in South Africa has been a long and difficult process; 25 years later, it still appears to be evolving. In 1994, the new democratic government undertook to restructure the country’s racially segregated administrative structure by integrating areas to form cohesive municipal entities that would allow for the more efficient administration management of the regions. It planned to achieve this within a short seven-year period from 1993 to 2000, which was to be divided into three phases, namely, the pre-interim phase from 1994 to1995, the interim phase from 1996 to 1999, and the post-interim phase from 2000 onwards. However, the extensive integrated municipal approach was easier to pen on paper than to implement in practice. This paper seeks to explore the South African spatial reform process from 1993 to 2020, by analyzing policy documents and literature in order to determine how exactly the government attempted to achieve this. The study found that the spatial restructuring process was particularly complex since the democratic government inherited an unequal society located on a fragmented spatial landscape of which there was limited knowledge with many unresolved issues. Furthermore, the study found that there is a lack of literature on the topic from an urban planning perspective and calls for further research to ensure the formation of more efficient administrative regions.

Keywords: categorization, demarcation, municipalities, racial integration, spatial reform

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Authors: Jon Ajuria, Edurne Redondo, Roman Mysyk, Eider Goikolea

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Hybrid capacitor configurations are now of increasing interest to overcome the current energy limitations of supercapacitors entirely based on non-Faradaic charge storage. Among them, Li-ion capacitors including a negative battery-type lithium intercalation electrode and a positive capacitor-type electrode have achieved tremendous progress and have gone up to commercialization. Inexpensive electrode materials from renewable sources have recently received increased attention since cost is a persistently major criterion to make supercapacitors a more viable energy solution, with electrode materials being a major contributor to supercapacitor cost. Additionally, Na-ion battery chemistries are currently under development as less expensive and accessible alternative to Li-ion based battery electrodes. In this work, we are presenting both lithium and sodium ion capacitor (LIC & NIC) entirely based on electrodes prepared from carbon materials derived from recycled olive pits. Yearly, around 1 million ton of olive pit waste is generated worldwide, of which a third originates in the Spanish olive oil industry. On the one hand, olive pits were pyrolized at different temperatures to obtain a low specific surface area semigraphitic hard carbon to be used as the Li/Na ion intercalation (battery-type) negative electrode. The best hard carbon delivers a total capacity of 270mAh/g vs Na/Na+ in 1M NaPF6 and 350mAh/g vs Li/Li+ in 1M LiPF6. On the other hand, the same hard carbon is chemically activated with KOH to obtain high specific surface area -about 2000 m2g-1- activated carbon that is further used as the ion-adsorption (capacitor-type) positive electrode. In a voltage window of 1.5-4.2V, activated carbon delivers a specific capacity of 80 mAh/g vs. Na/Na+ and 95 mAh/g vs. Li/Li+ at 0.1A /g. Both electrodes were assembled in the same hybrid cell to build a LIC/NIC. For comparison purposes, a symmetric EDLC supercapacitor cell using the same activated carbon in 1.5M Et4NBF4 electrolyte was also built. Both LIC & NIC demonstrates considerable improvements in the energy density over its EDLC counterpart, delivering a maximum energy density of 110Wh/Kg at a power density of 30W/kg AM and a maximum power density of 6200W/Kg at an energy density of 27 Wh/Kg in the case of NIC and a maximum energy density of 110Wh/Kg at a power density of 30W/kg and a maximum power density of 18000W/Kg at an energy density of 22 Wh/Kg in the case of LIC. In conclusion, our work demonstrates that the same biomass waste can be adapted to offer a hybrid capacitor/battery storage device overcoming the limited energy density of corresponding double layer capacitors.

Keywords: hybrid supercapacitor, Na-Ion capacitor, supercapacitor, Li-Ion capacitor, EDLC

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Authors: Mateusz Janas

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Innovative implementations in the micro, small, and medium-sized enterprises (MSME) sector are among the essential activities considering the current market realities, technological advancements, and digitization trends. MSMEs play a crucial role and significantly influence the economic conditions of countries, as their competitiveness directly impacts the global economy. Business development and investment in innovation and technology are integral parts of every modern enterprise's strategy, seeking to maintain and achieve a desired competitive position. The instability of the socio-economic environment, along with contemporary changes in artificial intelligence implementation and digitization, requires businesses to adopt increasingly newer solutions and actions. Enterprises must strive to survive in the global market and build competitive positions, especially in uncertain conditions. Being aware of the significance of innovative actions is crucial for MSMEs as it enables them to enhance their operations and expand their scope. It is essential for managers and executives of MSMEs to be focused on development and innovation, as their approach will also impact their employees, emphasizing results and maximizing the company's value. Managers of MSMEs must be aware of various threats, costs, opportunities, and gains that can arise from implementing new technical and organizational solutions. Businesses must view development as an integral part of their strategy and continuously strive for improvement.

Keywords: innovation, SME, develop, management

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Authors: Lakshmi Sujeesh, Aaron Ramzeen, Ricky Ziming Guo, Abhishek Agrawal

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Introduction: Range of motion (ROM) is often measured by physiotherapists using hand-held goniometer as part of mobility assessment for diagnosis. Due to the nature of hand-held goniometer measurement procedure, readings often tend to have some variations depending on the physical therapist taking the measurements (Riddle et al.). This study aims to validate computer vision software readings against goniometric measurements for quick and consistent ROM measurements to be taken by clinicians. The use of this computer vision software hopes to improve the future of musculoskeletal space with more efficient diagnosis from recording of patient’s ROM with minimal human error across different physical therapists. Methods: Using the hand-held long arm goniometer measurements as the “gold-standard”, healthy study participants (n = 20) were made to perform 4 exercises: Front elevation, Abduction, Internal Rotation, and External Rotation, using both arms. Assessment of active ROM using computer vision software at different angles set by goniometer for each exercise was done. Interclass Correlation Coefficient (ICC) using 2-way random effects model, Box-Whisker plots, and Root Mean Square error (RMSE) were used to find the degree of correlation and absolute error measured between set and recorded angles across the repeated trials by the same rater. Results: ICC (2,1) values for all 4 exercises are above 0.9, indicating excellent reliability. Lowest overall RMSE was for external rotation (5.67°) and highest for front elevation (8.00°). Box-whisker plots showed have showed that there is a potential zero error in the measurements done by the computer vision software for abduction, where absolute error for measurements taken at 0 degree are shifted away from the ideal 0 line, with its lowest recorded error being 8°. Conclusion: Our results indicate that the use of computer vision software is valid and reliable to use in clinical settings by physiotherapists for measuring shoulder ROM. Overall, computer vision helps improve accessibility to quality care provided for individual patients, with the ability to assess ROM for their condition at home throughout a full cycle of musculoskeletal care (American Academy of Orthopaedic Surgeons) without the need for a trained therapist.

Keywords: physiotherapy, frozen shoulder, joint range of motion, computer vision

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Authors: A. Kourou, A. Ioakeimidou, V. Avramea

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Planning for natural disasters and emergencies is something every school or educational institution must consider, regardless of its size or location. Preparedness is the key to save lives if a disaster strikes. School disaster management mirrors individual and family disaster prevention, and wider community disaster prevention efforts. This paper presents the usage of E-PreS System as a helpful, managerial tool during the school earthquake drill, in order to support schools in developing effective disaster and emergency plans specific to their local needs. The project comes up with a holistic methodology using real-time evaluation involving different categories of actors, districts, steps and metrics. The main outcomes of E-PreS project are the development of E-PreS web platform that host the needed data of school emergency planning; the development of E-PreS System; the implementation of disaster drills using E-PreS System in educational premises and local schools; and the evaluation of E-PreS System. Taking into consideration that every disaster drill aims to test and valid school plan and procedures; clarify and train personnel in roles and responsibilities; improve interagency coordination; identify gaps in resources; improve individual performance; and identify opportunities for improvement, E-PreS Project was submitted and approved by the European Commission (EC).

Keywords: disaster drills, earthquake preparedness, E-PreS System, school emergency plans

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Authors: Mastawal Melese, Yismaw Assefa

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This study aims to identify household-level determinants of solid waste disposal (SWD) practices in Bure Town, north-western Ethiopia. Using a cross-sectional design and a mixed-methods approach, data were collected from 238 randomly selected households through structured interviews, focus group discussions, and field observations. Descriptive analysis revealed that 14.7% of households used composting as a primary SWD method, 37.4% practiced open dumping, 25.6% used burning, and 22.3% resorted to burial. Multinomial logistic regression showed that factors such as monthly income, age, family size, length of residence, sex, home ownership, solid waste sorting procedures, and education significantly influenced the choice of disposal method. Households with lower education, income, home ownership, and shorter residence times were more likely to use improper disposal methods. Females were found to be more likely to engage in better waste disposal practices than males. These findings underscore the need for context-specific interventions in newly developing towns to enhance household-level SWM systems by addressing key socio-economic factors.

Keywords: multinomial logistic regression, solid waste management, solid waste disposal, urban household

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Authors: Mariam Dianat Sabet Gilani, Lars M. Blank, Birgitta E. Ebert

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Plant-derived lupane-type, pentacyclic triterpenoids are biologically active compounds that are highly interesting for applications in medical, pharmaceutical, and cosmetic industries. Due to the low abundance of these valuable compounds in their natural sources, and the environmentally harmful downstream process, alternative production methods, such as microbial cell factories, are investigated. Engineered Saccharomyces cerevisiae strains, harboring the heterologous genes for betulinic acid synthesis, can produce up to 2 g L-1 triterpenoids, showing high potential for large-scale production of triterpenoids. One limitation of the microbial synthesis is the intracellular product accumulation. It not only makes cell disruption a necessary step in the downstream processing but also limits productivity and product yield per cell. To overcome these restrictions, the aim of this study is to develop an in-situ extraction method, which extracts triterpenoids into a second organic phase. Such a continuous or sequential product removal from the biomass keeps the cells in an active state and enables extended production time or biomass recycling. After screening of twelve different solvents, selected based on product solubility, biocompatibility, as well as environmental and health impact, isopropyl myristate (IPM) was chosen as a suitable solvent for in-situ product removal from S. cerevisiae. Impedance-based single-cell analysis and off-gas measurement of carbon dioxide emission showed that cell viability and physiology were not affected by the presence of IPM. Initial experiments demonstrated that after the addition of 20 vol % IPM to cultures in the stationary phase, 40 % of the total produced triterpenoids were extracted from the cells into the organic phase. In future experiments, the application of IPM in a repeated batch process will be tested, where IPM is added at the end of each batch run to remove triterpenoids from the cells, allowing the same biocatalysts to be used in several sequential batch steps. Due to its high biocompatibility, the amount of IPM added to the culture can also be increased to more than 20 vol % to extract more than 40 % triterpenoids in the organic phase, allowing the cells to produce more triterpenoids. This highlights the potential for the development of a continuous large-scale process, which allows biocatalysts to produce intracellular products continuously without the necessity of cell disruption and without limitation of the cell capacity.

Keywords: betulinic acid, biocompatible solvent, in-situ extraction, isopropyl myristate, process development, secondary metabolites, triterpenoids, yeast

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Authors: Jalil ur Rehman, Ramesh C, Tailor, Isa Khan, Jahanzeeb Ashraf, Muhammad Afzal, Geofferry S. Ibbott

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The purpose of this analysis is to estimate secondary cancer risks after VMAT compared to other modalities of head and neck radiotherapy (IMRT, 3DCRT). Computer tomography (CT) scans of Radiological Physics Center (RPC) head and neck phantom were acquired with CT scanner and exported via DICOM to the treatment planning system (TPS). Treatment planning was done using four arc (182-178 and 180-184, clockwise and anticlockwise) for volumetric modulated arc therapy (VMAT) , Nine fields (200, 240, 280, 320,0,40,80,120 and 160), which has been commonly used at MD Anderson Cancer Center Houston for intensity modulated radiation therapy (IMRT) and four fields for three dimensional radiation therapy (3DCRT) were used. True beam linear accelerator of 6MV photon energy was used for dose delivery, and dose calculation was done with CC convolution algorithm with prescription dose of 6.6 Gy. Primary Target Volume (PTV) coverage, mean and maximal doses, DVHs and volumes receiving more than 2 Gy and 3.8 Gy of OARs were calculated and compared. Absolute point dose and planar dose were measured with thermoluminescent dosimeters (TLDs) and GafChromic EBT2 film, respectively. Quality Assurance of VMAT and IMRT were performed by using ArcCHECK method with gamma index criteria of 3%/3mm dose difference to distance to agreement (DD/DTA). PTV coverage was found 90.80 %, 95.80 % and 95.82 % for 3DCRT, IMRT and VMAT respectively. VMAT delivered the lowest maximal doses to esophagus (2.3 Gy), brain (4.0 Gy) and thyroid (2.3 Gy) compared to all other studied techniques. In comparison, maximal doses for 3DCRT were found higher than VMAT for all studied OARs. Whereas, IMRT delivered maximal higher doses 26%, 5% and 26% for esophagus, normal brain and thyroid, respectively, compared to VMAT. It was noted that esophagus volume receiving more than 2 Gy was 3.6 % for VMAT, 23.6 % for IMRT and up to 100 % for 3DCRT. Good agreement was observed between measured doses and those calculated with TPS. The averages relative standard errors (RSE) of three deliveries within eight TLD capsule locations were, 0.9%, 0.8% and 0.6% for 3DCRT, IMRT and VMAT, respectively. The gamma analysis for all plans met the ±5%/3 mm criteria (over 90% passed) and results of QA were greater than 98%. The calculations for maximal doses and volumes of OARs suggest that the estimated risk of secondary cancer induction after VMAT is considerably lower than IMRT and 3DCRT.

Keywords: RPC, 3DCRT, IMRT, VMAT, EBT2 film, TLD

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Authors: R. Farhoud, G. Hermand, S. Delepine-lesoille

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Future underground facility of French radioactive waste disposal, named Cigeo, is designed to store intermediate and high level - long-lived French radioactive waste. Intermediate level waste cells are tunnel-like, about 400m length and 65 m² section, equipped with several concrete layers, which can be grouted in situ or composed of tunnel elements pre-grouted. The operating space into cells, to allow putting or removing waste containers, should be monitored for several decades without any maintenance. To provide the required information, design was performed and tested in situ in Andra’s underground laboratory (URL) at 500m under the surface. Based on distributed optic fiber sensors (OFS) and backscattered Brillouin for strain and Raman for temperature interrogation technics, the design consists of 2 loops of OFS, at 2 different radiuses, around the monitored section (Orthoradiale strains) and longitudinally. Strains measured by distributed OFS cables were compared to classical vibrating wire extensometers (VWE) and platinum probes (Pt). The OFS cables were composed of 2 cables sensitive to strains and temperatures and one only for temperatures. All cables were connected, between sensitive part and instruments, to hybrid cables to reduce cost. The connection has been made according to 2 technics: splicing fibers in situ after installation or preparing each fiber with a connector and only plugging them together in situ. Another challenge was installing OFS cables along a tunnel mad in several parts, without interruption along several parts. First success consists of the survival rate of sensors after installation and quality of measurements. Indeed, 100% of OFS cables, intended for long-term monitoring, survived installation. Few new configurations were tested with relative success. Measurements obtained were very promising. Indeed, after 3 years of data, no difference was observed between cables and connection methods of OFS and strains fit well with VWE and Pt placed at the same location. Data, from Brillouin instrument sensitive to strains and temperatures, were compensated with data provided by Raman instrument only sensitive to temperature and into a separated fiber. These results provide confidence in the next steps of the qualification processes which consists of testing several data treatment approach for direct analyses.

Keywords: monitoring, fiber optic, sensor, data treatment

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Authors: A. Luft, S. Bremen, N. Balc

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The task of flexibility planning and design, just like factory planning, for example, is to create the long-term systemic framework that constitutes the restriction for short-term operational management. This is a strategic challenge since, due to the decision defect character of the underlying flexibility problem, multiple types of flexibility need to be considered over the course of various scenarios, production programs, and production system configurations. In this context, an evaluation model has been developed that integrates both conventional and additive resources on a basic task level and allows the quantification of flexibility enhancement in terms of mix and volume flexibility, complexity reduction, and machine capacity. The model helps companies to decide in early decision-making processes about the potential gains of implementing additive manufacturing technologies on a strategic level. For companies, it is essential to consider both additive and conventional manufacturing beyond pure unit costs. It is necessary to achieve an integrative view of manufacturing that incorporates both additive and conventional manufacturing resources and quantifies their potential with regard to flexibility and manufacturing complexity. This also requires a structured process for the strategic production systems design that spans the design of various scenarios and allows for multi-dimensional and comparative analysis. A respective guideline for the planning of additive resources on a strategic level is being laid out in this paper.

Keywords: additive manufacturing, production system design, flexibility enhancement, strategic guideline

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Authors: Rui Lin, Jimmy Xiangji Huang, Gary Spraakman

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This forthcoming systematic review will underscore the imperative of leveraging technology to mitigate social isolation in older adults, particularly in the context of unprecedented global challenges such as the COVID-19 pandemic. With the continual evolution of technology, it becomes crucial to scrutinize the efficacy of interventions and discern how they can alleviate social isolation and augment social well-being among the elderly. This review will strive to clarify the best methods for older adults to utilize cost-effective and user-friendly technology and will investigate how the adaptation and execution of such interventions can be fine-tuned to maximize their positive outcomes. The study will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to filter pertinent studies. We foresee conducting an analysis of articles and executing a narrative analysis to discover themes and indicators related to quality of life and, technology use and well-being. The review will examine how involving older adults at the community level, applying top practices from community-based participatory research, can establish efficient strategies to implement technology-based interventions designed to diminish social isolation and boost digital use self-efficacy. Applications based on mobile technology and virtual platforms are set to assume a crucial role not only in enhancing connections within families but also in connecting older adults to vital healthcare resources, fostering both physical and mental well-being. The review will investigate how technological devices and platforms can address the cognitive, visual, and auditory requirements of older adults, thus strengthening their confidence and proficiency in digital use—a crucial factor during enforced social distancing or self-isolation periods during pandemics. This review will endeavor to provide insights into the multifaceted benefits of technology for older adults, focusing on how tailored technological interventions can be a beacon of social and mental wellness in times of social restrictions. It will contribute to the growing body of knowledge on the intersection of technology and elderly well-being, offering nuanced understandings and practical implications for developing user-centric, effective, and inclusive technological solutions for older populations.

Keywords: older adults, health service delivery, digital health, social isolation, social well-being

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Authors: Duaa Al Maani, Andrew Roberts

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Students in higher education are expected to learn actively and independently. Whilst quite work has been done to understand the perceptions of students’ learning transition regarding independent learning, to author’s best knowledge, it seems relatively few published research on independent learning in studio-based subjects such as architecture. Another major issue in independent learning research concerned the inconsistency in terminology; there appears to be a paucity of research on its definition, challenges, and tools within the UK university sector. It is not always clear how independent learning works in practice, or what are the challenges that face students toward being independent learners. Accordingly, this paper seeks to highlight these problems by analyzing previous and current literature of independent learning, in addition, to measure students’ independence at the very begging of their first academic year and compare it with their level of learning independence at the end of the same year. Eighty-seven student enrolled in 2017/2018 at Cardiff University completed the Autonomous Learning Questionnaire in order to measure their level of learning independence. Students’ initial responses were very positive and showed high level of learning independence. Interestingly, these responses significantly decreased at the end of the year. Time management was the most obvious challenge facing students transition into higher education, and contrary to expectations, we found no effect of student maturity on their level of independence. Moreover, we found no significant differences among students’ gender, but we did find differences among nationalities.

Keywords: autonomous learning, first year, learning independence, transition

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Authors: O. Ekrami, P. Claes, S. Van Dongen

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Fluctuating asymmetry (FA) has been studied for many years as an indicator of developmental stability or ‘genetic quality’ based on the assumption that perfect symmetry is ideally the expected outcome for a bilateral organism. Further studies have also investigated the possible link between FA and attractiveness or levels of masculinity or femininity. These hypotheses have been mostly examined using 2D images, and the structure of interest is usually presented using a limited number of landmarks. Such methods have the downside of simplifying and reducing the dimensionality of the structure, which will in return increase the error of the analysis. In an attempt to reach more conclusive and accurate results, in this study we have used high-resolution 3D scans of human faces and have developed an algorithm to measure and localize FA, taking a spatially-dense approach. A symmetric spatially dense anthropometric mask with paired vertices is non-rigidly mapped on target faces using an Iterative Closest Point (ICP) registration algorithm. A set of 19 manually indicated landmarks were used to examine the precision of our mapping step. The protocol’s accuracy in measurement and localizing FA is assessed using simulated faces with known amounts of asymmetry added to them. The results of validation of our approach show that the algorithm is perfectly capable of locating and measuring FA in 3D simulated faces. With the use of such algorithm, the additional captured information on asymmetry can be used to improve the studies of FA as an indicator of fitness or attractiveness. This algorithm can especially be of great benefit in studies of high number of subjects due to its automated and time-efficient nature. Additionally, taking a spatially dense approach provides us with information about the locality of FA, which is impossible to obtain using conventional methods. It also enables us to analyze the asymmetry of a morphological structures in a multivariate manner; This can be achieved by using methods such as Principal Components Analysis (PCA) or Factor Analysis, which can be a step towards understanding the underlying processes of asymmetry. This method can also be used in combination with genome wide association studies to help unravel the genetic bases of FA. To conclude, we introduced an algorithm to study and analyze asymmetry in human faces, with the possibility of extending the application to other morphological structures, in an automated, accurate and multi-variate framework.

Keywords: developmental stability, fluctuating asymmetry, morphometrics, 3D image processing

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Authors: Hugo Badia

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This research answers which is the most suitable transit network structure to serve specific demand requirements in an increasing urban dispersion process. Two main approaches of network design are found in the literature. On the one hand, a traditional answer, widespread in our cities, that develops a high number of lines to connect most of origin-destination pairs by direct trips; an approach based on the idea that users averse to transfers. On the other hand, some authors advocate an alternative design characterized by simple networks where transfer is essential to complete most of trips. To answer which of them is the best option, we use a two-step methodology. First, by means of an analytical model, three basic network structures are compared: a radial scheme, starting point for the other two structures, a direct trip-based network, and a transfer-based one, which represent the two alternative transit network designs. The model optimizes the network configuration with regard to the total cost for each structure. For a scenario of dispersion, the best alternative is the structure with the minimum cost. This dispersion degree is defined in a simple way considering that only a central area attracts all trips. If this area is small, we have a high concentrated mobility pattern; if this area is too large, the city is highly decentralized. In this first step, we can determine the area of applicability for each structure in function to that urban dispersion degree. The analytical results show that a radial structure is suitable when the demand is so centralized, however, when this demand starts to scatter, new transit lines should be implemented to avoid transfers. If the urban dispersion advances, the introduction of more lines is no longer a good alternative, in this case, the best solution is a change of structure, from direct trips to a network based on transfers. The area of applicability of each network strategy is not constant, it depends on the characteristics of demand, city and transport technology. In the second step, we translate analytical results to a real case study by the relationship between the parameters of dispersion of the model and direct measures of dispersion in a real city. Two dimensions of the urban sprawl process are considered: concentration, defined by Gini coefficient, and centralization by area based centralization index. Once it is estimated the real dispersion degree, we are able to identify in which area of applicability the city is located. In summary, from a strategic point of view, we can obtain with this methodology which is the best network design approach for a city, comparing the theoretical results with the real dispersion degree.

Keywords: analytical network design model, network structure, public transport, urban dispersion

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Authors: Abigail Ekeigwe, Bethany McGowan, Loran C. Parker, Stephen Byrn, Kari L. Clase

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There are growing calls in the literature to develop and implement competency-based regulatory sciences education (CBRSE) in sub-Saharan Africa to expand and create a pipeline of a competent workforce of regulatory scientists. A defined competence framework is an essential component in developing competency-based education. However, such a competence framework is not available for regulatory scientists in sub-Saharan Africa. The purpose of this research is to identify entry-level competencies for inclusion in a competency framework for regulatory scientists in sub-Saharan Africa as a first step in developing CBRSE. The team systematically reviewed the literature following the PRISMA guidelines for systematic reviews and based on a pre-registered protocol on Open Science Framework (OSF). The protocol has the search strategy and the inclusion and exclusion criteria for publications. All included publications were coded to identify entry-level competencies for regulatory scientists. The team deductively coded the publications included in the study using the 'framework synthesis' model for systematic literature review. The World Health Organization’s conceptualization of competence guided the review and thematic synthesis. Topic and thematic codings were done using NVivo 12™ software. Based on the search strategy in the protocol, 2345 publications were retrieved. Twenty-two (n=22) of the retrieved publications met all the inclusion criteria for the research. Topic and thematic coding of the publications yielded three main domains of competence: knowledge, skills, and enabling behaviors. The knowledge domain has three sub-domains: administrative, regulatory governance/framework, and scientific knowledge. The skills domain has two sub-domains: functional and technical skills. Identification of competencies is the primal step that serves as a bedrock for curriculum development and competency-based education. The competencies identified in this research will help policymakers, educators, institutions, and international development partners design and implement competence-based regulatory science education in sub-Saharan Africa, ultimately leading to access to safe, quality, and effective medical products.

Keywords: competence-based regulatory science education, competencies, systematic review, sub-Saharan Africa

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Authors: Hyunsik Park

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Objective: To provide information of charged nursing care facility for helping to establish geriatric health care policy, and to figure out which factors would be the main determinants for the choice of it. Method: 46 males and 53 females, and the same number of their caregivers admitted into the charged nursing care facility were recruited for intensive interview including personal information, disease information, and economic, familial, marital and emotional statuses. This is a cross-sectional study and we analyzed the data qualitatively. Results: Patients had 3.2 diseases and a hospitalization for 2.3 years on average. They were consists of 46 singles (46.9%), 8 unmarried (8.2%), 5 divorced (5.1%) and 32 married (32.7%). More than two third (70.1%) were supported by their eldest son or daughter. Mostly, the family caregivers decided to admit into the facilities by the doctor’s recommendation (68.4%). When they made a choice for a facility, most of them (42.9%) considered environmental and sanitary conditions. According to their expectation for management in nursing care facility, most caregivers (59.2%) wanted simple-staying for the duration, but most patients (61.3%) expected to be home after taking comprehensive rehabilitation. Three-quarter of the caregivers would agree to use nursing care facilities in the future, if they would be the same situation. Conclusion: Life style and environment are rapidly changing. In the near future, we need lots of the charged nursing care facilities for the old, thus this study can be the good reference for the preparing upcoming aged and super-aged society.

Keywords: nursing care facility, aged society, qualitative analysis, health

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Authors: Dennis Glen G. Ramos, Angelica S. Mendoza, Juliene Marie A. Alvarez, Claudette A. Nagal, Kayzee C. Blanza, Jayson M. Narbonita, John Anthony D. Dayot, Rebecca M. Reduca, Jermaine Jem M. Flojo, Michael E. Resultan, Clyde C. Fomocod, Cindy A. Vinluan, Jeffrie Aleona Mari C. Maclang

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RN HEALS, an acronym for Registered Nurses for Health Enhancement and Local Service, is expected to address the shortage of skilled and experienced nurses in 1,221 rural and unserved or underserved communities for one year. The study would like to explore the lived experiences of the nurses deployed under this program.The study is a Descriptive Qualitative Research. Interview was utilized as a data gathering tool. Six community nurses who are deployed under the RN HEALS program are included in the study. Van Kaam method was used as data management. Data gathering was done from October to December 2013.Two themes emerged in the study; Value and Challenge. Under Value, it had three sub-themes; Job Satisfaction, Upholding Competency, including Personal Development and Professional Growth, and Employability. While under Challenge, it had one sub-theme, Job Stress. The study concludes that nurses adapt to strategies to pursue personal and professional competence and an evolutionary journey. The researchers recommend that Health Administrators improve the work environment of nurses to lessen the challenges experienced by nurses.

Keywords: lived experience, RN HEALS, health enhancement, local service

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Authors: Vithya Veeramani, Karunanidhi Subbaiah

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Emotional problems were found to be the predominant cause of suicide and second leading cause of death among adolescents in India. Emotional problems seem to be the underlying cause for various other severe psycho-social problems experienced in adolescence and also in later years of life. The Corporation schools in Chennai city are named as Chennai High School or Chennai Higher Secondary School run by the Corporation of Chennai. These schools fulfill the educational needs of students who hail from lower socio-economic status living in slums of the Chennai city. Adolescent students of Chennai schools tend to lack basic needs like food, clothes, shelter, etc. Some of the other significant problems faced by them are broken family, lack of parental support, frequent quarrel between parents, alcoholic parents, drug abuse and substance abuse among parents and neighbors, extended family, illiterate parents, deprivation of love and care, and lack of sense of belongingness. This prevailing condition may affect them emotionally and could lead to maladaptive behaviour, aggressiveness, poor interpersonal relationship with others, school refusal behaviour, school drop-out, suicide, etc. Therefore, it is very important to investigate the emotional problems faced by the adolescent students studying in Chennai schools, Chennai. A cross-sectional survey design was used to find the prevalence of emotional problems among adolescent students. Cluster sampling technique was used to select the schools for the present study considering the school as a cluster. In total, there are 15 zones, under the control of Chennai Corporation, of which only 7 zones have Corporation Schools in Chennai city, comprising of 32 Chennai Higher Secondary Schools and 38 Chennai High Schools. Out of these 70 schools, 29 schools comprising of 17 high schools and 12 higher secondary schools were selected randomly using lottery method. A sample of 2594 adolescent students from 9th standard and 11th standard was chosen for the study. Percentage analysis was done to find out the prevalence rate of emotional problems among adolescents students studying in Chennai Schools. Results of the study revealed that, out of 2594 students surveyed, 21.04% adolescent students were found to have academic problems (n = 546), 15.99% adolescent students had social problems (n = 415), behaviour problems was found to be prevalent among 12.87% adolescent students (n = 334), depression was prevalent among 15.88% adolescent students (n = 412) and anxiety was prevalent among 14.42% adolescent students (n = 374). Prevalence of emotional problems among male and female revealed that academic problems were more prevalent compared to other problems. Behaviour problems were least prevalent among boys and anxiety was least prevalent among girls than other problems. The overall prevalence rate of emotional problems was found to be on an increasing trend among adolescent students of low socio-economic status in Chennai city. The findings indicated the need for intervention to prevent and rehabilitate these adolescent students.

Keywords: adolescents, corporation schools, emotional problems, prevalence

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Authors: Melliti Rihab, Zaeid Sonia, Khechine Wiem, Daldoul Amira

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Introduction: Lung cancer is the leading cause of cancer death. Its incidence is increasing, and its prognosis remains pejorative. We present the clinical, pathological, and therapeutic characteristics of bronchopulmonary cancer (BPC) in Tunisia. Methods: Retrospective study including patients followed in the oncology department of the University Hospital of Monastir between April 2014 and December 2021 suffering from lung cancer. Results: These are 117 patients, including 86.3% men and 13.7% women (sex ratio 6.3). The average age was 64 years ± 9 (37-83), with 95.7% being over 50 years old. Patients were smokers in 82% of cases. The clinical signs were dominated by chest pain (27.5%) and dyspnea in 21.1% of cases. In 6 patients, an episode of COVID-19 infection revealed the diagnosis. Half of the patients had a PS between 0 and 1. Small cell lung cancer was present in 18 patients (15.4%). The majority of non small cell lung cancer was of the adenocarcinoma type (68.7%). The diagnosis was late (stage IV) in 62.4% of cases. BPC was metastatic to bone (52%), contralateral lung (25.9%), and brain (27.3%). Patients were oligometastatic in 26% of cases. Surgery and radiotherapy were performed respectively in 14.5% and 23.1% of cases. Three-quarters of the patients had had nutrition (75.2%). The ROS1 mutation was present in 1 patient. PDL-1 expression was >40% in 2 patients. Survival was mean eight months ± 7.4. Conclusion: Lung cancer is diagnosed at a late stage in Tunisia. The lack of molecular study for non-small cell PBC and the lack of marketing authorization for tyrosine kinase inhibitors in Tunisia make the management incomplete.

Keywords: SCLC, NCSLC, ROS1, PDL1

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