Search results for: case allocation

Authors: Corinna Barraco, Ornella Salimbene

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This research involves the Ethiopian locality of Jeldi (North Africa), an area particularly affected by water shortage and in which the pumping and treatment of drinking water are extremely sensitive issues. The study aims to develop and apply low-cost tools for the design of solar water pumping and water purification systems in a not developed country. Consequently, two technical tools have been implemented in Excel i) Solar photovoltaic Pumping (Spv-P) ii) Water treatment (Wt). The Spv-P tool was applied to the existing well (depth 110 [m], dynamic water level 90 [m], static water level 53 [m], well yield 0.1728 [m³h⁻¹]) in the Jeldi area, where estimated water demand is about 50 [m3d-1]. Through the application of the tool, it was designed the water extraction system of the well, obtaining the number of pumps and solar panels necessary for water pumping from the well of Jeldi. Instead, the second tool Wt has been applied in the subsequent phase of extracted water treatment. According to the chemical-physical parameters of the water, Wt returns as output the type of purification treatment(s) necessary to potable the extracted water. In the case of the well of Jeldi, the tool identified a high criticality regarding the turbidity parameter (12 [NTU] vs 5 [NTU]), and a medium criticality regarding the exceeding limits of sodium concentration (234 [mg/L Na⁺] vs 200 [mg/L Na⁺]) and ammonia (0.64 [mg/L NH³-N] vs 0.5 [mg/L NH³-N]). To complete these tools, two specific manuals are provided for the users. The joint use of the two tools would help reduce problems related to access to water resources compared to the current situation and represents a simplified solution for the design of pumping systems and analysis of purification treatments to be performed in undeveloped countries.

Keywords: drinking water, Ethiopia, treatments, water pumping

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Authors: Hamad Albadr

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Joint Commission International (JCI) accreditation process intent to improve the safety and quality of care in the international community through the provision of education, publications, consultation, and evaluation services. These standards apply to the entire organization as well as to each department, unit, or service within the organization. Medical Technology that contains both medical equipment and devices, is an essential part of health care. Appropriate management of equipment maintenance for ensuring medical technology safe, the equipment life is maximized, and the total costs are minimized. JCI medical technology evaluation and accreditation use standards, intents, and measurable elements. The paper focuses on evaluation of JCI standards for medical technology in Saudi Arabian hospitals: a Study Case of PSMMC that define the performance expectation, structures, or functions that must be in place for a hospital to be accredited by JCI through measurable elements that indicate a score during the survey process that identify the requirements for full compliance with the standard specially through Facility Management and Safety (FMS) section that require the hospital establishes and implements a program for inspecting, testing, and maintaining medical technology and documenting the results, to ensure that medical technology is available for use and functioning properly, the hospital performs and documents; an inventory of medical technology; regular inspections of medical technology; testing of medical technology according to its use and manufacturers’ requirements; and performance of preventive maintenance.

Keywords: joint commission international (JCI) accreditation, medical technology, Saudi Arabia, Saudi Arabian hospitals

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Authors: Peter Adekunle, Clinton Aigbavboa, Matthew Ikuabe, Opeoluwa Akinradewo

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Contemporary building methods typically pay little attention to the built environment's greater economic, environmental, or social impacts or energy efficiency. Green construction aims to sever ties with these conventions. In order to provide better living and working conditions and lessen environmental consequences, green building today combines numerous building design, construction, and operation and maintenance approaches. As one of Sub-Saharan Africa's most industrialized nations, South Africa has a good number of green building projects. Therefore, this study examines the elements impacting the adoption of green buildings and regulations created to encourage the growth of green buildings using South Africa as a case study. The study has a survey-style design. A total of one hundred fifty (150) questionnaires were distributed to professionals in the construction industry in South Africa, of which one hundred and twenty-four (128) were returned and judged appropriate for investigation. The gathered data was examined using percentage, mean item scores, standard deviation, and Kruskal-Wallis. The findings show that cost and market circumstances are the two main elements impacting the adoption of green construction, while leadership advice is the most important policy. The study concluded that in order to encourage the construction of green buildings, additional Sub-Saharan nations should adopt these suggested policies.

Keywords: green building, Sub-Saharan Africa, building design, environmental conditions

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Authors: Sulemana Ibrahim

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Food security remains a paramount global challenge, with vulnerable regions grappling with issues of hunger and malnutrition. This study embarks on a comprehensive exploration of data-driven strategies aimed at ameliorating food security in such regions. Our research employs a multifaceted approach, integrating data analytics to predict crop yields, optimizing supply chains, and enhancing food distribution networks. The study unfolds as a multi-dimensional analysis, commencing with the development of robust machine learning models harnessing remote sensing data, historical crop yield records, and meteorological data to foresee crop yields. These predictive models, underpinned by convolutional and recurrent neural networks, furnish critical insights into anticipated harvests, empowering proactive measures to confront food insecurity. Subsequently, the research scrutinizes supply chain optimization to address food security challenges, capitalizing on linear programming and network optimization techniques. These strategies intend to mitigate loss and wastage while streamlining the distribution of agricultural produce from field to fork. In conjunction, the study investigates food distribution networks with a particular focus on network efficiency, accessibility, and equitable food resource allocation. Network analysis tools, complemented by data-driven simulation methodologies, unveil opportunities for augmenting the efficacy of these critical lifelines. This study also considers the ethical implications and privacy concerns associated with the extensive use of data in the realm of food security. The proposed methodology outlines guidelines for responsible data acquisition, storage, and usage. The ultimate aspiration of this research is to forge a nexus between data science and food security policy, bestowing actionable insights to mitigate the ordeal of food insecurity. The holistic approach converging data-driven crop yield forecasts, optimized supply chains, and improved distribution networks aspire to revitalize food security in the most vulnerable regions, elevating the quality of life for millions worldwide.

Keywords: data-driven strategies, crop yield prediction, supply chain optimization, food distribution networks

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Authors: Meng Wang

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Historically, young members (children) in the society have been oppressed by adults through direct violent acts. Direct violence was evident in rampant child labor and child maltreatment cases. After acknowledging the rights of children from the United Nations, it is believed in public that children have been protected against direct physical violence. Nevertheless, at present, this paper argues from Foucauldian and disability study standpoints that similar to the old times, children are oppressed objects in the context of child play, which is constructed by adults to substitute direct violence in regulating children. Particularly, this paper suggests that on the one hand, preschool play is a new way that adults adopt to oppress preschoolers and regulate the society as a whole; on the other hand, preschoolers are taught how to play as an acquired skill and master self-regulation through play. There is a line of contemporary research that centers on child play from social constructivism perspective. Yet, current teaching practices pertaining to child play including guided child play and free play, in fact, serve the interest of adults and society at large. By acknowledging and deconstructing the prevalence of 'evidence-based best practice' in early childhood education field within western society, reconstruction of child-adult power relation could be achieved and alternative truth could be found in early childhood education. To support the argument of this paper, an on-going observational case study is conducted in a preschool setting in the United States. Age range of children is 2.5 to 4 years old. Approximately 10 children (5 boys) are participating in this case study. Observation is conducted throughout the weekdays as children follow through the classroom routine with a lead and an assistant teacher. Classroom teachers are interviewed pertaining to their classroom management strategies. Preliminary research finding of this case study suggested that preschool teachers tended to utilize scenarios from preschoolers’ dramatic play to impart core cultural values to young children. These values were pre-determined by adults. In addition, if young children have failed to follow teachers' guidance in terms of playing in a correct way, children ran the risk of being excluded from the play scenario by peers and adults. Furthermore, this study tended to indicate that through child play, preschoolers are obliged to develop an internal violence system, that is self-regulation skill to regulate their own behavior; and if this internal system is unestablished based on various assessments by adults, then potentially there will be consequences of negative labeling and disabling toward young children intended by adults. In conclusion, this paper applies Foucauldian analysis into the context of child play. At present, within preschool, child play is not free as it seems to be. Young children are expected to perform cultural tasks through their play activities designed by adults. Adults utilize child play as technologies of governmentality to further predict and regulate future society at large.

Keywords: child play, developmentally appropriate practice, DAP, poststructuralism, technologies of governmentality

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Authors: İlhami Karahanoglu, Oguz Ceylan

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As its well-known definitions; systemic risk refers to whole economic system down-turn movement even collapse together in very severe cases. In fact, it points out the contagion effects of the defaults. Such a risk is can be depicted with the famous Chinese game of falling domino stones. During and after the Bear & Sterns and Lehman Brothers cases, it was well understood that there is a very strong effect of systemic risk in financial services sector. In this study, we concentrate on the existence of systemic risk in Turkish Banking Sector based upon the Halkbank Case during the end month of 2013; there was a political turmoil in Turkey in which the close relatives of the upper politicians were involved in illegal trading activities. In that operation, the CEO of Halkbank was also arrested and in investigation, Halkbank was considered as part of such illegal actions. That operation had an impact on Halkbanks stock value. The Halkbank stock value during that time interval decreased remarkably, the distributional profile of stock return changed and became more volatile as well as more skewed. In this study, the daily returns of 5 leading banks in Turkish banking sector were used to obtain 48 return distributions (for each month, 90-days-back stock value returns are used) of 5 banks for the period 12/2011-12/2013 (pre operation period) and 12/2013-12/2015 (post operation period). When those distributions are compared with timely manner, interestingly; the distribution of the 5 other leading banks in Turkey, public or private, had also distribution profiles which was different from the past 2011-2013 period just like Halkbank. Those 5 big banks, whose stock values are monitored with sub index in Istanbul stock exchange (BIST) as BN10, had more skewed distribution just following the Halkbank stock return movement during the post operation period, with lover mean value and as well higher volatility. In addition, the correlation between the stock value return distributions of the leading banks after Halkbank case, where the returns are more skewed to the left, increased (which is measured in monthly base before and after the operation). The dependence between those banks was stronger under the case where the stock values were falling compared with the normal market condition. Such distributional effect of stock returns between the leading banks in Turkey, which is valid for down sub-market (financial/banking sector) condition, can be evaluated as an evidence for the existence of contagious effect and systemic risk.

Keywords: financial risk, systemic risk, banking sector, return distribution, dependency structure

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Authors: Hannah O'Sullivan, Esther Quinn

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Purpose: The Architectural, Engineering, and Construction (AEC) industry has historically struggled to adapt to change. Although the ability to innovate and successfully implement organizational change has been demonstrated to be critical in achieving a sustainable competitive advantage in the industry, many AEC organizations continue to struggle when affecting organizational change. One prominent area of organizational change that presents many challenges in the industry is the adoption of new forms of technology, for example, Building Information Modelling (BIM). Certain Organisational Change Management (OCM) practices have been proven to be effective in supporting organizations to adopt change, but little research has been carried out on diverging employee attitudes to change relative to their roles within the organization. The purpose of this research study is to examine how OCM practices influence employee attitudes to change when adopting new forms of technology and to analyze the diverging employee perspectives within an organization on the importance of different OCM strategies. Methodology: Adopting an interview-based approach, a case study was carried out on a large-sized, prominent Irish construction organization who are currently adopting a new technology platform for its projects. Qualitative methods were used to gain insight into differing perspectives on the utilization of various OCM practices and their efficacy when adopting a new form of technology on projects. Change agents implementing the organizational change gave insight into their intentions with the technology rollout strategy, while other employees were interviewed to understand how this rollout strategy was received and the challenges that were encountered. Findings: The results of this research study are currently being finalized. However, it is expected that employees in different roles will value different OCM practices above others. Findings and conclusions will be determined within the coming weeks. Value: This study will contribute to the body of knowledge relating to the introduction of new technologies, including BIM, to AEC organizations. It will also contribute to the field of organizational change management, providing insight into methods of introducing change that will be most effective for different employees based on their roles and levels of experience within the industry. The focus of this study steers away from traditional studies of the barriers to adopting BIM in its first instance at an organizational level and centers on the direct effect on employees when a company changes the technology platform being used.

Keywords: architectural, engineering, and construction (AEC) industry, Building Information Modelling, case study, challenges, employee perspectives, organisational change management.

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Authors: Patrícia Pires, Renata Vaz, Bárbara Teles, Marco Pato, Pedro Beckert

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Introduction: The management of lateral third clavicle fractures can be challenging due to difficulty in distinguishing subtle variations in the fracture pattern, which may be suggestive of potential fracture instability. They occur most often in men between 30 and 50 years of age, and in individuals over 70 years of age, its distribution is equal between both men and women. These fractures account for 10%–30% of all clavicle fractures and roughly 30%–45% of all clavicle nonunion fractures. Lateral third clavicle fractures may be treated conservatively or surgically, and there is no gold standard, although the risk of nonunion or pseudoarthrosis impacts the recommendation of surgical treatment when these fractures are unstable. There are many strategies for surgical treatment, including locking plates, hook plates fixation, coracoclavicular fixation using suture anchors, devices or screws, tension band fixation with suture or wire, transacromial Kirschner wire fixation and arthroscopically assisted techniques. Whenever taking the hardware into consideration, we must not disregard that obtaining adequate lateral fixation of small fragments is a difficult task, and plates are more associated to local irritation. The aim of the appropriate treatment is to ensure fracture healing and a rapid return to preinjury activities of daily living but, as explained, definitive treatment strategies have not been established and the variety of techniques avalilable add up to the discussion of this topic. Methods and Results: We present a clinical case of a 43-year-old man with the diagnosis of a lateral third clavicle fracture (Neer IIC) in the sequence of a fall on his right shoulder after a bicycle fall. He was operated three days after the injury, and through K-wire temporary fixation and indirect reduction using a ZipTight, he underwent osteosynthesis with an interfragmentary figure-of-eight tension band with polydioxanone suture (PDS). Two weeks later, there was a good aligment. He kept the sling until 6 weeks pos-op, avoiding efforts. At 7-weeks pos-op, there was still a good aligment, starting the physiotherapy exercises. After 10 months, he had no limitation in mobility or pain and returned to work with complete recovery in strength. Conclusion: Some distal clavicle fractures may be conservatively treated, but it is widely accepted that unstable fractures require surgical treatment to obtain superior clinical outcomes. In the clinical case presented, the authors chose an osteosuture technique due to the fracture pattern, its location. Since there isn´t a consensus on the prefered fixation method, it is important for surgeons to be skilled in various techniques and decide with their patient which approach is most appropriate for them, weighting the risk-benefit of each method. For instance, with the suture technique used, there is no wire migration or breakage, and it doesn´t require a reoperation for hardware removal; there is also less tissue exposure since it requires a smaller approach in comparison to the plate fixation and avoids cuff tears like the hook plate. The good clinical outcome on this case report serves the purpose of expanding the consideration of this method has a therapeutic option.

Keywords: lateral third, clavicle, suture, fixation

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Authors: Agustinus Bandur, Dyah Budiastuti

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With the rapid development of information and communication technology (ICT) in globalisation era, higher education (HE) internationalisation has become a worldwide phenomenon. However, even though various studies have been widely published in existing literature, the settings of these studies were taken places in developed countries. Accordingly, the major purpose of this article is to explore the current trends of higher education internationalisation programs with particular reference to identify the benefits and challenges confronted by participating staff and students. For these purposes, ethnographic qualitative study with the usage of NVivo 11 software was applied in coding, analyzing, and visualization of non-numeric data gathered from interviews, videos, web contents, social media, and relevant documents. Purposive sampling technique was applied in this study with a total of ten high-ranked accredited government and private universities in Indonesia. On the basis of thematic and cross-case analyses, this study indicates that while Australia has led other countries in dual-degree programs, partner universities from Japan and Korea have the most frequent collaboration on student exchange programs. Meanwhile, most visiting scholars who have collaborated with the universities in this study came from the US, the UK, Japan, Australia, Netherlands, and China. Other European countries such as Germany, French, and Norway have also conducted joint research with Indonesian universities involved in this study. This study suggests that further supports of government policy and grants are required to overcome the challenges as well as strategic leadership and management roles to achieve high impacts of such programs on higher education quality.

Keywords: higher education, internationalisation, challenges, Indonesia

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Authors: Emily J. Winnall

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It is understood that China has the largest population of people living with dementia in the world; however, little is known about this culturally diverse community, specifically the Chinese Communities, which has been poorly represented in past British research Literature. Further research is needed to gain a greater understanding of the support needs of caregivers caring for a relative living with dementia from the Chinese background. Dementia care and caregivers in Chinese communities are less investigated. The study is a case study of two Chinese community centers and one housing support service. Semi-structured one-to-one interviews and a pilot questionnaire were used as the methods for the study. A toolkit will also be created as a document that provides guidance and signposting to health and social care services for Chinese communities. The findings identified three main themes. Caregivers do not receive any formal support from the UK health and social services, and they felt they would have benefited from getting advice on what support they could access. Furthermore, the data also identified that Chinese organisations do not have the knowledge of dementia, to be able to support those living with dementia and their families. Also, people living with dementia and their families rarely present to Chinese organisations and UK health and social care services, meaning they are not receiving the support they are entitled to or need. Additionally, the community center would like to see workshops/courses around dementia for people from Chinese backgrounds. The study concludes that people from Chinese cultural backgrounds do not have sufficient access to support from UK health and social care services. More information needs to be published that will benefit Chinese communities.

Keywords: Chinese, Chinese organisations, Dementia, family caregivers, social care

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Authors: Yared Pawlos Woldeyes

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Public Relations often referred to as ‘PR’, is the practice of managing the spread of information between an individual or organization, such as a business, government agency, or a nonprofit organization, and the public. Public Relations are important because they help organizations or entities cultivate and maintain meaningful connections with society at large through platforms like print media and social media. Individuals that identify as public relation specialists establish and maintain relationships with an organization’s target audiences, relevant media sources, and opinion leaders. With regard to the challenges, when trying to practice public relations for government institutions, the priority for specialists is often to help members of society exercise a positive attitude and impression of a country’s political systems and practices. If you consider the case of public relations for government entities in Ethiopia there are several factors to consider. First, public relations in Ethiopia are very much driven by a desire to create a good image of the country and prevent the spread of any information that creates a bad image of Ethiopia. Also, the current ruling party dominates public relations in Ethiopia. Unfortunately, this means that more often than not, public relations specialists are forced by the government to spread and mass communicate false information to the public instead of the truth. Any opposition to government’s agenda will result in seriously negative repercussions for public relations specialists. Although public relations is supposed to create a positive and honest relationship between an organization or the government with the public, in Ethiopia, that is not the case. As a result, very few people express an interest in practicing public relations here. Despite this, there is an opportunity for the development of an accountable public relation affairs in developing nations, taking Ethiopian’s case. For instance, the fact that Public relations are provided as a field of study in college or university to produce competent and trained specialists, the enormous contribution of good communication to the public developmental efforts linking the government to the people, and the better payment to employees of public relation officers are some of them. Therefore, there is a need by the respective stakeholders to work in coalition in raising awareness of the youth regarding the importance of a responsible public relations officer to the country’s developmental efforts, encouragement of Civil Society Organizations working in promoting free press and expression of ideas, improving the governmental structure to be transparent and that allows independent officers, and hosting international conferences on public relations practice so that the specialists can exchange knowledge and skills.

Keywords: developing nations, Ethiopia, public relations, public relations specialist

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Authors: Daphine Namara, Jeremy I. Schwartz, Andrew K. Tusubira, Willi McFarland, Caroline Birungi, Fred C. Semitala, Martin Muddu

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Emerging evidence suggests a possible association between hyperglycemia and dolutegravir (DTG), a preferred first-line antiretroviral agent in sub-Saharan Africa (SSA). There is a need for rigorous studies to validate this association in the face of increasing DTG use and the burden of non-communicable diseases among people living with HIV (PLHIV). We conducted a case-control study to assess the risk of hyperglycemia associated with the use of DTG among PLHIV attending Mulago ISS Clinic in Kampala. Cases had hyperglycemia, while controls had no hyperglycemia, as confirmed by fasting plasma glucose and oral glucose tolerance tests. Demographic, laboratory, and clinical data were collected using interviewer-administered questionnaires and medical record abstraction. The analysis compared cases and controls on DTG use prior to diagnosis of hyperglycemia while controlling for potential confounders using multivariable logistic regression. We included 204 cases and 231 controls. In multivariable analysis, patients with prior DTG use had seven times greater odds of subsequent diagnosis of hyperglycemia compared to those who had non-DTG-based regimens (adjusted odds ratio [aOR] 7.01, 95% CI 1.96-25.09). The odds of hyperglycemia also increased with age (56 years and above vs. 18-35, aOR 12.38, 95% CI 3.79-40.50) and hypertension (aOR 5.78, 95% CI 2.53-13.21). Our study demonstrates a strong association between prior DTG exposure and subsequent diagnosis of hyperglycemia. Given the benefits of DTG, wide-scale use, and the growing burden of diabetes mellitus (DM) in SSA, there is a need for systematic screening for hyperglycemia and consideration of alternate regimens for those at risk for DM.

Keywords: HIV, hyperglycemia, doluteravir, diabetes

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Authors: D. Pugazhendhi

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The ancient Greeks were forerunners in many fields than other societies. So, the Greeks were well connected with all the countries which were well developed during that time through trade route. In this connection, trading of goods from the ancient Greece to Tamil Nadu which is presently in India, though they are geographically far away, played an important role. In that way, the word and the goods related with kos and kare got exchanged between these two societies. So, it is necessary to compare the phonology and the morphological occurrences of these words that are found common both in the ancient Greek and Tamil literatures of the contemporary period. The results show that there were many words derived from the root kos with the basic meaning of ‘arrange’ in the ancient Greek language, but this is not the case in the usage of the word kare. In the ancient Tamil literature, the word ‘kos’ does not have any root and also had rare occurrences. But it was just the opposite in the case of the word ‘kare’. One of all the meanings of the word, which was derived from the root ‘kos’ in ancient Greek literature, is related with costly ornaments. This meaning seems to have close resemblance with the usage of word ‘kos’ in ancient Tamil literature. Also, the meaning of the word ‘kare’ in ancient Tamil literature is related with spices whereas, in the ancient Greek literature, its meaning is related to that of the cooking of meat using spices. Hence, the similarity seen in the meanings of these words ‘kos’ and ‘kare’ in both these languages provides lead for further study. More than that, the ancient literary resources which are available in both these languages ensure the export and import of gold and spices from the ancient Greek land to Tamil land.

Keywords: arrange, kare, Kos, ornament, Tamil

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Authors: Yufeng Wu, Yifan Gu, Bin Li, Wei Wang

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Resource recycling process contains a subsystem with interactions of three dimensions including coupling allocation of primary and secondary resources, responsibility coordination of stakeholders in forward and reverse supply chains, and trans-boundary transfer of hidden resource and environmental responsibilities between regions. Overlap or lack of responsibilities is easy to appear at the intersection of the three management dimensions. It is urgent to make an overall design of the policy system for recycling resources. From theoretical perspective, this paper analyzes the unique external differences of resource and environment in various dimensions and explores the reason why the effects of trans-dimensional policies are strongly correlated. Taking the example of the copper resources contained in the waste electrical and electronic equipment, this paper constructs reduction effect accounting model of resources recycling and set four trans-dimensional policy scenarios including resources tax and environmental tax reform of the raw and secondary resources, application of extended producer responsibility system, promotion of clean development mechanism, and strict entry barriers of imported wastes. In these ways, the paper simulates the impact effect of resources recycling process on resource deduction and emission reduction of waste water and gas, and constructs trans-dimensional policy mix scenario through integrating dominant strategy. The results show that combined application of various dimensional policies can achieve incentive compatibility and the trans-dimensional policy mix scenario can reach a better effect. Compared with baseline scenario, this scenario will increase 91.06% copper resources reduction effect and improve emission reduction of waste water and gas by eight times from 2010 to 2030. This paper further analyzes the development orientation of policies in various dimension. In resource dimension, the combined application of compulsory, market and authentication methods should be promoted to improve the use ratio of secondary resources. In supply chain dimension, resource value, residual functional value and potential information value contained in waste products should be fully excavated to construct a circular business system. In regional dimension, it should give full play to the comparative advantages of manufacturing power to improve China’s voice in resource recycling in the world.

Keywords: resource recycling, trans-dimension, policy design, incentive compatibility, life cycle

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Authors: Chengbin Wang, Li Lu, Luodan Suo, Qinghai Wang, Fan Yang, Xu Wang, Mona Marin

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Background: Two-dose varicella vaccination has been recommended in Beijing since November 2012. We investigated a varicella outbreak in a highly vaccinated elementary school population to examine transmission patterns and risk factors for vaccine failure. Methods: A varicella case was defined as an acute generalized maculopapulovesicular rash without other apparent cause in a student attending the school from March 28 to May 17, 2015. Breakthrough varicella was defined as varicella >42 days after last vaccine dose. Vaccination information was collected from immunization records. Information on prior disease and clinical presentation was collected via survey of students’ parents. Results: Of the 1056 school students, 1028 (97.3%) reported no varicella history, of whom 364 (35.4%) had received 1-dose and 650 (63.2%) had received 2-dose varicella vaccine, for 98.6% school-wide vaccination coverage with ≥ 1 dose before the outbreak. A total of 20 cases were identified for an overall attack rate of 1.9%. The index case was in a 2-dose vaccinated student who was not isolated. The majority of cases were breakthrough (19/20, 95%) with attack rates of 7.1% (1/14), 1.6% (6/364) and 2.0% (13/650) among unvaccinated, 1-dose, and 2-dose students, respectively. Most cases had < 50 lesions (18/20, 90%). No difference was found between 1-dose and 2-dose breakthrough cases in disease severity or sociodemographic factors. Conclusion: Moderate 2-dose varicella vaccine coverage was insufficient to prevent a varicella outbreak. Two-dose breakthrough varicella is still contagious. High 2-dose varicella vaccine coverage and timely isolation of ill persons might be needed for varicella outbreak control in the 2-dose era.

Keywords: varicella, outbreak, breakthrough varicella, vaccination

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Authors: Marin Kanarev, Delyan Stoyanov, Ivanna Popova, Nadezhda Petrova

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Thanks to increased survival rates in patients bearing oncological malignancies due to recent developments in anti-cancer therapies and diagnostic techniques, observation of clinical cases of metachronous cancers is more common and can provide more in-depth knowledge of their development and, as a result, help clinicians apply suitable therapy. This unusual case of three metachronous tumors presented the opportunity to follow their occurrence, progression, and treatment thoroughly. A 77-year-old male presented with carcinoma ventriculi of the pylorus region, which was surgically removed via upper subtotal stomach resection, a lateral antecolical gastro-enteroanastomosis, and a subsequent Braun anastomosis. An EOX chemotherapy regimen followed. A CT scan four months later showed no indication of recurrence or dissemination. The same scan, performed as a part of the follow-up plan two years later, showed an indication of neoplastic growth in the urinary bladder. After the patient had been directed to a urologist, the suspicion was confirmed, and the growth was histologically diagnosed as a carcinoma of the urinary bladder. An immunohistochemistry test showed an expression of PDL1 of less than 5%, which resulted in treatment with GemCis chemotherapy regimen that led to full remission. Two years and seven months after the first surgery, a CT scan showed again that the two carcinomas were gone. However, four months later, elevated tumor markers prompted a PET/CT scan, which showed data indicative of recurring neoplastic growth in the region of the stomach cardia. It was diagnosed as an adenocarcinoma infiltrating the esophagus. Preoperative chemotherapy with the ECF regimen was completed in four courses, and a CT scan showed no progression of the disease. In less than a month after therapy, the patient underwent laparotomy, debridement, gastrectomy, and a subsequent mechanical terminal-lateral esophago-jejunoanasthomosis. It was verified that the tumor originated from metastasis from the carcinoma ventriculi, which was located in the pylorus. In conclusion, this case report highlights the importance of patient follow-up and studying recurring neoplastic growth. Despite the absence of symptoms, clinicians should maintain a high level of suspicion when evaluating the patient data and choosing the most suitable therapy.

Keywords: carcinoma, follow-up, metachronous, neoplastic growth, recurrence

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Authors: A. Kourou, A. Ioakeimidou, A. Gakou

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Greece due to its location in the Eastern Mediterranean region is characterized by a high degree of seismicity and occurrence of severe earthquakes. It is generally accepted that preventive planning is vital in mitigating impacts, protecting those who are the most vulnerable namely children and increasing the degree of resilience of local communities. Worldwide, States have highlighted the need to ensure the safety of early childhood environments in case of disaster. A great number of children are enrolled in daycare facilities, so building and improving the preparedness of pre-primary schools to prevent injuries and fatalities in case of an earthquake becomes an important policy issue. It is more than evident that preparedness in early preschool level will be increased through awareness and education of the people who work to pre-primary classes and provide early childhood care. The aim of the present study is to assess the level of awareness and preparedness of the Greek pre-primary schools staff concerning earthquake protection issues, as well as their risk mitigation behaviors and earthquake management in case of a strong event. In this framework, specific questionnaire was developed and filled by the abovementioned target group at 30 different municipalities of Greece (2014-2016). Also in the framework of this study it is presented the Pre-Primary Schools’ Earthquake Safety Initiative that has been undertaken by Earthquake Planning and Protection Organization (EPPO) the last years. This initiative aims to develop disaster-resilient day care centers through awareness, self-help, cooperation and education. Recognizing the necessity of integration of the disaster safety concept at pre-primary environments, EPPO published practical guidelines that focused on earthquake planning of these workspaces. Furthermore, dozens of seminars are implemented in municipality or prefecture-level every year by EPPO, in order the early childhood schools’ staff to be appropriately educated and adequately trained to face the earthquake risk. Great progress has been made towards building awareness and increasing preschool preparedness in Greece but significant gaps still remain. Anyway, it is extremely important that the implementation of effective programs and practices and the broad collaboration of all involved parties have been recognized as essential in order to develop a comprehensive disaster management system at preschool environment.

Keywords: awareness, earthquake, education, emergency plans, preparedness, pre-primary schools

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Authors: Mihail Nagea, Olivera Lupescu, Elena Taina Avramescu, Cristina Patru

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Classical education of orthopedic surgeons involves lectures, self study, workshops and cadaver dissections, and sometimes supervised practical training within surgery, which quite seldom gives the young surgeons the feeling of being unable to apply what they have learned especially in surgical practice. The purpose of this paper is to present a different approach from the classical one, which enhances the practical skills of the orthopedic trainees and prepare them for future practice. The paper presents the content of the research project 2015-1-RO01-KA202-015230, ERASMUS+ VET ‘Collaborative learning for enhancing practical skills for patient-focused interventions in gait rehabilitation after orthopedic surgery’ which, using e learning as a basic tool , delivers to the trainees not only courses, but especially practical information through videos and case scenarios including gait analysis in order to build patient focused therapeutic plans, adapted to the characteristics of each patient. The outcome of this project is to enhance the practical skills in orthopedic surgery and the results are evaluated following the answers to the questionnaires, but especially the reactions within the case scenarios. The participants will thus follow the idea that any mistake within solving the cases might represent a failure of treating a real patient. This modern approach, besides using interactivity to evaluate the theoretical and practical knowledge of the trainee, increases the sense of responsibility, as well as the ability to react properly in real cases.

Keywords: interdisciplinary approach, gait analysis, orthopedic surgery, vocational training

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Authors: S. Behnam Asl, H. Sadeghi Naeini, L. Sadat Ensaniat, R. Khorshidian, S. Alipour, S. Behnam Asl

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Nowadays, the construction industry is growing, especially among developing countries. Iran also has a critical role in these industries in terms of workers disorders. Work-related musculoskeletal disorders (WMSDs) account for 7% of the whole diseases in the society, which makes some limitations. One of the main factors which causes WMSDs is awkward posture. Steel bar bending is considered as one of the prominent performance among construction workers. In this case study, we aimed to find the major tasks of bar benders and the most important risk factors related to it. This study was carried out among twenty workers (18-45 years) as our volunteer samples in some construction sites with less than 6 floors in two regions of Tehran municipality. The data was gathered through in depth observation, interview and questionnaire. Also postural analysis was done by OWAS method. In another part of study we used NMQ for gathering some data about psychosocial effects of work related disorders. Our findings show that 64% of workers were not aware of work risks, about 59% of workers had troubles in their wrists, hands, especially workers who worked in steel bar bending. In 46% cases lower back pain was in prevalence. Considering gathered data and results, awkward postures and long term tasks and their duration are known as the main risk factors of WMSDs among construction workers, meaning that work-rest schedule and tools design should be reconsidered to make an ergonomic condition for the mentioned workers.

Keywords: bar benders, construction workers, musculoskeletal disorders (WMSDs), OWAS method

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Authors: Annesha Ghosh, S. B. Agrawal

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Agricultural sector is facing a serious threat due to climate change and exacerbation of different atmospheric pollutants. Tropospheric ozone (O₃) is considered as a dynamic air pollutant imposing substantial phytotoxicity to natural vegetations and agriculture worldwide. Naturally, plants are exposed to different environmental factors and their interactions. Amongst such interactions, studies related to O₃ and water stress are still rare. In the present experiment, wheat cultivar HD2967 were grown in open top chambers (OTC) under two O₃ concentration; ambient O₃ level (A) and elevated O₃ (E) (ambient + 20 ppb O₃) along with two different water supply; well-watered (W) and 50% water stress conditions (WS), with an aim to assess the individual and interactive effect of two most prevailing stress factors in Indo-Gangetic Plains of India. Exposure to elevated O₃ dose caused early senescence symptoms and reduction in growth and biomass of the test cultivar. The adversity was more pronounced under the combined effect of EWS. Significant reduction of stomatal conductance (gs) and assimilation rate were observed under combined stress condition compared to the control (AW). However, plants grown under individual stress conditions displayed higher gs, biomass, and antioxidant defense mechanism compared to the plants grown under the presence of combined stresses. Higher induction in most of the enzyme activities of catalase (CAT), ascorbate peroxidase (APX), glutathione reductase (GR), peroxidase (POD) and superoxide dismutase (SOD) was displayed by HD 2967 under EW while, under the presence of combined stresses (EWS), a moderate increment of APX and CAT activity was observed only at its vegetative phase. Furthermore, variations in nutrient uptake and redistribution to different plants parts were also observed in the present study. Reduction in water availability has checked nutrient uptake (N, K, P, Ca, Cu, Mg, Zn) in above-ground parts (leaf) and below-ground parts (root). On the other hand, carbon (C) accumulation with subsequent C-N ratio was observed to be higher in the leaves under EWS. Such major nutrient check and limitation in carbon fixation due to lower gs under combined stress conditions might have weakened the defense mechanisms of the test cultivar. Grain yield was significantly reduced under EWS followed by AWS and EW as compared to their control, exhibiting an additive effect on the grain yield.

Keywords: antioxidants, open-top chambers, ozone, water stress, wheat, yield

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Authors: Kalpana Jamdhade, Anita Chorey, Bharti Tijare, V. M. Bhale

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A field experiment was conducted during summer season of 2011 at Agronomy research farm, Dr. PDKV, Akola, to study the effect of irrigation regime and nitrogen levels on growth and productivity of summer sesame. The experiment was laid out in split plot Design in which three irrigation scheduling on the basis of IW/CPE ratio viz., irrigation at 0.6, 0.8 and 1.0 IW/CPE ratios (I1, I2 and I3, respectively) and one irrigation scheduling based on critical growth stages of sesame (I4), in main plot and three nitrogen levels 0, 30 and 60 kg N ha-1 (N0, N1 and N2, respectively) in subplot. The result showed that plant height, number of leaves plant-1, leaf area and dry matter accumulation were maximum in irrigation scheduling at 1.0 IW/CPE ratio, which significantly superior over 0.6 IW/CPE ratio and irrigation at critical growth stages but were statistically at par with irrigation at 0.8 IW/CPE ratio. Nitrogen levels, application of 60 kg N ha-1 was recorded significantly superior all growth parameters over treatment 30 kg N ha-1 and 0 kg N ha-1. In case of yield attributes viz., No. of capsules plant-1, Test wt., grain yield and Stalk yield (qha-1) were maximum in irrigation scheduling at 1.0 IW/CPE ratio and were significantly superior over 0.8 IW/CPE ratio, 0.6 IW/CPE ratio and irrigation at critical growth stages. Application of 60 kg N ha-1 increased all yield attributing characters over application of 30 and 0 kg N ha-1. In case of economics of crop same trend was found and the highest B:C ration was obtained in irrigation scheduling at 1.0 IW/CPE ratio. Whereas, application of 30 kg N ha-1 was recorded highest B:C ration over application of 60 and 0 kg N ha-1. Interaction effect of irrigation and nitrogen levels were found to be non significant in summer season.

Keywords: irrigation regimes, nitrogen levels, summer sesame, agricultural technology

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Authors: Daniel Gidey, Kunwar Siddarth Dadhwal, Tagel Wondimu

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There are numerous ways for ending conflict; hitherto, most conflicts are resolved either through negotiated or victor's peace, this article is about the former. Negotiations entail concessions, consensus-building, and mutual trust in order to transform a belligerent situation into a settlement. In such a context, regional and sub-regional organizations play a critical role in mediating conflicting parties so as to prevent, manage, and resolve conflicts between and among conflicting parties. This article is about the AU-led negotiated peace deal on the bloody conflict between the Tigray Peoples Liberation Front (TPLF) and the Federal Democratic Republic of Ethiopia (FDRE) by undertaking the Pretoria Peace Accord as a case study. In terms of research method, the article is based on a critical evaluation of the literature and content analysis on the very research topic. Findings of the study revealed that the AU, through Olusegun Obasanjo and other dignitaries, played a critical role in nurturing compromise and mutual trust between the TPLF and the Ethiopian federal government so as to take along the Pretoria peace deal. Through critical literature review and content analysis of the Peace deal, the article has concluded that negotiated peace is likely, at least, to achieve negative peace.

Keywords: regional organizations, peace promotion, African Union, negotiating conflicts, Northern Ethiopia, conflict resolution

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Authors: Nadir Ali Mugheri, Shaukat Ali Lohar

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In a multilingual society like Pakistan, code switching is commonly observed in different contexts. Mostly people use L1 (Native Languages) and L2 for common communications and L3 (i.e. English, Urdu, Sindhi) in formal contexts and for academic writings. Such a frequent code switching does affect EFL learners' acquisition of grammar and lexis of the target language which in the long run result in different types of errors in their writings. The current study is to investigate and identify common elements of L1 and L2 (spoken by students of the Universities in Pakistan) which create hindrances for EFL learners. Case study method was used for this research. Formal writings of 400 EFL learners (as participants from various Universities of the country) were observed. Among 400 participants, 200 were female and 200 were male EFL learners having different academic backgrounds. Errors found were categorized into different types according to grammatical items, the difference in meanings, structure of sentences and identifiers of tenses of L1 or L2 in comparison with those of the target language. The findings showed that EFL learners in Pakistani varsities have serious problems in their writings and they committed serious errors related to the grammar and meanings of the target language. After analysis of the committed errors, the results were found in the affirmation of the hypothesis that L1 or L2 does affect EFL learners. The research suggests in the end to adopt natural ways in pedagogy like task-based learning or communicative methods using contextualized material so as to avoid impediments of L1 or L2 in acquisition the target language.

Keywords: multilingualism, L2 acquisition, code switching, language acquisition, communicative language teaching

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Authors: Atif Zafar, Fan Haijun

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A sequence of different Reservoir Engineering methods and tools in reservoir characterization and field development are presented in this paper. The real data of Jin Gas Field of L-Basin of Pakistan is used. The basic concept behind this work is to enlighten the importance of well test analysis in a broader way (i.e. reservoir characterization and field development) unlike to just determine the permeability and skin parameters. Normally in the case of reservoir characterization we rely on well test analysis to some extent but for field development plan, the well test analysis has become a forgotten tool specifically for locations of new development wells. This paper describes the successful implementation of well test analysis in Jin Gas Field where the main uncertainties are identified during initial stage of field development when location of new development well was marked only on the basis of G&G (Geologic and Geophysical) data. The seismic interpretation could not encounter one of the boundary (fault, sub-seismic fault, heterogeneity) near the main and only producing well of Jin Gas Field whereas the results of the model from the well test analysis played a very crucial rule in order to propose the location of second well of the newly discovered field. The results from different methods of well test analysis of Jin Gas Field are also integrated with and supported by other tools of Reservoir Engineering i.e. Material Balance Method and Volumetric Method. In this way, a comprehensive way out and algorithm is obtained in order to integrate the well test analyses with Geological and Geophysical analyses for reservoir characterization and field development. On the strong basis of this working and algorithm, it was successfully evaluated that the proposed location of new development well was not justified and it must be somewhere else except South direction.

Keywords: field development plan, reservoir characterization, reservoir engineering, well test analysis

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Authors: Karissa Graham, Andrew Campbell-Lloyd

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The deep inferior epigastric artery perforator flap (DIEP) is used to reconstruct large volumes of tissue. The DIEP flap is based on the deep inferior epigastric artery (DIEA) and vein. Accurate knowledge of the anatomy of these vessels allows for efficient dissection of the flap, minimal damage to surrounding tissue, and a well vascularized flap. A 54 year old lady was assessed for bilateral delayed autologous reconstruction with DIEP free flaps. The right DIEA was consistent with the described anatomy. The left DIEA had a vessel branching shortly after leaving the external iliac artery and before entering the muscle. This independent branch entered the muscle and had a long intramuscular course to the largest perforator. The main DIEA vessel demonstrated a type II branching pattern but had perforators that were too small to have a viable DIEP flap. There were no communicating arterial branches between the independent vessel and DIEA, however, there was one venous communication between them. A muscle sparing transverse rectus abdominis muscle flap was raised using the main periumbilical perforator from the independent vessel. Our case report demonstrated an unreported anatomical variant of the DIEA. A few anatomical variants have been described in the literature, including a unilateral absent DIEA and peritoneal-cutaneous perforators that had no connection to the DIEA. Doing a pre-operative CTA helps to identify these rare anatomical variations, which leads to safer, more efficient, and effective operating.

Keywords: aberrant anatomy, CT angiography, DIEP anatomy, free flap

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Authors: Gopala Krishna Darbha

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Microplastics (MPs) are secondary fragments of large-sized plastic debris released into the environment and fall in the size range of less than 5 mm. Though reports indicate the abundance of MPs in both riverine and soil environments, their fate is still not completely understood due to the complexity of natural conditions. Mineral particles are ubiquitous in the rivers and may play a vital role in accumulating MPs to the riverbed, thus affecting the benthic life and posing a threat to the river's health. Apart, the chemistry (pH, ionic strength, humics) at the interface can be very prominent. The MPs can also act as potential vectors to transport other contaminants in the environment causing secondary water pollution. The present study focuses on understanding the interaction of MPs with weathering sequence of minerals (feldspar, kaolinite and gibbsite) under batch mode under relevant environmental and natural conditions. Simultaneously, we performed stability studies and transport (column) experiments to understand the mobility of MPs under varying soil solutions (SS) chemistry and the influence of contaminants (CuO nanoparticles). Results showed that the charge and morphology of the gibbsite played an significant role in sorption of NPs (108.1 mg/g) compared to feldspar (7.7 mg/g) and kaolinite (11.9 mg/g). The Fourier transform infrared spectroscopy data supports the complexation of NPs with gibbsite particles via hydrogen bonding. In case of feldspar and kaolinite, a weak interaction with NPs was observed which can be due to electrostatic repulsions and low surface area to volume ration of the mineral particles. The study highlights the enhanced mobility in presence of feldspar and kaolinite while gibbsite rich zones can cause entrapment of NPs accumulating in the riverbeds. In the case of soils, in the absence of MPs, a very high aggregation of CuO NPs observed in SS extracted from black, lateritic, and red soils, which can be correlated with ionic strength (IS) and type of ionic species. The sedimentation rate (Ksed(1/h)) for CuO NPs was >0.5 h−1 in the case of these SS. Interestingly, the stability and sedimentation behavior of CuO NPs varied significantly in the presence of MPs. The Ksed for CuO NPs decreased to half and found <0.25 h−1 in the presence of MPs in all SS. C/C0 values in breakthrough curves increased drastically (black < alluvial < laterite < red) in the presence of MPs. Results suggest that the release of MPs in the terrestrial ecosystem is a potential threat leading to increased mobility of metal nanoparticles in the environment.

Keywords: microplastics, minerals, sorption, soils

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Authors: Mei-Ying Liao

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The main purpose of this study was to examine the requirements of a successful concert for young children in preschool in Taiwan. This study reports a case study of a preschool’s experience which undertook ten concerts for young children. The main audiences were young children who were two to six years of age. The performers, including children’s family, amateurs and professional performers, were invited to perform music instruments or singing twice a week. The performers participated in these concerts separately, as a solo or ensemble performance. There were totally ten concerts. The structure of concert included the performance, musical activities, questions and answers, song requests, and exploration of instruments. Data collection included interviews with children, teachers and performers, concert observations, and footnotes. Results showed that the requirements of a successful and meaningful concert for young children were suggested to include concert preparation, concert, and post activities. The concert organizer, host and classroom teachers played vital roles for a successful concert. The organizer had to organize the programs and prepared for the concerts based on the needs and interests of their audience of young children, engage their attention and offer the potential to expand their musical worlds. The hosts had to build a bridge between performers and young children who had to know how they could delight and educate children. Concerts combined games, storytelling, instrument exploration and great music had great effects. Finally, the classroom teachers had to do the extension activities after the concerts so that the children will involve more and get more enthusiasm in concerts.

Keywords: case study, concert, music education, performance

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Authors: Aliakbar Golshani, Seyyed Mehdi Poorhashemi, Mahsa Gharizadeh

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The under passing tunnels are strongly influenced by the soils around. There are some complexities in the specification of real soil behavior, owing to the fact that lots of uncertainties exist in soil properties, and additionally, inappropriate soil constitutive models. Such mentioned factors may cause incompatible settlements in numerical analysis with the obtained values in actual construction. This paper aims to report a case study on a specific tunnel constructed by NATM. The tunnel has a depth of 11.4 m, height of 12.2 m, and width of 14.4 m with 2.5 lanes. The numerical modeling was based on a 2D finite element program. The soil material behavior was modeled by hardening soil model. According to the field observations, the numerical estimated settlement at the ground surface was approximately four times more than the measured one, after the entire installation of the initial lining, indicating that some unknown factors affect the values. Consequently, the geotechnical parameters are accurately revised by a numerical back-analysis using laboratory and field test data and based on the obtained monitoring data. The obtained result confirms that typically, the soil parameters are conservatively low-estimated. And additionally, the constitutive models cannot be applied properly for all soil conditions.

Keywords: NATM tunnel, initial lining, laboratory test data, numerical back-analysis

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Authors: Ilham Benali, Nasser Hajji, Nawfal Acha

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Given the fact that the pharmaceutical industry is a commonly studied sector in the context of innovation, the majority of innovation research is devoted to the developed markets known by high research and development (R&D) assets and intensive innovation. In contrast, in developing countries where R&D assets are very low, there is relatively little research to mention in the area of pharmaceutical sector innovation, characterized mainly by two principal elements which are the presence of foreign-owned firms and licensed manufacturing agreements between local firms and multinationals. With the scarcity of research in this field, this paper attempts to study the effect of these two elements on the firms’ innovation tendencies. Other traditional factors that influence innovation, which are the age and the size of the firm, the R&D activities and the market structure, revealed in the literature review, will be included in the study in order to try to make this work more exhaustive. The study starts by examining innovation tendency in pharmaceutical firms located in developing countries before analyzing the effect of foreign-owned firms and licensed manufacturing agreements between local firms and multinationals on technological, organizational and marketing innovation. Based on the related work and on the theoretical framework developed, there is a probability that foreign-owned firms and licensed manufacturing agreements between local firms and multinationals have a negative influence on technological innovation. The opposite effect is possible in the case of organizational and marketing innovation.

Keywords: developing countries, foreign owned firms, innovation, licensed manufacturing agreements, pharmaceutical industry

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Authors: Serag El Hegazi

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The development of an assessment methodological framework for local and institutional sustainability is a key factor for future development plans and visions. This paper develops an approach to local and institutional sustainability assessment (ALISA). The ALISA methodology is a methodological framework that assists in the clarification, formulation, preparation, selection, and ranking of key indicators to facilitate the assessment of the level of sustainability at the local and institutional levels in North African and Middle Eastern cities. According to the literature review, this paper formulates a methodological framework, ALISA, which is a combination of the UNCSD (2001) Theme Indicators Framework and the issue-based Framework illustrated by McLaren (1996). The methodological framework has been implemented to formulate, select, and prioritise key indicators that most directly reflect the issues of a case study at the local community and institutional level. Yet, in the meantime, there is a lack of clear indicators and frameworks that can be developed to apply successfully at the local and institutional levels in the MENA Region, particularly in the cities of Benghazi and Amman. This is an essential issue for sustainability development estimation. Therefore, a conceptual framework was developed to be tested as a methodology to collect and classify data. The Approach to Local and Institutional Sustainability Assessment (ALISA) is a methodological framework that was developed to apply to certain cities in the MENA region. The main goal is to develop the ALISA framework to formulate, choose, and prioritize sustainability key indicators, which then can assist in guiding an assessment progress to improve decisions and policymakers towards the development of sustainable cities at the local and institutional level in the city of Benghazi. The conceptual, methodological framework, which supports this research with joint documentary and analysed data in two case studies, including focus-group discussions, semi-structured interviews, and questionnaires, reflects the approach required to develop a combined framework that assists the development of sustainability indicators. To achieve this progress and reach the aim of this paper, which is developing a practical approach for sustainability indicators framework that could be used as a tool to develop local and institutional sustainability indicators, appropriate stages must be applied to propose a set of local and institutional sustainability indicators as follows: Step one: issues clarifications, Step two: objectives formation/analysing of issues and boundaries, Step three: indicators preparation, First list of proposed indictors, Step four: indicator selection, Step five: indicator rating/ranking.

Keywords: sustainability indicators, approach to local and institutional level, ALISA, policymakers

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