Search results for: Kevin Moustapha
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 170

Search results for: Kevin Moustapha

80 Organic Co-Polymer Monolithic Columns for Liquid Chromatography Mixed Mode Protein Separations

Authors: Ahmed Alkarimi, Kevin Welham

Abstract:

Organic mixed mode monolithic columns were fabricated from; glycidyl methacrylate-co-ethylene dimethacrylate-co-stearyl methacrylate, using glycidyl methacrylate and stearyl methacrylate as co monomers representing 30% and 70% respectively of the liquid volume with ethylene dimethacrylate crosslinker and 2,2-dimethoxy-2-phenylacetophenone as the free radical initiator. The monomers were mixed with a binary porogenic solvent, comprising propan-1-ol, and methanol (0.825 mL each). The monolith was formed by photo polymerization (365 nm) inside a borosilicate glass tube (1.5 mm ID and 3 mm OD x 50 mm length). The monolith was observed to have formed correctly by optical examination and generated reasonable backpressure, approximately 650 psi at a flow rate of 0.2 mL min⁻¹ 50:50 acetonitrile: water. The morphological properties of the monolithic columns were investigated using scanning electron microscopy images, and Brunauer-Emmett-Teller analysis, the results showed that the monolith was formed properly with 19.98 ± 0.01 mm² surface area, 0.0205 ± 0.01 cm³ g⁻¹ pore volume and 6.93 ± 0.01 nm average pore size. The polymer monolith formed was further investigated using proton nuclear magnetic resonance, and Fourier transform infrared spectroscopy. The monolithic columns were investigated using high-performance liquid chromatography to test their ability to separate different samples with a range of properties. The columns displayed both hydrophobic/hydrophilic and hydrophobic/ion exchange interactions with the compounds tested indicating that true mixed mode separations. The mixed mode monolithic columns exhibited significant separation of proteins.

Keywords: LC separation, proteins separation, monolithic column, mixed mode

Procedia PDF Downloads 135
79 Mercury (Hg) Concentration in Fish Marketed in the São Luís Fish Market (MA) and Potential Exposure of Consumers

Authors: Luiz Drude de Lacerda, Kevin Luiz Cordeiro Ferrer do Carmo, Victor Lacerda Moura, Rayone Wesley Santos de Oliveira, Moisés Fernandes Bezerra

Abstract:

Fish is a food source well recognized for its health benefits. However, the consumption of fish, especially carnivorous species, is the main path of human exposure to Hg, a widely distributed pollutant on the planet and that accumulates along food chains. Studies on the impacts on public health by fish intake show existing toxic risks even when at low concentrations. This study quantifies, for the first time, the concentrations of Hg in muscle tissue of the nine most commercialized fish species in the fish market of São Luís (MA) in north Brazil and estimates the consequent human exposure through consumption. Concentrations varied according to trophic level, with the highest found in the larger carnivorous species; the Yellow hake (Cynoscion acoupa) (296.4 ± 241.2 ng/g w.w) and the Atlantic croaker (Micropogonias undulatus) (262.8 ± 89.1 ng/g w.w.), whereas the lowest concentrations were recorded in iliophagous Mullets (Mugil curema) (20.5 ± 9.6 ng/g w.w.). Significant correlations were observed between Hg concentrations and individual length in only two species: the Flaming catfish (Bagre marinus) and the Atlantic bumper (Chloroscombrus crysurus). Given the relatively uniform size of individuals of the other species and/or the small number of samples, this relationship was not found for the other species. The estimated risk coefficients, despite the relatively low concentrations of Hg, suggest that yellow hake and Whitemouth croaker (Micropogonias furnieri), fish most consumed by the local population, present some risk to human health (> 1) HQ and THQ, depending on the frequency of their consumption.

Keywords: contamination, fish, human exposure, risk assessment

Procedia PDF Downloads 75
78 Botulism Clinical Experience and Update

Authors: Kevin Yeo, Christine Hall, Babinchak Tim

Abstract:

BAT® [Botulism Antitoxin Heptavalent (A,B,C,D,E,F,G)-(Equine)] anti-toxin is a mixture of equine immune globulin fragments indicated for the treatment of symptomatic botulism in adult and pediatric patients. The effectiveness of BAT anti-toxin is based on efficacy studies conducted in animal models. A general explanation of the pivotal animal studies, post market surveillance and outcomes of an observational patient registry for patients treated with BAT product distributed in the USA is briefly discussed. Overall it took 20 animal studies for two well-designed and appropriately powered pivotal efficacy studies – one in which the effectiveness of BAT was assessed against all 7 serotypes in the guinea pig, and the other where efficacy is confirmed in the Rhesus macaque using Serotype A. Clinical Experience for BAT to date involves approximately 600 adult and pediatric patients with suspected botulism. In pre-licensure, patient data was recorded under the US CDC expanded access program (259 adult and pediatric patients between 10 days to 88 years of age). In post licensure, greater than 350 patients to date have received BAT and been followed up by enhanced expanded access program. The analysis of the post market surveillance data provided a unique opportunity to demonstrate clinical benefit in the field study required by the animal rule. While the animal rule is applied because human efficacy studies are not ethical or feasible, a post-marketing requirement is to conduct a study to evaluate safety and clinical benefit when circumstances arise and demonstrate the favourable benefit-risk profile that supported licensure.

Keywords: botulism, threat, clinical benefit, observational patient registry

Procedia PDF Downloads 147
77 International Tourists’ Travel Motivation by Push-Pull Factors and Decision Making for Selecting Thailand as Destination Choice

Authors: Siripen Yiamjanya, Kevin Wongleedee

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This research paper aims to identify travel motivation by push and pull factors that affected decision making of international tourists in selecting Thailand as their destination choice. A total of 200 international tourists who traveled to Thailand during January and February, 2014 were used as the sample in this study. A questionnaire was employed as a tool in collecting the data, conducted in Bangkok. The list consisted of 30 attributes representing both psychological factors as “push- based factors” and destination factors as “pull-based factors”. Mean and standard deviation were used in order to find the top ten travel motives that were important determinants in the respondents’ decision making process to select Thailand as their destination choice. The finding revealed the top ten travel motivations influencing international tourists to select Thailand as their destination choice included [i] getting experience in foreign land; [ii] Thai food; [iii] learning new culture; [iv] relaxing in foreign land; [v] wanting to learn new things; [vi] being interested in Thai culture, and traditional markets; [vii] escaping from same daily life; [viii] enjoying activities; [ix] adventure; and [x] good weather. Classification of push- based and pull- based motives suggested that getting experience in foreign land was the most important push motive for international tourists to travel, while Thai food portrayed its highest significance as pull motive. Discussion and suggestions were also made for tourism industry of Thailand.

Keywords: decision making, destination choice, international tourist, pull factor, push factor, Thailand, travel motivation

Procedia PDF Downloads 363
76 Text Mining of Veterinary Forums for Epidemiological Surveillance Supplementation

Authors: Samuel Munaf, Kevin Swingler, Franz Brülisauer, Anthony O’Hare, George Gunn, Aaron Reeves

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Web scraping and text mining are popular computer science methods deployed by public health researchers to augment traditional epidemiological surveillance. However, within veterinary disease surveillance, such techniques are still in the early stages of development and have not yet been fully utilised. This study presents an exploration into the utility of incorporating internet-based data to better understand the smallholder farming communities within Scotland by using online text extraction and the subsequent mining of this data. Web scraping of the livestock fora was conducted in conjunction with text mining of the data in search of common themes, words, and topics found within the text. Results from bi-grams and topic modelling uncover four main topics of interest within the data pertaining to aspects of livestock husbandry: feeding, breeding, slaughter, and disposal. These topics were found amongst both the poultry and pig sub-forums. Topic modeling appears to be a useful method of unsupervised classification regarding this form of data, as it has produced clusters that relate to biosecurity and animal welfare. Internet data can be a very effective tool in aiding traditional veterinary surveillance methods, but the requirement for human validation of said data is crucial. This opens avenues of research via the incorporation of other dynamic social media data, namely Twitter and Facebook/Meta, in addition to time series analysis to highlight temporal patterns.

Keywords: veterinary epidemiology, disease surveillance, infodemiology, infoveillance, smallholding, social media, web scraping, sentiment analysis, geolocation, text mining, NLP

Procedia PDF Downloads 66
75 Polymeric Microspheres for Bone Tissue Engineering

Authors: Yamina Boukari, Nashiru Billa, Andrew Morris, Stephen Doughty, Kevin Shakesheff

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Poly (lactic-co-glycolic) acid (PLGA) is a synthetic polymer that can be used in bone tissue engineering with the aim of creating a scaffold in order to support the growth of cells. The formation of microspheres from this polymer is an attractive strategy that would allow for the development of an injectable system, hence avoiding invasive surgical procedures. The aim of this study was to develop a microsphere delivery system for use as an injectable scaffold in bone tissue engineering and evaluate various formulation parameters on its properties. Porous and lysozyme-containing PLGA microspheres were prepared using the double emulsion solvent evaporation method from various molecular weights (MW). Scaffolds were formed by sintering to contain 1 -3mg of lysozyme per gram of scaffold. The mechanical and physical properties of the scaffolds were assessed along with the release of lysozyme, which was used as a model protein. The MW of PLGA was found to have an influence on microsphere size during fabrication, with increased MW leading to an increased microsphere diameter. An inversely proportional relationship was displayed between PLGA MW and mechanical strength of formed scaffolds across loadings for low, intermediate and high MW respectively. Lysozyme release from both microspheres and formed scaffolds showed an initial burst release phase, with both microspheres and scaffolds fabricated using high MW PLGA showing the lowest protein release. Following the initial burst phase, the profiles for each MW followed a similar slow release over 30 days. Overall, the results of this study demonstrate that lysozyme can be successfully incorporated into porous PLGA scaffolds and released over 30 days in vitro, and that varying the MW of the PLGA can be used as a method of altering the physical properties of the resulting scaffolds.

Keywords: bone, microspheres, PLGA, tissue engineering

Procedia PDF Downloads 407
74 Photomicrograph-Based Neuropathology Consultation in Tanzania; The Utility of Static-Image Neurotelepathology in Low- And Middle-Income Countries

Authors: Francis Zerd, Brian E. Moore, Atuganile E. Malango, Patrick W. Hosokawa, Kevin O. Lillehei, Laurence Lemery Mchome, D. Ryan Ormond

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Introduction: Since neuropathologic diagnosis in the developing world is hampered by limitations in technical infrastructure, trained laboratory personnel, and subspecialty-trained pathologists, the use of telepathology for diagnostic support, second-opinion consultations, and ongoing training holds promise as a means of addressing these challenges. This research aims to assess the utility of static teleneuropathology in improving neuropathologic diagnoses in low- and middle-income countries. Methods: Consecutive neurosurgical biopsy and resection specimens obtained at Muhimbili National Hospital in Tanzania between July 1, 2018, and June 30, 2019, were selected for retrospective, blinded static-image neuropathologic review followed by on-site review by an expert neuropathologist. Results: A total of 75 neuropathologic cases were reviewed. The agreement of static images and on-site glass diagnosis was 71% with strict criteria and 88% with less stringent criteria. This represents an overall improvement in diagnostic accuracy from 36% by general pathologists to 71% by a neuropathologist using static telepathology (or 76% to 88% with less stringent criteria). Conclusions: Telepathology offers a suitable means of providing diagnostic support, second-opinion consultations, and ongoing training to pathologists practicing in resource-limited countries. Moreover, static digital teleneuropathology is an uncomplicated, cost-effective, and reliable way to achieve these goals.

Keywords: neuropathology, resource-limited settings, static image, Tanzania, teleneuropathology

Procedia PDF Downloads 81
73 COVID_ICU_BERT: A Fine-Tuned Language Model for COVID-19 Intensive Care Unit Clinical Notes

Authors: Shahad Nagoor, Lucy Hederman, Kevin Koidl, Annalina Caputo

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Doctors’ notes reflect their impressions, attitudes, clinical sense, and opinions about patients’ conditions and progress, and other information that is essential for doctors’ daily clinical decisions. Despite their value, clinical notes are insufficiently researched within the language processing community. Automatically extracting information from unstructured text data is known to be a difficult task as opposed to dealing with structured information such as vital physiological signs, images, and laboratory results. The aim of this research is to investigate how Natural Language Processing (NLP) techniques and machine learning techniques applied to clinician notes can assist in doctors’ decision-making in Intensive Care Unit (ICU) for coronavirus disease 2019 (COVID-19) patients. The hypothesis is that clinical outcomes like survival or mortality can be useful in influencing the judgement of clinical sentiment in ICU clinical notes. This paper introduces two contributions: first, we introduce COVID_ICU_BERT, a fine-tuned version of clinical transformer models that can reliably predict clinical sentiment for notes of COVID patients in the ICU. We train the model on clinical notes for COVID-19 patients, a type of notes that were not previously seen by clinicalBERT, and Bio_Discharge_Summary_BERT. The model, which was based on clinicalBERT achieves higher predictive accuracy (Acc 93.33%, AUC 0.98, and precision 0.96 ). Second, we perform data augmentation using clinical contextual word embedding that is based on a pre-trained clinical model to balance the samples in each class in the data (survived vs. deceased patients). Data augmentation improves the accuracy of prediction slightly (Acc 96.67%, AUC 0.98, and precision 0.92 ).

Keywords: BERT fine-tuning, clinical sentiment, COVID-19, data augmentation

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72 Looking beyond Lynch's Image of a City

Authors: Sandhya Rao

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Kevin Lynch’s Theory on Imeageability, let on explore a city in terms of five elements, Nodes, Paths, Edges, landmarks and Districts. What happens when we try to record the same data in an Indian context? What happens when we apply the same theory of Imageability to a complex shifting urban pattern of the Indian cities and how can we as Urban Designers demonstrate our role in the image building ordeal of these cities? The organizational patterns formed through mental images, of an Indian city is often diverse and intangible. It is also multi layered and temporary in terms of the spirit of the place. The pattern of images formed is loaded with associative meaning and intrinsically linked with the history and socio-cultural dominance of the place. The embedded memory of a place in one’s mind often plays an even more important role while formulating these images. Thus while deriving an image of a city one is often confused or finds the result chaotic. The images formed due to its complexity are further difficult to represent using a single medium. Under such a scenario it’s difficult to derive an output of an image constructed as well as make design interventions to enhance the legibility of a place. However, there can be a combination of tools and methods that allows one to record the key elements of a place through time, space and one’s user interface with the place. There has to be a clear understanding of the participant groups of a place and their time and period of engagement with the place as well. How we can translate the result obtained into a design intervention at the end, is the main of the research. Could a multi-faceted cognitive mapping be an answer to this or could it be a very transient mapping method which can change over time, place and person. How does the context influence the process of image building in one’s mind? These are the key questions that this research will aim to answer.

Keywords: imageability, organizational patterns, legibility, cognitive mapping

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71 Smart Oxygen Deprivation Mask: An Improved Design with Biometric Feedback

Authors: Kevin V. Bui, Richard A. Claytor, Elizabeth M. Priolo, Weihui Li

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Oxygen deprivation masks operate through the use of restricting valves as a means to reduce respiratory flow where flow is inversely proportional to the resistance applied. This produces the same effect as higher altitudes where lower pressure leads to reduced respiratory flow. Both increased resistance with restricting valves and reduce the pressure of higher altitudes make breathing difficultier and force breathing muscles (diaphragm and intercostal muscles) working harder. The process exercises these muscles, improves their strength and results in overall better breathing efficiency. Currently, these oxygen deprivation masks are purely mechanical devices without any electronic sensor to monitor the breathing condition, thus not be able to provide feedback on the breathing effort nor to evaluate the lung function. That is part of the reason that these masks are mainly used for high-level athletes to mimic training in higher altitude conditions, not suitable for patients or customers. The design aims to improve the current method of oxygen deprivation mask to include a larger scope of patients and customers while providing quantitative biometric data that the current design lacks. This will be accomplished by integrating sensors into the mask’s breathing valves along with data acquisition and Bluetooth modules for signal processing and transmission. Early stages of the sensor mask will measure breathing rate as a function of changing the air pressure in the mask, with later iterations providing feedback on flow rate. Data regarding breathing rate will be prudent in determining whether training or therapy is improving breathing function and quantify this improvement.

Keywords: oxygen deprivation mask, lung function, spirometer, Bluetooth

Procedia PDF Downloads 196
70 Digital Self-Identity and the Role of Interactivity in Psychiatric Assessment and Treatment

Authors: Kevin William Taylor

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This work draws upon research in the fields of games development and mental health treatments to assess the influence that interactive entertainment has on the populous, and the potential of technology to affect areas of psychiatric assessment and treatment. It will use studies to establish the evolving direction of interactive media in the development of ‘digital self-identity,’ and how this can be incorporated into treatment to the benefit of psychiatry. It will determine that this approach will require collaborative production between developers and psychiatrists in order to ensure precise goals are met, improving the success of serious gaming for psychiatric assessment and treatment. Analysis documents the reach of video games across a growing global community of gamers, highlighting cases of the positives and negatives of video game usage. The games industry is largely oblivious to the psychological negatives, with psychiatrists encountering new conditions such as gaming addiction, which is now recognized by the World Health Organization. With an increasing amount of gamers worldwide, and an additional time per day invested in online gaming and character development, the concept of virtual identity as a means of expressing the id needs further study to ensure successful treatment. In conclusion, the assessment and treatment of game-related conditions are currently reactionary, and while some mental health professionals have begun utilizing interactive technologies to assist with the assessment and treatment of conditions, this study will determine how the success of these products can be enhanced. This will include collaboration between software developers and psychiatrists, allowing new avenues of skill-sharing in interactive design and development. Outlining how to innovate approaches to engagement will reap greater rewards in future interactive products developed for psychiatric assessment and treatment.

Keywords: virtual reality, virtual identity, interactivity, psychiatry

Procedia PDF Downloads 115
69 Usability Evaluation of a Self-Report Mobile App for COVID-19 Symptoms: Supporting Health Monitoring in the Work Context

Authors: Kevin Montanez, Patricia Garcia

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The confinement and restrictions adopted to avoid an exponential spread of the COVID-19 have negatively impacted the Peruvian economy. In this context, Industries offering essential products could continue operating, but they have to follow safety protocols and implement strategies to ensure employee health. In view of the increasing internet access and mobile phone ownership, “Alerta Temprana”, a mobile app, was developed to self-report COVID-19 symptoms in the work context. In this study, the usability of the mobile app “Alerta Temprana” was evaluated from the perspective of health monitors and workers. In addition to reporting the metrics related to the usability of the application, the utility of the system is also evaluated from the monitors' perspective. In this descriptive study, the participants used the mobile app for two months. Afterwards, System Usability Scale (SUS) questionnaire was answered by the workers and monitors. A Usefulness questionnaire with open questions was also used for the monitors. The data related to the use of the application was collected during one month. Furthermore, descriptive statistics and bivariate analysis were used. The workers rated the application as good (70.39). In the case of the monitors, usability was excellent (83.0). The most important feature for the monitors were the emails generated by the application. The average interaction per user was 30 seconds and a total of 6172 self-reports were sent. Finally, a statistically significant association was found between the acceptability scale and the work area. The results of this study suggest that Alerta Temprana has the potential to be used for surveillance and health monitoring in any context of face-to-face modality. Participants reported a high degree of ease of use. However, from the perspective of workers, SUS cannot diagnose usability issues and we suggest we use another standard usability questionnaire to improve "Alerta Temprana" for future use.

Keywords: public health in informatics, mobile app, usability, self-report

Procedia PDF Downloads 71
68 Cognitive Behaviour Drama: A Research-Based Intervention Model to Improve Social Thinking in High-Functioning Children with Autism

Authors: Haris Karnezi, Kevin Tierney

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Cognitive Behaviour Drama is a research-based intervention model that brought together the science of psychology with the art form of drama to create an unobtrusive and exciting approach that would provide children on the higher end of the autism spectrum the motivation to explore the rules of social interaction and develop competencies associated with communicative success. The method involves engaging the participants in exciting fictional scenarios and encouraging them to seek various solutions on a number of problems that will lead them to an understanding of causal relationships and how a different course of action may lead to a different outcome. The sessions are structured to offer opportunities to the participants to practice target behaviours and understand the functions they serve. The study involved six separate interventions and employed both single case and group designs. Overall 8 children aged between 6 to 13 years, diagnosed with ASD participated in the study. Outcomes were measured using theory of mind tests, executive functioning tests, behavioural observations, pre and post intervention standardised social competence questionnaires for parents and teachers. Collectively, the results indicated positive changes in the self esteem and behaviour of all eight participants. In particular, improvements in the ability to solve theory of mind tasks were noted in the younger group; and qualitative improvements in social communication, in terms of verbal (content) and non verbal expression (body posture, vocal expression, fluency, eye contact, reduction of ritualistic mannerisms) were noted in the older group. The need for reliable impact measures to assess the effectiveness of the model in generating global changes in the participants’ behaviour outside the therapeutic context was identified.

Keywords: autism, drama, intervention, social skills

Procedia PDF Downloads 129
67 Charter versus District Schools and Student Achievement: Implications for School Leaders

Authors: Kara Rosenblatt, Kevin Badgett, James Eldridge

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There is a preponderance of information regarding the overall effectiveness of charter schools and their ability to increase academic achievement compared to traditional district schools. Most research on the topic is focused on comparing long and short-term outcomes, academic achievement in mathematics and reading, and locale (i.e., urban, v. Rural). While the lingering unanswered questions regarding effectiveness continue to loom for school leaders, data on charter schools suggests that enrollment increases by 10% annually and that charter schools educate more than 2 million U.S. students across 40 states each year. Given the increasing share of U.S. students educated in charter schools, it is important to better understand possible differences in student achievement defined in multiple ways for students in charter schools and for those in Independent School District (ISD) settings in the state of Texas. Data were retrieved from the Texas Education Agency’s (TEA) repository that includes data organized annually and available on the TEA website. Specific data points and definitions of achievement were based on characterizations of achievement found in the relevant literature. Specific data points include but were not limited to graduation rate, student performance on standardized testing, and teacher-related factors such as experience and longevity in the district. Initial findings indicate some similarities with the current literature on long-term student achievement in English/Language Arts; however, the findings differ substantially from other recent research related to long-term student achievement in social studies. There are a number of interesting findings also related to differences between achievement for students in charters and ISDs and within different types of charter schools in Texas. In addition to findings, implications for leadership in different settings will be explored.

Keywords: charter schools, ISDs, student achievement, implications for PK-12 school leadership

Procedia PDF Downloads 107
66 Analyzing Middle Actors' Influence on Land Use Policy: A Case Study in Central Kalimantan, Indonesia

Authors: Kevin Soubly, Kaysara Khatun

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This study applies the existing Middle-Out Perspective (MOP) as a complementing analytical alternative to the customary dichotomous options of top-down vs. bottom-up strategies of international development and commons governance. It expands the framework by applying it to a new context of land management and environmental change, enabling fresh understandings of decision making around land use. Using a case study approach in Central Kalimantan, Indonesia among a village of indigenous Dayak, this study explores influences from both internal and external middle actors, utilizing qualitative empirical evidence and incorporating responses across 25 village households and 11 key stakeholders. Applying the factors of 'agency' and 'capacity' specific to the MOP, this study demonstrates middle actors’ unique capabilities and criticality to change due to their influence across various levels of decision-making. Study results indicate that middle actors play a large role, both passively and actively, both directly and indirectly, across various levels of decision-making, perception-shaping, and commons governance. In addition, the prominence of novel 'passive' middle actors, such as the internet, can provide communities themselves with a level of agency beyond that provided by other middle actors such as NGOs and palm oil industry entities – which often operate at the behest of the 'top' or out of self-interest. Further, the study posits that existing development and decision-making frameworks may misidentify the 'bottom' as the 'middle,' raising questions about traditional development and livelihood discourse, strategies, and support, from agricultural production to forest management. In conclusion, this study provides recommendations including that current policy preconceptions be reevaluated to engage middle actors in locally-adapted, integrative manners in order to improve governance and rural development efforts more broadly.

Keywords: environmental management, governance, Indonesia, land use, middle actors, middle-out perspective

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65 A Continuous Real-Time Analytic for Predicting Instability in Acute Care Rapid Response Team Activations

Authors: Ashwin Belle, Bryce Benson, Mark Salamango, Fadi Islim, Rodney Daniels, Kevin Ward

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A reliable, real-time, and non-invasive system that can identify patients at risk for hemodynamic instability is needed to aid clinicians in their efforts to anticipate patient deterioration and initiate early interventions. The purpose of this pilot study was to explore the clinical capabilities of a real-time analytic from a single lead of an electrocardiograph to correctly distinguish between rapid response team (RRT) activations due to hemodynamic (H-RRT) and non-hemodynamic (NH-RRT) causes, as well as predict H-RRT cases with actionable lead times. The study consisted of a single center, retrospective cohort of 21 patients with RRT activations from step-down and telemetry units. Through electronic health record review and blinded to the analytic’s output, each patient was categorized by clinicians into H-RRT and NH-RRT cases. The analytic output and the categorization were compared. The prediction lead time prior to the RRT call was calculated. The analytic correctly distinguished between H-RRT and NH-RRT cases with 100% accuracy, demonstrating 100% positive and negative predictive values, and 100% sensitivity and specificity. In H-RRT cases, the analytic detected hemodynamic deterioration with a median lead time of 9.5 hours prior to the RRT call (range 14 minutes to 52 hours). The study demonstrates that an electrocardiogram (ECG) based analytic has the potential for providing clinical decision and monitoring support for caregivers to identify at risk patients within a clinically relevant timeframe allowing for increased vigilance and early interventional support to reduce the chances of continued patient deterioration.

Keywords: critical care, early warning systems, emergency medicine, heart rate variability, hemodynamic instability, rapid response team

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64 An Early Attempt of Artificial Intelligence-Assisted Language Oral Practice and Assessment

Authors: Paul Lam, Kevin Wong, Chi Him Chan

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Constant practicing and accurate, immediate feedback are the keys to improving students’ speaking skills. However, traditional oral examination often fails to provide such opportunities to students. The traditional, face-to-face oral assessment is often time consuming – attending the oral needs of one student often leads to the negligence of others. Hence, teachers can only provide limited opportunities and feedback to students. Moreover, students’ incentive to practice is also reduced by their anxiety and shyness in speaking the new language. A mobile app was developed to use artificial intelligence (AI) to provide immediate feedback to students’ speaking performance as an attempt to solve the above-mentioned problems. Firstly, it was thought that online exercises would greatly increase the learning opportunities of students as they can now practice more without the needs of teachers’ presence. Secondly, the automatic feedback provided by the AI would enhance students’ motivation to practice as there is an instant evaluation of their performance. Lastly, students should feel less anxious and shy compared to directly practicing oral in front of teachers. Technically, the program made use of speech-to-text functions to generate feedback to students. To be specific, the software analyzes students’ oral input through certain speech-to-text AI engine and then cleans up the results further to the point that can be compared with the targeted text. The mobile app has invited English teachers for the pilot use and asked for their feedback. Preliminary trials indicated that the approach has limitations. Many of the users’ pronunciation were automatically corrected by the speech recognition function as wise guessing is already integrated into many of such systems. Nevertheless, teachers have confidence that the app can be further improved for accuracy. It has the potential to significantly improve oral drilling by giving students more chances to practice. Moreover, they believe that the success of this mobile app confirms the potential to extend the AI-assisted assessment to other language skills, such as writing, reading, and listening.

Keywords: artificial Intelligence, mobile learning, oral assessment, oral practice, speech-to-text function

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63 Application of a Lighting Design Method Using Mean Room Surface Exitance

Authors: Antonello Durante, James Duff, Kevin Kelly

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The visual needs of people in modern work based buildings are changing. Self-illuminated screens of computers, televisions, tablets and smart phones have changed the relationship between people and the lit environment. In the past, lighting design practice was primarily based on providing uniform horizontal illuminance on the working plane, but this has failed to ensure good quality lit environments. Lighting standards of today continue to be set based upon a 100 year old approach that at its core, considers the task illuminance of the utmost importance, with this task typically being located on a horizontal plane. An alternative method focused on appearance has been proposed, as opposed to the traditional performance based approach. Mean Room Surface Exitance (MRSE) and Target-Ambient Illuminance Ratio (TAIR) are two new metrics proposed to assess illumination adequacy in interiors. The hypothesis is that these factors will be superior to the existing metrics used, which are horizontal illuminance led. For the six past years, research has examined this, within the Dublin Institute of Technology, with a view to determining the suitability of this approach for application to general lighting practice. Since the start of this research, a number of key findings have been produced that centered on how occupants will react to various levels of MRSE. This paper provides a broad update on how this research has progressed. More specifically, this paper will: i) Demonstrate how MRSE can be measured using HDR images technology, ii) Illustrate how MRSE can be calculated using scripting and an open source lighting computation engine, iii) Describe experimental results that demonstrate how occupants have reacted to various levels of MRSE within experimental office environments.

Keywords: illumination hierarchy (IH), mean room surface exitance (MRSE), perceived adequacy of illumination (PAI), target-ambient illumination ratio (TAIR)

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62 Community Arts-Based Learning for Interdisciplinary Pedagogy: Measuring Program Effectiveness Using Design Imperatives for 'a New American University'

Authors: Kevin R. Wilson, Roger Mantie

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Community arts-based learning and participatory education are pedagogical techniques that serve to be advantageous for students, curriculum development, and local communities. Using an interpretive approach to examine the significance of this arts-informed research in relation to the eight ‘design imperatives’ proposed as the new model for measuring quality in scholarship for Arizona State University as ‘A New American University’, the purpose of this study was to investigate personal, social, and cultural benefits resulting from student engagement in interdisciplinary community-based projects. Students from a graduate level music education class at the ASU Tempe campus (n=7) teamed with students from an undergraduate level community development class at the ASU Downtown Phoenix campus (n=14) to plan, facilitate, and evaluate seven community-based projects in several locations around the Phoenix-metro area. Data was collected using photo evidence, student reports, and evaluative measures designed by the students. The effectiveness of each project was measured in terms of their ability to meet the eight design imperatives to: 1) leverage place; 2) transform society; 3) value entrepreneurship; 4) conduct use-inspired research; 5) enable student success; 6) fuse intellectual disciplines; 7) be socially embedded; and 8) engage globally. Results indicated that this community arts-based project sufficiently captured the essence of each of these eight imperatives. Implications for how the nature of this interdisciplinary initiative allowed for the eight imperatives to manifest are provided, and project success is expounded upon in relation to utility of each imperative. Discussion is also given for how this type of service learning project formatted within the ‘New American University’ model for measuring quality in academia can be a beneficial pedagogical tool in higher education.

Keywords: community arts-based learning, participatory education, pedagogy, service learning

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61 Inpatient Neonatal Deaths in Rural Uganda: A Retrospective Comparative Mortality Study of Labour Ward versus Community Admissions

Authors: Najade Sheriff, Malaz Elsaddig, Kevin Jones

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Background: Death in the first month of life accounts for an increasing proportion of under-five mortality. Advancement to reduce this number is being made across the globe; however, progress is slowest in sub-Saharan Africa. Objectives: The study aims to identify differences between neonatal deaths of inpatient babies born in a hospital facility in rural Uganda to those of neonates admitted from the community and to explore whether they can be used to risk stratify neonatal admissions. Results: A retrospective chart review was conducted on records for neonates admitted to the Special Care Baby Unit (SCBU) Kitovu Hospital from 1st July 2016 to 21st July 2017. A total of 442 babies were admitted and the overall neonatal mortality was 24.8% (40% inpatient, 37% community, 23% hospital referrals). 40% of deaths occurred within 24 hours of admission and the majority were male (63%). 43% of babies were hypothermic upon admission, a significantly greater proportion of which were inpatient babies born in labour ward (P=0.0025). Intrapartum related death accounted for ½ of all inpatient babies whereas complications of prematurity were the predominant cause of death in the community group (37%). Severe infection does not seem like a significant factor of mortality for inpatients (2%) as it does for community admissions (29%). Furthermore, with 52.5% of community admissions weighing < 1500g, very low birth weight (VLBW) may be a significant risk factor for community neonatal death. Conclusion: The neonatal mortality rate in this study is high, and the leading causes of death are all largely preventable. A high rate of inpatient birth asphyxiation indicates the need for good quality facility-based perinatal care as well as a greater focus on the management of hypothermia, such as Kangaroo care. Moreover, a reduction in preterm deliveries is necessary to reduce associated comorbidities, and monitoring for signs of infection is especially important for community admissions.

Keywords: community, mortality, newborn, Uganda

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60 Study Variation of Blade Angle on the Performance of the Undershot Waterwheel on the Pico Scale

Authors: Warjito, Kevin Geraldo, Budiarso, Muhammad Mizan, Rafi Adhi Pranata, Farhan Rizqi Syahnakri

Abstract:

According to data from 2021, the number of households in Indonesia that have access to on-grid electricity is claimed to have reached 99.28%, which means that around 0.7% of Indonesia's population (1.95 million people) still have no proper access to electricity and 38.1% of it comes from remote areas in Nusa Tenggara Timur. Remote areas are classified as areas with a small population of 30 to 60 families, have limited infrastructure, have scarce access to electricity and clean water, have a relatively weak economy, are behind in access to technological innovation, and earn a living mostly as farmers or fishermen. These people still need electricity but can’t afford the high cost of electricity from national on-grid sources. To overcome this, it is proposed that a hydroelectric power plant driven by a pico-hydro turbine with an undershot water wheel will be a suitable pico-hydro turbine technology because of the design, materials and installation of the turbine that is believed to be easier (i.e., operational and maintenance) and cheaper (i.e., investment and operating costs) than any other type. The comparative study of the angle of the undershot water wheel blades will be discussed comprehensively. This study will look into the best variation of curved blades on an undershot water wheel that produces maximum hydraulic efficiency. In this study, the blade angles were varied by 180 ̊, 160 ̊, and 140 ̊. Two methods of analysis will be used, which are analytical and numerical methods. The analytical method will be based on calculations of the amount of torque and rotational speed of the turbine, which is used to obtain the input and output power of the turbine. Whereas the numerical method will use the ANSYS application to simulate the flow during the collision with the designed turbine blades. It can be concluded, based on the analytical and numerical methods, that the best angle for the blade is 140 ̊, with an efficiency of 43.52% for the analytical method and 37.15% for the numerical method.

Keywords: pico hydro, undershot waterwheel, blade angle, computational fluid dynamics

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59 An Interpretive Study of Entrepreneurial Experience towards Achieving Business Growth Using the Theory of Planned Behaviour as a Lens

Authors: Akunna Agunwah, Kevin Gallimore, Kathryn Kinmond

Abstract:

Entrepreneurship is widely associated and seen as a vehicle for economic growth; however, different scholars have studied entrepreneurship from various perspectives, resulting in multiple definitions. It is surprising to know most entrepreneurship definition does not incorporate growth as part of their definition of entrepreneurship. Economic growth is engineered by the activities of the entrepreneurs. The purpose of the present theoretical study is to explore the working practices of the successful entrepreneurs towards achieving business growth by understanding the experiences of the entrepreneur using the Theory of Planned Behaviour (TPB) as a lens. Ten successful entrepreneurs in the North West of England in various business sectors were interviewed using semi-structured interview method. The recorded audio interviews transcribed and subsequently evaluated using the thematic deductive technique (qualitative approach). The themes were examined using Theory of Planned Behaviour to ascertain the presence of the three intentional antecedents (attitude, subjective norms, and perceived behavioural control). The findings categorised in two folds, firstly, it was observed that the three intentional antecedents, which make up Theory of Planned Behaviour were evident in the transcript. Secondly, the entrepreneurs are most concerned with achieving a state of freedom and realising their visions and ambitions. Nevertheless, the entrepreneur employed these intentional antecedents to enhance business growth. In conclusion, the work presented here showed a novel way of understanding the working practices and experiences of the entrepreneur using the theory of planned behaviour in qualitative approach towards enhancing business growth. There exist few qualitative studies in entrepreneurship research. In addition, this work applies a novel approach to studying the experience of the entrepreneurs by examining the working practices of the successful entrepreneurs in the North-West England through the lens of the theory of planned behaviour. Given the findings regarding TPB as a lens in the study, the entrepreneur does not differentiate between the categories of the antecedents reasonably sees them as processes that can be utilised to enhance business growth.

Keywords: business growth, experience, interpretive, theory of planned behaviour

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58 Land Tenure and Erosion as Determinants of Guerrilla Violence in Assam, India: An Ethnographic and Remote Sensing Approach

Authors: Kevin T. Inks

Abstract:

India’s Brahmaputra River Valley has, since independence, experienced consistent low-intensity guerrilla warfare between ethnic and religious groups. These groups are often organized around perceived ethnic territoriality, and target civilians, communities, and especially migrants belonging to other ethnic and religious groups. Intense flooding and erosion have led to widespread displacement, and disaster relief funds are largely tied to legal land tenure. Displaced residents of informal settlements receive little or no resettlement aid, and their subsequent migration strategies and risk from guerrilla violence are poorly understood. Semi-structured interviews and comprehensive surveys focused on perceptions of risk, efficacy of disaster relief, and migration and adaptation strategies were conducted with households identified as being ‘at-risk’ of catastrophic flooding and erosion in Majuli District, Assam. Interviews with policymakers and government workers were conducted to assess disaster relief efforts in informal settlements, and remote sensing methods were used to identify informal settlement and hydrogeomorphic change. The results show that various ethnic and religious groups have differential strategies and preferences for resettlement. However, these varying strategies are likely to lead to differential levels of risk from guerrilla violence. Members of certain ethnic groups residing in informal settlements, in the absence of resettlement assistance, are more likely to seek out unofficial settlement on land far from the protection of the state and experience greater risk of becoming victims of political violence. As climate change and deforestation are likely to increase the severity of the displacement crisis in the Brahmaputra River Valley, more comprehensive disaster relief and surveying efforts are vital for limiting migration and informal settlement in potential sites of guerrilla warfare.

Keywords: climate, displacement, flooding, India, violence

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57 ROSgeoregistration: Aerial Multi-Spectral Image Simulator for the Robot Operating System

Authors: Andrew R. Willis, Kevin Brink, Kathleen Dipple

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This article describes a software package called ROS-georegistration intended for use with the robot operating system (ROS) and the Gazebo 3D simulation environment. ROSgeoregistration provides tools for the simulation, test, and deployment of aerial georegistration algorithms and is available at github.com/uncc-visionlab/rosgeoregistration. A model creation package is provided which downloads multi-spectral images from the Google Earth Engine database and, if necessary, incorporates these images into a single, possibly very large, reference image. Additionally a Gazebo plugin which uses the real-time sensor pose and image formation model to generate simulated imagery using the specified reference image is provided along with related plugins for UAV relevant data. The novelty of this work is threefold: (1) this is the first system to link the massive multi-spectral imaging database of Google’s Earth Engine to the Gazebo simulator, (2) this is the first example of a system that can simulate geospatially and radiometrically accurate imagery from multiple sensor views of the same terrain region, and (3) integration with other UAS tools creates a new holistic UAS simulation environment to support UAS system and subsystem development where real-world testing would generally be prohibitive. Sensed imagery and ground truth registration information is published to client applications which can receive imagery synchronously with telemetry from other payload sensors, e.g., IMU, GPS/GNSS, barometer, and windspeed sensor data. To highlight functionality, we demonstrate ROSgeoregistration for simulating Electro-Optical (EO) and Synthetic Aperture Radar (SAR) image sensors and an example use case for developing and evaluating image-based UAS position feedback, i.e., pose for image-based Guidance Navigation and Control (GNC) applications.

Keywords: EO-to-EO, EO-to-SAR, flight simulation, georegistration, image generation, robot operating system, vision-based navigation

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56 Experimental and Theoretical Characterization of Supramolecular Complexes between 7-(Diethylamino)Quinoline-2(1H)-One and Cucurbit[7] Uril

Authors: Kevin A. Droguett, Edwin G. Pérez, Denis Fuentealba, Margarita E. Aliaga, Angélica M. Fierro

Abstract:

Supramolecular chemistry is a field of growing interest. Moreover, studying the formation of host-guest complexes between macrocycles and dyes is highly attractive due to their potential applications. Examples of the above are drug delivery, catalytic process, and sensing, among others. There are different dyes of interest in the literature; one example is the quinolinone derivatives. Those molecules have good optical properties and chemical and thermal stability, making them suitable for developing fluorescent probes. Secondly, several macrocycles can be seen in the literature. One example is the cucurbiturils. This water-soluble macromolecule family has a hydrophobic cavity and two identical carbonyl portals. Additionally, the thermodynamic analysis of those supramolecular systems could help understand the affinity between the host and guest, their interaction, and the main stabilization energy of the complex. In this work, two 7-(diethylamino) quinoline-2 (1H)-one derivative (QD1-2) and their interaction with cucurbit[7]uril (CB[7]) were studied from an experimental and in-silico point of view. For the experimental section, the complexes showed a 1:1 stoichiometry by HRMS-ESI and isothermal titration calorimetry (ITC). The inclusion of the derivatives on the macrocycle lends to an upward shift in the fluorescence intensity, and the pKa value of QD1-2 exhibits almost no variation after the formation of the complex. The thermodynamics of the inclusion complexes was investigated using ITC; the results demonstrate a non-classical hydrophobic effect with a minimum contribution from the entropy term and a constant binding on the order of 106 for both ligands. Additionally, dynamic molecular studies were carried out during 300 ns in an explicit solvent at NTP conditions. Our finding shows that the complex remains stable during the simulation (RMSD ~1 Å), and hydrogen bonds contribute to the stabilization of the systems. Finally, thermodynamic parameters from MMPBSA calculations were obtained to generate new computational insights to compare with experimental results.

Keywords: host-guest complexes, molecular dynamics, quinolin-2(1H)-one derivatives dyes, thermodynamics

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55 A Single Feature Probability-Object Based Image Analysis for Assessing Urban Landcover Change: A Case Study of Muscat Governorate in Oman

Authors: Salim H. Al Salmani, Kevin Tansey, Mohammed S. Ozigis

Abstract:

The study of the growth of built-up areas and settlement expansion is a major exercise that city managers seek to undertake to establish previous and current developmental trends. This is to ensure that there is an equal match of settlement expansion needs to the appropriate levels of services and infrastructure required. This research aims at demonstrating the potential of satellite image processing technique, harnessing the utility of single feature probability-object based image analysis technique in assessing the urban growth dynamics of the Muscat Governorate in Oman for the period 1990, 2002 and 2013. This need is fueled by the continuous expansion of the Muscat Governorate beyond predicted levels of infrastructural provision. Landsat Images of the years 1990, 2002 and 2013 were downloaded and preprocessed to forestall appropriate radiometric and geometric standards. A novel approach of probability filtering of the target feature segment was implemented to derive the spatial extent of the final Built-Up Area of the Muscat governorate for the three years period. This however proved to be a useful technique as high accuracy assessment results of 55%, 70%, and 71% were recorded for the Urban Landcover of 1990, 2002 and 2013 respectively. Furthermore, the Normalized Differential Built – Up Index for the various images were derived and used to consolidate the results of the SFP-OBIA through a linear regression model and visual comparison. The result obtained showed various hotspots where urbanization have sporadically taken place. Specifically, settlement in the districts (Wilayat) of AL-Amarat, Muscat, and Qurayyat experienced tremendous change between 1990 and 2002, while the districts (Wilayat) of AL-Seeb, Bawshar, and Muttrah experienced more sporadic changes between 2002 and 2013.

Keywords: urban growth, single feature probability, object based image analysis, landcover change

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54 Introducing Two Species of Parastagonospora (Phaeosphaeriaceae) on Grasses from Italy and Russia, Based on Morphology and Phylogeny

Authors: Ishani D. Goonasekara, Erio Camporesi, Timur Bulgakov, Rungtiwa Phookamsak, Kevin D. Hyde

Abstract:

Phaeosphaeriaceae comprises a large number of species occurring mainly on grasses and cereal crops as endophytes, saprobes and especially pathogens. Parastagonospora is an important genus in Phaeosphaeriaceae that includes pathogens causing leaf and glume blotch on cereal crops. Currently, there are fifteen Parastagonospora species described, including both pathogens and saprobes. In this study, one sexual morph species and an asexual morph species, occurring as saprobes on members of Poaceae are introduced based on morphology and a combined molecular analysis of the LSU, SSU, ITS, and RPB2 gene sequence data. The sexual morph species Parastagonospora elymi was isolated from a Russian sample of Elymus repens, a grass commonly known as couch grass, and important for grazing animals, as a weed and used in traditional Austrian medicine. P. elymi is similar to the sexual morph of P. avenae in having cylindrical asci, bearing 8, overlapping biseriate, fusiform ascospores but can be distinguished by its subglobose to conical shaped, wider ascomata. In addition, no sheath was observed surrounding the ascospores. The asexual morph species was isolated from a specimen from Italy, on Dactylis glomerata, a commonly found grass distributed in temperate regions. It is introduced as Parastagonospora macrouniseptata, a coelomycete, and bears a close resemblance to P. allouniseptata and P. uniseptata in having globose to subglobose, pycnidial conidiomata and hyaline, cylindrical, 1-septate conidia. However, the new species could be distinguished in having much larger conidiomata. In the phylogenetic analysis which consisted of a maximum likelihood and Bayesian analysis P. elymi showed low bootstrap support, but well segregated from other strains within the Parastagonospora clade. P. neoallouniseptata formed a sister clade with P. allouniseptata with high statistical support.

Keywords: dothideomycetes, multi-gene analysis, Poaceae, saprobes, taxonomy

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53 Understanding the Fundamental Driver of Semiconductor Radiation Tolerance with Experiment and Theory

Authors: Julie V. Logan, Preston T. Webster, Kevin B. Woller, Christian P. Morath, Michael P. Short

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Semiconductors, as the base of critical electronic systems, are exposed to damaging radiation while operating in space, nuclear reactors, and particle accelerator environments. What innate property allows some semiconductors to sustain little damage while others accumulate defects rapidly with dose is, at present, poorly understood. This limits the extent to which radiation tolerance can be implemented as a design criterion. To address this problem of determining the driver of semiconductor radiation tolerance, the first step is to generate a dataset of the relative radiation tolerance of a large range of semiconductors (exposed to the same radiation damage and characterized in the same way). To accomplish this, Rutherford backscatter channeling experiments are used to compare the displaced lattice atom buildup in InAs, InP, GaP, GaN, ZnO, MgO, and Si as a function of step-wise alpha particle dose. With this experimental information on radiation-induced incorporation of interstitial defects in hand, hybrid density functional theory electron densities (and their derived quantities) are calculated, and their gradient and Laplacian are evaluated to obtain key fundamental information about the interactions in each material. It is shown that simple, undifferentiated values (which are typically used to describe bond strength) are insufficient to predict radiation tolerance. Instead, the curvature of the electron density at bond critical points provides a measure of radiation tolerance consistent with the experimental results obtained. This curvature and associated forces surrounding bond critical points disfavors localization of displaced lattice atoms at these points, favoring their diffusion toward perfect lattice positions. With this criterion to predict radiation tolerance, simple density functional theory simulations can be conducted on potential new materials to gain insight into how they may operate in demanding high radiation environments.

Keywords: density functional theory, GaN, GaP, InAs, InP, MgO, radiation tolerance, rutherford backscatter channeling

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52 The Impact of Project Management Approaches in Enhancing Entrepreneurial Growth: A Study Using the Theory of Planned Behaviour as a Lens to Understand

Authors: Akunna Agunwah, Kevin Gallimore, Kathryn Kinnmond

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Entrepreneurship and project management are widely associated and seen as a vehicle for economic growth, but are studied separately. A few authors have considered the interconnectivity existing between these two fields, but relatively little empirical data currently exist in the literature. The purpose of the present empirical study is to explore whether successful entrepreneurs utilise project management approaches in enhancing enterprise growth by understanding the working practices and experiences of the entrepreneurs’ using the Theory of Planned Behaviour (TPB) as a lens. In order to understand those experiences, ten successful entrepreneurs in various business sectors in the North West of England were interviewed through a face-to-face semi-structured interview method. The collected audio tape-recorded data was transcribed and analysed using the deductive thematic technique (qualitative approach). The themes were viewed through the lens of Theory of Planned Behaviour to identify the three intentional antecedents (attitude, subjective norms, and perceived behavioural control) and to understand how they relate to the project management approaches (Planning, execution, and monitoring). The findings are twofold, the first evidence of the three intentional antecedents, which make up Theory of Planned Behaviour was present. Secondly, the analysis of project management approaches themes (planning, execution, and monitoring) using the lens of the theory of planned behaviour shows evidence of the three intentional antecedents. There were more than one intentional antecedents found in a particular project management theme, which indicates that the entrepreneur does utilise these approaches without categorising them into definite themes. However, the entrepreneur utilised these intentional antecedents as processes to enhanced business growth. In conclusion, the work presented here showed a way of understanding the interconnectivity between entrepreneurship and project management towards enhancing enterprise growth by examining the working practices and experiences of the successful entrepreneurs in the North-West England.

Keywords: business growth, entrepreneurship, project management approaches, theory of planned behaviour

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51 Using a Train-the-Trainer Model to Deliver Post-Partum Haemorrhage Simulation in Rural Uganda

Authors: Michael Campbell, Malaz Elsaddig, Kevin Jones

Abstract:

Background: Despite encouraging progress, global maternal mortality has remained stubbornly high since the declaration of the Millennium development goals. Sub-Saharan Africa accounts for well over half of maternal deaths with Post-Partum Haemorrhage (PPH) being the lead cause. ‘In house’ simulation training delivered by local doctors may be a sustainable approach for improving emergency obstetric care. The aim of this study was to evaluate the use of a Train-the-Trainer (TtT) model in a rural Ugandan hospital to ascertain whether it can feasibly improve practitioners’ management of PPH. Methods: Three Ugandan doctors underwent a training course to enable them to design and deliver simulation training. These doctors used MamaNatalie® models to simulate PPH scenarios for midwives, nurses and medical students. The main outcome was improvement in participants’ knowledge and confidence, assessed using self-reported scores on a 10-point scale. Results: The TtT model produced significant improvements in the confidence and knowledge scores of the ten participants. The mean confidence score rose significantly (p=0.0005) from 6.4 to 8.6 following the simulation training. There was also a significant increase in the mean knowledge score from 7.2 to 9.0 (p=0.04). Medical students demonstrated the greatest overall increase in confidence scores whilst increases in knowledge scores were largest amongst nurses. Conclusions: This study demonstrates that a TtT model can be used in a low resource setting to improve healthcare professionals’ confidence and knowledge in managing obstetric emergencies. This Train-the-Trainer model represents a sustainable approach to addressing skill deficits in low resource settings. We believe that its expansion across healthcare institutions in Sub-Saharan Africa will help to reduce the region’s high maternal mortality rate and step closer to achieving the ambitions of the Millennium development goals.

Keywords: low resource setting, post-partum haemorrhage, simulation training, train the trainer

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