Search results for: gaps

Authors: Zohra Mhedhbi, Meheret Gaston, Sinda Haoues-Jouve, Julia Hidalgo, Pierre Mazzega

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In the current context of climate change, supporting national and local stakeholders to make climate-smart decisions is necessary but still underdeveloped in many countries. To overcome this problem, the Global Frameworks for Climate Services (GFCS), implemented under the aegis of the United Nations in 2012, has initiated many programs in different countries. The GFCS contributes to the development of Climate Services, an instrument based on the production and transfer of scientific climate knowledge for specific users such as citizens, urban planning actors, or agricultural professionals. As cities concentrate on economic, social and environmental issues that make them more vulnerable to climate change, the New Urban Agenda (NUA), adopted at Habitat III in October 2016, highlights the importance of paying particular attention to disaster risk management, climate and environmental sustainability and urban resilience. In order to support the implementation of the NUA, the World Meteorological Organization (WMO) has identified the urban dimension as one of its priorities and has proposed a new tool, the Integrated Urban Services (IUS), for more sustainable and resilient cities. In the southern countries, there’s a lack of development of climate services, which can be partially explained by problems related to their economic financing. In addition, it is often difficult to make climate change a priority in urban planning, given the more traditional urban challenges these countries face, such as massive poverty, high population growth, etc. Climate services and Integrated Urban Services, particularly in African cities, are expected to contribute to the sustainable development of cities. These tools will help promoting the acquisition of meteorological and socio-ecological data on their transformations, encouraging coordination between national or local institutions providing various sectoral urban services, and should contribute to the achievement of the objectives defined by the United Nations Framework Convention on Climate Change (UNFCCC) or the Paris Agreement, and the Sustainable Development Goals. To assess the state of the art on these various points, the Web of Science metadatabase is queried. With a query combining the keywords "climate*" and "urban*", more than 24,000 articles are identified, source of more than 40,000 distinct keywords (but including synonyms and acronyms) which finely mesh the conceptual field of research. The occurrence of one or more names of the 514 African cities of more than 100,000 inhabitants or countries, reduces this base to a smaller corpus of about 1410 articles (2990 keywords). 41 countries and 136 African cities are cited. The lexicometric analysis of the metadata of the articles and the analysis of the structural indicators (various centralities) of the networks induced by the co-occurrence of expressions related more specifically to climate services show the development potential of these services, identify the gaps which remain to be filled for their implementation and allow to compare the diversity of national and regional situations with regard to these services.

Keywords: African cities, climate change, climate services, integrated urban services, lexicometry, networks, urban planning, web of science

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Authors: Catherine Constantinidis (Nee Tsacalos)

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This paper presents one aspect of the larger Masters qualitative study exploring the roles of married Greek Orthodox clergy, the Priest and Presbytera, under the wing of the Greek Orthodox Archdiocese of Australia. This ground breaking research necessitated the creation of primary data within a phenomenological paradigm drawing from lived experiences of the Priests and Presbyteres in contemporary society. As a Social Worker, a bilingual (Greek/English) Mental Health practitioner and a Presbytera, the questions constantly raised and pondered are: Who do the Priest and Presbytera turn to when they experience difficulties or problems? Where do they go for support? What is in place for their emotional and psychological health and well-being? Who cares for the spiritual carer? Who is there to catch our falling clergy and their wives? What is their 'safety net'? Identified phenomena of angst, stress, frustration and confusion experienced by the Priest and (by extension) the Presbytera, within their position, coupled with basic assumptions, perceptions and expectations about their roles, the role of the organisation (the Church), and their role as spouse often caused confusion and in some cases conflict. Unpacking this complex and multi-dimensional relationship highlighted not only the roller coaster of emotions, potentially affecting their physical and mental health, but also the impact on the interwoven relationships of marriage and ministry. The author considers these phenomena in the light of bilingual cultural and religious organisational practice frameworks, specifically the Greek Orthodox Church, whilst filtering these findings through a mental health lens. One could argue that it is an expectation that clergy (and by default their wives) take on the responsibility to be kind, nurturing and supportive to others. However, when it comes to taking care of self, they are not nearly as kind. This research looks at a recurrent theme throughout the interviews where all participants talked about limited support systems and poor self care strategies and the impact this has on their ministry, mental, emotional, and physical health and ultimately on their relationships with self and others. The struggle all participants encountered at some point in their ministry was physical, spiritual and psychological burn out. The overall aim of the researcher is to provide a voice for the Priest and the Presbytera painting a clearer picture of these roles and facilitating an awareness of struggles and dilemmas faced in their ministry. It is hoped these identified gaps in self care strategies and support systems will provide solid foundations for building a culturally sensitive, empathetic and effective support system framework, incorporating the spiritual and psychological well-being of the Priest and Presbytera, a ‘safety net’. A supplementary aim is to inform and guide ministry practice frameworks for clergy, spouses, the church hierarchy and religious organisations on a local and global platform incorporating some sort of self-care system.

Keywords: care for the carer, mental health, Priest, Presbytera, religion, support system

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Authors: Owen Cegielski, Kristi Maida, Danny Morales, Sylvia L. Mendez

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This study explores the challenges and threats US secondary educators experience in incorporating culturally relevant education (CRE) practices in their classrooms. CRE is a social justice pedagogical practice used to connect student’s cultural references to academic skills and content, to promote critical reflection, to facilitate cultural competence, and to critique discourses of power and oppression. Empirical evidence on CRE demonstrates positive student educational outcomes in terms of achievement, engagement, and motivation. Additionally, due to the direct focus on uplifting diverse cultures through the curriculum, students experience greater feelings of belonging, increased interest in the subject matter, and stronger racial/ethnic identities. When these teaching practices are in place, educators develop deeper relationships with their students and appreciate the multitude of gifts they (and their families) bring to the classroom environment. Yet, educators regularly report being unprepared to incorporate CRE in their daily teaching practice and identify substantive gaps in their knowledge and skills in this area. Often, they were not exposed to CRE in their educator preparation program, nor do they receive adequate support through school- or district-wide professional development programming. Through a descriptive phenomenological research design, 20 interviews were conducted with a diverse set of secondary school educators to explore the challenges and threats they experience in incorporating CRE practices in their classrooms. The guiding research question for this study is: What are the challenges and threats US secondary educators face when seeking to incorporate CRE practices in their classrooms? Interviews were grounded by the theory of challenge and threat states, which highlights the ways in which challenges and threats are appraised and how resources factor into emotional valence and perception, as well as the potential to meet the task at hand. Descriptive phenomenological data analysis strategies were utilized to develop an essential structure of the educators’ views of challenges and threats in regard to incorporating CRE practices in their secondary classrooms. The attitude of the phenomenological reduction method was adopted, and the data were analyzed through five steps: sense of the whole, meaning units, transformation, structure, and essential structure. The essential structure that emerged was while secondary educators display genuine interest in learning how to successfully incorporate CRE practices, they perceive it to be a challenge (and not a threat) due to lack of exposure which diminishes educator capacity, comfort, and confidence in employing CRE practices. These findings reveal the value of attending to emotional valence and perception of CRE in promoting this social justice pedagogical practice. Findings also reveal the importance of appropriately resourcing educators with CRE support to ensure they develop and utilize this practice.

Keywords: culturally relevant education, descriptive phenomenology, social justice practice, US secondary education

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Authors: Lauren Dhugga, Meena Parameswaran, David Blundell, Abbas Khushnood

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Context: A multidisciplinary weekly safety briefing was implemented at the Paediatric Cardiothoracic Unit at the Freeman Hospital in Newcastle-upon-Tyne. It is a tertiary referral centre with a quarternary cardiac paediatric intensive care unit and provides complexed care including heart and lung transplants, mechanical support and advanced heart failure assessment. Aim: The aim of this briefing is to provide a structured platform of communication, in an effort to improve efficiency, safety, and patient care. Problem: The paediatric cardiothoracic unit is made up of a vast multidisciplinary team including doctors, intensivists, anaesthetists, surgeons, specialist nurses, echocardiogram technicians, physiotherapists, psychologists, dentists, and dietitians. It provides care for children with congenital and acquired cardiac disease and is one of only two units in the UK to offer paediatric heart transplant. The complexity of cases means that there can be many teams involved in providing care to each patient, and frequent movement of children between ward, high dependency, and intensive care areas. Currently, there is no structured forum for communicating important information across the department, for example, staffing shortages, prescribing errors and significant events. Strategy: An initial survey questioning the need for better communication found 90% of respondents agreed that they could think of an incident that had occurred due to ineffective communication, and 85% felt that incident could have been avoided had there been a better form of communication. Lastly, 80% of respondents felt that a weekly 60 second safety briefing would be beneficial to improve communication within our multidisciplinary team. Based on those promising results, a weekly 60 second safety briefing was implemented to be conducted on a Monday morning. The safety briefing covered four key areas (SAFE): staffing, awareness, fix and events. This was to highlight any staffing gaps, any incident reports to be learned from, any issues that required fixing and any events including teachings for the week ahead. The teams were encouraged to email suggestions or issues to be raised for the week or to approach in person with information to add. The safety briefing was implemented using change theory. Effect: The safety briefing has been trialled over 6 weeks and has received a good buy in from staff across specialties. The aim is to embed this safety briefing into a weekly meeting using the PDSA cycle. There will be a second survey in one month to assess the efficacy of the safety briefing and to continue to improve the delivery of information. The project will be presented at the next clinical governance briefing to attract wider feedback and input from across the trust. Lessons: The briefing displays promise as a tool to improve vigilance and communication in a busy multi-disciplinary unit. We have learned about how to implement quality improvement and about the culture of our hospital - how hierarchy influences change. We demonstrate how to implement change through a grassroots process, using a junior led briefing to improve the efficiency, safety, and communication in the workplace.

Keywords: briefing, communication, safety, team

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Authors: Geremew Geidare Kailo, Igor Gáspár, András Koris, Ivana Pajčin, Flóra Vitális, Vanja Vlajkov

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Three-dimension (3D) printing, a very popular additive manufacturing technology, has recently undergone rapid growth and replaced the use of conventional technology from prototyping to producing end-user parts and products. The 3D Printing technology involves a digital manufacturing machine that produces three-dimensional objects according to designs created by the user via 3D modeling or computer-aided design/manufacturing (CAD/CAM) software. The most popular 3D printing system is Fused Deposition Modeling (FDM) or also called Fused Filament Fabrication (FFF). A 3D-printed object is considered food safe if it can have direct contact with the food without any toxic effects, even after cleaning, storing, and reusing the object. This work analyzes the processing timeline of the filament (material for 3D printing) from unboxing to the extrusion through the nozzle. It is an important task to analyze the growth of bacteria on the 3D printed surface and in gaps between the layers. By default, the 3D-printed object is not food safe after longer usage and direct contact with food (even though they use food-safe filaments), but there are solutions for this problem. The aim of this work was to evaluate the 3D-printed object from different perspectives of food safety. Firstly, testing antimicrobial 3D printing filaments from a food safety aspect since the 3D Printed object in the food industry may have direct contact with the food. Therefore, the main purpose of the work is to reduce the microbial load on the surface of a 3D-printed part. Coating with epoxy resin was investigated, too, to see its effect on mechanical strength, thermal resistance, surface smoothness and food safety (cleanability). Another aim of this study was to test new temperature-resistant filaments and the effect of high temperature on 3D printed materials to see if they can be cleaned with boiling or similar hi-temp treatment. This work proved that all three mentioned methods could improve the food safety of the 3D printed object, but the size of this effect variates. The best result we got was with coating with epoxy resin, and the object was cleanable like any other injection molded plastic object with a smooth surface. Very good results we got by boiling the objects, and it is good to see that nowadays, more and more special filaments have a food-safe certificate and can withstand boiling temperatures too. Using antibacterial filaments reduced bacterial colonies to 1/5, but the biggest advantage of this method is that it doesn’t require any post-processing. The object is ready out of the 3D printer. Acknowledgements: The research was supported by the Hungarian and Serbian bilateral scientific and technological cooperation project funded by the Hungarian National Office for Research, Development and Innovation (NKFI, 2019-2.1.11-TÉT-2020-00249) and the Ministry of Education, Science and Technological Development of the Republic of Serbia. The authors acknowledge the Hungarian University of Agriculture and Life Sciences’s Doctoral School of Food Science for the support in this study

Keywords: food safety, 3D printing, filaments, microbial, temperature

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Authors: Simon Winberg

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The landscape of professional postgraduate education is changing: the focus of these programmes is moving from preparing candidates for a life in academia towards a focus of training in expert knowledge and skills to support industry. This is especially pronounced in engineering disciplines where increasingly more complex products are drawing on a depth of knowledge from multiple fields. This connects strongly with the broader notion of Industry 4.0 – where technology and society are being brought together to achieve more powerful and desirable products, but products whose inner workings also are more complex than before. The changes in what we do, and how we do it, has a profound impact on what industry would like universities to provide. One such change is the increased demand for taught doctoral and Masters programmes. These programmes aim to provide skills and training for professionals, to expand their knowledge of state-of-the-art tools and technologies. This paper investigates one such course, namely a Software Defined Radio (SDR) Master’s degree course. The teaching support for this course had to be drawn from an existing pool of academics, none of who were specialists in this field. The paper focuses on the kind of educator, a ‘hybrid academic’, assembled from available academic staff and bolstered by research. The conceptual framework for this paper combines Activity Theory and Genre Ecology. Activity Theory is used to reason about learning and interactions during the course, and Genre Ecology is used to model building and sharing of technical knowledge related to using tools and artifacts. Data were obtained from meetings with students and lecturers, logs, project reports, and course evaluations. The findings show how the course, which was initially academically-oriented, metamorphosed into a tool-dominant peer-learning structure, largely supported by the sharing of technical tool-based knowledge. While the academic staff could address gaps in the participants’ fundamental knowledge of radio systems, the participants brought with them extensive specialized knowledge and tool experience which they shared with the class. This created a complicated dynamic in the class, which centered largely on engagements with technology artifacts, such as simulators, from which knowledge was built. The course was characterized by a richness of ‘epistemic objects’, which is to say objects that had knowledge-generating qualities. A significant portion of the course curriculum had to be adapted, and the learning methods changed to accommodate the dynamic interactions that occurred during classes. This paper explains the SDR Masters course in terms of conflicts and innovations in its activity system, as well as the continually hybridizing genre ecology to show how the structuring and resource-dependence of the course transformed from its initial ‘traditional’ academic structure to a more entangled arrangement over time. It is hoped that insights from this paper would benefit other educators involved in the design and teaching of similar types of specialized professional postgraduate taught programmes.

Keywords: professional postgraduate education, taught masters, engineering education, software defined radio

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Authors: Ariane Plaisance, Holly O. Witteman, Patrick Michel Archambault

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Upon admission to an intensive care unit (ICU), all patients should discuss their wishes concerning life-sustaining interventions (e.g., cardiopulmonary resuscitation (CPR)). Without such discussions, interventions that prolong life at the cost of decreasing its quality may be used without appropriate guidance from patients. We employed user-centered design to adapt an existing decision aid (DA) about CPR to create a novel wiki-based DA adapted to the context of a single ICU and tailored to individual patient’s risk factors. During Phase 1, we conducted three weeks of ethnography of the decision-making context in our ICU to identify clinician and patient needs for a decision aid. During this time, we observed five dyads of intensivists and patients discussing their wishes concerning life-sustaining interventions. We also conducted semi-structured interviews with the attending intensivists in this ICU. During Phase 2, we conducted three rounds of rapid prototyping involving 15 patients and 11 other allied health professionals. We recorded discussions between intensivists and patients and used a standardized observation grid to collect patients’ comments and sociodemographic data. We applied content analysis to field notes, verbatim transcripts and the completed observation grids. Each round of observations and rapid prototyping iteratively informed the design of the next prototype. We also used the programming architecture of a wiki platform to embed the GO-FAR prediction rule programming code that we linked to a risk graphics software to better illustrate outcome risks calculated. During Phase I, we identified the need to add a section in our DA concerning invasive mechanical ventilation in addition to CPR because both life-sustaining interventions were often discussed together by physicians. During Phase II, we produced a context-adapted decision aid about CPR and mechanical ventilation that includes a values clarification section, questions about the patient’s functional autonomy prior to admission to the ICU and the functional decline that they would judge acceptable upon hospital discharge, risks and benefits of CPR and invasive mechanical ventilation, population-level statistics about CPR, a synthesis section to help patients come to a final decision and an online calculator based on the GO-FAR prediction rule. Even though the three rounds of rapid prototyping led to simplifying the information in our DA, 60% (n= 3/5) of the patients involved in the last cycle still did not understand the purpose of the DA. We also identified gaps in the discussion and documentation of patients’ preferences concerning life-sustaining interventions (e.g.,. CPR, invasive mechanical ventilation). The final version of our DA and our online wiki-based GO-FAR risk calculator using the IconArray.com risk graphics software are available online at www.wikidecision.org and are ready to be adapted to other contexts. Our results inform producers of decision aids on the use of wikis and user-centered design to develop DAs that are better adapted to users’ needs. Further work is needed on the creation of a video version of our DA. Physicians will also need the training to use our DA and to develop shared decision-making skills about goals of care.

Keywords: ethnography, intensive care units, life-sustaining therapies, user-centered design

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Authors: Dianelys Vega, Carlos Magluta, Ney Roitman

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The simulation of loads induced by walking people in civil engineering structures is still challenging It has been the focus of considerable research worldwide in the recent decades due to increasing number of reported vibration problems in pedestrian structures. One of the most important key in the designing of slender structures is the Human-Structure Interaction (HSI). How moving people interact with structures and the effect it has on their dynamic responses is still not well understood. To rely on calibrated pedestrian models that accurately estimate the structural response becomes extremely important. However, because of the complexity of the pedestrian mechanisms, there are still some gaps in knowledge and more reliable models need to be investigated. On this topic several authors have proposed biodynamic models to represent the pedestrian, whether these models provide a consistent approximation to physical reality still needs to be studied. Therefore, this work comes to contribute to a better understanding of this phenomenon bringing an experimental validation of a pedestrian walking model and a Human-Structure Interaction model. In this study, a bi-dimensional bipedal walking model was used to represent the pedestrians along with an interaction model which was applied to a prototype footbridge. Numerical models were implemented in MATLAB. In parallel, experimental tests were conducted in the Structures Laboratory of COPPE (LabEst), at Federal University of Rio de Janeiro. Different test subjects were asked to walk at different walking speeds over instrumented force platforms to measure the walking force and an accelerometer was placed at the waist of each subject to measure the acceleration of the center of mass at the same time. By fitting the step force and the center of mass acceleration through successive numerical simulations, the model parameters are estimated. In addition, experimental data of a walking pedestrian on a flexible structure was used to validate the interaction model presented, through the comparison of the measured and simulated structural response at mid span. It was found that the pedestrian model was able to adequately reproduce the ground reaction force and the center of mass acceleration for normal and slow walking speeds, being less efficient for faster speeds. Numerical simulations showed that biomechanical parameters such as leg stiffness and damping affect the ground reaction force, and the higher the walking speed the greater the leg length of the model. Besides, the interaction model was also capable to estimate with good approximation the structural response, that remained in the same order of magnitude as the measured response. Some differences in frequency spectra were observed, which are presumed to be due to the perfectly periodic loading representation, neglecting intra-subject variabilities. In conclusion, this work showed that the bipedal walking model could be used to represent walking pedestrians since it was efficient to reproduce the center of mass movement and ground reaction forces produced by humans. Furthermore, although more experimental validations are required, the interaction model also seems to be a useful framework to estimate the dynamic response of structures under loads induced by walking pedestrians.

Keywords: biodynamic models, bipedal walking models, human induced loads, human structure interaction

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Authors: M. Bukowski, K. Kreissl

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Social and environmental pressures in our times bear threats that often cross-border in scale, such as climate change, poverty-driven migration, demographic change as well as socio-economic developments. One of the hot topics is prevailing in many societies across Europe and worldwide, concerns 'affordable housing' and poverty-driven international and domestic migration (including displacements through gentrification processes), focusing here on the urban and regional context. The right to adequate housing and shelter is one of the recognized in the Universal Declaration of Human rights and International Covenant on Economic, Social and Cultural Rights, and as such considered as a human right of the second generation. The decreasing supply of affordable housing, especially in urban areas, has reached dimensions that have led to an increasing 'housing crisis'. This crisis, which has even reached middle-income homes, has an even more devastating impact on low income and poor households raising poverty levels. Therefore, the understanding of the connection between housing and poverty is vital to integrate and support the different stakeholders in order to tackle poverty. When it comes to issues of inequalities and poverty within the SDG framework, multi-faceted stakeholders with different claims, distribution of resources and interactions with other development goals (spill-over and trade-offs) account for a highly complex context. To contribute to a sustainable and fair society and hence to support the UN Sustainable Development Goals, the University of Salzburg participates in the Austrian-wide universities' network 'UniNEtZ'. Our joint target is to develop an options report for the Austrian Government regarding the seventeen SDGs, so far hosted by 18 Austrian universities. In this vein, the University of Salzburg; i.e., the Centre for Ethics and Poverty Research, the departments of Geography and Geology and the Department of Sociology and Political Science are focusing on the SDG 1 (No Poverty) and SDG 10 (Reduced Inequalities). Our target and research focus is to assess and evaluate the status of SDG 1 and 10 in Austria, to find possible solutions and to support stakeholders' integration. We aim at generating and deducing appropriate options as scientific support, from interdisciplinary research studies to 'Sustainability Developing Goals and their Targets' in action. For this reason, and to deal with the complexity of the Agenda 2030, we have developed a special Model for Inequalities and Poverty Assessment (IPAM). Through the example of 'affordable housing' we provide insight into the situation focusing on sustainable outcomes, including ethical and justice perceptions. The IPAM has proven to be a helpful tool in detecting the different imponderables on the Agenda 2030, assessing the situation, showing gaps and options for ethical SDG actions combining different SDG targets. Supported by expert and expert group interviews, this assessment allows different stakeholders to overview a complex and dynamic SDG challenge (here housing) which is necessary to be involved in an action finding process.

Keywords: affordable housing, inequality, poverty, sustainable development goals

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Authors: Cosette Maiky

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Seven years have passed since the crisis erupted and the list of challenges to peacebuilding and interreligious dialogue is still growing ever more discouraging: Violence, displacement, sectarianism, discrimination, radicalisation, fragmentation, and collapse of various social and economic infrastructure have notoriously plagued the war-torn country. As the situation in Syria and neighbouring countries is still creating a real concern about the future of the social cohesion and the coexistence in the region, in her function as Field Expert on Arab Countries at King Abdullah bin Abdelaziz Centre for Interreligious and Intercultural Dialogue, the author shall present a systematic review paper that focuses on the radicalization of Islam in Syria. The exercise was based on a series of research questions that guided both the review of literature as well as the interviews. Their relative meaningfulness shall be assessed and trade-offs discussed in each case to ensure that key questions were addressed and to avoid unnecessary effort. There was an element of flexibility, as the assessment progressed, to further provide and inject additional generic questions. The main sources for the information were: Documents and literature with a direct bearing on the issues of relevance collected in all available formats and information collected through key informant interviews. This latter was particularly helpful to understand what some of the capacity constraints are, as well as the gaps, enablers and barriers. Respondents were selected among those who are engaged in IRD activities clearly linked to peacebuilding (i.e. religious leaders, leaders in religious communities, peace actors, religious actors, conflict parties, minority groups, women initiatives, youth initiatives, civil society organizations, academia, etc.), with relevant professional qualifications and work experience. During the research process, the Consultant carefully took account of sensitivities around terminologies as well as a highly insecure and dynamic context. The Consultant (Arabic native speaker), therefore, adapted terminologies while conducting interviews according to the area and respondent. Findings revealed: the deep ideological polarization and lack of trust dividing communities and preventing meaningful dialogue opportunities; the challenge of prioritizing IRD and peacebuilding work in the context of such a severe humanitarian crisis facing the country; the need to engage religious leaders and institutions in peacebuilding processes and initiatives, the need to have institutions with specific IRD mandate, which can have a sustainable influence on peace through various levels of interventions (from grassroots level to policy and research), and lastly, the need to address stigma in media representation of Muslims and Islam. While religion and religious agendas have been massively used for political issues and power play in the Middle East – and elsewhere, more extensive policy and research efforts are needed to highlight the positive role of religion and religious actors in dialogue and peacebuilding processes.

Keywords: radicalisation, Islam, Syria, conflict

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Authors: Atin Adhikari, Aniruddha Mitra, Abbas Rashidi, Imaobong Ekpo, Jefferson Doehling, Alexis Pawlak, Shane Lewis, Jacob Schwartz

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Building constructions in the US involve numerous wooden structures. Woods are routinely used in walls, framing floors, framing stairs, and making of landings in building constructions. Cross-laminated timbers are currently being used as construction materials for tall buildings. Numerous workers are involved in these timber based constructions, and wood dust is one of the most common occupational exposures for them. Wood dust is a complex substance composed of cellulose, polyoses and other substances. According to US OSHA, exposure to wood dust is associated with a variety of adverse health effects among workers, including dermatitis, allergic respiratory effects, mucosal and nonallergic respiratory effects, and cancers. The amount and size of particles released as wood dust differ according to the operations performed on woods. For example, shattering of wood during sanding operations produces finer particles than does chipping in sawing and milling industries. To our knowledge, how shattering, cutting and sanding of woods and wood slabs during new building construction release fine particles and nanoparticles are largely unknown. General belief is that the dust generated during timber cutting and sanding tasks are mostly large particles. Consequently, little attention has been given to the generated submicron ultrafine and nanoparticles and their exposure levels. These data are, however, critically important because recent laboratory studies have demonstrated cytotoxicity of nanoparticles on lung epithelial cells. The above-described knowledge gaps were addressed in this study by a novel newly developed nanoparticle monitor and conventional particle counters. This study was conducted in a large new building construction site in southern Georgia primarily during the framing of wooden side walls, inner partition walls, and landings. Exposure levels of nanoparticles (n = 10) were measured by a newly developed nanoparticle counter (TSI NanoScan SMPS Model 3910) at four different distances (5, 10, 15, and 30 m) from the work location. Other airborne particles (number of particles/m3) including PM2.5 and PM10 were monitored using a 6-channel (0.3, 0.5, 1.0, 2.5, 5.0 and 10 µm) particle counter at 15 m, 30 m, and 75 m distances at both upwind and downwind directions. Mass concentration of PM2.5 and PM10 (µg/m³) were measured by using a DustTrak Aerosol Monitor. Temperature and relative humidity levels were recorded. Wind velocity was measured by a hot wire anemometer. Concentration ranges of nanoparticles of 13 particle sizes were: 11.5 nm: 221 – 816/cm³; 15.4 nm: 696 – 1735/cm³; 20.5 nm: 879 – 1957/cm³; 27.4 nm: 1164 – 2903/cm³; 36.5 nm: 1138 – 2640/cm³; 48.7 nm: 938 – 1650/cm³; 64.9 nm: 759 – 1284/cm³; 86.6 nm: 705 – 1019/cm³; 115.5 nm: 494 – 1031/cm³; 154 nm: 417 – 806/cm³; 205.4 nm: 240 – 471/cm³; 273.8 nm: 45 – 92/cm³; and 365.2 nm: Keywords: wood dust, industrial hygiene, aerosol, occupational exposure

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Authors: Salman Imran, Chris Healey

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Traditionally, medical care of children in England and Wales starts from primary care with a referral to secondary care paediatricians who may not investigate further. Many primary care doctors do not undergo a paediatric rotation/exposure in training. As a result, there are many who have not acquired the necessary skills to manage children hence increasing hospital referral. With the current demand on hospitals in the National Health Service managing more problems in the community is needed. One way of handling this is to set up clinics, meetings and huddles in GP surgeries where professionals involved (general practitioner, paediatrician, health visitor, community nurse, dietician, school nurse) come together and share information which can help improve communication and care. The increased awareness and education that paediatricians can impart in this way will help boost confidence for primary care professionals to be able to be more self-sufficient. This has been tried successfully in other regions e.g., St. Mary’s Hospital in London but is crucial for a more rural setting like ours. The primary aim of this project would be to educate specifically GP’s and generally all other health professionals involved. Additional benefits would be providing care nearer home, increasing patient’s confidence in their local surgery, improving communication and reducing unnecessary patient flow to already stretched hospital resources. Methods: This was done as a plan do study act cycle (PDSA). Three clinics were delivered in different practices over six months where feedback from staff and patients was collected. Designated time for teaching/discussion was used which involved some cases from the actual clinics. Both new and follow up patients were included. Two clinics were conducted by a paediatrician and nurse whilst the 3rd involved paediatrician and local doctor. The distance from hospital to clinics varied from two miles to 22 miles approximately. All equipment used was provided by primary care. Results: A total of 30 patients were seen. All patients found the location convenient as it was nearer than the hospital. 70-90% clearly understood the reason for a change in venue. 95% agreed to the importance of their local doctor being involved in their care. 20% needed to be seen in the hospital for further investigations. Patients felt this to be a more personalised, in-depth, friendly and polite experience. Local physicians felt this to be a more relaxed, familiar and local experience for their patients and they managed to get immediate feedback regarding their own clinical management. 90% felt they gained important learning from the discussion time and the paediatrician also learned about their understanding and gaps in knowledge/focus areas. 80% felt this time was valuable for targeted learning. Equipment, information technology, and office space could be improved for the smooth running of any future clinics. Conclusion: The acute paediatric outpatient clinic can be successfully established in primary care facilities. Careful patient selection and adequate facilities are important. We have demonstrated a further step in the reduction of patient flow to hospitals and upskilling primary care health professionals. This service is expected to become more efficient with experience.

Keywords: clinics, education, paediatricians, primary care

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Authors: Niina Jallinoja, Anu Moisio

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Focus on adult learning is vital to overcome economic challenges as well as to respond to the demand for new competencies and sustained productivity in the digitalized world economy. Employees of all ages must be able to carry on continuous professional development to remain competitive in the labor market. According to EU policies, countries should offer more flexible opportunities for adult learners who study online and in so-called ‘second chance’ qualification programmes. Traditionally, adult education in Finland has comprised of not only liberal adult education but also the government funding to study for Bachelor, Master's, and Ph.D. degrees in Finnish Universities and Universities of Applied Sciences (UAS). From the beginning of 2021, public funding is allocated not only to degrees but also to courses to achieve new competencies for adult learners in Finland. Consequently, there will be degree students (often younger of age) and adult learners studying in the same evening, online and blended courses. The question is thus: How are combined studies meeting the different needs of degree students and adult learners? Haaga-Helia University of Applied Sciences (UAS), located in the metropolitan area of Finland, is taking up the challenge of continuous learning for adult learners. Haaga-Helia has been reforming the bachelor level education and respective shorter courses from 2019 in the biggest project in its history. By the end of 2023, Haaga-Helia will have a flexible, modular curriculum for the bachelor's degrees of hospitality management, business administration, business information technology, journalism and sports management. Building on the shared key competencies, degree students will have the possibility to build individual study paths more flexibly, thanks to the new modular structure of the curriculum. They will be able to choose courses across all degrees, and thus, build their own unique competence combinations. All modules can also be offered as separate courses or learning paths to non-degree students, both publicly funded and as commercial services for employers. Consequently, there will be shared course implementations for degree studies and adult learners with various competence requirements. The newly designed courses are piloted in parallel of the designing of the curriculum in Haaga-Helia during 2020 and 2021. Semi-structured online surveys are composed among the participants for the key competence courses. The focus of the research is to understand how students in the bachelor programme and adult learners from Open UAE perceive the learning experience in such a diverse learning group. A comparison is also executed between learning methods of in-site teaching, online implementation, blended learning and virtual self-learning courses to understand how the pedagogy is meeting the learning objectives of these two different groups. The new flexible curricula and the study modules are to be designed to fill the most important competence gaps that exist in the Finnish labor markets. The new curriculum will be dynamic and constantly evolving over time according to the future competence needs in the labor market. This type of approach requires constant dialogue between Haaga-Helia and workplaces during and after designing of the shared curriculum.

Keywords: ccompetence development, continuous learning, curriculum, higher education

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Authors: M. F. Abreu, A. I. Aguiar, R. Gaio, R. Duarte

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Background: Prison establishments constitute high-risk environments for the transmission and spread of tuberculosis (TB), given their epidemiological context and the difficulty of implementing preventive and control measures. Guidelines for control and prevention of tuberculosis in prisons have been described as incomplete and heterogeneous internationally, due to several identified obstacles, for example scarcity of human resources and funding of prisoner health services. In Portugal, a protocol was created in 2014 with the aim to define and standardize procedures of detection and prevention of tuberculosis within prisons. Objective: The main objective of this study was to identify and describe barriers to tuberculosis detection in prisons of Porto and Lisbon districts in Portugal. Methods: A cross-sectional study was conducted from 2ⁿᵈ January 2018 till 30ᵗʰ June 2018. Semi-structured questionnaires were applied to health care professionals working in the prisons of the districts of Porto (n=6) and Lisbon (n=8). As inclusion criteria we considered having work experience in the area of tuberculosis (either in diagnosis, treatment, or follow up). The questionnaires were self-administered, in paper format. Descriptive analyses of the questionnaire variables were made using frequencies and median. Afterwards, a hierarchical agglomerative clusters analysis was performed. After obtaining the clusters, the chi-square test was applied to study the association between the variables collected and the clusters. The level of significance considered was 0.05. Results: From the total of 186 health professionals, 139 met the criteria of inclusion and 82 health professionals were interviewed (62,2% of participation). Most were female, nurses, with a median age of 34 years, with term employment contract. From the cluster analysis, two groups were identified with different characteristics and behaviors for the procedures of this protocol. Statistically significant results were found in: elements of cluster 1 (78% of the total participants) work in prisons for a longer time (p=0.003), 45,3% work > 4 years while 50% of the elements of cluster 2 work for less than a year, and more frequently answered they know and apply the procedures of the protocol (p=0.000). Both clusters answered frequently the need of having theoretical-practical training for TB (p=0.000), especially in the areas of diagnosis, treatment and prevention and that there is scarcity of funding to prisoner health services (p=0.000). Regarding procedures for TB screening (periodic and contact screening) and procedures for transferring a prisoner with this disease, cluster 1 also answered more frequently to perform them (p=0.000). They also referred that the material/equipment for TB screening is accessible and available (p=0.000). From this clusters we identified as barriers scarcity of human resources, the need to theoretical-practical training for tuberculosis, inexperience in working in health services prisons and limited knowledge of protocol procedures. Conclusions: The barriers found in this study are the same described internationally. This protocol is mostly being applied in portuguese prisons. The study also showed the need to invest in human and material resources. This investigation bridged gaps in knowledge that could help prison health services optimize the care provided for early detection and adherence of prisoners to treatment of tuberculosis.

Keywords: barriers, health care professionals, prisons, protocol, tuberculosis

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Authors: Isabel Latz, Mark Lusk, Josiah Heyman

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The rise of restrictive U.S. immigration policies and their strengthened enforcement has reportedly caused concerns among providers about their inadvertent effects on service utilization among Latinx and immigrant communities. This study presents perceptions on this issue from twenty service providers in health care, mental health, nutrition assistance, legal assistance, and immigrant advocacy in El Paso, Texas. All participants were experienced professionals, with fifteen in CEO, COO, executive director, or equivalent positions, and based at organizations that provide services for immigrant and/or low-income populations in a bi-national border community. Quantitative and qualitative data were collected by two primary investigators via semi-structured telephone interviews with an average length of 20 minutes. A survey script with closed and open-ended questions inquired about participants’ demographic information and perceptions of impacts of immigration enforcement policies under the current federal administration on their work and patient or client populations. Quantitative and qualitative data were analyzed to produce descriptive statistics and identify salient themes, respectively. Nearly all respondents stated that their work has been negatively (N=13) or both positively and negatively (N=5) affected by current immigration enforcement policies. Negative effects were most commonly related to immigration enforcement-related fear and uncertainty among patient or client populations. Positive effects most frequently referred to a sense of increased community organizing and greater cooperation among organizations. Similarly, the majority of service providers either reported an increase (N=8) or decrease (N=6) in service utilization due to changes in immigration enforcement policies. Increased service needs were primarily related to a need for public education about immigration enforcement policy changes, information about how new policies impact individuals’ service eligibility, legal status, and civil rights, as well as a need to correct misinformation. Decreased service utilization was primarily related to fear-related service avoidance. While providers observed changes in service utilization among undocumented immigrants and mixed-immigration status families, in particular, participants also noted ‘spillover’ effects on the larger Latinx community, including legal permanent and temporary residents, refugees or asylum seekers, and U.S. citizens. This study reveals preliminary insights into providers’ widespread concerns about the effects of current immigration enforcement policies on health, social, and legal service utilization among Latinx individuals. Further research is necessary to comprehensively assess impacts of immigration enforcement policies on service utilization in Latinx and immigrant communities. This information is critical to address gaps in service utilization and prevent an exacerbation of health disparities among Latinx, immigrant, and border populations. In a global climate of rising nationalism and xenophobia, it is critical for policymakers to be aware of the consequences of immigration enforcement policies on the utilization of essential services to protect the well-being of minority and immigrant communities.

Keywords: immigration enforcement, immigration policy, provider perceptions, service utilization

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Authors: Mangala. Sadasivan, Mary Hughes, Bryan Kelly

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Medical Education must focus on bridging the gap between teaching and learning when training pre-clinical year students in skills needed to keep up with medical knowledge and to meet the demands of health care in the future. The authors were interested in showing that a 3-S Model (building strength, developing stamina, and increasing speed) using a bridged curriculum design helps connect teaching and learning and improves students’ retention of basic science and clinical knowledge. The authors designed three learning modules using the 3-S Model within a systems course in a pre-clerkship medical curriculum. Each module focused on a bridge (concept map) designed by the instructor for specific content delivered to students in the course. This with-in-subjects design study included 304 registered MSU osteopathic medical students (3 campuses) ranked by quintile based on previous coursework. The instructors used the bridge to create self-directed learning exercises (building strength) to help students master basic science content. Students were video coached on how to complete assignments, and given pre-tests and post-tests designed to give them control to assess and identify gaps in learning and strengthen connections. The instructor who designed the modules also used video lectures to help students master clinical concepts and link them (building stamina) to previously learned material connected to the bridge. Boardstyle practice questions relevant to the modules were used to help students improve access (increasing speed) to stored content. Unit Examinations covering the content within modules and materials covered by other instructors teaching within the units served as outcome measures in this study. This data was then compared to each student’s performance on a final comprehensive exam and their COMLEX medical board examinations taken some time after the course. The authors used mean comparisons to evaluate students’ performances on module items (using 3-S Model) to non-module items on unit exams, final course exam and COMLEX medical board examination. The data shows that on average, students performed significantly better on module items compared to non-module items on exams 1 and 2. The module 3 exam was canceled due to a university shut down. The difference in mean scores (module verses non-module) items disappeared on the final comprehensive exam which was rescheduled once the university resumed session. Based on Quintile designation, the mean scores were higher for module items than non-module items and the difference in scores between items for Quintiles 1 and 2 were significantly better on exam 1 and the gap widened for all Quintile groups on exam 2 and disappeared in exam 3. Based on COMLEX performance, all students on average as a group, whether they Passed or Failed, performed better on Module items than non-module items in all three exams. The gap between scores of module items for students who passed COMLEX to those who failed was greater on Exam 1 (14.3) than on Exam 2 (7.5) and Exam 3 (10.2). Data shows the 3-S Model using a bridge effectively connects teaching and learning

Keywords: bridging gap, medical education, teaching and learning, model of learning

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Authors: Juan Du

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Climate change is one of the most crucial issues of this era, with contentious debates on it among scholars. But there are sparse studies on climate change discourse in China. Including China in the study of climate change is essential for a sociological understanding of climate change. China -- as a developing country and an essential player in tackling climate change -- offers an ideal case for studying climate change for scholars moving beyond developed countries and enriching their understandings of climate change by including diverse social settings. This project contrasts the macro- and micro-level understandings of climate change in China, which helps scholars move beyond a focus on climate skepticism and denialism and enriches sociology of climate change knowledge. The macro-level understanding of climate change is obtained by analyzing over 4,000 newspaper articles from various official outlets in China. State-controlled newspapers play an essential role in transmitting essential and high-quality information and promoting broader public understanding of climate change and its anthropogenic nature. Thus, newspaper articles can be seen as tools employed by governments to mobilize the public in terms of supporting the development of a strategy shift from economy-growth to an ecological civilization. However, media is just one of the significant factors influencing an individual’s climate change concern. Extreme weather events, access to accurate scientific information, elite cues, and movement/countermovement advocacy influence an individual’s perceptions of climate change. Hence, there are differences in the ways that both newspaper articles and the public frame the issues. The online forum is an informative channel for scholars to understand the public’s opinion. The micro-level data comes from Zhihu, which is China’s equivalence of Quora. Users can propose, answer, and comment on questions. This project analyzes the questions related to climate change which have over 20 answers. By open-coding both the macro- and micro-level data, this project will depict the differences between ideology as presented in government-controlled newspapers and how people talk and act with respect to climate change in cyberspace, which may provide an idea about any existing disconnect in public behavior and their willingness to change daily activities to facilitate a greener society. The contemporary Yellow Vest protests in France illustrate that the large gap between governmental policies of climate change mitigation and the public’s understanding may lead to social movement activity and social instability. Effective environmental policy is impossible without the public’s support. Finding existing gaps in understanding may help policy-makers develop effective ways of framing climate change and obtain more supporters of climate change related policies. Overall, this qualitative project provides answers to the following research questions: 1) How do different state-controlled newspapers transmit their ideology on climate change to the public and in what ways? 2) How do individuals frame climate change online? 3) What are the differences between newspapers’ framing and individual’s framing?

Keywords: climate change, China, framing theory, media, public’s climate change concern

Procedia PDF Downloads 110

Authors: M. Soubadra Devy, Savitha Swamy, Chethana V. Casiker

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Sustainable smart cities are emerging as an important concept in response to the exponential rise in the world’s urbanizing population. While earlier, only technical, economic and governance based solutions were considered, more and more layers are being added in recent times. With the prefix of 'sustainability', solutions which help in judicious use of resources without negatively impacting the environment have become critical. We present a case study of Bangalore city which has transformed from being a garden city and pensioners' paradise to being an IT city with a huge, young population from different regions and diverse cultural backgrounds. This has had a big impact on the green spaces in the city and the biodiversity that they support, as well as on farming/gardening practices. Edible landscapes comprising farms lands, home gardens and neighbourhood parks (NPs henceforth) were examined. The land prices of areas having NPs were higher than those that did not indicate an appreciation of their aesthetic value. NPs were part of old and new residential areas largely managed by the municipality. They comprised manicured gardens which were similar in vegetation structure and composition. Results showed that NPs that occurred in higher density supported reasonable levels of biodiversity. In situations where NPs occurred in lower density, the presence of a larger green space such as a heritage park or botanical garden enhanced the biodiversity of these parks. In contrast, farm lands and home gardens which were common within the city are being lost at an unprecedented scale to developmental projects. However, there is also the emergence of a 'neo-culture' of home-gardening that promotes 'locovory' or consumption of locally grown food as a means to a sustainable living and reduced carbon footprint. This movement overcomes the space constraint by using vertical and terrace gardening techniques. Food that is grown within cities comprises of vegetables and fruits which are largely pollinator dependent. This goes hand in hand with our landscape-level study that has shown that cities support pollinator diversity. Maintaining and improving these man-made ecosystems requires analysing the functioning and characteristics of the existing structures of governance. Social network analysis tool was applied to NPs to examine relationships, between actors and ties. The management structures around NPs, gaps, and means to strengthen the networks from the current state to a near-ideal state were identified for enhanced services. Learnings from NPs were used to build a hypothetical governance structure and functioning of integrated governance of NPs and edible landscapes to enhance ecosystem services such as biodiversity support, food production, and aesthetic value. They also contribute to the sustainability axis of smart cities.

Keywords: biodiversity support, ecosystem services, edible green spaces, neighbourhood parks, sustainable smart city

Procedia PDF Downloads 118

Authors: Fiona Mwaniki

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Climate change is considered a serious threat to sustainable development globally and as one of the greatest ecological, economic and social challenges of our time. The global demand for food is projected to increase by 60% by 2050. Small holder farmers who are vulnerable to the adverse effects of climate change are expected to contribute to this projected demand. Effective climate change education and communication is therefore required for smallholder and subsistence farmers’ in order to build communities that are more climate change aware, prepared and resilient. In Kenya radio is the most important and dominant mass communication tool for agricultural extension. This study investigated the potential role of radio in influencing farmers’ understanding and use of climate change information. The broad aims of this study were three-fold. Firstly, to identify Kenyan farmers’ perceptions and responses to the impacts of climate change. Secondly, to develop radio programs that communicate climate change information to Kenyan farmers and thirdly, to evaluate the impact of information disseminated through radio on farmers’ understanding and responses to climate change mitigation and adaptation. This study was conducted within the farming community of Kilifi County, located along the Kenyan coast. Education and communication about climate change was undertaken using radio to make available information understandable to different social and cultural groups. A mixed methods pre-and post-intervention design that provided the opportunity for triangulating results from both quantitative and qualitative data was used. Quantitative and qualitative data was collected simultaneously, where quantitative data was collected through semi structured surveys with 421 farmers’ and qualitative data was derived from 11 focus group interviews, six interviews with key informants and nine climate change experts. The climate change knowledge gaps identified in the initial quantitative and qualitative data were used in developing radio programs. Final quantitative and qualitative data collection and analysis enabled an assessment of the impact of climate change messages aired through radio on the farming community in Kilifi County. Results of this study indicate that 32% of the farmers’ listened to the radio programs and 26% implemented technologies aired on the programs that would help them adapt to climate change. The most adopted technologies were planting drought tolerant crops including indigenous crop varieties, planting trees, water harvesting and use of manure. The proportion of farmers who indicated they knew “a fair amount” about climate change increased significantly (Z= -5.1977, p < 0.001) from 33% (at the pre intervention phase of this study) to 64% (post intervention). However, 68% of the farmers felt they needed “a lot more” information on agriculture interventions (43%), access to financial resources (21%) and the effects of climate change (15%). The challenges farmers’ faced when adopting the interventions included lack of access to financial resources (18%), high cost of adaptation measures (17%), and poor access to water (10%). This study concludes that radio effectively complements other agricultural extension methods and has the potential to engage farmers’ on climate change issues and motivate them to take action.

Keywords: climate change, climate change intervention, farmers, radio

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Authors: Sherine El-Menshawy

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Death, funerary beliefs and customs form an essential feature of belief systems and practices in many cultures. It is evident that during the pre-historical periods, various techniques of corpses burial and funerary rituals were conducted. Occasionally, corpses were merely buried in the sand, or in a grave where the body is placed in a contracted position- with knees drawn up under the chin and hands normally lying before the face- with mounds of sand, marking the grave or the bodies were burnt. However, common practice, that was demonstrable in the archaeological record, was burial. The earliest graves were very simple consisting of a shallow circular or oval pits in the ground. The current study focuses on the material culture at Qatar during the pre-historical period, specifically their funerary architecture and burial practices. Since information about burial customs and funerary practices in Qatar prehistory is both scarce and fragmentary, the importance of such study is to answer research questions related to funerary believes and burial habits during the early stages of civilization transformations at prehistory Qatar compared with Mesopotamia, since chronologically, the earliest pottery discovered in Qatar belongs to prehistoric Ubaid culture of Mesopotamia, that was collected from the excavations. This will lead to deep understanding of life and social status in pre-historical period at Qatar. The research also explores the relationship between pre-history Qatar funerary traditions and those of neighboring cultures in the Mesopotamia and Ancient Egypt, with the aim of ascertaining the distinctive aspects of pre-history Qatar culture, the reception of classical culture and the role it played in the creation of local cultural identities in the Near East. Methodologies of this study based on published books and articles in addition to unpublished reports of the Danish excavation team that excavated in and around Doha, Qatar archaeological sites from the 50th. The study is also constructed on compared material related to burial customs found in Mesopotamia. Therefore this current research: (i) Advances knowledge of the burial customs of the ancient people who inhabited Qatar, a study which is unknown recently to scholars, the study though will apply deep understanding of the history of ancient Qatar and its culture and values with an aim to share this invaluable human heritage. (ii) The study is of special significance for the field of studies, since evidence derived from the current study has great value for the study of living conditions, social structure, religious beliefs and ritual practices. (iii) Excavations brought to light burials of different categories. The graves date to the bronze and Iron ages. Their structure varies between mounds above the ground or burials below the ground level. Evidence comes from sites such as Al-Da’asa, Ras Abruk, and Al-Khor. Painted Ubaid sherds of Mesopotamian culture have been discovered in Qatar from sites such as Al-Da’asa, Ras Abruk, and Bir Zekrit. In conclusion, there is no comprehensive study which has been done and lack of general synthesis of information about funerary practices is problematic. Therefore, the study will fill in the gaps in the area.

Keywords: archaeological, burial, findings, prehistory, Qatar

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Authors: Ruth Hegarty, Noel Connaughton

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Sustainability reporting has become a priority for many global multinational companies. This is associated with ever-increasing expectations from key stakeholders for companies to be transparent about their strategies, activities and management with regard to sustainability issues. The Global Reporting Initiative (GRI) encourages reporters to only provide information on the issues that are really critical in order to achieve the organisation’s goals for sustainability and manage its impact on environment and society. A key challenge for most reporting organisations is how to identify relevant issues for sustainability reporting and prioritise those material issues in accordance with company and stakeholder needs. A recent study indicates that most of the largest companies listed on the world’s stock exchanges are failing to provide data on key sustainability indicators such as employee turnover, energy, greenhouse gas emissions (GHGs), injury rate, pay equity, waste and water. This paper takes an indepth look at the approaches used by a select number of international sustainability leader corporates to identify key sustainability issues. The research methodology involves performing a detailed analysis of the sustainability report content of up to 50 companies listed on the 2014 Dow Jones Sustainability Indices (DJSI). The most recent sustainability report content found on the GRI Sustainability Disclosure Database is then compared with 91 GRI Specific Standard Disclosures and a small number of GRI Standard Disclosures. Preliminary research indicates significant gaps in the information disclosed in corporate sustainability reports versus the indicator content specified in the GRI Content Index. The following outlines some of the key findings to date: Most companies made a partial disclosure with regard to the Economic indicators of climate change risks and infrastructure investments, but did not focus on the associated negative impacts. The top Environmental indicators disclosed were energy consumption and reductions, GHG emissions, water withdrawals, waste and compliance. The lowest rates of indicator disclosure included biodiversity, water discharge, mitigation of environmental impacts of products and services, transport, environmental investments, screening of new suppliers and supply chain impacts. The top Social indicators disclosed were new employee hires, rates of injury, freedom of association in operations, child labour and forced labour. Lesser disclosure rates were reported for employee training, composition of governance bodies and employees, political contributions, corruption and fines for non-compliance. The reporting on most other Social indicators was found to be poor. In addition, most companies give only a brief explanation on how material issues are defined, identified and ranked. Data on the identification of key stakeholders and the degree and nature of engagement for determining issues and their weightings is also lacking. Generally, little to no data is provided on the algorithms used to score an issue. Research indicates that most companies lack a rigorous and thorough methodology to systematically determine the material issues of sustainability reporting in accordance with company and stakeholder needs.

Keywords: identification of key stakeholders, material issues, sustainability reporting, transparency

Procedia PDF Downloads 279

Authors: Cynthia Sau Chun Yip, Richard Fielding

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High meat and especially red meat intakes are significantly and positively associated with a multiple burden of diseases and also high greenhouse gas (GHG) emissions. This study investigated population meat intake patterns in Hong Kong. It quantified the burden of disease and GHG emission outcomes by modeling to adjust Hong Kong population meat intakes to recommended healthy levels. It compared age- and sex-specific population meat, fruit and vegetable intakes obtained from a population survey among adults aged 20 years and over in Hong Kong in 2005-2007, against intake recommendations suggested in the Modelling System to Inform the Revision of the Australian Guide to Healthy Eating (AGHE-2011-MS) technical document. This study found that meat and meat alternatives, especially red meat intakes among Hong Kong males aged 20+ years and over are significantly higher than recommended. Red meat intakes among females aged 50-69 years and other meat and alternatives intakes among aged 20-59 years are also higher than recommended. Taking the 2005-07 age- and sex-specific population meat intake as baselines, three counterfactual scenarios of adjusting Hong Kong adult population meat intakes to AGHE-2011-MS and Pre-2011 AGHE recommendations by the year 2030 were established. Consequent energy intake gaps were substituted with additional legume, fruit and vegetable intakes. To quantify the consequent GHG emission outcomes associated with Hong Kong meat intakes, Cradle-to-ready-to-eat lifecycle assessment emission outcome modelling was used. Comparative risk assessment of burden of disease model was used to quantify the health outcomes. This study found adjusting meat intakes to recommended levels could reduce Hong Kong GHG emission by 17%-44% when compared against baseline meat intake emissions, and prevent 2,519 to 7,012 premature deaths in males and 53 to 1,342 in females, as well as multiple burden of diseases when compared to the baseline meat intake scenario. Comparing lump sum meat intake reduction and outcome measures across the entire population, and using emission factors, and relative risks from individual studies in previous co-benefit studies, this study used age- and sex-specific input and output measures, emission factors and relative risks obtained from high quality meta-analysis and meta-review respectively, and has taken government dietary recommendations into account. Hence evaluations in this study are of better quality and more reflective of real life practices. Further to previous co-benefit studies, this study pinpointed age- and sex-specific population and meat-type-specific intervention points and leverages. When compared with similar studies in Australia, this study also showed that intervention points and leverages among populations in different geographic and cultural background could be different, and that globalization also globalizes meat consumption emission effects. More regional and cultural specific evaluations are recommended to promote more sustainable meat consumption and enhance global food security.

Keywords: burden of diseases, greenhouse gas emissions, Hong Kong diet, sustainable meat consumption

Procedia PDF Downloads 291

Authors: Enrico Maria la Forgia

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Since the 80ies, in specific situations, France’s Muslims have enacted political actions to reply to attacks on their identity or assimilation attempts, using their religious affiliation as a resource for the organization and expression of collective claims. Indeed, despite Islam's internal sectarian and ethnic differences, religion may be politicized when minorities’ social and cultural rights are under attack. French Civil Society organizations, in this specific case with an Islamic background (ICSO - Islamic Civil Society Organizations), play an essential role in defending Muslims’ social and cultural rights. As a matter of fact, Civil Society organized on an ethnic or religious base is a way to strengthen minoritarian communities and their role as political actors, especially in multicultural contexts. Since the first 1983’s “Marche des Beurs” (slang word referring to French citizens with foreign origins), which involved many Muslims, the development of ICSO contributed to the strenghtening of Islam in France, here meant as a Social Movement aiming to constitute a French version of Islam, defending minorities’ cultural and religious rights, and change the perception of Islam itself in national society. However, since a visible and stigmatized minority, ICSO do not relate only to protests as a strategy to achieve their goals: on several occasions, pressure on authorities through personal networks and connections, or the introduction into public debates of bargaining through the exploitation of national or international crisis, might appear as more successfully - public discourses on minorities and Islam are generally considered favorable conditions to advance requests for cultural legitimation. The proposed abstract, based on a literary review and theoretical/methodological reflection on the state of knowledge on the topic, aims to open a new branch of studies and analysis of Civil Society and Social Movements in Europe, focusing on the French Islamic community as a political actor relating on ICSO to pressure society, local, and national authorities to improve Muslims' rights. The opted methodology relies on a qualitative approach based on ethnography and face-to-face interviews addressing heads and middle-high level activists from ICSO, in an attempt to individuate the strategies enacted by ICSO for mobilizing Muslims and build relations with, on one hand, local and national authorities; into the other, with actors belonging to the Civil Society/political sphere. The theoretical framework, instead, relies on the main Social Movements Theories (resources mobilization, political opportunity structure, and contentious/non-contentious movements), aiming to individuate eventual gaps in the analysis of Islamic Social Movements and Civil Society in minoritarian contexts.

Keywords: Islam, islamophobia, civil society, social movements, sociology, qualitative methodology, Islamic activism in social movement theory, political change, Islam as social movement, religious movements, protest and politics, France, Islamic civil society

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Authors: Lauren G. Coggins

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Catheter-associated urinary tract infections (CAUTI) and central line-associated bloodstream infections (CLABSI) are among the most common healthcare-associated infections (HAI), contributing to prolonged lengths of stay, greater costs of patient care, and increased patient mortality. Evidence-based preventative care bundles exist to establish consistent, safe patient-care practices throughout an entire organization, helping to ensure the collective application of care strategies that aim to improve patient outcomes and minimize complications. The cardiac intensive care unit at a nationally ranked teaching and research hospital in the United States exceeded its annual CAUTI and CLABSI targets in the fiscal year 2019, prompting examination into the unit’s infection prevention efforts that included preventative care bundles for both HAIs. Adherence to the CAUTI and CLABSI preventative care bundles was evaluated through frequent audits conducted over three months, using standards and resources from The Joint Commission, a globally recognized leader in quality improvement in healthcare and patient care safety. The bundle elements with the lowest scores were identified as the most commonly missed elements. Three elements from both bundles, six elements in total, served as key content areas for the educational interventions targeted to bedside nurses. The CAUTI elements included appropriate urinary catheter order, appropriate continuation criteria, and urinary catheter care. The CLABSI elements included primary tubing compliance, needleless connector compliance, and dressing change compliance. An integrated, multi-platform education campaign featured content on each CAUTI and CLABSI preventative care bundle in its entirety, with additional reinforcement focused on the lowest scoring elements. One-on-one educational materials included an informational pamphlet, badge buddy, a presentation to reinforce nursing care standards, and real-time application through case studies and electronic health record demonstrations. A digital hub was developed on the hospital’s Intranet for quick access to unit resources, and a bulletin board helped track the number of days since the last CAUTI and CLABSI incident. Audits continued to be conducted throughout the education campaign, and staff were given real-time feedback to address any gaps in adherence. Nearly every nurse in the cardiac intensive care unit received all educational materials, and adherence to all six key bundle elements increased after the implementation of educational interventions. Recommendations from this implementation include providing consistent, comprehensive education across multiple teaching tools and regular audits to track adherence. The multi-platform education campaign brought focus to the evidence-based CAUTI and CLABSI bundles, which in turn will help to reduce CAUTI and CLABSI rates in clinical practice.

Keywords: education, healthcare-associated infections, infection, nursing, prevention

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Authors: Lucile Rapin, Cynthia El Hage, Rihab Gamaoun, Maria-Fernanda Arboleda, Erin Prosk

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Introduction: Sante Cannabis (SC), a Canadian group of clinics dedicated to medical cannabis, based in Montreal and in the province of Quebec, has served more than 8000 patients seeking cannabis-based treatment over the past five years. As randomized clinical trials with natural medical cannabis are scarce, real-world evidence offers the opportunity to fill research gaps between scientific evidence and clinical practice. Data on the use of medical cannabis products from SC patients were prospectively collected, leading to a large real-world database on the use of medical cannabis. The aim of this study was to report information on the profiles of both patients and prescribed medical cannabis products at SC clinics, and to assess the safety of medical cannabis among Canadian patients. Methods: This is an observational retrospective study of 1342 adult patients who were authorized with medical cannabis products between October 2017 and September 2019. Information regarding demographic characteristics, therapeutic indications for medical cannabis use, patterns in dosing and dosage form of medical cannabis and adverse effects over one-year follow-up (initial and 4 follow-up (FUP) visits) were collected. Results: 59% of SC patients were female, with a mean age of 56.7 (SD= 15.6, range= (19-97)). Cannabis products were authorized mainly for patients with a diagnosis of chronic pain (68.8% of patients), cancer (6.7%), neurological disorders (5.6%), and mood disorders (5.4 %). At initial visit, a large majority (70%) of patients were authorized exclusively medical cannabis products, 27% were authorized a combination of pharmaceutical cannabinoids and medical cannabis and 3% were prescribed only pharmaceutical cannabinoids. This pattern was recurrent over the one-year follow-up. Overall, oil was the preferred formulation (average over visits 72.5%) followed by a combination of oil and dry (average 19%), other routes of administration accounted for less than 4%. Patients were predominantly prescribed products with a balanced THC:CBD ratio (59%-75% across visits). 28% of patients reported at least one adverse effect (AE) at the 3-month follow-up visit and 12% at the six-month FUP visit. 84.8% of total AEs were mild and transient. No serious AE was reported. Overall, the most common side effects reported were dizziness (11.95% of total AEs), drowsiness (11.4%), dry mouth (5.5%), nausea (4.8%), headaches (4.6%), cough (4.4%), anxiety (4.1%) and euphoria (3.5%). Other adverse effects accounted for less than 3% of total AE. Conclusion: Our results confirm that the primary area of clinical use for medical cannabis is in pain management. Patients in this cohort are largely utilizing plant-based cannabis oil products with a balanced ratio of THC:CBD. Reported adverse effects were mild and included dizziness and drowsiness. This real-world data confirms the tolerable safety profile of medical cannabis and suggests medical indications not yet validated in controlled clinical trials. Such data offers an important opportunity for the investigation of the long-term effects of cannabinoid exposure in real-life conditions. Real-world evidence can be used to direct clinical trial research efforts on specific indications and dosing patterns for product development.

Keywords: medical cannabis, safety, real-world data, Canada

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Authors: Manish Saha, Manish Kumar Niranjan, Saket Asthana

Abstract:

The K₀.₅Na₀.₅NbO₃ (KNN) system has emerged as one of the most promising lead-free piezoelectric over the years. In this work, we perform a comprehensive investigation of electronic structure, lattice dynamics and dielectric/ferroelectric properties of the room temperature phase of KNN by combining ab-initio DFT-based theoretical analysis and experimental characterization. We assign the symmetry labels to KNN vibrational modes and obtain ab-initio polarized Raman spectra, Infrared (IR) reflectivity, Born-effective charge tensors, oscillator strengths etc. The computed Raman spectrum is found to agree well with the experimental spectrum. In particular, the results suggest that the mode in the range ~840-870 cm-¹ reported in the experimental studies is longitudinal optical (LO) with A_1 symmetry. The Raman mode intensities are calculated for different light polarization set-ups, which suggests the observation of different symmetry modes in different polarization set-ups. The electronic structure of KNN is investigated, and an optical absorption spectrum is obtained. Further, the performances of DFT semi-local, metal-GGA and hybrid exchange-correlations (XC) functionals, in the estimation of KNN band gaps are investigated. The KNN bandgap computed using GGA-1/2 and HSE06 hybrid functional schemes are found to be in excellant agreement with the experimental value. The COHP, electron localization function and Bader charge analysis is also performed to deduce the nature of chemical bonding in the KNN. The solid-state reaction and hydrothermal methods are used to prepare the KNN ceramics, and the effects of grain size on the physical characteristics these ceramics are examined. A comprehensive study on the impact of different synthesis techniques on the structural, electrical, and photocatalytic properties of ferroelectric ceramics KNN. The KNN-S prepared by solid-state method have significantly larger grain size as compared to that for KNN-H prepared by hydrothermal method. Furthermore, the KNN-S is found to exhibit higher dielectric, piezoelectric and ferroelectric properties as compared to KNN-H. On the other hand, the increased photocatalytic activity is observed in KNN-H as compared to KNN-S. As compared to the hydrothermal synthesis, the solid-state synthesis causes an increase in the relative dielectric permittivity (ε^') from 2394 to 3286, remnant polarization (P_r) from 15.38 to 20.41 μC/cm^², planer electromechanical coupling factor (k_p) from 0.19 to 0.28 and piezoelectric coefficient (d_33) from 88 to 125 pC/N. The KNN-S ceramics are also found to have a lower leakage current density, and higher grain resistance than KNN-H ceramic. The enhanced photocatalytic activity of KNN-H is attributed to relatively smaller particle sizes. The KNN-S and KNN-H samples are found to have degradation efficiencies of RhB solution of 20% and 65%, respectively. The experimental study highlights the importance of synthesis methods and how these can be exploited to tailor the dielectric, piezoelectric and photocatalytic properties of KNN. Overall, our study provides several bench-mark important results on KNN that have not been reported so far.

Keywords: lead-free piezoelectric, Raman intensity spectrum, electronic structure, first-principles calculations, solid state synthesis, photocatalysis, hydrothermal synthesis

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Authors: Alena Semeradtova, Marcel Stofik, Lucie Mareckova, Petr Maly, Ondrej Stanek, Jan Maly

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Recently, novel strategies based on so-called molecular evolution were shown to be effective for the production of various peptide ligand libraries with high affinities to molecular targets of interest comparable or even better than monoclonal antibodies. The major advantage of these peptide scaffolds is mainly their prevailing low molecular weight and simple structure. This study describes a new high-affinity binding molecules based immunesensor using a simple optical system for human serum albumin (HSA) detection as a model molecule. We present a comparison of two variants of recombinant binders based on albumin binding domain of the protein G (ABD) performed on micropatterned glass chip. Binding domains may be tailored to any specific target of interest by molecular evolution. Micropatterened glass chips were prepared using UV-photolithography on chromium sputtered glasses. Glass surface was modified by (3-aminopropyl)trietoxysilane and biotin-PEG-acid using EDC/NHS chemistry. Two variants of high-affinity binding molecules were used to detect target molecule. Firstly, a variant is based on ABD domain fused with TolA chain. This molecule is in vivo biotinylated and each molecule contains one molecule of biotin and one ABD domain. Secondly, the variant is ABD domain based on streptavidin molecule and contains four gaps for biotin and four ABD domains. These high-affinity molecules were immobilized to the chip surface via biotin-streptavidin chemistry. To eliminate nonspecific binding 1% bovine serum albumin (BSA) or 6% fetal bovine serum (FBS) were used in every step. For both variants range of measured concentrations of fluorescently labelled HSA was 0 – 30 µg/ml. As a control, we performed a simultaneous assay without high-affinity binding molecules. Fluorescent signal was measured using inverse fluorescent microscope Olympus IX 70 with COOL LED pE 4000 as a light source, related filters, and camera Retiga 2000R as a detector. The fluorescent signal from non-modified areas was substracted from the signal of the fluorescent areas. Results were presented in graphs showing the dependence of measured grayscale value on the log-scale of HSA concentration. For the TolA variant the limit of detection (LOD) of the optical immunosensor proposed in this study is calculated to be 0,20 µg/ml for HSA detection in 1% BSA and 0,24 µg/ml in 6% FBS. In the case of streptavidin-based molecule, it was 0,04 µg/ml and 0,07 µg/ml respectively. The dynamical range of the immunosensor was possible to estimate just in the case of TolA variant and it was calculated to be 0,49 – 3,75 µg/ml and 0,73-1,88 µg/ml respectively. In the case of the streptavidin-based the variant we didn´t reach the surface saturation even with the 480 ug/ml concentration and the upper value of dynamical range was not estimated. Lower value was calculated to be 0,14 µg/ml and 0,17 µg/ml respectively. Based on the obtained results, it´s clear that both variants are useful for creating the bio-recognizing layer on immunosensors. For this particular system, it is obvious that the variant based on streptavidin molecule is more useful for biosensing on glass planar surfaces. Immunosensors based on this variant would exhibit better limit of detection and wide dynamical range.

Keywords: high affinity binding molecules, human serum albumin, optical immunosensor, protein G, UV-photolitography

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Authors: Erimias Firre

Abstract:

This study is situated within the religio-cultural milieu of Coptic Orthodox Christians of the Tigrinya ethnic group in Eritrea. With this ethnic group being conservative and traditionally bound, extended family structures dissected along various clans and expansive community networks are the distinguishing mark of its members. Notably, Coptic Tigrinya constitutes the largest percentage of all Christian denominations in Eritrea. As religious, cultural beliefs, rituals and teachings permeate in all aspects of social life, a distinct worldview and traditionalized health and illness conceptualization are common. Accordingly, this study argues that religio-culturally bound illness ideologies immensely determine the perception, help seeking behavior and healing preference of Coptic Tigrinya in Eritrea. The study bears significance in the sense that it bridges an important knowledge gap, given that it is ethno-linguistically (within the Tigrinya ethnic group), spatially (central region of Eritrea) and religiously (Coptic Christianity) specific. The conceptual framework guiding this research centered on the social determinants of mental health, and explores through the lens of critical theory how existing systems generate social vulnerability and structural inequality, providing a platform to reveal how the psychosocial model has the capacity to emancipate and empower those with mental disorders to live productive and meaningful lives. A case study approach was employed to explore the interrelationship between religio-cultural beliefs and practices and perception of common mental disorders of depression, anxiety, bipolar affective, schizophrenia and post-traumatic stress disorders and the impact of these perceptions on people with those mental disorders. Purposive sampling was used to recruit 41 participants representing seven diverse cohorts; people with common mental disorders, family caregivers, general community members, ex-fighters , priests, staff at St. Mary’s and Biet-Mekae Community Health Center; resulting in rich data for thematic analysis. Findings highlighted current religio-cultural perceptions, causes and treatment of mental disorders among Coptic Tigrinya result in widespread labelling, stigma and discrimination, both of those with mental disorders and their families. Traditional healing sources are almost exclusively tried, sometimes for many years, before families and sufferers seek formal medical assessment and treatment, resulting difficult to treat illness chronicity. Service gaps in the formal medical system result in the inability to meet the principles enshrined in the WHO Mental Health Action Plan 2013-2020 to which the Eritrean Government is a signatory. However, the study found that across all participant cohorts, there was a desire for change that will create a culture whereby those with mental disorders will have restored hope, connectedness, healing and self-determination.

Keywords: Coptic Tigrinya, mental disorders, psychosocial model social integration and recovery, traditional healing

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Authors: Alexis D'Agostino, Celeste Sununtunasuk, Jack Fiedler

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Background: Iron-folic acid (IFA) supplementation during antenatal care (ANC) has existed in many countries for decades. Despite this, low national coverage persists and women do not often consume appropriate amounts during pregnancy. USAID’s SPRING Project investigated pregnant women’s access to, and consumption of, IFA tablets through ANC. Cross-country analysis provided a global picture of the state of IFA-supplementation, while country-specific results noted key contextual issues, including geography, wealth, and ANC attendance. The analysis can help countries prioritize strategies for systematic performance improvements within one of the most common micronutrient supplementation programs aimed at reducing maternal anemia. Methodology: Using falter point analysis on Demographic and Health Survey (DHS) data collected from 162,958 women across 22 countries, SPRING identified four sequential falter points (ANC attendance, IFA receipt or purchase, IFA consumption, and number of tablets taken) where pregnant women fell out of the IFA distribution structure. SPRING analyzed data on IFA intake from DHS surveys with women of reproductive age. SPRING disaggregated these data by ANC participation during the most recent pregnancy, residency, and women’s socio-economic status. Results: Average sufficient IFA tablet use across all countries was only eight percent. Even in the best performing countries, only about one-third of pregnant women consumed 180 or more IFA tablets during their most recent pregnancy. ANC attendance was an important falter point for a quarter of women across all countries (with highest falter rates in Democratic Republic of the Congo, Nigeria, and Niger). Further analysis reveals patterns, with some countries having high ANC coverage but low IFA provision during ANC (DRC and Haiti), others having high ANC coverage and IFA provision but few women taking any tablets (Nigeria and Liberia), and countries that perform well in ANC, supplies, and initial consumption but where very few women consume the recommended 180 tablets (Malawi and Cambodia). Country-level analysis identifies further patterns of supplementation. In Indonesia, for example, only 62% of women in the poorest quintile took even one IFA tablet, while 86% of the wealthiest women did. This association between socioeconomic status and IFA intake held across nearly all countries where these data are available and was also visible in rural/urban comparisons. Analysis of ANC attendance data also suggests that higher numbers of ANC visits are associated with higher tablet intake. Conclusions: While it is difficult to disentangle which specific aspects of supply or demand cause the low rates of consumption, this tool allows policy-makers to identify major bottlenecks to scaling-up IFA supplementation during ANC. In turn, each falter point provides possible explanations of program performance and helps strategically identify areas for improved IFA supplementation. For example, improving the delivery of IFA supplementation in Ethiopia relies on increasing access to ANC, but also on identifying and addressing program gaps in IFA supply management and health workers’ practices in order to provide quality ANC services. While every country requires a customized approach to improving IFA supplementation, the multi-country analysis conducted by SPRING is a helpful first step in identifying country bottlenecks and prioritizing interventions.

Keywords: iron and folic acid, supplementation, antenatal care, micronutrient

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Authors: Molly Parker

Abstract:

Unintended pregnancy rates in Australia are amongst the highest in the developed world. Women with Substance Use Disorder often have riskier sexual behavior with nil contraceptive use and face disproportionately higher unintended pregnancies and Sexually Transmitted Infections, alongside Substance Use in Pregnancy (SUP) climbing at an alarming rate. In an inner-city Drug and Alcohol (D&A) service, significant barriers to sexual and reproductive health services have been identified, aligning with research. Rapid pathways were created for women seeking D&A treatment to be referred to Sexual and Reproductive Health services for the administration of Long-acting reversible contraception (LARC) and sexual health screening. For clients attending a D&A service, this is an opportunistic time to offer sexual and reproductive health services. Collaboration and multidisciplinary team input between D&A and sexual health and reproductive services are paramount, with rapid referral pathways being identified as the main strategy to improve access to sexual and reproductive health support for this population. With this evidence, a rapid referral pathway was created for women using the D&A service to access LARC, particularly in view of fertility often returning once stable on D&A treatment. A closed-ended survey was used for D&A staff to identify gaps in reproductive health knowledge and views of referral accessibility. Results demonstrated a lack of knowledge of contraception and appropriate referral processes. A closed-ended survey for clients was created to establish the need and access to services and to quantify data. A follow-up data collection will be reviewed to access uptake and satisfaction of the intervention from clients. Sexual health screening access was also identified as a deficit, particularly concerning due to the higher rates of STIs in this cohort. A rapid referral pathway will be undergoing implementation, reducing risks of untreated STIS both pre and post-conception. Similarly, pre and post-intervention structured surveys will be used to identify client satisfaction from the pathway. Although currently in progress, the research and pathway aim to be completed by December 2023. This research and implementation of sexual and reproductive health pathways from the D&A service have significant health and well-being benefits to clients and the wider community, including possible fetal/infancy outcomes. Women now have rapid access to sexual and reproductive health services, with the aim of reducing unplanned pregnancies, poor outcomes associated with SUP, client/staff trauma from termination of pregnancy, and client/staff trauma following the assumption of care of the child due to substance use, the financial cost for out of home care as required, the poor outcomes of untreated STIs to the fetus in pregnancy and the spread of STIs in the wider community. As evidence suggests, the implementation of a streamlined referral process is required between D&A and sexual and reproductive health services and has positive feedback from both clinicians and clients in improving care.

Keywords: substance use in pregnancy, drug and alcohol, substance use disorder, sexual health, reproductive health, contraception, long-acting reversible contraception, neonatal abstinence syndrome, FASD, sexually transmitted infections, sexually transmitted infections pregnancy

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