Search results for: hip reductions

Authors: Luke Sniewski, Pante Farvid, Phil Carter, Rita Csako

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Background and Aims: Self-Perceived Problematic Porn Use (SPPPU) refers to individuals who identify as or perceive themselves to be addicted to porn. These individuals feel they are unable to regulate their porn consumption and experience adverse consequences as a result of their use in everyday life. To the author’s best knowledge, this research represents the first study to intervene with pornography use with mindfulness meditation, and aims to investigate the experiences and challenges of men with SPPPU as they engage in a mindfulness meditation intervention. As meditation is commonly characterized by sitting and observing one’s internal experience with non-reaction and acceptance, the study’s principal hypothesis was that consistent practice of meditation would develop the participant’s capacity to respond to cravings, urges, and unwanted thoughts in less reactive, more productive ways. Method: This 12-mixed method research utilised Single Case Experimental Design (SCED) methodology, with a standard AB design. Each participant was randomly assigned to an initial baseline time period between 2 to 5 weeks before learning the meditation technique and practicing it for the remainder of the 12-week study. The pilot study included 3 participants, while the intervention study included 12. The meditation technique used for the study involved a 15-minute guided breathing exercise in the morning, along with a 15-minute guided concentration meditation in the evening. Results: At the time of submission, only pilot study results were available. Results from the pilot study indicate an improved capacity for self-awareness of the uncomfortable mental and emotional states that drove their participants’ pornography use. Statistically significant reductions were also observed in daily porn use, total weekly time spent viewing porn, as well as lowered Pornography Craving Questionnaire (PCQ) and Problematic Pornography Use Scale (PPUS) scores. Conclusion: Pilot study results suggest that meditation could serve as a complementary tool for health professionals to provide clients in conjunction with therapeutic interventions. Study limitations, directions for future research, and clinical implications to be discussed as well.

Keywords: meditation, behavioural change, pornography, mindfulness

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Authors: Yuanxiaoyue Yang

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Emissions trading, or ‘cap-and-trade', has been long promoted by economists as a more cost-effective pollution control approach than traditional performance standard approaches. While there is a large body of empirical evidence for the overall effectiveness of emissions trading, relatively little attention has been paid to other unintended consequences brought by emissions trading. One important consequence is that cap-and-trade could introduce the risk of creating high-level emission concentrations in areas where emitting facilities purchase a large number of emission allowances, which may cause an unequal distribution of environmental benefits. This study will contribute to the current environmental policy literature by linking trading activity with environmental injustice concerns and empirically analyzing the causal relationship between trading activity and emissions reduction under a cap-and-trade program for the first time. To investigate the potential environmental injustice concern in cap-and-trade, this paper uses a differences-in-differences (DID) with instrumental variable method to identify the causal effect of allowance trading behaviors on emission reduction levels under the clean air interstate rule (CAIR), a cap-and-trade program targeting on the power sector in the eastern US. The major data source is the facility-year level emissions and allowance transaction data collected from US EPA air market databases. While polluting facilities from CAIR are the treatment group under our DID identification, we use non-CAIR facilities from the Acid Rain Program - another NOx control program without a trading scheme – as the control group. To isolate the causal effects of trading behaviors on emissions reduction, we also use eligibility for CAIR participation as the instrumental variable. The DID results indicate that the CAIR program was able to reduce NOx emissions from affected facilities by about 10% more than facilities who did not participate in the CAIR program. Therefore, CAIR achieves excellent overall performance in emissions reduction. The IV regression results also indicate that compared with non-CAIR facilities, purchasing emission permits still decreases a CAIR participating facility’s emissions level significantly. This result implies that even buyers under the cap-and-trade program have achieved a great amount of emissions reduction. Therefore, we conclude little evidence of environmental injustice from the CAIR program.

Keywords: air pollution, cap-and-trade, emissions trading, environmental justice

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Authors: Aniko Babits, Ahmad Daoud

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Introduction: The beach chair position (BCP) is a good approach to almost all types of shoulder procedures. However, moving an anaesthetized patient from the supine to sitting position may pose a risk of cerebral hypoperfusion and potential cerebral ischaemia as a result of significant reductions in blood pressure and cardiac output. Hypocapnia in ventilated patients and impaired blood flow to the vertebral artery due to hyperextension, rotation, or tilt of the head may have an impact too. Co-morbidities that may increase the risk of cerebral ischaemia in the BCP include diabetes with autonomic neuropathy, cerebrovascular disease, cardiac disease, severe hypertension, generalized vascular disease, history of fainting, and febrile conditions. Beach chair surgery requires a careful anaesthetic and surgical management to optimize patient safety and minimize the risk of adverse outcomes. Methods: We describe the necessary steps for optimal patient positioning and the aims of intraoperative management, including anaesthetic techniques to ensure patient safety in the BCP. Results: Regardless of the anaesthetic technique, adequate patient positioning is paramount in the BCP. The key steps to BCP are aimed at optimizing surgical success and minimizing the risk of severe neurovascular complications. The primary aim of anaesthetic management is to maintain cardiac output and mean arterial pressure (MAP) to protect cerebral perfusion. Blood pressure management includes treating a fall in MAP of more than 25% from baseline or a MAP less than 70 mmHg. This can be achieved by using intravenous fluids or vasopressors. A number of anaesthetic techniques could also improve cerebral oxygenation, including avoidance of intermittent positive pressure ventilation (IPPV) with general anaesthesia (GA), using regional anaesthesia, maintaining normocapnia and normothermia, and the application of compression stockings. Conclusions: In summary, BCP is a reliable and effective position to perform shoulder procedures. Simple steps to patient positioning and careful anaesthetic management could maximize patient safety and avoid unwanted adverse outcomes in patients undergoing surgery in BCP.

Keywords: beach chair position, cerebral oxygenation, cerebral perfusion, sitting position

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Authors: Ahmad Haidar

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Modern economic systems are characterized by growing complexity, and addressing their challenges requires innovative approaches. This study examines the implications of artificial intelligence (AI) on unemployment in Europe from a macroeconomic perspective, employing data modeling techniques to understand the relationship between AI integration and labor market dynamics. To understand the AI-unemployment nexus comprehensively, this research considers factors such as sector-specific AI adoption, skill requirements, workforce demographics, and geographical disparities. The study utilizes a panel data model, incorporating data from European countries over the last two decades, to explore the potential short-term and long-term effects of AI implementation on unemployment rates. In addition to investigating the direct impact of AI on unemployment, the study also delves into the potential indirect effects and spillover consequences. It considers how AI-driven productivity improvements and cost reductions might influence economic growth and, in turn, labor market outcomes. Furthermore, it assesses the potential for AI-induced changes in industrial structures to affect job displacement and creation. The research also highlights the importance of policy responses in mitigating potential negative consequences of AI adoption on unemployment. It emphasizes the need for targeted interventions such as skill development programs, labor market regulations, and social safety nets to enable a smooth transition for workers affected by AI-related job displacement. Additionally, the study explores the potential role of AI in informing and transforming policy-making to ensure more effective and agile responses to labor market challenges. In conclusion, this study provides a comprehensive analysis of the macroeconomic implications of AI on unemployment in Europe, highlighting the importance of understanding the nuanced relationships between AI adoption, economic growth, and labor market outcomes. By shedding light on these relationships, the study contributes valuable insights for policymakers, educators, and researchers, enabling them to make informed decisions in navigating the complex landscape of AI-driven economic transformation.

Keywords: artificial intelligence, unemployment, macroeconomic analysis, european labor market

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Authors: Christine A. Odinga, G. Sanjay, M. Mathew, S. Gupta, F. M. Swalaha, F. A. O. Otieno, F. Bux

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Wastewater discharged from municipal treatment plants contain an amalgamation of trace metals. The presence of metal pollutants in wastewater poses a huge challenge to the choice and applications of the preferred treatment method. Conventional treatment methods are inefficient in the removal of trace metals due to their design approach. This study evaluated the treatment performance of a constructed rhizofiltration system in the removal of heavy metals from municipal wastewater. The study was conducted at an eThekwni municipal wastewater treatment plant in Kingsburgh - Durban in the province of KwaZulu-Natal. The construction details of the pilot-scale rhizofiltration unit included three different layers of substrate consisting of medium stones, coarse gravel and fine sand. The system had one section planted with Phragmites australis L. and Kyllinga nemoralis L. while the other section was unplanted and acted as the control. Influent, effluent and sediment from the system were sampled and assessed for the presence of and removal of selected trace heavy metals using standard methods. Efficiency of metals removal was established by gauging the transfer of metals into leaves, roots and stem of the plants by calculations based on standard statistical packages. The Langmuir model was used to assess the heavy metal adsorption mechanisms of the plants. Heavy metals were accumulated in the entire rhizofiltration system at varying percentages of 96.69% on planted and 48.98% on control side for cadmium. Chromium was 81% and 24%, Copper was 23.4% and 1.1%, Nickel was 72% and 46.5, Lead was 63% and 31%, while Zinc was 76% and 84% on the on the water and sediment of the planted and control sides of the rhizofilter respectively. The decrease in metal adsorption efficiencies on the planted side followed the pattern of Cd>Cr>Zn>Ni>Pb>Cu and Ni>Cd>Pb>Cr>Cu>Zn on the control side. Confirmatory analysis using Electron Scanning Microscopy revealed that higher amounts of metals was deposited in the root system with values ranging from 0.015mg/kg (Cr), 0.250 (Cu), 0.030 (Pb) for P. australis, and 0.055mg/kg (Cr), 0.470mg/kg (Cu) and 0.210mg/kg,(Pb) for K. nemoralis respectively. The system was found to be efficient in removing and reducing metals from wastewater and further research is necessary to establish the immediate mechanisms that the plants display in order to achieve these reductions.

Keywords: wastewater treatment, Phragmites australis L., Kyllinga nemoralis L., heavy metals, pathogens, rhizofiltration

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Authors: Philippe Judlin, Olivier Morel

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Background: In France, the resident curriculum (RC) in Obstetrics and Gynecology (OBGYN) takes five years. In the course of the last 15 years, this RC has undergone major changes, characterized mainly by successive reductions of work hours. The program used to comprise long and frequent shifts, huge workload, poor supervision and erratic theoretical teaching. A decade ago, the French Ministry of Heath recommended a limitation of shift duration up to 24 hours and a minimum of 11 hours off duty between shifts. Last year, in order to comply with European Union directives, new recommendations have further limited residents’ work hours to 48 hours per week. Methods: Assessment of the residency program adjustments recently made to accommodate the recommendations while improving the training quality in resorting to new methods. Results: The challenge facing program directors was to provide an all-encompassing curriculum to OBGYN residents despite fewer work hours. Program has been dramatically redesigned, and several measures have been put in place: -The resident rotation system has been redesigned. Residents used to make 6-month rotations between 10-12 Departments of OBGYN or Surgery. Fewer Departments, those providing the best teaching, have been kept in the new RC. -Extensive inhouse supervision has been implemented for all kinds of clinical activities. Effectual supervision of residents has proved to be an effective tool to improve the quality of training. -The tutorship system, with academic members individually overseeing residents during their curriculum, has been perfected. It allows a better follow-up of residents’ progresses during the 5-year program. -The set up of an extensive program of lectures encompassing all maters in Obstetrics & Gynecology. These mandatory lectures are available online in a dedicated website. Therefore, face-to-face lectures have been limited in order to fit in the 48-hour limit. -The use of simulation has been significantly increased in obstetrics, materno-fetal medicine and surgery (stressing especially laparoscopic training). -Residents’ feedback has been taken into account in the setup of the new RC. Conclusion: This extensive overhaul of the Obstetrics and Gynecology RC has been in place since last year only. Nevertheless, the new program seems to adequately take into account the new recommendations while providing a better and more consistent teaching to the OBGYN residents.

Keywords: education, laparoscopy, residency, simulation

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Authors: Mateus L. O. Freitas, Flávia H. de M. Libório, Letycia L. Ricardo, Patrícia da C. Zonetti, Graciene de S. Bido

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Weeds compete with agricultural crops for resources such as light, water, and nutrients. This competition can cause significant damage to agricultural producers, and, currently, the use of agrochemicals is the most effective method for controlling these undesirable plants. Morning glory (Ipomoea grandifolia [Dammer] O'Donell) is an aggressive weed and significantly reduces agricultural productivity making harvesting difficult, especially mechanical harvesting. The biggest challenge in modern agriculture is to preserve high productivity reducing environmental damage and maintaining soil characteristics. No-till is a sustainable practice that can reduce the use of agrochemicals and environmental impacts due to the presence of plant residues in the soil, which release allelopathic compounds and reduce the incidence or alter the growth and development of crops and weeds. Sorghum (Sorghum bicolor [L.] Moench) is a forage with proven allelopathic activity, mainly for producing sorgholeone. In this context, this research aimed to evaluate the allelopathic action of sorghum fractions using hexane, dichloromethane, butanol, and ethyl acetate on the germination and initial growth of morning glory. The parameters analyzed were the percentage of germination, speed of germination, seedling length, and biomass weight (fresh and dry). The bioassays were performed in Petri dishes, kept in an incubation chamber for 7 days, at 25 °C, with a 12h photoperiod. The experimental design was completely randomized, with five replicates of each treatment. The data were evaluated by analysis of variance, and the averages between each treatment were compared using the Scott Knott test at a 5% significance level. The results indicated that the dichloromethane and ethyl acetate fractions showed bioherbicidal effects, promoting effective reductions on germination and initial growth of the morning glory. It was concluded that allelochemicals were probably extracted in these fractions. These secondary metabolites can reduce the use of agrochemicals and environmental impact, making agricultural production systems more sustainable.

Keywords: allelochemicals, secondary metabolism, sorgoleone, weeds

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Authors: Emiru Birhane, Tesfay Gidey, Haftu Abrha, Abrha Brhan, Amanuel Zenebe, Girmay Gebresamuel, Florent Noulèkoun

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Dracaena ombet and Dobera glabra are two of the most rare and endangered tree species in dryland areas. Unfortunately, their sustainability is being compromised by different anthropogenic and natural factors. However, the impacts of ongoing land use and climate change on the population structure and distribution of the species are less explored. This study was carried out in the grazing lands and hillside areas of the Desa'a dry Afromontane forest, northern Ethiopia, to characterize the population structure of the species and predict the impact of climate change on their potential distributions. In each land-use type, abundance, diameter at breast height, and height of the trees were collected using 70 sampling plots distributed over seven transects spaced one km apart. The geographic coordinates of each individual tree were also recorded. The results showed that the species populations were characterized by low abundance and unstable population structure. The latter was evinced by a lack of seedlings and mature trees. The study also revealed that the total abundance and dendrometric traits of the trees were significantly different between the two land uses. The hillside areas had a denser abundance of bigger and taller trees than the grazing lands. Climate change predictions using the MaxEnt model highlighted that future temperature increases coupled with reduced precipitation would lead to significant reductions in the suitable habitats of the species in northern Ethiopia. The species' suitable habitats were predicted to decline by 48–83% for D. ombet and 35–87% for D. glabra. Hence, to sustain the species populations, different strategies should be adopted, namely the introduction of alternative livelihoods (e.g., gathering NTFP) to reduce the overexploitation of the species for subsistence income and the protection of the current habitats that will remain suitable in the future using community-based exclosures. Additionally, the preservation of the species' seeds in gene banks is crucial to ensure their long-term conservation.

Keywords: grazing lands, hillside areas, land-use change, MaxEnt, range limitation, rare and endangered tree species

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Authors: Bindhiya Thomas, Rehana Hafeez

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Background: The Surgical Ambulatory Unit (SAU) also known as the Same Day Emergency Care (SDEC) is an established part of many hospitals providing same day emergency care service to surgical patients who would have otherwise required admission through the A&E. Prior to Covid, the SAU was functioning as a 12-hour service, but during the Covid crisis this service was transformed to a 24 hour functioning Surgical Ambulatory Assessment unit (SAAU). We studied the effects that this change brought about in-patient care in our hospital. Objective: The objective of the study was to assess the impact of a 24-hour Surgical Ambulatory Assessment unit on patient care during the time of Covid, in particular its role in freeing A&E capacity and delivering effective patient care. Methods: We collected two sets of data retrospectively. The first set was collected over a 6-week period when the SAU was functioning at the Princess Royal University Hospital. On March 23rd, 2020, the SAU was transformed into a 24-hour SAAU. Following this transformation, a second set of patient data was collected over a period of 6 weeks. A comparison was made between data collected from when the hospital had a 12-hour Surgical Ambulatory unit and later when it was transformed into a 24-hour facility. Its effects on the change in the number of patients breaching the four hour waiting period and the number of emergency surgical admissions. Results: The 24-hour Surgical Ambulatory Assessment unit brought significant reductions in the number of patients breaching the waiting period of 4 hours in A&E from 44% during the period of the 12-hour Surgical Ambulatory care facility to 0% from when the 24-hour Surgical Ambulatory Assessment Unit was established. A 28% reduction was also seen in the number of surgical patients' admissions from A&E. Conclusions: The 24-hour SAAU was found to have a profound positive impact on emergency care of surgical patients. Especially during the Covid crisis, it played a crucial role in providing not only effective and accessible patient care but also in reducing the A&E workload and admissions. It thus proved to be a strategic tool that helped to deal with the immense workload in emergency care during the Covid crisis and helped free much needed headspace at a time of uncertainty for the A&E to better configure their services. If sustained, the 24-hour SAAU could be relied on to augment the NHS emergency services in the future, especially in the event of another crisis.

Keywords: Princess Royal University Hospital, surgical ambulatory assessment unit, surgical ambulatory unit, same day emergency care

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Authors: Onur Ercan, Buket Askin, Erdogan Kucukoner

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Blueberry (Vaccinium corymbosum, bluegold) has become popular beverage due to their nutritional values such as vitamins, minerals, and antioxidants. In the study, the effects of pressing, mashing, enzymatic treatment, and pasteurization on anthocyanins, colour, and polyphenolics of blueberry juice (BJ) were studied. The blueberry juice (BJ) was produced with two different methods that direct juice extraction (DJE) and mash treatment process (MTP) were applied. After crude blueberry juice (CBJ) production, the samples were first treated with commercial enzymes [Novoferm-61 (Novozymes A/S) (2–10 mL/L)], to break down the hydrocolloid polysaccharides, mainly pectin and starch. The enzymes were added at various concentrations. The highest transmittance (%) was obtained for Novoferm-61 at a concentration of 2 mL/L was 66.53%. After enzymatic treatment, clarification trials were applied to the enzymatically treated BJs with adding various amounts of bentonite (10%, w/v), gelatin (1%, w/v) and kiselsol (15%, v/v). The turbidities of the clarified samples were then determined. However, there was no significant differences between transmittances (%) for samples. For that, only enzymatic treatment was applied to the blueberry juice processing (DDBJ, depectinized direct blueberry juice). Based on initial pressing process made to evaluate press function, it was determined that pressing fresh blueberries with no other processing did not render adequate juice due to lack of liquefaction. Therefore, the blueberries were mash into small pieces (3 mm) and then enzymatic treatments and clarification trials were performed. Finally, both BJ samples were pasteurized. Compositional analyses, colour properties, polyphenols and antioxidant properties were compared. Enzymatic treatment caused significant reductions in ACN content (30%) in Direct Blueberry Juice Processing (DBJ), while there was a significant increasing in Mash Treatment Processing (MTP). Overall anthocyanin levels were higher intreated samples after each processing step in MTP samples, but polyphenolic levels were slightly higher for both processes (DBJ and MTP). There was a reduction for ACNs and polyphenolics only after pasteurization. It has a result that the methods for tried to blueberry juice is suitable into obtain fresh juice. In addition, we examined fruit juice during processing stages; anthocyanin, phenolic substance content and antioxidant activity are higher, and yield is higher in fruit juice compared to DBJ method in MTP method, the MTP method should be preferred in processing juice of blueberry into fruit juice.

Keywords: anthocyanins, blueberry, depectinization, polyphenols

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Authors: Xiaohong Xu, Tianchu Zhang, Yangfan Chen, Rongtai Tan

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In Canada, Air Quality Health Index (AQHI) is a scale designed to help residences understand the impact of air quality on human health. In Ontario, Canada, AQHI was implemented in June 2015. This study investigated temporal variability of daily AQHI and impact of regional transport on AQHI in Windsor, Ontario, Canada from 2016 to 2019. During 2016–2019, 1428 daily AQHIs were recorded in Windsor Downtown Station. Among those, the AQHIs were at the low health risk level (AQHI = 1, 2 or 3) in 82% of days, only a few days at high risk level (AQHI = 7), the rest were at moderate health risk level (AQHI = 4, 5, 6), indicating air quality in Windsor was fairly good with relatively low health risk. The annual mean AQHI value decreased from 2.95 in 2016 to 2.81 in 2019, demonstrating the improvement of air quality. Half of the days, AQHI were 3 regardless of season. AQHI was higher in the warm season (3.1) than in the cold season (2.6) due to more frequent moderate risk days (27%, AQHI = 4) in warm season and more frequent low risk days (42%, AQHI = 2) in the cold season. Among the three pollutants considered in AQHI calculation, O3 was the most frequently reported dominant contributor to daily AQHI (88% of days), followed by NO2 (12%), especially in the cold season, with small contribution from PM2.5 (<1%). In the past two decades, NO2 concentrations had decreased significantly and O3 concentrations had increased, resulting in daily AQHI being less reliance on NO2 (from 51% of days being the primary contributor during 2003–2010 to 12% during 2016–2019) and more on O3 concentrations (49% to 88%). Trajectory analysis found that AQHI ≤ 3 days were closely associated with air masses from the north and northwest, whereas AQHI > 3 days were closely associated with air masses from the west and southwest. This is because northerly flows brought in clear air mass owing to less industrial facilities, while polluted air masses were transported from the south of Windsor, where several industrial states of the US were located. Overall, O3 concentrations dictate the daily AQHI values, the seasonal variability of AQHI, and the impact of regional transport on AQHI in Windsor. This makes further reductions of AQHI challenging because O3 concentrations are likely to continue increasing due to weakened consumption of O3 by NO owing to decreasing NO emissions and more hot days because of climate change. The predominant and increasing contribution of O3 to AQHI calls for more effective control measures to mitigate O3 pollution and its impact on human health and the environment.

Keywords: air quality, Air Quality Health Index (AQHI), hysplit, regional transport, windsor

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Authors: Luciana Aparecida Bastos, Tatiana Diair L. F. Rosa, Jesus Creapldi

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The idea of Latin American integration occurred from the ideals of Simón Bolívar that, in 1824, called the Ibero-American nations to Amphictyonic Congress of Panama, on June 22, 1826, where he would defend the importance of Latin American unity. However, this congress was frustrating and the idea of Bolívar went no further. It was only after the European Union to start the process, driven by the end of World War II that the subject returned to emerge in Latin America. Thus, in 1960, supported by the European integration process, started in 1957 with the excellent result of the ECSC - European Coal and Steel Community, a result of the Customs Union of the BENELUX (integration between Belgium, the Netherlands and Luxembourg) in 1948, was created in Latin America, LAFTA - Latin American Free Trade Association, in 1960. In 1980, LAFTA was replaced by LAAI- Latin American Association, both with the same goal: to integrate Latin America, it´s economy and its trade. Most researchers in this period agree that the regional market would be expanded through the integration. The creation of one or more economic blocs in the region would provide the union of Latin American countries through a fusion of common interests and by their geographical proximity, which would try to develop common projects to promote mutual growth and economic development, tariff reductions, promotion of increased trade between, among many other goals set together. Thus, taking into account Mercosur, the main Latin-American block, created in 1994, the aim of this paper is to make a brief analysis of the trade balance performance of Brazil (larger economy of the block) in Mercosur in the periods: 1989-1994 and 1994-2012. The choice of this period was because the objective is to compare the period before and after the integration of Brazil in Mercosur. The methodologies used were the literature review and descriptive statistics. The results showed that after the integration of Brazil in Mercosur, the exports and imports grew within the bloc and the country turned out to become the leading importer of other economies of Mercosur after integration, that is, Brazil, after integration to Mercosur, was largely responsible for promoting the expansion of regional trade through the import of products from other members of the block.

Keywords: Brazil, mercosur, integration, trade balance, comparison

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Authors: Md. Kausar Alam, Ramin Motamed

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The damaging effects of liquefaction-induced ground movements have been frequently observed in past earthquakes, such as the 2010-2011 Canterbury Earthquake Sequence (CES) in New Zealand and the 2011 Tohoku earthquake in Japan. To reduce the consequences of soil liquefaction at shallow depths, various ground improvement techniques have been utilized in engineering practice, among which this research is focused on experimentally evaluating the press-in sheet piling technique. The press-in sheet pile technique eliminates the vibration, hammering, and noise pollution associated with dynamic sheet pile installation methods. Unfortunately, there are limited experimental studies on the press-in sheet piling technique for liquefaction mitigation using 1g shake table tests in which all the controlling mechanisms of liquefaction-induced foundation settlement, including sand ejecta, can be realistically reproduced. In this study, a series of moderate scale 1g shake table experiments were conducted at the University of Nevada, Reno, to evaluate the performance of this technique in liquefiable soil layers. First, a 1/5 size model was developed based on a recent UC San Diego shaking table experiment. The scaled model has a density of 50% for the top crust, 40% for the intermediate liquefiable layer, and 85% for the bottom dense layer. Second, a shallow foundation is seated atop an unsaturated sandy soil crust. Third, in a series of tests, a sheet pile with variable embedment depth is inserted into the liquefiable soil using the press-in technique surrounding the shallow foundations. The scaled models are subjected to harmonic input motions with amplitude and dominant frequency properly scaled based on the large-scale shake table test. This study assesses the performance of the press-in sheet piling technique in terms of reductions in the foundation movements (settlement and tilt) and generated excess pore water pressures. In addition, this paper discusses the cost-effectiveness and carbon footprint features of the studied mitigation measures.

Keywords: excess pore water pressure, foundation settlement, press-in sheet pile, soil liquefaction

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Authors: Cagdas Agirdas

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Background: The Affordable Care Act (ACA) requires non-grandfathered private insurance plans, starting with plan years on or after September 23rd, 2010, to provide certain preventive care services without any cost sharing in the form of deductibles, copayments or co-insurance. This requirement may affect racial and ethnic disparities in preventive care as it provides the largest copay reduction in preventive care. Objectives: We ask whether the ACA’s free preventive care benefits are associated with a reduction in racial and ethnic disparities in the utilization of four preventive services: cholesterol screenings, colonoscopies, mammograms, and pap smears. Methods: We use a data set of over 6,000 individuals from the 2009, 2010, and 2013 Medical Expenditure Panel Surveys (MEPS). We restrict our data set only to individuals who are old enough to be eligible for each preventive service. Our difference-in-differences logistic regression model classifies privately-insured Hispanics, African Americans, and Asians as the treatment groups and 2013 as the after-policy year. Our control group consists of non-Hispanic whites on Medicaid as this program already covered preventive care services for free or at a low cost before the ACA. Results: After controlling for income, education, marital status, preferred interview language, self-reported health status, employment, having a usual source of care, age and gender, we find that the ACA is associated with increases in the probability of the median, privately-insured Hispanic person to get a colonoscopy by 3.6% and a mammogram by 3.1%, compared to a non-Hispanic white person on Medicaid. Similarly, we find that the median, privately-insured African American person’s probability of receiving these two preventive services improved by 2.3% and 2.4% compared to a non-Hispanic white person on Medicaid. We do not find any significant improvements for any racial or ethnic group for cholesterol screenings or pap smears. Furthermore, our results do not indicate any significant changes for Asians compared to non-Hispanic whites in utilizing the four preventive services. These reductions in racial/ethnic disparities are robust to reconfigurations of time periods, previous diagnosis, and residential status. Conclusions: Early effects of the ACA’s provision of free preventive care are significant for Hispanics and African Americans. Further research is needed for the later years as more individuals became aware of these benefits.

Keywords: preventive care, Affordable Care Act, cost sharing, racial disparities

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Authors: Brandon Knopp, Matthew Harris

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Purpose: Tip-apex distance (TAD) has long been discussed as a metric for determining risk of failure in the fixation of peritrochanteric fractures. TAD measurements over 25 millimeters (mm) have been associated with higher rates of screw cut out and other complications in the first several months after surgery. However, there is limited evidence for the efficacy of this measurement in predicting the long-term risk of negative outcomes following hip fixation surgery. The purpose of our study was to investigate risk factors including TAD for hospital readmission, loss of pre-injury ambulation and development of complications within 1 year after hip fixation surgery. Methods: A retrospective review of proximal hip fractures treated with single screw intramedullary devices between 2016 and 2020 was performed at a 327-bed regional medical center. Patients included had a postoperative follow-up of at least 12 months or surgery-related complications developing within that time. Results: 44 of the 67 patients in this study met the inclusion criteria with adequate follow-up post-surgery. There was a total of 10 males (22.7%) and 34 females (77.3%) meeting inclusion criteria with a mean age of 82.1 (± 12.3) at the time of surgery. The average TAD in our study population was 19.57mm and the average 1-year readmission rate was 15.9%. 3 out of 6 patients (50%) with a TAD > 25mm were readmitted within one year due to surgery-related complications. In contrast, 3 out of 38 patients (7.9%) with a TAD < 25mm were readmitted within one year due to surgery-related complications (p=0.0254). Individual TAD measurements, averaging 22.05mm in patients readmitted within 1 year of surgery and 19.18mm in patients not readmitted within 1 year of surgery, were not significantly different between the two groups (p=0.2113). Conclusions: Our data indicate a significant improvement in hospital readmission rates up to one year after hip fixation surgery in patients with a TAD < 25mm with a decrease in readmissions of over 40% (50% vs 7.9%). This result builds upon past investigations by extending the follow-up time to 1 year after surgery and utilizing hospital readmissions as a metric for surgical success. With the well-documented physical and financial costs of hospital readmission after hip surgery, our study highlights a reduction of TAD < 25mm as an effective method of improving patient outcomes and reducing financial costs to patients and medical institutions. No relationship was found between TAD measurements and secondary outcomes, including loss of pre-injury ambulation and development of complications.

Keywords: hip fractures, hip reductions, readmission rates, open reduction internal fixation

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Authors: Zahra Jandaghian, Mehdi Ghobadi, Michal Bartko, Alex Hayes, Marianne Armstrong, Alexandra Thompson, Michael Lacasse

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The Intergovernmental Panel on Climate Change (IPCC) report stated the urgent need to cut greenhouse gas emissions to avoid the adverse impacts of climatic changes. The United Nations has forecasted that nearly 70 percent of people will live in urban areas by 2050 resulting in a doubling of the global building stock. Given that buildings are currently recognised as emitting 40 percent of global carbon emissions, there is thus an urgent incentive to decarbonize existing buildings and to build net-zero carbon buildings. To attain net zero carbon emissions in communities in the future requires action in two directions: I) reduction of emissions; and II) removal of on-going emissions from the atmosphere once de-carbonization measures have been implemented. Nature-based solutions (NBS) have a significant role to play in achieving net zero carbon communities, spanning both emission reductions and removal of on-going emissions. NBS for the decarbonisation of buildings can be achieved by using green roofs and green walls – increasing vertical and horizontal vegetation on the building envelopes – and using nature-based materials that either emit less heat to the atmosphere thus decreasing photochemical reaction rates, or store substantial amount of carbon during the whole building service life within their structure. The NBS approach can also mitigate urban flooding and overheating, improve urban climate and air quality, and provide better living conditions for the urban population. For existing buildings, de-carbonization mostly requires retrofitting existing envelopes efficiently to use NBS techniques whereas for future construction, de-carbonization involves designing new buildings with low carbon materials as well as having the integrity and system capacity to effectively employ NBS. This paper presents the opportunities and challenges in respect to the de-carbonization of buildings using NBS for both building retrofits and new construction. This review documents the effectiveness of NBS to de-carbonize Canadian buildings, identifies the missing links to implement these techniques in cold climatic conditions, and determine a road map and immediate approaches to mitigate the adverse impacts of climate change such as urban heat islanding. Recommendations are drafted for possible inclusion in the Canadian building and energy codes.

Keywords: decarbonization, nature-based solutions, GHG emissions, greenery enhancement, buildings

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Authors: Nargiza Nuralieva

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This meta-analysis investigates the effectiveness of mental health interventions tailored for international students in China, with a specific focus on Uzbek students and Silk Road scholarship recipients. The comprehensive literature review synthesizes existing studies, papers, and reports, evaluating the outcomes, limitations, and cultural considerations of these programs. Data selection targets mental health programs for international students, honing in on a subset analysis related to Uzbek students and Silk Road scholarship recipients. The analysis encompasses diverse outcome measures, such as reported stress levels, utilization rates of mental health services, academic performance, and more. Results reveal a consistent and statistically significant reduction in reported stress levels, emphasizing the positive impact of these interventions. Utilization rates of mental health services witness a significant increase, highlighting the accessibility and effectiveness of support. Retention rates show marked improvement, though academic performance yields mixed findings, prompting nuanced exploration. Psychological well-being, quality of life, and overall well-being exhibit substantial enhancements, aligning with the overarching goal of holistic student development. Positive outcomes are observed in increased help-seeking behavior, positive correlations with social support, and significant reductions in anxiety levels. Cultural adaptation and satisfaction with interventions both indicate positive outcomes, underscoring the effectiveness of culturally sensitive mental health support. The findings emphasize the importance of tailored mental health interventions for international students, providing novel insights into the specific needs of Uzbek students and Silk Road scholarship recipients. This research contributes to a nuanced understanding of the multifaceted impact of mental health programs on diverse student populations, offering valuable implications for the design and refinement of future interventions. As educational institutions continue to globalize, addressing the mental health needs of international students remains pivotal for fostering inclusive and supportive learning environments.

Keywords: international students, mental health interventions, cross-cultural support, silk road scholarship, meta-analysis

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Authors: Hanna Schübel, Ivo Wallimann-Helmer

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In order to reach the goal of the Paris Agreement to not overshoot 1.5°C of warming above pre-industrial levels, various countries including the UK and Switzerland have committed themselves to net zero emissions by 2050. The employment of negative emission technologies (NETs) is very likely going to be necessary for meeting these national objectives as well as other internationally agreed climate targets. NETs are methods of removing carbon from the atmosphere and are thus a means for addressing climate change. They range from afforestation to technological measures such as direct air capture and carbon storage (DACCS), where CO2 is captured from the air and stored underground. As all so-called geoengineering technologies, the development and deployment of NETs are often subject to moral hazard arguments. As these technologies could be perceived as an alternative to mitigation efforts, so the argument goes, they are potentially a dangerous distraction from the main target of mitigating emissions. We think that this is a dangerous argument to make as it may hinder the development of NETs which are an essential element of net zero emission targets. In this paper we argue that the moral hazard argument is only problematic if we do not reflect upon which levels of emissions are at stake in order to meet net zero emissions. In response to the moral hazard argument we develop an account of which levels of emissions in given societies should be mitigated and not be the target of NETs and which levels of emissions can legitimately be a target of NETs. For this purpose, we define four different levels of emissions: the current level of individual emissions, the level individuals emit in order to appear in public without shame, the level of a fair share of individual emissions in the global budget, and finally the baseline of net zero emissions. At each level of emissions there are different subjects to be assigned responsibilities if societies and/or individuals are committed to the target of net zero emissions. We argue that all emissions within one’s fair share do not demand individual mitigation efforts. The same holds with regard to individuals and the baseline level of emissions necessary to appear in public in their societies without shame. Individuals are only under duty to reduce their emissions if they exceed this baseline level. This is different for whole societies. Societies demanding more emissions to appear in public without shame than the individual fair share are under duty to foster emission reductions and are not legitimate to reduce by introducing NETs. NETs are legitimate for reducing emissions only below the level of fair shares and for reaching net zero emissions. Since access to NETs to achieve net zero emissions demands technology not affordable to individuals there are also no full individual responsibilities to achieve net zero emissions. This is mainly a responsibility of societies as a whole.

Keywords: climate change, mitigation, moral hazard, negative emission technologies, responsibility

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Authors: Ramon Omar Rosales-Espinoza

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Pile-to-pile mechanical connections are used if the depth of the soil layers with sufficient bearing strength exceeds the original (“leading”) pile length, with the additional pile segment being termed “extension” pile. Mechanical connectors permit a safe transmission of forces from leading to extension pile while meeting strength and serviceability requirements. Common types of connectors consist of an assembly of sleeve-type external couplers, bolts, pins, and other mechanical interlock devices that ensure the transmission of compressive, tensile, torsional and bending stresses between leading and extension pile segments. While welded connections allow for a relatively simple structural design, mechanical connections are advantageous over welded connections because they lead to shorter installation times and significant cost reductions since specialized workmanship and inspection activities are not required. However, common practices followed to design mechanical connectors neglect important aspects of the assembly response, such as stress concentration around pin/bolt holes, torsional stresses from the installation process, and interaction between the forces at the installation (torsion), service (compression/tension-bending), and removal stages (torsion). This translates into potentially unsatisfactory designs in terms of the ultimate and service limit states, exhibiting either reduced strength or excessive deformations. In this study, the experimental response under compressive forces of a type of mechanical connector is presented, in terms of strength, deformation and failure modes. The tests revealed that the type of connector used can safely transmit forces from pile to pile. Using the results from the compressive tests, an analysis model was developed using the finite element (FE) method to study the interaction of forces under installation and service stages of a typical mechanical connector. The response of the analysis model is used to identify potential areas for design optimization, including size, gap between leading and extension piles, number of pin/bolts, hole sizes, and material properties. The results show the design of mechanical connectors should take into account the interaction of forces present at every stage of their life cycle, and that the torsional stresses occurring during installation are critical for the safety of the assembly.

Keywords: piles, FEA, steel, mechanical connector

Procedia PDF Downloads 237

Authors: Soma Sarkar

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A number of authors have recently argued that there are strong links between ecosystem services and sustainable development, particularly development efforts that aim to reduce rural poverty. We see two distinct routes by which the science of ecosystem services can contribute to both nature conservation and sustainable development. First, a thorough accounting of ecosystem services and a better understanding of how and at what rates ecosystems produce these services can be used to motivate payment for nature conservation. At least part of the generated funds can be used to compensate people who suffer lost economic opportunities to protect these services. For example, if rural poor are asked to take actions that reduce farm productivity to protect and regulate water supply, those farmers could be compensated for the reduced productivity they experience. When the benefits of natural ecosystems are explicitly quantified, those benefits are more valued both by the people who directly interact with the ecosystems and the governmental and other agencies that would have to pay for substitute sources of these services if these ecosystems should become impaired. Appreciating the value of ecosystem services can motivate increased conservation investment to prevent having to pay for substitutes later. This approach could be characterized as a ‘‘government investment’’ approach because the payments will generally come from beneficiaries outside of the local area, and a governmental or other agency is typically responsible for collecting and redistributing the funds. Second, a focus on the conservation of ecosystem services could improve the success of projects that attempt to both conserve nature and improve the welfare of the rural poor by fostering markets for the goods and services that local people produce or extract from ecosystems. These projects could be characterized as more ‘‘community based’’ because the goal is to foster the more organic, or grassroots, development of cottage industries, such as ecotourism, or the production of non-timber forest products, that are enhanced by better protection of local ecosystems. Using this framework, we discuss the factors that may have contributed to failure or success for several projects in the district of Purulia, one of the most backward districts of India and inhabited by indigenous group of people. A large majority of people in this district are dependent on environment based incomes for their sustenance. The erosion of natural resource base owing to poor governance in the district has led to the reductions in the household incomes of these people. The scale of our analysis is local or project level. The plight of poor has little to do with the production functions of ecosystem services. But for rural poor, at the local level, the status of ecosystem services can make a big difference in their daily lives.

Keywords: ecosystem services, governance, rural poor, community based natural resource management

Procedia PDF Downloads 339

Authors: Tetyana Kendzerska, David T. Zhu, Michael Pugliese, Douglas Manuel, Mohsen Sadatsafavi, Marcus Povitz, Therese A. Stukel, Teresa To, Shawn D. Aaron, Sunita Mulpuru, Melanie Chin, Claire E. Kendall, Kednapa Thavorn, Rebecca Robillard, Andrea S. Gershon

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The impact of the COVID-19 pandemic on the management of ambulatory care sensitive conditions (ACSCs) remains unknown. To compare observed and expected (projected based on previous years) trends in all-cause mortality and healthcare use for ACSCs in the first year of the pandemic (March 2020 - March 2021). A population-based study using provincial health administrative data.General adult population (Ontario, Canada). Monthly all-cause mortality, and hospitalizations, emergency department (ED) and outpatient visit rates (per 100,000 people at-risk) for seven combined ACSCs (asthma, COPD, angina, congestive heart failure, hypertension, diabetes, and epilepsy) during the first year were compared with similar periods in previous years (2016-2019) by fitting monthly time series auto-regressive integrated moving-average models. Compared to previous years, all-cause mortality rates increased at the beginning of the pandemic (observed rate in March-May 2020 of 79.98 vs. projected of 71.24 [66.35-76.50]) and then returned to expected in June 2020—except among immigrants and people with mental health conditions where they remained elevated. Hospitalization and ED visit rates for ACSCs remained lower than projected throughout the first year: observed hospitalization rate of 37.29 vs. projected of 52.07 (47.84-56.68); observed ED visit rate of 92.55 vs. projected of 134.72 (124.89-145.33). ACSC outpatient visit rates decreased initially (observed rate of 4,299.57 vs. projected of 5,060.23 [4,712.64-5,433.46]) and then returned to expected in June 2020. Reductions in outpatient visits for ACSCs at the beginning of the pandemic combined with reduced hospital admissions may have been associated with temporally increased mortality—disproportionately experienced by immigrants and those with mental health conditions. The Ottawa Hospital Academic Medical Organization

Keywords: COVID-19, chronic disease, all-cause mortality, hospitalizations, emergency department visits, outpatient visits, modelling, population-based study, asthma, COPD, angina, heart failure, hypertension, diabetes, epilepsy

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Authors: Timothy Garvey, Don Driscoll

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Within Tasmania, the growling grass frog (Litoria raniformis) has experienced a rapid contraction in distribution. This decline is primarily attributed to habitat loss through landscape modification and improved land drainage. Reductions in seasonal water-sources have placed increasing importance on permanent water bodies for reproduction and foraging. Tasmanian agricultural and commercial forestry landscapes often feature small artificial ponds, utilized for watering livestock and fighting wildfires. Improved knowledge of how L. raniformis may be exploiting anthropogenic ponds is required for improved conservation management. We implemented telemetric tracking in order to evaluate the spatial ecology of L. raniformis (n = 20) within agricultural and managed forestry sites, with tracking conducted periodically over the breeding season (November/December, January/February, March/April). We investigated (1) potential differences in habitat utilization between agricultural and plantation sites, and (2) the post-breeding dispersal of individual frogs. Frogs were found to remain in close proximity to ponds throughout November/December, with individuals occupying vegetative depauperate water bodies beginning to disperse by January/February. Dispersing individuals traversed exposed plantation understory and agricultural pasture land in order to enter patches of native scrubland. By March/April all individuals captured at minimally vegetated ponds had retreated to adjacent scrub corridors. Animals found in ponds featuring dense riparian vegetation were not recorded to disperse. No difference in behavior was recorded between sexes. Rising temperatures coincided with increased movement by individuals towards native scrub refugia. The patterns of movement reported in this investigation emphasize the significant contribution of manmade water-bodies towards the conservation of L. raniformis within modified landscapes. The use of natural scrubland as cyclical retreats between breeding seasons also highlights the importance of the continued preservation of remnant vegetation corridors. Loss of artificial dams or buffering scrubland in heavily altered landscapes could see the breakdown of the greater L. raniformis meta-population further threatening their regional persistence.

Keywords: habitat loss, modified landscapes, spatial ecology, telemetry

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Authors: Preet Shah, Om Shrivastav

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Introduction : In India, Leishmania donovani is the only parasite causing Leishmaniasis. The parasite infects the reticuloendothelial system and is found in the bone marrow, spleen and liver. Treatment of choice is amphotericin-B with sodium stibogluconate being an alternative. Miltefosine is useful in refractory cases. In our case, Leishmaniasis occurred in a person residing in western India (which is quite rare) and it failed to respond to two different drugs (again an uncommon feature) before it finally responded to a third one. Description: A 50 year old lady, a resident of western India, with no history of recent travel, presented with an ulcer on the left side of the nose since 8 months. She was apparently alright 8 months back, when she noticed a small ulcerated lesion on the left ala of the nose which was immediately biopsied. The biopsy revealed amastigotes of Leishmania for which she was administered intra-lesional sodium stibogluconate for 1 month (4 doses every 8 days).Despite this, there was no regression of the ulcer and hence she presented to us for further management. On examination, her vital parameters were normal. Barring an ulcer on the left side of the nose, rest of the examination findings were unremarkable. Complete blood count was normal. Ultrasound abdomen showed hepatomegaly. PET-CT scan showed increased metabolic activity in left ala of nose, hepatosplenomegaly and increased metabolic activity in spleen and bone marrow. Bone marrow biopsy was done which showed hypercellular marrow with erythroid preponderance. Considering a diagnosis of leishmaniasis which had so far been unresponsive to sodium stibogluconate, she was started on liposomal amphotericin-B. At the time of admission, her creatinine level was normal, but it started rising with the administration of liposomal amphotericin-B, hence the dose was reduced. Despite this, creatinine levels did not improve, and she started developing hypokalemia and hypomagnesemia as side effects of the drug, hence further reductions in the dosage were made. Despite a total of 3 weeks of liposomal amphotericin-B, there was no improvement in the ulcer. As had so far failed to respond to sodium stibogluconate and liposomal amphotericin-B, it was decided to start her on miltefosine. She received the miltefosine for a total of 12 weeks. At the end of this duration, there was a marked regression of the cutaneous lesion. Conclusion: Refractoriness to amphotericin-B in leishmaniasis may be seen in up to 5 % cases. Here, an alternative drug such as miltefosine is useful and hence we decided to use it, to which she responded adequately. Furthermore, although leishmaniasis is common in the eastern part of India, it is a relatively unknown entity in the western part of the country with the occurrence being very rare. Because of these 2 reasons, we consider our case to be a unique one.

Keywords: amphotericin-b, leishmaniasis, miltefosine, tropical diseases

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Authors: Usman Asif, Klaus Schmidt

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In recent years, the development of alternate fuel vehicles has helped to reduce carbon emissions worldwide. As the number of vehicles will continue to increase in the future, the energy demand will also increase. Therefore, we must consider automotive technologies that are efficient and less harmful to the environment in the long run. Battery Electric Vehicles (BEVs) have gained popularity in recent years because of their lower maintenance, lower fuel costs, and lower carbon emissions. Nevertheless, BEVs show several disadvantages, such as slow charging times and lower range than traditional combustion-powered vehicles. These factors keep many people from switching to BEVs. The authors of this research believe that these limitations can be overcome by using fuel cell technology. Fuel cell technology converts chemical energy into electrical energy from hydrogen power and therefore serves as fuel to power the motor and thus replacing heavy lithium batteries that are expensive and hard to recycle. Also, in contrast to battery-powered electric vehicle technology, Fuel Cell Electric Vehicles (FCEVs) offer higher ranges and lower fuel-up times and therefore are more competitive with electric vehicles. However, FCEVs have not gained the same popularity as electric vehicles due to stringent legal frameworks, underdeveloped infrastructure, high fuel transport, and storage costs plus the expense of fuel cell technology itself. This research will focus on the legal frameworks for hydrogen-powered vehicles, and how a change in these policies may affect and improve hydrogen fueling infrastructure and lower hydrogen transport and storage costs. These policies may also facilitate reductions in fuel cell technology costs. In order to attain a better framework, a number of countries have developed conceptual roadmaps. These roadmaps have set out a series of objectives to increase the access of FCEVs to their respective markets. This research will specifically focus on policies in Japan, Europe, and the USA in their attempt to shape the automotive industry of the future. The researchers also suggest additional policies that may help to accelerate the advancement of FCEVs to mass-markets. The approach was to provide a solid literature review using resources from around the globe. After a subsequent analysis and synthesis of this review, the authors concluded that in spite of existing legal challenges that have hindered the advancement of fuel-cell technology in the automobile industry in the past, new initiatives that enhance and advance the very same technology in the future are underway.

Keywords: fuel cell electric vehicles, fuel cell technology, legal frameworks, policies and regulations

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Authors: M. Abd El Hamid Ezzat

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Two field trials were conducted to study the effect of plant densities i.e., 190, 222, 266, 330 and 440 10³ plants ha⁻¹ on morphological characters, physiological and yield attributes of two faba bean types viz. determinate (FLIP-87 -117 strain) and indeterminate (c.v. Giza-461). The results showed that the indeterminate plants significantly surpassed the determinate plants in plant height at 75 and 90 days from sowing, number of leaves at all growth stages and dry matter accumulation at 45 and 90 days from sowing. Determinate plants possessed greater number of side branches than that of the indeterminate plants, but it was only significant at 90 days from sowing. Greater number of flowers were produced by the indeterminate plants than that of the determinate plants at 75 and 90 days from sowing, and although shedding was obvious in both types, it was greater in the determinate plants as compared with the indeterminate one at 90 days from sowing. Increasing plant density resulted in reductions in number of leaves, branches flowers and dry matter accumulation per plant of both faba bean types. However, plant height criteria took a reversible magnitude. Moreover, under all rates of plant densities the indeterminate type plants surpassed the determinate plants in all growth characters studied except for number of branches per plant at 90 days from sowing. The indeterminate plant leaves significantly contained greater concentrations of photosynthetic pigments i.e., chl. a, b and carotenoids than those found in the determinate plant leaves. Also, the data showed significant reduction in photosynthetic pigments concentration as planting density increases. Light extinction coefficient (K) values reached their maximum level at 60 days from sowing, then it declined sharply at 75 days from sowing. The data showed that the illumination inside the determinate faba bean canopies was better than the indeterminate plants. (K) values tended to increase as planting density increases, meanwhile, significant interactions were reported between faba bean type as planting density on (K) at all growth stages. Both of determinate and indeterminate faba bean plant leaves reached their maximum expansion at 75 days from sowing reflecting the highest LAI values, then their declined in the subsequent growth stage. The indeterminate faba bean plants significantly surpassed the determinate plants in LAI up to 75 days from sowing. Growth analysis showed that NAR, RGR and CGR reached their maximum rates at (60-75 days growth stage). Faba bean types did not differ significantly in NAR at the early growth stage. The indeterminate plants were able to grow faster with significant CGR values than the determinate plants. The indeterminate faba bean plants surpassed the determinate ones in number of seeds/pod and per plant, 100-seed weight, seed yield per plant and per hectare at all rates of plant density. Seed yield increased with increasing plant densities of both types. The highest seed yield was attained for both types 440 103 plants ha⁻¹.

Keywords: determinate, indeterminate faba bean, Physiological attributes, yield attributes

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Authors: Pascale Brasseur, Binu Gurung, Nicholas Halfpenny, James Eaton

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Development of minimally invasive treatments in recent years provides a potential alternative to invasive surgical interventions which are of limited value to patients with spinal metastases due to short life expectancy. A systematic review was conducted to explore the efficacy and safety of radiofrequency ablation (RFA), a minimally invasive treatment in patients with spinal metastases. EMBASE, Medline and CENTRAL were searched from database inception to March 2017 for randomised controlled trials (RCTs) and non-randomised studies. Conference proceedings for ASCO and ESMO published in 2015 and 2016 were also searched. Fourteen studies were included: three prospective interventional studies, four prospective case series and seven retrospective case series. No RCTs or studies comparing RFA with another treatment were identified. RFA was followed by cement augmentation in all patients in seven studies and some patients (40-96%) in the remaining seven studies. Efficacy was assessed as pain relief in 13/14 studies with the use of a numerical rating scale (NRS) or a visual analogue scale (VAS) at various time points. Ten of the 13 studies reported a significant decrease in pain outcome, post-RFA compared to baseline. NRS scores improved significantly at 1 week (5.9 to 3.5, p < 0.0001; 8 to 4.3, p < 0.02 and 8 to 3.9, p < 0.0001) and this improvement was maintained at 1 month post-RFA compared to baseline (5.9 to 2.6, p < 0.0001; 8 to 2.9, p < 0.0003; 8 to 2.9, p < 0.0001). Similarly, VAS scores decreased significantly at 1 week (7.5 to 2.7, p=0.00005; 7.51 to 1.73, p < 0.0001; 7.82 to 2.82, p < 0.001) and this pattern was maintained at 1 month post-RFA compared to baseline (7.51 to 2.25, p < 0.0001; 7.82 to 3.3; p < 0.001). A significant pain relief was achieved regardless of whether patients had cement augmentation in two studies assessing the impact of RFA with or without cement augmentation on VAS pain scores. In these two studies, a significant decrease in pain scores was reported for patients receiving RFA alone and RFA+cement at 1 week (4.3 to 1.7. p=0.0004 and 6.6 to 1.7, p=0.003 respectively) and 15-36 months (7.9 to 4, p=0.008 and 7.6 to 3.5, p=0.005 respectively) after therapy. Few minor complications were reported and these included neural damage, radicular pain, vertebroplasty leakage and lower limb pain/numbness. In conclusion, the efficacy and safety of RFA were consistently positive between prospective and retrospective studies with reductions in pain and few procedural complications. However, the lack of control groups in the identified studies indicates the possibility of selection bias inherent in single arm studies. Controlled trials exploring efficacy and safety of RFA in patients with spinal metastases are warranted to provide robust evidence. The identified studies provide an initial foundation for such future trials.

Keywords: pain relief, radiofrequency ablation, spinal metastases, systematic review

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Authors: Sven Borén, Henrik Ny

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Ambitions within the EU for moving towards sustainable transport include major emission reductions for fossil fuel road vehicles, especially for buses, trucks, and cars. The electric driveline seems to be an attractive solution for such development. This study first applied the Framework for Strategic Sustainable Development to compare sustainability effects of today’s fossil fuel vehicles with electric vehicles that have batteries or hydrogen fuel cells. The study then addressed a scenario were electric vehicles might be in majority in Europe by 2050. The methodology called Strategic Lifecycle Assessment was first used, were each life cycle phase was assessed for violations against sustainability principles. This indicates where further analysis could be done in order to quantify the magnitude of each violation, and later to create alternative strategies and actions that lead towards sustainability. A Life Cycle Assessment of combustion engine cars, plug-in hybrid cars, battery electric cars and hydrogen fuel cell cars was then conducted to compare and quantify environmental impacts. The authors found major violations of sustainability principles like use of fossil fuels, which contribute to the increase of emission related impacts such as climate change, acidification, eutrophication, ozone depletion, and particulate matters. Other violations were found, such as use of scarce materials for batteries and fuel cells, and also for most life cycle phases for all vehicles when using fossil fuel vehicles for mining, production and transport. Still, the studied current battery and hydrogen fuel cell cars have less severe violations than fossil fuel cars. The life cycle assessment revealed that fossil fuel cars have overall considerably higher environmental impacts compared to electric cars as long as the latter are powered by renewable electricity. By 2050, there will likely be even more sustainable alternatives than the studied electric vehicles when the EU electricity mix mainly should stem from renewable sources, batteries should be recycled, fuel cells should be a mature technology for use in vehicles (containing no scarce materials), and electric drivelines should have replaced combustion engines in other sectors. An uncertainty for fuel cells in 2050 is whether the production of hydrogen will have had time to switch to renewable resources. If so, that would contribute even more to a sustainable development. Except for being adopted in the GreenCharge roadmap, the authors suggest that the results can contribute to planning in the upcoming decades for a sustainable increase of EVs in Europe, and potentially serve as an inspiration for other smaller or larger regions. Further studies could map the environmental effects in LCA further, and include other road vehicles to get a more precise perception of how much they could affect sustainable development.

Keywords: strategic, electric vehicles, sustainability, LCA

Procedia PDF Downloads 346

Authors: Khadija Al-Hosni, Moon Fai Chan, Mohammed Al-Azri

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Background: Several studies suggest that most school-age adolescents are poorly informed on cancer warning signs and risk factors. Providing adolescents with sufficient knowledge would increase their awareness in adulthood and improve seeking behaviors later. Significant: The results will provide a clear vision in assisting key decision-makers in formulating policies on the students' awareness programs towards cancer. So, the likelihood of avoiding cancer in the future will be increased or even promote early diagnosis. Objectives: to evaluate the effectiveness of an education program designed to increase awareness of cancer signs and symptoms risk factors, improve the behavior of seeking help among school students in Oman, and address the barriers to obtaining medical help. Methods: A randomized controlled trial with two groups was conducted in Oman. A total of 1716 students (n=886/control, n= 830/education), aged 15-17 years, at 10th and 11th grade from 12 governmental schools 3 in governorates from 20-February-2022 to 12-May-2022. Basic demographic data were collected, and the Cancer Awareness Measure (CAM) was used as the primary outcome. Data were collected at baseline (T0) and 4 weeks after (T1). The intervention group received an education program about cancer's cause and its signs and symptoms. In contrast, the control group did not receive any education related to this issue during the study period. Non-parametric tests were used to compare the outcomes between groups. Results: At T0, the lamp was the most recognized cancer warning sign in control (55.0%) and intervention (55.2%) groups. However, there were no significant changes at T1 for all signs in the control group. In contrast, all sign outcomes were improved significantly (p<0.001) in the intervention group, the highest response was unexplained pain (93.3%). Smoking was the most recognized risk factor in both groups: (82.8% for control; 84.1% for intervention) at T0. However, there was no significant change in T1 for the control group, but there was for the intervention group (p<0.001), the highest identification was smoking cigarettes (96.5%). Too scared was the largest barrier to seeking medical help by students in the control group at T0 (63.0%) and T1 (62.8%). However, there were no significant changes in all barriers in this group. Otherwise, being too embarrassed (60.2%) was the largest barrier to seeking medical help for students in the intervention group at T0 and too scared (58.6%) at T1. Although there were reductions in all barriers, significant differences were found in six of ten only (p<0.001). Conclusion: The intervention was effective in improving students' awareness of cancer symptoms, warning signs (p<0.001), and risk factors (p<0.001 reduced the most addressed barriers to seeking medical help (p<0.001) in comparison to the control group. The Ministry of Education in Oman could integrate awareness of cancer within the curriculum, and more interventions are needed on the sociological part to overcome the barriers that interfere with seeking medical help.

Keywords: adolescents, awareness, cancer, education, intervention, student

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Authors: Anastasia Constantinou, Panayiotis Laouris, Stephen Morris

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Background: Climate change has been reported as one of the worst threats to healthcare. The healthcare sector is a significant contributor to greenhouse gas emissions with primary care being responsible for 23% of the NHS’ total carbon footprint. Digital interventions, primarily focusing on telemedicine, offer a route to change. This systematic review aims to quantify and characterize the carbon footprint savings associated with the implementation of digital interventions in the setting of primary care. Methods: A systematic review of published literature was conducted according to PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guidelines. MEDLINE, PubMed, and Scopus databases as well as Google scholar were searched using key terms relating to “carbon footprint,” “environmental impact,” “sustainability”, “green care”, “primary care,”, and “general practice,” using citation tracking to identify additional articles. Data was extracted and analyzed in Microsoft Excel. Results: Eight studies were identified conducted in four different countries between 2010 and 2023. Four studies used interventions to address primary care services, three studies focused on the interface between primary and specialist care, and one study addressed both. Digital interventions included the use of mobile applications, online portals, access to electronic medical records, electronic referrals, electronic prescribing, video-consultations and use of autonomous artificial intelligence. Only one study carried out a complete life cycle assessment to determine the carbon footprint of the intervention. It estimate that digital interventions reduced the carbon footprint at primary care level by 5.1 kgCO2/visit, and at the interface with specialist care by 13.4 kg CO₂/visit. When assessing the relationship between travel-distance saved and savings in emissions, we identified a strong correlation, suggesting that most of the carbon footprint reduction is attributed to reduced travel. However, two studies also commented on environmental savings associated with reduced use of paper. Patient savings in the form of reduced fuel cost and reduced travel time were also identified. Conclusion: All studies identified significant reductions in carbon footprint following implementation of digital interventions. In the future, controlled, prospective studies incorporating complete life cycle assessments and accounting for double-consulting effects, use of additional resources, technical failures, quality of care and cost-effectiveness are needed to fully appreciate the sustainable benefit of these interventions

Keywords: carbon footprint, environmental impact, primary care, sustainable healthcare

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Authors: Stephen McCarthy, Joanne Gray, Esther Carr, Gerard Danjoux, Paul Baker, Rhiannon Hackett

Abstract:

Background: The Go Well Health (GWH) platform is a web-based programme that allows patients to access personalised care plans and resources, aimed at prehabilitation prior to surgery. The online digital platform delivers essential patient education and support for patients prior to undergoing total hip replacements (THR) and total knee replacements (TKR). This study evaluated the impact of an online digital platform (ODP) in terms of functional health outcomes, health related quality of life and hospital length of stay following surgery. Methods: A retrospective cohort study comparing a cohort of patients who used the online digital platform (ODP) to deliver patient education and support (PES) prior to undergoing THR and TKR surgery relative to a cohort of patients who did not access the ODP and received usual care. Routinely collected Patient Reported Outcome Measures (PROMs) data was obtained on 2,406 patients who underwent a knee replacement (n=1,160) or a hip replacement (n=1,246) between 2018 and 2019 in a single surgical centre in the United Kingdom. The Oxford Hip and Knee Score and the European Quality of Life Five-Dimensional tool (EQ5D-5L) was obtained both pre-and post-surgery (at 6 months) along with hospital LOS. Linear regression was used to compare the estimate the impact of GWH on both health outcomes and negative binomial regressions were used to impact on LOS. All analyses adjusted for age, sex, Charlson Comorbidity Score and either pre-operative Oxford Hip/Knee scores or pre-operative EQ-5D scores. Fractional polynomials were used to represent potential non-linear relationships between the factors included in the regression model. Findings: For patients who underwent a knee replacement, GWH had a statistically significant impact on Oxford Knee Scores and EQ5D-5L utility post-surgery (p=0.039 and p=0.002 respectively). GWH did not have a statistically significant impact on the hospital length of stay. For those patients who underwent a hip replacement, GWH had a statistically significant impact on Oxford Hip Scores and EQ5D-5L utility post (p=0.000 and p=0.009 respectively). GWH also had a statistically significant reduction in the hospital length of stay (p=0.000). Conclusion: Health Outcomes were higher for patients who used the GWH platform and underwent THR and TKR relative to those who received usual care prior to surgery. Patients who underwent a hip replacement and used GWH also had a reduced hospital LOS. These findings are important for health policy and or decision makers as they suggest that prehabilitation via an ODP can maximise health outcomes for patients following surgery whilst potentially making efficiency savings with reductions in LOS.

Keywords: digital prehabilitation, online digital platform, orthopaedics, surgery

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