Search results for: land use planning

Authors: Elena Parmentier, Henrik Endeman

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Introduction: Large mediastinal masses often present with diagnostic and clinical challenges due to compression of the respiratory and hemodynamic system. We present a case of a mediastinal mass with symptomatic mechanical compression of the trachea, resulting in challenging airway management. Methods: We present a case of 66-year-old male, complaining of progressive dysphagia. Initial esophagogastroscopy revealed a stenosis secondary to external compression, biopsies were inconclusive. Additional CT scan showed a large mediastinal mass of unknown origin, situated between the vertebrae and esophagus. Symptoms progressed and patient developed dyspnea and stridor. A new CT showed quick growth of the mass with compression of the trachea, subglottic to just above the carina. A tracheal covered stent was successfully placed. Endobronchial ultrasound revealed a large irregular mass without tracheal invasion, biopsies were taken. 4 days after stent placement, the patients’ condition deteriorated with worsening of stridor, dyspnea and desaturation. Migration of the tracheal stent into the right main bronchus was seen on chest X ray, with obstruction of the left main bronchus and secondary atelectasis. Different methods have been described in the literature for tracheobronchial stent removal (surgical, endoscopic, fluoroscopyguided), our first choice in this case was flexible bronchoscopy. However, this revealed tracheal compression above the migrated stent and passage of the scope occurred impossible. Patient was admitted to the ICU, high-flow nasal oxygen therapy was started and the situation stabilized, giving time for extensive assessment and preparation of the airway management approach. Close cooperation between the intensivist, pulmonologist, anesthesiologist and otorhinolaryngologist was essential. Results: In case of sudden deterioration, a protocol for emergency situations was made. Given the increased risk of additional tracheal compression after administration of neuromuscular blocking agents, an approach with awake fiberoptic intubation maintaining spontaneous ventilation was proposed. However, intubation without retrieval of the tracheal stent was found undesirable due to expected massive shunting over the left atelectatic lung. As rescue option, assistance of extracorporeal circulation was considered and perfusionist was kept on standby. The patient stayed stable and was transferred to the operating theatre. High frequency jet ventilation under general anesthesia resulted in desaturations up to 50%, making rigid bronchoscopy impossible. Subsequently an endotracheal tube size 8 could be placed successfully and the stent could be retrieved via bronchoscopy over (and with) the tube, after which the patient was reintubated. Finally, a tracheostomy (Shiley™ Tracheostomy Tube With Cuff, size 8) was placed, fiberoptic control showed a patent airway. Patient was readmitted to the ICU and could be quickly weaned of the ventilator. Pathology was positive for rhabdomyosarcoma, without indication for systemic therapy. Extensive surgery (laryngectomy, esophagectomy) was suggested, but patient refused and palliative care was started. Conclusion: Due to meticulous planning in an interdisciplinary team, we showed a successful airway management approach in this complicated case of critical airway compression secondary to a rare rhabdomyosarcoma, complicated by tracheal stent migration. Besides presenting our thoughts and considerations, we support exploring other possible approaches of this specific clinical problem.

Keywords: airway management, rhabdomyosarcoma, stent displacement, tracheal stenosis

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Authors: Z. A. Al Marhoon, H. S. Al Ramis, C. Teodoriu

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Well-integrity is one of the major elements considered for drilling geothermal, oil, and gas wells. Well-integrity is minimizing the risk of unplanned fluid flow in the well bore throughout the well lifetime. Well integrity is maximized by applying technical concepts along with practical practices and strategic planning. These practices are usually governed by standardization and regulation entities. Practices during well construction can affect the integrity of the seal at the time of abandonment. On the other hand, achieving a perfect barrier system is impracticable due to the needed cost. This results in a needed balance between regulations requirements and practical applications. The guidelines are only effective when they are attainable in practical applications. Various governmental regulations and international standards have different guidelines on what constitutes high-quality isolation from unwanted flow. Each regulating or standardization body differ in requirements based on the abandonment objective. Some regulation account more for the environmental impact, water table contamination, and possible leaks. Other regulation might lean towards driving more economical benefits while achieving an acceptable isolation criteria. The research methodology used in this topic is derived from a literature review method combined with a compare and contrast analysis. The literature review on various zonal isolation regulations and standards has been conducted. A review includes guidelines from NORSOK (Norwegian governing entity), BSEE (USA offshore governing entity), API (American Petroleum Institute) combined with ISO (International Standardization Organization). The compare and contrast analysis is conducted by assessing the objective of each abandonment regulations and standardization. The current state of well barrier regulation is in balancing action. From one side of this balance, the environmental impact and complete zonal isolation is considered. The other side of the scale is practical application and associated cost. Some standards provide a fair amount of details concerning technical requirements and are often flexible with the needed associated cost. These guidelines cover environmental impact with laws that prevent major or disastrous environmental effects of improper sealing of wells. Usually these regulations are concerned with the near future of sealing rather than long-term. Consequently, applying these guidelines become more feasible from a cost point of view to the required plugging entities. On the other hand, other regulation have well integrity procedures and regulations that lean toward more restrictions environmentally with an increased associated cost requirements. The environmental impact is detailed and covered with its entirety, including medium to small environmental impact in barrier installing operations. Clear and precise attention to long-term leakage prevention is present in these regulations. The result of the compare and contrast analysis of the literature showed that there are various objectives that might tip the scale from one side of the balance (cost) to the other (sealing quality) especially in reference to zonal isolation. Furthermore, investing in initial well construction is a crucial part of ensuring safe final well abandonment. The safety and the cost saving at the end of the well life cycle is dependent upon a well-constructed isolation systems at the beginning of the life cycle. Long term studies on zonal isolation using various hydraulic or mechanical materials need to take place to further assess permanently abandoned wells to achieve the desired balance. Well drilling and isolation techniques will be more effective when they are operationally feasible and have reasonable associated cost to aid the local economy.

Keywords: plug and abandon, P&A regulation, P&A standards, international guidelines, gap analysis

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Authors: R. Verwiebe, L. Seewann, M. Wolf

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This presentation addresses marginalization and discrimination as experienced by young academics with a migrant background in the Austrian labor market. Focusing on second generation academics of Central Eastern European and Turkish descent we explore two major issues. First, we ask whether their career-entry and everyday professional life entails origin-specific barriers. As educational residents, they show competences which, when lacking, tend to be drawn upon to explain discrimination: excellent linguistic skills, accredited high-level training, and networks. Second, we concentrate on how this group reacts to discrimination and overcomes experiences of marginalization. To answer these questions, we utilize recent sociological and social psychological theories that focus on the diversity of individual experiences. This distinguishes us from a long tradition of research that has dealt with the motives that inform discrimination, but has less often considered the effects on those concerned. Similarly, applied coping strategies have less often been investigated, though they may provide unique insights into current problematic issues. Building upon present literature, we follow recent discrimination research incorporating the concepts of ‘multiple discrimination’, ‘subtle discrimination’, and ‘visual social markers’. 21 problem-centered interviews are the empirical foundation underlying this study. The interviewees completed their entire educational career in Austria, graduated in different universities and disciplines and are working in their first post-graduate jobs (career entry phase). In our analysis, we combined thematic charting with a coding method. The results emanating from our empirical material indicated a variety of discrimination experiences ranging from barely perceptible disadvantages to directly articulated and overt marginalization. The spectrum of experiences covered stereotypical suppositions at job interviews, the disavowal of competencies, symbolic or social exclusion by new colleges, restricted professional participation (e.g. customer contact) and non-recruitment due to religious or ethnical markers (e.g. headscarves). In these experiences the role of the academics education level, networks, or competences seemed to be minimal, as negative prejudice on the basis of visible ‘social markers’ operated ‘ex-ante’. The coping strategies identified in overcoming such barriers are: an increased emphasis on effort, avoidance of potentially marginalizing situations, direct resistance (mostly in the form of verbal opposition) and dismissal of negative experiences by ignoring or ironizing the situation. In some cases, the academics drew into their specific competences, such as an intellectual approach of studying specialist literature, focus on their intercultural competences or planning to migrate back to their parent’s country of origin. Our analysis further suggests a distinction between reactive (i.e. to act on and respond to experienced discrimination) and preventative strategies (applied to obviate discrimination) of coping. In light of our results, we would like to stress that the tension between educational and professional success experienced by academics with a migrant background – and the barriers and marginalization they continue to face – are essential issues to be introduced to socio-political discourse. It seems imperative to publicly accentuate the growing social, political and economic significance of this group, their educational aspirations, as well as their experiences of achievement and difficulties.

Keywords: coping strategies, discrimination, labor market, second generation university graduates

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Authors: Christiane H. Kellner, Sarah Reker

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The UN-Convention on the Rights of Persons with Disabilities, which Germany also ratified, postulates the necessity of user-centred design, especially when it comes to evaluating the individual needs and wishes of all citizens. Therefore, a multidimensional approach is required. Based on this insight, the structure of the town-like centre in Schönbrunn - a large residential complex and service provider for persons with disabilities in the outskirts of Munich - will be remodelled to open up the community to all people as well as transform social space. This strategy should lead to more equal opportunities and open the way for a much more diverse community. The research project “Index for participation development and quality of life for persons with disabilities” (TeLe-Index, 2014-2016), which is anchored at the Technische Universität München in Munich and at the Franziskuswerk Schönbrunn supports this transformation process called “Vision 2030”. In this context, we have provided academic supervision and support for three projects (the construction of a new school, inclusive housing for children and teenagers with disabilities and the professionalization of employees using person-centred planning). Since we cannot present all the issues of the umbrella-project within the conference framework, we will be focusing on one sub-project more in-depth, namely “The Person-Centred Think Tank” [Arbeitskreis Personenzentriertes Denken; PZD]. In the context of person-centred thinking (PCT), persons with disabilities are encouraged to (re)gain or retain control of their lives through the development of new choice options and the validation of individual lifestyles. PCT should thus foster and support both participation and quality of life. The project aims to establish PCT as a fundamental approach for both employees and persons with disabilities in the institution through in-house training for the staff and, subsequently, training for users. Hence, for the academic support and supervision team, the questions arising from this venture can be summed up as follows: (1) has PCT already gained a foothold at the Franziskuswerk Schönbrunn? And (2) how does it affect the interaction with persons with disabilities and how does it influence the latter’s everyday life? According to the holistic approach described above, the target groups for this study are both the staff and the users of the institution. Initially, we planned to implement the group discussion method for both target-groups. However, in the course of a pretest with persons with intellectual disabilities, it became clear that this type of interview, with hardly any external structuring, provided only limited feedback. In contrast, when the discussions were moderated, there was more interaction and dialogue between the interlocutors. Therefore, for this target-group, we introduced structured group interviews. The insights we have obtained until now will enable us to present the intermediary results of our evaluation. We analysed and evaluated the group interviews and discussions with the help of qualitative content analysis according to Mayring in order to obtain information about users’ quality of life. We sorted out the statements relating to quality of life obtained during the group interviews into three dimensions: subjective wellbeing, self-determination and participation. Nevertheless, the majority of statements were related to subjective wellbeing and self-determination. Thus, especially the limited feedback on participation clearly demonstrates that the lives of most users do not take place beyond the confines of the institution. A number of statements highlighted the fact that PCT is anchored in the everyday interactions within the groups. However, the implementation and fostering of PCT on a broader level could not be detected and thus remain further aims of the project. The additional interviews we have planned should validate the results obtained until now and open up new perspectives.

Keywords: person-centered thinking, research with persons with disabilities, residential complex and service provider, participation, self-determination.

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Authors: Tehrrie Konig, Cassiano Bortolozo, Daniel Metodiev, Rodolfo Mendes, Marcio Andrade, Marcio Moraes

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Gravitational mass movements are recurrent events in Brazil, usually triggered by intense rainfall. When these events occur in urban areas, they end up becoming disasters due to the economic damage, social impact, and loss of human life. To identify the landslide-susceptible areas, it is important to know the geotechnical parameters of the soil, such as cohesion, internal friction angle, unit weight, hydraulic conductivity, and hydraulic diffusivity. The measurement of these parameters is made by collecting soil samples to analyze in the laboratory and by using geophysical methodologies, such as Vertical Electrical Survey (VES). The geophysical surveys analyze the soil properties with minimal impact in its initial structure. Statistical analysis and mathematical models of physical basis are used to model and calculate the Factor of Safety for steep slope areas. In general, such mathematical models work from the combination of slope stability models and hydrological models. One example is the mathematical model TRIGRS (Transient Rainfall Infiltration and Grid-based Regional Slope- Stability Model) which calculates the variation of the Factor of Safety of a determined study area. The model relies on changes in pore-pressure and soil moisture during a rainfall event. TRIGRS was written in the Fortran programming language and associates the hydrological model, which is based on the Richards Equation, with the stability model based on the principle of equilibrium limit. Therefore, the aims of this work are modeling the slope stability of Campos do Jordão with TRIGRS, using geotechnical and geophysical methodologies to acquire the soil properties. The study area is located at southern-east of Sao Paulo State in the Mantiqueira Mountains and has a historic landslide register. During the fieldwork, soil samples were collected, and the VES method applied. These procedures provide the soil properties, which were used as input data in the TRIGRS model. The hydrological data (infiltration rate and initial water table height) and rainfall duration and intensity, were acquired from the eight rain gauges installed by Cemaden in the study area. A very high spatial resolution digital terrain model was used to identify the slopes declivity. The analyzed period is from March 6th to March 8th of 2017. As results, the TRIGRS model calculates the variation of the Factor of Safety within a 72-hour period in which two heavy rainfall events stroke the area and six landslides were registered. After each rainfall, the Factor of Safety declined, as expected. The landslides happened in areas identified by the model with low values of Factor of Safety, proving its efficiency on the identification of landslides susceptible areas. This study presents a critical threshold for landslides, in which an accumulated rainfall higher than 80mm/m² in 72 hours might trigger landslides in urban and natural slopes. The geotechnical and geophysics methods are shown to be very useful to identify the soil properties and provide the geological characteristics of the area. Therefore, the combine geotechnical and geophysical methods for soil characterization and the modeling of landslides susceptible areas with TRIGRS are useful for urban planning. Furthermore, early warning systems can be developed by combining the TRIGRS model and weather forecast, to prevent disasters in urban slopes.

Keywords: landslides, susceptibility, TRIGRS, vertical electrical survey

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Authors: Marija Mihajlovic Pereira

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Teaching and learning a musical instrument is challenging for both teachers and students. Teachers generally use diverse strategies to resolve students' particular issues in a one-to-one context. Considering individual sessions as a supportive educational context, the teacher can play a decisive role in stimulating and promoting self-regulated learning strategies, especially with beginning learners. The teachers who promote self-controlling behaviors, strategic monitoring, and regulation of actions toward goals could expect their students to practice more qualitatively and consciously. When encouraged to adopt self-regulation habits, students' could benefit from greater productivity on a longer path. Founded on Bary Zimmerman's cyclical model that comprehends three phases - forethought, performance, and self-reflection, this work aims to articulate self-regulated and music learning. Self-regulated learning appeals to the individual's attitude in planning, controlling, and reflecting on their performance. Furthermore, this study aimed to present an observation grid for perceiving teaching instructions that encourage students' controlling cognitive behaviors in light of the belief that conscious promotion of self-regulation may motivate strategic actions toward goals in musical performance. The participants, two teachers, and two students have been involved in the social inclusion project in Lisbon (Portugal). The author and one independent inter-observer analyzed six video-recorded string instrument lessons. The data correspond to three sessions per teacher lectured to one (different) student. Violin (f) and violoncello (m) teachers hold a Master's degree in music education and approximately five years of experience. In their second year of learning an instrument, students have acquired reasonable skills in musical reading, posture, and sound quality until then. The students also manifest positive learning behaviors, interest in learning a musical instrument, although their study habits are still inconsistent. According to the grid's four categories (parent codes), in-class rehearsal frames were coded using MaxQda software, version 20, according to the grid's four categories (parent codes): self-regulated learning, teaching verbalizations, teaching strategies, and students' in-class performance. As a result, selected rehearsal frames qualitatively describe teaching instructions that might promote students' body and hearing awareness, such as "close the eyes while playing" or "sing to internalize the pitch." Another analysis type, coding the short video events according to the observation grid's subcategories (child codes), made it possible to perceive the time teachers dedicate to specific verbal or non-verbal strategies. Furthermore, a coding overlay analysis indicated that teachers tend to stimulate. (i) Forethought – explain tasks, offer feedback and ensure that students identify a goal, (ii) Performance – teach study strategies and encourage students to sing and use vocal abilities to ensure inner audition, (iii) Self-reflection – frequent inquiring and encouraging the student to verbalize their perception of performance. Although developed in the context of individual string instrument lessons, this classroom observation grid brings together essential variables in a one-to-one lesson. It may find utility in a broader context of music education due to the possibility to organize, observe and evaluate teaching practices. Besides that, this study contributes to cognitive development by suggesting a practical approach to fostering self-regulated learning.

Keywords: music education, observation grid, self-regulated learning, string instruments, teaching practices

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Authors: Farhana Alam Bhuiyan, Saad Khan, Tanveer Hassan, Jhalok Ranjon Talukder, Syeda Farjana Ahmed, Rahil Roodsaz, Els Rommes, Sabina Faiz Rashid

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Breaking the shame’ is a 3 year (2015-2018) qualitative implementation research project which investigates several aspects of sexual and reproductive health and rights (SRHR) issues for adolescents living in Bangladesh. Scope of learning SRHR issues for adolescents is limited here due to cultural and religious taboos. This study adds to the ongoing discussions around adolescent’s SRHR needs and aims to, 1) understand the overall SRHR needs of urban and rural unmarried female and male adolescents and the challenges they face, 2) explore existing gaps in the content of SRHR curriculum and 3) finally, addresses some critical knowledge gaps by developing and implementing innovative SRHR educational materials. 18 in-depth interviews (IDIs) and 10 focus-group discussions (FGDs) with boys and 21 IDIs and 14 FGDs with girls of ages 13-19, from both urban and rural setting took place. Curriculum materials from two leading organizations, Unite for Body Rights (UBR) Alliance Bangladesh and BRAC Adolescent Development Program (ADP) were also reviewed, with discussions with 12 key program staff. This paper critically analyses the relevance of some of the SRHR topics that are covered, the challenges with existing pedagogic approaches and key sexuality issues that are not covered in the content, but are important for adolescents. Adolescents asked for content and guidance on a number of topics which remain missing from the core curriculum, such as emotional coping mechanisms particularly in relationships, bullying, impact of exposure to porn, and sexual performance anxiety. Other core areas of concern were effects of masturbation, condom use, sexual desire and orientation, which are mentioned in the content, but never discussed properly, resulting in confusion. Due to lack of open discussion around sexuality, porn becomes a source of information for the adolescents. For these reasons, several myths and misconceptions regarding SRHR issues like body, sexuality, agency, and gender roles still persist. The pedagogical approach is very didactic, and teachers felt uncomfortable to have discussions on certain SRHR topics due to cultural taboos or shame and stigma. Certain topics are favored- such as family planning, menstruation- and presented with an emphasis on biology and risk. Rigid formal teaching style, hierarchical power relations between students and most teachers discourage questions and frank conversations. Pedagogy approaches within classrooms play a critical role in the sharing of knowledge. The paper also describes the pilot approaches to implementing new content in SRHR curriculum. After a review of findings, three areas were selected as critically important, 1) myths and misconceptions 2) emotional management challenges, and 3) how to use condom, that have come up from adolescents. Technology centric educational materials such as web page based information platform and you tube videos are opted for which allow adolescents to bypass gatekeepers and learn facts and information from a legitimate educational site. In the era of social media, when information is always a click away, adolescents need sources that are reliable and not overwhelming. The research aims to ensure that adolescents learn and apply knowledge effectively, through creating the new materials and making it accessible to adolescents.

Keywords: adolescents, Bangladesh, media, sexuality education, unmet needs

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Authors: Maria Areias, Diogo Simões, Ana Figueiredo, Anishur Rahman, Filipa Figueiredo, João Nunes

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It is expected that close to 7 billion people will live in urban areas by 2050. In order to improve the sustainability of the territories and its transition towards circular economy, it’s necessary to understand its metabolism and promote and guide the entrepreneurship answer. The study of a macroeconomic metabolism involves the quantification of the inputs, outputs and storage of energy, water, materials and wastes for an urban region. This quantification and analysis representing one opportunity for the promotion of green entrepreneurship. There are several methods to assess the environmental impacts of an urban territory, such as human and environmental risk assessment (HERA), life cycle assessment (LCA), ecological footprint assessment (EF), material flow analysis (MFA), physical input-output table (PIOT), ecological network analysis (ENA), multicriteria decision analysis (MCDA) among others. However, no consensus exists about which of those assessment methods are best to analyze the sustainability of these complex systems. Taking into account the weaknesses and needs identified, the CiiM - Circular Innovation Inter-Municipality project aims to define an uniform and globally accepted methodology through the integration of various methodologies and dynamic approaches to increase the efficiency of macroeconomic metabolisms and promoting entrepreneurship in a circular economy. The pilot territory considered in CiiM project has a total area of 969,428 ha, comprising a total of 897,256 inhabitants (about 41% of the population of the Center Region). The main economic activities in the pilot territory, which contribute to a gross domestic product of 14.4 billion euros, are: social support activities for the elderly; construction of buildings; road transport of goods, retailing in supermarkets and hypermarkets; mass production of other garments; inpatient health facilities; and the manufacture of other components and accessories for motor vehicles. The region's business network is mostly constituted of micro and small companies (similar to the Central Region of Portugal), with a total of 53,708 companies identified in the CIM Region of Coimbra (39 large companies), 28,146 in the CIM Viseu Dão Lafões (22 large companies) and 24,953 in CIM Beiras and Serra da Estrela (13 large companies). For the construction of the database was taking into account data available at the National Institute of Statistics (INE), General Directorate of Energy and Geology (DGEG), Eurostat, Pordata, Strategy and Planning Office (GEP), Portuguese Environment Agency (APA), Commission for Coordination and Regional Development (CCDR) and Inter-municipal Community (CIM), as well as dedicated databases. In addition to the collection of statistical data, it was necessary to identify and characterize the different stakeholder groups in the pilot territory that are relevant to the different metabolism components under analysis. The CIIM project also adds the potential of a Geographic Information System (GIS) so that it is be possible to obtain geospatial results of the territorial metabolisms (rural and urban) of the pilot region. This platform will be a powerful visualization tool of flows of products/services that occur within the region and will support the stakeholders, improving their circular performance and identifying new business ideas and symbiotic partnerships.

Keywords: circular economy tools, life cycle assessment macroeconomic metabolism, multicriteria decision analysis, decision support tools, circular entrepreneurship, industrial and regional symbiosis

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Authors: Michael R. Shurin, Galina Shurin, Vladimir A. Kirichenko

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Background. Visibility of hepatic malignancies is poor on non-contrast imaging for daily verification of liver malignancies prior to radiation therapy on MRI-guided Linear Accelerators (MR-Linac). Ferumoxytol® (Feraheme, AMAG Pharmaceuticals, Waltham, MA) is a SPION agent that is increasingly utilized off-label as hepatic MRI contrast. This agent has the advantage of providing a functional assessment of the liver based upon its uptake by hepatic Kupffer cells proportionate to vascular perfusion, resulting in strong T1, T2 and T2* relaxation effects and enhanced contrast of malignant tumors, which lack Kupffer cells. The latter characteristic has been recently utilized for MRI-guided radiotherapy planning with precision targeting of liver malignancies. However potential radiotoxicity of SPION has never been addressed for its safe use as an MRI-contrast agent during liver radiotherapy on MRI-Linac. This study defines the radiomodulating properties of SPIONs in vitro on human monocyte and macrophage cell lines exposed to 60Go gamma-rays within clinical radiotherapy dose range. Methods. Human monocyte and macrophages cell line in cultures were loaded with a clinically relevant concentration of Ferumoxytol (30µg/ml) for 2 and 24 h and irradiated to 3Gy, 5Gy and 10Gy. Cells were washed and cultured for additional 24 and 48 h prior to assessing their phenotypic activation by flow cytometry and function, including viability (Annexin V/PI assay), proliferation (MTT assay) and cytokine expression (Luminex assay). Results. Our results reveled that SPION affected both human monocytes and macrophages in vitro. Specifically, iron oxide nanoparticles decreased radiation-induced apoptosis and prevented radiation-induced inhibition of human monocyte proliferative activity. Furthermore, Ferumoxytol protected monocytes from radiation-induced modulation of phenotype. For instance, while irradiation decreased polarization of monocytes to CD11b+CD14+ and CD11bnegCD14neg phenotype, Ferumoxytol prevented these effects. In macrophages, Ferumoxytol counteracted the ability of radiation to up-regulate cell polarization to CD11b+CD14+ phenotype and prevented radiation-induced down-regulation of expression of HLA-DR and CD86 molecules. Finally, Ferumoxytol uptake by human monocytes down-regulated expression of pro-inflammatory chemokines MIP-1α (Macrophage inflammatory protein 1α), MIP-1β (CCL4) and RANTES (CCL5). In macrophages, Ferumoxytol reversed the expression of IL-1RA, IL-8, IP-10 (CXCL10) and TNF-α, and up-regulates expression of MCP-1 (CCL2) and MIP-1α in irradiated macrophages. Conclusion. SPION agent Ferumoxytol increases resistance of human monocytes to radiation-induced cell death in vitro and supports anti-inflammatory phenotype of human macrophages under radiation. The effect is radiation dose-dependent and depends on the duration of Feraheme uptake. This study also finds strong evidence that SPIONs reversed the effect of radiation on the expression of pro-inflammatory cytokines involved in initiation and development of radiation-induced liver damage. Correlative translational work at our institution will directly assess the cyto-protective effects of Ferumoxytol on human Kupfer cells in vitro and ex vivo analysis of explanted liver specimens in a subset of patients receiving Feraheme-enhanced MRI-guided radiotherapy to the primary liver tumors as a bridge to liver transplant.

Keywords: superparamagnetic iron oxide nanoparticles, radioprotection, magnetic resonance imaging, liver

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Authors: Yasar Samet Gokceoglu, Ayse Nur Incesu, Furkan Okatar, Berk Nimetoglu, Serkan Bayram, Turgut Akgul

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Ankle syndesmosis injuries pose a significant challenge in orthopedic practice due to their potential for prolonged recovery and chronic ankle dysfunction. Accurate diagnosis and management of these injuries are essential for achieving optimal patient outcomes. The use of radiological methods, such as X-ray, computed tomography (CT), and magnetic resonance imaging (MRI), plays a vital role in the accurate diagnosis of syndesmosis injuries in the context of ankle fractures. Treatment options for ankle syndesmosis injuries vary, with surgical interventions such as screw fixation and suture-button implantation being commonly employed. The choice of treatment is influenced by the severity of the injury and the presence of associated fractures. Additionally, the mechanism of injury, such as pure syndesmosis injury or specific fracture types, can impact the stability and management of syndesmosis injuries. Ankle fractures with syndesmosis injury present a complex clinical scenario, requiring accurate diagnosis, appropriate reduction, and tailored management strategies. The interplay between the mechanism of injury, associated fractures, and treatment modalities significantly influences the outcomes of these challenging injuries. The long-term outcomes and patient satisfaction following ankle fractures with syndesmosis injury are crucial considerations in the field of orthopedics. Patient-reported outcome measures, such as the Foot and Ankle Outcome Score (FAOS), provide essential information about functional recovery and quality of life after these injuries. When diagnosing syndesmosis injuries, standard measurements, such as the medial clear space, tibiofibular overlap, tibiofibular clear space, anterior tibiofibular ratio (ATFR), and the anterior-posterior tibiofibular ratio (APTF), are assessed through radiographs and computed tomography (CT) scans. These parameters are critical in evaluating the presence and severity of syndesmosis injuries, enabling clinicians to choose the most appropriate treatment approach. Despite advancements in diagnostic imaging, challenges remain in accurately diagnosing and treating ankle syndesmosis injuries. Traditional diagnostic parameters, while beneficial, may not capture the full extent of the injury or provide sufficient information to guide therapeutic decisions. This gap highlights the need for exploring additional diagnostic parameters that could enhance the accuracy of syndesmosis injury diagnoses and inform treatment strategies more effectively. The primary goal of this research is to evaluate the usefulness of traditional radiographic measurements in comparison to new CT-based measurements for diagnosing ankle syndesmosis injuries. Specifically, this study aims to assess the accuracy of conventional parameters, including medial clear space, tibiofibular overlap, tibiofibular clear space, ATFR, and APTF, in contrast with the recently proposed CT-based measurements such as the delta and gamma angles. Moreover, the study intends to explore the relationship between these diagnostic parameters and functional outcomes, as measured by the Foot and Ankle Outcome Score (FAOS). Establishing a correlation between specific diagnostic measurements and FAOS scores will enable us to identify the most reliable predictors of functional recovery following syndesmosis injuries. This comparative analysis will provide valuable insights into the accuracy and dependability of CT-based measurements in diagnosing ankle syndesmosis injuries and their potential impact on predicting patient outcomes. The results of this study could greatly influence clinical practices by refining diagnostic criteria and optimizing treatment planning for patients with ankle syndesmosis injuries.

Keywords: ankle syndesmosis injury, diagnostic accuracy, computed tomography, radiographic measurements, Tibiofibular syndesmosis distance

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Authors: Anne E. Goodenough

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One of the most important roles of higher education professionals is to ensure that graduates have excellent employment prospects. This means providing students with the skills necessary to be immediately effective in the workplace. Increasingly, universities are seeking to achieve this by moving from lecture-based and campus-delivered curricula to more varied delivery, which takes students out of their academic comfort zone and allows them to engage with, and be challenged by, real world issues. One popular approach is integration of problem-based learning (PBL) projects into curricula. However, although the potential benefits of PBL are considerable, it can be difficult to devise projects that are meaningful, such that they can be regarded as mere ‘hoop jumping’ exercises. This study examines three-way partnerships between academics, students, and external link organizations. It studied the experiences of all partners involved in different collaborative projects to identify how benefits can be maximized and challenges overcome. Focal collaborations included: (1) development of real-world modules with novel assessment whereby the organization became the ‘client’ for student consultancy work; (2) frameworks where students collected/analyzed data for link organizations in research methods modules; (3) placement-based internships and dissertations; (4) immersive fieldwork projects in novel locations; and (5) students working as partners on staff-led research with link organizations. Focus groups, questionnaires and semi-structured interviews were used to identify opportunities and barriers, while quantitative analysis of students’ grades was used to determine academic effectiveness. Common challenges identified by academics were finding suitable link organizations and devising projects that simultaneously provided education opportunities and tangible benefits. There was no ‘one size fits all’ formula for success, but careful planning and ensuring clarity of roles/responsibilities were vital. Students were very positive about collaboration projects. They identified benefits to confidence, time-keeping and communication, as well as conveying their enthusiasm when their work was of benefit to the wider community. They frequently highlighted employability opportunities that collaborative projects opened up and analysis of grades demonstrated the potential for such projects to increase attainment. Organizations generally recognized the value of project outputs, but often required considerable assistance to put the right scaffolding in place to ensure projects worked. Benefits were maximized by ensuring projects were well-designed, innovative, and challenging. Co-publication of projects in peer-reviewed journals sometimes gave additional benefits for all involved, being especially beneficial for student curriculum vitae. PBL and student projects are by no means new pedagogic approaches: the novelty here came from creating meaningful three-way partnerships between academics, students, and link organizations at all undergraduate levels. Such collaborations can allow students to make a genuine contribution to knowledge, answer real questions, solve actual problems, all while providing tangible benefits to organizations. Because projects are actually needed, students tend to engage with learning at a deep level. This enhances student experience, increases attainment, encourages development of subject-specific and transferable skills, and promotes networking opportunities. Such projects frequently rely upon students and staff working collaboratively, thereby also acting to break down the traditional teacher/learner division that is typically unhelpful in developing students as advanced learners.

Keywords: higher education, employability, link organizations, innovative teaching and learning methods, interactions between enterprise and education, student experience

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Authors: Hilary Modir, Kyle Dutton, Michelle Swab, Shabnam Asghari

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Since its emergence, the cutaneous manifestations of COVID-19 have been documented in the literature. However, the majority are case reports with significant limitations in appraisal quality, thus leaving the role of dermatological manifestations of COVID-19 erroneously underexplored. The primary aim of this review was to systematically examine clinical patterns of dermatological manifestations as reported in the literature. This study was designed as a systematic review of case reports. The inclusion criteria consisted of all published reports and articles regarding COVID-19 in English, from September 1st, 2019, until June 22nd, 2020. The population consisted of confirmed cases of COVID-19 with associated cutaneous signs and symptoms. Exclusion criteria included research in planning stages, protocols, book reviews, news articles, review studies, and policy analyses. With the collaboration of a librarian, a search strategy was created consisting of a mixture of keyword terms and controlled vocabulary. Electronic databases searched were MEDLINE via PubMed, EMBASE, CINAHL, Web of Science, LILACS, PsycINFO, WHO Global Literature on Coronavirus Disease, Cochrane Library, Campbell Collaboration, Prospero, WHO International Clinical Trials Registry Platform, Australian and New Zealand Clinical Trials Registry, U.S. Institutes of Health Ongoing Trials Register, AAD Registry, OSF preprints, SSRN, MedRxiV and BioRxiV. The study selection featured an initial pre-screening of titles and abstracts by one independent reviewer. Results were verified by re-examining a random sample of 1% of excluded articles. Eligible studies progressed for full-text review by two calibrated independent reviewers. Covidence was used to store and extract data, such as citation information and findings pertaining to COVID-19 and cutaneous signs and symptoms. Data analysis and summarization methodology reflect the framework proposed by PRISMA and recommendations set out by Cochrane and Joanna Brigg’s Institute for conducting systematic reviews. The Oxford Centre for Evidence-Based Medicine’s level of evidence was used to appraise the quality of individual studies. The literature search revealed a total of 1221 articles. After the abstract and full-text screening, only 95 studies met the eligibility criteria, proceeding to data extraction. Studies were divided into 58% case reports and 42% series. A total of 833 manifestations were reported in 723 confirmed COVID-19 cases. The most frequent lesions were 23% maculopapular, 15% urticarial and 13% pseudo-chilblains, with 46% of lesions reporting pruritus, 16% erythema, 14% pain, 12% burning sensation, and 4% edema. The most common lesion locations were 20% trunk, 19.5% lower limbs, and 17.7% upper limbs. The time to resolution of lesions was between one and twenty-one days. In conclusion, over half of the reported cutaneous presentations in COVID-19 positive patients were maculopapular, urticarial and pseudo-chilblains, with the majority of lesions distributed to the extremities and trunk. As this review’s sample size only contained COVID-19 confirmed cases with skin presentations, it becomes difficult to deduce the direct relationship between skin findings and COVID-19. However, it can be correlated that acute onset of skin lesions, such as chilblains-like, may be associated with or may warrant consideration of COVID-19 as part of the differential diagnosis.

Keywords: COVID-19, cutaneous manifestations, cutaneous signs, general dermatology, medical dermatology, Sars-Cov-2, skin and infectious disease, skin findings, skin manifestations

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Authors: Caroline Spencer, Suzanne Cross, Dudley McArdle, Frank Archer

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Objectives: The evolution of the Victorian Compendium of Community-Based Resilience Building Case Studies and its capacity to help communities implement activities that encourage adaptation to disaster risk reduction and promote community resilience in rural and urban locations provide this paper's objectives. Background: Between 2012 and 2019, community groups presented at the Monash University Disaster Resilience Initiative (MUDRI) 'Advancing Community Resilience Annual Forums', provided opportunities for communities to impart local resilience activities, how to solve challenges and share unforeseen learning and be considered for inclusion in the Compendium. A key tenet of the Compendium encourages compiling and sharing of grass-roots resilience building activities to help communities before, during, and after unexpected emergencies. The online Compendium provides free access for anyone wanting to help communities build expertise, reduce program duplication, and save valuable community resources. Identifying case study features across the emergency phases and analyzing critical success factors helps communities understand what worked and what did not work to achieve success and avoid known barriers. International exemplars inform the Compendium, which represents an Australian first and enhances Victorian community resilience initiatives. Emergency Management Victoria provided seed funding for the Compendium. MUDRI matched this support and continues to fund the project. A joint Steering Committee with broad-based user input and Human ethics approval guides its continued growth. Methods: A thematic analysis of the Compendium identified case study features, including critical success factors. Results: The Compendium comprises 38 case studies, representing all eight Victorian regions. Case studies addressed emergency phases, before (29), during (7), and after (17) events. Case studies addressed all hazards (23), bushfires (11), heat (2), fire safety (1), and house fires (1). Twenty case studies used a framework. Thirty received funding, of which nine received less than $20,000 and five received more than $100,000. Twenty-nine addressed a whole of community perspective. Case studies revealed unique and valuable learning in diverse settings. Critical success factors included strong governance; board support, leadership, and trust; partnerships; commitment, adaptability, and stamina; community-led initiatives. Other success factors included a paid facilitator and local government support; external funding, and celebrating success. Anecdotally, we are aware that community groups reference Compendium and that its value adds to community resilience planning. Discussion: The Compendium offers an innovative contribution to resilience research and practice. It augments the seven resilience characteristics to strengthen and encourage communities as outlined in the Statewide Community Resilience Framework for Emergency Management; brings together people from across sectors to deliver distinct, yet connected actions to strengthen resilience as a part of the Rockefeller funded Resilient Melbourne Strategy, and supports communities and economies to be resilient when a shock occurs as identified in the recently published Australian National Disaster Risk Reduction Framework. Each case study offers learning about connecting with community and how to increase their resilience to disaster risks and to keep their community safe from unexpected emergencies. Conclusion: The Compendium enables diverse communities to adopt or adapt proven resilience activities, thereby preserving valuable community resources and offers the opportunity to extend to a national or international Compendium.

Keywords: case study, community, compendium, disaster risk reduction, resilience

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Authors: Liane J. Ioannou, Jonathan Serpell, Cino Bendinelli, David Walters, Jenny Gough, Dean Lisewski, Win Meyer-Rochow, Julie Miller, Duncan Topliss, Bill Fleming, Stephen Farrell, Andrew Kiu, James Kollias, Mark Sywak, Adam Aniss, Linda Fenton, Danielle Ghusn, Simon Harper, Aleksandra Popadich, Kate Stringer, David Watters, Susannah Ahern

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BACKGROUND: There are significant variations in the management, treatment and outcomes of thyroid cancer, particularly in the role of: diagnostic investigation and pre-treatment scanning; optimal extent of surgery (total or hemi-thyroidectomy); use of active surveillance for small low-risk cancers; central lymph node dissections (therapeutic or prophylactic); outcomes following surgery (e.g. recurrent laryngeal nerve palsy, hypocalcaemia, hypoparathyroidism); post-surgical hormone, calcium and vitamin D therapy; and provision and dosage of radioactive iodine treatment. A proven strategy to reduce variations in the outcome and to improve survival is to measure and compare it using high-quality clinical registry data. Clinical registries provide the most effective means of collecting high-quality data and are a tool for quality improvement. Where they have been introduced at a state or national level, registries have become one of the most clinically valued tools for quality improvement. To benchmark clinical care, clinical quality registries require systematic measurement at predefined intervals and the capacity to report back information to participating clinical units. OBJECTIVE: The aim of this study was to develop a core set clinical indicators that enable measurement and reporting of quality of care for patients with thyroid cancer. We hypothesise that measuring clinical quality indicators, developed to identify differences in quality of care across sites, will reduce variation and improve patient outcomes and survival, thereby lessening costs and healthcare burden to the Australian community. METHOD: Preparatory work and scoping was conducted to identify existing high quality, clinical guidelines and best practice for thyroid cancer both nationally and internationally, as well as relevant literature. A bi-national panel was invited to participate in a modified Delphi process. Panelists were asked to rate each proposed indicator on a Likert scale of 1–9 in a three-round iterative process. RESULTS: A total of 236 potential quality indicators were identified. One hundred and ninety-two indicators were removed to reflect the data capture by the Australian and New Zealand Thyroid Cancer Registry (ANZTCR) (from diagnosis to 90-days post-surgery). The remaining 44 indicators were presented to the panelists for voting. A further 21 indicators were later added by the panelists bringing the total potential quality indicators to 65. Of these, 21 were considered the most important and feasible indicators to measure quality of care in thyroid cancer, of which 12 were recommended for inclusion in the final set. The consensus indicator set spans the spectrum of care, including: preoperative; surgery; surgical complications; staging and post-surgical treatment planning; and post-surgical treatment. CONCLUSIONS: This study provides a core set of quality indicators to measure quality of care in thyroid cancer. This indicator set can be applied as a tool for internal quality improvement, comparative quality reporting, public reporting and research. Inclusion of these quality indicators into monitoring databases such as clinical quality registries will enable opportunities for benchmarking and feedback on best practice care to clinicians involved in the management of thyroid cancer.

Keywords: clinical registry, Delphi survey, quality indicators, quality of care

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Authors: A. Chandra, M. Arthur, L. Mize, A. Pomeroy-Stevens

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Background: Lower and middle-income countries (LMICs) in Asia face rapid urbanization resulting in both economic opportunities (the urban advantage) and emerging health challenges. Urban health risks are magnified in informal settlements and include infectious disease outbreaks, inadequate access to health services, and poor air quality. Over the coming years, urban spaces in Asia will face accelerating public health risks related to migration, climate change, and environmental health. These challenges are complex and require multi-sectoral and multi-stakeholder solutions. The Building Health Cities (BHC) program is funded by the United States Agency for International Development (USAID) to work with smart city initiatives in the Asia region. BHC approaches urban health challenges by addressing policies, planning, and services through a health equity lens, with a particular focus on informal settlements and migrant communities. The program works to develop data-driven decision-making, build inclusivity through stakeholder engagement, and facilitate the uptake of appropriate technology. Methodology: The BHC program has partnered with the smart city initiatives of Indore in India, Makassar in Indonesia, and Da Nang in Vietnam. Implementing partners support municipalities to improve health delivery and equity using two key approaches: political economy analysis and participatory systems mapping. Political economy analyses evaluate barriers to collective action, including corruption, security, accountability, and incentives. Systems mapping evaluates community health challenges using a cross-sectoral approach, analyzing the impact of economic, environmental, transport, security, health system, and built environment factors. The mapping exercise draws on the experience and expertise of a diverse cohort of stakeholders, including government officials, municipal service providers, and civil society organizations. Results: Systems mapping and political economy analyses identified significant barriers for health care in migrant populations. In Makassar, migrants are unable to obtain the necessary card that entitles them to subsidized health services. This finding is being used to engage with municipal governments to mitigate the barriers that limit migrant enrollment in the public social health insurance scheme. In Indore, the project identified poor drainage of storm and wastewater in migrant settlements as a cause of poor health. Unsafe and inadequate infrastructure placed residents of these settlements at risk for both waterborne diseases and injuries. The program also evaluated the capacity of urban primary health centers serving migrant communities, identifying challenges related to their hours of service and shortages of health workers. In Da Nang, the systems mapping process has only recently begun, with the formal partnership launched in December 2019. Conclusion: This paper explores lessons learned from BHC’s systems mapping, political economy analyses, and stakeholder engagement approaches. The paper shares progress related to the health of migrants in informal settlements. Case studies feature barriers identified and mitigating steps, including governance actions, taken by local stakeholders in partner cities. The paper includes an update on ongoing progress from Indore and Makassar and experience from the first six months of program implementation from Da Nang.

Keywords: informal settlements, migration, stakeholder engagement mapping, urban health

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Authors: Tim Crocker-Buque, Sandra Mounier-Jack, Natasha Howard

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Background: Due to both the increasing scale and speed of urbanisation, urban areas in low and middle-income countries (LMICs) host increasingly large populations of under-immunized children, with the additional associated risks of rapid disease transmission in high-density living environments. Multiple interdependent factors are associated with these coverage disparities in urban areas and most evidence comes from relatively few countries, e.g., predominantly India, Kenya, Nigeria, and some from Pakistan, Iran, and Brazil. This study aimed to identify, describe, and assess the main tools used to measure or improve coverage of immunisation services in poor urban areas. Methods: Authors used a qualitative review design, including academic and non-academic literature, to identify tools used to improve coverage of public health interventions in urban areas. Authors selected and extracted sources that provided good examples of specific tools, or categories of tools, used in a context relevant to urban immunization. Diagnostic (e.g., for data collection, analysis, and insight generation) and programme tools (e.g., for investigating or improving ongoing programmes) and interventions (e.g., multi-component or stand-alone with evidence) were selected for inclusion to provide a range of type and availability of relevant tools. These were then prioritised using a decision-analysis framework and a tool selection guide for programme managers developed. Results: Authors reviewed tools used in urban immunisation contexts and tools designed for (i) non-immunization and/or non-health interventions in urban areas, and (ii) immunisation in rural contexts that had relevance for urban areas (e.g., Reaching every District/Child/ Zone). Many approaches combined several tools and methods, which authors categorised as diagnostic, programme, and intervention. The most common diagnostic tools were cross-sectional surveys, key informant interviews, focus group discussions, secondary analysis of routine data, and geographical mapping of outcomes, resources, and services. Programme tools involved multiple stages of data collection, analysis, insight generation, and intervention planning and included guidance documents from WHO (World Health Organisation), UNICEF (United Nations Children's Fund), USAID (United States Agency for International Development), and governments, and articles reporting on diagnostics, interventions, and/or evaluations to improve urban immunisation. Interventions involved service improvement, education, reminder/recall, incentives, outreach, mass-media, or were multi-component. The main gaps in existing tools were an assessment of macro/policy-level factors, exploration of effective immunization communication channels, and measuring in/out-migration. The proposed framework uses a problem tree approach to suggest tools to address five common challenges (i.e. identifying populations, understanding communities, issues with service access and use, improving services, improving coverage) based on context and available data. Conclusion: This study identified many tools relevant to evaluating urban LMIC immunisation programmes, including significant crossover between tools. This was encouraging in terms of supporting the identification of common areas, but problematic as data volumes, instructions, and activities could overwhelm managers and tools are not always suitably applied to suitable contexts. Further research is needed on how best to combine tools and methods to suit local contexts. Authors’ initial framework can be tested and developed further.

Keywords: health equity, immunisation, low and middle-income countries, poverty, urban health

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Authors: Daniela Salih Khidir, Mohamed G. Al Kuwari, Mercia V. Walt, Izzeldin J. Ibrahim

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Background: University-based physical activity interventions aim to establish durable social patterns during the transition to adulthood. This study is a comprehensive evaluation of a 3-year intervention-based program to increase the culture of physical activity (PA) routine in Qatar campuses community, using a holistic approach. Methodology: General assessment methods: formative evaluation-SIH Campuses logic model design, stakeholders’ identification; process evaluation-members’ step counts analyze and qualitative Appreciative Inquiry session (4-D model); daily steps categorized as: ≤5,000, inactive; 5,000-7,499 low active; ≥7,500, physically active; outcome evaluation - records 3 years interventions. Holistic PA interventions methods: walking interventions - pedometers distributions and walking competitions for students and staff; educational interventions - in campuses implementation of bilingual educational materials, lectures, video related to PA in prevention of non-communicable diseases (NCD); articles published online; monthly emails and sms notifications for pedometer use; mass media campaign - radio advertising, yearly pre/post press releases; community stakeholders interventions-biyearly planning/reporting/achievements rewarding/ qualitative meetings; continuous follow-up communication, biweekly steps reports. Findings: Results formative evaluation - SIH in Campuses logic model identified the need of PA awareness and education within universities, resources, activities, health benefits, program continuity. Results process evaluation: walking interventions: Phase 1: 5 universities recruited, 2352 members, 3 months competition; Phase 2: 6 new universities recruited, 1328 members in addition, 4 months competition; Phase 3: 4 new universities recruited in addition, 1210 members, 6 months competition. Results phase 1 and 2: 1,299 members eligible for analyzes: 800 females (62%), 499 males (38%); 86% non-Qataris, 14% Qatari nationals, daily step count 5,681 steps, age groups 18–24 (n=841; 68%) students, 25–64; (n=458; 35.3%) staff; 38% - low active, 37% physically active and 25% inactive. The AI main themes engaging stakeholders: awareness/education - 5 points (100%); competition, multi levels of involvement in SIH, community-based program/motivation - 4 points each (80%). The AI points represent themes’ repetition within stakeholders’ discussions. Results education interventions: 2 videos implementation, 35 000 educational materials, 3 online articles, 11 walking benefits lectures, 40 emails and sms notifications. Results community stakeholders’ interventions: 6 stakeholders meetings, 3 rewarding gatherings, 1 focus meeting, 40 individual reports, 18 overall reports. Results mass media campaign: 1 radio campaign, 7 press releases, 52 campuses newsletters. Results outcome evaluation: overall 2013-2016, the study used: 1 logic model, 3 PA holistic interventions, partnerships 15 universities, registered 4890 students and staff (aged 18-64 years), engaged 30 campuses stakeholders and 14 internal stakeholders; Total registered population: 61.5% female (2999), 38.5% male (1891), 20.2% (988) Qatari nationals, 79.8% (3902) non-Qataris, 55.5% (2710) students aged 18 – 25 years, 44.5% (2180) staff aged 26 - 64 years. Overall campaign 1,558 members eligible for analyzes: daily step count 7,923; 37% - low active, 43% physically active and 20% inactive. Conclusion: The study outcomes confirm program effectiveness and engagement of young campuses community, specifically female, in PA. The authors recommend implementations of 'holistic PA intervention program approach in Qatar' aiming to impact the community at national level for PA guidelines achievement in support of NCD prevention.

Keywords: campuses, evaluation, Qatar, step-count

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Authors: Oluwaseun Adeleke, Samuel O. Ikani, Simeon Christian Chukwu, Fidelis Edet, Anthony Nwala, Mopelola Raji, Simeon Christian Chukwu

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Background: Health service providers are offered in-service training periodically to strengthen their ability to deliver services that are ethical, quality, timely and safe. Not all capacity-building courses have successfully resulted in intended service delivery outcomes because of poor training content, design, approach, and ambiance. The Delivering Innovations in Selfcare (DISC) project developed a Moment of Truth innovation, which is a proven training model focused on improving consumer/provider interaction that leads to an increase in the voluntary uptake of subcutaneous depot medroxyprogesterone acetate (DMPA-SC) self-injection among women who opt for injectable contraception. Methodology: Six months after training on a moment of truth (MoT) training manual, the project conducted two intensive rounds of qualitative data collection and triangulation that included provider, client, and community mobilizer interviews, facility observations, and routine program data collection. Respondents were sampled according to a convenience sampling approach, and data collected was analyzed using a codebook and Atlas-TI. Providers and clients were interviewed to understand their experience, perspective, attitude, and awareness about the DMPA-SC self-inject. Data were collected from 12 health facilities in three states – eight directly trained and four cascades trained. The research team members came together for a participatory analysis workshop to explore and interpret emergent themes. Findings: Quality-of-service delivery and performance outcomes were observed to be significantly better in facilities whose providers were trained directly trained by the DISC project than in sites that received indirect training through master trainers. Facilities that were directly trained recorded SI proportions that were twice more than in cascade-trained sites. Direct training comprised of full-day and standalone didactic and interactive sessions constructed to evoke commitment, passion and conviction as well as eliminate provider bias and misconceptions in providers by utilizing human interest stories and values clarification exercises. Sessions also created compelling arguments using evidence and national guidelines. The training also prioritized demonstration sessions, utilized job aids, particularly videos, strengthened empathetic counseling – allaying client fears and concerns about SI, trained on positioning self-inject first and side effects management. Role plays and practicum was particularly useful to enable providers to retain and internalize new knowledge. These sessions provided experiential learning and the opportunity to apply one's expertise in a supervised environment where supportive feedback is provided in real-time. Cascade Training was often a shorter and abridged form of MoT training that leveraged existing training already planned by master trainers. This training was held over a four-hour period and was less emotive, focusing more on foundational DMPA-SC knowledge such as a reorientation to DMPA-SC, comparison of DMPA-SC variants, counseling framework and skills, data reporting and commodity tracking/requisition – no facility practicums. Training on self-injection was not as robust, presumably because they were not directed at methods in the contraceptive mix that align with state/organizational sponsored objectives – in this instance, fostering LARC services. Conclusion: To achieve better performance outcomes, consideration should be given to providing training that prioritizes practice-based and emotive content. Furthermore, a firm understanding and conviction about the value training offers improve motivation and commitment to accomplish and surpass service-related performance outcomes.

Keywords: training, performance outcomes, innovation, family planning, contraception, DMPA-SC, self-care, self-injection.

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Authors: Stephen Verderber

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The World Health Organization (WHO) calls for research and development on ecologically sustainable, resilient structures capable of effectively responding to disaster events globally, in response to climate change, politically based diasporas, earthquakes, and other adverse events upending the rhythms of everyday life globally. By 2050, nearly 80% of the world’s population will reside in coastal zones, and this, coupled with the increasingly dire impacts of climate change, constitute a recipe for further chaos and disruption, and in light of these events, architects have yet to rise up to meet the challenge. In the arena of healthcare, rapidly deployable clinics and field hospitals can provide immediate assistance in medically underserved disaster strike zones. Transportable facilities offer multiple advantages over conventional, fixed-site hospitals, as lightweight, comparatively unencumbered alternatives. These attributes have been proven repeatedly in 20th century vehicular and tent-based structures deployed in frontline combat theaters and in prior natural disasters. Prefab transportable clinics and trauma centers recently responded adroitly to medical emergencies in the aftermath of the Haitian (2010) and Ecuadorian (2016) earthquakes, and in North American post-hurricane relief efforts (2017) while architects continue to be castigated by their engineer colleagues as chronically poor first responders. Architecturally based portable structures for healthcare currently include Redeployable Health Centers (RHCs), Redeployable Trauma Centers (RTCs), and Permanent Modular Installations (PMIs). Five tectonic variants within this typology have recently been operationalized in the field: 1. Vehicular-based Nomadics: Prefab modules installed on a truck chassis with interior compartments dropped in prior to final assembly. Alternately, a two-component apparatus is preferred, with a truck cab pulling a modular medical unit, with independent transiting component; 2. Tent and Pneumatic Systems: Tent/yurt precursors and inflatable systems lightweight and responsive to topographically challenging terrain and diverse climates; 3. Containerized Systems: The standard modular intermodal-shipping container affords structural strength, resiliency in difficult transiting conditions, and can be densely close-packed and these can be custom-built or hold flat-pack systems; 4. Flat-Packs and Pop-Up Systems: These kit-of-part assemblies are shipped in standardized or specially-designed ISO containers; and 5. Hybrid Systems: These consist of composite facilities representing a synthesis of mobile vehicular components and/or tent or shipping containers, fused with conventional or pneumatically activated tent systems. Hybrids are advantageous in many installation contexts from an aesthetic, fabrication, and transiting perspective. Advantages/disadvantages of various modular systems are comparatively examined, followed by presentation of a compendium of 80 evidence (research)-based planning and design considerations addressing site/context, transiting and commissioning, triage, decontamination/intake, diagnostic and treatment, facility tectonics, and administration/total environment. The benefits of offsite pre-manufactured fabrication are examined, as is anticipated growth in international demand for transportable healthcare facilities to meet the challenges posed by accelerating global climate change and global conflicts. This investigation into rapid response facilities for pre and post-disaster zones is drawn from a recent book by the author, the first on architecture on this topic (Innovations in Transportable Healthcare Architecture).

Keywords: disaster mitigation, rapid response healthcare architecture, offsite prefabrication

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Authors: Manavjit Singh Dhindsa, Ursula Das, Kshirasagar Naik, Marzia Zaman, Richard Purcell, Srinivas Sampalli, Abdul Mutakabbir, Chung-Horng Lung, Thambirajah Ravichandran

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These days, wildland fires, also known as forest fires, are more prevalent than ever. Wildfires have major repercussions that affect ecosystems, communities, and the environment in several ways. Wildfires lead to habitat destruction and biodiversity loss, affecting ecosystems and causing soil erosion. They also contribute to poor air quality by releasing smoke and pollutants that pose health risks, especially for individuals with respiratory conditions. Wildfires can damage infrastructure, disrupt communities, and cause economic losses. The economic impact of firefighting efforts, combined with their direct effects on forestry and agriculture, causes significant financial difficulties for the areas impacted. This research explores different forest fire spread models and presents a comprehensive review of various techniques and methodologies used in the field. A forest fire spread model is a computational or mathematical representation that is used to simulate and predict the behavior of a forest fire. By applying scientific concepts and data from empirical studies, these models attempt to capture the intricate dynamics of how a fire spreads, taking into consideration a variety of factors like weather patterns, topography, fuel types, and environmental conditions. These models assist authorities in understanding and forecasting the potential trajectory and intensity of a wildfire. Emphasizing the need for a comprehensive understanding of wildfire dynamics, this research explores the approaches, assumptions, and findings derived from various models. By using a comparison approach, a critical analysis is provided by identifying patterns, strengths, and weaknesses among these models. The purpose of the survey is to further wildfire research and management techniques. Decision-makers, researchers, and practitioners can benefit from the useful insights that are provided by synthesizing established information. Fire spread models provide insights into potential fire behavior, facilitating authorities to make informed decisions about evacuation activities, allocating resources for fire-fighting efforts, and planning for preventive actions. Wildfire spread models are also useful in post-wildfire mitigation strategies as they help in assessing the fire's severity, determining high-risk regions for post-fire dangers, and forecasting soil erosion trends. The analysis highlights the importance of customized modeling approaches for various circumstances and promotes our understanding of the way forest fires spread. Some of the known models in this field are Rothermel’s wildland fuel model, FARSITE, WRF-SFIRE, FIRETEC, FlamMap, FSPro, cellular automata model, and others. The key characteristics that these models consider include weather (includes factors such as wind speed and direction), topography (includes factors like landscape elevation), and fuel availability (includes factors like types of vegetation) among other factors. The models discussed are physics-based, data-driven, or hybrid models, also utilizing ML techniques like attention-based neural networks to enhance the performance of the model. In order to lessen the destructive effects of forest fires, this initiative aims to promote the development of more precise prediction tools and effective management techniques. The survey expands its scope to address the practical needs of numerous stakeholders. Access to enhanced early warning systems enables decision-makers to take prompt action. Emergency responders benefit from improved resource allocation strategies, strengthening the efficacy of firefighting efforts.

Keywords: artificial intelligence, deep learning, forest fire management, fire risk assessment, fire simulation, machine learning, remote sensing, wildfire modeling

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