Search results for: low-income setting

Authors: K. Power, M. White, B. Dunleavey, E. Comerford, C. Doherty, N. Delanty, R. Corbridge, M. Fitzsimons

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Introduction: Providing people with access to their own healthcare information and engaging them as co-authors of their health record can promote better transparency, trust, and inclusivity in the healthcare system. With the advent of electronic health records, there is a move towards involving patients as partners in their healthcare by providing them with access to their own health data via electronic patient portals (ePortal). For example, a recently developed ePortal to the Irish National Epilepsy Electronic Patient Record (EPR) provides access to summary medical records, tools for Patient Reported Outcomes (PROM), health goal-setting and preparation for clinical appointments. Aim: To determine what people with epilepsy (their families/carers) value about the Irish epilepsy ePortal. Methods: A socio-technical process was employed recruiting 30 families of people with epilepsy who also have an intellectual disability (ID). Family members who are a care partner of the person with epilepsy (PWE) were invited to co-design, develop and implement the ePortal. Family members engaged in usability and utility testing which involved a face to face meeting to learn about the ePortal, register for a user account and evaluate its structure and content. Family members were instructed to login to the portal on at least two separate occasions following the meeting and to complete a self-report evaluation tool during this time. The evaluation tool, based on a Usability Questionnaire (Lewis, 1993), consists of a short assessment of comfort using technology, instructions for using the ePortal and some tasks to complete. Tasks included validating summary record details, assessing ePortal ease of use, evaluation of information presented. Participants were asked for suggestions on how to improve the portal and make it more applicable to PWE who also have an ID. Results: Family members responded positively to the ePortal and valued the ability to share information between clinicians and care partners; use the ePortal as a passport between different healthcare settings (e.g., primary care to hospital). In the context of elderly parents of PWE, the ePortal is valued as a tool for supporting shared care between family members. Participants welcomed the facility to log lists of questions and goals to discuss with the clinician at the next clinical appointment as a means of improving quality of care. Participants also suggested further enhancements to the ePortal such as access to clinic letters which can provide an aide memoir in terms of the careplan agreed with the clinical team. For example, through the ePortal, people could see what investigations or therapies are scheduled. Conclusion: The Epilepsy Patient Portal is accessible via a range of devices such as smartphones and tablets. ePortals have the potential to help personalise care, improve patient involvement in clinical decision making, engage them as quality and safety partners, and help clinicians be more responsive to patient needs. Acknowledgement: The epilepsy ePortal project is part of PISCES, a Lighthouse Project funded by eHealth Ireland and HSE to help build an understanding of the benefits of eHealth technologies in the Irish Healthcare System.

Keywords: electronic patient portal, electronic patient record, epilepsy, intellectual disability, usability testing

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Authors: Iuri Salukvadze

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Construction takes importance role in the history of mankind, there is not a single thing-product in our lives in which the builder’s work was not to be materialized, because to create all of it requires setting up factories, roads, and bridges, etc. The function of the Republic of Georgia, as part of the connecting Europe-Asia transport corridor, is significantly increased. In the context of transit function a large part of the cargo traffic belongs to motor transport, hence the improvement of motor roads transport infrastructure is rather important and rise the new, increased operational demands for existing as well as new motor roads. Construction of the durable road surface is related to rather large values, but because of high transport-operational properties, such as high-speed, less fuel consumption, less depreciation of tires, etc. If the traffic intensity is high, therefore the reimbursement of expenses occurs rapidly and accordingly is increasing income. If the traffic intensity is relatively small, it is recommended to use lightened structures of road carpet in order to pay for capital investments amounted to no more than normative one. The road carpet is divided into the following basic types: asphaltic concrete and cement concrete. Asphaltic concrete is the most perfect type of road carpet. It is arranged in two or three layers on rigid foundation and will be compacted. Asphaltic concrete is artificial building material, which due stratum will be selected and measured from stone skeleton and sand, interconnected by bitumen and a mixture of mineral powder. Less strictly selected similar material is called as bitumen-mineral mixture. Asphaltic concrete is non-rigid building material and well durable on vertical loadings; it is less resistant to the impact of horizontal forces. The cement concrete is monolithic and durable material, it is well durable the horizontal loads and is less resistant related to vertical loads. The cement concrete consists from strictly selected, measured stone material and sand, the binder is cement. The cement concrete road carpet represents separate slabs of sizes from 3 ÷ 5 op to 6 ÷ 8 meters. The slabs are reinforced by a rather complex system. Between the slabs are arranged seams that are designed for avoiding of additional stresses due temperature fluctuations on the length of slabs. For the joint behavior of separate slabs, they are connected by metal rods. Rods provide the changes in the length of slabs and distribute to the slab vertical forces and bending moments. The foundation layers will be extremely durable, for that is required high-quality stone material, cement, and metal. The qualification work aims to: in order for improvement of traffic conditions on motor roads to prolong operational conditions and improving their characteristics. The work consists from three chapters, 80 pages, 5 tables and 5 figures. In the work are stated general concepts as well as carried out by various companies using modern methods tests and their results. In the chapter III are stated carried by us tests related to this issue and specific examples to improving the operational characteristics.

Keywords: asphalt, cement, cylindrikal sample of asphalt, building

Procedia PDF Downloads 195

Authors: Julia Baker

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Development plays a major role in stopping biodiversity loss. But the ‘silo species’ protection of legislation (where certain species are protected while many are not) means that development can be ‘legally compliant’ and result in biodiversity loss. ‘Net Gain’ (NG) policies can help overcome this by making it an absolute requirement that development causes no overall loss of biodiversity and brings a benefit. However, offsetting biodiversity losses in one location with gains elsewhere is controversial because people suspect ‘offsetting’ to be an easy way for developers to buy their way out of conservation requirements. Yet the good practice principles (GPP) of offsetting provide several advantages over existing legislation for protecting biodiversity from development. This presentation describes the learning from implementing NG approaches based on GPP. It regards major upgrades of the UK’s transport networks, which involved removing vegetation in order to construct and safely operate new infrastructure. While low-lying habitats were retained, trees and other habitats disrupting the running or safety of transport networks could not. Consequently, achieving NG within the transport corridor was not possible and offsetting was required. The first ‘lessons learnt’ were on obtaining a commitment from business leaders to go beyond legislative requirements and deliver NG, and on the institutional change necessary to embed GPP within daily operations. These issues can only be addressed when the challenges that biodiversity poses for business are overcome. These challenges included: biodiversity cannot be measured easily unlike other sustainability factors like carbon and water that have metrics for target-setting and measuring progress; and, the mindset that biodiversity costs money and does not generate cash in return, which is the opposite of carbon or waste for example, where people can see how ‘sustainability’ actions save money. The challenges were overcome by presenting the GPP of NG as a cost-efficient solution to specific, critical risks facing the business that also boost industry recognition, and by using government-issued NG metrics to develop business-specific toolkits charting their NG progress whilst ensuring that NG decision-making was based on rich ecological data. An institutional change was best achieved by supporting, mentoring and training sustainability/environmental managers for these ‘frontline’ staff to embed GPP within the business. The second learning was from implementing the GPP where business partnered with local governments, wildlife groups and land owners to support their priorities for nature conservation, and where these partners had a say in decisions about where and how best to achieve NG. From this inclusive approach, offsetting contributed towards conservation priorities when all collaborated to manage trade-offs between: -Delivering ecologically equivalent offsets or compensating for losses of one type of biodiversity by providing another. -Achieving NG locally to the development whilst contributing towards national conservation priorities through landscape-level planning. -Not just protecting the extent and condition of existing biodiversity but ‘doing more’. -The multi-sector collaborations identified practical, workable solutions to ‘in perpetuity’. But key was strengthening linkages between biodiversity measures implemented for development and conservation work undertaken by local organizations so that developers support NG initiatives that really count.

Keywords: biodiversity offsetting, development, nature conservation planning, net gain

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Authors: S. MacDougall-Davis, S. Wysling, R. Willmore

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Background: The application of good non-technical skills, also known as crew resource management (CRM), is central to the delivery of safe, effective healthcare. The authors have been running remote trauma courses for over 10 years, primarily focussing on developing participants’ CRM in time-critical, high-stress clinical situations. The course has undergone an iterative process over the past 10 years. We employ a number of experiential learning techniques for improving CRM, including small group workshops, military command tasks, high fidelity simulations with reflective debriefs, and a ‘flipped classroom’, where participants are asked to create their own simulations and assess and debrief their colleagues’ CRM. We created a randomised simulation study to assess the impact of our course on UK medical students’ CRM, both at an individual and a teams level. Methods: Sixteen students took part. Four clinical scenarios were devised, designed to be of similar urgency and complexity. Professional moulage effects and experienced clinical actors were used to increase fidelity and to further simulate high-stress environments. Participants were block randomised into teams of 4; each team was randomly assigned to one pre-course simulation. They then underwent our 5 day remote trauma CRM course. Post-course, students were re-randomised into four new teams; each was randomly assigned to a post-course simulation. All simulations were videoed. The footage was reviewed by two independent CRM-trained assessors, who were blinded to the before/after the status of the simulations. Assessors used the internationally validated team emergency assessment measure (TEAM) to evaluate key areas of team performance, as well as a global outcome rating. Prior to the study, assessors had scored two unrelated scenarios using the same assessment tool, demonstrating 89% concordance. Participants also completed pre- and post-course questionnaires. Likert scales were used to rate individuals’ perceived NTS ability and their confidence to work in a team in time-critical, high-stress situations. Results: Following participation in the course, a significant improvement in CRM was observed in all areas of team performance. Furthermore, the global outcome rating for team performance was markedly improved (40-70%; mean 55%), thus demonstrating an impact at Level 4 of Kirkpatrick’s hierarchy. At an individual level, participants’ self-perceived CRM improved markedly after the course (35-70% absolute improvement; mean 55%), as did their confidence to work in a team in high-stress situations. Conclusion: Our study demonstrates that with a short, cost-effective course, using easily reproducible teaching sessions, it is possible to significantly improve participants’ CRM skills, both at an individual and, perhaps more importantly, at a teams level. The successful functioning of multi-disciplinary teams is vital in a healthcare setting, particularly in high-stress, time-critical situations. Good CRM is of paramount importance in these scenarios. The authors believe that these concepts should be introduced from the earliest stages of medical education, thus promoting a culture of effective CRM and embedding an early appreciation of the importance of these skills in enabling safe and effective healthcare.

Keywords: crew resource management, non-technical skills, training, simulation

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Authors: Bonnie R. Brammall, Rhonda M. Garad, Helena J. Teede, Cheryce L. Harrison

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Introduction: Reproductive aged women are at high-risk for accelerated weight gain and obesity development, with pregnancy recognised as a critical contributory life phase. Healthy lifestyle interventions during the preconception and antenatal period improve maternal and infant health outcomes. Yet, interventions from preconception through to postpartum and translation and implementation into real-world healthcare settings remain limited. OptimalMe is a randomised, hybrid implementation effectiveness study of evidence-based healthy lifestyle intervention. Here, we report engagement, acceptability of the intervention during preconception, and self-reported behaviour change outcomes as a result of the preconception phase of the intervention. Methods: Reproductive aged women who upgraded their private health insurance to include pregnancy and birth cover, signalling a pregnancy intention, were invited to participate. Women received access to an online portal with preconception health and lifestyle modules, goal-setting and behaviour change tools, monthly SMS messages, and two coaching sessions (randomised to video or phone) prior to pregnancy. Results: Overall n=527 expressed interest in participating. Of these, n=33 did not meet inclusion criteria, n=8 were not contactable for eligibility screening, and n=177 failed to engage after the screening, leaving n=309 who were enrolled in OptimalMe and randomised to intervention delivery method. Engagement with coaching sessions dropped by 25% for session two, with no difference between intervention groups. Women had a mean (SD) age of 31.7 (4.3) years and, at baseline, a self-reported mean BMI of 25.7 (6.1) kg/m², with 55.8% (n=172) of a healthy BMI. Behaviour was sub-optimal with infrequent self-weighing (38.1%), alcohol consumption prevalent (57.1%), sub-optimal pre-pregnancy supplementation (61.5%), and incomplete medical screening. Post-intervention 73.2% of women reported engagement with a GP for preconception care and improved lifestyle behaviour (85.5%), since starting OptimalMe. Direct pre-and-post comparison of individual participant data showed that of 322 points of potential change (up-to-date cervical screening, elimination of high-risk behaviours [alcohol, drugs, smoking], uptake of preconception supplements and improved weighing habits) 158 (49.1%) points of change were achieved. Health coaching sessions were found to improve accountability and confidence, yet further personalisation and support were desired. Engagement with video and phone sessions was comparable, having similar impacts on behaviour change, and both methods were well accepted and increased women's accountability. Conclusion: A low-intensity digital health and lifestyle program with embedded health coaching can improve the uptake of preconception care and lead to self-reported behaviour change. This is the first program of its kind to reach an otherwise healthy population of women planning a pregnancy. Women who were otherwise healthy showed divergence from preconception health and lifestyle objectives and benefited from the intervention. OptimalMe shows promising results for population-based behaviour change interventions that can improve preconception lifestyle habits and increase engagement with clinical health care for pregnancy preparation.

Keywords: preconception, pregnancy, preventative health, weight gain prevention, self-management, behaviour change, digital health, telehealth, intervention, women's health

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Authors: S. Toufigh Bararpour, Davood Karami, Nader Mahinpey

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Dependence of global economics on fossil fuels has led to a large growth in the emission of greenhouse gases (GHGs). Among the various GHGs, carbon dioxide is the main contributor to the greenhouse effect due to its huge emission amount. To mitigate the threatening effect of CO₂, carbon capture and sequestration (CCS) technologies have been studied widely in recent years. For the combustion processes, three main CO₂ capture techniques have been proposed such as post-combustion, pre-combustion and oxyfuel combustion. Post-combustion is the most commonly used CO₂ capture process as it can be readily retrofit into the existing power plants. Multiple advantages have been reported for the post-combustion by solid sorbents such as high CO₂ selectivity, high adsorption capacity, and low required regeneration energy. Chemical adsorption of CO₂ over alkali-metal-based solid sorbents such as K₂CO₃ is a promising method for the selective capture of diluted CO₂ from the huge amount of nitrogen existing in the flue gas. To improve the CO₂ capture performance, K₂CO₃ is supported by a stable and porous material. Al₂O₃ has been employed commonly as the support and enhanced the cyclic CO₂ capture efficiency of K₂CO₃. Different phases of alumina can be obtained by setting the calcination temperature of boehmite at 300, 600 (γ-alumina), 950 (δ-alumina) and 1200 °C (α-alumina). By increasing the calcination temperature, the regeneration capacity of alumina increases, while the surface area reduces. However, sorbents with lower surface areas have lower CO₂ capture capacity as well (except for the sorbents prepared by hydrophilic support materials). To resolve this issue, a highly efficient alumina-aerogel support was synthesized with a BET surface area of over 2000 m²/g and then calcined at a high temperature. The synthesized alumina-aerogel was impregnated on K₂CO₃ based on 50 wt% support/K₂CO₃, which resulted in the preparation of a sorbent with remarkable CO₂ capture performance. The effect of synthesis conditions such as types of alcohols, solvent-to-co-solvent ratios, and aging times was investigated on the performance of the support. The best support was synthesized using methanol as the solvent, after five days of aging time, and at a solvent-to-co-solvent (methanol-to-toluene) ratio (v/v) of 1/5. Response surface methodology was used to investigate the effect of operating parameters such as carbonation temperature and H₂O-to-CO₂ flowrate ratio on the CO₂ capture capacity. The maximum CO₂ capture capacity, at the optimum amounts of operating parameters, was 7.2 mmol CO₂ per gram K₂CO₃. Cyclic behavior of the sorbent was examined over 20 carbonation and regenerations cycles. The alumina-aerogel-supported K₂CO₃ showed a great performance compared to unsupported K₂CO₃ and γ-alumina-supported K₂CO₃. Fundamental performance analyses and long-term thermal and chemical stability test will be performed on the sorbent in the future. The applicability of the sorbent for a bench-scale process will be evaluated, and a corresponding process model will be established. The fundamental material knowledge and respective process development will be delivered to industrial partners for the design of a pilot-scale testing unit, thereby facilitating the industrial application of alumina-aerogel.

Keywords: alumina-aerogel, CO₂ capture, K₂CO₃, optimization

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Authors: Faruk Inaltekin, Imran Gurakan

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This paper will aim to discuss the importance of value-added services provided by Science and Technology Parks for entrepreneurship development in Turkey. Entrepreneurship is vital subject for all countries. It has not only fostered economic development but also promoted innovation at local and international levels. To foster high tech entrepreneurship ecosystem, Technopark (Science and Technology Park/STP) concept was initiated with the establishment of Silicon Valley in the 1950s. The success and rise of Silicon Valley led to the spread of technopark activities. Developed economies have been setting up projects to plan and build STPs since the 1960s and 1970s. To promote the establishment of STPs, necessary legislations were made by Ministry of Science, Industry, and Technology in 2001, Technology Development Zones Law (No. 4691) and it has been revised in 2016 to provide more supports. STPs’ basic aim is to provide customers high-quality office spaces with various 'value added services' such as business development, network connections, cooperation programs, investor/customers meetings and internationalization services. For this aim, STPs should help startups deal with difficulties in the early stages and to support mature companies’ export activities in the foreign market. STPs should support the production, commercialization and more significantly internationalization of technology-intensive business and foster growth of companies. Nowadays within this value-added services, internationalization is very popular subject in the world. Most of STPs design clusters or accelerator programs in order to support their companies in the foreign market penetration. If startups are not ready for international competition, STPs should help them to get ready for foreign market with training and mentoring sessions. These training and mentoring sessions should take a goal based approach to working with companies. Each company has different needs and goals. Therefore the definition of ‘success' varies for each company. For this reason, it is very important to create customized value added services to meet the needs of startups. After local supports, STPs should also be able to support their startups in foreign market. Organizing well defined international accelerator program plays an important role in this mission. Turkey is strategically placed between key markets in Europe, Russia, Central Asia and the Middle East. Its population is young and well educated. So both government agencies and the private sectors endeavor to foster and encourage entrepreneurship ecosystem with many supports. In sum, the task of technoparks with these and similar value added services is very important for developing entrepreneurship ecosystem. The priorities of all value added services are to identify the commercialization and growth obstacles faced by entrepreneurs and get rid of them with the one-to-one customized services. Also, in order to have a healthy startup ecosystem and create sustainable entrepreneurship, stakeholders (technoparks, incubators, accelerators, investors, universities, governmental organizations etc.) should fulfill their roles and/or duties and collaborate with each other. STPs play an important role as bridge for these stakeholders & entrepreneurs. STPs always should benchmark and renew services offered to how to help the start-ups to survive, develop their business and benefit from these stakeholders.

Keywords: accelerator, cluster, entrepreneurship, startup, technopark, value added services

Procedia PDF Downloads 119

Authors: Vinti Davar

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Introduction: Childhood overweight increases the risk for certain medical and psychological conditions. Millions of school-age children worldwide are affected by serious yet easily treatable and preventable illnesses that inhibit their ability to learn. Healthier children stay in school longer, attend more regularly, learn more and become healthier and more productive adults. Schools are an important setting for nutrition education because one can reach most children, teachers and parents. These years offer a key window for shaping their lifetime habits, which have an impact on their health throughout life. Against this background, an attempt was made to impart nutrition education to school children in Haryana state of India to promote healthy food choices and assess the effectiveness of this program. Methodology: This study was completed in two phases. During the first phase, pre-intervention anthropometric and dietary survey was conducted; the teaching materials for nutrition intervention program were developed and tested; and the questionnaire was validated. In the second phase, an intervention was implemented in two schools of Kurukshetra, Haryana for six months by personal visits once a week. A total of 350 children in the age group of 6-12 years were selected. Out of these, 279 children, 153 boys and 126 girls completed the study. The subjects were divided into four groups namely: underweight, normal, overweight and obese based on body mass index-for-age categories. A power point colorful presentation to improve the quality of tiffin, snacks and meals emphasizing inclusion of all food groups especially vegetables every day and fruits at least 3-4 days per week was used. An extra 20 minutes of aerobic exercise daily was likewise organized and a healthy school environment created. Provision of clean drinking water by school authorities was ensured. Selling of soft drinks and energy-dense snacks in the school canteen as well as advertisements about soft drink and snacks on the school walls were banned. Post intervention, anthropometric indices and food selections were reassessed. Results: The results of this study reiterate the critical role of nutrition education and promotion in improving the healthier food choices by school children. It was observed that normal, overweight and obese children participating in nutrition education intervention program significantly (p≤0.05) increased their daily seasonal fruit and vegetable consumption. Fat and oil consumption was significantly reduced by overweight and obese subjects. Fast food intake was controlled by obese children. The nutrition knowledge of school children significantly improved (p≤0.05) from pre to post intervention. A highly significant increase (p≤0.00) was noted in the nutrition attitude score after intervention in all four groups. Conclusion: This study has shown that a well-planned nutrition education program could improve nutrition knowledge and promote positive changes in healthy food choices. A nutrition program inculcates wholesome eating and active life style habits in children and adolescents that could not only prevent them from chronic diseases and early death but also reduce healthcare cost and enhance the quality of life of citizens and thereby nations.

Keywords: children, eating habits healthy food, obesity, school going, fast foods

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Authors: Ann P. Daunic, Nancy Corbett

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Background and Significance: Researchers emphasize the role that motivation, self-esteem, and self-regulation play in children’s early adjustment to the school culture, including skills such as identifying their own feelings and understanding the feelings of others. As social-emotional growth, academic learning, and successful integration within culture and society are inextricably connected, the Social-Emotional Learning Foundations (SELF) curriculum was designed to integrate social-emotional learning (SEL) instruction within early literacy instruction (specifically, reading) for Kindergarten and first-grade students at risk for emotional and behavioral difficulties. Storybook reading is a typically occurring activity in the primary grades; thus SELF provides an intervention that is both theoretically and practically sound. Methodology: The researchers will report on findings from the first two years of a three-year study funded by the US Department of Education’s Institute of Education Sciences to evaluate the effects of the SELF curriculum versus “business as usual” (BAU). SELF promotes the development of self-regulation by incorporating instructional strategies that support children’s use of SEL related vocabulary, self-talk, and critical thinking. The curriculum consists of a carefully coordinated set of materials and pedagogy designed specifically for primary grade children at early risk for emotional and behavioral difficulties. SELF lessons (approximately 50 at each grade level) are organized around 17 SEL topics within five critical competencies. SELF combines whole-group (the first in each topic) and small-group lessons (the 2nd and 3rd in each topic) to maximize opportunities for teacher modeling and language interactions. The researchers hypothesize that SELF offers a feasible and substantial opportunity within the classroom setting to provide a small-group social-emotional learning intervention integrated with K-1 literacy-related instruction. Participating target students (N = 876) were identified by their teachers as potentially at risk for emotional or behavioral issues. These students were selected from 122 Kindergarten and 100 first grade classrooms across diverse school districts in a southern state in the US. To measure the effectiveness of the SELF intervention, the researchers asked teachers to complete assessments related to social-emotional learning and adjustment to the school culture. A social-emotional learning related vocabulary assessment was administered directly to target students receiving small-group instruction. Data were analyzed using a 3-level MANOVA model with full information maximum likelihood to estimate coefficients and test hypotheses. Major Findings: SELF had significant positive effects on vocabulary, knowledge, and skills associated with social-emotional competencies, as evidenced by results from the measures administered. Effect sizes ranged from 0.41 for group (SELF vs. BAU) differences in vocabulary development to 0.68 for group differences in SEL related knowledge. Conclusion: Findings from two years of data collection indicate that SELF improved outcomes related to social-emotional learning and adjustment to the school culture. This study thus supports the integration of SEL with literacy instruction as a feasible and effective strategy to improve outcomes for K-1 students at risk for emotional and behavioral difficulties.

Keywords: Socio-cultural context for learning, social-emotional learning, social skills, vocabulary development

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Authors: Pedro A. Marques, Francisco Monteiro, Alessandra Zumbo, Alessia Simonini, Miguel A. Mendez

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Cryogenic fuels such as Liquid Hydrogen (LH₂) must be transported and stored at extremely low temperatures. Without expensive active cooling solutions, preventing fuel boil-off over time is impossible. Hence, one must resort to venting systems at the cost of significant energy and fuel mass loss. These losses increase significantly in propellant tanks installed on vehicles, as the presence of external accelerations induces sloshing. Sloshing increases heat and mass transfer rates and leads to significant pressure oscillations, which might further trigger propellant venting. To make LH₂ economically viable, it is essential to minimize these factors by using advanced control techniques. However, these require accurate modelling and a full understanding of the tank's thermodynamics. The present research aims to implement a simple thermodynamic model capable of predicting the state of a cryogenic fuel tank under different operating conditions (i.e., filling, pressurization, fuel extraction, long-term storage, and sloshing). Since this model relies on a set of closure parameters to drive the system's transient response, it must be calibrated using experimental or numerical data. This work focuses on the former approach, wherein the model is calibrated through an experimental campaign carried out on a reduced-scale model of a cryogenic tank. The thermodynamic model of the system is composed of three control volumes: the ullage, the liquid, and the insulating walls. Under this lumped formulation, the governing equations are derived from energy and mass balances in each region, with mass-averaged properties assigned to each of them. The gas-liquid interface is treated as an infinitesimally thin region across which both phases can exchange mass and heat. This results in a coupled system of ordinary differential equations, which must be closed with heat and mass transfer coefficients between each control volume. These parameters are linked to the system evolution via empirical relations derived from different operating regimes of the tank. The derivation of these relations is carried out using an inverse method to find the optimal relations that allow the model to reproduce the available data. This approach extends classic system identification methods beyond linear dynamical systems via a nonlinear optimization step. Thanks to the data-driven assimilation of the closure problem, the resulting model accurately predicts the evolution of the tank's thermodynamics at a negligible computational cost. The lumped model can thus be easily integrated with other submodels to perform complete system simulations in real time. Moreover, by setting the model in a dimensionless form, a scaling analysis allowed us to relate the tested configurations to a representative full-size tank for naval applications. It was thus possible to compare the relative importance of different transport phenomena between the laboratory model and the full-size prototype among the different operating regimes.

Keywords: destratification, hydrogen, modeling, pressure-drop, pressurization, sloshing, thermodynamics

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Authors: Md. Abu Sufian, Robiqul Islam, Imam Hossain Shajid, Mahesh Hanumanthu, Jarasree Varadarajan, Md. Sipon Miah, Mingbo Niu

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Coronary Heart Disease (CHD) remains a principal cause of global morbidity and mortality, characterized by atherosclerosis—the build-up of fatty deposits inside the arteries. The study introduces an innovative methodology that leverages cloud-based platforms like AWS Live Streaming and Artificial Intelligence (AI) to early detect and prevent CHD symptoms in web applications. By employing novel simulation processes and AI algorithms, this research aims to significantly mitigate the health and societal impacts of CHD. Methodology: This study introduces a novel simulation process alongside a multi-phased model development strategy. Initially, health-related data, including heart rate variability, blood pressure, lipid profiles, and ECG readings, were collected through user interactions with web-based applications as well as API Integration. The novel simulation process involved creating synthetic datasets that mimic early-stage CHD symptoms, allowing for the refinement and training of AI algorithms under controlled conditions without compromising patient privacy. AWS Live Streaming was utilized to capture real-time health data, which was then processed and analysed using advanced AI techniques. The novel aspect of our methodology lies in the simulation of CHD symptom progression, which provides a dynamic training environment for our AI models enhancing their predictive accuracy and robustness. Model Development: it developed a machine learning model trained on both real and simulated datasets. Incorporating a variety of algorithms including neural networks and ensemble learning model to identify early signs of CHD. The model's continuous learning mechanism allows it to evolve adapting to new data inputs and improving its predictive performance over time. Results and Findings: The deployment of our model yielded promising results. In the validation phase, it achieved an accuracy of 92% in predicting early CHD symptoms surpassing existing models. The precision and recall metrics stood at 89% and 91% respectively, indicating a high level of reliability in identifying at-risk individuals. These results underscore the effectiveness of combining live data streaming with AI in the early detection of CHD. Societal Implications: The implementation of cloud-based AI for CHD symptom detection represents a significant step forward in preventive healthcare. By facilitating early intervention, this approach has the potential to reduce the incidence of CHD-related complications, decrease healthcare costs, and improve patient outcomes. Moreover, the accessibility and scalability of cloud-based solutions democratize advanced health monitoring, making it available to a broader population. This study illustrates the transformative potential of integrating technology and healthcare, setting a new standard for the early detection and management of chronic diseases.

Keywords: coronary heart disease, cloud-based ai, machine learning, novel simulation techniques, early detection, preventive healthcare

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Authors: Joanna Marie A. Paulino-Morente, Vaneza Valentina L. Penolio, Grace Sabado

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Ovarian cancer is extremely hard to diagnose in its early stages, and those afflicted at the time of diagnosis are typically asymptomatic and in the late stages of the disease, with metastasis to other organs. Ovarian cancers often occur sporadically, with only 5% associated with hereditary mutations. Mutations in the BRCA1 and BRCA2 tumor suppressor genes have been found to be responsible for the majority of hereditary ovarian cancers. One type of ovarian tumor is Malignant Mixed Mullerian Tumor (MMMT), which is a very rare and aggressive type, accounting for only 1% of all ovarian cancers. Reported is a case of a 43-year-old G3P3 (3003), who came into our institution due to a 2-month history of difficulty of breathing. Family history reveals that her eldest and younger sisters both died of ovarian malignancy, with her younger sister having a histopathology report of endometrioid ovarian carcinoma, left ovary stage IIIb. She still has 2 asymptomatic sisters. Physical examination pointed to pleural effusion of right lung, and presence of bilateral ovarian new growth, which had a Sassone score of 13. Admitting Diagnosis was G3P3 (3003), Ovarian New Growth, bilateral, Malignant; Pleural effusion secondary to malignancy. BRCA was requested to establish a hereditary mutation; however, the patient had no funds. Once the patient was stabilized, TAHBSO with surgical staging was performed. Intraoperatively, the pelvic cavity was occupied by firm, irregularly shaped ovaries, with a colorectal metastasis. Microscopic sections from both ovaries and the colorectal metastasis had pleomorphic tumor cells lined by cuboidal to columnar epithelium exhibiting glandular complexity, displaying nuclear atypia and increased nuclear-cytoplasmic ratio, which are infiltrating the stroma, consistent with the features of Malignant Mixed Mullerian Tumor, since MMMT is composed histologically of malignant epithelial and sarcomatous elements. In conclusion, discussed is the clinic-pathological feature of a patient with primary ovarian Malignant Mixed Mullerian Tumor, a rare malignancy comprising only 1% of all ovarian neoplasms. Also, by understanding the hereditary ovarian cancer syndromes and its relation to this patient, it cannot be overemphasized that a comprehensive family history is really fundamental for early diagnosis. The familial association of the disease, given that the patient has two sisters who were diagnosed with an advanced stage of ovarian cancer and succumbed to the disease at a much earlier age than what is reported in the general population, points to a possible hereditary syndrome which occurs in only 5% of ovarian neoplasms. In a low-resource setting, being in a third world country, the following will be recommended for monitoring and/or screening women who are at high risk for developing ovarian cancer, such as the remaining sisters of the patient: 1) Physical examination focusing on the breast, abdomen, and rectal area every 6 months. 2) Transvaginal sonography every 6 months. 3) Mammography annually. 4) CA125 for postmenopausal women. 5) Genetic testing for BRCA1 and BRCA2 will be reserved for those who are financially capable.

Keywords: BRCA, hereditary breast-ovarian cancer syndrome, malignant mixed mullerian tumor, ovarian cancer

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Authors: Jung-Hun Cho, Tae-Heon Moon, Sun-Young Heo

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A lot of urban problems, caused by urbanization and industrialization, have occurred around the world. In particular, the creation of satellite towns, which was attributed to the explicit expansion of the city, has led to the traffic problems and the hollowization of old towns, raising the necessity of urban regeneration in old towns along with the aging of existing urban infrastructure. To select urban regeneration priority regions for the strategic execution of urban regeneration in Korea, the number of population, the number of businesses, and deterioration degree were chosen as standards. Existing standards had a limit in coping with solving urban problems fundamentally and rapidly changing reality. Therefore, it was necessary to add new indicators that can reflect the decline in relevant cities and conditions. In this regard, this study selected Busan Metropolitan City, Korea as the target area as a leading city, where urban regeneration such as an international port city has been activated like Yokohama, Japan. Prior to setting the urban regeneration priority region, the conditions of reality should be reflected because uniform and uncharacterized projects have been implemented without a quantitative analysis about population behavior within the region. For this reason, this study conducted a characterization analysis and type classification, based on the user behaviors by using representative floating population of the big data, which is a hot issue all over the society in recent days. The target areas were analyzed in this study. While 23 regions were classified as three types in existing Busan Metropolitan City urban regeneration priority region, 23 regions were classified as four types in existing Busan Metropolitan City urban regeneration priority region in terms of the type classification on the basis of user behaviors. Four types were classified as follows; type (Ⅰ) of young people - morning type, Type (Ⅱ) of the old and middle-aged- general type with sharp floating population, type (Ⅲ) of the old and middle aged-24hour-type, and type (Ⅳ) of the old and middle aged with less floating population. Characteristics were shown in each region of four types, and the study results of user behaviors were different from those of existing urban regeneration priority region. According to the results, in type (Ⅰ) young people were the majority around the existing old built-up area, where floating population at dawn is four times more than in other areas. In Type (Ⅱ), there were many old and middle-aged people around the existing built-up area and general neighborhoods, where the average floating population was more than in other areas due to commuting, while in type (Ⅲ), there was no change in the floating population throughout 24 hours, although there were many old and middle aged people in population around the existing general neighborhoods. Type (Ⅳ) includes existing economy-based type, central built-up area type, and general neighborhood type, where old and middle aged people were the majority as a general type of commuting with less floating population. Unlike existing urban regeneration priority region, these types were sub-divided according to types, and in this study, approach methods and basic orientations of urban regeneration were set to reflect the reality to a certain degree including the indicators of effective floating population to identify the dynamic activity of urban areas and existing regeneration priority areas in connection with urban regeneration projects by regions. Therefore, it is possible to make effective urban plans through offering the substantial ground by utilizing scientific and quantitative data. To induce more realistic and effective regeneration projects, the regeneration projects tailored to the present local conditions should be developed by reflecting the present conditions on the formulation of urban regeneration strategic plans.

Keywords: floating population, big data, urban regeneration, urban regeneration priority region, type classification

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Authors: Waleed Al-Nuaimy, Luke Anastassiou, Manjinder Kainth

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As the process of teaching has evolved with the advent of new technologies over the ages, so has the process of learning. Educators have perpetually found themselves on the lookout for new technology-enhanced methods of teaching in order to increase learning efficiency and decrease ever expanding workloads. Shortly after the invention of the internet, web-based learning started to pick up in the late 1990s and educators quickly found that the process of providing learning material and marking assignments could change thanks to the connectivity offered by the internet. With the creation of early web-based virtual learning environments (VLEs) such as SPIDER and Blackboard, it soon became apparent that VLEs resulted in higher reported computer self-efficacy among students, but at the cost of students being less satisfied with the learning process . It may be argued that the impersonal nature of VLEs, and their limited functionality may have been the leading factors contributing to this reported dissatisfaction. To this day, often faced with the prospects of assigning colossal engineering cohorts their homework and assessments, educators may frequently choose optimally curated assessment formats, such as multiple-choice quizzes and numerical answer input boxes, so that automated grading software embedded in the VLEs can save time and mark student submissions instantaneously. A crucial skill that is meant to be learnt during most science and engineering undergraduate degrees is gaining the confidence in using, solving and deriving mathematical equations. Equations underpin a significant portion of the topics taught in many STEM subjects, and it is in homework assignments and assessments that this understanding is tested. It is not hard to see that this can become challenging if the majority of assignment formats students are engaging with are multiple-choice questions, and educators end up with a reduced perspective of their students’ ability to manipulate equations. Artificial intelligence (AI) has in recent times been shown to be an important consideration for many technologies. In our paper, we explore the use of new AI based software designed to work in conjunction with current VLEs. Using our experience with the software, we discuss its potential to solve a selection of problems ranging from impersonality to the reduction of educator workloads by speeding up the marking process. We examine the software’s potential to increase learning efficiency through its features which claim to allow more customized and higher-quality feedback. We investigate the usability of features allowing students to input equation derivations in a range of different forms, and discuss relevant observations associated with these input methods. Furthermore, we make ethical considerations and discuss potential drawbacks to the software, including the extent to which optical character recognition (OCR) could play a part in the perpetuation of errors and create disagreements between student intent and their submitted assignment answers. It is the intention of the authors that this study will be useful as an example of the implementation of AI in a practical assessment scenario insofar as serving as a springboard for further considerations and studies that utilise AI in the setting and marking of science and engineering assignments.

Keywords: engineering education, assessment, artificial intelligence, optical character recognition (OCR)

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Authors: Monica Arnaudo, Monika Topel, Bjorn Laumert

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Within the Swedish context, the current trend of relatively low electricity prices promotes the electrification of the energy infrastructure. The residential heating sector takes part in this transition by proposing a switch from a centralized district heating system towards a distributed heat pumps-based setting. When it comes to urban environments, two issues arise. The first, seen from an electricity-sector perspective, is related to the fact that existing networks are limited with regards to their installed capacities. Additional electric loads, such as heat pumps, can cause severe overloads on crucial network elements. The second, seen from a heating-sector perspective, has to do with the fact that the indoor comfort conditions can become difficult to handle when the operation of the heat pumps is limited by a risk of overloading on the distribution grid. Furthermore, the uncertainty of the electricity market prices in the future introduces an additional variable. This study aims at assessing the extent to which distributed heat pumps can penetrate an existing heat energy network while respecting the technical limitations of the electricity grid and the thermal comfort levels in the buildings. In order to account for the multi-disciplinary nature of this research question, a cosimulation modeling approach was adopted. In this way, each energy technology is modeled in its customized simulation environment. As part of the cosimulation methodology: a steady-state power flow analysis in pandapower was used for modeling the electrical distribution grid, a thermal balance model of a reference building was implemented in EnergyPlus to account for space heating and a fluid-cycle model of a heat pump was implemented in JModelica to account for the actual heating technology. With the models set in place, different scenarios based on forecasted electricity market prices were developed both for present and future conditions of Hammarby Sjöstad, a neighborhood located in the south-east of Stockholm (Sweden). For each scenario, the technical and the comfort conditions were assessed. Additionally, the average cost of heat generation was estimated in terms of levelized cost of heat. This indicator enables a techno-economic comparison study among the different scenarios. In order to evaluate the levelized cost of heat, a yearly performance simulation of the energy infrastructure was implemented. The scenarios related to the current electricity prices show that distributed heat pumps can replace the district heating system by covering up to 30% of the heating demand. By lowering of 2°C, the minimum accepted indoor temperature of the apartments, this level of penetration can increase up to 40%. Within the future scenarios, if the electricity prices will increase, as most likely expected within the next decade, the penetration of distributed heat pumps can be limited to 15%. In terms of levelized cost of heat, a residential heat pump technology becomes competitive only within a scenario of decreasing electricity prices. In this case, a district heating system is characterized by an average cost of heat generation 7% higher compared to a distributed heat pumps option.

Keywords: cosimulation, distributed heat pumps, district heating, electrical distribution grid, integrated energy systems

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Authors: Athina Thanou, Eirini Eleni Tsiropoulou, Symeon Papavassiliou

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The problem of museum visitor experience and congestion management – in various forms - has come increasingly under the spotlight over the last few years, since overcrowding can significantly decrease the quality of visitors’ experience. Evidence suggests that on busy days the amount of time a visitor spends inside a crowded house museum can fall by up to 60% compared to a quiet mid-week day. In this paper we consider the aforementioned problem, by treating museums as evolving social systems that induce constraints. However, in a cultural heritage space, as opposed to the majority of social environments, the momentum of the experience is primarily controlled by the visitor himself. Visitors typically behave selfishly regarding the maximization of their own Quality of Experience (QoE) - commonly expressed through a utility function that takes several parameters into consideration, with crowd density and waiting/visiting time being among the key ones. In such a setting, congestion occurs when either the utility of one visitor decreases due to the behavior of other persons, or when costs of undertaking an activity rise due to the presence of other persons. We initially investigate how visitors’ behavioral risk attitudes, as captured and represented by prospect theory, affect their decisions in resource sharing settings, where visitors’ decisions and experiences are strongly interdependent. Different from the majority of existing studies and literature, we highlight that visitors are not risk neutral utility maximizers, but they demonstrate risk-aware behavior according to their personal risk characteristics. In our work, exhibits are organized into two groups: a) “safe exhibits” that correspond to less congested ones, where the visitors receive guaranteed satisfaction in accordance with the visiting time invested, and b) common pool of resources (CPR) exhibits, which are the most popular exhibits with possibly increased congestion and uncertain outcome in terms of visitor satisfaction. A key difference is that the visitor satisfaction due to CPR strongly depends not only on the invested time decision of a specific visitor, but also on that of the rest of the visitors. In the latter case, the over-investment in time, or equivalently the increased congestion potentially leads to “exhibit failure”, interpreted as the visitors gain no satisfaction from their observation of this exhibit due to high congestion. We present a framework where each visitor in a distributed manner determines his time investment in safe or CPR exhibits to optimize his QoE. Based on this framework, we analyze and evaluate how visitors, acting as prospect-theoretic decision-makers, respond and react to the various pricing policies imposed by the museum curators. Based on detailed evaluation results and experiments, we present interesting observations, regarding the impact of several parameters and characteristics such as visitor heterogeneity and use of alternative pricing policies, on scalability, user satisfaction, museum capacity, resource fragility, and operation point stability. Furthermore, we study and present the effectiveness of alternative pricing mechanisms, when used as implicit tools, to deal with the congestion management problem in the museums, and potentially decrease the exhibit failure probability (fragility), while considering the visitor risk preferences.

Keywords: museum resource and visitor management, congestion management, propsect theory, cyber physical social systems

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Authors: Prince Chukwuneme Enwereji, Annelien Van Rooyen

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In recent years, technology integration in education has transformed the learning landscape, particularly in online institutions. One technological advancement that has gained popularity is e-tutoring, which offers personalised academic support to students through online platforms. While e-tutoring has become well-known and has been adopted to promote collaborative learning, there are still students who do not use these services for various reasons. However, little attention has been given to understanding the perspectives of students who have not utilized these services. The research objectives include identifying the perceived benefits that non-e-tutoring students believe e-tutoring could offer, such as enhanced academic support, personalized learning experiences, and improved performance. Additionally, the study explored the potential drawbacks or concerns that non-e-tutoring students associate with e-tutoring, such as concerns about efficacy, a lack of face-to-face interaction, and platform accessibility. The study adopted a quantitative research approach with a descriptive design to gather and analyze data on non-e-tutoring students' perspectives. Online questionnaires were employed as the primary data collection method, allowing for the efficient collection of data from many participants. The collected data was analyzed using the Statistical Package for the Social Sciences (SPSS). Ethical concepts such as informed consent, anonymity of responses and protection of respondents against harm were maintained. Findings indicate that non-e-tutoring students perceive a sense of control over their own pace of learning, suggesting a preference for self-directed learning and the ability to tailor their educational experience to their individual needs and learning styles. They also exhibit high levels of motivation, believe in their ability to effectively participate in their studies and organize their academic work, and feel comfortable studying on their own without the help of e-tutors. However, non-e-tutoring students feel that e-tutors do not sufficiently address their academic needs and lack engagement. They also perceive a lack of clarity in the roles of e-tutors, leading to uncertainty about their responsibilities. In terms of communication, students feel overwhelmed by the volume of announcements and find repetitive information frustrating. Additionally, some students face challenges with their internet connection and associated cost, which can hinder their participation in online activities. Furthermore, non-e-tutoring students express a desire for interactions with their peers and a sense of belonging to a group or team. They value opportunities for collaboration, teamwork in their learning experience, the importance of fostering social interactions and creating a sense of community in online learning environments. This study recommended that students seek alternate support systems by reaching out to professors or academic advisors for guidance and clarification. Developing self-directed learning skills is essential, empowering students to take charge of their own learning through setting objectives, creating own study plans, and utilising resources. For HEIs, it was recommended that they should ensure that a variety of support services are available to cater to the needs of all students, including non-e-tutoring students. HEIs should also ensure easy access to online resources, promote a supportive community, and regularly evaluate and adapt their support techniques to meet students' changing requirements.

Keywords: online-tutor;, student support;, online education, educational practices, distance education

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Authors: Ma Chu Jui

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Culture plays a pivotal role in shaping societal responses to change and fostering adaptability. In the realm of healthcare provision, hospitals serve as dynamic settings molded by the cultural consciousness of healthcare professionals. This intricate interplay extends to their expectations of leadership, communication styles, and attitudes towards patient care. Recognizing the cultural inclinations of healthcare professionals becomes imperative in navigating this complex landscape. This study will utilize Hofstede's Value Survey Module 2013 (VSM 2013) as a comprehensive analytical tool. The targeted participants for this research are in-service nursing professionals with a tenure of at least three months, specifically employed in the nursing department of an Eastern hospital. This quantitative approach seeks to quantify diverse cultural tendencies among the targeted nursing professionals, elucidating not only abstract cultural concepts but also revealing their cultural inclinations across different dimensions. The study anticipates gathering between 400 to 500 responses, ensuring a robust dataset for a comprehensive analysis. The focused approach on nursing professionals within the Eastern hospital setting enhances the relevance and specificity of the cultural insights obtained. The research aims to contribute valuable knowledge to the understanding of cultural tendencies among in-service nursing personnel in the nursing department of this specific Eastern hospital. The VSM 2013 will be initially distributed to this specific group to collect responses, aiming to calculate scores on each of Hofstede's six cultural dimensions—Power Distance Index (PDI), Individualism vs. Collectivism (IDV), Uncertainty Avoidance Index (UAI), Masculinity vs. Femininity (MAS), Long-Term Orientation vs. Short-Term Normative Orientation (LTO), and Indulgence vs. Restraint (IVR). the study unveils a significant correlation between different cultural dimensions and healthcare professionals' tendencies in understanding leadership expectations through PDI, grasping behavioral patterns via IDV, acknowledging risk acceptance through UAI, and understanding their long-term and short-term behaviors through LTO. These tendencies extend to communication styles and attitudes towards patient care. These findings provide valuable insights into the nuanced interconnections between cultural factors and healthcare practices. Through a detailed analysis of the varying levels of these cultural dimensions, we gain a comprehensive understanding of the predominant inclinations among the majority of healthcare professionals. This nuanced perspective adds depth to our comprehension of how cultural values shape their approach to leadership, communication, and patient care, contributing to a more holistic understanding of the healthcare landscape. A profound comprehension of the cultural paradigms embraced by healthcare professionals holds transformative potential. Beyond a mere understanding, it acts as a catalyst for elevating the caliber of healthcare services. This heightened awareness fosters cohesive collaboration among healthcare teams, paving the way for the establishment of a unified healthcare ethos. By cultivating shared values, our study envisions a healthcare environment characterized by enhanced quality, improved teamwork, and ultimately, a more favorable and patient-centric healthcare landscape. In essence, our research underscores the critical role of cultural awareness in shaping the future of healthcare delivery.

Keywords: hofstede's cultural, cultural dimensions, cultural values in healthcare, cultural awareness in nursing

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Authors: N. Cihan KayaçEtin, Stijn Verdoodt, Alexis Versele

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The construction industry is accounted for one-third of all waste generated in the European Union (EU) countries. The Circular Economy Action Plan of the EU aims to tackle this issue and aspires to enhance the sustainability of the construction industry by adopting more circular principles and bio-based material use. The Interreg Circular Bio-Based Construction Industry (CBCI) project was conceived to research how this adoption can be facilitated. For this purpose, an approach is developed that integrates technical, legal and social aspects and provides business models for circular designing and building with bio-based materials. In the scope of the project, the research outputs are to be displayed in a real-life setting by constructing a demo terraced single-family house, the living lab (LL) located in Ghent (Belgium). The realization of the LL is conducted in a step-wise approach that includes iterative processes for design, description, criteria definition and multi-criteria assessment of building components. The essence of the research lies within the exploratory approach to the state-of-art building envelope and technical systems options for achieving an optimum combination for a circular and bio-based construction. For this purpose, nine preliminary designs (PD) for building envelope are generated, which consist of three basic construction methods: masonry, lightweight steel construction and wood framing construction supplemented with bio-based construction methods like cross-laminated timber (CLT) and massive wood framing. A comparative analysis on the PDs was conducted by utilizing several complementary tools to assess the circularity. This paper focuses on the life cycle assessment (LCA) approach for evaluating the environmental impact of the LL Ghent. The adoption of an LCA methodology was considered critical for providing a comprehensive set of environmental indicators. The PDs were developed at the component level, in particular for the (i) inclined roof, (ii-iii) front and side façade, (iv) internal walls and (v-vi) floors. The assessment was conducted on two levels; component and building level. The options for each component were compared at the first iteration and then, the PDs as an assembly of components were further analyzed. The LCA was based on a functional unit of one square meter of each component and CEN indicators were utilized for impact assessment for a reference study period of 60 years. A total of 54 building components that are composed of 31 distinct materials were evaluated in the study. The results indicate that wood framing construction supplemented with bio-based construction methods performs environmentally better than the masonry or steel-construction options. An analysis on the correlation between the total weight of components and environmental impact was also conducted. It was seen that masonry structures display a high environmental impact and weight, steel structures display low weight but relatively high environmental impact and wooden framing construction display low weight and environmental impact. The study provided valuable outputs in two levels: (i) several improvement options at component level with substitution of materials with critical weight and/or impact per unit, (ii) feedback on environmental performance for the decision-making process during the design phase of a circular single family house.

Keywords: circular and bio-based materials, comparative analysis, life cycle assessment (LCA), living lab

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Authors: Aileen O'loughlin

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‘Is Everybody Going WeLL?’ (IEGW?) is a 33-hour classroom-based initiative created to a) explore values and how they impact on well-being, b) encourage adolescents to connect with their community, and c) provide them with the education to encourage and maintain a lifetime love of physical activity (PA) to ensure beneficial effects on their personal well-being. This initiative is also aimed at achieving sustainable education and aligning with the United Nation’s Sustainable Development Goals numbers 3 and 4. The classroom is a unique setting in which adolescents’ PA participation can be positively influenced through fun PA policies and initiatives. The primary purpose of this research is to evaluate a range of psychosocial and PA outcomes following the 33-hour education programme. This research examined the impact of a PA and well-being programme consisting of either a 60minute or 80minute class, depending on the timetable structure of the school, delivered once a week. Participant outcomes were measured using validated questionnaires regarding Self-esteem, Mental Health Literacy (MHL) and Daily Physical Activity Participation. These questionnaires were administered at three separate time points; baseline, mid-intervention, and post intervention. Semi-structured interviews with participating teachers regarding adherence and participants’ attitudes were completed post-intervention. These teachers were randomly selected for interview. This perspective analytical cohort study included 235 post-primary school students between 11-13 years of age (100 boys and 135 girls) from five public Irish post-primary schools. Three schools received the intervention only; a 33hour interactive well-being learning unit, one school formed a control group and one school had participants in both the intervention and control group. Participating schools were a convenience sample. Data presented outlines baseline data collected pre-participation (0 hours completed). N = 18 junior certificate students returned all three questionnaires fully completed for a 56.3% return rate from 1 school, Intervention School #3. 94.4% (n = 17) of participants enjoy taking part in some form of PA, however only 5.5% (n = 1) of the participants took part in PA every day of the previous 7 days and only 5.5% (n = 1) of those surveyed participated in PA every day during a normal week. 55% (n = 11) had a low level of self-esteem, 50% (n = 9) fall within the normal range of self-esteem, and n = 0 surveyed demonstrated a high level of self-esteem. Female participants’ Mean score was higher than their male counterparts when MHL was compared. Correlation analyses revealed a small association between Self-esteem and Happiness (r = 0.549). Positive correlations were also revealed between MHL and Happiness, MHL and Self-esteem and Self-esteem and 60+ minutes of PA completed daily. IEGW? is a classroom-based with simple methods easy to implement, replicate and financially viable to both public and private schools. It’s unique dataset will allow for the evaluation of a societal approach to the psycho-social well-being and PA participation levels of adolescents. This research is a work in progress and future work is required to learn how to best support the implementation of ‘Is Everybody Going WeLL?’ as part of the school curriculum.

Keywords: education, life-long learning, physical activity, psychosocial well-being

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Authors: Jayden R. Hunter, Brett A. Gordon, Stephen R. Bird, Amanda C. Benson

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The World Health Organisation recognises the workplace as an important setting for exercise promotion, with potential benefits including improved employee health and fitness, and reduced worker absenteeism and presenteeism. Despite these potential benefits to both employee and employer, there is a lack of evidence supporting the long-term effectiveness of workplace exercise programs. There is, therefore, a need for better-informed programs that cater to employee exercise preferences. Specifically, workplace exercise programs should address any time, motivation, internal and external barriers to participation reported by sub-groups of employees. This study sought to compare exercise participation to perceived barriers and facilitators to workplace exercise engagement of university employees. This information is needed to design and implement wider-reaching programs aiming to maximise long-term employee exercise adherence and subsequent health, fitness and productivity benefits. An online survey was advertised at an Australian university with the potential to reach 3,104 full-time employees. Along with exercise participation (International physical activity questionnaire) and behaviour (stage of behaviour change in relation to physical activity questionnaire), perceived barriers (corporate exercise barriers scale) and facilitators to workplace exercise participation were identified. The survey response rate was 8.1% (252 full-time employees; 95% white-collar; 60% female; 79.4% aged 30–59 years; 57% professional and 38% academic). Most employees reported meeting (43.7%) or exceeding (42.9%) exercise guidelines over the previous week (i.e. ⩾30 min of moderate-intensity exercise on most days or ⩾ 25 min of vigorous-intensity exercise on at least three days per week). Reported exercise behaviour over the previous six months showed that 64.7% of employees were in maintenance, 8.3% were in action, 10.9% were in preparation, 12.4% were in contemplation, and 3.8% were in the pre-contemplation stage of change. Perceived barriers towards workplace exercise participation were significantly higher in employees not attaining weekly exercise guidelines compared to employees meeting or exceeding guidelines, including a lack of time or reduced motivation (p < 0.001; partial eta squared = 0.24 (large effect)), exercise attitude (p < 0.05; partial eta squared = 0.04 (small effect)), internal (p < 0.01; partial eta squared = 0.10 (moderate effect)) and external (p < 0.01; partial eta squared = 0.06 (moderate effect)) barriers. The most frequently reported exercise facilitators were personal training (particularly for insufficiently active employees; 33%) and group exercise classes (20%). The most frequently cited preferred modes of exercise were walking (70%), swimming (50%), gym (48%), and cycling (45%). In conclusion, providing additional means of support such as individualised gym, swimming and cycling programs with personal supervision and guidance may be particularly useful for employees not meeting recommended moderate-vigorous volumes of exercise, to help overcome reported exercise barriers in order to improve participation, health, and fitness. While individual biopsychosocial factors should be considered when making recommendations for interventions, the specific barriers and facilitators to workplace exercise participation identified by this study can inform the development of workplace exercise programs aiming to broaden employee engagement and promote greater ongoing exercise adherence. This is especially important for the uptake of less active employees who perceive greater barriers to workplace exercise participation than their more active colleagues.

Keywords: exercise barriers, exercise facilitators, physical activity, workplace health

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Authors: Daniel Puciato, Piotr Oleśniewicz, Julita Markiewicz-Patkowska, Krzysztof Widawski, Michał Rozpara, Władysław Mynarski, Agnieszka Gawlik, Małgorzata Dębska, Soňa Jandová

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Physical activity as a part of people’s everyday life reduces the risk of many diseases, including those induced by lifestyle, e.g. obesity, type 2 diabetes, osteoporosis, coronary heart disease, degenerative arthritis, and certain types of cancer. That refers particularly to professionally active people, including the early senior group working on non-manual positions. The aim of the study is to evaluate the relationship between physical activity and the socio-economic status of non-manual workers from Wroclaw—one of the biggest cities in Poland, a model setting for such investigations in this part of Europe. The crucial problem in the research is to find out the percentage of respondents who meet the health-related recommendations of the World Health Organization (WHO) concerning the volume, frequency, and intensity of physical activity, as well as to establish if the most important socio-economic factors, such as gender, age, education, marital status, per capita income, savings and debt, determine the compliance with the WHO physical activity recommendations. During the research, conducted in 2013, 1,170 people (611 women and 559 men) aged 21–60 years were examined. A diagnostic poll method was applied to collect the data. Physical activity was measured with the use of the short form of the International Physical Activity Questionnaire with extended socio-demographic questions, i.e. concerning gender, age, education, marital status, income, savings or debts. To evaluate the relationship between physical activity and selected socio-economic factors, logistic regression was used (odds ratio statistics). Statistical inference was conducted on the adopted ex ante probability level of p<0.05. The majority of respondents met the volume of physical effort recommended for health benefits. It was particularly noticeable in the case of the examined men. The probability of compliance with the WHO physical activity recommendations was highest for workers aged 21–30 years with secondary or higher education who were single, received highest incomes and had savings. The results indicate the relations between physical activity and socio-economic status in the examined women and men. People with lower socio-economic status (e.g. manual workers) are physically active primarily at work, whereas those better educated and wealthier implement physical effort primarily in their leisure time. Among the investigated subjects, the youngest group of non-manual workers have the best chances to meet the WHO standards of physical activity. The study also confirms that secondary education has a positive effect on the public awareness on the role of physical activity in human life. In general, the analysis of the research indicates that there is a relationship between physical activity and some socio-economic factors of the respondents, such as gender, age, education, marital status, income per capita, and the possession of savings. Although the obtained results cannot be applied for the general population, they show some important trends that will be verified in subsequent studies conducted by the authors of the paper.

Keywords: IPAQ, nonmanual workers, physical activity, socioeconomic factors, WHO

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Authors: Karen Chad, Louise Humbert, Kenzie Friesen, Dave Sandomirsky

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Background: The pandemic of COVID-19 presented many historical challenges to the sporting community. For organizations and individuals, sport was put on hold resulting in social, economic, physical, and mental health consequences for all involved. High school sports are seen as an effective and accessible pathway for students to receive health, social, and academic benefits. Studies examining sport cessation due to COVID-19 found substantial negative outcomes on the physical and mental well-being of participants in the high school setting. However, the pandemic afforded an opportunity to examine sport participation and the value people place upon their engagement in high school sport. Study objectives: (1) Examine the experiences of students, parents, administrators, officials, and coaches during a year without high school sports; (2) Understand why participants are involved in high school sports; and (3) Learn what supports are needed for future involvement. Methodology: A mixed method design was used, including semi-structured interviews and a survey (SurveyMonkey software), which was disseminated electronically to high school students, coaches, school administrators, parents, and officials. Results: 1222 respondents completed the survey. Findings showed: (1) 100% of students participate in high school sports to improve their mental health, with >95% said it keeps them active and healthy, helps them make friends and teaches teamwork, builds confidence and positive self-perceptions, teaches resiliency, enhances connectivity to their school, and supports academic learning; (2) Top three reasons teachers coach is their desire to make a difference in the lives of students, enjoyment, and love of the sport, and to give back. Teachers said what they enjoy most is contributing to and watching athletes develop, direct involvement with student sport success, and the competitiveatmosphere; (3) 90% of parents believe playing sports is a valuable experience for their child, 95% said it enriches student academic learning and educational experiences, and 97% encouraged their child to play school sports; (4) Officials participate because of their enjoyment and love of the sport, experience, and expertise, desire to make a difference in the lives of children, the competitive/sporting atmosphere and growing the sport. 4% of officials said it was financially motivated; (5) 100% of administrators said high school sports are important for everyone. 80% believed the pandemic will decrease teachers coaching and increase student mental health and well-being. When there was no sport, many athletes got a part-time job and tried to stay active, with limited success. Coaches, officials, and parents spent more time with family. All participants did little physical activity, were bored; and struggled with mental health and poor physical health. Respondents recommended better communication, promotion, and branding of high school sport benefits, equitable funding for all sports, athlete development, compensation and recognition for coaching, and simple processes to strengthen the high school sport model. Conclusions: High school sport is an effective vehicle for athletes, parents, coaches, administrators, and officials to derive many positive outcomes. When it is taken away, serious consequences prevail. Paying attention to important success factors will be important for the effectiveness of high school sports.

Keywords: physical activity, high school, sports, pandemic

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Authors: Elena Cangelosi, Wayne Beyea

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This research expands the resilience planning literature by exploring the barriers and enablers to climate and health adaptation planning for small urban, coastal Great Lakes communities. With funding from the United States Centers for Disease Control and Prevention (CDC) Climate Ready City and States Initiative, this research took place during a 3-year pilot intervention project which integrates urban planning and public health. The project used the CDC’s Building Resilience Against Climate Effects (BRACE) framework to prevent or reduce the human health impacts from climate change in Marquette County, Michigan. Using a deliberation with the analysis planning process, interviews, focus groups, and community meetings with over 25 stakeholder groups and over 100 participants identified the area’s climate-related health concerns and adaptation interventions to address those concerns. Marquette County, on the shores of Lake Superior, the largest of the Great Lakes, was selected for the project based on their existing adaptive capacity and proactive approach to climate adaptation planning. With Marquette County as the context, this study fills a gap in the adaptation literature, which currently heavily emphasizes large-urban or agriculturally-based rural areas, and largely neglects small urban areas. This research builds on the qualitative case-study, survey, and interview approach established by previous researchers on contextual barriers and enablers for adaptation planning. This research uses a case study approach, including surveys and interviews of public officials, to identify the barriers and enablers for climate and health adaptation planning for small-urban areas within a large, non-agricultural, Great Lakes county. The researchers hypothesize that the barriers and enablers will, in some cases, overlap those found in other contexts, but in many cases, will be unique to a rural setting. The study reveals that funding, staff capacity, and communication across a large, rural geography act as the main barriers, while strong networks and collaboration, interested leaders, and community interest through a strong human-land connection act as the primary enablers. Challenges unique to rural areas are revealed, including weak opportunities for grant funding, large geographical distances, communication challenges with an aging and remote population, and the out-migration of education residents. Enablers that may be unique to rural contexts include strong collaborative relationships across jurisdictions for regional work and strong connections between residents and the land. As the factors that enable and prevent climate change planning are highly contextual, understanding, and appropriately addressing the unique factors at play for small-urban communities is key for effective planning in those areas. By identifying and addressing the barriers and enablers to climate and health adaptation planning for small-urban, coastal areas, this study can help Great Lakes communities appropriately build resilience to the adverse impacts of climate change. In addition, this research expands the breadth of research and understanding of the challenges and opportunities planners confront in the face of climate change.

Keywords: climate adaptation and resilience, climate change adaptation, climate change and urban resilience, governance and urban resilience

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Authors: Xu Qian

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This abstract explores the importance of building resilience within families and offers evidence-based strategies for promoting positive parenting and enhancing emotional well-being. It emphasizes the role of effective communication, conflict resolution, and fostering a supportive environment to strengthen family bonds and promote healthy child development. Introduction: The well-being and resilience of families play a crucial role in fostering healthy child development and promoting overall emotional well-being. This abstract highlights the significance of nurturing resilient families and provides evidence-based strategies for positive parenting. By focusing on effective communication, conflict resolution, and creating a supportive environment, families can strengthen their bonds and enhance emotional well-being for both parents and children. Methods: This abstract draws upon a comprehensive review of existing research and literature on resilient families, positive parenting, and emotional well-being. The selected studies employ various methodologies, including surveys, interviews, and longitudinal observations, to investigate the factors contributing to family resilience and the strategies that promote positive parenting practices. The findings from these studies serve as the foundation for the strategies discussed in this abstract. Results: The results of the reviewed studies demonstrate that effective communication within families is a key factor in building resilience and promoting emotional well-being. Open and honest communication allows family members to express their thoughts, feelings, and concerns, fostering trust and understanding. Conflict resolution skills, such as active listening, compromise, and problem-solving, are vital in managing conflicts constructively and preventing negative consequences on family dynamics and children's well-being. Creating a supportive environment that nurtures emotional well-being is another critical aspect of promoting resilient families. This includes providing emotional support, setting clear boundaries, and promoting positive discipline strategies. Research indicates that consistent and responsive parenting approaches contribute to improved self-regulation skills, emotional intelligence, and overall mental health in children. Discussion: The discussion centers on the implications of these findings for promoting positive parenting and emotional well-being. It emphasizes the need for parents to prioritize self-care and seek support when facing challenges. Parental well-being directly influences the quality of parenting and the overall family environment. By attending to their own emotional needs, parents can better meet the needs of their children and create a nurturing atmosphere. Furthermore, the importance of fostering resilience in children is highlighted. Resilient children are better equipped to cope with adversity, adapt to change, and thrive in challenging circumstances. By cultivating resilience through supportive relationships, encouragement of independence, and providing opportunities for growth, parents can foster their children's ability to bounce back from setbacks and develop essential life skills. Conclusion: In conclusion, nurturing resilient families is crucial for positive parenting and enhancing emotional well-being. This abstract presents evidence-based strategies that emphasize effective communication, conflict resolution, and creating a supportive environment. By implementing these strategies, parents can strengthen family bonds, promote healthy child development, and enhance overall family resilience. Investing in resilient families not only benefits individual family members but also contributes to the well-being of the broader community.

Keywords: childrearing families, family education, children's mental health, positive parenting, emotional health

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Authors: Evgenia Iakovleva, Juha Koivisto, Pasi Karppinen, J. Inkinen, Mikko Alava

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Preventing the spread of infectious diseases throughout the worldwide is one of the most important tasks of modern health care. Infectious diseases not only account for one fifth of the deaths in the world, but also cause many pathological complications for the human health. Touch surfaces pose an important vector for the spread of infections by varying microorganisms, including antimicrobial resistant organisms. Further, antimicrobial resistance is reply of bacteria to the overused or inappropriate used of antibiotics everywhere. The biggest challenges in bacterial detection by existing methods are non-direct determination, long time of analysis, the sample preparation, use of chemicals and expensive equipment, and availability of qualified specialists. Therefore, a high-performance, rapid, real-time detection is demanded in rapid practical bacterial detection and to control the epidemiological hazard. Among the known methods for determining bacteria on the surfaces, Hyperspectral methods can be used as direct and rapid methods for microorganism detection on different kind of surfaces based on fluorescence without sampling, sample preparation and chemicals. The aim of this study was to assess the relevance of such systems to remote sensing of surfaces for microorganisms detection to prevent a global spread of infectious diseases. Bacillus subtilis and Escherichia coli with different concentrations (from 0 to 10x8 cell/100µL) were detected with hyperspectral camera using different filters as visible visualization of bacteria and background spots on the steel plate. A method of internal standards was applied for monitoring the correctness of the analysis results. Distances from sample to hyperspectral camera and light source are 25 cm and 40 cm, respectively. Each sample is optically imaged from the surface by hyperspectral imaging system, utilizing a JAI CM-140GE-UV camera. Light source is BeamZ FLATPAR DMX Tri-light, 3W tri-colour LEDs (red, blue and green). Light colors are changed through DMX USB Pro interface. The developed system was calibrated following a standard procedure of setting exposure and focused for light with λ=525 nm. The filter is ThorLabs KuriousTM hyperspectral filter controller with wavelengths from 420 to 720 nm. All data collection, pro-processing and multivariate analysis was performed using LabVIEW and Python software. The studied human eye visible and invisible bacterial stains clustered apart from a reference steel material by clustering analysis using different light sources and filter wavelengths. The calculation of random and systematic errors of the analysis results proved the applicability of the method in real conditions. Validation experiments have been carried out with photometry and ATP swab-test. The lower detection limit of developed method is several orders of magnitude lower than for both validation methods. All parameters of the experiments were the same, except for the light. Hyperspectral imaging method allows to separate not only bacteria and surfaces, but also different types of bacteria, such as Gram-negative Escherichia coli and Gram-positive Bacillus subtilis. Developed method allows skipping the sample preparation and the use of chemicals, unlike all other microbiological methods. The time of analysis with novel hyperspectral system is a few seconds, which is innovative in the field of microbiological tests.

Keywords: Escherichia coli, Bacillus subtilis, hyperspectral imaging, microorganisms detection

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Authors: Rodríguez Sánchez Carla, Sancho-Esper Franco, Guillen-Davo Marina

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Tourism is one of the most important sectors worldwide since it is an important economic engine for today's society. It is also one of the sectors that most negatively affect the environment in terms of CO₂ emissions due to this expansion. In light of this, airlines are developing Voluntary Carbon Offset (VCO). There is important evidence focused on analyzing the features of these VCO programs and their efficacy in reducing CO₂ emissions, and findings are mixed without a clear consensus. Different research approaches have centered on analyzing factors and consequences of VCO programs, such as economic modelling based on panel data, survey research based on traveler responses or experimental research analyzing customer decisions in a simulated context. This study belongs to the latter group because it tries to understand how different characteristics of an online ticket purchase website affect the willingness of a traveler to choose a sustainable one. The proposed behavioral model is based on several theories, such as the nudge theory, the dual processing ELM and the cognitive dissonance theory. This randomized experiment aims at overcoming previous studies based on self-reported measures that mainly study sustainable behavioral intention rather than actual decision-making. It also complements traditional self-reported independent variables by gathering objective information from an eye-tracking device. This experiment analyzes the influence of two characteristics of the online purchase website: i) the type of information regarding flight CO₂ emissions (quantitative vs. qualitative) and the comparison framework related to the sustainable purchase decision (negative: alternative with more emissions than the average flight of the route vs. positive: alternative with less emissions than the average flight of the route), therefore it is a 2x2 experiment with four alternative scenarios. A pretest was run before the actual experiment to refine the experiment features and to check the manipulations. Afterward, a different sample of students answered the pre-test questionnaire aimed at recruiting the cases and measuring several pre-stimulus measures. One week later, students came to the neurolab at the University setting to be part of the experiment, made their decision regarding online purchases and answered the post-test survey. A final sample of 21 students was gathered. The committee of ethics of the institution approved the experiment. The results show that qualitative information generates more sustainable decisions (less contaminant alternative) than quantitative information. Moreover, evidence shows that subjects are more willing to choose the sustainable decision to be more ecological (comparison of the average with the less contaminant alternative) rather than to be less contaminant (comparison of the average with the more contaminant alternative). There are also interesting differences in the information processing variables from the eye tracker. Both the total time to make the choice and the specific times by area of interest (AOI) differ depending on the assigned scenario. These results allow for a better understanding of the factors that condition the decision of a traveler to be part of a VCO program and provide useful information for airline managers to promote these programs to reduce environmental impact.

Keywords: voluntary carbon offset, airline, online purchase, carbon emission, sustainability, randomized experiment

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Authors: Nervana Elbakary, Sami Ouanes, Sadaf Riaz, Oraib Abdallah, Islam Mahran, Noriya Al-Khuzaei, Yassin Eltorki

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Major Depressive Disorder (MDD) requires therapeutic interventions during the initial month after being diagnosed for better disease outcomes. International guidelines recommend a duration of 4–12 weeks for an initial antidepressant (IAD) trial at an optimized dose to get a response. If depressive symptoms persist after this duration, guidelines recommend switching, augmenting, or combining strategies as the next step. Most patients with MDD in the mental health setting have been labeled incorrectly as treatment-resistant where in fact they have not been subjected to an adequate trial of guideline-recommended therapy. Premature discontinuation of IAD due to ineffectiveness can cause unfavorable consequences. Avoiding irrational practices such as subtherapeutic doses of IAD, premature switching between the ADs, and refraining from unjustified polypharmacy can help the disease to go into a remission phase We aimed to determine the prevalence and the patterns of strategies applied after an IAD was changed because of a suboptimal response as a primary outcome. Secondary outcomes included the median survival time on IAD before any change; and the predictors that were associated with IAD change. This was a retrospective cross- sectional study conducted in Mental Health Services in Qatar. A dataset between January 1, 2018, and December 31, 2019, was extracted from the electronic health records. Inclusion and exclusion criteria were defined and applied. The sample size was calculated to be at least 379 patients. Descriptive statistics were reported as frequencies and percentages, in addition, to mean and standard deviation. The median time of IAD to any change strategy was calculated using survival analysis. Associated predictors were examined using two unadjusted and adjusted cox regression models. A total of 487 patients met the inclusion criteria of the study. The average age for participants was 39.1 ± 12.3 years. Patients with first experience MDD episode 255 (52%) constituted a major part of our sample comparing to the relapse group 206(42%). About 431 (88%) of the patients had an occurrence of IAD change to any strategy before end of the study. Almost half of the sample (212 (49%); 95% CI [44–53%]) had their IAD changed less than or equal to 30 days. Switching was consistently more common than combination or augmentation at any timepoint. The median time to IAD change was 43 days with 95% CI [33.2–52.7]. Five independent variables (age, bothersome side effects, un-optimization of the dose before any change, comorbid anxiety, first onset episode) were significantly associated with the likelihood of IAD change in the unadjusted analysis. The factors statistically associated with higher hazard of IAD change in the adjusted analysis were: younger age, un-optimization of the IAD dose before any change, and comorbid anxiety. Because almost half of the patients in this study changed their IAD as early as within the first month, efforts to avoid treatment failure are needed to ensure patient-treatment targets are met. The findings of this study can have direct clinical guidance for health care professionals since an optimized, evidence-based use of AD medication can improve the clinical outcomes of patients with MDD; and also, to identify high-risk factors that could worsen the survival time on IAD such as young age and comorbid anxiety

Keywords: initial antidepressant, dose optimization, major depressive disorder, comorbid anxiety, combination, augmentation, switching, premature discontinuation

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Authors: Anastasia Constantinou, Stephen Morris

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Background: The adoption of synchronous and asynchronous telemedicine modalities for primary care consultations has exponentially increased since the COVID-19 pandemic. However, there is limited understanding of how virtual consultations influence healthcare resource utilization and other quality measures including safety, timeliness, efficiency, patient and provider satisfaction, cost-effectiveness and environmental impact. Aim: Quantify the rate of follow-up visits, emergency department visits, hospitalizations, request for investigations and prescriptions and comment on the effect on different quality measures associated with different telemedicine modalities used for primary care services and primary care referrals to secondary care Design and setting: Systematic review in primary care Methods: A systematic search was carried out across three databases (Medline, PubMed and Scopus) between August and November 2023, using terms related to telemedicine, general practice, electronic referrals, follow-up, use and efficiency and supported by citation searching. This was followed by screening according to pre-defined criteria, data extraction and critical appraisal. Narrative synthesis and metanalysis of quantitative data was used to summarize findings. Results: The search identified 2230 studies; 50 studies are included in this review. There was a prevalence of asynchronous modalities in both primary care services (68%) and referrals from primary care to secondary care (83%), and most of the study participants were females (63.3%), with mean age of 48.2. The average follow-up for virtual consultations in primary care was 28.4% (eVisits: 36.8%, secure messages 18.7%, videoconference 23.5%) with no significant difference between them or F2F consultations. There was an average annual reduction of primary care visits by 0.09/patient, an increase in telephone visits by 0.20/patient, an increase in ED encounters by 0.011/patient, an increase in hospitalizations by 0.02/patient and an increase in out of hours visits by 0.019/patient. Laboratory testing was requested on average for 10.9% of telemedicine patients, imaging or procedures for 5.6% and prescriptions for 58.7% of patients. When looking at referrals to secondary care, on average 36.7% of virtual referrals required follow-up visit, with the average rate of follow-up for electronic referrals being higher than for videoconferencing (39.2% vs 23%, p=0.167). Technical failures were reported on average for 1.4% of virtual consultations to primary care. When using carbon footprint estimates, we calculate that the use of telemedicine in primary care services can potentially provide a net decrease in carbon footprint by 0.592kgCO2/patient/year. When follow-up rates are taken into account, we estimate that virtual consultations reduce carbon footprint for primary care services by 2.3 times, and for secondary care referrals by 2.2 times. No major concerns regarding quality of care, or patient satisfaction were identified. 5/7 studies that addressed cost-effectiveness, reported increased savings. Conclusions: Telemedicine provides quality, cost-effective, and environmentally sustainable care for patients in primary care with inconclusive evidence regarding the rates of subsequent healthcare utilization. The evidence is limited by heterogeneous, small-scale studies and lack of prospective comparative studies. Further research to identify the most appropriate telemedicine modality for different patient populations, clinical presentations, service provision (e.g. used to follow-up patients instead of initial diagnosis) as well as further education for patients and providers alike on how to make best use of this service is expected to improve outcomes and influence practice.

Keywords: telemedicine, healthcare utilisation, digital interventions, environmental impact, sustainable healthcare

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Authors: M. Velana, G. Rinkenauer

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Nowadays, nurses are facing unprecedented amounts of pressure due to the ongoing global health demands. Work-related stress can cause a high physical and psychological workload, which can lead, in turn, to burnout. On the physiological level, stress triggers an initial activation of the sympathetic nervous and adrenomedullary systems resulting in increases in cardiac activity. Furthermore, activation of the hypothalamus-pituitary-adrenal axis provokes endocrine and immune changes leading to the release of cortisol and cytokines in an effort to re-establish body balance. Based on the current state of the literature, it has been identified that resilience and mindfulness exercises among nurses can effectively decrease stress and improve mood. However, it is still unknown what relaxation techniques would be suitable for and to what extent would be effective to decrease psychophysiological arousal deriving from either a physiological or a psychological stressor. Moreover, although cardiac activity and cortisol are promising candidates to examine the effectiveness of relaxation to reduce stress, it still remains to shed light on the role of cytokines in this process so as to thoroughly understand the body’s response to stress and to relaxation. Therefore, the main aim of the present study is to develop a comprehensive experimental paradigm and assess different relaxation techniques, namely progressive muscle relaxation and a mindfulness exercise originating from cognitive therapy by means of biofeedback, under highly controlled laboratory conditions. An experimental between-subject design will be employed, where 120 participants will be randomized either to a physiological or a psychological stress-related experiment. Particularly, the cold pressor test refers to a procedure in which the participants have to immerse their non-dominant hands into ice water (2-3 °C) for 3 min. The participants are requested to keep their hands in the water throughout the whole duration. However, they can immediately terminate the test in case it would be barely tolerable. A pre-test anticipation phase and a post-stress period of 3 min, respectively, are planned. The Trier Social Stress Test will be employed to induce psychological stress. During this laboratory stressor, the participants are instructed to give a 5-min speech in front of a committee of communication specialists. Before the main task, there is a 10-min anticipation period. Subsequently, participants are requested to perform an unexpected arithmetic task. After stress exposure, the participants will perform one of the relaxation exercises (treatment condition) or watch a neutral video (control condition). Electrocardiography, salivary samples, and self-report will be collected at different time points. The preliminary results deriving from the pilot study showed that the aforementioned paradigm could effectively induce stress reactions and that relaxation might decrease the impact of stress exposure. It is of utmost importance to assess how the human body responds under different stressors and relaxation exercises so that an evidence-based intervention could be transferred in a clinical setting to improve nurses’ general health. Based on suggestive future laboratory findings, the research group plans to conduct a pilot-level randomized study to decrease stress and promote well-being among nurses who work in the stress-riddled environment of a hospital located in Northern Germany.

Keywords: nurses, psychophysiology, relaxation, stress

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