Search results for: management control systems
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 24443

Search results for: management control systems

4133 A Decision-Support Tool for Humanitarian Distribution Planners in the Face of Congestion at Security Checkpoints: A Real-World Case Study

Authors: Mohanad Rezeq, Tarik Aouam, Frederik Gailly

Abstract:

In times of armed conflicts, various security checkpoints are placed by authorities to control the flow of merchandise into and within areas of conflict. The flow of humanitarian trucks that is added to the regular flow of commercial trucks, together with the complex security procedures, creates congestion and long waiting times at the security checkpoints. This causes distribution costs to increase and shortages of relief aid to the affected people to occur. Our research proposes a decision-support tool to assist planners and policymakers in building efficient plans for the distribution of relief aid, taking into account congestion at security checkpoints. The proposed tool is built around a multi-item humanitarian distribution planning model based on multi-phase design science methodology that has as its objective to minimize distribution and back ordering costs subject to capacity constraints that reflect congestion effects using nonlinear clearing functions. Using the 2014 Gaza War as a case study, we illustrate the application of the proposed tool, model the underlying relief-aid humanitarian supply chain, estimate clearing functions at different security checkpoints, and conduct computational experiments. The decision support tool generated a shipment plan that was compared to two benchmarks in terms of total distribution cost, average lead time and work in progress (WIP) at security checkpoints, and average inventory and backorders at distribution centers. The first benchmark is the shipment plan generated by the fixed capacity model, and the second is the actual shipment plan implemented by the planners during the armed conflict. According to our findings, modeling and optimizing supply chain flows reduce total distribution costs, average truck wait times at security checkpoints, and average backorders when compared to the executed plan and the fixed-capacity model. Finally, scenario analysis concludes that increasing capacity at security checkpoints can lower total operations costs by reducing the average lead time.

Keywords: humanitarian distribution planning, relief-aid distribution, congestion, clearing functions

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4132 Impact of Disposed Drinking Water Sachets in Damaturu Town, Yobe State, Nigeria

Authors: Meeta Ratawa Tiwary

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Damaturu is the capital of Yobe State in northeastern Nigeria where civic amenities and facilities are not adequate even after 24 years of its existence. The volatile security and political situations are most significant causes for the same. The basic facility for the citizens in terms of drinking water and electricity are not available. For the drinking water, they have to rely on personal bore holes or the filtered borehole waters available in packaged sachets in the market. The present study is concerned with the environmental impact of indiscriminate disposal of drinking synthetic polythene water sachets in Damaturu. The sachet water is popularly called as ‘pure water’, but its purity is questionable. Increased production and consumption of sachet water has led to indiscriminate dumping and disposal of empty sachets leading to a serious environmental threat. The evidence of this is seen in the amount of disposed sachets littering the streets and also the drainages blocked by ‘blocks’ of water sachet waste. Sachet water gained much popularity in Nigeria because the product is convenient for use, affordable and economically viable. The present study aims to find out the solution to this environmental problem. The field-based study has found some significant factors that cause environmental and socio-economic effect due to this. Some recommendations have been made based on research findings regarding sustainable waste management, recycling and re-use of the non-biodegradable products in society.

Keywords: civic amenities, non-biodegradable, pure water, sustainable environment, waste disposal

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4131 Exploring Causes of Homelessness and Shelter Entry: A Case Study Analysis of Shelter Data in New York

Authors: Lindsay Fink, Sarha Smith-Moyo, Leanne W. Charlesworth

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In recent years, the number of individuals experiencing homelessness has increased in the United States. This paper analyzes 2019 data from 16 different emergency shelters in Monroe County, located in Upstate New York. The data were collected through the County’s Homeless Management Information System (HMIS), and individuals were de-identified and de-duplicated for analysis. The purpose of this study is to explore the basic characteristics of the homeless population in Monroe County, and the dynamics of shelter use. The results of this study showed gender as a significant factor when analyzing the relationship between demographic variables and recorded reasons for shelter entry. Results also indicated that age and ethnicity did not significantly influence odds of re-entering a shelter, but did significantly influence reasons for shelter entry. Overall, the most common recorded cause of shelter entry in 2019 in the examined county was eviction by primary tenant. Recommendations to better address recurrent shelter entry and potential chronic homelessness include more consideration for the diversity existing within the homeless population, and the dynamics leading to shelter stays, including enhanced funding and training for shelter staff, as well as expanded access to permanent supportive housing programs.

Keywords: chronic homelessness, homeless shelter stays, permanent supportive housing, shelter population dynamics

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4130 Urban Vegetative Planning for Ambient Ozone Pollution: An Eco-Management Approach

Authors: M. Anji Reddy, R. Uma Devi

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Environmental planning for urban development is very much needed to reduce air pollution through the enhancement of vegetative cover in the cities like Hyderabad. This can be mainly based on the selection of appropriate native plant species as bioindicators to assess the impact of ambient Ozone. In the present study, tolerant species are suggested aimed to reduce the magnitude of ambient ozone concentrations which not only increase eco-friendly vegetation but also moderate air pollution. Hyderabad city is divided into 5 zones based on Land Use/Land Cover category further each zone divided into residential, traffic, industrial, and peri-urban areas. Highest ambient ozone levels are recorded in Industrial areas followed by traffic areas in the entire study area ( > 180 µg/m3). Biomonitoring of selected sixteen local urban plant species with the help of Air Pollution Tolerance Index (APTI) showed its susceptibility to air pollution. Statistical regression models in between the tolerant plant species and ambient ozone levels suggested five plant species namely Azardirachta indica A. Juss which have a high tolerant response to ambient ozone followed by Delonix regia Hook. along with Millingtonia hortensis L.f., Alestonia Scholaries L., and Samania saman Jacq. in the industrial and traffic areas of the study area to mitigate ambient Ozone pollution and also to improve urban greenery.

Keywords: air pollution tolerance index, bio-indicators, eco-friendly vegetation, urban greenery

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4129 Interior Design: Changing Values

Authors: Kika Ioannou Kazamia

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This paper examines the action research cycle of the second phase of longitudinal research on sustainable interior design practices, between two groups of stakeholders, designers and clients. During this phase of the action research, the second step - the change stage - of Lewin’s change management model has been utilized to change values, approaches, and attitudes toward sustainable design practices among the participants. Affective domain learning theory is utilized to attach new values. Learning with the use of information technology, collaborative learning, and problem-based learning are the learning methods implemented toward the acquisition of the objectives. Learning methods, and aims, require the design of interventions with participants' involvement in activities that would lead to the acknowledgment of the benefits of sustainable practices. Interventions are steered to measure participants’ decisions for the worth and relevance of ideas, and experiences; accept or commit to a particular stance or action. The data collection methods used in this action research are observers’ reports, participants' questionnaires, and interviews. The data analyses use both quantitative and qualitative methods. The main beneficial aspect of the quantitative method was to provide the means to separate many factors that obscured the main qualitative findings. The qualitative method allowed data to be categorized, to adapt the deductive approach, and then examine for commonalities that could reflect relevant categories or themes. The results from the data indicate that during the second phase, designers and clients' participants altered their behaviours.

Keywords: design, change, sustainability, learning, practices

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4128 ARABEX: Automated Dotted Arabic Expiration Date Extraction using Optimized Convolutional Autoencoder and Custom Convolutional Recurrent Neural Network

Authors: Hozaifa Zaki, Ghada Soliman

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In this paper, we introduced an approach for Automated Dotted Arabic Expiration Date Extraction using Optimized Convolutional Autoencoder (ARABEX) with bidirectional LSTM. This approach is used for translating the Arabic dot-matrix expiration dates into their corresponding filled-in dates. A custom lightweight Convolutional Recurrent Neural Network (CRNN) model is then employed to extract the expiration dates. Due to the lack of available dataset images for the Arabic dot-matrix expiration date, we generated synthetic images by creating an Arabic dot-matrix True Type Font (TTF) matrix to address this limitation. Our model was trained on a realistic synthetic dataset of 3287 images, covering the period from 2019 to 2027, represented in the format of yyyy/mm/dd. We then trained our custom CRNN model using the generated synthetic images to assess the performance of our model (ARABEX) by extracting expiration dates from the translated images. Our proposed approach achieved an accuracy of 99.4% on the test dataset of 658 images, while also achieving a Structural Similarity Index (SSIM) of 0.46 for image translation on our dataset. The ARABEX approach demonstrates its ability to be applied to various downstream learning tasks, including image translation and reconstruction. Moreover, this pipeline (ARABEX+CRNN) can be seamlessly integrated into automated sorting systems to extract expiry dates and sort products accordingly during the manufacturing stage. By eliminating the need for manual entry of expiration dates, which can be time-consuming and inefficient for merchants, our approach offers significant results in terms of efficiency and accuracy for Arabic dot-matrix expiration date recognition.

Keywords: computer vision, deep learning, image processing, character recognition

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4127 Mediated and Moderated Effects of Insecure Attachment Style and Depressions

Authors: Li-Ting Chen, Chih-Tao Cheng, I-Ping Huang, Jen-Ho Chang, Nien-Tzu Chang, Fei-Hsiu Hsiao

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Background: Insecurity adult attachment style may be triggered by cancer threat, which in turn influences depression symptoms. Dispositional mindfulness may have benefits of insecure attachment on depression for colorectal patient transfer to survivor. Objective: This study examined the mediating and moderating effects of quality of life (QOL) and dispositional mindfulness on the relationship between insecure attachment style and depression symptoms. Methods: A cross-sectional study design was used. Data were collected using the QOL functional and symptoms (EORTC-C30 and EORTC CR29), dispositional mindfulness (FFMQ), Short form of Experience in Close Relationships Revised Questionnaire (SF-ECRRQ), and depressive symptoms (BDI-II scale). Results: Of the 90 CRC survivors who participated, the indirect effect of both ECR anxiety (β=0.23, CI=0.05-0.44) and ECR avoidance (β=0.12, CI=0.02-0.24) on depression were significantly mediated through EORTC-C29 colorectal symptoms. Three components of dispositional mindfulness (i.e., acting of awareness, non-judging, non-reactivity) as the moderator in the relationship between ECR anxiety and depressive symptoms. Acting of awareness was a moderator in the relationship between ECR avoidance and depressive symptoms. Conclusions: There are two pathways from insecure attachment to depression: through the mediator of colorectal symptoms and the moderator of dispositional mindfulness. Cancer symptom management and mindfulness practices could improve the impact of insecure attachment on depression among CRC patients in a post-treatment transition period.

Keywords: acting of awareness, attachment style, colorectal cancer, disposisitonal mindfulness, depression

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4126 Efficient Reuse of Exome Sequencing Data for Copy Number Variation Callings

Authors: Chen Wang, Jared Evans, Yan Asmann

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With the quick evolvement of next-generation sequencing techniques, whole-exome or exome-panel data have become a cost-effective way for detection of small exonic mutations, but there has been a growing desire to accurately detect copy number variations (CNVs) as well. In order to address this research and clinical needs, we developed a sequencing coverage pattern-based method not only for copy number detections, data integrity checks, CNV calling, and visualization reports. The developed methodologies include complete automation to increase usability, genome content-coverage bias correction, CNV segmentation, data quality reports, and publication quality images. Automatic identification and removal of poor quality outlier samples were made automatically. Multiple experimental batches were routinely detected and further reduced for a clean subset of samples before analysis. Algorithm improvements were also made to improve somatic CNV detection as well as germline CNV detection in trio family. Additionally, a set of utilities was included to facilitate users for producing CNV plots in focused genes of interest. We demonstrate the somatic CNV enhancements by accurately detecting CNVs in whole exome-wide data from the cancer genome atlas cancer samples and a lymphoma case study with paired tumor and normal samples. We also showed our efficient reuses of existing exome sequencing data, for improved germline CNV calling in a family of the trio from the phase-III study of 1000 Genome to detect CNVs with various modes of inheritance. The performance of the developed method is evaluated by comparing CNV calling results with results from other orthogonal copy number platforms. Through our case studies, reuses of exome sequencing data for calling CNVs have several noticeable functionalities, including a better quality control for exome sequencing data, improved joint analysis with single nucleotide variant calls, and novel genomic discovery of under-utilized existing whole exome and custom exome panel data.

Keywords: bioinformatics, computational genetics, copy number variations, data reuse, exome sequencing, next generation sequencing

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4125 The Risk Assessments of Water Quality in Selected White Water River in Malaysia

Authors: Jaffry Zakaria, Nor Azlina Hasbullah

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The research on water quality based on 'Water Quality Index' (WQI) has been on the run along Kampar River in Perak State of Malaysia. This study was conducted to achieve several key objective that determe the value of the parameters that were studied based on Water Quality Index (WQI). The parameters include Dissolved Oxygen (DO), pH, Biochemical Oxygen Demand (BOD), Chemical Oxygen Demand (COD) and Suspended Solids. In this study, three sampling stations were selected. Through observations from the researchers, several pollutions were found occurring along the research area such as the disposal of waste water directly without treatment from villagers, widespread dumping of solid waste and the development of the surrounding areas that contributed to the pollution of Sungai Kampar in Perak, Malaysia. Sungai Kampar is commonly used for water recreational activities as well as for bathing purposes. Results showed that Sungai Kampar is classified under category III. According to Interim National Water Quality Standard for Malaysia (INWQS), rivers in the third grade are clean but not suitable for river recreational activities. Therefore, there is a requirement to investigate and analysis the water quality of all white water rivers in Malaysia focusing on the area of water activities. The combination of technology and risk management based on risk assessments can help the recreational industry to survive in future.

Keywords: risk assessments, White Water River, water quality index (WQI), Interim National Water Quality Standard for Malaysia (INWQS)

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4124 An Overview of Technology Availability to Support Remote Decentralized Clinical Trials

Authors: Simone Huber, Bianca Schnalzer, Baptiste Alcalde, Sten Hanke, Lampros Mpaltadoros, Thanos G. Stavropoulos, Spiros Nikolopoulos, Ioannis Kompatsiaris, Lina Pérez- Breva, Vallivana Rodrigo-Casares, Jaime Fons-Martínez, Jeroen de Bruin

Abstract:

Developing new medicine and health solutions and improving patient health currently rely on the successful execution of clinical trials, which generate relevant safety and efficacy data. For their success, recruitment and retention of participants are some of the most challenging aspects of protocol adherence. Main barriers include: i) lack of awareness of clinical trials; ii) long distance from the clinical site; iii) the burden on participants, including the duration and number of clinical visits and iv) high dropout rate. Most of these aspects could be addressed with a new paradigm, namely the Remote Decentralized Clinical Trials (RDCTs). Furthermore, the COVID-19 pandemic has highlighted additional advantages and challenges for RDCTs in practice, allowing participants to join trials from home and not depend on site visits, etc. Nevertheless, RDCTs should follow the process and the quality assurance of conventional clinical trials, which involve several processes. For each part of the trial, the Building Blocks, existing software and technologies were assessed through a systematic search. The technology needed to perform RDCTs is widely available and validated but is yet segmented and developed in silos, as different software solutions address different parts of the trial and at various levels. The current paper is analyzing the availability of technology to perform RDCTs, identifying gaps and providing an overview of Basic Building Blocks and functionalities that need to be covered to support the described processes.

Keywords: architectures and frameworks for health informatics systems, clinical trials, information and communications technology, remote decentralized clinical trials, technology availability

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4123 Clinical Risk Score for Mortality and Predictors of Severe Disease in Adult Patients with Dengue

Authors: Siddharth Jain, Abhenil Mittal, Surendra Kumar Sharma

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Background: With its recent emergence and re-emergence, dengue has become a major international public health concern, imposing significant financial burden especially in developing countries. Despite aggressive control measures in place, India experienced one of its largest outbreaks in 2015 with Delhi being most severely affected. There is a lack of reliable predictors of disease severity and mortality in dengue. The present study was carried out to identify these predictors during the 2015 outbreak. Methods: This prospective observational study conducted at an apex tertiary care center in Delhi, India included confirmed adult dengue patients admitted between August-November 2015. Patient demographics, clinical details, and laboratory findings were recorded in a predesigned proforma. Appropriate statistical tests were used to summarize and compare the clinical and laboratory characteristics and derive predictors of mortality and severe disease, while developing a clinical risk score for mortality. Serotype analysis was also done for 75 representative samples to identify the dominant serotypes. Results: Data of 369 patients were analyzed (mean age 30.9 years; 67% males). Of these, 198 (54%) patients had dengue fever, 125 (34%) had dengue hemorrhagic fever (DHF Grade 1,2)and 46 (12%) developed dengue shock syndrome (DSS). Twenty two (6%) patients died. Late presentation to the hospital (≥5 days after onset) and dyspnoea at rest were identified as independent predictors of severe disease. Age ≥ 24 years, dyspnoea at rest and altered sensorium were identified as independent predictors of mortality. A clinical risk score was developed (12*age + 14*sensorium + 10*dyspnoea) which, if ≥ 22, predicted mortality with a high sensitivity (81.8%) and specificity (79.2%). The predominant serotypes in Delhi (2015) were DENV-2 and DENV-4. Conclusion: Age ≥ 24 years, dyspnoea at rest and altered sensorium were identified as independent predictors of mortality. Platelet counts did not determine the outcome in dengue patients. Timely referral/access to health care is important. Development and use of validated predictors of disease severity and simple clinical risk scores, which can be applied in all healthcare settings, can help minimize mortality and morbidity, especially in resource limited settings.

Keywords: dengue, mortality, predictors, severity

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4122 Maximizing Customer Service through Logistics Service Support in the Automobile Industry in Ghana

Authors: John M. Frimpong, Matilda K. Owusu-Bio, Caleb Annan

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Business today is highly competitive, and the automobile industry is no exception. Therefore, it is necessary to determine the customer value and service quality measures that lead to customer satisfaction which in turn lead to customer loyalty. However, in the automobile industry, the role of logistics service support in these relationships cannot be undermined. It could be inferred that logistics service supports and its management has a direct correlation with customer service and or service quality. But this is not always the same for all industries. Therefore, this study was to investigate how automobile companies implement the concept of customer service through logistics service supports. In order to ascertain this, two automobile companies in Ghana were selected, and these are Toyota Ghana Limited and Mechanical Lloyd Company Ltd. The study developed a conceptual model to depict the study’s objectives from which questionnaires were developed from for data collection. Respondents were made up of customers and staff of the two companies. The findings of the study revealed that the automobile industry partly attributes their customer satisfaction to the customer value, service quality or customer value. It shows a positive relationship between logistics service supports and service quality and customer value. However, the results indicate that customer satisfaction is not predicted by logistics services. This implies that in the automobile industry, it is not always the case that when customer service is implemented through logistics service supports, it leads to customer satisfaction. Therefore, there is the need for all players and stakeholders in the automobile industry investigate other factors which help to increase customer satisfaction in addition to logistics service supports. It is recommended that logistics service supports should be geared towards meeting customer expectations and not just based on the organization’s standards and procedures. It is necessary to listen to the voice of the customer to tailor the service package to suit the needs and expectations of the customer.

Keywords: customer loyalty, customer satisfaction, customer service, customer value, logistics service supports

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4121 The Abundance and Distribution of Locally Important Species Along Different Altitude: The Case of Mountain Damota, Wolaita South Ethiopia

Authors: Tamirat Solomon, Tadesse Faltamo, Belete Limani

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This study was conducted on the mountain Damota of Wolaita to assess the abundance and spatial distribution of two locally important indigenous medicinal plants on the mountain landscape. A total of 130 plots measuring 20x20m were established along eight systematically laid transect lines. In each plot, the abundance and distribution of Hagenia abyssinica (tree) and Pentas schiperiana Vatke (shrub) were evaluated. The abundance and distribution of H. abyssinica were evaluated by measuring height and DBH for mature trees and counting seedlings and saplings, whereas the P. schiperiana Vatke was assessed for its abundance and distribution by counting in each plot. In the entire study plots, a total of 485 H. abyssinica and 760 P. schiperiana vatake were recorded. It was observed that the distribution of the species increased while the altitude increased and the highest abundance of the species was recorded at an altitude range between 2332 and 2661m.a.s.l. However, at the altitudes below 2320 m.a.s.l., the species distributions and abundance was decreased, indicating either the ecological preference of the species or the extraction of the local community surrounding the mountain influenced the species. On average, only 28 seedlings/ha of H. abyssinica and 146/ha of P. schiperiana vatke were recorded in the study areas showing the tendency of decline in the abundance and distribution of both species. Finally, we recommend management intervention for the socially important species which are under threat on the mountain landscape.

Keywords: indigenous medicinal plants, H.abyssinic, P. schiperiana, distribution, abundance, socio-economic importance

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4120 Physical and Chemical Parameters of Lower Ogun River, Ogun State, Nigeria

Authors: F.I. Adeosun, A.A. Idowu, D.O. Odulate,

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The aims of carrying out this experiment were to determine the water quality and to investigate if the various human and ecological activities around the river have any effect on the physico-chemical parameters of the river’s resources with a view to effectively utilizing these resources. Water samples were collected from two stations on the surface water of Lower Ogun River Akomoje biweekly for a period of 5 months (January to May, 2011). Results showed that temperature ranged between 24.0-30.7oC, transparency (0.53-1.00 m), depth (1.0-3.88 m), alkalinity (4.5-14.5 mg/l), nitrates (0.235-5.445 mg/l), electrical conductivity (140-190µS/cm), dissolved oxygen (4.12-5.32 mg/l), phosphates (0.02 mg/l-0.7 5 mg/l) and total dissolved solids (70-95).The parameters at the deep end (station A) accounted for the bulk of the highest values; there was however no significant differences between the stations at P˂0.05 with the exception of transparency, depth, total dissolved solids and electrical conductivity. The phosphate value was relatively low which accounted for the low productivity and high transparency. The results obtained from the physico-chemical parameters agreed with the limits set by both national and international bodies for drinking and fish growth. It was however observed that during the period of data collection, catch was low and this could be attributed to low level of primary productivity due to the quality of physico-chemical parameters of the water. It is recommended that the agencies involved in the management of the river should put the right policies in place that will effectively enhance proper exploitation of the water resources. More research should also be carried out on the physico-chemical parameters since this work only studied the water for five months.

Keywords: physical, chemical, parameters, water quality, Ogunriver

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4119 Development and Evaluation of a Calcium Rich Plant-Based Supplement on Bone Turnover of Peri and Post Menopausal Women

Authors: Gayathri.G, Hemamalini.A.J, Chandrasekaran.A

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Problem statement: Nutritional deficiency, especially calcium, may lead to poor bone formation and mineralization. Although there are plenty of synthetic supplements available, it is essential to make a calcium rich food supplement accessible to combat calcium deficiency that could be readily prepared at the household level. Thus the current study aimed to formulate and standardize an indigenous low-cost calcium-rich food supplement and to study the impact of supplementation on the bone resorption and formation markers. Methods: A Randomized controlled trial was conducted with 60 subjects distributed equally in control and experimental groups, including perimenopausal and postmenopausal women. A plant-based calcium-rich product was developed and supplemented in form of balls as a midmorning and evening snack by addition of optimized proportions of leaves of Sesbania Grandiflora, seeds of Sesamum indicum, Eleusine coracana, Glycine max, Vigna mungo for a period of 6 months. Postmenopausal and perimenopausal women received 1200mg and 800mg of calcium per day from the supplemented, respectively. Outcome measures like serum calcium; betacrosslaps (bone resorption marker) and total P1NP (bone absorption marker) were assessed after 3 months and after 6 months. Results: There were no significant changes seen in the serum calcium and total P1NP levels (bone formation marker) among the subjects during the supplementation period. The bone resorption marker (betacrosslaps) reduced in all the groups and the reduction (0.32 ± 0.130 ng/ml to 0.25 ± 0.130 ng/ml) was found to be statistically highly significant (p < 0.01) in experimental group of perimenopausal subjects and significant (p < 0.05) in experimental group of postmenopausal subjects (1.11 ± 0.290 ng/ml to 0.42 ± 0.263 ng/ml). Conclusion: With the current severe calcium deficiency in the Indian population, integrating low-cost, calcium-rich native foods that could be readily prepared at household level would be useful in raising the nutritional consumption of calcium, which would, in turn, decrease bone turnover.

Keywords: calcium, sesbania grandiflora, sesamum indicum, eleusine coracana, glycine max, vigna mungo, postmenopause, perimenopause, bone resorption, bone absorption, betacrosslaps, total P1NP

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4118 Oncological and Antiresorptive Treatment of Breast Cancer: Dental Assessment and Risk of MRONJ Development

Authors: Magdalena Korytowska, Gunnar Lengstrand, Cecilia Larsson Wexell

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Background: Breast cancer (BC) is the most common cancer among women worldwide, and cases are continuing to increase in Sweden. Bone is the most common metastatic site in breast cancer patients, where > 65-75% of women with advanced breast cancer develop bone metastases during their disease. To prevent the skeletal-related events of metastases (e.g., pathological fractures, bone loss, cancer-induced bone pain, and hypercalcemia bone), two different classes of antiresorptive medications (AR), bisphosphonate and denosumab are typically administered every 3 to 4 weeks. Since 2015, adjuvant bisphosphonate treatment has been used every six months for three to five years in postmenopausal women for the prevention of skeletal metastases and improved survival. Methods: A case-control study was conducted to test the hypotheses that patients treated with high-dose AR are at higher risk of developing MRONJ than breast cancer patients with adjuvant bisphosphonate treatment at a lower dose. Medical and odontological data was collected between 2015-2020. Assessment of oral health and dental care before and during oncological treatment took place at the specialist clinic for Orofacial medicine linked to the specific hospital. Results: In total, 220 patients were included, 101 patients in the high-dose group and 119 patients in the adjuvant BP-treatment group. MRONJ was diagnosed in 13 patients (14%) in the high-dose group. The mandible was affected in most of the cases (84.6%), with a mean duration of high-dose treatment of 19.7 months. In 46.2% of cases, no dental cause of MRONJ could be identified. Overall, estrogen receptor-positive (ER+) BC was the most representative type in 172 patients (78.2%). However, this was 83.9% in the high-dose cases group. The most used drug was denosumab. Twenty-five patients (26.9%) switched their medication from ZOL to denosumab during their oncological treatment. Patients with ER+ breast cancer were reported in 88 patients (87.8%) in the adjuvant group that was treated with ZOL. Conclusions: MRONJ was diagnosed only in the high-dose AR group. Dental assessment and care of patients in the adjuvant group should be considered, with a recommendation to potentially prolong ZOL treatment from 3 to 5 years, with concomitant use of hormonal therapy in patients diagnosed with ER+ breast cancer to prevent bone loss induced by oncological treatment. A new referral for dental assessment is very important in the case of bone metastases when treatment with high dose AR will be required since it is associated with a higher risk of MRONJ.

Keywords: antiresorptive therapy, breast cancer, dental care, MRONJ

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4117 Development of a Fuzzy Logic Based Model for Monitoring Child Pornography

Authors: Mariam Ismail, Kazeem Rufai, Jeremiah Balogun

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A study was conducted to apply fuzzy logic to the development of a monitoring model for child pornography based on associated risk factors, which can be used by forensic experts or integrated into forensic systems for the early detection of child pornographic activities. A number of methods were adopted in the study, which includes an extensive review of related works was done in order to identify the factors that are associated with child pornography following which they were validated by an expert sex psychologist and guidance counselor, and relevant data was collected. Fuzzy membership functions were used to fuzzify the associated variables identified alongside the risk of the occurrence of child pornography based on the inference rules that were provided by the experts consulted, and the fuzzy logic expert system was simulated using the Fuzzy Logic Toolbox available in the MATLAB Software Release 2016. The results of the study showed that there were 4 categories of risk factors required for assessing the risk of a suspect committing child pornography offenses. The results of the study showed that 2 and 3 triangular membership functions were used to formulate the risk factors based on the 2 and 3 number of labels assigned, respectively. The results of the study showed that 5 fuzzy logic models were formulated such that the first 4 was used to assess the impact of each category on child pornography while the last one takes the 4 outputs from the 4 fuzzy logic models as inputs required for assessing the risk of child pornography. The following conclusion was made; there were factors that were related to personal traits, social traits, history of child pornography crimes, and self-regulatory deficiency traits by the suspects required for the assessment of the risk of child pornography crimes committed by a suspect. Using the values of the identified risk factors selected for this study, the risk of child pornography can be easily assessed from their values in order to determine the likelihood of a suspect perpetuating the crime.

Keywords: fuzzy, membership functions, pornography, risk factors

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4116 Non-Invasive Viscosity Determination of Liquid Organic Hydrogen Carriers by Alteration of Temperature and Flow Velocity Using Cavity Based Permittivity Measurement

Authors: I. Wiemann, N. Weiß, E. Schlücker, M. Wensing, A. Kölpin

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Chemical storage of hydrogen by liquid organic hydrogen carriers (LOHC) is a very promising alternative to compression or cryogenics. These carriers have high energy density and allow at the same time efficient and safe storage of hydrogen under ambient conditions and without leakage losses. Another benefit of LOHC is the possibility to transport it using already available infrastructure for transport of fossil fuels. Efficient use of LOHC is related to a precise process control, which requires a number of sensors in order to measure all relevant process parameters, for example, to measure the level of hydrogen loading of the carrier. The degree of loading is relevant for the energy content of the storage carrier and represents simultaneously the modification in chemical structure of the carrier molecules. This variation can be detected in different physical properties like viscosity, permittivity or density. Thereby, each degree of loading corresponds to different viscosity values. Conventional measurements currently use invasive viscosity measurements or near-line measurements to obtain quantitative information. Avoiding invasive measurements has several severe advantages. Efforts are currently taken to provide a precise, non-invasive measurement method with equal or higher precision of the obtained results. This study investigates a method for determination of the viscosity of LOHC. Since the viscosity can retroactively derived from the degree of loading, permittivity is a target parameter as it is a suitable for determining the hydrogenation degree. This research analyses the influence of common physical properties on permittivity. The permittivity measurement system is based on a cavity resonator, an electromagnetic resonant structure, whose resonation frequency depends on its dimensions as well as the permittivity of the medium inside. For known resonator dimensions, the resonation frequency directly characterizes the permittivity. In order to determine the dependency of the permittivity on temperature and flow velocity, an experimental setup with heating device and flow test bench was designed. By varying temperature in the range of 293,15 K -393,15 K and flow velocity up to 140 mm/s, corresponding changes in the resonation frequency were measured in the hundredths of the GHz range.

Keywords: liquid organic hydrogen carriers, measurement, permittivity, viscosity., temperature, flow process

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4115 Assessment of Water Quality of Selected Lakes of Coimbatore District, Tamil Nadu, India

Authors: K. P. Ganesh, T. Gomathi, L. Arul Pragasan

Abstract:

Degradation of lake water quality is one of the serious environmental threats for the last few decades, particularly, the lakes situated in and around urban and industrial areas. The present study aimed to analyze the physicochemical and biological parameters, and metal elements to determine the water quality of Krishnampathi, Ukkadam, Kurichi, Sulur and Singanallur Lakes. Of the 23 physicochemical parameters analyzed in the five lakes, except TDS, Chloride and Total hardness values all the 20 parameters were found within the prescribed limit as recommended by World Health Organization (WHO) and Bureau of Indian Standards (BIS). In case of biological parameter, both Total Coliform and Fecal Coliform bacteria (Escherichia coli) were identified. This indicates the contamination of lakes by fecal matter, and warns of potential of disease causing by viruses, bacteria and other organisms. Among the twelve metal elements (Al, Cr, Mn, Fe, Ni, Cu, Zn, As, Se, Mo, Cd and Pb) determined by inductively coupled plasma-mass spectroscopy, except Cd (for all lakes), and Pb (for Ukkadam, Kurichi, Sulur & Singanallur), all the elements were found above the prescribed limits of BIS. The results of the present study revealed that all the five major lakes of Coimbatore were contaminated. It is recommended that proper implementation of the new wetland waste management system and monitoring of water quality be of the urgent need to sustain the water bodies for future generations.

Keywords: heavy metals, inductively coupled plasma-mass spectroscopy, physicochemical and biological parameters, water quality

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4114 A Pilot Study Based on Online Survey Research Assessing the COVID-19 Impact on the Wellbeing of 15 Dogs Involved in Flemish Animal-Assisted Intervention Projects

Authors: L. Meers, L. Contalbrigo, V. Stevens, O. Ulitina, S. Laufer, W. E. Samuels, S. Normando

Abstract:

Since the COVID-19 pandemic started, there has been concern that domestic animals may help spread SARS-Cov-2. This concern also greatly affected human-animal interaction projects such as animal-assisted interventions (AAI). As a result, institutions and AAI practitioners developed new safety protocols and procedures to control the spread of the SARS-Cov-2 virus during AAI sessions and to guarantee safety for their clients and animals. However, little is known yet about the impact on animals' needs and the possible welfare issues due to these lifestyle adaptions. Fifteen therapists in Flanders, Belgium, who were currently conducting canine-assisted interventions, conducted unstructured observations on how their dogs' (11 mixed breeds, 3 Labradors, 1 terrier aged 2 – 12 years) behaviors changed due to institutional COVID-19 safety protocols. Most (80%) of the respondents reported that their dogs showed sniffing or sneezing after smelling disinfected areas. Two (13%) dogs responded with vomiting and gagging, and three (20%) dogs urinated over disinfected areas. All protocols advise social distancing between participants and animals. When held back, eight (53%) dogs showed self-calming behaviors. Respondents reported that most (73%) dogs responded with flight reactions when seeing humans wearing facial masks. When practitioners threw their used masks in open dustbins, five (33%) dogs tried to take them out with their mouths and play with them; two (13%) Labradors tried to eat them. Taking the dogs' temperatures was the most frequently (53%) used method to supervise their health. However, all dogs showed behaviors as ducking the tail, trying to escape, or biting the animal handler during this procedure. We interpret these results to suggest that dogs tended to react with stress and confusion to the changes in AAI practices they're part of. The health and safety protocols that institutions used were largely borne from recommendations made to protect humans. The participating practitioners appeared to use their knowledge of dog behavior and safety to modify them as best they could—but with more significant concern directed towards the other humans. Given their inter-relatedness and mutual importance for welfare, we advocate for integrated human and animal health and welfare assessments and protocols to provide a framework for "One health" approaches in animal-assisted interventions.

Keywords: animal-assisted therapy, COVID-19 protocol, one health, welfare

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4113 Developing a Spatial Transport Model to Determine Optimal Routes When Delivering Unprocessed Milk

Authors: Sunday Nanosi Ndovi, Patrick Albert Chikumba

Abstract:

In Malawi, smallholder dairy farmers transport unprocessed milk to sell at Milk Bulking Groups (MBGs). MBGs store and chill the milk while awaiting collection by processors. The farmers deliver milk using various modes of transportation such as foot, bicycle, and motorcycle. As a perishable food, milk requires timely transportation to avoid deterioration. In other instances, some farmers bypass the nearest MBGs for facilities located further away. Untimely delivery worsens quality and results in rejection at MBG. Subsequently, these rejections lead to revenue losses for dairy farmers. Therefore, the objective of this study was to optimize routes when transporting milk by selecting the shortest route using time as a cost attribute in Geographic Information Systems (GIS). A spatially organized transport system impedes milk deterioration while promoting profitability for dairy farmers. A transportation system was modeled using Route Analysis and Closest Facility network extensions. The final output was to find the quickest routes and identify the nearest milk facilities from incidents. Face-to-face interviews targeted leaders from all 48 MBGs in the study area and 50 farmers from Namahoya MBG. During field interviews, coordinates were captured in order to create maps. Subsequently, maps supported the selection of optimal routes based on the least travel times. The questionnaire targeted 200 respondents. Out of the total, 182 respondents were available. Findings showed that out of the 50 sampled farmers that supplied milk to Namahoya, only 8% were nearest to the facility, while 92% were closest to 9 different MBGs. Delivering milk to the nearest MBGs would minimize travel time and distance by 14.67 hours and 73.37 km, respectively.

Keywords: closest facility, milk, route analysis, spatial transport

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4112 Engineering Education for Sustainable Development in China: Perceptions Bias between Experienced Engineers and Engineering Students

Authors: Liang Wang, Wei Zhang

Abstract:

Nowadays, sustainable development has increasingly become an important research topic of engineering education. Existing research on Engineering Education for Sustainable Development (EESD) has highlighted the importance of perceptions for ethical responsibility to address sustainable development in practice. However, whether and how the professional engineering experience affects those perceptions has not been proved, especially in a Chinese context. Our study fills this gap by investigating the perceptions bias of EESD between experienced engineers and engineering students. We specifically examined what EESD means for experienced engineers and engineering students using a triple-dimensional model to understand if there are obvious differences between the two groups. Our goal is to make the benefits of these experiences more accessible in school context. The data (n=438) came from a questionnaire created and adapted from previously published studies containing 288 students from mechanical or civil engineering and 150 civil engineers with rich working experience, and the questionnaire was distributed during Fall 2020. T-test was used to find the difference in different dimensions between the two groups. The statistical results show that there is a significant difference in the perceptions of EESD between experienced engineers and inexperienced engineering students in China. Experienced engineers tend to consider sustainable development from ecological, economic, and social perspectives, while engineering students' answers focus more on ecology and ignore economic and social dimensions to some extend. The findings provide empirical evidence that professional experience is helpful to cultivate the cognition and ability of sustainable development in engineering education. The results of this work indicate that more practical content should be added to engineering education to promote sustainable development. In addition, for the design of engineering courses and professional practice systems for sustainable development, we should not only pay attention to the ecological aspects but also emphasize the coordination of ecological, economic, and socially sustainable development (e.g., engineer's ethical responsibility).

Keywords: engineering education, sustainable development, experienced engineers, engineering students

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4111 Integration of Big Data to Predict Transportation for Smart Cities

Authors: Sun-Young Jang, Sung-Ah Kim, Dongyoun Shin

Abstract:

The Intelligent transportation system is essential to build smarter cities. Machine learning based transportation prediction could be highly promising approach by delivering invisible aspect visible. In this context, this research aims to make a prototype model that predicts transportation network by using big data and machine learning technology. In detail, among urban transportation systems this research chooses bus system.  The research problem that existing headway model cannot response dynamic transportation conditions. Thus, bus delay problem is often occurred. To overcome this problem, a prediction model is presented to fine patterns of bus delay by using a machine learning implementing the following data sets; traffics, weathers, and bus statues. This research presents a flexible headway model to predict bus delay and analyze the result. The prototyping model is composed by real-time data of buses. The data are gathered through public data portals and real time Application Program Interface (API) by the government. These data are fundamental resources to organize interval pattern models of bus operations as traffic environment factors (road speeds, station conditions, weathers, and bus information of operating in real-time). The prototyping model is designed by the machine learning tool (RapidMiner Studio) and conducted tests for bus delays prediction. This research presents experiments to increase prediction accuracy for bus headway by analyzing the urban big data. The big data analysis is important to predict the future and to find correlations by processing huge amount of data. Therefore, based on the analysis method, this research represents an effective use of the machine learning and urban big data to understand urban dynamics.

Keywords: big data, machine learning, smart city, social cost, transportation network

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4110 The Impact of Stigma on the Course of Mental Illness: A Brief Review

Authors: Mariana Mangas, Yaroslava Martins, Ana Matos Pires

Abstract:

Introduction: Stigmatization is a common problem to overcome for people suffering from chronic diseases. It usually follows mental disorders and complicates the course of illness and reduces quality of life for people with mental illness. Objective: unsystematic review concerning stigma and mental illness, its impact on psychiatric disease and strategies to eradicate stigma. Methods: A search was conducted on PubMed, using keywords 'stigma' and 'mental illness'. Results and Discussion: Stigma is a psychosocial process that identifies individuals by the negative label of their differences. Stigma often brings a loss of occupational success and social support, reduced functioning and lower quality of life. The sense of stigma is common in individuals with mental illness and has considerable negative repercussions: delays treatment achievement, promotes social isolation, stress and maladaptive coping behaviors and it is associated with higher symptom levels, placing these individuals at higher risk for a poorer outcome and prognoses. Conclusion: Given the interrelation between stigma, symptoms, treatment seeking and disease management, stigma is a key construct in mental illness upon which anti-stigma initiatives may have considerable therapeutic potential. It will take multidisciplinary interventions to overcome mental illness stigma, including changes in social policy, attitudes and practices among mental health professionals, liaison between general public and people with a mental illness under conditions of equity and parity, family support, and easy access to evidence-based treatments.

Keywords: discrimination, stigma, mental illness, quality of life

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4109 Expression-Based Learning as a Starting Point to Promote Students’ Creativity in K-12 Schools in China

Authors: Yanyue Yuan

Abstract:

In this paper, the author shares the findings of a pilot study that examines students’ creative expressions and their perceptions of creativity when engaged in project-based learning. The study is based on an elective course that the author co-designed and co-taught with a colleague to sixteen grade six and seven students over the spring semester in 2019. Using the Little Prince story as the main prompt, they facilitated students’ original creation of a storytelling concert that integrated script writing, music production, lyrics, songs, and visual design as a result of both individual and collaborative work. The author will share the specific challenges we met during the project, including learning cultures of the school, class management, teachers' and parents’ attitude, process-oriented versus product-oriented mindset, and facilities and logistical resources. The findings of this pilot study will inform the ongoing research initiative of exploring how we can foster creative learning in public schools in the Chinese context. While K-12 schools of China’s public education system are still dominated by exam-oriented and teacher-centered approaches, the author proposes that expression-based learning can be a starting point for promoting students’ creativity and can serve as experimental efforts to initiate incremental changes within the current education framework. The paper will also touch upon insights gained from collaborations between university and K-12 schools.

Keywords: creativity, expression-based learning, K-12, incremental changes

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4108 Pastoralist Transhumance and Conflict along the Nigeria-niger Borderlands: Towards New Perspective for Effective Border Management in Africa

Authors: Abubakar Samaila

Abstract:

Pastoralism has been an old practice in the Sahel region of west Africa. In recent years, pastoralists in Nigeria have increasingly been migrating on seasonal transhumance southward from the neighboring countries, especially Niger Republic, in search of better grazing conditions due to mainly, climate change. This has increased pressure on farm lands which instigate farmer-herder conflicts. These conflicts occur mainly between farmers and pastoralists but also between pastoralist groups themselves. However, there has been a shift in these conflicts recently to involve traditional institutions and, in some cases, the local authorities along the borderlands. The involvement of local institutions in the conflict has created an incentive to local actors, particularly pastoralcommunity-based groups, in responding to these violent threats. As pastoralists are mobile, these conflicts became difficult to contain and, thus, spill across borders. Consequently, the conflict has now transformed into an urbanized regional conflicts that involve some major cities along the Nigeria-Niger borderlands; Sokoto, Zamfara, and Katsina on the Nigerian side andDosso, Tahoa andMaradi in Niger republic. These areas are now experiencing unprecedented growing wave of violence that have become complex and escalates into a hydra-social conflict. The aim of this research is to investigate how the fluidities of Nigeria-Niger borderland intensified armed conflicts between the local pastoral organizations and sedentary populationspreading to some urban cities along the borderlands. The paper further suggests alternative approaches towards addressing the perennial crisis in African borderlands.

Keywords: pastoralism, climate change, conflict, nigeria, niger, borderlands

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4107 Comparative Life Cycle Assessment of an Extensive Green Roof with a Traditional Gravel-Asphalted Roof: An Application for the Lebanese Context

Authors: Makram El Bachawati, Rima Manneh, Thomas Dandres, Carla Nassab, Henri El Zakhem, Rafik Belarbi

Abstract:

A vegetative roof, also called a garden roof, is a "roofing system that endorses the growth of plants on a rooftop". Garden roofs serve several purposes for a building, such as embellishing the roofing system, enhancing the water management, and reducing the energy consumption and heat island effects. Lebanon is a Middle East country that lacks the use of a sustainable energy system. It imports 98% of its non-renewable energy from neighboring countries and suffers flooding during heavy rains. The objective of this paper is to determine if the implementation of vegetative roofs is effectively better than the traditional roofs for the Lebanese context. A Life Cycle Assessment (LCA) is performed in order to compare an existing extensive green roof to a traditional gravel-asphalted roof. The life cycle inventory (LCI) was established and modeled using the SimaPro 8.0 software, while the environmental impacts were classified using the IMPACT 2002+ methodology. Results indicated that, for the existing extensive green roof, the waterproofing membrane and the growing medium were the highest contributors to the potential environmental impacts. When comparing the vegetative to the traditional roof, results showed that, for all impact categories, the extensive green roof had the less environmental impacts.

Keywords: life cycle assessment, green roofs, vegatative roof, environmental impact

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4106 Emergence of Fluoroquinolone Resistance in Pigs, Nigeria

Authors: Igbakura I. Luga, Alex A. Adikwu

Abstract:

A comparison of resistance to quinolones was carried out on isolates of Shiga toxin-producing Escherichia coliO157:H7 from cattle and mecA and nuc genes harbouring Staphylococcus aureus from pigs. The isolates were separately tested in the first and current decades of the 21st century. The objective was to demonstrate the dissemination of resistance to this frontline class of antibiotic by bacteria from food animals and bring to the limelight the spread of antibiotic resistance in Nigeria. A total of 10 isolates of the E. coli O157:H7 and 9 of mecA and nuc genes harbouring S. aureus were obtained following isolation, biochemical testing, and serological identification using the Remel Wellcolex E. coli O157:H7 test. Shiga toxin-production screening in the E. coli O157:H7 using the verotoxin E. coli reverse passive latex agglutination (VTEC-RPLA) test; and molecular identification of the mecA and nuc genes in S. aureus. Detection of the mecA and nuc genes were carried out using the protocol by the Danish Technical University (DTU) using the following primers mecA-1:5'-GGGATCATAGCGTCATTATTC-3', mecA-2: 5'-AACGATTGTGACACGATAGCC-3', nuc-1: 5'-TCAGCAAATGCATCACAAACAG-3', nuc-2: 5'-CGTAAATGCACTTGCTTCAGG-3' for the mecA and nuc genes, respectively. The nuc genes confirm the S. aureus isolates and the mecA genes as being methicillin-resistant and so pathogenic to man. The fluoroquinolones used in the antibiotic resistance testing were norfloxacin (10 µg) and ciprofloxacin (5 µg) in the E. coli O157:H7 isolates and ciprofloxacin (5 µg) in the S. aureus isolates. Susceptibility was tested using the disk diffusion method on Muller-Hinton agar. Fluoroquinolone resistance was not detected from isolates of E. coli O157:H7 from cattle. However, 44% (4/9) of the S. aureus were resistant to ciprofloxacin. Resistance of up to 44% in isolates of mecA and nuc genes harbouring S. aureus is a compelling evidence for the rapid spread of antibiotic resistance from bacteria in food animals from Nigeria. Ciprofloxacin is the drug of choice for the treatment of Typhoid fever, therefore widespread resistance to it in pathogenic bacteria is of great public health significance. The study concludes that antibiotic resistance in bacteria from food animals is on the increase in Nigeria. The National Food and Drug Administration and Control (NAFDAC) agency in Nigeria should implement the World Health Organization (WHO) global action plan on antimicrobial resistance. A good starting point can be coordinating the WHO, Office of International Epizootics (OIE), Food and Agricultural Organization (FAO) tripartite draft antimicrobial resistance monitoring and evaluation (M&E) framework in Nigeria.

Keywords: Fluoroquinolone, Nigeria, resistance, Staphylococcus aureus

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4105 Efficient Frequent Itemset Mining Methods over Real-Time Spatial Big Data

Authors: Hamdi Sana, Emna Bouazizi, Sami Faiz

Abstract:

In recent years, there is a huge increase in the use of spatio-temporal applications where data and queries are continuously moving. As a result, the need to process real-time spatio-temporal data seems clear and real-time stream data management becomes a hot topic. Sliding window model and frequent itemset mining over dynamic data are the most important problems in the context of data mining. Thus, sliding window model for frequent itemset mining is a widely used model for data stream mining due to its emphasis on recent data and its bounded memory requirement. These methods use the traditional transaction-based sliding window model where the window size is based on a fixed number of transactions. Actually, this model supposes that all transactions have a constant rate which is not suited for real-time applications. And the use of this model in such applications endangers their performance. Based on these observations, this paper relaxes the notion of window size and proposes the use of a timestamp-based sliding window model. In our proposed frequent itemset mining algorithm, support conditions are used to differentiate frequents and infrequent patterns. Thereafter, a tree is developed to incrementally maintain the essential information. We evaluate our contribution. The preliminary results are quite promising.

Keywords: real-time spatial big data, frequent itemset, transaction-based sliding window model, timestamp-based sliding window model, weighted frequent patterns, tree, stream query

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4104 Health and the Politics of Trust: Multi-Drug-Resistant Tuberculosis in Kathmandu

Authors: Mattia Testuzza

Abstract:

Public health is a social endeavour, which involves many different actors: from extremely stratified, structured health systems to unofficial networks of people and knowledge. Health and diseases are an intertwined individual and social experiences. Both patients and health workers navigate this public space through relations of trust. Trust in healthcare goes from the personal trust between a patient and her/his doctor to the trust of both the patient and the health worker in the medical knowledge and the healthcare system. Trust it is not a given, but it is continuously negotiated, given and gained. The key to understand these essential relations of trust in health is to recognise them as a social practice, which therefore implies agency and power. In these terms, health is constantly public and made public, as trust emerges as a meaningfully political phenomenon. Trust as a power relation can be observed at play in the implementation of public health policies such as the WHO’s Directly-Observed Theraphy Short-course (DOTS), and with the increasing concern for drug-resistance that tuberculosis pose, looking at the role of trust in the healthcare delivery system and implementation of public health policies becomes significantly relevant. The ethnographic fieldwork was carried out in four months through observation of the daily practices at the National Tuberculosis Center of Nepal, and semi-structured interviews with MultiDrug-Resistant Tuberculosis (MDR-TB) patients at different stages of the treatment, their relatives, MDR-TB specialised nurses, and doctors. Throughout the research, the role which trust plays in tuberculosis treatment emerged as one fundamental ax that cuts through all the different factors intertwined with drug-resistance development, unfolding a tension between the DOTS policy, which undermines trust, and the day-to-day healthcare relations and practices which cannot function without trust. Trust also stands out as a key component of the solutions to unforeseen issues which develop from the overall uncertainty of the context - for example, political instability and extreme poverty - in which tuberculosis treatment is carried out in Nepal.

Keywords: trust, tuberculosis, drug-resistance, politics of health

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