Search results for: managing

Authors: Yimeng Zhang

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Major depressive disorder (MDD) is a prevalent mental health condition with a substantial economic impact and limited treatment options. Acupuncture has gained attention as a promising non-pharmacological intervention for alleviating depressive symptoms. However, its mechanisms and clinical effectiveness remain incompletely understood. This meta-analysis aims to (1) synthesize existing evidence on the mechanisms and clinical effectiveness of acupuncture for depression and (2) compare these findings with pharmacological interventions, providing insights for future research. Evidence from animal models and clinical studies indicates that acupuncture may enhance hippocampal and network neuroplasticity and reduce brain inflammation, potentially alleviating depressive disorders. Clinical studies suggest that acupuncture can effectively relieve primary depression, particularly in milder cases, and is beneficial in managing post-stroke depression, pain-related depression, and postpartum depression, both as a standalone and adjunctive treatment. Notably, combining acupuncture with antidepressant pharmacotherapy appears to enhance treatment outcomes and reduce medication side effects, addressing a critical issue in conventional drug therapy's high dropout rates. This meta-analysis, encompassing 12 studies and 710 participants, draws data from eight digital databases (PubMed, EMBASE, Web of Science, EBSCOhost, CNKI, CBM, Wangfang, and CQVIP) covering the period from 2012 to 2022. Utilizing Stata software 15.0, the meta-analysis employed random-effects and fixed-effects models to assess the distribution of depression in Traditional Chinese Medicine (TCM). The results underscore the substantial evidence supporting acupuncture's beneficial effects on depression. However, the small sample sizes of many clinical trials raise concerns about the generalizability of the findings, indicating a need for further research to validate these outcomes and optimize acupuncture's role in treating depression.

Keywords: Chinese medicine, acupuncture, depression, meta-analysis

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Authors: Sangeeta Girdhar, Amanat Grewal, Nahush Bansal

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Introduction: There is an increasing burden of hypertension in India. The morbidity and mortality arising from complications are mainly due to non-adherence to medication, unhealthy dietary habits, and lack of physical activity. Non-adherence is a well-recognised factor contributing to inadequate control of high blood pressure. Adherence to pharmacotherapy for hypertension varies from 43% to 88%. Non-adherence is influenced by various socio-demographic factors. Understanding these factors is useful in managing non-adherence. Therefore, the study was planned to determine adherence among hypertensives and factors associated with non-adherence to treatment. Methodology: A cross-sectional study was conducted at Urban Health Training Centre of Dayanand Medical College and Hospital Ludhiana. Patients attending the OPD over a period of 3 months were included in the study. Prior ethical approval was obtained, and informed consent was taken from subjects. A predesigned semi-structured questionnaire was applied, which included socio-demographic profile, treatment-seeking behaviour, adherence to the antihypertensive medication, lifestyle factors (intake of alcohol, smoking, consumption of junk food, high salt intake) contributing to the development of the disease. Reasons for non-adherence to the therapy were also explored. Data was entered into excel, and SPSS 26 version was used for analysis. Results: A total of 186 individuals were interviewed. Out of these, 113 females (60.8%) and 73 males (39.2%) participated in the study. Mean age of participants was 60.9 ± 10.7 years. Adherence to anti-hypertensive treatment was found in 68.3% of the participants. It was observed that adherence was more in literate individuals as compared to illiterate (p value- 0.78). Adherence was lower among smokers (33.3%) and alcohol consumers (53.8%) as compared to non-users (69.4% and 70.6%, respectively). The predominant reasons for skipping medications were discontinuing medication when feeling well, forgetfulness and unawareness. Conclusion: There is a need to generate awareness regarding the importance of adherence to therapy among patients. Intensive health education and counselling of the patients is the need of the hour.

Keywords: hypertension, anti-hypertensive, adherence, counselling

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Authors: A. Pascual Ramsay

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Accounts of the management of the economic and euro crisis in Spain have been dominated by an emphasis on external constraints. However, this approach leaves unanswered important questions about the role of domestic political factors. Using systematic qualitative primary research and employing elite interviewing and process tracing, this paper aims to fill this gap for the period of the Partido Socialista Obrero Español (PSOE) administration. The paper shows that domestic politics played a crucial role in the management of the crisis, most importantly by determining the shape of the measures undertaken. In its three distinct stages – downplaying/inaction, reaction/stimulus, and austerity/reform – the PSOE's response was certainly constrained by external factors, most notably EMU membership and the actions of sovereign-bond investors, the ECB and Germany. Yet while these external constraints forced the government to act, domestic political factors fundamentally shaped the content of key measures: the fiscal stimulus, the labour, financial and pension reforms, the refusal to accept a bailout or the reform of the Constitution. Seven factors were particularly influential: i) electoral and political cost, ii) party and partisanship, iii) organised interests, iv) domestic institutions, v) ideological preferences, vi) ineffective decision-making, and vii) judgement and personal characteristics of decision-makers. In conclusion, domestic politics played an important role in the management of the crisis, a role that has been underestimated by dominant approaches focusing on external constraints and weak domestic policy autonomy. The findings provide empirical evidence to support research agendas that identify significant state discretion in the face of international economic integration and an important role for domestic political factors such as institutions, material interests, partisanship and ideology in shaping economic outcomes.

Keywords: economic crisis, Euro, PSOE, Spain

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Authors: Basant Kumar Singh, S. Subhachandhar, Vineet Ranjan Tripathi, Amit Kumar Singh, Uttam Singh, Santosh Kumar Lal

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Productivity of Blast Furnace is largely impacted by fuel efficiency and controlling heat loss is one of the enabling parameters for achieving lower fuel rate. 'I' Blast Furnace is the latest and largest Blast Furnace of Tata Steel Jamshedpur with working volume of 3230 m³ and with rated capacity of 3.055 million tons per annum. Optimizing heat losses in Belly and Bosh zone remained major challenge for blast furnace operators after its commissioning. 'I' Blast has installed Cast Iron & Copper Staves cooling members where copper staves are installed in Belly, Bosh & Lower Stack whereas cast iron staves are installed in upper stack area. Stave cooled Blast Furnaces are prone to higher heat losses in Belly and Bosh region with an increase in coal injection rate as Bosh gas volume increases. Under these conditions, managing gas flow pattern through proper burden distribution, casting techniques & by maintaining desired raw material qualities are of utmost importance for sustaining high injection rates. This study details, the burden distribution control by Ore & Coke ratio adjustment at wall and center of Blast Furnace as the coal injection rates increased from 140 kg/thm to 210 kg/thm. Control of blowing parameters, casting philosophy, specification for raw materials & devising operational practice for controlling heat losses is also elaborated with the model that is used to visualize heat loss pattern in different zones of Blast Furnace.

Keywords: blast furnace, staves, gas flow pattern, belly/bosh heat losses, ore/coke ratio, blowing parameters, casting, operation practice

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Authors: Kana Matsuyanagi

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Anorexia Nervosa (AN) is a psychiatric disorder characterized by a relentless pursuit of thinness and strict restriction of food. The current therapeutic approaches for AN predominantly revolve around outpatient psychotherapies, which create significant financial barriers for the majority of affected patients, hindering their access to treatment. Nonetheless, AN exhibit one of the highest mortality and relapse rates among psychological disorders, underscoring the urgent need to provide patients with an affordable self-treatment tool, enabling those unable to access conventional medical intervention to address their condition autonomously. To this end, a neurofeedback software, termed RelaxNeuron, was developed with the objective of providing an economical and portable means to aid individuals in self-managing AN. Electroencephalography (EEG) was chosen as the preferred modality for RelaxNeuron, as it aligns with the study's goal of supplying a cost-effective and convenient solution for addressing AN. The primary aim of the software is to ameliorate the negative emotional responses towards food stimuli and the accompanying aberrant eye-tracking patterns observed in AN patient, ultimately alleviating the profound fear towards food an elemental symptom and, conceivably, the fundamental etiology of AN. The core functionality of RelaxNeuron hinges on the acquisition and analysis of EEG signals, alongside an electrocardiogram (ECG) signal, to infer the user's emotional state while viewing dynamic food-related imagery on the screen. Moreover, the software quantifies the user's performance in accurately tracking the moving food image. Subsequently, these two parameters undergo further processing in the subsequent algorithm, informing the delivery of either negative or positive feedback to the user. Preliminary test results have exhibited promising outcomes, suggesting the potential advantages of employing RelaxNeuron in the treatment of AN, as evidenced by its capacity to enhance emotional regulation and attentional processing through repetitive and persistent therapeutic interventions.

Keywords: Anorexia Nervosa, fear conditioning, neurofeedback, BCI

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Authors: Said Benaissa, David Plets, Emmeric Tanghe, Jens Trogh, Luc Martens, Leen Vandaele, Annelies Van Nuffel, Frank A. M. Tuyttens, Bart Sonck, Wout Joseph

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The herd monitoring and managing - in particular the detection of ‘attention animals’ that require care, treatment or assistance is crucial for effective reproduction status, health, and overall well-being of dairy cows. In large sized farms, traditional methods based on direct observation or analysis of video recordings become labour-intensive and time-consuming. Thus, automatic monitoring systems using sensors have become increasingly important to continuously and accurately track the health status of dairy cows. Wireless sensor networks (WSNs) and internet-of-things (IoT) can be effectively used in health tracking of dairy cows to facilitate herd management and enhance the cow welfare. Since on-cow measuring devices are energy-constrained, a proper characterization of the off-body wireless channel between the on-cow sensor nodes and the back-end base station is required for a power-optimized deployment of these networks in barns. The aim of this study was to characterize the off-body wireless channel in indoor (barns) environment at 868 MHz using LoRa nodes. LoRa is an emerging wireless technology mainly targeted at WSNs and IoT networks. Both large scale fading (i.e., path loss) and temporal fading were investigated. The obtained path loss values as a function of the transmitter-receiver separation were well fitted by a lognormal path loss model. The path loss showed an additional increase of 4 dB when the wireless node was actually worn by the cow. The temporal fading due to movement of other cows was well described by Rician distributions with a K-factor of 8.5 dB. Based on this characterization, network planning and energy consumption optimization of the on-body wireless nodes could be performed, which enables the deployment of reliable dairy cow monitoring systems.

Keywords: channel, channel modelling, cow monitoring, dairy cows, health monitoring, IoT, LoRa, off-body propagation, PLF, propagation

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Authors: Matteo Mazzucato, Elena Faccio, Antonio Iudici

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Prison is a social reality constructed by everyday interactions between an inmate, other social actors (cellmates, prison officers, educationalists and psychologists or other detainees) and the external world which participates in this complex construction through the social discourses on prison reality and its problems. Being a detainee means performing a self dealing with processes of stereotypization, attribution of a social role and prejudices assigned by various interlocutors and depending on what kind of crime one has been convicted of. Among all inmates, sex offenders are the ones who risk more to be socially condemned beyond a legal sentence since they have committed one of the most hated and disapproved crime. Regarding this, prison has to be considered as a critical context in which all community expectations and beliefs are converged: for common sense, rapists and child molesters are dangerous people who have to be stigmatized, punished and isolated. Furthermore, other detainees share a code of conduct by which the ‘sex offender’ is collocated at the lowest level of the social hierarchy of the prison. The penitentiary administration too defines this kind of detainee as a ‘vulnerable person to protect’ while prison staff considers him as a particular inmate who has to be treated and definitely changed. Considering all the complexities connected with being imprisoned as a sex offender, our research aimed at exploring how people convicted of sex crimes are called upon to manage all these hetero-narrations about their selves. Set this goal, textual data retrieved from this qualitative research show that sex offenders tend to not face the stigma assigned to them. They are rather used to minimize the story telling about their selves and costruct alternative biographies to be shared with other inmates. Managing narrations about their selves in this way permits to distance them from all the threats perceived living together with other detainees but it blocks sex offenders’ ri-signification of their offences during prison treatment. Given these results, prison administration should develop activities in order to create fields of interaction between detainees where experiencing new versions of their selves spendable even in external social situations. Regarding this it’s important to re-consider prison as part of the community and the sex offenders as a member of it.

Keywords: interactions, qualitative research, prison reality, sex offender

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Authors: Daniel Mokatsanyane, Johnny Jansen Van Rensburg

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The integral role oil-crushing companies play in sunflower oil production is often overlooked to offer high-quality oil to refineries and end consumers. Sunflower oil crushing companies in South Africa are exposed to price fluctuations resulting from the local and international markets. Hedging instruments enable these companies to hedge themselves against unexpected prices spikes and to ensure sustained profitability. A crushing company is a necessary middleman, and as such, these companies have exposure to the purchasing and selling sides of sunflower. Sunflower oil crushing companies purchase sunflower seeds from farmers or agricultural companies that provide storage facilities. The purchasing price is determined by the supply and demand of sunflower seed, both national and international. When the price of sunflower seeds in South Africa is high but still below import parity, then the crush margins realised by these companies are reduced or even negative at times. There are three main products made by sunflower oil crushing companies, oil, meal, and shells. Profits are realised from selling three products, namely, sunflower oil, meal and shells. However, when selling sunflower oil to refineries, sunflower oil crushing companies needs to hedge themselves against a reduction in vegetable oil prices. Hedging oil prices is often done via futures and is subject to specific volume commitments before a hedge position can be taken in. Furthermore, South African oil-crushing companies hedge sunflower oil with international, Over-the-counter contracts as South Africa is a price taker of sunflower oil and not a price maker. As such, South Africa provides a fraction of the world’s sunflower oil supply and, therefore, has minimal influence on price changes. The advantage of hedging using futures ensures that the sunflower crushing company will know the profits they will realise, but the downside is that they can no longer benefit from a price increase. Alternative hedging instruments like options might pose a solution to the opportunity cost does not go missing and that profit margins are locked in at the best possible prices for the oil crushing company. This paper aims to investigate the possibility of employing options alongside futures to simulate different scenarios to determine if options can bridge the opportunity cost gap.

Keywords: derivatives, hedging, price risk, sunflower, sunflower oil, South Africa

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Authors: Neha Devi, P. K. Joshi

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Fire fuel map is one of the most critical factors for planning and managing the fire hazard and risk. One of the most significant forms of global disturbance, impacting community dynamics, biogeochemical cycles and local and regional climate across a wide range of ecosystems ranging from boreal forests to tropical rainforest is wildfire Assessment of fire danger is a function of forest type, fuelwood stock volume, moisture content, degree of senescence and fire management strategy adopted in the ground. Remote sensing has potential of reduction the uncertainty in mapping fuels. Hyperspectral remote sensing is emerging to be a very promising technology for wildfire fuels characterization. Fine spectral information also facilitates mapping of biophysical and chemical information that is directly related to the quality of forest fire fuels including above ground live biomass, canopy moisture, etc. We used Hyperion imagery acquired in February, 2016 and analysed four fuel characteristics using Hyperion sensor data on-board EO-1 satellite, acquired over the Shiwalik Himalayas covering the area of Champawat, Uttarakhand state. The main objective of this study was to present an overview of methodologies for mapping fuel properties using hyperspectral remote sensing data. Fuel characteristics analysed include fuel biomass, fuel moisture, and fuel condition and fuel type. Fuel moisture and fuel biomass were assessed through the expression of the liquid water bands. Fuel condition and type was assessed using green vegetation, non-photosynthetic vegetation and soil as Endmember for spectral mixture analysis. Linear Spectral Unmixing, a partial spectral unmixing algorithm, was used to identify the spectral abundance of green vegetation, non-photosynthetic vegetation and soil.

Keywords: forest fire fuel, Hyperion, hyperspectral, linear spectral unmixing, spectral mixture analysis

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Authors: Michael Campbell, Malaz Elsaddig, Kevin Jones

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Background: Despite encouraging progress, global maternal mortality has remained stubbornly high since the declaration of the Millennium development goals. Sub-Saharan Africa accounts for well over half of maternal deaths with Post-Partum Haemorrhage (PPH) being the lead cause. ‘In house’ simulation training delivered by local doctors may be a sustainable approach for improving emergency obstetric care. The aim of this study was to evaluate the use of a Train-the-Trainer (TtT) model in a rural Ugandan hospital to ascertain whether it can feasibly improve practitioners’ management of PPH. Methods: Three Ugandan doctors underwent a training course to enable them to design and deliver simulation training. These doctors used MamaNatalie® models to simulate PPH scenarios for midwives, nurses and medical students. The main outcome was improvement in participants’ knowledge and confidence, assessed using self-reported scores on a 10-point scale. Results: The TtT model produced significant improvements in the confidence and knowledge scores of the ten participants. The mean confidence score rose significantly (p=0.0005) from 6.4 to 8.6 following the simulation training. There was also a significant increase in the mean knowledge score from 7.2 to 9.0 (p=0.04). Medical students demonstrated the greatest overall increase in confidence scores whilst increases in knowledge scores were largest amongst nurses. Conclusions: This study demonstrates that a TtT model can be used in a low resource setting to improve healthcare professionals’ confidence and knowledge in managing obstetric emergencies. This Train-the-Trainer model represents a sustainable approach to addressing skill deficits in low resource settings. We believe that its expansion across healthcare institutions in Sub-Saharan Africa will help to reduce the region’s high maternal mortality rate and step closer to achieving the ambitions of the Millennium development goals.

Keywords: low resource setting, post-partum haemorrhage, simulation training, train the trainer

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Authors: Sousan Arafeh

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Educational systems and schools worldwide are increasingly reliant on information and communication technology (ICT). Unfortunately, most educational leadership development programs do not offer formal curricular and/or field experiences that prepare students for managing ICT resources, personnel, and processes. The result is a steep learning curve for the leader and his/her staff and dissipated organizational energy that compromises desired outcomes. To address this gap in education leaders’ development, Arafeh’s Integrated Technology Leadership Model (AITLM) was created. It is a conceptual model and tool that educational leadership students can use to better understand the ICT ecology that exists within their schools. The AITL Model consists of six 'infrastructure types' where ICT activity takes place: technical infrastructure, communications infrastructure, core business infrastructure, context infrastructure, resources infrastructure, and human infrastructure. These six infrastructures are further divided into 16 key areas that need management attention. The AITL Model was created by critically analyzing existing technology/ICT leadership models and working to make something more authentic and comprehensive regarding school leaders’ purview and experience. The AITL Model then served as a tool when it was distributed to over 150 educational leadership students who were asked to review it and qualitatively share their reactions. Students said the model presented crucial areas of consideration that they had not been exposed to before and that the exercise of reviewing and discussing the AITL Model as a group was useful for identifying areas of growth that they could pursue in the leadership development program and in their professional settings. While development in all infrastructures and key areas was important for students’ understanding of ICT, they noted that they were least aware of the importance of the intangible area of the resources infrastructure. The AITL Model will be presented and session participants will have an opportunity to review and reflect on its impact and utility. Ultimately, the AITL Model is one that could have significant policy and practice implications. At the very least, it might help shape ICT content in educational leadership development programs through curricular and pedagogical updates.

Keywords: education leadership, information and communications technology, ICT, leadership capacity building, leadership development

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Authors: Wan-I Lee, Nelio Mendoza Figueredo

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The impact of COVID-19 has a significant effect on all sectors of society globally. Health information technology (HIT) has become an effective health strategy in this age of distancing. In this regard, Mobile Health (mHealth) plays a critical role in managing patient and provider workflows during the COVID-19 pandemic. Therefore, the users' perception of service quality about mHealth services plays a significant role in shaping confidence and subsequent behaviors regarding the mHealth users' intention of use. This study's objective was to explore levels of user attributes analyzed by a qualitative method of how health practitioners and patients are satisfied or dissatisfied with using mHealth services; and analyzed the users' intention in the context of Taiwan during the COVID-19 pandemic. This research explores the experienced usability of a mHealth services during the Covid-19 pandemic. This study uses qualitative methods that include in-depth and semi-structured interviews that investigate participants' perceptions and experiences and the meanings they attribute to them. The five cases consisted of health practitioners, clinic staff, and patients' experiences using mHealth services. This study encourages participants to discuss issues related to the research question by asking open-ended questions, usually in one-to-one interviews. The findings show the positive and negative attributes of mHealth service quality. Hence, the significant importance of patients' and health practitioners' issues on several dimensions of perceived service quality is system quality, information quality, and interaction quality. A concept map for perceptions regards to emergency uses' intention of mHealth services process is depicted. The findings revealed that users pay more attention to "Medical care", "ease of use" and "utilitarian benefits" and have less importance for "Admissions and Convenience" and "Social influence". To improve mHealth services, the mHealth providers and health practitioners should better manage users' experiences to enhance mHealth services. This research contributes to the understanding of service quality issues in mHealth services during the COVID-19 pandemic.

Keywords: COVID-19, mobile health, service quality, use intention

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Authors: Naiara de Almeida Rios

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The environmental education, from Tbilisi, is signaled as an important instrument for conservation and environmental management. However, the social, economic, political and environmental aspects of each place require an environmental management that corresponds to the reality to which they are inserted, as well as environmental education practices. The city of Belém, the capital of the State of Pará, is one of the most important cities in the Amazon Region, and its vast water dimension requires that its watersheds take a careful look at their socio-environmental management. The Estrada Nova Hydrographic Basin is considered as one of the most critical river basins in the city due to flooding, lack of basic sanitation and degradation of water bodies. In this context, environmental education is understood as one of the necessary conditions to reduce environmental degradation. Environmental education presents itself as an instrument of social transformation and conservation of natural resources (especially water resources), where thinking about the sustainability of natural resources is moving towards dialogue on the importance of building an environmental awareness. The commitment that environmental education proposes covers all spheres of society, since the main objective of the same is the transformation of thought and attitudes from the understanding of reality. Therefore, to analyze how the government is managing the basin, as well as the environmental education practices developed in it, is fundamental, so that government can be charged with improvements for the population and for the natural environment. Therefore, the objective of this study is to analyze the influence of environmental education actions developed by local public authorities in the management of the Estrada Nova Hydrographic Basin, Belém/PA. For the accomplishment of this study, some methodological procedures will be used, like documentary analysis, bibliographical survey and fieldwork. If the multivariate statistical method is used to analyze the results obtained in the field. Unfortunately, public policies in the area of ​environmental education in Belém are still moving in short steps, since government interests have had very little dialogue with the socio-environmental problems that affect the Estrada Nova Hydrographic Basin. Both formal and informal environmental education has been poorly developed, hampering the continuous process proposed by water resources management.

Keywords: environmental education, environmental management, hydrographic basin, water resources

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Authors: Zarabizan Zakaria, Hayati Zainal

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The construction industry is one of the most important sectors that contribute to the nation’s economy and catalyze towards the growth of other industries. However, some construction projects have not been completed on its stipulated time and duration, scope and budget due to several factors. This problem arises due to the weaknesses of human factors, especially from ineffective leadership quality practiced by project managers and contractors in managing project teams. Therefore, a construction project should impose the element of Project Team. The project team is formed in the implementation of the project which includes the project brief, project scope, customer requirements and provided designs. Many organizations in the construction sector use teams to meet today's global competition and customer expectations, however, team effectiveness evaluation is required. In insuring the construction team is successful and effectiveness, the construction department must encourage, measure, set up, and evaluate or review the effectiveness of project team that was formed. In order to produce a better outcome for a high-end project, an effective and efficient project team is required which also help in increasing overall productivity. The purpose of this study is to determine the role of team effectiveness in the construction project team based on the overall construction project performance. It examines several different factors which related to team effectiveness. It also examines the relationship between team effectiveness factor and project performance aspect. Team Effect Review and Project Performance Review are developed to be used for data collection. Data collected were analyzed using several statistical tests. Results obtained from data analysis are validated using semi-structured interviews. Besides that, a comprehensive survey were developed to assess the way construction project teams in order to maintain its effectiveness throughout the project phase. In order to determine a project successful it has been found that Project Team Leadership is the most important factor. In addition, the definition of team effectiveness in the construction project team is developed based on the perspective of project clients and project team members. The results of this study are expected to provide an idea on the factors that are needed to be focused on improving the team's effectiveness towards project performance aspects. At the same time, the definition of team effectiveness from team members and owner views has been developed in order to provide a better understanding of the word team's effectiveness in construction projects.

Keywords: project team, leadership, construction project, project successful

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Authors: Theophilus O. Odunlami, Hasan Haroglu, Nader Saleh-Matter

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The challenges facing the construction industry are often worsened by the compounded nature of projects coupled with the complexity of key stakeholders involved at different stages of the project. Projects are planned to achieve outlined benefits in line with the business case; however, a lack of effective management of key stakeholders can result in unrealistic delivery aspirations, unnecessary re-works, and overruns. The aim of this study is to examine the early stages of a project lifecycle and investigate the stakeholder management and involvement processes and their impact on the successful delivery of the project. The research engaged with conventional construction organisations and project personnel and stakeholders on diverse projects, using a research strategy to analyse existing project case studies, narrative enquiries, interviews, and surveys using a combined qualitative, quantitative, and mixed method of analysis. Research findings have shown that the involvement of stakeholders at different levels during the early stages has pronounced effects on project delivery; it helps to forge synergy and promotes a clear understanding of individual responsibilities, strengths, and weaknesses. This has often fostered a positive sense of productive collaboration right through the early stages of the project. These research findings intend to contribute to the development of a process framework for stakeholder and project team involvement in the early stages of a project. This framework will align with the selection criteria for stakeholders, contractors, and resources, ultimately contributing to the successful completion of projects. The primary question addressed in this study is stakeholder involvement and management of the early stages of a building project life cycle impacts project delivery. Findings showed that early-stage stakeholder involvement and collaboration between project teams and contractors significantly contribute to project success. However, a strong and healthy communication strategy would be required to maintain the flow of value-added ideas among stakeholders at the early stages to benefit the project at the execution stage.

Keywords: early stages, project lifecycle, stakeholders, decision-making strategy, project framework

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Authors: Cesar A. Nava-Gaxiola, C. Barrado

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Harmonized with SESAR (Single European Sky Research) initiatives, a new concept related with airspace structures have been introduced in Europe, the Free Route Airspace. The key of free route is based in an airspace where users may freely plan a route between a defined entry and exit waypoint, with the possibility of routing via intermediate points, the free route flights remain subject to air traffic control (ATC) for the established separations. Free route airspace does not present anymore fixed airways to airspace users, as a consequence it brings a new paradigm for managing safe separations of aircrafts inside these airspace blocks . Nowadays, several European nations have been introduced the concept, some of them in a complete or partial stage, but finally offering limited benefits to airspace users for this condition. This research evaluates the future scenario of free route implementation across Europe, considering a unique airspace block configuration with a complete upper airspace with free route. The paper is centered in investigating the benefits for airspace users, and the study of possible increments of Air Traffic Controllers task loads with a full application. In this research, fast time simulations are carrying out for discovering how much flight time and distance aircrafts can save with an overall free route establishment. In the other side, the paper explains the evolution of conflicts derivate from possible separation losses between aircrafts in this new environment. Free route conflicts can emerges in any points of the airspace, requiring a great effort for solving it, in comparison with fixed airways, where conflicts normally were found by controllers in known waypoints, and they solved using the fixed network as reference. The airspace configuration modelled in this study take into account the actual navigation waypoints structure, moving into a future scenario, where new ones waypoints are added and new traffic flow patterns appears. In this sense, this research explores the advantages and unknown difficulties that a large scale application of free route concept can carry out in the European airspace.

Keywords: ATC conflicts, efficiency, free route airspace, SESAR

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Authors: Yan Zhang, Felix Kin Peng Hui, Colin Duffield, Caroline X. Gao

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In post-pandemic Australia, it is unclear how building occupant have changed their behaviour in their interaction with buildings and other occupants. This research provides information on occupant behaviour change compared to before the pandemic and examines the predictors for those behaviour changes. This paper analyses survey responses from 2298 building occupants in Melbourne to investigate occupant behaviour change and determinants for those changes one year after the pandemic in Australia. The behaviour changes were grouped into three categories based on respiratory infection routes: (1) fomite: hand-shaking and hand hygiene behaviours; (2) airborne: individual interventions to indoor air quality such as face masking, window openings for occupants working in naturally ventilated space; (3) droplets: social distancing, reducing working hours in the workplace. The survey shows that the pandemic has significantly changed occupants' behaviour in all three categories compared to before the pandemic. The changes are significantly associated with occupants' perceived indoor air quality, indoor environmental cleanliness, and occupant density, demonstrating their growing awareness of respiratory infection risk that influences their health behaviours. The two most significant factors identified from multivariate regressions to drive the behaviour change include occupant risk perception of respiratory infections at the workplace and their observed co-worker's behaviour change. Based on the survey results, the paper provides adjusted estimates for related occupant behaviour parameters. The study also discusses alternatives for managing window operations in naturally ventilated buildings to improve occupant satisfaction. This paper could help Building Managers, and Building Designers understand occupant behaviour change to improve building operations and new building design to enhance occupant experience. Also, building energy modellers and risk assessors may use the findings to adjust occupant behaviour-related parameters to improve the models. The findings contribute to the knowledge of Human-Building Interaction.

Keywords: human-building interaction, risk perception, occupant behaviour, IAQ, COVID-19

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Authors: Warnakulasuriya Arachichige Malisha Ann Rosary Fernando, Udalamatta Gamage Omila Chalanka Jinadasa, Bihini Pabasara Amandi Amarasinghe, Manul Thisuraka Mandalawatta, Uthpala Samarakoon, Manori Gamage

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The surge in sexually transmitted diseases (STDs) has become a critical public health crisis demanding urgent attention and action. Like many other nations, Sri Lanka is grappling with a significant increase in STDs due to a lack of education and awareness regarding their dangers. Presently, the available applications for tracking and managing STDs cover only a limited number of easily detectable infections, resulting in a significant gap in effectively controlling their spread. To address this gap and combat the rising STD rates, it is essential to leverage technology and data. Employing technology to enhance the tracking and management of STDs is vital to prevent their further propagation and to enable early intervention and treatment. This requires adopting a comprehensive approach that involves raising public awareness about the perils of STDs, improving access to affordable healthcare services for early detection and treatment, and utilizing advanced technology and data analysis. The proposed mobile application aims to cater to a broad range of users, including STD patients, recovered individuals, and those unaware of their STD status. By harnessing cutting-edge technologies like image detection, symptom-based identification, prevention methods, doctor and clinic recommendations, and virtual counselor chat, the application offers a holistic approach to STD management. In conclusion, the escalating STD rates in Sri Lanka and across the globe require immediate action. The integration of technology-driven solutions, along with comprehensive education and healthcare accessibility, is the key to curbing the spread of STDs and promoting better overall public health.

Keywords: STD, machine learning, NLP, artificial intelligence

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Authors: Amina Beldjazia, Djamel Alatou, Khaled Missaoui

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The forest of Mahouna is a part of the mountain range of the Tell Atlas in the northeast of Algeria. It is characterized by a significant biodiversity. The management of this resource requires thorough the understanding of the current state of the vegetation (inventories), degradation factors and ongoing monitoring of the various long-term ecological changes. Digital mapping is a very effective way to in-depth knowledge of natural resources. The realization of a vegetation map based on satellite images, aerial photographs and the use of geographic information system (GIS), shows large values results of the vegetation of the massif in the scientific view point (the development of a database of the different formations that exist on the site, ecological conditions) and economic (GIS facilitate our task of managing the various resources and diversity of the forest). The methodology is divided into three stages: the first involves an analysis of climate data (1988 to 2013); the second is to conduct field surveys (soil and phytoecological) during the months of June and July 2013 (10 readings), the third is based on the development of different themes and synthetic cards by software of GIS (ENVI 4.6 and 10 ARCMAP). The results show: cork oak covers an area of 1147 ha. Depending on the environmental conditions, it rests on sandstone and individualizes between 3 layers of vegetation from thermo-mediterranean (the North East part with 40ha), meso-Mediterranean (1061 ha) and finally the supra-Mediterranean (46ha ). The map shows the current actual state of the cork oak forest massif of Mahouna, it is an older forest (>150 years) where regeneration is absent because of several factors (fires, overgrazing, leaching, erosion, etc.). The cork oak is in the form of dense forest with Laburnum and heather as the dominant species. It may also present in open forest dominated by scrub species: Daphne gniduim, Erica arborea, Calycotome spinosa, Phillyrea angustifolia, Lavandula stoechas, Cistus salvifolius.

Keywords: biodiversity, environmental, Mahouna, Cork oak

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Authors: Jonghyuk Yoon, Hyoungwoon Song

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Recently, there are lots of increasing interest in a smart farming that represents application of modern Information and Communication Technologies (ICT) into agriculture since it provides a methodology to optimize production efficiencies by managing growing conditions of crops automatically. In order to obtain high performance and stability for smart greenhouse, it is important to identify the effect of various working parameters such as capacity of ventilation fan, vent opening area and etc. In the present study, a 3-dimensional CFD (Computational Fluid Dynamics) simulation for single-span greenhouse was conducted using the commercial program, Ansys CFX 18.0. The numerical simulation for single-span greenhouse was implemented to figure out the internal thermal and flow characteristics. In order to numerically model solar radiation that spread over a wide range of wavelengths, the multiband model that discretizes the spectrum into finite bands of wavelength based on Wien’s law is applied to the simulation. In addition, absorption coefficient of vinyl varied with the wavelength bands is also applied based on Beer-Lambert Law. To validate the numerical method applied herein, the numerical results of the temperature at specific monitoring points were compared with the experimental data. The average error rates (12.2~14.2%) between them was shown and numerical results of temperature distribution are in good agreement with the experimental data. The results of the present study can be useful information for the design of various greenhouses. This work was supported by Korea Institute of Planning and Evaluation for Technology in Food, Agriculture, Forestry and Fisheries (IPET) through Advanced Production Technology Development Program, funded by Ministry of Agriculture, Food and Rural Affairs (MAFRA)(315093-03).

Keywords: single-span greenhouse, CFD (computational fluid dynamics), solar radiation, multiband model, absorption coefficient

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Authors: Deepa Kundu, Prabhakar Sharma, Sayan Bhattacharya, Jianying Shang

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The discharge of dye-containing effluents in the water bodies has raised concern due to the potential hazards related to their toxicity in the environment. There are various treatment technologies available for the removal of dyes from wastewaters. The use of biosorbent to remove dyes from wastewater is one of the effective and inexpensive techniques. In the study, the adsorption of phenothiazine dye methylene blue onto biosorbent prepared from Lantana camara L. has been studied in aqueous solutions. The batch adsorption experiments were conducted and the effects of various parameters such as pH (3-12), contact time, adsorbent dose (100-400 mg/L), initial dye concentration (5-20 mg/L), and temperature (303, 313 and 323 K) were investigated. The prepared leaf (BCL600) and shoot (BCS600) biochar of Lantana were characterized using FTIR, SEM, elemental analysis, and zeta potential (pH~7). A comparison between the adsorption potential of both the biosorbent was also evaluated. The results indicated that the amount of methylene blue dye (mg/g) adsorbed onto the surface of biochar was highly dependent on the pH of the dye solutions as it increased with an increase in pH from 3 to 12. It was observed that the dye treated with BCS600 and BCL600 attained an equilibrium within 60 and 100 minutes, respectively. The rate of the adsorption process was determined by performing the Lagergren pseudo-first-order and pseudo-second-order kinetics. It was found that dye treated with both BCS600 and BCL600 followed pseudo-second-order kinetics implying the multi-step nature of the adsorption process involving external adsorption and diffusion of dye molecules into the interior of the adsorbents. The data obtained from batch experiments were fitted well with Langmuir and Freundlich isotherms (R² > 0.98) to indicate the multilayer adsorption of dye over the biochar surfaces. The thermodynamic studies revealed that the adsorption process is favourable, spontaneous, and endothermic in nature. Based on the results, the inexpensive and easily available Lantana camara biomass can be used to remove methylene blue dye from wastewater. It can also help in managing the growth of the notorious weed in the environment.

Keywords: adsorption kinetics, biochar, Lantana camara, methylene blue dye, possible mechanism, thermodynamics

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Authors: Margarita Gáfaro, Karelys Guzmán, Paola Poveda

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This paper establishes the theoretical aspects that explain the barriers to accessing credit for small agricultural producers in developing countries and identifies successful policy experiences to mitigate them. We will test two hypotheses. The first one is that information asymmetries, high transaction costs and high-risk exposure limit the supply of credit to small agricultural producers in developing countries. The second hypothesis is that low levels of financial education and productivity and high uncertainty about the returns of agricultural activity limit the demand for credit. To test these hypotheses, a review of the theoretical and empirical literature on access to rural credit in developing countries will be carried out. The first part of this review focuses on theoretical models that incorporate information asymmetries in the credit market and analyzes the interaction between these asymmetries and the characteristics of the agricultural sector in developing countries. Some of the characteristics we will focus on are the absence of collateral, the underdevelopment of the judicial systems and insurance markets, and the high dependence on climatic factors of production technologies. The second part of this review focuses on the determinants of credit demand by small agricultural producers, including the profitability of productive projects, security conditions, risk aversion or loss, financial education, and cognitive biases, among others. There are policies that focus on resolving these supply and demand constraints and managing to improve credit access. Therefore, another objective of this paper is to present a review of effective policies that have promoted access to credit for smallholders in the world. For this, information available in policy documents will be collected. This information will be complemented by interviews with officials in charge of the design and execution of these policies in a subset of selected countries. The information collected will be analyzed in light of the conceptual framework proposed in the first two parts of this section. The barriers to access to credit that each policy attempts to resolve and the factors that could explain its effectiveness will be identified.

Keywords: agricultural economics, credit access, smallholder, developing countries

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Authors: Isabela Thomas Mkude

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This research was done to assess how the community is involved in waste management activities and their willingness to pay for services. Mnadani and Madukani are among the old wards in Dodoma urban. These two areas are similar and face numerous environmental problems, poor solid waste management practices being among them. People realize problems because they live with them daily but the study advice that the only way to stay off problems is to find appropriate measures. The findings recognized some problems that led to poor community involvement solid waste management the study areas. Lack of community education on how to deal with solid wastes, poor responsibility of ward leaders in issues concerning the environment and in active participation of communities in environmental meeting are among other major problems found during the research. The research also revealed that there is low willingness to pay for waste collection among communities and financial problems that make environmental committee inactive; that leading to a poor disposal and unavailable collection facilities in urban area. Although the municipal improves disposal activities by increasing amount of waste to be disposed off by 11% in three years, the amount of waste that collected is also increasing by 41% each day. It is advised that some corrective measures need to be put in place so that the communities are well involved in managing solid wastes as the best way to attain achievement in keeping the urban free from solid waste. Environmental education dissemination to the communities is needed so that they become responsible and dedicated citizen on the environment. There should be some incentives from government to the wards local government and CBOs so that they can practically implement solid waste management programs and to attract formation of more groups and motivate the present groups. Capacity building programs to the ward leaders need to be given priority so that leaders are well organized and able to plan, coordinate and cooperate with various governmental institutions, and NGOs responsible for development and environmental management.

Keywords: solid waste, waste management, public involvement, rapid urbanized region

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Authors: Julius M. Ndambuki, Gislar E. Kifanyi, Samuel N. Odai, Charles Gyamfi

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Conjunctive management of surface and groundwater resources is a challenging task due to the spatial and temporal variability nature of hydrology as well as hydrogeology of the water storage systems. Surface water-groundwater hydrogeology is highly uncertain; thus it is imperative that this uncertainty is explicitly accounted for, when managing water resources. Various methodologies have been developed and applied by researchers in an attempt to account for the uncertainty. For example, simulation-optimization models are often used for conjunctive water resources management. However, direct application of such an approach in which all realizations are considered at each iteration of the optimization process leads to a very expensive optimization in terms of computational time, particularly when the number of realizations is large. The aim of this paper, therefore, is to introduce and apply an efficient approach referred to as Retrospective Optimization Approximation (ROA) that can be used for optimizing conjunctive use of surface water and groundwater over a multiple hydrogeological model simulations. This work is based on stochastic simulation-optimization framework using a recently emerged technique of sample average approximation (SAA) which is a sampling based method implemented within the Retrospective Optimization Approximation (ROA) approach. The ROA approach solves and evaluates a sequence of generated optimization sub-problems in an increasing number of realizations (sample size). Response matrix technique was used for linking simulation model with optimization procedure. The k-means clustering sampling technique was used to map the realizations. The methodology is demonstrated through the application to a hypothetical example. In the example, the optimization sub-problems generated were solved and analysed using “Active-Set” core optimizer implemented under MATLAB 2014a environment. Through k-means clustering sampling technique, the ROA – Active Set procedure was able to arrive at a (nearly) converged maximum expected total optimal conjunctive water use withdrawal rate within a relatively few number of iterations (6 to 7 iterations). Results indicate that the ROA approach is a promising technique for optimizing conjunctive water use of surface water and groundwater withdrawal rates under hydrogeological uncertainty.

Keywords: conjunctive water management, retrospective optimization approximation approach, sample average approximation, uncertainty

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Authors: Kadhim Alabady

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Purpose: Mental health problems affect women and men equally, but some are more common among women. To Provide a baseline of the current picture of major mental health challenges among women in Dubai. which can then be used to measure the impact of interventions or service development. Method: We have used mixed methods evaluation approaches. This was used to increase the validity of findings by using a variety of data collection techniques. We have integrated qualitative and quantitative methods in this piece of work. Conducting the two approaches is to explore issues that might not be highlighted enough through one method. Results: The key findings are: The prevalence of people who suffer from different types of mental disorders remains largely unknown, many women are unwilling to seek professional help because of lack of awareness or the stigma attached to it. -It is estimated there were around 2,928–4,392 mothers in Dubai (2014) suffering from postnatal depression of which 858–1,287, early intervention can be effective. -The system for managing health care for women with mental illness is fragmented and contains gaps and duplications. -It is estimated 1,029 girl aged 13–19 years affected with anorexia nervosa and there would be an estimated 1,029 girl aged 13–19 years affected with anorexia nervosa. Recommendations: -Work is required with primary health care in order to identify women with undiagnosed mental illnesses. Further work is undertaken within primary health care to assess disease registries with the aim of helping GP practices to improve their disease registers. -It is important to conduct local psychiatric morbidity surveys in Dubai to obtain data and assess the prevalence of essential mental health symptoms and conditions that are not routinely collected to get a clear sense of what is needed and to assist decision and policy making in getting a complete picture on what services are required. -Emergency Mental Health Care – there is a need for a crisis response team to respond to emergencies in the community. -Continuum of care – a significant gap in the services for women once they diagnosed with mental disorder.

Keywords: mental health, depression, schizophrenia, women

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Authors: Vitor Carneiro, Augusto Barata Da Rocha, Barbara Rangel, Jorge Lino Alves

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In the European Union countries, Small and Medium-Sized Enterprises (SME’s) have an important contribution to economic activity and to the Gross Domestic Product (GDP). The implementation of design practices in SME’s is often a difficult task due to resources limitations. Unlike large companies, their product development and innovation processes frequentlylack adequate planning and systematic procedures. Design management interest has grown exponentially in recent years, but as it is a recent topic there is an absence of systematic methodologies to implement design management in SME’s with little or no design experience. This work presents a contribution to improve and optimize the process of design integration and management in SME’s. A review analysis is presented to select relevant articles on the subject, review and classify the main published contributions. Based on the selected articles content it was possible to identify five main themes related to the subject under analysis: Design Function Organization, Design Management Integration, Design Management Capabilities, Managing Design Projects, and Tools and Methods. Design management is discussed from different perspectives depending on the focus on which it is placed, whether in a design or management perspective, leading to different visions and definitions: from a more upstream strand at the intersection of design and the organization's strategic management (strategic design management) to a more downstream strand related to project management and design process (design management operational). The review analysis of the selected articles allowed the identification of a high level of complexity of connections and parameters in the design management during the product development process in the context of SME’s. Within each group of the five main themes, several sub-themes, directly or indirectly related, should be considered.Sub-connections also occur between sub-themes of different themes creating a complex and intricate web of connections. This complexity of connections is often the main obstacle to conduct design management and product development efficiently. This work proposes a formulation of a systematic methodological approach to optimize the integrated project and the management and control of the product development process among SME's. The implementation of this formulation will improve the integration of design management in the product development and innovation process in SME’s.

Keywords: design management, product development, product innovation, SME’s.

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Authors: Ibrahim M. I. Hamoda, Ahmed R. Z. Baghdadi, Mohammed K. Mohamed, Nawal A. Abu-Shady

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Background: Most of patients with vestibular dysfunction suffering from balance disorders, Abnormality in balance increase effort and exertion which affect the independency, so this study might be a guide in managing balance problem and consequently improve walking with less exertion and maximum function. Purpose: to analyze and discuss the effect of transcranial magnetic therapy on balance in patients with vestibular dysfunction. Methods: forty subjects from both sexes were classified to divided randomly into two equal groups; Group I study group: this group received transcranial magnetic therapy, with a selected physical therapy program for improving balance and vestibular disorders (Balance training, Cawthorne-Cooksey Exercises) and group II (control group): this group received a selected physical therapy program as group I without transcranial magnetic therapy. This treatment procedure will be applied three times weekly for three months. The mean age was 54.53±3.44 and 55.33±2.32 years and BMI 35.7±3.03 and 35.73±1.03 kg/m2 for group I and II respectively. The Biodex Balance System, Berge balances scale (BBS) and brain MRI were used for assessment. Assessments were conducted before and after treatment. The treatment program for group I included balance training, Cawthorne-Cooksey Exercises and pulsed magnetic therapy (Parameters used in the program of 20 minutes, Intensity 2 gausses, Frequency 1 Hz). This selected program was done in approximately one hour every other day for three month. The treatment program group II Patients received the same program as group A without transcranial magnetic therapy. Results: The One-way ANOVA revealed that there were no significant differences in BBS scores, overall balance index, Anterior / posterior balance index, Medial / lateral balance index and dynamic limits of stability between both groups. Moreover, the BBS scores increased and overall balance index, Anterior / posterior balance index, Medial / lateral balance index and dynamic limits of stability decreased significantly after treatment in group I and II compared with before treatment. Interpretation/Conclusion: Adding pulsed magnetic therapy to balance training, Cawthorne-Cooksey Exercises has no effect on static and dynamic balance in patients with balance problems due to benign positional paroxysmal vertigo.

Keywords: balance, transcranial magnetic therapy, vestibular dysfunction, biomechanic

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Authors: Shankaran Sitarama

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Teamwork is an extremely effective pedagogical tool in engineering education. New Product Development (NPD) has been an effective strategy of companies to streamline and bring innovative products and solutions to customers. Thus, Engineering curriculum in many schools, some collaboratively with business schools, have brought NPD into the curriculum at the graduate level. Teamwork is invariably used during instruction, where students work in teams to come up with new products and solutions. There is a significant emphasis of grade on the semester long teamwork for it to be taken seriously by students. As the students work in teams and go through this process to develop the new product prototypes, their effectiveness and learning to a great extent depends on how they function as a team and go through the creative process, come together, and work towards the common goal. A core attribute of a successful NPD team is their creativity and innovation. The team needs to be creative as a group, generating a breadth of ideas and innovative solutions that solve or address the problem they are targeting and meet the user’s needs. They also need to be very efficient in their teamwork as they work through the various stages of the development of these ideas resulting in a POC (proof-of-concept) implementation or a prototype of the product. The simultaneous requirement of teams to be creative and at the same time also converge and work together imposes different types of tensions in their team interactions. These ideational tensions / conflicts and sometimes relational tensions / conflicts are inevitable. Effective teams will have to deal with the Team dynamics and manage it to be resilient enough and yet be creative. This research paper provides a computational analysis of the teams’ communication that is reflective of the team dynamics, and through a superimposition of latent semantic analysis with social network analysis, provides a computational methodology of arriving at patterns of visual interaction. These team interaction patterns have clear correlations to the team dynamics and provide insights into the functioning and thus the effectiveness of the teams. 23 student NPD teams over 2 years of a course on Managing NPD that has a blend of engineering and business school students is considered, and the results are presented. It is also correlated with the teams’ detailed and tailored individual and group feedback and self-reflection and evaluation questionnaire.

Keywords: team dynamics, social network analysis, team interaction patterns, new product development teamwork, NPD teams

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Authors: Asif Khaliq, Sayeeda A. Sayed

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The drug information centers provide drug related information to the requesters that include physicians, pharmacist, nurses and other allied health care professionals. The International Pharmacist Federation (FIP) describes basic functions of a drug and poison information centers as drug evaluation, therapeutic counseling, pharmaceutical advice, research, pharmaco-vigilence and toxicology. Continuous advancement in the field of medicine has expanded the medical literature, which has increased demand of a drug and poison information center for the guidance, support and facilitation of physicians. The objective of the study is to determine the need of drug and poison information centers in public and private hospitals of Karachi, Pakistan. A cross sectional study was conducted during July 2013 to April 2014 using a self-administered, multi-itemed questionnaire. Non Probability Convenient sampling was used to select the study participants. A total of 307 physicians from public and private hospitals of Karachi participated in the study. The need for 24/7 Drug and poison information center was highlighted by 92 % of physicians and 67% physicians suggested opening a drug information center at the hospital. It was reported that 70% physicians take at least 15 minutes for searching the information about the drug while managing a case. Regarding the poisoning case management, 52% physicians complaint about the unavailability of medicines in hospitals; and mentioned the importance of medicines for safe and timely management of patients. Although 73% physicians attended continued medical education (CME) sessions, 92 % physicians insisted on the need of 24/7 Drug and poison information center. The scarcity of organized channel for obtaining the information about drug and poisons is one of the most crucial problems for healthcare workers in Pakistan. The drug and poison information center is an advisory body that assists health care professional and patients in provision of appropriate drug and hazardous substance information. Drug and poison information center is one of the integral needs for running an effective health care system. Provision of a 24 /7 drug information centers with specialized staff offer multiple benefits to the hospitals while reducing treatment delays, addressing awareness gaps of all stakeholders and ensuring provision of quality health care.

Keywords: drug and poison information centers, Pakistan, physicians, public and private hospitals

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Authors: Telma Fontao de Castro, Kylee Miller, Maria Xavier Araújo, Isabel Brandao, Sandra Torres

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Objective: There is a dearth of research investigating the long-term emotional functioning of individuals recovered from anorexia nervosa (AN). This 15-year longitudinal study aimed to examine whether difficulties in cognitive processing of emotions persisted after long-term AN recovery and its link to anxiety and depression. Method: Twenty-four females, who were tested longitudinally during their acute and recovered AN phases, and 24 healthy control (HC) women, were screened for anxiety, depression, alexithymia, and emotion regulation difficulties (ER; only assessed in recovery phase). Results: Anxiety, depression, and alexithymia levels decreased significantly with AN recovery. However, scores on anxiety and difficulty in identifying feelings (alexithymia factor) remained high when compared to the HC group. Scores on emotion regulation difficulties were also lower in HC group. The abovementioned differences between AN recovered group and HC group in difficulties in identifying and accepting feelings and lack of emotional clarity were no longer present when the effect of anxiety and depression was controlled. Conclusions: Findings suggest that emotional dysfunction tends to decrease in AN recovered phase. However, using an HC group as a reference, we conclude that several emotional difficulties are still increased after long-term AN recovery, in particular, limited access to emotion regulation strategies, and difficulty controlling impulses and engaging in goal-directed behavior, thus suggesting to be a trait vulnerability. In turn, competencies related to emotional clarity and acceptance of emotional responses seem to be state-dependent phenomena linked to anxiety and depression. In sum, managing emotions remains a challenge for individuals recovered from AN. Under this circumstance, maladaptive eating behavior can serve as an affect regulatory function, increasing the risk of relapse. Emotional education and stabilization of depressive and anxious symptomatology after recovery emerge as an important avenue to protect from long-term AN relapse.

Keywords: alexithymia, anorexia nervosa, emotion recognition, emotion regulation

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