Search results for: outcome.

Authors: Yah-Ling Hung

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eHealth is undoubtedly emerging as a promising vehicle to provide information for individual self-care management. However, the accessing ability, reading strategies and navigating behavior between higher literacy users and lower literacy users are significantly different. Yet, ways to tailor audiences’ health literacy and develop appropriate eHealth to feed their need become a big challenge. The purpose of this study is to compare the educational effectiveness of eHealth to deliver health knowledge between higher literacy users and lower literacy users, thus establishing useful design strategies of eHealth for users with different level of health literacy. The study was implemented in four stages, the first of which developed a website as the testing media to introduce health care knowledge relating to children’s allergy. Secondly, a reliability and validity test was conducted to make sure that all of the questions in the questionnaire were good indicators. Thirdly, a pre-post knowledge test was conducted with 66 participants, 33 users with higher literacy and 33 users with lower literacy respectively. Finally, a usability evaluation survey was undertaken to explore the criteria used by users with different levels of health literacy to evaluate eHealth. The results demonstrated that the eHealth Intervention in both groups had a positive outcome. There was no significant difference between the effectiveness of eHealth intervention between users with higher literacy and users with lower literacy. However, the average mean of lower literacy group was marginally higher than the average mean of higher literacy group. The findings also showed that the criteria used to evaluate eHealth could be analyzed in terms of the quality of information, appearance, appeal and interaction, but the users with lower literacy have different evaluation criteria from those with higher literacy. This is an interdisciplinary research which proposes the sequential key steps that incorporate the planning, developing and accessing issues that need to be considered when designing eHealth for patients with varying degrees of health literacy.

Keywords: eHealth, health intervention, health literacy, usability evaluation.

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Authors: Hanifeh Imanian, Morteza Kolahdoozan

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The purpose of this study is to present a mathematical phrase for calculating the dispersion rate of spilled oil in water column under non-breaking waves. In this regard, a multiphase numerical model is applied for which waves and oil phase were computed concurrently, and accuracy of its hydraulic calculations have been proven. More than 200 various scenarios of oil spilling in wave waters were simulated using the multiphase numerical model and its outcome were collected in a database. The recorded results were investigated to identify the major parameters affected vertical oil dispersion and finally 6 parameters were identified as main independent factors. Furthermore, some statistical tests were conducted to identify any relationship between the dependent variable (dispersed oil mass in the water column) and independent variables (water wave specifications containing height, length and wave period and spilled oil characteristics including density, viscosity and spilled oil mass). Finally, a mathematical-statistical relationship is proposed to predict dispersed oil in marine waters. To verify the proposed relationship, a laboratory example available in the literature was selected. Oil mass rate penetrated in water body computed by statistical regression was in accordance with experimental data was predicted. On this occasion, it was necessary to verify the proposed mathematical phrase. In a selected laboratory case available in the literature, mass oil rate penetrated in water body computed by suggested regression. Results showed good agreement with experimental data. The validated mathematical-statistical phrase is a useful tool for oil dispersion prediction in oil spill events in marine areas.

Keywords: Dispersion, marine environment, mathematical-statistical relationship, oil spill.

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Authors: Syarifah Abd Rahim, Fatinah Ab Rahman, Engku N. E. M. Nasir, Noor A. Ramle

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Co-crystal is believed to improve the solubility and dissolution rates and thus, enhanced the bioavailability of poor water soluble drugs particularly during the oral route of administration. With the existing of poorly soluble drugs in pharmaceutical industry, the screening of co-crystal formation using carbamazepine (CBZ) as a model drug compound with dicarboxylic acids co-crystal formers (CCF) namely fumaric (FA) and succinic (SA) acids in ethanol has been studied. The co-crystal formations were studied by varying the mol ratio values of CCF to CBZ to access the effect of CCF concentration on the formation of the co-crystal. Solvent evaporation, slurry and cooling crystallization which representing the solution based method co-crystal screening were used. Based on the differential scanning calorimetry (DSC) analysis, the melting point of CBZ-SA in different ratio was in the range between 188oC-189oC. For CBZ-FA form A and CBZ-FA form B the melting point in different ratio were in the range of 174oC-175oC and 185oC-186oC respectively. The product crystal from the screening was also characterized using X-ray powder diffraction (XRPD). The XRPD pattern profile analysis has shown that the CBZ co-crystals with FA and SA were successfully formed for all ratios studied. The findings revealed that CBZ-FA co-crystal were formed in two different polymorphs. It was found that CBZ-FA form A and form B were formed from evaporation and slurry crystallization methods respectively. On the other hand, in cooling crystallization method, CBZ-FA form A was formed at lower mol ratio of CCF to CBZ and vice versa. This study disclosed that different methods and mol ratios during the co-crystal screening can affect the outcome of co-crystal produced such as polymorphic forms of co-crystal and thereof. Thus, it was suggested that careful attentions is needed during the screening since the co-crystal formation is currently one of the promising approach to be considered in research and development for pharmaceutical industry to improve the poorly soluble drugs.

Keywords: Carbamazepine, co-crystal, co-crystal former, dicarboxylic acid.

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Authors: Saeid Haghjoo, Ebrahim Reyhani, Fahimeh Kolahdouz

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The present study aimed to evaluate the understanding of the students in Tehran universities (Iran) about the numerical representation of the average rate of change based on the Structure of Observed Learning Outcomes (SOLO). In the present descriptive-survey research, the statistical population included undergraduate students (basic sciences and engineering) in the universities of Tehran. The samples were 604 students selected by random multi-stage clustering. The measurement tool was a task whose face and content validity was confirmed by math and mathematics education professors. Using Cronbach's Alpha criterion, the reliability coefficient of the task was obtained 0.95, which verified its reliability. The collected data were analyzed by descriptive statistics and inferential statistics (chi-squared and independent t-tests) under SPSS-24 software. According to the SOLO model in the prestructural, unistructural, and multistructural levels, basic science students had a higher percentage of understanding than that of engineering students, although the outcome was inverse at the relational level. However, there was no significant difference in the average understanding of both groups. The results indicated that students failed to have a proper understanding of the numerical representation of the average rate of change, in addition to missconceptions when using physics formulas in solving the problem. In addition, multiple solutions were derived along with their dominant methods during the qualitative analysis. The current research proposed to focus on the context problems with approximate calculations and numerical representation, using software and connection common relations between math and physics in the teaching process of teachers and professors.

Keywords: Average rate of change, context problems, derivative, numerical representation, SOLO taxonomy.

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Authors: Kasra Majbouri Yazdi, Adel Majbouri Yazdi, Saeid Khodayi, Jingyu Hou, Wanlei Zhou, Saeed Saedy

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Fake news and false information are big challenges of all types of media, especially social media. There is a lot of false information, fake likes, views and duplicated accounts as big social networks such as Facebook and Twitter admitted. Most information appearing on social media is doubtful and in some cases misleading. They need to be detected as soon as possible to avoid a negative impact on society. The dimensions of the fake news datasets are growing rapidly, so to obtain a better result of detecting false information with less computation time and complexity, the dimensions need to be reduced. One of the best techniques of reducing data size is using feature selection method. The aim of this technique is to choose a feature subset from the original set to improve the classification performance. In this paper, a feature selection method is proposed with the integration of K-means clustering and Support Vector Machine (SVM) approaches which work in four steps. First, the similarities between all features are calculated. Then, features are divided into several clusters. Next, the final feature set is selected from all clusters, and finally, fake news is classified based on the final feature subset using the SVM method. The proposed method was evaluated by comparing its performance with other state-of-the-art methods on several specific benchmark datasets and the outcome showed a better classification of false information for our work. The detection performance was improved in two aspects. On the one hand, the detection runtime process decreased, and on the other hand, the classification accuracy increased because of the elimination of redundant features and the reduction of datasets dimensions.

Keywords: Fake news detection, feature selection, support vector machine, K-means clustering, machine learning, social media.

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Authors: Olupemi E. Oludare

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This paper discusses the thematic structure of Yoruba popular music of Southwest Nigeria. It examines the use of themes and variations in early and contemporary Juju music. The work is an outcome of a research developed by the author in his doctoral studies at the University of Lagos, Nigeria, with the aim of analyzing the thematic and motivic developments in Yoruba popular genres. Observations, interviews, live recordings and CDs were used as methods for eliciting information. Field recordings and CDs of selected musical samples were also transcribed and notated. The research established the prevalent use of string of themes by Juju musicians as a compositional technique in moving from one musical section to another, as they communicate the verbal messages in their song. These themes consist of the popular ‘call and response’ form found in most African music, analogous to the western ‘subject and answer’ style of the fugue or sonata form, although without the tonic– dominant relations. Due to the short and repetitive form of African melodies and rhythms, a theme is restated as a variation, where its rhythmic and melodic motifs are stylistically developed and repeated, but still retaining its recognizable core musical structure. The findings of this study showed that Juju musicians generally often employ a thematic plan where new themes are used to arrange the songs into sections, and each theme is developed into variations in order to further expand the music, eliminate monotony, and create musical aesthetics, serving as hallmark of its musical identity. The study established the musical and extra-musical attributes of the genre, while recommending further research towards analyzing the various compositional techniques employed in African popular genres.

Keywords: Compositional techniques, Popular music, Theme and variation, Thematic development.

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Authors: S. Homrossukon, A. Anurathapunt

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This is an application research presenting the improvement of production quality using the six sigma solutions and the analyses of benefit-cost ratio. The case of interest is the production of tile-concrete. Such production has faced with the problem of high nonconforming products from an inappropriate surface coating and had low process capability based on the strength property of tile. Surface coating and tile strength are the most critical to quality of this product. The improvements followed five stages of six sigma solutions. After the improvement, the production yield was improved to 80% as target required and the defective products from coating process was remarkably reduced from 29.40% to 4.09%. The process capability based on the strength quality was increased from 0.87 to 1.08 as customer oriented. The improvement was able to save the materials loss for 3.24 millions baht or 0.11 million dollars. The benefits from the improvement were analyzed from (1) the reduction of the numbers of non conforming tile using its factory price for surface coating improvement and (2) the materials saved from the increment of process capability. The benefit-cost ratio of overall improvement was high as 7.03. It was non valuable investment in define, measure, analyses and the initial of improve stages after that it kept increasing. This was due to there were no benefits in define, measure, and analyze stages of six sigma since these three stages mainly determine the cause of problem and its effects rather than improve the process. The benefit-cost ratio starts existing in the improve stage and go on. Within each stage, the individual benefitcost ratio was much higher than the accumulative one as there was an accumulation of cost since the first stage of six sigma. The consideration of the benefit-cost ratio during the improvement project helps make decisions for cost saving of similar activities during the improvement and for new project. In conclusion, the determination of benefit-cost ratio behavior through out six sigma implementation period provides the useful data for managing quality improvement for the optimal effectiveness. This is the additional outcome from the regular proceeding of six sigma.

Keywords: Six Sigma Solutions, Process Improvement, QualityManagement, Benefit Cost Ratio

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Authors: Ramin Mirzada, Takuya Maruyama

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Kabul is the heart of political, commercial, cultural, educational and social life in Afghanistan and the fifth fastest growing city in the world. Minimum income inclined most of Kabul residents to use public transport, especially buses, although there is no proper bus system, beside that there is no proper fare exist in Kabul city Due to wars. From 1992 to 2001 during civil wars, Kabul suffered damage and destruction of its transportation facilities including pavements, sidewalks, traffic circles, drainage systems, traffic signs and signals, trolleybuses and almost all of the public transport system (e.g. Millie bus). This research is mainly focused on Kabul city’s transportation system. In this research, the data used have been gathered by Japan International Cooperation Agency (JICA) in 2008 and this data will be used to find demand and fare structure, additionally a survey was done in 2016 to find satisfaction level of Kabul residents for fare structure. Aim of this research is to observe the demand for Large Buses, compare to the actual supply from the government, analyze the current fare structure and compare it with the proposed fare (distance based fare) structure which has already been analyzed. Outcome of this research shows that the demand of Kabul city residents for the public transport (Large Buses) exceeds from the current supply, so that current public transportation (Large Buses) is not sufficient to serve public transport in Kabul city, worth to be mentioned, that in order to overcome this problem, there is no need to build new roads or exclusive way for buses. This research proposes government to change the fare from fixed fare to distance based fare, invest on public transportation and increase the number of large buses so that the current demand for public transport is met.

Keywords: Transportation, planning, public transport, large buses, fixed fare, distance based fare, Kabul, Afghanistan.

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Authors: Saeeda Batool, Ather Maqsood Ahmed

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This study investigates the impact of public healthcare facilities and socio-economic circumstances on the status of child health in Pakistan. The complete analysis is carried out in correspondence with fourth and sixth millennium development goals. Further, the health variables chosen are also inherited from targeted indicators of the mentioned goals (MDGs). Trends in the Human Opportunity Index (HOI) for both health inequalities and coverage are analyzed using the Pakistan Social and Living Standards Measurement (PLSM) data set for 2001-02 to 2012-13 at the national and provincial level. To reveal the relative importance of each circumstance in achieving the targeted values for child health, Shorrocks decomposition is applied on HOI. The annual point average growth rate of HOI is used to simulate the time period for the achievement of target set by MDGs and universal access also. The results indicate an improvement in HOI for a reduction in child mortality rates from 52.1% in 2001-02 to 67.3% in 2012-13, which confirms the availability of healthcare opportunities to a larger segment of society. Similarly, immunization against measles and other diseases such as Diphtheria, Polio, Bacillus Calmette-Guerin (BCG), and Hepatitis has also registered an improvement from 51.6% to 69.9% during the period of study at the national level. On a positive note, no gender disparity has been found for child health indicators and that health outcome is mostly affected by the parental and geographical features and availability of health infrastructure. However, the study finds that this achievement has been uneven across provinces. Pakistan is not only lagging behind in achieving its health goals, disappointingly with the current rate of health care provision, but it will take many additional years to achieve its targets.

Keywords: Socio-economic circumstances, unmet MDGs, public healthcare services, child and infant mortality.

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Authors: Laura Çami (Vorpsi), Xhon Skënderi

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In today's rapidly evolving technological landscape, the traditional principles of contract law are facing significant challenges. The emergence of new technologies, such as electronic signatures, smart contracts, and online dispute resolution mechanisms, is transforming the way contracts are formed, interpreted, and enforced. This paper examines the implications of these technological advancements on the constitutional principles of contract law. One of the fundamental principles of contract law is freedom of contract, which ensures that parties have the autonomy to negotiate and enter into contracts as they see fit. However, the use of technology in the contracting process has the potential to disrupt this principle. For example, online platforms and marketplaces often offer standard-form contracts, which may not reflect the specific needs or interests of individual parties. This raises questions about the equality of bargaining power between parties and the extent to which parties are truly free to negotiate the terms of their contracts. Another important principle of contract law is the requirement of consideration, which requires that each party receives something of value in exchange for their promise. The use of digital assets, such as cryptocurrencies, has created new challenges in determining what constitutes valuable consideration in a contract. Due to the ambiguity in this area, disagreements about the legality and enforceability of such contracts may arise. Furthermore, the use of technology in dispute resolution mechanisms, such as online arbitration and mediation, may raise concerns about due process and access to justice. The use of algorithms and artificial intelligence to determine the outcome of disputes may also raise questions about the impartiality and fairness of the process. Finally, it should be noted that there are many different and complex effects of technical improvements on the fundamental constitutional foundations of contract law. As technology continues to evolve, it will be important for policymakers and legal practitioners to consider the potential impacts on contract law and to ensure that the principles of fairness, equality, and access to justice are preserved in the contracting process.

Keywords: Technological advancements, constitutional principles, contract law, smart contracts, online dispute resolution, freedom of contract.

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Authors: Viridiana Edith Ardura Perea, José Luis Bermúdez Alcocer

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The purpose of this paper is to establish the influence of shading on a Building Integrated Photovoltaic (BIPV) system´s performance in an urban context. The PV systems of the Science Center of Complexity (Centro de Ciencias de la Complejidad) Building based in the Main Campus of the National and Autonomous University of Mexico (UNAM) in Mexico City was taken as case study.  The PV systems are placed on the rooftop and on the south façade of the building.  The south-façade PV system, operating as sunshades, consists of two strings:  one at the ground floor and the other one at the first floor.  According to the building’s facility manager, the south-façade PV system generates 42% less electricity per kilowatt peak (kWp) installed than the one on the roof.  The methods applied in this study were Solar Radiation Analysis (SRA) simulations performed with the Insight 360 Plug-in from Revit 2018^® and an on-site measurement using specialized tools.  The results of the SRA simulations showed that the shading casted by the PV system placed on the first floor on top of the PV system of the ground floor decreases its solar incident radiation over 50%.  The simulation outcome was compared and validated to the measured data obtained from the on-site measurement.  In conclusion, the loss factor achieved from the shading of the PVs is due to the surroundings and the PV system´s own design.  The south-façade BIPV system’s deficient design generates critical losses on its performance and decreases its profitability.

Keywords: Building integrated photovoltaics (BIPV) design, energy analysis software, shading losses, solar radiation analysis.

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Authors: Murtuza Ali Lakhani, Michelle Marquard

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From an organizational perspective, leaders are a variation of the same talent pool in that they all score a larger than average value on the bell curve that maps leadership behaviors and characteristics, namely competence, vision, communication, confidence, cultural sensibility, stewardship, empowerment, authenticity, reinforcement, and creativity. The question that remains unanswered and essentially unresolved is how to explain the irony that leaders are so much alike yet their organizations diverge so noticeably in their ability to innovate. Leadership intersects with innovation at the point where human interactions get exceedingly complex and where certain paradoxical forces cohabit: conflict with conciliation, sovereignty with interdependence, and imagination with realism. Rather than accepting that leadership is without context, we argue that leaders are specialists of their domain and that those effective at leading for innovation are distinct within the broader pool of leaders. Keeping in view the extensive literature on leadership and innovation, we carried out a quantitative study with data collected over a five-year period involving 240 participants from across five dissimilar companies based in the United States. We found that while innovation and leadership are, in general, strongly interrelated (r = .89, p = 0.0), there are five qualities that set leaders apart on innovation. These qualities include a large radius of trust, a restless curiosity with a low need for acceptance, an honest sense of self and other, a sense for knowledge and creativity as the yin and yang of innovation, and an ability to use multiple senses in the engagement with followers. When these particular behaviors and characteristics are present in leaders, organizations out-innovate their rivals by a margin of 29.3 per cent to gain an unassailable edge in a business environment that is regularly disruptive. A strategic outcome of this study is a psychometric scale named iLeadership, proposed with the underlying evidence, limitations, and potential for leadership and innovation in organizations.c

Keywords: Innovation, leadership, ileadership, stewardship, communication, empowerment, creativity, vision, influence, emotional connection, group membership, sense of community, knowledge creation.

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Authors: I. M. Yusuff, A. M. Arogunjo, S. B. Ibikunle, O. M. Oni, P. O. Osho

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Generally, water contamination is a serious health concern, affecting millions of people worldwide every year. Among the water contaminants, radon is a radioactive contaminant understudied and under-regulated. It produces many adverse health effects, including cancer. It is a natural gas that cannot be seen, tasted, or smelled. It develops from the radioactive decay of radium found in the rock of soil and has been considered a health hazard due to its radioactivity in nature. To examine its effects and physicochemical characteristics on the blood biomarkers due to its ingestion in drinking water, its concentrations were monitored and measured in treated and untreated water using Electronic Radon Active Detector (RAD7), while human blood samples were collected using the required laboratory tools. The blood samples were collected and examined physicochemically using semi-automated chemistry analyzer to evaluate the chemistry parameters of the blood. Statistically, results obtained were analyzed using T-test of variables at 95% confidence interval. The outcome of results revealed 112.03 Bq/m3, 561.67 Bq/m3 and 2,753.00 Bq/m3 of radon-222 concentrations in the three water samples used respectively. Demographically, chemistry parameters biomarkers of the blood determined displayed some levels of variations due to radon-222 contaminants ingested from untreated water. Also, analyzed results of blood revealed the associations between the physicochemical parameters of the blood biomarkers and volunteers’ health consequences. The consequences observed were more severed with group B volunteers than group A, due to high level of radon contaminants in borehole water consumed by group B than in well water consumed by group A. The percentages of elevated and depressed biomarkers observed differ from initial reference values and, were the dysfunction indicators. They are directly or indirectly associated to human’s state of health. Most significant biomarkers affected were; HCO3, Cl, K, Cr and Na, they are relevant biomarkers in medicine to determine human’s state of health at any point in time.

Keywords: Radioactive, radon, biomarker, ingestion, dysfunction.

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Authors: Sanchita B. Sarma, M. P. Nath

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Adequate analgesia following caesarean section decreases morbidity, hastens ambulation, improves patient outcome and facilitates care of the newborn. Intrathecal magnesium, an NMDA antagonist, has been shown to prolong analgesia without significant side effects in healthy parturients. The aim of this study was to evaluate the onset and duration of sensory and motor block, hemodynamic effect, postoperative analgesia, and adverse effects of magnesium or fentanyl given intrathecally with hyperbaric 0.5% bupivacaine in patients with mild preeclampsia undergoing caesarean section. Sixty women with mild preeclampsia undergoing elective caesarean section were included in a prospective, double blind, controlled trial. Patients were randomly assigned to receive spinal anesthesia with 2 mL 0.5% hyperbaric bupivacaine with 12.5 μg fentanyl (group F) or 0.1 ml of 50% magnesium sulphate (50 mg) (group M) with 0.15ml preservative free distilled water. Onset, duration and recovery of sensory and motor block, time to maximum sensory block, duration of spinal anaesthesia and postoperative analgesic requirements were studied. Statistical comparison was carried out using the Chi-square or Fisher’s exact tests and Independent Student’s t-test where appropriate. The onset of both sensory and motor block was slower in the magnesium group. The duration of spinal anaesthesia (246 vs. 284) and motor block (186.3 vs. 210) were significantly longer in the magnesium group. Total analgesic top up requirement was less in group M. Hemodynamic parameters were similar in both the groups. Intrathecal magnesium caused minimal side effects. Since Fentanyl and other opioid congeners are not available throughout the country easily, magnesium with its easy availability and less side effect profile can be a cost effective alternative to fentanyl in managing pregnancy induced hypertension (PIH) patients given along with Bupivacaine intrathecally in caesarean section.

Keywords: Analgesia, magnesium, preeclampsia, spinal anaesthesia.

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Authors: Muhammad Ridhuan Tony Lim Abdullah, Zulqarnain Abu Bakar, Razol Mahari Ali, Ibrahima Faye, Hilmi Hasan

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This paper describes a research project on Year 3 primary school students in Malaysia in their use of computer-based video game to enhance learning of multiplication facts (tables) in the Mathematics subject. This study attempts to investigate whether video games could actually contribute to positive effect on children-s learning or otherwise. In conducting this study, the researchers assume a neutral stand in the investigation as an unbiased outcome of the study would render reliable response to the impact of video games in education which would contribute to the literature of technology-based education as well as impact to the pedagogical aspect of formal education. In order to conduct the study, a subject (Mathematics) with a specific topic area in the subject (multiplication facts) is chosen. The study adopts a causal-comparative research to investigate the impact of the inclusion of a computer-based video game designed to teach multiplication facts to primary level students. Sample size is 100 students divided into two i.e., A: conventional group and B conventional group aided by video games. The conventional group (A) would be taught multiplication facts (timetables) and skills conventionally. The other group (B) underwent the same lessons but with supplementary activity: a computer-based video game on multiplication which is called Timez-Attack. Analysis of marks accrued from pre-test will be compared to post- test using comparisons of means, t tests, and ANOVA tests to investigate the impact of computer games as an added learning activity. The findings revealed that video games as a supplementary activity to classroom learning brings significant and positive effect on students- retention and mastery of multiplication tables as compared to students who rely only upon formal classroom instructions.

Keywords: Technology for education, Gaming for education, Computer-based video games, Cognitive learning

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Authors: Wajiha Javed, Arsalan Jabbar, Nelofer Mehboob, Muhammad Tafseer, Zahid Memon

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Introduction: Researchers globally have strived to explore diverse factors that augment the continuation and uptake of family planning methods. Clients’ satisfaction is one of the core determinants facilitating continuation of family planning methods. There is a major debate yet scanty evidence to contrast public and private sectors with respect to client satisfaction. The objective of this study is to compare quality-of-care provided by public and private sectors of Pakistan through a client satisfaction lens. Methods: We used Pakistan Demographic Heath Survey 2012-13 dataset on 3133 women. Ten different multivariate models were made. to explore the relationship between client satisfaction and dependent outcome after adjusting for all known confounding factors and results are presented as OR and AOR (95% CI). Results: Multivariate analyses showed that clients were less satisfied in contraceptive provision from private sector as compared to public sector (AOR 0.92, 95% CI 0.63-1.68) even though the result was not statistically significant. Clients were more satisfied from private sector as compared to the public sector with respect to other determinants of quality-of-care follow-up care (AOR 3.29, 95% CI 1.95-5.55), infection prevention (AOR 2.41, 95% CI 1.60-3.62), counseling services (AOR 2.01, 95% CI 1.27-3.18, timely treatment (AOR 3.37, 95% CI 2.20-5.15), attitude of staff (AOR 2.23, 95% CI 1.50-3.33), punctuality of staff (AOR 2.28, 95% CI 1.92-4.13), timely referring (AOR 2.34, 95% CI 1.63-3.35), staff cooperation (AOR 1.75, 95% CI 1.22-2.51) and complications handling (AOR 2.27, 95% CI 1.56-3.29). Discussion: Public sector has successfully attained substantial satisfaction levels with respect to provision of contraceptives, but it contrasts previous literature from a multi country studies. Our study though in is concordance with a study from Tanzania where public sector was more likely to offer family planning services to clients as compared to private facilities. Conclusion: In majority of the developing countries, public sector is more involved in FP service provision; however, in Pakistan clients’ satisfaction in private sector is more, which opens doors for public-private partnerships and collaboration in the near future. 

Keywords: Client satisfaction, Family Planning, Public private partnership, Quality of care

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Authors: Mário Silva, Filipa Gomes, Filipa Oliveira, Simone Morais, Cristina Delerue-Matos

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Brown seaweeds are abundant in Portuguese coastline and represent an almost unexploited marine economic resource. One of the most common species, easily available for harvesting in the northwest coast, is Saccorhiza polyschides grows in the lowest shore and costal rocky reefs. It is almost exclusively used by local farmers as natural fertilizer, but contains a substantial amount of valuable compounds, particularly alginates, natural biopolymers of high interest for many industrial applications. Alginates are natural polysaccharides present in cell walls of brown seaweed, highly biocompatible, with particular properties that make them of high interest for the food, biotechnology, cosmetics and pharmaceutical industries. Conventional extraction processes are based on thermal treatment. They are lengthy and consume high amounts of energy and solvents. In recent years, microwave-assisted extraction (MAE) has shown enormous potential to overcome major drawbacks that outcome from conventional plant material extraction (thermal and/or solvent based) techniques, being also successfully applied to the extraction of agar, fucoidans and alginates. In the present study, acid pretreatment of brown seaweed Saccorhiza polyschides for subsequent microwave-assisted extraction (MAE) of alginate was optimized. Seaweeds were collected in Northwest Portuguese coastal waters of the Atlantic Ocean between May and August, 2014. Experimental design was used to assess the effect of temperature and acid pretreatment time in alginate extraction. Response surface methodology allowed the determination of the optimum MAE conditions: 40 mL of HCl 0.1 M per g of dried seaweed with constant stirring at 20ºC during 14h. Optimal acid pretreatment conditions have enhanced significantly MAE of alginates from Saccorhiza polyschides, thus contributing for the development of a viable, more environmental friendly alternative to conventional processes.

Keywords: Acid pretreatment, Alginate, Brown seaweed, Microwave-assisted extraction, Response surface methodology.

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Authors: Katie Emerson, Sara Perez-Ojalvo, Jim Komorowski, Danielle Greenberg

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The purpose of this study was to evaluate arginase activity levels in response to combinations of an inositol-stabilized arginine silicate (ASI; Nitrosigine®), L-arginine, and Inositol. Arginine acts as a vasodilator that promotes increased blood flow resulting in enhanced delivery of oxygen and nutrients to the brain and other tissues. Arginase, found in human serum, catalyzes the conversion of arginine to ornithine and urea, completing the last step in the urea cycle. Decreasing arginase levels maintains arginine and results in increased nitric oxide production. This study aimed to determine the most effective combination of ASI, L-arginine and inositol for minimizing arginase levels and therefore maximize ASI’s effect on cognition. Serum was taken from untreated healthy donors by separation from clotted factors. Arginase activity of serum in the presence or absence of test products was determined (QuantiChrom™, DARG-100, Bioassay Systems, Hayward CA). The remaining ultra-filtrated serum units were harvested and used as the source for the arginase enzyme. ASI alone or combined with varied levels of Inositol were tested as follows: ASI + inositol at 0.25 g, 0.5 g, 0.75 g, or 1.00 g. L-arginine was also tested as a positive control. All tests elicited changes in arginase activity demonstrating the efficacy of the method used. Adding L-arginine to serum from untreated subjects, with or without inositol only had a mild effect. Adding inositol at all levels reduced arginase activity. Adding 0.5 g to the standardized amount of ASI led to the lowest amount of arginase activity as compared to the 0.25 g, 0.75 g or 1.00g doses of inositol or to L-arginine alone. The outcome of this study demonstrates an interaction of the pairing of inositol with ASI on the activity of the enzyme arginase. We found that neither the maximum nor minimum amount of inositol tested in this study led to maximal arginase inhibition. Since the inhibition of arginase activity is desirable for product formulations looking to maintain arginine levels, the most effective amount of inositol was deemed preferred. Subsequent studies suggest this moderate level of inositol in combination with ASI leads to cognitive improvements including reaction time, executive function, and concentration.

Keywords: Arginine, blood flow, colorimetry, urea cycle.

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Authors: Aynaz Lotfata

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Planning community has been long discussing emerging paradigms within the planning theory in the face of the changing conditions of the world order. The paradigm shift concept was introduced by Thomas Kuhn, in 1960, who claimed the necessity of shifting within scientific knowledge boundaries; and following him in 1970 Imre Loktas also gave priority to the emergence of multi-paradigm societies [24]. Multi-paradigm is changing our predetermined lifeworld through uncertainties. Those uncertainties are reflected in two sides, the first one is uncertainty as a concept of possibility and creativity in public sphere and the second one is uncertainty as a risk. Therefore, it is necessary to apply a resilience planning approach to be more dynamic in controlling uncertainties which have the potential to transfigure present time and space definitions. In this way, stability of system can be achieved. Uncertainty is not only an outcome of worldwide changes but also a place-specific issue, i.e. it changes from continent to continent, a country to country; a region to region. Therefore, applying strategic spatial planning with respect to resilience principle contributes to: control, grasp and internalize uncertainties through place-specific strategies. In today-s fast changing world, planning system should follow strategic spatial projects to control multi-paradigm societies with adaptability capacities. Here, we have selected two alternatives to demonstrate; these are; 1.Tehran (Iran) from the Middle East 2.Bath (United Kingdom) from Europe. The study elaborates uncertainties and particularities in their strategic spatial planning processes in a comparative manner. Through the comparison, the study aims at assessing place-specific priorities in strategic planning. The approach is to a two-way stream, where the case cities from the extreme end of the spectrum can learn from each other. The structure of this paper is to firstly compare semi-periphery (Tehran) and coreperiphery (Bath) cities, with the focus to reveal how they equip to face with uncertainties according to their geographical locations and local particularities. Secondly, the key message to address is “Each locality requires its own strategic planning approach to be resilient.--

Keywords: Adaptation, Relational Network, Socio-Spatial Strategic Resiliency, Uncertainty.

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Authors: Theingi Shwe, Riken Homma, Kazuhisa Iki, Juko Ito

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The growing cities of the developing country are characterized by rapid growth and poor infrastructure management inviting and accelerating relative environmental problems. Even though the movements of the sustainability had already been developed around the world, it is still increasing in the developing countries to plant sustainable practices. Aligned with the sustainable development actions, many sustainable assessment tools are also developed to rate and evaluate the sustainability performances through the building to community level. Among them, CASBEE is developed by Japanese organizations and is recognized as one of the international well-known assessment tools. The main purpose of the study is to find out the potential of CASBEE tool reflecting sustainability city level performances in developing countries. The research framework was designed with three major phases: Quantitative Approach, Qualitative Approach and Evaluation Reflection. The first two approaches were based on the investigation of tool’s contents and indicators by means of three sustainable dimensions and sustainability categories. To know the reality and reflection on developing country, Pathein City from Myanmar was selected and evaluated by 2012 version of CASBEE for Cities. The evaluation practices went through assigned indicators and the evaluation outcome presents the performances of Pathein city’s environmental efficiency as a very good in current conditions. The results of this study indicate that the indicators of this tool have balance coverage among three dimensions of sustainability but it has not yet counted enough for some indicators like location, infrastructure and institution which are relative to society dimension. In the developing countries’ cities, the most critical issues on development such as affordable housing and heritage preservation which are already planted in Pathein City but the tool does not account for those issues. Moreover, in some of the indicators, the benchmark and the weighting coefficient are strongly linked to the system birth region. By means of this study, it can be stated that CASBEE for Cities would be potential for delivering sustainable city level development in developing country especially in Myanmar along with further inclusion of the indicators.

Keywords: Assessment tool, CASBEE, developing country, Myanmar, Pathein city, sustainable development.

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Authors: Manjusha R. Vagal, Shyam K. Shrivastava, Umesh Mahantshetty, Sudeep Gupta, Supriya Chopra, Reena Engineer, Amita Maheshwari, Atul Buduk

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Vaginal stenosis is a common side effect associated with pelvic radiotherapy in cervical cancer patients which contributes negatively to woman’s health and prevents adequate vaginal/cervical examination. Vaginal dilation with a dilator is routine practice and is internationally advocated as a prophylactic measure to preserve vaginal patency. This retrospective study was carried out with the aim to know the usefulness of vaginal dilation following pelvic radiation therapy in cervical cancer patients in India. Data from medical records of 183 cervical cancer patients, which met the study criteria, were collected related to the stage of the disease, treatment received, commencement period of dilation post radiation therapy, sexual status and side effects associated to dilation practice. Data related to vaginal dimensions as per the length of insertion of a small, medium and large dilator were collected on regular follow-ups until 36 months and/or more. Vaginal dimensions as measured with the length of medium dilator insertion were used for analysis of dilation therapy results using paired t-test. Patients who underwent vaginal dilation with dilator maintained vaginal patency, also the mean vaginal length significantly increased, from 8.02 cm ± 2.69 to 9.96 ± 2.89 cm with a p value <0.001. There was no significant difference found on vaginal patency with different intervals of initiation of dilation therapy. At the third year and more following dilation therapy, significant increase in vaginal length observed with a p value of 0.0001 in both sexually active and inactive patients. Compilation of vaginal dosage during brachytherapy was inadequate, and hence, the secondary objective of the study to determine the effect of radiotherapy on the outcome of rehabilitation intervention was not studied in detail. This retrospective study has found that dilation therapy with vaginal dilators post pelvic radiotherapy is effective in preventing vaginal stenosis and improving vaginal patency and cannot be substituted with vaginal intercourse. Sexual quality of life assessment in the Indian population needs much attention.

Keywords: Dilator, sexually active, vaginal dilation, vaginal stenosis.

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Authors: A. Anastasopoulou, A. Kolios, T. Somorin, A. Sowale, Y. Jiang, B. Fidalgo, A. Parker, L. Williams, M. Collins, E. J. McAdam, S. Tyrrel

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Developing countries are nowadays confronted with great challenges related to domestic sanitation services in view of the imminent water scarcity. Contemporary sanitation technologies established in these countries are likely to pose health risks unless waste management standards are followed properly. This paper provides a solution to sustainable sanitation with the development of an innovative toilet system, called Nano Membrane Toilet (NMT), which has been developed by Cranfield University and sponsored by the Bill & Melinda Gates Foundation. The particular technology converts human faeces into energy through gasification and provides treated wastewater from urine through membrane filtration. In order to evaluate the environmental profile of the NMT system, a deterministic life cycle assessment (LCA) has been conducted in SimaPro software employing the Ecoinvent v3.3 database. The particular study has determined the most contributory factors to the environmental footprint of the NMT system. However, as sensitivity analysis has identified certain critical operating parameters for the robustness of the LCA results, adopting a stochastic approach to the Life Cycle Inventory (LCI) will comprehensively capture the input data uncertainty and enhance the credibility of the LCA outcome. For that purpose, Monte Carlo simulations, in combination with an artificial neural network (ANN) model, have been conducted for the input parameters of raw material, produced electricity, NO_X emissions, amount of ash and transportation of fertilizer. The given analysis has provided the distribution and the confidence intervals of the selected impact categories and, in turn, more credible conclusions are drawn on the respective LCIA (Life Cycle Impact Assessment) profile of NMT system. Last but not least, the specific study will also yield essential insights into the methodological framework that can be adopted in the environmental impact assessment of other complex engineering systems subject to a high level of input data uncertainty.

Keywords: Sanitation systems, nano membrane toilet, LCA, stochastic uncertainty analysis, Monte Carlo Simulations, artificial neural network.

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Authors: Ola A. Nassr, Ali M. Abd Alridha, Rua A. Naser, Rasha S. Abbas

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Background: Excessive and inappropriate use of antimicrobial agents among hospitalized patients remains an important patient safety and public health issue worldwide. Not only does this behavior incur unnecessary cost but it is also associated with increased morbidity and mortality. The objective of this study is to obtain an insight into the prescribing patterns of antibiotics in surgical and medical wards, to help identify a scope for improvement in service delivery. Method: A simple point prevalence survey included a convenience sample of 200 patients admitted to medical and surgical wards in a government teaching hospital in Baghdad between October 2017 and April 2018. Data were collected by a trained pharmacy intern using a standardized form. Patient’s demographics and details of the prescribed antibiotics, including dose, frequency of dosing and route of administration, were reported. Patients were included if they had been admitted at least 24 hours before the survey. Patients under 18 years of age, having a diagnosis of cancer or shock, or being admitted to the intensive care unit, were excluded. Data were checked and entered by the authors into Excel and were subjected to frequency analysis, which was carried out on anonymized data to protect patient confidentiality. Results: Overall, 88.5% of patients (n=177) received 293 antibiotics during their hospital admission, with a small variation between wards (80%-97%). The average number of antibiotics prescribed per patient was 1.65, ranging from 1.3 for medical patients to 1.95 for surgical patients. Parenteral third-generation cephalosporins were the most commonly prescribed at a rate of 54.3% (n=159) followed by nitroimidazole 29.4% (n=86), quinolones 7.5% (n=22) and macrolides 4.4% (n=13), while carbapenems and aminoglycosides were the least prescribed together accounting for only 4.4% (n=13). The intravenous route was the most common route of administration, used for 96.6% of patients (n=171). Indications were reported in only 63.8% of cases. Culture to identify pathogenic organisms was employed in only 0.5% of cases. Conclusion: Broad-spectrum antibiotics are prescribed at an alarming rate. This practice may provoke antibiotic resistance and adversely affect the patient outcome. Implementation of an antibiotic stewardship program is warranted to enhance the efficacy, safety and cost-effectiveness of antimicrobial agents.

Keywords: Acute care, antibiotic misuse, Iraq, prescribing.

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Authors: Lara Dutil-Fafard, Caroline Rhéaume, Patrick Archambault, Daniel Lafond, Neal W. Pollock

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Improving resources for medical autonomy of astronauts in prolonged space missions, such as a Mars mission, requires not only technology development, but also decision-making support systems. The Advanced Crew Medical System - Medical Condition Requirements study, funded by the Canadian Space Agency, aimed to create knowledge content and a scenario-based query capability to support medical autonomy of astronauts. The key objective of this study was to create a prototype tool for identifying medical infrastructure requirements in terms of medical knowledge, skills and materials. A multicriteria decision-making method was used to prioritize the highest risk medical events anticipated in a long-term space mission. Starting with those medical conditions, event sequence diagrams (ESDs) were created in the form of decision trees where the entry point is the diagnosis and the end points are the predicted outcomes (full recovery, partial recovery, or death/severe incapacitation). The ESD formalism was adapted to characterize and compare possible outcomes of medical conditions as a function of available medical knowledge, skills, and supplies in a given mission scenario. An extensive literature review was performed and summarized in a medical condition database. A PostgreSQL relational database was created to allow query-based evaluation of health outcome metrics with different medical infrastructure scenarios. Critical decision points, skill and medical supply requirements, and probable health outcomes were compared across chosen scenarios. The three medical conditions with the highest risk rank were acute coronary syndrome, sepsis, and stroke. Our efforts demonstrate the utility of this approach and provide insight into the effort required to develop appropriate content for the range of medical conditions that may arise.

Keywords: Decision support system, event sequence diagram, exploration mission, medical autonomy, scenario-based queries, space medicine.

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Authors: Kazunori Nomura, Hiromichi Ogi, Masaumi Nakahara, Sou Watanabe, Atsuhiro Shibata

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Chemical Processing Facility of Japan Atomic Energy Agency is a basic research field for advanced back-end technology developments with using actual high-level radioactive materials such as irradiated fuels from the fast reactor, high-level liquid waste from reprocessing plant. In the nature of a research facility, various kinds of chemical reagents have been offered for fundamental tests. Most of them were treated properly and stored in the liquid waste vessel equipped in the facility, but some were not treated and remained at the experimental space as a kind of legacy waste. It is required to treat the waste in safety. On the other hand, we formulated the Medium- and Long-Term Management Plan of Japan Atomic Energy Agency Facilities. This comprehensive plan considers Chemical Processing Facility as one of the facilities to be decommissioned. Even if the plan is executed, treatment of the “legacy” waste beforehand must be a necessary step for decommissioning operation. Under this circumstance, we launched a collaborative research project called the STRAD project, which stands for Systematic Treatment of Radioactive liquid waste for Decommissioning, in order to develop the treatment processes for wastes of the nuclear research facility. In this project, decomposition methods of chemicals causing a troublesome phenomenon such as corrosion and explosion have been developed and there is a prospect of their decomposition in the facility by simple method. And solidification of aqueous or organic liquid wastes after the decomposition has been studied by adding cement or coagulants. Furthermore, we treated experimental tools of various materials with making an effort to stabilize and to compact them before the package into the waste container. It is expected to decrease the number of transportation of the solid waste and widen the operation space. Some achievements of these studies will be shown in this paper. The project is expected to contribute beneficial waste management outcome that can be shared world widely.

Keywords: Chemical Processing Facility, medium- and long-term management plan of JAEA Facilities, STRAD project, treatment of radioactive waste.

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Authors: A.H. Sajedipoor, N. Hedayat , M. Mashal, R. Nazarzadeh

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Sedimentation formation is a complex hydraulic phenomenon that has emerged as a major operational and maintenance consideration in modern hydraulic engineering in general and river engineering in particular. Sediments accumulation along the river course and their eventual storage in a form of islands affect water intake in the canal systems that are fed by the storage reservoirs. Without proper management, sediment transport can lead to major operational challenges in water distribution system of arid regions like the Dez and Hamidieh command areas. The paper aims to investigate sedimentation in the Western Canal of Dez Diversion Weir using the SHARC model and compare the results with the two intake structures of the Hamidieh dam in Iran using SSIIM model. The objective was to identify the factors which influence the process, check reliability of outcome and provide ways in which to mitigate the implications on operation and maintenance of the structures. Results estimated sand and silt bed loads concentrations to be 193 ppm and 827ppm respectively. This followed ,ore or less similar pattern in Hamidieh where the sediment formation impeded water intake in the canal system. Given the available data on average annual bed loads and average suspended sediment loads of 165ppm and 837ppm in the Dez, there was a significant statistical difference (16%) between the sand grains, whereas no significant difference (1.2%) was find in the silt grain sizes. One explanation for such finding being that along the 6 Km river course there was considerable meandering effects which explains recent shift in the hydraulic behavior along the stream course under investigation. The sand concentration in downstream relative to present state of the canal showed a steep descending curve. Sediment trapping on the other hand indicated a steep ascending curve. These occurred because the diversion weir was not considered in the simulation model. The comparative study showed very close similarities in the results which explains the fact that both software can be used as accurate and reliable analytical tools for simulation of the sedimentation in hydraulic engineering.

Keywords: SHARC, SSIIM, sedimentation, Dez diversion weir, Hamidieh dam, Intake structures

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Authors: Sami W. Tabsh

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The strength of reinforced concrete depends on the member dimensions and material properties. The properties of concrete and steel materials are not constant but random variables. The variability of concrete strength is due to batching errors, variations in mixing, cement quality uncertainties, differences in the degree of compaction and disparity in curing. Similarly, the variability of steel strength is attributed to the manufacturing process, rolling conditions, characteristics of base material, uncertainties in chemical composition, and the microstructure-property relationships. To account for such uncertainties, codes of practice for reinforced concrete design impose resistance factors to ensure structural reliability over the useful life of the structure. In this investigation, the effects of reductions in concrete and reinforcing steel strengths from the nominal values, beyond those accounted for in the structural design codes, on the structural reliability are assessed. The considered limit states are flexure, shear and axial compression based on the ACI 318-11 structural concrete building code. Structural safety is measured in terms of a reliability index. Probabilistic resistance and load models are compiled from the available literature. The study showed that there is a wide variation in the reliability index for reinforced concrete members designed for flexure, shear or axial compression, especially when the live-to-dead load ratio is low. Furthermore, variations in concrete strength have minor effect on the reliability of beams in flexure, moderate effect on the reliability of beams in shear, and sever effect on the reliability of columns in axial compression. On the other hand, changes in steel yield strength have great effect on the reliability of beams in flexure, moderate effect on the reliability of beams in shear, and mild effect on the reliability of columns in axial compression. Based on the outcome, it can be concluded that the reliability of beams is sensitive to changes in the yield strength of the steel reinforcement, whereas the reliability of columns is sensitive to variations in the concrete strength. Since the embedded target reliability in structural design codes results in lower structural safety in beams than in columns, large reductions in material strengths compromise the structural safety of beams much more than they affect columns.

Keywords: Code, flexure, limit states, random variables, reinforced concrete, reliability, reliability index, shear, structural safety.

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Authors: A. Lauvray, F. Poulhaon, P. Michaud, P. Joyot, E. Duc

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Additive Friction Stir Manufacturing, or AFSM, is a new industrial process that follows the emergence of friction-based processes. The AFSM process is a solid-state additive process using the energy produced by the friction at the interface between a rotating non-consumable tool and a substrate. Friction depends on various parameters like axial force, rotation speed or friction coefficient. The feeder material is a metallic rod that flows through a hole in the tool. There is still a lack in understanding of the physical phenomena taking place during the process. This research aims at a better AFSM process understanding and implementation, thanks to numerical simulation and experimental validation performed on a prototype effector. Such an approach is considered a promising way for studying the influence of the process parameters and to finally identify a process window that seems relevant. The deposition of material through the AFSM process takes place in several phases. In chronological order these phases are the docking phase, the dwell time phase, the deposition phase, and the removal phase. The present work focuses on the dwell time phase that enables the temperature rise of the system due to pure friction. An analytic modeling of heat generation based on friction considers as main parameters the rotational speed and the contact pressure. Another parameter considered influential is the friction coefficient assumed to be variable, due to the self-lubrication of the system with the rise in temperature or the materials in contact roughness smoothing over time. This study proposes through a numerical modeling followed by an experimental validation to question the influence of the various input parameters on the dwell time phase. Rotation speed, temperature, spindle torque and axial force are the main monitored parameters during experimentations and serve as reference data for the calibration of the numerical model. This research shows that the geometry of the tool as well as fluctuations of the input parameters like axial force and rotational speed are very influential on the temperature reached and/or the time required to reach the targeted temperature. The main outcome is the prediction of a process window which is a key result for a more efficient process implementation.

Keywords: numerical model, additive manufacturing, frictional heat generation, process

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Authors: S. Jamshidi, E. Feizi Ashtiani, M. Ardestani

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Waste Load Allocation (WLA) strategies usually intend to find economic policies for water resource management. Water quality trading (WQT) is an approach that uses discharge permit market to reduce total environmental protection costs. This primarily requires assigning discharge limits known as total maximum daily loads (TMDLs). These are determined by monitoring organizations with respect to the receiving water quality and remediation capabilities. The purpose of this study is to compare two approaches of TMDL assignment for WQT policy in small catchment area of Haraz River, in north of Iran. At first, TMDLs are assigned uniformly for the whole point sources to keep the concentrations of BOD and dissolved oxygen (DO) at the standard level at checkpoint (terminus point). This was simply simulated and controlled by Qual2kw software. In the second scenario, TMDLs are assigned using multi objective particle swarm optimization (MOPSO) method in which the environmental violation at river basin and total treatment costs are minimized simultaneously. In both scenarios, the equity index and the WLA based on trading discharge permits (TDP) are calculated. The comparative results showed that using economically optimized TMDLs (2nd scenario) has slightly more cost savings rather than uniform TMDL approach (1st scenario). The former annually costs about 1 M$ while the latter is 1.15 M$. WQT can decrease these annual costs to 0.9 and 1.1 M$, respectively. In other word, these approaches may save 35 and 45% economically in comparison with command and control policy. It means that using multi objective decision support systems (DSS) may find more economical WLA, however its outcome is not necessarily significant in comparison with uniform TMDLs. This may be due to the similar impact factors of dischargers in small catchments. Conversely, using uniform TMDLs for WQT brings more equity that makes stakeholders not feel that much envious of difference between TMDL and WQT allocation. In addition, for this case, determination of TMDLs uniformly would be much easier for monitoring. Consequently, uniform TMDL for TDP market is recommended as a sustainable approach. However, economical TMDLs can be used for larger watersheds.

Keywords: Waste load allocation (WLA), Water quality trading (WQT), Total maximum daily loads (TMDLs), Haraz River, Multi objective particle swarm optimization (MOPSO), Equity.

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Authors: Kasra Afsahi, Maryam Soheilifar, S. Hossein Hosseini

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Background: There is growing evidence that Cerebral Vascular Accident (CVA) can be a consequence of COVID-19 infection. Understanding novel treatment approaches is important in optimizing patient outcomes. Case: This case explores the use of Virtual Reality (VR) in the treatment of a 23-year-old COVID-positive female presenting with left hemiparesis in August 2020. Imaging showed right globus pallidus, thalamus, and internal capsule ischemic stroke. Conventional rehabilitation was started two weeks later, with VR included. This game-based VR technology developed for stroke patients was based on upper extremity exercises and functions for stroke. Physical examination showed left hemiparesis with muscle strength 3/5 in the upper extremity and 4/5 in the lower extremity. The range of motion of the shoulder was 90-100 degrees. The speech exam showed a mild decrease in fluency. Mild lower lip dynamic asymmetry was seen. Babinski was positive on the left. Gait speed was decreased (75 steps per minute). Intervention: Our game-based VR system was developed based on upper extremity physiotherapy exercises for post-stroke patients to increase the active, voluntary movement of the upper extremity joints and improve the function. The conventional program was initiated with active exercises, shoulder sanding for joint ROMs, walking shoulder, shoulder wheel, and combination movements of the shoulder, elbow, and wrist joints, alternative flexion-extension, pronation-supination movements, Pegboard and Purdo pegboard exercises. Also, fine movements included smart gloves, biofeedback, finger ladder, and writing. The difficulty of the game increased at each stage of the practice with progress in patient performances. Outcome: After 6 weeks of treatment, gait and speech were normal and upper extremity strength was improved to near normal status. No adverse effects were noted. Conclusion: This case suggests that VR is a useful tool in the treatment of a patient with COVID-19 related CVA. The safety of developed instruments for such cases provides approaches to improve the therapeutic outcomes and prognosis as well as increased satisfaction rate among patients.

Keywords: COVID-19, stroke, virtual reality, rehabilitation.

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