The Impact of Social Media, Customer Experience and Servicescape on The Revisit Intention in Marine Tourism (A Case Study on Akkarena Beach, Makassar)

This study aims to determine the impact of social media, customer experience and servicescape on revisit intention in marine tourism objects at Akkarena Beach, Makassar and to determine the factors that impact the interest in revisit intention to Akkarena Beach, Makassar. This research was conducted from January to March 2021. The type of research used is associative. The research data was collected using the interview method and the distribution of a list of questions (questionnaires) distributed to 94 respondents who had visited the Akkarena Beach marine tourism object and active users of social media. The analysis technique used is multiple regression to prove the research hypothesis. Data that has met the validity test, reliability test and classical assumption are the processed to obtain a regression equation. The results of this research indicate that the impact of social media, customer experience and servicescape together has a positive and significant effect on revisit intention with a value of Fcount 11,403 > Ftable 2,709. The partial test shows that social media, customer experience and servicescape each have a positive and significant effect on revisit intention. Social media variabels have a positive and significant effect on revisit intention, it is seen from the value of Tcount 2,893 > Ttable 1,9864 with significance 0,002 < 0,05. Customer experience variabels have a positive and significant effect on revisit intention, it is seen from the value of Tcount 4,038 > Ttable 1,9864 with a significance 0,000 < 0,05. Servicescape variabels have a positive and significant effect on revisit intention, it is seen from the value of Tcount 2,984 > Ttable 1,9864 with a significance 0,004 < 0,05. The value of Adjusted R Square obtained from the Determinant Coefficient (R2) test on the revisit intention of 0,651 explains that 65,1% in revisit intention is able to be explained by variables are social media, customer experience and servicescape, while the remaining 34,9% us explained by other variables that are not investigated in this research.

Pathways for minimal and zero liquid discharge with enhanced reverse osmosis technologies: Module-scale modeling and techno-economic assessment

While mechanical vapor compression is typically applied for the concentration of brine, new approaches that are less costly and less energy intensive are needed to facilitate minimal and zero liquid discharge. Several variations of reverse osmosis for high-salinity desalination and increasing recovery rates beyond the pressure limitation of conventional RO have been proposed in the literature. The promise of these enhanced RO approaches entails a reduction in energy consumption when compared with thermal desalination methods. In this paper, low-salt rejection reverse osmosis (LSRRO), cascading osmotically mediated reverse osmosis (COMRO), and osmotically assisted reverse osmosis (OARO) were comparatively assessed via module-scale, cost optimization models to gain an accurate perspective of the performance differences between each of these configurations. We quantified the optimal levelized cost of water (LCOW) of each technology for the case of desalinating feedwater at 70 g/L at 75% recovery, which would result in a brine concentration near 250 g/L, a level that allows further treatment with crystallizers. For baseline scenarios, LCOW results for LSRRO, COMRO, and OARO were 6.63, 7.90, and 5.14 $/m3 of product water, respectively, while the corresponding specific energy consumption (SEC) values were 28.9, 12.8, and 10.3 kWh/m3. A sensitivity analysis is also presented

"Kala-Azar is a Dishonest Disease": Community Perspectives on Access Barriers to Visceral Leishmaniasis (Kala-Azar) Diagnosis and Care in Southern Gadarif, Sudan

Early diagnosis and treatment is the principal strategy to control visceral leishmaniasis (VL), or kala-azar in East Africa. As VL strikes remote rural, sparsely populated areas, kala-azar care might not be accessed optimally or timely. We conducted a qualitative study to explore access barriers in a longstanding kala-azar endemic area in southern Gadarif, Sudan. Former kala-azar patients or caretakers, community leaders, and health-care providers were purposively sampled and thematic data analysis was used. Our study participants revealed the multitude of difficulties faced when seeking care. The disease is well known in the area, yet misconceptions about causes and transmission persist. The care-seeking itineraries were not always straightforward: "shopping around" for treatments are common, partly linked to difficulties in diagnosing kala-azar. Kala-azar is perceived to be "hiding," requiring multiple tests and other diseases must be treated first. Negative perceptions on quality of care in the public hospitals prevail, with the unavailability of drugs or staff as the main concern. Delay to seek care remains predominantly linked to economic constraint: albeit treatment is for free, patients have to pay out of pocket for everything else, pushing families further into poverty. Despite increased efforts to tackle the disease over the years, access to quality kala-azar care in this rural Sudanese context remains problematic. The barriers explored in this study are a compelling reminder of the need to boost efforts to address these barriers

Variation in life history traits and transcriptome associated with adaptation to diet shifts in the ladybird Cryptolaemus montrouzieri

Background: Despite the broad diet range of many predatory ladybirds, the mechanisms involved in their adaptation to diet shifts are not completely understood. Here, we explored how a primarily coccidophagous ladybird Cryptolaemus montrouzieri adapts to feeding on aphids. Results: Based on the lower survival rate, longer developmental time, and lower adult body weight and reproduction rate of the predator, the aphid Megoura japonica proved being less suitable to support C. montrouzieri as compared with the citrus mealybug Planococcus citri. The results indicated up-regulation of genes related to ribosome and translation in fourth instars, which may be related to their suboptimal development. Also, several genes related to biochemical transport and metabolism, and detoxification were up-regulated as a result of adaptation to the changes in nutritional and non-nutritional (toxic) components of the prey. Conclusion: Our results indicated that C. montrouzieri succeeded in feeding on aphids by regulation of genes related to development, digestion and detoxification. Thus, we argue that these candidate genes are valuable for further studies of the functional evolution of ladybirds led by diet shifts

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Technical and Economic Modeling for Sustainable Desalination: Renewable-Powered, Adaptive Reverse Osmosis Desalination with Load Flexibility and Pathways to Zero Liquid Discharge

Freshwater scarcity is a dire problem for exposed human societies and natural ecosystems—a problem expected to grow worse with anticipated climate change. Reverse osmosis (RO) desalination is currently the most energy-efficient and ubiquitous desalination process used for freshwater production in water-scarce regions. The synergy of high solar radiation and significantly reduced costs in photovoltaics (PV) creates the opportunity for PV to become a dominant and sustainable solution for powering the energy-intensive process of desalination and reducing greenhouse gas emissions.While photovoltaic-powered reverse osmosis (PVRO) is a promising technological solution, several significant challenges must be further addressed to sustain high RO performance. First, the inherently intermittent nature of solar energy generation can adversely affect the freshwater conversion process and thereby decrease water recovery and quality. Furthermore, global desalination capacity is dominated by large-scale plants, whereas PVRO systems are currently limited to small-scale systems. Thus, to truly integrate renewable energy with desalination systems in an impactful way, there is a need to explore pathways for modifying the RO process to enable flexible operation on a large-scale, in response to power variability. Furthermore, the techno-economic feasibility of flexible, renewable-powered RO processes and the potential benefits that could be provided to variable renewable energy (VRE) plants and the electric grid warrants investigation. Brine minimization is another major challenge for sustainable desalination. Brine management is especially an issue for inland desalination plants. Novel approaches that are less costly and less energy intensive are needed to facilitate minimal and zero liquid discharge. To enable high-salinity desalination, several variations of osmotically assisted RO, which each surpass the pressure limitation of conventional RO, have been proposed in the literature but require further assessment. The promise of these enhanced RO approaches entails a reduction in energy consumption when compared with thermal desalination methods. The primary deliverables and novel contributions of this thesis include the development of (i) design, simulation, and cost optimization models for variable-powered, variable-salinity RO systems, (ii) module-scale, cost-optimization models for enhanced RO technologies that reduce transmembrane osmotic pressure to enable high-salinity desalination and brine minimization, (iii) examining the effects of cyclic reverse osmosis on inorganic scaling mitigation, and (iv) quantifying the availability of unconventional, alternative water sources to alleviate local water scarcity in the contiguous US. First, the techno-economic feasibility of PV-powered RO desalination plants in the Gulf region was assessed using Hybrid Optimization Model for Electric Renewables (HOMER) and Desalination Economic Evaluation Program (DEEP) to model both the power system and desalination system, respectively. Subsequently, an hourly simulation model for desalination was developed to replace the use of DEEP in the workflow. Grid-connected and off-grid cases with combinations of PV, batteries, and diesel generators were evaluated primarily by the levelized cost of electricity (LCOE) and levelized cost of water (LCOW). The shortcoming of conventional and PV-powered RO is that variable power compromises cumulative water production, which in turn increases water costs. Thus, we proposed the concept of active-salinity-control reverse osmosis (ASCRO) which enables control of the transmembrane osmotic pressure and water production in response to variable power. The ASCRO system dynamically controls energy consumption by operating across a range of feed salinity, allowing it to shift over a wide range of pump feed flows and pressures. To accomplish this, ASCRO utilizes feedwater from both low- and high-salinity sources. Enabling a dynamic power consumption profile can enhance demand-response capabilities, compensating for stressors on the grid. Moreover, ASCRO can improve the integration of renewable energy (RE) by responding to power fluctuations without compromising permeate production. This system can include on-site RE and energy storage to power the ASCRO plant and provide services to the grid. We considered the following grid-connected scenarios: 1) ASCRO, 2) ASCRO and battery storage, 3) ASCRO and photovoltaics (PV), and 4) ASCRO, battery storage, and PV. The LCOW was minimized by providing load-shifting and regulation capacity services in the California Independent System Operator (CAISO) market. We quantified that the ASCRO plant can ramp from minimum to maximum load within 84 seconds, which is adequate for participation in fast-timescale markets. The LCOW for these scenarios ranged from 49 – 59 cents/m³. We also present sensitivity analyses showing the effects of capital cost, CAISO market prices, and PV size on LCOW. To investigate alternative pathways to minimal and zero liquid discharge, low-salt rejection reverse osmosis (LSRRO), cascading osmotically mediated reverse osmosis (COMRO), and osmotically assisted reverse osmosis (OARO) were comparatively assessed via module-scale, cost optimization models to gain an accurate perspective of the performance differences between each of these configurations. We quantified the optimal LCOW of each technology for the case of desalinating feedwater at 70 g/L at 75% recovery, which would result in a brine concentration near 250 g/L, a level that allows further treatment with crystallizers. For baseline scenarios, LCOW results for OARO, COMRO, and LSRRO were 5.14, 7.90, and 6.63 $/m³ of product water, respectively, while the corresponding specific energy consumption (SEC) values were 10.31, 12.77, and 28.90 kWh/m³. A sensitivity analysis is also presented. Additionally, we sought to examine the possibility of whether adaptive RO operation could provide the added benefit of fouling mitigation. Using the Pitzer model, nucleation theory, and dissolution kinetics to guide a set of bench-scale fouling experiments, CaSO₄-NaCl solution, supersaturated with respect to gypsum, was fed through a membrane test cell to determine nucleation induction times, rates of flux decline, and scale reversal. Lastly, a geospatial analysis was conducted to estimate volumes of water deficits and potential alternative water sources for the contiguous US. Namely, wastewater effluent, brackish groundwater, agricultural drainage water, and produced water were considered in this analysis as alternatives for alleviating water scarcity. We formulated a conservative estimate of groundwater availability based on environmental flow limits. Additionally, agricultural drainage volumes were estimated based on USGS water use data. Overall, the results showed that water deficits amounted to an equivalent daily capacity of 149 million m³/day—nearly 50% more than the desalination capacity of the world in 2020. Furthermore, the total availability of alternative water sources was estimated to be between 192 – 240 million m³/day, but most of this volume was not in the same location as deficits. Thus, 58 – 65% of national water deficits would have to be alleviated via long-range transport. Additionally, the potential for integrating desalination and water reuse by interconnecting existing RO plants with wastewater treatments plants was also assessed

Modeling Framework for Cost Optimization of Process-Scale Desalination Systems with Mineral Scaling and Precipitation.

Cost-optimization models are powerful tools for evaluating emerging water treatment processes. However, to date, optimization models do not incorporate detailed chemical reaction phenomena, limiting the assessment of pretreatment and mineral scaling. Moreover, novel approaches for high-salinity and high-recovery desalination are typically proposed without direct quantification of pretreatment needs or mineral scaling. This work addresses a critical gap in the literature by presenting a modeling framework that includes complex water chemistry predictions with process-scale optimization. We use this approach to conduct a technoeconomic assessment on a conceptual high-recovery treatment train that includes chemical pretreatment (i.e., soda ash softening and recarbonation) and membrane-based desalination (i.e., standard and high-pressure reverse osmosis). We demonstrate how to develop and integrate accurate multidimensional surrogate models for predicting precipitation, pH, and mineral scaling tendencies. Our findings show that cost-optimal results balance the costs of pretreatment with reverse osmosis system design. Optimizing across a range of water recoveries (i.e., 50-90%) reveals multiple cost-optimal schemas that vary the chemical dosing in pretreatment and the design and operation of reverse osmosis. Our results reveal that pretreatment costs can be more than double the cost of the primary desalination process at high recoveries due to the extensive pretreatment required to control scaling. This work emphasizes the importance of and provides a framework for including chemistry and mineral scaling predictions in the evaluation of emerging technologies in high-recovery desalination