Search results for: optical gain

Authors: Carmen W. H. Chan, Helen Y. L. Chan, Kai Chow Choi, Ka Ming Chow, Cecilia W. M. Kwan, Nancy H. Y. Ng, Jackie Robinson

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Introduction: In Hong Kong, a significant number of deaths occur in acute care wards, which requires nurses in these settings to provide end-of-life care and lead ACP implementation. However, nurses in these settings, in fact, have very low-level involvement in ACP discussions because of limited training in ACP conversations. Objective: This study aims to assess the impact of a multi-media experiential ACP (MEACP) training program, which is guided by the experiential learning model and theory of planned behaviour, on nurses' knowledge and confidence in assisting patients with ACP. Methodology: The study utilizes a cluster randomized controlled trial with a 12-week follow-up. Eligible nurses working in acute care hospital wards are randomly assigned at the ward level, in a 1:1 ratio, to either the control group (no ACP education) or the intervention group (4-week MEACP training program). The training programme includes training through a webpage and mobile application, as well as a face-to-face training workshop with enhanced lectures and role play, which is based on the Theory of Planned Behavior and Kolb's Experiential Learning Model. Questionnaires were distributed to assess nurses' knowledge (a 10-item true/false questionnaire) and level of confidence (five-point Likert scale) in ACP at baseline (T0), four weeks after the baseline assessment (T1), and 12 weeks after T1 (T2). In this interim report, data analysis was mainly descriptive in nature. Result: The interim report focuses on the preliminary results of 165 nurses at T0 (Control: 74, Intervention: 91) over a 5-month period, 69 nurses from the control group who completed the 4-week follow-up and 65 nurses from the intervention group who completed the 4-week MEACP training program at T1. The preliminary attrition rate is 6.8% and 28.6% for the control and intervention groups, respectively, as some nurses did not complete the whole set of online modules. At baseline, the two groups were generally homogeneous in terms of their years of nursing practice, weekly working hours, working title, and level of education, as well as ACP knowledge and confidence levels. The proportion of nurses who answered all ten knowledge questions correctly increased from 13.8% (T0) to 66.2% (T1) for the intervention group and from 13% (T0) to 20.3% (T1) for the control group. The nurses in the intervention group answered an average of 7.57 and 9.43 questions correctly at T0 and T1, respectively. They showed a greater improvement in the knowledge assessment at T1 with respect to T0 when compared with their counterparts in the control group (mean difference of change score, Δ=1.22). They also exhibited a greater gain in level of confidence at T1 compared to their colleagues in the control group (Δ=0.91). T2 data is yet available. Conclusion: The prevalence of nurses engaging in ACP and their level of knowledge about ACP in Hong Kong is low. The MEACP training program can enrich nurses by providing them with more knowledge about ACP and increasing their confidence in conducting ACP.

Keywords: advance directive, advance care planning, confidence, knowledge, multi-media experiential, randomised control trial

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Authors: Ahmed Elaksher, Islam Omar

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Accurate geometric relation algorithms are imperative in Earth and planetary satellite and aerial image processing, particularly for high-resolution images that are used for topographic mapping. Most of these satellites carry push-broom sensors. These sensors are optical scanners equipped with linear arrays of CCDs. These sensors have been deployed on most EOSs. In addition, the LROC is equipped with two push NACs that provide 0.5 meter-scale panchromatic images over a 5 km swath of the Moon. The HiRISE carried by the MRO and the HRSC carried by MEX are examples of push-broom sensor that produces images of the surface of Mars. Sensor models developed in photogrammetry relate image space coordinates in two or more images with the 3D coordinates of ground features. Rigorous sensor models use the actual interior orientation parameters and exterior orientation parameters of the camera, unlike approximate models. In this research, we generate a generic push-broom sensor model to process imageries acquired through linear array cameras and investigate its performance, advantages, and disadvantages in generating topographic models for the Earth, Mars, and the Moon. We also compare and contrast the utilization, effectiveness, and applicability of available photogrammetric techniques and softcopies with the developed model. We start by defining an image reference coordinate system to unify image coordinates from all three arrays. The transformation from an image coordinate system to a reference coordinate system involves a translation and three rotations. For any image point within the linear array, its image reference coordinates, the coordinates of the exposure center of the array in the ground coordinate system at the imaging epoch (t), and the corresponding ground point coordinates are related through the collinearity condition that states that all these three points must be on the same line. The rotation angles for each CCD array at the epoch t are defined and included in the transformation model. The exterior orientation parameters of an image line, i.e., coordinates of exposure station and rotation angles, are computed by a polynomial interpolation function in time (t). The parameter (t) is the time at a certain epoch from a certain orbit position. Depending on the types of observations, coordinates, and parameters may be treated as knowns or unknowns differently in various situations. The unknown coefficients are determined in a bundle adjustment. The orientation process starts by extracting the sensor position and, orientation and raw images from the PDS. The parameters of each image line are then estimated and imported into the push-broom sensor model. We also define tie points between image pairs to aid the bundle adjustment model, determine the refined camera parameters, and generate highly accurate topographic maps. The model was tested on different satellite images such as IKONOS, QuickBird, and WorldView-2, HiRISE. It was found that the accuracy of our model is comparable to those of commercial and open-source software, the computational efficiency of the developed model is high, the model could be used in different environments with various sensors, and the implementation process is much more cost-and effort-consuming.

Keywords: photogrammetry, push-broom sensors, IKONOS, HiRISE, collinearity condition

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Authors: Laura E. Hall, Joel Monárrez-Espino, Luz María Tejada Tayabas

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College students are at risk of weight gain and poor dietary habits, and health behaviours established during this period have been shown to track into midlife. They may therefore be an important target group for health promotion strategies, yet there is a lack of literature regarding dietary intakes and associated factors in this group, particularly in middle-income countries such as Mexico. The aim of this exploratory research was to describe and compare reported dietary intakes among nursing and nutrition college students at two public universities in Mexico, and to explore the relationship between demographic, behavioural and other health-related factors and the risk of low diet quality. Mexican college students (n=444) majoring in nutrition or nursing at two urban universities completed questionnaires regarding dietary and health-related behaviours and risks. Dietary intake was assessed via 24-hour recall. Weight, height and abdominal circumference were measured. Descriptive statistics were reported and nutrient intakes were compared between colleges and study tracks using Student’s t tests, odds ratios and Pearson chi square tests. Two dietary quality scores were constructed to explore the relationship between demographic, behavioural and other health-related factors and the diet quality scores using binary logistic regression. Analysis was performed using SPSS statistics, with differences considered statistically significant at p<0.05. The response rate to the survey was 91%. When macronutrients were considered as a percentage of total energy, the majority of students had protein intakes within recommended ranges, however one quarter of students had carbohydrate and fat intakes exceeding recommended levels. Three quarters had fibre intakes that were below recommendations. More than half of the students reported intakes of magnesium, zinc, vitamin A, folate and vitamin E that were below estimated average requirements. Students studying nutrition reported macronutrient and micronutrient intakes that were more compliant with recommendations compared to nursing students, and students studying in central-north Mexico were more compliant than those studying in southeast Mexico. Breakfast skipping (Adjusted Odds Ratio (OR) = 5.3; 95% Confidence Interval (CI) = 1.2-22.7), risk of anxiety (OR = 2.3; CI = 1.3-4.4), and university location (OR = 1.6; CI = 1.03-2.6) were associated with a greater risk of having a low macronutrient score. Caloric intakes <1800kcal (OR = 5.8; CI = 3.5-9.7), breakfast skipping (OR = 3.7; CI = 1.4-10.3), vigorous exercise ≤1h/week (OR = 2.6; CI = 1.3-5.2), soda consumption >250mls/day (OR = 2.0; CI = 1.2-3.3), unhealthy diet perception (OR = 1.9; CI = 1.2-3.0), and university location (OR = 1.8; CI = 1.1-2.8) were significantly associated with greater odds of having a low micronutrient score. College students studying nursing and nutrition did not report ideal diets, and these students should not be overlooked in public health interventions. Differences in dietary intakes between universities and study tracks were evident, with more favourable profiles evident in nutrition compared to nursing, and North-central compared to Southeast students. Further, demographic, behavioural and other health-related factors were associated with diet quality scores, warranting further research.

Keywords: college student, diet quality, nutrient intake, young adult

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Authors: Meiling Yu, Nadia Rouatbi, Khuloud T. Al-Jamal

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Background: Treatment of neurological disorders with modern medical and surgical approaches remains difficult. Gene therapy, allowing the delivery of genetic materials that encodes potential therapeutic molecules, represents an attractive option. The treatment of brain diseases with gene therapy requires the gene-editing tool to be delivered efficiently to the central nervous system. In this study, we explored the efficiency of different delivery routes, namely intravenous (i.v.), intra-cranial (i.c.), and intra-nasal (i.n.), to deliver stable nucleic acid-lipid particles (SNALPs) containing gene-editing tools namely Cas9 mRNA and sgRNA encoding for GFP as a reporter protein. We hypothesise that SNALPs can reach the brain and perform gene-editing to different extents depending on the administration route. Intranasal administration (i.n.) offers an attractive and non-invasive way to access the brain circumventing the blood–brain barrier. Successful delivery of gene-editing tools to the brain offers a great opportunity for therapeutic target validation and nucleic acids therapeutics delivery to improve treatment options for a range of neurodegenerative diseases. In this study, we utilised Rosa26-Cas9 knock-in mice, expressing GFP, to study brain distribution and gene-editing efficiency of SNALPs after i.v.; i.c. and i.n. routes of administration. Methods: Single guide RNA (sgRNA) against GFP has been designed and validated by in vitro nuclease assay. SNALPs were formulated and characterised using dynamic light scattering. The encapsulation efficiency of nucleic acids (NA) was measured by RiboGreen™ assay. SNALPs were incubated in serum to assess their ability to protect NA from degradation. Rosa26-Cas9 knock-in mice were i.v., i.n., or i.c. administered with SNALPs to test in vivo gene-editing (GFP knockout) efficiency. SNALPs were given as three doses of 0.64 mg/kg sgGFP following i.v. and i.n. or a single dose of 0.25 mg/kg sgGFP following i.c.. knockout efficiency was assessed after seven days using Sanger Sequencing and Inference of CRISPR Edits (ICE) analysis. In vivo, the biodistribution of DiR labelled SNALPs (SNALPs-DiR) was assessed at 24h post-administration using IVIS Lumina Series III. Results: Serum-stable SNALPs produced were 130-140 nm in diameter with ~90% nucleic acid loading efficiency. SNALPs could reach and stay in the brain for up to 24h following i.v.; i.n. and i.c. administration. Decreasing GFP expression (around 50% after i.v. and i.c. and 20% following i.n.) was confirmed by optical imaging. Despite the small number of mice used, ICE analysis confirmed GFP knockout in mice brains. Additional studies are currently taking place to increase mice numbers. Conclusion: Results confirmed efficient gene knockout achieved by SNALPs in Rosa26-Cas9 knock-in mice expressing GFP following different routes of administrations in the following order i.v.= i.c.> i.n. Each of the administration routes has its pros and cons. The next stages of the project involve assessing gene-editing efficiency in wild-type mice and replacing GFP as a model target with therapeutic target genes implicated in Motor Neuron Disease pathology.

Keywords: CRISPR, nanoparticles, brain diseases, administration routes

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Authors: Ola Hall, Ibrahim Wahab, Thorsteinn Rognvaldsson, Mattias Ohlsson

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The subfield of poverty and welfare estimation that applies machine learning tools and methods on satellite imagery is a nascent but rapidly growing one. This is in part driven by the sustainable development goal, whose overarching principle is that no region is left behind. Among other things, this requires that welfare levels can be accurately and rapidly estimated at different spatial scales and resolutions. Conventional tools of household surveys and interviews do not suffice in this regard. While they are useful for gaining a longitudinal understanding of the welfare levels of populations, they do not offer adequate spatial coverage for the accuracy that is needed, nor are their implementation sufficiently swift to gain an accurate insight into people and places. It is this void that satellite imagery fills. Previously, this was near-impossible to implement due to the sheer volume of data that needed processing. Recent advances in machine learning, especially the deep learning subtype, such as deep neural networks, have made this a rapidly growing area of scholarship. Despite their unprecedented levels of performance, such models lack transparency and explainability and thus have seen limited downstream applications as humans generally are apprehensive of techniques that are not inherently interpretable and trustworthy. While several studies have demonstrated the superhuman performance of AI models, none has directly compared the performance of such models and human readers in the domain of poverty studies. In the present study, we directly compare the performance of human readers and a DL model using different resolutions of satellite imagery to estimate the welfare levels of demographic and health survey clusters in Tanzania, using the wealth quintile ratings from the same survey as the ground truth data. The cluster-level imagery covers all 608 cluster locations, of which 428 were classified as rural. The imagery for the human readers was sourced from the Google Maps Platform at an ultra-high resolution of 0.6m per pixel at zoom level 18, while that of the machine learning model was sourced from the comparatively lower resolution Sentinel-2 10m per pixel data for the same cluster locations. Rank correlation coefficients of between 0.31 and 0.32 achieved by the human readers were much lower when compared to those attained by the machine learning model – 0.69-0.79. This superhuman performance by the model is even more significant given that it was trained on the relatively lower 10-meter resolution satellite data while the human readers estimated welfare levels from the higher 0.6m spatial resolution data from which key markers of poverty and slums – roofing and road quality – are discernible. It is important to note, however, that the human readers did not receive any training before ratings, and had this been done, their performance might have improved. The stellar performance of the model also comes with the inevitable shortfall relating to limited transparency and explainability. The findings have significant implications for attaining the objective of the current frontier of deep learning models in this domain of scholarship – eXplainable Artificial Intelligence through a collaborative rather than a comparative framework.

Keywords: poverty prediction, satellite imagery, human readers, machine learning, Tanzania

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Authors: Jingsi Li, Neil S. Ferguson

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Time pressure could have an influence on the productivity, quality of decision making, and the efficiency of problem-solving. This has been mostly stemmed from cognitive research or psychological literature. However, a salient scarce discussion has been held for transport adjacent fields. It is conceivable that in many activity-travel contexts, time pressure is a potentially important factor since an excessive amount of decision time may incur the risk of late arrival to the next activity. The activity-travel rescheduling behavior is commonly explained by costs and benefits of factors such as activity engagements, personal intentions, social requirements, etc. This paper hypothesizes that an additional factor of perceived time pressure could affect travelers’ rescheduling behavior, thus leading to an impact on travel demand management. Time pressure may arise from different ways and is assumed here to be essentially incurred due to travelers planning their schedules without an expectation of unforeseen elements, e.g., transport disruption. In addition to a linear-additive utility-maximization model, the less computationally compensatory heuristic models are considered as an alternative to simulate travelers’ responses. The paper will contribute to travel behavior modeling research by investigating the following questions: how to measure the time pressure properly in an activity-travel day plan context? How do travelers reschedule their plans to cope with the time pressure? How would the importance of the activity affect travelers’ rescheduling behavior? What will the behavioral model be identified to describe the process of making activity-travel rescheduling decisions? How do these identified coping strategies affect the transport network? In this paper, a Mixed Heuristic Model (MHM) is employed to identify the presence of different choice heuristics through a latent class approach. The data about travelers’ activity-travel rescheduling behavior is collected via a web-based interactive survey where a fictitious scenario is created comprising multiple uncertain events on the activity or travel. The experiments are conducted in order to gain a real picture of activity-travel reschedule, considering the factor of time pressure. The identified behavioral models are then integrated into a multi-agent transport simulation model to investigate the effect of the rescheduling strategy on the transport network. The results show that an increased proportion of travelers use simpler, non-compensatory choice strategies instead of compensatory methods to cope with time pressure. Specifically, satisfying - one of the heuristic decision-making strategies - is adopted commonly since travelers tend to abandon the less important activities and keep the important ones. Furthermore, the importance of the activity is found to increase the weight of negative information when making trip-related decisions, especially route choices. When incorporating the identified non-compensatory decision-making heuristic models into the agent-based transport model, the simulation results imply that neglecting the effect of perceived time pressure may result in an inaccurate forecast of choice probability and overestimate the affectability to the policy changes.

Keywords: activity-travel rescheduling, decision making under uncertainty, mixed heuristic model, perceived time pressure, travel demand management

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Authors: Faris Algahtani

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Background: In Saudi Arabia, it is essential to know what practices are employed and considered effective by special education teachers working with preschool children with intellectual disabilities, as a prerequisite for identifying areas for improvement. Preschool provision for these children is expanding through a network of Intellectual Disability Centres while, in primary schools, a policy of inclusion is pursued and, in mainstream preschools, pilots have been aimed at enhancing learning in readiness for primary schooling. This potentially widens the attainment gap between preschool children with and without intellectual disabilities, and influences the scope for improvement. Goal: The aim of the study was to explore special education teachers’ practices and perceived perceptions of those practices for preschool children with intellectual disabilities in Saudi Arabia Method: A qualitative interpretive approach was adopted in order to gain a detailed understanding of how special education teachers in an IDC operate in the classroom. Fifteen semi-structured interviews were conducted with experienced and qualified teachers. Data were analysed using thematic analysis, based on themes identified from the literature review together with new themes emerging from the data. Findings: American methods strongly influenced teaching practices, in particular TEACCH (Treatment and Education of Autistic and Communication related handicapped Children), which emphasises structure, schedules and specific methods of teaching tasks and skills; and ABA (Applied Behaviour Analysis), which aims to improve behaviours and skills by concentrating on detailed breakdown and teaching of task components and rewarding desired behaviours with positive reinforcement. The Islamic concept of education strongly influenced which teaching techniques were used and considered effective, and how they were applied. Tensions were identified between the Islamic approach to disability, which accepts differences between human beings as created by Allah in order for people to learn to help and love each other, and the continuing stigmatisation of disability in many Arabic cultures, which means that parents who bring their children to an IDC often hope and expect that their children will be ‘cured’. Teaching methods were geared to reducing behavioural problems and social deficits rather than to developing the potential of the individual child, with some teachers recognizing the child’s need for greater freedom. Relationships with parents could in many instances be improved. Teachers considered both initial teacher education and professional development to be inadequate for their needs and the needs of the children they teach. This can be partly attributed to the separation of training and development of special education teachers from that of general teachers. Conclusion: Based on the findings, teachers’ practices could be improved by the inclusion of general teaching strategies, parent-teacher relationships and practical teaching experience in both initial teacher education and professional development. Coaching and mentoring support from carefully chosen special education teachers could assist the process, as could the presence of a second teacher or teaching assistant in the classroom.

Keywords: special education, intellectual disabilities, early intervention , early childhood

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Authors: Jasna Milošević Đorđević, Jelisaveta Blagojević, Jovana Timotijević, Alison Mckinley

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Young people in Serbia, have grown up in turbulent times during the Balkan wars, in a cultural and economic isolation without adequate education on (ethnic, gender, social,..) equality. They often have very strong patriarchal gender stereotypes. The perception of gender in Serbia is still heavily influenced by traditional worldview and young people have little opportunity in traditional educational system to challenge it, receiving no formal sex education. Educational policies have addressed achieving gender equality as one of the goals, supporting all young people to gain better educational opportunities, but there are obvious shortcomings of the official education system in implementation of those goals. Therefore new approaches should be implemented. We evaluate the impact of non traditional approach, such as participatory theatre performance with strong transformative potential, especially in relation to gender issues. Theatre based intervention (TBI) was created to provoke the young people to become aware of their gender constructs. Engaging young people in modern form of education such as transformative gender intervention through participatory theatre could have positive impact on their sex knowledge and understanding gender roles. The transformative process in TBI happens on two levels – the affective and the cognitive. The founding agency of the project and evaluation is IPPF. The most important aim of this survey is evaluation of the transformative TBI, as a new educational approach related to better understanding gender as social construct. To reach this goal, we have measured attitude change in three indicators: a) gender identity/ perception of feminine identity, perception of masculine identity, importance of gender for personal identity, b) gender roles on the labor market, c) Gender equality in partnership & sexual behavior. Our main hypothesis is that participatory theatre-based intervention can have a transformational potential in challenging traditional gender knowledge and attitudes among youth in Serbia. To evaluate the impact of TB intervention, we implement: online baseline and end-line survey with nonparticipants of the TBI on the representative sample in targeted towns (control group). Additionally we conducted testing the experimental group twice: pretest at the beginning of each TBI and post testing of participants after the play. A sample of 500 respondents aged 18-30 years, from 9 towns in Serbia responded to online questionnaire in September 2017, in a baseline research. Pre and post measurement of all tested variables among participants in nine towns would be performed. End-line survey with 500 respondents would be conducted at the end of the project (early year 2018). After the first TBI (60 participants) no impact was detected on measured indicators: perception of desirable characteristics of man F(1,59)= 1.291, p=.260; perception of desirable characteristics of women F(1,55)=1.386, p= .244; gender identity importance F(1,63)= .050, p=.824; sex related behavior F(1,61)=1,145, p=.289; gender equality on labor market F(1,63)=.076, p=.783; gender equality in partnership F(1,61)=.201, p=.656; However, we hope that following intervention would bring more data showing that participatory theatre intervention explaining gender as a social construct could have additional positive impact in traditional educational system.

Keywords: educational impact, gender identity, gender role, participatory theatre based intervention

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Authors: J. S. M. Yang, G. E. T. Chua

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Diploma in Optometry (OPT) course is a three-year program offered by Ngee Ann Polytechnic (NP) to train students to provide primary eye care. Students are equipped with foundational conceptual knowledge and practical skills in the first three semesters before clinical modules in fourth to six semesters. In the clinical modules, students typically have difficulties in integrating the acquired knowledge and skills from the past semesters to perform general eye examinations on public patients at NP Optometry Centre (NPOC). To help the students overcome the challenge, a web-based game Virtual Optometrist (VO) was developed to help students apply their skills and knowledge through scenario-based learning. It consisted of two interfaces, Optical Practice Counter (OPC) and Optometric Consultation Room (OCR), to provide two simulated settings for authentic learning experiences. In OPC, students would recommend and provide appropriate frame and lens selection based on virtual patient’s case history. In OCR, students would diagnose and manage virtual patients with common ocular conditions. Simulated scenarios provided real-world clinical situations that required contextual application of integrated knowledge from relevant modules. The stages in OPC and OCR are of increasing complexity to align to expected students’ clinical competency as they progress to more senior semesters. This prevented gameplay fatigue as VO was used over the semesters to achieve different learning outcomes. Numerous feedback opportunities were provided to students based on their decisions to allow individualized learning to take place. The game-based learning element in VO was achieved through the scoreboard and leader board to enhance students' motivation to perform. Scores were based on the speed and accuracy of students’ responses to the questions posed in the simulated scenarios, preparing the students to perform accurately and effectively under time pressure in a realistic optometric environment. Learning analytics was generated in VO’s backend office based on students’ responses, offering real-time data on distinctive and observable learners’ behavior to monitor students’ engagement and learning progress. The backend office allowed versatility to add, edit, and delete scenarios for different intended learning outcomes. Likert Scale was used to measure students’ learning experience with VO for OPT Year 2 and 3 students. The survey results highlighted the learning benefits of implementing VO in the different modules, such as enhancing recall and reinforcement of clinical knowledge for contextual application to develop higher-order thinking skills, increasing efficiency in clinical decision-making, facilitating learning through immediate feedback and second attempts, providing exposure to common and significant ocular conditions, and training effective communication skills. The results showed that VO has been useful in reinforcing optometry students’ learning and supporting the development of higher-order thinking, increasing efficiency in clinical decision-making, and allowing students to learn from their mistakes with immediate feedback and second attempts. VO also exposed the students to diverse ocular conditions through simulated real-world clinical scenarios, which may otherwise not be encountered in NPOC, and promoted effective communication skills.

Keywords: authentic learning, game-based learning, scenario-based learning, simulated clinical scenarios

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Authors: Carlu Van Der Westhuizen

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The South African Agricultural Sector is of major socio-economic importance to the country due to its contribution in maintaining stability in food production and food security, providing labour opportunities, eradicating poverty and earning foreign currency. Against this reality, this paper investigates within the Agricultural Sector in South Africa the changes in Land Policies that the new democratically elected government (African National Congress) brought about since their takeover in 1994. The change in the agricultural environment is decidedly dualistic, with 1) a commercial sector, and 2) a subsistence and emerging farmer sector. The future demands and challenges are mostly identified as those of land redistribution and social upliftment. Opportunities that arose from the challenge of change are, among others, the small-holder participation in the value chain, while the challenge of change in Agriculture and the opportunities that were identified could serve as a yardstick against which the Sectors’ (Agriculture) Performance could be measured in future. Unfortunately, despite all Governments’ Policies, Programmes and Projects and inputs of the Private Sector, the outcomes are, to a large extend, unsuccessful. The urgency with the Land Redistribution Programme is that, for the period 1994 – 2014, only 7.5% of the 30% aim in the redistribution of land was achieved. Another serious aspect of concern is that 90% of the Land Redistribution Projects are not in a state of productive use by emerging farmers. Several reasons may be offered for these failures, amongst others the uncoordinated way in which different stakeholders are involved in a specific farming project. These stakeholders could generally in most cases be identified as: - The Government as the policy maker; - The Private Sector that has the potential to contribute to the sustainable pre- and post-settlement stages of the Programme by cooperating the supporting services to Government; - Inputs from the communities in rural areas where the settlement takes place; - The landowners as sellers of land (e.g. a Traditional Council); and - The emerging beneficiaries as the receivers of land. Mentorship is mostly the medium with which the support are coordinated. In this paper focus will be on three scenarios of different types of mentorship (or management support) namely: - The Taung Irrigation Scheme (TIS) where multiple new land beneficiaries were established by sharing irrigation pivots and receiving mentorship support from commodity organisations within a traditional land sharing system; - Projects whereby the mentor is a strategic partner (mostly a major agricultural 'cooperative' which is also providing inputs to the farmer and responsible for purchasing/marketing all commodities produced); and - An individual mentor who is a private person focussing mainly on farm management mentorship without direct gain other than a monthly stipend paid to the mentor by Government. Against this introduction the focus of the study is investigating the process for the sustainable implementation of Governments’ Land Redistribution in South African Agriculture. To achieve this, the research paper is presented under the themes of problem statement, objectives, methodology and limitations, outline of the research process, as well as proposing possible solutions.

Keywords: land reform, role-players, failures, mentorship, management models

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Authors: Grace E. Santella, Shawn G. Gallaher, Joseph P. Smith

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In order to determine the importance of small-system riverine heat flux on regional landfast sea ice breakup, our study explores the annual spring freshet of the Sagavanirktok River from 2014-2019. Seasonal heat cycling ultimately serves as the driving mechanism behind the freshet; however, as an emerging area of study, the extent to which inland thermodynamics influence coastal tundra geomorphology and connected landfast sea ice has not been extensively investigated in relation to small-scale Arctic river systems. The Sagavanirktok River is a small-to-midsized river system that flows south-to-north on the Alaskan North Slope from the Brooks mountain range to the Beaufort Sea at Prudhoe Bay. Seasonal warming in the spring rapidly melts snow and ice in a northwards progression from the Brooks Range and transitional tundra highlands towards the coast and when coupled with seasonal precipitation, results in a pulsed freshet that propagates through the Sagavanirktok River. The concentrated presence of newly exposed vegetation in the transitional tundra region due to spring melting results in higher absorption of solar radiation due to a lower albedo relative to snow-covered tundra and/or landfast sea ice. This results in spring flood runoff that advances over impermeable early-season permafrost soils with elevated temperatures relative to landfast sea ice and sub-ice flow. We examine the extent to which interannual temporal variability influences the onset and magnitude of river discharge by analyzing field measurements from the United States Geological Survey (USGS) river and meteorological observation sites. Rapid influx of heat to the Arctic Ocean via riverine systems results in a noticeable decay of landfast sea ice independent of ice breakup seaward of the shear zone. Utilizing MODIS imagery from NASA’s Terra satellite, interannual variability of river discharge is visualized, allowing for optical validation that the discharge flow is interacting with landfast sea ice. Thermal erosion experienced by sediment fast ice at the arrival of warm overflow preconditions the ice regime for rapid thawing. We investigate the extent to which interannual heat flux from the Sagavanirktok River’s freshet significantly influences the onset of local landfast sea ice breakup. The early-season warming of atmospheric temperatures is evidenced by the presence of storms which introduce liquid, rather than frozen, precipitation into the system. The resultant decreased albedo of the transitional tundra supports the positive relationship between early-season precipitation events, inland thermodynamic cycling, and degradation of landfast sea ice. Early removal of landfast sea ice increases coastal erosion in these regions and has implications for coastline geomorphology which stress industrial, ecological, and humanitarian infrastructure.

Keywords: Albedo, freshet, landfast sea ice, riverine heat flux, seasonal heat cycling

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Authors: Brenda Ravenscroft, Ulemu Luhanga, Bev King

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A comprehensive evaluation of online learning needs to include a blend of educational design, technology use, and online instructional practices that integrate technology appropriately for developing and delivering quality online courses. Research shows that classroom-based evaluation tools do not adequately capture the dynamic relationships between content, pedagogy, and technology in online courses. Furthermore, studies suggest that using classroom evaluations for online courses yields lower than normal scores for instructors, and may affect faculty negatively in terms of administrative decisions. In 2014, the Faculty of Arts and Science at Queen’s University responded to this evidence by seeking an alternative to the university-mandated evaluation tool, which is designed for classroom learning. The Faculty is deeply engaged in e-learning, offering large variety of online courses and programs in the sciences, social sciences, humanities and arts. This paper describes the process by which a new student survey instrument for online courses was developed and piloted, the methods used to analyze the data, and the ways in which the instrument was subsequently adapted based on the results. It concludes with a critical reflection on the challenges of evaluating e-learning. The Student Evaluation of Online Teaching Effectiveness (SEOTE), developed by Arthur W. Bangert in 2004 to assess constructivist-compatible online teaching practices, provided the starting point. Modifications were made in order to allow the instrument to serve the two functions required by the university: student survey results provide the instructor with feedback to enhance their teaching, and also provide the institution with evidence of teaching quality in personnel processes. Changes were therefore made to the SEOTE to distinguish more clearly between evaluation of the instructor’s teaching and evaluation of the course design, since, in the online environment, the instructor is not necessarily the course designer. After the first pilot phase, involving 35 courses, the results were analyzed using Stobart's validity framework as a guide. This process included statistical analyses of the data to test for reliability and validity, student and instructor focus groups to ascertain the tool’s usefulness in terms of the feedback it provided, and an assessment of the utility of the results by the Faculty’s e-learning unit responsible for supporting online course design. A set of recommendations led to further modifications to the survey instrument prior to a second pilot phase involving 19 courses. Following the second pilot, statistical analyses were repeated, and more focus groups were used, this time involving deans and other decision makers to determine the usefulness of the survey results in personnel processes. As a result of this inclusive process and robust analysis, the modified SEOTE instrument is currently being considered for adoption as the standard evaluation tool for all online courses at the university. Audience members at this presentation will be stimulated to consider factors that differentiate effective evaluation of online courses from classroom-based teaching. They will gain insight into strategies for introducing a new evaluation tool in a unionized institutional environment, and methodologies for evaluating the tool itself.

Keywords: evaluation, online courses, student survey, teaching effectiveness

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Authors: Kirsten Techmer, Jan-Erik Rybak, Simon Rudolph

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Natural formed pyrites (FeS2) are frequent sulfides in sedimentary and metamorphic rocks. Growth textures of idiomorphic pyrite assemblages reflect the conditions during their formation in the geologic sequence, furtheron the local texture analyses of the growth patterns of pyrite assemblages by EBSD reveal the possibility to resolve the growth conditions during the formation of pyrite at the micron scale. The spatial resolution of local texture measurements in the Scanning Electron Microscope used can be in the nanomete scale. Orientation contrasts resulting from domains of smaller misorientations within larger pyrite crystals can be resolved as well. The electron optical studies have been carried out in a Field-Emission Scanning Electron Microscope (FEI Quanta 200) equipped with a CCD camera to study the orientation contrasts along the surfaces of pyrite. Idiomorphic cubic single crystals of pyrite, polycrystalline assemblages of pyrite, spherically grown spheres of pyrite as well as pyrite-bearing ammonites have been studied by EBSD in the Scanning Electron Microscope. Samples were chosen to show no or minor secondary deformation and an idiomorphic 3D crystal habit, so the local textures of pyrite result mainly from growth and minor from deformation. The samples studied derived from Navajun (Spain), Chalchidiki (Greece), Thüringen (Germany) and Unterkliem (Austria). Chemical analyses by EDAX show pyrite with minor inhomogeneities e.g., single crystals of galena and chalcopyrite along the grain boundaries of larger pyrite crystals. Intergrowth between marcasite and pyrite can be detected in one sample. Pyrite may form intense growth twinning lamellae on {011}. Twinning, e.g., contact twinning is abundant within the crystals studied and the individual twinning lamellaes can be resolved by EBSD. The ammonites studied show a replacement of the shale by newly formed pyrite resulting in an intense intergrowth of calcite and pyrite. EBSD measurements indicate a polycrystalline microfabric of both minerals, still reflecting primary surface structures of the ammonites e.g, the Septen. Discs of pyrite (“pyrite dollar”) as well as pyrite framboids show growth patterns comprising a typical microfabric. EBSD studies reveal an equigranular matrix in the inner part of the discs of pyrite and a fiber growth with larger misorientations in the outer regions between the individual segments. This typical microfabric derived from a formation of pyrite crystals starting at a higher nucleation rate and followed by directional crystal growth. EBSD studies show, that the growth texture of pyrite in the samples studied reveals a correlation between nucleation rate and following growth rate of the pyrites, thus leading to the characteristic crystal habits. Preferential directional growth at lower nucleation rates may lead to the formation of 3D framboids of pyrite. Crystallographic misorientations between the individual fibers are similar. In ammonites studied, primary anisotropies of the substrates like e.g., ammonitic sutures, influence the nucleation, crystal growth and habit of the newly formed pyrites along the surfaces.

Keywords: Electron Back Scatter Diffraction (EBSD), growth pattern, Fe-sulfides (pyrite), texture analyses

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Authors: Rafat Fazeli, Reza Fazeli

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This paper focuses on the study of the welfare state and social wage in the leading liberal economy of the United States. The welfare state acquired a broad acceptance as a major socioeconomic achievement of the liberal democracy in the Western industrialized countries during the postwar boom period. The modern and modified vision of capitalist democracy offered, on the one hand, the possibility of high growth rate and, on the other hand, the possibility of continued progression of a comprehensive system of social support for a wider population. The economic crises of the 1970s, provided the ground for a great shift in economic policy and ideology in several Western countries, most notably the United States and the United Kingdom (and to a lesser extent Canada under Prime Minister Brian Mulroney). In the 1980s, the free market oriented reforms undertaken under Reagan and Thatcher greatly affected the economic outlook not only of the United States and the United Kingdom, but of the whole Western world. The movement which was behind this shift in policy is often called neo-conservatism. The neoconservatives blamed the transfer programs for the decline in economic performance during the 1970s and argued that cuts in spending were required to go back to the golden age of full employment. The agenda for both Reagan and Thatcher administrations was rolling back the welfare state, and their budgets included a wide range of cuts for social programs. The question is how successful were Reagan and Thatcher’s efforts to achieve retrenchment? The paper involves an empirical study concerning the distributive role of the welfare state in the two countries. Other studies have often concentrated on the redistributive effect of fiscal policy on different income brackets. This study examines the net benefit/ burden position of the working population with respect to state expenditures and taxes in the postwar period. This measurement will enable us to find out whether the working population has received a net gain (or net social wage). This study will discuss how the expansion of social expenditures and the trend of the ‘net social wage’ can be linked to distinct forms of economic and social organizations. This study provides an empirical foundation for analyzing the growing significance of ‘social wage’ or the collectivization of consumption and the share of social or collective consumption in total consumption of the working population in the recent decades. The paper addresses three other major questions. The first question is whether the expansion of social expenditures has posed any drag on capital accumulation and economic growth. The findings of this study provide an analytical foundation to evaluate the neoconservative claim that the welfare state is itself the source of economic stagnation that leads to the crisis of the welfare state. The second question is whether the increasing ideological challenges from the right and the competitive pressures of globalization have led to retrenchment of the American welfare states in the recent decades. The third question is how social policies have performed in the presence of the rising inequalities in the recent decades.

Keywords: the welfare state, social wage, The United States, limits to growth

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Authors: David Oyewumi Oyekunle, David Preston, Florence Ibeh

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The paper provides an overview of the impacts of the human dimension in project management and team management on projects, which is increasingly affecting the performance of organizations. Recognizing its crucial significance, the research focuses on analyzing the psychological and interpersonal dynamics within project teams. This research is highly significant in the dynamic field of project management, as it addresses important gaps and offers vital insights that align with the constantly changing demands of the profession. A case study was conducted at the University of Salford to examine how human activity affects project management and performance. The study employed a mixed methodology to gain a deeper understanding of the real-world experiences of the subjects and project teams. Data analysis procedures to address the research objectives included the deductive approach, which involves testing a clear hypothesis or theory, as well as descriptive analysis and visualization. The survey comprised a sample size of 40 participants out of 110 project management professionals, including staff and final students in the Salford Business School, using a purposeful sampling method. To mitigate bias, the study ensured diversity in the sample by including both staff and final students. A smaller sample size allowed for more in-depth analysis and a focused exploration of the research objective. Conflicts, for example, are intricate occurrences shaped by a multitude of psychological stimuli and social interactions and may have either a deterrent perspective or a positive perspective on project performance and project management productivity. The study identified conflict elements, including culture, environment, personality, attitude, individual project knowledge, team relationships, leadership, and team dynamics among team members, as crucial human activities to minimize conflict. The findings are highly significant in the dynamic field of project management, as they address important gaps and offer vital insights that align with the constantly changing demands of the profession. It provided project professionals with valuable insights that can help them create a collaborative and high-performing project environment. Uncovering human influence on project performance, effective communication, optimal team synergy, and a keen understanding of project scope are necessary for the management of projects to attain exceptional performance and efficiency. For the research to achieve the aims of this study, it was acknowledged that the productive dynamics of teams and strong group cohesiveness are crucial for effectively managing conflicts in a beneficial and forward-thinking manner. Addressing the identified human influence will contribute to a more sustainable project management approach and offer opportunities for exploration and potential contributions to both academia and practical project management.

Keywords: human dimension, project management, team dynamics, conflict resolution

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Authors: Shereen Yehia El Ezabi

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The transition from the advanced to the superior level of Arabic proficiency is widely known to pose considerable challenges for English speaking students of Arabic as a Foreign Language (AFL). Apart from the increasing complexity of the grammar at this juncture, together with the sprawling vocabulary, to name but two of those challenges, there is also the somewhat less studied hurdle along the way to superior level proficiency, namely, the seeming opacity of many aspects of Arab/ic culture to such learners. This presentation tackles one specific dimension of such issues: religious references in literary texts. It illustrates how carefully constructed translation activities may be used to expand and deepen students’ understanding and use of them. This is shown to be vital for making the leap to the desired competency, given that such elements, as reflected in customs, traditions, institutions, worldviews, and formulaic expressions lie at the very core of Arabic culture and, as such, pervade all modes and levels of Arabic discourse. A short story from the collection “Stories from Our Alley”, by preeminent novelist Naguib Mahfouz is selected for use in this context, being particularly replete with such religious references, of which religious expressions will form the focus of the presentation. As a miniature literary work, it provides an organic whole, so to speak, within which to explore with the class the most precise denotation, as well as the subtlest connotation of each expression in an effort to reach the ‘best’ English rendering. The term ‘best’ refers to approximating the meaning in its full complexity from the source text, in this case Arabic, to the target text, English, according to the concept of equivalence in translation theory. The presentation will show how such a process generates the sort of thorough discussion and close text analysis which allows students to gain valuable insight into this central idiom of Arabic. A variety of translation methods will be highlighted, gleaned from the presenter’s extensive work with advanced/superior students in the Center for Arabic Study Abroad (CASA) program at the American University in Cairo. These begin with the literal rendering of expressions, with the purpose of reinforcing vocabulary learning and practicing the rules of derivational morphology as they form each word, since the larger context remains that of an AFL class, as opposed to a translation skills program. However, departures from the literal approach are subsequently explored by degrees, moving along the spectrum of functional and pragmatic freer translations in order to transmit the ‘real’ meaning in readable English to the target audience- no matter how culture/religion specific the expression- while remaining faithful to the original. Samples from students’ work pre and post discussion will be shared, demonstrating how class consensus is formed as to the final English rendering, proposed as the closest match to the Arabic, and shown to be the result of the above activities. Finally, a few examples of translation work which students have gone on to publish will be shared to corroborate the effectiveness of this teaching practice.

Keywords: superior level proficiency in Arabic as a foreign language, teaching Arabic as a foreign language, teaching idiomatic expressions, translation in foreign language teaching

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Authors: Khachen Kongpakwattana, Nathorn Chaiyakunapruk

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Background: Decision-analytic models for Alzheimer’s disease (AD) have been advanced to discrete-event simulation (DES), in which individual-level modelling of disease progression across continuous severity spectra and incorporation of key parameters such as treatment persistence into the model become feasible. This study aimed to apply the DES to perform a cost-effectiveness analysis of treatment for AD in Thailand. Methods: A dataset of Thai patients with AD, representing unique demographic and clinical characteristics, was bootstrapped to generate a baseline cohort of patients. Each patient was cloned and assigned to donepezil, galantamine, rivastigmine, memantine or no treatment. Throughout the simulation period, the model randomly assigned each patient to discrete events including hospital visits, treatment discontinuation and death. Correlated changes in cognitive and behavioral status over time were developed using patient-level data. Treatment effects were obtained from the most recent network meta-analysis. Treatment persistence, mortality and predictive equations for functional status, costs (Thai baht (THB) in 2017) and quality-adjusted life year (QALY) were derived from country-specific real-world data. The time horizon was 10 years, with a discount rate of 3% per annum. Cost-effectiveness was evaluated based on the willingness-to-pay (WTP) threshold of 160,000 THB/QALY gained (4,994 US$/QALY gained) in Thailand. Results: Under a societal perspective, only was the prescription of donepezil to AD patients with all disease-severity levels found to be cost-effective. Compared to untreated patients, although the patients receiving donepezil incurred a discounted additional costs of 2,161 THB, they experienced a discounted gain in QALY of 0.021, resulting in an incremental cost-effectiveness ratio (ICER) of 138,524 THB/QALY (4,062 US$/QALY). Besides, providing early treatment with donepezil to mild AD patients further reduced the ICER to 61,652 THB/QALY (1,808 US$/QALY). However, the dominance of donepezil appeared to wane when delayed treatment was given to a subgroup of moderate and severe AD patients [ICER: 284,388 THB/QALY (8,340 US$/QALY)]. Introduction of a treatment stopping rule when the Mini-Mental State Exam (MMSE) score goes below 10 to a mild AD cohort did not deteriorate the cost-effectiveness of donepezil at the current treatment persistence level. On the other hand, none of the AD medications was cost-effective when being considered under a healthcare perspective. Conclusions: The DES greatly enhances real-world representativeness of decision-analytic models for AD. Under a societal perspective, treatment with donepezil improves patient’s quality of life and is considered cost-effective when used to treat AD patients with all disease-severity levels in Thailand. The optimal treatment benefits are observed when donepezil is prescribed since the early course of AD. With healthcare budget constraints in Thailand, the implementation of donepezil coverage may be most likely possible when being considered starting with mild AD patients, along with the stopping rule introduced.

Keywords: Alzheimer's disease, cost-effectiveness analysis, discrete event simulation, health technology assessment

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Authors: Lizeth Fuentes-Mera, Vanessa Perez-Silos, Nidia K. Moncada-Saucedo, Alejandro Garcia-Ruiz, Alberto Camacho, Jorge Lara-Arias, Ivan Marino-Martinez, Victor Romero-Diaz, Adolfo Soto-Dominguez, Humberto Rodriguez-Rocha, Hang Lin, Victor Pena-Martinez

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Biphasic scaffolds in cartilage tissue engineering have been designed to influence not only the recapitulation of the osteochondral architecture but also to take advantage of the healing ability of bone to promote the implant integration with the surrounding tissue and then bone restoration and cartilage regeneration. This study reports the development and characterization of a biphasic scaffold based on the assembly of a cartilage phase constituted by fibroin biofunctionalized with bovine cartilage matrix; cellularized with differentiated pre-chondrocytes from adipose tissue stem cells (autologous) and well attached to a bone phase (bone bovine decellularized) to mimic the structure of the nature of native tissue and to promote the cartilage regeneration in a model of joint damage in pigs. Biphasic scaffolds were assembled by fibroin crystallization with methanol. The histological and ultrastructural architectures were evaluated by optical and scanning electron microscopy respectively. Mechanical tests were conducted to evaluate Young's modulus of the implant. For the biological evaluation, pre-chondrocytes were loaded onto the scaffolds and cellular adhesion, proliferation, and gene expression analysis of cartilage extracellular matrix components was performed. The scaffolds that were cellularized and matured for 10 days were implanted into critical 3 mm in diameter and 9-mm in depth osteochondral defects in a porcine model (n=4). Three treatments were applied per knee: Group 1: monophasic cellular scaffold (MS) (single chondral phase), group 2: biphasic scaffold, cellularized only in the chondral phase (BS1), group 3: BS cellularized in both bone and chondral phases (BS2). Simultaneously, a control without treatment was evaluated. After 4 weeks of surgery, integration and regeneration tissues were analyzed by x-rays, histology and immunohistochemistry evaluation. The mechanical assessment showed that the acellular biphasic composites exhibited Young's modulus of 805.01 kPa similar to native cartilage (400-800 kPa). In vitro biological studies revealed the chondroinductive ability of the biphasic implant, evidenced by an increase in sulfated glycosaminoglycan (GAGs) and type II collagen, both secreted by the chondrocytes cultured on the scaffold during 28 days. No evidence of adverse or inflammatory reactions was observed in the in vivo trial; however, In group 1, the defects were not reconstructed. In group 2 and 3 a good integration of the implant with the surrounding tissue was observed. Defects in group 2 were fulfilled by hyaline cartilage and normal bone. Group 3 defects showed fibrous repair tissue. In conclusion; our findings demonstrated the efficacy of biphasic and bioactive scaffold based on silk fibroin, which entwined chondroinductive features and biomechanical capability with appropriate integration with the surrounding tissue, representing a promising alternative for osteochondral tissue-engineering applications.

Keywords: biphasic scaffold, extracellular cartilage matrix, silk fibroin, osteochondral tissue engineering

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Authors: Hatem Abou-Senna

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Interstate 4 (I-4) is a primary east-west transportation corridor between Tampa and Daytona cities, serving commuters, commercial and recreational traffic. I-4 is known to have severe recurring congestion during peak hours. The congestion spans about 11 miles in the evening peak period in the central corridor area as it is considered the only non-tolled limited access facility connecting the Orlando Central Business District (CBD) and the tourist attractions area (Walt Disney World). Florida officials had been skeptical of tolling I-4 prior to the recent legislation, and the public through the media had been complaining about the excessive toll facilities in Central Florida. So, in search for plausible mitigation to the congestion on the I-4 corridor, this research is implemented to evaluate the effectiveness of different toll pricing alternatives that might divert traffic from I-4 to the toll facilities during the peak period. The network is composed of two main diverging limited access highways, freeway (I-4) and toll road (SR 417) in addition to two east-west parallel toll roads SR 408 and SR 528, intersecting the above-mentioned highways from both ends. I-4 and toll road SR 408 are the most frequently used route by commuters. SR-417 is a relatively uncongested toll road with 15 miles longer than I-4 and $5 tolls compared to no monetary cost on 1-4 for the same trip. The results of the calibrated Orlando PARAMICS network showed that percentages of route diversion vary from one route to another and depends primarily on the travel cost between specific origin-destination (O-D) pairs. Most drivers going from Disney (O1) or Lake Buena Vista (O2) to Lake Mary (D1) were found to have a high propensity towards using I-4, even when eliminating tolls and/or providing real-time information. However, a diversion from I-4 to SR 417 for these OD pairs occurred only in the cases of the incident and lane closure on I-4, due to the increase in delay and travel costs, and when information is provided to travelers. Furthermore, drivers that diverted from I-4 to SR 417 and SR 528 did not gain significant travel-time savings. This was attributed to the limited extra capacity of the alternative routes in the peak period and the longer traveling distance. When the remaining origin-destination pairs were analyzed, average travel time savings on I-4 ranged between 10 and 16% amounting to 10 minutes at the most with a 10% increase in the network average speed. High propensity of diversion on the network increased significantly when eliminating tolls on SR 417 and SR 528 while doubling the tolls on SR 408 along with the incident and lane closure scenarios on I-4 and with real-time information provided. The toll roads were found to be a viable alternative to I-4 for these specific OD pairs depending on the user perception of the toll cost which was reflected in their specific travel times. However, on the macroscopic level, it was concluded that route diversion through toll reduction or elimination on surrounding toll roads would only have a minimum impact on reducing I-4 congestion during the peak period.

Keywords: congestion pricing, dynamic feedback assignment, microsimulation, paramics, route diversion

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Authors: Martina I. Reinhold, Theresa Bacon-Baguley

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Background: Medical knowledge continuously evolves and to help health care providers to stay up-to-date, evidence-based medicine (EBM) has emerged as a model. The practice of EBM requires new skills of the health care provider, including directed literature searches, the critical evaluation of research studies, and the direct application of the findings to patient care. This paper describes the integration and evaluation of an evidence-based medicine course sequence into a Physician Assistant curriculum. This course sequence teaches students to manage and use the best clinical research evidence to competently practice medicine. A survey was developed to assess the outcomes of the EBM course sequence. Methodology: The cornerstone of the three-semester sequence of EBM are interactive small group discussions that are designed to introduce students to the most clinically applicable skills to identify, manage and use the best clinical research evidence to improve the health of their patients. During the three-semester sequence, the students are assigned each semester to participate in small group discussions that are facilitated by faculty with varying background and expertise. Prior to the start of the first EBM course in the winter semester, PA students complete a knowledge-based survey that was developed by the authors to assess the effectiveness of the course series. The survey consists of 53 Likert scale questions that address the nine objectives for the course series. At the end of the three semester course series, the same survey was given to all students in the program and the results from before, and after the sequence of EBM courses are compared. Specific attention is paid to overall performance of students in the nine course objectives. Results: We find that students from the Class of 2016 and 2017 consistently improve (as measured by percent correct responses on the survey tool) after the EBM course series (Class of 2016: Pre- 62% Post- 75%; Class of 2017: Pre- 61 % Post-70%). The biggest increase in knowledge was observed in the areas of finding and evaluating the evidence, with asking concise clinical questions (Class of 2016: Pre- 61% Post- 81%; Class of 2017: Pre- 61 % Post-75%) and searching the medical database (Class of 2016: Pre- 24% Post- 65%; Class of 2017: Pre- 35 % Post-66 %). Questions requiring students to analyze, evaluate and report on the available clinical evidence regarding diagnosis showed improvement, but to a lesser extend (Class of 2016: Pre- 56% Post- 77%; Class of 2017: Pre- 56 % Post-61%). Conclusions: Outcomes identified that students did gain skills which will allow them to apply EBM principles. In addition, the outcomes of the knowledge-based survey allowed the faculty to focus on areas needing improvement, specifically the translation of best evidence into patient care. To address this area, the clinical faculty developed case scenarios that were incorporated into the lecture and discussion sessions, allowing students to better connect the research studies with patient care. Students commented that ‘class discussion and case examples’ contributed most to their learning and that ‘it was helpful to learn how to develop research questions and how to analyze studies and their significance to a potential client’. As evident by the outcomes, the EBM courses achieved the goals of the course and were well received by the students. 

Keywords: evidence-based medicine, clinical education, assessment tool, physician assistant

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Authors: Piyaorn Wajanatinapart, Diane R. Lauver

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The number of persons with dementia (PWD) has increased. Informal caregivers are the major providing care. They can have perceived gains and burdens. Caregivers who reported high in perceived gains may report low in burdens and better health. Gaps of caregiving literature were: no report psychometrics in a few studies and unclear definitions of gains; most studies with no theory-guided and conducting in Western countries; not fully described relationships among caregiving variables: motivations, satisfaction with psychological needs, social support, gains, burdens, and physical and psycho-emotional health. Those gaps were filled by assessing psychometric properties of selected measures, providing clearly definitions of gains, using self-determination theory (SDT) to guide the study, and developing the study in Thailand. The study purposes were to evaluate six measures for internal consistency reliability, content validity, and construct validity. This study also examined relationships of caregiving variables: motivations (controlled and autonomous motivations), satisfaction with psychological needs (autonomy, competency, and relatedness), perceived social support, perceived gains, perceived burdens, and physical and psycho-emotional health. This study was a cross-sectional and correlational descriptive design with two convenience samples. Sample 1 was five Thai experts to assess content validity of measures. Sample 2 was 146 Thai caregivers of PWD to assess construct validity, reliability, and relationships among caregiving variables. Experts rated questionnaires and sent them back via e-mail. Caregivers answered questionnaires at clinics of four Thai hospitals. Data analysis was used descriptive statistics and bivariate and multivariate analyses using the composite indicator structural equation model to control measurement errors. For study results, most caregivers were female (82%), middle age (M =51.1, SD =11.9), and daughters (57%). They provided care for 15 hours/day with 4.6 years. The content validity indices of items and scales were .80 or higher for clarity and relevance. Experts suggested item revisions. Cronbach’s alphas were .63 to .93 of ten subscales of four measures and .26 to .57 of three subscales. The gain scale was acceptable for construct validity. With controlling covariates, controlled motivations, the satisfaction with three subscales of psychological needs, and perceived social support had positive relationships with physical and psycho-emotional health. Both satisfaction with autonomy subscale and perceived social support had negative relationship with perceived burdens. The satisfaction with three subscales of psychological needs had positive relationships among them. Physical and psycho-emotional health subscales had positive relationships with each other. Furthermore, perceived burdens had negative relationships with physical and psycho-emotional health. This study was the first use SDT to describe relationships of caregiving variables in Thailand. Caregivers’ characteristics were consistent with literature. Four measures were valid and reliable except two measures. Breadth knowledge about relationships was provided. Interpretation of study results was cautious because of using same sample to evaluate psychometric properties of measures and relationships of caregiving variables. Researchers could use four measures for further caregiving studies. Using a theory would help describe concepts, propositions, and measures used. Researchers may examine the satisfaction with psychological needs as mediators. Future studies to collect data with caregivers in communities are needed.

Keywords: caregivers, caregiving, dementia, measures

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Authors: Akiko Ohta, Masahiro Minami, Yusra Qadir, Jennifer York

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The Home Instruction for Parents of Preschool Youngsters (HIPPY) is a home instruction program for mothers of children 3 to 5 years old. Using role-play as a method of teaching, the participating mothers work with their home visitors and learn how to deliver the HIPPY curriculum to their children. Applying HIPPY, Reviving Hope and Home for High-risk Refugee Mothers Program (RHH) was created to provide more personalized peer support and to respond to ongoing settlement challenges for isolated and vulnerable Government Assisted Refugee (GAR) mothers. GARs often have greater needs and vulnerabilities than other refugee groups. While the support is available, they often face various challenges and barriers in starting their new lives in Canada, such as inadequate housing, low first-language literacy levels, low competency in English or French, and social isolation. The pilot project was operated by Mothers Matter Centre (MMC) from January 2019 to March 2021 in partnership with the Immigrant Services Society of BC (ISSofBC). The formative evaluation was conducted by a research team at Simon Fraser University. In order to provide more suitable support for GAR mothers, RHH intended to offer more flexibility in HIPPY delivery, supported by a home visitor, to meet the need of refugee mothers facing various conditions and challenges; to have a pool of financial resources to be used for the RHH families when necessitated during the program period; to have another designated staff member, called a community navigator, assigned to facilitate the support system for the RHH families in their settlement; to have a portable device available for each RHH mother to navigate settlement support resources; and to provide other variations of the HIPPY curriculum as an option for the RHH mothers, including a curriculum targeting pre-HIPPY age children. Reflections on each program component was collected from RHH mothers and staff members of MMC and ISSofBC, including frontline workers and management staff, through individual interviews and focus group discussions. Each of the RHH program components was analyzed and evaluated by applying Moore’s four domains framework to identify key information and generate new knowledge (data). To capture RHH mothers’ program experience more in depth based on their own reflections, the photovoice method was used. Some photos taken by the mothers will be shared to illustrate their RHH experience as part of their life stories. Over the period of the program, this evaluation observed how RHH mothers became more confident in various domains, such as communicating with others, taking public transportations alone, and teaching their own child(ren). One of the major factors behind the success was their home visitors’ flexibility and creativity to create a more meaningful and tailored approach for each mother, depending on her background and personal situation. The role of the community navigator was tested out and improved during the program period. The community navigators took the key role to assess the needs of the RHH families and connect them with community resources. Both the home visitors and community navigators were immigrant mothers themselves and owing to their dedicated care for the RHH mothers; they were able to gain trust and work closely and efficiently with RHH mothers.

Keywords: refugee mothers, settlement support, program evaluation, Canada

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Authors: Marina Gold, Yves Jackson, David Parrat

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The high predominance of Latin American migrants in Geneva from countries where Chagas disease is endemic (Bolivia, Brazil, Argentina, Colombia) is increasing the incidence of chronic Chagas-related problems, especially cardiovascular complications. The precarious migratory status of what are mostly undocumented migrants complicates access to health and affects patients’ and doctors’ health perceptions regarding screening, treatment and monitoring of Chagas-related health concerns. This project results from a 3 year collaboration between the Geneva University Hospital and the NGO Mundo Sano to understand the following questions: 1) how do Latin American migrants perceive their health? 2) What do they understand from Chagas disease? 3) Are patients’ and doctors’ health perceptions similar or do they have competing agendas? This paper aims to present the results of a long-term study that interrogates health perceptions among Latin American migrants in Geneva. The first phase consisted in completing surveys at three community screening events (2016, 2017. 2018), and the results of these surveys reveal the subordination of the importance of health to that of having met economic family obligation. That is, health is important only when it becomes an impediment to economic gain. The contradictory result emerged that people are aware of the importance of health prevention in order to ensure long-term health, but they do not always have agency over their life-style habits (healthy food, regular exercise, emotional stability). The second phase of the research collected open-ended interviews with selected participants, in order to explore in more detail how Latin American migrants deal with Chagas in a different socio-political and economic context to that of endemic countries. These interviews (5 in total) reveal mixed methods of managing health: social networks, access to health care transnationally (in Geneva, Spain and back in their home country), and different valuations of health problems in each situation. The third phase consisted in observations of doctor-patient consultations and further extended interviews with patients to determine doctor/patient health perceptions around Chagas disease. This phase is ongoing, but it has yielded preliminarily observations regarding the expectations that patients’ have of doctors, and the understanding of doctors’ to patients’ complex situations. Positive and complementary health perceptions include patients’ feeling that doctors in Geneva are more understanding, more knowledgeable and less racist than those in their home country, who do not provide detailed information about Chagas or its treatment and discriminate against them for being indigenous or from poor rural areas, enabling a better communication between doctors and patients. Possible conflicting health perceptions include patients addressing their health concerns more holistically and encountering the specialist’s limitations to only treating one health concern, given time limitations and lack of competition with their colleagues (the general practitioner that referred the patient, for example). The implications of this study extend the case of Chagas disease in Geneva and is relevant for all chronic concerns and migratory contexts of precarity.

Keywords: chagas disease, health perceptions, Latin American Migrants, non-endemic countries

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Authors: Guilherme Oliveira

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The assimilation of images and their potential symbolism into lived experiences is inherent. It is through this exercise of recognition via imagistic records that the questioning of the origins of a constant narrative stimulated by the media arises. The construction of the "Man" archetype and the reflections of active masculine imagery in the 21st century, when conveyed through media channels, could potentially have detrimental effects. Addressing this systematic behavioral chronology of virile cisgender, permeated imagistically through these means, involves exploring potential resolutions. Thus, an investigation process is initiated into the potential representation of the 'hero' in this media emulation through idols contextualized in the political sphere, with the purpose of elucidating the processes of simulation and emulation of narratives based on mythical, historical, and sacred accounts. In this process of sharing, the narratives contained in the imagistic structuring offered by information dissemination channels seek validation through a process of public acceptance. To achieve this consensus, a visual set adorned with mythological and sacred symbolisms adapted to the intended environment is promoted, thus utilizing sociocultural characteristics in favor of political marketing. Visual recognition, therefore, becomes a direct reflection of a cultural heritage acquired through lived human experience, stimulated by continuous representations throughout history. Echoes of imagery and narratives undergo a constant process of resignification of their concepts, sharpened by their premises, and adapted to the environment in which they seek to establish themselves. Political figures analyzed in this article employ the practice of taking possession of symbolisms, mythological stories, and heroisms and adapt their visual construction through a continuous praxis of emulation. Thus, they utilize iconic mythological narratives to gain credibility through belief. Utilizing iconic mythological narratives for credibility through belief, the idol becomes the very act of release of trauma, offering believers liberation from preconceived concepts and allowing for the attribution of new meanings. To dissolve this issue and highlight the subjectivities within the intention of the image, a linguistic, semiotic, and anthropological methodology is created. Linguistics uses expressions like 'Blaming the Image' to create a mechanism of expressive action in questioning why to blame a construction or visual composition and thus seek answers in the first act. Semiotics and anthropology develop an imagistic atlas of graphic analysis, seeking to make connections, comparisons, and relations between modern and sacred/mystical narratives, emphasizing the different subjective layers of embedded symbolism. Thus, it constitutes a performative act of disarming the image. It creates a disenchantment of the superficial gaze under the constant reproduction of visual content stimulated by virtual networks, enabling a discussion about the acceptance of caricatures characterized by past fables.

Keywords: image, heroic narrative, media heroism, virile politics, political, myth, sacred performance, visual mythmaking, characterization dynamics

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Authors: B. S. Premalatha, Mereen Rose Babu, Vaishali Prabhu

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Background: Dysphagia must be assessed, either subjectively or objectively, in order to properly address the swallowing difficulty. Providing therapeutic care to patients with dysphagia via tele mode was one approach for providing clinical services during the COVID-19 epidemic. As a result, the teleassessment of dysphagia has increased in India. Aim: This study aimed to identify challenges faced by Indian SLPs while providing teleassessment to individuals with dysphagia during the outbreak of COVID-19 from 2020 to 2021. Method: After receiving approval from the institute's institutional review board and ethics committee, the current study was carried out. The study was cross-sectional in nature and lasted from 2020 to 2021. The study enrolled participants who met the inclusion and exclusion criteria of the study. It was decided to recruit roughly 246 people based on the sample size calculations. The research was done in three stages: questionnaire development and content validation, questionnaire administration. Five speech and hearing professionals' content verified the questionnaire for faults and clarity. Participants received questionnaires via various social media platforms such as e-mail and WhatsApp, which were written in Microsoft Word and then converted to Google Forms. SPSS software was used to examine the data. Results: In light of the obstacles that Indian SLPs encounter, the study's findings were examined. Only 135 people responded. During the COVID-19 lockdowns, 38% of participants said they did not deal with dysphagia patients. After the lockout, 70.4% of SLPs kept working with dysphagia patients, while 29.6% did not. From the beginning of the oromotor examination, the main problems in completing tele evaluation of dysphagia have been highlighted. Around 37.5% of SLPs said they don't undertake the OPME online because of difficulties doing the evaluation, such as the need for repeated instructions from patients and family members and trouble visualizing structures in various positions. The majority of SLPs' online assessments were inefficient and time-consuming. A bigger percentage of SLPs stated that they will not advocate tele evaluation in dysphagia to their colleagues. SLPs' use of dysphagia assessment has decreased as a result of the epidemic. When it came to the amount of food, the majority of people proposed a small amount. Apart from placing the patient for assessment and gaining less cooperation from the family, most SLPs found that Internet speed was a source of concern and a barrier. Hearing impairment and the presence of a tracheostomy in patients with dysphagia proved to be the most difficult conditions to treat online. For patients with NPO, the majority of SLPs did not advise tele-evaluation. In the anterior region of the oral cavity, oral meal residue was more visible. The majority of SLPs reported more anterior than posterior leakage. Even while the majority of SLPs could detect aspiration by coughing, many found it difficult to discern the gurgling tone of speech after swallowing. Conclusion: The current study sheds light on the difficulties that Indian SLPs experience when assessing dysphagia via tele mode, indicating that tele-assessment of dysphagia is still to gain importance in India.

Keywords: dysphagia, teleassessment, challenges, Indian SLP

Procedia PDF Downloads 103

Authors: Ece A. Irmak, Amdulla O. Mekhrabov, M. Vedat Akdeniz

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There is a growing interest on the synthesis and characterization of nanoalloys since the unique chemical, and physical properties of nanoalloys can be tuned and, consequently, new structural motifs can be created by varying the type of constituent elements, atomic and magnetic ordering, as well as size and shape of the nanoparticles. Due to the fine size effects, magnetic nanoalloys have considerable attention with their enhanced mechanical, electrical, optical and magnetic behavior. As an important magnetic nanoalloy, the novel application area of Fe-Ni based nanoalloys is expected to be widened in the chemical, aerospace industry and magnetic biomedical applications. Noble metals have been using in biomedical applications for several years because of their surface plasmon properties. In this respect, iron-nickel nanoalloys are promising materials for magnetic biomedical applications because they show novel properties such as superparamagnetism and surface plasmon resonance property. Also, there is great attention for the usage Fe-Ni based nanoalloys as radar absorbing materials in aerospace and stealth industry due to having high Curie temperature, high permeability and high saturation magnetization with good thermal stability. In this study, FeNi₃ bimetallic nanoalloys were synthesized by mechanical alloying in a planetary high energy ball mill. In mechanical alloying, micron size powders are placed into the mill with milling media. The powders are repeatedly deformed, fractured and alloyed by high energy collision under the impact of balls until the desired composition and particle size is achieved. The experimental studies were carried out in two parts. Firstly, dry mechanical alloying with high energy dry planetary ball milling was applied to obtain FeNi₃ nanoparticles. Secondly, dry milling was followed by surfactant-assisted ball milling to observe the surfactant and solvent effect on the structure, size, and properties of the FeNi₃ nanoalloys. In the first part, the powder sample of iron-nickel was prepared according to the 1:3 iron to nickel ratio to produce FeNi₃ nanoparticles and the 1:10 powder to ball weight ratio. To avoid oxidation during milling, the vials had been filled with Ar inert gas before milling started. The powders were milled for 80 hours in total and the synthesis of the FeNi₃ intermetallic nanoparticles was succeeded by mechanical alloying in 40 hours. Also, regarding the particle size, it was found that the amount of nano-sized particles raised with increasing milling time. In the second part of the study, dry milling of the Fe and Ni powders with the same stoichiometric ratio was repeated. Then, to prevent agglomeration and to obtain smaller sized nanoparticles with superparamagnetic behavior, surfactants and solvent are added to the system, after 40-hour milling time, with the completion of the mechanical alloying. During surfactant-assisted ball milling, heptane was used as milling medium, and as surfactants, oleic acid and oleylamine were used in the high energy ball milling processes. The characterization of the alloyed particles in terms of microstructure, morphology, particle size, thermal and magnetic properties with respect to milling time was done by X-ray diffraction, scanning electron microscopy, energy dispersive spectroscopy, vibrating-sample magnetometer, and differential scanning calorimetry.

Keywords: iron-nickel systems, magnetic nanoalloys, mechanical alloying, nanoalloy characterization, surfactant-assisted ball milling

Procedia PDF Downloads 153

Authors: Giulia Fredi, Andrea Dorigato, Luca Fambri, Alessandro Pegoretti

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Thermal energy storage (TES) is the storage of heat for later use, thus filling the gap between energy request and supply. The most widely used materials for TES are the organic solid-liquid phase change materials (PCMs), such as paraffin. These materials store/release a high amount of latent heat thanks to their high specific melting enthalpy, operate in a narrow temperature range and have a tunable working temperature. However, they suffer from a low thermal conductivity and need to be confined to prevent leakage. These two issues can be tackled by confining PCMs with carbon nanotubes (CNTs). TES applications include the buildings industry, solar thermal energy collection and thermal management of electronics. In most cases, TES systems are an additional component to be added to the main structure, but if weight and volume savings are key issues, it would be advantageous to embed the TES functionality directly in the structure. Such multifunctional materials could be employed in the automotive industry, where the diffusion of lightweight structures could complicate the thermal management of the cockpit environment or of other temperature sensitive components. This work aims to produce epoxy/carbon structural laminates containing CNT-stabilized paraffin. CNTs were added to molten paraffin in a fraction of 10 wt%, as this was the minimum amount at which no leakage was detected above the melting temperature (45°C). The paraffin/CNT blend was cryogenically milled to obtain particles with an average size of 50 µm. They were added in various percentages (20, 30 and 40 wt%) to an epoxy/hardener formulation, which was used as a matrix to produce laminates through a wet layup technique, by stacking five plies of a plain carbon fiber fabric. The samples were characterized microstructurally, thermally and mechanically. Differential scanning calorimetry (DSC) tests showed that the paraffin kept its ability to melt and crystallize also in the laminates, and the melting enthalpy was almost proportional to the paraffin weight fraction. These thermal properties were retained after fifty heating/cooling cycles. Laser flash analysis showed that the thermal conductivity through the thickness increased with an increase of the PCM, due to the presence of CNTs. The ability of the developed laminates to contribute to the thermal management was also assessed by monitoring their cooling rates through a thermal camera. Three-point bending tests showed that the flexural modulus was only slightly impaired by the presence of the paraffin/CNT particles, while a more sensible decrease of the stress and strain at break and the interlaminar shear strength was detected. Optical and scanning electron microscope images revealed that these could be attributed to the preferential location of the PCM in the interlaminar region. These results demonstrated the feasibility of multifunctional structural TES composites and highlighted that the PCM size and distribution affect the mechanical properties. In this perspective, this group is working on the encapsulation of paraffin in a sol-gel derived organosilica shell. Submicron spheres have been produced, and the current activity focuses on the optimization of the synthesis parameters to increase the emulsion efficiency.

Keywords: carbon fibers, carbon nanotubes, lightweight materials, multifunctional composites, thermal energy storage

Procedia PDF Downloads 132

Authors: Welder A. Baldassini, Jon J. Ramsey, Marcos R. Chiaratti, Amália S. Chaves, Renata H. Branco, Sarah F. M. Bonilha, Dante P. D. Lanna

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With increased production costs there is a need for animals that are more efficient in terms of meat production. In this context, the role of mitochondrial DNA (mtDNA) on physiological processes in liver, muscle and adipose tissues may account for inter-animal variation in energy expenditures and heat production. The purpose this study was to investigate if the amounts of mtDNA in liver, muscle and adipose tissue (subcutaneous and visceral depots) of Nellore bulls are associated with residual feed intake (RFI) and estimated heat production (EHP). Eighteen animals were individually fed in a feedlot for 90 days. RFI values were obtained by regression of dry matter intake (DMI) in relation to average daily gain (ADG) and mid-test metabolic body weight (BW). The animals were classified into low (more efficient) and high (less efficient) RFI groups. The bulls were then randomly distributed in individual pens where they were given excess feed twice daily to result in 5 to 10% orts for 90 d with diet containing 15% crude protein and 2.7 Mcal ME/kg DM. The heart rate (HR) of bulls was monitored for 4 consecutive days and used for calculation of EHP. Electrodes were fitted to bulls with stretch belts (POLAR RS400; Kempele, Finland). To calculate oxygen pulse (O2P), oxygen consumption was obtained using a facemask connected to the gas analyzer (EXHALYZER, ECOMedics, Zurich, Switzerland) and HR were simultaneously measured for 15 minutes period. Daily oxygen (O2) consumption was calculated by multiplying the volume of O2 per beat by total daily beats. EHP was calculated multiplying O2P by the average HR obtained during the 4 days, assuming 4.89 kcal/L of O2 to measure daily EHP that was expressed in kilocalories/day/kilogram metabolic BW (kcal/day/kg BW0.75). Blood samples were collected between days 45 and 90th after the beginning of the trial period in order to measure the concentration of hemoglobin and hematocrit. The bulls were slaughtered in an experimental slaughter house in accordance with current guidelines. Immediately after slaughter, a section of liver, a portion of longissimus thoracis (LT) muscle, plus a portion of subcutaneous fat (surrounding LT muscle) and portions of visceral fat (kidney, pelvis and inguinal fat) were collected. Samples of liver, muscle and adipose tissues were used to quantify mtDNA copy number per cell. The number of mtDNA copies was determined by normalization of mtDNA amount against a single copy nuclear gene (B2M). Mean of EHP, hemoglobin and hematocrit of high and low RFI bulls were compared using two-sample t-tests. Additionally, the one-way ANOVA was used to compare mtDNA quantification considering the mains effects of RFI groups. We found lower EHP (83.047 vs. 97.590 kcal/day/kgBW0.75; P < 0.10), hemoglobin concentration (13.533 vs. 15.108 g/dL; P < 0.10) and hematocrit percentage (39.3 vs. 43.6 %; P < 0.05) in low compared to high RFI bulls, respectively, which may be useful traits to identify efficient animals. However, no differences were observed between the mtDNA content in liver, muscle and adipose tissue of Nellore bulls with high and low RFI.

Keywords: bioenergetics, Bos indicus, feed efficiency, mitochondria

Procedia PDF Downloads 221

Authors: Saule Balmagambetova, Zhenisgul Tlegenova, Saule Madinova

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Cardiotoxicity associated with anticancer treatment, now defined as cancer therapy-related cardiac dysfunction (CTRCD), accompanies cancer patients and negatively impacts their survivorship. Currently, a cardio-oncological service is being created in Kazakhstan based on the provisions of the European Society of Cardio-oncology (ESC) Guidelines. In the frames of a pilot project, a cohort study on CTRCD conditions was initiated at the Aktobe Cancer center. One hundred twenty-eight newly diagnosed breast cancer patients started on doxorubicin and/or trastuzumab were recruited. Echocardiography with global longitudinal strain (GLS) assessment, biomarkers panel (cardiac troponin (cTnI), brain natriuretic peptide (BNP), myeloperoxidase (MPO), galectin-3 (Gal-3), D-dimers, C-reactive protein (CRP)), and other tests were performed at baseline and every three months. Patients were stratified by the cardiovascular risks according to the ESC recommendations and allocated into the risk groups during the pre-treatment visit. Of them, 10 (7.8%) patients were assigned to the high-risk group, 48 (37.5%) to the medium-risk group, and 70 (54.7%) to the low-risk group, respectively. High-risk patients have been receiving their cardioprotective treatment from the outset. Patients were also divided by treatment - in the anthracycline-based 83 (64.8%), in trastuzumab- only 13 (10.2%), and in the mixed anthracycline/trastuzumab group 32 individuals (25%), respectively. Mild symptomatic CTRCD was revealed and treated in 2 (1.6%) participants, and a mild asymptomatic variant in 26 (20.5%). Mild asymptomatic conditions are defined as left ventricular ejection fraction (LVEF) ≥50% and further relative reduction in GLS by >15% from baseline and/or a further rise in cardiac biomarkers. The listed biomarkers were assessed longitudinally in repeated-measures linear regression models during 12 months of observation. The associations between changes in biomarkers and CTRCD and between changes in biomarkers and LVEF were evaluated. Analysis by risk groups revealed statistically significant differences in baseline LVEF scores (p 0.001), BNP (p 0.0075), and Gal-3 (p 0.0073). Treatment groups found no statistically significant differences at baseline. After 12 months of follow-up, only LVEF values showed a statistically significant difference by risk groups (p 0.0011). When assessing the temporal changes in the studied parameters for all treatment groups, there were statistically significant changes from visit to visit for LVEF (p 0.003); GLS (p 0.0001); BNP (p<0.00001); MPO (p<0.0001); and Gal-3 (p<0.0001). No moderate or strong correlations were found between the biomarkers values and LVEF, between biomarkers and GLS. Between the biomarkers themselves, a moderate, close to strong correlation was established between cTnI and D-dimer (r 0.65, p<0.05). The dose-dependent effect of anthracyclines has been confirmed: the summary dose has a moderate negative impact on GLS values: -r 0.31 for all treatment groups (p<0.05). The present study found myeloperoxidase as a promising biomarker of cardiac dysfunction in the mixed anthracycline/trastuzumab treatment group. The hazard of CTRCD increased by 24% (HR 1.21; 95% CI 1.01;1.73) per doubling in baseline MPO value (p 0.041). Increases in BNP were also associated with CTRCD (HR per doubling, 1.22; 95% CI 1.12;1.69). No cases of chemotherapy discontinuation due to cardiotoxic complications have been recorded. Further observations are needed to gain insight into the ability of biomarkers to predict CTRCD onset.

Keywords: breast cancer, chemotherapy, cardiotoxicity, Kazakhstan

Procedia PDF Downloads 62

Authors: Z. Xu

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Immersive virtual reality (VR) has gained momentum in humanitarian communication due to its utopian promises of co-presence, immediacy, and transcendence. These potential benefits have led the United Nations (UN) to tirelessly produce and distribute VR series to evoke global empathy and encourage policymakers, philanthropic business tycoons and citizens around the world to actually do something (i.e. give a donation). However, it is unclear whether or not VR can cultivate cosmopolitans with a sense of social responsibility towards the geographically, socially/culturally and morally mediated misfortune of faraway others. Drawing upon existing works on the mediation of distant suffering, this article constructs an analytical framework to articulate the issue. Applying this framework on a case study of five of the UN’s VR pieces, the article identifies three paradoxes that exist between cyber-utopian and cyber-dystopian narratives. In the “paradox of distance”, VR relies on the notions of “presence” and “storyliving” to implicitly link audiences spatially and temporally to distant suffering, creating global connectivity and reducing perceived distances between audiences and others; yet it also enables audiences to fully occupy the point of view of distant sufferers (creating too close/absolute proximity), which may cause them to feel naive self-righteousness or narcissism with their pleasures and desire, thereby destroying the “proper distance”. In the “paradox of agency”, VR simulates a superficially “real” encounter for visual intimacy, thereby establishing an “audiences–beneficiary” relationship in humanitarian communication; yet in this case the mediated hyperreality is not an authentic reality, and its simulation does not fill the gap between reality and the virtual world. In the “paradox of the hierarchies of human life”, VR enables an audience to experience virtually fundamental “freedom”, epitomizing an attitude of cultural relativism that informs a great deal of contemporary multiculturalism, providing vast possibilities for a more egalitarian representation of distant sufferers; yet it also takes the spectator’s personally empathic feelings as the focus of intervention, rather than structural inequality and political exclusion (an economic and political power relations of viewing). Thus, the audience can potentially remain trapped within the minefield of hegemonic humanitarianism. This study is significant in two respects. First, it advances the turn of digitalization in studies of media and morality in the polymedia milieu; it is motivated by the necessary call for a move beyond traditional technological environments to arrive at a more novel understanding of the asymmetry of power between the safety of spectators and the vulnerability of mediated sufferers. Second, it not only reminds humanitarian journalists and NGOs that they should not rely entirely on the richer news experience or powerful response-ability enabled by VR to gain a “moral bond” with distant sufferers, but also argues that when fully-fledged VR technology is developed, it can serve as a kind of alchemy and should not be underestimated merely as a “bugaboo” of an alarmist philosophical and fictional dystopia.

Keywords: audience, cosmopolitan, distant suffering, virtual reality, humanitarian communication

Procedia PDF Downloads 111