Search results for: independent work
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 15274

Search results for: independent work

11974 Knowledge, Attitudes and Practices of Menstrual Hygiene of Adolescent Girls Aged 12 to 19 Years Old at Lake Tanganyika Lycee

Authors: Yvette Nsabimana, Nadine Misago, Minani Methode

Abstract:

Context: the issue of menstrual hygiene is an entry point for demonstrating the gender-specific nature of the needs of women and adolescent girls. Women and girls around the world face many challenges in managing their periods. They may be deprived of certain basic human rights, including those relating to education, work and health. This work describes the Knowledge, Attitudes and Practices of menstrual hygiene among adolescent girls from 12 to 19 years of Lake Tanganyika Secondary School. Method: This is a descriptive cross-sectional study among 384 adolescent girls from Lake Tanganyika secondary school over a period of 2 weeks from September 13 to September 27 and with a purely general objective of describing the Knowledge, Attitudes and Practices of menstrual hygiene in secondary schools. The study was conducted using a non-probability method and the sampling technique was for convenience. The data collection technique used was the survey by questionnaire and the exploitation of the documentary. The data collection tool used was the questionnaire. Microsoft Word 2013, Microsoft Excel 2.13 and EPI INFO7 software were used for this purpose. Results: We noticed that 55.47% of the participants knew that menstruation is a physiological process; 57.55% of the teenage girls surveyed get their information about menstrual hygiene from their mothers; 75.72% use sanitary napkins and 24.02% use fabrics as protective material; 35.16% of respondents have already lacked sanitary napkins since their menarche; 37.29% are absent from classes due to lack of sanitary napkins; 23.82% use soap and other products to wash.

Keywords: knowledge, attitudes, practices, menstrual hygiene

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11973 Anti-Gravity to Neo-Concretism: The Epodic Spaces of Non-Objective Art

Authors: Alexandra Kennedy

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Making use of the notion of ‘epodic spaces’ this paper presents a reconsideration of non-objective art practices, proposing alternatives to established materialist, formalist, process-based conceptualist approaches to such work. In his Neo-Concrete Manifesto (1959) Ferreira Gullar (1930-2016) sought to create a distinction between various forms of non-objective art. He distinguished the ‘geometric’ arts of neoplasticism, constructivism, and suprematism – which he described as ‘dangerously acute rationalism’ – from other non-objective practices. These alternatives, he proposed, have an expressive potential lacking in the former and this formed the basis for their categorisation as neo-concrete. Gullar prioritized the phenomenological over the rational, with an emphasis on the role of the spectator (a key concept of minimalism). Gullar highlighted the central role of sensual experience, colour and the poetic in such work. In the early twentieth century, Russian Cosmism – an esoteric philosophical movement – was highly influential on Russian avant-garde artists and can account for suprematist artists’ interest in, and approach to, planar geometry and four-dimensional space as demonstrated in the abstract paintings of Kasimir Malevich (1879-1935). Nikolai Fyodorov (1823-1903) promoted the idea of anti-gravity and cosmic space as the field for artistic activity. The artist and writer Kuzma Petrov-Vodkin (1878-1939) wrote on the concept of Euclidean space, the overcoming of such rational conceptions of space and the breaking free from the gravitational field and the earth’s sphere. These imaginary spaces, which also invoke a bodily experience, present a poetic dimension to the work of the suprematists. It is a dimension that arguably aligns more with Gullar’s formulation of his neo-concrete rather than that of his alignment of Suprematism with rationalism. While found in experiments with planar geometry, the interest in forms suggestive of an experience of breaking free–both physically from the earth and conceptually from rational, mathematical space (in a pre-occupation with non-Euclidean space and anti-geometry) and in their engagement with the spatial properties of colour, Suprematism presents itself as imaginatively epodic. The paper discusses both historical and contemporary non-objective practices in this context, drawing attention to the manner in which the category of the non-objective is used to categorise art works which are, arguably, qualitatively different.

Keywords: anti-gravity, neo-concrete, non-Euclidian geometry, non-objective painting

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11972 Child Labour and Contemporary Slavery: A Nigerian Perspective

Authors: Obiageli Eze

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Millions of Nigerian children are subjected daily to all forms of abuse, ranging from trafficking to slavery, and forced labor. These under age children are taken from different parts of the Country to be used as sex slaves and laborers in the big cities, killed for rituals, organ transplantation, or used for money laundering, begging on the streets or are put to work in the fields. These children are made to do inhuman jobs under degrading conditions and face all kinds of abuse at the hands of their owners with no hope of escape. While lots of people blame poverty or culture as a basis for human trafficking in Nigeria, the National Agency for the Prohibition and Trafficking in Persons and other Related Matters (NAPTIP) says other causes of the outrageous rate of human trafficking in the country are ignorance, desperation, and the promotion and commercialization of sex by the European Union (EU) as dozens of young Nigerian children and women are forced to work as prostitutes in European countries including the Netherlands, France, Italy, and Spain. In the cause of searching for greener pastures, they are coerced into work they have not chosen and subjected to perpetual life in bondage. The Universal Declaration of Human Rights 1948 prohibits slave trade and slavery. Despite the fact that Nigeria is a Sovereign member of the United Nations and signatory to this International instrument, Child trafficking and slavery is still on the increase. This may be caused by the fact that the punishment for this crime in Nigeria is a maximum term of 10 years imprisonment with some of the worst offenders getting off with as little as 2 years imprisonment or an option of fine. It goes without saying that this punishment is not sufficient to act as a deterrent to these modern slave traders. Another major factor oiling the wheel of trafficking in the country is voodoo. The victims are taken to shrines of voodoo priests for oath taking. There, underage girls and boys are made to swear that they would never reveal the identities of their traffickers to anyone if arrested whether in the course of the journey or in the destination countries and that they would pay off debt. Nigeria needs tougher Laws in order to be able to combat human trafficking and slave trade. Also there has to be aggressive sensitization and awareness programs designed to educate and enlighten the public as to the dangers faced by these victims and the need to report any suspicious activity to the authorities. This paper attempts to give an insight into the plight of under-age Nigerian children trafficked and sold as slaves and offer a more effective stand in the fight against it.

Keywords: child labor, slavery, slave trade, trafficking

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11971 Analytical Description of Disordered Structures in Continuum Models of Pattern Formation

Authors: Gyula I. Tóth, Shaho Abdalla

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Even though numerical simulations indeed have a significant precursory/supportive role in exploring the disordered phase displaying no long-range order in pattern formation models, studying the stability properties of this phase and determining the order of the ordered-disordered phase transition in these models necessitate an analytical description of the disordered phase. First, we will present the results of a comprehensive statistical analysis of a large number (1,000-10,000) of numerical simulations in the Swift-Hohenberg model, where the bulk disordered (or amorphous) phase is stable. We will show that the average free energy density (over configurations) converges, while the variance of the energy density vanishes with increasing system size in numerical simulations, which suggest that the disordered phase is a thermodynamic phase (i.e., its properties are independent of the configuration in the macroscopic limit). Furthermore, the structural analysis of this phase in the Fourier space suggests that the phase can be modeled by a colored isotropic Gaussian noise, where any instant of the noise describes a possible configuration. Based on these results, we developed the general mathematical framework of finding a pool of solutions to partial differential equations in the sense of continuous probability measure, which we will present briefly. Applying the general idea to the Swift-Hohenberg model we show, that the amorphous phase can be found, and its properties can be determined analytically. As the general mathematical framework is not restricted to continuum theories, we hope that the proposed methodology will open a new chapter in studying disordered phases.

Keywords: fundamental theory, mathematical physics, continuum models, analytical description

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11970 A Key Parameter in Ocean Thermal Energy Conversion Plant Design and Operation

Authors: Yongjian Gu

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Ocean thermal energy is one of the ocean energy sources. It is a renewable, sustainable, and green energy source. Ocean thermal energy conversion (OTEC) applies the ocean temperature gradient between the warmer surface seawater and the cooler deep seawater to run a heat engine and produce a useful power output. Unfortunately, the ocean temperature gradient is not big. Even in the tropical and equatorial regions, the surface water temperature can only reach up to 28oC and the deep water temperature can be as low as 4oC. The thermal efficiency of the OTEC plants, therefore, is low. In order to improve the plant thermal efficiency by using the limited ocean temperature gradient, some OTEC plants use the method of adding more equipment for better heat recovery, such as heat exchangers, pumps, etc. Obviously, the method will increase the plant's complexity and cost. The more important impact of the method is the additional equipment needs to consume power too, which may have an adverse effect on the plant net power output, in turn, the plant thermal efficiency. In the paper, the author first describes varied OTEC plants and the practice of using the method of adding more equipment for improving the plant's thermal efficiency. Then the author proposes a parameter, plant back works ratio ϕ, for measuring if the added equipment is appropriate for the plant thermal efficiency improvement. Finally, in the paper, the author presents examples to illustrate the application of the back work ratio ϕ as a key parameter in the OTEC plant design and operation.

Keywords: ocean thermal energy, ocean thermal energy conversion (OTEC), OTEC plant, plant back work ratio ϕ

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11969 An Econometric Analysis of the Flat Tax Revolution

Authors: Wayne Tarrant, Ethan Petersen

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The concept of a flat tax goes back to at least the Biblical tithe. A progressive income tax was first vociferously espoused in a small, but famous, pamphlet in 1848 (although England had an emergency progressive tax for war costs prior to this). Within a few years many countries had adopted the progressive structure. The flat tax was only reinstated in some small countries and British protectorates until Mart Laar was elected Prime Minister of Estonia in 1992. Since Estonia’s adoption of the flat tax in 1993, many other formerly Communist countries have likewise abandoned progressive income taxes. Economists had expectations of what would happen when a flat tax was enacted, but very little work has been done on actually measuring the effect. With a testbed of 21 countries in this region that currently have a flat tax, much comparison is possible. Several countries have retained progressive taxes, giving an opportunity for contrast. There are also the cases of Czech Republic and Slovakia, which have adopted and later abandoned the flat tax. Further, with over 20 years’ worth of economic history in some flat tax countries, we can begin to do some serious longitudinal study. In this paper we consider many economic variables to determine if there are statistically significant differences from before to after the adoption of a flat tax. We consider unemployment rates, tax receipts, GDP growth, Gini coefficients, and market data where the data are available. Comparisons are made through the use of event studies and time series methods. The results are mixed, but we draw statistically significant conclusions about some effects. We also look at the different implementations of the flat tax. In some countries there are equal income and corporate tax rates. In others the income tax has a lower rate, while in others the reverse is true. Each of these sends a clear message to individuals and corporations. The policy makers surely have a desired effect in mind. We group countries with similar policies, try to determine if the intended effect actually occurred, and then report the results. This is a work in progress, and we welcome the suggestion of variables to consider. Further, some of the data from before the fall of the Iron Curtain are suspect. Since there are new ruling regimes in these countries, the methods of computing different statistical measures has changed. Although we first look at the raw data as reported, we also attempt to account for these changes. We show which data seem to be fictional and suggest ways to infer the needed statistics from other data. These results are reported beside those on the reported data. Since there is debate about taxation structure, this paper can help inform policymakers of change the flat tax has caused in other countries. The work shows some strengths and weaknesses of a flat tax structure. Moreover, it provides beginnings of a scientific analysis of the flat tax in practice rather than having discussion based solely upon theory and conjecture.

Keywords: flat tax, financial markets, GDP, unemployment rate, Gini coefficient

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11968 Gender Stereotypes at the Court of Georgia: Perceptions of Attorneys on Gender Bias

Authors: Tatia Kekelia

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This paper is part of an ongoing research addressing gender discrimination in the Court of Georgia. The research suggests that gender stereotypes influence the processes at the Court in contemporary Georgia, which causes uneven fights for women and men, not to mention other gender identities. The sub-hypothesis proposes that the gender stereotypes derive from feudal representations, which persisted during the Soviet rule. It is precisely those stereotypes that feed gender-based discrimination today. However, this paper’s main focus is on the main hypothesis, describing the revealed stereotypes, and identifying the Court as a place where their presence is most hindering societal development. First of all, this happens by demotivating people, causing loss of trust in the Court, and therefore potentially encouraging crime. Secondly, it becomes harder to adequately mobilize human resources, since more than a half of the population is female, and under the influence of rigid or more subtle forms of discrimination, they lose not only equal rights, but also the motivation to work or fight for them. Consequently, this paper falls under democracy studies as well – considering that an unbiased Court is one of the most important criteria for assessing the democratic character of a state. As the research crosses the disciplines of sociology, law, and history, a complex of qualitative research methods is applied, among which this paper relies mainly on expert interviews, interviews with attorneys, and desk research. By showcasing and undermining the gender stereotypes that work at the Court of Georgia, this research might assist in rising trust towards it in the long-term. As for the broader relevance, the study of the Georgian case opens the possibility to conduct comparative analyses in the region and the continent, and, presumably, carve the lines of cultural influences.

Keywords: gender, stereotypes, bias, democratization, judiciary

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11967 Near Optimal Closed-Loop Guidance Gains Determination for Vector Guidance Law, from Impact Angle Errors and Miss Distance Considerations

Authors: Karthikeyan Kalirajan, Ashok Joshi

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An optimization problem is to setup to maximize the terminal kinetic energy of a maneuverable reentry vehicle (MaRV). The target location, the impact angle is given as constraints. The MaRV uses an explicit guidance law called Vector guidance. This law has two gains which are taken as decision variables. The problem is to find the optimal value of these gains which will result in minimum miss distance and impact angle error. Using a simple 3DOF non-rotating flat earth model and Lockheed martin HP-MARV as the reentry vehicle, the nature of solutions of the optimization problem is studied. This is achieved by carrying out a parametric study for a range of closed loop gain values and the corresponding impact angle error and the miss distance values are generated. The results show that there are well defined lower and upper bounds on the gains that result in near optimal terminal guidance solution. It is found from this study, that there exist common permissible regions (values of gains) where all constraints are met. Moreover, the permissible region lies between flat regions and hence the optimization algorithm has to be chosen carefully. It is also found that, only one of the gain values is independent and that the other dependent gain value is related through a simple straight-line expression. Moreover, to reduce the computational burden of finding the optimal value of two gains, a guidance law called Diveline guidance is discussed, which uses single gain. The derivation of the Diveline guidance law from Vector guidance law is discussed in this paper.

Keywords: Marv guidance, reentry trajectory, trajectory optimization, guidance gain selection

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11966 Carbon Aerogel Spheres from Resorcinol/Phenol and Formaldehyde for CO₂ Adsorption

Authors: Jessica Carolina Hernandez Galeano, Juan Carlos Moreno Pirajan, Liliana Giraldo

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Carbon gels are materials whose structure and porous texture can be designed and controlled on a nanoscale. Among their characteristics it is found their low density, large surface area and high degree of porosity. These materials are produced by a sol-gel polymerization of organic monomers using basic or acid catalysts, followed by drying and controlled carbonization. In this work, the synthesis and characterization of carbon aerogels from resorcinol, phenol and formaldehyde in ethanol is described. The aim of this study is obtaining different carbonaceous materials in the form of spheres using the Stöber method to perform a further evaluation of CO₂ adsorption of each material. In general, the synthesis consisted of a sol-gel polymerization process that generates a cluster (cross-linked organic monomers) from the precursors in the presence of NH₃ as a catalyst. This cluster was subjected to specific conditions of gelling and curing (30°C for 24 hours and 100°C for 24 hours, respectively) and CO₂ supercritical drying. Finally, the dry material was subjected to a process of carbonization or pyrolysis, in N₂ atmosphere at 350°C (1° C / min) for 2 h and 600°C (1°C / min) for 4 hours, to obtain porous solids that retain the structure initially desired. For this work, both the concentrations of the precursors and the proportion of ammonia in the medium where modify to describe the effect of the use of phenol and the amount of catalyst in the resulting material. Carbon aerogels were characterized by Scanning Electron Microscope (SEM), N₂ isotherms, infrared spectroscopy (IR) and X-ray Powder Diffraction (XRD) showing the obtention of carbon spheres in the nanometric scale with BET areas around 500 m2g-1.

Keywords: carbon aerogels, carbon spheres, CO₂ adsorption, Stöber method

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11965 The Effectiveness of Summative Assessment in Practice Learning

Authors: Abdool Qaiyum Mohabuth, Syed Munir Ahmad

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Assessment enables students to focus on their learning, assessment. It engages them to work hard and motivates them in devoting time to their studies. Student learning is directly influenced by the type of assessment involved in the programme. Summative Assessment aims at providing measurement of student understanding. In fact, it is argued that summative assessment is used for reporting and reviewing, besides providing an overall judgement of achievement. While summative assessment is a well defined process for learning that takes place in the classroom environment, its application within the practice environment is still being researched. This paper discusses findings from a mixed-method study for exploring the effectiveness of summative assessment in practice learning. A survey questionnaire was designed for exploring the perceptions of mentors and students about summative assessment in practice learning. The questionnaire was administered to the University of Mauritius students and mentors who supervised students for their Work-Based Learning (WBL) practice at the respective placement settings. Some students, having undertaken their WBL practice, were interviewed, for capturing their views and experiences about the application of summative assessment in practice learning. Semi-structured interviews were also conducted with three experienced mentors who have assessed students on practice learning. The findings reveal that though learning in the workplace is entirely different from learning at the University, most students had positive experiences about their summative assessments in practice learning. They felt comfortable and confident to be assessed by their mentors in their placement settings and wished that the effort and time that they devoted to their learning be recognised and valued. Mentors on their side confirmed that the summative assessment is valid and reliable, enabling them to better monitor and coach students to achieve the expected learning outcomes.

Keywords: practice learning, judgement, summative assessment, knowledge, skills, workplace

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11964 Phenomenology of Child Labour in Estates, Farms and Plantations in Zimbabwe: A Comparative Analysis of Tanganda and Eastern Highlands Tea Estates

Authors: Chupicai Manuel

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The global efforts to end child labour have been increasingly challenged by adages of global capitalism, inequalities and poverty affecting the global south. In the face the of rising inequalities whose origin can be explained from historical and political economy analysis between the poor and the rich countries, child labour is also on the rise particularly on the global south. The socio-economic and political context of Zimbabwe has undergone serious transition from colonial times through the post-independence normally referred to as the transition period up to the present day. These transitions have aided companies and entities in the business and agriculture sector to exploit child labour while country provided conditions that enhance child labour due to vulnerability of children and anomic child welfare system that plagued the country. Children from marginalised communities dominated by plantations and farms are affected most. This paper explores the experiences and perceptions of children working in tea estates, plantations and farms, and the adults who formerly worked in these plantations during their childhood to share their experiences and perceptions on child labour in Zimbabwe. Childhood theories that view children as apprentices and a human rights perspectives were employed to interrogate the concept of childhood, child labour and poverty alleviation strategies. Phenomenological research design was adopted to describe the experiences of children working in plantations and interpret the meanings they have on their work and livelihoods. The paper drew form 30 children from two plantations through semi-structured interviews and 15 key informant interviews from civil society organisations, international labour organisation, adults who formerly worked in the plantations and the personnel of the plantations. The findings of the study revealed that children work on the farms as an alternative model for survival against economic challenges while the majority cited that poverty compel them to work and get their fees and food paid for. Civil society organisations were of the view that child rights are violated and the welfare system of the country is malfunctional. The perceptions of the majority of the children interviewed are that the system on the plantations is better and this confirmed the socio-constructivist theory that views children as apprentices. The study recommended child sensitive policies and welfare regime that protects children from exploitation together with policing and legal measures that secure child rights.

Keywords: child labour, child rights, phenomenology, poverty reduction

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11963 Online vs. in vivo Workshops in a Masters’ Degree Course in Mental Health Nursing: Students’ Views and Opinions

Authors: Evmorfia Koukia, Polyxeni Mangoulia

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Workshops tend to be a vivid and productive way as an in vivo teaching method. Due to the pandemic, COVID-19 university courses were conducted through the internet. Method It was tried for the first time to integrate online art therapy workshops in a core course named “Special Themes of Mental Health Nursing” in a MSc Program in Mental Health. The duration of the course is 3-hours per week for 11 weeks in a single semester. The course has a main instructor, a professor of psychiatric nursing experienced in arts therapies workshops and visiting art therapists. All art therapists were given a certain topic to cover. Students were encouraged to keep a logbook that was evaluated at the end of the semester and was submitted as a part of the examination process of the course. An interview of 10 minutes was conducted with each student at the end of the course from an independent investigator (an assistant professor) Participants The students (sample) of the program were: nurses, psychologists, and social workers Results: All students who participated in the courses found that the learning process was vivid, encouraging participation and self-motivation, and there were no main differences from in vivo learning. The students identified their personal needs, and they felt a personal connection with the learning experience. The result of the personalized learning was that students discovered their strengths and weaknesses and developed skills like critical thinking. All students admitted that the workshops were the optimal way for them to comprehend the courses’ content, their capability to become therapists, as well as their obstacles and weaknesses while working with patients in mental health. Conclusion: There were no important differences between the views of students in online and in vivo teaching method of the workshops. The result has shown that workshops in mental health can contribute equally in the learning experience.

Keywords: mental health, workshops, students, nursing

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11962 Effects of Spent Dyebath Recycling on Pollution and Cost of Production in a Cotton Textile Industry

Authors: Dinesh Kumar Sharma, Sanjay Sharma

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Textile manufacturing industry uses a substantial amount of chemicals not only in the production processes but also in manufacturing the raw materials. Dyes are the most significant raw material which provides colour to the fabric and yarn. Dyes are produced by using a large amount of chemicals both organic and inorganic in nature. Dyes are further classified as Reactive or Vat Dyes which are mostly used in cotton textiles. In the process of application of dyes to the cotton fiber, yarn or fabric, several auxiliary chemicals are also used in the solution called dyebath to improve the absorption of dyes. There is a very little absorption of dyes and auxiliary chemicals and a residual amount of all these substances is released as the spent dye bath effluent. Because of the wide variety of chemicals used in cotton textile dyes, there is always a risk of harmful effects which may not be apparent immediately but may have an irreversible impact in the long term. Colour imparted by the dyes to the water also has an adverse effect on its public acceptability and the potability. This study has been conducted with an objective to assess the feasibility of reuse of the spent dye bath. Studies have been conducted in two independent industries manufacturing dyed cotton yarn and dyed cotton fabric respectively. These have been referred as Unit-I and Unit-II. The studies included assessment of reduction in pollution levels and the economic benefits of such reuse. The study conclusively establishes that the reuse of spent dyebath results in prevention of pollution, reduction in pollution loads and cost of effluent treatment & production. This pollution prevention technique presents a good preposition for pollution prevention in cotton textile industry.

Keywords: dyes, dyebath, reuse, toxic, pollution, costs

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11961 The Ideal Memory Substitute for Computer Memory Hierarchy

Authors: Kayode A. Olaniyi, Olabanji F. Omotoye, Adeola A. Ogunleye

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Computer system components such as the CPU, the Controllers, and the operating system, work together as a team, and storage or memory is the essential parts of this team apart from the processor. The memory and storage system including processor caches, main memory, and storage, form basic storage component of a computer system. The characteristics of the different types of storage are inherent in the design and the technology employed in the manufacturing. These memory characteristics define the speed, compatibility, cost, volatility, and density of the various storage types. Most computers rely on a hierarchy of storage devices for performance. The effective and efficient use of the memory hierarchy of the computer system therefore is the single most important aspect of computer system design and use. The memory hierarchy is becoming a fundamental performance and energy bottleneck, due to the widening gap between the increasing demands of modern computer applications and the limited performance and energy efficiency provided by traditional memory technologies. With the dramatic development in the computers systems, computer storage has had a difficult time keeping up with the processor speed. Computer architects are therefore facing constant challenges in developing high-speed computer storage with high-performance which is energy-efficient, cost-effective and reliable, to intercept processor requests. It is very clear that substantial advancements in redesigning the existing memory physical and logical structures to meet up with the latest processor potential is crucial. This research work investigates the importance of computer memory (storage) hierarchy in the design of computer systems. The constituent storage types of the hierarchy today were investigated looking at the design technologies and how the technologies affect memory characteristics: speed, density, stability and cost. The investigation considered how these characteristics could best be harnessed for overall efficiency of the computer system. The research revealed that the best single type of storage, which we refer to as ideal memory is that logical single physical memory which would combine the best attributes of each memory type that make up the memory hierarchy. It is a single memory with access speed as high as one found in CPU registers, combined with the highest storage capacity, offering excellent stability in the presence or absence of power as found in the magnetic and optical disks as against volatile DRAM, and yet offers a cost-effective attribute that is far away from the expensive SRAM. The research work suggests that to overcome these barriers it may then mean that memory manufacturing will take a total deviation from the present technologies and adopt one that overcomes the associated challenges with the traditional memory technologies.

Keywords: cache, memory-hierarchy, memory, registers, storage

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11960 Mammographic Multi-View Cancer Identification Using Siamese Neural Networks

Authors: Alisher Ibragimov, Sofya Senotrusova, Aleksandra Beliaeva, Egor Ushakov, Yuri Markin

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Mammography plays a critical role in screening for breast cancer in women, and artificial intelligence has enabled the automatic detection of diseases in medical images. Many of the current techniques used for mammogram analysis focus on a single view (mediolateral or craniocaudal view), while in clinical practice, radiologists consider multiple views of mammograms from both breasts to make a correct decision. Consequently, computer-aided diagnosis (CAD) systems could benefit from incorporating information gathered from multiple views. In this study, the introduce a method based on a Siamese neural network (SNN) model that simultaneously analyzes mammographic images from tri-view: bilateral and ipsilateral. In this way, when a decision is made on a single image of one breast, attention is also paid to two other images – a view of the same breast in a different projection and an image of the other breast as well. Consequently, the algorithm closely mimics the radiologist's practice of paying attention to the entire examination of a patient rather than to a single image. Additionally, to the best of our knowledge, this research represents the first experiments conducted using the recently released Vietnamese dataset of digital mammography (VinDr-Mammo). On an independent test set of images from this dataset, the best model achieved an AUC of 0.87 per image. Therefore, this suggests that there is a valuable automated second opinion in the interpretation of mammograms and breast cancer diagnosis, which in the future may help to alleviate the burden on radiologists and serve as an additional layer of verification.

Keywords: breast cancer, computer-aided diagnosis, deep learning, multi-view mammogram, siamese neural network

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11959 Exploring the Illness Experience of Fibromyalgia Patients Using Identity Boxes

Authors: Nicole Brown

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This study considers the illness experience of fibromyalgia patients by using identity boxes. The results improve health care professionals' understanding of patient experiences. Additionally, the concept of the identity boxes may offer a practical solution for helping patients accept the diagnosis of fibromyalgia. Fibromyalgia research traditionally refers to pain experiences and relies on questionnaires, surveys, interviews and some narrative analysis. However, due to the variability in symptoms, symptom levels, and locations, these methods may not be best suited to provide an insight into the patient experience. On the other hand, lengthy interview processes are not easily accessible for sufferers of fibromyalgia. In addition to timelines and diary extracts, this study uses identity boxes as its main data collection method. Participants are asked to find items in response to specific questions and to arrange them in their box. The objects represent the patients' experiences holistically. Participants provide photographs of their identity box at each stage of the process and explain their chosen items. The photographs of the identity boxes and the patients' explanations of their objects and their boxes are subjected to interpretative phenomenological analysis. Despite the unique forms of the completed boxes, common experiences are described: the need for comfort, the role of spirituality and the impact of fibromyalgia on everyday life, that it plays a significant role but those patients are determined not to let it rule their lives. The work with the identity boxes has shown beneficial impact due to the reflective nature involved in the tasks. Further investigations will be needed to identify the long-term impact of identity work using such boxes.

Keywords: biographical disruption, fibromyalgia, illness experience, illness narrative

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11958 Simultaneous Bilateral Patella Tendon Rupture: A Systematic Review

Authors: André Rui Coelho Fernandes, Mariana Rufino, Divakar Hamal, Amr Sousa, Emma Fossett, Kamalpreet Cheema

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Aim: A single patella tendon rupture is relatively uncommon, but a simultaneous bilateral event is a rare occurrence and has been scarcely reviewed in the literature. This review was carried out to analyse the existing literature on this event, with the aim of proposing a standardised approach to the diagnosis and management of this injury. Methods: A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three independent reviewers conducted searches in PubMed, OvidSP for Medline and Embase, as well as Cochrane Library using the same search strategy. From a total of 183 studies, 45 were included, i.e. 90 patellas. Results: 46 patellas had a Type 1 Rupture equating to 51%, with Type 3 being the least common, with only 7 patellas sustaining this injury. The mean Insall-Salvio ratio for each knee was 1.62 (R) and 1.60 (L) Direct Primary Repair was the most common surgical technique compared to Tendon Reconstruction, with End to End and Transosseous techniques split almost equally. Brace immobilisation was preferred over cast, with a mean start to weight-bearing of 3.23 weeks post-op. Conclusions: Bilateral patellar tendon rupture is a rare injury that should be considered in patients with knee extensor mechanism disruption. The key limitation of this study was the low number of patients encompassed by the eligible literature. There is space for a higher level of evidence study, specifically regarding surgical treatment choice and methods, as well as post-operative management, which could potentially improve the outcomes in the management of this injury.

Keywords: trauma and orthopaedic surgery, bilateral patella, tendon rupture, trauma

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11957 Clinical Prediction Score for Ruptured Appendicitis In ED

Authors: Thidathit Prachanukool, Chaiyaporn Yuksen, Welawat Tienpratarn, Sorravit Savatmongkorngul, Panvilai Tangkulpanich, Chetsadakon Jenpanitpong, Yuranan Phootothum, Malivan Phontabtim, Promphet Nuanprom

Abstract:

Background: Ruptured appendicitis has a high morbidity and mortality and requires immediate surgery. The Alvarado Score is used as a tool to predict the risk of acute appendicitis, but there is no such score for predicting rupture. This study aimed to developed the prediction score to determine the likelihood of ruptured appendicitis in an Asian population. Methods: This study was diagnostic, retrospectively cross-sectional and exploratory model at the Emergency Medicine Department in Ramathibodi Hospital between March 2016 and March 2018. The inclusion criteria were age >15 years and an available pathology report after appendectomy. Clinical factors included gender, age>60 years, right lower quadrant pain, migratory pain, nausea and/or vomiting, diarrhea, anorexia, fever>37.3°C, rebound tenderness, guarding, white blood cell count, polymorphonuclear white blood cells (PMN)>75%, and the pain duration before presentation. The predictive model and prediction score for ruptured appendicitis was developed by multivariable logistic regression analysis. Result: During the study period, 480 patients met the inclusion criteria; of these, 77 (16%) had ruptured appendicitis. Five independent factors were predictive of rupture, age>60 years, fever>37.3°C, guarding, PMN>75%, and duration of pain>24 hours to presentation. A score > 6 increased the likelihood ratio of ruptured appendicitis by 3.88 times. Conclusion: Using the Ramathibodi Welawat Ruptured Appendicitis Score. (RAMA WeRA Score) developed in this study, a score of > 6 was associated with ruptured appendicitis.

Keywords: predictive model, risk score, ruptured appendicitis, emergency room

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11956 Natural Regeneration Dynamics in Different Microsites within Gaps of Different Sizes

Authors: M. E. Hammond, R. Pokorny

Abstract:

Not much research has gone into the dynamics of natural regeneration of trees species in tropical forest regions. This study seeks to investigate the impact of gap sizes and light distribution in forest floors on the regeneration of Celtis mildbraedii (CEM), Nesogordonia papaverine (NES) and Terminalia superba (TES). These are selected economically important tree species with different shade tolerance attributes. The spatial distribution patterns and the potential regeneration competition index (RCI) among species using height to diameter ratio (HDR) have been assessed. Gap sizes ranging between 287 – 971 m² were selected at the Bia Tano forest reserve, a tropical moist semi-deciduous forest in Ghana. Four (4) transects in the cardinal directions were constructed from the center of each gap. Along each transect, ten 1 m² sampling zones at 2 m spacing were established. Then, three gap microsites (labeled ecozones I, II, III) were delineated within these sampling zones based on the varying temporal light distribution on the forest floor. Data on height (H), root collar diameter (RCD) and regeneration census were gathered from each of the ten sampling zones. CEM and NES seedlings (≤ 50 cm) and saplings (≥ 51 cm) were present in all ecozones of the large gaps. Seedlings of TES were observed in all ecozones of large and small gaps. Regression analysis showed a significant negative linear relationship between independent RCD and H growth variables on dependent HDR index in ecozones II and III of both large and small gaps. There was a correlation between RCD and H in both large and small gaps. A strong regeneration competition was observed among species in ecozone II in large (df 2, F=3.6, p=0.035) and small (df 2, F=17.9, p=0.000) gaps. These results contribute to the understanding of the natural regeneration of different species with regards to light regimes in forest floors.

Keywords: Celtis mildbraedii, ecozones, gaps, Nesogordonia papaverifera, regeneration, Terminalia superba

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11955 Expounding the Evolution of the Proto-Femme Fatale and Its Correlation with the New Woman: A Close Study of David Mamet's Oleanna

Authors: Silvia Elias

Abstract:

The 'Femme Fatale' figure has become synonymous with a mysterious and seductive woman whose charms captivate her lovers into bonds of irresistible desire, often leading them to compromise or downfall. Originally, a Femme Fatale typically uses her beauty to lead men to their destruction but in modern literature, she represents a direct attack on traditional womanhood and the nuclear family as she refuses to abide by the pillars of mainstream society creating an image of a strong independent woman who defies the control of men and rejects the institution of the family. This research aims at discussing the differences and similarities between the femme fatale and the New Woman and how they are perceived by the audience. There is often confusion between the characteristics that define a New Woman and a Femme Fatale since both women desire independence, challenge typical gender role casting, push against the limits of the patriarchal society and take control of their sexuality. The study of the femme fatale remains appealing in modern times because the fear of gender equality gives life to modern femme fatale versions and post-modern literary works introduce their readers to new versions of the deadly seductress. One that does not fully depend on her looks to destroy men. The idea behind writing this paper was born from reading David Mamet's two-character play Oleanna (1992) and tracing the main female protagonist/antagonist's transformation from a helpless inarticulate girl into a powerful controlling negotiator who knows how to lead a bargain and maintain the upper hand.

Keywords: Circe, David, Eve, evolution, feminist, femme fatale, gender, Mamet, new, Odysseus, Oleanna, power, Salome, schema, seduction, temptress, woman

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11954 Investigating the Effects of Two Functional and Extra-Functional Stretching Methods of the Leg Muscles on a Selection of Kinematical and Kinetic Indicators in Women with Ankle Instability

Authors: Parvin Malhami

Abstract:

The purpose of the present study was to investigate the effects of two functional and functional stretching methods of the leg muscles on a selection of kinematical and kinetic indicators among women with ankle instability. Twenty-four persons were targeted and randomly divided into the functional exercise (8 persons), extra-functional exercise (8 persons) and control (8 persons) groups on the basis of inclusion and exclusion criteria. The experimental groups received stretching for eight weeks, 3 sessions each week, and the control group merely performed its daily activities. Then, in order to measure the pre -test and post -test variables, the dorsi flexion, Plantar flexion and ground reaction force were investigated and measured. Data were analyzed using paired T-test and independent T-tests at a significant level of 0.05. All statistical analyses were conducted using SPSS 25 software. The results of the T-test showed the significant effect of eight weeks of functional and Extra functional exercises on dorsi Flexion, Plantar Flexion and ground reaction force. (P≤ 0/001). The results of this study showed that the implementation of the functional and Extra-functional exercise protocol had an impact on the amount of Ankle dorsi Flexion and the Plantar felxion of women with an ankle instability. It was also found that muscle flexibility following the stretch ability of the gastrocnemius muscles facilitates the walking of the wrist installation by affecting the amount of wrist flexion, so these people are recommended to use the functional and extra-functional exercise protocol.

Keywords: functional stretching, extra functional stretching, dorsi flexion, plantar flexion

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11953 A Qualitative Study Examining the Process of EFL Course Design from the Perspectives of Teachers

Authors: Iman Al Khalidi

Abstract:

Recently, English has become the language of globalization and technology. In turn, this has resulted in a seemingly bewildering array of influences and trends in the domain of TESOL curriculum. In light of these changes, higher education has to provide a new and more powerful kind of education. It should prepare students to be more engaged citizens, more capable to solve complex problems at work, and well prepared to lead meaningful life. In response to this, universities, colleges, schools, and departments have to work out in light of the requirements and challenges of the global and technological era. Consequently they have to focus on the adoption of contemporary curriculum which goes in line with the pedagogical shifts from teaching –centered approach to learning centered approach. Ideally, there has been noticeable emphasis on the crucial importance of developing and professionalizing teachers in order to engage them in the process of curriculum development and action research. This is a qualitative study that aims at understanding and exploring the process of designing EFL courses by teachers at the tertiary level from the perspectives of the participants in a professional context in TESOL, Department of English, a private college in Oman. It is a case study that stands on the philosophy of the qualitative approach. It employs multi methods for collecting qualitative data: semi-structured interviews with teachers, focus group discussions with students, and document analysis. The collected data have been analyzed qualitatively by adopting Miles and Huberman's Approach using procedures of reduction, coding, displaying and conclusion drawing and verification.

Keywords: course design, components of course design, case study, data analysis

Procedia PDF Downloads 526
11952 A Qualitative Study Examining the Process of Course Design from the Perspectives of Teachers

Authors: Iman Al Khalidi

Abstract:

Recently, English has become the language of globalization and technology. In turn, this has resulted in a seemingly bewildering array of influences and trends in the domain of TESOL curriculum. In light of these changes, higher education has to provide a new and more powerful kind of education. It should prepare students to be more engaged citizens, more capable to solve complex problems at work, and well prepared to lead a meaningful life. In response to this, universities, colleges, schools, and departments have to work out in light of the requirements and challenges of the global and technological era. Consequently, they have to focus on the adoption of contemporary curriculum which goes in line with the pedagogical shifts from teaching –centered approach to learning centered approach. Ideally, there has been noticeable emphasis on the crucial importance of developing and professionalizing teachers in order to engage them in the process of curriculum development and action research. This is a qualitative study that aims at understanding and exploring the process of designing EFL courses by teachers at the tertiary level from the perspectives of the participants in a professional context in TESOL, Department of English, a private college in Oman. It is a case study that stands on the philosophy of the qualitative approach. It employs multi-methods for collecting qualitative data: semi-structured interviews with teachers, focus group discussions with students, and document analysis. The collected data have been analyzed qualitatively by adopting Miles and Huberman's Approach using procedures of reduction, coding, displaying, and conclusion drawing and verification.

Keywords: course design, components of course design, case study, data analysis

Procedia PDF Downloads 431
11951 Designing the Procedures of Building and Environment Management for Basic Education Schools by Using Quality Management

Authors: Suppara Charoenpoom

Abstract:

This study focuses on 1) a good-quality management procedures of buildings and environment in schools 2) designing the management procedures and 3) creating an operation manual for the procedures. This study is the combination of qualitative and quantitative research method. Populations in the research were 83 deans and directors of primary and secondary schools from the 10th educational district in Samut Songkram. Sample group was selected from the voluntary deans and directors. There were 14 participants in sample group. Research tools in this study were divided into 2 categories. The first one was data-collecting tools, which were in-depth interview and questionnaires. The second one was the designing tools to help creating management procedures: quality business, quality work procedure and key quality indicator of each activity in schools. All data were analyzed by mean and standard deviation. The result from this study has found out 1 effective process of building and environment management for basic education schools which is called Quality Business Process (QBP) and 7 Quality Work Procedures (QWP). In terms of academic feasibility checkup by experts, the research had shown that new design of building and environment management was approved unanimously. It means that new process of building and environment management in schools works very well and can be adapted. After examining the possibility of management process being used in schools by calculating the mean value among sample group (14 school deans and directors), the mean value was between 0.64-1.00. It means that the new design of building and environment management can be operated effectively in schools. For the satisfaction part, deans and school directors gave the satisfaction score in the highest level (Mean = 4.7372, S.D. = 0.4385).

Keywords: buildings, environment, procedures, quality management

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11950 Re-Examining Contracts in Managing and Exploiting Strategic National Resources: A Case in Divestation Process in the Share Distribution of Mining Corporation in West Nusa Tenggara, Indonesia

Authors: Hayyan ul Haq, Zainal Asikin

Abstract:

This work aims to explore the appropriate solution in solving legal problems stemmed from managing and exploiting strategic natural resources in Indonesia. This discussion will be focused on the exploitation of gold mining, i.e. divestation process in the New Mont Corporation, West Nusa Tenggara. These legal problems relate to the deviation of the national budget regulation, UU. No. 19/2012, and the implementation of the divestastion process, which infringes PP. No. 50/2007 concerning the Impelementation Procedure of Regional Cooperation, which is an implementation regulation of UU No. 1/2004 on State’s Treasury. The cooperation model, have been developed by the Provincial Government, failed to create a permanent legal solution through normative approach. It has merely used practical approach that tends (instant solution), by using some loopholes in the divestation process. The above blunders have accumulated by other secondary legal blunders, i.e. good governance principles, particularly justice, transparency, efficiency, effective principles and competitiveness principle. To solve the above problems, this work offers constitutionalisation of contract that aimed at reviewing and coherencing all deviated contracts, rules and policies that have deprived the national and societies’ interest to optimize the strategic natural resources towards the greatest benefit for the greatest number of people..

Keywords: constitutionalisation of contract, strategic national resources, divestation, the greatest benefit for the greatest number of people, Indonesian Pancasila values

Procedia PDF Downloads 442
11949 The Role of Leukocyte-Derived IL-10 on Postoperative ileus and Intestinal Macrophage Differentiation in Mice

Authors: Kathy Stein, Mariola Lysson, Anja Schmidt, Beatrix Schumak, Sabine Specht, Hicham Bouabe, Jürgen Heesemann, Axel Roers, Joerg C. Kalff, Sven Wehner

Abstract:

Objective: Postoperative ileus (POI) is a common complication of abdominal surgery. Monocyte infiltration is a hallmark of POI. The polarization of macrophages/monocytes in this process is not well understood. We aimed to investigate if and how M2 macrophage/monocyte differentiation is involved in POI pathogenesis. Design: POI was induced by intestinal manipulation (IM). C57Bl/6, CCR2-/-, IL-10 reporter (ITIB), IL-10-/- and LysMcre/IL-10fl/fl mice underwent IM. At various points in time leukocyte influx, gene and protein expression of cytokines, chemokines and M2 differentiation markers and intestinal motility were analyzed. Results: IM induced the postoperative expression of the M2 markers Arginase-1 and YM-1, predominantly in F4/80+Ly6C+ monocytes. Gene expression analyses indicated an IL-10-dependent, IL-4-independent M2 polarization of these monocytes. IL-10 dependency of M2 differentiation was confirmed in IL-10 deficient mice. Leukocytes, in the order of infiltrating monocytes, neutrophils, and resident macrophages were the main IL-10 producers during POI. IL-10 producing monocytes as well as M2 marker expression were almost absent in CCR2-deficient mice. However, postoperative IL-10 expression was not altered in CCR2-/- mice. The loss of M2 polarized monocytes neither protected CCR2-/- mice from nor affected resolution of POI. In contrast, IL-10 deficiency reduced postoperative neutrophil numbers and ameliorated POI. IL-10Ra expression was strongly induced in neutrophils but not in monocytes. Conclusion: We conclude that IL-10 counteracts POI resolution by activating IL-10Ra-expressing neutrophils in the late phase of disease while IL-10-dependent M2 differentiation is not pivotal to POI manifestation and resolution.

Keywords: interleukin-10, macrophages, neutrophils, postoperative ileus

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11948 Information Literacy among Faculty and Students of Medical Colleges of Haryana, Punjab and Chandigarh

Authors: Sanjeev Sharma, Suman Lata

Abstract:

With the availability of diverse printed, electronic literature and web sites on medical and health related information, it is impossible for the medical professional to get the information he seeks in the shortest possible time. For all these problems information literacy is the only solution. Thus, information literacy is recognized as an important aspect of medical education. In the present study, an attempt has been made to know the information literacy skills of the faculty and students at medical colleges of Haryana, Punjab and Chandigarh. The scope of the study was confined to the 12 selected medical colleges of three States (Haryana, Punjab, and Chandigarh). The findings of the study were based on the data collected through 1018 questionnaires filled by the respondents of the medical colleges. It was found that Online Medical Websites (such as WebMD, eMedicine and Mayo Clinic etc.) were frequently used by 63.43% of the respondents of Chandigarh which is slightly more than Haryana (61%) and Punjab (55.65%). As well, 30.86% of the respondents of Chandigarh, 27.41% of Haryana and 27.05% of Punjab were familiar with the controlled vocabulary tool; 25.14% respondents of Chandigarh, 23.80% of Punjab, 23.17% of Haryana were familiar with the Boolean operators; 33.05% of the respondents of Punjab, 28.19% of Haryana and 25.14% of Chandigarh were familiar with the use and importance of the keywords while searching an electronic database; and 51.43% of the respondents of Chandigarh, 44.52% of Punjab and 36.29% of Haryana were able to make effective use of the retrieved information. For accessing information in electronic format, 47.74% of the respondents rated their skills high, while the majority of respondents (76.13%) were unfamiliar with the basic search technique i.e. Boolean operator used for searching information in an online database. On the basis of the findings, it was suggested that a comprehensive training program based on medical professionals information needs should be organized frequently. Furthermore, it was also suggested that information literacy may be included as a subject in the health science curriculum so as to make the medical professionals information literate and independent lifelong learners.

Keywords: information, information literacy, medical professionals, medical colleges

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11947 Enhanced Performance of Perovskite Solar Cells by Modifying Interfacial Properties Using MoS2 Nanoflakes

Authors: Kusum Kumari, Ramesh Banoth, V. S. Reddy Channu

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Organic-inorganic perovskite solar cells (PrSCs) have emerged as a promising solar photovoltaic technology in terms of realizing high power conversion efficiency (PCE). However, their limited lifetime and poor device stability limits their commercialization in future. In this regard, interface engineering of the electron transport layer (ETL) using 2D materials have been currently used owing to their high carrier mobility, high thermal stability and tunable work function, which in turn enormously impact the charge carrier dynamics. In this work, we report an easy and effective way of simultaneously enhancing the efficiency of PrSCs along with the long-term stability through interface engineering via the incorporation of 2D-Molybdenum disulfide (2D-MoS₂, few layered nanoflakes) in mesoporous-Titanium dioxide (mp-TiO₂)scaffold electron transport buffer layer, and using poly 3-hexytheophene (P3HT) as hole transport layers. The PSCs were fabricated in ambient air conditions in device configuration, FTO/c-TiO₂/mp-TiO₂:2D-MoS₂/CH3NH3PbI3/P3HT/Au, with an active area of 0.16 cm². The best device using c-TiO₂/mp-TiO₂:2D-MoS₂ (0.5wt.%) ETL exhibited a substantial increase in PCE ~13.04% as compared to PCE ~8.75% realized in reference device fabricated without incorporating MoS₂ in mp-TiO₂ buffer layer. The incorporation of MoS₂ nanoflakes in mp-TiO₂ ETL not only enhances the PCE to ~49% but also leads to better device stability in ambient air conditions without encapsulation (retaining PCE ~86% of its initial value up to 500 hrs), as compared to ETLs without MoS₂.

Keywords: perovskite solar cells, MoS₂, nanoflakes, electron transport layer

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11946 Person-Led Organizations Nurture Bullying Behavior: A Qualitative Study

Authors: Shreya Mishra, Manosi Chaudhuri, Ajoy K. Dey

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Workplace bullying is a social phenomenon which has proved to be hazardous not only for employees’ well-being but also organizations. Despite being prevalent across geographical boundaries, Indian organizations have failed to acknowledge its vices. This paper aims to understand targets’ perception on what makes bullying nurture in organizations. The paper suggests that person-led Indian work settings give birth to bullying behavior as it lacks professional acumen and systems. An analysis of 13 in-depth interviews of employees from the organized sector suggests that organizations, where decision making lies with single individual, may be a hub of hostile behavior due to the culture which promotes ‘yesmanship’, ‘authoritarianism’ and/or blind belief of leaders on certain set of employees. The study used constructivist grounded theory approach, and the data was analyzed using R Based Qualitative Data Analysis (RQDA) software. Respondents reported that bullying behavior is taken lightly by the management with 'just ignore it' attitude. According to the respondents, the behavior prolong as the perpetrator have a direct approach to the top authority. The study concludes that person-led organizations may create a family-like environment which is favored by employees; however, authoritative leaders are unable to gain the trust of employees. Also, employees who are close to the leader may either be a perpetrator or a target of bullying. It is recommended that leaders in such organizations need to acknowledge the presence of bullying which affects an employees’ commitment towards their job and/or organization. They need to have an assertive check on individuals who hide behind ‘yesman’ attitude. This may help employees feel safe in such work settings.

Keywords: constructivist grounded theory, person-led organization, RQDA, workplace bullying

Procedia PDF Downloads 189
11945 Lean Implementation in a Nurse Practitioner Led Pediatric Primary Care Clinic: A Case Study

Authors: Lily Farris, Chantel E. Canessa, Rena Heathcote, Susan Shumay, Suzanna V. McRae, Alissa Collingridge, Minna K. Miller

Abstract:

Objective: To describe how the Lean approach can be applied to improve access, quality and safety of care in an ambulatory pediatric primary care setting. Background: Lean was originally developed by Toyota manufacturing in Japan, and subsequently adapted for use in the healthcare sector. Lean is a systematic approach, focused on identifying and reducing waste within organizational processes, improving patient-centered care and efficiency. Limited literature is available on the implementation of the Lean methodologies in a pediatric ambulatory care setting. Methods: A strategic continuous improvement event or Rapid Process Improvement Workshop (RPIW) was launched with the aim evaluating and structurally supporting clinic workflow, capacity building, sustainability, and ultimately improving access to care and enhancing the patient experience. The Lean process consists of five specific activities: Current state/process assessment (value stream map); development of a future state map (value stream map after waste reduction); identification, quantification and prioritization of the process improvement opportunities; implementation and evaluation of process changes; and audits to sustain the gains. Staff engagement is a critical component of the Lean process. Results: Through the implementation of the RPIW and shifting workload among the administrative team, four hours of wasted time moving between desks and doing work was eliminated from the Administrative Clerks role. To streamline clinic flow, the Nursing Assistants completed patient measurements and vitals for Nurse Practitioners, reducing patient wait times and adding value to the patients visit with the Nurse Practitioners. Additionally, through the Nurse Practitioners engagement in the Lean processes a need was recognized to articulate clinic vision, mission and the alignment of NP role and scope of practice with the agency and Ministry of Health strategic plan. Conclusions: Continuous improvement work in the Pediatric Primary Care NP Clinic has provided a unique opportunity to improve the quality of care delivered and has facilitated further alignment of the daily continuous improvement work with the strategic priorities of the Ministry of Health.

Keywords: ambulatory care, lean, pediatric primary care, system efficiency

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