Search results for: culturally informed care

Authors: Hoora Beheshti Haradasht, Abooali Golzary

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Environmental education plays a pivotal role in shaping the future stewards of our planet. Leveraging the power of artificial intelligence (AI) in this endeavor presents an innovative approach to captivate and educate elementary school children about environmental sustainability. This paper explores the application of AI technologies in designing interactive and personalized learning experiences that foster curiosity, critical thinking, and a deep connection to nature. By harnessing AI-driven tools, virtual simulations, and personalized content delivery, educators can create engaging platforms that empower children to comprehend complex environmental concepts while nurturing a lifelong commitment to protecting the Earth. With the pressing challenges of climate change and biodiversity loss, cultivating an environmentally conscious generation is imperative. Integrating AI in environmental education revolutionizes traditional teaching methods by tailoring content, adapting to individual learning styles, and immersing students in interactive scenarios. This paper delves into the potential of AI technologies to enhance engagement, comprehension, and pro-environmental behaviors among elementary school children. Modern AI technologies, including natural language processing, machine learning, and virtual reality, offer unique tools to craft immersive learning experiences. Adaptive platforms can analyze individual learning patterns and preferences, enabling real-time adjustments in content delivery. Virtual simulations, powered by AI, transport students into dynamic ecosystems, fostering experiential learning that goes beyond textbooks. AI-driven educational platforms provide tailored content, ensuring that environmental lessons resonate with each child's interests and cognitive level. By recognizing patterns in students' interactions, AI algorithms curate customized learning pathways, enhancing comprehension and knowledge retention. Utilizing AI, educators can develop virtual field trips and interactive nature explorations. Children can navigate virtual ecosystems, analyze real-time data, and make informed decisions, cultivating an understanding of the delicate balance between human actions and the environment. While AI offers promising educational opportunities, ethical concerns must be addressed. Safeguarding children's data privacy, ensuring content accuracy, and avoiding biases in AI algorithms are paramount to building a trustworthy learning environment. By merging AI with environmental education, educators can empower children not only with knowledge but also with the tools to become advocates for sustainable practices. As children engage in AI-enhanced learning, they develop a sense of agency and responsibility to address environmental challenges. The application of artificial intelligence in elementary environmental education presents a groundbreaking avenue to cultivate environmentally conscious citizens. By embracing AI-driven tools, educators can create transformative learning experiences that empower children to grasp intricate ecological concepts, forge an intimate connection with nature, and develop a strong commitment to safeguarding our planet for generations to come.

Keywords: artificial intelligence, environmental education, elementary children, personalized learning, sustainability

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Authors: Jennifer Reese, Josh Biber, Howard Weeks, Rachel Hess

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Aim: The Edinburgh Postnatal Depression Screen (EPDS) is a mental health screening for pregnant women that has been widely used over the last 30 years. This screen is typically given in clinic on paper to patients throughout pregnancy and postpartum. The screen helps identify patients who may be at risk for pregnancy related depression or postpartum depression. In early 2016, University of Utah Health implemented an electronic version of the EPDS as well as the PROMIS Depression v1.0 instrument for all pregnant and postpartum patients. We asked patients both instruments to understand coverage of patients identified as at risk for each instrument. Methods: The EPDS is currently administered as part of our PRO template for pregnant and postpartum women. We also administer the PROMIS Depression as part of a standard PRO assessment to all patients. Patients are asked to complete an assessment no more often than every eight weeks. PRO assessments are either completed at home or in clinic with a tablet computer. Patients with a PROMIS score of ≥ 65 or a EPDS score of ≥ 10 were identified as at risk for depression Results: From April 2016 to April 2017, 1,330 unique patients were screened at University of Utah Health in OBGYN clinics with both the EPDS and PROMIS depression instrument on the same day. There were 28 (2.1%) patients were identified as at risk for depression using the PROMIS depression screen, while 262 (19.7%) patients were identified as at risk for postpartum depression using the EPDS screen. Overall, 27 (2%) patients were identified as at risk on both instruments. Conclusion: The EPDS identified a higher percent (19.7%) of patients at risk for depression when compared to the PROMIS depression (2.1%). Ninety-six percent of patients who screened positive on the PROMIS depression screen also screened positive on the EPDS screen. Mental health is an important component to a patient’s overall wellbeing. We want to ensure all patients, particularly pregnant or post-partum women, receive screening and treatment when necessary. A combination of screenings may be necessary to provide the overall best care for patients and to identify the highest percentage of patients at risk.

Keywords: patient reported outcomes, mental health, maternal, depression

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Authors: Krizette Ladera

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Fathers are there not only to provide the financial stability of a family but a father is also there to provide the love and support that usually people would see as the mother’s responsibility. To describe the lived experiences and how fathers make sense of their lived experiences with their children who have cerebral palsy is the main objective of the study. A qualitative research using a thematic analysis was used for the study. The qualitative research focused on the personal narratives, self-report and expression of the participant’s memory in terms of how they tell their stories. The interpretative phenomenological analysis was used to focus on the experience of the participants on how they will describe their experiences, and to also add on that the IPA will also attempt to describe and explain the meaning of human experiences using interview, specifically on the father who have a child that suffers from cerebral palsy. For the sampling technique, the snowball technique was used to gather participants from the referral of other participants. The five non-randomly selected fathers will be served as the participants for the research. A self-made interview with an open-ended question was used as the research instrument; it includes profiling of the respondent as well as their experiences in taking care of their child that suffers from cerebral palsy. In analyzing a data, the researcher used the thematic analysis where in the interview was made into a transcript, then it was organized and divided themes. After that, the relations of each themes, was identified and it was later documented and translated into written text format using thematic grouping. Finally, the researcher analyzed each data according to its themes and put it in a table to be presented in the result section of the study And as for the result of the study, the researcher was able to come up with the four (4) main themes that most of the participants experienced and those are: The experiences in finding out about the condition of the Child, disclosing the condition of the child to the family and its emotional effect, The experiences of living the day of day realities in providing the physical, financial, emotional and a well balanced environment to the child, and the religious perspectives of the fathers. Along with those four (4) themes comes the subtheme which explains the themes in a more detailed explanation.

Keywords: cerebral palsy, children, fathers, lived experiences

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Authors: Andriy Fedorenko

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Background Early closure of the open abdomen is a priority after damage control laparotomy to prevent retraction of fascial layers and prevent hernia formation that requires definitive repair at a later stage. This substantially reduces the complications associated with ventral hernia formation for up to a year after initial surgery. TopClosure® is an innovative method that employs stress-relaxation and mechanical creep for skin stretching. Its use enables the primary closure of large abdominal wall defects and mitigates large ventral hernia formation. Materials and Methods A 7-year-old girl presented with severe blast injury. She underwent initial laparotomy in a facility within the conflict zone and was transferred in a state of septic shock to our facility for further care. Her abdominal injuries included liver lacerations, multiple perforations of the transverse colon and ileum, and a 8x16cm oblique abdominal wall defect. Further damage control laparotomy was performed with primary suture of the colon and ileum and temporary closure of the abdomen using a Bagota bag. Twelve hours later, negative pressure wound therapy (NPWT) was applied to the abdominal wound after relook laparotomy. Five days later, TopClosure® was applied to the lower part of the wound incorporating NPWT to the upper wound. Results The patient suffered leak from the colonic suture line and required relaparotomy. TopClosure® abdominal closure was achieved after every laparotomy. Conclusion TopClosure® utilizes the viscoelastic properties of the skin achieving full closure of the abdominal wall (including the fascia and skin),eliminating the need for prolonged NPWT, skin graft, and delayed ventral hernia repair surgery.

Keywords: topclosure, abdominal wall defect, hernia, damage control

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Authors: Antonia Harold-Barry, Eugene Dempsey

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Background: The objective is to examine the survival and outcome of infants born under 26 weeks gestation in an Irish tertiary maternity hospital from 2007-2016 and to describe the survival and neurodevelopmental outcomes of these extremely preterm infants. Method: The population is 132 infants born at 23, 24, and 25 weeks in Cork University Maternity Hospital from 2007 to 2016. Ethical approval was granted by the Cork Clinical Research Ethics Committee. Patient details were obtained from the Vermont Oxford and Badger Networks. Survival rates and Bayley scores were calculated to assess neurodevelopmental outcomes. Statistical analysis with SPSS included frequencies, distributions, and comparisons between data from 2007-2011 and 2012-2016. Results: Overall survival rate was 63%. Of the surviving babies, 61% had Bayley scores calculated. Survival stood at 39% for delivery at 23 weeks, 50% at 24 weeks, and 83% at 25 weeks. The 2012 to 2016 cohort has shown further increases in survival, with 50% of babies at 23 weeks, 58% at 24 weeks, and 89% at 25 weeks. Corresponding figures for 2007-2011 are 20%, 39%, and 75%. Gestational age and incidence of periventricular leukomalacia were statistically significant, with a p-value of 0.022. Gestational age and delivery room deaths had a p-value of 0.025, as did gestational age and birth weight. A comparison of the two cohorts (2007-2011 and 2012-2016) with the administration of antenatal steroids showed a statistically significant p-value of 0.044. Conclusion: There is less morbidity and mortality in infants born at 25 than at 23 or 24 weeks. Survival of extremely premature infants has increased significantly over the past ten years. Survival rates with normal neurodevelopmental outcomes are comparable with international standards and reflect positive changes in attitude and practices in neonatal intensive care. This study will inform parents about the potential outcomes of extreme prematurity and policy regarding the management of extreme prematurity.

Keywords: extreme of viability, neurodevelopmental outcome, periventricular leukomalacia, prematurity

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Authors: Aikaterini Amanatidou

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We describe the case of a 20-year-old female patient diagnosed with Ehlers-Danlos Syndrome (EDS) who was scheduled to undergo a wisdom teeth extraction in outpatient surgery. EDS is a hereditary connective tissue disorder characterized by joint hypermobility, skin hyper-extensibility, and vascular and soft tissue fragility. There are six subtypes of Ehlers-Danlos, and in our case, the patient had EDS hyper-mobility (HT) type disorder. One important clinical feature of this syndrome is chronic pain, which is often poorly understood and treated. Our patient had a long history of articular and lumbar pain when she was diagnosed. She was prescribed analgesic treatment for acute and neuropathic pain and had multiple sessions of psychotherapy and physiotherapy to ease the pain. Unfortunately, her extensive medical history was underrated by our anesthetic team, and no further measures were taken for the operation. Despite an uneventful intra-operative phase, the patient experienced several episodes of hyperalgesia during the immediate post-operative care. Management of pain was challenging for the anesthetic team: initial opioid treatment had only a temporary effect and a paradoxical reaction after a while. Final pain relief was eventually obtained with psycho-physiologic treatment, high doses of ketamine, and patient-controlled analgesia infusion of morphine-ketamine-dehydrobenzperidol. We suspected an episode of Opioid-Induced hyperalgesia. This case report supports the hypothesis that anti-hyperalgesics such as ketamine as well as lidocaine, and dexmedetomidine should be considered intra-operatively to avoid opioid-induced hyperalgesia and may be an alternative solution to manage complex chronic pain like others in neuropathic pain syndromes.

Keywords: Ehlers-Danlos, post-operative management, hyperalgesia, opioid-induced hyperalgesia, rare disease

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Authors: Nurunnaher Nurunnaher

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This paper examines the impact of women’s participation in microcredit on women’s decision making in the slum areas of Dhaka city, Bangladesh. There is confusion in the literature about whether women’s empowerment is or is not a trickle down impact of poverty alleviation or household well-being, and the studies use more or less similar indicators to measure the status of household and the status of women. Studies very rarely conceptualize and operationalize the term ‘empowerment’ as the word is often used without proper care by policy makers and development practitioners instead of household wellbeing. Currently, decision making in many studies has been used as an indicator of women’s empowerment when assessing the impact of microcredit programs on women. Based on a qualitative and feminist study this paper operationalizes women’s empowerment through the development of a conceptual framework, the identification of assessment criteria and the development of proper indicators that guided the whole study. The testimonies of participants, both men and women, were the basis of exploration of women’s lived experiences, which is the most appropriate method to explore the impact of such programs on women’s empowerment. The study considers empowerment as a process that affects various levels of life and gender relationships. The study found that there is a positive change in women’s position in decision making when women have developed an independent economic base with credit money. However, predominantly, women’s decision making is shared with men with the final decision still in the men’s hands. It can be said that women’s microcredit participation has not significantly challenged the social norms, therefore it is not surprising that women who hand over credit to their husband rarely have any power in intra-household bargaining process. Nevertheless, overall it is evident that women are continuously struggling toward the freedom to have the authority over household, economic and personal matters. It is concluded that while making strategic choices or gaining empowerment requires several steps, women’s participation in decision-making has several implications on their lives and potentially challenges patriarchy.

Keywords: women, gender inequality/equality, decision making, empowerment, microcredit, slums, Dhaka, Bangladesh

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Authors: Aleema Rahman

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Introduction: This study aims to estimate the prevalence of long-term otitis media with effusion (OME) and hearing loss in a prospective longitudinal cohort studyand to study the relationship between the condition and educational and psychosocial outcomes. Methods: Analysis of data from the Avon Longitudinal Study of Parents and Children (ALSPAC) will be undertaken. ALSPAC is a longitudinal birth cohort study carried out in the UK, which has collected detailed measures of hearing on ~7000 children from the age of seven. A descriptive analysis of the data will be undertaken to estimate the prevalence of OME and hearing loss (defined as having average hearing levels > 20dB and type B tympanogram) at 7, 9, 11, and 15 years as well as that of long-term OME and hearing loss. Logistic and linear regression analyses will be conducted to examine associations between long-term OME and hearing loss and educational outcomes (grades obtained from standardised national attainment tests) and psychosocial outcomes such as anxiety, social fears, and depression at ages 10-11 and 15-16 years. Results: Results will be presented in terms of the prevalence of OME and hearing loss in the population at each age. The prevalence of long-term OME and hearing loss, defined as having OME and hearing loss at two or more time points, will also be reported. Furthermore, any associations between long-term OME and hearing loss and the educational and psychosocial outcomes will be presented. Analyses will take into account demographic factors such as sex and social deprivation and relevant confounders, including socioeconomic status, ethnicity, and IQ. Discussion: Findings from this study will provide new epidemiological information on the prevalence of long-term OME and hearing loss. The research will provide new knowledge on the impact of OME for the small group of children who do not grow out of condition by age 7 but continue to have hearing loss and need clinical care through later childhood. The study could have clinical implications and may influence service delivery for this group of children.

Keywords: educational attainment, hearing loss, otitis media with effusion, psychosocial development

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Authors: Min-Tao Hsu

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This study aims to explore the lived experiences of women with breast cancer, including their life world of illness and their adaptation to breast cancer. Breast cancer is not only a potentially lethal disease, but also a disease that may lead to many irreversible changes for female patients. Especially, in a culture where the wholeness is pursuit as an essential value, the sickness and/or broken body bring great challenge of life. Based on holism and symbolic interactionism, this study used interpretive ethnography including in-depth interviews and participant observations to collect the narrative of women with breast cancer concerning their illness experience. In addition, this study used Agar’s hermeneutic cycle to analyze data. The average age of 35 participants was 54.2. A total of 15 patients were within 2 years of onset, 5 patients were within 2-5 years of the treatment observation period, and 15 patients suffered from breast cancer for more than 5 years. The average age of onset was 50.4. Result: The main storyline of the life world of illness is ‘breast cancer is a turning point of life.’ Loss of breast was in terms of ‘no more a woman’ in Taiwanese culture. Two young women, one in her newly wedded and another right before marry, were divorced and cancelled wedding right after being diagnosed. All of them addressed that they have a ‘broken body.’ Single women accounted that they won’t marry for not being humiliated and most of married women said they never show female body in front of her husband or partner even in intimacy encounter. Three common themes were discovered: 1) new self and new identity; 2) new social relationships and new me; 3) new body and new life. The intertwining bodies, illness, selves, suffering, and medical treatments of female patients were observed. More, the recovery, of cause, was happened when new self, relationship, and new body were generated. Their identity to be a woman and a wife is shattered and their life is urged into another facet. For helping them to recovery from such situation, building a new identity and new social fabric on the new body need to be included in nursing care plan.

Keywords: breast cancer, illness narrative, world of illness, self-healing, interpretive ethnography

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Authors: Mikel Niño, Roberto V. Zicari, Todor Ivanov, Kim Hee, Naveed Mushtaq, Marten Rosselli, Concha Sánchez-Ocaña, Karsten Tolle, José Miguel Blanco, Arantza Illarramendi, Jörg Besier, Harry Underwood

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One of the application fields for data analysis techniques and technologies gaining momentum is the area of social good or “common good”, covering cases related to humanitarian crises, global health care, or ecology and environmental issues, among others. The promotion of data-driven projects in this field aims at increasing the efficacy and efficiency of social initiatives, improving the way these actions help humanity in general and people in need in particular. This application field, however, poses its own barriers and challenges when developing data-driven projects, lagging behind in comparison with other scenarios. These challenges derive from aspects such as the scope and scale of the social issue to solve, cultural and political barriers, the skills of main stakeholders and the technological resources available, the motivation to be engaged in such projects, or the ethical and legal issues related to sensitive data. This paper analyzes the application of data projects in the field of social good, reviewing its current state and noteworthy initiatives, and presenting a framework covering the key aspects to analyze in such projects. The goal is to provide guidelines to understand the main challenges and opportunities for this type of data project, as well as identifying the main differential issues compared to “classical” data projects in general. A case study is presented on the initial steps and stakeholder analysis of a data project for the inclusion of refugees in the city of Frankfurt, Germany, in order to empirically confront the framework with a real example.

Keywords: data-driven projects, humanitarian operations, personal and sensitive data, social good, stakeholders analysis

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Authors: Rahil Bahrami, Kaveh Ashenayi

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This paper presents a systematic classification and comparative analysis of non-isolated bi-directional DC-DC converters. The increasing demand for efficient energy conversion in diverse applications has spurred the development of various converter topologies. In this study, we categorize bi-directional converters into three distinct classes: Inverting, Non-Inverting, and Interleaved. Each category is characterized by its unique operational characteristics and benefits. Furthermore, a practical comparison is conducted by evaluating the results of simulation of each bi-directional converter. BDCs can be classified into isolated and non-isolated topologies. Non-isolated converters share a common ground between input and output, making them suitable for applications with minimal voltage change. They are easy to integrate, lightweight, and cost-effective but have limitations like limited voltage gain, switching losses, and no protection against high voltages. Isolated converters use transformers to separate input and output, offering safety benefits, high voltage gain, and noise reduction. They are larger and more costly but are essential for automotive designs where safety is crucial. The paper focuses on non-isolated systems.The paper discusses the classification of non-isolated bidirectional converters based on several criteria. Common factors used for classification include topology, voltage conversion, control strategy, power capacity, voltage range, and application. These factors serve as a foundation for categorizing converters, although the specific scheme might vary depending on contextual, application, or system-specific requirements. The paper presents a three-category classification for non-isolated bi-directional DC-DC converters: inverting, non-inverting, and interleaved. In the inverting category, converters produce an output voltage with reversed polarity compared to the input voltage, achieved through specific circuit configurations and control strategies. This is valuable in applications such as motor control and grid-tied solar systems. The non-inverting category consists of converters maintaining the same voltage polarity, useful in scenarios like battery equalization. Lastly, the interleaved category employs parallel converter stages to enhance power delivery and reduce current ripple. This classification framework enhances comprehension and analysis of non-isolated bi-directional DC-DC converters. The findings contribute to a deeper understanding of the trade-offs and merits associated with different converter types. As a result, this work aids researchers, practitioners, and engineers in selecting appropriate bi-directional converter solutions for specific energy conversion requirements. The proposed classification framework and experimental assessment collectively enhance the comprehension of non-isolated bi-directional DC-DC converters, fostering advancements in efficient power management and utilization.The simulation process involves the utilization of PSIM to model and simulate non-isolated bi-directional converter from both inverted and non-inverted category. The aim is to conduct a comprehensive comparative analysis of these converters, considering key performance indicators such as rise time, efficiency, ripple factor, and maximum error. This systematic evaluation provides valuable insights into the dynamic response, energy efficiency, output stability, and overall precision of the converters. The results of this comparison facilitate informed decision-making and potential optimizations, ensuring that the chosen converter configuration aligns effectively with the designated operational criteria and performance goals.

Keywords: bi-directional, DC-DC converter, non-isolated, energy conversion

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Authors: Jukka Törrönen

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In the article, we examine the interplay between the practices of heavy drinking and exercise among young people as patterned around the ‘social’ and ‘physical health’ approaches. The comparison helps us to clarify why young people are currently drinking less than earlier and how the neoliberal healthism discourse, as well as the feminine tradition of taking care of one’s body, are modifying young people’s heavy drinking practices. The data is based on interviews (n = 56) in Sweden among 15-16-year-olds and 18˗19-year-olds. By drawing on Pierre Bourdieu’s concepts of habitus, field, and capital, we examine what kinds of resources of wellbeing young people accumulate in the fields of heavy drinking and exercise, how these resources carry symbolic value for distinction, and what kind of health-related habitus they imply. The analysis suggests that as heavy drinking is no longer able to stand as a practice through which one may acquire capital that is more valuable than the capital acquired in other fields, this lessens peer pressure to drink among young people. Our analysis further shows that the healthism discourse modifies young people’s heavy drinking practices both from inside and from outside. The interviewees translate the symbolic value of healthism discourse to social vulnerability and deploy it for the purposes of increasing one’s social status among peers. Moreover, our analysis demonstrates that the social spaces and positions in intoxication and exercise are shaped by gendered dualisms of masculine dominance. However, while the interviewees naturalize the gender binaries in intoxication as based on biological drives, they understand gender binaries in exercise as normative social constructions of neoliberal society. As these binaries emphasize the struggle for recognition of the symbolic value of bodily look, they may shift young men’s attention from risk-taking to issues that traditionally have been female concerns.

Keywords: young people, decline in drinking , health, intoxication, exercise, Bourdieu

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Authors: Hardisiswo Soedjana, Inne Caroline

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Deep dermal or full thickness burns are inevitably lead to post-burn contractures. These contractures remain to be one of the most concerning late complications of burn injuries. Surgical management includes releasing the contracture followed by resurfacing the defect accompanied by post-operative rehabilitation. Optimal treatment of post-burn contractures depends on the characteristics of the contractures. This study is aimed to describe clinical characteristics, problems, and management of post-burn contractures in adults and children. A retrospective analysis was conducted from medical records of patients suffered from contractures after burn injuries admitted to Hasan Sadikin general hospital between January 2016 and January 2018. A total of 50 patients with post burn contractures were included in the study. There were 17 adults and 33 children. Most patients were male, whose age range within 15-59 years old and 5-9 years old. Educational background was mostly senior high school among adults, while there was only one third of children who have entered school. Etiology of burns was predominantly flame in adults (82.3%); whereas flame and scald were the leading cause of burn injury in children (11%). Based on anatomical regions, hands were the most common affected both in adults (35.2%) and children (48.5%). Contractures were identified in 6-12 months since the initial burns. Most post-burn hand contractures were resurfaced with full-thickness skin graft (FTSG) both in adults and children. There were 11 patients who presented with recurrent contracture after previous history of contracture release. Post-operative rehabilitation was conducted for all patients; however, it is important to highlight that it is still challenging to control splinting and exercise when patients are discharged and especially the compliance in children. In order to improve quality of life in patients with history of deep burn injuries, prevention of contractures should begin right after acute care has been established. Education for the importance of splinting and exercise should be administered as comprehensible as possible for adult patients and parents of pediatric patients.

Keywords: burn, contracture, education, exercise, splinting

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Authors: Induja R. Nimma, Anand Reddy Maligireddy, Artur Schneider, Melissa Lyle

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Background: Although heart failure is one of the most common causes of hospitalization in adult patients, there is limited knowledge on outcomes following initial hospitalization for COVID-19 with heart failure (HCF-19). We felt it pertinent to analyze 30-day readmission causes and outcomes among patients with HCF-19 using the United States using real-world big data via the National readmission database. Objective: The aim is to describe the rate and causes of readmissions and morbidity of heart failure with coinciding COVID-19 (HFC-19) in the United States, using the 2020 National Readmission Database (NRD). Methods: A descriptive, retrospective study was conducted on the 2020 NRD, a nationally representative sample of all US hospitalizations. Adult (>18 years) inpatient admissions with COVID-19 with HF and readmissions in 30 days were selected based on the International Classification of Diseases-Tenth Revision, Procedure Code. Results: In 2020, 2,60,372 adult patients were hospitalized with COVID-19 and HF. The median age was 74 (IQR: 64-83), and 47% were female. The median length of stay was 7(4-13) days, and the total cost of stay was 62,025 (31,956 – 130,670) United States dollars, respectively. Among the index hospital admissions, 61,527 (23.6%) died, and 22,794 (11.5%) were readmitted within 30 days. The median age of patients readmitted in 30 days was 73 (63-82), 45% were female, and 1,962 (16%) died. The most common principal diagnosis for readmission in these patients was COVID-19= 34.8%, Sepsis= 16.5%, HF = 7.1%, AKI = 2.2%, respiratory failure with hypoxia =1.7%, and Pneumonia = 1%. Conclusion: The rate of readmission in patients with heart failure exacerbations is increasing yearly. COVID-19 was observed to be the most common principal diagnosis in patients readmitted within 30 days. Complicated hypertension, chronic pulmonary disease, complicated diabetes, renal failure, alcohol use, drug use, and peripheral vascular disorders are risk factors associated with readmission. Familiarity with the most common causes and predictors for readmission helps guide the development of initiatives to minimize adverse outcomes and the cost of medical care.

Keywords: Covid-19, heart failure, national readmission database, readmission outcomes

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Authors: Lin Fu-Gong

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Background: As WHO announced, people with intellectual disability (ID) were vulnerable to mental health problems. And there were few custom-made mental health scales for those people to monitor their mental health. Those people with mental problems often accompanied worse prognosis and usually became to be a heavier burden on the caregivers. Purpose: In this study, we intend to develop a psychopathy scale as a practical tool for monitoring the mental health for people with ID living in institute. Methods: In this study, we adopt the Psychopathology Inventory for Mentally Retarded Adults developed by professor Matson with certified reliability and validity in Western countries with Dr. Matson’s agreement in advance. We first translated the inventory into Chinese validated version considering the domestic culture background in the past year. And the validity and reliability evaluation of mental health status using this inventory among the people with intellectual living in the institute were done. Results: The inventory includes eight psychiatric disorder scales as schizophrenic, affective, psychosexual, adjustment, anxiety, somatoform, personality disorders and inappropriate mental adjustment. Around 83% of 40 invested people, who randomly selected from the institute, were found to have at least one disorder who were recommended with medical help by two evaluators. Among the residents examined, somatoform disorder and inappropriate mental adjustment were most popular with 60% and 78% people respectively. Conclusion: The result showed the prevalence psychiatric disorders were relatively high among people with ID in institute and the mental problems need to be further cared and followed for their mental health. The results showed that the psychopathology inventory was a useful tool for institute caregiver, manager and for long-term care policy to the government. In the coming stage, we plan to extend the use of the valid Chinese version inventory among more different type institutes for people with ID to establish their dynamic mental health status including medical need, relapse and rehabilitation to promote their mental health.

Keywords: intellectual disability, psychiatric disorder, psychopathology inventory, mental health, the institute

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Authors: Mohd Aslam Aslam

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Chronic renal failure is a debilitating condition responsible for high morbidity and mortality. Because of its costs and the complexity of its treatment, proper care is available to very few patients in India. According to researchers, the number of adults aged 30 or older who have chronic kidney disease is projected to increase from 13.2 percent currently, to 14.4 percent in 2020 and 16.7 percent in 2030. The aerial part of Aerva lanata (Busehri booti) have been used in kidney disorders by the Unani physicians. In the present study, the effect of extract of Aerva lanata was investigated on cisplatin-induced nephrotoxicity in rats. The renal effects of this drug was evaluated by monitoring levels of blood urea nitrogen (BUN), serum creatinine, serum uric acid in blood and histopathological examination of kidney. Aerva lanata was evaluated at two different doses (1400 mg/kg and 2800 mg/kg). The effect of higher dose was more pronounced in terms of inhibition in the rise of BUN, serum creatinine and uric acid. Higher dose show greater prevention in the rise of BUN, serum creatinine, and uric acid. The histopathological examination of the kidney tissue of the rats treated with aqueous methanolic extract of Aerva lanata (Higher dose-2800 mg/kg) showed marked inhibition of glomerular congestion, tubular casts, peritubular congestion, epithelial desquamation, blood vessel congestion, interstitial edema and inflammatory cells produced by the cisplatin-induced nephrotoxicity. This finding clearly indicates the protective role of Aerva lanata at higher dose. Present investigation validates the use of Aerva lanata in kidney disorders by Unani physicians.

Keywords: Aerva lanata, Busehri booti, nephroprotective, unani medicine

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Authors: Dawit Thomas

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Feeding and weaning practices vary from culture to culture and depend on different child-rearing values. The socio-cultural dimensions that influence the acceptable infant feeding practices are varied and complex. Understanding cultural differences in beliefs and practices relating to infant feeding is important to enhance designing programs for delivering successful psychological, social, physiological and economic well-being of mothers and infants. The main purpose of this study was exploring mothers infant feeding practices in the context of Hadiyya culture. After purposively selecting Harche Huyaya Uyaya Kebele eight infant feeding mothers were selected using snowball sampling technique. The study employed interviews and focus group discussion. The study found out early initiation and prolonged breastfeeding and early complementary feeding in some instances immediately after birth. In addition, infants were not forced to wean unless the mothers encounter pressing issues like pregnancy and health related problems. Furthermore, the main weaning techniques were putting unpleasant materials on the tip of nipples and sending infants to grandparents home. The study also found out gender difference in weaning, i.e., early initiation of weaning for girls. This can be indicative of gender-based bias on weaning practice. Finally, health extension workers, office of women and children affairs and Hadiyya Zone Tourism office should organize awareness raising programs to preserve vital infant feeding practices like prolonged breastfeeding and length of weaning. In addition, the offices should raise awareness among communities on negative side effects of sending infant to grandparents home that may weaken infant-mothers attachment and create favorable ground for the development of phobia.

Keywords: feeding, infant, practices, weaning

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Authors: Oluwayemisi Femi-Pius, Kazeem Arogundade, Eberechukwu Eke, Jimmy Eko

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Introduction: Globally, community involvement in improving their own health has been widely adopted as a strategy in Sub-Saharan Africa principally to ensure equitable access to essential health care as well as improve the uptake of maternal and newborn health services especially in poor-resource settings. Method: The Saving Mother Giving Life (SMGL) Initiative implemented by Pathfinder International with funding support from USAID conducted a Health Facility Assessment (HFA) and found out that maternal mortality ratio in Cross River State was 812 per 100,000 live birth and perinatal mortality was 160 per 1000 live birth. To reduce maternal and perinatal mortality, Pathfinder International mobilized, selected and trained community members as community volunteers, traditional birth attendants, and emergency transport service volunteer drivers mainly to address the delay in decision making and reaching the health facility among pregnant women. Results: The results showed that maternal mortality ratio in Cross River State decrease by 25% from 812 per 100,000 live birth at baseline to 206 per 100,000 live birth at June 2018 and perinatal mortality reduced by 35% from 160 per 100,000 at baseline to 58 per 1000 live birth at June 2018. Data also show that ANC visit increased from 7,451 to 11,344; institutional delivery increased from 8,931 at baseline to 10,784 in June 2018. There was also a remarkable uptake of post-partum family planning from 0 at baseline to 233 in June 2018. Conclusion: There is clear evidence that community involvement yields positive maternal outcomes and is pivotal for sustaining most health interventions.

Keywords: maternal mortality, Nigeria, pathfinder international, perinatal mortality, saving mother giving life

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Authors: Kasipandi Muniyandi, Parimelazhagan Thangaraj

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Plants are important prospective wealth of a country, combination of local health care information about a specific plant together with data published by several groups of scientists, can help in deciding whether it should be considered acceptable for medicinal use. In the developed countries, too, plant-derived drugs may be of importance. The wide variety of ailments that are being treated with Plectranthus is an indication of the medicinal value of the genus. A number of species are not toxic and so may be taken orally, whilst others are used topically on the skin or as enemas. This study was designed to evaluate the different properties of Plectranthus stocksii and the aerial parts were collected and extracted with petroleum ether, chloroform, ethyl acetate, acetone and methanol by Soxhlet apparatus and finally macerated with hot water. The quantification assays revealed that, leaf methanol extract showed higher total phenolic (415.41 mg GAE/ g extract) and tannin (177.53 mg GAE/ g extract) contents whereas leaf ethyl acetate exhibited higher flavonoids (777.11 mg RE/ g extract) content. The antioxidant efficiency of the extracts was analyzed by various radical scavenging assays. Among the different antioxidant assays, leaf ethyl acetate extract showed higher free radical scavenging activities against DPPH (IC50 = 3.46 µg/mL), ABTS (27417.65 µM TE/ g extract), FRAP (152.17 mM Fe(II)E/ mg extract) NO• radical (21.46%) and Superoxide radical (IC50 = 24.16 µg/mL) assays. All the parts P. stocksii extracts showed significant protection against OH• induced DNA damage at 50 µg concentration. The HPLC analysis of leaf ethyl acetate extract revealed the presence of Quercetin (30.29 µg/mg of extract) was the major compound. Anticancer activity of leaf ethyl acetate extract showed better IC50 values were 48.87 and 36.08 µg/ mL against MCF-7 and Caco-2 respectively. From this study, P. stocksii can act as a potent antioxidant and cytotoxic antimicrobial agent. The scope for drug development from this plant is endless and there is undoubtedly a call for further research in pharmaceutical industries.

Keywords: antioxidant, cytotoxicity, phenolics, plectranthus stocksii

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Authors: A. Raj Kumar, A. Okunseinde, P. Raghavan, V. Kapila

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Stroke is the leading cause of adult disability worldwide. With recent advances in immediate post-stroke care, there is an increasing number of young stroke survivors, under the age of 65 years. While most stroke survivors will regain the ability to walk, they often experience long-term arm and hand motor impairments. Long term upper limb rehabilitation is needed to restore movement and function, and prevent deterioration from complications such as learned non-use and learned bad-use. We have developed a novel virtual coach, a wearable instrumented rehabilitation jacket, to motivate individuals to participate in long-term skill re-learning, that can be personalized to their impairment profile. The jacket can estimate the movements of an individual’s arms using embedded off-the-shelf sensors (e.g., 9-DOF IMU for inertial measurements, flex-sensors for measuring angular orientation of fingers) and a Bluetooth Low Energy (BLE) powered microcontroller (e.g., RFduino) to non-intrusively extract data. The 9-DOF IMU sensors contain 3-axis accelerometer, 3-axis gyroscope, and 3-axis magnetometer to compute the quaternions, which are transmitted to a computer to compute the Euler angles and estimate the angular orientation of the arms. The data are used in a gaming environment to provide visual, and/or haptic feedback for goal-based, augmented-reality training to facilitate re-learning in a cost-effective, evidence-based manner. The full paper will elaborate the technical aspects of communication, interactive gaming environment, and physical aspects of electronics necessary to achieve our stated goal. Moreover, the paper will suggest methods to utilize the proposed system as a cheaper, portable, and versatile system vis-à-vis existing instrumentation to facilitate post-stroke personalized arm rehabilitation.

Keywords: feedback, gaming, Euler angles, rehabilitation, augmented reality

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Authors: Wafa Al Jabri

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Sickle cell disease (SCD) is a genetic blood disorder that is characterized by a severe painful crisis. SCD among children requires long term dependencies and high caregiving demands that increase the overall family burdens. It is, therefore, essential to examine, support, and promote the well-being of families of children with SCD. Although there has been considerable progress in the international research on family quality of life (FQOL) in recent years; however, research in this field is relatively recent and diverse. Oman is a country in which family quality of life has definitely been under-researched. Therefore, the purpose of the study is to describe the FQOL in families of children with SCD in Oman. The study will also examine the relationships between child, mother, and family-related factors that may influence the overall FQOL. Theoretical Framework: The study is guided by the unified theory of family quality of life to help in understanding the concept of FQOL and the factors that shape it. Method:A convenience sample of 98 mothers of children with SCD will be recruited from the pediatric hematology clinic at Sultan Qaboos University Hospital in Oman to participate in this descriptive, cross sectional, correlational study. Data will be obtained using a self-administered questionnaire that includes child and mother socio-demographic data, questions about the number of visits and admissions to health care facilities for vaso- occlusive crises (VOCs), the Perceived Stress Scale-10, and the Beachcenter-FQOL scale. Anticipated Results: It is expected to find an association among frequency of VOCs, mother’s perceived stress level, and FQOL in families of children with SCD in Oman. Family type, socio-economic status, and number of SCD children in the family are also expected to influence the overall FQOL. Conclusion: The findings of the study might be pivotal in designing and implementing tailored family-based interventions to improve families’ wellbeing.

Keywords: family quality of life, sickle cell disaes, children, family well-being

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Authors: Emily Simone Doffing, Danielle Kohfeldt

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Disabled students are underrepresented in graduate-level degree enrollment and completion. There is limited research on disabled students' progression during the pandemic. Disabled graduate students (DGS) face unique interpersonal and institutional barriers, yet, limited research explores these barriers, buffering facilitators, and aids to academic persistence. This study adopts an asset-based, embodied disability approach using the critical pedagogy theoretical framework instead of the deficit research approach. The Participatory Action Research (PAR) paradigm, the critical pedagogy theoretical framework, and emancipatory disability research share the same purpose -creating a socially just world through reciprocal learning. This study is one of few, if not the first, to center solely on DGS’ lived understanding using a Participatory Action Research (PAR) epistemology. With a PAR paradigm, participants and investigators work as a research team democratically at every stage of the research process. PAR has individual and systemic outcomes. PAR lessens the researcher-participant power gap and elevates a marginalized community’s knowledge as expertise for local change. PAR and critical pedagogy work toward enriching everyone involved with empowerment, civic engagement, knowledge proliferation, socio-cultural reflection, skills development, and active meaning-making. The PAR process unveils the tensions between disability and graduate school in policy and practice during the pandemic. Likewise, institutional and ideological tensions influence the PAR process. This project is recruiting 10 DGS until September through purposive and snowball sampling. DGS will collectively practice praxis during four monthly focus groups in the fall 2023 semester. Participant researchers can attend a focus group or an interview, both with field notes. September will be our orientation and first monthly meeting. It will include access needs check-ins, ice breakers, consent form review, a group agreement, PAR introduction, research ethics discussion, research goals, and potential research topics. October and November will be available for meetings for dialogues about lived experiences during our collaborative data collection. Our sessions can be semi-structured with “framing questions,” which would be revised together. Field notes include observations that cannot be captured through audio. December will focus on local social action planning and dissemination. Finally, in January, there will be a post-study focus group for students' reflections on their experiences of PAR. Iterative analysis methods include transcribed audio, reflexivity, memos, thematic coding, analytic triangulation, and member checking. This research follows qualitative rigor and quality criteria: credibility, transferability, confirmability, and psychopolitical validity. Results include potential tension points, social action, individual outcomes, and recommendations for conducting PAR. Tension points have three components: dubious practices, contestable knowledge, and conflict. The dissemination of PAR recommendations will aid and encourage researchers to conduct future PAR projects with the disabled community. Identified stakeholders will be informed of DGS’ insider knowledge to drive social sustainability.

Keywords: participatory action research, graduate school, disability, higher education

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Authors: Rohit Kothari, Muneer Mohamed, Vivekanandh K., Sunmeet Sandhu, Preema Sinha, Anuj Bhatnagar

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Introduction: Hyper-IgE syndrome is a rare primary immunodeficiency syndrome characterised by triad of severe atopic dermatitis, recurrent pulmonary infections, and recurrent staphylococcal skin infections. The diagnosis requires a high degree of suspicion, typical clinical features, and not mere rise in serum-IgE levels, which may be seen in multiple conditions. Genetic studies are not always possible in a resource poor setting. This study highlights various presentations of Hyper-IgE syndrome in skin of color children. Case-series: Our study had six children of Hyper-IgE syndrome aged twomonths to tenyears. All had onset in first ten months of life except one with a late-onset at two years. All had recurrent eczematoid rash, which responded poorly to conventional treatment, secondary infection, multiple episodes of hospitalisation for pulmonary infection, and raised serum IgE levels. One case had occasional vesicles, bullae, and crusted plaques over both the extremities. Genetic study was possible in only one of them who was found to have pathogenic homozygous deletions of exon-15 to 18 in DOCK8 gene following which he underwent bone marrow transplant (BMT), however, succumbed to lower respiratory tract infection two months after BMT and rest of them received multiple courses of antibiotics, oral/ topical steroids, and cyclosporine intermittently with variable response. Discussion: Our study highlights various characteristics, presentation, and management of this rare syndrome in children. Knowledge of these manifestations in skin of color will facilitate early identification and contribute to optimal care of the patients as representative data on the same is limited in literature.

Keywords: absolute eosinophil count, atopic dermatitis, eczematous rash, hyper-immunoglobulin E syndrome, pulmonary infection, serum IgE, skin of color

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Authors: Aparna Lal, Ashwin Swaminathan, Teisa Holani

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Background: Clostridium difficile infections (CDIs) have been on the rise globally. In Australia, rates of CDI in all States and Territories have increased significantly since mid-2011. Identifying risk factors for CDI in the community can help inform targeted interventions to reduce infection. Methods: We examine the role of neighbourhood socio-economic status, demography, testing practices and the number of residential aged care facilities on spatial patterns in CDI incidence in the Australian Capital Territory. Data on all tests conducted for CDI were obtained from ACT Pathology by postcode for the period 1st January 2004 through 31 December 2014. Distribution of age groups and the neighbourhood Index of Relative Socio-economic Advantage Disadvantage (IRSAD) were obtained from the Australian Bureau of Statistics 2011 National Census data. A Bayesian spatial conditional autoregressive model was fitted at the postcode level to quantify the relationship between CDI and socio-demographic factors. To identify CDI hotspots, exceedance probabilities were set at a threshold of twice the estimated relative risk. Results: CDI showed a positive spatial association with the number of tests (RR=1.01, 95% CI 1.00, 1.02) and the resident population over 65 years (RR=1.00, 95% CI 1.00, 1.01). The standardized index of relative socio-economic advantage disadvantage (IRSAD) was significantly negatively associated with CDI (RR=0.74, 95% CI 0.56, 0.94). We identified three postcodes with high probability (0.8-1.0) of excess risk. Conclusions: Here, we demonstrate geographic variations in CDI in the ACT with a positive association of CDI with socioeconomic disadvantage and identify areas with a high probability of elevated risk compared with surrounding communities. These findings highlight community-based risk factors for CDI.

Keywords: spatial, socio-demographic, infection, Clostridium difficile

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Authors: Albert W. K. Tan

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This research consolidates a comprehensive array of publications from peer-reviewed journals, case studies, and seminar reports focused on reverse logistics and network design. By synthesizing this secondary knowledge, our objective is to identify and articulate key decision factors crucial to reverse logistics network design for e-commerce. Through this exploration, we aim to present a refined mathematical model that offers valuable insights for companies seeking to optimize their reverse logistics operations. The primary goal of this research endeavor is to develop a comprehensive framework tailored to advising organizations and companies on crafting effective networks for their reverse logistics operations, thereby facilitating the achievement of their organizational goals. This involves a thorough examination of various network configurations, weighing their advantages and disadvantages to ensure alignment with specific business objectives. The key objectives of this research include: (i) Identifying pivotal factors pertinent to network design decisions within the realm of reverse logistics across diverse supply chains. (ii) Formulating a structured framework designed to offer informed recommendations for sound network design decisions applicable to relevant industries and scenarios. (iii) Propose a mathematical model to optimize its reverse logistics network. A conceptual framework for designing a reverse logistics network has been developed through a combination of insights from the literature review and information gathered from company websites. This framework encompasses four key stages in the selection of reverse logistics operations modes: (1) Collection, (2) Sorting and testing, (3) Processing, and (4) Storage. Key factors to consider in reverse logistics network design: I) Centralized vs. decentralized processing: Centralized processing, a long-standing practice in reverse logistics, has recently gained greater attention from manufacturing companies. In this system, all products within the reverse logistics pipeline are brought to a central facility for sorting, processing, and subsequent shipment to their next destinations. Centralization offers the advantage of efficiently managing the reverse logistics flow, potentially leading to increased revenues from returned items. Moreover, it aids in determining the most appropriate reverse channel for handling returns. On the contrary, a decentralized system is more suitable when products are returned directly from consumers to retailers. In this scenario, individual sales outlets serve as gatekeepers for processing returns. Considerations encompass the product lifecycle, product value and cost, return volume, and the geographic distribution of returns. II) In-house vs. third-party logistics providers: The decision between insourcing and outsourcing in reverse logistics network design is pivotal. In insourcing, a company handles the entire reverse logistics process, including material reuse. In contrast, outsourcing involves third-party providers taking on various aspects of reverse logistics. Companies may choose outsourcing due to resource constraints or lack of expertise, with the extent of outsourcing varying based on factors such as personnel skills and cost considerations. Based on the conceptual framework, the authors have constructed a mathematical model that optimizes reverse logistics network design decisions. The model will consider key factors identified in the framework, such as transportation costs, facility capacities, and lead times. The authors have employed mixed LP to find the optimal solutions that minimize costs while meeting organizational objectives.

Keywords: reverse logistics, supply chain management, optimization, e-commerce

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Authors: N. P. Bhandary, R. C. Tiwari, R. Yatabe

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The research employs finite element method to evaluate the stability of roadside settlements slopes from Barpak to Yamagaon through Laprak village of Gorkha, Nepal after the 7.8Mw 2015 Barpak, Gorkha, Nepal earthquake. It includes three major villages of Gorkha, i.e., Barpak, Laprak and Yamagaun that were devastated by 2015 Gorkhas’ earthquake. The road head distance from the Barpak to Laprak and Laprak to Yamagaun are about 14 and 29km respectively. The epicentral distance of main shock of magnitude 7.8 and aftershock of magnitude 6.6 were respectively 7 and 11 kilometers (South-East) far from the Barpak village nearer to Laprak and Yamagaon. It is also believed that the epicenter of the main shock as said until now was not in the Barpak village, it was somewhere near to the Yamagaun village. The chaos that they had experienced during the earthquake in the Yamagaun was much more higher than the Barpak. In this context, we have carried out a detailed study to investigate the stability of Yamagaun settlements slope as a case study, where ground fissures, ground settlement, multiple cracks and toe failures are the most severe. In this regard, the stability issues of existing settlements and proposed road alignment, on the Yamagaon village slope are addressed, which is surrounded by many newly activated landslides. Looking at the importance of this issue, field survey is carried out to understand the behavior of ground fissures and multiple failure characteristics of the slopes. The results suggest that the Yamgaun slope in Profile 2-2, 3-3 and 4-4 are not safe enough for infrastructure development even in the normal soil slope conditions as per 2, 3 and 4 material models; however, the slope seems quite safe for at Profile 1-1 for all 4 material models. The result also indicates that the first three profiles are marginally safe for 2, 3 and 4 material models respectively. The Profile 4-4 is not safe enough for all 4 material models. Thus, Profile 4-4 needs a special care to make the slope stable.

Keywords: earthquake, finite element method, landslide, stability

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Authors: Yi Shan Cheng, Ya Hui Yeh, Hsiao Wen Hsu

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Delirium is an acute state of confusion, which is mainly the result of the interaction of many factors, including: age>65 years, comorbidity, cognitive function and visual/auditory impairment, dehydration, pain, sleep disorder, pipeline retention, general anesthesia and major surgery… etc. Researches show the prevalence of delirium in hospitalized elderly patients over 50%. If it doesn't improve in time, may cause cognitive decline or impairment, not only prolong the length of hospital stay but also increase mortality. Some studies have shown that multiple nonpharmacological interventions are the most effective and common strategies, which are reorientation, early mobility, promoting sleep and nutritional support (including water intake), could improve or prevent delirium in the hospitalized elderly. In Taiwan, only one research to compare the delirium incidence of the older patients who have received orthopedic surgery between multi-nonpharmacological interventions and general routine care. Therefore, the purpose of this study is to address the prevention or improvement of delirium incidence density in medical hospitalized elderly, provide clinical nurses as a reference for clinical implementation, and develop follow-up related research. This study is a quasi-experimental design using purposive sampling. Samples are from two wards: the geriatric ward and the general medicine ward at a medical center in central Taiwan. The sample size estimated at least 100, and then the data will be collected through a self-administered structured questionnaire, including: demographic and professional evaluation items. Case recruiting from 5/13/2023. The research results will be analyzed by SPSS for Windows 22.0 software, including descriptive statistics and inferential statistics: logistic regression、Generalized Estimating Equation(GEE)、multivariate analysis of variance(MANOVA).

Keywords: multiple nonpharmacological interventions, hospitalized elderly, delirium incidence, delirium

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Authors: Pauliina Haustein

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Improvisation was part of Western classical concert culture and performers’ skill sets until early 20th century. Historical accounts, as well as recent studies, indicate that improvisatory elements in the programme may contribute specifically towards the audiences’ experience of enhanced emotional engagement during the concert. This paper presents findings from the author’s artistic practice research, which explored re-introducing improvisation to Western classical performance practice as a musician (cellist and ensemble partner/leader). In an investigation of four concert cycles, the performer-researcher sought to gain solo and chamber music improvisation techniques (both related to and independent of repertoire), conduct ensemble improvisation rehearsals, design concerts with an improvisatory approach, and reflect on interactions with audiences after each concert. Data was collected through use of reflective diary, video recordings, measurement of sound parameters, questionnaires, a focus group, and interviews. The performer’s empirical experiences and findings from audience research components were juxtaposed and interrogated to better understand the (1) rehearsal and planning processes that enable improvisatory elements to return to Western classical concert experience and (2) the emotional experience and type of engagement that occur throughout the concert experience for both performer and audience members. This informed the development of a concert model, in which a programme of solo and chamber music repertoire and improvisations were combined according to historically evidenced performance practice (including free formal solo and ensemble improvisations based on audience suggestions). Inspired by historical concert culture, where elements of risk-taking, spontaneity, and audience involvement (such as proposing themes for fantasies) were customary, this concert model invited musicians to contribute to the process personally and creatively at all stages, from programme planning, and throughout the live concert. The type of democratic, personal, creative, and empathetic collaboration that emerged, as a result, appears unique in Western classical contexts, rather finding resonance in jazz ensemble, drama, or interdisciplinary settings. The research identified features of ensemble improvisation, such as empathy, emergence, mutual engagement, and collaborative creativity, that became mirrored in audience’s responses, generating higher levels of emotional engagement, empathy, inclusivity, and a participatory, co-creative experience. It appears that duringimprovisatory moments in the concert programme, audience members started feeling more like active participants in za\\a creative, collaborative exchange and became stakeholders in a deeper phenomenon of meaning-making and narrativization. Examining interactions between all involved during the concert revealed that performer-audience impulse exchange occurred on multiple levels of awareness and seemed to build upon each other, resulting in particularly strong experiences of both performer and audience’s engagement. This impact appeared especially meaningful for audience members who were seldom concertgoers and reported little familiarity with classical music. The study found that re-introducing improvisatory elements to Western classical concert programmes has strong potential in increasing audience’s emotional engagement with the musical performance, enabling audience members to connect more personally with the individual performers, and in reaching new-to-classical-music audiences.

Keywords: artistic research, audience engagement, audience experience, classical improvisation, ensemble improvisation, emotional engagement, improvisation, improvisatory approach, musical performance, practice research

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Authors: Marlene Rosa, Susana Lopes

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There are few studies that explore the potential of board games as a performance measure, despite it can be an interesting strategy in the context of frailty populations. In fact, board games are immersive strategies than can inhibit the pressure of being evaluated. This study aimed to test the ability of gamed-base strategies to assess executive function in elderly population. Sixteen old participants were included: 10 with affected executive functions (G1 – 85.30±6.00 yrs old; 10 male); 6 with executive functions with non-clinical important modifications (G2 - 76.30±5.19 yrs old; 6 male). Executive tests were assessed using the Frontal Assessment Battery (FAB), which is a quick-applicable cognitive screening test (score<12 means impairment). The board game used in this study was the TATI Hand Game, specifically for training rhythmic coordination of the upper limbs with multiple cognitive stimuli. This game features 1 table grid, 1 set of Single Game cards (to play with one hand); Double Game cards (to play simultaneously with two hands); 1 dice to plan Single Game mode; cards to plan the Double Game mode; 1 bell; 2 cups. Each participant played 3 single game cards, and the following data were collected: (i) variability in time during board game challenges (SD); (ii) number of errors; (iii) execution speed (sec). G1 demonstrated: high variability in execution time during board game challenges (G1 – 13.0s vs G2- 0.5s); a higher number of errors (1.40 vs 0.67); higher execution velocity (607.80s vs 281.83s). These results demonstrated the potential of implementing board games as a functional assessment strategy in geriatric care. Future studies might include larger samples and statistical methodologies to find cut-off values for impairment in executive functions during performance in TATI game.

Keywords: board game, aging, executive function, evaluation

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Authors: Salimah Hasnah, Namratha Radhakrishnan

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Communities play a vital role in mobilizing people and resources for the benefit of all. Since time immemorial, communities have been spear heading different activities ranging from disaster management, palliative care, local economic development and many more with laudable success. Urban agriculture is one such activity where communities can prove to make a real difference. Farming activities in cities across different developed countries have proved to have favorable outcomes in the form of increased food security, neighborhood revitalization, health benefits and local economic growth. However, urban agriculture in the developing nations have never been prioritized as an important planning tool to cater to the basic needs of the public. Urban agricultural practices are being carried out in a fragmented fashion without a formal backing. The urban dwellers rely heavily on their far-off rural counterparts for daily food requirements. With the onset of the pandemic and the recurring lockdowns, the significance of geographic proximity and its impact on the availability of food to the public are gradually being realized around the globe. This warrants a need for localized food systems by shortening the distance between production and consumption of food. The significance of communities in realizing these urban farming benefits is explored in this paper. A case-study approach is adopted to understand how different communities have overcome barriers to urban farming in cities. The applicability of these practices is validated against the state of Kerala in India wherein different community centered approaches have been successful in the past. The existing barriers are assessed and way forward to achieve a self-sufficient localized food systems is formulated with the key lessons from the case studies. These recommendations will be helpful to successfully establish and sustain farming activities in urban areas by leveraging the power of communities.

Keywords: community-centric, COVID-19, drivers and barriers, local food system, urban agriculture

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