Search results for: outcomes that matter

Authors: Nicholas Bayfield, Liam Bibo, Kaushelandra Rathore, Lucas Sanders, Mark Newman

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INTRODUCTION: Surgical pulmonary embolectomy is an established therapy for acute pulmonary embolism causing right heart dysfunction and haemodynamic instability. Massive intraoperative airway haemorrhage is a rare complication of pulmonary embolectomy. We present our institutional experience with massive airway haemorrhage complicating pulmonary embolectomy and discuss optimal therapeutic strategies. METHODS: A retrospective review of emergent surgical pulmonary embolectomy patients was undertaken. Cases complicated by massive intra-operative airway haemorrhage were identified. Intra- and peri-operative management strategies were analysed and discussed. RESULTS: Of 76 patients undergoing emergent or salvage pulmonary embolectomy, three cases (3.9%) of massive intraoperative airway haemorrhage were identified. Haemorrhage always began on weaning from cardiopulmonary bypass. Successful management strategies involved intraoperative isolation of the side of bleeding, occluding the affected airway with an endobronchial blocker, institution of veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) and reversal of anticoagulation. Running the ECMO without heparinisation allows coagulation to occur. Airway haemorrhage was controlled within 24 hours of operation in all patients, allowing re-institution of dual lung ventilation and decannulation from ECMO. One case in which positive end-expiratory airway pressure was trialled initially was complicated by air embolism. Although airway haemorrhage was controlled successfully in all cases, all patients died in-hospital for reasons unrelated to the airway haemorrhage. CONCLUSION: Massive intraoperative airway haemorrhage during pulmonary embolectomy is a rare complication with potentially catastrophic outcomes. Re-perfusion alveolar and capillary injury is the likely aetiology. With a systematic approach to management, airway haemorrhage can be well controlled intra-operatively and often resolves within 24 hours. Stopping blood flow to the pulmonary arteries and support of oxygenation by the institution of VA ECMO is important. This management has been successful in our 3 cases.

Keywords: pulmonary embolectomy, cardiopulmonary bypass, cardiac surgery, pulmonary embolism

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Authors: N. A. D. P. Niwunhella, W. G. R. C. K. Sirisena

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Appendicitis is one of the most encountered abdominal emergencies worldwide. Proper clinical diagnosis and appendicectomy with minimal post operative complications are therefore priorities. Aim of this study was to ascertain the overall management of acute appendicitis in Sri Lanka in special preference to delayed primary suturing of the surgical site, comparing other local and international treatment outcomes. Data were collected prospectively from 155 patients who underwent appendicectomy following clinical and radiological diagnosis with ultrasonography. Histological assessment was done for all the specimens. All perforated appendices were managed with delayed primary closure. Patients were followed up for 28 days to assess complications. Mean age of patient presentation was 27 years; mean pre-operative waiting time following admission was 24 hours; average hospital stay was 72 hours; accuracy of clinical diagnosis of appendicitis as confirmed by histology was 87.1%; post operative wound infection rate was 8.3%, and among them 5% had perforated appendices; 4 patients had post operative complications managed without re-opening. There was no fistula formation or mortality reported. Current study was compared with previously published data: a comparison on management of acute appendicitis in Sri Lanka vs. United Kingdom (UK). The diagnosis of current study was equally accurate, but post operative complications were significantly reduced - (current study-9.6%, compared Sri Lankan study-16.4%; compared UK study-14.1%). During the recent years, there has been an exponential rise in the use of Computerised Tomography (CT) imaging in the assessment of patients with acute appendicitis. Even though, the diagnostic accuracy without using CT, and treatment outcome of acute appendicitis in this study match other local studies as well as with data compared to UK. Therefore CT usage has not increased the diagnostic accuracy of acute appendicitis significantly. Especially, delayed primary closure may have reduced post operative wound infection rate for ruptured appendices, therefore suggest this approach for further evaluation as a safer and an effective practice in other hospitals worldwide as well.

Keywords: acute appendicitis, computerised tomography, diagnostic accuracy, delayed primary closure

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Authors: Camila Freire Barrios, Gonzalo Rivera Talavera

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The importance of public spaces has been shown for many years, and in different disciplines, with one example being their ability for developing a sustainable social environment, especially in mega cities like Lima. The aim of this study was to explore the process of space appropriation that occurs in the Peripheral Library of the district El Agustino in Lima, Peru. Space appropriation is a process by which people develop a link with a place within a specific sociocultural context. This process has been related to positive outcomes, such as: participation and in the development of compassionate behaviors with these places. To achieve the purpose of the research, a qualitative design was selected because this will allowed exploring in deep the process in an specific context. The study interviewed six adults, all of whom were deliberately chosen to have the longest residence time in the district and also utilized the library the most. In a complementary manner, two children and one adolescent were interviewed. Likewise, two observations were made on a weekday and weekend, and public documentation information was collected. As a result, five categories linked to this process were identified. It was found that the process of space appropriation begins with the needs of the people who arrive at the library, which provides benefits to these people by fulfilling them. Next in the process, through the construction of meanings, the library is then valued as a pleasant, productive, safe and regulated place; as a result, people become identified with the library. The identification generated is subsequently reflected in the level of participation that the person has in the library, which may go in a continuum from no participating at all to a more direct involvement in the library activities, as well as voluntary and altruistic work. Finally, this process leads to the library becoming part of the neighborhood. This study allows having a better understanding of how sociospatial processes work in a Latinamerican context and in cities like Lima, where the third of the country’s population lives. Also, Lima has grown in the past 50 years in a excessively way and with lack of planification. Therefore, these results brings new research questions and highlights the importance of learning how to design public spaces in order to promote these processes to develop.

Keywords: bond with the place, place identity, public spaces, space appropriation

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Authors: Shabnam Abdi, Behzad Toosi

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Background: Melanoma is the most lethal type of malignant skin cancer in humans and dogs since it spreads rapidly throughout the body. Despite significant advances in treatment, cancer at an advanced stage has a poor prognosis. Hence, more effective treatments are needed to enhance outcomes with fewer side effects. Erythropoietin-producing hepatocellular receptors are the largest family of receptor tyrosine kinases and are divided into two subfamilies, EphA and EphB, both of which play a significant role in disease, especially cancer. Due to their association with proliferation and invasion in many aggressive types of cancer, Eph receptor tyrosine kinases (Eph RTKs) are promising cancer therapy molecules. Because these receptors have not been studied in canine melanoma, we investigated how EphA2 influences survival and tumorigenicity of melanoma cells. Methods: Expression of EphA2 protein in canine melanoma cell lines and human melanoma cell line was evaluated by Western blot. Melanoma cells were transduced with lentiviral particles encoding Eph-targeting shRNAs or non-silencing shRNAs (control) for silencing the expression of EphA2 receptor, and silencing was confirmed by Western blotting and immunofluorescence. The effect of siRNA treatment on cellular proliferation, colony formation, tumorsphere assay, invasion was analyzed by Resazurin assay Matrigel invasion assay, respectively. Results: Expression of EphA2 was detected in canine and human melanoma cell lines. Moreover, stably silencing EphA2 by specific shRNAs significantly and consistently decreased the expression of EphA2 protein in both human and canine melanoma cells. Proliferation, colony formation, tumorsphere and invasion of melanoma cells were significantly decreased in EphA2 siRNA-treated cells compared to control. Conclusion: Our data provide the first functional evidence that the EphA2 receptor plays a critical role in the malignant cellular behavior of melanoma in both human and dogs.

Keywords: ephA2, targeting, melanoma, human, canine

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Authors: Bolajoko I. Malomo, Maryam O. Yusuf

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Lagos urban mini-bus drivers play a critical role in the transportation sector. The current major mode of transportation within Lagos metropolis remains road transportation and this confirms the relevance of urban mini-bus drivers in transporting the populace to their various destinations. Other modes of transportation such as the train and waterways are currently inadequate. Various threats to the well-being of urban bus drivers include congested traffic typical of modern day lifestyles, dwindling financial returns due to long hours in traffic, fewer hours of sleep, inadequate diet, time pressure, and assaults related to fare disputes. Several health-related problems have been documented to be associated with urban bus driving. For instance, greater rates of hypertension, obesity and cholesterol level has been reported. Research studies are yet to identify the influence of age and marital status on the well-being of urban mini-bus drivers in Lagos metropolis. A study of this nature is necessary as it is culturally perceived in Nigeria that older and married people are especially influenced by family affiliation and would behave in ways that would project positive outcomes. The study sample consisted of 150 urban mini-bus drivers who were conveniently sampled from six (6) different terminuses where their journey begins and terminates. The well-being questionnaire was administered to participants. The criteria for inclusion in the study included the ability to read in English language and the confirmation that interested participants were on duty and suited to be driving mini-buses. Due to the nature of the job of bus driving, the researcher administered the questionnaires on participants who were free and willing to respond to the survey. All participants were males of various age groups and of different marital statuses. Results of analyses conducted revealed no significant influence of age and marital status on the well-being of urban mini-bus drivers. This indicates that the well-being of urban mini-bus drivers is not influenced by age nor marital status. The findings of this study have cultural implications. It negates the popularly held belief that older and married people care more about their well-being than younger and single people. It brings to fore the need to also identify and consider other factors when certifying people for the job of urban bus driving.

Keywords: age, Lagos metropolis, marital status, well-being of urban mini bus drivers

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Authors: Paulomi (Polly) Burey, Zoe Lynch

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In STEM education, students often have difficulty linking static images and words from textbooks or online resources, to the underlying mechanisms of the topic of study. This can often dissuade some students from pursuing study in the physical and chemical sciences. A growing movement in current day students demonstrates that the YouTube generation feel they learn best from video or dynamic, interactive learning tools, and will seek these out as alternatives to their textbooks and the classroom learning environment. Chemistry, and in particular visualization of molecular structures in everyday materials, can prove difficult to comprehend without significant interaction with the teacher of the content and concepts, beyond the timeframe of a typical class. This can cause a learning hurdle for distance education students, and so it is necessary to provide strong electronic tools and resources to aid their learning. As one of the electronic resources, an animation design approach to link everyday materials to their underlying chemistry would be beneficial for student learning, with the focus here being on food. These animations were designed and storyboarded with a scaling approach and commence with a focus on the food material itself and its component parts. This is followed by animated transitions to its underlying microstructure and identifying features, and finally showing the molecules responsible for these microstructural features. The animation ends with a reverse transition back through the molecular structure, microstructure, all the way back to the original food material, and also animates some reactions that may occur during food processing to demonstrate the purpose of the underlying chemistry and how it affects the food we eat. Using this cyclical approach of linking students’ existing knowledge of food to help guide them to understanding more complex knowledge, and then reinforcing their learning by linking back to their prior knowledge again, enhances student understanding. Food is also an ideal material system for students to interact with, in a hands-on manner to further reinforce their learning. These animations were launched this year in a 2nd year University Food Chemistry course with improved learning outcomes for the cohort.

Keywords: chemistry, food science, future pedagogy, STEM Education

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Authors: Krishna Dahiya, Esha Charaya

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Induction of labour is a common obstetrical intervention. Around 1 in every 4 patient undergo induction of labour for different indications Purpose: To study the efficacy of the combination of Foley bulb and vaginal misoprostol in comparison to vaginal misoprostol alone for cervical ripening and induction of labour. Methods: A prospective randomised study was conducted on 150 patients with term singleton pregnancy admitted for induction of labour. Seventy-five patients were induced with both Foley bulb, and vaginal misoprostol and another 75 were given vaginal misoprostol alone for induction of labour. Both groups were then compared with respect to change in Bishop score, induction to the active phase of labour interval, induction delivery interval, duration of labour, maternal complications and neonatal outcomes. Data was analysed using statistical software SPSS version 11.5. Tests with P,.05 were considered significant. Results: The two groups were comparable with respect to maternal age, parity, gestational age, indication for induction, and initial Bishop scores. Both groups had a significant change in Bishop score (2.99 ± 1.72 and 2.17 ± 1.48 respectively with statistically significant difference (p=0.001 S, 95% C.I. -0.1978 to 0.8378). Mean induction to delivery interval was significantly lower in the combination group (11.76 ± 5.89 hours) than misoprostol group (14.54 ± 7.32 hours). Difference was of 2.78 hours (p=0.018,S, 95% CI -5.1042 to -0.4558). Induction to delivery interval was significantly lower in nulliparous women of combination group (13.64 ± 5.75 hours) than misoprostol group (18.4±7.09 hours), and the difference was of 4.76 hours (p=0.002, S, 95% CI 1.0465 to 14.7335). There was no difference between the groups in the mode of delivery, infant weight, Apgar score and intrapartum complications. Conclusion: From the present study it was concluded that addition of Foley catheter to vaginal misoprostol have the synergistic effect and results in early cervical ripening and delivery. These results suggest that the combination may be used to achieve timely and safe delivery in the presence of an unfavorable cervix. A combination of the Foley bulb and vaginal misoprostol resulted in a shorter induction-to-delivery time when compared with vaginal misoprostol alone without increasing labor complications.

Keywords: Bishop score, Foley catheter, induction of labor, misoprostol

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Authors: Shanza Akram, Samir Salah, Imran Saleem, Ashraf Alzaabi, Jassim Abdou

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Introduction: 300 million people worldwide are affected by asthma .In UAE, prevalence is around 10% (900,000 people).Patients with persistent symptoms despite using high dose ICS plus a second controller +/- OCS are considered to have severe asthma. Omalizumab (Xolaire) an IgE monoclonal antibody is approved as add on therapy for severe allergic asthma. Objective: To determine the efficacy of omalizumab based on clinical outcomes in our cohort of patient pre and post 52 weeks of treatment to assess safety and tolerability of treatment. Methods: Medical records of patients receiving omalizumab therapy for asthma at ZMH ,Abu Dhabi were retrospectively analyzed.Patients fulfilling the criteria of severe allergic asthma as per GINA guidelines were included. Asthma control over 12 months prior to and 12 months after commencement of omalizumab therapy was analysed by taking into account the number of exacerbations and hospitalizations in addition to maintenance of medication dosages, need for rescue reliever therapy and pulmonary function testing. Results: Total cohort of 21 patient (5 females), average age 41 years and av length of therapy 22 months were included. Seven patients (total 11/52%) managed to stop steroids on treatment while four were able to decrease the dosage. Mean exacerbation rate decreased from five/ year pre treatment to 1.36 while on treatment. Number of hospitalizations decreased from mean of two per year to 0.9 per year. Rescue reliever inhaler usage decreased from mean of 40 puffs to 15 puffs per week. 2 patients discontinued therapy, 1 due to lack of benefit (2 doses) and 2nd due to severe persistent side effects including local irritation, severe limb and joint pains after 6 months. Conclusion: Treatment with omalizumab showed effect in terms of reduced number of exacerbations, maintenance therapy and reliever medications. However, no improvement was seen in PFTs.There is room for improved documentation in terms of symptom recording and use of rescue medicationas as well as for better patient education and counselling in order to improve compliance.

Keywords: asthma, omalizumab, severe allergic asthma, UAE

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Authors: Aschenaki Zerihun Kea, Bernt Lindtjorn, Achamyelesh Gebretsadik, Sven Gudmund Hinderaker

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Introduction: Maternal mortality studies conducted at the national level do not provide the information needed for planning and monitoring health programs at lower administrative levels. The aim of this study was to measure maternal mortality, identify risk factors and district-level variations in Sidama National Regional State, southern Ethiopia. Methods: A cross sectional population-based survey was carried out in households where women reported pregnancy and birth outcomes in the past five years. The study was conducted in the Sidama National Regional State, southern Ethiopia, from July 2019 to May 2020. Multi-stage cluster sampling technique was employed. The outcome variable of the study was maternal mortality. Complex sample logistic regression analysis was applied to assess variables independently associated with maternal mortality. Results: We registered 10602 live births (LB) and 48 maternal deaths, yielding an overall maternal mortality ratio (MMR) of 419; 95% CI: 260-577 per 100,000 LB. Aroresa district had the highest MMR with 1142 (95% CI: 693-1591) per 100,000 LB. Leading causes of death were haemorrhage 21 (41%) and eclampsia 10 (27%). Thirty (59%) mothers died during labour, or within 24 hours after delivery, 25 (47%) died at home and 17 (38%) at a health facility. Mothers who did not have formal education had a higher risk of maternal death (AOR: 4.4; 95% CI: 1.7 – 11.0). The risk of maternal death was higher in districts with a low midwife-to-population ratio (AOR: 2.9; 95% CI: 1.0-8.9). Conclusion: The high maternal mortality with district-level variations in Sidama Region highlights the importance of improving obstetric care and employing targeted interventions in areas with high mortality rates. Due attention should be given to improving access to female education. Additional midwives have to be trained and deployed to improve maternal health services and consequently save the lives of mothers.

Keywords: maternal mortality variation, maternal death, Sidama, Ethiopia

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Authors: Journey Whitfield

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This study investigates the United States' ongoing violation of Black Americans' fundamental human rights, as evidenced by mass incarceration, social injustice, and economic deprivation. It argues that the U.S. contravenes Article 9 of the International Covenant on Civil and Political Rights through policies that uphold systemic racism. The analysis dissects current practices within the criminal justice system, social welfare programs, and economic policy, uncovering the racially disparate impacts of seemingly race-neutral policies. This study establishes a clear lineage between past systems of oppression – slavery and Jim Crow – and present-day racial disparities, demonstrating their inextricable link. The thesis proposes that only a comprehensive reparations program for Black Americans can begin to redress these systemic injustices. This program must transcend mere financial compensation, demanding structural reforms within U.S. institutions to dismantle systemic racism and promote transformative justice. This study explores potential forms of reparations, drawing upon historical precedents, comparative case studies from other nations, and contemporary debates within political philosophy and legal studies. The research employs both qualitative and quantitative methods. Qualitative methods include historical analysis of legal frameworks and policy documents, as well as discourse analysis of political rhetoric. Quantitative methods involve statistical analysis of socioeconomic data and criminal justice outcomes to expose racial disparities. This study makes a significant contribution to the existing literature on reparations, human rights, and racial injustice in the United States. It offers a rigorous analysis of the enduring consequences of historical oppression and advocates for bold, justice-centered solutions.

Keywords: Black Americans, reparations, mass incarceration, racial injustice, human rights, united states

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Authors: A. Giannakopoulos, S. B. Buckley

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Problem solving in any field is recognised as a prerequisite for any advancement in knowledge. For example in South Africa it is one of the seven critical outcomes of education together with critical thinking. As a systematic way to problem solving was initiated in mathematics by the great mathematician George Polya (the father of problem solving), more detailed and comprehensive ways in problem solving have been developed. This paper is based on the findings by the author and subsequent recommendations for further research in problem solving and critical thinking. Although the study was done in mathematics, there is no doubt by now in almost anyone’s mind that mathematics is involved to a greater or a lesser extent in all fields, from symbols, to variables, to equations, to logic, to critical thinking. Therefore it stands to reason that mathematical principles and learning cannot be divorced from any field. In management of knowledge situations, the types of problems are similar to mathematics problems varying from simple to analogical to complex; from well-structured to ill-structured problems. While simple problems could be solved by employees by adhering to prescribed sequential steps (the process), analogical and complex problems cannot be proceduralised and that diminishes the capacity of the organisation of knowledge creation and innovation. The low efficiency in some organisations and the low pass rates in mathematics prompted the author to view problem solving as a product. The authors argue that using mathematical approaches to knowledge management problem solving and treating problem solving as a product will empower the employee through further training to tackle analogical and complex problems. The question the authors asked was: If it is true that problem solving and critical thinking are indeed basic skills necessary for advancement of knowledge why is there so little literature of knowledge management (KM) about them and how they are connected and advance KM?This paper concludes with a conceptual model which is based on general accepted principles of knowledge acquisition (developing a learning organisation), knowledge creation, sharing, disseminating and storing thereof, the five pillars of knowledge management (KM). This model, also expands on Gray’s framework on KM practices and problem solving and opens the doors to a new approach to training employees in general and domain specific areas problems which can be adapted in any type of organisation.

Keywords: critical thinking, knowledge management, mathematics, problem solving

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Authors: Mehar Fatima

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This study intends to make analysis of Emotional Intelligence (EI) in the process of pedagogy and look into its repercussions in different educational institutions including school, college, and university in the capital state of India, Delhi in 2015. Field of education is a complex area with challenging issues in a modern society. Education is the breeding ground for nurturing human souls, and personalities. Since antiquity, man has been in search of truth, wisdom, contentment, peace. His efforts have brought him to acquire these through hardship, evidently through the process of teaching and learning. Computer aids and artificial intelligence have made life easy but complex. Efficient pedagogy involves direct human intervention despite the flux of technological advancements. Time and again, pedagogical practices demand sincere human efforts to understand and improve upon life’s many pragmatic concerns. Apart from the intense academic scientific approaches, EI in academia plays a vital role in the growth of education, positively achieving national progression; ‘pedagogy of pragmatic purpose.’ Use of literature is found to be one of the valuable pragmatic tools of Emotional Intelligence. This research examines the way literature provides useful influence in building better practices in teaching-learning process. The present project also scrutinizes various pieces of world literature and translation, incorporating efforts of intellectuals in promoting comprehensive amity. The importance of EI in educational arena with its pragmatic uses was established by the study of interviews, and questionnaire collected from teachers and students. In summary the analysis of obtained empirical data makes it possible to accomplish that the use Emotional Intelligence in academic scenario yields multisided positive pragmatic outcomes; positive attitude, constructive aptitude, value-added learning, enthusiastic participation, creative thinking, lower apprehension, diminished fear, leading to individual as well as collective advancement, progress, and growth of pedagogical agents.

Keywords: emotional intelligence, human efforts, pedagogy, pragmatic concerns

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Authors: Stephanie Ducrot, Marie Vernet, Eve Meiss, Yves Chaix

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Learning to read is a key topic of debate today, both in terms of its implications on school failure and illiteracy and regarding what are the best teaching methods to develop. It is estimated today that four to six percent of school-age children suffer from specific developmental disorders that impair learning. The findings from people with dyslexia and typically developing readers suggest that the problems children experience in learning to read are related to the preliteracy skills that they bring with them from kindergarten. Most tools available to professionals are designed for the evaluation of child language problems. In comparison, there are very few tools for assessing the relations between visual skills and the process of learning to read. Recent literature reports that visual-motor skills and visual-spatial attention in preschoolers are important predictors of reading development — the main goal of this study aimed at improving screening for future reading difficulties in preschool children. We used a prospective, longitudinal approach where oculomotor processes (assessed with the DiagLECT test) were measured in pre-readers, and the impact of these skills on future reading development was explored. The dialect test specifically measures the online time taken to name numbers arranged irregularly in horizontal rows (horizontal time, HT), and the time taken to name numbers arranged in vertical columns (vertical time, VT). A total of 131 preschoolers took part in this study. At Time 0 (kindergarten), the mean VT, HT, errors were recorded. One year later, at Time 1, the reading level of the same children was evaluated. Firstly, this study allowed us to provide normative data for a standardized evaluation of the oculomotor skills in 5- and 6-year-old children. The data also revealed that 25% of our sample of preschoolers showed oculomotor impairments (without any clinical complaints). Finally, the results of this study assessed the validity of the DiagLECT test for predicting reading outcomes; the better a child's oculomotor skills are, the better his/her reading abilities will be.

Keywords: vision, attention, oculomotor processes, reading, preschoolers

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Authors: Mirjana Ilic, Dragan Zivotic, Aleksandra Perovic, Predrag Gavrilovic

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The service quality perception depends on many factors, such as the area in which the services are provided, socioeconomic status, educational status, experience, age and gender of consumers, as well as many others. For this reason, it is not possible to apply instrument for establishing the service quality perception that is developed in other areas and in other populations. The aim of the research was to form an instrument for assessing the quality perception in the field of fitness in Serbia. After analyzing the available literature and conducting a pilot research, there were 15 isolated areas in which it was possible to observe the service quality perception. The areas included: material and technical basis, secondary facilities, coaches, programs, reliability, credibility, security, rapid response, compassion, communication, prices, satisfaction, loyalty, quality outcomes and motives. These areas were covered by a questionnaire consisted of 100 items where the number of items varied from area to area from 3 up to 11. The questionnaire was administered to 350 subjects of both genders (174 men and 176 women) aged from 18 to 68 years, being beneficiaries of fitness services for at least 1 year. In each of the areas was conducted a factor analysis in its exploratory form by principal components method. The number of significant factors has been determined in accordance with the Kaiser Guttman criterion. The initial factor solutions were simplified using the Varimax rotation. Analyses per areas have produced from 1 to 4 factors. Afterward, the factor analysis of factor scores on the first principal component of each of the respondents in each of the analyzed area was performed, and the factor structure was obtained with four latent dimensions interpreted as offer, the relationship with the coaches, the experience of quality and the initial impression. This factor structure was analysed by hierarchical analysis of Oblique factors, which in the second order space produced single factor interpreted as a general factor of the service quality perception. The resulting questionnaire represents an instrument which can serve managers in the field of fitness to optimize the centers development, raising the quality of services in line with consumers needs and expectations.

Keywords: fitness, hierarchical model, quality perception, factor analysis

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Authors: Pothula Madhusudhan Reddy

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Introduction: Yoga is a way of life. of uniting the mind, body and soul. It is also an art of living the right way. The techniques of Yoga are very practical, so they can always be applied. This is the reason why Yoga has been practiced for thousands of years and is still valid today. Importance of Yoga: Yoga that helps to inculcate healthy habits and adopt a healthy lifestyle to achieve good health Research Aim: The aim of this study is to explore the potential benefits of yoga for holistic health and wellbeing, both at an individual and societal level The ultimate goal of human being is to attain the state of perfect freedom from the shackles of ignorance, which is the generator of all the pangs and miseries of life. Methodology: This research follows a thematic and practical experience approach. Yoga includes body postures and movements (stretching), breathing practices, imagery, meditation, and progressive relaxation techniques. Data Collection: The data for this research is collected through a combination of literature review, expert interviews, and practical yoga sessions. The literature review provides a comprehensive understanding of the principles and practices of yoga, while expert interviews offer insights from experienced practitioners. Practical yoga sessions allow for first hand experiences and observations, facilitating a deeper understanding of the subject matter. Analysis Procedures: The collected data is analyzed thematically, where key themes and patterns related to the benefits and effects of yoga on holistic health and wellbeing are identified. The findings are then interpreted and synthesized to draw meaningful conclusions. Questions Addressed: This research addresses the following questions: What are the potential benefits of yoga for holistic health and wellbeing? How does yoga promote rejuvenate the body, mind, and senses? What are the implications of a society embracing yoga for overall societal wellbeing and happiness? Findings: The research highlights that practicing yoga can lead to increased awareness of the body, mind, and senses. It promotes overall physical and mental health, helping individuals achieve a state of happiness and contentment. Moreover, the study emphasizes that a society embracing yoga can contribute to the development of a healthy and happy community. Theoretical Importance: The study of yoga for holistic health and wellbeing holds theoretical importance as it provides insights into the science of yoga and its impact on individuals and society. It contributes to the existing body of knowledge on the subject and further establishes yoga as a potential tool for enhancing overall wellness. Conclusion: The study concludes that yoga is a powerful practice for achieving holistic health and wellbeing. This research provides valuable insights into the science of yoga and its potential as a tool for promoting overall wellness.

Keywords: yoga, asana, pranayama, meditation

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Authors: Ghassan Kbar, Shady Aly, Ibrahim Alsharawy, Akshay Bhatia, Nur Alhasan, Ronaldo Enriquez

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The Smart Help for persons with disability (PWD) is a part of the project SMARTDISABLE which aims to develop relevant solution for PWD that target to provide an adequate workplace environment for them. It would support PWD needs smartly through smart help to allow them access to relevant information and communicate with other effectively and flexibly, and smart editor that assist them in their daily work. It will assist PWD in knowledge processing and creation as well as being able to be productive at the work place. The technical work of the project involves design of a technological scenario for the Ambient Intelligence (AmI) - based assistive technologies at the workplace consisting of an integrated universal smart solution that suits many different impairment conditions and will be designed to empower the Physically disabled persons (PDP) with the capability to access and effectively utilize the ICTs in order to execute knowledge rich working tasks with minimum efforts and with sufficient comfort level. The proposed technology solution for PWD will support voice recognition along with normal keyboard and mouse to control the smart help and smart editor with dynamic auto display interface that satisfies the requirements for different PWD group. In addition, a smart help will provide intelligent intervention based on the behavior of PWD to guide them and warn them about possible misbehavior. PWD can communicate with others using Voice over IP controlled by voice recognition. Moreover, Auto Emergency Help Response would be supported to assist PWD in case of emergency. This proposed technology solution intended to make PWD very effective at the work environment and flexible using voice to conduct their tasks at the work environment. The proposed solution aims to provide favorable outcomes that assist PWD at the work place, with the opportunity to participate in PWD assistive technology innovation market which is still small and rapidly growing as well as upgrading their quality of life to become similar to the normal people at the workplace. Finally, the proposed smart help solution is applicable in all workplace setting, including offices, manufacturing, hospital, etc.

Keywords: ambient intelligence, ICT, persons with disability PWD, smart application, SHW

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Authors: Mahdi Taheri Asl

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Using a variety of strategies to read text plays an important role to make students strategic independent, strategic, and metacognitive readers. Given the importance of comprehension instruction (CI), it is essential to support the fostering comprehension skills at elementary age students, particularly those who struggle with or dislike reading. One of the main components of CI is activating metacognitive skills, which double function of elementary students. Thus, it’s important to evaluate the implemented comprehension interventions to inform reading specialist and teachers. There has been limited review research in the area of CI, so the conduction review research is required. The purpose of this review is to examine the effectiveness of metacognitive reading strategies in a regular classroom environment with elementary aged students. We develop five inclusion criteria to identify researches relevant to our research. First, the article had to be published in a peer-reviewed journal from 2000 to 2023. second, the study had to include participants in elementary school it could include of special education students. Third, the intervention needed to be involved with metacognitive strategies. Fourth, the articles had to use experimental or quasi experimental design. The last one needed to include measurement of reading performance in pre and post intervention. We used computer data-based site like Eric, PsychoINFO, and google scholar to search for articles that met these criteria. we used the following search terms: comprehension instruction, meta cognitive strategies, and elementary school. The next step was to do an ancestral search that get in reviewing the relevant studies cited in the articles that were found in the database search. We identified 30studies in the initial searches. After coding agreement, we synthesized 13 with respect to the participant, setting, research design, dependent variables, measures, the intervention used by instructors, and general outcomes. The finding show metacognitive strategies were effective to empower student’s comprehension skills. It also showed that linguistic instruction will be effective if got mixed with metacognitive strategies. The research provides a useful view into reading intervention. Despite the positive effect of metacognitive instruction on students’ comprehension skills, it is not widely used in classroom.

Keywords: comprehension instruction, metacogntion, metacognitive skills, reading intervention

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Authors: Xinrui Zhao

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Connective actions acquired a completely different outlook of a social movement which credited with the rapid developed of social media technologies. New social movements amalgamate and mobilize around hashtags, memes, and personalized action frames. In 2017, the #MeToo movements from America spread to a variety of countries as a hashtag on social media. It attempted to demonstrate the widespread prevalence of sexual assault and harassment movement. It also encouraged Chinese women to participate by devoting and contributing their voices and acts. Furthermore, China’s #MeToo movement shows certain characteristics which are strongly shaped by particular political and cultural backgrounds, that also need to be studied. This paper serves as supplementary materials of connective action studies by addressing the #MeToo movement issues in China, which is rarely mentioned previously in the literature, it also supports a view that suggests that ideological and cultural drivers both strategically contribute to personalized action frames. This paper combines textual analysis methods, collecting attached materials from search engines in China’s social media, portrays the structure of China’s #MeToo movements by showing prominent activists, scholars, organization and the public’s action frame in China’s social media(Weibo, wechat, zhihu, douban). In doing so, it seeks to find how China’s #MeToo movements are organized and reveal diversities of social action approaches among those three subjects, digs out the correlations of their actions related to different social media platforms. This analysis suggests that while facing the government's censorship and moral judgments from the public, China’s #MeToo movement combines with few influential sexual assault and harassment events and is lead by the prominent activists who also are the victims in the events. The debates and critiques among Chinese scholars concerned the outcomes and significance of China’s #MeToo movement are divided into sides. Organizations still show less power in participating China’s movement social media. Public’s participation is varied of platforms which hugely affected by their personal experiences and knowledge.

Keywords: connective action, China, MeToo movement, social media

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Authors: Hafizah Harun, Habibah Harun, Azlina Kamaruddin

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Virtual reality has become a powerful and promising tool in education because of their unique technological characteristics that differentiate them from the other ICT applications. Despite the numerous interpretations of its definition, virtual reality can be concisely and precisely described as the integration of computer graphics and various input and display technologies to create the illusion of immersion in a computer generated reality. Generally, there are two major types based on the level of interaction and immersive environment that are immersive and non-immersive virtual reality. In the study of the role of virtual reality in built environment education, Horne and Thompson were reported as saying that the benefits of using visualization technologies were seen as having the potential to improve and extend the learning process, increase student motivation and awareness, and add to the diversity of teaching methods. Youngblut reported that students enjoy working with virtual worlds and this experience can be highly motivating. The impact of virtual reality on youth learning in Malaysia is currently not well explored because the technology is still not widely used here. Only a handful of the universities, such as University Malaya, MMU, and Unimas are applying virtual reality strategy in some of their undergraduate programs. From the literature, it has been identified that there are several virtual reality learning strategies currently available. Therefore, this study aims to investigate the impact of Virtual Reality strategy on Youth Learning Motivation in Malaysian higher learning institutions. We will explore the relationship between virtual reality (gaming, laboratory, simulation) and youth leaning motivation. Another aspect that we will explore is the framework for virtual reality implementation at higher learning institution in Malaysia. This study will be carried out quantitatively by distributing questionnaires to respondents from sample universities. Data analysis are descriptive and multiple regression. Researcher will carry out a pilot test prior to distributing the questionnaires to 300 undergraduate students who are undergoing their courses in virtual reality environment. The respondents come from two universities, MMU CyberJaya and University Malaya. The expected outcomes from this study are the identification of which virtual reality strategy has most impact on students’ motivation in learning and a proposed framework of virtual reality implementation at higher learning.

Keywords: virtual reality, learning strategy, youth learning, motivation

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Authors: Mmatladi D. Mnguni, Mustapha Mohammed, George Y. Mahama, Alhassan L. Abdulai, Felix D. Dakora

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Industrial-based nitrogen (N) fertilizers are justifiably credited for the current state of food production across the globe, but their continued use is not sustainable and has an adverse effect on the environment. The search for greener and sustainable technologies has led to an increase in exploiting biological systems such as legumes and organic amendments for plant growth promotion in cropping systems. Although the benefits of legume rotation with cereal crops have been documented, the full benefits of soybean-sorghum rotation systems have not been properly evaluated in Africa. This study explored the benefits of soybean-sorghum rotation through assessing N₂ fixation and water-use efficiency of soybean in rotation with sorghum with and without organic and inorganic amendments. The field trials were conducted from 2017 to 2020. Sorghum was grown on plots previously cultivated to soybean and vice versa. The succeeding sorghum crop received fertilizer amendments [organic fertilizer (5 tons/ha as poultry litter, OF); inorganic fertilizer (80N-60P-60K) IF; organic + inorganic fertilizer (OF+IF); half organic + inorganic fertilizer (HIF+OF); organic + half inorganic fertilizer (OF+HIF); half organic + half inorganic (HOF+HIF) and control] and was arranged in a randomized complete block design. The soybean crop succeeding fertilized sorghum received a blanket application of triple superphosphate at 26 kg P ha⁻¹. Nitrogen fixation and water-use efficiency were respectively assessed at the flowering stage using the ¹⁵N and ¹³C natural abundance techniques. The results showed that the shoot dry matter of soybean plants supplied with HOF+HIF was much higher (43.20 g plant-1), followed by OF+HIF (36.45 g plant⁻¹), and HOF+IF (33.50 g plant⁻¹). Shoot N concentration ranged from 1.60 to 1.66%, and total N content from 339 to 691 mg N plant⁻¹. The δ¹⁵N values of soybean shoots ranged from -1.17‰ to -0.64‰, with plants growing on plots previously treated to HOF+HIF exhibiting much higher δ¹⁵N values, and hence lower percent N derived from N₂ fixation (%Ndfa). Shoot %Ndfa values varied from 70 to 82%. The high %Ndfa values obtained in this study suggest that the previous year’s organic and inorganic fertilizer amendments to sorghum did not inhibit N₂ fixation in the following soybean crop. The amount of N-fixed by soybean ranged from 106 to 197 kg N ha⁻¹. The treatments showed marked variations in carbon (C) content, with HOF+HIF treatment recording the highest C content. Although water-use efficiency varied from -29.32‰ to -27.85‰, shoot water-use efficiency, C concentration, and C:N ratio were not altered by previous fertilizer application to sorghum. This study provides strong evidence that previous HOF+HIF sorghum residues can enhance N nutrition and water-use efficiency in nodulated soybean.

Keywords: ¹³C and ¹⁵N natural abundance, N-fixed, organic and inorganic fertilizer amendments, shoot %Ndfa

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Authors: Azizul Baten, Kamrul Hossain, Abdullah-Al-Zabir

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The objective of this study is to develop an appropriate stochastic frontier secondary schools efficiency model by ICT Intervention and to examine the impact of ICT challenges on secondary schools efficiency in the Sylhet division in Bangladesh using stochastic frontier analysis. The Translog stochastic frontier model was found an appropriate than the Cobb-Douglas model in secondary schools efficiency by ICT Intervention. Based on the results of the Cobb-Douglas model, it is found that the coefficient of the number of teachers, the number of students, and teaching ability had a positive effect on increasing the level of efficiency. It indicated that these are related to technical efficiency. In the case of inefficiency effects for both Cobb-Douglas and Translog models, the coefficient of the ICT lab decreased secondary school inefficiency, but the online class in school was found to increase the level of inefficiency. The coefficients of teacher’s preference for ICT tools like multimedia projectors played a contributor role in decreasing the secondary school inefficiency in the Sylhet division of Bangladesh. The interaction effects of the number of teachers and the classrooms, and the number of students and the number of classrooms, the number of students and teaching ability, and the classrooms and teaching ability of the teachers were recorded with the positive values and these have a positive impact on increasing the secondary school efficiency. The overall mean efficiency of urban secondary schools was found at 84.66% for the Translog model, while it was 83.63% for the Cobb-Douglas model. The overall mean efficiency of rural secondary schools was found at 80.98% for the Translog model, while it was 81.24% for the Cobb-Douglas model. So, the urban secondary schools performed better than the rural secondary schools in the Sylhet division. It is observed from the results of the Tobit model that the teacher-student ratio had a positive influence on secondary school efficiency. The teaching experiences of those who have 1 to 5 years and 10 years above, MPO type school, conventional teaching method have had a negative and significant influence on secondary school efficiency. The estimated value of σ-square (0.0625) was different from Zero, indicating a good fit. The value of γ (0.9872) was recorded as positive and it can be interpreted as follows: 98.72 percent of random variation around in secondary school outcomes due to inefficiency.

Keywords: efficiency, secondary schools, ICT, stochastic frontier analysis

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Authors: Leonore Robieux, Franck Zenasni, Marc Pocard, Clarisse Eveno

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Empirical data in health psychology studies show the necessity to consider the doctor-patient communication and its positive impact on outcomes such as patients’ satisfaction, treatment adherence, physical and psychological wellbeing. In this line, the present research aims to define the role and determinants of an effective doctor–patient communication during the treatment of patients with serious illness (peritoneal carcinomatosis). We carried out a prospective longitudinal study including patients treated for peritoneal carcinomatosis of various origins. From November 2016, to date, data were collected using validated questionnaires at two times of evaluation: one month before the surgery (T0) and one month after (T1). Thus, patients reported their (a) anxiety and depression levels, (b) standardized and individualized quality of life and (c) how they perceived communication, attitude and empathy of the surgeon. 105 volunteer patients (Mean age = 58.18 years, SD = 10.24, 62.2% female) participated to the study. PC arose from rare diseases (14%), colorectal (38%), eso-gastric (24%) and ovarian (8%) cancer. Three groups are defined according to the severity of their pathology and the treatment offered to them: (1) important surgical treatment with the goal of healing (53%), (2) repeated palliative surgical treatment (17%), and (3) the patients recused for surgical treatment, only palliative approach (30%). Results are presented according to Baron and Kenny recommendations. The regressions analyses show that only depression and anxiety are sensitive to the communication and empathy of surgeon. The main results show that a good communication and high level of empathy at T0 and T1 limit depression and anxiety of the patients in T1. Results also indicate that the severity of the disease modulates this positive impact of communication: better is the communication the less are the level of depression and anxiety of the patients. This effect is higher for patients treated for the more severe disease. These results confirm that, even in the case severe disease a good communication between patient and physician remains a significant factor in promoting the well-being of patients. More specific training need to be developed to promote empathic care.

Keywords: clinical empathy, determinants, healthcare, psychological wellbeing

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Authors: Rania Hanafi Mahmoud Said, Rasha Mohamed Taha

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Background: A recent study has explored the potential of an approach to treating infected root canals using a combination of Mineral Trioxide Aggregate (MTA) and Tetracycline-loaded Nanochitosan. Material and methods: Forty dogs were included in the study, with infected periapical areas induced by leaving access openings in their teeth for four months. Bacteriological samples from the infected root canals were collected and managed anaerobically to identify and count the different microorganisms present. The most common microorganisms detected were Prevotella oris, Fusobacterium nucleatum, Streptococcus viridans, Enterococcus faecalis, Clostridium subterminale, Porphyromonas gingivalis, and Peptostreptococcus anaerobius. The dogs were divided into four groups based on the sealant used to treat the infected periapical areas: Group I: Negative control (no treatment) Group II: Positive control (MTA only) Group III: MTA + tetracycline Group IV: MTA + tetracycline loaded on nanochitosan Results: Periapical areas in Group IV showed significantly more bone healing than those in Groups I, II, and III. The newly formed bone was evaluated radiographically, histologically, and immunohistochemically using Osteopontin (OSP) antibodies. Data collected was statistically analysed using SPSS software at a 0.05 significance level. Conclusion: The study concluded that the combined use of Tetracycline-loaded Nanochitosan and MTA presents a promising approach for the treatment of infected root canals. The potent antimicrobial activity of Tetracycline-loaded Nanochitosan, along with the biocompatibility and desirable properties of MTA, may synergistically contribute to improved clinical outcomes in endodontic therapy. This study has important implications for the clinical management of infected root canals. The combination of Tetracycline-loaded Nanochitosan and MTA could provide a more effective and efficient means of treating these challenging cases. Further research is needed to confirm these findings in humans and to optimize the treatment protocol.

Keywords: mineral trioxide aggregate, tetracycline-loaded nanochitosan, periapical infection, osteopontine

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Authors: Emily Warren

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Despite the growing body of research on Japanese food history, little has been written about the attitudes and perspectives premodern Japanese people held about their food, even on special celebratory days. In fact, the overall image that arises from the literature is one of ambivalence: that the medieval nobility of the Heian and Kamakura periods (795-1333) did not much care about what they ate and for that reason, food seems relatively scarce in certain historical records. This study challenges this perspective by analyzing the manuals written to guide palace management and feast preparation for royals, introducing two of the sources into English for the first time. This research is primarily based on three manuals that address different aspects of royal food culture and preparation. The Chujiruiki, or Record of the Palace Kitchens (1295), is a fragmentary manual written by a bureaucrat in charge of the main palace kitchen office. This document collection details the utensils, furnishing, and courses that officials organized for the royals’ two daily meals in the morning (asagarei gozen) and in the afternoon (hiru gozen) when they enjoyed seven courses, each one carefully cooked and plated. The orchestration of daily meals and frequent banquets would have been complicated affairs for those preparing the tableware and food, thus requiring texts like the Chûjiruiki, as well as another manual, the Nicchûgyôji (11th c.), or The Daily Functions. Because of the complex coordination between various kitchen-related bureaucratic offices, kitchen officials endeavored to standardize the menus and place settings depending on the time of year, religious abstinence days, and available ingredients flowing into the capital as taxes. For the most important annual banquets and rites celebrating deities and the royal family, kitchen officials would likely refer to the Engi Shiki (927), or Protocols of the Engi Era, for details on offerings, servant payments, and menus. This study proposes that many of the great feast events, and indeed even daily meals at the palace, were so standardized and carefully planned for repetition that there would have been little need for the contents of such feasts to be detailed in diaries or novels—places where historians have noted a lack of the mention of food descriptions. These descriptions were not included for lack of interest on the part of the nobility, but rather because knowledge of what would be served at banquets and feasts would be considered a matter-of-course in the same way that a modern American would likely not need to state the menu of a traditional Thanksgiving meal to an American audience. Where food was concerned, novelty more so than tradition prompted a response in personal records, like diaries.

Keywords: banquets, bureaucracy, Engi shiki, Japanese food

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Authors: Tess Howard, Lily Owens, Maneesha De Silva, Russell Hodgson

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Purpose: This study aims to evaluate the cost-effectiveness of laparoscopic common bile duct exploration (CBDE) compared to endoscopic retrograde cholangiopancreatography (ERCP) and cholecystectomy for the emergency management of common bile duct (CBD) stones. Methodology: A retrospective case note review was conducted on consecutive patients undergoing emergency management of CBD stones using either CBDE, or ERCP and cholecystectomy at a single centre between January 2014-October 2014. Data on admission and procedural costs, length of hospital stay, postoperative complications and further stone related interventions were analysed. Results: A total of 350 patients were analysed. Among them, 299 patients underwent CBDE at the time of cholecystectomy, while the remaining 51 underwent ERCP either pre-, intra- or post cholecystectomy. CBDE was associated with lower overall costs compared to ERCP with an average hospital stay cost of $13,093 vs $22,930 respectively. This was largely attributed to shorter hospital stays (6.5 vs 10.3 days), decreased need for intensive care unit admission and fewer postoperative interventions within the CBDE group. Notably, single procedure laparoscopic cholecystectomy with CBDE demonstrated decreased operative costs compared to laparoscopic cholecystectomy combined with ERCP pre-/intra- or post-operatively ($3,747 vs. $4,641). Conclusion: Emergent CBDE is a cost-effective alternative to ERCP for managing CBD stones when combined with cholecystectomy. The upfront investment in equipment for CBDE and increased cholecystectomy procedural time is counterbalanced by reduced hospital stay, fewer procedures and subsequent cost savings. Economic considerations, in conjunction with clinical outcomes, should inform the selection of the optimal approach for CBD stone management in emergency settings.

Keywords: choledocolithiasis, management, cost-effectiveness, endoscopic retrograde cholangiopancreatography, ERCP, CBDE, common bile duct exploration

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Authors: Forouzan Salehi Fergeni

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Converting the movement intents of a person into commands for action employing brain signals like electroencephalogram signals is a brain-computer interface (BCI) system. When left or right-hand motions are imagined, different patterns of brain activity appear, which can be employed as BCI signals for control. To make better the brain-computer interface (BCI) structures, effective and accurate techniques for increasing the classifying precision of motor imagery (MI) based on electroencephalography (EEG) are greatly needed. Subject dependency and non-stationary are two features of EEG signals. So, EEG signals must be effectively processed before being used in BCI applications. In the present study, after applying an 8 to 30 band-pass filter, a car spatial filter is rendered for the purpose of denoising, and then, a method of analysis of variance is used to select more appropriate and informative channels from a category of a large number of different channels. After ordering channels based on their efficiencies, a sequential forward channel selection is employed to choose just a few reliable ones. Features from two domains of time and wavelet are extracted and shortlisted with the help of a statistical technique, namely the t-test. Finally, the selected features are classified with different machine learning and neural network classifiers being k-nearest neighbor, Probabilistic neural network, support-vector-machine, Extreme learning machine, decision tree, Multi-layer perceptron, and linear discriminant analysis with the purpose of comparing their performance in this application. Utilizing a ten-fold cross-validation approach, tests are performed on a motor imagery dataset found in the BCI competition III. Outcomes demonstrated that the SVM classifier got the greatest classification precision of 97% when compared to the other available approaches. The entire investigative findings confirm that the suggested framework is reliable and computationally effective for the construction of BCI systems and surpasses the existing methods.

Keywords: brain-computer interface, channel selection, motor imagery, support-vector-machine

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Authors: Madhavi-Priya Singh, Liam Lowe, Farouk Arnaout, Ludmilla Pillay, Giordan Perez, Luke Mischker, Steve Costa

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Introduction: An Emergency Department consultant identified the failure of medical students to complete the task of clerking a patient in its entirety. As six medical students on our first clinical placement, we recognised our own failure and endeavored to examine why this failure was consistent among all medical students that had been given this task, despite our best motivations as adult learners. Aim: Our aim is to understand and investigate the elements which impeded our ability to learn and perform as medical students in the clinical environment, with reference to the prescribed task. We also aim to generate a discussion around the delivery of medical education with potential solutions to these barriers. Methods: Six medical students gathered together to have a comprehensive reflective discussion to identify possible factors leading to the failure of the task. First, we thoroughly analysed the delivery of the instructions with reference to the literature to identify potential flaws. We then examined personal, social, ethical, and cultural factors which may have impacted our ability to complete the task in its entirety. Results: Through collation of our shared experiences, with support from discussion in the field of medical education and ethics, we identified two major areas that impacted our ability to complete the set task. First, we experienced an ethical conflict where we believed the inconvenience and potential harm inflicted on patients did not justify the positive impact the patient interaction would have on our medical learning. Second, we identified a lack of confidence stemming from multiple factors, including the conflict between preclinical and clinical learning, perceptions of perfectionism in the culture of medicine, and the influence of upward social comparison. Discussion: After discussions, we found that the various factors we identified exacerbated the fears and doubts we already had about our own abilities and that of the medical education system. This doubt led us to avoid completing certain aspects of the tasks that were prescribed and further reinforced our vulnerability and perceived incompetence. Exploration of philosophical theories identified the importance of the role of doubt in education. We propose the need for further discussion around incorporating both pedagogic and andragogic teaching styles in clinical medical education and the acceptance of doubt as a driver of our learning. Conclusion: Doubt will continue to permeate our thoughts and actions no matter what. The moral or psychological distress that arises from this is the key motivating factor for our avoidance of tasks. If we accept this doubt and education embraces this doubt, it will no longer linger in the shadows as a negative and restrictive emotion but fuel a brighter dialogue and positive learning experience, ultimately assisting us in achieving our full potential.

Keywords: ethics, medical student, doubt, medical education, faith

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Authors: Cindy Davis

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Higher education is changing globally and there is increasing pressure from professional social work accreditation bodies for academic programs to demonstrate how students have successfully met mandatory graduate competencies. As professional accreditation organizations increase their demand for evidence of graduate competencies, strategies to document and recording learning outcomes becomes increasingly challenging for academics and students. Studies in higher education have found support for the pedagogical value of ePortfolios, a flexible personal learning space that is owned by the student and include opportunity for assessment, feedback and reflection as well as a virtual space to store evidence of demonstration of professional competencies and graduate attributes. Examples of institutional uses of ePortfolios include e-administration of a diverse student population, assessment of student learning, and the demonstration of graduate attributes attained and future student career preparation. The current paper presents a case study on the introduction of ePortfolios for social work graduates in Australia as part of an institutional approach to technology-enhanced learning and e-learning. Social work graduates were required to submit an ePortfolio hosted on PebblePad. The PebblePad platform was selected because it places the student at the center of their learning whilst providing powerful tools for staff to structure, guide and assess that learning. The ePortofolio included documentation and evidence of how the student met each graduate competency as set out by the social work accreditation body in Australia (AASW). This digital resource played a key role in the process of external professional accreditation by clearly documenting and evidencing how students met required graduate competencies. In addition, student feedback revealed a positive outcome on how this resource provided them with a consolidation of their learning experiences and assisted them in obtaining employment post-graduation. There were also significant institutional factors that were key to successful implementation such as investment in the digital technology, capacity building amongst academics, and technical support for staff and students.

Keywords: accreditation, social work, teaching, technology

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Authors: Clare S. Sullivan

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The high desert of central Oregon, USA is a challenging growing environment: short growing season (70-100 days); average annual precipitation of 280 mm; drastic swings in diurnal temperatures; possibility of frost any time of year; and sandy soils low in organic matter. Despite strong demand, there is almost no fruit grown in central Oregon due to potential yield loss caused by early and late frosts. Elsewhere in the USA, protected culture (i.e., high tunnels) has been used to extend fruit production seasons and improve yields. In central Oregon, high tunnels are used to grow multiple high-value vegetable crops, and farmers are unlikely to plant a perennial crop in a high tunnel unless proven profitable. In May 2019, two berry trials were established on a farm in Alfalfa, OR, to evaluate raspberry and strawberry yield, season length, and fruit quality in protected (high tunnels) vs. unprotected culture (open field). The main objective was to determine whether high tunnel berry production is a viable enterprise for the region. Each trial was arranged using a split-plot design. The main factor was the production system (high tunnel vs. open field), and the replicated, subplot factor was berry variety. Four day-neutral strawberry varieties and four primocane-bearing raspberry varieties were planted for the study and were managed using organic practices. Berries were harvested once a week early in the season, and twice a week as production increased. Harvested berries were separated into ‘marketable’ and ‘unmarketable’ in order to calculate percent cull. First-year results revealed berry yield and quality differences between varieties and production systems. Strawberry marketable yield and berry fruit size increased significantly in the high tunnel compared to the field; percent yield increase ranged from 7-46% by variety. Evie 2 was the highest yielding strawberry, although berry quality was lower than other berries. Raspberry marketable yield and berry fruit size tended to increase in the high tunnel compared to the field, although variety had a more significant effect. Joan J was the highest yielding raspberry and out-yielded the other varieties by 250% outdoor and 350% indoor. Overall, strawberry and raspberry yields tended to improve in high tunnels as compared to the field, but data from a second year will help determine whether high tunnel investment is worthwhile. It is expected that the production system will have more of an effect on berry yield and season length for second-year plants in 2020.

Keywords: berries, high tunnel, local food, organic

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Authors: Dounya Barrit, Ming-Chun Tang, Hoang Dang, Kai Wang, Detlef-M. Smilgies, Aram Amassian

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Several deposition methods have been developed for perovskite film preparation. The one-step spin-coating process has emerged as a more popular option thanks to its ability to produce films of different compositions, including mixed cation and mixed halide perovskites, which can stabilize the perovskite phase and produce phases with desired band gap. The two-step method, however, is not understood in great detail. There is a significant need and opportunity to adopt the two-step process toward mixed cation and mixed halide perovskites, but this requires deeper understanding of the two-step conversion process, for instance when using different cations and mixtures thereof, to produce high-quality perovskite films with uniform composition. In this work, we demonstrate using in situ investigations that the conversion of PbI₂ to perovskite is largely dictated by the state of the PbI₂ precursor film in terms of its solvated state. Using time-resolved grazing incidence wide-angle X-Ray scattering (GIWAXS) measurements during spin coating of PbI₂ from a DMF (Dimethylformamide) solution we show the film formation to be a sol-gel process involving three PbI₂-DMF solvate complexes: disordered precursor (P₀), ordered precursor (P₁, P₂) prior to PbI₂ formation at room temperature after 5 minutes. The ordered solvates are highly metastable and eventually disappear, but we show that performing conversion from P₀, P₁, P₂ or PbI₂ can lead to very different conversion behaviors and outcomes. We compare conversion behaviors by using MAI (Methylammonium iodide), FAI (Formamidinium Iodide) and mixtures of these cations, and show that conversion can occur spontaneously and quite rapidly at room temperature without requiring further thermal annealing. We confirm this by demonstrating improvements in the morphology and microstructure of the resulting perovskite films, using techniques such as in situ quartz crystal microbalance with dissipation monitoring, SEM and XRD.

Keywords: in situ GIWAXS, lead iodide, mixed cation, perovskite solar cell, sol-gel process, solvate phase

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