Search results for: water process analysis
Commenced in January 2007
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Edition: International
Paper Count: 42176

Search results for: water process analysis

446 The Development of Quality Standards for the Qualification of Community Interpreters in Germany: A Needs Assessment

Authors: Jessica Terese Mueller, Christoph Breitsprecher, Mike Oliver Mosko

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Due to an unusually high number of asylum seekers entering Germany over the course of the past few years, the need for community interpreters has increased dramatically, in order to make the communication between asylum seekers and various actors in social and governmental agencies possible. In the field of social work in particular, there are community interpreters who possess a wide spectrum of qualifications spanning from state-certified professional interpreters with graduate degrees to lay or ad-hoc interpreters with little to no formal training. To the best of our knowledge, Germany has no official national quality standards for the training of community interpreters at present, which would serve to professionalise this field as well as to assure a certain degree of quality in the training programmes offered. Given the current demand for trained community interpreters, there is a growing number of training programmes geared toward qualifying community interpreters who work with asylum seekers in Germany. These training programmes range from short one-day workshops to graduate programmes with specialisations in Community Interpreting. As part of a larger project to develop quality standards for the qualification of community interpreters working with asylum seekers in the field of social work, a needs assessment was performed in the city-state of Hamburg and the state of North Rhine Westphalia in the form of focus groups and individual interviews with relevant actors in the field in order to determine the content and practical knowledge needed for community interpreters from the perspectives of those who work in and rely on this field. More specifically, social workers, volunteers, certified language and cultural mediators, paid and volunteer community interpreters and asylum seekers were invited to take part in focus groups in both locations, and asylum seekers, training providers, researchers, linguists and other national and international experts were individually interviewed. The responses collected in these focus groups and interviews have been analysed using Mayring’s concept of content analysis. In general, the responses indicate a high degree of overlap related to certain categories as well as some categories which seemed to be of particular importance to certain groups individually, while showing little to no relevance for other groups. For example, the topics of accuracy and transparency of the interpretations, as well as professionalism and ethical concerns were touched on in some form in most groups. Some group-specific topics which are the focus of experts were topics related to interpreting techniques and more concretely described theoretical and practical knowledge which should be covered in training programmes. Social workers and volunteers generally concentrated on issues regarding the role of the community interpreters and the importance of setting and clarifying professional boundaries. From the perspective of service receivers, asylum seekers tended to focus on the importance of having access to interpreters who are from their home region or country and who speak the same regiolect, dialect or variety as they do in order to prevent misunderstandings or misinterpretations which might negatively affect their asylum status. These results indicate a certain degree of consensus with trainings offered internationally for community interpreters.

Keywords: asylum seekers, community interpreting, needs assessment, quality standards, training

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445 The Direct and Indirect Effects of Buddhism on Fertility Rates in General and in Specific Socioeconomic Circumstances of Women

Authors: Szerena Vajkovszki

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Our worldwide aging society, especially in developed countries, including members of EU, raise sophisticated sociological and economic issues and challenges to be met. As declining fertility has outstanding influence underlying this trend, numerous studies have attempted to identify, describe, measure and interpret contributing factors of the fertility rate, out of which relatively few revealed the impact of religion. Identified, examined and influential factors affecting birth rate as stated by the present scientific publications are more than a dozen out of which religious beliefs, traditions, and cultural norms were examined first with a special focus on abortion and forms of birth control. Nevertheless, connected to religion, not only these topics are crucial regarding fertility, but many others as well. Among many religious guidelines, we can separate two major categories: direct and indirect. The aim of this research was to understand what are the most crucial identified (family values, gender related behaviors, religious sentiments) and not yet identified most influential contributing religious factors. Above identifying these direct or indirect factors, it is also important to understand to what extent and how do they influence fertility, which requires a wider (inter-discipline) perspective. As proved by previous studies religion has also an influential role on health, mental state, well-being, working activity and many other components that are also related to fertility rates. All these components are inter-related. Hence direct and indirect religious effects can only be well understood if we figure out all necessary fields and their interaction. With the help of semi-structured opened interviews taking place in different countries, it was showed that indeed Buddhism has significant direct and indirect effect on fertility. Hence the initial hypothesis was proved. However, the interviews showed an overall positive effect; the results could only serve for a general understanding of how Buddhism affects fertility. Evolution of Buddhism’s direct and indirect influence may vary in different nations and circumstances according to their specific environmental attributes. According to the local patterns, with special regard to women’s position and role in the society, outstandingly indirect influences could show diversifications. So it is advisory to investigate more for a deeper and clearer understanding of how Buddhism function in different socioeconomic circumstances. For this purpose, a specific and detailed analysis was developed from recent related researches about women’s position (including family roles and economic activity) in Hungary with the intention to be able to have a complex vision of crucial socioeconomic factors influencing fertility. Further interviews and investigations are to be done in order to show a complex vision of Buddhism’s direct and indirect effect on fertility in Hungary to be able to support recommendations and policies pointing to higher fertility rates in the field of social policies. The present research could serve as a general starting point or a common basis for further specific national investigations.

Keywords: Buddhism, children, fertility, gender roles, religion, women

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444 Humanizing Industrial Architecture: When Form Meets Function and Emotion

Authors: Sahar Majed Asad

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Industrial structures have historically focused on functionality and efficiency, often disregarding aesthetics and human experience. However, a new approach is emerging that prioritizes humanizing industrial architecture and creating spaces that promote well-being, sustainability, and social responsibility. This study explores the motivations and design strategies behind this shift towards more human-centered industrial environments, providing practical guidance for architects, designers, and other stakeholders interested in incorporating these principles into their work. Through in-depth interviews with architects, designers, and industry experts, as well as a review of relevant literature, this study uncovers the reasons for this change in industrial design. The findings reveal that this shift is driven by a desire to create environments that prioritize the needs and experiences of the people who use them. The study identifies strategies such as incorporating natural elements, flexible design, and advanced technologies as crucial in achieving human-centric industrial design. It also emphasizes that effective communication and collaboration among stakeholders are crucial for successful human-centered design outcomes. This paper provides a comprehensive analysis of the motivations and design strategies behind the humanization of industrial architecture. It begins by examining the history of industrial architecture and highlights the focus on functionality and efficiency. The paper then explores the emergence of human-centered design principles in industrial architecture, discussing the benefits of this approach, including creating more sustainable and socially responsible environments.The paper explains specific design strategies that prioritize the human experience of industrial spaces. It outlines how incorporating natural elements like greenery and natural lighting can create more visually appealing and comfortable environments for industrial workers. Flexible design solutions, such as movable walls and modular furniture, can make spaces more adaptable to changing needs and promote a sense of ownership and creativity among workers. Advanced technologies, such as sensors and automation, can improve the efficiency and safety of industrial spaces while also enhancing the human experience. To provide practical guidance, the paper offers recommendations for incorporating human-centered design principles into industrial structures. It emphasizes the importance of understanding the needs and experiences of the people who use these spaces and provides specific examples of how natural elements, flexible design, and advanced technologies can be incorporated into industrial structures to promote human well-being. In conclusion, this study demonstrates that the humanization of industrial architecture is a growing trend that offers tremendous potential for creating more sustainable and socially responsible built environments. By prioritizing the human experience of industrial spaces, designers can create environments that promote well-being, sustainability, and social responsibility. This research study provides practical guidance for architects, designers, and other stakeholders interested in incorporating human-centered design principles into their work, demonstrating that a human-centered approach can lead to functional and aesthetically pleasing industrial spaces that promote human well-being and contribute to a better future for all.

Keywords: human-centered design, industrial architecture, sustainability, social responsibility

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443 Gene Expression Profiling of Iron-Related Genes of Pasteurella multocida Serotype A Strain PMTB2.1

Authors: Shagufta Jabeen, Faez Jesse Firdaus Abdullah, Zunita Zakaria, Nurulfiza Mat Isa, Yung Chie Tan, Wai Yan Yee, Abdul Rahman Omar

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Pasteurella multocida is associated with acute, as well as, chronic infections in avian and bovine such as pasteurellosis and hemorrhagic septicemia (HS) in cattle and buffaloes. Iron is one of the most important nutrients for pathogenic bacteria including Pasteurella and acts as a cofactor or prosthetic group in several essential enzymes and is needed for amino acid, pyrimidine, and DNA biosynthesis. In our recent study, we showed that 2% of Pasteurella multocida serotype A strain PMTB2.1 encode for iron regulating genes (Accession number CP007205.1). Genome sequencing of other Pasteurella multocida serotypes namely PM70 and HB01 also indicated up to 2.5% of the respective genome encode for iron regulating genes, suggesting that Pasteurella multocida genome comprises of multiple systems for iron uptake. Since P. multocida PMTB2.1 has more than 40 CDs out of 2097 CDs (approximately 2%), encode for iron-regulated. The gene expression profiling of four iron-regulating genes namely fbpb, yfea, fece and fur were characterized under iron-restricted environment. The P. multocida strain PMTB2.1 was grown in broth with and without iron chelating agent and samples were collected at different time points. Relative mRNA expression profile of these genes was determined using Taqman probe based real-time PCR assay. The data analysis, normalization with two house-keeping genes and the quantification of fold changes were carried out using Bio-Rad CFX manager software version 3.1. Results of this study reflect that iron reduced environment has significant effect on expression profile of iron regulating genes (p < 0.05) when compared to control (normal broth) and all evaluated genes act differently with response to iron reduction in media. The highest relative fold change of fece gene was observed at early stage of treatment indicating that PMTB2.1 may utilize its periplasmic protein at early stage to acquire iron. Furthermore, down-regulation expression of fece with the elevated expression of other genes at later time points suggests that PMTB2.1 control their iron requirements in response to iron availability by down-regulating the expression of iron proteins. Moreover, significantly high relative fold change (p ≤ 0.05) of fbpb gene is probably associated with the ability of P. multocida to directly use host iron complex such as hem, hemoglobin. In addition, the significant increase (p ≤ 0.05) in fbpb and yfea expressions also reflects the utilization of multiple iron systems in P. multocida strain PMTB2.1. The findings of this study are very much important as relative scarcity of free iron within hosts creates a major barrier to microbial growth inside host and utilization of outer-membrane proteins system in iron acquisition probably occurred at early stage of infection with P. multocida. In conclusion, the presence and utilization of multiple iron system in P. multocida strain PMTB2.1 revealed the importance of iron in the survival of P. multocida.

Keywords: iron-related genes, real-time PCR, gene expression profiling, fold changes

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442 Optimization of Territorial Spatial Functional Partitioning in Coal Resource-based Cities Based on Ecosystem Service Clusters - The Case of Gujiao City in Shanxi Province

Authors: Gu Sihao

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The coordinated development of "ecology-production-life" in cities has been highly concerned by the country, and the transformation development and sustainable development of resource-based cities have become a hot research topic at present. As an important part of China's resource-based cities, coal resource-based cities have the characteristics of large number and wide distribution. However, due to the adjustment of national energy structure and the gradual exhaustion of urban coal resources, the development vitality of coal resource-based cities is gradually reduced. In many studies, the deterioration of ecological environment in coal resource-based cities has become the main problem restricting their urban transformation and sustainable development due to the "emphasis on economy and neglect of ecology". Since the 18th National Congress of the Communist Party of China (CPC), the Central Government has been deepening territorial space planning and development. On the premise of optimizing territorial space development pattern, it has completed the demarcation of ecological protection red lines, carried out ecological zoning and ecosystem evaluation, which have become an important basis and scientific guarantee for ecological modernization and ecological civilization construction. Grasp the regional multiple ecosystem services is the precondition of the ecosystem management, and the relationship between the multiple ecosystem services study, ecosystem services cluster can identify the interactions between multiple ecosystem services, and on the basis of the characteristics of the clusters on regional ecological function zoning, to better Social-Ecological system management. Based on this cognition, this study optimizes the spatial function zoning of Gujiao, a coal resource-based city, in order to provide a new theoretical basis for its sustainable development. This study is based on the detailed analysis of characteristics and utilization of Gujiao city land space, using SOFM neural networks to identify local ecosystem service clusters, according to the cluster scope and function of ecological function zoning of space partition balance and coordination between different ecosystem services strength, establish a relationship between clusters and land use, and adjust the functions of territorial space within each zone. Then, according to the characteristics of coal resources city and national spatial function zoning characteristics, as the driving factors of land change, by cellular automata simulation program, such as simulation under different restoration strategy situation of urban future development trend, and provides relevant theories and technical methods for the "third-line" demarcations of Gujiao's territorial space planning, optimizes territorial space functions, and puts forward targeted strategies for the promotion of regional ecosystem services, providing theoretical support for the improvement of human well-being and sustainable development of resource-based cities.

Keywords: coal resource-based city, territorial spatial planning, ecosystem service cluster, gmop model, geosos-FLUS model, functional zoning optimization and upgrading

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441 Effect of Climate Change on the Genomics of Invasiveness of the Whitefly Bemisia tabaci Species Complex by Estimating the Effective Population Size via a Coalescent Method

Authors: Samia Elfekih, Wee Tek Tay, Karl Gordon, Paul De Barro

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Invasive species represent an increasing threat to food biosecurity, causing significant economic losses in agricultural systems. An example is the sweet potato whitefly, Bemisia tabaci, which is a complex of morphologically indistinguishable species causing average annual global damage estimated at US$2.4 billion. The Bemisia complex represents an interesting model for evolutionary studies because of their extensive distribution and potential for invasiveness and population expansion. Within this complex, two species, Middle East-Asia Minor 1 (MEAM1) and Mediterranean (MED) have invaded well beyond their home ranges whereas others, such as Indian Ocean (IO) and Australia (AUS), have not. In order to understand why some Bemisia species have become invasive, genome-wide sequence scans were used to estimate population dynamics over time and relate these to climate. The Bayesian Skyline Plot (BSP) method as implemented in BEAST was used to infer the historical effective population size. In order to overcome sampling bias, the populations were combined based on geographical origin. The datasets used for this particular analysis are genome-wide SNPs (single nucleotide polymorphisms) called separately in each of the following groups: Sub-Saharan Africa (Burkina Faso), Europe (Spain, France, Greece and Croatia), USA (Arizona), Mediterranean-Middle East (Israel, Italy), Middle East-Central Asia (Turkmenistan, Iran) and Reunion Island. The non-invasive ‘AUS’ species endemic to Australia was used as an outgroup. The main findings of this study show that the BSP for the Sub-Saharan African MED population is different from that observed in MED populations from the Mediterranean Basin, suggesting evolution under a different set of environmental conditions. For MED, the effective size of the African (Burkina Faso) population showed a rapid expansion ≈250,000-310,000 years ago (YA), preceded by a period of slower growth. The European MED populations (i.e., Spain, France, Croatia, and Greece) showed a single burst of expansion at ≈160,000-200,000 YA. The MEAM1 populations from Israel and Italy and the ones from Iran and Turkmenistan are similar as they both show the earlier expansion at ≈250,000-300,000 YA. The single IO population lacked the latter expansion but had the earlier one. This pattern is shared with the Sub-Saharan African (Burkina Faso) MED, suggesting IO also faced a similar history of environmental change, which seems plausible given their relatively close geographical distributions. In conclusion, populations within the invasive species MED and MEAM1 exhibited signatures of population expansion lacking in non-invasive species (IO and AUS) during the Pleistocene, a geological epoch marked by repeated climatic oscillations with cycles of glacial and interglacial periods. These expansions strongly suggested the potential of some Bemisia species’ genomes to affect their adaptability and invasiveness.

Keywords: whitefly, RADseq, invasive species, SNP, climate change

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440 An Analysis of Preliminary Intervention for Developing to Promote Resiliency of Children Whose Parents Suffer Mental Illness

Authors: Sookbin Im, Myounglyun Heo

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This study aims at analyzing composition and effects of the preliminary intervention to promote resiliency of children whose parents suffer mental illness, and considerations according to the program, and developing the resiliency promotion program for children of psychiatric patients. For participants of preliminary intervention, they were recruited through a community mental health and social welfare center in a city, and there were 10 children (eight girls and two boys) who are from second to five graders in elementary school, and whose parents suffer schizophrenia, depression, or alcoholism, etc. The program was conducted in the seminar room of the community mental illness and social welfare center from October to December 2015 and from July to September 2016. The elements of resiliency were figured out by reviewing the literature. And therapeutic activities to promote resiliency was composed, and total twice, 8 sessions(two hours, once a week) were applied. Each session consisted of playgroup activities, art activities, and role-playing with feedback for achieving goals to promote self-awareness, self-efficacy, positive outlook, ability to solve problems, empathy for others, peer group acceptance, having goals and aspirations, and assertiveness. In addition, auxiliary managers as many as children played a role as mentor and role model, and children's behaviors were collected by participatory observation. As a result of the study, four children quit the program because the schedules of their own school programs were overlapped with it. Therefore, six children completed the program. Children who completed it became active, positive, decreased compulsive actions, and increased self-expressions. The participants reacted the 8-session program is too short and regretted about it. However, recruiting the participants were difficult, and too distracting children caused negative influences in the group activities. Based on the results, the program was developed as follows: The program would consist of total 11 sessions, and the first eight sessions would be made of plays, art activities, role-plays, and presentations for promoting self-understanding, improving positiveness, providing meaning for experiences, emotional control, and interpersonal relations. In order to balance various contents, methods such as structuring environments, storytelling, emotional coaching, and group feedback would be applied, and the ninth to eleventh sessions would be booster sessions consisting of optional activities for children. This program is for children who attend school with active linguistic communications and interactions with peers. Especially, considering that effective development starts at around 10 years old, it would be for children who are third and fourth graders in elementary school. These result showed that this program was useful for improving the key elements of resiliency such as positive thinking or impulse control. It is suggested the necessary of resiliency promoting program model and practical guidance with comprehensive measuring methods(narratives, drawing, self-reported questionnaire, behavioral observation). Also, it is necessary to make a training program for the coaches or leaders to operate this program to spread out for child health.

Keywords: children, mental, parents, resilience

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439 Drivers of the Performance of Members of a Social Incubator Considering the Values of Work: A Qualitative Study with Social Entrepreneurs

Authors: Leticia Lengler, Vania Estivalete, Vivian Flores Costa, Tais De Andrade, Lisiane Fellini Faller

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Social entrepreneurship has emerged and driven a new development perspective, and as the literature mentions, it is based on innovation, and mainly, on the creation of social value, rather than personal wealth and shareholders. In this field of study, one of the focuses of discussion refers to the distinct characteristics of the individuals responsible for socially directed initiatives, named as social entrepreneurs. To contribute to this perspective, the present study aims to identify the values related to work that guide the performance of social entrepreneurs, members of enterprises that have developed themselves within a social incubator at a federal institution of higher education in Brazil. Each person's value system is present in different facets of his life, manifesting himself in his choices and in the way he conducts the relationship with other people in society. Especially the values of work, the focus of this research, play a significant role in organizational studies, since they are considered one of the important guiding principles of the behavior of individuals in the work environment. Regarding the method of the study, a descriptive and qualitative research was carried out. In the data collection, 24 entrepreneurs, members of five different enterprises belonging to the social incubator, were interviewed. The research instrument consisted of three open questions, which could be answered with the support of a "disc of values", an artifact organized to clearly demonstrate the values of the work to the respondents. The analysis of the interviews took into account the categories defined a priori, based on the model proposed by previous authors who validated these constructs within their research contexts, contemplating the following dimensions: Self-determination and stimulation; Safety; Conformity; Universalism and benevolence; Achievement; and Power. It should be noted that, in order to provide a better understanding of the interviewees, in the "disc of values" used in the research, these dimensions were represented by the objectives that define them, being respectively: Challenge; Financial independence; Commitment; Welfare of others; Personal success; And Power. Some preliminary results show that, as guiding principles of the investigation, priority is given to work values related to Self-determination and stimulation, Conformity and Universalism and benevolence. Such findings point to the importance given by these individuals to independent thinking and acting, as well as to novelty and constant challenge. Still, they demonstrate the appreciation of commitment to their enterprise, the people who make it and the quality of their work. They also point to the relevance of the possibility of contributing to the greater social good, that is, of the search for the well-being of close people and of society, as it is implied in models of social entrepreneurship coming from literature. With a lower degree of priority, the values denominated Safety and Realization, as the financial question at work and the search for satisfaction and personal success, through the use of socially recognized skills were mentioned aspects with little emphasis by social entrepreneurs. The Power value was not considered as guiding principle of the work for the respondents.

Keywords: qualitative study, social entrepreneur, social incubator, values of work

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438 Tectono-Stratigraphic Architecture, Depositional Systems and Salt Tectonics to Strike-Slip Faulting in Kribi-Campo-Cameroon Atlantic Margin with an Unsupervised Machine Learning Approach (West African Margin)

Authors: Joseph Bertrand Iboum Kissaaka, Charles Fonyuy Ngum Tchioben, Paul Gustave Fowe Kwetche, Jeannette Ngo Elogan Ntem, Joseph Binyet Njebakal, Ribert Yvan Makosso-Tchapi, François Mvondo Owono, Marie Joseph Ntamak-Nida

Abstract:

Located in the Gulf of Guinea, the Kribi-Campo sub-basin belongs to the Aptian salt basins along the West African Margin. In this paper, we investigated the tectono-stratigraphic architecture of the basin, focusing on the role of salt tectonics and strike-slip faults along the Kribi Fracture Zone with implications for reservoir prediction. Using 2D seismic data and well data interpreted through sequence stratigraphy with integrated seismic attributes analysis with Python Programming and unsupervised Machine Learning, at least six second-order sequences, indicating three main stages of tectono-stratigraphic evolution, were determined: pre-salt syn-rift, post-salt rift climax and post-rift stages. The pre-salt syn-rift stage with KTS1 tectonosequence (Barremian-Aptian) reveals a transform rifting along NE-SW transfer faults associated with N-S to NNE-SSW syn-rift longitudinal faults bounding a NW-SE half-graben filled with alluvial to lacustrine-fan delta deposits. The post-salt rift-climax stage (Lower to Upper Cretaceous) includes two second-order tectonosequences (KTS2 and KTS3) associated with the salt tectonics and Campo High uplift. During the rift-climax stage, the growth of salt diapirs developed syncline withdrawal basins filled by early forced regression, mid transgressive and late normal regressive systems tracts. The early rift climax underlines some fine-grained hangingwall fans or delta deposits and coarse-grained fans from the footwall of fault scarps. The post-rift stage (Paleogene to Neogene) contains at least three main tectonosequences KTS4, KTS5 and KTS6-7. The first one developed some turbiditic lobe complexes considered as mass transport complexes and feeder channel-lobe complexes cutting the unstable shelf edge of the Campo High. The last two developed submarine Channel Complexes associated with lobes towards the southern part and braided delta to tidal channels towards the northern part of the Kribi-Campo sub-basin. The reservoir distribution in the Kribi-Campo sub-basin reveals some channels, fan lobes reservoirs and stacked channels reaching up to the polygonal fault systems.

Keywords: tectono-stratigraphic architecture, Kribi-Campo sub-basin, machine learning, pre-salt sequences, post-salt sequences

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437 Fake News Domination and Threats on Democratic Systems

Authors: Laura Irimies, Cosmin Irimies

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The public space all over the world is currently confronted with the aggressive assault of fake news that have lately impacted public agenda setting, collective decisions and social attitudes. Top leaders constantly call out most mainstream news as “fake news” and the public opinion get more confused. "Fake news" are generally defined as false, often sensational, information disseminated under the guise of news reporting and has been declared the word of the year 2017 by Collins Dictionary and it also has been one of the most debated socio-political topics of recent years. Websites which, deliberately or not, publish misleading information are often shared on social media where they essentially increase their reach and influence. According to international reports, the exposure to fake news is an undeniable reality all over the world as the exposure to completely invented information goes up to the 31 percent in the US, and it is even bigger in Eastern Europe countries, such as Hungary (42%) and Romania (38%) or in Mediterranean countries, such as Greece (44%) or Turkey (49%), and lower in Northern and Western Europe countries – Germany (9%), Denmark (9%) or Holland (10%). While the study of fake news (mechanism and effects) is still in its infancy, it has become truly relevant as the phenomenon seems to have a growing impact on democratic systems. Studies conducted by the European Commission show that 83% of respondents out of a total of 26,576 interviewees consider the existence of news that misrepresent reality as a threat for democracy. Studies recently conducted at Arizona State University show that people with higher education can more easily spot fake headlines, but over 30 percent of them can still be trapped by fake information. If we were to refer only to some of the most recent situations in Romania, fake news issues and hidden agenda suspicions related to the massive and extremely violent public demonstrations held on August 10th, 2018 with a strong participation of the Romanian diaspora have been massively reflected by the international media and generated serious debates within the European Commission. Considering the above framework, the study raises four main research questions: 1. Is fake news a problem or just a natural consequence of mainstream media decline and the abundance of sources of information? 2. What are the implications for democracy? 3. Can fake news be controlled without restricting fundamental human rights? 4. How could the public be properly educated to detect fake news? The research uses mostly qualitative but also quantitative methods, content analysis of studies, websites and media content, official reports and interviews. The study will prove the real threat fake news represent and also the need for proper media literacy education and will draw basic guidelines for developing a new and essential skill: that of detecting fake in news in a society overwhelmed by sources of information that constantly roll massive amounts of information increasing the risk of misinformation and leading to inadequate public decisions that could affect democratic stability.

Keywords: agenda setting democracy, fake news, journalism, media literacy

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436 Chemical Composition and Insecticidal Activity of Three Essential Oil and Beauvericin Nanogel on Plodia Interpunctella (Lepidoptera: Pyralidae)

Authors: Magda Mahmoud Amin Sabbour, El-Sayed H. Shaurub

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The Indian meal moth Plodia interpunctella (Hübner) (Lepidoptera: Pyralidae), of stored grain pests which destroy the seed completely. Their larval stages feed on the nutrient germinating kernels part found in the seeds grain. This leads to a reduction causing a badness to seed germination and seed viability. It controlled by many insecticides which pollute and cusses a harmful diseases to human being. Three tested oils were evaluated on this target pests. Plant extracts, essential oils and medical oils are materials which used to control many stored pests. Plant oils extracts have a lower effects on parasites and predators and not pollute the medium. By using the apparatus gas chromatography flame ionization detector gas chromatography–analysis of three essential oil tested. This research was point to explore and appreciation the activity of three oils and nano gel Beauvericin against P. interpunctella in the laboratory conditions and in the store conditions. The three essential oil tested proved that, percentage of α-Pinene recoded 7.76, 7.72 and 6.66 for C. cyminum, A. squamosal and G. officinale respectively. The composition of the β-Pinene recoded 4.61, 8.92 and 30.63 for the corresponding oils tested. Results showed that after analytically the oils tested, the effective compound of C. cyminum oil are p-cyinene and Terpinene. Results obtained show that the LC50 recorded 125, 112, 55 and 20 ppm after P. interpunctella treated with medical oils of Guaiacum officinale, Annona squamosa, Cuminum cyminum and Beauvericin 3% respectively. The accumulative mortality of P. interpunctella after treated with A.squamosa oil-loaded nanogels which showed that it is the highest oils from infestations recoded when the seed treated with 3% after 48 days, the accumulations obtained 44% at followed by 24 after24 days of storage. Results, cleared that the seed protection by G. officinale recorded 40% at concentrations of 3% after 48 days of storage seeds. C. cyminum was the highest mortality by 98, at concentrations 3%. The highest seed protection proved after C. cyminum oil-loaded nanogels 14% followed by G. officinale 29% and A.squamosa 44%.when the seeds treated with Beauvericin 3%. Results of this work cleared that the essential medical oils have a useful action effect on target insects. Plant essential and medical oils, their active ingredient have potentially high bioactivity against on P. interpunctella. The medical and essential oils incorporation and usage the nano-formulation release stopped the highly degradation vaporization and the increasing in the constancy, and save the lower effectiveness of the dosage/application. The research results proved that the highest seed protection obtained after C. cyminum oil-loaded nanogels followed by G. officinale and A.squamosa. It could be complemented that P. interpunctella were more susceptible to medical oils loaded nanogel (MOLNs ) than medical oils only (MO). MOLNs had best lower amount of the residual activity than MO only. MOLNs might mend the insecticidal action of the medical oil tested by the slow effective release of the medical oils to control P. interpunctella mostly at the lower doses.

Keywords: Cuminum cyminum, annona squamosa, guaiacum officinale, beauvericin 3 %, plodia interpunctella

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435 User-Centered Design in the Development of Patient Decision Aids

Authors: Ariane Plaisance, Holly O. Witteman, Patrick Michel Archambault

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Upon admission to an intensive care unit (ICU), all patients should discuss their wishes concerning life-sustaining interventions (e.g., cardiopulmonary resuscitation (CPR)). Without such discussions, interventions that prolong life at the cost of decreasing its quality may be used without appropriate guidance from patients. We employed user-centered design to adapt an existing decision aid (DA) about CPR to create a novel wiki-based DA adapted to the context of a single ICU and tailored to individual patient’s risk factors. During Phase 1, we conducted three weeks of ethnography of the decision-making context in our ICU to identify clinician and patient needs for a decision aid. During this time, we observed five dyads of intensivists and patients discussing their wishes concerning life-sustaining interventions. We also conducted semi-structured interviews with the attending intensivists in this ICU. During Phase 2, we conducted three rounds of rapid prototyping involving 15 patients and 11 other allied health professionals. We recorded discussions between intensivists and patients and used a standardized observation grid to collect patients’ comments and sociodemographic data. We applied content analysis to field notes, verbatim transcripts and the completed observation grids. Each round of observations and rapid prototyping iteratively informed the design of the next prototype. We also used the programming architecture of a wiki platform to embed the GO-FAR prediction rule programming code that we linked to a risk graphics software to better illustrate outcome risks calculated. During Phase I, we identified the need to add a section in our DA concerning invasive mechanical ventilation in addition to CPR because both life-sustaining interventions were often discussed together by physicians. During Phase II, we produced a context-adapted decision aid about CPR and mechanical ventilation that includes a values clarification section, questions about the patient’s functional autonomy prior to admission to the ICU and the functional decline that they would judge acceptable upon hospital discharge, risks and benefits of CPR and invasive mechanical ventilation, population-level statistics about CPR, a synthesis section to help patients come to a final decision and an online calculator based on the GO-FAR prediction rule. Even though the three rounds of rapid prototyping led to simplifying the information in our DA, 60% (n= 3/5) of the patients involved in the last cycle still did not understand the purpose of the DA. We also identified gaps in the discussion and documentation of patients’ preferences concerning life-sustaining interventions (e.g.,. CPR, invasive mechanical ventilation). The final version of our DA and our online wiki-based GO-FAR risk calculator using the IconArray.com risk graphics software are available online at www.wikidecision.org and are ready to be adapted to other contexts. Our results inform producers of decision aids on the use of wikis and user-centered design to develop DAs that are better adapted to users’ needs. Further work is needed on the creation of a video version of our DA. Physicians will also need the training to use our DA and to develop shared decision-making skills about goals of care.

Keywords: ethnography, intensive care units, life-sustaining therapies, user-centered design

Procedia PDF Downloads 340
434 Structural and Functional Correlates of Reaction Time Variability in a Large Sample of Healthy Adolescents and Adolescents with ADHD Symptoms

Authors: Laura O’Halloran, Zhipeng Cao, Clare M. Kelly, Hugh Garavan, Robert Whelan

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Reaction time (RT) variability on cognitive tasks provides the index of the efficiency of executive control processes (e.g. attention and inhibitory control) and is considered to be a hallmark of clinical disorders, such as attention-deficit disorder (ADHD). Increased RT variability is associated with structural and functional brain differences in children and adults with various clinical disorders, as well as poorer task performance accuracy. Furthermore, the strength of functional connectivity across various brain networks, such as the negative relationship between the task-negative default mode network and task-positive attentional networks, has been found to reflect differences in RT variability. Although RT variability may provide an index of attentional efficiency, as well as being a useful indicator of neurological impairment, the brain substrates associated with RT variability remain relatively poorly defined, particularly in a healthy sample. Method: Firstly, we used the intra-individual coefficient of variation (ICV) as an index of RT variability from “Go” responses on the Stop Signal Task. We then examined the functional and structural neural correlates of ICV in a large sample of 14-year old healthy adolescents (n=1719). Of these, a subset had elevated symptoms of ADHD (n=80) and was compared to a matched non-symptomatic control group (n=80). The relationship between brain activity during successful and unsuccessful inhibitions and gray matter volume were compared with the ICV. A mediation analysis was conducted to examine if specific brain regions mediated the relationship between ADHD symptoms and ICV. Lastly, we looked at functional connectivity across various brain networks and quantified both positive and negative correlations during “Go” responses on the Stop Signal Task. Results: The brain data revealed that higher ICV was associated with increased structural and functional brain activation in the precentral gyrus in the whole sample and in adolescents with ADHD symptoms. Lower ICV was associated with lower activation in the anterior cingulate cortex (ACC) and medial frontal gyrus in the whole sample and in the control group. Furthermore, our results indicated that activation in the precentral gyrus (Broadman Area 4) mediated the relationship between ADHD symptoms and behavioural ICV. Conclusion: This is the first study first to investigate the functional and structural correlates of ICV collectively in a large adolescent sample. Our findings demonstrate a concurrent increase in brain structure and function within task-active prefrontal networks as a function of increased RT variability. Furthermore, structural and functional brain activation patterns in the ACC, and medial frontal gyrus plays a role-optimizing top-down control in order to maintain task performance. Our results also evidenced clear differences in brain morphometry between adolescents with symptoms of ADHD but without clinical diagnosis and typically developing controls. Our findings shed light on specific functional and structural brain regions that are implicated in ICV and yield insights into effective cognitive control in healthy individuals and in clinical groups.

Keywords: ADHD, fMRI, reaction-time variability, default mode, functional connectivity

Procedia PDF Downloads 240
433 Women's Entrepreneurship in Mena Region: Gem Key Learnings

Authors: Fatima Boutaleb

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Entrepreneurship proves to be crucial for the economic growth and development, since it contributes to job creation and the improvement of the overall productivity thus generating a positive impact upon society at various levels. Promoting entrepreneurship stimulates therefore economic diversity that is key to the betterment and/or maintaining of the standard of living. In fact, recent research suggests that entrepreneurship contributes to development by creating businesses and jobs, stimulating innovation, creating social capital across borders, and channeling political and financial capital. However, different research studies indicate that among the main factors impeding the entrepreneurship are politico-economic as socio-cultural problems, with an intensity for those related to young people and to women. In the MENA region, discrimination inherent in gender is alarming: Only one woman in eight runs her own business against 1 in 3 men. In most countries, young women and young men are facing problems involving access to finance, inadequate infrastructure, lack of support and, in general, an ecosystem that is rather unfavorable. According to the International Labor Organization, North Africa and the Middle East has the highest unemployment rate in all other regions of the world. In other hand, nearly a quarter of the population under 30 is unemployed and youth unemployment costs more than $40 billion each year to the region. In the current context, the situations in the Middle East and North Africa region are singular, both in terms of demographic trends and socio-economic issues around the employment of a large and better trained youth, but still strongly affected by unemployment and under-employment. According to a study published in 2015 by McKinsey, the world gain 26% of additional GDP (47% in the MENA region), more than 28 trillion dollars by 2025, if women came to participate, as well as men, to the economy. Promoting entrepreneurship represents an excellent alternative for the countries whose productive fabric fails to integrate the contingent of young people entering the job market each year. The MENA region, presenting entrepreneurial activity rates below those of other regions in terms of comparable development, has undoubtedly leeway at this level, even though the region displays large national heterogeneity, namely in the priority given to the promotion of entrepreneurship. The objective of this article is therefore to examine the women entrepreneurial vocation in the MENA region, to see to what extent research on the determinant of gender can provide information on the trend of the emerging entrepreneurial activity whether driven by necessity or by opportunity and, on this basis, to submit public policy proposals for the improvement of the mechanisms of inclusion among the youth women people. The objective is not to analyze the causality models but rather to identify the entrepreneurial construct specific to the MENA region via the analysis of GEM data from 2017 to 2019 among adults belonging to 10 countries of the MENA region. Notably, the study shows that inclusion of young women may be enhanced. These disadvantaged segments frequently intend to become entrepreneurs, but they tend not to enact their vocational intentions.

Keywords: economic development, entrepreneurial activity, GEM, gender, informal sector

Procedia PDF Downloads 89
432 The Establishment of Primary Care Networks (England, UK) Throughout the COVID-19 Pandemic: A Qualitative Exploration of Workforce Perceptions

Authors: Jessica Raven Gates, Gemma Wilson-Menzfeld, Professor Alison Steven

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In 2019, the Primary Care system in the UK National Health Service (NHS) was subject to reform and restructuring. Primary Care Networks (PCNs) were established, which aligned with a trend towards integrated care both within the NHS and internationally. The introduction of PCNs brought groups of GP practices in a locality together, to operate as a network, build on existing services and collaborate at a larger scale. PCNs were expected to bring a range of benefits to patients and address some of the workforce pressures in the NHS, through an expanded and collaborative workforce. The early establishment of PCNs was disrupted by the emerging COVID-19 pandemic. This study, set in the context of the pandemic, aimed to explore experiences of the PCN workforce, and their perceptions of the establishment of PCNs. Specific objectives focussed on examining factors perceived as enabling or hindering the success of a PCN, the impact on day-to-day work, the approach to implementing change, and the influence of the COVID-19 pandemic upon PCN development. This study is part of a three-phase PhD project that utilized qualitative approaches and was underpinned by social constructionist philosophy. Phase 1: a systematic narrative review explored the provision of preventative healthcare services in UK primary settings and examined facilitators and barriers to delivery as experienced by the workforce. Phase 2: informed by the findings of phase 1, semi-structured interviews were conducted with fifteen participants (PCN workforce). Phase 3: follow-up interviews were conducted with original participants to examine any changes to their experiences and perceptions of PCNs. Three main themes span across phases 2 and 3 and were generated through a Framework Analysis approach: 1) working together at scale, 2) network infrastructure, and 3) PCN leadership. Findings suggest that through efforts to work together at scale and collaborate as a network, participants have broadly accepted the concept of PCNs. However, the workforce has been hampered by system design and system complexity. Operating against such barriers has led to a negative psychological impact on some PCN leaders and others in the PCN workforce. While the pandemic undeniably increased pressure on healthcare systems around the world, it also acted as a disruptor, offering a glimpse into how collaboration in primary care can work well. Through the integration of findings from all phases, a new theoretical model has been developed, which conceptualises the findings from this Ph.D. study and demonstrates how the workforce has experienced change associated with the establishment of PCNs. The model includes a contextual component of the COVID-19 pandemic and has been informed by concepts from Complex Adaptive Systems theory. This model is the original contribution to knowledge of the PhD project, alongside recommendations for practice, policy and future research. This study is significant in the realm of health services research, and while the setting for this study is the UK NHS, the findings will be of interest to an international audience as the research provides insight into how the healthcare workforce may experience imposed policy and service changes.

Keywords: health services research, qualitative research, NHS workforce, primary care

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431 A Mixed-Methods Design and Implementation Study of ‘the Attach Project’: An Attachment-Based Educational Intervention for Looked after Children in Northern Ireland

Authors: Hannah M. Russell

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‘The Attach Project’ (TAP), is an educational intervention aimed at improving educational and socio-emotional outcomes for children who are looked after. TAP is underpinned by Attachment Theory and is adapted from Dyadic Developmental Psychotherapy (DDP), which is a treatment for children and young people impacted by complex trauma and disorders of attachment. TAP has been implemented in primary schools in Northern Ireland throughout the 2018/19 academic year. During this time, a design and implementation study has been conducted to assess the promise of effectiveness for the future dissemination and ‘scaling-up’ of the programme for a larger, randomised control trial. TAP has been designed specifically for implementation in a school setting and is comprised of a whole school element and a more individualised Key Adult-Key Child pairing. This design and implementation study utilises a mixed-methods research design consisting of quantitative, qualitative, and observational measures with stakeholder input and involvement being considered an integral component. The use of quantitative measures, such as self-report questionnaires prior to and eight months following the implementation of TAP, enabled the analysis of the strengths and direction of relations between the various components of the programme, as well as the influence of implementation factors. The use of qualitative measures, incorporating semi-structured interviews and focus groups, enabled the assessment of implementation factors, identification of implementation barriers, and potential methods of addressing these issues. Observational measures facilitated the continual development and improvement of ‘TAP training’ for school staff. Preliminary findings have provided evidence of promise for the effectiveness of TAP and indicate the potential benefits of introducing this type of attachment-based intervention across other educational settings. This type of intervention could benefit not only children who are looked after but all children who may be impacted by complex trauma or disorders of attachment. Furthermore, findings from this study demonstrate that it is possible for children to form a secondary attachment relationship with a significant adult in school. However, various implementation factors which should be addressed were identified throughout the study, such as the necessity of protected time being introduced to facilitate the development of a positive Key Adult- Key Child relationship. Furthermore, additional ‘re-cap’ training is required in future dissemination of the programme, to maximise ‘attachment friendly practice’ in the whole staff team. Qualitative findings have also indicated that there is a general opinion across school staff that this type of Key Adult- Key Child pairing could be more effective if it was introduced as soon as children begin primary school. This research has provided ample evidence for the need to introduce relationally based interventions in schools, to help to ensure that children who are looked after, or who are impacted by complex trauma or disorders of attachment, can thrive in the school environment. In addition, this research has facilitated the identification of important implementation factors and barriers to implementation, which can be addressed prior to the ‘scaling-up’ of TAP for a robust, randomised controlled trial.

Keywords: attachment, complex trauma, educational interventions, implementation

Procedia PDF Downloads 169
430 Role of Baseline Measurements in Assessing Air Quality Impact of Shale Gas Operations

Authors: Paula Costa, Ana Picado, Filomena Pinto, Justina Catarino

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Environmental impact associated with large scale shale gas development is of major concern to the public, policy makers and other stakeholders. To assess this impact on the atmosphere, it is important to monitoring ambient air quality prior to and during all shale gas operation stages. Baseline observations can provide a standard of the pre-shale gas development state of the environment. The lack of baseline concentrations was identified as an important knowledge gap to assess the impact of emissions to the air due to shale gas operations. In fact baseline monitoring of air quality are missing in several regions, where there is a strong possibility of future shale gas exploration. This makes it difficult to properly identify, quantify and characterize environmental impacts that may be associated with shale gas development. The implementation of a baseline air monitoring program is imperative to be able to assess the total emissions related with shale gas operations. In fact, any monitoring programme should be designed to provide indicative information on background levels. A baseline air monitoring program should identify and characterize targeted air pollutants, most frequently described from monitoring and emission measurements, as well as those expected from hydraulic fracturing activities, and establish ambient air conditions prior to start-up of potential emission sources from shale gas operations. This program has to be planned for at least one year accounting for ambient variations. In the literature, in addition to GHG emissions of CH4, CO2 and nitrogen oxides (NOx), fugitive emissions from shale gas production can release volatile organic compounds (VOCs), aldehydes (formaldehyde, acetaldehyde) and hazardous air pollutants (HAPs). The VOCs include a.o., benzene, toluene, ethyl benzene, xylenes, hexanes, 2,2,4-trimethylpentane, styrene. The concentrations of six air pollutants (ozone, particulate matter (PM), carbon monoxide (CO), nitrogen oxides (NOx), sulphur oxides (SOx), and lead) whose regional ambient air levels are regulated by the Environmental Protection Agency (EPA), are often discussed. However, the main concern in the emissions to air associated to shale gas operations, seems to be the leakage of methane. Methane is identified as a compound of major concern due to its strong global warming potential. The identification of methane leakage from shale gas activities is complex due to the existence of several other CH4 sources (e.g. landfill, agricultural activity or gas pipeline/compressor station). An integrated monitoring study of methane emissions may be a suitable mean of distinguishing the contribution of different sources of methane to ambient levels. All data analysis needs to be carefully interpreted taking, also, into account the meteorological conditions of the site. This may require the implementation of a more intensive monitoring programme. So, it is essential the development of a low-cost sampling strategy, suitable for establishing pre-operations baseline data as well as an integrated monitoring program to assess the emissions from shale gas operation sites. This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 640715.

Keywords: air emissions, baseline, green house gases, shale gas

Procedia PDF Downloads 315
429 Assessment of On-Site Solar and Wind Energy at a Manufacturing Facility in Ireland

Authors: A. Sgobba, C. Meskell

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The feasibility of on-site electricity production from solar and wind and the resulting load management for a specific manufacturing plant in Ireland are assessed. The industry sector accounts directly and indirectly for a high percentage of electricity consumption and global greenhouse gas emissions; therefore, it will play a key role in emission reduction and control. Manufacturing plants, in particular, are often located in non-residential areas since they require open spaces for production machinery, parking facilities for the employees, appropriate routes for supply and delivery, special connections to the national grid and other environmental impacts. Since they have larger spaces compared to commercial sites in urban areas, they represent an appropriate case study for evaluating the technical and economic viability of energy system integration with low power density technologies, such as solar and wind, for on-site electricity generation. The available open space surrounding the analysed manufacturing plant can be efficiently used to produce a discrete quantity of energy, instantaneously and locally consumed. Therefore, transmission and distribution losses can be reduced. The usage of storage is not required due to the high and almost constant electricity consumption profile. The energy load of the plant is identified through the analysis of gas and electricity consumption, both internally monitored and reported on the bills. These data are not often recorded and available to third parties since manufacturing companies usually keep track only of the overall energy expenditures. The solar potential is modelled for a period of 21 years based on global horizontal irradiation data; the hourly direct and diffuse radiation and the energy produced by the system at the optimum pitch angle are calculated. The model is validated using PVWatts and SAM tools. Wind speed data are available for the same period within one-hour step at a height of 10m. Since the hub of a typical wind turbine reaches a higher altitude, complementary data for a different location at 50m have been compared, and a model for the estimate of wind speed at the required height in the right location is defined. Weibull Statistical Distribution is used to evaluate the wind energy potential of the site. The results show that solar and wind energy are, as expected, generally decoupled. Based on the real case study, the percentage of load covered every hour by on-site generation (Level of Autonomy LA) and the resulting electricity bought from the grid (Expected Energy Not Supplied EENS) are calculated. The economic viability of the project is assessed through Net Present Value, and the influence the main technical and economic parameters have on NPV is presented. Since the results show that the analysed renewable sources can not provide enough electricity, the integration with a cogeneration technology is studied. Finally, the benefit to energy system integration of wind, solar and a cogeneration technology is evaluated and discussed.

Keywords: demand, energy system integration, load, manufacturing, national grid, renewable energy sources

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428 Initiating the Provision of Adolescent Reproductive Health Information and Services (ARHIS) to Communities in Quezon City, Beginning with District 2

Authors: Erickson Bernardo, Caridad Pineda

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The project Adolescent Reproductive Health Information and Services (ARHIS) is a nine-month pilot project which intends to bridge the existing gap between reproductive health information and services, particularly with regard to family planning and HIV, among adolescent boys and girls aged 10-19 years in the 2nd Congressional District of Quezon City, in the Philippines. It aims to increase adolescents' and young people's awareness about their reproductive health concerns and at the same time make a wide range of reproductive health (RH) services accessible and available to them. A number of methodologies were utilized in the implementation of the project. At the onset, a baseline survey was conducted by community mobilizers to gather a situational analysis of adolescents' and young people's issues and concerns. The results of this survey were then presented in a multi-stakeholders' meeting to gather community support and foster their involvement. Further, interactive learning sessions (ILS) on a variety of reproductive health topics, among young people, parents and community leaders based on the results of the baseline survey was conducted. With regard to reproductive health service provision, both facility-based delivery and conduct of outreach activities were employed. In the span of nine months, the project was able to yield the following results: • A total of 521 adolescents and youth (AY) were reached by ILS on puberty, responsible relationships, teenage pregnancy, family planning, as well as HIV & AIDS. • A total of 218 parents and community leaders were informed of AY RH-related issues and concerns. • More than 350 AYs availed of a wide range of FP services including pills – both combined oral and progestin-only, and progestin-only injectables and implants. • More than 380 AYs availed of condoms as means of STI and HIV prevention. A noble initiative of the project is the utilization of a "condom distributor", a youth leader who has been educated about STI and HIV prevention as well as correct condom use, as the focal point for condom access in the community. • A total of 25 young people, parents, and community leaders were identified as ARHIS champions who have been instrumental in the achievement of project deliverables through their dedication and commitment to support the project. The concept of adolescent sexual and reproductive health (ASRH) remains to be a major challenge in the Philippine context. This is due to the fact that majority of Filipinos are still not keen on discussing issues and concerns related to ASRH, albeit the alarming number of teenage pregnancies and the rapid increase of HIV cases among 15- 24 year olds. In addition, Republic Act 10354 or the Responsible Parenthood and Reproductive Health Act of 2012, requires minor adolescents to present a written parental consent prior to accessing RH services. However, with the involvement and support of parents and key community stakeholders, these barriers may be addressed. The project has demonstrated how adolescents and young people yearn for reproductive health information and services.

Keywords: adolescent sexual reproductive health, barriers to access, reproductive health information and services, teenage pregnancies

Procedia PDF Downloads 161
427 Effectiveness of Prehabilitation on Improving Emotional and Clinical Recovery of Patients Undergoing Open Heart Surgeries

Authors: Fatma Ahmed, Heba Mostafa, Bassem Ramdan, Azza El-Soussi

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Background: World Health Organization stated that by 2020 cardiac disease will be the number one cause of death worldwide and estimates that 25 million people per year will suffer from heart disease. Cardiac surgery is considered an effective treatment for severe forms of cardiovascular diseases that cannot be treated by medical treatment or cardiac interventions. In spite of the benefits of cardiac surgery, it is considered a major stressful experience for patients who are candidate for surgery. Prehabilitation can decrease incidences of postoperative complications as it prepares patients for surgical stress through enhancing their defenses to meet the demands of surgery. When patients anticipate the postoperative sequence of events, they will prepare themselves to act certain behaviors, identify their roles and actively participate in their own recovery, therefore, anxiety levels are decreased and functional capacity is enhanced. Prehabilitation programs can comprise interventions that include physical exercise, psychological prehabilitation, nutritional optimization and risk factor modification. Physical exercises are associated with improvements in the functioning of the various physiological systems, reflected in increased functional capacity, improved cardiac and respiratory functions and make patients fit for surgical intervention. Prehabilitation programs should also prepare patients psychologically in order to cope with stress, anxiety and depression associated with postoperative pain, fatigue, limited ability to perform the usual activities of daily living through acting in a healthy manner. Notwithstanding the benefits of psychological preparations, there are limited studies which investigated the effect of psychological prehabilitation to confirm its effect on psychological, quality of life and physiological outcomes of patients who had undergone cardiac surgery. Aim of the study: The study aims to determine the effect of prehabilitation interventions on outcomes of patients undergoing cardiac surgeries. Methods: Quasi experimental study design was used to conduct this study. Sixty eligible and consenting patients were recruited and divided into two groups: control and intervention group (30 participants in each). One tool namely emotional, physiological, clinical, cognitive and functional capacity outcomes of prehabilitation intervention assessment tool was utilized to collect the data of this study. Results: Data analysis showed significant improvement in patients' emotional state, physiological and clinical outcomes (P < 0.000) with the use of prehabilitation interventions. Conclusions: Cardiac prehabilitation in the form of providing information about surgery, circulation exercise, deep breathing exercise, incentive spirometer training and nutritional education implemented daily by patients scheduled for elective open heart surgery one week before surgery have been shown to improve patients' emotional state, physiological and clinical outcomes.

Keywords: emotional recovery, clinical recovery, coronary artery bypass grafting patients, prehabilitation

Procedia PDF Downloads 192
426 Automatic Adult Age Estimation Using Deep Learning of the ResNeXt Model Based on CT Reconstruction Images of the Costal Cartilage

Authors: Ting Lu, Ya-Ru Diao, Fei Fan, Ye Xue, Lei Shi, Xian-e Tang, Meng-jun Zhan, Zhen-hua Deng

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Accurate adult age estimation (AAE) is a significant and challenging task in forensic and archeology fields. Attempts have been made to explore optimal adult age metrics, and the rib is considered a potential age marker. The traditional way is to extract age-related features designed by experts from macroscopic or radiological images followed by classification or regression analysis. Those results still have not met the high-level requirements for practice, and the limitation of using feature design and manual extraction methods is loss of information since the features are likely not designed explicitly for extracting information relevant to age. Deep learning (DL) has recently garnered much interest in imaging learning and computer vision. It enables learning features that are important without a prior bias or hypothesis and could be supportive of AAE. This study aimed to develop DL models for AAE based on CT images and compare their performance to the manual visual scoring method. Chest CT data were reconstructed using volume rendering (VR). Retrospective data of 2500 patients aged 20.00-69.99 years were obtained between December 2019 and September 2021. Five-fold cross-validation was performed, and datasets were randomly split into training and validation sets in a 4:1 ratio for each fold. Before feeding the inputs into networks, all images were augmented with random rotation and vertical flip, normalized, and resized to 224×224 pixels. ResNeXt was chosen as the DL baseline due to its advantages of higher efficiency and accuracy in image classification. Mean absolute error (MAE) was the primary parameter. Independent data from 100 patients acquired between March and April 2022 were used as a test set. The manual method completely followed the prior study, which reported the lowest MAEs (5.31 in males and 6.72 in females) among similar studies. CT data and VR images were used. The radiation density of the first costal cartilage was recorded using CT data on the workstation. The osseous and calcified projections of the 1 to 7 costal cartilages were scored based on VR images using an eight-stage staging technique. According to the results of the prior study, the optimal models were the decision tree regression model in males and the stepwise multiple linear regression equation in females. Predicted ages of the test set were calculated separately using different models by sex. A total of 2600 patients (training and validation sets, mean age=45.19 years±14.20 [SD]; test set, mean age=46.57±9.66) were evaluated in this study. Of ResNeXt model training, MAEs were obtained with 3.95 in males and 3.65 in females. Based on the test set, DL achieved MAEs of 4.05 in males and 4.54 in females, which were far better than the MAEs of 8.90 and 6.42 respectively, for the manual method. Those results showed that the DL of the ResNeXt model outperformed the manual method in AAE based on CT reconstruction of the costal cartilage and the developed system may be a supportive tool for AAE.

Keywords: forensic anthropology, age determination by the skeleton, costal cartilage, CT, deep learning

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425 Enhancing Financial Security: Real-Time Anomaly Detection in Financial Transactions Using Machine Learning

Authors: Ali Kazemi

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The digital evolution of financial services, while offering unprecedented convenience and accessibility, has also escalated the vulnerabilities to fraudulent activities. In this study, we introduce a distinct approach to real-time anomaly detection in financial transactions, aiming to fortify the defenses of banking and financial institutions against such threats. Utilizing unsupervised machine learning algorithms, specifically autoencoders and isolation forests, our research focuses on identifying irregular patterns indicative of fraud within transactional data, thus enabling immediate action to prevent financial loss. The data we used in this study included the monetary value of each transaction. This is a crucial feature as fraudulent transactions may have distributions of different amounts than legitimate ones, such as timestamps indicating when transactions occurred. Analyzing transactions' temporal patterns can reveal anomalies (e.g., unusual activity in the middle of the night). Also, the sector or category of the merchant where the transaction occurred, such as retail, groceries, online services, etc. Specific categories may be more prone to fraud. Moreover, the type of payment used (e.g., credit, debit, online payment systems). Different payment methods have varying risk levels associated with fraud. This dataset, anonymized to ensure privacy, reflects a wide array of transactions typical of a global banking institution, ranging from small-scale retail purchases to large wire transfers, embodying the diverse nature of potentially fraudulent activities. By engineering features that capture the essence of transactions, including normalized amounts and encoded categorical variables, we tailor our data to enhance model sensitivity to anomalies. The autoencoder model leverages its reconstruction error mechanism to flag transactions that deviate significantly from the learned normal pattern, while the isolation forest identifies anomalies based on their susceptibility to isolation from the dataset's majority. Our experimental results, validated through techniques such as k-fold cross-validation, are evaluated using precision, recall, and the F1 score alongside the area under the receiver operating characteristic (ROC) curve. Our models achieved an F1 score of 0.85 and a ROC AUC of 0.93, indicating high accuracy in detecting fraudulent transactions without excessive false positives. This study contributes to the academic discourse on financial fraud detection and provides a practical framework for banking institutions seeking to implement real-time anomaly detection systems. By demonstrating the effectiveness of unsupervised learning techniques in a real-world context, our research offers a pathway to significantly reduce the incidence of financial fraud, thereby enhancing the security and trustworthiness of digital financial services.

Keywords: anomaly detection, financial fraud, machine learning, autoencoders, isolation forest, transactional data analysis

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424 Authenticity from the Perspective of Locals: What Prince Edward Islanders Had to Say about Authentic Tourism Experiences

Authors: Susan C. Graham

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Authenticity has grown to be ubiquitous within the tourism vernacular. Yet, agreement regarding what authenticity means in relation to tourism remains nebulous. In its simplest form, authenticity in tourism refers to products and experiences that provide insights into the social, cultural, economic, natural, historical, and political life of a place. But this definition is unwieldy in its scope and may not help industry leaders nor tourist in identifying that which is authentic. Much of what is projected as authentic is a carefully curated and crafted message developed by marketers to appeal to visitors and bears little resemblance to the everyday lives of locals. So perhaps one way to identify authentic tourism experiences is to ask locals themselves. The purpose of this study was to explore the perspectives of locals with respect to what constituted an authentic tourism experience in Prince Edward Island (PEI), Canada. Over 600 volunteers in a tourism research panel were sent a survey asking them to describe authentic PEI experiences within ten sub-categories relevant to the local tourism industry. To make participation more manageable, each respondent was asked their perspectives on any three of the tourism sub-categories. Over 400 individuals responded, providing 1391 unique responses. The responses were grouped thematically using interpretive phenomenological analysis whereby the participants’ responses were clustered into higher order groups to extract meaning. Two interesting thematic observations emerged: first, that respondents tended to clearly articulate and differentiate between intra- versus interpersonal experiences as a means of authentically experiencing PEI; and second, while respondents explicitly valued unstaged experiences over staged, several exceptions to this general rule were expressed. Responses could clearly be grouped into those that emphasized “going off the beaten path,” “exploring pristine and untouched corners,” “lesser known,” “hidden”, “going solo,” and taking the opportunity to “slow down.” Each of these responses was “self” centered, and focused on the visitor discovering and exploring in search of greater self-awareness and inner peace. In contrast, other responses encouraged the interaction of visitors with locals as a means of experiencing the authentic place. Respondents sited “going deep-sea fishing” to learn about local fishers and their communities, stopping by “local farm stands” and speaking with farmers who worked the land for generations,” patronizing “local restaurants, pubs, and b&bs”, and partaking in performances or exhibits by local artists. These kinds of experiences, the respondents claimed, provide an authentic glimpse into a place’s character. The second set of observations focused on the distinction between staged and unstaged experiences, with respondents overwhelmingly advocating for unstaged. Responses were clear in shunning “touristy,” “packaged,” and “fake” offerings for being inauthentic and misrepresenting the place as locals view it. Yet many respondents made exceptions for certain “staged” experiences, including (quite literally) the stage production of Anne of Green Gables based on the novel of the same name, the theatrical re-enactment of the founding of Canada, and visits to PEI’s many provincial and national parks, all of which respondents considered both staged and authentic at the same time.

Keywords: authentic, local, Prince Edward Island, tourism

Procedia PDF Downloads 255
423 Wildfire Risk and Biodiversity Management: Understanding Perceptions and Preparedness

Authors: Emily Moskwa, Delene Weber, Jacob Arnold, Guy M. Robinson, Douglas K. Bardsley

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Management strategies to reduce the risks to human life and property from wildfire are key contemporary concerns, with a growing literature exploring these issues from a social research perspective. Efforts range from narrowly focused examinations, such as comparing the level of community support for vegetation clearance with that of controlled burning, to broader considerations of what constitutes effective fire management policy and education campaigns. However, little analysis is available that integrates the social component of risk mitigation and the influence of educational materials with the biodiversity conservation strategies so often needed in fire-prone ecosystems found on the periphery of urban areas. Indeed many communities living on the fringe of Australian cities face major issues relating to an increased risk of wildfire events and a decline in local biodiversity. Inadequate policy and planning, and a lack of awareness or information, exacerbate this risk. This has brought forward an emerging governance challenge that requires the mitigation of wildfire risk while simultaneously supporting improved conservation practices in these urban-fringe areas. Focusing on the perceptions and experiences of residents of the Lower Eyre Peninsula in South Australia, this study analyses data collected from a series of semi-structured interviews with landholders (n=20) living in rural and urban-fringe areas surrounding the city of Port Lincoln, a city with a growing population and one that has faced a number of very large fires in recent years. In South Australia, new policies have assigned increased responsibility on individual landholders to manage their land and prepare themselves for a wildfire event, potentially to the detriment of the surrounding native vegetation. Our findings indicate the value of gaining a more nuanced understanding of the perceptions and behaviours of landholders living in areas of high fire risk, who often choose to live there in order to be close to the natural environment. Many interviewees demonstrated a high awareness of wildfire risk as a result of their past experience with fire, and the majority considered themselves to be well-prepared in the event of a future fire. Community interactions and educational programs were found to be effective in raising awareness of risk; however, negative trust relationships with government authorities and low exposure to information concerning biodiversity resulted in an overall misunderstanding of the relationship between risk mitigation and biodiversity protection. The study offers insights into how catastrophic fires are reframing perceptions of what constitutes effective vegetation management. It provides recommendations to assist with the development of education strategies that concurrently address wildfire management and biodiversity conservation, and contribute towards environmentally-informed and risk conscious governance.

Keywords: biodiversity conservation, risk, peri-urban planning, wildfire management

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422 Criticality of Socio-Cultural Factors in Public Policy: A Study of Reproductive Health Care in Rural West Bengal

Authors: Arindam Roy

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Public policy is an intriguing terrain, which involves complex interplay of administrative, social political and economic components. There is hardly any fit-for all formulation of public policy as Lindbloom has aptly categorized it as a science of muddling through. In fact, policies are both temporally and contextually determined as one the proponents of policy sciences Harold D Lasswell has underscored it in his ‘contextual-configurative analysis’ as early as 1950s. Though, a lot of theoretical efforts have been made to make sense of this intricate dynamics of policy making, at the end of the day the applied area of public policy negates any such uniform, planned and systematic formulation. However, our policy makers seem to have learnt very little of that. Until recently, policy making was deemed as an absolutely specialized exercise to be conducted by a cadre of professionally trained seasoned mandarin. Attributes like homogeneity, impartiality, efficiency, and neutrality were considered as the watchwords of delivering common goods. Citizen or clientele was conceptualized as universal political or economic construct, to be taken care of uniformly. Moreover, policy makers usually have the proclivity to put anything into straightjacket, and to ignore the nuances therein. Hence, least attention has been given to the ground level reality, especially the socio-cultural milieu where the policy is supposed to be applied. Consequently, a substantial amount of public money goes in vain as the intended beneficiaries remain indifferent to the delivery of public policies. The present paper in the light of Reproductive Health Care policy in rural West Bengal has tried to underscore the criticality of socio-cultural factors in public health delivery. Indian health sector has traversed a long way. From a near non-existent at the time of independence, the Indian state has gradually built a country-wide network of health infrastructure. Yet it has to make a major breakthrough in terms of coverage and penetration of the health services in the rural areas. Several factors are held responsible for such state of things. These include lack of proper infrastructure, medicine, communication, ambulatory services, doctors, nursing services and trained birth attendants. Policy makers have underlined the importance of supply side in policy formulation and implementation. The successive policy documents concerning health delivery bear the testimony of it. The present paper seeks to interrogate the supply-side oriented explanations for the failure of the delivery of health services. Instead, it identified demand side to find out the answer. The state-led and bureaucratically engineered public health measures fail to engender demands as these measures mostly ignore socio-cultural nuances of health and well-being. Hence, the hiatus between supply side and demand side leads to huge wastage of revenue as health infrastructure, medicine and instruments remain unutilized in most cases. Therefore, taking proper cognizance of these factors could have streamlined the delivery of public health.

Keywords: context, policy, socio-cultural factor, uniformity

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421 Potential Assessment and Techno-Economic Evaluation of Photovoltaic Energy Conversion System: A Case of Ethiopia Light Rail Transit System

Authors: Asegid Belay Kebede, Getachew Biru Worku

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The Earth and its inhabitants have faced an existential threat as a result of severe manmade actions. Global warming and climate change have been the most apparent manifestations of this threat throughout the world, with increasingly intense heat waves, temperature rises, flooding, sea-level rise, ice sheet melting, and so on. One of the major contributors to this disaster is the ever-increasing production and consumption of energy, which is still primarily fossil-based and emits billions of tons of hazardous GHG. The transportation industry is recognized as the biggest actor in terms of emissions, accounting for 24% of direct CO2 emissions and being one of the few worldwide sectors where CO2 emissions are still growing. Rail transportation, which includes all from light rail transit to high-speed rail services, is regarded as one of the most efficient modes of transportation, accounting for 9% of total passenger travel and 7% of total freight transit. Nonetheless, there is still room for improvement in the transportation sector, which might be done by incorporating alternative and/or renewable energy sources. As a result of these rapidly changing global energy situations and rapidly dwindling fossil fuel supplies, we were driven to analyze the possibility of renewable energy sources for traction applications. Even a small achievement in energy conservation or harnessing might significantly influence the total railway system and have the potential to transform the railway sector like never before. As a result, the paper begins by assessing the potential for photovoltaic (PV) power generation on train rooftops and existing infrastructure such as railway depots, passenger stations, traction substation rooftops, and accessible land along rail lines. As a result, a method based on a Google Earth system (using Helioscopes software) is developed to assess the PV potential along rail lines and on train station roofs. As an example, the Addis Ababa light rail transit system (AA-LRTS) is utilized. The case study examines the electricity-generating potential and economic performance of photovoltaics installed on AALRTS. As a consequence, the overall capacity of solar systems on all stations, including train rooftops, reaches 72.6 MWh per day, with an annual power output of 10.6 GWh. Throughout a 25-year lifespan, the overall CO2 emission reduction and total profit from PV-AA-LRTS can reach 180,000 tons and 892 million Ethiopian birrs, respectively. The PV-AA-LRTS has a 200% return on investment. All PV stations have a payback time of less than 13 years, and the price of solar-generated power is less than $0.08/kWh, which can compete with the benchmark price of coal-fired electricity. Our findings indicate that PV-AA-LRTS has tremendous potential, with both energy and economic advantages.

Keywords: sustainable development, global warming, energy crisis, photovoltaic energy conversion, techno-economic analysis, transportation system, light rail transit

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420 Perception Differences in Children Learning to Golf with Traditional versus Modified (Scaled) Equipment

Authors: Lindsey D. Sams, Dean R. Gorman, Cathy D. Lirgg, Steve W. Dittmore, Jack C. Kern

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Golf is a lifetime sport that provides numerous physical and psychological benefits. The game has struggled with attrition and retention within minority groups and this has exposed the lack of a modified introduction to the game that is uniformly accessible and developmentally appropriate. Factors that have been related to sport participatory behaviors include perceived competence, enjoyment and intention. The purpose of this study was to examine self-reported perception differences in competence and enjoyment between learners using modified and traditional equipment as well as the potential effects these factors could have on intent for future participation. For this study, SNAG Golf was chosen to serve as the scaled equipment used by the modified equipment group. The participants in this study were 99 children (24 traditional equipment users/ 75 modified equipment users) located across the U.S. with ages ranging from 7 to 12 years (2nd-5th grade). Utilizing a convenience sampling method, data was obtained on a voluntary basis through surveys measuring children’s golf participation and self-perceptions concerning perceived competence, enjoyment and intention to continue participation. The scales used for perceived competence and enjoyment included Susan Harter’s Self-Perception Profile for Children (SPPC) along with the Physical Activity Enjoyment Scale (PACES). Analysis revealed no significant differences for enjoyment, perceived competence or intention between children learning with traditional golf equipment and modified golf equipment. This was true even though traditional equipment users reported significantly higher experience levels than that of modified users. Intention was regressed on the enjoyment and perceived competence variables. Congruent with current literature, enjoyment was a strong predictor of intention to continue participation, for both groups. Modified equipment users demonstrated significantly lower experience levels but reported similar levels of competence, enjoyment and intent to continue participation as reported by the more experienced, and potentially more skilled, traditional users. The ability to immediately generate these positive affects suggests the potential adoption of a more effective way to learn golf and a method that is conducive to participatory behaviors related to attrition and retention. These implications in turn, highlight an equipment candidate ideal for inception into physical education programs where new learners are introduced to various sports in safe and developmentally appropriate environments. A major goal of this study was to provide foundational research that instigates the further examination of golf’s introductory teaching methodologies, as there is a lack of its presence in current literature. Future research recommendations range from improvements in the current research design to expansive approaches related to the topic, such as progressive skill development, knowledge of the game’s tactical and strategic concepts, playing ability and teaching effectiveness when utilizing modified versus traditional equipment.

Keywords: adaptive sports, enjoyment, golf participation, modified equipment, perceived competence, SNAG golf

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419 The Lacuna in Understanding of Forensic Science amongst Law Practitioners in India

Authors: Poulomi Bhadra, Manjushree Palit, Sanjeev P. Sahni

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Forensic science uses all branches of science for criminal investigation and trial and has increasingly emerged as an important tool in the administration of justice. However, the growth and development of this field in India has not been as rapid or widespread as compared to the more developed Western countries. For successful administration of justice, it is important that all agencies involved in law enforcement adopt an inter-professional approach towards forensic science, which is presently lacking. In light of the alarmingly high average acquittal rate in India, this study aims to examine the lack of understanding and appreciation of the importance and scope of forensic evidence and expert opinions amongst law professionals such as lawyers and judges. Based on a study of trial court cases from Delhi and surrounding areas, the study underline the areas in forensics where the criminal justice system has noticeably erred. Using this information, the authors examine the extent of forensic understanding amongst legal professionals and attempt to conclusively identify the areas in which they need further appraisal. A cross-sectional study done using a structured questionnaire was conducted amongst law professionals across age, gender, type and years of experience in court, to determine their understanding of DNA, fingerprints and other interdisciplinary scientific materials used as forensic evidence. In our study, we understand the levels of understanding amongst lawyers with regards to DNA and fingerprint evidence, and how it affects trial outcomes. We also aim to understand the factors that prevent credible and advanced awareness amongst legal personnel, amongst others. The survey identified the areas in modern and advanced forensics, such as forensic entomology, anthropology, cybercrime etc., in which Indian legal professionals are yet to attain a functional understanding. It also brings to light, what is commonly termed as the ‘CSI-effect’ in the Western courtrooms, and provides scope to study the existence of this phenomenon and its effects on the Indian courts and their judgements. This study highlighted the prevalence of unchallenged expert testimony presented by the prosecution in criminal trials and impressed upon the judicial system the need for independent analysis and evaluation of the scientist’s data and/or testimony by the defense. Overall, this study aims to define a clearer and rigid understanding of why legal professionals should have basic understanding of the interdisciplinary nature of forensic sciences. Based on the aforementioned findings, the author suggests various measures by which judges and lawyers might obtain an extensive knowledge of the advances and promising potentialities of forensic science. This includes promoting a forensic curriculum in legal studies at Bachelor’s and Master’s level as well as in mid-career professional courses. Formation of forensic-legal consultancies, in consultation with the Department of Justice, will not only assist in training police, military and law personnel but will also encourage legal research in this field. These suggestions also aim to bridge the communication gap that presently exists between law practitioners, forensic scientists and the general community’s awareness of the criminal justice system.

Keywords: forensic science, Indian legal professionals, interdisciplinary awareness, legal education

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418 Ethical Decision-Making by Healthcare Professionals during Disasters: Izmir Province Case

Authors: Gulhan Sen

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Disasters could result in many deaths and injuries. In these difficult times, accessible resources are limited, demand and supply balance is distorted, and there is a need to make urgent interventions. Disproportionateness between accessible resources and intervention capacity makes triage a necessity in every stage of disaster response. Healthcare professionals, who are in charge of triage, have to evaluate swiftly and make ethical decisions about which patients need priority and urgent intervention given the limited available resources. For such critical times in disaster triage, 'doing the greatest good for the greatest number of casualties' is adopted as a code of practice. But there is no guide for healthcare professionals about ethical decision-making during disasters, and this study is expected to use as a source in the preparation of the guide. This study aimed to examine whether the qualities healthcare professionals in Izmir related to disaster triage were adequate and whether these qualities influence their capacity to make ethical decisions. The researcher used a survey developed for data collection. The survey included two parts. In part one, 14 questions solicited information about socio-demographic characteristics and knowledge levels of the respondents on ethical principles of disaster triage and allocation of scarce resources. Part two included four disaster scenarios adopted from existing literature and respondents were asked to make ethical decisions in triage based on the provided scenarios. The survey was completed by 215 healthcare professional working in Emergency-Medical Stations, National Medical Rescue Teams and Search-Rescue-Health Teams in Izmir. The data was analyzed with SPSS software. Chi-Square Test, Mann-Whitney U Test, Kruskal-Wallis Test and Linear Regression Analysis were utilized. According to results, it was determined that 51.2% of the participants had inadequate knowledge level of ethical principles of disaster triage and allocation of scarce resources. It was also found that participants did not tend to make ethical decisions on four disaster scenarios which included ethical dilemmas. They stayed in ethical dilemmas that perform cardio-pulmonary resuscitation, manage limited resources and make decisions to die. Results also showed that participants who had more experience in disaster triage teams, were more likely to make ethical decisions on disaster triage than those with little or no experience in disaster triage teams(p < 0.01). Moreover, as their knowledge level of ethical principles of disaster triage and allocation of scarce resources increased, their tendency to make ethical decisions also increased(p < 0.001). In conclusion, having inadequate knowledge level of ethical principles and being inexperienced affect their ethical decision-making during disasters. So results of this study suggest that more training on disaster triage should be provided on the areas of the pre-impact phase of disaster. In addition, ethical dimension of disaster triage should be included in the syllabi of the ethics classes in the vocational training for healthcare professionals. Drill, simulations, and board exercises can be used to improve ethical decision making abilities of healthcare professionals. Disaster scenarios where ethical dilemmas are faced should be prepared for such applied training programs.

Keywords: disaster triage, medical ethics, ethical principles of disaster triage, ethical decision-making

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417 Psychosocial Challenges of Multi-Drug Resistant Tuberculosis (MDR-TB) Patients at St. Peter TB Specialized Hospital in Addis Ababa

Authors: Tamrat Girma Biru

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Multidrug-resistant tuberculosis (MDR-TB) is defined as resistant to at least Refampicin and Isoniazed: the most two power full TB drugs. It is a leading cause of high rates of morbidity and mortality, and increasing psychosocial challenges to patients, especially when co-infected with Human Immunodeficiency Virus (HIV). Ethiopia faces the highest rates of MDR-TB infection in the world. Objectives: The main objective of this study was to identify the psychosocial challenges of MDR-TB patients, to investigate the extent of the psychosocial challenges on (self-esteem, depression, and stigma) that MDR-TB patients encounter, to examine whether there is a sex difference in experiencing psychosocial challenges and assess the counseling needs of MDR-TB patients. Methodology: A cross-sectional study was conducted at St. Peter TB Specialized Hospital, Addis Ababa on 40 patients (25 males and 15 females) who are hospitalized for treatment. The patients were identified by using purposive sampling and made fill a questionnaire measuring their level of self-esteem, depression and stigma. Besides, data were collected from 16 participants, 28 care providers and 8 guardians, using semi-structured interview. The obtained data were analyzed using SPSS statistical program, descriptive statistics, independent t-test, and qualitative description. Results and Discussion: The results of the study showed that the majority (80%) of the respondents had suffered psychological challenges and social discriminations. Thus, the significance of MDR-TB and its association with HIV/AIDS problems is considered. Besides the psychosocial challenges, various aggravating factors such as length of treatment, drug burden and insecurity in economy together highly challenges the life of patients. In addition, 60% of participants showed low level of self-esteem. The patients also reported that they experienced high self-stigma and stigma by other members of the society. The majority of the participants (75%) showed moderate and severe level of depression. In terms of sex there is no difference between the mean scores of males and females in the level of depression and stigmatization by others and by themselves. But females showed lower level of self-esteem than males. The analysis of the t-test also shows that there were no statistically significant sex difference on the level of depression and stigma. Based on the qualitative data MDR-TB patients face various challenges in their life sphere such as: Psychological (depression, low self value, lowliness, anxiety), social (stigma, isolation from social relations, self-stigmatization,) and medical (drug side effect, drug toxicity, drug burden, treatment length, hospital stays). Recommendations: Based on the findings of this study possible recommendations were forwarded: develop and extend MDR-TB disease awareness creation through by media (printing and electronic), school net TB clubs, and door to door community education. Strengthen psychological wellbeing and social relationship of MDR-TB patients using proper and consistent psychosocial support and counseling. Responsible bodies like Ministry of Health (MOH) and its stakeholders and Non Governmental Organizations (NGOs) need to assess the challenges of patients and take measures on this pressing issue.

Keywords: psychosocial challenges, counseling, multi-drug resistant tuberculosis (MDR-TB), tuberculosis therapy

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