Search results for: integrated health interventions

Authors: Reema Alghamdi, Rasees Aleisa, Layan Sukkar

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The primary objective of this research is to conduct an examination of the Flo menstrual cycle application. We do that by evaluating the user experience and their satisfaction with integrated AI features. The study seeks to gather data from primary resources, primarily through surveys, to gather different insights about the application, like its usability functionality in addition to the overall user satisfaction. The focus of our project will be particularly directed towards the impact and user perspectives regarding the integration of artificial intelligence features within the application, contributing to an understanding of the holistic user experience.

Keywords: period, women health, machine learning, AI features, menstrual cycle

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Authors: K. V. F. Fatokun, P. A. Eniayeju

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This study concerns the effects of concept mapping-guided discovery integrated teaching approach on the learning style and achievement of chemistry students. The sample comprised 162 senior secondary school (SS 2) students drawn from two science schools in Nasarawa State which have equivalent mean scores of 9.68 and 9.49 in their pre-test. Five instruments were developed and validated while the sixth was purely adopted by the investigator for the study, Four null hypotheses were tested at α = 0.05 level of significance. Chi square analysis showed that there is a significant shift in students’ learning style from accommodating and diverging to converging and assimilating when exposed to concept mapping- guided discovery approach. Also t-test and ANOVA that those in experimental group achieve and retain content learnt better. Results of the Scheffe’s test for multiple comparisons showed that boys in the experimental group performed better than girls. It is therefore concluded that the concept mapping-guided discovery integrated approach should be used in secondary schools to successfully teach electrochemistry. It is strongly recommended that chemistry teachers should be encouraged to adopt this method for teaching difficult concepts.

Keywords: integrated teaching approach, concept mapping-guided discovery, achievement, retention, learning styles and interest

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Authors: Joyce Fernandez

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This study examined the effects of critical incident stress debriefing and other related interventions on the psychological recovery of earthquake survivors. It is a mixed experimental and qualitative study using post-test only control group design and focus group discussion. After the conduct of critical incident stress debriefing activities and other related interventions in the form of counseling and psychiatric treatment to the survivors of a 6.9 magnitude earthquake, a post-test measuring the level of psychological recovery was given to randomized participants categorized as intervention and control groups. Using the traumatic assessment and belief scale as instrument for the quantitative aspect in order to gauge recovery in the psychological need areas of safety, trust, esteem, intimacy and control, the findings are the following: Intervention group participants have relatively better adjustment along the five psychological need areas compared to the control group participants; there is no significant difference in the psychological recovery among female and male participants of the invention and control groups and; there are significant differences between intervention and control groups in the psychological need areas of self-safety, self-trust, other-trust, self-esteem, and self-intimacy. Using a guided interview for the qualitative data, the themes derived are the following. Safety: The world is an unsafe place to live because of the calamities. Trust: Trust and dependence are anchored on the family. Esteem: Participants are having confused self-worth. Intimacy: Participants are thriving on attachment with their family. Control: Participants have unaltered desire to help but feeling restricted because of personal and logistical concerns.As an outcome of the study a Psychosocial Care Program for Individuals, Families and Communities Affected by Disaster and Trauma was proposed.

Keywords: critical incident stress debriefing, earthquake survivors, psychological recovery, related interventions

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Authors: Avigail Moor, Michal Otmazgin, Hagar Tsiddon, Avivit Mahazri

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The goal of the present study was to refine sexual assault therapy through the examination of the level of agreement between survivor and therapist assessments of key recovery-promoting therapeutic interventions. This is the first study to explore the level of agreement between those who partake in the treatment process from either position. Semi structured interviews were conducted in this qualitative study with 10 survivors and 10 experienced therapists. The results document considerable concurrence between them regarding relational and trauma processing treatment components alike. Together, these reports outline key effective interventions, both common and specific in nature, concomitantly supported by both groups.

Keywords: sexual assault, rape treatment, therapist training, psychotherapy

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Authors: Najmeh Hamid, Vajiheh Hamedy , Zahra Rostamianasl

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Background: Cancer is one of the medical problems that have been associated with pain. Moreover, the pain is combined with negative emotions such as anxiety, depression and anger. Poor pain management causes negative effects on the quality of life, which results in negative effects that continue a long time after the painful experiences. Objectives: The aim of this research was to compare the effectiveness of Common Cognitive Behavioral Therapy for Pain and its computerized version on the reduction of pain intensity, depression, anger and anxiety in children with cancer. Methods: The research method of this “Randomized Controlled Clinical Trial” was a pre, post-test and follow-up with a control group. In this research, we have examined the effectiveness of Common Cognitive Behavioral Therapy for Pain and its computerized version on the reduction of pain intensity, anxiety, depression and anger in children with cancer in Ahvaz. Two psychological interventions (cognitive behavioral therapy for pain and the computerized version) were compared with the control group. The sample consisted of 60 children aged 8 to 12 years old with different types of cancer at Shafa hospital in Ahwaz. According to the including and excluding criteria such as age, socioeconomic status, clinical diagnostic interview and other criteria, 60 subjects were selected. Then, randomly, 45 subjects were selected. The subjects were randomly divided into three groups of 15 (two experimental and one control group). The research instruments included Spielberger Anxiety Inventory (STAY-2) and International Pain Measurement Scale. The first experimental group received 6 sessions of cognitive-behavioral therapy for 6 weeks, and the second group was subjected to a computerized version of cognitive-behavioral therapy for 6 weeks, but the control group did not receive any interventions. For ethical considerations, a version of computerized cognitive-behavioral therapy was provided to them. After 6 weeks, all three groups were evaluated as post-test and eventually after a one-month follow-up. Results: The findings of this study indicated that both interventions could reduce the negative emotions (pain, anger, anxiety, depression) associated with cancer in children in comparison with a control group (p<0.0001). In addition, there were no significant differences between the two interventions (p<0.01). It means both interventions are useful for reducing the negative effects of pain and enhancing adjustment. Conclusion: we can use CBT in situations in which there is no access to psychologists and psychological services. In addition, it can be a useful alternative to conventional psychological interventions.

Keywords: pain, children, psychological intervention, cancer, anger, anxiety, depression

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Authors: Niveen M. Hassan-Abbas

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The COVID-19 pandemic created a range of stressors, among them difficulties related to work conditions, financial changes, lack of childcare, and confinement or isolation due to social distancing. Among families and married individuals, these stressors were often expressed in additional daily hassles, with an influence on mental health. This study examined two moderated mediation models based on Bodenmann’s systemic-transactional stress model. Specifically, the models tested the hypothesis that intra-dyadic stress mediates the association between extra-dyadic stress and mental health, while two measures of family functioning, cohesion, and flexibility, moderate the relationship between extra and intra-dyadic stress. Participants were 480 heterosexual married Palestinians from Israel who completed self-report questionnaires. The results showed partial mediation patterns supporting both models, indicating that family cohesion and flexibility weakened the mediating effect of intra-dyadic stress on the relationship between extra-dyadic stress and mental health. These findings increase our understanding of the variables that affected mental health during the pandemic and suggested that when faced with extra-dyadic stress, married individuals with good family environments are less likely to experience high levels of intra-dyadic stress, which is in turn associated with preserved mental health. Limitations and implications for planning interventions for couples and families during the pandemic are discussed.

Keywords: Palestinian families in Israel, COVID-19 pandemic, family cohesion and flexibility, extra-dyadic stress, intra-dyadic stress, mental health

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Authors: Raul G. Angeles, Rowena R. De Guzman

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The future workforce for health in a globalized context highlights better health human resource planning. Health sciences students are challenged to develop skills needed for global migration. Advancing health sciences education is crucial in preparing them to overcome border challenges. The purpose of this mixed-method, two-part study was to determine the extent by which the current instructional planning and implementation (IPI) framework is reframed with teaching approaches that foster students' 21st-century skills development and to examine participants’ over-all insights on learner-centered teaching and learning (LCTL) particularly in health sciences classrooms. Participants were groups of teachers and students drawn from a national sample through the Philippine higher education institutions (HEIs). To the participants, the use of technology, practices driven by students’ interests and enriching learning experiences through project-based learning are the approaches that must be incorporated with great extent in IPI to encourage student engagement, active learning and collaboration. Participants were asked to detail their insights of learner-centered teaching and learning and using thematic content analysis parallel insights between the groups of participants lead to three emerging themes: opportunities, challenges and prospects. More contemporary understanding of LTCL in today’s health sciences classrooms were demonstrated by the participants. Armed with true understanding, educational leaders can provide interventions appropriate to the students’ level of need, teachers’ preparation and school’s readiness in terms of resources. Health sciences classrooms are innovated to meet the needs of the current and future students.

Keywords: globalization, health workforce, role of education, student-centered teaching and learning, technology in education

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Authors: Komal Fizza

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All around the world in every field professionals are taking great support from their computers. Computer assisted strategies not only increase the efficiency of the professionals but also in case of healthcare they help in life-saving interventions. The background of this current research is aimed towards two things; first to find out if computer assisted strategies are useful for Pharmacist for not and secondly how much these assist a Pharmacist to do quality interventions. Shifa International Hospital is a 500 bedded hospital, and it is running Antimicrobial Stewardship, during their stewardship rounds pharmacists observed that a lot of wrong doses of antibiotics were coming at times those were being overlooked by the other pharmacist even. So, with the help of MIS team the patients were categorized into adult and peads depending upon their age. Minimum and maximum dose of every single antibiotic present in the pharmacy that could be dispensed to the patient was developed. These were linked to the order entry window. So whenever pharmacist would type any order and the dose would be below or above the therapeutic limit this would give an alert to the pharmacist. Whenever this message pop-up this was recorded at the back end along with the antibiotic name, pharmacist ID, date, and time. From 14th of January 2015 and till 14th of March 2015 the software stopped different users 350 times. Out of this 300 were found to be major errors which if reached to the patient could have harmed them to the greater extent. While 50 were due to typing errors and minor deviations. The pilot study showed that computer assisted strategies can be of great help to the pharmacist. They can improve the efficacy and quality of interventions.

Keywords: antibiotics, computer assisted strategies, pharmacist, stewardship

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Authors: Xiaodong Li, Peng Gao, Chao-Jung Huang, Shiying Hao, Xuefeng B. Ling, Yongxia Han, Yaqi Zhang, Le Zheng, Chengyin Ye, Modi Liu, Minjie Xia, Changlin Fu, Bo Jin, Karl G. Sylvester, Eric Widen

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Predicting the risk of Pancreatic Adenocarcinoma (PA) in advance can benefit the quality of care and potentially reduce population mortality and morbidity. The aim of this study was to develop and prospectively validate a risk prediction model to identify patients at risk of new incident PA as early as 3 months before the onset of PA in a statewide, general population in Maine. The PA prediction model was developed using Deep Neural Networks, a deep learning algorithm, with a 2-year electronic-health-record (EHR) cohort. Prospective results showed that our model identified 54.35% of all inpatient episodes of PA, and 91.20% of all PA that required subsequent chemoradiotherapy, with a lead-time of up to 3 months and a true alert of 67.62%. The risk assessment tool has attained an improved discriminative ability. It can be immediately deployed to the health system to provide automatic early warnings to adults at risk of PA. It has potential to identify personalized risk factors to facilitate customized PA interventions.

Keywords: cancer prediction, deep learning, electronic health records, pancreatic adenocarcinoma

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Authors: S. M. Ashikur Elahee, Md. Zahidur Rahman, Md. Shofiqur Rahman

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This study evaluated the impact of different water interventions under WASH program on access of household's to safe drinking water. Following survey method, the study was carried out in two Upazila of South-west coastal region of Bangladesh namely Koyra from Khulna and Shymnagar from Satkhira district. Being an explanatory study, a total of 200 household's selected applying random sampling technique were interviewed using a structured interview schedule. The predicted probability suggests that around 62 percent household's are out of year-round access to safe drinking water whereby, only 25 percent household's have access at SPHERE standard (913 Liters/per person/per year). Besides, majority (78 percent) of the household's have not accessed at both indicators simultaneously. The distance from household residence to the water source varies from 0 to 25 kilometer with an average distance of 2.03 kilometers. The study also reveals that the increase in monthly income around BDT 1,000 leads to additional 11 liters (coefficient 0.01 at p < 0.1) consumption of safe drinking water for a person/year. As expected, lining up time has significant negative relationship with dependent variables i.e., for higher lining up time, the probability of getting access for both SPHERE standard and year round access variables becomes lower. According to ordinary least square (OLS) regression results, water consumption decreases at 93 liters for per person/year of a household if one member is added to that household. Regarding water consumption intensity, ordered logistic regression (OLR) model shows that one-minute increase of lining up time for water collection tends to reduce water consumption intensity. On the other hand, as per OLS regression results, for one-minute increase of lining up time, the water consumption decreases by around 8 liters. Considering access to Deep Tube Well (DTW) as a reference dummy, in OLR, the household under Pond Sand Filter (PSF), Shallow Tube Well (STW), Reverse Osmosis (RO) and Rainwater Harvester System (RWHS) are respectively 37 percent, 29 percent, 61 percent and 27 percent less likely to ensure year round access of water consumption. In line of health impact, different type of water born diseases like diarrhea, cholera, and typhoid are common among the coastal community caused by microbial impurities i.e., Bacteria, Protozoa. High turbidity and TDS in pond water caused by reduction of water depth, presence of suspended particle and inorganic salt stimulate the growth of bacteria, protozoa, and algae causes affecting health hazard. Meanwhile, excessive growth of Algae in pond water caused by excessive nitrate in drinking water adversely effects on child health. In lieu of ensuring access at SPHERE standard, we need to increase the number of water interventions at reasonable distance, preferably a half kilometer away from the dwelling place, ensuring community peoples involved with its installation process where collectively owned water intervention is found more effective than privately owned. In addition, a demand-responsive approach to supply of piped water should be adopted to allow consumer demand to guide investment in domestic water supply in future.

Keywords: access, impact, safe drinking water, Sphere standard, water interventions

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Authors: Phenphak Horadee, Rodchares Hanrinth, Saithip Suttiruksa

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Inappropriate use of antibiotics has happened in several hospitals, Thailand. Drug use evaluation (DUE) is one strategy to overcome this difficulty. However, most community hospitals still encounter incomplete evaluation resulting overuse of antibiotics with high cost. Consequently, drug-resistant bacteria have been rising due to inappropriate antibiotic use. The aim of this study was to involve stakeholders in conceptualizing, developing, and prioritizing a feasible intervention strategy to promote and support appropriate antibiotic prescribing in a community hospital, Thailand. Study antibiotics included four antibiotics such as Meropenem, Piperacillin/tazobactam, Amoxicillin/clavulanic acid, and Vancomycin. The study was conducted for the 1-year period between March 1, 2018, and March 31, 2019, in a community hospital in the northeastern part of Thailand. Concept mapping was used in a purposive sample, including doctors (one was an administrator), pharmacists, and nurses who involving drug use evaluation of antibiotics. In-depth interviews for each participant and survey research were conducted to seek the problems for inappropriate use of antibiotics based on drug use evaluation system. Seventy-seven percent of DUE reported appropriate antibiotic prescribing, which still did not reach the goal of 80 percent appropriateness. Meropenem led other antibiotics for inappropriate prescribing. The causes of the unsuccessful DUE program were classified into three themes such as personnel, lack of public relation and communication, and unsupported policy and impractical regulations. During the first meeting, stakeholders (n = 21) expressed the generation of interventions. During the second meeting, participants who were almost the same group of people in the first meeting (n = 21) were requested to independently rate the feasibility and importance of each idea and to categorize them into relevant clusters to facilitate multidimensional scaling and hierarchical cluster analysis. The outputs of analysis included the idealist, cluster list, point map, point rating map, cluster map, and cluster rating map. All of these were distributed to participants (n = 21) during the third meeting to reach consensus on an intervention model. The final proposed intervention strategy included 29 feasible and crucial interventions in seven clusters: development of information technology system, establishing policy and taking it into the action plan, proactive public relations of the policy, action plan and workflow, in cooperation of multidisciplinary teams in drug use evaluation, work review and evaluation with performance reporting, promoting and developing professional and clinical skill for staff with training programs, and developing practical drug use evaluation guideline for antibiotics. These interventions are relevant and fit to several intervention strategies for antibiotic stewardship program in many international organizations such as participation of the multidisciplinary team, developing information technology to support antibiotic smart use, and communication. These interventions were prioritized for implementation over a 1-year period. Once the possibility of each activity or plan is set up, the proposed program could be applied and integrated into hospital policy after evaluating plans. Effectiveness of each intervention could be promoted to other community hospitals to promote and support antibiotic smart use.

Keywords: antibiotic, concept mapping, drug use evaluation, multidisciplinary teams

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Authors: M. Louise Humbert, Karen E. Chad, Natalie E. Houser, Marta E. Erlandson

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Physical literacy is the motivation, confidence, physical competence, knowledge, and understanding to value and takes responsibility for engagement in physical activities for life. In recent years, physical literacy has emerged as a determinant of health, promoting a positive lifelong physical activity trajectory. Physical literacy’s holistic approach and emphasis on the intrinsic valuation of movement provide an encouraging avenue for intervention among children to develop competent and confident movers. Although there is research on physical literacy interventions, no evidence exists on the outcomes of multi-sectoral interventions involving a combination of home, school, and community contexts. Since children interact with and in a wide range of contexts (home, school, community) daily, interventions designed to address a combination of these contexts are critical to the development of physical literacy. Working with school administrators and teachers, sports and recreation leaders, and community members, our team of university and community researchers conducted and evaluated one of the first multi-contextual and multi-sectoral physical literacy interventions in Canada. Schools played a critical role in this multi-sector intervention, and in this project, teachers and administrators focused their actions on developing physical literacy in students 10 to 14 years of age through the instruction of physical literacy-focused physical education lessons. Little is known about the experiences of educators when they work alongside an array of community representatives to develop physical literacy in school-aged children. Given the uniqueness of this intervention, we sought to answer the question, ‘What were the experiences of school-based educators involved in a multi-sectoral partnership focused on creating a physical literacy enriched community intervention?’ A thematic analysis approach was used to analyze data collected from interviews with educators and administrators, informal conversations, documents, and observations at workshops and meetings. Results indicated that schools and educators played the largest role in this multi-sector intervention. Educators initially reported a limited understanding of physical literacy and expressed a need for resources linked to the physical education curriculum. Some anxiety was expressed by the teachers as their students were measured, and educators noted they wanted to increase their understanding and become more involved in the assessment of physical literacy. Teachers reported that the intervention’s focus on physical literacy positively impacted the scheduling and their instruction of physical education. Administrators shared their desire for school and division-level actions targeting physical literacy development like the current focus on numeracy and literacy, treaty education, and safe schools. As this was one of the first multi-contextual and multi-sectoral physical literacy interventions, it was important to document creation and delivery experiences to encourage future growth in the area and develop suggested best practices.

Keywords: physical literacy, multi sector intervention, physical education, teachers

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Authors: Abdullah Tahir

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The omission of regular medications in surgical patients poses a significant challenge in healthcare settings and is associated with increased morbidity during hospital stays. Human factors such as high workload, poor communication, and emotional stress are known to contribute to these omissions, particularly evident in the surgical assessment unit (SAU) due to its high patient burden and long wait times. This study aimed to quantify and address the issue by implementing targeted interventions to enhance compliance in prescribing regular medications for surgical patients at Stoke Mandeville Hospital, United Kingdom. Data were collected on 14 spontaneous days between April and May 2023, and the frequency of prescription omissions was recorded using a tally chart. Subsequently, informative posters were introduced in the SAU, and presentations were given to the surgical team to emphasize the importance of compliance in this area. The interventions were assessed using a second data collection cycle, again over 14 spontaneous days in May 2023. Results demonstrated an improvement from 40% (60 out of 150) to 74% (93 out of 126) of patients having regular medications prescribed at the point of clerking. These findings highlight the efficacy of frequent prompts and awareness-raising interventions in increasing workforce compliance and addressing the issue of prescription omissions in the SAU.

Keywords: prescription omissions, quality improvement, regular medication, surgical assessment unit

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Authors: Mohammad H. Yarmohammadian, Fatemeh Rezaei

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Introduction: Improving patient safety in health systems is one of the main priorities in healthcare systems, so clinical risk management in organizations has become increasingly significant. Although several tools have been developed for clinical risk management, each has its own limitations. Aims: This study aims to develop a comprehensive tool that can complete the limitations of each risk assessment and management tools with the advantage of other tools. Methods: Procedure was determined in two main stages included development of an initial model during meetings with the professors and literature review, then implementation and verification of final model. Subjects and Methods: This study is a quantitative − qualitative research. In terms of qualitative dimension, method of focus groups with inductive approach is used. To evaluate the results of the qualitative study, quantitative assessment of the two parts of the fourth phase and seven phases of the research was conducted. Purposive and stratification sampling of various responsible teams for the selected process was conducted in the operating room. Final model verified in eight phases through application of activity breakdown structure, failure mode and effects analysis (FMEA), healthcare risk priority number (RPN), root cause analysis (RCA), FT, and Eindhoven Classification model (ECM) tools. This model has been conducted typically on patients admitted in a day-clinic ward of a public hospital for surgery in October 2012 to June. Statistical Analysis Used: Qualitative data analysis was done through content analysis and quantitative analysis done through checklist and edited RPN tables. Results: After verification the final model in eight-step, patient's admission process for surgery was developed by focus discussion group (FDG) members in five main phases. Then with adopted methodology of FMEA, 85 failure modes along with its causes, effects, and preventive capabilities was set in the tables. Developed tables to calculate RPN index contain three criteria for severity, two criteria for probability, and two criteria for preventability. Tree failure modes were above determined significant risk limitation (RPN > 250). After a 3-month period, patient's misidentification incidents were the most frequent reported events. Each RPN criterion of misidentification events compared and found that various RPN number for tree misidentification reported events could be determine against predicted score in previous phase. Identified root causes through fault tree categorized with ECM. Wrong side surgery event was selected by focus discussion group to purpose improvement action. The most important causes were lack of planning for number and priority of surgical procedures. After prioritization of the suggested interventions, computerized registration system in health information system (HIS) was adopted to prepare the action plan in the final phase. Conclusion: Complexity of health care industry requires risk managers to have a multifaceted vision. Therefore, applying only one of retrospective or prospective tools for risk management does not work and each organization must provide conditions for potential application of these methods in its organization. The results of this study showed that the integrated clinical risk management model can be used in hospitals as an efficient tool in order to improve clinical governance.

Keywords: failure modes and effective analysis, risk management, root cause analysis, model

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Authors: Malik D. Halidu, Cathrine F. Moe, Tommy Haugan

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Purpose: The demand for effective school-based interventions in shaping adolescents' unmet mental health needs is growing. Grounding in the functional contextualism approach, this study investigates the role of school satisfaction (SS) in serving as a buffer to school absenteeism (SAB) among adolescents experiencing social anxiety (SA). Methods: A unique and large population-based sample of adolescents (upper secondary school pupils; n= 1864) from the Young-HUNT 3 survey dataset merged with the national educational registry from Norway. Moderation regression analysis was performed using Stata 17. Results: We find a statistically significant moderating role of school satisfaction on the relationship between social anxiety and school absenteeism (β=-0.109,p<0.01) among upper secondary school pupils. Among socially anxious adolescents associated with a higher perceived quality of school life, it functions as a buffer by reducing the positive relationship between SA and SAB. But, there was no statistically significant difference between social anxiety and school absenteeism for adolescents with low school satisfaction. Conclusion: Overall, the study's hypothesis model was statistically supported and contributes to the discourse that school satisfaction as a target of school-based interventions can effectively improve school outcomes (e.g., reduced absenteeism) among socially anxious pupils.

Keywords: social anxiety, school satisfaction, school absenteeism, Norwegian adolescent

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Authors: Jill Hanass-Hancock, Bradley Carpenter, Samantha Willan, Kristin Dunkle

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Access to quality health care for persons with disabilities is the litmus test in our strive toward universal health coverage. Persons with disabilities experience a variety of health disparities related to increased health risks, greater socioeconomic challenges, and persistent ableism in the provision of health care. In low- and middle-income countries, the support needed to address the diverse needs of persons with disabilities and close the gaps in inclusive and accessible health care can appear overwhelming to staff with little knowledge and tools available. An action-orientated disability inclusion toolkit for health facilities was developed through consensus-building consultations and field testing in South Africa. The co-creation of the toolkit followed a bottom-up approach with healthcare staff and persons with disabilities in two developmental cycles. In cycle one, a disability facility assessment tool was developed to increase awareness of disability accessibility and service delivery gaps in primary healthcare services in a simple and action-orientated way. In cycle two, an intervention menu was created, enabling staff to respond to identified gaps and improve accessibility and inclusion. Each cycle followed five distinct steps of development: a review of needs and existing tools, design of the draft tool, consensus discussion to adapt the tool, pilot-testing and adaptation of the tool, and identification of the next steps. The continued consultations, adaptations, and field-testing allowed the team to discuss and test several adaptations while co-creating a meaningful and feasible toolkit with healthcare staff and persons with disabilities. This approach led to a simplified tool design with ‘key elements’ needed to achieve universal health coverage: universal design of health facilities, reasonable accommodation, health care worker training, and care pathway linkages. The toolkit was adapted for paper or digital data entry, produces automated, instant facility reports, and has easy-to-use training guides and online modules. The cyclic approach enabled the team to respond to emerging needs. The pilot testing of the facility assessment tool revealed that healthcare workers took significant actions to change their facilities after an assessment. However, staff needed information on how to improve disability accessibility and inclusion, where to acquire accredited training, and how to improve disability data collection, referrals, and follow-up. Hence, intervention options were needed for each ‘key element’. In consultation with representatives from the health and disability sectors, tangible and feasible solutions/interventions were identified. This process included the development of immediate/low-cost and long-term solutions. The approach gained buy-in from both sectors, who called for including the toolkit in the standard quality assessments for South Africa’s health care services. Furthermore, the process identified tangible solutions for each ‘key element’ and highlighted where research and development are urgently needed. The cyclic and consultative approach enabled the development of a feasible facility assessment tool and a complementary intervention menu, moving facilities toward universal health coverage for and persons with disabilities in low- or better-resourced contexts while identifying gaps in the availability of interventions.

Keywords: public health, disability, accessibility, inclusive health care, universal health coverage

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Authors: Evren Aysev Denec

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As an urban settlement dating as early as 8000 years and the capital for Byzantine and Ottoman empires; İstanbul has been a significant global city throughout history. The most drastic changes in the macro form of Istanbul have taken place in the last seven decades; starting from 1950’s with rapid industrialization and population growth; pacing up after the 1980’s with the efforts of integration to the global capitalist system; reaching to a climax in the 2000’s with the adaptation of a neoliberal urban regime. Today, the rate of urbanization together with land speculation and real estate investment has been growing enormously. Every inch of urban land is conceptualized as a commodity to be capitalized. This neoliberal mindset has many controversial implementations, from the privatization of public land to the urban transformation of historic neighbourhoods and consumption of natural resources. The planning decisions concerning the city have been mainly top down initiations; conceptualising historical, cultural and natural heritage as commodities to be capitalised and consumed in favour of creating rent value. One of the most crucial implementations of this neoliberal urban regime is the project of establishing a ‘new city’ around northern Istanbul; together with a number of large-scale infrastructural projects such as the Third Bosporus Bridge; a new highway system, a Third Airport Project and a secondary Bosporus project called the ‘Canal Istanbul’. Urbanizing northern Istanbul is highly controversial as this area consists of major natural resources of the city; being the northern forests, water supplies and wildlife; which are bound to be destroyed to a great extent following the implementations. The construction of the third bridge and the third airport has begun in 2013, despite environmental objections and protests. Over five hundred thousand trees are planned be cut for solely the construction of the bridge and the Northern Marmara Motorway. Yet the real damage will be the urbanization of the forest area; irreversibly corrupting the natural resources and attracting millions of additional population towards Istanbul. Furthermore, these projects lack an integrated planning scope as the plans prepared for Istanbul are constantly subjected to alterations forced by the central government. Urban interventions mentioned above are executed despite the rulings of Istanbul Environmental plan, due to top down planning decisions. Instead of an integrated action plan that prepares for the future of the city, Istanbul is governed by partial plans and projects that are issued by a profit based agenda; supported by legal alterations and laws issued by the central government. This paper aims to discuss the ongoing implementations with regards to northern Istanbul; claiming that they are not merely infrastructural interventions but parts of a greater neoliberal urbanization strategy. In the course of the study, firstly a brief account on the northern forests of Istanbul will be presented. Then, the projects will be discussed in detail, addressing how the current planning schemes deal with the natural heritage of the city. Lastly, concluding remarks on how the implementations could affect the future of Istanbul will be presented.

Keywords: Istanbul, urban design, urban planning, natural resources

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Authors: Daniil Chernov

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In the modern world, the number of conventional interstate wars is declining while the number of military interventions is rising. States no longer initiate conflicts by declaring war but actively intervene in existing military confrontations, often using a comparable number of coercive means. According to existing scholarly understanding, the decision to use force in international relations (in any form) is influenced by roughly the same set of factors: the dynamics of domestic political processes, national interests, international law, and ethical considerations. In the database on armed intervention to be presented in the report, the multifactor model of decision-making is developed. The database describes more than 200 different parameters for armed interventions between 1992 and 2022. The report will present the structure of the database, descriptive statistics, and its key advantages over other sources.

Keywords: conflict resolution, international relations, military intervention, database

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Authors: James Beauchemin

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Introduction: The incarceration of people with mental illness and substance use disorders is a major public health issue, with social, clinical, and economic implications. Yoga participation has been associated with numerous psychological benefits; however, there is a paucity of research examining impacts of yoga with incarcerated populations. The purpose of this study was to evaluate effectiveness of a six-week yoga intervention on several mental health-related variables, including emotion regulation, body awareness, and warnings of substance relapse among incarcerated females. Methods: This study utilized a pre-post, three-arm design, with participants assigned to intervention, therapeutic community, or general population groups. A between-groups analysis of covariance (ANCOVA) was conducted across groups to assess intervention effectiveness using the Difficulties in Emotion Regulation Scale (DERS), Scale of Body Connection (SBC), and Warnings of Relapse (AWARE) Questionnaire. Results: ANCOVA results for warnings of relapse (AWARE) revealed significant between-group differences F(2, 80) = 7.15, p = .001; np2 = .152), with significant pairwise comparisons between the intervention group and both the therapeutic community (p = .001) and the general population (p = .005) groups. Similarly, significant differences were found for emotional regulation (DERS) F(2, 83) = 10.521, p = .000; np2 = .278). Pairwise comparisons indicated a significant difference between the intervention and general population (p = .01). Finally, significant differences between the intervention and control groups were found for body awareness (SBC) F(2, 84) = 3.69, p = .029; np2 = .081). Between-group differences were clarified via pairwise comparisons, indicating significant differences between the intervention group and both the therapeutic community (p = .028) and general population groups (p = .020). Implications: Study results suggest that yoga may be an effective addition to integrative mental health and substance use treatment for incarcerated women, and contributes to increasing evidence that holistic interventions may be an important component for treatment with this population. Specifically, given the prevalence of mental health and substance use disorders, findings revealed that changes in body awareness and emotion regulation may be particularly beneficial for incarcerated populations with substance use challenges as a result of yoga participation. From a systemic perspective, this proactive approach may have long-term implications for both physical and psychological well-being for the incarcerated population as a whole, thereby decreasing the need for traditional treatment. By integrating a more holistic, salutogenic model that emphasizes prevention, interventions like yoga may work to improve the wellness of this population, while providing an alternative or complementary treatment option for those with current symptoms.

Keywords: yoga, mental health, incarceration, wellness

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Authors: Natan C. G. Silva, Carlos A. C. Girao Neto, Marcele M. S. Vasconcelos, Luciana R. B. Goncalves, Maria Valderez P. Rocha

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Galactooligosaccharides (GOS) are sugars with prebiotic function that can be synthesized chemically or enzymatically, and this last one can be promoted by the action of β-galactosidases. In addition to favoring the transgalactosylation reaction to form GOS, these enzymes can also catalyze the hydrolysis of lactose. A highly studied type of GOS is lactulose because it presents therapeutic properties and is a health promoter. Among the different raw materials that can be used to produce lactulose, whey stands out as the main by-product of cheese manufacturing, and its discarded is harmful to the environment due to the residual lactose present. Therefore, its use is a promising alternative to solve this environmental problem. Thus, lactose from whey is hydrolyzed into glucose and galactose by β-galactosidases. However, in order to favor the transgalactosylation reaction, the medium must contain fructose, due this sugar reacts with galactose to produce lactulose. Then, the glucose-isomerase enzyme can be used for this purpose, since it promotes the isomerization of glucose into fructose. In this scenario, the aim of the present work was first to develop β-galactosidase biocatalysts of Kluyveromyces lactis and to apply it in the integrated reactions of hydrolysis, isomerization (with the glucose-isomerase from Streptomyces murinus) and transgalactosylation reaction, using whey as a substrate. The immobilization of β-galactosidase in chitosan previously functionalized with 0.8% glutaraldehyde was evaluated using different enzymatic loads (2, 5, 7, 10, and 12 mg/g). Subsequently, the hydrolysis and transgalactosylation reactions were studied and conducted at 50°C, 120 RPM for 20 minutes. In parallel, the isomerization of glucose into fructose was evaluated under conditions of 70°C, 750 RPM for 90 min. After, the integration of the three processes for the production of lactulose was investigated. Among the evaluated loads, 7 mg/g was chosen because the best activity of the derivative (44.3 U/g) was obtained, being this parameter determinant for the reaction stages. The other parameters of immobilization yield (87.58%) and recovered activity (46.47%) were also satisfactory compared to the other conditions. Regarding the integrated process, 94.96% of lactose was converted, achieving 37.56 g/L and 37.97 g/L of glucose and galactose, respectively. In the isomerization step, conversion of 38.40% of glucose was observed, obtaining a concentration of 12.47 g/L fructose. In the transgalactosylation reaction was produced 13.15 g/L lactulose after 5 min. However, in the integrated process, there was no formation of lactulose, but it was produced other GOS at the same time. The high galactose concentration in the medium probably favored the reaction of synthesis of these other GOS. Therefore, the integrated process proved feasible for possible production of prebiotics. In addition, this process can be economically viable due to the use of an industrial residue as a substrate, but it is necessary a more detailed investigation of the transgalactosilation reaction.

Keywords: beta-galactosidase, glucose-isomerase, galactooligosaccharides, lactulose, whey

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Authors: B. Thanasansomboon, S. Choemprayong, N. Parinyanitikul, U. Tanlamai

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Being diagnosed with metastatic breast cancer, the patients as well as their caretakers are affected physically and mentally. Although the medical systems in Thailand have been attempting to improve the quality and effectiveness of the treatment of the disease in terms of physical illness, the success of the treatment also depends on the quality of mental health. Metastatic breast cancer patients have found that social support is a key factor that helps them through this difficult time. It is recognized that social support in different dimensions, including emotional support, social network support, informational support, instrumental support and appraisal support, are contributing factors that positively affect the quality of life of patients in general, and it is undeniable that social support in various forms is important in promoting the quality of life of metastatic breast patients. However, previous studies have not been dedicated to investigating their quality of life concerning affective, cognitive, and behavioral outcomes. Therefore, this study aims to develop integrated social support through social networks to improve the quality of life of metastatic breast cancer patients in Thailand.

Keywords: social support, metastatic breath cancer, quality of life, social network

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Authors: Yutong An

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Premature babies in the Neonatal Intensive Care Unit (NICU) are usually protected in individual incubators to ensure a constant temperature and humidity. Accompanied by 24-hour monitoring by medical equipment, this provides a considerable degree of protection for the growth of preterm babies. However, preterm babies are still continuously exposed to noise at excessively high decibels (>45dB). Such noise has a highly damaging effect on the growth and development of preterm babies. For example, in the short term, it can lead to sleep deprivation, stress reactions, and difficulty calming emotions, while in the long term, it can trigger endocrine disorders, metabolic disorders, and hearing impairment. Fortunately, musical interventions in the NICU have been shown to provide calmness to newborns. This article integrates existing research on three types of music that are beneficial for preterm infants and their respective advantages and disadvantages. This paper aims to present a possibility, based on existing NICU equipment and experimental data related to musical interventions, to reduce the impact of noise on preterm babies in the NICU through a system design approach that incorporates a personalized adjustable music system in the incubator and an overall music enhancement in the open bay of the NICU.

Keywords: music interventions, neonatal intensive care unit (NICU), premature babies, neonatal nursing

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Authors: Simangele Dlamini

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Smart city development is seen as a way of facing the challenges brought about by the growing urban population the world over. Research indicates that cities have a role to play in combating urban challenges like crime, waste disposal, greenhouse gas emissions, and resource efficiency. These solutions should be such that they do not make city management less sustainable but should be solutions-driven, cost and resource-efficient, and smart. This study explores opportunities on how the City of Johannesburg, South Africa, can use Geographic Information Systems, Big Data and the Internet of Things (IoT) in identifying opportune areas to initiate smart city initiatives such as smart safety, smart utilities, smart mobility, and smart infrastructure in an integrated manner. The study will combine Big Data, using real-time data sources to identify hotspot areas that will benefit from ICT interventions. The GIS intervention will assist the city in avoiding a silo approach in its smart city development initiatives, an approach that has led to the failure of smart city development in other countries.

Keywords: smart cities, internet of things, geographic information systems, johannesburg

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Authors: Shan Li, Qiuwen Ma

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Integrated project delivery (IPD) is a project delivery method distinguished by a shared risk/rewards mechanism and multiparty agreement. IPD has drawn increasing attention from construction industry due to its reliability to deliver high-performing buildings. However, unavailable IPD specific insurance concerns the industry participants who are interested in IPD implementation. Even though the risk management capability can be enhanced using shared risk mechanism, some risks may occur when the partners do not commit themselves into the integrated practices in a desired manner. This is because the intense collaboration and close integration can not only create added value but bring new opportunistic behaviors and disputes. The study is aimed to investigate the risks of implementing IPD using Bayesian theory. IPD risk taxonomy is presented to identify all potential risks of implementing IPD and a risk network map is developed to capture the interdependencies between IPD risks. The conditional relations between risk occurrences and the impacts of IPD risks on project performances are evaluated and simulated based on Bayesian theory. The probability of project outcomes is predicted by simulation. In addition, it is found that some risks caused by integration are most possible occurred risks. This study can help the IPD project participants identify critical risks of adopting IPD to improve project performances. In addition, it is helpful to develop IPD specific insurance when the pertinent risks can be identified.

Keywords: Bayesian theory, integrated project delivery, project risks, project performances

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Authors: Eleni Panagiotarakou

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This paper argues that humans have a collective moral responsibility to help wild animals during the Anthropocene era. Seen from the perspective of deontic logic, this moral responsibility did not exist in the Holocene era (ca. 11,700 BC-1945 AD) on account of humanity’s limited impact on the natural environment. By contrast in the Anthropocene, human activities are causing significant disturbances to planetary ecosystems and by inference to wildlife communities. Under these circumstances controversial and deeply regrettable interventional methods such as Managed Relocations (MR) and synthetic biology should be expanded and become policy measures despite their known and unknown risks. The main rationale for the above stems from the fact that traditional management strategies are simply insufficient in the Anthropocene. If the same anthropogenic activities continue unabated they risk triggering a sixth mass species extinction.

Keywords: anthropocene, humanitarian interventions, managed relocations, species extinctions, synthetic biology

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Authors: E. Asadollahi-Yazdi, J. Gardan, P. Lafon

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Nowadays, manufactures are encountered with production of different version of products due to quality, cost and time constraints. On the other hand, Additive Manufacturing (AM) as a production method based on CAD model disrupts the design and manufacturing cycle with new parameters. To consider these issues, the researchers utilized Design For Manufacturing (DFM) approach for AM but until now there is no integrated approach for design and manufacturing of product through the AM. So, this paper aims to provide a general methodology for managing the different production issues, as well as, support the interoperability with AM process and different Product Life Cycle Management tools. The problem is that the models of System Engineering which is used for managing complex systems cannot support the product evolution and its impact on the product life cycle. Therefore, it seems necessary to provide a general methodology for managing the product’s diversities which is created by using AM. This methodology must consider manufacture and assembly during product design as early as possible in the design stage. The latest approach of DFM, as a methodology to analyze the system comprehensively, integrates manufacturing constraints in the numerical model in upstream. So, DFM for AM is used to import the characteristics of AM into the design and manufacturing process of a hybrid product to manage the criteria coming from AM. Also, the research presents an integrated design method in order to take into account the knowledge of layers manufacturing technologies. For this purpose, the interface model based on the skin and skeleton concepts is provided, the usage and manufacturing skins are used to show the functional surface of the product. Also, the material flow and link between the skins are demonstrated by usage and manufacturing skeletons. Therefore, this integrated approach is a helpful methodology for designer and manufacturer in different decisions like material and process selection as well as, evaluation of product manufacturability.

Keywords: additive manufacturing, 3D printing, design for manufacturing, integrated design, interoperability

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Authors: Sidramappa Gaddnakeri, Lokanath Malligawad

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Any kind of research on production technology of individual crop / commodity /breed has not brought sustainability or stability in crop production. The sustainability of the system over years depends on the maintenance of the soil health. Organic production system includes use of organic manures, biofertilizers, green manuring for nutrient supply and biopesticides for plant protection helps to sustain the productivity even under adverse climatic condition. The study was initiated to evaluate the performance of different cropping systems under organic, inorganic and integrated production systems at The Institute of Organic Farming, University of Agricultural Sciences, Dharwad (Karnataka-India) under ICAR Network Project on Organic Farming. The trial was conducted for four years (2013-14 to 2016-17) on fixed site. Five cropping systems viz., sequence cropping of cowpea – safflower, greengram– rabi sorghum, maize-bengalgram, sole cropping of pigeonpea and intercropping of groundnut + cotton were evaluated under six nutrient management practices. The nutrient management practices are NM1 (100% Organic farming (Organic manures equivalent to 100% N (Cereals/cotton) or 100% P2O5 (Legumes), NM2 (75% Organic farming (Organic manures equivalent to 75% N (Cereals/cotton) or 100% P2O5 (Legumes) + Cow urine and Vermi-wash application), NM3 (Integrated farming (50% Organic + 50% Inorganic nutrients, NM4 (Integrated farming (75% Organic + 25% Inorganic nutrients, NM5 (100% Inorganic farming (Recommended dose of inorganic fertilizers)) and NM6 (Recommended dose of inorganic fertilizers + Recommended rate of farm yard manure (FYM). Among the cropping systems evaluated for different production systems indicated that the Groundnut + Hybrid cotton (2:1) intercropping system found more remunerative as compared to Sole pigeonpea cropping system, Greengram-Sorghum sequence cropping system, Maize-Chickpea sequence cropping system and Cowpea-Safflower sequence cropping system irrespective of the production systems. Production practices involving application of recommended rates of fertilizers + recommended rates of organic manures (Farmyard manure) produced higher net monetary returns and higher B:C ratio as compared to integrated production system involving application of 50 % organics + 50 % inorganic and application of 75 % organics + 25 % inorganic and organic production system only Both the two organic production systems viz., 100 % Organic production system (Organic manures equivalent to 100 % N (Cereals/cotton) or 100 % P2O5 (Legumes) and 75 % Organic production system (Organic manures equivalent to 75 % N (Cereals) or 100 % P2O5 (Legumes) + Cow urine and Vermi-wash application) are found to be on par. Further, integrated production system involving application of organic manures and inorganic fertilizers found more beneficial over organic production systems.

Keywords: cropping systems, production systems, cowpea, safflower, greengram, pigeonpea, groundnut, cotton

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Authors: Alvaro Valera Sosa

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Background: In recent years, childhood overweight and obesity have become an increasing and challenging phenomenon in Berlin and Germany in general. The highest shares of childhood overweight in Berlin are district localities within the inner city ring with lowest socio-economic levels and the highest number of migration background populations. Most factors explaining overweight and obesity are linked to individual dispositions and nutrition balances. Among various strategies, to target drinking behaviors of children and adolescents has been proven to be effective. On the one hand, encouraging the intake of water – which does not contain energy and thus may support a healthy weight status – on the other hand, reducing the consumption of sugar-containing beverages – which are linked to weight gain and obesity. Anyhow, these preventive approaches have mostly developed into individual or educational interventions widely neglecting environmental modifications. Therefore, little is known on how urban physical environment patterns and features can act as influence factors for childhood overweight. Aiming the development of a physical environment intervention tackling children overweight, this study evaluated urban situations surrounding public playgrounds in Berlin where the issue is evident. It verified the presence and state of physical environmental conditions that can be conducive for children to engage physical activity and water intake. Methods: The study included public playgrounds for children from 0-12 y/o within district localities with the highest prevalence of childhood overweight, highest population density, and highest mixed uses. A systematic observation was realized to describe physical environment patterns and features that may affect children health behavior leading to overweight. Neighborhood walkability for all age groups was assessed using the Walkability for Health framework (TU-Berlin). Playground physical environment conditions were evaluated using Active Living Research assessment sheets. Finally, the food environment in the playground’s pedestrian catchment areas was reviewed focusing on: proximity to suppliers offering sugar-containing beverages, and physical access for 5 y/o children and up to drinking water following the Drinking Fountains and Public Health guidelines of the Pacific Institute. Findings: Out of 114 locations, only 7 had a child population over 3.000. Three with the lowest socio-economic index and highest percentage of migration background were selected. All three urban situations presented similar walkability: large trafficked avenues without buffer bordering at least one side of the playground, and important block to block disconnections for active travel. All three playgrounds rated equipment conditions from good to very good. None had water fountains at the reach of a 5 y/o. and all presented convenience stores and/or fast food outlets selling sugar-containing beverages nearby the perimeter. Conclusion: The three playground situations selected are representative of Berlin locations where most factors that influence children overweight are found. The results delivered urban and architectural design directives for an environmental intervention, used to study children health-related behavior. A post-intervention evaluation could prove associations between designed spaces and children overweight rate reduction creating a precedent in public health interventions and providing novel strategies for the health sector.

Keywords: children overweight, evaluation research, public playgrounds, urban design, urban health

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Authors: C. Silvestros, K. Mellou, T. Georgakopoulou, A. Koustenis, E. Kokkinou, C. Botsi, A. Terzidis

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'PHILOS – Emergency health response to refugee crisis' is a programme of the Greek Ministry of Health, implemented by the Hellenic Center for Disease Control and Prevention (HCDCP) funded by the Asylum, Migration and Integration Fund (AMIF) of EU’s DG Migration and Home Affairs. One of the main objectives of the program is the immunization coverage of the target – population to assure the prevention of vaccine-preventable diseases. The program foresees vaccination needs assessment of children hosted at camps at the mainland and implementation of interventions to cover the vaccination gaps in co-operation with the Ministry of Health. The National Immunization Advisory Committee in Greece recommended that MMR (Measles, Mumps, and Rubella), PCV (Pneumococcal conjugate vaccine) and HEXA (diphtheria, tetanus, pertussis, polio, hepatitis B and Haemophilus influenzae type b) vaccines should be performed in priority. Recording was completed at 24 camps (May - June 2017); 3381 children (0-18 years) were recorded. The median number of children hosted at each camp was 95 (range: 5-553). For 68% of the children, the WHO vaccination booklet was available. 44%, 48.5% and 61% of the children were vaccinated with at least one dose of PCV, HEXA, and MMR, respectively. The proportion of vaccinated children for the three vaccines mentioned above is significantly lower for the remaining doses; PCV (second dose 8%, third dose 1.3%), HEXA (second dose 13%, third dose 2.7%, forth dose 0.1%) and MMR (second dose 23%). None of the 37 (10 from Afghanistan, 3 from Bangladesh, 23 from Pakistan, 1 from Syria) recorded unaccompanied children did not have a WHO vaccination booklet and were considered unvaccinated. There is no differentiation in vaccination coverage among different ethnicities. Massive catch up vaccination was performed at 4 camps, and 671 vaccinations were performed (245 PCV, 307 HEXA, and 119 MMR). Similar interventions are planned for all camps of the country. Recording reveled gaps in vaccination coverage of the population, mainly because of the mobility of the population, the influx of refugees- which is still ongoing- and new births. Mass vaccination campaigns are considered vital in order to increase vaccination coverage, and continuous efforts are needed in order all children living at the camps to have full access to the National Childhood Immunization Program.

Keywords: vaccine preventable, refugee–migrants camps, vaccination coverage, PCV, MMR, HEXA

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Authors: Mohammad Saleem, Neeta Kumar, Anita Sharma, Sazina Muzammil

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It is observed that some of the dental students in our setting take less interest in medical subjects. Various teaching methods are focus of research interest currently and being tried to generate interest among students. An approach of interactive integrated tutorial was used to assess its feasibility in teaching medical subjects to dental undergraduates. The aim was to generate interest and promote active self-learning among students. The objectives were to (1) introduce the integrated interactive learning method through two departments, (2) get feedback from the students and faculty on feasibility and effectiveness of this method. Second-year students in Bachelor of Dental Surgery course were divided into two groups. Each group was asked to study physiology and pathology of a common and important condition (anemia and hypertension) in a week’s time. During the tutorial, students asked questions on physiology and pathology of that condition from each other in the presence of teachers of both physiology and pathology departments. The teachers acted only as facilitators. After the session, the feedback from students and faculty on this alternative learning method was obtained. Results: Majority of the students felt that this method of learning is enjoyable, helped to develop reasoning skills and ability to correlate and integrate the knowledge from two related fields. Majority of the students felt that this kind of learning led to better understanding of the topic and motivated them towards deep learning. Teachers observed that the study promoted interdepartmental cross-discipline collaboration and better students’ linkages. Conclusion: Interactive integrated tutorial is effective in motivating dental students for better and deep learning of medical subjects.

Keywords: active learning, education, integrated, interactive, self-learning, tutorials

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