Search results for: teaching hospital of Oran

Authors: Libing Zhu, Waichung Chen, Kwaicing Lo, Lei Li

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Background: Tian Jiu Therapy (a medicinal vesiculation therapy according to traditional Chinese medicine theory) in San Fu Days (the three hottest days in a year is calculated by the Chinese ancient calendar) is widely used by patients with chronic asthma in China although from modern medicine perspective there is insufficient evidence of its effectiveness and safety issues. We investigated the efficacy and safety of Tian Jiu Therapy compared with placebo in patients with chronic asthma. Methods: Patients with chronic asthma were randomly assigned to Tian Jiu treatment group (n=165), placebo control group (n=158). Registered Chinese Medicine practitioners, in Orthopedics-Traumatology, Acupuncture, and Tui-na Clinical Centre for Teaching and Research, School of Chinese Medicine, The University of Hong Kong, administered Tian Jiu Therapy and placebo treatment in 3 times over 2 months. Patients completed questionnaires and lung function test before treatment and after treatment, 3, 6, 9, and 11 months, respectively. The primary outcome was the no of asthma-related sub-healthy symptoms and the percentage of patients with twenty-three symptoms. Results: 451 patients were recruited totally, 111 patients refused or did not participate according the appointment time and 17 did not meet the inclusion criteria. Consequently, 323 of eligible patients were enrolled. There was nothing difference between Tian Jiu Therapy group and placebo control group at the end of all treatments neither primary nor secondary outcomes. While Tian Jiu Therapy as compared with placebo significantly reduced the percentage of participants who are susceptible waken up by asthma symptoms from 27% to 14% at 2nd follow-up (P < 0.05). Similarly, Tian Jiu Therapy significantly reduced the proportion of participants who had the symptom of running nose and sneezing before onset from 18% to 8% at 2nd follow-up (P < 0.05). Additionally, Tian Jiu Therapy significantly reduced the level of asthma, the proportion of participants who don’t need to processed during asthma attack increased from 6% to 15% at 1st follow-up and 0% to 7% at 3rd follow-up (P < 0.05). Improvements also occurred with Tian Jiu Therapy group, it reduced the proportion of participants who were spontaneously sweating at 3rd follow up and diarrhea after intake of oily food at 4th follow-up (P < 0.05). Conclusion: When added to a regimen of foundational therapy for chronic asthma participants, Tian Jiu Therapy further reduced the need for medications to control asthma, improved the quality of participants’ life, and significantly reduced the level of asthma. What is more, this benefit seems to have an accumulative effect over time was in accordance with the TCM theory of 'winter disease is being cured in summer'.

Keywords: asthma, Tian Jiu Therapy, San Fu Days, triaditional Chinese medicine, clinical trial

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Authors: Ibrahima Diallo

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The literature on teacher education foregrounds reflection as an important aspect of professional practice. Reflection for a teacher consists in critically analysing and evaluating retrospectively a lesson to see what worked, what did not work, and how to improve it for the future. Now, many teacher education programmes worldwide consider the ability to reflect as one of the hallmarks of an effective educator. However, in some context like Senegal, reflection has not been given due consideration in teacher education programmes. In contexts where it has been in the education landscape for some time now, reflection is mostly depicted as an individual written activity and many teacher trainees have become disenchanted by the repeated enactments of this task that is solely intended to satisfy course requirements. This has resulted in whitewashing weaknesses or even ‘faking’ reflection. Besides, the “one-size-fits-all” approach of reflection could not flourish because how reflection impacts on practice is still unproven. Therefore, reflective practice needs to be contextualised and made more thought-provoking through dialogue and by using classroom data. There is also a need to highlight change brought in teachers’ practice through reflection. So, this study introduces reflection in a new context and aims to show evidenced change in novice EFL teachers’ practice through dialogic data-led reflection. The purpose of this study is also to contribute to the scarce literature on reflection in sub-Saharan Africa by bringing new perspectives on contextualised teacher-led reflection. Eight novice EFL teachers participated in this qualitative longitudinal study, and data have been gathered online through post-lesson reflection recordings and lesson videos for a period of four months. Then, the data have been thematically analysed using NVivo to systematically organize and manage the large amount of data. The analysis followed the six steps approach to thematic analysis. Major themes related to teachers’ classroom practice and their conception of reflection emerged from the analysis of the data. The results showed that post-lesson reflection with a peer can help novice EFL teachers gained more awareness on their classroom practice. Dialogic reflection also helped them evaluate their lessons and seek for improvement. The analysis of the data also gave insight on teachers’ conception of reflection in an EFL context. It was found that teachers were more engaged in reflection when using their lesson video recordings. Change in teaching behaviour as a result of reflection was evidenced by the analysis of the lesson video recordings. This study has shown that video-stimulated reflection is practical form of professional development that can be embedded in teachers’ professional life.

Keywords: novice EFL teachers, practice, professional development, video-stimulated reflection

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Authors: Saeyoung Lee

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As the enthusiasm for education in Korea is too much high, it is well known by others that children in Korea get good scores in Mathematics. However, behind of this good reputation, children in Korea are easy to get lose self-confidence, tend to complaint and rarely participate in the class because of too much competition which leads to lack of competences. In this regard, the main goals of this paper are, by applying the programme based on peer-communication on Mathematics education field, it would like to improve self-managemental competence to make children gain self-confidence, communicative competence to make them deal with complaint and communitive competence to make them participated in the class for the age of 10 children to solve this problem. 14 children the age of 10 in one primary school in Gangnam, Seoul, Korea had participated in the research from March 2018 to October 2018. They were under the programme based on peer-communication during the period. Every Mathematics class maintained the same way. Firstly a problem was given to children. Secondly, children were asked to find many ways to solve the problem as much as they could by themselves. Thirdly all ways to solve the problem by children were posted on the board and three of the children made a group to distinguish the ways from valid to invalid. Lastly, all children made a discuss to find one way which is the most efficient among valid ways. Pre-test was carried out by the questionnaire based on Likert scale before applying the programme. The result of the pre-test was 3.89 for self-managemental competence, 3.91 for communicative competence and 4.19 for communitive competence. Post-test was carried out by the same questionnaire after applying the programme. The result of the post-test was 3.93 for self-managemental competence, 4.23 for communicative competence and 4.20 for communitive competence. That means by applying the programme based on peer-communication on Mathematics education field, the age of 10 children in Korea could improve self-managemental, communicative and communitive competence. Especially it works very well on communicative competence by increasing 0.32 points as it marked. Considering this research, Korean Mathematics education based on competition which leads to lack of competences should be changed to cooperative structure to make students more competent rather than just getting good scores. In conclusion, innovative teaching methods which are focused on improving competences such as the programme based on peer-communication which was applied in this research are strongly required to be studied and widely used.

Keywords: competences, mathematics education, peer-communication, primary education

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Authors: Sultan Samah A. Alenezi

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Many EFL teachers are eager to look into the best way to suit the needs of their students in EFL writing courses. Numerous studies suggest that online blogging may present a social interaction opportunity for EFL writing students. Additionally, it can foster peer collaboration and social support in the form of scaffolding, which, when viewed from the perspective of socio-cultural theory, can boost social support and foster the development of students' writing abilities. This idea is based on Vygotsky's theories, which emphasize how collaboration and social interaction facilitate effective learning. In Saudi Arabia, students are taught to write using conventional methods that are totally under the teacher's control. Without any peer contact or cooperation, students are spoon-fed in a passive environment. This study included the cognitive processes of the genre-process approach into the EFL writing classroom to facilitate the use of internet blogging in EFL writing education. Thirty second-year undergraduate students from the Department of Languages and Translation at a Saudi college participated in this study. This study employed an action research project that blended qualitative and quantitative methodologies to comprehend Saudi students' perceptions and experiences with internet blogging in an EFL process-genre writing classroom. It also looked at the advantages and challenges people faced when blogging. They included a poll, interviews, and blog postings made by students. The intervention's outcomes showed that merging genre-process procedures with blogging was a successful tactic, and the Saudi students' perceptions of this method of online blogging for EFL writing were quite positive. The socio-cultural theory constructs that Vygotsky advocates, such as scaffolding, collaboration, and social interaction, were also improved by blogging. These elements demonstrated the improvement in the students' written, reading, social, and collaborative thinking skills, as well as their positive attitudes toward English-language writing. But the students encountered a variety of problems that made blogging difficult for them. These problems ranged from technological ones, such sluggish internet connections, to learner inadequacies, like a lack of computer know-how and ineffective time management.

Keywords: blogging, process-gnere approach, saudi learenrs, writing quality

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Authors: Sheelagh Heugh, Michael Upton, Kriya Kalidas, Stephen Breen

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This article aims to create awareness of the opportunities and issues the artificial intelligence (AI) tool GPT-3 (Generative Pre-trained Transformer-3) brings to higher education. Technological disruptors have featured in higher education (HE) since Konrad Klaus developed the first functional programmable automatic digital computer. The flurry of technological advances, such as personal computers, smartphones, the world wide web, search engines, and artificial intelligence (AI), have regularly caused disruption and discourse across the educational landscape around harnessing the change for the good. Accepting AI influences are inevitable; we took mixed methods through participatory action research and evaluation approach. Joining HE communities, reviewing the literature, and conducting our own research around Chat GPT-3, we reviewed our institutional approach to changing our current practices and developing policy linked to assessments and the use of Chat GPT-3. We review the impact of GPT-3, a high-powered natural language processing (NLP) system first seen in 2020 on HE. Historically HE has flexed and adapted with each technological advancement, and the latest debates for educationalists are focusing on the issues around this version of AI which creates natural human language text from prompts and other forms that can generate code and images. This paper explores how Chat GPT-3 affects the current educational landscape: we debate current views around plagiarism, research misconduct, and the credibility of assessment and determine the tool's value in developing skills for the workplace and enhancing critical analysis skills. These questions led us to review our institutional policy and explore the effects on our current assessments and the development of new assessments. Conclusions: After exploring the pros and cons of Chat GTP-3, it is evident that this form of AI cannot be un-invented. Technology needs to be harnessed for positive outcomes in higher education. We have observed that materials developed through AI and potential effects on our development of future assessments and teaching methods. Materials developed through Chat GPT-3 can still aid student learning but lead to redeveloping our institutional policy around plagiarism and academic integrity.

Keywords: artificial intelligence, Chat GPT-3, intellectual property, plagiarism, research misconduct

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Authors: Paul Essel, Eric T. Glover, Gustav Gbeddy, Yaw Adjei-Kyereme, Abdallah M. A. Dawood, Evans M. Ameho, Emmanuel A. Aberikae

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Radioactive materials mainly in the form of Sealed Radioactive Sources are being used in various sectors (medicine, agriculture, industry, research, and teaching) for the socio-economic development of Ghana. The use of these beneficial radioactive materials has resulted in an inventory of Disused Sealed Radioactive Sources (DSRS) in storage. Most of the DSRS are legacy/historic sources which cannot be returned to their manufacturer or country of origin. Though small in volume, DSRS can be intensively radioactive and create a significant safety and security liability. They need to be managed in a safe and secure manner in accordance with the fundamental safety objective. The Radioactive Waste Management Center (RWMC) of the Ghana Atomic Energy Commission (GAEC) is currently storing a significant volume of DSRS. The initial activities of the DSRS range from 7.4E+5 Bq to 6.85E+14 Bq. If not managed properly, such DSRS can represent a potential hazard to human health and the environment. Storage is an important interim step, especially for DSRS containing very short-lived radionuclides, which can decay to exemption levels within a few years. Long-term storage, however, is considered an unsustainable option for DSRS with long half-lives hence the need for a disposal facility. The GAEC intends to use the International Atomic Energy Agency’s (IAEA’s) Borehole Disposal System (BDS) to provide a safe, secure, and cost-effective disposal option to dispose of its DSRS in storage. The proposed site for implementation of the BDS is on the GAEC premises at Kwabenya. The site has been characterized to gain a general understanding in terms of its regional setting, its past evolution and likely future natural evolution over the assessment time frame. Due to the long half-lives of some of the radionuclides to be disposed of (Ra-226 with half-life of 1600 years), the engineered barriers of the system must be robust to contain these radionuclides for this long period before they decay to harmless levels. There is the need to assess the safety related functions of the engineered barriers of this disposal system.

Keywords: radionuclides, disposal, radioactive waste, engineered barrier

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Authors: Stephanie Yun Yu Law

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Background: This study aims to investigate into communication between trainee doctors and patients, especially how doctor’s reaction to patient’s emotional issues expressed in the consultation affect patient’s satisfaction. Objectives: Thus, there are three aims in this study, 1.) how do trainee doctors react to patients emotional cues in OSCE station? 2.) Any differences in the respond type to emotional cues between first year students and third year students? 3.) Is response type (reducing space) related to OSCE outcome (patient satisfaction and expert rating)? Methods: Fifteen OSCE stations was videotaped, in which 9 were stations with first-year students and 6 were with third-year students. OSCE outcomes were measured by Communication Assessment Tool and Examiners Checklist. Analyses: All patient’s cues/concerns and student’s reaction were coded by Verona Coding Definitions of Emotional Sequence. Descriptive data was gathered from Observer XT and logistic regression (two-level) was carried out to see if occurrence of reducing space response can be predicted by OSCE outcomes. Results: Reducing space responses from all students were slightly less than a half in total responses to patient’s cues. The mean percentage of reducing space behaviours was lower among first year students when compared to third year students. Patient’s satisfaction significantly (p<0.05) and negatively predicted reducing space behaviours. Conclusions: Most of the medical students, to some extent, did not provide adequate responses for patient’s emotional cues. But first year students did provide more space for patients to talk about their emotional issues when compared to third year students. Lastly, patients would feel less satisfied if trainee doctors use more reducing space responses in reaction to patient’s expressed emotional cues/concerns. Practical implications: Firstly, medical training programme can be tailored on teaching students how to detect and respond appropriately to emotional cues in order to improve underperformed student’s communication skills in healthcare setting. Furthermore, trainee doctor’s relationship with patients in clinical practice can also be improved by reacting appropriately to patient’s emotive cues in consultations (such as limit the use of reducing space behaviours).

Keywords: doctors-patients communication, applied clinical psychology, health psychology, healthcare professionals

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Authors: Maryam Ziaee, Himanshu Shee, Amrik Sohal

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Big Data Analytics (BDA) in supply chain management has recently drawn the attention of academics and practitioners. Big data refers to a massive amount of data from different sources, in different formats, generated at high speed through transactions in business environments and supply chain networks. Traditional statistical tools and techniques find it difficult to analyse this massive data. BDA can assist organisations to capture, store, and analyse data specifically in the field of supply chain. Currently, there is a paucity of research on BDA in the pharmaceutical supply chain context. In this research, the Australian pharmaceutical supply chain was selected as the case study. This industry is highly significant since the right medicine must reach the right patients, at the right time, in right quantity, in good condition, and at the right price to save lives. However, drug shortages remain a substantial problem for hospitals across Australia with implications on patient care, staff resourcing, and expenditure. Furthermore, a massive volume and variety of data is generated at fast speed from multiple sources in pharmaceutical supply chain, which needs to be captured and analysed to benefit operational decisions at every stage of supply chain processes. As the pharmaceutical industry lags behind other industries in using BDA, it raises the question of whether the use of BDA can improve transparency among pharmaceutical supply chain by enabling the partners to make informed-decisions across their operational activities. This presentation explores the impacts of BDA on supply chain management. An exploratory qualitative approach was adopted to analyse data collected through interviews. This study also explores the BDA potential in the whole pharmaceutical supply chain rather than focusing on a single entity. Twenty semi-structured interviews were undertaken with top managers in fifteen organisations (five pharmaceutical manufacturers, five wholesalers/distributors, and five public hospital pharmacies) to investigate their views on the use of BDA. The findings revealed that BDA can enable pharmaceutical entities to have improved visibility over the whole supply chain and also the market; it enables entities, especially manufacturers, to monitor consumption and the demand rate in real-time and make accurate demand forecasts which reduce drug shortages. Timely and precise decision-making can allow the entities to source and manage their stocks more effectively. This can likely address the drug demand at hospitals and respond to unanticipated issues such as drug shortages. Earlier studies explore BDA in the context of clinical healthcare; however, this presentation investigates the benefits of BDA in the Australian pharmaceutical supply chain. Furthermore, this research enhances managers’ insight into the potentials of BDA at every stage of supply chain processes and helps to improve decision-making in their supply chain operations. The findings will turn the rhetoric of data-driven decision into a reality where the managers may opt for analytics for improved decision-making in the supply chain processes.

Keywords: big data analytics, data-driven decision, pharmaceutical industry, supply chain management

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Authors: Yi-Hsuan Gloria Lo

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The educational objective of vocational high schools (VHSs) is to equip VHS students with practical skills and knowledge that can be applied in the job-related market. However, with the increasing number of technological universities over the past two decades, the majority of VHS students have chosen to receive higher education rather than enter the job market. VHS English education has been confronting a dilemma: Should an English for specific purposes (ESP) approach, which aligns with the educational goal of VHS education, be taken or should an English for general purposes (EGP) approach, which prepares VHS students for advanced studies in universities, be followed? While ESP theorists proposed that that ESP can be taught to secondary learners, little was known about VHS students’ perspective on this ESP-versus-EGP dilemma. Scant research has investigated different facets of students’ needs (necessities, wants, and lacks) for both ESP and EGP in terms of the four language skills and the factors that contribute to any differences. To address the gap in the literature, 100 VHS students responded to statements related to their necessities, wants, and lacks in learning ESP and EGP on a 6-point Likert scale. Six VHS students were interviewed to tap into the reasons for different facets of the needs for learning EGP and ESP. The statistical analysis indicates that at this stage of learning English, VHS subjects believed that EGP was more necessary than ESP; EGP was more desirable than ESP. However, they reported that they were more lacking in ESP than in EGP learning. Regarding EGP, the results show that the VHS subjects rated speaking as their most necessary skill, speaking as the most desirable skill, and writing as the most lacking skill. A significant difference was found between perceived learning necessities and lacks and between perceived wants and lacks. No statistical difference was found between necessities and wants. In the aspect of ESP, the results indicate that the VHS subjects marked reading as their most necessary skill, speaking as the most desirable skill, and writing as the most lacking skill. A significant difference exists between their perceived necessities and lacks and between their wants and lacks. However, there is no statistically significant difference between their perceived lacks and wants. Despite the lack of a significant difference between learning necessities and wants, the qualitative interview data reveal that the reasons for their perceived necessities and wants were different. The findings of the study confirm previous research that demonstrates that ‘needs’ is a multiple and conflicting construct. What VHS students felt most lacking was not necessarily what they believed they should learn or would like to learn. Although no statistical difference was found, different reasons were attributed to their perceived necessities and wants. Both theoretical and practical implications have been drawn and discussed for ESP research in general and teaching ESP in VHSs in particular.

Keywords: vocational high schools (VHSs), English for General Purposes (EGP), English for Specific Purposes (ESP), needs analysis

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Authors: O. Sauperl, L. Fras Zemljic

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The textile industry is gaining increasing importance in the field of medical materials. Therefore, presented research is focused on textile materials for external (out-of-body) use. Such materials could be various hygienic textile products (diapers, tampons, sanitary napkins, incontinence products, etc.), protective textiles and various hospital linens (surgical covers, masks, gowns, cloths, bed linens, etc.) wound pillows, bandages, orthopedic socks, etc. Function of tampons and sanitary napkins is not only to provide protection during the menstrual cycle, but their function can be also to take care of physiological or pathological vaginal discharge. In general, women's intimate areas are against infection protected by a low pH value of the vaginal flora. High pH inhibits the development of harmful microorganisms, as it is difficult to be reproduced in an acidic environment. The normal vaginal flora in healthy women is highly colonized by lactobacilli. The lactic acid produced by these organisms maintains the constant acidity of the vagina. If the balance of natural protection breaks, infections can occur. In the market, there exist probiotic tampons as a medical product supplying the vagina with beneficial probiotic lactobacilli. But, many users have concerns about the use of tampons due to the possible dry-out of the vagina as well as the possible toxic shock syndrome, which is the reason that they use mainly sanitary napkins during the menstrual cycle. Functionalization of sanitary napkins with probiotics is, therefore, interesting in regard to maintain a healthy vaginal flora and to offer to users added value of the sanitary napkins in the sense of health- and environmentally-friendly products. For this reason, the presented research is oriented in functionalization of the sanitary napkins with the probiotic paste in order to activate the lactic acid bacteria presented in the core of the functionalized sanitary napkin at the time of the contact with the menstrual fluid. In this way, lactobacilli could penetrate into vagina and by maintaining healthy vaginal flora to reduce the risk of vaginal disorders. In regard to the targeted research problem, the influence of probiotic paste applied onto cotton hygienic napkins on selected properties was studied. The aim of the research was to determine whether the sanitary napkins with the applied probiotic paste may assure suitable vaginal pH to maintain a healthy vaginal flora during the use of this product. Together with this, sorption properties of probiotic functionalized sanitary napkins were evaluated and compared to the untreated one. The research itself was carried out on the basis of tracking and controlling the input parameters, currently defined by Slovenian producer (Tosama d.o.o.) as the most important. Successful functionalization of sanitary pads with the probiotic paste was confirmed by ATR-FTIR spectroscopy. Results of the methods used within the presented research show that the absorption of the pads treated with probiotic paste deteriorates compared to non-treated ones. The coating shows a 6-month stability. Functionalization of sanitary pads with probiotic paste is believed to have a commercial potential for lowering the probability of infection during the menstrual cycle.

Keywords: functionalization, probiotic paste, sanitary pads, textile materials

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Authors: Anne Öman

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Today in Sweden and in other countries, a variety of digital artefacts, such as laptops, tablets, interactive whiteboards, are being used at all school levels. From an educational perspective, digital artefacts challenge traditional teaching because they provide a range of modes for expression and communication and are not limited to the traditional medium of paper. Digital technologies offer new opportunities for representations and physical interactions with objects, which put forward the role of the body in interaction and learning. From a multimodal perspective the emphasis is on the use of multiple semiotic resources for meaning- making and the study presented here has examined the differential use of semiotic resources by pupils interacting in a digitally designed task in a primary school context. The instances analyzed in this paper come from a case study where the learning task was to create an advertising film in a film-software. The study in focus involves the analysis of a single case with the emphasis on the examination of the classroom setting. The research design used in this paper was based on a micro ethnographic perspective and the empirical material was collected through video recordings of small-group work in order to explore pupils’ communication within the group activity. The designed task described here allowed students to build, share, collaborate upon and publish the redesigned products. The analysis illustrates the variety of communicative modes such as body position, gestures, visualizations, speech and the interaction between these modes and the representations made by the pupils. The findings pointed out the importance of embodied communication during the small- group processes from a learning perspective as well as a pedagogical understanding of pupils’ representations, which were similar from a cultural literacy perspective. These findings open up for discussions with further implications for the school practice concerning the small- group processes as well as the redesigned products. Wider, the findings could point out how multimodal interactions shape the learning experience in the meaning-making processes taking into account that language in a globalized society is more than reading and writing skills.

Keywords: communicative learning, interactive learning environments, pedagogical issues, primary school education

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Authors: Chang Liu, Hanwen Zhang, Vikash Sharma, Don Eliseo Lucerno-Prisno III, Emmanuel Yujuico, Maulik Chokshi, Prashanthi Krishnakumar, Bach Xuan Tran, Giang Thu Vu, Kamilla Anna Pinter, Shenglan Tang

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Background and Aims: Globally, many health systems focus on hospital-based healthcare models targeting acute care and disease treatment, which are not effective in addressing the challenges of ageing populations, chronic conditions, multi-morbidities, and increasingly unhealthy lifestyles. Recently, integrated care programs on chronic diseases have been developed, piloted, and implemented to meet such challenges. However, integrated care programs in the Asia-Pacific region vary in the levels of integration from linkage to coordination to full integration. This study aims to identify and analyze existing cases of integrated care in the Asia-Pacific region and identify the facilitators and barriers in order to improve existing cases and inform future cases. Methods: The study is a comparative study, with a combination approach of desk-based research and key informant interviews. The selected countries included in this study represent a good mix of lower-middle income countries (the Philippines, India, Vietnam, and Fiji), upper-middle income country (China), and high-income country (Singapore) in the Asia-Pacific region. Existing integrated care programs were identified through the scoping review approach. Trigger, history, general design, beneficiaries, and objectors were summarized with barriers and facilitators of integrated care based on key informant interviews. Representative case(s) in each country were selected and comprehensively analyzed through deep-dive case studies. Results: A total of 87 existing integrated care programs on chronic diseases were found in all countries, with 44 in China, 21 in Singapore, 12 in India, 5 in Vietnam, 4 in the Philippines, and 1 in Fiji. 9 representative cases of integrated care were selected for in-depth description and analysis, with 2 in China, the Philippines, and Vietnam, and 1 in Singapore, India, and Fiji. Population aging and the rising chronic disease burden have been identified as key drivers for almost all the six countries. Among the six countries, Singapore has the longest history of integrated care, followed by Fiji, the Philippines, and China, while India and Vietnam have a shorter history of integrated care. Incentives, technologies, education, and performance evaluation would be crucial for developing strategies for implementing future programs and improve already existing programs. Conclusion: Integrated care is important for addressing challenges surrounding the delivery of long-term care. To date, there is an increasing trend of integrated care programs on chronic diseases in the Asia-Pacific region, and all six countries in our study set integrated care as a direction for their health systems transformation.

Keywords: integrated healthcare, integrated care delivery, chronic diseases, Asia-Pacific region

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Authors: Marion G. Ben-Jacob, David Wang

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There is a mathematics requirement for entry level college and university students, especially those who plan to study STEM (Science, Technology, Engineering and Mathematics). Most of them take College Algebra, and to continue their studies, they need to succeed in this course. Different pedagogical strategies are employed to promote the success of our students. There is, of course, the Traditional Method of teaching- lecture, examples, problems for students to solve. The Emporium Model, another pedagogical approach, replaces traditional lectures with a learning resource center model featuring interactive software and on-demand personalized assistance. This presentation will compare these two methods of pedagogy and the study done with its results on this comparison. Math is the foundation for science, technology, and engineering. Its work is generally used in STEM to find patterns in data. These patterns can be used to test relationships, draw general conclusions about data, and model the real world. In STEM, solutions to problems are analyzed, reasoned, and interpreted using math abilities in a assortment of real-world scenarios. This presentation will examine specific examples of how math is used in the different STEM disciplines. Math becomes practical in science when it is used to model natural and artificial experiments to identify a problem and develop a solution for it. As we analyze data, we are using math to find the statistical correlation between the cause of an effect. Scientists who use math include the following: data scientists, scientists, biologists and geologists. Without math, most technology would not be possible. Math is the basis of binary, and without programming, you just have the hardware. Addition, subtraction, multiplication, and division is also used in almost every program written. Mathematical algorithms are inherent in software as well. Mechanical engineers analyze scientific data to design robots by applying math and using the software. Electrical engineers use math to help design and test electrical equipment. They also use math when creating computer simulations and designing new products. Chemical engineers often use mathematics in the lab. Advanced computer software is used to aid in their research and production processes to model theoretical synthesis techniques and properties of chemical compounds. Mathematics mastery is crucial for success in the STEM disciplines. Pedagogical research on formative strategies and necessary topics to be covered are essential.

Keywords: emporium model, mathematics, pedagogy, STEM

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Authors: Garima Singh

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Objectives: Behavioral Crisis Center (BCC) is a community solution to a community problem. There has been an exponential increase in the incidence and prevalence of mental health crises around the world. The effects of the crisis negatively impact our patients and their families and strain the law enforcement and emergency room. The goal of the multi-disciplinary care model is to break the crisis cycle and provide 24-7 rapid access to an acre and crisis stabilization. We initiated our first BCC care center in 2020 in the midst of the COVID pandemic and have seen a remarkable improvement in patient ‘care and positive financial outcome. Background: Mental illnesses are common in the United States. Nearly one in five U.S. adults live with a mental illness (52.9 million in 2020). This number represented 21.0% of all U.S. adults. To address some of these challenges and help our community, In May 2020, we opened our first Behavioral crisis center (BCC). Since then, we have served more than 2500 patients and is the first southwest Missouri’s first 24/7 facility for crisis–level behavioral health and substance use needs. It has been proven to be a more effective place than emergency departments, jails, or local law enforcement. Methods: BCC was started in 2020 to serve the unmet need of the community and provide access to behavioral health and substance use services identified in the community. Funding was possible with significant investment from the county and Missouri Foundation for Health, with contributions from medical partners. It is a multi-disciplinary care center consisting of Physicians, nurse practitioners, nurses, behavioral technicians, peer support specialists, clinical intake specialists, and clinical coordinators and hospitality specialists. The center provides services including psychiatry care, outpatient therapy, community support services, primary care, peer support and engagement. It is connected to a residential treatment facility for substance use treatment for continuity of care and bridging the gap, which has resulted in the completion of treatment and better outcomes. Results: BCC has proven to be a great resource to the community and the Missouri Health Coalition is providing funding to replicate the model in other regions and work on a similar model for children and adolescents. Overall, 29% of the patients seen at BCC are stabilized and discharged with outpatient care. 50% needed acute stabilization in a hospital setting and 21% required long-term admission, mostly for substance use treatment. The local emergency room had a 42% reduction in behavioral health encounters compared to the previous 3 years. Also, by a quick transfer to BCC, the average stay in ER was reduced by 10 hours and time to follow up behavioral health assessment decreased by an average of 4 hours. Uninsured patients are also provided Medicaid application assistance which has benefited 55% of individuals receiving care at BCC. Conclusions: BCC is impacting community health and improving access to quality care and substance use treatment. It is a great investment for our patients and families.

Keywords: BCC, behvaioral health, community health care, addiction treatment

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Authors: Naziema Jappie

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There is a wealth of knowledge about JEDI (Justice Equity Diversity Inclusion), but unfortunately this remains at a discrete initiative level at universities. South African universities are committed to social justice by promoting inclusive teaching, learning and research environments, diversity and equity in access and participation of students and staff regardless of age; disability; gender; sexual orientation; nationality, ethnic or national origin; religion; and socioeconomic background in all aspects of higher education at a national level. Universities strive to promote and protect equal rights and equity of access is safeguarded for international students by recognizing the foreign policies and practices. Nevertheless, many international students remain underrepresented, alienated and often without employment. Universities see internationalisation as a commercial venture, but where does JEDI fit into this plan? Given the focus on diversity in higher education institutions, one would assume that JEDI should have a broader compass rather than a narrow scope. Over the past decades, national trends have emerged in the commitment to international diversification by admitting students and recruiting staff, mainly from the African continent. Most importantly, emergence of statements of broader diversity and equity plans across the campuses, included in the strategic plans of institutions are counterproductive to the statements of the Employment Equity plans and targets when aligned to the recruitment processes. These trends are certainly significant and relevant given the increasing diverse populations in higher education. What is missing in JEDI initiatives is the lack of global perspective and situating JEDI within a larger and inclusive context to embrace institutional internationalization. It is not a separate construct but internationalization framework takes the JEDI vision from local to global. Embracing JEDI and internationalization are fundamental for future economic growth. JEDI creates diverse perspectives and builds a team of top diverse and international talent that will gives a competitive edge. Increasing internationalization efforts and creating a knowledge platform will affect the innovation performance of the economy. Transforming South African policies require a comprehensive educational strategy on justice, equity, diversity, and inclusion (JEDI).

Keywords: equity, diversity, inclusion, internationalization, justice, higher education

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Authors: Atara Shriki, Ilana Lavy

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Teaching for the first time an online course dealing with the history of mathematics, we were struggling with questions related to the design of a proper learning environment (LE). Thirteen high school mathematics teachers, M.Ed. students, attended the course. The teachers were engaged in independent reading of mathematical texts, a task that is recognized as complex due to the unique characteristics of such texts. In order to support the learning processes and develop skills that are essential for succeeding in learning online (e.g. self-regulated learning skills, meta-cognitive skills, reflective ability, and self-assessment skills), the LE comprised of three components aimed at “scaffolding” the learning: (1) An online "self-feedback" questionnaires that included drill-and-practice questions. Subsequent to responding the questions the online system provided a grade and the teachers were entitled to correct their answers; (2) Open-ended questions aimed at stimulating critical thinking about the mathematical contents; (3) Reflective questionnaires designed to assist the teachers in steering their learning. Using a mixed-method methodology, an inquiry study examined the learning processes, the learners' difficulties in reading the mathematical texts and on the unique contribution of each component of the LE to the ability of teachers to comprehend the mathematical contents, and support the development of their learning skills. The results indicate that the teachers found the online feedback as most helpful in developing self-regulated learning skills and ability to reflect on deficiencies in knowledge. Lacking previous experience in expressing opinion on mathematical ideas, the teachers had troubles in responding open-ended questions; however, they perceived this assignment as nurturing cognitive and meta-cognitive skills. The teachers also attested that the reflective questionnaires were useful for steering the learning. Although in general the teachers found the LE as supportive, most of them indicated the need to strengthen instructor-learners and learners-learners interactions. They suggested to generate an online forum to enable them receive direct feedback from the instructor, share ideas with other learners, and consult with them about solutions. Apparently, within online LE, supporting learning merely with respect to cognitive aspects is not sufficient. Leaners also need an emotional support and sense a social presence.

Keywords: cognitive and meta-cognitive skills, independent reading of mathematical texts, online learning environment, self-regulated learning skills

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Authors: Shang Yee Chong

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Perioperative pain is a complex mechanism activated by various nociceptive, neuropathic, and inflammatory pathways. Opioids have long been a mainstay for analgesia in this period, even as we are continuously moving towards a multimodal model to improve pain control while minimising side effects. Dexmedetomidine, a potent alpha-2 agonist, is a useful sedative and hypnotic agent. Its use in the intensive care unit has been well described, and it is increasingly an adjunct intraoperatively for its opioid sparing effects and to decrease pain scores. We describe a case of a general surgical patient in whom minimal opioids was required with dexmedetomidine use. The patient was a 61-year-old Indian gentleman with a history of hyperlipidaemia and type 2 diabetes mellitus, presenting with rectal adenocarcinoma detected on colonoscopy. He was scheduled for a robotic ultra-low anterior resection. The patient was induced with intravenous fentanyl 75mcg, propofol 160mg and atracurium 40mg. He was intubated conventionally and mechanically ventilated. Anaesthesia was maintained with inhalational desflurane and anaesthetic depth was measured with the Masimo EEG Sedline brain function monitor. An initial intravenous dexmedetomidine dose (bolus) of 1ug/kg for 10 minutes was given prior to anaesthetic induction and thereafter, an infusion of 0.2-0.4ug/kg/hr to the end of surgery. In addition, a bolus dose of intravenous lignocaine 1.5mg/kg followed by an infusion at 1mg/kg/hr throughout the surgery was administered. A total of 10mmol of magnesium sulphate and intravenous paracetamol 1000mg were also given for analgesia. There were no significant episodes of bradycardia or hypotension. A total of intravenous phenylephrine 650mcg was given throughout to maintain the patient’s mean arterial pressure within 10-15mmHg of baseline. The surgical time lasted for 5 hours and 40minutes. Postoperatively the patient was reversed and extubated successfully. He was alert and comfortable and pain scores were minimal in the immediate post op period in the postoperative recovery unit. Time to first analgesia was 4 hours postoperatively – with paracetamol 1g administered. This was given at 6 hourly intervals strictly for 5 days post surgery, along with celecoxib 200mg BD as prescribed by the surgeon regardless of pain scores. Oral oxycodone was prescribed as a rescue analgesic for pain scores > 3/10, but the patient did not require any dose. Neither was there nausea or vomiting. The patient was discharged on postoperative day 5. This case has reinforced the use of dexmedetomidine as an adjunct in general surgery cases, highlighting its excellent opioid-sparing effects. In the entire patient’s hospital stay, the only dose of opioid he received was 75mcg of fentanyl at the time of anaesthetic induction. The patient suffered no opioid adverse effects such as nausea, vomiting or postoperative ileus, and pain scores varied from 0-2/10. However, intravenous lignocaine infusion was also used in this instance, which would have helped improve pain scores. Paracetamol, lignocaine, and dexmedetomidine is thus an effective, opioid-sparing combination of multi-modal analgesia for major abdominal surgery cases.

Keywords: analgesia, dexmedetomidine, general surgery, opioid sparing

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Authors: Kantha Siddhanth Gujjari, Shaani Singhal, Robert Andrew Danks, Adrian Praeger

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Background: Trigeminal neuralgia (TN) is a heterogenous pain syndrome characterised by short paroxysms of lancinating facial pain in the distribution of the trigeminal nerve, often triggered by usually innocuous stimuli. TN has a low prevalence of less than 0.1%, of which 80% to 90% is caused by compression of the trigeminal nerve from an adjacent artery or vein. The root entry zone of the trigeminal nerve is most sensitive to neurovascular conflict (NVC), causing dysmyelination. Whilst microvascular decompression (MVD) is an effective treatment for TN with NVC, all patients do not achieve long-term pain relief. Pre-operative scoring systems by Panczykowski and Hardaway have been proposed but have not been externally validated. These pre-operative scoring systems are composite scores calculated according to a subtype of TN, presence and degree of neurovascular conflict, and response to medical treatments. There is discordance in the assessment of NVC identified on pre-operative magnetic resonance imaging (MRI) between neurosurgeons and radiologists. To our best knowledge, the prognostic impact for MVD of this difference of interpretation has not previously been investigated in the form of a composite scoring system such as those suggested by Panczykowski and Hardaway. Aims: This study aims to identify prognostic factors and externally validate the proposed scoring systems by Panczykowski and Hardaway for TN. A secondary aim is to investigate the prognostic difference between a neurosurgeon's interpretation of NVC on MRI compared with a radiologist’s. Methods: This retrospective cohort study included 95 patients who underwent de novo MVD in a single neurosurgical unit in Melbourne. Data was recorded from patients’ hospital records and neurosurgeon’s correspondence from perioperative clinic reviews. Patient demographics, type of TN, distribution of TN, response to carbamazepine, neurosurgeon, and radiologist interpretation of NVC on MRI, were clearly described prospectively and preoperatively in the correspondence. Scoring systems published by Panczykowski et al. and Hardaway et al. were used to determine composite scores, which were compared with the recurrence of TN recorded during follow-up over 1-year. Categorical data analysed using Pearson chi-square testing. Independent numerical and nominal data analysed with logistical regression. Results: Logistical regression showed that a Panczykowski composite score of greater than 3 points was associated with a higher likelihood of pain-free outcome 1-year post-MVD with an OR 1.81 (95%CI 1.41-2.61, p=0.032). The composite score using neurosurgeon’s impression of NVC had an OR 2.96 (95%CI 2.28-3.31, p=0.048). A Hardaway composite score of greater than 2 points was associated with a higher likelihood of pain-free outcome 1 year post-MVD with an OR 3.41 (95%CI 2.58-4.37, p=0.028). The composite score using neurosurgeon’s impression of NVC had an OR 3.96 (95%CI 3.01-4.65, p=0.042). Conclusion: Composite scores developed by Panczykowski and Hardaway were validated for the prediction of response to MVD in TN. A composite score based on the neurosurgeon’s interpretation of NVC on MRI, when compared with the radiologist’s had a greater correlation with pain-free outcomes 1 year post-MVD.

Keywords: de novo microvascular decompression, neurovascular conflict, prognosis, trigeminal neuralgia

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Authors: Rahaf Mandura, Fatmah Abusharkh, Layan Kurdi, Rahaf Shigdar, Khadijah Alattas

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Introduction: Age-related macular degeneration (AMD) in older individuals are serious health issues that severely impact the quality of life of millions globally. In 2020, the fourth leading cause of blindness worldwide was AMD. The global prevalence of AMD is estimated to be around 8.7%. AMD is a progressive disease involving the macular region of the retina, and it has a complex pathophysiology. RPE cell dysfunction plays a crucial step in the pathway leading to irreversible degeneration of photoreceptors with yellowish lipid-rich, protein-containing drusen deposits accumulating between Bruch's membrane and the RPE. Furthermore, lipofuscinogenesis, drusogenesis, inflammation, and neovascularization are four main processes responsible for the formation of the two types of AMD: the wet (exudative, neovascular) and dry (non-exudative, geographic atrophy) types. We retrospectively evaluated the prevalence of AMD among patients visiting the retina clinic at King Abdulaziz University Hospital (Jeddah, Makkah Province, Saudi Arabia) to identify the commonly associated risk factors of AMD. Methods: The records of 3,067 individuals from 2017 to 2021 were reviewed. Of these, 1,935 satisfied the inclusion criteria and were included in this study. We excluded all patient below 18 years, and those who did not undergo fundus imaging or attend their booked appointments, follow-ups, treatments, and referrals were excluded. Results: The prevalence of AMD among the patients was 4%. The age of patients with AMD was significantly greater than those without AMD (72.4 ± 9.8 years vs. 57.2 ± 15.5 years; p < 0.001). Participants with a family history of AMD tended to have the disease more than those without such a history (85.7% vs. 45%; p = 0.043). Ex- and current smokers were more likely to have AMD than non-smokers (34% and 18.6% vs. 7.2%; p < 0.001). Patients with hypertension and those without type 1 diabetes were at a higher risk of developing AMD than those without hypertension (5.5% vs. 2.8%; p = 0.002) and those with type 1 diabetes (4.2% vs. 0.8%; p = 0.040). In contrast, sex, nationality, type 2 diabetes, and abnormal lipid profile were not significantly associated with AMD. Regarding the clinical characteristics of AMD cases, most cases (70.4%) were of the dry type and affected both eyes (77.2%). The disease duration was ≥5 years in 43.1% of the patients. The most frequent chronic diseases associated with AMD were type 2 diabetes (69.1%), hypertension (61.7%), and dyslipidemia (18.5%). Conclusion: In summary, our single tertiary center study showed that AMD is widely prevalent in Jeddah, Saudi Arabia (4%) and linked to a wide range of risk factors. Some of these are modifiable risk factors that can be adjusted to help reduce AMD occurrence. Furthermore, this study has shown the importance of screening and follow-up of family members of patients with AMD to promote early detection and intervention of AMD. We recommend conducting further research on AMD in Saudi Arabia. Concerning the study design, a community-based cross-sectional study would be more helpful for assessing the disease's prevalence. Finally, recruiting a larger sample size is required for more accurate estimation.

Keywords: age related macular degeneration, prevelence, risk factor, dry AMD

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Authors: Lalanthica Yogendran, Manassa Hany, Saira Pasha, Benjamin Chaucer, Simarpreet Kaur, Christopher Janusz

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Children and adolescent patients visit the Psychiatric Emergency Department (ED) for multiple reasons. Visiting the Psychiatric ED itself can be a traumatic experience that can affect an adolescents mental well-being, regardless of a history of mental illness. Despite this, limited research exists in this domain. Prospective studies have correlated adverse psychosocial determinants among adolescents to risk factors for poor well-being and unfavorable behavior outcomes. Studies have also shown that physiological stress is a contributor in the development of health problems and an increase in substance abuse in adolescents. This study aimed to retrospectively determine which psychosocial factors are associated with an increase in psychiatric ED visits. 600 charts of patients who had a psychiatric ED and inpatient admission visit from January 2014 through December 2014 were reviewed. Sociodemographics, diagnoses, ED visits and inpatient admissions were collected. Descriptive statistics, chi-square tests and independent t-test analyses were utilized to examine differences in the sample to determine which factors affected ED visits and admissions. The sample was 50% female, 35.2% self-identified black, and had a mean age of 13 years. The majority, 85%, went to public school and 17% were in special education. Attention Deficit Hyperactivity Disorder was the most common admitting diagnosis, found in 132(23%) responders. Most patients came from single parent household 305 (53%). The mean ages of patients that were sexually active, with legal issues, and reporting marijuana substance abuse were 15, 14.35, and 15 years respectively. Patients from two biological parent households had significantly fewer ED visits (1.2 vs. 1.7, p < 0.01) and admissions (0.09 vs. 0.26, p < 0.01). Among social factors, those who reported sexual, physical or emotional abuse had a significantly greater number of ED visits (2.1 vs. 1.5, p < 0.01) and admissions (0.61 vs. 0.14, p < 0.01) than those who did not. Patients that were sexually active or had legal issues or substance abuse with marijuana had a significantly greater number of admissions (0.43 vs. 0.17, p < 0.01), (0.54 vs. .18, p < 0.01) and (0.46 vs. 0.18, p < 0.01) respectively. This data supports the theory of the stability of a two parent home. Dual parenting plays a role in creating a safe space where a child can develop; this is shown by subsequent decreases in psychiatric ED visits and admissions. This may highlight the psychological protective role of a two parent household. Abuse can exacerbate existing psychiatric illness or initiate the onset of new disease. Substance abuse and legal issues result in early induction to the criminal system. Results show that this causes an increase in frequency of visits and severity of symptoms. Only marijuana, but not other illicit substances, correlated with higher incidence of psychiatric ED visits. This may speak to the psychotropic nature of tetrahydrocannabinols and their role in mental illness. This study demonstrates the array of psychosocial factors that lead to increased ED visits and admissions in children and adolescents.

Keywords: adolescent, child psychiatry, emergency department, substance abuse

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Authors: Ruthanne Tobin

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As our data-driven, cloud-based, knowledge-centric lives become ever more global, mobile, and digital, educational systems everywhere are struggling to keep pace. Schools need to prepare students to become critical-thinking, tech-savvy, life-long learners who are engaged and adaptable enough to find their unique calling in a post-industrial world of work. Recognizing that no nation can afford poor achievement or high dropout rates without jeopardizing its social and economic future, the thirty-two nations of the OECD are launching initiatives to redesign schools, generally under the banner of Personalized Learning or 21st Century Learning. Their intention is to transform education by situating students as co-enquirers and co-contributors with their teachers of what, when, and how learning happens for each individual. In this focused review of the 2007-2017 literature on personalized learning, the author sought answers to two main questions: “What are the theoretical frameworks that guide personalized learning?” and “What is the conceptual understanding of the model?” Ultimately, the review reveals that, although the research area is overly theorized and under-substantiated, it does provide a significant body of knowledge about this potentially transformative educational restructuring. For example, it addresses the following questions: a) What components comprise a PL model? b) How are teachers facilitating agency (voice & choice) in their students? c) What kinds of systems, processes and procedures are being used to guide the innovation? d) How is learning organized, monitored and assessed? e) What role do inquiry based models play? f) How do teachers integrate the three types of knowledge: Content, pedagogical and technological? g) Which kinds of forces enable, and which impede, personalizing learning? h) What is the nature of the collaboration among teachers? i) How do teachers co-regulate differentiated tasks? One finding of the review shows that while technology can dramatically expand access to information, expectations of its impact on teaching and learning are often disappointing unless the technologies are paired with excellent pedagogies in order to address students’ needs, interests and aspirations. This literature review fills a significant gap in this emerging field of research, as it serves to increase conceptual clarity that has hampered both the theorizing and the classroom implementation of a personalized learning model.

Keywords: curriculum change, educational innovation, personalized learning, school reform

Procedia PDF Downloads 200

Authors: Abdullah S. Alghamdi, Khaled Alghamdi, Richard O. Jenkins, Parvez I. Haris

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Background: Quantity and quality of sleep have been reported to be significant risk factors for obesity and development of metabolic disorders such as type 2 diabetes mellitus (T2DM). The relationship between diabetes and sleep quantity was reported to be U-shaped, which means increased or decreased sleeping hours can increase the risk of diabetes. The plasma glucagon levels were found to continuously decrease during night-time sleep in healthy individuals, independently of blood glucose and insulin levels. The disturbance of the circadian rhythm is also important and has been linked with an increased the chance of diabetes incidence. There is a lack of research on sleep patterns on Saudis with T2DM and how this is affected by Ramadan fasting. Aim: To assess the sleeping patterns of Saudis with T2DM (before, during, and after Ramadan), using two different techniques and relate this to their HbA1c levels. Method: This study recruited 82 Saudi with T2DM, who chose to fast during Ramadan, from the Endocrine and Diabetic Centre of Al Iman General Hospital, Riyadh, Saudi Arabia. Ethical approvals for the study were obtained from De Montfort University and Saudi Ministry of Health. Their sleeping patterns were assessed by a self-administered questionnaire (before, during, and after Ramadan). The assessment included the daily total sleeping hours (DTSH), and total night-time sleeping hours (TNTSH) of the participants. In addition, sleeping patterns of 36 patients, randomly selected from the 82 participants, were further tracked during and after Ramadan by using Fitbit Flex 2™ accelerometer. Blood samples were collected in each period for measuring HbA1c. Results: Questionnaire analysis revealed that the sleeping patterns significantly changed between the periods, with shorter hours during Ramadan (P < 0.001 for DTSH, and P < 0.001 for TNTSH). These findings were confirmed by the Fitbit data, which also indicated significant shorter sleeping hours for the DTSH, and the TNTSH during Ramadan (P < 0.001 and P < 0.001, respectively). Although there were no significant correlations between the questionnaire and Fitbit data, the TNTSH were shorter among the participants in all periods by both techniques. The mean HbA1c significantly varied between periods, with lowest level during Ramadan. Although the statistical tests did not show significant variances in the mean HbA1c between the groups of participants regarding their hours of sleeping, the lowest mean HbA1c was observed in the group of participants who slept for 6-8 hours and had longer night-time sleeping hours. Conclusion: A short sleep duration, and absence of night-time sleep were significantly observed among the majority of the study population during Ramadan, which could suppress the full benefits of Ramadan fasting for diabetic patients. This study showed that there is a good agreement between the findings of the questionnaire and the Fitbit device for evaluating sleeping patterns in a Saudi population. A larger study is needed in the future to investigate the impact of Ramadan fasting on sleep quality and quantity and its relationship with health and disease.

Keywords: Diabetes, Fasting, Fitbit, HbA1c, IPAQ, Ramadan, Sleep

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Authors: Flavia Oliveira de A. M. Cruz, Edison Tostes Faria, Paula Elaine D. Reis

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When the breast is submitted to radiation therapy (RT), the most common effects are pain, skin changes, mobility restrictions, local sensory alteration, and fatigue. These effects, if not managed properly, may reduce the quality of life of cancer patients and may lead to the treatment discontinuation. Therefore, promoting knowledge and guidelines for symptom management remain a high priority for patients and a challenge for health professionals, due to the need to handle side effects in a population with a life-threatening disease. Printed materials are important strategies for supporting educative activities since they help the individual to assimilate and understand the amount of information transmitted. Nurses' behavior can be systematized through the use of an educative manual, which may be effective in promoting information regarding the treatment, self-care and how to control the effects of RT at home. In view of the importance of guaranteeing the validity of the material before its use, the objective of this research was to validate the content and appearance of an educative manual for breast cancer patients undergoing RT. The Theory of Psychometrics was used for the validation process in this descriptive methodological research. A minimum agreement rate (AR) of 80% was considered to guarantee the validity of the material. The data were collected from October to December 2017, by means of two assessments tools, constructed in the form of a Likert scale, with five levels of understanding. These instruments addressed different aspects of the evaluation, in view of two different groups of participants; 17 experts in the theme area of the educative manual, and 12 women that received RT previously to treat breast cancer. The manual was titled 'Orientation Manual: radiation therapy in breast', and was focused on breast cancer patients attended at the Department of Oncology of the Brasília University Hospital (UNACON/HUB). The research project was submitted to the Research Ethics Committee at the School of Health Sciences of the University of Brasília (CAAE: 24592213.1.0000.0030). Only two items of the assessment tool for the experts, one related to the manual's ability to promote behavioral and attitude changes and the other related to the extent of its use for other health services, obtained AR < 80% and were reformulated based on the participants' suggestions and in the literature. All other items were considered appropriate and/or complete appropriate in the three blocks proposed for the experts: objectives - 89%, structure and form - 93%, and relevance - 93%; and good and/or very good in the five blocks of analysis proposed for patients: objectives - 100%, organization - 100%, writing style - 100%, appearance - 100%, and motivation. The appearance and content validation of the educative manual proposed were attended to. The educative manual was considered relevant and pertinent and may contribute to the understanding of the therapeutic process by breast cancer patients during RT, as well as support clinical practice through the nursing consultation.

Keywords: oncology nursing, nursing care, validation studies, educational technology

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Authors: Hazel P. Atilano

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In this age of AI-assisted teaching and learning, there seems to be a dearth of research literature on the linguistic analysis of English as a Second Language (ESL) student-generated paraphrased academic texts. This study sought to examine the lexico-semantic, morphosyntactic features of paraphrased academic texts generated by ESL students. Employing a descriptive qualitative design, specifically linguistic analysis, the study involved a total of 85 students from senior high school, college, and graduate school enrolled in research courses. Data collection consisted of a 60-minute real-time, on-site paraphrasing practice exercise using excerpts from discipline-specific literature reviews of 150 to 200 words. A focus group discussion (FGD) was conducted to probe into the challenges experienced by the participants. The writing exercise yielded a total of 516 paraphrase pairs. A total of 176 paraphrase units (PUs) and 340 non-paraphrase pairs (NPPs) were detected. Findings from the linguistic analysis of PUs reveal that the modifications made to the original texts are predominantly syntax-based (Diathesis Alterations and Coordination Changes) and a combination of Miscellaneous Changes (Change of Order, Change of Format, and Addition/Deletion). Results of the analysis of paraphrase extremes (PE) show that Identical Structures resulting from the use of synonymous substitutions, with no significant change in the structural features of the original, is the most frequently occurring instance of PE. The analysis of paraphrase errors reveals that synonymous substitutions resulting in identical structures are the most frequently occurring error that leads to PE. Another type of paraphrasing error involves semantic and content loss resulting from the deletion or addition of meaning-altering content. Three major themes emerged from the FGD: (1) The Challenge of Preserving Semantic Content and Fidelity; (2) The Best Words in the Best Order: Grappling with the Lexico-semantic and Morphosyntactic Demands of Paraphrasing; and (3) Contending with Limited Vocabulary, Poor Comprehension, and Lack of Practice. A pedagogical paradigm was designed based on the major findings of the study for a sustainable instructional intervention.

Keywords: academic text, lexico-semantic analysis, linguistic analysis, morphosyntactic analysis, paraphrasing

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Authors: Julius Oluwayomi Oluwadamilare, Michael Olutayo Olatunji

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In the African traditional societies, women have always played the role of a teacher, albeit informally. This is evident in the upbringing of their babies. As mothers, they also serve as the first teachers to teach their wards lessons through day-to-day activities. Furthermore, women always play the role of a musician during naming ceremonies, in the singing of lullabies, during initiation rites of adolescent boys and girls into adulthood, and in preparing their children especially daughters (and sons) for marriage. They also perform this role during religious and cultural activities, chieftaincy title/coronation ceremonies, singing of dirges during funeral ceremonies, and so forth. This traditional role of the African/Nigerian women puts them at a vantage point to contribute maximally to the teaching and learning of music at every level of education. The need for more women in the field of music education in Nigeria cannot be overemphasized. Today, gender equality is a major discourse in most countries of the world, Nigeria inclusive. Statistical data in the field of education and music education reveal the high ratio of male teachers/lecturers over their female counterparts in Nigerian tertiary institutions. The percentage is put at 80% Male and a distant 20% Female! This paper, therefore, examines feminine gender in Nigerian music education by tracing the involvement of women in musical practice from the pre-colonial to the post-colonial periods. The study employed both primary and secondary sources of data collection. The primary source included interviews conducted with 19 music lecturers from 8 purposively selected tertiary institutions from 4 geo-political zones of Nigeria. In addition, observation method was employed in the selected institutions. The results show, inter alia, that though there is a remarkable improvement in the rate of admission of female students into the music programme of Nigerian tertiary institutions, there is still an imbalance in the job placement in these institutions especially in the Colleges of Education which is the main focus of this research. Religious and socio-cultural factors are highly traceable to this development. This paper recommends the need for more female music teachers to be employed in the Nigerian tertiary institutions in line with the provisions stated in the Millennium Development Goals (MDGs) of the Federal Republic of Nigeria.

Keywords: gender, education, music, women

Procedia PDF Downloads 181

Authors: Ayse Gul Bilen

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Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed antidepressants that are used clinically for the treatment of anxiety disorders, obsessive-compulsive disorder (OCD), panic disorders and eating disorders. The first SSRI, fluoxetine (sold under the brand names Prozac and Sarafem among others), had an adverse effect profile better than any other available antidepressant when it was introduced because of its selectivity for serotonin receptors. They have been considered almost free of side effects and have become widely prescribed, however questions about the safety and tolerability of SSRIs have emerged with their continued use. Most SSRI side effects are dose-related and can be attributed to serotonergic effects such as nausea. Continuous use might trigger adverse effects such as hyponatremia, tremor, nausea, weight gain, sleep disturbance and sexual dysfunction. Moderate toxicity can be safely observed in the hospital for 24 hours, and mild cases can be safely discharged (if asymptomatic) from the emergency department once cleared by Psychiatry in cases of intentional overdose and after 6 to 8 hours of observation. Although fluoxetine is relatively safe in terms of overdose, it might still be cardiotoxic and inhibit platelet secretion, aggregation, and plug formation. There have been reported clinical cases of seizures, cardiac conduction abnormalities, and even fatalities associated with fluoxetine ingestions. While the medical literature strongly suggests that most fluoxetine overdoses are benign, emergency physicians need to remain cognizant that intentional, high-dose fluoxetine ingestions may induce seizures and can even be fatal due to cardiac arrhythmia. Our case is a 35-year old female patient who was sent to ER with symptoms of confusion, amnesia and loss of orientation for time and location after being found wandering in the streets unconsciously by police forces that informed 112. Upon laboratory examination, no pathological symptom was found except sinus tachycardia in the EKG and high levels of aspartate transaminase (AST) and alanine transaminase (ALT). Diffusion MRI and computed tomography (CT) of the brain all looked normal. Upon physical and sexual examination, no signs of abuse or trauma were found. Test results for narcotics, stimulants and alcohol were negative as well. There was a presence of dysrhythmia which required admission to the intensive care unit (ICU). The patient gained back her conscience after 24 hours. It was discovered from her story afterward that she had been using fluoxetine due to post-traumatic stress disorder (PTSD) for 6 months and that she had attempted suicide after taking 3 boxes of fluoxetine due to the loss of a parent. She was then transferred to the psychiatric clinic. Our study aims to highlight the need to consider toxicologic drug use, in particular, the abuse of selective serotonin reuptake inhibitors (SSRIs), which have been widely prescribed due to presumed safety and tolerability, for diagnosis of patients applying to the emergency room (ER).

Keywords: abuse, amnesia, fluoxetine, intoxication, SSRI

Procedia PDF Downloads 181

Authors: Anna Demian, Levi Howard, L. Ng, Leslie Simon, Mark Dragon, A. Desai, Timothy Devlantes, W. David Freeman

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Introduction: Out-of-hospital cardiac arrest (OHCA) can carry a high mortality. For survivors, the most common complication is hypoxic-ischemic brain injury (HIBI). Rarely, lumbosacral spinal cord and/or other spinal cord artery ischemia can occur due to anatomic variation and variable mean arterial pressure after the return of spontaneous circulation. We present a case of an OHCA survivor who later woke up with bilateral leg weakness with preserved sensation (ASIA grade B, L2 level). Methods: We describe a clinical, radiographic, and laboratory presentation, as well as a National Library of Medicine (NLM) search engine methodology, characterizing incidence/prevalence of this entity is discussed. A 70-year-old male, a longtime smoker, and alcohol user, suddenly collapsed at a bar surrounded by friends. He had complained of chest pain before collapsing. 911 was called. EMS arrived, and the patient was in pulseless electrical activity (PEA), cardiopulmonary resuscitation (CPR) was initiated, and the patient was intubated, and a LUCAS device was applied for continuous, high-quality CPR in the field by EMS. In the ED, central lines were placed, and thrombolysis was administered for a suspected Pulmonary Embolism (PE). It was a prolonged code that lasted 90 minutes. The code continued with the eventual return of spontaneous circulation. The patient was placed on an epinephrine and norepinephrine drip to maintain blood pressure. ECHO was performed and showed a “D-shaped” ventricle worrisome for PE as well as an ejection fraction around 30%. A CT with PE protocol was performed and confirmed bilateral PE. Results: The patient woke up 24 hours later, following commands, and was extubated. He was found paraplegic below L2 with preserved sensation, with hypotonia and areflexia consistent with “spinal shock” or anterior spinal cord syndrome. MRI thoracic and lumbar spine showed a conus medullaris level spinal cord infarction. The patient was given IV steroids upon initial discovery of cord infarct. NLM search using “cardiac arrest” and “spinal cord infarction” revealed 57 results, with only 8 review articles. Risk factors include age, atherosclerotic disease, and intraaortic balloon pump placement. AoA (Artery of Adamkiewicz) anatomic variation along with existing atherosclerotic factors and low perfusion were also known risk factors. Conclusion: Acute paraplegia from anterior spinal cord infarction of the AoA territory after cardiac arrest is rare. Larger prospective, multicenter trials are needed to examine potential interventions of hypothermia, lumbar drains, which are sometimes used in aortic surgery to reduce ischemia and/or other neuroprotectants.

Keywords: cardiac arrest, spinal cord infarction, artery of Adamkiewicz, paraplegia

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Authors: Farzaneh Badinlou, Reza Kormi-Nouri, Monika Knopf, Kamal Kharrazi

Abstract:

When we teach, we have two critical elements at our disposal to help students: learning styles as well as testing styles. There are many different ways in which educators can effectively teach their students; verbal learning and experience-based learning. Lecture as a form of verbal learning style is a traditional arrangement in which teachers are more active and share information verbally with students. In experienced-based learning as the process of through, students learn actively through hands-on learning materials and observing teachers or others. Meanwhile, standard testing or assessment is the way to determine progress toward proficiency. Teachers and instructors mainly use essay (requires written responses), multiple choice questions (includes the correct answer and several incorrect answers as distractors), or open-ended questions (respondents answers it with own words). The current study focused on exploring an effective teaching style and testing methods as the function of age over school ages. In the present study, totally 410 participants were selected randomly from four grades (2ⁿᵈ, 4ᵗʰ, 6ᵗʰ, and 8ᵗʰ). Each subject was tested individually in one session lasting around 50 minutes. In learning tasks, the participants were presented three different instructions for learning materials (learning by doing, learning by observing, and learning by listening). Then, they were tested via different standard assessments as free recall, cued recall, and recognition tasks. The results revealed that generally students remember more of what they do and what they observe than what they hear. The age effect was more pronounced in learning by doing than in learning by observing, and learning by listening, becoming progressively stronger in the free-recall, cued-recall, and recognition tasks. The findings of this study indicated that learning by doing and free recall task is more age sensitive, suggesting that both of them are more strategic and more affected by developmental differences. Pedagogically, these results denoted that learning by modeling and engagement in program activities have the special role for learning. Moreover, the findings indicated that the multiple-choice questions can produce the best performance for school-aged children but is less age-sensitive. By contrast, the essay as essay can produce the lowest performance but is more age-sensitive. It will be very helpful for educators to know that what types of learning styles and test methods are most effective for students in each school grade.

Keywords: experience-based learning, learning style, school-aged children, testing methods, verbal learning

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Authors: Tristan R. Fraser, Christopher D. Steadman, Christopher J. Boos

Abstract:

Myopericarditis is an inflammation syndrome characterised by clinical diagnostic criteria for pericarditis, such as chest pain, combined with evidence of myocardial involvement, such as elevation of biomarkers of myocardial damage, e.g., troponins. It can rarely be a complication of therapeutics used for dysregulated immune-mediated diseases such as inflammatory bowel disease (IBD), for example, mesalazine. The infrequency of mesalazine-induced myopericarditis adds to the challenge in its recognition. Rapid diagnosis and the early introduction of treatment are crucial. This case report follows a 24-year-old professional footballer with a past medical history of ulcerative colitis, recently started on mesalazine for disease control. Three weeks after mesalazine was initiated, he was admitted with fever, shortness of breath, and chest pain worse whilst supine and on deep inspiration, as well as elevated venous blood cardiac troponin T level (cTnT, 288ng/L; normal: <13ng/L). Myocarditis was confirmed on initial inpatient cardiac MRI, revealing the presence of florid myocarditis with preserved left ventricular systolic function and an ejection fraction of 67%. This was a longitudinal case study following the progress of a single individual with myopericarditis over four acute hospital admissions over nine weeks, with admissions ranging from two to five days. Parameters examined included clinical signs and symptoms, serum troponin, transthoracic echocardiogram, and cardiac MRI. Serial measurements of cardiac function, including cardiac MRI and transthoracic echocardiogram, showed progressive deterioration of cardiac function whilst mesalazine was continued. Prior to cessation of mesalazine, transthoracic echocardiography revealed a small global pericardial effusion of < 1cm and worsening left ventricular systolic function with an ejection fraction of 45%. After recognition of mesalazine as a potential cause and consequent cessation of the drug, symptoms resolved, with cardiac MRI performed as an outpatient showing resolution of myocardial oedema. The patient plans to make a return to competitive sport. Patients suffering from myopericarditis are advised to refrain from competitive sport for at least six months in order to reduce the risk of cardiac remodelling and sudden cardiac death. Additional considerations must be taken in individuals for whom competitive sport is an essential component of their livelihood, such as professional athletes. Myopericarditis is an uncommon, however potentially serious medical condition with a wide variety of aetiologies, including viral, autoimmune, and drug-related causes. Management is mainly supportive and relies on prompt recognition and removal of the aetiological process. Mesalazine-induced myopericarditis is a rare condition; as such increasing awareness of mesalazine as a precipitant of myopericarditis is vital for optimising the management of these patients.

Keywords: myopericarditis, mesalazine, inflammatory bowel disease, professional athlete

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Authors: Koteswara Rao Pagolu, Raghava Rao Tamanam

Abstract:

The present study was aimed to find out the prevalence of DD's in Visakhapatnam, one of the north coastal districts of Andhra Pradesh, India during a span of five years. A cross-sectional investigation was held at District early intervention center (DEIC), Visakhapatnam from 2016 to 2020. To identify the pattern and trend of different DD's including seasonal variations, a retrospective analysis of the health center's inpatient database for the past 5 years was done. Male and female children aged 2 months-18 years are included in the study with the prior permission of the concerned medical officer. The screening tool developed by the Ministry of health and family welfare, India, was used for the study. Among 26,423 cases, children with birth defects are 962, 2229 with deficiencies, 7516 with diseases, and 15716 with disabilities were admitted during the study period. From birth defects, congenital deafness occurred in large numbers with 22.66%, and neural tube defect observed in a small number of cases with 0.83% during the period. From the side of deficiencies, severe acute malnutrition has mostly occurred (66.80 %) and a small number of children were affected with goiter (1.70%). Among the diseases, dental carriers (67.97%) are mostly found and these cases were at peak during the years 2016 and 2019. From disabilities, children with vision impairment (20.55%) have mostly approached the center. Over the past 5 years, the admission rate of down's syndrome and congenital deafness cases showed a rising trend up to 2019 and then declined. Hearing impairment, motor delay, and learning disorder showed a steep rise and gradual decline trend, whereas severe anemia, vitamin-D deficiency, otitis media, reactive airway disease, and attention deficit hyperactivity disorder showed a declining trend. However, congenital heart diseases, dental caries, and vision impairment admission rates showed a zigzag pattern over the past 5 years. This center had inadequate diagnostic facilities related to genetic disease management. For advanced confirmation, the cases are referred to a district government hospital or private diagnostic laboratories in the city for genetic tests. Information regarding the overall burden and pattern of admissions in the health center is obtained by the review of DEIC records. Through this study, it is observed that the incidence of birth defects, as well as genetic disease burden, is high in the Visakhapatnam district. Hence there is a need for strengthening of management services for these diseases in this region.

Keywords: child health screening, developmental delays, district early intervention center, genetic disease management, infrastructural facility, Visakhapatnam district

Procedia PDF Downloads 185