Search results for: continuous improvement

Authors: Mahmoud F. Mohamadin, Ahmed Abdel Malek, Wessam Said

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Achieving energy efficient architecture in general, and in emerging countries in particular, is a challenging process that requires the contribution of various governmental, institutional, and individual entities. The rule of architectural design is essential in this process as it is considered as one of the earliest steps on the road to sustainability. Architectural firms have a moral and professional responsibility to respond to these challenges and deliver buildings that consume less energy. This study aims to evaluate the design processes and tools in practice of Egyptian architectural firms based on a limited survey to investigate if their processes and methods can lead to projects that meet the Egyptian Code of Energy Efficiency Improvement. A case study of twenty architectural firms in Cairo was selected and categorized according to their scale; large-scale, medium-scale, and small-scale. A questionnaire was designed and distributed to the firms, and personal meetings with the firms’ representatives took place. The questionnaire answered three main points; the design processes adopted, the usage of performance-based simulation tools, and the usage of BIM tools for energy efficiency purposes. The results of the study revealed that only little percentage of the large-scale firms have clear strategies for building energy efficiency in their building design, however the application is limited to certain project types, or according to the client request. On the other hand, the percentage of medium-scale firms is much less, and it is almost absent in the small-scale ones. This demonstrates the urgent need of enhancing the awareness of the Egyptian architectural design community of the great importance of implementing these methods starting from the early stages of the building design. Finally, the study proposed recommendations for such firms to be able to create a healthy built environment and improve the quality of life in emerging countries.

Keywords: architectural firms, emerging countries, energy efficiency, performance-based simulation tools

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Authors: Elaine Wong

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This research protocol aims to explore and justify the need for nutrition and physical activity intervention to improve health outcomes among SME (Small Medium Enterprise) employees. It was found that the worksite is an ideal and convenient setting for employees to take charge of their health thru active participation in health programmes since they spent a great deal of time at their workplace. This study will examine the impact of both general or/and targeted health interventions in both SME and non-SME companies utilizing the Workplace Health Promotion (WHP) grant over a 12 months period and assessed the improvement in chronic health disease outcomes in Singapore. Random sampling of both non-SME and SME companies will be conducted to undergo health intervention and statistical packages such as Statistical Package for Social Science (SPSS) 25 will be used to examine the impact of both general and targeted interventions on employees who participate and those who do not participate in the intervention and their effects on blood glucose (BG), blood lipid, blood pressure (BP), body mass index (BMI), and body fat percentage. Using focus groups and interviews, the data results will be transcribed to investigate enablers and barriers to workplace health intervention revealed by employees and WHP coordinators that could explain the variation in the health screening results across the organisations. Dietary habits and physical activity levels of the employees participating and not participating in the intervention will be collected before and after intervention to assess any changes in their lifestyle practices. It makes economic sense to study the impact of these interventions on health screening outcomes across various organizations that are existing grant recipients to justify the sustainability of these programmes by the local government. Healthcare policy makers and employers can then tailor appropriate and relevant programmes to manage these escalating chronic health disease conditions which is integral to the competitiveness and productivity of the nation’s workforce.

Keywords: chronic diseases, health screening, nutrition and fitness intervention , workplace health

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Authors: Khawaja A. Wahaj Wani, Aykut Erkal

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Pakistan's construction industry, a key player in economic development, has experienced remarkable growth. However, the surge in activities has been accompanied by dangerous working conditions, attributed to legislative gaps and flaws. Unhealthy construction practices, uncertain site conditions, and hazardous environments contribute to a concerning rate of injuries and fatalities. The principal aim of this research study is to undertake a thorough evaluation based on the assessment of the current situation of Health & Safety policies and the surveys performed by stakeholders of Pakistan with the aim of providing solution-centric methodologies for the enforcement of health and safety regulations within construction companies operating on project sites. Recognizing the pivotal role that the construction industry plays in bolstering a nation's economy, it is imperative to address the pressing need for heightened awareness among site engineers and laborers. The study adopts a robust approach, utilizing questionnaire surveys and interviews. As an exclusive investigative study, it encompasses all stakeholders: clients, consultants, contractors, and subcontractors. Targeting PEC-registered companies. Safety performance was assessed through the examination of sixty safety procedures using SPSS-18. A high Cronbach's alpha value of 0.958 ensures data reliability, and non-parametric tests were employed due to the non-normal distribution of data. The safety performance evaluation revealed significant insights. "Using Hoists and Cranes" and "Precautionary Measures (Shoring and Excavation)" exhibited commendable safety levels. Conversely, "Trainings on Safety" displayed a lower safety performance, alongside areas such as "Safety in Contract Documentation," "Meetings for Safety," and "Worker Participation," indicating room for improvement. These findings provide stakeholders with a detailed understanding of current safety measures within Pakistan's construction industry.

Keywords: construction industry, health and safety regulations, Pakistan, risk management

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Authors: Poojan Kothari, Yash Madhani, Chayan Jani, Bharti Saini

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The requirements for quality drinking and industrial water are increasing and water resources are depleting. Moreover large amount of wastewater is being generated and dumped into water bodies without treatment. These have made improvement in water treatment efficiency and its reuse, an important agenda. Membrane technology for wastewater treatment is an advanced process and has become increasingly popular in past few decades. There are many traditional methods for tertiary treatment such as chemical coagulation, adsorption, etc. However recent developments in membrane technology field have led to manufacturing of better quality membranes at reduced costs. This along with the high costs of conventional treatment processes, high separation efficiency and relative simplicity of the membrane treatment process has made it an economically viable option for municipal and industrial purposes. Ultrafiltration polymeric membranes can be used for wastewater treatment and drinking water applications. The proposed work focuses on preparation of one such UF membrane - Polyvinylidene fluoride (PVDF) doped with LiBr for wastewater treatment. Majorly all polymeric membranes are hydrophobic in nature. This property leads to repulsion of water and hence solute particles occupy the pores, decreasing the lifetime of a membrane. Thus modification of membrane through addition of small amount of salt such as LiBr helped us attain certain characteristics of membrane, which can then be used for wastewater treatment. The membrane characteristics are investigated through measuring its various properties such as porosity, contact angle and wettability to find out the hydrophilic nature of the membrane and morphology (surface as well as structure). Pure water flux, solute rejection and permeability of membrane is determined by permeation experiments. A study of membrane characteristics with various concentration of LiBr helped us to compare its effectivity.

Keywords: Lithium bromide (LiBr), morphology, permeability, Polyvinylidene fluoride (PVDF), solute rejection, wastewater treatment

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Authors: Khachen Kongpakwattana, Charungthai Dejthevaporn, Orapitchaya Krairit, Piyameth Dilokthornsakul, Devi Mohan, Nathorn Chaiyakunapruk

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Background: Although an increase in the burden of Alzheimer’s disease (AD) is evident worldwide, knowledge of costs and health-related quality of life (HR-QoL) associated with AD in Low- and Middle-Income Countries (LMICs) is still lacking. We, therefore, aimed to collect real-world cost and HR-QoL data, and investigate their associations with multiple disease-severity indicators among AD patients in Thailand. Methods: We recruited AD patients aged ≥ 60 years accompanied by their caregivers at a university-affiliated tertiary hospital. A one-time structured interview was conducted to collect disease-severity indicators, HR-QoL and caregiving information using standardized tools. The hospital’s database was used to retrieve healthcare resource utilization occurred over 6 months preceding the interview date. Costs were annualized and stratified based on cognitive status. Generalized linear models were employed to evaluate determinants of costs and HR-QoL. Results: Among 148 community-dwelling patients, average annual total societal costs of AD care were 8,014 US$ [95% Confidence Interval (95% CI): 7,295 US$ - 8,844 US$] per patient. Total costs of patients with severe stage (9,860 US$; 95% CI: 8,785 US$ - 11,328 US$) were almost twice as high as those of mild stage (5,524 US$; 95% CI: 4,649 US$ - 6,593 US$). The major cost driver was direct medical costs, particularly those incurred by AD prescriptions. Functional status was the strongest determinant for both total costs and patient’s HR-QoL (p-value < 0.001). Conclusions: Our real-world findings suggest the distinct major cost driver which results from expensive AD treatment, emphasizing the demand for country-specific cost evidence. Increases in cognitive and functional status are significantly associated with decreases in total costs of AD care and improvement on patient’s HR-QoL.

Keywords: Alzheimer's disease, associations, costs, disease-severity indicators, health-related quality of life

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Authors: Firoozeh Ghazanfari, Kourosh Amraei, Parisa Poorabadi

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Mild cognitive impairment is one of the neurocognitive disorders that go beyond age-related decline in cognitive functions, but in fact, it is not so severe which affects daily activities. This study aimed to investigate and compare the effectiveness of treatment with cranial electrical stimulation, brain training and their double combination on the language and verbal fluency of the elderly with mild cognitive impairment. This is a single-subject method with comparative intervention designs. Four patients with a definitive diagnosis of mild cognitive impairment by a psychiatrist were selected via purposive and convenience sampling method. Addenbrooke's Cognitive Examination Scale (2017) was used to assess language and verbal fluency. Two groups were formed with different order of cranial electrical stimulation treatment, brain training by pencil and paper method and their double combination, and two patients were randomly replaced in each group. The arrangement of the first group included cranial electrical stimulation, brain training, double combination and the second group included double combination, cranial electrical stimulation and brain training, respectively. Treatment plan included: A1, B, A2, C, A3, D, A4, where electrical stimulation treatment was given in ten 30-minutes sessions (5 mA and frequency of 0.5-500 Hz) and brain training in ten 30-minutes sessions. Each baseline lasted four weeks. Patients in first group who first received cranial electrical stimulation treatment showed a higher percentage of improvement in the language and verbal fluency subscale of Addenbrooke's Cognitive Examination in comparison to patients of the second group. Based on the results, it seems that cranial electrical stimulation with its effect on neurotransmitters and brain blood flow, especially in the brain stem, may prepare the brain at the neurochemical and molecular level for a better effectiveness of brain training at the behavioral level, and the selective treatment of electrical stimulation solitude in the first place may be more effective than combining it with paper-pencil brain training.

Keywords: cranial electrical stimulation, treatment, brain training, verbal fluency, cognitive impairment

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Authors: M. L. Anitha, K. A. Radhakrishna Rao

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With the advent of modern computing technology, there is an increased demand for developing recognition systems that have the capability of verifying the identity of individuals. Recognition systems are required by several civilian and commercial applications for providing access to secured resources. Traditional recognition systems which are based on physical identities are not sufficiently reliable to satisfy the security requirements due to the use of several advances of forgery and identity impersonation methods. Recognizing individuals based on his/her unique physiological characteristics known as biometric traits is a reliable technique, since these traits are not transferable and they cannot be stolen or lost. Since the performance of biometric based recognition system depends on the particular trait that is utilized, the present work proposes a fusion approach which combines Inner knuckle print (IKP) trait of the middle, ring and index fingers with the geometrical features of hand. The hand image captured from a digital camera is preprocessed to find finger IKP as region of interest (ROI) and hand geometry features. Geometrical features are represented as the distances between different key points and IKP features are extracted by applying local binary pattern descriptor on the IKP ROI. The decision level AND fusion was adopted, which has shown improvement in performance of the combined scheme. The proposed approach is tested on the database collected at our institute. Proposed approach is of significance since both hand geometry and IKP features can be extracted from the palm region of the hand. The fusion of these features yields a false acceptance rate of 0.75%, false rejection rate of 0.86% for verification tests conducted, which is less when compared to the results obtained using individual traits. The results obtained confirm the usefulness of proposed approach and suitability of the selected features for developing biometric based recognition system based on features from palmar region of hand.

Keywords: biometrics, hand geometry features, inner knuckle print, recognition

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Authors: Aniketh Ravukutam, Rajath Rao M., Pradyumna S. A.

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In the past few decades there has been great advancement in use of aerodynamics in cars. Now its use has been evident from commercial cars to race cars for achieving higher speeds, stability and efficiency. This paper focusses on studying the effects of aerodynamics in Formula Student car. These cars weigh around 200kgs with an average speed of 60kmph. With increasing competition every year, developing a competitive car is a herculean task. The race track comprises mostly of tight corners and little or no straights thus testing the car’s cornering capabilities. Higher cornering speeds can be achieved by increasing traction at the tires. Studying the aerodynamics helps in achieving higher traction without much addition in overall weight of car. The main focus is to develop an aerodynamic package involving front wing, under tray and body to obtain an optimum value of down force. The initial process involves the detail study of geometrical constraints mentioned in the rule book and calculating the limiting value of drag as per the engine specifications. The successive steps involve conduction of various iterations in ANSYS for selection of airfoils, deciding the number of elements, designing the nose for low drag, channelizing the flow under the body and obtain an optimum value of down force within the limits defined in the initial process. The final step involves design of model using these results in Virtual environment called OptimumLap® for detailed study of performance with and without the presence of aerodynamics. The CFD analysis results showed an overall down force of 377.44N with a drag of 164.08N. The corresponding parameters of the last model were applied in OptimumLap® and an improvement of 3.5 seconds in lap times was observed.

Keywords: aerodynamics, formula student, traction, front wing, undertray, body, rule book, drag, down force, virtual environment, computational fluid dynamics (CFD)

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Authors: Igone Guerra, Xabier Barandiaran

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The deep crisis (economic, social and cultural) in which Europe and Gipuzkoa, in the Basque Country (Spain), have been immersed in since 2008 forces governments to face a necessary transformation. These challenges demand different solutions and answers to meet the needs of the citizens. Adapting to continuous and sometimes abrupt changes in the social and political landscape requires an undeniable will to reinvent the way in which governments practice politics. This reinvention of government should help us build different organizations that, first, develop challenging public services, second, respond effectively to the needs of the citizens, and third, manage scarce resources, ultimately offering a contemporary concept of public value. In this context, the Etorkizuna Eraikiz initiative was designed to face the future challenges of the territory in a collaborative way. The aim of the initiative is to promote an alternative form of governance to generate common good and greater public value. In Etorkizuna Eraikiz democratic values, such as collaboration, participation, and accountability are prominent. This government approach is based on several features such as the creation of relational spaces to design and deliberate about the public politics or the promotion of a team-working approach, breaking down the silos between and within organizations, as an exercise in defining a shared vision regarding the Future of the Territory. A future in which the citizens are becoming actors in the problem-solving process and in the construction of a culture of participation and collective learning. In this paper, the Etorkizuna Eraikiz initiative will be presented (vision and methodology) as a model of a local approach to public policy innovation resulting in a way of governance that is more open and collaborative. Based on this case study, this paper explores the way in which collaborative governance leads to better decisions, better leadership, and better citizenry. Finally, the paper also describes some preliminary findings of this local approach, such as the level of knowledge of the citizenry about the projects promoted within Etorkizuna Eraikiz as well as the link between the challenges of the territory, as identified by the citizenry, and the political agenda promoted by the provincial government. Regarding the former, the Survey on the socio-political situation of Gipuzkoa showed that 27.9% of the respondents confirmed that they knew about the projects promoted within the initiative and gave it a mark of 5.71. In connection with the latter, over the last three years, 65 millions of euros have been allocated for a total of 73 projects that have covered socio-economic and political challenges such as aging, climate change, mobility, participation in democratic life, and so on. This governance approach of Etorkizuna Eraikiz has allowed the local government to match the needs of citizens to the political agenda fostering in this way a shared vision about the public value.

Keywords: collaborative governance, citizen participation, public good, social listening, public innovation

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Authors: Andrea Vega-Tinoco, Ana I. Gil-Lacruz, Marta Gil-Lacruz

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The main objective of this research is to acknowledge whether civic participation affects the well-being of the elderly, thus being a key activity of active aging. It is also of interest to recognize any differences among genders, generational cohorts or country of residence. If a positive relationship is found between civic participation and well-being, the actions that promote this participation will benefit the quality of life of senior citizens. Otherwise, independent action must be taken in the improvement of social and human capital. The sample consists of approximately 50.000 individuals from the European Social Survey (2002-2016). Only individuals born before 1965 in 15 European countries were considered. The sample was distributed according to gender, year of birth, country, level of studies and ESS wave to form pseudo-panel data cohorts, leaving a total of 1.318 observations. The data were analyzed through a Cross-Lagged Model using Fixed-Effects. A bidirectional association is observed between the civic participation and well-being variables. However, participating in the past seems to have a higher impact on today’s health, happiness and life satisfaction than the other way around. Furthermore, 26% of the respondents expressed to be satisfied with their life, 27% to be happy and 57% to have good health. On the other hand, 49% have participated civically in the last year, being the most common activities: signing petitions, boycotting products and volunteer work in non-political organizations. A slight trend of BabyBoomers and men towards greater participation can be observed, as well as a higher impact of this participation on their well-being. In addition, international differences exhibit a stronger relation for Nordic, East European and Mediterranean countries. The given results support the hypothesis that civic participation is a promoter of well-being for the elderly. This paper positively highlights the activity of involving in political and non-political organizations, as well as wearing badges. At any rate, almost all forms of civic participation show a positive relationship with well-being and should therefore be promoted, although differences between countries must be taken into consideration.

Keywords: active aging, civic participation, Europe, well-being

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Authors: F. Ainlhout, S. Boutaleb, M. C. Diaz-Barradas, M. Zunzunegui

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Argania spinosa is an endemic tree of the southwest of Morocco, occupying 828,000 Ha, distributed mainly between Mediterranean vegetation and the desert. This tree can grow in extremely arid regions in Morocco, where annual rainfall ranges between 100-300 mm where no other tree species can live. It has been designated as a UNESCO Biosphere reserve since 1998. Argania tree is of great importance in human and animal feeding of rural population as well as for oil production, it is considered as a multi-usage tree. Admine forest located in the suburbs of Agadir city, 5 km inland, was selected to conduct this work. The aim of the study was to investigate the temporal variation in root-zone moisture dynamic in response to variation in climatic conditions and vegetation water uptake, using a geophysical technique called Electrical resistivity imaging (ERI). This technique discriminates resistive woody roots, dry and moisture soil. Time-dependent measurements (from April till July) of resistivity sections were performed along the surface transect (94 m Length) at 2 m fixed electrode spacing. Transect included eight Argan trees. The interactions between the tree and soil moisture were estimated by following the tree water status variations accompanying the soil moisture deficit. For that purpose we measured midday leaf water potential and relative water content during each sampling day, and for the eight trees. The first results showed that ERI can be used to accurately quantify the spatiotemporal distribution of root-zone moisture content and woody root. The section obtained shows three different layers: middle conductive one (moistured); a moderately resistive layer corresponding to relatively dry soil (calcareous formation with intercalation of marly strata) on top, this layer is interspersed by very resistant layer corresponding to woody roots. Below the conductive layer, we find the moderately resistive layer. We note that throughout the experiment, there was a continuous decrease in soil moisture at the different layers. With the ERI, we can clearly estimate the depth of the woody roots, which does not exceed 4 meters. In previous work on the same species, analyzing the δ18O in water of xylem and in the range of possible water sources, we argued that rain is the main water source in winter and spring, but not in summer, trees are not exploiting deep water from the aquifer as the popular assessment, instead of this they are using soil water at few meter depth. The results of the present work confirm the idea that the roots of Argania spinosa are not growing very deep.

Keywords: Argania spinosa, electrical resistivity imaging, root system, soil moisture

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Authors: Ali Karimi, Shabnam Karimifam, Amirhosein Karimi, Farahnaz Pournavvab

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Researches have emphasis on the important role of psychosocial support and appropriate interventions for individuals that involved in serious physical and psychological problems . Patients with AIDS are often discussed in studies, but sometimes the psychological conditions of the people who live with them are ignored. In the present study, while paying attention to the spouses of AIDS patients, the role of supportive interventions has been investigated. the other word , Researchers Show that life skills training causes significant improvement in the mean scores of mothers physical health , mental health, social relationship and ultimately quality of life in the experimental group . The purpose of this study is determine of mental health of Twenty-one wives of patients with HIV+ In Shiraz ( city in sought of Iran) and effects of life skills on promotion of their mental health . Sampling was systematic randomize . These women were selected and invited to the training program based on their husbands' file numbers, who were selected to the counseling center for people with AIDS. first , they filled out GHQ questionnaires . Then , the life skills training for 8 sessions were taught for these women . Results indicated that Psychological condition of wife of patients with HIV+ was not appropriate . Scores of most them were above of cut of point of questionnaires .T test was done . worse scores were Assigned to anxiety and weakness in social functions . In the other hand , life skills have been effective significantly only in social functions of women . Scores of research’s participants in anxiety , depression and total test score were enhanced , but have not been significant . In the main of article , researchers have discussed why life skills training does not have much effect on some emotional problems .Despite the fact that life skills training had a positive effect on these spouses, but due to the stress of women with AIDS spouses, life skills training did not show much effectiveness, and for outstanding effects, there is a need for individual psychological treatments and broader social support.

Keywords: Hiv, aids, social suport, life skills

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Authors: Cristina-Corina Bențea, Teodora-Mihaela Iconomescu, Laurențiu-Gabriel Talaghir, Claudiu Mereuță, Anamaria Berdilă

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The study aims to examine the relationships between motor abilities, self-evaluation of athletic competence, and demographic characteristics in a sample of late-childhood participants. Defined as physical elements that enable the movements, motor skills are classified according to movement precision as gross and fine motor skills. Across their development, children enhance their ability to coordinate the limbs to produce different actions. In educational settings, they perform various instructional activities that involve the improvement of their athletic prowess and are taught how to strengthen their gross and fine motor abilities. Also, in relation to their activities, children tend to evaluate themselves differently across the various domains of their life. Starting from childhood, athletic competence is one of the area-specific evaluations of competence that refers to one’s ability to do well at sports, including outdoor games. Method: The sample consisted of fifty-eight primary school children, thirty girls, and twenty-eight boys, with ages between 8-10 years. The Bruininks-Oseretsky test of motor proficiency was used to assess both gross and fine motor skills in eight specific areas (fine motor precision, fine motor integration, manual dexterity, bilateral coordination, balance, running speed and agility, upper-limb coordination, strength). Athletic competence self-perceived was assessed with one of the six subscales of the Self-Perception Profile for Children. Results: Were examined both the relationships between each motor skills scale and subscales and between motor skills and general self-perceived athletic competence. Results indicated correlations between the athletic competence and four motor skills subscales depending on the gender and age of the children. The findings of the study were discussed related to the possibility to improve children's physical proficiency in educational settings according to the level of self-perceived athletic competence.

Keywords: gross motor skills, fine motor skills, athletic competence, self-evaluation, children, education

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Authors: Anshika Kankane, Dongshik Kang

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Marine debris has a significant influence on coastal environments, damaging biodiversity, and causing loss and damage to marine and ocean sector. A functional cost-effective and automatic approach has been used to look up at this problem. Computer vision combined with a deep learning-based model is being proposed to identify and categorize marine debris of seven kinds on different beach locations of Japan. This research compares state-of-the-art deep learning models with a suggested model architecture that is utilized as a feature extractor for debris categorization. The model is being proposed to detect seven categories of litter using a manually constructed debris dataset, with the help of Mask R-CNN for instance segmentation and a shape matching network called HOGShape, which can then be cleaned on time by clean-up organizations using warning notifications of the system. The manually constructed dataset for this system is created by annotating the images taken by fixed KaKaXi camera using CVAT annotation tool with seven kinds of category labels. A pre-trained HOG feature extractor on LIBSVM is being used along with multiple templates matching on HOG maps of images and HOG maps of templates to improve the predicted masked images obtained via Mask R-CNN training. This system intends to timely alert the cleanup organizations with the warning notifications using live recorded beach debris data. The suggested network results in the improvement of misclassified debris masks of debris objects with different illuminations, shapes, viewpoints and litter with occlusions which have vague visibility.

Keywords: computer vision, debris, deep learning, fixed live camera images, histogram of gradients feature extractor, instance segmentation, manually annotated dataset, multiple template matching

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Authors: Yazmin Pineda Zapata

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Leading a complete school and culture transformation can be a daunting task for any administrator. This is especially true when change agents are advocating for inclusive reform in their schools. As leaders embark on this journey, they must ascertain that an inclusive environment is not a place, a classroom, or a resource setting; it is a place of acceptance nurtured by supportive and meaningful learning opportunities where all students can thrive. A qualitative approach, phenomenology, was used to investigate principals’ actions and behaviors that supported inclusive schooling for students with disabilities. Specifically, this study sought to answer the following research question: How do leaders develop and maintain inclusive education? Fourteen K-12 principals purposefully selected from various sources (e.g., School Wide Integrated Framework for Transformation (SWIFT), The Maryland Coalition for Inclusive Education (MCIE), The Arc of Texas Inclusion Works organization, The Association for Persons with Severe Handicaps (TASH), the CAL State Summer Institute in San Marcos, and the PEAK Parent Center and/or other recognitions were interviewed individually using a semi-structured protocol. Upon completion of data collection, all interviews were transcribed and marked using A priori coding to analyze the responses and establish a correlation among Villa and Thousand’s five organizational supports to achieve inclusive educational reform: Vision, Skills, Incentives, Resources, and Action Plan. The findings of this study reveal the insights of principals who met specific criteria and whose schools had been highlighted as exemplary inclusive schools. Results show that by implementing the five organizational supports, principals were able to develop and sustain successful inclusive environments where both teachers and students were motivated, made capable, and supported through the redefinition and restructuring of systems within the school. Various key details of the five variables for change depict essential components within these systems, which include quality professional development, coaching and modeling of co-teaching strategies, collaborative co-planning, teacher leadership, and continuous stakeholder (e.g., teachers, students, support staff, and parents) involvement. The administrators in this study proved the valuable benefits of inclusive education for students with disabilities and their typically developing peers. Together, along with their teaching and school community, school leaders became capable stakeholders that promoted the vision of inclusion, planned a structured approach, and took action to make it a reality.

Keywords: Inclusive education, leaders, principals, shared-decision making, shared leadership, special education, sustainable change

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Authors: Bhavishya Ramchandani

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A little electronic device that is worn on the finger is called a smart ring. It incorporates mobile technology and has features that make it simple to use the device. These gadgets, which resemble conventional rings and are usually made to fit on the finger, are outfitted with features including access management, gesture control, mobile payment processing, and activity tracking. A poor sleep pattern, an irregular schedule, and bad eating habits are all part of the problems with health that a lot of people today are facing. Diets lacking fruits, vegetables, legumes, nuts, and whole grains are common. Individuals in India also experience metabolic issues. In the medical field, smart rings will help patients with problems relating to stomach illnesses and the incapacity to consume meals that are tailored to their bodies' needs. The smart ring tracks all bodily functions, including blood sugar and glucose levels, and presents the information instantly. Based on this data, the ring generates what the body will find to be perfect insights and a workable site layout. In addition, we conducted focus groups and individual interviews as part of our core approach and discussed the difficulties they're having maintaining the right diet, as well as whether or not the smart ring will be beneficial to them. However, everyone was very enthusiastic about and supportive of the concept of using smart rings in healthcare, and they believed that these rings may assist them in maintaining their health and having a well-balanced diet plan. This response came from the primary data, and also working on the Emerging Technology Canvas Analysis of smart rings in healthcare has led to a significant improvement in our understanding of the technology's application in the medical field. It is believed that there will be a growing demand for smart health care as people become more conscious of their health. The majority of individuals will finally utilize this ring after three to four years when demand for it will have increased. Their daily lives will be significantly impacted by it.

Keywords: smart ring, healthcare, electronic wearable, emerging technology

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Authors: Naum Simanovsky, Vladimir Goldman, Michael Zaidman

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Background: The optimal algorithm for the management of symptomatic tarsal coalition is still under discussion in pediatric literature. It's debatable what surgical steps are essential to achieve the best outcome. Method: The investigators retrospectively reviewed the records of twelve patients with symptomatic tarsal coalition that were treated operatively between 2017 and 2019. Only painful flat feet were operated. Two patients were excluded from the study due to lack of sufficient follow-up. Ten of eleven feet were treated with the combination of calcaneal lengthening osteotomy (CLO) and resection of coalition (RC). Only one foot was operated with CLO alone. In half of our patients, Achilles lengthening was performed. For two children, medial plication was added. Short leg cast was applied to all children for 6-8 weeks, and soft shoe insoles for medial arch support were prescribed after. Demographic, clinical, and radiographic records were reviewed. The outcome was evaluated using American Orthopedic Foot and Ankle Society (AOFAS) Ankle Hindfoot Score. Results: There were seven boys and three girls. The mean age at the time of surgery was 13.9 (range 12 to 17) years, and the mean follow-up was 18 (range 8 to 34) months. The early complications included one superficial wound infection and dehiscence. Late complication includes two children with residual forefoot supination. None of our patients required additional operations during the follow-up period. All feet achieved complete deformity correction or dramatic improvement. In the last follow-up, seven feet were painless, and four children had some mild pain after intensive activities. All feet achieved excellent and good scoring on AOFAS. Conclusions: Many patients with talocalcaneal coalition also have rigid or stiff, painful, flat feet. For these patients, the resection of coalition with concomitant CLO can be safely recommended.

Keywords: Tarsal coalition, calcaneal lengthening osteotomy., flat foot, coalition resection

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Authors: Ramin Zargarbashi, Hamid Rabie, Behnam Panjavi, Hooman Kamran, Seyedarad Mosalamiaghili, Zohre Erfani, Seyed Peyman Mirghaderi, Maryam Salimi

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Background: Posterior shoulder dislocation is one of the disabling complications of brachial plexus birth injury (BPBI), and various treatment options, including capsule and surrounding muscles release for open reduction, humeral derotational osteotomy, and tendon transfers, have been recommended to manage it. In the present study, we aimed to determine the clinical outcome of open reduction with soft tissue release, tendon transfer, and glenoid osteotomy inpatients with BPBI and posterior shoulder dislocation or subluxation. Methods: From 2018 to 2020, 33 patients that underwent open reduction, glenoid osteotomy, and tendon transfer were included. The glenohumeral deformity was classified according to the Waters radiographic classification. Functional assessment was performed using the Mallet grading system before and at least two years after the surgery. Results: The patients were monitored for 26.88± 5.47 months. Their average age was 27.5±14 months. Significant improvement was seen in the overall Mallet score (from 13.5 to 18.91 points) and its segments, including hand to mouth, hand to the neck, global abduction, global external rotation, abduction degree, and external rotation degree. Hand-to-back score and the presence of trumpet sign were significantly decreased in the post-operation phase (all p values<0.001). The above-mentioned variables significantly changed for both infantile and non-infantile dislocations. Conclusion: Our study demonstrated that open reduction along with glenoid osteotomy improves retroversion, and muscle strengthening with different muscle transfers is an effective technique for BPBI.

Keywords: birth injuries, nerve injury, brachial plexus birth palsy, Erb palsy, tendon transfer

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Authors: Aziz Zulazmi Samsudin, Siti Norhedayah Abdul Latif

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The lack of normalization of mental health as a conversational topic is becoming increasingly evident in certain cultures. The fact that students underutilize mental health services in schools can be attributed to the presence of various barriers that impede their willingness to seek for help. Stigma surrounding mental health services continue to be the most prevalent barrier for help seeking behavior. Alternative barriers have emerged that are both personal and public in nature that can have a substantial impact on students’ preference to seek for help in schools. A sequential explanatory study was carried out among 256 Muslim students in a school with dual education system in exploring both their Self-Stigma of Seeking Help (SSOSH) and Mental Health Help-Seeking Attitude (MHSA). In addition, 12 students were interviewed in a focus group setting to explore further the phenomena of help seeking approach by students to understand the initial quantitative analysis. Preliminary findings indicated that the students’ level of self-stigma was only moderate, but they had a favorable attitude towards counselling help. There was no significant difference on gender for both variables; however, the lower the self-stigma, the higher the mental help-seeking attitude for this current study, which is a common trend of relationship between the two variables. The interview revealed that, apart from public stigma, the absence of a qualified counsellor, a lack of ethical principles of counselling, a confidentiality issue, and the emotional openness of the students were identified as other barriers to their help-seeking attitudes. This paper also discussed the recommendation made by students in addressing barriers to counselling and facilitating their counselling needs for the improvement of students' mental and academic well-being. Additionally, this research offers the most recent data about mental health in the context of schools with a dual education system in Brunei Darussalam. It is hoped to serve as a guide for policy makers to consider the provision of mental health services that is more appealing to the students’ mental and academic well-being.

Keywords: mental health help-seeking attitude (MHSA), public stigma, school counselling, self-stigma, self-stigma of seeking help (SSOSH), well-being.

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Authors: Diana Flores Galindo, Richard Gil Herrera

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Nowadays, Lean Manufacturing and Industry 4.0 are very important in every country. One of the main benefits is continued market presence. It has been identified that there is a need to change existing educational programs, as well as update the knowledge and skills of existing employees. It should be borne in mind that behind each technological improvement, there is a human being. Human talent cannot be neglected. The main objectives of this article are to review the link between Lean Manufacturing, the incorporation of Industry 4.0 and the steps to follow to implement it; analyze the current situation and study the implications and benefits of this new trend, with a particular focus on Mexico. Lean Manufacturing and Industry 4.0 implementation waves must always take care of the most important capital – intellectual capital. The methodology used in this article comprised the following steps: reviewing the reality of the fourth industrial revolution, reviewing employees’ skills on the journey to become world-class, and analyzing the situation in Mexico. Lean Manufacturing and Industry 4.0 were studied not as exclusive concepts, but as complementary ones. The methodological framework used is focused on motivating companies’ collaborators to guarantee common results, innovate, and remain in the market in the face of new requirements from company stakeholders. The key findings were that both trends emphasize the need to improve communication across the entire company and incorporate new technologies into everyday work, from the shop floor to administrative staff, to help improve processes. Taking care of people, activities and processes will bring a company success. In the specific case of Mexico, companies in all sectors need to be aware of and implement technological improvements according to their specific needs. Low-cost labor represents one of the most typical barriers. In conclusion, companies must build a roadmap according to their strategy and needs to achieve their short, medium- and long-term goals.

Keywords: lean management, lean manufacturing, industry 4.0, motivation, SWOT analysis, Hoshin Kanri

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Authors: Heena Dabas, Anju Paul, Suman Chaurasia, Ramesh Agarwal, M. Jeeva Sankar, Anurag Bajpai, Manju Saksena

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Background: Traumatic lumbar puncture (LP) is a common occurrence and causes substantial diagnostic ambiguity. There is paucity of data regarding its epidemiology. Objective: To assess the incidence and risk factors of traumatic LP in newborns. Design/Methods: In a prospective cohort study, all inborn neonates admitted in NICU and planned to undergo LP for a clinical indication of sepsis were included. Neonates with diagnosed intraventricular hemorrhage (IVH) of grade III and IV were excluded. The LP was done by operator - often a fellow or resident assisted by bedside nurse. The unit has policy of not routinely using any sedation/analgesia during the procedure. LP is done by 26 G and 0.5-inch-long hypodermic needle inserted in third or fourth lumbar space while the infant is in lateral position. The infants were monitored clinically and by continuous measurement of vital parameters using multipara monitor during the procedure. The occurrence of traumatic tap along with CSF parameters and other operator and assistant characteristics were recorded at the time of procedure. Traumatic tap was defined as presence of visible blood or more than 500 red blood cells on microscopic examination. Microscopic trauma was defined when CSF is not having visible blood but numerous RBCs. The institutional ethics committee approved the study protocol. A written informed consent from the parents and the health care providers involved was obtained. Neonates were followed up till discharge/death and final diagnosis was assigned along with treating team. Results: A total of 362 (21%) neonates out of 1726 born at the hospital were admitted during the study period (July 2016 to January, 2017). Among these neonates, 97 (26.7%) were suspected of sepsis. A total of 54 neonates were enrolled who met the eligibility criteria and parents consented to participate in the study. The mean (SD) birthweight was 1536 (732) grams and gestational age 32.0 (4.0) weeks. All LPs were indicated for late onset sepsis at the median (IQR) age of 12 (5-39) days. The traumatic LP occurred in 19 neonates (35.1%; 95% C.I 22.6% to 49.3%). Frank blood was observed in 7 (36.8%) and in the remaining, 12(63.1%) CSF was detected to have microscopic trauma. The preliminary risk factor analysis including birth weight, gestational age and operator/assistant and other characteristics did not demonstrate clinically relevant predictors. Conclusion: A significant number of neonates requiring lumbar puncture in our study had high incidence of traumatic tap. We were not able to identify modifiable risk factors. There is a need to understand the reasons and further reduce this issue for improving management in NICUs.

Keywords: incidence, newborn, traumatic, lumbar puncture

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Authors: Hela Ghali, Sihem Ben Fredj, Mohamed Ben Rejeb, Sawssen Layouni, Salwa Khefacha, Lamine Dhidah, Houyem Said Laatiri

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Background: Antimicrobial resistance is a growing threat to public health and motivates to improve prevention and control programs both at international (WHO) and national levels. Despite their low pathogenicity, vancomycin-resistant enterococci (VRE) are common nosocomial pathogens in several countries. The high potential for transmission of VRE between patients and the threat to send its resistance genes to other bacteria such as staphylococcus aureus already resistant to meticilin, justify strict control measures. Indeed, in Europe, the proportion of Enterococcus faecium responsible for invasive infections, varies from 1% to 35% in 2011 and less than 5% were resistant to vancomycin. In addition, it represents the second cause of urinary tract and wound infections and the third cause of nosocomial bacteremia in the United States. The nosocomial outbreaks of VRE have been mainly described in intensive care services, hematology-oncology and haemodialysis. An epidemic of VRE has affected our hospital and the objective of this work is to describe the measures put in place. Materials/Methods: Following the alert given by the service of plastic surgery concerning a patient carrier of VRE, a team of the prevention and healthcare security service (doctor + technician) made an investigation. A review of files was conducted to draw the synoptic table and the table of cases. Results: By contacting the microbiology laboratory, we have identified four other cases of VRE and who were hospitalized in Medical resuscitation department (2 cases, one of them was transferred to the Physical rehabilitation department), and Nephrology department (2 cases). The visit has allowed to detect several malfunctions in professional practice. A crisis cell has allowed to validate, coordinate and implement control measures following the recommendations of the Technical Center of nosocomial infections. In fact, the process was to technically isolate cases in their sector of hospitalization, to restrict the use of antibiotics, to strength measures of basic hygiene, and to make a screening by rectal swab for both cases and contacts (other patients and health staff). These measures have helped to control the situation and no other case has been reported for a month. 2 new cases have been detected in the intensive care unit after a month. However, these are short-term strategies, and other measures in the medium and long term should be taken into account in order to face similar outbreaks. Conclusion: The efforts to control the outbreak were not efficient since 2 new cases have been reported after a month. Therefore, a continuous monitoring in order to detect new cases earlier is crucial to minimize the dissemination of VRE.

Keywords: hospitals, nosocomial infection, outbreak, vancomycin-resistant enterococci

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Authors: Randa M. Ali, Naguiba F. Loutfy, Osama M. Awad

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Background: Leishmaniasis is a worldwide disease, affecting 88 countries, it is estimated that about 350 million people are at risk of leishmaniasis. Overall prevalence is 12 million people with annual mortality of about 60,000. Annual incidence is 1,500,000 cases of cutaneous leishmaniasis (CL) worldwide and half million cases of visceral Leishmaniasis (VL). Objectives: The objective of this study was to assess primary health care physicians knowledge (PHP) and attitude about leishmaniasis and to assess awareness of local inhabitants about the disease and its vector in four areas in west Alexandria, Egypt. Methods: This study was a cross sectional survey that was conducted in four PHC units in west Alexandria. All physicians currently working in these units during the study period were invited to participate in the study, only 20 PHP completed the questionnaire. 60 local inhabitant were selected randomly from the four areas of the study, 15 from each area; Data was collected through two different specially designed questionnaires. Results: 11(55%) percent of the physicians had satisfactory knowledge, they answered more than 9 (60%) questions out of a total 14 questions about leishmaniasis and sandfly. The second part of the questionnaire is concerned with attitude of the primary health care physicians about leishmaniasis, 17 (85%) had good attitude and 3 (15%) had poor attitude. The second questionnaire showed that the awareness of local inhabitants about leishmaniasis and sandly as a vector of the disease is poor and needs to be corrected. Most of the respondents (90%) had not heard about leishmaniasis, Only 3 (5%) of the interviewed inhabitants said they know sandfly and its role in transmission of leishmaniasis. Conclusions: knowledge and attitudes of physicians are acceptable. However, there is, room for improvement and could be done through formal training courses and distribution of guidelines. In addition to raising the awareness of primary health care physicians about the importance of early detection and notification of cases of lesihmaniasis. Moreover, health education for raising awareness of the public regarding the vector and the disease is necessary because related studies have demonstrated that if the inhabitants do not perceive mosquitoes to be responsible for diseases such as malaria they do not take enough measures to protect themselves against the vector.

Keywords: leishmaniasis, PHP, knowledge, attitude, local inhabitants

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Authors: You-Lin Wu, Yi-Hsing Sung, Shih-Hung Lin, Jing-Jenn Lin

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Performance improvement in optoelectronic devices such as solar cells and photodetectors has been reported when a polymer/ZnO nanorods stack is used. Resistance switching of polymer/ZnO nanocrystals (or nanorods) hybrid has also gained a lot of research interests recently. It has been reported that high- and low-resistance states of a metal/insulator/metal (MIM) structure diode with a polystyrene (PS) and ZnO hybrid as the insulator layer can be switched by applied bias after a high-voltage forming process, while the same device structure merely with a PS layer does not show any forming behavior. In this work, we investigated the current-voltage (I-V) characteristics of an MIM device with a PS/ZnO nanorods stack deposited on fluorine-doped tin oxide (FTO) glass substrate. The ZnO nanorods were grown by a hydrothermal method using a mixture of zinc nitrate, hexamethylenetetramine, and DI water. Following that, a PS layer was deposited by spin coating. Finally, the device with a structure of Ti/ PS/ZnO nanorods/FTO was completed by e-gun evaporated Ti layer on top of the PS layer. Semiconductor parameters analyzer Agilent 4156C was then used to measure the I-V characteristics of the device by applying linear ramp sweep voltage with sweep sequence of 0V → 4V → 0V → 3V → 0V → 2V → 0V → 1V → 0V in both positive and negative directions. It is interesting to find that the I-V characteristics are bias dependent and hysteretic, indicating that the device Ti/PS/ZnO nanorods/FTO structure has ferroelectricity. Our results also show that the maximum hysteresis loop height of the I-V characteristics as well as the voltage at which the maximum hysteresis loop height of each scan occurs increase with increasing maximum sweep voltage. It should be noticed that, although ferroelectricity has been found in ZnO at its melting temperature (1975℃) and in Li- or Co-doped ZnO, neither PS nor ZnO has ferroelectricity at room temperature. Using the same structure but with a PS or ZnO layer only as the insulator does not give and hysteretic I-V characteristics. It is believed that a charge polarization layer is induced near the PS/ZnO nanorods stack interface and thus causes the ferroelectricity in the device with Ti/PS/ZnO nanorods/FTO structure. Our results show that the PS/ZnO stack can find a potential application in a resistive switching memory device with MIM structure.

Keywords: ferroelectricity, hysteresis, polystyrene, resistance switching, ZnO nanorods

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Authors: Hanan Al-Jabri

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Simultaneous interpreting is deemed to be the most challenging mode of interpreting by many scholars. The special constraints involved in this task including time constraints, different linguistic systems, and stress pose a great challenge to most interpreters. These constraints are likely to maximise when the interpreting task is done live on TV. The TV interpreter is exposed to a wide variety of audiences with different backgrounds and needs and is mostly asked to interpret high profile tasks which raise his/her levels of stress, which further complicate the task. Under these constraints, which require fast and efficient performance, TV interpreters of four TV channels were asked to render Trump's victory speech into Arabic. However, they had also to deal with the burden of rendering English emotive overtones employed by the speaker into a whole different linguistic system. The current study aims at investigating the way TV interpreters, who worked in the simultaneous mode, handled this task; it aims at exploring and evaluating the TV interpreters’ linguistic choices and whether the original emotive effect was maintained, upgraded, downgraded or abandoned in their renditions. It also aims at exploring the possible difficulties and challenges that emerged during this process and might have influenced the interpreters’ linguistic choices. To achieve its aims, the study analysed Trump’s victory speech delivered on November 6, 2016, along with four Arabic simultaneous interpretations produced by four TV channels: Al-Jazeera, RT, CBC News, and France 24. The analysis of the study relied on two frameworks: a macro and a micro framework. The former presents an overview of the wider context of the English speech as well as an overview of the speaker and his political background to help understand the linguistic choices he made in the speech, and the latter framework investigates the linguistic tools which were employed by the speaker to stir people’s emotions. These tools were investigated based on Shamaa’s (1978) classification of emotive meaning according to their linguistic level: phonological, morphological, syntactic, and semantic and lexical levels. Moreover, this level investigates the patterns of rendition which were detected in the Arabic deliveries. The results of the study identified different rendition patterns in the Arabic deliveries, including parallel rendition, approximation, condensation, elaboration, transformation, expansion, generalisation, explicitation, paraphrase, and omission. The emerging patterns, as suggested by the analysis, were influenced by factors such as speedy and continuous delivery of some stretches, and highly-dense segments among other factors. The study aims to contribute to a better understanding of TV simultaneous interpreting between English and Arabic, as well as the practices of TV interpreters when rendering emotiveness especially that little is known about interpreting practices in the field of TV, particularly between Arabic and English.

Keywords: emotive overtones, interpreting strategies, political speeches, TV interpreting

Procedia PDF Downloads 148

Authors: Jeongil Kim

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The present study examined the effects of arts-mediated mother-child dyads mindfulness-based intervention for Korean children with attention deficit hyperactivity disorder (ADHD) and their mothers, on behaviors in children and subjective psychological states in mothers. Four elementary school boys with ADHD and their mothers participated in the study. Using a multiple baseline design across four mother-child dyads, data were collected on the target behaviors (disruptive behavior, on-task behavior, and compliance in class) in children using a 10-second partial interval recording system and on the subjective psychological states in mothers using four questionnaires (on perceived stress, burnout, mindfulness, and satisfaction with life). The intervention consisted of a) mindfulness training, b) mindfulness practice, and c) mindful management of body and feeling. The arts activities, making a coiled clay pot and Korean traditional music performance, were utilized to facilitate the environment to help each participant to understand the content and progress of the intervention program. The results showed that all four dyads showed improvement in adaptive behaviors in the children (increase in on-task behavior; decrease in disruptive behavior) and positive change in subjective psychological states in the mothers (increase in scores of mindfulness and satisfaction with life; decrease in scores of perceived stress and burnout). The changes in the children’s behaviors and in the mothers’ subjective psychological states were maintained when the intervention was drawn and generalized in novel settings. The results suggest that arts-mediated mother-child dyads mindfulness-based intervention would be a mutual benefiting strategy to support both children with ADHD and their mothers who experience diverse challenges in behavioral and psychological aspects.

Keywords: mindfulness, attention deficit hyperactivity disorder (ADHD), arts-mediated, behavior, psychological well-being, child-mother

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Authors: Henry Pariaman, Iwa Garniwa, Isti Surjandari, Bambang Sugiarto

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Availability of a complex system of thermal power plant is strongly influenced by the reliability of spare parts and maintenance management policies. A reliability-centered maintenance (RCM) technique is an established method of analysis and is the main reference for maintenance planning. This method considers the consequences of failure in its implementation, but does not deal with further risk of down time that associated with failures, loss of production or high maintenance costs. Risk-based maintenance (RBM) technique provides support strategies to minimize the risks posed by the failure to obtain maintenance task considering cost effectiveness. Meanwhile, condition-based maintenance (CBM) focuses on monitoring the application of the conditions that allow the planning and scheduling of maintenance or other action should be taken to avoid the risk of failure prior to the time-based maintenance. Implementation of RCM, RBM, CBM alone or combined RCM and RBM or RCM and CBM is a maintenance technique used in thermal power plants. Implementation of these three techniques in an integrated maintenance will increase the availability of thermal power plants compared to the use of maintenance techniques individually or in combination of two techniques. This study uses the reliability, risks and conditions-based maintenance in an integrated manner to increase the availability of thermal power plants. The method generates MPI (Priority Maintenance Index) is RPN (Risk Priority Number) are multiplied by RI (Risk Index) and FDT (Failure Defense Task) which can generate the task of monitoring and assessment of conditions other than maintenance tasks. Both MPI and FDT obtained from development of functional tree, failure mode effects analysis, fault-tree analysis, and risk analysis (risk assessment and risk evaluation) were then used to develop and implement a plan and schedule maintenance, monitoring and assessment of the condition and ultimately perform availability analysis. The results of this study indicate that the reliability, risks and conditions-based maintenance methods, in an integrated manner can increase the availability of thermal power plants.

Keywords: integrated maintenance techniques, availability, thermal power plant, MPI, FDT

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Authors: Michael Zaidman, Naum Simanovsky

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Introduction. Symptomatic tarsal coalition with rigid flat foot often demands operative solution. An isolated coalition resection does not guarantee pain relief; correction of co-existing foot deformity may be required. The objective of the study was to analyze the results of combination of tarsal coalition resection and arthroereisis. Patients and methods. We retrospectively reviewed medical records and radiographs of children operatively treated in our institution for symptomatic calcaneonavicular or talocalcaneal coalition between the years 2019 and 2022. Eight patients (twelve feet), 4 boys and 4 girls with mean age 11.2 years, were included in the study. In six patients (10 feet) calcaneonavicular coalition was diagnosed, two patients (two feet) sustained talonavicular coalition. To quantify degrees of foot deformity, we used calcaneal pitch angle, lateral talar-first metatarsal (Meary's) angle, and talonavicular coverage angle. The clinical results were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle Hindfoot Score. Results. The mean follow-up was 28 month. The preoperative mean talonavicular coverage angle was 17,75º as compared with postoperative mean angle of 5.4º. The calcaneal pitch angle improved from mean 6,8º to 16,4º. The mean preoperative Meary’s angle of -11.3º improved to mean 2.8º. The preoperative mean AOFAS score improved from 54.7 to 93.1 points post-operatively. In nine of twelve feet, overall clinical outcome judged by AOFAS scale was excellent (90-100 points), in three feet was good (80-90 points). Six patients (ten feet) obviously improved their subtalar range of motion. Conclusion. For symptomatic stiff or rigid flat feet associated with tarsal coalition, the combination of coalition resection and arthroereisis leads to normalization of radiographic parameters, clinical and functional improvement with good patient’s satisfaction and likely to be more effective than the isolated procedures.

Keywords: rigid flat foot, tarsal coalition resection, arthroereisis, outcome

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Authors: Gloria Chen

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When offering conventional level-appropriate ESL classes for adults is not feasible, a multilevel adult ESL class can be formed to benefit those who need to learn English for daily function. This paper examines the rationale, the process, the contents, and the outcomes of a multilevel ESL class for adults. The action research discusses a variety of assessments, lesson plans, teaching strategies that facilitate lifelong language learning. In small towns where adult ESL learners are only a handful, often advanced students and inexperienced students have to be placed in one class. Such class might not be viewed as desirable, but with on-going assessments, careful lesson plans, and purposeful strategies, a multilevel ESL class for adults can overcome the obstacles and help learners to reach a higher level of English proficiency. This research explores some hand-on strategies, such as group rotating, cooperative learning, and modifying textbook contents for practical purpose, and evaluate their effectiveness. The data collected in this research include Needs Assessment (beginning of class term), Mid-term Self-Assessment (5 months into class term), End-of-term Student Reflection (10 months into class), and End-of-term Assessment from the Instructor (10 months into class). A descriptive analysis of the data explains the practice of this particular learning community, and reveal the areas for improvement and enrichment. This research answers the following questions: (1) How do the assessments positively help both learners and instructors? (2) How do the learning strategies prepare students to become independent, life-long English learners? (3) How do materials, grouping, and class schedule enhance the learning? The result of the research contributes to the field of teaching and learning in language, not limited in English, by (a) examining strategies of conducting a multilevel adult class, (b) involving adult language learners with various backgrounds and learning styles for reflection and feedback, and (c) improving teaching and learning strategies upon research methods and results. One unique feature of this research is how students can work together with the instructor to form a learning community, seeking and exploring resources available to them, to become lifelong language learners.

Keywords: adult language learning, assessment, multilevel, teaching strategies

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Authors: Raman Sharma, Ashok Kumar, Vipin Koushal

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Healthcare facilities are always seen as places of haven and protection for managing the external incidents, but the situation becomes more difficult and challenging when such facilities themselves are affected from internal hazards. Such internal hazards are arguably more disruptive than external incidents affecting vulnerable ones, as patients are always dependent on supportive measures and are neither in a position to respond to such crisis situation nor do they know how to respond. The situation becomes more arduous and exigent to manage if, in case critical care areas like Intensive Care Units (ICUs) and Operating Rooms (OR) are convoluted. And, due to these complexities of patients’ in-housed there, it becomes difficult to move such critically ill patients on immediate basis. Healthcare organisations use different types of electrical equipment, inflammable liquids, and medical gases often at a single point of use, hence, any sort of error can spark the fire. Even though healthcare facilities face many fire hazards, damage caused by smoke rather than flames is often more severe. Besides burns, smoke inhalation is primary cause of fatality in fire-related incidents. The greatest cause of illness and mortality in fire victims, particularly in enclosed places, appears to be the inhalation of fire smoke, which contains a complex mixture of gases in addition to carbon monoxide. Therefore, healthcare organizations are required to have a well-planned disaster mitigation strategy, proactive and well prepared manpower to cater all types of exigencies resulting from internal as well as external hazards. This case report delineates a true OR fire incident in Emergency Operation Theatre (OT) of a tertiary care multispecialty hospital and details the real life evidence of the challenges encountered by OR staff in preserving both life and property. No adverse event was reported during or after this fire commotion, yet, this case report aimed to congregate the lessons identified of the incident in a sequential and logical manner. Also, timely smoke evacuation and preventing the spread of smoke to adjoining patient care areas by opting appropriate measures, viz. compartmentation, pressurisation, dilution, ventilation, buoyancy, and airflow, helped to reduce smoke-related fatalities. Henceforth, precautionary measures may be implemented to mitigate such incidents. Careful coordination, continuous training, and fire drill exercises can improve the overall outcomes and minimize the possibility of these potentially fatal problems, thereby making a safer healthcare environment for every worker and patient.

Keywords: healthcare, fires, smoke, management, strategies

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