Search results for: outpatient housing options for children and teenagers with disabilities

Authors: Meltem Anafarta Şendağ, Funda Kutlu

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Attachment theory has some major postulates that direct attention of psychologists from many different domains. First, the theory suggests that attachment is a lifetime process. This means that every human being from cradle to grave needs someone stronger to depend on in times of stress. Second, the attachment is a dynamic process and as one goes through developmental stages it is being transferred from one figure to another (friends, romantic partners). Third, the quality of attachment relationships later in time directly affected by the earliest attachment relationship established between the mother and the infant. Depending on these postulates, attachment literature focuses mostly on mother – child attachment during childhood and romantic relationship during adulthood. However, although romantic partners are important attachment figures in adults’ life, parents are not dropped out from the attachment hierarchy but they keep being important attachment figures. Despite the fact that parents could still be an important figure in adults’ life, adult – parent attachment is overlooked in the literature. Accordingly, this study focuses on adult daughters’ current attachment to their old mothers in relation with early parental bonding and current attachment to husbands. Participants of the study were 383 adult women (Average age = 40, ranging between 23 and 70) whose mothers were still alive and who were married at the time of the study. Participants were completed Adult Attachment Scale, Parental Bonding Instrument, and Experiences in Close Relationship – II together with demographic questionnaire. Results revealed that daughters’ attachment to their mothers weakens as they get older, have more children, and have longer marriages. Stronger attachment to mothers was found positively correlated with current satisfaction with the relationship, perception of maternal care before the age of 12 and negatively correlated with perception of controlling behavior before the age 12. Considering the relationship between current parental attachment and romantic attachment, it was found that as the current attachment to mother strengthens attachment avoidance towards husband decreases. Results revealed that although attachment between the adult daughters and old mothers weakens, the relationship is still critical in daughters’ lives. The strength of current attachment with the mother is related both with the early relationship with the mother and current attachment with the husband. The current study is thought to contribute to attachment theory emphasizing the attachment as a lifetime construct.

Keywords: adult daughter, attachment, old mothers, parental bonding

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Authors: Mostafa Elbaba

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Because childhood renal diseases are grossly different compared to adult diseases, pediatric nephrology was founded as a specialty in 1965. Renal pathology specialty was introduced at the London Ciba Symposium in 1961. The history of renal pathology can be divided into two eras: one starting in the 1650s with the invention of the microscope, the second in the 1950s with the implementation of renal biopsy, and the presence of electron microscopy and immunofluorescence study. Prior to the 1950s, the study of diseased human kidneys was restricted to postmortem examination by gross pathology. In 1827, Richard Bright first described his triad of kidney disease, which was confirmed by morbid kidney changes at autopsy. In 1905 Friedrich Mueller coined the term “nephrosis” describing the inflammatory form of “degenerative” diseases, and later F. Munk added the term “lipoid nephrosis”. The most profound influence on renal diseases’ classification came from the publication of Volhard and Fahr in 1914. In 1899, Carl Max Wilhelm Wilms described Wilms' tumor of the kidneys in children. Chronic pyelonephritis was a popular renal diagnosis and the most common cause of uremia until the 1960s. Although kidney biopsy had been used early in the 1930s for renal tumors, the earliest reports of its use in the diagnosis of medical kidney disease were by Iversen and Brun in 1951, followed by Alwall in 1952, then by Pardo in 1953. The earliest intentional renal biopsies were done in 1944 by Nils Alwall, while the procedure was abandoned after the death of one of his 13 patients who biopsied. In 1950, Antonino Perez-Ara attempted renal biopsies, but his results were missed because of an unpopular journal publication. In the year 1951, Claus Brun and Poul Iverson developed the biopsy procedure using an aspiration technique. Popularizing renal biopsy practice is accredited to Robert Kark, who published his distinct work in 1954. He perfected the technique of renal biopsy in the prone position using the Vim-Silverman needle and used intravenous pyelography to improve the localization of the kidney.

Keywords: history, medicine, nephrology, pediatrics, pathology

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Authors: T. Frawley, G. O'Kelly

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The UCD School of Nursing, Midwifery and Health Systems Higher Diploma in Mental Health (HDMH) nursing programme commenced in January 2017. Forty students successfully completed the programme. Programme evaluation was conducted from the outset. Research ethics approval was granted by the UCD Human Research Ethics Committee – Sciences in November 2016 (LS-E-16-163). Plan for Sustainability: Each iteration of the programme continues to be evaluated and adjusted accordingly. Aims: The ultimate purpose of the HDMH programme is to prepare registered nurses (registered children’s nurse (RCN), registered nurse in intellectual disability (RNID) and registered general nurse (RGN)) to function as effective registered psychiatric nurses in all settings which provide care and treatment for people experiencing mental health difficulties. Curriculum evaluation is essential to ensure that the programme achieves its purpose, that aims and expected outcomes are met and that required changes are highlighted for the programme’s continuing positive development. Methods: Both quantitative and qualitative methods were used in the evaluation. A series of questionnaires were used (the majority pre and post programme) to determine student perceptions of the programme, behaviour and attitudinal change from commencement to completion. These included the student assessment of learning gains (SALG); mental health knowledge schedule (MAKS); mental health clinician attitudes scale (MICA); reported and intended behaviour scale (RIBS); and community attitudes towards the mentally ill (CAMI). In addition, student and staff focus groups were conducted. Evaluation methods also incorporated module feedback. Outcome/Results: The evaluation highlighted a very positive response in relation to the achievement of programme outcomes and preparation for future work as registered psychiatric nursing. Some areas were highlighted for further development, which have been taken cognisance of in the 2019 iteration of the programme.

Keywords: learning gains, mental health, nursing, stigma

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Authors: Sadeeq Launi

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NGOs, the world over, have been recognized as part of the institutions that complement government activities in providing services to the people, particularly in respect of human development. This study examined the role played by the NGOs in human development in Bauchi State, Nigeria, between 2004 and 2013. The emphasis was on reproductive health and access to education role of the selected NGOs. All the research questions, objectives and hypotheses were stated in line with these variables. The theoretical framework that guided the study was the participatory development approach. Being a survey research, data were generated from both primary and secondary sources with questionnaires and interviews as the instruments for generating the primary data. The population of the study was made up of the staff of the selected NGOs, beneficiaries, health staff and school teachers in Bauchi State. The sample drawn from these categories were 90, 107 and 148 units respectively. Stratified random and simple random sampling techniques were adopted for NGOs staff, and Health staff and school teachers data were analyzed quantitatively and qualitatively and hypotheses were tested using Pearson Chi-square test through SPSS computer statistical package. The study revealed that despite the challenges facing NGOs operations in the study area, NGOs rendered services in the areas of health and education This research recommends among others that, both government and people should be more cooperative to NGOs to enable them provide more efficient and effective services. Governments at all levels should be more dedicated to increasing accessibility and affordability of basic education and reproductive health care facilities and services in Bauchi state through committing more resources to the Health and Education sectors, this would support and facilitate the complementary role of NGOs in providing teaching facilities, drugs, and other reproductive health services in the States. More enlightenment campaigns should be carried out by governments to sensitize the public, particularly women on the need to embrace immunization programmes for their children and antenatal care services being provided by both the government and NGOs.

Keywords: access to education, human development, NGOs, reproductive health

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Authors: Nibedita Priyadarsini

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It is said that Ethics has a wide range of application which mainly deals with human life and human behavior. All ethical decisions are ultimately concerned with life and death. Both life and death must be considered dignified. Medical ethics with its different topics mostly deals with life and death concepts among which euthanasia is one. Various types of debates continue over Euthanasia long since. The question of putting an end to someone’s life has aroused controversial in legal sphere as well as in moral sphere. To permit or not to permit has remained an enigma the world over. Modern medicine is in the stage of transcending limits that cannot be set aside. The morality of allowing people to die without treatment has become more important as methods of treatment have become more sophisticated. Allowing someone to die states an essential recognition that there is some point in any terminal illness when further curative treatment has no purpose and the patient in such situation should allow dying a natural death in comfort, peace, and dignity, without any interference from medical science and technology. But taking a human life is in general sense is illogical in itself. It can be said that when we kill someone, we cause the death; whereas if we merely let someone die, then we will not be responsible for anyone’s death. This point is often made in connection with the euthanasia cases and which is often debatable. Euthanasia in the pediatric age group involves some important issues that are different from those of adult issues. The main distinction that occurs is that the infants and newborns and young children are not able to decide about their future as the adult does. In certain cases, where the child born with some serious deformities with no hope of recovery, in that cases doctor decide not to perform surgery in order to remove the blockage, and let the baby die. Our aim in this paper is to examine, whether it is ethically justified to withhold or to apply euthanasia on the part of the defective infant. What to do with severely defective infants from earliest time if got to know that they are not going to survive at all? Here, it will deal mostly with the ethics in deciding the relevant ethical concerns in the practice of euthanasia with the defective newborns issues. Some cases in relation to disabled infants and newborn baby will be taken in order to show what to do in a critical condition, that the patient and family members undergoes and under which condition those could be eradicated, if not all but some. The final choice must be with the benefit of the patient.

Keywords: ethics, medical ethics, euthanasia, defective newborns

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Authors: Angelis P. Barlampas

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An 89 years old woman came to the emergency department complaining of long-lasting headaches and nausea. A CT examination was performed, and a homogeneous midline anterior cranial fossa lesion was revealed, which was situated near the base and measured 2,4 cm in diameter. The patient was allergic, and an i.v.c injection could not be done on the spot, and neither could an MRI exam because of metallic implants. How could someone narrow down the differential diagnosis? The interhemispheric meningioma is usually a silent midline lesion with no edema, and most often presents as a homogeneous, solid type, isodense, or slightly hyperdense mass ( usually the smallest lesions as this one ). Of them, 20-30% have some calcifications. Hyperostosis is typical for meningiomas that abut the base of the skull but is absent in the current case, presumably of a more cephalad location that is borderline away from the bone. Because further investigation could not be done, as the patient was allergic to the contrast media, some other differential options should be considered. Regarding the site of the lesion, the most common other entities to keep in mind are the following: Metastasis, tumor of skull base, abscess, primary brain tumors, meningioma, giant aneurysm of the anterior cerebral artery, olfactory neuroblastoma, interhemispheric meningioma, giant aneurysm of the anterior cerebral artery, midline lesion. Appearance will depend on whether the aneurysm is non-thrombosed, or partially, or completely thrombosed. Non-contrast: slightly hyperdense, well-defined round extra-axial mass, may demonstrate a peripheral calcified rim, olfactory neuroblastoma, midline lesion. The mass is of soft tissue attenuation and is relatively homogeneous. Focal calcifications are occasionally present. When an intracranial extension is present, peritumoral cysts between it and the overlying brain are often present. Final diagnosis interhemispheric meningioma (Known from the previous patient’s history). Meningiomas come from the meningocytes or the arachnoid cells of the meninges. They are usually found incidentally, have an indolent course, and their most common location is extra-axial, parasagittal, and supratentorial. Other locations include the sphenoid ridge, olfactory groove, juxtasellar, infratentorial, intraventricular, pineal gland area, and optic nerve meningioma. They are clinically silent entities, except for large ones, which can present with headaches, changes in personality status, paresis, or symptomatology according to their specific site and may cause edema of the surrounding brain tissue. Imaging findings include the presence of calcifications, the CSF cleft sign, hyperostosis of adjacent bone, dural tail, and white matter buckling sign. After i.v.c. injection, they enhance brightly and homogenously, except for large ones, which may exhibit necrotic areas or may be heavily calcified. Malignant or cystic variants demonstrate more heterogeneity and less intense enhancement. Sometimes, it is inevitable that the needed CT protocol cannot be performed, especially in the emergency department. In these cases, the radiologist must focus on the characteristic imaging features of the unenhanced lesion, as well as in previous examinations or a known lesion history, in order to come to the right report conclusion.

Keywords: computed tomography, emergency radiology, metastasis, tumor of skull base, abscess, primary brain tumors, meningioma, giant aneurysm of the anterior cerebral artery, olfactory neuroblastoma, interhemispheric meningioma

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Authors: Camila Freire Barrios, Gonzalo Rivera Talavera

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

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

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Authors: Steven D. Capener

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The 1997 Asian financial crisis was a watershed event in Korea as it necessitated changes that begin an unravelling of many of the norms and traditions that had served to underpin society. Divorce skyrocketed; the era of lifetime employment was over; women came out the home to become, in many cases, the main breadwinners; competitive forces were exacerbated; and traditional sources of authority began to crumble. All of these changes weekend the power to structure human relations of the Confucian Three Bonds and Five Relationships (삼강오륜). Since then, this “de-confucianization” has only become more pronounced with women increasingly refusing to marry, partly in protest to what they perceive as entrenched gender inequality, married couples eschewing childbirth resulting in the lowest birthrate in the world, and diminishing inheritances eroding the traditionally strong sense of filial piety (효) of children toward parents. The result of all this can be seen in the continued weakening or outright crumbling of the hierarchies codified in the Three Bonds and Five Relationship, which have served as a social template in Korea for centuries. In his 2004 work “Oppa Came Back,” writer Kim Yong Ha depicts what he apparently sees as the “post-Confucian” family in a wickedly funny portrayal of what Korean society could look like if traditional bulwarks of prescriptive values suddenly collapse and are not replaced with tenable alternatives. In the short story, Kim subverts all the traditional hierarchies while leaving the desire to dominate these hierarchies intact. This produces the picture of a Korean family governed by the new values of money and physical power. After lying out what can be identified as major cultural changes in what could be called “traditional” society,” the article uses a close reading of Kim’s story for its implications regarding a possible new, dysfunctional version of Korean society. It seems apparent that Kim’s story is a cautionary tale of the pitfalls that lie athwart the late-modern Korean landscape. These changes have important implications in the areas of education and socio-political philosophy. The conclusion focuses on possible alternatives to this post-Confucian conundrum.

Keywords: post-confucian, three bonds and five relationships, traditional society, hierarchies

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Authors: Luyin Liang

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Although sibling relationship has been viewed as one of the most important family relationships that significantly impacted on the quality of life of both adults with Intellectual Disability (AWID) and their brothers/sisters, very few research have been done to investigate this relationship in China. This study investigated Chinese siblings of AWID’s relational motivations in sibling relationship and their determining factors. Quantitative research method has been adopted and 284 samples were recruited in this study. Siblings of AWID’s two types of relational motivations, including obligatory motivations and discretionary motivations were examined. Their emotional closeness, senses of responsibility, experiences of ID stigma, and expectancy of self-reward in sibling relationship were measured by validated scales. Personal, and familial-social demographic characteristics were also investigated. Linear correlation test and standard multiple regression analysis were the major statistical methods that have been used to analyze the data. The findings of this study showed that all the measured factors, including siblings of AWID’s emotional closeness, their senses of responsibility, experiences of ID stigma, and self-reward expectations had significant relationships with their both types of motivations. However, when these factors were grouped together to measure each type of these motivations, the prediction results were varied. The order of factors that best predict siblings of AWID’s obligatory motivations was: their senses of responsibility, emotional closeness, experiences of ID stigma, and their expectancy of self-reward, whereas the order of these factors that best determine siblings of AWID’s discretionary motivations was: their self-reward expectations, experiences of ID stigma, senses of responsibility, and emotional closeness. Among different demographic characteristics, AWID’s disability condition, their siblings’ age, gender, marital status, number of children, both siblings’ living arrangements and family financial status were found to have significant impacts on siblings of AWID’s both types of motivations in sibling relationship. The results of this study could enhance social work practitioners’ understandings about the needs and challenges of siblings of AWID. Suggestions on advocacies for policy changes and services improvements for these siblings were discussed in this study.

Keywords: sibling relationship, intellectual disability, adults, China

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Authors: Abdirahim Mohamed, Sarita Rana Chhetri, Michael Sleath, Nadia Saleem

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Rationale: Internet usage has been very much integrated into our daily lives. Internet usage within a neurodevelopmental disorder population is also on the increase. Nevertheless, there is very little empirical research on how this population virtually protect themselves; along with how their parents can keep them safe online. This topic was an ever-growing concern to the parents within our services and in many cases would add to the stresses and mental health of parents. This ignited an idea within our team to conduct research to explore the perceived online risks within this population and how they keep themselves safe. In conjunction, we also explored how parents and caregivers monitor and safeguard their young people to the potential threats online. Our hypothesis was that the perceived risks will heavily outnumber the safeguarding measures implemented by this population. Method: Within the Coventry and Warwickshire NHS Partnership Trust Child and Adolescent Mental Health Service (CAMHS), we distributed qualitative questionnaires to all the clinical bases (N=80). Questions explored topics such as daily internet usage, safeguarding measures, and perceived threats. The researchers requested for all CAMHS clinicians to identify participants. Participants in this study were accessing CAMHS for neurodevelopmental specific interventions. Results: The data were analysed using both Excel and SPSS. Within SPSS, a MANOVA was conducted and found a significant difference between safeguarding measures and perceived online risks within responses (p ≤ 0.5). This supports our hypothesis that participants in this population are well versed in the safeguarding issues of the internet; however, struggle to implement appropriate preventative measures. Data were also screened using Excel and found that all parents and carers stated they 'monitored their child’s internet use'. Conclusion: Data suggest that parents/carers may require more specific intervention to equip them with preventative measures due to the clear discrepancy between perceived risks and safeguarding measures. More research may also need to be conducted around this area to determine appropriate methodology to explore this topic further.

Keywords: Internet, health , how safe are we , internet health check

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Authors: Tamar Lin, Nufar Buchshtab, Yifat Elharar, Julian Nicenboim, Rotem Edgar, Iddo Weiner, Lior Zelcbuch, Ariel Cohen, Sharon Kredo-Russo, Inbar Gahali-Sass, Naomi Zak, Sailaja Puttagunta, Merav Bassan

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Background: Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disorder that is characterized by dry skin and flares of eczematous lesions and intense pruritus. Multiple lines of evidence suggest that AD is associated with increased colonization by Staphylococcus aureus, which contributes to disease pathogenesis through the release of virulence factors that affect both keratinocytes and immune cells, leading to disruption of the skin barrier and immune cell dysfunction. The aim of the current study is to develop a bacteriophage-based product that specifically targets S. aureus. Methods: For the discovery of phage, environmental samples were screened on 118 S. aureus strains isolated from skin samples, followed by multiple enrichment steps. Natural phages were isolated, subjected to Next-generation Sequencing (NGS), and analyzed using proprietary bioinformatics tools for undesirable genes (toxins, antibiotic resistance genes, lysogeny potential), taxonomic classification, and purity. Phage host range was determined by an efficiency of plating (EOP) value above 0.1 and the ability of the cocktail to completely lyse liquid bacterial culture under different growth conditions (e.g., temperature, bacterial stage). Results: Sequencing analysis demonstrated that the 118 S. aureus clinical strains were distributed across the phylogenetic tree of all available Refseq S. aureus (~10,750 strains). Screening environmental samples on the S. aureus isolates resulted in the isolation of 50 lytic phages from different genera, including Silviavirus, Kayvirus, Podoviridae, and a novel unidentified phage. NGS sequencing confirmed the absence of toxic elements in the phages’ genomes. The host range of the individual phages, as measured by the efficiency of plating (EOP), ranged between 41% (48/118) to 79% (93/118). Host range studies in liquid culture revealed that a subset of the phages can infect a broad range of S. aureus strains in different metabolic states, including stationary state. Combining the single-phage EOP results of selected phages resulted in a broad host range cocktail which infected 92% (109/118) of the strains. When tested in vitro in a liquid infection assay, clearance was achieved in 87% (103/118) of the strains, with no evidence of phage resistance throughout the study (24 hours). A S. aureus host was identified that can be used for the production of all the phages in the cocktail at high titers suitable for large-scale manufacturing. This host was validated for the absence of contaminating prophages using advanced NGS methods combined with multiple production cycles. The phages are produced under optimized scale-up conditions and are being used for the development of a topical formulation (BX005) that may be administered to subjects with atopic dermatitis. Conclusions: A cocktail of natural phages targeting S. aureus was effective in reducing bacterial burden across multiple assays. Phage products may offer safe and effective steroid-sparing options for atopic dermatitis.

Keywords: atopic dermatitis, bacteriophage cocktail, host range, Staphylococcus aureus

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Authors: Elisabetta Cianfanelli, Maria Claudia Coppola, Margherita Tufarelli

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Design practices throughout history return a critical understanding of society since they always conveyed values and meanings aimed at (re)framing reality by acting in everyday life: here, design gains cultural and normative character, since its artifacts, services, and environments hold the power to intercept, influence and inspire thoughts, behaviors, and relationships. In this sense, design can be persuasive, engaging in the production of worlds and, as such, acting in the space between poietics and politics so that chasing preferable futures and their aesthetic strategies becomes a matter full of political responsibility. This resonates with contemporary landscapes of radical interdependencies challenging designers to focus on complex socio-technical systems and to better support values such as equality and justice for both humans and nonhumans. In fact, it is in times of crisis and structural uncertainty that designers turn into visionaries at the service of society, envisioning scenarios and dwelling in the territories of imagination to conceive new fictions and frictions to be added to the thickness of the real. Here, design’s main tasks are to develop options, to increase the variety of choices, to cultivate its role as scout, jester, agent provocateur for the public, so that design for transformation emerges, making an explicit commitment to society, furthering structural change in a proactive and synergic manner. However, the exploration of possible futures is both a trap and a trampoline because, although it embodies a radical research tool, it raises various challenges when the design process goes further in the translation of such vision into an artefact - whether tangible or intangible -, through which it should deliver that bit of future into everyday experience. Today designers are making up new tools and practices to tackle current wicked challenges, combining their approaches with other disciplinary domains: futuring through design, thus, rises from research strands like speculative design, design fiction, and critical design, where the blending of design approaches and futures thinking brings an action-oriented and product-based approach to strategic insights. The contribution positions at the intersection of those approaches, aiming at discussing design’s tools of inquiry through which it is possible to grasp the agency of imagined futures into present time. Since futures are not remote, they actively participate in creating path-dependent decisions, crystallized into designed artifacts par excellence, prototypes, and their conceptual other, provotypes: with both being unfinished and multifaceted, the first ones are effective in reiterating solutions to problems already framed, while the second ones prove to be useful when the goal is to explore and break boundaries, bringing closer preferable futures. By focusing on some provotypes throughout history which challenged markets and, above all, social and cultural structures, the contribution’s final aim is understanding the knowledge produced by provotypes, understood as design spaces where designs’s humanistic side might help developing a deeper sensibility about uncertainty and, most of all, the unfinished feature of societal artifacts, whose experimentation would leave marks and traces to build up f(r)ictions as vital sparks of plurality and collective life.

Keywords: speculative design, provotypes, design knowledge, political theory

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Authors: Francisco Fernandez de Castro

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The Conditional Cash Transfer (CCT) model gives monetary transfers to beneficiary families on the condition that they take specific education and health actions. According to the economic rationale of CCTs the poor need incentives to invest in their human capital because they are trapped by a lack of information and misleading beliefs. If left to their own decision, the poor will not be able to choose what is in their best interests. The basic assumption of the CCT model is that the poor need incentives to take care of their own education and health-nutrition. Due to the incentives (income cash transfers and conditionalities), beneficiary families are supposed to attend doctor visits and health talks. Children would stay in the school. These incentivized behaviors would produce outcomes such as better health and higher level of education, which in turn will reduce poverty. Based on a grounded theory approach to conduct a two-year period of qualitative data collection in northern Mexico, this study shows that this explanation is incomplete. In addition to the information failure and inadequate beliefs, there are structural barriers in everyday life of households that make health-nutrition and education investments difficult. In-depth interviews and observation work showed that the program takes for granted local conditions in which beneficiary families should fulfill their co-responsibilities. Data challenged the program’s assumptions and unveiled local obstacles not contemplated in the program’s design. These findings have policy and research implications for the CCT agenda. They bring elements for late programming due to the gap between the CCT strategy as envisioned by policy designers, and the program that beneficiary families experience on the ground. As for research consequences, these findings suggest new avenues for scholarly work regarding the causal mechanisms and social processes explaining CCT outcomes.

Keywords: conditional cash transfers, incentives, poverty, structural barriers

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Authors: Meena Agrawal, Chaitanya P. Agrawal

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The power systems are transforming and becoming smarter with innovations in technologies to enable embark simultaneously upon the sustainable energy needs, rising environmental concerns, economic benefits and quality requirements. The advantages provided by inter-connection of renewable energy resources are becoming more viable and dependable with the smart controlling technologies. The limitation of most renewable resources have their diversity and intermittency causing problems in power quality, grid stability, reliability, security etc. is being cured by these efforts. A necessitate of optimal energy management by intelligent Micro-Grids at the distribution end of the power system has been accredited to accommodate sustainable renewable Distributed Energy Resources on large scale across the power grid. All over the world Smart Grids are emerging now as foremost concern infrastructure upgrade programs. The hardware setup includes NI cRIO 9022, Compact Reconfigurable Input Output microcontroller board connected to the PC on a LAN router with three hardware modules. The Real-Time Embedded Controller is reconfigurable controller device consisting of an embedded real-time processor controller for communication and processing, a reconfigurable chassis housing the user-programmable FPGA, Eight hot-swappable I/O modules, and graphical LabVIEW system design software. It has been employed for signal analysis, controls and acquisition and logging of the renewable sources with the LabVIEW Real-Time applications. The employed cRIO chassis controls the timing for the module and handles communication with the PC over the USB, Ethernet, or 802.11 Wi-Fi buses. It combines modular I/O, real-time processing, and NI LabVIEW programmable. In the presented setup, the Analog Input Module NI 9205 five channels have been used for input analog voltage signals from renewable energy sources and NI 9227 four channels have been used for input analog current signals of the renewable sources. For switching actions based on the programming logic developed in software, a module having Electromechanical Relays (single-pole single throw) with 4-Channels, electrically isolated and LED indicating the state of that channel have been used for isolating the renewable Sources on fault occurrence, which is decided by the logic in the program. The module for Ethernet based Data Acquisition Interface ENET 9163 Ethernet Carrier, which is connected on the LAN Router for data acquisition from a remote source over Ethernet also has the module NI 9229 installed. The LabVIEW platform has been employed for efficient data acquisition, monitoring and control. Control logic utilized in program for operation of the hardware switching Related to Fault Relays has been portrayed as a flowchart. A communication system has been successfully developed amongst the sources and loads connected on different computers using Hypertext transfer protocol, HTTP or Ethernet Local Stacked area Network TCP/IP protocol. There are two main I/O interfacing clients controlling the operation of the switching control of the renewable energy sources over internet or intranet. The paper presents experimental results of the briefed setup for intelligent control of the micro-grid for renewable energy sources, besides the control of Micro-Grid with data acquisition and control hardware based on a microcontroller with visual program developed in LabVIEW.

Keywords: data acquisition and control, LabVIEW, microcontroller cRIO, Smart Micro-Grid

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Authors: Georges F. Hatoum, Thomas H. Temple, Silvio Garcia, Xiaodong Wu

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Soft Tissue Sarcomas (STS) represent a diverse group of malignancies with heterogeneous clinical and pathological features. The treatment of extremity STS aims to achieve optimal local tumor control, improved survival, and preservation of limb function. The National Comprehensive Cancer Network guidelines, based on the cumulated clinical data, recommend radiation therapy (RT) in conjunction with limb-sparing surgery for large, high-grade STS measuring greater than 5 cm in size. Such treatment strategy can offer a cure for patients. However, when recurrence occurs (in nearly half of patients), the prognosis is poor, with a median survival of 12 to 15 months and with only palliative treatment options available. The spatially-fractionated-radiotherapy (SFRT), with a long history of treating bulky tumors as a non-mainstream technique, has gained new attention in recent years due to its unconventional therapeutic effects, such as bystander/abscopal effects. Combining single fraction of GRID, the original form of SFRT, with conventional RT was shown to have marginally increased the rate of pathological necrosis, which has been recognized to have a positive correlation to overall survival. In an effort to consistently increase the pathological necrosis rate over 90%, multiple fractions of Lattice RT (LRT), a newer form of 3D SFRT, interdigitated with the standard RT as neoadjuvant therapy was conducted in a preliminary clinical setting. With favorable results of over 95% of necrosis rate in a small cohort of patients, a Phase I/II clinical study was proposed to exam the safety and feasibility of this new strategy. Herein the design of the clinical study is presented. In this single-arm, two-stage phase I/II clinical trial, the primary objectives are >80% of the patients achieving >90% tumor necrosis and to evaluation the toxicity; the secondary objectives are to evaluate the local control, disease free survival and overall survival (OS), as well as the correlation between clinical response and the relevant biomarkers. The study plans to accrue patients over a span of two years. All patient will be treated with the new neoadjuvant RT regimen, in which one of every five fractions of conventional RT is replaced by a LRT fraction with vertices receiving dose ≥10Gy while keeping the tumor periphery at or close to 2 Gy per fraction. Surgical removal of the tumor is planned to occur 6 to 8 weeks following the completion of radiation therapy. The study will employ a Pocock-style early stopping boundary to ensure patient safety. The patients will be followed and monitored for a period of five years. Despite much effort, the rarity of the disease has resulted in limited novel therapeutic breakthroughs. Although a higher rate of treatment-induced tumor necrosis has been associated with improved OS, with the current techniques, only 20% of patients with large, high-grade tumors achieve a tumor necrosis rate exceeding 50%. If this new neoadjuvant strategy is proven effective, an appreciable improvement in clinical outcome without added toxicity can be anticipated. Due to the rarity of the disease, it is hoped that such study could be orchestrated in a multi-institutional setting.

Keywords: lattice RT, necrosis, SFRT, soft tissue sarcoma

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Authors: Sengly Sroy, Elodie Arnaud, Adrien Servent, Sokneang In, Sylvie Avallone

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In Cambodia, fish plays an important role for local community in term of food habits, preference and contribution to several nutritional intakes. Consumed on a daily basis, fishes and their derivatives products are good sources of proteins, essential fatty acids and fat-soluble vitamins. They mainly obtain from the Tonle Sap Lake but, during the last decade, the fish population decreased drastically due to climate change and human activities as well. Contamination by agricultural residues and heavy metals were identified. However, fishes are currently used in several nutrition programs for children and pregnant women to improve their nutritional status. The aim of our work was to characterize the nutritional profile and contamination of 10 fish species consumed near the Tonle Sap Lake with a special attention to fatty acid and fat-soluble vitamin profiles. Fish samples were analyzed for their nutritional profiles (AOAC methods for macronutrients and micronutrients), their lipid content (Folch modified method), their Fatty acid (FAME method), their vitamin A (HPLC) and their heavy metals (ICP-MS). The total lipid contents ranged from 1.43 to 10.00% according to fish species. Lipid profile was mainly dominated by saturated fat (from 47.95 to 57.32%) but some fish species were particularly rich in ω-3 and ω-6 especially eicosapentaenoic acid EPA (3.05%) and docosahexaenoic acid DHA (2.82%). The more the fishes were fats, the more they contained vitamin A, DHA and EPA. Vitamin A is particularly abundant in small fishes (250.10 μg RE/100 g) compare to big ones (13.77 μg RE/100 g) because they are consumed as a whole with their organs (liver) and head. However, the contents of heavy metal in some species are higher than the maximum permitted level (MPL) from codex alimentarius, especially Mn. The results obtained provided important information on the most interesting fish in term of human nutrition and the potential risk of contaminants. The fatty acids are important for child development and pregnant women. These data are useful for supply chain stakeholders and the people in charge of nutrition program.

Keywords: fat-soluble vitamin, fatty acid, freshwater fish, lipid content, Tonle Sap Lake

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Authors: Fatemeh Abdollahi, Munn-Sann Lye, Jamshid Yazdani Charati, Mehran Zarghami

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Fathers are at risk of depression during the postpartum period. Some studies have been reported maternal depression is the key predictor of paternal postpartum depression (PPD). This study aimed to estimate the prevalence and predictors of parental PPD and its association with maternal PPD. In a cross-sectional study, via a stratified random and convenience sampling method, participants referring to health centers during 2-8 weeks postpartum were recruited from March to October 2017. Paternal PPD and its relation to maternal PPD and other related factors were assessed using multiple logistic regression. Participants were 591 literate couples who referred to Mazandaran province primary health centers during to study period. Couples were screened for depression using Edinburgh Postnatal Depression Scale (EPDS). Fathers provided information on socio-demographic characteristics, life events, neonatal stressor, perceived stress (Perceived Stress Scale), social support (Multidimensional Scale of Perceived Social Support), and general health status using General Health Questionnaire (GHQ) as well. Data on mothers ‘demographic characteristics and obstetrics factors was also gathered. Overall, 93 fathers (15.7%) and 188 mothers (31.8%) reported depressive symptoms above the cut-off EPDS score of 12. In the multiple logistic regression model, older age [OR=1.20, (95%CI: 1.05- 1.36)], maternal depressive symptoms [OR=1.15, (95%CI: 1.04-1.27)], higher GHQ scores [OR=1.21, (95%CI: 1.11-1.33)] and increased recent life events [OR=1.42, (95%CI: 1.01-1.2.00)] were related to paternal PPD. A significant inverse association was found between number of children and paternal PPD [OR=0.20, (95%CI: 0.07-0.53)]. Depressive symptoms, especially in first-time fathers following the birth of a child, are not uncommon. Maternal depressive symptoms and paternal well-being were strong predictors of parental PPD. Creating opportunities for men to access special health care services, parental education to help adapting to parenthood, screening programs, and psychiatric/psychosocial interventions to decrease the suffering of depression for both depressed parents are recommended.

Keywords: depression, men, postpartum, risk factors, women

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Authors: Tillie Curran

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This co-production project aimed for an expansive exploration of disabled young people’s hopes and dreams in the context of unprecedented societal changes. The research questions developed with disabled young people acting as peer researchers, ask ‘what does a good life look like now, and, what are your hopes and dreams for the future?’ Disabled children’s childhood studies and an asset-based approach placed the voice of disabled young people at the centre of the research process and inviting participants to ‘think big’! Over 18 months, academics, members of a Centre for Independent Living and peer researchers, came together to facilitate knowledge cafes with fifty disabled young people aged between 14 and 25 in a college and youth club setting. Methods used included trigger questions, photos voice, video, and cartooning. The peer researchers also investigated how house robots and connected autonomous vehicles might support their future aspirations and sense of freedom in this new era with a trip to the university robotic laboratory. Key themes arising from participants’ hopes and dream were about ‘being responsible’, ‘loving’, ‘freedom and happiness’ and a ‘strong sense of self and togetherness’ and suggest alternative narratives and rich visions of the future possibilities for disabled young people. The five key messages peer researchers produced for the report emphasised freedom to define their futures, desires to make the world a better place, to belong and have the chance of their own family life. Thematic analysis, production of the report and impact activities were all co-produced and as the project progressed peer researchers increasingly demonstrated a role as ‘change makers’ and have formed a young people’s co-production group going on into the future. Discussion of the project highlights the factors that made these processes successful and the ethical dilemmas encountered in the context of normalcy. Finally, we consider the implications for all involved as we rethink ‘the future’, not in terms of normative ideals or trajectories, or seeing service ‘transition’ as an end, but in terms of disabled young people’s contribution, participation, freedoms, and possibilities.

Keywords: co-production, disability, robotic, youth

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Authors: Ida Bruheim Jensen, Hulda Mjöll Gunnarsdottir, Ingunn T. Ellingsen

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Digital government is often seen as an enabler or even driver of transformation of public administration, with the objective of creating public value. The increasing use of digital solutions in public services comes with great expectations of new and/or more efficient service provision. Digitalizing public sector services involve multi-level implementation. It involves national policy negotiations and decisions of digital government solutions. It involves co-creation/-production of ideas where planning, design, and implementation involves several groups of actors targeting end-users. Norway is among the most digitalised countries in the world, and Government spendings on digital technologies in public services are high compared to other OECD countries. This contribution studies an ongoing digital transformation in the Norwegian child welfare services. DigiBarnevern (Digi child welfare) is a nationwide project promising better and more efficient child welfare services through various digital technologies. The digitalization process, which is managed by the state and municipalities, is still in its early stages, and as of 2022, only a few services are operative. Digital technologies such as DigiBarnevern are implemented with promises of qualitatively improving child protection work, making the services more effective, foster user participation, and increase availability. There is limited research on the implications of using digital technologies in child protection work. We aim to present findings from an ongoing research project (2022-2024). Drawing on data from focus group interviews with social workers in 5 municipal child welfare services in Norway, we explore social workers’ experiences and expectations towards using digital technologies in child welfare services. Technological solutions may change the services and child protection work in numerous ways. Potential points of departure for discussion are how technologies may change the relationships between social workers, children, youth, and their families, how technologies can alter and obscure responsibilities, and how technologies may demand digital competence among social workers and service recipients.

Keywords: child welfare, social work, technology, digitalisation

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Authors: Rachel Talbot, Nasuh Malas

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Stigma in child and adolescent psychiatry continues to be a significant barrier for youth to receive much needed psychiatric care. Parents misperceptions regarding mental health may interfere with their child’s care and negatively influence their child’s view of mental health. For some children, their first experience with psychiatry may occur during medical hospitalization when they are seen by the Psychiatry Consultation-Liaison (C/L) Service. Despite this unique role, there is limited data on how to address mental health stigma with patients and families within the context of Child and Adolescent C/L Psychiatry. This study explores the use of a brief introductory video with messages from the psychiatry C/L team, families who have accessed mental health consultation in the hospital, as well as clips of family and C/L team interactions to address parental stigma of psychiatry. Common stigmatized concerns shared by parents include concerns about confidentiality, later ramifications of mental healthcare, outsider status, and parental self-blame. There are also stigmatized concerns about psychiatric medication use including overmedication, sedation, long-term effects, medicating ‘real problems’ and personality blunting. Each of these are addressed during the video parents will see with the intent of reducing negative parental perceptions relating to mental healthcare. For this study, families are given a survey highlighting these concerns, prior to and after watching the video. Pre-and post-video responses are compared with the hypothesis that watching the video will effectively reduce parental stigma about psychiatric care. Data collection is currently underway and will be completed by the end of November 2017 with data analysis completed by January 2018. This study will also give vital information about the demographic differences in perceptions of stigma so future interventions can be targeted towards those with higher perceived stigma. This study posits that use of an introductory video is an effective strategy to combat stigma and help educate and empower families. In this way, we will be reducing further barriers for patients and families to seek out mental health resources and supports that are often desperately needed for these youths.

Keywords: child and adolescent psychiatry, consult-liaison psychiatry, media, stigma

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Authors: Luiz Nolasco Jr. Rezende, Antonio Villar M. Sá, Claudia Marcia L. Pato

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The increasing urban violence in Brazil involves more and more infractions committed by children and youths. The challenges faced by the institutional environments responsible for the education and resocialization of adolescents in conflict with the law are enormous, especially of those deprived of their liberty. These institutions have an inadequate educational structure. They are characterized by a dirty and unhealthy environment without the minimum basic conditions for their activities, by frequent practices of degradation, humiliation, and the physical and psychological punishment of inmates. This mixed-method study investigated the personal values of adolescents with restriction of freedom in a socio-educational institutional environment aiming to contribute to the development of their morality through an educational process. For that, we used a survey and transdisciplinary play workshops involving thirty-two boys aged between 15 and 19 years old and at least two years out of school. To evaluate the survey the reduced version of the Portrait Questionnaire—PQ21—was used. The workshops happened once a week, lasting 80 minutes each, totaling twelve meetings. By using the game of chess and its metaphors, participants produced texts and engaged in critical brainstorming about their lives. The survey results pointed out that these young people showed a predominance of values of openness to change and self-transcendence, dissatisfaction with one's own reality and surroundings, not considering the consequences of their actions on themselves and others, difficulties in speaking and writing, and desire for changes in their lives. After the pedagogical interventions, these adolescents demonstrated an understanding of the implications of their actions for themselves, for their families, especially for the mothers, with whom they demonstrated stronger bonds. It was possible to observe evidence of improvement in the capacity of linguistic expression, more autonomy and critical vision, including about themselves and their respective contexts. These results demonstrated the educational potential of lively, symbolic, dynamic and playful activities that favor the mediation and identification of these adolescents with their lives, and contribute to the projection of dreams.

Keywords: adolescents arrested, human values, moral development, playful workshops

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Authors: Orly Sela

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The lecture discusses a Language Teaching program in a Teacher Education College in northern Israel. An on-line course was added to the program in order to keep on-campus attendance at a minimum, thus allowing the students to keep their full-time jobs in school. In addition, the use of educational technology to allow students to study anytime anywhere, in keeping with 21st-century innovative teaching-learning practices, was also an issue, as was the wish for this course to serve as a model which the students could then possibly use in their K-12 teaching. On the other hand, there were strong considerations against including an online course in the program. The students in the program were mostly Israeli-Arab married women with young children, living in a traditional society which places a strong emphasis on the place of the woman as a wife, mother, and home-maker. In addition, as teachers, they used much of their free time on school-related tasks. Having careers at the same time as studying was ground-breaking for these women, and using their time at home for studying rather than taking care of their families may have been simply too much to ask of them. At the end of the course, feedback was collected through an online questionnaire including both open and closed questions. The data collected shows that the students believed in online teaching-learning in principle, but had trouble implementing it in practice. This evidence raised the question of whether or not such a course should be included in a graduate program for mature, professional students, particular women with families living in a traditional society. This issue is not relevant to Israel alone, but also to academic institutions worldwide serving such populations. The lecture discusses this issue, sharing the researcher’s conclusions with the audience. Based on the evidence offered, it is the researcher’s conclusion that online education should, indeed, be offered to such audiences. However, the courses should be designed with the students’ special needs in mind, with emphasis placed on initial planning and course organization based on acknowledgment of the teaching context; modeling of online teaching/learning suited for in-service teacher education, and special attention paid to social-constructivist aspects of learning.

Keywords: course design, in-service teacher-education, mature students, online teaching/learning

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Authors: Kan Yu, Khui Hung Lee, Eben Afrifa-Yamoah, Jing Guo, Katrina Harrison, Jack Goldblatt, Nicholas Pachter, Jitian Xiao, Guicheng Brad Zhang

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Background and Significance of the Study: Congenital Heart Defects (CHDs) are the most common malformation at birth and one of the leading causes of infant death. Although the exact etiology remains a significant challenge, epigenetic modifications, such as DNA methylation, are thought to contribute to the pathogenesis of congenital heart defects. At present, no existing DNA methylation biomarkers are used for early detection of CHDs. The existing CHD diagnostic techniques are time-consuming and costly and can only be used to diagnose CHDs after an infant was born. The present study employed a machine learning technique to analyse genome-wide methylation data in children with and without CHDs with the aim to find methylation biomarkers for CHDs. Methods: The Illumina Human Methylation EPIC BeadChip was used to screen the genome‐wide DNA methylation profiles of 24 infants diagnosed with congenital heart defects and 24 healthy infants without congenital heart defects. Primary pre-processing was conducted by using RnBeads and limma packages. The methylation levels of top 600 genes with the lowest p-value were selected and further investigated by using a random forest approach. ROC curves were used to analyse the sensitivity and specificity of each biomarker in both training and test sample sets. The functionalities of selected genes with high sensitivity and specificity were then assessed in molecular processes. Major Findings of the Study: Three genes (MIR663, FGF3, and FAM64A) were identified from both training and validating data by random forests with an average sensitivity and specificity of 85% and 95%. GO analyses for the top 600 genes showed that these putative differentially methylated genes were primarily associated with regulation of lipid metabolic process, protein-containing complex localization, and Notch signalling pathway. The present findings highlight that aberrant DNA methylation may play a significant role in the pathogenesis of congenital heart defects.

Keywords: biomarker, congenital heart defects, DNA methylation, random forest

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Authors: Saidasanov Saidazal Shokhmurodovich, Topolnickiy Orest Zinovyevich, Afaunova Olga Arturovna

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Relevance: Bilateral congenital cleft is one of the most complex forms of all clefts, which makes it difficult to choose a surgical method of treatment. During primary operations to close the hard and soft palate, there is a shortage of soft tissues and their lack during standard uranoplasty, and these factors aggravate the period of rehabilitation of patients. Materials and methods: The results of surgical treatment of children with bilateral cleft, who underwent uranoplasty using a flap from the tongue, were analyzed. The study used methods: clinical and statistical, which allowed us to solve the tasks, based on the principles of evidence-based medicine. Results and discussion: in our study, 15 patients were studied, who underwent surgical treatment in the following volume: uranoplasty using a flap from the tongue in two stages. Of these, 9 boys and 6 girls aged 2.5 to 6 years. The first stage was surgical treatment in the volume: veloplasty. The second stage was a surgical intervention in volume: uranoplasty using a flap from the tongue. In all patients, the width of the cleft ranged from 1.6-2.8 cm. All patients in this group were orthodontically prepared. Using this method, the surgeon can achieve the following results: maximum narrowing of the palatopharyngeal ring, long soft palate, complete closure of the hard palate, alveolar process, and the mucous membrane of the nasal cavity is also sutured, which creates good conditions for the next stage of osteoplastic surgery. Based on the result obtained, patients have positive results of working with a speech therapist. In all patients, the dynamics were positive without complications. Conclusions: Based on our observation, tongue flap uranoplasty is one of the effective techniques for patients with wide clefts of the hard and soft palate. The use of a flap from the tongue makes it possible to reduce the number of repeated reoperations and improve the quality of social adaptation of this group of patients, which is one of the important stages of rehabilitation. Upon completion of the stages of rehabilitation, all patients had the maximum improvement in functional, anatomical and social indicators.

Keywords: congenital cleft lips and palate, bilateral cleft, child surgery, maxillofacial surgery

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Authors: Jude Harrison

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Child protection is a complex and sensitive practice. The core responsibility is the care and protection of children and young people who have been subject to or who are at risk from abuse and neglect. The work involves investigating allegations of harm, preparing for and making representations to the legal system, and case planning and management across a continuum of complicated care interventions. Professionals’ learning for child protection practice is evident in a range of literature investigating multiple learning processes such as university preparation, student placements, professional supervision, training, and other post-qualifying professional development experiences at work. There is, however, very limited research into how caseworkers learn in and through their daily practice. Little is known, therefore, about how learning at work unfolds for caseworkers, the dimensions in which it can be understood or the ways in which it can be best facilitated and supported. Compounding this, much of the current child protection learning literature reflects an orthodox conception of learning as mentalistic and individualised, in which knowledge is typically understood as abstract theory or as technical skill or competency. This presentation outlines key findings from a PhD research study that explored learning at work for statutory child protection caseworkers from an alternative interpretation of learning using a practice theory approach. Practice theory offers an interpretation of learning as performative and grounded in situated experience. The findings of the study show that casework practice is both a mode and site of learning. The study was ethnographic in design based and followed 17 child protection caseworkers via in-depth interviews, observations and participant reflective journaling. Inductive and abductive analysis was used to organise and interpret the data and expand analysis, leading to themes. Key findings show learning to be a sociomaterial property of doing; the social ontological character of learning; and teleoaffectivity as a feature of learning. The findings contribute to theoretical and practical understandings of learning and practice in child protection, child welfare and the professional learning literature more broadly. The findings have potential to contribute to policy directions at state, territory and national levels to enhance child protection practice and systems.

Keywords: adiult learning, workplace learning, child welfare, sociomaterial, practice theory

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Authors: Marco Frieslaar, Bing Chu, Eric Rogers

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Stroke is a devastating illness that is the second biggest cause of death in the world (after heart disease). Where it does not kill, it leaves survivors with debilitating sensory and physical impairments that not only seriously harm their quality of life, but also cause a high incidence of severe depression. It is widely accepted that early intervention is essential for recovery, but current rehabilitation techniques largely favor hospital-based therapies which have restricted access, expensive and specialist equipment and tend to side-step the emotional challenges. In addition, there is insufficient funding available to provide the long-term assistance that is required. As a consequence, recovery rates are poor. The relatively unexplored solution is to develop therapies that can be harnessed in the home and are formulated from technologies that already exist in everyday life. This would empower individuals to take control of their own improvement and provide choice in terms of when and where they feel best able to undertake their own healing. This research seeks to identify how effective post-stroke, rehabilitation therapy can be applied to upper limb mobility, within the physical context of a home rather than a hospital. This is being achieved through the design and construction of an automation scheme, based on iterative learning control and the Riener muscle model, that has the ability to adapt to the user and react to their level of fatigue and provide tangible physical recovery. It utilizes a SMART Phone and laptop to construct an iterative learning control (ILC) system, that monitors upper arm movement in three dimensions, as a series of exercises are undertaken. The equipment generates functional electrical stimulation to assist in muscle activation and thus improve directional accuracy. In addition, it monitors speed, accuracy, areas of motion weakness and similar parameters to create a performance index that can be compared over time and extrapolated to establish an independent and objective assessment scheme, plus an approximate estimation of predicted final outcome. To further extend its assessment capabilities, nerve conduction velocity readings are taken by the software, between the shoulder and hand muscles. This is utilized to measure the speed of response of neuron signal transfer along the arm and over time, an online indication of regeneration levels can be obtained. This will prove whether or not sufficient training intensity is being achieved even before perceivable movement dexterity is observed. The device also provides the option to connect to other users, via the internet, so that the patient can avoid feelings of isolation and can undertake movement exercises together with others in a similar position. This should create benefits not only for the encouragement of rehabilitation participation, but also an emotional support network potential. It is intended that this approach will extend the availability of stroke recovery options, enable ease of access at a low cost, reduce susceptibility to depression and through these endeavors, enhance the overall recovery success rate.

Keywords: home-based therapy, iterative learning control, Riener muscle model, SMART phone, stroke rehabilitation

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Authors: Maliha Ahmed Suleman, Sidra Ahmed Suleman

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Introduction: The use of pacifiers is common amongst infants and young children as a comforting behavior. These non-nutritive sucking habits can be detrimental to the developing occlusion should they persist while the permanent dentition is established. Orthodontic pacifiers have been recommended as an alternative to conventional pacifiers as they are considered to have less interference with orofacial development. However, there is a lack of consensus on whether this is true. Aim and objectives: To review the prevalence of malocclusion associated with the use of orthodontic pacifiers. Methodology: Literature was identified through a rigorous search of the Embase, Pubmed, CINAHL, and Cochrane Library databases. Articles published from 2000 onwards were included. In total, 5 suitable papers were identified. Results: One study showed that the use of orthodontic pacifiers increased the risk of malocclusion, as seen through a greater prevalence of accentuated overjet, posterior crossbites, and anterior open bites in comparison to individuals who did not use pacifiers. However, this study found that there was a clinically significant reduction in the prevalence of anterior open bites amongst orthodontic pacifier users in comparison to conventional pacifier users. Another study found that both types of pacifiers lead to malocclusion; however, they found no difference in the mean overjet and prevalence of anterior open bites amongst conventional and orthodontic pacifier users. In contrast, one study suggested that orthodontic pacifiers do not seem to be related to the development of malocclusions in the primary dentitions, and using them between the ages of 0-3 months was actually beneficial as it prevents thumb-sucking habits. One of the systemic reviews concluded that orthodontic pacifiers do not seem to reduce the occurrence of posterior crossbites; however, they could reduce the development of open bites by virtue of their thin neck design. Whereas another systematic review concluded that there were no differences as to the effects on the stomatognathic system when comparing conventional and orthodontic pacifiers. Conclusion: There is limited and conflicting evidence to support the notion that orthodontic pacifiers can reduce the prevalence of malocclusion when compared to conventional pacifiers. Well-designed randomized controlled trials are required in the future in order to thoroughly assess the effects of orthodontic pacifiers on the developing occlusion and orofacial structures.

Keywords: orthodontics, pacifier, malocclusion, review

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Authors: Matthew Heidman, Susan Dallabrida, Analice Costa

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Background:Accuracy of caregiver reported outcomes is essential for infant growth and tolerability study success. Crying/fussiness, stool consistencies, and other gastrointestinal characteristics are important parameters regarding tolerability, and inter-caregiver reporting can see a significant amount of subjectivity and vary greatly within a study, compromising data. This study sought to elucidate how caregiver reported questions related to stool frequency are answered before and after a short amount of training and how training impacts caregivers’ understanding, and how they would answer the question. Methods:A digital survey was issued for 90 daysin the US (n=121) and 30 days in Mexico (n=88), targeting respondents with children ≤4 years of age. Respondents were asked a question in two formats, first without a line of training text and second with a line of training text. The question set was as follows, “If your baby had stool in his/her diaper and you changed the diaper and 10 min later there was more stool in the diaper, how many stools would you report this as?” followed by the same question beginning with “If you were given the instruction that IF there are at least 5 minutes in between stools, then it counts as two (2) stools…”.Four response items were provided for both questions, 1) 2 stools, 2) 1stool, 3) it depends on how much stool was in the first versus the second diaper, 4) There is not enough information to be able to answer the question. Response frequencies between questions were compared. Results: Responses to the question without training saw some variability in the US, with 69% selecting “2 stools”,11% selecting “1 stool”, 14% selecting “it depends on how much stool was in the first versus the second diaper”, and 7% selecting “There is not enough information to be able to answer the question” and in Mexico respondents selected 9%, 78%, 13%, and 0% respectively. However, responses to the question after training saw more consolidation in the US, with 85% of respondents selecting“2 stools,” representing an increase in those selecting the correct answer. Additionally in Mexico, with 84% of respondents selecting “1 episode” representing an increase in the those selecting the correct response. Conclusions: Caregiver reported outcomes are critical for infant growth and tolerability studies, however, they can be highly subjective and see a high variability of responses without guidance. Training is critical to standardize all caregivers’ perspective regarding how to answer questions accurately in order to provide an accurate dataset.

Keywords: infant nutrition, clinical trial optimization, stool reporting, decentralized clinical trials

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Authors: Sadia Munir

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The aim of this study is to investigate changes in placental development and vascular dysfunction which subsequently affect feto-maternal health in pregnancies complicated by gestational diabetes mellitus (GDM). Fetal and postnatal adverse health outcomes of GDM are shown to be associated with disturbances in placental structure and function. Children of women with GDM are more likely to be obese and diabetic in childhood and adulthood. GDM also increases the risk of adverse pregnancy outcomes, including preeclampsia, birth injuries, macrosomia and neonatal hypoglycemia, respiratory distress syndrome, neonatal cardiac dysfunction and stillbirth. Incidences of type 2 diabetes in the MENA region are growing at an alarming rate which is estimated to become more than double by 2030. Five of the top 10 countries for diabetes prevalence in 2010 were in the Gulf region. GDM also increases the risk of development of type 2 diabetes. Interestingly, more than half of the women with GDM develop diabetes later in their life. The human placenta is a temporary organ located at the interface between mother and fetal blood circulation. Placenta has a central role as both a producer as well as a target of several molecules that are involved in placental development and function. We have investigated performed a Pubmed search with key words placenta, GDM, placental villi, vascularization, cytokines, growth factors, inflammation, hypoxia, oxidative stress and pathophysiology. We have investigated differences in the development and vascularization of placenta, their underlying causes and impact on feto-maternal health through literature review. We have also identified gaps in the literature and research questions that need to be answered to completely understand the central role of placenta in the GDM. This study is important in understanding the pathophysiology of placenta due to changes in the vascularization of villi, surface area and diameter of villous capillaries in pregnancies complicated by GDM. It is necessary to understand these mechanisms in order to develop treatments to reverse their effects on placental malfunctioning, which in turn, will result in improved mother and child health.

Keywords: gestational diabetes mellitus, placenta, vasculature, villi

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Authors: Sumattana Glangkarn, Vorapoj Promasatayaprot

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Background: Proportion of population ageing in Thailand has been increased rapidly in the past decades according to living longer and the fertility rates have decreased. The most important challenge related to this situation is to consider how to improve quality and years of healthy of life. This study aimed to implement the older persons’ long term care (LTC) system for elderly care by family and community. Method: The Consolidated Framework for Implementation Research (CFIR) was employed for guiding and evaluating an implementation process in ageing care. The CFIR composed of five major domains: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation. Results: most elderly participants were couples, educating primary school and living with children and grandchildren. More than half of them had chronic diseases such as diabetes mellitus and hypertension. Factor analysis revealed factors related to health care of older participants which consisted of exercise, diet, accidental prevention, relaxation, self-care capacity, joyfulness, family relationship, and personal hygiene. A pre-implementation phase showed intervention characteristics included facilities and services of the LTC policy from the Ministry of Public Health. The complexities of the LTC and relative advantages were explained. Community leaders, public health volunteers, care givers and health professionals had participated in the LTC activities. Outer and inner settings consisted of context of community, culture, and readiness. Characteristics of the individuals related to knowledge, self-efficacy, perceptions, and believes. The process consisted of planning, acting, observing, and reflecting. The implementation outcomes and service outcomes had been evaluated during-implementation phase. Conclusion: the participation of caregivers, community leaders, public health volunteers, and health professionals had supported the LTC services. Thus, family and community care could improve quality of life of the ageing.

Keywords: ageing, CFIR, long term care, implementation

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