Search results for: supportive care intervention
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 6073

Search results for: supportive care intervention

1093 Improving Low English Oral Skills of 5 Second-Year English Major Students at Debark University

Authors: Belyihun Muchie

Abstract:

This study investigates the low English oral communication skills of 5 second-year English major students at Debark University. It aims to identify the key factors contributing to their weaknesses and propose effective interventions to improve their spoken English proficiency. Mixed-methods research will be employed, utilizing observations, questionnaires, and semi-structured interviews to gather data from the participants. To clearly identify these factors, structured and informal observations will be employed; the former will be used to identify their fluency, pronunciation, vocabulary use, and grammar accuracy, and the later will be suited to observe the natural interactions and communication patterns of learners in the classroom setting. The questionnaires will assess their self-perceptions of their skills, perceived barriers to fluency, and preferred learning styles. Interviews will also delve deeper into their experiences and explore specific obstacles faced in oral communication. Data analysis will involve both quantitative and qualitative responses. The structured observation and questionnaire will be analyzed quantitatively, whereas the informal observation and interview transcripts will be analyzed thematically. Findings will be used to identify the major causes of low oral communication skills, such as limited vocabulary, grammatical errors, pronunciation difficulties, or lack of confidence. They are also helpful to develop targeted solutions addressing these causes, such as intensive pronunciation practice, conversation simulations, personalized feedback, or anxiety-reduction techniques. Finally, the findings will guide designing an intervention plan for implementation during the action research phase. The study's outcomes are expected to provide valuable insights into the challenges faced by English major students in developing oral communication skills, contribute to the development of evidence-based interventions for improving spoken English proficiency in similar contexts, and offer practical recommendations for English language instructors and curriculum developers to enhance student learning outcomes. By addressing the specific needs of these students and implementing tailored interventions, this research aims to bridge the gap between theoretical knowledge and practical speaking ability, equipping them with the confidence and skills to flourish in English communication settings.

Keywords: oral communication skills, mixed-methods, evidence-based interventions, spoken English proficiency

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1092 Bridge Healthcare Access Gap with Artifical Intelligence

Authors: Moshmi Sangavarapu

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The US healthcare industry has undergone tremendous digital transformation in recent years, but critical care access to lower-income ethnicities is still in its nascency. This population has historically showcased substantial hesitation to seek any medical assistance. While the lack of sufficient financial resources plays a critical role, the existing cultural and knowledge barriers also contribute significantly to widening the access gap. It is imperative to break these barriers to ensure timely access to therapeutic procedures that can save important lives! Based on ongoing research, healthcare access barriers can be best addressed by tapping the untapped potential of caregiver communities first. They play a critical role in patients’ diagnoses, building healthcare knowledge and instilling confidence in required therapeutic procedures. Recent technological advancements have opened many avenues by developing smart ways of reaching the large caregiver community. A digitized go-to-market strategy featuring connected media coupled with smart IoT devices and geo-location targeting can be collectively leveraged to reach this key audience group. AI/ML algorithms can be thoroughly trained to identify relevant data signals from users' location and browsing behavior and determine useful marketing touchpoints. The web behavior can be further assimilated with natural language processing to identify contextually relevant interest topics and decipher potential caregivers on digital avenues to serve that brand message. In conclusion, grasping the true health access journey of any lower-income ethnic group is important to design beneficial touchpoints that can alleviate patients’ concerns and allow them to break their own access barriers and opt for timely and quality healthcare.

Keywords: healthcare access, market access, diversity barriers, patient journey

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1091 Women Entrepreneurs in Health Care: An Exploratory Study

Authors: Priya Nambisan, Lien B. Nguyen

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Women participate extensively in the healthcare field, professionally (as physicians, nurses, dietitians, etc.) as well as informally (as caregivers at home). This provides them with a better understanding of the health needs of people. Women are also in the forefront of using social media and other mobile health related apps. Further, many health mobile apps are specifically designed for women users. All of these indicate the potential for women to be successful entrepreneurs in healthcare, especially, in the area of mobile health app development. However, extant research in entrepreneurship has paid limited attention to women entrepreneurship in healthcare. The objective of this study is to determine the key factors that shape the intentions and actions of women entrepreneurs with regard to their entrepreneurial pursuits in the healthcare field. Specifically, the study advances several hypotheses that relate key variables such as personal skills and capabilities, experience, support from institutions and family, and perceptions regarding entrepreneurship to individual intentions and actions regarding entrepreneurship (specifically, in the area of mobile apps). The study research model will be validated using survey data collected from potential women entrepreneurs in the healthcare field – students in the area of health informatics and engineering. The questionnaire-based survey relates to woman respondents’ intention to become entrepreneurs in healthcare and the key factors (independent variables) that may facilitate or inhibit their entrepreneurial intentions and pursuits. The survey data collection is currently ongoing. We also plan to conduct semi-structured interviews with around 10-15 women entrepreneurs who are currently developing mobile apps to understand the key issues and challenges that they face in this area. This is an exploratory study and as such our goal is to combine the findings from the regression analysis of the survey data and that from the content analysis of the interview data to inform on future research on women entrepreneurship in healthcare. The study findings will hold important policy implications, specifically for the development of new programs and initiatives to promote women entrepreneurship, particularly in healthcare and technology areas.

Keywords: women entrepreneurship, healthcare, mobile apps, health apps

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1090 Hospital Acquired Bloodstream Infections Among Patients With Hematological and Solid Malignancies: Epidemiology, Causative Pathogens and Mortality

Authors: Marah El-Beeli, Abdullah Balkhair, Zakaryia Al Muharmi, Samir Al Adawi, Mansoor Al-Jabri, Abdullah Al Rawahi, Hazaa Al Yahyae, Eman Al Balushi, Yahya M. Al-Farsi

Abstract:

The health care service and the anticancer chemotherapeutics has changed the natural history of cancer into manageable chronic disease and improve the cancer patient’s lifestyle and increase the survival time. Despite that, still, infection is the major dilemma opposing the cancer patient either because of the clinical presentation of the cancer type and impaired immune system or as a consequence of anticancer therapy. This study has been conducted to1) track changes in the epidemiology of hospital-acquired bloodstream infections among patients with malignancies in the last five years. 2) To explore the causative pathogens and 3) the outcome of HA-BSIs in patients with a different types of malignancies. An ampi-directional study (retrospective and prospective follow up) of patients with malignancies admitted at Sultan Qaboos University hospital (570-bed tertiary hospital) during the study period (from January 2015 to December 2019). The cumulative frequency and prevalence rates of HA-BSIs by patients and isolates were calculated. In addition, the cumulative frequency of participants with single versus mixed infections and types of causative micro-organisms of HA-BSIs were obtained. A total of 1246 event of HA-BSIs has occurred during the study period. Nearly the third (30.25%) of the HA-BSI events was identified among 288 patients with malignancies. About 20% of cases were mixed infections (more than one isolate). Staphylococcus spp were the predominant isolated pathogen (24.7%), followed by Klebsiella spp (15.8%), Escherichia spp (13%), and Pseudomonas spp (9.3%). About half (51%) of cases died in the same year, and (64%) of the deaths occur within two weeks after the infection. According to the observations, no changes in the trends of epidemiology, causative pathogens, morbidity, and mortality rates in the last five years.

Keywords: epidemiology, haematological malignancies, hospital acquired bloodstream infections, solid malignancies

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1089 Actionable Personalised Learning Strategies to Improve a Growth-Mindset in an Educational Setting Using Artificial Intelligence

Authors: Garry Gorman, Nigel McKelvey, James Connolly

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This study will evaluate a growth mindset intervention with Junior Cycle Coding and Senior Cycle Computer Science students in Ireland, where gamification will be used to incentivise growth mindset behaviour. An artificial intelligence (AI) driven personalised learning system will be developed to present computer programming learning tasks in a manner that is best suited to the individuals’ own learning preferences while incentivising and rewarding growth mindset behaviour of persistence, mastery response to challenge, and challenge seeking. This research endeavours to measure mindset with before and after surveys (conducted nationally) and by recording growth mindset behaviour whilst playing a digital game. This study will harness the capabilities of AI and aims to determine how a personalised learning (PL) experience can impact the mindset of a broad range of students. The focus of this study will be to determine how personalising the learning experience influences female and disadvantaged students' sense of belonging in the computer science classroom when tasks are presented in a manner that is best suited to the individual. Whole Brain Learning will underpin this research and will be used as a framework to guide the research in identifying key areas such as thinking and learning styles, cognitive potential, motivators and fears, and emotional intelligence. This research will be conducted in multiple school types over one academic year. Digital games will be played multiple times over this period, and the data gathered will be used to inform the AI algorithm. The three data sets are described as follows: (i) Before and after survey data to determine the grit scores and mindsets of the participants, (ii) The Growth Mind-Set data from the game, which will measure multiple growth mindset behaviours, such as persistence, response to challenge and use of strategy, (iii) The AI data to guide PL. This study will highlight the effectiveness of an AI-driven personalised learning experience. The data will position AI within the Irish educational landscape, with a specific focus on the teaching of CS. These findings will benefit coding and computer science teachers by providing a clear pedagogy for the effective delivery of personalised learning strategies for computer science education. This pedagogy will help prevent students from developing a fixed mindset while helping pupils to exhibit persistence of effort, use of strategy, and a mastery response to challenges.

Keywords: computer science education, artificial intelligence, growth mindset, pedagogy

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1088 Building Exoskeletons for Seismic Retrofitting

Authors: Giuliana Scuderi, Patrick Teuffel

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The proven vulnerability of the existing social housing building heritage to natural or induced earthquakes requires the development of new design concepts and conceptual method to preserve materials and object, at the same time providing new performances. An integrate intervention between civil engineering, building physics and architecture can convert the social housing districts from a critical part of the city to a strategic resource of revitalization. Referring to bio-mimicry principles the present research proposes a taxonomy with the exoskeleton of the insect, an external, light and resistant armour whose role is to protect the internal organs from external potentially dangerous inputs. In the same way, a “building exoskeleton”, acting from the outside of the building as an enclosing cage, can restore, protect and support the existing building, assuming a complex set of roles, from the structural to the thermal, from the aesthetical to the functional. This study evaluates the structural efficiency of shape memory alloys devices (SMADs) connecting the “building exoskeleton” with the existing structure to rehabilitate, in order to prevent the out-of-plane collapse of walls and for the passive dissipation of the seismic energy, with a calibrated operability in relation to the intensity of the horizontal loads. The two case studies of a masonry structure and of a masonry structure with concrete frame are considered, and for each case, a theoretical social housing building is exposed to earthquake forces, to evaluate its structural response with or without SMADs. The two typologies are modelled with the finite element program SAP2000, and they are respectively defined through a “frame model” and a “diagonal strut model”. In the same software two types of SMADs, called the 00-10 SMAD and the 05-10 SMAD are defined, and non-linear static and dynamic analyses, namely push over analysis and time history analysis, are performed to evaluate the seismic response of the building. The effectiveness of the devices in limiting the control joint displacements resulted higher in one direction, leading to the consideration of a possible calibrated use of the devices in the different walls of the building. The results show also a higher efficiency of the 00-10 SMADs in controlling the interstory drift, but at the same time the necessity to improve the hysteretic behaviour, to maximise the passive dissipation of the seismic energy.

Keywords: adaptive structure, biomimetic design, building exoskeleton, social housing, structural envelope, structural retrofitting

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1087 The Development of Cultural Routes: The Case of Greece

Authors: Elissavet Kosta

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Introduction: In this research, we will propose the methodology, which is required for the planning of the cultural route in order to prepare substantiated proposals for the development and planning of cultural routes in Greece in the near future. Our research has started at 2016. Methodology in our research: Α combination of primary and secondary research will be used as project methodology. Furthermore, this study aims to follow a multidisciplinary approach, using dimensions of qualitative and quantitative data analysis models. Regarding the documentation of the theoretical part of the project, the method of secondary research will be mainly used, yet in combination with bibliographic sources. However, the data collection regarding the research topic will be conducted exclusively through primary research (questionnaires and interviews). Cultural Routes: The cultural route is defined as a brand name touristic product, that is a product of cultural tourism, which is shaped according to a specific connecting element. Given its potential, the cultural route is an important ‘tool’ for the management and development of cultural heritage. Currently, a constant development concerning the cultural routes is observed in an international level during the last decades, as it is widely accepted that cultural tourism has an important role in the world touristic industry. Cultural Routes in Greece: Especially for Greece, we believe, actions have not been taken to the systematic development of the cultural routes yet. The cultural routes that include Greece and have been design in a world scale as well as the cultural routes, which have been design in Greek ground up to this moment are initiations of the Council of Europe, World Tourism Organization UNWTO and ‘Diazoma’ association. Regarding the study of cultural routes in Greece as a multidimensional concept, the following concerns have arisen: Firstly, we are concerned about the general impact of cultural routes at local and national level and specifically in the economic sector. Moreover, we deal with the concerns regarding the natural environment and we delve into the educational aspect of cultural routes in Greece. In addition, the audience we aim at is both specific and broad and we put forward the institutional framework of the study. Finally, we conduct the development and planning of new cultural routes, having in mind the museums as both the starting and ending point of a route. Conclusion: The contribution of our work is twofold and lies firstly on the fact that we attempt to create cultural routes in Greece and secondly on the fact that an interdisciplinary approach is engaged towards realizing our study objective. In particular, our aim is to take advantage of all the ways in which the promotion of a cultural route can have a positive influence on the way of life of society. As a result, we intend to analyze how a cultural route can turn into a well-organized activity that can be used as social intervention to develop tourism, strengthen the economy and improve access to cultural goods in Greece during the economic crisis.

Keywords: cultural heritage, cultural routes, cultural tourism, Greece

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1086 The Impact of Simulation-based Learning on the Clinical Self-efficacy and Adherence to Infection Control Practices of Nursing Students

Authors: Raeed Alanazi

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Introduction: Nursing students have a crucial role to play in the inhibition of infectious diseases and, therefore, must be trained in infection control and prevention modules prior to entering clinical settings. Simulations have been found to have a positive impact on infection control skills and the use of standard precautions. Aim: The purpose of this study was to use the four sources of self-efficacy in explaining the level of clinical self-efficacy and adherence to infection control practices in Saudi nursing students during simulation practice. Method: A cross-sectional design with convenience sampling was used. This study was conducted in all Saudi nursing schools, with a total number of 197 students participated in this study. Three scales were used simulation self- efficacy Scale (SSES), the four sources of self-efficacy scale (SSES), and Compliance with Standard Precautions Scale (CSPS). Multiple linear regression was used to test the use of the four sources of self-efficacy (SSES) in explaining level of clinical self-efficacy and adherence to infection control in nursing students. Results: The vicarious experience subscale (p =.044) was statistically significant. The regression model indicated that for every one unit increase in vicarious experience (observation and reflection in simulation), the participants’ adherence to infection control increased by .13 units (β =.22, t = 2.03, p =.044). In addition, the regression model indicated that for every one unit increase in education level, the participants’ adherence to infection control increased by 1.82 units (beta=.34= 3.64, p <.001). Also, the mastery experience subscale (p <.001) and vicarious experience subscale (p = .020) were shared significant associations with clinical self-efficacy. Conclusion: The findings of this research support the idea that simulation-based learning can be a valuable teaching-learning method to help nursing students develop clinical competence, which is essential in providing quality and safe nursing care.

Keywords: simulation-based learning, clinical self-efficacy, infection control, nursing students

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1085 A Comparison of Convolutional Neural Network Architectures for the Classification of Alzheimer’s Disease Patients Using MRI Scans

Authors: Tomas Premoli, Sareh Rowlands

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In this study, we investigate the impact of various convolutional neural network (CNN) architectures on the accuracy of diagnosing Alzheimer’s disease (AD) using patient MRI scans. Alzheimer’s disease is a debilitating neurodegenerative disorder that affects millions worldwide. Early, accurate, and non-invasive diagnostic methods are required for providing optimal care and symptom management. Deep learning techniques, particularly CNNs, have shown great promise in enhancing this diagnostic process. We aim to contribute to the ongoing research in this field by comparing the effectiveness of different CNN architectures and providing insights for future studies. Our methodology involved preprocessing MRI data, implementing multiple CNN architectures, and evaluating the performance of each model. We employed intensity normalization, linear registration, and skull stripping for our preprocessing. The selected architectures included VGG, ResNet, and DenseNet models, all implemented using the Keras library. We employed transfer learning and trained models from scratch to compare their effectiveness. Our findings demonstrated significant differences in performance among the tested architectures, with DenseNet201 achieving the highest accuracy of 86.4%. Transfer learning proved to be helpful in improving model performance. We also identified potential areas for future research, such as experimenting with other architectures, optimizing hyperparameters, and employing fine-tuning strategies. By providing a comprehensive analysis of the selected CNN architectures, we offer a solid foundation for future research in Alzheimer’s disease diagnosis using deep learning techniques. Our study highlights the potential of CNNs as a valuable diagnostic tool and emphasizes the importance of ongoing research to develop more accurate and effective models.

Keywords: Alzheimer’s disease, convolutional neural networks, deep learning, medical imaging, MRI

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1084 The Impact of Artificial Intelligence on Children with Autism

Authors: Rania Melad Kamel Hakim

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A descriptive statistical analysis of the data showed that the most important factor evoking negative attitudes among teachers is student behavior. These have been presented as useful models for understanding the risk factors and protective factors associated with the emergence of autistic traits. Although these ‘syndrome’ forms of autism reach clinical thresholds, they appear to be distinctly different from the idiopathic or ‘non-syndrome’ autism phenotype. Most teachers reported that kindergartens did not prepare them for the educational needs of children with autism, particularly in relation to non-verbal skills. The study is important and points the way to improving teacher inclusion education in Thailand. Inclusive education for students with autism is still in its infancy in Thailand. Although the number of autistic children in schools has increased significantly since the Thai government introduced the Education Regulations for Persons with Disabilities Act in 2008, there is a general lack of services for autistic students and their families. This quantitative study used the Teaching Skills and Readiness Scale for Students with Autism (APTSAS) to test the attitudes and readiness of 110 elementary school teachers when teaching students with autism in general education classrooms. To uncover the true nature of these co-morbidities, it is necessary to expand the definition of autism to include the cognitive features of the disorder and then apply this expanded conceptualization to examine patterns of autistic syndromes. This study used various established eye-tracking paradigms to assess the visual and attention performance of children with DS and FXS who meet the autism thresholds defined in the Social Communication Questionnaire. To study whether the autistic profiles of these children are associated with visual orientation difficulties (‘sticky attention’), decreased social attention, and increased visual search performance, all of which are hallmarks of the idiopathic autistic child phenotype. Data will be collected from children with DS and FXS, aged 6 to 10 years, and two control groups matched for age and intellectual ability (i.e., children with idiopathic autism).In order to enable a comparison of visual attention profiles, cross-sectional analyzes of developmental trajectories are carried out. Significant differences in the visual-attentive processes underlying the presentation of autism in children with FXS and DS have been suggested, supporting the concept of syndrome specificity. The study provides insights into the complex heterogeneity associated with autism syndrome symptoms and autism itself, with clinical implications for the utility of autism intervention programs in DS and FXS populations.

Keywords: attitude, autism, teachers, sports activities, movement skills, motor skills

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1083 Social Factors and Suicide Risk in Modern Russia

Authors: Maria Cherepanova, Svetlana Maximova

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Background And Aims: Suicide is among ten most common causes of death of the working-age population in the world. According to the WHO forecasts, by 2025 suicide will be the third leading cause of death, after cardiovascular diseases and cancer. In 2019, the global suicide rate in the world was 10,5 per 100,000 people. In Russia, the average figure was 11.6. However, in some depressed regions of Russia, such as Buryatia and Altai, it reaches 35.3. The aim of this study was to develop models based on the regional factors of social well-being deprivation that provoke the suicidal risk of various age groups of Russian population. We also investigated suicidal risk prevention in modern Russia, analyzed its efficacy, and developed recommendations for suicidal risk prevention improvement. Methods: In this study, we analyzed the data from sociological surveys from six regions of Russia. Totally we interviewed 4200 people, the age of the respondents was from 16 to 70 years. The results were subjected to factorial and regression analyzes. Results: The results of our study indicate that young people are especially socially vulnerable, which result in ineffective patterns of self-preservation behavior and increase the risk of suicide. That is due to lack of anti-suicidal barriers formation; low importance of vital values; the difficulty or impossibility to achieve basic needs; low satisfaction with family and professional life; and decrease in personal unconditional significance. The suicidal risk of the middle-aged population is due to a decrease in social well-being in the main aspects of life, which determines low satisfaction, decrease in ontological security, and the prevalence of auto-aggressive deviations. The suicidal risk of the elderly population is due to increased factors of social exclusion which result in narrowing the social space and limiting the richness of life. Conclusions: The existing system for lowering suicide risk in modern Russia is predominantly oriented to a medical treatment, which provides only intervention to people who already committed suicide, that significantly limits its preventive effectiveness and social control of this deviation. The national strategy for suicide risk reduction in modern Russian society should combine medical and social activities, designed to minimize possible situations resulting to suicide. The strategy for elimination of suicidal risk should include a systematic and significant improvement of the social well-being of the population and aim at overcoming the basic aspects of social disadvantages such as poverty, unemployment as well as implementing innovative mental health improvement, developing life-saving behavior that will help to counter suicides in Russia.

Keywords: social factors, suicide, prevention, Russia

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1082 Vascular Crossed Aphasia in Dextrals: A Study on Bengali-Speaking Population in Eastern India

Authors: Durjoy Lahiri, Vishal Madhukar Sawale, Ashwani Bhat, Souvik Dubey, Gautam Das, Biman Kanti Roy, Suparna Chatterjee, Goutam Gangopadhyay

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Crossed aphasia has been an area of considerable interest for cognitive researchers as it offers a fascinating insight into cerebral lateralization for language function. We conducted an observational study in the stroke unit of a tertiary care neurology teaching hospital in eastern India on subjects with crossed aphasia over a period of four years. During the study period, we detected twelve cases of crossed aphasia in strongly right-handed patients, caused by ischemic stroke. The age, gender, vernacular language and educational status of the patients were noted. Aphasia type and severity were assessed using Bengali version of Western Aphasia Battery (validated). Computed tomography, magnetic resonance imaging and angiography were used to evaluate the location and extent of the ischemic lesion in brain. Our series of 12 cases of crossed aphasia included 7 male and 5 female with mean age being 58.6 years. Eight patients were found to have Broca’s aphasia, 3 had trans-cortical motor aphasia and 1 patient suffered from global aphasia. Nine patients were having very severe aphasia and 3 suffered from mild aphasia. Mirror-image type of crossed aphasia was found in 3 patients, whereas 9 had anomalous variety. In our study crossed aphasia was found to be more frequent in males. Anomalous pattern was more common than mirror-image. Majority of the patients had motor-type aphasia and no patient was found to have pure comprehension deficit. We hypothesize that in Bengali-speaking right-handed population, lexical-semantic system of the language network remains loyal to the left hemisphere even if the phonological output system is anomalously located in the right hemisphere.

Keywords: aphasia, crossed, lateralization, language function, vascular

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1081 A Mixed Methods Study: Evaluation of Experiential Learning Techniques throughout a Nursing Curriculum to Promote Empathy

Authors: Joan Esper Kuhnly, Jess Holden, Lynn Shelley, Nicole Kuhnly

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Empathy serves as a foundational nursing principle inherent in the nurse’s ability to form those relationships from which to care for patients. Evidence supports, including empathy in nursing and healthcare education, but there is limited data on what methods are effective to do so. Building evidence supports experiential and interactive learning methods to be effective for students to gain insight and perspective from a personalized experience. The purpose of this project is to evaluate learning activities designed to promote the attainment of empathic behaviors across 5 levels of the nursing curriculum. Quantitative analysis will be conducted on data from pre and post-learning activities using the Toronto Empathy Questionnaire. The main hypothesis, that simulation learning activities will increase empathy, will be examined using a repeated measures Analysis of Variance (ANOVA) on Pre and Post Toronto Empathy Questionnaire scores for three simulation activities (Stroke, Poverty, Dementia). Pearson product-moment correlations will be conducted to examine the relationships between continuous demographic variables, such as age, credits earned, and years practicing, with the dependent variable of interest, Post Test Toronto Empathy Scores. Krippendorff’s method of content analysis will be conducted to identify the quantitative incidence of empathic responses. The researchers will use Colaizzi’s descriptive phenomenological method to describe the students’ simulation experience and understand its impact on caring and empathy behaviors employing bracketing to maintain objectivity. The results will be presented, answering multiple research questions. The discussion will be relevant to results and educational pedagogy in the nursing curriculum as they relate to the attainment of empathic behaviors.

Keywords: curriculum, empathy, nursing, simulation

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1080 Effect of Stress Relief of the Footbath Using Bio-Marker in Japan

Authors: Harumi Katayama, Mina Suzuki, Taeko Muramatsu, Yui Shimogawa, Yoshimi Mizushima, Mitsuo Hiramatsu, Kimitsugu Nakamura, Takeshi Suzue

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Purpose: There are very often footbaths in the hot-spring area as culture from old days in Japan. This culture moderately supported mental and physical health among people. In Japanese hospitals, nurses provide footbath for severe patients to mental comfortable. However, there are only a few evidences effect of footbath for mental comfortable. In this presentation, we show the effect of stress relief of the footbath using biomarker among 35 college students in volunteer. Methods: The experiment was designed in two groups of the footbath group and the simple relaxation group randomly. As mental load, Kraepelin test was given to the students beforehand. Ultra-weak chemiluminescence (UCL) in saliva and self-administered liner scale measurable emotional state were measured on four times concurrently; there is before and after the mental load, after the stress relief, and 30 minutes after the stress relief. The scale that measured emotional state was consisted of 7 factors; there is excitement, relaxation, vigorous, fatigue, tension, calm, and sleepiness with 22 items. ANOVA was calculated effect of the footbath for stress relief. Results: The level of UCL (photons/100sec) was significantly increased in response on both groups after mental load. After the two types of stress relief, UCL (photons/100sec) of footbath group was significantly decreased compared to simple relaxation group. Score of sleepiness and relaxation were significantly increased after the stress relief in the footbath group than the simple relaxation group. However, score of excitement, vigorous, tension, and calm were exhibit the same degree of decrease after the stress relief on both group. Conclusion: It was suggested that salivary UCL may be a sensitive biomarker for mild stress relief as nursing care. In the future, we will measure using UCL to evaluate as stress relief for inpatients, outpatients, or general public as the subjects.

Keywords: bio-marker, footbath, Japan, stress relief

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1079 Comparison the Effectiveness of Pain Cognitive- Behavioral Therapy and Its Computerized Version on Reduction of Pain Intensity, Depression, Anger and Anxiety in Children with Cancer: A Randomized Controlled Trial

Authors: Najmeh Hamid, Vajiheh Hamedy , Zahra Rostamianasl

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

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

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1078 Virtual Reality in COVID-19 Stroke Rehabilitation: Preliminary Outcomes

Authors: Kasra Afsahi, Maryam Soheilifar, S. Hossein Hosseini

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Background: There is growing evidence that Cerebral Vascular Accident (CVA) can be a consequence of Covid-19 infection. Understanding novel treatment approaches are important in optimizing patient outcomes. Case: This case explores the use of Virtual Reality (VR) in the treatment of a 23-year-old COVID-positive female presenting with left hemiparesis in August 2020. Imaging showed right globus pallidus, thalamus, and internal capsule ischemic stroke. Conventional rehabilitation was started two weeks later, with virtual reality (VR) included. This game-based virtual reality (VR) technology developed for stroke patients was based on upper extremity exercises and functions for stroke. Physical examination showed left hemiparesis with muscle strength 3/5 in the upper extremity and 4/5 in the lower extremity. The range of motion of the shoulder was 90-100 degrees. The speech exam showed a mild decrease in fluency. Mild lower lip dynamic asymmetry was seen. Babinski was positive on the left. Gait speed was decreased (75 steps per minute). Intervention: Our game-based VR system was developed based on upper extremity physiotherapy exercises for post-stroke patients to increase the active, voluntary movement of the upper extremity joints and improve the function. The conventional program was initiated with active exercises, shoulder sanding for joint ROMs, walking shoulder, shoulder wheel, and combination movements of the shoulder, elbow, and wrist joints, alternative flexion-extension, pronation-supination movements, Pegboard and Purdo pegboard exercises. Also, fine movements included smart gloves, biofeedback, finger ladder, and writing. The difficulty of the game increased at each stage of the practice with progress in patient performances. Outcome: After 6 weeks of treatment, gait and speech were normal and upper extremity strength was improved to near normal status. No adverse effects were noted. Conclusion: This case suggests that VR is a useful tool in the treatment of a patient with covid-19 related CVA. The safety of newly developed instruments for such cases provides new approaches to improve the therapeutic outcomes and prognosis as well as increased satisfaction rate among patients.

Keywords: covid-19, stroke, virtual reality, rehabilitation

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1077 Changes in Pulmonary Functions in Diabetes Mellitus Type 2

Authors: N. Anand, P. S. Nayyer, V. Rana, S. Verma

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Background: Diabetes mellitus is a group of disorders characterized by hyperglycemia and associated with microvascular and macrovascular complications. Among the lesser known complications is the involvement of respiratory system. Changes in pulmonary volume, diffusion and elastic properties of lungs as well as the performance of the respiratory muscles lead to a restrictive pattern in lung functions. The present study was aimed to determine the changes in various parameters of pulmonary function tests amongst patients with Type 2 Diabetes Mellitus and also try to study the effect of duration of Diabetes Mellitus on pulmonary function tests. Methods: It was a cross sectional study performed at Dr Baba Saheb Ambedkar Hospital and Medical College in, Delhi, A Tertiary care referral centre which included 200 patients divided into 2 groups. The first group included diagnosed patients with diabetes and the second group included controls. Cases and controls symptomatic for any acute or chronic Respiratory or Cardiovascular illness or a history of smoking were excluded. Both the groups were subjected to spirometry to evaluate for the pulmonary function tests. Result: The mean Forced Vital Capacity (FVC), Forced Expiratory Volume in first second (FEV1), Peak Expiratory Flow Rate(PEFR) was found to be significantly decreased ((P < 0.001) as compared to controls while the mean ratio of Forced Expiratory Volume in First second to Forced Vital Capacity was not significantly decreased( p>0.005). There was no correlation seen with duration of the disease. Conclusion: Forced Vital Capacity (FVC), Forced Expiratory Volume in first second (FEV1), Peak Expiratory Flow Rate(PEFR) were found to be significantly decreased in patients of Diabetes mellitus while ratio of Forced Expiratory Volume in First second to Forced Vital Capacity (FEV1/FVC) was not significantly decreased. The duration of Diabetes mellitus was not found to have any statistically significant effect on Pulmonary function tests (p > 0.005).

Keywords: diabetes mellitus, pulmonary function tests, forced vital capacity, forced expiratory volume in first second

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1076 Development of a Plant-Based Dietary Supplement to Address Critical Micronutrient Needs of Women of Child-Bearing Age in Europe

Authors: Sara D. Garduno-Diaz, Ramona Milcheva, Chanyu Xu

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Women’s reproductive stages (pre-pregnancy, pregnancy, and lactation) represent a time of higher micronutrient needs. With a healthy food selection as the first path of choice to cover these increased needs, tandem micronutrient supplementation is often required. Because pregnancy and lactation should be treated with care, all supplements consumed should be of quality ingredients and manufactured through controlled processes. This work describes the process followed for the development of plant-based multiple micronutrient supplements aimed at addressing the growing demand for natural ingredients of non-animal origin. A list of key nutrients for inclusion was prioritized, followed by the identification and selection of qualified raw ingredient providers. Nutrient absorption into the food matrix was carried out through natural processes. The outcome is a new line of products meeting the set criteria of being gluten and lactose-free, suitable for vegans/vegetarians, and without artificial conservatives. In addition, each product provides the consumer with 10 vitamins, 6 inorganic nutrients, 1 source of essential fatty acids, and 1 source of phytonutrients each (maca, moringa, and chlorella). Each raw material, as well as the final product, was submitted to microbiological control three-fold (in-house and external). The final micronutrient mix was then tested for human factor contamination, pesticides, total aerobic microbial count, total yeast count, and total mold count. The product was created with the aim of meeting product standards for the European Union, as well as specific requirements for the German market in the food and pharma fields. The results presented here reach the point of introduction of the newly developed product to the market, with acceptability and effectiveness results to be published at a later date.

Keywords: fertility, lactation, organic, pregnancy, vegetarian

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1075 Impact of Stress on Physical-Mental Wellbeing of Working Women in India: Awareness and Acceptability

Authors: Meera Shanker

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Excellent education and financial need have encouraged Indian women to go out and work in well-paid and high-status occupations. In the era of cutthroat competition, women are expected to work hard to produce the desired result; hence, workload and expectations haveincreased. At home, they are anticipated to take care of family members, children, and household work. Women are stretching themselves mechanically to remain in the job competition and try to give their best at home. Consequentially, they are under tremendous pressure, stressed, and having issues related to physical-mental wellness. Mental healthcare is often ignored and not accepted due to a lack of awareness and cultural barriers. These further compounds the problem, resulting in decreased productivity in economic terms and an increase in stress-related physical-mental ailments. The main objective of the study was to find out the impact of stress on the physical-mental wellbeing of working women in India, along with their awareness and acceptability related to mental health. Six hundred and one woman working at various levels took part in this study, responding to the items related to stress and physical-mental illness. Finally, 21 items were retained under four meaningful factors measuring stress dimensions along with 17 items with three factors measuring physical-mental wellbeing. Confirmatory Factor Analysis (CFA), path analysis, in Structural Equation Modeling (SEM), was used to get a relationship, validity of the instruments. The psychometric properties of items and Cronbach’s Alpha reliabilities calculated for the subscales were relatively acceptable. The subscale correlations, regression, and path analysis of stress dimensions with physical-mental illness were found to be positive, indicating the growing stress among working women in India, which is impacting their physical-mental health. Single item analysis revealed that 77 percent of women have never visited psychologists. However, 70 percent of working women were not ready to seek the help of a psychologist.

Keywords: working women, stress, physical-mental well-being, confirmatory factor analysis

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1074 Real-World Prevalence of Musculoskeletal Disorders in Nigeria

Authors: F. Fatoye, C. E. Mbada, T. Gebrye, A. O. Ogunsola, C. Fatoye, O. Oyewole

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Musculoskeletal disorders (MSDs) are a major cause of pain and disability. It is likely to become a greater economic and public health burden that is unnecessary. Thus, reliable prevalence figures are important for both clinicians and policy-makers to plan health care needs for those affected with the disease. This study estimated hospital based real-world prevalence of MSDs in Nigeria. A review of medical charts for adult patients attending Physiotherapy Outpatient Clinic at the Obafemi Awolowo University Teaching Hospitals Complex, Osun State, Nigeria between 2009 and 2018 was carried out to identify common MSDs including low back pain (LBP), cervical spondylosis (CSD), post immobilization stiffness (PIS), sprain, osteoarthritis (OA), and other conditions. Occupational class of the patients was determined using the International Labour Classification (ILO). Data were analysed using descriptive statistics of frequency and percentages. Overall, medical charts of 3,340 patients were reviewed within the span of ten years (2009 to 2018). Majority of the patients (62.8%) were in the middle class, and the remaining were in low class (25.1%) and high class (10.5%) category. An overall prevalence of 47.35% of MSD was found within the span of ten years. Of this, the prevalence of LBP, CSD, PIS, sprain, OA, and other conditions was 21.6%, 10%, 18.9%, 2%, 6.3%, and 41.3%, respectively. The highest (14.2%) and lowest (10.5%) prevalence of MSDs was recorded in the year of 2012 and 2018, respectively. The prevalence of MSDs is considerably high among Nigerian patients attending outpatient a physiotherapy clinic. The high prevalence of MSDs underscores the need for clinicians and decision makers to put in place appropriate strategies to reduce the prevalence of these conditions. In addition, they should plan and evaluate healthcare services to improve the health outcomes of patients with MSDs. Further studies are required to determine the economic burden of the condition and examine the clinical and cost-effectiveness of physiotherapy interventions for patients with MSDs.

Keywords: musculoskeletal disorders, Nigeria, prevalence, real world

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1073 Practice Educators' Perspective: Placement Challenges in Social Work Education in England

Authors: Yuet Wah Echo Yeung

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Practice learning is an important component of social work education. Practice educators are charged with the responsibility to support and enable learning while students are on placement. They also play a key role in teaching students to integrate theory and practice, as well as assessing their performance. Current literature highlights the structural factors that make it difficult for practice educators to create a positive learning environment for students. Practice educators find it difficult to give sufficient attention to their students because of the lack of workload relief, the increasing emphasis on managerialism and bureaucratisation, and a range of competing organisational and professional demands. This paper reports the challenges practice educators face and how they manage these challenges in this context. Semi-structured face-to-face interviews were conducted with thirteen practice educators who support students in statutory and voluntary social care settings in the Northwest of England. Interviews were conducted between April and July 2017 and each interview lasted about 40 minutes. All interviews were recorded and transcribed. All practice educators are experienced social work practitioners with practice experience ranging from 6 to 42 years. On average they have acted as practice educators for 13 years and all together have supported 386 students. Our findings reveal that apart from the structural factors that impact how practice educators perform their roles, they also faced other challenges when supporting students on placement. They include difficulty in engaging resistant students, complexity in managing power dynamics in the context of practice learning, and managing the dilemmas of fostering a positive relationship with students whilst giving critical feedback. Suggestions to enhance the practice educators’ role include support from organisations and social work teams; effective communication with university tutors, and a forum for practice educators to share good practice and discuss placement issues.

Keywords: social work education, placement challenges, practice educator, practice learning

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1072 The Impact of Artificial Intelligence on Autism Attitudes

Authors: Sara Asham Mahrous Kamel

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A descriptive statistical analysis of the data showed that the most important factor evoking negative attitudes among teachers is student behavior. have been presented as useful models for understanding the risk factors and protective factors associated with the emergence of autistic traits. Although these "syndrome" forms of autism reach clinical thresholds, they appear to be distinctly different from the idiopathic or "non-syndrome" autism phenotype. Most teachers reported that kindergartens did not prepare them for the educational needs of children with autism, particularly in relation to non-verbal skills. The study is important and points the way for improving teacher inclusion education in Thailand. Inclusive education for students with autism is still in its infancy in Thailand. Although the number of autistic children in schools has increased significantly since the Thai government introduced the Education Regulations for Persons with Disabilities Act in 2008, there is a general lack of services for autistic students and their families. This quantitative study used the Teaching Skills and Readiness Scale for Students with Autism (APTSAS) to test the attitudes and readiness of 110 elementary school teachers when teaching students with autism in general education classrooms. To uncover the true nature of these co morbidities, it is necessary to expand the definition of autism to include the cognitive features of the disorder, and then apply this expanded conceptualization to examine patterns of autistic syndromes. This study used various established eye-tracking paradigms to assess the visual and attention performance of children with DS and FXS who meet the autism thresholds defined in the Social Communication Questionnaire. To study whether the autistic profiles of these children are associated with visual orientation difficulties ("sticky attention"), decreased social attention, and increased visual search performance, all of which are hallmarks of the idiopathic autistic child phenotype. Data will be collected from children with DS and FXS, aged 6 to 10 years, and two control groups matched for age and intellectual ability (i.e., children with idiopathic autism).In order to enable a comparison of visual attention profiles, cross-sectional analyzes of developmental trajectories are carried out. Significant differences in the visual-attentive processes underlying the presentation of autism in children with FXS and DS have been suggested, supporting the concept of syndrome specificity. The study provides insights into the complex heterogeneity associated with autism syndrome symptoms and autism itself, with clinical implications for the utility of autism intervention programs in DS and FXS populations.

Keywords: attitude, autism, teachers, sports activities, movement skills, motor skills

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1071 Maternal Mental Health and Patient Reported Outcomes: Identifying At-Risk Pregnant and Postpartum Patients

Authors: Jennifer Reese, Josh Biber, Howard Weeks, Rachel Hess

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Aim: The Edinburgh Postnatal Depression Screen (EPDS) is a mental health screening for pregnant women that has been widely used over the last 30 years. This screen is typically given in clinic on paper to patients throughout pregnancy and postpartum. The screen helps identify patients who may be at risk for pregnancy related depression or postpartum depression. In early 2016, University of Utah Health implemented an electronic version of the EPDS as well as the PROMIS Depression v1.0 instrument for all pregnant and postpartum patients. We asked patients both instruments to understand coverage of patients identified as at risk for each instrument. Methods: The EPDS is currently administered as part of our PRO template for pregnant and postpartum women. We also administer the PROMIS Depression as part of a standard PRO assessment to all patients. Patients are asked to complete an assessment no more often than every eight weeks. PRO assessments are either completed at home or in clinic with a tablet computer. Patients with a PROMIS score of ≥ 65 or a EPDS score of ≥ 10 were identified as at risk for depression Results: From April 2016 to April 2017, 1,330 unique patients were screened at University of Utah Health in OBGYN clinics with both the EPDS and PROMIS depression instrument on the same day. There were 28 (2.1%) patients were identified as at risk for depression using the PROMIS depression screen, while 262 (19.7%) patients were identified as at risk for postpartum depression using the EPDS screen. Overall, 27 (2%) patients were identified as at risk on both instruments. Conclusion: The EPDS identified a higher percent (19.7%) of patients at risk for depression when compared to the PROMIS depression (2.1%). Ninety-six percent of patients who screened positive on the PROMIS depression screen also screened positive on the EPDS screen. Mental health is an important component to a patient’s overall wellbeing. We want to ensure all patients, particularly pregnant or post-partum women, receive screening and treatment when necessary. A combination of screenings may be necessary to provide the overall best care for patients and to identify the highest percentage of patients at risk.

Keywords: patient reported outcomes, mental health, maternal, depression

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1070 The Lived Experiences of Fathers with Children Who Have Cerebral Palsy: An Interpretative Phenomenological Analysis

Authors: Krizette Ladera

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Fathers are there not only to provide the financial stability of a family but a father is also there to provide the love and support that usually people would see as the mother’s responsibility. To describe the lived experiences and how fathers make sense of their lived experiences with their children who have cerebral palsy is the main objective of the study. A qualitative research using a thematic analysis was used for the study. The qualitative research focused on the personal narratives, self-report and expression of the participant’s memory in terms of how they tell their stories. The interpretative phenomenological analysis was used to focus on the experience of the participants on how they will describe their experiences, and to also add on that the IPA will also attempt to describe and explain the meaning of human experiences using interview, specifically on the father who have a child that suffers from cerebral palsy. For the sampling technique, the snowball technique was used to gather participants from the referral of other participants. The five non-randomly selected fathers will be served as the participants for the research. A self-made interview with an open-ended question was used as the research instrument; it includes profiling of the respondent as well as their experiences in taking care of their child that suffers from cerebral palsy. In analyzing a data, the researcher used the thematic analysis where in the interview was made into a transcript, then it was organized and divided themes. After that, the relations of each themes, was identified and it was later documented and translated into written text format using thematic grouping. Finally, the researcher analyzed each data according to its themes and put it in a table to be presented in the result section of the study And as for the result of the study, the researcher was able to come up with the four (4) main themes that most of the participants experienced and those are: The experiences in finding out about the condition of the Child, disclosing the condition of the child to the family and its emotional effect, The experiences of living the day of day realities in providing the physical, financial, emotional and a well balanced environment to the child, and the religious perspectives of the fathers. Along with those four (4) themes comes the subtheme which explains the themes in a more detailed explanation.

Keywords: cerebral palsy, children, fathers, lived experiences

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1069 TopClosure® of Large Abdominal Wall Defect Instead of Staged Hernia Repair as Part of Damage Control Laparotomy

Authors: Andriy Fedorenko

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Background Early closure of the open abdomen is a priority after damage control laparotomy to prevent retraction of fascial layers and prevent hernia formation that requires definitive repair at a later stage. This substantially reduces the complications associated with ventral hernia formation for up to a year after initial surgery. TopClosure® is an innovative method that employs stress-relaxation and mechanical creep for skin stretching. Its use enables the primary closure of large abdominal wall defects and mitigates large ventral hernia formation. Materials and Methods A 7-year-old girl presented with severe blast injury. She underwent initial laparotomy in a facility within the conflict zone and was transferred in a state of septic shock to our facility for further care. Her abdominal injuries included liver lacerations, multiple perforations of the transverse colon and ileum, and a 8x16cm oblique abdominal wall defect. Further damage control laparotomy was performed with primary suture of the colon and ileum and temporary closure of the abdomen using a Bagota bag. Twelve hours later, negative pressure wound therapy (NPWT) was applied to the abdominal wound after relook laparotomy. Five days later, TopClosure® was applied to the lower part of the wound incorporating NPWT to the upper wound. Results The patient suffered leak from the colonic suture line and required relaparotomy. TopClosure® abdominal closure was achieved after every laparotomy. Conclusion TopClosure® utilizes the viscoelastic properties of the skin achieving full closure of the abdominal wall (including the fascia and skin),eliminating the need for prolonged NPWT, skin graft, and delayed ventral hernia repair surgery.

Keywords: topclosure, abdominal wall defect, hernia, damage control

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1068 Outcome at the Extreme of Viability: A Single-Centre Experience

Authors: Antonia Harold-Barry, Eugene Dempsey

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Background: The objective is to examine the survival and outcome of infants born under 26 weeks gestation in an Irish tertiary maternity hospital from 2007-2016 and to describe the survival and neurodevelopmental outcomes of these extremely preterm infants. Method: The population is 132 infants born at 23, 24, and 25 weeks in Cork University Maternity Hospital from 2007 to 2016. Ethical approval was granted by the Cork Clinical Research Ethics Committee. Patient details were obtained from the Vermont Oxford and Badger Networks. Survival rates and Bayley scores were calculated to assess neurodevelopmental outcomes. Statistical analysis with SPSS included frequencies, distributions, and comparisons between data from 2007-2011 and 2012-2016. Results: Overall survival rate was 63%. Of the surviving babies, 61% had Bayley scores calculated. Survival stood at 39% for delivery at 23 weeks, 50% at 24 weeks, and 83% at 25 weeks. The 2012 to 2016 cohort has shown further increases in survival, with 50% of babies at 23 weeks, 58% at 24 weeks, and 89% at 25 weeks. Corresponding figures for 2007-2011 are 20%, 39%, and 75%. Gestational age and incidence of periventricular leukomalacia were statistically significant, with a p-value of 0.022. Gestational age and delivery room deaths had a p-value of 0.025, as did gestational age and birth weight. A comparison of the two cohorts (2007-2011 and 2012-2016) with the administration of antenatal steroids showed a statistically significant p-value of 0.044. Conclusion: There is less morbidity and mortality in infants born at 25 than at 23 or 24 weeks. Survival of extremely premature infants has increased significantly over the past ten years. Survival rates with normal neurodevelopmental outcomes are comparable with international standards and reflect positive changes in attitude and practices in neonatal intensive care. This study will inform parents about the potential outcomes of extreme prematurity and policy regarding the management of extreme prematurity.

Keywords: extreme of viability, neurodevelopmental outcome, periventricular leukomalacia, prematurity

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1067 Post-Operative Pain Management in Ehlers-Danlos Hypermobile-Type Syndrome Following Wisdom Teeth Extraction: A Case Report and Literature Review

Authors: Aikaterini Amanatidou

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We describe the case of a 20-year-old female patient diagnosed with Ehlers-Danlos Syndrome (EDS) who was scheduled to undergo a wisdom teeth extraction in outpatient surgery. EDS is a hereditary connective tissue disorder characterized by joint hypermobility, skin hyper-extensibility, and vascular and soft tissue fragility. There are six subtypes of Ehlers-Danlos, and in our case, the patient had EDS hyper-mobility (HT) type disorder. One important clinical feature of this syndrome is chronic pain, which is often poorly understood and treated. Our patient had a long history of articular and lumbar pain when she was diagnosed. She was prescribed analgesic treatment for acute and neuropathic pain and had multiple sessions of psychotherapy and physiotherapy to ease the pain. Unfortunately, her extensive medical history was underrated by our anesthetic team, and no further measures were taken for the operation. Despite an uneventful intra-operative phase, the patient experienced several episodes of hyperalgesia during the immediate post-operative care. Management of pain was challenging for the anesthetic team: initial opioid treatment had only a temporary effect and a paradoxical reaction after a while. Final pain relief was eventually obtained with psycho-physiologic treatment, high doses of ketamine, and patient-controlled analgesia infusion of morphine-ketamine-dehydrobenzperidol. We suspected an episode of Opioid-Induced hyperalgesia. This case report supports the hypothesis that anti-hyperalgesics such as ketamine as well as lidocaine, and dexmedetomidine should be considered intra-operatively to avoid opioid-induced hyperalgesia and may be an alternative solution to manage complex chronic pain like others in neuropathic pain syndromes.

Keywords: Ehlers-Danlos, post-operative management, hyperalgesia, opioid-induced hyperalgesia, rare disease

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1066 Empowerment Means Decision-Making: How Does It Empower Women: Case of Slum Areas of Dhaka City, Bangladesh

Authors: Nurunnaher Nurunnaher

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This paper examines the impact of women’s participation in microcredit on women’s decision making in the slum areas of Dhaka city, Bangladesh. There is confusion in the literature about whether women’s empowerment is or is not a trickle down impact of poverty alleviation or household well-being, and the studies use more or less similar indicators to measure the status of household and the status of women. Studies very rarely conceptualize and operationalize the term ‘empowerment’ as the word is often used without proper care by policy makers and development practitioners instead of household wellbeing. Currently, decision making in many studies has been used as an indicator of women’s empowerment when assessing the impact of microcredit programs on women. Based on a qualitative and feminist study this paper operationalizes women’s empowerment through the development of a conceptual framework, the identification of assessment criteria and the development of proper indicators that guided the whole study. The testimonies of participants, both men and women, were the basis of exploration of women’s lived experiences, which is the most appropriate method to explore the impact of such programs on women’s empowerment. The study considers empowerment as a process that affects various levels of life and gender relationships. The study found that there is a positive change in women’s position in decision making when women have developed an independent economic base with credit money. However, predominantly, women’s decision making is shared with men with the final decision still in the men’s hands. It can be said that women’s microcredit participation has not significantly challenged the social norms, therefore it is not surprising that women who hand over credit to their husband rarely have any power in intra-household bargaining process. Nevertheless, overall it is evident that women are continuously struggling toward the freedom to have the authority over household, economic and personal matters. It is concluded that while making strategic choices or gaining empowerment requires several steps, women’s participation in decision-making has several implications on their lives and potentially challenges patriarchy.

Keywords: women, gender inequality/equality, decision making, empowerment, microcredit, slums, Dhaka, Bangladesh

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1065 Critical Mathematics Education and School Education in India: A Study of the National Curriculum Framework 2022 for Foundational Stage

Authors: Eish Sharma

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Literature around Mathematics education suggests that democratic attitudes can be strengthened through teaching and learning Mathematics. Furthermore, connections between critical education and Mathematics education are observed in the light of critical pedagogy to locate Critical Mathematics Education (CME) as the theoretical framework. Critical pedagogy applied to Mathematics education is identified as one of the key themes subsumed under Critical Mathematics Education. Through the application of critical pedagogy in mathematics, unequal power relations and social injustice can be identified, analyzed, and challenged. The research question is: have educational policies in India viewed the role of critical pedagogy applied to mathematics education (i.e., critical mathematics education) to ensure social justice as an educational aim? The National Curriculum Framework (NCF), 2005 upholds education for democracy and the role of mathematics education in facilitating the same. More than this, NCF 2005 rests on Critical Pedagogy Framework and it recommends that critical pedagogy must be practiced in all dimensions of school education. NCF 2005 visualizes critical pedagogy for social sciences as well as sciences, stating that the science curriculum, including mathematics, must be used as an “instrument for achieving social change to reduce the divide based on economic class, gender, caste, religion, and the region”. Furthermore, the implementation of NCF 2005 led to a reform in the syllabus and textbooks in school mathematics at the national level, and critical pedagogy was applied to mathematics textbooks at the primary level. This intervention led to ethnomathematics and critical mathematics education in the school curriculum in India for the first time at the national level. In October 2022, the Ministry of Education launched the National Curriculum Framework for Foundational Stage (NCF-FS), developed in light of the National Education Policy, 2020, for children in the three to eight years age group. I want to find out whether critical pedagogy-based education and critical pedagogy-based mathematics education are carried forward in NCF 2022. To find this, an argument analysis of specific sections of the National Curriculum Framework 2022 document needs to be executed. Des Gasper suggests two tables: The first table contains four columns, namely, text component, comments on meanings, possible reformulation of the same text, and identified conclusions and assumptions (both stated and unstated). This table is for understanding the components and meanings of the text and is based on Scriven’s model for understanding the components and meanings of words in the text. The second table contains four columns i.e., claim identified, given data, warrant, and stated qualifier/rebuttal. This table is for describing the structure of the argument, how and how well the components fit together and is called ‘George Table diagram based on Toulmin-Bunn Model’.

Keywords: critical mathematics education, critical pedagogy, social justice, etnomathematics

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1064 Long-Term Otitis Media with Effusion and Related Hearing Loss and Its Impact on Developmental Outcomes

Authors: Aleema Rahman

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Introduction: This study aims to estimate the prevalence of long-term otitis media with effusion (OME) and hearing loss in a prospective longitudinal cohort studyand to study the relationship between the condition and educational and psychosocial outcomes. Methods: Analysis of data from the Avon Longitudinal Study of Parents and Children (ALSPAC) will be undertaken. ALSPAC is a longitudinal birth cohort study carried out in the UK, which has collected detailed measures of hearing on ~7000 children from the age of seven. A descriptive analysis of the data will be undertaken to estimate the prevalence of OME and hearing loss (defined as having average hearing levels > 20dB and type B tympanogram) at 7, 9, 11, and 15 years as well as that of long-term OME and hearing loss. Logistic and linear regression analyses will be conducted to examine associations between long-term OME and hearing loss and educational outcomes (grades obtained from standardised national attainment tests) and psychosocial outcomes such as anxiety, social fears, and depression at ages 10-11 and 15-16 years. Results: Results will be presented in terms of the prevalence of OME and hearing loss in the population at each age. The prevalence of long-term OME and hearing loss, defined as having OME and hearing loss at two or more time points, will also be reported. Furthermore, any associations between long-term OME and hearing loss and the educational and psychosocial outcomes will be presented. Analyses will take into account demographic factors such as sex and social deprivation and relevant confounders, including socioeconomic status, ethnicity, and IQ. Discussion: Findings from this study will provide new epidemiological information on the prevalence of long-term OME and hearing loss. The research will provide new knowledge on the impact of OME for the small group of children who do not grow out of condition by age 7 but continue to have hearing loss and need clinical care through later childhood. The study could have clinical implications and may influence service delivery for this group of children.

Keywords: educational attainment, hearing loss, otitis media with effusion, psychosocial development

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