Search results for: rapid review

Authors: Habib Abida, Noura Dahri

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Flash floods are among the most serious natural hazards that have disastrous environmental and human impacts. They are associated with exceptional rain events, characterized by short durations, very high intensities, rapid flows and small spatial extent. Flash floods happen very suddenly and are difficult to forecast. They generally cause damage to agricultural crops and property, infrastructures, and may even result in the loss of human lives. The city of Gabes (South-eastern Tunisia) has been exposed to numerous damaging floods because of its mild topography, clay soil, high urbanization rate and erratic rainfall distribution. The risks associated with this situation are expected to increase further in the future because of climate change, deemed responsible for the increase of the frequency and the severity of this natural hazard. Recently, exceptional events hit Gabes City causing death and major property losses. A major flooding event hit the region on June 2nd, 2014, causing human deaths and major material losses. It resulted in the stagnation of storm water in the numerous low zones of the study area, endangering thereby human health and causing disastrous environmental impacts. The characterization of flood risk in Gabes Watershed (South-eastern Tunisia) is considered an important step for flood management. Analytical Hierarchy Process (AHP) method coupled with Monte Carlo simulation and geographic information system were applied to delineate and characterize flood areas. A spatial database was developed based on geological map, digital elevation model, land use, and rainfall data in order to evaluate the different factors susceptible to affect flood analysis. Results obtained were validated by remote sensing data for the zones that showed very high flood hazard during the extreme rainfall event of June 2014 that hit the study basin. Moreover, a survey was conducted from different areas of the city in order to understand and explore the different causes of this disaster, its extent and its consequences.

Keywords: analytical hierarchy process, flash floods, Gabes, remote sensing, Tunisia

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Authors: Matthew T. McCarthy, Sarah Janse, Natalie M. Pizzimenti, Anthony K. Savino, Brian Crosser, Sean C. Rose

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Concussion is diagnosed clinically using a comprehensive history and exam, supported by ancillary testing. Frequently, symptom checklists are used as part of the evaluation of concussion. Existing symptom scales are based on a subjective Likert scale, without relation of symptoms to clinical or functional impairment. This is a retrospective review of 133 patients under age 30 seen in an outpatient neurology practice within 30 days of a probable or definite concussion. Each patient completed 2 symptom checklists at the initial visit – the SCAT-3 symptom evaluation (22 symptoms, 0-6 scale) and a scale based on the degree of clinical impairment for each symptom (22 symptoms, 0-3 scale related to functional impact of the symptom). Final clearance date was determined by the treating physician. 60.9% of patients were male with mean age 15.7 years (SD 2.3). Mean time from concussion to first visit was 6.9 days (SD 6.2), and 101 patients had definite concussions (75.9%), while 32 were diagnosed as probable (24.1%). 94 patients had a known clearance date (70.7%) with mean clearance time of 20.6 days (SD 18.6) and median clearance time of 19 days (95% CI 16-21). Mean total symptom score was 27.2 (SD 22.9) on the SCAT-3 and 14.7 (SD 11.9) for the functional impairment scale. Pearson’s correlation between the two scales was 0.98 (p < 0.001). After adjusting for patient and injury characteristics, an equivalent increase in score on each scale was associated with longer time to clearance (SCAT-3 hazard ratio 0.885, 95%CI 0.835-0.938, p < 0.001; functional impairment scale hazard ratio 0.851, 95%CI 0.802-0.902, p < 0.001). A concussion symptom scale based on degree of functional impairment correlates strongly with the SCAT-3 scale and demonstrates a similar association with time to clearance. By assessing the degree of impact on clinical functioning, this symptom scale reflects a more intuitive approach to rating symptoms and can be used in the management of concussion.

Keywords: checklist, concussion, neurology, scale, sports, symptoms

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Authors: Imran Hanif, Amanda Persdotter, Sedigheh Bigdeli, Jesper Liske, Torbjorn Jonsson

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Renewable fuels such as biomass/waste for power production is an attractive alternative to fossil fuels in order to achieve a CO₂ -neutral power generation. However, the combustion results in the release of corrosive species. This puts high demands on the corrosion resistance of the alloys used in the boiler. Stainless steels containing nickel and/or nickel containing coatings are regarded as suitable corrosion resistance material especially in the superheater regions. However, the corrosive environment in the boiler caused by the presence of water vapour and reactive alkali very rapidly breaks down the primary protection, i.e., the Cr-rich oxide scale formed on stainless steels. The lifetime of the components, therefore, relies on the properties of the oxide scale formed after breakaway, i.e., the secondary protection. The aim of the current study is to investigate the role of varying nickel content (0–82%) on the high-temperature corrosion of model alloys with 18% Cr (Fe in balance) in the laboratory mimicking industrial conditions at 600°C. The influence of nickel is investigated on both the primary protection and especially the secondary protection, i.e., the scale formed after breakaway, during the oxidation/corrosion process in the dry O₂ (primary protection) and more aggressive environment such as H₂O, K₂CO₃ and KCl (secondary protection). All investigated alloys experience a very rapid loss of the primary protection, i.e., the Cr-rich (Cr, Fe)₂O₃, and the formation of secondary protection in the aggressive environments. The microstructural investigation showed that secondary protection of all alloys has a very similar microstructure in all more aggressive environments consisting of an outward growing iron oxide and inward growing spinel-oxide (Fe, Cr, Ni)₃O₄. The oxidation kinetics revealed that it is possible to influence the protectiveness of the scale formed after breakaway (secondary protection) through the amount of nickel in the alloy. The difference in oxidation kinetics of the secondary protection is linked to the microstructure and chemical composition of the complex spinel-oxide. The detailed microstructural investigations were carried out using the extensive analytical techniques such as electron back scattered diffraction (EBSD), energy dispersive X-rays spectroscopy (EDS) via the scanning and transmission electron microscopy techniques and results are compared with the thermodynamic calculations using the Thermo-Calc software.

Keywords: breakaway corrosion, EBSD, high-temperature oxidation, SEM, TEM

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Authors: Rahimah Akbar, Abdullah Al-Hashemi, Hanan Taqi, Taiba Sadeq

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As technology continues to develop, teaching curriculums in both schools and universities have begun adopting a more computer/digital based approach to the transmission of knowledge and information, as opposed to the more old-fashioned use of textbooks. This gives rise to the question: Are there any differences in learning from a digital source over learning from a printed source, as in from a textbook? More specifically, which medium of information results in better long-term retention? A review of the confounding factors implicated in understanding the relationship between learning from the two different mediums was done. Alongside this, a 4-week cohort study involving 76 1st year English Language female students was performed, whereby the participants were divided into 2 groups. Group A studied material from a paper source (referred to as the Print Medium), and Group B studied material from a digital source (Digital Medium). The dependent variables were grading of memory recall indexed by a 4 point grading system, and total frequency of item repetition. The study was facilitated by advanced computer software called Super Memo. Results showed that, contrary to prevailing evidence, the Digital Medium group showed no statistically significant differences in terms of the shift from Remember (Episodic) to Know (Semantic) when all confounding factors were accounted for. The shift from Random Guess and Familiar to Remember occurred faster in the Digital Medium than it did in the Print Medium.

Keywords: digital medium, print medium, long-term memory recall, episodic memory, semantic memory, super memo, forgetting index, frequency of repetitions, total time spent

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Authors: Mohammad Sadegh Allahyari, Sorush Marzban

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The main aim of this study was to investigate the factors affecting farmers' attitude of the Shanderman District in Masal (Guilan Province in the north of Iran), towards the concepts of multifunctional agriculture. The statistical population consisted of all 4908 in Shanderman.The sample of the present study consisted of 209 subjects who were selected from the total population using the Bartlett et al. Table. Questionnaire as the main tool of data collection was divided in two parts. The first part of questionnaire consisted of farmers' profiles regarding individual, technical-agronomic, economic and social characteristics. The second part included items to identify the farmers’ attitudes regarding different aspects of multifunctional agriculture. The validity of the questionnaire was assessed by professors and experts. Cronbach's alpha was used to determine the reliability (α= 0.844), which is considered an acceptable reliability value. Overall, the average scores of attitudes towards multifunctional agriculture show a positive tendency towards multifunctional agriculture, considering farmers' attitudes of the Shanderman district (SD = 0.53, M = 3.81). Results also highlight a significant difference between farmers' income source levels (F = 0.049) and agricultural literature review (F = 0.022) toward farmers' attitudes considering multifunctional agriculture (p < 0.05). Pearson correlations also indicated that there is a positive relationship between positive attitudes and family size (r = 0.154), farmers' experience (r = 0.246), size of land under cultivation (r = 0.186), income (r = 0.227), and social contribution activities (r = 0.224). The results of multiple regression analyses showed that the variation in the dependent variable depended on the farmers' experience in agricultural activities and their social contribution activities. This means that the variables included in the regression analysis are estimated to explain 12 percent of the variation in the dependent variable.

Keywords: multifunctional agriculture, attitude, effective factor, sustainable agriculture

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Authors: Nicolas Georges, Akiki Simon, Bassil Naim, Nawfal Georges, Abi Fares Georges

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Introduction: Dyslipidemia has been recognized as a risk factor for cardiovascular diseases. While the development of atherosclerotic lesions begins in childhood and progresses throughout life, data on the prevalence of dyslipidemic children in Lebanon is lacking. Objectives: This study was conducted to assess the benefit of a protocol for universal screening for lipid disorder in Lebanese children aged between two and ten years old. Materials and Methods: A total of four hundred children aged 2 to 10 years old (51.5% boys) were included in the study. The subjects were recruited from private pediatric clinics after parental consent. Fasting total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL) levels were measured and non-HDL cholesterol was calculated. The values were categorized according to 2011 Expert on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents. Results: The overall prevalence of high TC ( ≥ 200 mg/dL), high non-HDL-C ( ≥ 145 mg/dL), high LDL ( ≥ 130 mg/dL), high TG ( ≥ 100 mg/dL) and low HDL ( < 40 mg/dL) was respectively 19.5%, 23%, 19%, 31.8% and 20%. The overall frequency of dyslipidemia was 51.7%. In a bivariate analysis, dyslipidemia in children was associated with a BMI ≥ 95ᵗʰ percentile and parents having TC > 240 mg/dL with a P value respectively of 0.006 and 0.0001. Furthermore, high TG was independently associated with a BMI ≥ 95ᵗʰ percentile (P=0.0001). Children with parents having TC > 240 mg/dL was significantly correlated with high TC, high non-HDL-C and high LDL (P=0.0001 for all variables). Finally, according to the Pediatric dyslipidemia screening guidelines from the 2011 Expert Panel, 62.3% of dyslipidemic children had at least 1 risk factor that qualified them for screening while 37.7% of them didn’t have any risk factor. Conclusions: It is preferable to review the latest pediatric dyslipidemia screening guidelines by performing a universal screening program since a third of our dyslipidemic Lebanese children have been missed.

Keywords: cardiovascular risk factors, dyslipidemia, Lebanese children, screening

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Authors: Kayla Renteria

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This study explored the role animal-assisted psychotherapy (AAP) can play in treating Post-Traumatic Stress Disorder (PTSD) when incorporated into Trauma-informed cognitive behavioral therapy (TF-CBT). A review of the literature was performed to show how incorporating AAP could benefit TF-CBT since this treatment model often presents difficulties, such as client motivation and avoidance of the exposure element of the intervention. In addition, the fluidity of treatment goals during complex trauma cases was explored, as this issue arose in the case study. This study follows the course of treatment of a 12-year-old female presenting with symptoms of PTSD. Treatment consisted of traditional components of the TF-CBT model, with the added elements of AAP to address typical treatment obstacles in TF-CBT. A registered therapy dog worked with the subject in all sessions throughout her treatment. The therapy dog was incorporated into components such as relaxation and coping techniques, narrative therapy techniques, and psychoeducation on the cognitive triangle. Throughout the study, the client’s situation and clinical needs required the therapist to switch goals to focus on current safety and stability. The therapy dog provided support and neurophysiological benefits to the client through AAP during this shift in treatment. The client was assessed quantitatively using the Child PTSD Symptom Scale Self Report for DSM-5 (CPSS-SR-5) before and after therapy and qualitatively through a feedback form given after treatment. The participant showed improvement in CPSS-SR-V scores, and she reported that the incorporation of the therapy animal improved her therapy. The results of this study show how the use of AAP provided the client a solid, consistent relationship with the therapy dog that supported her through processing various types of traumas. Implications of the results of treatment and for future research are discussed.

Keywords: animal-assisted therapy, trauma-focused cognitive behavioral therapy, PTSD in children, trauma treatment

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Authors: Alban Igwe, Ijeoma Kalu, Alloy Ezirim

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Food insecurity is a global problem, and the search for food security has assumed a central stage in the global development agenda as the United Nations currently placed zero hunger as a goal number in its sustainable development goals. Nigeria currently ranks 107th out of 113 countries in the global food security index (GFSI), a metric that defines a country's ability to furnish its citizens with food and nutrients for healthy living. Paradoxically, Nigeria is a global leader in food production, ranking 1st in yam (over 70% of global output), beans (over 41% of global output), cassava (20% of global output) and shea nuts, where it commands 53% of global output. Furthermore, it ranks 2nd in millet, sweet potatoes, and cashew nuts. It is Africa's largest producer of rice. So, it is apparent that Nigeria's food insecurity woes must relate to a factor other than food production. We investigated the nexus between food security and downstream supply chain losses in the yam industry with secondary data from the Food and Agricultural Organization (FAOSTAT) and the National Bureau of Statics for the decade 2012-2021. In analyzing the data, multiple regression techniques were used, and findings reveal that downstream losses have a strong positive correlation with food security (r = .763*) and a 58.3% variation in food security is explainable by post-downstream supply chain food losses. The study discovered that yam supply chain losses within the period under review averaged 50.6%, suggestive of the fact that downstream supply chain losses are the drainpipe and the major source of food insecurity in Nigeria. Therefore, the study concluded that there is a significant relationship between downstream supply chain losses and food insecurity and recommended the establishment of food supply chain structures and policies to enhance food security in Nigeria.

Keywords: food security, downstream supply chain losses, yam, nigeria, supply chain

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Authors: Ying Zhu

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Recent years have witnessed a boom of foreign investments in the field of artificial intelligence (AI). Foreign investments provide critical capital for AI development but also trigger national security concerns of host states. A notable example is an increasing number of cases in which the Committee on Foreign Investment in the United States (CFIUS) has denied Chinese acquisitions of US technology companies on national security grounds. On July 19, 2018, the Congress has reached a deal on the final draft of a new provision to strengthen CFIUS’s authority to review overseas transactions involving sensitive US technology. The question is: how to reconcile the emerging tension between, on the one hand, foreign AI investors’ expectations of a predictable investment environment, and on the other hand, host states’ regulatory power on national security? This paper provides a methodology to reconcile this tension under international investment law. Based on an examination, the national security exception clauses in international investment treaties and the application of national security justification in investor-state arbitration jurisprudence, the paper argues that a traditional interpretation of the national security exception, based on the necessity concept in customary international law, fails to take into account new risks faced by countries, including security concerns over strategic industries such as AI. To overcome this shortage, the paper proposes to incorporate an integrated national security clause in international investment treaties, which includes a two-tier test: a ‘self-judging’ test in the pre-establishment period and a ‘proportionality’ test in the post-establishment period. At the end, the paper drafts a model national security clause for future treaty-drafting practice.

Keywords: foreign investment, artificial intelligence, international investment law, national security exception

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Authors: Tamer ElSerafi

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In recent approaches to heritage conservation, the whole context of historic areas becomes as important as the single historic building. This makes the provision of infrastructure and network of mobility an effective element in the urban conservation. Sustainable urban conservation projects consider the high density of activities, the need for a good quality access system to the transit system, and the importance of the configuration of the mobility network by identifying the best way to connect the different districts of the urban area through a complex unique system that helps the synergic development to achieve a sustainable mobility system. A sustainable urban mobility is a key factor in maintaining the integrity between socio-cultural aspects and functional aspects. This paper illustrates the mobility aspects, mobility problems in historic districts, and the needs of the mobility systems in the first part. The second part is a practical analysis for different mobility plans. It is challenging to find innovative and creative conservation solutions fitting modern uses and needs without risking the loss of inherited built resources. Urban mobility management is becoming an essential and challenging issue in the urban conservation projects. Depending on literature review and practical analysis, this paper tries to define and clarify the guidelines for mobility management in historic districts as a key element in sustainability of urban conservation and development projects. Such rules and principles could control the conflict between the socio–cultural and economic activities, and the different needs for mobility in these districts in a sustainable way. The practical analysis includes a comparison between mobility plans which have been implemented in four different cities; Freiburg in Germany, Zurich in Switzerland and Bray Town in Ireland. This paper concludes with a matrix of guidelines that considers both principles of sustainability and livability factors in urban historic districts.

Keywords: sustainable mobility, urban mobility, mobility management, historic districts

Procedia PDF Downloads 143

Authors: Anvesh Gaddam, Amit Agrawal, Suhas Joshi, Mark Thompson

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An increase in surface area to volume ratio with a decrease in characteristic length scale, leads to a rapid increase in pressure drop across the microchannel. Texturing the microchannel surfaces reduce the effective surface area, thereby decreasing the pressured drop. Surface texturing introduces two wetting states: a metastable Cassie-Baxter state and stable Wenzel state. Predicting wetting transition in textured microchannels is essential for identifying optimal parameters leading to maximum drag reduction. Optical methods allow visualization only in confined areas, therefore, obtaining whole-field information on wetting transition is challenging. In this work, we propose a non-invasive method to capture wetting transitions in textured microchannels under flow conditions. To this end, we tracked the behavior of the Poiseuille number Po = f.Re, (with f the friction factor and Re the Reynolds number), for a range of flow rates (5 < Re < 50), and different wetting states were qualitatively demarcated by observing the inflection points in the f.Re curve. Microchannels with both longitudinal and transverse ribs with a fixed gas fraction (δ, a ratio of shear-free area to total area) and at a different confinement ratios (ε, a ratio of rib height to channel height) were fabricated. The measured pressure drop values for all the flow rates across the textured microchannels were converted into Poiseuille number. Transient behavior of the pressure drop across the textured microchannels revealed the collapse of liquid-gas interface into the gas cavities. Three wetting states were observed at ε = 0.65 for both longitudinal and transverse ribs, whereas, an early transition occurred at Re ~ 35 for longitudinal ribs at ε = 0.5, due to spontaneous flooding of the gas cavities as the liquid-gas interface ruptured at the inlet. In addition, the pressure drop in the Wenzel state was found to be less than the Cassie-Baxter state. Three-dimensional numerical simulations confirmed the initiation of the completely wetted Wenzel state in the textured microchannels. Furthermore, laser confocal microscopy was employed to identify the location of the liquid-gas interface in the Cassie-Baxter state. In conclusion, the present method can overcome the limitations posed by existing techniques, to conveniently capture wetting transition in textured microchannels.

Keywords: drag reduction, Poiseuille number, textured surfaces, wetting transition

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Authors: Isaiah Phillip Smith, Sam Erevbenagie Usadolo, Pamela Theresa Tancsik

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This paper is part of ongoing doctoral research that examines the role of Theatre for Development (TfD) in addressing climate change in the Mosuthu community in Reservoir Hills, Durban, South Africa. The context of the research underscores the pressing challenges facing South Africa, including drought, water shortages, deterioration of land, and civil unrest that require innovative approaches to the mitigation of climate change. TfD, described as a dialogical form of theatre that allows communities to express and contribute to development, emerges as a strategic medium for engaging communities in the process. The research problem focused on the unexamined potential of TfD in promoting community involvement and critical awareness of climate change. The study objectives included assessing the community's understanding of climate change, exploring TfD's potential as a participatory tool, examining its role in community mobilization, and developing recommendations for its effective implementation. A review of relevant literature and preliminary investigations in the research community indicates that TfD is an effective medium for promoting societal transformation and engaging marginalized communities. Through culturally resonant narratives, TfD can instill a deeper understanding of environmental challenges, fostering empathy and motivating behavioural changes. By integrating community voices and cultural elements, TfD serves as a powerful catalyst for promoting climate change awareness and inspiring collective action within the South African context. This research contributes to the global discourse on innovative approaches to climate change awareness and action.

Keywords: TfD, climate change, community involvement, societal transformation, culture

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Authors: Oscar Sang, Shadrack David Rotich

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Parliamentary immunity is grounded on the notion that parliaments need certain rights or immunities to ensure they can operate independently make fair and impartial decisions without capitulating to political pressure or intimidation. The 2013 election in Kenya marked an important milestone in the development of the law of parliamentary privilege. Such importance relates to the dramatic increase in the number of legislatures in the country from one unicameral parliament, to a bicameral national parliament and forty-seven other regional legislative assemblies. The increase in legislatures has resulted in a dramatic increase in political contestations which have led to legal wrangles. The judiciary in Kenya, once considered submissive, has been invited to arbitrate on various matters pitting individual rights and parliamentary privilege and have invalidated a number of legislative action. While judicial intervention is indeed necessary to ensure that legislatures in Kenya live true to the constitutional aspirations of the Kenyan people, certain judicial decisions have had an effect on eroding parliamentary immunity. This paper highlights a number of instances in which it could be argued that parliamentary privilege came under attack by the courts in Kenya. The paper aims to make a case that while Kenya’s progressive constitution necessitates the scope and extent of legislature’s immunities and privilege to be determined by the courts, it is important that courts exercise restraint in its review of legislative action. The paper makes the argument that unrestrained judicial action in Kenya on questions within the realm parliamentary privilege may undermine the functioning of Kenya’s legislatures. The paper explores approaches taken by a number of jurisdictions in establishing a proper balance between maintaining a viable parliamentary privilege regime in a rights-based constitutional system.

Keywords: Kenya, constitution, judicial restraint, parliamentary privilege

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Authors: G. Henini, Y. Laidani, F. Souahi, A. Labbaci, S. Hanini

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Environmental contamination is a major problem being faced by the society today. Industrial, agricultural, and domestic wastes, due to the rapid development in the technology, are discharged in the several receivers. Generally, this discharge is directed to the nearest water sources such as rivers, lakes, and seas. While the rates of development and waste production are not likely to diminish, efforts to control and dispose of wastes are appropriately rising. Wastewaters from textile industries represent a serious problem all over the world. They contain different types of synthetic dyes which are known to be a major source of environmental pollution in terms of both the volume of dye discharged and the effluent composition. From an environmental point of view, the removal of synthetic dyes is of great concern. Among several chemical and physical methods, adsorption is a promising technique due to the ease of use and low cost compared to other applications in the process of discoloration, especially if the adsorbent is inexpensive and readily available. The focus of the present study was to assess the potentiality of Brahea edulis (BE) for the removal of synthetic dye Yellow bemacid (YB) from aqueous solutions. The results obtained here may transfer to other dyes with a similar chemical structure. Biosorption studies were carried out under various parameters such as mass adsorbent particle, pH, contact time, initial dye concentration, and temperature. The biosorption kinetic data of the material (BE) was tested by the pseudo first-order and the pseudo-second-order kinetic models. Thermodynamic parameters including the Gibbs free energy ΔG, enthalpy ΔH, and entropy ΔS have revealed that the adsorption of YB on the BE is feasible, spontaneous, and endothermic. The equilibrium data were analyzed by using Langmuir, Freundlich, Elovich, and Temkin isotherm models. The experimental results show that the percentage of biosorption increases with an increase in the biosorbent mass (0.25 g: 12 mg/g; 1.5 g: 47.44 mg/g). The maximum biosorption occurred at around pH value of 2 for the YB. The equilibrium uptake was increased with an increase in the initial dye concentration in solution (C_o = 120 mg/l; q = 35.97 mg/g). Biosorption kinetic data were properly fitted with the pseudo-second-order kinetic model. The best fit was obtained by the Langmuir model with high correlation coefficient (R² > 0.998) and a maximum monolayer adsorption capacity of 35.97 mg/g for YB.

Keywords: adsorption, Brahea edulis, isotherm, yellow Bemacid

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Authors: Shamsulhaq Amin

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Drought can arise from several hydrometeorological phenomena that result in insufficient precipitation, soil moisture, and surface and groundwater flow, leading to conditions that are considerably drier than the usual water content or availability. Drought is often assessed using indices that are associated with meteorological, agricultural, and hydrological phenomena. In order to effectively handle drought disasters, it is essential to accurately determine the kind, intensity, and extent of the drought using drought characterization. This information is critical for managing the drought before, during, and after the rehabilitation process. Over a hundred drought assessments have been created in literature to evaluate drought disasters, encompassing a range of factors and variables. Some models utilise solely hydrometeorological drivers, while others employ remote sensing technology, and some incorporate a combination of both. Comprehending the entire notion of drought and taking into account drought indices along with their calculation processes are crucial for researchers in this discipline. Examining several drought metrics in different studies requires additional time and concentration. Hence, it is crucial to conduct a thorough examination of approaches used in drought indices in order to identify the most straightforward approach to avoid any discrepancies in numerous scientific studies. In case of practical application in real-world, categorizing indices relative to their usage in meteorological, agricultural, and hydrological phenomena might help researchers maximize their efficiency. Users have the ability to explore different indexes at the same time, allowing them to compare the convenience of use and evaluate the benefits and drawbacks of each. Moreover, certain indices exhibit interdependence, which enhances comprehension of their connections and assists in making informed decisions about their suitability in various scenarios. This study provides a comprehensive assessment of various drought indices, analysing their types and computation methodologies in a detailed and systematic manner.

Keywords: drought classification, drought severity, drought indices, agricultur, hydrological

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Authors: Veliswa Nonfundo Hoho, Jabulani Gilford Kheswa

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HIV/AIDS has been a long-term condition worldwide, which does not only affect physical health but also causes psychological and social challenges in people living with this condition. In Sub-Saharan countries, namely; Nigeria, Uganda, Zimbabwe and South Africa, people living with HIV/AIDS come across different challenges especially after one has disclosed his/her status. They experience stigma and discrimination, isolation, lack of accessing and receiving treatment, lack of support and experience psychological distress. By using the evidence-based systematic review as a form of methodology, journal articles, dissertations, internet, and books were explored. This paper seeks to describe the challenges faced by people living with HIV/AIDS after disclosure, which forms a critical component of HIV/AIDS prevention and treatment interventions. The disclosure process model is used to underpin the study. This theory allows one to understand when and why interpersonal and verbal self-disclosure is beneficial for individuals who live with concealable stigmatized identities such as HIV/AIDS. Literature findings advocate that both negative and positive results were noted after disclosing one’s HIV status and psychosocial well-being of the majority of people living with HIV/AIDS also get affected especially in societies which subscribe HIV/AIDS pandemic to witchcraft. As for the infected homosexuals, research indicates that they suffer in silence and to cover their emotional emptiness due to ostracism, they often report low- self-efficacy with regard to condom use and become susceptible to reinfections which further place their lives at heightened risk for low immune system. In this regard, this paper challenges the policies which protect the dignity of people living with HIV/AIDS and calls for unity and financial support in favour of psychoeducational programmes and support groups aimed at curbing discrimination.

Keywords: disclosure, discrimination, homosexuality, self-efficacy

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Authors: Yarra Sulina, Nunna Tagore Sai Priya, Ankhi Banerjee

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With the rapid growth in tourist arrivals, there has been a huge demand for the growth of infrastructure in the destinations. With the increasing preference of tourists to stay near attractions, there has been a considerable change in the land use around tourist sites. However, with the inclusion of certain regulations and guidelines provided by the authorities based on the nature of tourism activity and geographical constraints, the pattern of growth of built form is different for various tourist sites. Therefore, this study explores the patterns of growth of built-up for a decade from 2009 to 2019 through two-dimensional and three-dimensional analysis. Land use maps are created through supervised classification of satellite images obtained from LANDSAT 4-5 and LANDSAT 8 for 2009 and 2019, respectively. The overall expansion of the built-up area in the region is analyzed in relation to the distance from the city's geographical center and the tourism-related growth regions are identified which are influenced by the proximity of tourist attractions. The primary tourist sites of various destinations with different geographical characteristics and tourism activities, that have undergone a significant increase in built-up area and are occupied with tourism-related infrastructure are selected for further study. Proximity analysis of the tourism-related growth sites is carried out to delineate the influence zone of the tourist site in a destination. Further, a temporal analysis of volumetric growth of built form is carried out to understand the morphology of the tourist precincts over time. The Digital Surface Model (DSM) and Digital Terrain Model (DTM) are used to extract the building footprints along with building height. Factors such as building height, and building density are evaluated to understand the patterns of three-dimensional growth of the built area in the region. The study also explores the underlying reasons for such changes in built form around various tourist sites and predicts the impact of such growth patterns in the region. The building height and building density around tourist site creates a huge impact on the appeal of the destination. The surroundings that are incompatible with the theme of the tourist site have a negative impact on the attractiveness of the destination that leads to negative feedback by the tourists, which is not a sustainable form of development. Therefore, proper spatial measures are necessary in terms of area and volume of the built environment for a healthy and sustainable environment around the tourist sites in the destination.

Keywords: sustainable tourism, growth patterns, land-use changes, 3-dimensional analysis of built-up area

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Authors: Majid Alsubaie, Hamed Sarbazhosseini

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Many working environments have experienced increased uncertainty due to the fast-moving and unpredictable world. IT systems development projects, in particular, face several challenges because of their rapidly changing environments and emerging technologies. Information technology organizations within these contexts adapt systems development methodology and new software approaches to address this issue. One of these methodologies is the Agile method, which has gained huge attention in recent years. However, due to failure rates in IT projects, there is an increasing demand for the use of hybrid Agile methods among organizations. The scarce research in the area means that organizations do not have solid evidence-based knowledge for the use of hybrid Agile. This research was designed to provide further insights into the development of hybrid Agile methods within systems development projects, including how frameworks and processes are used and what benefits and challenges are gained and faced as a result of hybrid Agile methods. This paper presents how three organizations (two government and one private) use hybrid Agile methods in their Agile environments. The data was collected through interviews and a review of relevant documents. The results indicate that these organizations do not predominantly use pure Agile. Instead, they are waterfall organizations by virtue of systems nature and complexity, and Agile is used underneath as the delivery model. Prince2 Agile framework, SAFe, Scrum, and Kanban were the identified models and frameworks followed. This study also found that customer satisfaction and the ability to build quickly are the most frequently perceived benefits of using hybrid Agile methods. In addition, team resistance and scope changes are the common challenges identified by research participants in their working environments. The findings can help to understand Agile environmental conditions and projects that can help get better success rates and customer satisfaction.

Keywords: agile, hybrid, IT systems, management, success rate, technology

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Authors: Amel M. A. Osman, Roy Mahony, Lisa Dann, McKenna S.

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Background: Computed Tomography (CT) is a significant source of radiation in the pediatric population. A new head injury (HI) pathway was introduced in 2021, which altered the previous process of HI being jointly admitted with general pediatrics and surgery to admit these patients under the Emergency Medicine Team. Admitted patients included those with positive CT findings not requiring immediate neurosurgical intervention and those who did not meet current criteria for urgent CT brain as per NICE guidelines but were still symptomatic for prolonged observations. This approach aims to decrease the number of CT scans performed. The main aim is to assess the variation in CT scanning rates since the change in the admitting process. A retrospective review of patients presenting to CHI PECU with HI over 6-month period (01/01/19-31/05/19) compared to a 6-month period post introduction of the new pathway (01/06/2022-31/12/2022). Data was collected from the electronic record databases, symphony, and PACS. Results: In 2019, there were 869 presentations of HI, among which 32 (3.68%) had CT scans performed. 2 (6.25%) of those scanned had positive findings. In 2022, there were 1122 HI presentations, with 47 (4.19%) CT scans performed and positive findings in 5 (10.6%) cases. 57 patients were admitted under the new pathway for observation, with 1 having a CT scan following admission. Conclusion: Quantitative lifetime radiation risks for children are not negligible. While there was no statistically significant reduction in CTs performed amongst HIs presenting to our department, a significant group met the criteria for admission under the PECU consultant for prolonged monitoring. There was also a greater proportion of abnormalities on CT scans performed in 2022, demonstrating improved patient selection for imaging. Further data analysis is ongoing to determine if those who were admitted would have previously been scanned under the old pathway.

Keywords: head injury, CT, admission, guidline

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Authors: Waad Al Saleemi, Badriya Al Adawi, Zaaima Al Jabri, Sahim Al Ghafri, Jalila Al Hadhramia

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Objectives: Using standard lab methods, a positive blood culture requires a minimum of two days (two occasions of overnight incubation) to obtain a final identification (ID) and antimicrobial susceptibility results (AST) report. In this study, we aimed to evaluate the accuracy and precision of identification and antimicrobial susceptibility testing of an alternative method (direct method) that will reduce the turnaround time by 24 hours. This method involves the direct inoculation of positive blood culture broths into the Phoenix system using serum separation tubes (SST). Method: This prospective study included monomicrobial-positive blood cultures obtained from January 2022 to May 2023 in SQUH. Blood cultures containing a mixture of organisms, fungi, or anaerobic organisms were excluded from this study. The result of the new “direct method” under study was compared with the current “standard method” used in the lab. The accuracy and precision were evaluated for the ID and AST using Clinical and Laboratory Standards Institute (CLSI) recommendations. The categorical agreement, essential agreement, and the rates of very major errors (VME), major errors (ME), and minor errors (MIE) for both gram-negative and gram-positive bacteria were calculated. Passing criteria were set according to CLSI. Result: The results of ID and AST were available for a total of 158 isolates. Of 77 isolates of gram-negative bacteria, 71 (92%) were correctly identified at the species level. Of 70 isolates of gram-positive bacteria, 47(67%) isolates were correctly identified. For gram-negative bacteria, the essential agreement of the direct method was ≥92% when compared to the standard method, while the categorical agreement was ≥91% for all tested antibiotics. The precision of ID and AST were noted to be 100% for all tested isolates. For gram-positive bacteria, the essential agreement was >93%, while the categorical agreement was >92% for all tested antibiotics except moxifloxacin. Many antibiotics were noted to have an unacceptable higher rate of very major errors including penicillin, cotrimoxazole, clindamycin, ciprofloxacin, and moxifloxacin. However, no error was observed in the results of vancomycin, linezolid, and daptomycin. Conclusion: The direct method of ID and AST for positive blood cultures using SST is reliable for gram negative bacteria. It will significantly decrease the turnaround time and will facilitate antimicrobial stewardship.

Keywords: bloodstream infection, oman, direct ast, blood culture, rapid identification, antimicrobial susceptibility, phoenix, direct inoculation

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Authors: Pinar Sali, Esim Gursoy, Ebru Atak Damar

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Teachers’ awareness of and involvement in educational research (ER) is regarded as an indispensable aspect of professional growth and development. It is also believed to be a catalyst for effective teaching and learning. This strong emphasis on the significance of teacher research engagement has sparked inquiry into how teachers construe ER and whether or not they practice it. However, there seems to exist a few researches on teachers’ perceptions of and experience with ER in the field of English Language Teaching (ELT). The present study thus attempts to fill this gap in the ELT literature and aims to unearth English language teachers’ perceptions of ER. Understanding these perceptions would undoubtedly aid in the development of strategies to promote teacher interest and involvement in research. The participants of the present study are 70 English language teachers in public and private schools in Turkey. A mixed-method approach has been used in the study. Both qualitative and quantitative data have been gathered by means of a questionnaire consisting of two parts. The first part of the questionnaire consists of 20 close-ended items of Teachers’ Attitude Scale Towards Educational Research (TASTER). The second part of the questionnaire has been developed by the researchers via an extensive literature review and consists of a mixture of close- and open-ended questions. In addition, 15 language teachers have been interviewed for an in-depth understanding of the results. Descriptive statistics and dual comparisons have been employed for the quantitative data, and the qualitative data have been analyzed by means of content analysis. The present study provides intriguing information as to the English language teachers’ perceptions of the usefulness and practicality of ER as well as the value they attain to it. The findings are discussed in relation to language teacher education. The research has implications for the teacher education process, teacher trainers and policy makers.

Keywords: attitudes toward educational research, educational research, language teachers, teacher research

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Authors: Mohammad Saber Eslamlou

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Morphology of Islamic cities has been extensively studied by researchers of Islamic cities and different theories could be found about it. In this regard, there exist much difference in method of analysis, classification, recognition, confrontation and comparative method of urban morphology. The present paper aims to examine the previous methods, approaches and insights and that how Dr. Giulia Annalinda Neglia dealt with the analysis of morphology of Islamic cities. Neglia is assistant professor in University of Bari, Italy (UNIBA) who has published numerous papers and books on Islamic cities. I introduce her works in the field of morphology of Islamic cities. And then, her thoughts, insights and research methodologies are presented and analyzed in critical perspective. This is a qualitative research on her written works, which have been classified in three major categories. The first category consists mainly of her works on morphology and physical shape of Islamic cities. The results of her works’ review suggest that she has used Moratoria typology in investigating morphology of Islamic cities. Moreover, overall structure of the cities under investigation is often described linear; however, she’s against to define a single framework for the recognition of morphology in Islamic cities. She states that ‘to understand the physical complexity and irregularities in Islamic cities, it is necessary to study the urban fabric by typology method, focusing on transformation processes of the buildings’ form and their surrounding open spaces’ and she believes that fabric of each region in the city follows from the principles of an specific period or urban pattern, in particular, Hellenistic and Roman structures. Furthermore, she believes that it is impossible to understand the morphology of a city without taking into account the obvious and hidden developments associated with it, because form of building and their surrounding open spaces are written history of the city.

Keywords: city, Islamic city, Giulia Annalinda Neglia, morphology

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Authors: Edith Esparza-Young, Ángel M. Matos, Yaritza Gonzalez, Kirthana Sugunathevan

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Introduction: This research describes the existing medical school program which supports a multicultural setting and bilingualism. The rise of Spanish speakers in the United States has led to the recruitment of bilingual medical students who can serve the evolving demographics. This paper includes anecdotal evidence, narratives and the latest research on the outcomes of supporting a multilingual academic experience in medical school and beyond. People in the United States will continue to need health care from physicians who have experience with multicultural competence. Physicians who are bilingual and possess effective communication skills will be in high demand. Methodologies: This research is descriptive. Through this descriptive research, the researcher will describe the qualities and characteristics of the existing medical school programs, curriculum, and student services. Additionally, the researcher will shed light on the existing curriculum in the medical school and also describe specific programs which help to serve as safety nets to support diverse populations. The method included observations of the existing program and the implementation of the medical school program, specifically the Accelerated Review Program, the Language Education and Professional Communication Program, student organizations and the Global Health Institute. Concluding Statement: This research identified and described characteristics of the medical school’s program. The research explained and described the current and present phenomenon of this medical program, which has focused on increasing the graduation of bilingual and minority physicians. The findings are based on observations of the curriculum, programs and student organizations which evolves and remains innovative to stay current with student enrollment.

Keywords: bilingual, English, medicine, doctor

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Authors: Claire P. Griffin

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The education provision for students with special educational needs, including students with Autism Spectrum Disorder (ASD), has undergone significant national and international changes in recent years. In particular, an increase in resource-based provision has occurred across educational settings in an effort to support inclusive practices. This paper seeks to explore the role of the Special Needs Assistant (SNA) in supporting children with ASD in Irish schools. This research stems from the second national evaluation of ‘Education Provision for Students with Autism Spectrum Disorder in Ireland’ (NCSE, 2016). This research was commissioned by the National Council for Special Education (NCSE) in Ireland and conducted by a team of researchers from Mary Immaculate College, Limerick from February to July 2014. This study involved a multiple case study research strategy across 24 educational sites, as selected through a stratified sampling process. Research strategies included semi-structured interviews, classroom observations, documentary review and child conversations. Data analysis was conducted electronically using Nvivo software, with use of an additional quantitative recording mechanism based on scaled weighting criteria for collected data. Based on such information, key findings from the NCSE national evaluation will be presented and critically reviewed, with particular reference to the role of the SNA in supporting pupils with ASD. Examples of positive practice inherent within the SNA role will be outlined and contrasted with discrete areas for development. Based on such findings, recommendations for the evolving role of the SNA will be presented, with the aim of informing both policy and best practice within the field.

Keywords: autism spectrum disorder, inclusive education , paraprofessional, special needs assistant

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Authors: Alieh Farshbaf

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Introduction: Current anti-retroviral drugs have some restrictions for treatment of HIV-1 infection. The efficacy of retroviral drugs is not same in different infected patients and the virus rebound from latent reservoirs after stopping them. Recently, the engineering of stem cells and gene therapy provide new approaches to eliminate some drug problems by induction of resistance to HIV-1. Literature review: Up to now, AIDS-restriction genes (ARGs) were suitable candidate for gene and cell therapies, such as cc-chemokine receptor-5 (CCR5). In this manner, CCR5 provide effective cure in Berlin and Boston patients by inducing of HIV-1 resistance with allogeneic stem cell transplantation. It is showed that Zinc Finger Nuclease (ZFN) could induce HIV-1 resistance in stem cells of infected patients by homologous recombination or non-end joining mechanism and eliminate virus loading after returning the modified cells. Then, gene modification by HIV restriction factors, as TRIM5, introduced another gene candidate for HIV by interfering in infection process. These gene modifications/editing provided by stem cell futures that improve treatment in refractory disease such as HIV-1. Conclusion: Although stem cell transplantation has some complications, but in compare to retro-viral drugs demonstrated effective cure by elimination of virus loading. On the other hand, gene therapy is cost-effective for an infected patient than retroviral drugs payment in a person life-long. The results of umbilical cord blood stem cell transplantation showed that gene and cell therapy will be applied easier than previous treatment of AIDS with high efficacy.

Keywords: stem cell, AIDS, gene modification, cell engineering

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Authors: Paul Saah, Charles Mbohwa, Nelson Sizwe Madonsela

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The capacity to deliver projects on schedule, within budget, and to the pleasure of the client depends on effective communication, which is the lifeblood of project-based businesses. In order to pinpoint areas for development and shed light on the crucial role that communication plays in project success, the aim of this study is to evaluate the efficacy of communication practises and processes inside project-based organisations. In order to analyse concepts and get a greater grasp of their theoretical basis, this study's methodology combines a careful review of the relevant literature with a conceptual analysis of the subject. Data from a varied sample of project-based businesses spanning all industries and sizes were collected via document analysis. The relationship between communication practises, and processes were investigated in connection to key performance measures such as project outcomes, client satisfaction, and team dynamics. According to the study's findings, project-based businesses that adopt effective communication practises, and procedures experience a reduction in unfavourable experiences, stronger integration, and coordination, clarity of purpose, and practises that can hasten problem resolution. However, failing to adopt effective communication practises and procedures in project-based company result in counter issues, including project derailment from the schedule, failure to meet goals, inefficient use of existing resources, and failure to meet organisational goals. Therefore, optimising their communication practises, and procedures are crucial for sustainable growth and competitive advantage as project-based enterprises continue to play a crucial part in today's dynamic business scene.

Keywords: effective communication, project-based firms, communication practices, project success, communication strategies

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Authors: Batool Zarei

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This study aims to answer this question whether control criterion with two elements of power and benefit which is introduced as 'control criterion of consolidation scope' in national and international standards of accounting in public sector (and also private sector) is efficient enough or not. The methodology of this study is comparative and the results of this research are significantly generalizable, due to the given importance to the sample of countries which were studied. Findings of this study states that in spite of pervasive use of control criterion (including 2 elements of power and benefit), criteria for determining the existence of control in public sector accounting standards, are not efficient enough to determine the consolidation scope of whole of government financial statements in a way that meet decision making and accountability needs of managers, policy makers and supervisors; specially parliament. Therefore, the researcher believes that for determining consolidation scope in public sector, in addition to economic view, it is better to pay attention to budgetary, legal and statistical concepts and also to practical and financial risk and define indicators for proving the existence of control (power and benefit) which include accountability relationships (budgetary relation, legal form and nature of activity). these findings also reveals the necessity of passing a comprehensive public financial management (PFM) legislation in order to redefine the characteristics of public sector entities and whole of government financial statements scope and review Statistics organizations and central banks duties for preparing government financial statistics and national accounts in order to achieve sustainable development and resilient economy goals.

Keywords: control, consolidation scope, public sector accounting, government financial statistics, resilient economy

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Authors: Vladimíra Kňazovická, Mária Dovičičová, Miroslava Kačániová, Margita Čanigová

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The aim of the study was to test the storage of bee pollen at room temperature and in cold store, and to describe microorganisms originated from it. Fresh bee pollen originating in West Slovakia was collected in May 2010. It was tested for presence of particular microbial groups using dilution plating method, and divided into two parts with different storage (in cold store and at room temperature). Microbial analyses of pollen were repeated after one year of storage. Several bacterial strains were isolated and tested using Gram staining, for catalase and fructose-6-phosphate-phosphoketolase presence, and by rapid ID 32A (BioMérieux, France). Micromycetes were identified at genus level. Fresh pollen contained coliform bacteria, which were not detected after one year of storage in both ways. Total plate count (TPC) of aerobes and anaerobes and of yeasts in fresh bee pollen exceeded 5.00 log CFU/g. TPC of aerobes and anaerobes decreased below 2.00 log CFU/g after one year of storage in both ways. Count of yeasts decreased to 2.32 log CFU/g (at room temperature) and to 3.66 log CFU/g (in cold store). Microscopic filamentous fungi decreased from 3.41 log CFU/g (fresh bee pollen) to 1.13 log CFU/g (at room temperature) and to 1.89 log CFU/g (in cold store). In fresh bee pollen, 12 genera of micromycetes were identified in the following order according to their relative density: Penicillium > Mucor > Absidia > Cladosporium, Fusarium > Alternaria > Eurotium > Aspergillus, Rhizopus > Emericella > Arthrinium and Mycelium sterilium. After one year at room temperature, only three genera were detected in bee pollen (Penicillium > Aspergillus, Mucor) and after one year in cold store, seven genera were detected (Mucor > Penicillium, Emericella > Aspergillus, Absidia > Arthrinium, Eurotium). From the plates designated for anaerobes, eight colonies originating in fresh bee pollen were isolated. Among them, a single yeast isolate occurred. Other isolates were G+ bacteria, with a total of five rod shaped. In three out of these five, catalase was absent and fructose-6-phosphate-phosphoketolase was present. Bacterial isolates originating in fresh pollen belonged probably to genus Bifidobacterium or relative genera, but their identity was not confirmed unequivocally. In general, cold conditions are suitable for maintaining the natural properties of foodstuffs for a longer time. Slight decrease of microscopic fungal number and diversity was recorded in cold temperatures compared with storage at room temperature.

Keywords: bacteria, bee product, microscopic fungi, biosystems engineering

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Authors: Zeena Dcosta, Junaid Ahmed, Ceena Denny, Nandita Shenoy

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In the field of dentistry, there are many conditions which warrant the requirement of three-dimensional imaging that can aid in diagnosis and therapeutic management. Cone beam computed tomography (CBCT) is considered highly accurate in producing a three-dimensional image of an object and provides a complete insight of various findings in the captured volume. But, most of the clinicians focus primarily on the teeth and jaws and numerous unanticipated clinically significant incidental findings may be missed out. Rapid integration of CBCT into the practice of dentistry has led to the detection of various incidental findings. However, the prevalence of these incidental findings is still unknown. Thus, the study aimed to discern the reason for referral and to identify incidental findings on the referred CBCT scans. Patient’s demographic data such as age and gender was noted. CBCT scans of multiple fields of views (FOV) were considered. The referral for CBCT scans was broadly classified into two major categories: diagnostic scan and treatment planning scan. Any finding on the CBCT volumes, other than the area of concern was recorded as incidental finding which was noted under airway, developmental, pathological, endodontics, TMJ, bone, soft tissue calcifications and others. Few of the incidental findings noted under airway were deviated nasal septum, nasal turbinate hypertrophy, mucosal thickening and pneumatization of sinus. Developmental incidental findings included dilaceration, impaction, pulp stone and gubernacular canal. Resorption of teeth and periapical pathologies were noted under pathological incidental findings. Root fracture along with over and under obturation was noted under endodontics. Incidental findings under TMJ were flattening, erosion and bifid condyle. Enostosis and exostosis were noted under bone lesions. Tonsillolth, sialolith and calcified styloid ligament were noted under soft tissue calcifications. Incidental findings under others included foreign body, fused C1- C2 vertebrae, nutrient canals, and pneumatocyst. Maxillofacial radiologists should be aware of possible incidental findings and should be vigilant about comprehensively evaluating the entire captured volume, which can help in early diagnosis of any potential pathologies that may go undetected. Interpretation of CBCT is truly an art and with the experience, we can unravel the secrets hidden in the grey shades of the radiographic image.

Keywords: cone beam computed tomography, incidental findings, maxillofacial region, radiologist

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Authors: Ching-Yi Huang, Pi-Fen Cheng, Hui-Zhu Chen, Shi Ting Huang, Heng-Hua Wang

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This is a case of oral cancer after extensive resection and modified right lateral neck lymph node dissection followed by reconstruction with a skin flap. The nursing period lasted From September 25 to October 3, 2017, through observation, interview, physical assessment, and medical record review, the author identified the following nursing problems: acute pain, impaired oral mucous membrane, and body image change. During the nursing period, the author provided individual and overall nursing care and established mutual trust through the use of empathy. Author listened and eased the patient's physical indisposition, such as wound pain, we use medications and acupuncture massage to relieve pain. However, for oral mucosa change caused by surgery, provide continuous and complete oral care and oral exercise training to improve oral mucosal healing and restore swallowing function. In the body-image changes, guided him to express his feeling after the body-image change, and enhanced support and from the family, and encouraged him to attend head and neck cancer survivor alliance which allowed the patient to accept the altered body image and reaffirm self-worth. Hopefully, through sharing this nursing experience will help to the nursing care quality of nursing care for oral cancer patients after extensive resection and modified right lateral neck lymph node dissection followed by reconstruction with a skin flap.

Keywords: oral cancer, acute pain, impaired oral mucous membrane, body image change

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