Search results for: educational outcomes

Authors: Marina Charalambous, Phivos Phylactou, Thekla Elriz, Loukia Psychogios, Jean-Marie Annoni

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Background: Evidence-based practices for the evaluation and treatment of people with aphasia (PWA) in Greek are mainly impairment-based. Functional and multimodal communication is usually under assessed and neglected by clinicians. This study explores the adaptation and psychometric testing of the Greek (GR) version of The Scenario Test. The Scenario Test assesses the everyday functional communication of PWA in an interactive multimodal communication setting with the support of an active communication facilitator. Aims: To define the reliability and validity of The Scenario Test GR and discuss its clinical value. Methods & Procedures: The Scenario Test-GR was administered to 54 people with chronic stroke (6+ months post-stroke): 32 PWA and 22 people with stroke without aphasia. Participants were recruited from Greece and Cyprus. All measures were performed in an interview format. Standard psychometric criteria were applied to evaluate reliability (internal consistency, test-retest, and interrater reliability) and validity (construct and known – groups validity) of the Scenario Test GR. Video analysis was performed for the qualitative examination of the communication modes used. Outcomes & Results: The Scenario Test-GR shows high levels of reliability and validity. High scores of internal consistency (Cronbach’s α = .95), test-retest reliability (ICC = .99), and interrater reliability (ICC = .99) were found. Interrater agreement in scores on individual items fell between good and excellent levels of agreement. Correlations with a tool measuring language function in aphasia (the Aphasia Severity Rating Scale of the Boston Diagnostic Aphasia Examination), a measure of functional communication (the Communicative Effectiveness Index), and two instruments examining the psychosocial impact of aphasia (the Stroke and Aphasia Quality of Life questionnaire and the Aphasia Impact Questionnaire) revealed good convergent validity (all ps< .05). Results showed good known – groups validity (Mann-Whitney U = 96.5, p < .001), with significantly higher scores for participants without aphasia compared to those with aphasia. Conclusions: The psychometric qualities of The Scenario Test-GR support the reliability and validity of the tool for the assessment of functional communication for Greek-speaking PWA. The Scenario Test-GR can be used to assess multimodal functional communication, orient aphasia rehabilitation goal setting towards the activity and participation level, and be used as an outcome measure of everyday communication. Future studies will focus on the measurement of sensitivity to change in PWA with severe non-fluent aphasia.

Keywords: the scenario test GR, functional communication assessment, people with aphasia (PWA), tool validation

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Authors: Ambissah Asah Brigitte

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This research is guided by observations in the types of education offered at the secondary level in Cameroon. The secondary education system in Cameroon comprises two types of education, including General Education and Technical and Vocational Education. Although General Education and, Technical and Vocational Education are given equal importance by public authorities, General Education remains on the thriving trend, enjoying the greatest enrolment. In the meantime, Technical and Vocational Education is still to reach the adequate momentum expected to fostering the country’s full-fledged development, as specified in the National Development Strategy, which is the blue print of State policies in Cameroon for the 2020-2030 decade. Vocational Education is credited for its ability to foster a country’s development, since it teaches students the precise skills and knowledge needed to carry out a specific craft, technical skill or trade. Yet, formal training on Vocational Education for teachers offers a pale face in secondary education. This limits the ability of the educational system to nurture vocations and provide the country’s economy with the manpower necessary to achieving development goals. This article seeks to analyse how concretely does the institutional framework spur vocational skills in secondary school teachers. It overviews the instruments instituting Vocational Education at the secondary level in Cameroon, then assesses their effective implementation on the ground. Questionnaires addressed to both active teachers and vocational education policy-makers serve to collect data which are analysed using descriptive statistics. The final objective is to contribute in the debate urging to rethink the role of teachers in bolstering Vocational Education, which is the cornerstone of industrial development. This is true everywhere in the world. In Cameroon and in Africa in general, teachers must be empowered in this field with specific sets of competencies they will need to pass on to learners. They equally need to be given opportunities to acquire and adapt their knowledge and teaching skills accordingly.

Keywords: vocational education, cameroon, institutional framework, national development, competencies and skills

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Authors: Fangfei Li

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Studies on teacher feedback have produced a wide range of findings in aspects of characteristics of good feedback, factors influencing the quality of feedback and teachers’ perspectives on teacher feedback. However, perspectives from students on how they perceive and respond to teacher feedback are still under scrutiny. Especially for Chinese overseas students who come from a feedback-sparse educational context in China, they might have different experiences when engaging with teacher feedback in the UK Higher Education. Therefore, the research aims to investigate and shed some new light on how Chinese students engage with teacher feedback in the UK higher education and how teacher feedback could enhance their learning. Research questions of this study are 1) What are Chinese overseas students’ perceptions of teacher feedback in courses of the UK higher education? 2) How do they respond to the teacher feedback they obtained? 3) What factors might influence their’ engagement with teacher feedback? Qualitative case studies of five Chinese postgraduate students in a UK university have been conducted by employing various types of interviews, such as background interviews, scenario-based interviews, stimulated recall interviews and retrospective interviews to address the research inquiries. Data collection lasted seven months, covering two phases – the pre-sessional language programme and the first semester of the Master’s degree programme. Research findings until now indicate that some factors, such as tutors’ handwriting, implicit instruction and value comments, influence students understanding and internalizing tutor feedback. Except for difficulties in understanding tutor feedback, students’ responses to tutor feedback are also influenced by quantity and quality of tutor-student communication, time constraints and trust to tutor feedback, etc. Findings also reveal that tutor feedback is able to improve students’ learning in aspects of promoting reflection on professional knowledge, promoting students’ communication with peers and tutors, increasing problem awareness and writing with the reader in mind. This paper will mainly introduce the research topic, the methodological procedure and research findings gained until now.

Keywords: Chinese students, students’ perceptions, teacher feedback, the UK higher education

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Authors: Monika Foltyn-Zarychta

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Climate change mitigation investment activities are inevitably extended in time extremely. The project cycle does not last for decades – sometimes it stretches out for hundreds of years and the project outcomes impact several generations. The longevity of those activities raises multiple problems in the appraisal procedure. One of the pivotal issues is the choice of the discount rate, which affect tremendously the net present value criterion. The paper aims at estimating the value of social discount rate for intergenerational investment projects in Poland based on individual intertemporal preferences. The analysis is based on questionnaire surveying Polish citizens and designed as contingent valuation method. The analysis aimed at answering two questions: 1) whether the value of the individual discount rate decline with increased time of delay, and 2) whether the value of the individual discount rate changes with increased spatial distance toward the gainers of the project. The valuation questions were designed to identify respondent’s indifference point between lives saved today and in the future due to hypothetical project mitigating climate changes. Several project effects’ delays (of 10, 30, 90 and 150 years) were used to test the decline in value with time. The variability in regard to distance was tested by asking respondents to estimate their indifference point separately for gainers in Poland and in Latvia. The results show that as the time delay increases, the average discount rate value decreases from 15,32% for 10-year delay to 2,75% for 150-year delay. Similar values were estimated for Latvian beneficiaries. There should be also noticed that the average volatility measured by standard deviation also decreased with time delay. However, the results did not show any statistically significant difference in discount rate values for Polish and Latvian gainers. The results showing the decline of the discount rate with time prove the possible economic efficiency of the intergenerational effect of climate change mitigation projects and may induce the assumption of the altruistic behavior of present generation toward future people. Furthermore, it can be backed up by the same discount rate level declared by Polish for distant in space Latvian gainers. The climate change activities usually need significant outlays and the payback period is extremely long. The more precise the variables in the appraisal are, the more trustworthy and rational the investment decision is. The discount rate estimations for Poland add to the vivid discussion concerning the issue of climate change and intergenerational justice.

Keywords: climate change, social discount rate, investment appraisal, intergenerational justice

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Authors: Luís Rocha, Adam Gąska, Enrico Savio, Michael Marxer, Christoph Battaglia

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The changes observed in the last years in the field of manufacturing and production engineering, popularly known as "Fourth Industry Revolution", utilizes the achievements in the different areas of computer sciences, introducing new solutions at almost every stage of the production process, just to mention such concepts as mass customization, cloud computing, knowledge-based engineering, virtual reality, rapid prototyping, or virtual models of measuring systems. To effectively speed up the production process and make it more flexible, it is necessary to tighten the bonds connecting individual stages of the production process and to raise the awareness and knowledge of employees of individual sectors about the nature and specificity of work in other stages. It is important to discover and develop a suitable education method adapted to the specificities of each stage of the production process, becoming an extremely crucial issue to exploit the potential of the fourth industrial revolution properly. Because of it, the project “Train4Dim” (T4D) intends to develop complex training material for digital manufacturing, including content for design, manufacturing, and quality control, with a focus on coordinate metrology and portable measuring systems. In this paper, the authors present an approach to using an active learning methodology for digital manufacturing. T4D main objective is to develop a multi-degree (apprenticeship up to master’s degree studies) and educational approach that can be adapted to different teaching levels. It’s also described the process of creating the underneath methodology. The paper will share the steps to achieve the aims of the project (training model for digital manufacturing): 1) surveying the stakeholders, 2) Defining the learning aims, 3) producing all contents and curriculum, 4) training for tutors, and 5) Pilot courses test and improvements.

Keywords: learning, Industry 4.0, active learning, digital manufacturing

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Authors: Nádia Pereira, Paula Ferreira, Sofia Francisco, Sofia Oliveira, Sidclay Souza, Paula Paulino, Ana Margarida Veiga Simão

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Social media has progressed into a platform for hate speech among its users, and thus, there is an increasing need to develop automatic detection classifiers of offense and conflicts to help decrease the prevalence of such incidents. Online communication can be used to intentionally harm someone, which is why such classifiers could be essential in social networks. A possible application of these classifiers is the automatic detection of cyberbullying. Even though identifying the aggressive language used in online interactions could be important to build cyberbullying datasets, there are other criteria that must be considered. Being able to capture the language, which is indicative of the intent to harm others in a specific context of online interaction is fundamental. Offense and hate speech may be the foundation of online conflicts, which have become commonly used in social media and are an emergent research focus in machine learning and natural language processing. This study presents two Portuguese language offense-related datasets which serve as examples for future research and extend the study of the topic. The first is similar to other offense detection related datasets and is entitled Aggressiveness dataset. The second is a novelty because of the use of the history of the interaction between users and is entitled the Conflicts/Attacks dataset. Both datasets were developed in different phases. Firstly, we performed a content analysis of verbal aggression witnessed by adolescents in situations of cyberbullying. Secondly, we computed frequency analyses from the previous phase to gather lexical and linguistic cues used to identify potentially aggressive conflicts and attacks which were posted on Twitter. Thirdly, thorough annotation of real tweets was performed byindependent postgraduate educational psychologists with experience in cyberbullying research. Lastly, we benchmarked these datasets with other machine learning classifiers.

Keywords: aggression, classifiers, cyberbullying, datasets, hate speech, machine learning

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Authors: Farah Naja, Nahla Hwalla, Leila Itani, Shirine Baalbaki, Abla Sibai, Lara Nasreddine

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Purpose: To propose an index for assessing adherence to a Middle-Eastern version of the Mediterranean diet as represented by the traditional Lebanese Mediterranean diet (LMD), to evaluate the association between the LMD and selected European Mediterranean diets (EMD); to examine socio-demographic and lifestyle correlates of adherence to Mediterranean diet (MD) among Lebanese adults. Methods: Using nationally representative dietary intake data of Lebanese adults, an index to measure adherence to the LMD was derived. The choice of food groups used for calculating the LMD score was based on results of previous factor analyses conducted on the same dataset. These food groups included fruits, vegetables, legumes, olive oil, burghol, dairy products, starchy vegetables, dried fruits, and eggs. Using Pearson’s correlation and scores tertiles distributions agreement, the derived LMD index was compared to previously published EMD indexes from Greece, Spain, Italy, France, and EPIC. Results: Fruits, vegetables and olive oil were common denominators to all MD scores. Food groups, specific to the LMD, included burghol and dried fruits. The LMD score significantly correlated with the EMD scores, while being closest to the Italian (r=0.57) and farthest from the French (r=0.21). Percent agreement between scores’ tertile distributions and Kappa statistics confirmed these findings. Multivariate linear regression showed that older age, higher educational, female gender, and healthy lifestyle characteristics were associated with increased adherence to all MD studied. Conclusion: A novel LMD index was proposed to characterize Mediterranean diet in Lebanon, complementing international efforts to characterize the MD and its association with disease risk.

Keywords: mediterranean diet, adherence, Middle-East, Lebanon, Europe

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Authors: Abdela Zeinu Yasin

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The current research aimed to assess the status of IMC in providing treatment for malnourished children and programs in water, sanitation, and hygiene (WASH), food and livelihood security, and comprehensive healthcare through Mobile health and nutrition programs during the last 5 years period. We have conducted 60 in-depth interviews with women during the period from conception to a child’s birthday, health facility staff, and female community health volunteers (FCHVs), as well as 12 focus group discussions with health facility staff and other household decision-makers. We employed thematic analysis using framework matrices and analytical memorandums. The study revealed that 78% of the respondents, of whom 97% were women, have benefited from the selected vulnerable areas. The use of the clear water and sanitization program has reached the 81% of selected households. The use of a modern baby delivery system among the respondent has been 68% of the women and health facilities among the decision-makers/focal person. More than 8 in 10 participants (84%) could read and understand the health facility instructions, and the majority (82%) of women, health facility staff, and male decision-makers can also read and write bulletins and instructions. We found that decision-maker women preferred participative education, whereas health facilities and the IMC desired educational and motivational bulletins. A Mobile Health and Nutrition program intervention by the IMC is acceptable in the conditions of the Ethiopian community and has the potential to improve community health and nutrition service utilization, particularly by providing clean water and sanitization; women’s birth control, and health improvement in the vulnerable regions of the country. The current research findings shall contribute to text IMC Mobile Health and Nutritional intervention design in under-resourced settings.

Keywords: clean water, health and nutrition services, hygiene, IMC, mobile health, sanitation

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Authors: Michael Ryan, Rosemary E. Borgerding, Kimberly L. Oliver

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The objective of this study was to assess the effectiveness of a sports nutrition intervention on body composition in high-school athletes. The study aimed to improve the food and water intake of high-school athletes, evaluate the cost-effectiveness of the intervention, and assess changes in body fat. Data were collected through observations, questionnaires, and interviews. Additionally, bioelectrical impedance analysis was performed to assess the body composition of athletes both before and after the intervention. Athletes (n=25) participated in researcher-monitored training sessions three times a week over the course of 12 weeks. During these sessions, in addition to completing their auxiliary sports training, participants were exposed to educational interventions aimed at improving their nutrition. These included discussions regarding current eating habits, nutritional guidelines for athletes, and individualized recommendations. Food was also made available to athletes for consumption before and after practice. Meals of balanced macronutrient composition were prepared and provided to athletes on four separate occasions throughout the intervention, either prior to or following a competitive event such as a tournament or game. A paired t-test was used to determine the statistical significance of the changes in body fat percentage. The results showed that there was a statistically significant difference between pre and post-intervention body fat percentage (p= .006). Cohen's d of 0.603 was calculated, indicating a moderate effect size. In conclusion, this study provides evidence that a sports nutrition intervention that combines food availability, explicit prescription, and education can be effective in improving the body composition of high-school athletes. However, it's worth noting that this study had a small sample size, and the conclusions cannot be generalized to a larger population. Further research is needed to assess the scalability of this study. This preliminary study demonstrated the feasibility of this type of nutritional intervention and laid the groundwork for a larger, more extensive study to be conducted in the future.

Keywords: bioelectrical impedance, body composition, high-school athletes, sports nutrition, sports pedagogy

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Authors: Haoming Ma, Guo Yu, Peiru Zhou

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Background: Previous studies show that dysglycemia, mostly hyperglycemia, hypoglycemia and glycemic variability(GV), are associated with excess mortality in critically ill patients, especially those without diabetes. Glycemic variability is an increasingly important measure of glucose control in the intensive care unit (ICU) due to this association. However, there is limited data pertaining to the relationship between different clinical factors and glycemic variability and clinical outcomes categorized by their DM status. This retrospective study of 958 intensive care unit(ICU) patients was conducted to investigate the relationship between GV and outcome in critically ill patients and further to determine the significant factors that contribute to the glycemic variability. Aim: We hypothesize that the factors contributing to mortality and the glycemic variability are different from critically ill patients with or without diabetes. And the primary aim of this study was to determine which dysglycemia (hyperglycemia\hypoglycemia\glycemic variability) is independently associated with an increase in mortality among critically ill patients in different groups (DM/Non-DM). Secondary objectives were to further investigate any factors affecting the glycemic variability in two groups. Method: A total of 958 diabetic and non-diabetic patients with severe diseases in the ICU were selected for this retrospective analysis. The glycemic variability was defined as the coefficient of variation (CV) of blood glucose. The main outcome was death during hospitalization. The secondary outcome was GV. The logistic regression model was used to identify factors associated with mortality. The relationships between GV and other variables were investigated using linear regression analysis. Results: Information on age, APACHE II score, GV, gender, in-ICU treatment and nutrition was available for 958 subjects. Predictors remaining in the final logistic regression model for mortality were significantly different in DM/Non-DM groups. Glycemic variability was associated with an increase in mortality in both DM(odds ratio 1.05; 95%CI:1.03-1.08,p＜0.001) or Non-DM group(odds ratio 1.07; 95%CI:1.03-1.11,p=0.002). For critically ill patients without diabetes, factors associated with glycemic variability included APACHE II score(regression coefficient, 95%CI:0.29,0.22-0.36,p＜0.001), Mean BG(0.73,0.46-1.01,p＜0.001), total parenteral nutrition(2.87,1.57-4.17,p＜0.001), serum albumin(-0.18,-0.271 to -0.082,p＜0.001), insulin treatment(2.18,0.81-3.55,p=0.002) and duration of ventilation(0.006,0.002-1.010,p=0.003).However, for diabetes patients, APACHE II score(0.203,0.096-0.310,p＜0.001), mean BG(0.503,0.138-0.869,p=0.007) and duration of diabetes(0.167,0.033-0.301,p=0.015) remained as independent risk factors of GV. Conclusion: We found that the relation between dysglycemia and mortality is different in the diabetes and non-diabetes groups. And we confirm that GV was associated with excess mortality in DM or Non-DM patients. Furthermore, APACHE II score, Mean BG, total parenteral nutrition, serum albumin, insulin treatment and duration of ventilation were significantly associated with an increase in GV in Non-DM patients. While APACHE II score, mean BG and duration of diabetes (years) remained as independent risk factors of increased GV in DM patients. These findings provide important context for further prospective trials investigating the effect of different clinical factors in critically ill patients with or without diabetes.

Keywords: diabetes, glycemic variability, predictors, severe disease

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Authors: Santiago Quesada-García, María Lozano-Gómez, Pablo Valero-Flores

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The recent digital revolution, together with modern technologies, is changing the environment and the way people interact with inhabited space. However, in society, the elderly are a very broad and varied group that presents serious difficulties in understanding these modern technologies. Outpatients with cognitive disabilities, such as those suffering from Alzheimer's disease (AD), are distinguished within this cluster. This population group is in constant growth, and they have specific requirements for their inhabited space. According to architecture, which is one of the health humanities, environments are designed to promote well-being and improve the quality of life for all. Buildings, as well as the tools and technologies integrated into them, must be accessible, inclusive, and foster health. In this new digital paradigm, artificial intelligence (AI) appears as an innovative resource to help this population group improve their autonomy and quality of life. Some experiences and solutions, such as those that interact with users through chatbots and voicebots, show the potential of AI in its practical application. In the design of healthy spaces, the integration of AI in architecture will allow the living environment to become a kind of 'exo-brain' that can make up for certain cognitive deficiencies in this population. The objective of this paper is to address, from the discipline of neuroarchitecture, how modern technologies can be integrated into everyday environments and be an accessible resource for people with cognitive disabilities. For this, the methodology has a mixed structure. On the one hand, from an empirical point of view, the research carries out a review of the existing literature about the applications of AI to build space, following the critical review foundations. As a unconventional architectural research, an experimental analysis is proposed based on people with AD as a resource of data to study how the environment in which they live influences their regular activities. The results presented in this communication are part of the progress achieved in the competitive R&D&I project ALZARQ (PID2020-115790RB-I00). These outcomes are aimed at the specific needs of people with cognitive disabilities, especially those with AD, since, due to the comfort and wellness that the solutions entail, they can also be extrapolated to the whole society. As a provisional conclusion, it can be stated that, in the immediate future, AI will be an essential element in the design and construction of healthy new environments. The discipline of architecture has the compositional resources to, through this emerging technology, build an 'exo-brain' capable of becoming a personal assistant for the inhabitants, with whom to interact proactively and contribute to their general well-being. The main objective of this work is to show how this is possible.

Keywords: Alzheimer’s disease, artificial intelligence, healthy architecture, neuroarchitecture, architectural design

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Authors: Muhammad Irfan

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The rise of radicalization within Islam has spawned a new era of global terror. The battlefield Successes of ISIS and the Taliban are fuelled by an ideological war waged, largely and successfully, in the media arena. This research will examine how Islamic extremist groups are using media modalities and populist narratives to influence migrant Muslim populations in Europe towards extremism. In 2014, ISIS shocked the world in exporting horrifically graphic forms of violence on social media. Their Muslim support base was largely disgusted and reviled. In response, they reconfigured their narrative by introducing populist 'hooks', astutely portraying the Muslim populous as oppressed and exploited by unjust, corrupt autocratic regimes and Western power structures. Within this crucible of real and perceived oppression, hundreds of thousands of the most desperate, vulnerable and abused migrants left their homelands, risking their lives in the hope of finding peace, justice, and prosperity in Europe. Instead, many encountered social stigmatization, detention and/or discrimination for being illegal migrants, for lacking resources and for simply being Muslim. This research will examine how Islamic extremist groups are exploiting the disenfranchisement of these migrant populations and using populist messaging on social media to influence them towards violent extremism. ISIS, in particular, formulates specific encoded messages for newly-arriving Muslims in Europe, preying upon their vulnerability. Violence is posited, as a populist response, to the tyranny of European oppression. This research will analyze the factors and indicators which propel Muslim migrants along the spectrum from resilience to violence extremism. Expected outcomes are identification of factors which influence vulnerability towards violent extremism; an early-warning detection framework; predictive analysis models; and de-radicalization frameworks. This research will provide valuable tools (practical and policy level) for European governments, security stakeholders, communities, policy-makers, and educators; it is anticipated to contribute to a de-escalation of Islamic extremism globally.

Keywords: populism, radicalization, de-radicalization, social media, ISIS, Taliban, shariah, jihad, Islam, Europe, political communication, terrorism, migrants, refugees, extremism, global terror, predictive analysis, early warning detection, models, strategic communication, populist narratives, Islamic extremism

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Authors: Christine Lassen, Elizabeth Leonard, Matthew Oliver

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The management of trauma is often complex and outcomes dependent on clinical expertise, effective teamwork, and a supported trauma system. The implementation of a statewide trauma education program should be accessible to all clinicians who manage trauma, but this can be challenging due to diverse individual needs, trauma service needs and geography. The NSW Institute of Trauma and Injury Management (ITIM) is a government funded body, responsible for coordinating and supporting the NSW Trauma System. The aim of this presentation is to describe how education initiatives have been implemented across the state. Simulation: In 2006, ITIM developed a Trauma Team Training Course - aimed to educate clinicians on the technical and non-technical skills required to manage trauma. The course is now independently coordinated by trauma services across the state at major trauma centres as well as in regional and rural hospitals. ITIM is currently in the process of re-evaluating and updating the Trauma Team Training Course to allow for the development of new resources and simulation scenarios. Trauma Education Evenings: In 2013, ITIM supported major trauma services to develop trauma education evenings which allowed the provision of free education to staff within the area health service and local area. The success of these local events expanded to regional hospitals. A total of 75 trauma education evenings have been conducted within NSW, with over 10,000 attendees. Wed-Based Resources: Recently, ITIM commenced free live streaming of the trauma education evenings which have now had over 3000 live views. The Trauma App developed in 2015 provides trauma clinicians with a centralised portal for trauma information and works on smartphones and tablets that integrate with the ITIM website. This supports pre-hospital and bedside clinical decisions and allows for trauma care to be more standardised, evidence-based, timely, and appropriate. Online e-Learning modules have been developed to assist clinicians, reduce unwarranted clinical variation and provide up to date evidence based education. The modules incorporate clinically focused education content with summative and formative assessments. Conclusion: Since 2005, ITIM has helped to facilitate the development of trauma education programs for doctors, nurses, pre-hospital and allied health clinicians. ITIM has been actively involved in more than 100 specialized trauma education programs, seminars and clinical workshops - attended by over 12,000 staff. The provision of state-wide trauma education is a challenging task requiring collaboration amongst numerous agencies working towards a common goal – to provide easily accessible trauma education.

Keywords: education, simulation, team-training, trauma

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Authors: Nicholas McNamara, John Brookes, Michael Williams, Manish Mathew, Elizabeth Brookes, Tristan Yan, Paul Bannon

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Objective: Pericardial effusions are an uncommon but potentially fatal complication after cardiac surgery. The goal of this study was to describe the incidence and risk factors associated with the development of pericardial effusion requiring drainage after coronary artery bypass graft surgery (CABG). Methods: A retrospective analysis was undertaken using prospectively collected data. All adult patients who underwent CABG at our institution between 1st January 2017 and 31st December 2018 were included. Pericardial effusion was diagnosed using transthoracic echocardiography (TTE) performed for clinical suspicion of pre-tamponade or tamponade. Drainage was undertaken if considered clinically necessary and performed via a sub-xiphoid incision, pericardiocentesis, or via re-sternotomy at the discretion of the treating surgeon. Patient demographics, operative characteristics, anticoagulant exposure, and postoperative outcomes were examined to identify those variables associated with the development of pericardial effusion requiring drainage. Tests of association were performed using the Fischer exact test for dichotomous variables and the Student t-test for continuous variables. Logistic regression models were used to determine univariate predictors of pericardial effusion requiring drainage. Results: Between January 1st, 2017, and December 31st, 2018, a total of 408 patients underwent CABG at our institution, and eight (1.9%) required drainage of pericardial effusion. There was no difference in age, gender, or the proportion of patients on preoperative therapeutic heparin between the study and control groups. Univariate analysis identified preoperative atrial arrhythmia (37.5% vs 8.8%, p = 0.03), reduced left ventricular ejection fraction (47% vs 56%, p = 0.04), longer cardiopulmonary bypass (130 vs 84 min, p < 0.01) and cross-clamp (107 vs 62 min, p < 0.01) times, higher drain output in the first four postoperative hours (420 vs 213 mL, p <0.01), postoperative atrial fibrillation (100% vs 32%, p < 0.01), and pleural effusion requiring drainage (87.5% vs 12.5%, p < 0.01) to be associated with development of pericardial effusion requiring drainage. Conclusion: In this study, the incidence of pericardial effusion requiring drainage was 1.9%. Several factors, mainly related to preoperative or postoperative arrhythmia, length of surgery, and pleural effusion requiring drainage, were identified to be associated with developing clinically significant pericardial effusions. High clinical suspicion and low threshold for transthoracic echo are pertinent to ensure this potentially lethal condition is not missed.

Keywords: coronary artery bypass, pericardial effusion, pericardiocentesis, tamponade, sub-xiphoid drainage

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Authors: Xiao Wang, Qinge Zhang

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Background: This randomized, open-label study examined the therapeutic effects of computerized cognitive training (CCT) combined with selective serotonin reuptake inhibitors (SSRIs) on cognitive impairment among patients with late-life depression (LLD). Method: Study data were collected from May 5, 2021, to April 21, 2023. Outpatients who met diagnostic criteria for major depressive disorder according to the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria (i.e., a total score on the 17-item Hamilton Depression Rating Scale (HAMD-17) ≥ 18 and a total score on the Montreal Cognitive Assessment scale (MOCA) <26) were randomly assigned to receive up to 12 weeks of CCT and SSRIs treatment (n=57) or SSRIs and Control treatment (n=61). The primary outcome was the change in Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) scores from baseline to week 12 between the two groups. The secondary outcomes included changes in the HAMD-17 score, Hamilton Anxiety Scale (HAMA) score and Neuropsychiatric Inventory (NPI) score. Mixed model repeated measures (MMRM) analysis was performed on modified intention-to-treat (mITT) and completer populations. Results: The full analysis set (FAS) included 118 patients (CCT and SSRIs group, n=57; SSRIs and Control group, n =61). Over the 12-week study period, the reduction in the ADAS-cog total score was significant (P < 0.001) in both groups, while MMRM analysis revealed a significantly greater reduction in cognitive function (ADAS-cog total scores) from baseline to posttreatment in the CCT and SSRIs group than in the SSRI and Control group [(F (1,115) =13.65, least-squares mean difference [95% CI]: −2.77 [−3.73, −1.81], p<0.001)]. There were significantly greater improvements in depression symptoms (measured by the HAMD-17) in the CCT and SSRIs group than in the control group [MMRM, estimated mean difference (SE) between groups −3.59 [−5.02, −2.15], p < 0.001]. The least-squares mean changes in the HAMA scores and NPI scores between baseline and week 8 were greater in the CCT and SSRIs group than in the control group (all P < 0.05). There was no significant difference between groups on response rates and remission rates by using the last-observation-carried-forward (LOCF) method (all P > 0.05). The most frequent adverse events (AEs) in both groups were dry mouth, somnolence, and constipation. There was no significant difference in the incidence of adverse events between the two groups. Conclusions: CCT combined with SSRIs was efficacious and well tolerated in LLD patients with cognitive impairment.

Keywords: late-life depression, cognitive function, computerized cognitive training, SSRIs

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Authors: Azzah Alghamdi

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The Interactive White Boards (IWBs) as one of the innovative educational technologies have been extensively investigated in advanced countries such as the UK, US, and Australia. However, there is a significant lack of research studies, which mainly examine the use of IWBs in Saudi Arabia. Therefore, this study aims to investigate the attitudes of primary teachers towards using IWBs in both the teaching and learning processes. Moreover, it aims to investigate if there is any significant difference between male teachers and females regarding their attitudes towards using this technology. This study concentrated on teachers in primary schools, which participated in Tatweer project in the city of Jeddah, in Saudi Arabia. Mixed methods approach was employed in this study using a designed questionnaire, classroom observations, and a semi-structured interview. 587 teachers (286 men and 301 women) from Tatweer primary schools were completed the questionnaire as well as twenty teachers were interviewed including seven female teachers were observed in their classrooms. The findings of this study indicated that approximately 11% of the teachers within the sample (n=587) had negative attitudes towards the use of IWBs in the teaching and learning processes. However, the majority of them nearly 89% agreed about the benefits of using IWBs in their classrooms. Additionally, all the twenty teachers who were interviewed (including the seven observed female teachers) had positive attitudes towards the use of these technologies. Moreover, 87% of male teachers and 91% of female teachers who completed the questionnaire accepted the usefulness of using IWBs in improving their teaching and students' learning. Thus, this indicates that there was no significant difference between male and female teachers in Tatweer primary schools in terms of their views about using these innovative technologies in their lessons. The findings of the current study will help the Ministry of Education to improve the policies of using IWBs in Saudi Arabia. Indeed, examining teachers’ attitudes towards IWBs is a very important issue because they are the main users in classrooms. Hence, their views should be considered to addressing the powers and boundaries of using IWBs. Moreover, students will feel comfortable to use IWBs if their teachers accept and use them well.

Keywords: IWBs, Saudi teachers’ views, Tatweer schools, teachers' gender

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Authors: Daniela Magalhaes, Jorge Pedro, Pedro Souteiro, Joao S. Neves, Sofia Castro-Oliveira, Vanessa Guerreiro, Rita Bettencourt- Silva, Maria M. Costa, Ana Varela, Joana Queiros, Paula Freitas, Davide Carvalho

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Introduction: Obesity is an independent risk factor for renal dysfunction. Our aims were: (1) evaluate the impact of bariatric surgery (BS) on renal function; (2) clarify the factors determining the postoperative evolution of the glomerular filtration rate (GFR); (3) access the occurrence of oxalate-mediated renal complications. Methods: We investigated a cohort of 1448 obese patients who underwent bariatric surgery. Those with basal GFR (GFR0) < 30mL/min or without information about the GFR 2-year post-surgery (GFR2) were excluded. Results: We included 725 patients, of whom 647 (89.2%) women, with 41 (IQR 34-51) years, a median weight of 112.4 (IQR 103.0-125.0) kg and a median BMI of 43.4 (IQR 40.6-46.9) kg/m2. Of these, 459 (63.3%) performed gastric bypass (RYGB), 144 (19.9%) placed an adjustable gastric band (AGB) and 122 (16.8%) underwent vertical gastrectomy (VG). At 2-year post-surgery, excess weight loss (EWL) was 60.1 (IQR 43.7-72.4) %. There was a significant improve of metabolic and inflammatory status, as well as a significant decrease in the proportion of patients with diabetes, arterial hypertension and dyslipidemia (p < 0.0001). At baseline, 38 (5.2%) of subjects had hyperfiltration with a GFR0 ≥ 125mL/min/1.73m2, 492 (67.9%) had a GFR0 90-124 mL/min/1.73m2, 178 (24.6%) had a GFR0 60-89 mL/min/1.73m2, and 17 (2.3%) had a GFR0 < 60 mL/min/1.73m2. GFR decreased in 63.2% of patients with hyperfiltration (ΔGFR=-2.5±7.6), and increased in 96.6% (ΔGFR=22.2±12.0) and 82.4% (ΔGFR=24.3±30.0) of the subjects with GFR0 60-89 and < 60 mL/min/1.73m2, respectively ( p < 0.0001). This trend was maintained when adjustment was made for the type of surgery performed. Of 321 patients, 10 (3.3%) had a urinary albumin excretion (UAE) > 300 mg/dL (A3), 44 (14.6%) had a UAE 30-300 mg/dL (A2) and 247 (82.1%) has a UAE < 30 mg/dL (A1). Albuminuria decreased after surgery and at 2-year follow-up only 1 (0.3%) patient had A3, 17 (5.6%) had A2 and 283 (94%) had A1 (p < 0,0001). In multivariate analysis, the variables independently associated with ΔGFR were BMI (positively) and fasting plasma glucose (negatively). During the 2-year follow-up, only 57 of the 725 patients had transient urinary excretion of calcium oxalate crystals. None has records of oxalate-mediated renal complications at our center. Conclusions: The evolution of GFR after BS seems to depend on the initial renal function, as it decreases in subjects with hyperfiltration, but tends to increase in those with renal dysfunction. Our results suggest that BS is associated with improvement of renal outcomes, without significant increase of renal complications. So, apart the clear benefits in metabolic and inflammatory status, maybe obese adults with nondialysis-dependent CKD should be referred for bariatric surgery evaluation.

Keywords: albuminuria, bariatric surgery, glomerular filtration rate, renal function

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Authors: Sanjeet Patra, Soham Roychowdhury

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In recent times, functionally graded dielectric elastomer (FGDE) has gained significant attention within the realm of soft actuation due to its dual capacity to exert highly localized stresses while maintaining its compliant characteristics on application of electro-mechanical loading. Nevertheless, the full potential of dielectric elastomer (DE) has not been fully explored due to their susceptibility to instabilities when subjected to electro-mechanical loads. As a result, study and analysis of such instabilities becomes crucial for the design and realization of dielectric actuators. Prismatic bifurcation is a type of instability that has been recognized in a DE tube. Though several studies have reported on the analysis for prismatic bifurcation in an isotropic DE tube, there is an insufficiency in studies related to prismatic bifurcation of FGDE tubes. Therefore, this paper aims to determine the onset of prismatic bifurcations on an incompressible FGDE tube when subjected to electrical loading across the thickness of the tube and internal pressurization. The analysis has been conducted by imposing two axial boundary conditions on the tube, specifically axially free ends and axially clamped ends. Additionally, the rigidity modulus of the tube has been linearly graded in the direction of thickness where the inner surface of the tube has a lower stiffness than the outer surface. The static equilibrium equations for deformation of the axisymmetric tube are derived and solved using numerical technique. The condition for prismatic bifurcation of the axisymmetric static equilibrium solutions has been obtained by using the linearized incremental constitutive equations. Two modes of bifurcations, corresponding to two different non-circular cross-sectional geometries, have been explored in this study. The outcomes reveal that the FGDE tubes experiences prismatic bifurcation before the Hessian criterion of failure is satisfied. It is observed that the lower mode of bifurcation can be triggered at a lower critical voltage as compared to the higher mode of bifurcation. Furthermore, the tubes with larger stiffness gradient require higher critical voltages for triggering the bifurcation. Moreover, with the increase in stiffness gradient, a linear variation of the critical voltage is observed with the thickness of the tube. It has been found that on applying internal pressure to a tube with low thickness, the tube becomes less susceptible to bifurcations. A thicker tube with axially free end is found to be more stable than the axially clamped end tube at higher mode of bifurcation.

Keywords: critical voltage, functionally graded dielectric elastomer, linearized incremental approach, modulus of rigidity, prismatic bifurcation

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Authors: Vanessa Castro, Liria H. Okuda, Daniela P. Chiebao, Adriana H. C. N. Romaldini, Harumi Hojo, Marina Grandi, Joao Paulo A. Silva, Alessandra F. C. Nassar

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The Biological Institute of Sao Paulo, in partnership with a private company, develops an Animal Health Family Farming Program (Prosaf) to enable communication among smallholder farmers and scientists, on-farm consulting and lectures, solving health questions that will benefit agricultural productivity. In Vale do Paraiba region, a dairy region of Sao Paulo State, southern Brazil, many of these types of farms are found with several milk quality problems. Most of these farms are profit-based business; however, with non-technified cattle rearing systems and uncertain veterinary assistance. Feedback from Prosaf showed that the biggest complaints from farmers were low milk production, sick animals and, mainly, loss of selling price due to a high somatic cell count (SCC) and a total bacterial count (TBC). The aims of this study were to improve milk quality, animal hygiene and herd health status by adjustments into general management practices and introducing techniques of sanitary control and milk monitoring in five dairy farms from Sao Jose do Barreiro municipality, Sao Paulo State, Brazil, to increase their profits. A total of 119 milk samples from 56 animals positive for California Mastitis Test (CMT) were collected. The positive CMT indicates subclinical mastitis, therefore laboratorial exams were performed in the milk (microbiological, biochemical and antibiogram test) detect the presence of Staphylococcus aureus (41.8%), Bacillus sp. (11.8%), Streptococcus sp. (2.1%), nonfermenting, motile and oxidase-negative Gram-negative Bacilli (2.1%) and Enterobacter (2.1%). Antibiograms revealed high resistance to gentamicin and streptomycin, probably due to indiscriminate use of antibiotics without veterinarian prescription. We suggested the improvement of hygiene management in the complete milking and cooling tanks system. Using the results of the laboratory tests, animals were properly treated, and the effects observed were better CMT outcomes, lower SCCs, and TBCs leading to an increase in milk pricing. This study will have a positive impact on the family farmers from Sao Paulo State dairy region by improving their market milk competitiveness.

Keywords: milk, family farming, food quality, antibiogram, profitability

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Authors: Gail Louw, Helena Boshoff, Taeksun Song, Clifton Barry

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Drug resistance in Mycobacterium tuberculosis is primarily attributed to mutations in target genes. These mutations incur a fitness cost and result in bacterial generations that are less fit, which subsequently acquire compensatory mutations to restore fitness. We hypothesize that mutations in specific drug target genes influence bacterial metabolism and cellular function, which affects its ability to develop subsequent resistance to additional agents. We aim to determine whether the sequential acquisition of drug resistance and specific mutations in a well-defined clinical M. tuberculosis strain promotes or limits the development of additional resistance. In vitro mutants resistant to pretomanid, linezolid, moxifloxacin, rifampicin and kanamycin were generated from a pan-susceptible clinical strain from the Beijing lineage. The resistant phenotypes to the anti-TB agents were confirmed by the broth microdilution assay and genetic mutations were identified by targeted gene sequencing. Growth of mono-resistant mutants was done in enriched medium for 14 days to assess in vitro fitness. Double resistant mutants were generated against anti-TB drug combinations at concentrations 5x and 10x the minimum inhibitory concentration. Subsequently, mutation frequencies for these anti-TB drugs in the different mono-resistant backgrounds were determined. The initial level of resistance and the mutation frequencies observed for the mono-resistant mutants were comparable to those previously reported. Targeted gene sequencing revealed the presence of known and clinically relevant mutations in the mutants resistant to linezolid, rifampicin, kanamycin and moxifloxacin. Significant growth defects were observed for mutants grown under in vitro conditions compared to the sensitive progenitor. Mutation frequencies determination in the mono-resistant mutants revealed a significant increase in mutation frequency against rifampicin and kanamycin, but a significant decrease in mutation frequency against linezolid and sutezolid. This suggests that these mono-resistant mutants are more prone to develop resistance to rifampicin and kanamycin, but less prone to develop resistance against linezolid and sutezolid. Even though kanamycin and linezolid both inhibit protein synthesis, these compounds target different subunits of the ribosome, thereby leading to different outcomes in terms of fitness in the mutants with impaired cellular function. These observations showed that oxazolidinone treatment is instrumental in limiting the development of multi-drug resistance in M. tuberculosis in vitro.

Keywords: oxazolidinones, mutations, resistance, tuberculosis

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Authors: Md. Mahamud Hassan, Shantanu Biswas Linkon, Nur Mohammad Khan

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Over the last three decades, the primary education system in Bangladesh has experienced significant improvement, but it has failed to cope with different social and cultural aspects, which present many challenges for children, families, and the public school system. Neglecting our own contextual learning environment, it is a matter of sorrow that much attention has been paid to the more physical outcome-focused model, which is nothing but mere infrastructural development, and less subtle to the environment that suits the child's psychology and improves their social, emotional, physical, and moral competency. In South Asia, the symbol of education was never the little red house of colonial architecture but “A Guru sitting under a tree", whereas a responsive and inclusive design approach could help to create more innovative learning environments. Such an approach incorporates how the built, natural, and cultural environment shapes the learner; in turn, learners shape the learning. This research will be conducted to, i) identify the major issues and drawbacks of government policy for primary education development programs; ii) explore and evaluate the morphology of the conventional model of school, and iii) propose an alternative model in a collaborative design process with the stakeholders for maximizing the relationship between the physical learning environments and learners by treating “the built environment” as “the third teacher.” Based on observation, this research will try to find out to what extent built, and natural environments can be utilized as a teaching tool for a more optimal learning environment. It should also be evident that there is a significant gap in the state policy, predetermined educational specifications, and implementation process in response to stakeholders’ involvement. The outcome of this research will contribute to a people-place sensitive design approach through a more thoughtful and responsive architectural process.

Keywords: built environment, conventional planning, indigenous learning space, responsive design

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Authors: Alejandro Arnaldo Barroso Martinez

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Unlike sex, which is constituted by anatomic-physiological differences, gender is a social construction. Our thoughts and behaviors as females and males are not etched in stone by our biology but rather from how society expects us to think and behave based on our sex assignment in the womb. Social expectations, values, and roles are taken on by individuals and shape the ways considered acceptable and linked to our bodies, feelings, and interpersonal relationships. Furthermore, these evolve into dire consequences for those who do not meet these disciplinary, economic, and cultural standards. Then, the social learning of gender identity implies the individual’s psychological sense of being, and it might be highly linked to a sense of life and suicide attempts. As a result, suicide has been considered a gender issue with differences in the rates and means used by men and women worldwide. Nevertheless, there has been a misunderstanding of the meaning of being male or female in a particular context and how it becomes a risk process for suicide attempts. For this reason, the general objective of the current research is to explain how this process occurs in Cuba. From a Critical Sociology and Social Psychology, a qualitative methodology was developed through six case studies and qualitative in-depth interviews. The analysis is focused on the sequence and interplay between two dimensions of meaning: signifiers and voices. Findings show that the risk process of suicide attempts in Cuba means some patriarchal beliefs and practices as part of informal educational models and some positivist practices in mental health attention. Findings also show that community relations create a sense of belonging, and it is a protection against suicide attempts in Cuba. Those frames of signifiers and voices explain in both males and females but differently when and how they are suffering from isolation, violence, the normalization of emotional awareness, and emotional distress expression. Suicide prevention programs should take gender learning into account as a cultural process.

Keywords: social constructions, gender identity, meanings, suicide attempt

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Authors: Reemiah Alotaibi, Muthu Ramachandran, Ah-Lian Kor, Amin Hosseinian-Far

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In the past decade, developers of Web 2.0 technologies have shown increasing interest in the topic of e-government. There has been a rapid growth in social media technology because of its significant role in backing up some essential social needs. Its importance and power is derived from its capacity to support two-way communication. Governments are curious to get engaged in these websites, hoping to benefit from the new forms of communication and interaction offered by such technology. Greater participation by the public can be viewed as a chief indicator of effective government communication. Yet, the level of public participation in government 2.0 is not quite satisfactory. In general, it is still at the early stage in most developing countries, including Saudi Arabia. Although it is a fact that Saudi people are among the most active in using social media, the number of people who use social media to communicate with the public institutions is not high. Furthermore, most of the governmental organisations are not using social media tools to communicate with the public. They use these platforms to disseminate information. Our study focuses on the factors affecting citizens’ adoption of social media in Saudi Arabia. Our research question is: what are the factors affecting Saudi citizens’ use of social media to communicate with the government? To answer this research question, the research aims to validate the UTAUT model for examining social media tools from the citizen perspective. An amendment will be proposed to fit the adoption of social media platforms as a communication channel in government by using a developed conceptual model which integrates constructs from the UTAUT model and others external variables based on the literature review. The set of potential factors that affect these citizens' decisions to adopt social media to communicate with their government has been identified as perceived encouragement, trust and cultural influence. The connection between the above-mentioned constructs from the basis for the research hypothesis will be examined in the light of a quantitative methodology. Data collection will be performed through a survey targeting a number of Saudi citizens who are social media users. The data collected from the primary survey will later be analysed by using statistical methods. The outcomes of this research project are argued to have potential contributions to the fields of social media and e-Government adoption, both on the theoretical and practical levels. It is believed that this research project is the first of its type that attempts to identify the factors that affect citizens’ adoption of social media to communicate with the government. The importance of identifying these factors stems from the potential use of them to enhance the government’s implementation of social media and help in making more accurate decisions and strategies based on comprehending the most important factors that affect citizens’ decisions.

Keywords: social media, adoption, citizen, UTAUT model

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Authors: Sanchir Erdenebayar, Namuuntsetseg Oyunbaatar

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Objectives: Peritoneal dialysis treatment is one of the important forms of kidney replacement therapy, and it has recently developed instantly in Mongolia for the past five years. Currently, more than 120 patients undergo peritoneal dialysis nationwide. These patients lack nutritional education, which predisposes them to protein deficiency and further impairs their quality of life. However, there is no study which is conducted among those about their dietary in Mongolia. Therefore, integrated nutrition information and educating them about dietary patterns to follow are urgently needed for PD patients. Methods: A cross-sectional study was carried out on 45 patients aged between 18 and 60 years who were undergoing CAPD at the biggest Medvic dialysis center in Ulaanbaatar. The knowledge of nutrition and food intake is assessed by interview based on a validated questionnaire prepared from KDIGO guidelines, semi-FFQ and a 24-hour dietary recall method. In addition, a biochemical blood test that includes total protein, albumin, calcium, phosphorus, potassium, and hemoglobin is used for an assessment of the patient’s current nutritional status. Results: Knowledge of nutritional status for CAPD was great, with 21.4% of patients and 78.65% having poor nutrition knowledge. The rate of mild to moderate malnutrition was 48.8% among research participants. Serum albumin was 38.4 ± 4.7 g/L, and total protein was 67.3±7.5g/l. Patients met 62.5± 26.5% of their daily intake nutritional requirement for calories and 72±40% of their nutritional requirement for protein. All patients’ energy intake was significantly /1328±304kcal/ lower than the energy requirement (2124±378kcal). Only 14.2% met the recommended dietary protein intake recommended to them of greater than 1.2 g/kg. Conclusions: As was established before, nutritional education has a vital positive impact on the health and nutritional status of peritoneal dialysis patients. The results of this study show that nutritional education programs are not enough adequate in peritoneal dialysis patients. There is a crucial priority to establish nutritional educational programs and guidelines for PD patients in Mongolia.

Keywords: renal diet, peritoneal dialysis, nutrition education, CKD diet

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Authors: Bibiana Hlebova

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The Slovak Republic is a democratic and plural society consisting of people differing in language and culture, and its citizens should already be well prepared for the coexistence of multiple nations, nationalities or ethnic groups. Reflection on culture, art and literature of the Roma minority has taken on a new dimension in Slovakia in the past two decades when it comes to social, cultural and arts integration of this ethnic group with the plural society. Non-Roma view Roma as a specific ethnic group with their own culture, language, customs and traditions, social norms and coexistence that has retained archetypal qualities of Roma identity (romipen) in their real lives as well as in the literary world. Roma characters in works of art are specific and distinguishable from other literary characters simply by being Roma, that is, of a different origin and social status, they represent a different way of life, a distinctive hierarchy of values. The portrayal of Roma and the life of Roma ethnic group in the most dominant genre of Roma literature for children and youth, a Roma fairy tale (paramisi), can work as a suitable means to learn about, accept and tolerate the otherness of Roma in the conditions of school inclusion of students coming from the Roma ethnic group, and to support their identification with their own ethnic group and its cultural traditions. The paper aims to point out not only the specific nature of Roma identity (romipen) through the selected Roma fairy tale (paramisa) – Children of the Sun, but also the diversity of its uses in the educational process within primary education of pupils at elementary schools, advocating the philosophy of inclusive education. Through the suggestions of multi-cultural, emotional, and language and communication education of pupils through the work with the selected Roma fairy tale (paramisa), the author is exploring ways to overcome the issues stemming from the coexistence of Roma and Non-Roma pupils, which are burdened with prejudice, intolerance, aggression and racism on both sides, in the education process.

Keywords: inclusive education, otherness, Roma, Roma fairy tale, Roma identity

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Authors: P. Uma Devi, S. Sujith, K. Rahul, T. S. Dipu, V. Anil Kumar , Vidya Menon

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Introduction: Candida is an important cause of bloodstream infections (BSIs), causing significant mortality and morbidity. The epidemiology of Candida infection is also changing, mainly in relation to the number of episodes caused by species Candida non-albicans. However, in India, the true burden of candidemia is not clear. Thus, this study was conducted to evaluate the clinical characteristics, species distribution, antifungal susceptibility and outcome of candidemia at our hospital. Methodology: Between January 2012 and April 2014, adult patients with at least one positive blood culture for Candida species were identified through the microbiology laboratory database (for each patient only the first episode of candidemia was recorded). Patient data was collected by retrospective chart review of clinical characteristics including demographic data, risk factors; species distribution, resistance to antifungals and survival. Results: A total of 165 episodes of Candida BSI were identified, with 115 episodes occurring in adult patients. Most of the episodes occurred in males (69.6%). Nearly 82.6% patients were between 41 to 80 years and majority of the patients were in the intensive care unit (65.2%) at the time of diagnosis. On admission, 26.1% and 18.3% patients had pneumonia and urinary tract infection, respectively. Majority of the candidemia episodes were found in the general medicine department (23.5%) followed by gastrointestinal surgery (13.9%) and medical oncology & haematology (13%). Risk factors identified were prior hospitalization within one year (83.5%), antibiotic therapy within the last one month (64.3%), indwelling urinary catheter (63.5%), central venous catheter use (59.1%), diabetes mellitus (53%), severe sepsis (45.2%), mechanical ventilation (43.5%) and surgery (36.5%). C. tropicalis (30.4%) was the leading cause of infection followed by C. parapsilosis (28.7%) and C. albicans (13%). Other non-albicans species isolated included C. haemulonii (7.8%), C. glabrata (7%), C. famata (4.3%) and C. krusei (1.7%). Antifungal susceptibility to fluconazole was 87.9% (C. parapsilosis), 100% (C. tropicalis) and 93.3% (C. albicans). Mortality was noted in 51 patients (44.3%). Early mortality (within 7 days) was noted in 32 patients while late mortality (between 7 and 30 days) was noted in 19 patients. Conclusion: In recent years, candidemia has been flourishing in critically ill patients. Comparison of data from our own hospital from 2005 shows a doubling of the incidence. Rapid changes in the rate of infection, potential risk factors, and emergence of non-albicans Candida demand continued surveillance of this serious BSI. High index of suspicion and sensitive diagnostics are essential to improve outcomes in resource limited settings with emergence of non-albicans Candida.

Keywords: antifungal susceptibility, candida albicans, candidemia, non-albicans candida

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Authors: Silas Webb, Joseph Hartland

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Background: Long-term retention of patients on ART has become a major health challenge in Sub-Saharan Africa (SSA). In 2010 a systematic review of 39 papers found that 30% of patients were no longer taking their ARTs two years after starting treatment. In the same review, it was noted that there was a paucity of data as to why patients become lost to follow-up (LTFU) in SSA. This project was performed in Mulanje Mission Hospital in Malawi as part of Swindon Academy’s Global Health eSSC. The HIV prevalence for Malawi is 10.3%, one of the highest rates in the world, however prevalence soars to 18% in the Mulanje. Therefore it is essential that patients at risk of being LTFU are identified early and managed appropriately to help them continue to participate in the service. Methodology: All patients on adult antiretroviral formulations at MMH, who were classified as ‘defaulters’ (patients missing a scheduled follow up visit by more than two months) over the last 12 months were included in the study. Demographic varibales were collected from Mastercards for data analysis. A comparison group of patients currently not lost to follow up was created by using all of the patients who attended the HIV clinic between 18th-22nd July 2016 who had never defaulted from ART. Data was analysed using the chi squared (χ²) test, as data collected was categorical, with alpha levels set at 0.05. Results: Overall, 136 patients had defaulted from ART over the past 12 months at MMH. Of these, 43 patients had missing Mastercards, so 93 defaulter datasets were analysed. In the comparison group 93 datasets were also analysed and statistical analysis done using Chi-Squared testing. A higher proportion of men in the defaulting group was noted (χ²=0.034) and defaulters tended to be younger (χ²=0.052). 94.6% of patients who defaulted were taking Tenofovir, Lamivudine and Efavirenz, the standard first line ART therapy in Malawi. The mean length of time on ART was 39.0 months (RR: -22.4-100.4) in the defaulters group and 47.3 months (RR: -19.71-114.23) in the control group, with a mean difference of 8.3 less months in the defaulters group (χ ²=0.056). Discussion: The findings in this study echo the literature, however this review expands on that and shows the demographic for the patient at most risk of defaulting and being LTFU would be: a young male who has missed more than 4 doses of ART and is within his first year of treatment. For the hospital, this data is important at it identifies significant areas for public health focus. For instance, fear of disclosure and stigma may be disproportionately affecting younger men, so interventions can be aimed specifically at them to improve their health outcomes. The mean length of time on medication was 8.3 months less in the defaulters group, with a p-value of 0.056, emphasising the need for more intensive follow-up in the early stages of treatment, when patients are at the highest risk of defaulting.

Keywords: anti-retroviral therapy, ART, HIV, lost to follow up, Malawi

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Authors: Abi Miller, Eleanor Wilson, Claire Diver

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Background: UK Head and Neck Cancer incidence and prevalence were rising related to better treatment outcomes and changed demographics. More people of working-age now survive Head and Neck Cancer. For individuals, work provides income, purpose, and social connection. For society, work increases economic productivity and reduces welfare spending. In the UK, a cancer diagnosis is classed as a disability and more disabled people leave the workplace than non-disabled people. Limited evidence exists on return-to-work after Head and Neck Cancer, with no UK qualitative studies. Head and Neck Cancer survivors appear to return to work less when compared to other cancer survivors. This study aimed to explore the effects of Head and Neck Cancer disability on survivors’ return-to-work experience. Methodologies: This was an exploratory qualitative study using a critical realist approach to carry out semi-structured one-off interviews with Head and Neck Cancer survivors who had returned to work. Interviews were informed by an interview guide and carried out remotely by Microsoft Teams or telephone. Interviews were transcribed verbatim, pseudonyms allocated, and transcripts anonymized. Data were interpreted using Reflexive Thematic Analysis. Findings: Thirteen Head and Neck Cancer survivors aged between 41 -63 years participated in interviews. Three major themes were derived from the data: changed identity and meaning of work after Head and Neck Cancer, challenging and supportive work experiences and impact of healthcare professionals on return-to-work. Participants described visible physical appearance changes, speech and eating challenges, mental health difficulties and psycho-social shifts following Head and Neck Cancer. These factors affected workplace re-integration, ability to carry out work duties, and work relationships. Most participants experienced challenging work experiences, including stigmatizing workplace interactions and poor communication from managers or colleagues, which further affected participant confidence and mental health. Many participants experienced job change or loss, related both to Head and Neck Cancer and living through a pandemic. A minority of participants experienced strategies like phased return, which supported workplace re-integration. All participants, bar one, wanted conversations with healthcare professionals about return-to-work but perceived these conversations as absent. Conclusion: All participants found returning to work after Head and Neck Cancer to be a challenging experience. This appears to be impacted by participant physical, psychological, and functional disability following Head and Neck Cancer, work interaction and work context.

Keywords: disability, experience, head and neck cancer, qualitative, return-to-work

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Authors: Mina Rabipour, Elena Pallaske, Floyd Hassenrück, Rocio Rebollido-Rios

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Protein tyrosine kinases, including Lyn kinase of the Src family kinases (SFK), regulate cell proliferation, survival, and differentiation. Lyn kinase has been implicated in various cancers, positioning it as a promising therapeutic target. However, the conserved ATP-binding pocket across SFKs makes developing selective inhibitors challenging. This study aims to address this limitation by exploring the potential for allosteric modulation of Lyn kinase, focusing on how its structural dynamics and specific oncogenic mutations impact its conformation and function. To achieve this, we combined homology modeling, molecular dynamics simulations, and data science techniques to conduct microsecond-length simulations. Our approach allowed a detailed investigation into the interplay between Lyn’s catalytic and regulatory domains, identifying key conformational states involved in allosteric regulation. Additionally, we evaluated the structural effects of Dasatinib, a competitive inhibitor, and ATP binding on Lyn active conformation. Notably, our simulations show that cancer-related mutations, specifically I364L/N and E290D/K, shift Lyn toward an inactive conformation, contrasting with the active state of the wild-type protein. This may suggest how these mutations contribute to aberrant signaling in cancer cells. We conducted a dynamical network analysis to assess residue-residue interactions and the impact of mutations on the Lyn intramolecular network. This revealed significant disruptions due to mutations, especially in regions distant from the ATP-binding site. These disruptions suggest potential allosteric sites as therapeutic targets, offering an alternative strategy for Lyn inhibition with higher specificity and fewer off-target effects compared to ATP-competitive inhibitors. Our findings provide insights into Lyn kinase regulation and highlight allosteric sites as avenues for selective drug development. Targeting these sites may modulate Lyn activity in cancer cells, reducing toxicity and improving outcomes. Furthermore, our computational strategy offers a scalable approach for analyzing other SFK members or kinases with similar properties, facilitating the discovery of selective allosteric modulators and contributing to precise cancer therapies.

Keywords: lyn tyrosine kinase, mutation analysis, conformational changes, dynamic network analysis, allosteric modulation, targeted inhibition

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Authors: Emrah Ayhan, Puspa Saananta Irfani, Ömer Doğukan Şahin

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Public services, which are important for the order and continuity of social life, have begun to transform into electronic services (E-service) with the development of information and communication technologies in recent years. In particular, as a result of the widespread use of the internet and the increase in citizen demands, it has become necessary to provide public services electronically. In addition to facilitating traditional public services, new types of e-services strengthen the interaction, cooperation, accessibility, transparency, citizen participation (e-governance) and accountability between citizens and the state. In this context, the factors in the literature that are considered to influence the citizens’ satisfaction towards e-services will be examined through the example of student satisfaction with the e-services (Anasis, Mergen, E-mail, library, cafeteria and other transactions) offered by Anadolu University (Eskişehir, Türkiye) through university website and mobile application. The data for the analysis will be obtained from the survey research that will be used to measure user satisfaction with university e-services of 1,000 students studying at 9 different faculties and graduate schools of Anadolu University. These data will be analyzed with a unique methodology that uses the E-GovQual model and Importance Performance Analysis (IPA) methods together. The e-GovQual model serves as a framework for evaluating the quality of e-services, allowing a detailed understanding of students' perceptions. On the other hand, the IPA method will be used to determine the performance level of Anadolu University in the provision of e-services and to understand the areas that require improvement and student expectations. Strategic goals and suggestions will be made to decision-makers, students, and researchers in line with the findings obtained in the research. Thus, it is planned to contribute to e-governance and user satisfaction in educational institutions and to reveal practical implications for optimizing online platforms to better serve student needs.

Keywords: e-service, Anadolu university, student satisfaction, e-governance, e-govqual, importance performance analysis

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