Search results for: advance care planning

Authors: Raeed Alanazi

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

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

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Authors: Tomas Premoli, Sareh Rowlands

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

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

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Authors: Homa Hedayat

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Public spaces have been a central concern of urban planners for centuries but have been neglected for a long time. In the modernist planning, the focus has been on the requirements of cars rather than the needs and expectations of pedestrians, and therefore, cities have lost many qualities. Urban public space is a space within the city area which is accessible to all people and is the ground for their activity. People’s public life occurs in urban public spaces in a complex set of forms and functions. These spaces must facilitate diverse behavior, uses, and activities such as shopping, walking, conversation, entertainment, relaxation or even passing the time during festivities and events. One of the public spaces is the surrounding space of public transportation stations. Subway stations, although potentially encompass many different groups of people accommodate few social interactions. Making the surrounding areas of subway stations pedestrian-oriented, potentially increases the socialization capacity. The Sadeghieh Subway Station can be considered as the most important subway station in Tehran, which on the one hand is the rail port of Tehran's western entrance, and on the other is the port for railway journeys inside the city. The main concern of this study is to assess the success or failure of the interventions made by the municipality for changing the surrounding area of the Sadeghieh Subway Station into a pedestrian-oriented space and examine the amount of the area's improvement into a desirable space. The method used in this study is surveying, in which the data were collected using a questionnaire and interview. The study's population is all people who use Sadeghieh Subway, and the sample size for the study was 140 subjects. Using parametric one-sample t-test, we found improvement in factors such as transportation, security, pedestrian infrastructure, vitality and climate comfort. However, there was no improvement in mix use, recreational activity, readability.

Keywords: public space, public transportation stations, pedestrian-oriented space, socialization

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

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

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

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Authors: Walter M. Millanzi, Stephen M. Kibusi

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Background: Currently, there has been a progressive shortage not only to the number but also the quality of medical practitioners for the most of nursing. Despite that, those who are present exhibit unethical and illegal practices, under standard care and malpractices. The concern is raised in the ways they are prepared, or there might be something missing in nursing curricula or how it is delivered. There is a need for transforming or testing new teaching modalities to enhance competent health workforces. Objective: to investigate the Effect of Facilitation in a Problem-based Environment (FPBE) on metacognition, self-directed learning and learning motivation to undergraduate nurse student in Tanzanian higher learning institutions. Methods: quasi-experimental study (quantitative research approach). A purposive sampling technique was employed to select institutions and achieving a sample size of 401 participants (interventional = 134 and control = 267). Self-administered semi-structured questionnaire; was the main data collection methods and the Statistical Package for Service Solution (v. 20) software program was used for data entry, data analysis, and presentations. Results: The pre-post test results between groups indicated noticeably significant change on metacognition in an intervention (M = 1.52, SD = 0.501) against the control (M = 1.40, SD = 0.490), t (399) = 2.398, p < 0.05). SDL in an intervention (M = 1.52, SD = 0.501) against the control (M = 1.40, SD = 0.490), t (399) = 2.398, p < 0.05. Motivation to learn in an intervention (M = 62.67, SD = 14.14) and the control (n = 267, M = 57.75), t (399) = 2.907, p < 0.01). A FPBE teaching pedagogy, was observed to be effective on the metacognition (AOR = 1.603, p < 0.05), SDL (OR = 1.729, p < 0.05) and Intrinsic motivation in learning (AOR = 1.720, p < 0.05) against conventional teaching pedagogy. Needless, was less likely to enhance Extrinsic motivation (AOR = 0.676, p > 0.05) and Amotivation (AOR = 0.538, p > 0.05). Conclusion and recommendation: FPBE teaching pedagogy, can improve student’s metacognition, self-directed learning and intrinsic motivation to learn among nurse students. Nursing curricula developers should incorporate it to produce 21st century competent and qualified nurses.

Keywords: facilitation, metacognition, motivation, self-directed

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Authors: Xin Li

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The uncertainty and the complexity of the urban environment combining with the threat of climate change are contributing factors to the vulnerability in multiple-dimensions in Chinese megacities, especially in Shanghai. The urban area occupied high valuable technological infrastructure and density buildings is under the threats of climate change and can provide insufficient ecological service to remain the trade-off on urban sustainable development. Urban ecological-based adaptation (UEbA) combines practices and theoretical work and integrates ecological services into multiple-layers of urban environment planning in order to reduce the impact of the complexity and uncertainty. To understand and to respond to the challenges in the urban level, this paper considers Shanghai as the research objective. It is necessary that its urban adaptation strategies should be reflected and contain the concept and knowledge of EbA. In this paper, we firstly use software to illustrates the visualizing patterns and trends of UEBA research in the current 10 years. Specifically, Citespace software was used for interpreting the significant hubs, landmarks points of peer-reviewed literature on the context of ecological service research in recent 10 years. Secondly, 135 evidence-based EbA literature were reviewed for categorizing the methodologies and framework of evidence-based EbA by the systematic map protocol. Finally, a conceptual framework combined with culture, economic and social components was developed in order to assess the current adaptation strategies in Shanghai. This research founds that the key to reducing urban vulnerability does not only focus on co-benefit arguments but also should pay more attention to the concept of trade-off. This research concludes that the designed framework can provide key knowledge and indicates the essential gap as a valuable tool against climate variability in the process of urban adaptation in Shanghai.

Keywords: urban ecological-based adaptation, climate change, sustainable development, climate variability

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

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

Keywords: curriculum, empathy, nursing, simulation

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Authors: Akhilesh Kumar, Sathyanarayan G., Nirmala S.

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An unusual approach is developed to determine the orbit of satellites/space objects. The determination of orbits is considered a boundary value problem and has been solved using the finite difference method (FDM). Only positions of the satellites/space objects are known at two end times taken as boundary conditions. The technique of finite difference has been used to calculate the orbit between end times. In this approach, the governing equation is defined as the satellite's equation of motion with a perturbed acceleration. Using the finite difference method, the governing equations and boundary conditions are discretized. The resulting system of algebraic equations is solved using Tri Diagonal Matrix Algorithm (TDMA) until convergence is achieved. This methodology test and evaluation has been done using all GPS satellite orbits from National Geospatial-Intelligence Agency (NGA) precise product for Doy 125, 2023. Towards this, two hours of twelve sets have been taken into consideration. Only positions at the end times of each twelve sets are considered boundary conditions. This algorithm is applied to all GPS satellites. Results achieved using FDM compared with the results of NGA precise orbits. The maximum RSS error for the position is 0.48 [m] and the velocity is 0.43 [mm/sec]. Also, the present algorithm is applied on the IRNSS satellites for Doy 220, 2023. The maximum RSS error for the position is 0.49 [m], and for velocity is 0.28 [mm/sec]. Next, a simulation has been done for a Highly Elliptical orbit for DOY 63, 2023, for the duration of 6 hours. The RSS of difference in position is 0.92 [m] and velocity is 1.58 [mm/sec] for the orbital speed of more than 5km/sec. Whereas the RSS of difference in position is 0.13 [m] and velocity is 0.12 [mm/sec] for the orbital speed less than 5km/sec. Results show that the newly created method is reliable and accurate. Further applications of the developed methodology include missile and spacecraft targeting, orbit design (mission planning), space rendezvous and interception, space debris correlation, and navigation solutions.

Keywords: finite difference method, grid generation, NavIC system, orbit perturbation

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

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

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

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Authors: Rajkumar Ghosh

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Urban flooding is a common occurrence throughout Asia. Almost every city is vulnerable to urban floods in some fashion, and city people are particularly vulnerable. Pluvial and fluvial flooding are the most prominent causes of urban flooding in the Gomti Nagar region of Lucknow, Uttar Pradesh, India. The pluvial flooding is regarded to be less damaging because it is caused by heavy rainfall, Seasonal rainfall fluctuations, water flows off concrete infrastructures, blockages of the drainage system, and insufficient drainage capacity or low infiltration capacity. However, this study considers pluvial flooding in Lucknow to be a significant source of cumulative damage over time, and the risks of such events are increasing as a result of changes in ageing infrastructure, hazard exposure, rapid urbanization, massive water logging and global warming. As a result, urban flooding has emerged as a critical field of study. The popularity of analytical approaches to project the spatial extent of flood dangers has skyrocketed. To address future urban flood resilience, more effort is needed to enhance both hydrodynamic models and analytical tools to simulate risks under present and forecast conditions. Proper urban planning with drainage system and ample space for high infiltration capacity are required to reduce urban flooding. A better India with no urban flooding is a pipe dream that can be realized by putting household rooftop rainwater collection systems in every structure. According to the current study, domestic RTRWHs are strongly recommended as an alternative source of water, as well as to prevent surface runoff and urban floods in this region of Lucknow, urban areas of India.

Keywords: rooftop rainwater harvesting, urban flood, pluvial flooding, fluvial flooding

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Authors: Peter Olasupo Ogunjuyigbe, Sarafa Shittu

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This paper emphasizes the relevance of conjugal relationship and spousal communication towards enhancing men’s involvement in contraceptive use among the Yorubas of South Western Nigeria. An understanding of males influence and the role they play in reproductive decision making can throw better light on mechanisms through which egalitarianness of husband/wife decision making influences contraceptive use. The objective of this study was to investigate how close conjugal relationships can be a good indicator of joint decision making among couples using data derived from a survey conducted in three states of South Western Nigeria. The study sample consisted of five hundred and twenty one (521) male respondents aged 15-59 years and five hundred and forty seven (547) female respondents aged 15-49 years. The study used both quantitative and qualitative approached to elicit information from the respondents. In order that the study would be truly representative of the towns, each of the study locations in the capital cities was divided into four strata: The traditional area, the migrant area, the mixed area (i.e. traditional and migrant), and the elite area. In the rural areas, selection of the respondents was by simple random sampling technique. However, the random selection was made in such a way that all the different parts of the locations were represented. Generally, the data collected were analysed at univariate, bivariate, and multivariate levels. Logistic regression models were employed to examine the interrelationships between male reproductive behaviour, conjugal relationship and contraceptive use. The study indicates that current use of contraceptive is high among this major ethnic group in Nigeria because of the improved level of communication among couples. The problem, however, is that men still have lower exposure rate when it comes to question of family planning information, education and counseling. This has serious implications on fertility regulation in Nigeria.

Keywords: behavior, conjugal, communication, counseling, spouse

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Authors: F. Sahnoune

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The study focuses on the analysis of the Algerian greenhouse gase emissions. In Algeria, as in other countries, the issue of greenhouse gas (GHG) emissions and climate change is the subject of great concern. As climate change is a global problem and taking into consideration the principle of 'common but differentiated responsibilities' as mentioned in the Rio Declaration in 1992, Algeria has initiated a broad program of voluntary reduction of GHG emissions and climate change adaptation. Thus although the contribution of Algeria on global warming is minimal (less than 0.5% of global GHG emissions), the country is, because its geographical position and climatic characteristics, very vulnerable and should integrate mitigation and adaptation into its development policy. Even a small rise in temperature would lead to various socio-economic problems that hinder the development of the country. The models predict that rainfall events are less frequent but more intense, while droughts are more common and longer. The decrease of water resources, declining agricultural yields, encroaching desert, the challenge of planning and the energy consumption for air conditioning are only the initial impacts to which Algeria must find answers supportable economically and socially. The study examines to what extent, Algeria can significantly reduce greenhouse gas emissions. We present an analysis of the current situation, trends in CO2 emissions, footprint of Algeria, national climate plan and especially what will be the impact on GHG emissions of the new strategy for promoting renewable energy adopted in 2011 and expects to produce 40% of electricity needs from solar energy. The results show that in 2012 the GHG emissions totaled 153 MT CO2 eq and growing at a rate of over 3%. The Introduction of solar energy in electricity production and implementation of energy efficiency allow to reduce by 2030 more than 300 MT CO2 eq. Avenues of consideration relating to a combination of policies and improved technologies that are able to reduce CO2 emissions and mitigate the impacts caused by climate change in the medium term will also be presented.

Keywords: climate change, co2 mitigation, greenhouse gases, renewable energy, sustainable development

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Authors: Lawrence Babatunde Ogunsanya

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The university has been in existence, in one form or another, for over a thousand years and has contributed in multiple ways to modern society. It is considered a center of culture, aesthetic direction, and moral forces shaping the civilized society. Universities also contribute in important ways to the economic health and physical landscape of neighborhoods and cities, serving as permanent fixtures of the urban economy and the built environment. Due to the size and location of university campuses, they put demands on the urban character, systems, and infrastructure of the neighboring communities. These demands or impacts have substantial implications for the built environment. It is important to understand the impacts university campuses have on their surrounding communities and urban environments because the destiny of the university is inextricably linked to the destiny of the adjacent neighborhoods. This paper identifies the diverse factors generated by universities in shaping the built environments of their local communities within different spatial contexts such as urban, rural, and township regions situated in South Africa.By applying a mixed methods approach in four university campuses within the province of KwaZulu-Natal in South Africa. Several data collection instruments were used, such as in-depth interviews, a survey, remote sensing, and onsite observations. The thematic findings revealed numerous factors which influence the morphology of neighbourhood built environments and the myriad of relationships the university has with its local community. This paper also reveals that the university campus is more than a precinct which accommodates buildings and academic endeavours, the role of the university in this century has changed dramatically from its traditional roots of being an elite enclave of academics to a more inclusive and engaged entity that is concerned about providing relevant holistic solutions to society’s current challenges in the built environment.

Keywords: university campus, built environment, architecture, neighborhood planning

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Authors: Radzuan Junin, Dayang Zulaika A. Hasbollah

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The increasing amount of greenhouse gasses in the atmosphere recently has become one of the discussed topics in relation with world’s concern on climate change. Developing countries’ emissions (such as Malaysia) are now seen to surpass developed country’s emissions due to rapid economic development growth in recent decades. This paper presents the potential storage sites suitability and storage capacity assessment for CO2 sequestration in sedimentary basins of Malaysia. This study is the first of its kind that made an identification of potential storage sites and assessment of CO2 storage capacity within the deep saline aquifers in the country. The CO2 storage capacity in saline formation assessment was conducted based on the method for quick assessment of CO2 storage capacity in closed, and semi-closed saline formations modified to suit the geology setting of Malaysia. Then, an integrated approach that involved geographic information systems (GIS) analysis and field data assessment was adopted to provide the potential storage sites and its capacity for CO2 sequestration. This study concentrated on the assessment of major sedimentary basins in Malaysia both onshore and offshore where potential geological formations which CO2 could be stored exist below 800 meters and where suitable sealing formations are present. Based on regional study and amount of data available, there are 14 sedimentary basins all around Malaysia that has been identified as potential CO2 storage. Meanwhile, from the screening and ranking exercises, it is obvious that Malay Basin, Central Luconia Province, West Baram Delta and Balingian Province are respectively ranked as the top four in the ranking system for CO2 storage. 27% of sedimentary basins in Malaysia were evaluated as high potential area for CO2 storage. This study should provide a basis for further work to reduce the uncertainty in these estimates and also provide support to policy makers on future planning of carbon capture and sequestration (CCS) projects in Malaysia.

Keywords: CO₂ storage, deep saline aquifer, GIS, sedimentary basin

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

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

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

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

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

Keywords: fertility, lactation, organic, pregnancy, vegetarian

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Authors: Meera Shanker

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

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

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

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

Keywords: musculoskeletal disorders, Nigeria, prevalence, real world

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Authors: Yuet Wah Echo Yeung

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

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

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Authors: Farzaneh Bahrami

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Different indicators, such as modal shares in mobility practices or car ownership, may suggest that the century of car dominance - at least in Europe and North America - is already behind us. If the emergence of the car had radical spatial and social consequences, what would be the implications of its gradual disappearance - which could be expected in the context of ecological consciousness, economic and energetic constraints as a result of both urban policies as well as lifestyle choices? To what extend shall urban experts account for this limited but visible transition from car-dominated systems towards alternative models of mobility in which the individual-motorized mobility (car) is not central; what models of urbanity could be imagined to support such a transformation? We have examined a selection of projects at different scales and within different contexts - new planned cities, dense urban areas or territories of dispersion – whose visions involve a significant shift from the current car system. We have been looking into their tools, strategies and different measures of car reduction, as well as their varied approaches to public space as an inevitable corollary to this change. The car’s dominance was formerly questioned by advocates of public space, rather than through interests in ecological urban design or other urban planning concerns. In the 60s already a universal longing for the qualities of traditional urban space led to a critique of the proliferation of fast roads, and thus the car’s colonization of everyday life. Reclamation of public space as the city’s quintessential social territory reappears today in contemporary discourses and reinforces the shift-provoking trends towards a new urbanity freed from car dominance. In a hypothetical process of the progressive phasing-out of the car, we shall expect fundamental transformations in spatial practices of the city, accompanied by the physical configuration of its public spaces. What will be the main characteristics of the new emerging spaces of sociability and where shall we encounter them? This contribution is an ongoing research within the framework of Post-Car World, an interdisciplinary project that explores the future of mobility through the role of the car.

Keywords: mobility, urbanity, future visions, public space

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

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

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

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Authors: Krizette Ladera

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

Keywords: cerebral palsy, children, fathers, lived experiences

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Authors: Riaz A. Agha, Alexander J. Fowler, Seon-Young Lee, Buket Gundogan, Katharine Whitehurst, Harkiran K. Sagoo, Kyung Jin Lee Jeong, Douglas G. Altman, Dennis P. Orgill

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Introduction: Case Series are an important and common study type. Currently, no guideline exists for reporting case series and there is evidence of key data being missed from such reports. We propose to develop a reporting guideline for case series using a methodologically robust technique. The first step in this process is a systematic review of literature relevant to the reporting deficiencies of case series. Methods: A systematic review of methodological and reporting quality in surgical case series was performed. The electronic search strategy was developed by an information specialist and included MEDLINE, EMBASE, Cochrane Methods Register, Science Citation index and Conference Proceedings Citation index, from the start of indexing until 5th November 2014. Independent screening, eligibility assessments and data extraction was performed. Included articles were analyzed for five areas of deficiency: failure to use standardized definitions missing or selective data transparency or incomplete reporting whether alternate study designs were considered. Results: The database searching identified 2,205 records. Through the process of screening and eligibility assessments, 92 articles met inclusion criteria. Frequency of methodological and reporting issues identified was a failure to use standardized definitions (57%), missing or selective data (66%), transparency, or incomplete reporting (70%), whether alternate study designs were considered (11%) and other issues (52%). Conclusion: The methodological and reporting quality of surgical case series needs improvement. Our data shows that clear evidence-based guidelines for the conduct and reporting of a case series may be useful to those planning or conducting them.

Keywords: case series, reporting quality, surgery, systematic review

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Authors: Boris Blostotsky, Elia Efraim

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Testing of columns in sway mode is performed in order to determine the maximal allowable load limited by plastic deformations or their end connections and a critical load limited by columns stability. Motivation to determine accurate value of critical force is caused by its using as follow: - critical load is maximal allowable load for given column configuration and can be used as criterion of perfection; - it is used in calculation prescribed by standards for design of structural elements under combined action of compression and bending; - it is used for verification of theoretical analysis of stability at various end conditions of columns. In the present work a new non-destructive method for determination of columns critical buckling load in sway mode is proposed. The method allows performing measurements during the tests under loads that exceeds the columns critical load without losing its stability. The possibility of such loading is achieved by structure of the loading system. The system is performed as frame with rigid girder, one of the columns is the tested column and the other is additional two-hinged strut. Loading of the frame is carried out by the flexible traction element attached to the girder. The load applied on the tested column can achieve a values that exceed the critical load by choice of parameters of the traction element and the additional strut. The system lateral stiffness and the column critical load are obtained by the dynamic method. The experiment planning and the comparison between the experimental and theoretical values were performed based on the developed dependency of lateral stiffness of the system on vertical load, taking into account a semi-rigid connections of the column's ends. The agreement between the obtained results was established. The method can be used for testing of real full-size columns in industrial conditions.

Keywords: buckling, columns, dynamic method, semi-rigid connections, sway mode

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Authors: Andriy Fedorenko

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

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

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Authors: Mahdi PourAsghar, Abbas Mas'udzadeh, Abdulhakim Tirgari, Saeed Dabiri Roushan, Hooman Rashidi, Fariba Salehi

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Objective: One of the major objectives in sports areas is to achieve maximum athletic performance. Physical and psychological preparations are the basic factors for achieving maximum performance in athletes. Unfortunately, in the field of physical preparation, we can see maximum attention and planning of trainers and sports officials. But despite the importance of psychological preparation of athletes and its serious and profound effect on athletic performance, the results of sports competitions show that less attention is paid to this topic, and it is less under the control of counselors and psychologists in different areas of our sport. Therefore, this study aimed to evaluate the attitude of athletes and coaches to sport psychology. Materials and methods: A descriptive study with a sample size of 234 elite athletes and 216 skilled coaches was conducted in different areas of sports, in Sari, Mazandaran in 2015.The instrument was a questionnaire consisting of two parts of demographic data and Martin questionnaire, assessing the attitude to sport psychology. The data from this study were analyzed using Spss version 18, descriptive statistics tests, and Chi-square test. Results: In this study, positive attitudes of participants in need and confidence towards sport psychology consultation in athletes and coaches group were 55/1 and 56/5 percent, respectively. The positive attitude of female athletes in belief to psychology consultation was more than male athletes. Athletes with higher education had more positive attitude towards the presence of psychologists and psychiatrists in fields of sports. Conclusion: According to the findings based on the need to the psychology consultation in different areas of sports, it is recommended that through training of specialists in the field of sport psychology and review of sports programs in different fields of sports, the presence of these counselors to maintain the psychological preparation of athletes to achieve maximum athletic performance and reduce anxiety and stress be used.

Keywords: Keywords: Athletes, Eliteathletes, Coaches, Attitude, Sport psychology.

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Authors: Antonia Harold-Barry, Eugene Dempsey

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

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

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Authors: Aikaterini Amanatidou

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

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

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Authors: Nurunnaher Nurunnaher

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

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

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Authors: Aleema Rahman

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

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

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