Search results for: felt emotion
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 859

Search results for: felt emotion

289 Energy Efficient Autonomous Lower Limb Exoskeleton for Human Motion Enhancement

Authors: Nazim Mir-Nasiri, Hudyjaya Siswoyo Jo

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The paper describes conceptual design, control strategies, and partial simulation for a new fully autonomous lower limb wearable exoskeleton system for human motion enhancement that can support its weight and increase strength and endurance. Various problems still remain to be solved where the most important is the creation of a power and cost efficient system that will allow an exoskeleton to operate for extended period without batteries being frequently recharged. The designed exoskeleton is enabling to decouple the weight/mass carrying function of the system from the forward motion function which reduces the power and size of propulsion motors and thus the overall weight, cost of the system. The decoupling takes place by blocking the motion at knee joint by placing passive air cylinder across the joint. The cylinder is actuated when the knee angle has reached the minimum allowed value to bend. The value of the minimum bending angle depends on usual walk style of the subject. The mechanism of the exoskeleton features a seat to rest the subject’s body weight at the moment of blocking the knee joint motion. The mechanical structure of each leg has six degrees of freedom: four at the hip, one at the knee, and one at the ankle. Exoskeleton legs are attached to subject legs by using flexible cuffs. The operation of all actuators depends on the amount of pressure felt by the feet pressure sensors and knee angle sensor. The sensor readings depend on actual posture of the subject and can be classified in three distinct cases: subject stands on one leg, subject stands still on both legs and subject stands on both legs but transit its weight from one leg to other. This exoskeleton is power efficient because electrical motors are smaller in size and did not participate in supporting the weight like in all other existing exoskeleton designs.

Keywords: energy efficient system, exoskeleton, motion enhancement, robotics

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288 Analyzing Doctors’ Knowledge of the United Kingdom Chief Medical Officer's Guidelines for Physical Activity: Survey of Secondary Care Doctors in a District General Hospital

Authors: Alexandra Von Guionneau, William Sloper, Charlotte Burford

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The benefits of exercise for the prevention and management of chronic disease are well established and the importance of primary care practitioners in promoting exercise is becoming increasingly recognized. However, those with severe manifestations of the chronic disease are managed in a secondary care setting. Secondary care practitioners, therefore, have a role to play in promoting physical activity. Methods: In order to assess secondary care doctors’ knowledge of the Chief Medical Officer’s guidelines for physical activity, a 12-question survey was administered to staff working in a district general hospital in South England during team and unit meetings. Questions related to knowledge of the current guidelines for both 19 - 64 year olds and older adults (65 years and above), barriers to exercise discussion or prescription and doctors’ own exercise habits. Responses were collected anonymously and analyzed using SPSS Version 24.0. Results: 96 responses were collected. Doctors taking part in the survey ranged from foundation years (26%) to consultants (40%). 17.7% of participants knew the guidelines for moderate intensity activity for 19 - 64 year olds. Only one participant knew all of the guidance for both 19 - 64 year olds and older adults. While 71.6% of doctors felt they were adequately informed about how to exercise, only 45.6% met the minimum recommended guidance for moderate intensity activity. Conclusion: More work is needed to promote the physical activity guidelines and exercise prescription to doctors working within a secondary care setting. In addition, doctors require more support to personally meet the recommended minimum level of physical activity.

Keywords: exercise is medicine, exercise prescription, physical activity guidelines, exercise habits

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287 Challenges in Implementing the Inculcation of Noble Values During Teaching by Primary Schools Teachers in Peninsular Malaysia

Authors: Mohamad Khairi Haji Othman, Mohd Zailani Mohd Yusoff, Rozalina Khalid

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The inculcation of noble values in teaching and learning is very important, especially to build students with good characters and values. Therefore, the purpose of this research is to identify the challenges of implementing the inculcation of noble values in teaching in primary schools. This study was conducted at four North Zone Peninsular Malaysia schools. This study was used a qualitative approach in the form of case studies. The qualitative approach aims at gaining meaning and a deep understanding of the phenomenon studied from the perspectives of the study participants and not intended to make the generalization. The sample in this study consists of eight teachers who teach in four types of schools that have been chosen purposively. The method of data collection is through semi-structured interviews used in this study. The comparative method is continuously used in this study to analyze the primary data collected. The study found that the main challenges faced by teachers were students' problems and class control so that teachers felt difficult to the inculcation of noble values in teaching. In addition, the language challenge is difficult for students to understand. Similarly, peers are also challenging because students are more easily influenced by friends rather than listening to teachers' instructions. The last challenge was the influence of technology and mass media electronic more widespread. The findings suggest that teachers need to innovate in order to assist the school in inculcating religious and moral education towards the students. The school through guidance and counseling teachers can also plan some activities that are appropriate to the student's present condition. Through this study, teachers and the school should work together to develop the values of students in line with the needs of the National Education Philosophy that wishes to produce intelligent, emotional, spiritual, intellectual and social human capital.

Keywords: challenges, implementation, inculcation, noble values

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286 An Analytical Study on the Politics of Defection in India

Authors: Diya Sarkar, Prafulla C. Mishra

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In a parliamentary system, party discipline is the impulse; when it falls short, the government usually falls. Conceivably, the platform of Indian politics suffers with innumerous practical disorders. The politics of defection is one such specie entailing gross miscarriage of fair conduct turning politics into a game of thrones (powers). This practice of political nomaditude can trace its seed in the womb of British House of Commons. Therein, if a legislator was found to cross the floor, the party considered him disloyal. In other words, the legislator lost his allegiance to his former party by joining another party. This very phenomenon, in practice has a two way traffic i.e. ruling party to the opposition party or vice versa. The democracies like USA, Australia and Canada were also aware of this fashion of swapping loyalties. There have been several instances of great politicians changing party allegiance, for example Winston Churchill, Ramsay McDonald, William Gladstone etc. Nevertheless, it is interesting to cite that irrespective of such practice of changing party allegiance, none of the democracies in the west ever desired or felt the need to legislatively ban defections. But, exceptionally India can be traced to have passed anti-defection laws. The politics of defection had been a unique popular phenomenon on the floor of Indian Parliamentary system gradually gulping the democratic essence and synchronization of the Federation. This study is both analytical and doctrinal, which tries to examine whether representative democracy has lost its essence due to political nomadism. The present study also analyzes the classical as well as contemporary pulse of floor crossing amidst dynastic politics in a representative democracy. It will briefly discuss the panorama of defections under the Indian federal structure in the light of the anti-defection law and an attempt has been made to add valuable suggestions to streamline remedy for the still prevalent political defections.

Keywords: constitutional law, defection, democracy, polarization, political anti-trust

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285 Service Evaluation of Consent for Hand and Wrist Surgery and Formulation of Evidence-Based Guidelines

Authors: Parsa Keyvani, Alistair Phillips, David Warwick

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Background: The current process for gaining patient consent for hand and wrist surgery at University Hospital Southampton (UHS) is paper-based and makes use of generic forms provided by the NHS and no patient information leaflet is available relating to hand and wrist surgery. Aims: To evaluate the process of obtaining clinical consent and suggest ways in which the service can be improved. Methods: A log-book review of four orthopaedic surgeons at UHS was carried out over a three-month period in order to identify the 10 most common types of elective hand and wrist surgeries performed. A literature review was carried out to identify the complications of these surgeries. The surgeries were then divided into 6 types: nerve, bone, ligament, joint, tendon and dupuytren’s surgery. A digitised consent form was created covering the complications of all 6 surgery types. Finally, the surgeons at the orthopaedic department of UHS were asked whether they prefer the old paper-based or the digitised consent form. Results: All of the surgeons felt that the procedure type-based form was easier to read, use and understand. Conclusion: This research highlights a number of problems related to the use of current NHS consent forms. The proposed solution is to use a set of digitised, procedure type-based consent forms. Digital consent forms can be filled in in advance and sent to the patient electronically along with any relevant information leaflets, thus giving them time to absorb the information and come up with any questions before they have their pre-procedure discussion with their doctor. This would allow the doctor to focus the consultation on the patient rather than writing out the consent form and would ultimately be a step forward in making the NHS a global digital leader and fully embrace the opportunity offered by technology.

Keywords: digitised consent form, elective surgery, hand surgery complications, informed consent, procedure type-based consent form

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284 Students’ Academic and Personal Needs: Basis for a Guidance Program

Authors: Susan Marie R. De La Cruz, Bernadette F. De La Cruz, Georgia D. Demavibas

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This study determined the top 10 perceived students’ academic needs, personal needs, personal obstacles in achieving their academic goals, are as they need assistance, and their perceived feelings in math, reading and writing. The North Carolina State College, Student Support Services needs assessment survey was used. The respondents were the randomly chosen122Graduate school students. The top 10 academic needs are as follows: need to improve memory, communication skills, study habits, time management skills, career decisions, vocabulary, math skills, test taking skills, reading comprehension, and the need to reduce math anxiety. Top 10 personal needs are as follows: difficulty meeting deadline, difficulty managing money, inadequate computer skills, afraid of failing graduate school, difficulty participating in class/group discussions, absence from school, anxiety during exams, little or no experience with internet, personal counseling needs, and unsure of university academic procedures. Students’ top 10 perceived personal obstacles were as follows: issues surrounding sickness in family, lack of time management, lack of money, feeling tired, fears to speak in class, poor study habits, problems at home, late in class, too shy, and always feeling sick and easily distracted. Students felt need assistance in areas surrounding personal budget, stress management, motivation, anxiety, depressions, leadership development and goals/decision making. It is recommended that enrichment activities be provided to respond to students’ academic and personal needs. Also, Graduate School Guidance Counselor collaborates with other licensed Guidance Counselors in other colleges to have a well-coordinated and effective delivery of services responsive to students’ needs.

Keywords: academic needs, guidance counsellors, guidance service, needs assessment survey, personal needs, student services

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283 Disaster Education and Children with Visual Impairment

Authors: Vassilis Argyropoulos, Magda Nikolaraizi, Maria Papazafiri

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This study describes a series of learning workshops, which took place within CUIDAR project. The workshops aimed to empower children to share their experiences and views in relation to natural hazards and disasters. The participants in the workshops were ten primary school students who had severe visual impairments or multiple disabilities and visual impairments (MDVI). The main objectives of the workshops were: a) to promote access of the children through the use of appropriate educational material such as texts in braille, enlarged text, tactile maps and the implementation of differentiated instruction, b) to make children aware regarding their rights to have access to information and to participate in planning and decision-making especially in relation to disaster education programs, and c) to encourage children to have an active role during the workshops through child-led and experiential learning activities. The children expressed their views regarding the meaning of hazards and disasters. Following, they discussed their experiences and emotions regarding natural hazards and disasters, and they chose to place the emphasis on a hazard, which was more pertinent to them, their community and their region, namely fires. Therefore, they recalled fires that have caused major disasters, and they discussed about the impact that these fires had on their community or on their country. Furthermore, they were encouraged to become aware regarding their own role and responsibility to prevent a fire or get prepared and know how to behave if a fire occurs. They realized that prevention and preparation are a matter of personal responsibility. They also felt the responsibility to inform their own families. Finally, they met important people involved in fire protection such as rescuers and firefighters and had the opportunity to carry dialogues. In conclusion, through child led workshops, experiential and accessible activities, the students had the opportunity to share their own experiences, to express their views and their questions, to broaden their knowledge and to realize their personal responsibility in disaster risk reduction, specifically in relation to fires.

Keywords: accessibility, children, disasters, visual impairment

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282 Autism Management in Ghana: Comparative Analyses of Creative Art forms

Authors: Edwina Owusu Panin, Kwame Baah Owusu Panin

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This abstract intends to demonstrate multiple strategies of autism management in Ghana by exploring the possibilities. The advantages of adopting creative art forms as a therapeutic method. Autism is a developmental disorder that includes social interaction, communication, and repetitive behaviours. In Ghana, as in many other countries, there is a rising demand for effective intervention and support for people with autism and their families. Creative arts such as music, dance, drama and visual arts have shown promise in promoting communication, social interaction and inclusion of people with autism. These art forms provide alternative channels for self-expression and can be powerful tools for autistic people to interact with the world, their friends and families around them. Creative art forms interventions have been found to improve social skills, improve emotion regulation, promote creativity and increase self-confidence in people with autism. This study examines existing programs and interventions in Ghana involving creative art forms for people with autism through a comparative analysis. It explores the different approaches, methods and results of these interventions. By comparing and evaluating these programs, the study aims to identify best practices, challenges and areas for development in managing autism through the creative arts in Ghana. Although many schools and rehabilitation centres employ various forms in therapeutic approaches for autism. There is no comparative analysis of which type of autism and which creative art forms is suitable. The results of this study will contribute to the development of evidence-based practices for the management of autism in Ghana. It provides valuable information about the effectiveness of creative arts interventions and helps inform policy makers, educators, therapists and other stakeholders involved in autism support. Ultimately, the goal is to improve the well-being and quality of life of people with autism in Ghana and their families by promoting inclusive and accessible interventions that harness the power of creative art forms.

Keywords: autism, therapeutic, creative art, art form

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281 COVID-19 and Heart Failure Outcomes: Readmission Insights from the 2020 United States National Readmission Database

Authors: Induja R. Nimma, Anand Reddy Maligireddy, Artur Schneider, Melissa Lyle

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Background: Although heart failure is one of the most common causes of hospitalization in adult patients, there is limited knowledge on outcomes following initial hospitalization for COVID-19 with heart failure (HCF-19). We felt it pertinent to analyze 30-day readmission causes and outcomes among patients with HCF-19 using the United States using real-world big data via the National readmission database. Objective: The aim is to describe the rate and causes of readmissions and morbidity of heart failure with coinciding COVID-19 (HFC-19) in the United States, using the 2020 National Readmission Database (NRD). Methods: A descriptive, retrospective study was conducted on the 2020 NRD, a nationally representative sample of all US hospitalizations. Adult (>18 years) inpatient admissions with COVID-19 with HF and readmissions in 30 days were selected based on the International Classification of Diseases-Tenth Revision, Procedure Code. Results: In 2020, 2,60,372 adult patients were hospitalized with COVID-19 and HF. The median age was 74 (IQR: 64-83), and 47% were female. The median length of stay was 7(4-13) days, and the total cost of stay was 62,025 (31,956 – 130,670) United States dollars, respectively. Among the index hospital admissions, 61,527 (23.6%) died, and 22,794 (11.5%) were readmitted within 30 days. The median age of patients readmitted in 30 days was 73 (63-82), 45% were female, and 1,962 (16%) died. The most common principal diagnosis for readmission in these patients was COVID-19= 34.8%, Sepsis= 16.5%, HF = 7.1%, AKI = 2.2%, respiratory failure with hypoxia =1.7%, and Pneumonia = 1%. Conclusion: The rate of readmission in patients with heart failure exacerbations is increasing yearly. COVID-19 was observed to be the most common principal diagnosis in patients readmitted within 30 days. Complicated hypertension, chronic pulmonary disease, complicated diabetes, renal failure, alcohol use, drug use, and peripheral vascular disorders are risk factors associated with readmission. Familiarity with the most common causes and predictors for readmission helps guide the development of initiatives to minimize adverse outcomes and the cost of medical care.

Keywords: Covid-19, heart failure, national readmission database, readmission outcomes

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280 Design and Emotion: The Value of 1970s French Children’s Books in the Middle East

Authors: Tina Sleiman

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In the early 1970s, a graphics revolution - in quantity and quality - marked the youth publications sector in France. The increased interest in youth publications was supported with the emergence of youth libraries and major publishing houses. In parallel, the 'Agence de Cooperation Culturelle et Technique' (currently the International Organization of the Francophonie) was created, and several Arab countries had joined as members. In spite of political turmoil in the Middle East, French schools in Arab countries were still functioning and some even flourishing. This is a testament that French culture was, and still is, a major export to the region. This study focuses on the aesthetic value of the graphic styles that characterize French children’s books from the 1970s, and their personal value to Francophone people who have consumed these artifacts, in the Middle East. The first part of the study looks at the artifact itself: starting from the context of creation and consumption of these books, and continuing to the preservation and remaining collections. The aesthetic value is studied and compared to similar types of visuals of juxtaposed time periods. The second part examines the audience’s response to the visuals in terms of style recognition or identification, along with emotional significance or associations, and the personal value the artifacts might hold to their consumers. The methods of investigation consist of a literature review, a survey of book collections, and a visual questionnaire, supported by personal interviews. As an outcome, visual patterns will be identified: elements from 1970s children’s books reborn in contemporary youth-based publications. Results of the study shall inform us directly on the aesthetic and personal value of illustrated French children’s books in the Middle East, and indirectly on the capacity of youth-targeted design to create a long-term emotional response from its audience.

Keywords: children’s books, French visual culture, graphic style, publication design, revival

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279 Caregiver’s Perception Regarding Diagnosis Disclosure to Children Living with Human Immunodeficiency Virus in Resource-Limited Settings: Observational Study from India

Authors: Ramesh Chand Chauhan, Sanjay Kumar Rai, Shashi kant, Rakesh Lodha, Nand Kumar

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Background: With a better understanding of HIV pathogenesis and availability of antiretroviral therapy more children are growing and entering in teenage group; informing children of their own HIV status has become an important aspect of long-term disease management. There is little evidence of how and when this type of disclosure takes place in a resource-limited setting. Methods: A cross-sectional study was conducted from June 2010 to May 2011 among a dyads of 156 HIV-infected children and their caregivers, those were visiting pediatric clinic at a tertiary care hospital in Delhi, India. The study protocol was approved by the Institute Ethics Committee. After taking written informed consent; pretested structured questionnaire was administered to caregivers during routine clinic visits. Information regarding socio-demographic characteristics, awareness of HIV infection status among children and their perception regarding disclosure was collected. Mean and frequencies were calculated and chi-square and logistic regression test were applied. Results: The mean age of children was 8.4 ±3.45 years. Among them 73.7% were male and 39.1% were orphans. Among 156 enrolled children, 74.4% (n=116) were of ≥ 6 years and were assessed for disclosure. Only 18.1% (n=21) children had been informed of their HIV status. Of those under 9 years, 6.4% knew their status, whereas 18.4% of 9-11 years and 35.5% of 12-14 years children knew they had HIV. Awareness among males (23.3%) was higher than females (3.3%). Both age and sex of child were significantly (p<0.01) associated with disclosure status. Other factors favoring disclosure were orphan-hood, non-perinatal mode of transmission (OR = 4.32; 95% CI 1.01-7.12), ART initiation (OR = 4.21; 95% CI 1.03-6.98), and caregiver educated beyond primary level (OR = 1.89; 95% CI 1.03-3.26). Repeated enquiry regarding the visit to clinic was the most common reason (66.6%) for disclosure. In 52.4% children disclosure was done with the involvement of other family members. 82.5% caregivers felt the age of > 10 years is appropriate for disclosing the HIV infection status to the child. Conclusion: Detailed guidelines on disclosure are required focusing on children of school-going age with perinatal infection who are not on ART and with caregivers of low educational status.

Keywords: HIV, children, India, disclosure

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278 Tanzanian Food Origins and Protected Geographical Indications

Authors: Innocensia John, Henrik Egelyng, Razack Lokina

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As the world`s population is constantly growing, food security has become a thorny trending issue. The impact has particularly been felt more in Africa as most of the people depend on food Agriculture products. Geographical Indications can aid in transforming the Tanzania agriculture-dependent economy through tapping the unique attributes of their quality products like soil, taste color etc. Consumers worldwide demand more uniquer products featuring a ´connect´ with the land use systems producing particular qualities. Tanzania has demonstrated the capacity to tap into the organic world market and has untapped potential for harvesting market value from geographical indications. This paper presents preliminary results from VALOR — a research project investigating conditions under which Tanzanian origin food producers can add value by incorporating territory specific cultural, environmental and social qualities into marketing, production and processing of unique local, niche and specialty products. Cases are investigated of the prospects for Tanzania to leapfrog perhaps into exports of geographical indications products, and certainly into allowing smallholders to create employment and build monetary value, while stewarding local food cultures and natural environments and resources, and increasing the diversity of supply of natural and unique quality products and so contribute to enhanced food security. Rice from Kyela, coffee and Sugar from Kilimanjaro, are some of the product cases investigated and provides for the in-depth case study, as ´landscape´ products incorporating ´taste of place´. Framework conditions for producers creating or capturing market value as stewards of cultural and landscape values and environments and institutional requirements for such creation or capturing to happen, including presence of export opportunities, are discussed.

Keywords: food origins, food security, protected geographical indications, case study analysis

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277 Psychological Resilience Factors Associated with Climate Change Adaptations by Subsistence Farmers in a Rural Community, South Africa

Authors: Kgopa Bontle, Tholen Sodi

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Climate change poses a major threat to the well-being of both people and the environment, with subsistence farmers most affected as they rely on local supply systems that are sensitive to climate variation. This study documented psychological resilience factors associated with climate change adaptations by subsistence farmers in Maruleng Municipality, Limpopo Province. A qualitative study was conducted to examine the notions of climate change by subsistence farmers, the psychological resilience factors, the strategies to cope with climate change, adaptation methods, and the development of subsistence farmers’ psychological resilience factors model. Data were collected through direct interactions with participants using a grounded theory research design. An open-ended interview was used to collect data with a sample of 15 participants selected through theoretical sampling in Maruleng Municipality. The participants were both Sepedi and Xitsonga speaking from 2 villages, mostly unemployed, pensioners and dependent on social grants. The study included both males and females who were predominately the elderly. The research findings indicate that farmers have limited knowledge of what climate change is and what causes it. Furthermore, the research reflects that although their responses were non-scientific but sensible enough to know what they were dealing with. They mentioned extreme weather, which includes hot days and less rainfall and changes in seasons, as some of the impacts brought by climate change. The results also indicated that participants have learned to adapt through several adaptation strategies, including mulching, changes in irrigation time slots and being innovative. The resilience factors that emerged from the study were a passion for farming, hope, enthusiasm, courage, acceptance/tolerance, livelihood and belief systems. Looking at the socio-economic factors of the current study setting argumentation leads to the conclusion that it is important that government should assist the subsistence farmers as it was observed from the participants that they felt neglected by the government and policymakers as they are small scale farmers and are not included like commercial farmers.

Keywords: climate change, psychological resilience factors, human adaptation, subsistence farmers

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276 Creating Complementary Bi-Modal Learning Environments: An Exploratory Study Combining Online and Classroom Techniques

Authors: Justin P. Pool, Haruyo Yoshida

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This research focuses on the effects of creating an English as a foreign language curriculum that combines online learning and classroom teaching in a complementary manner. Through pre- and post-test results, teacher observation, and learner reflection, it will be shown that learners can benefit from online programs focusing on receptive skills if combined with a communicative classroom environment that encourages learners to develop their productive skills. Much research has lamented the fact that many modern mobile assisted language learning apps do not take advantage of the affordances of modern technology by focusing only on receptive skills rather than inviting learners to interact with one another and develop communities of practice. This research takes into account the realities of the state of such apps and focuses on how to best create a curriculum that complements apps which focus on receptive skills. The research involved 15 adult learners working for a business in Japan simultaneously engaging in 1) a commercial online English language learning application that focused on reading, listening, grammar, and vocabulary and 2) a 15-week class focused on communicative language teaching, presentation skills, and mitigation of error aversion tendencies. Participants of the study experienced large gains on a standardized test, increased motivation and willingness to communicate, and asserted that they felt more confident regarding English communication. Moreover, learners continued to study independently at higher rates after the study than they had before the onset of the program. This paper will include the details of the program, reveal the improvement in test scores, share learner reflections, and critically view current evaluation models for mobile assisted language learning applications.

Keywords: adult learners, communicative language teaching, mobile assisted language learning, motivation

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275 Verification of a Simple Model for Rolling Isolation System Response

Authors: Aarthi Sridhar, Henri Gavin, Karah Kelly

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Rolling Isolation Systems (RISs) are simple and effective means to mitigate earthquake hazards to equipment in critical and precious facilities, such as hospitals, network collocation facilities, supercomputer centers, and museums. The RIS works by isolating components acceleration the inertial forces felt by the subsystem. The RIS consists of two platforms with counter-facing concave surfaces (dishes) in each corner. Steel balls lie inside the dishes and allow the relative motion between the top and bottom platform. Formerly, a mathematical model for the dynamics of RISs was developed using Lagrange’s equations (LE) and experimentally validated. A new mathematical model was developed using Gauss’s Principle of Least Constraint (GPLC) and verified by comparing impulse response trajectories of the GPLC model and the LE model in terms of the peak displacements and accelerations of the top platform. Mathematical models for the RIS are tedious to derive because of the non-holonomic rolling constraints imposed on the system. However, using Gauss’s Principle of Least constraint to find the equations of motion removes some of the obscurity and yields a system that can be easily extended. Though the GPLC model requires more state variables, the equations of motion are far simpler. The non-holonomic constraint is enforced in terms of accelerations and therefore requires additional constraint stabilization methods in order to avoid the possibility that numerical integration methods can cause the system to go unstable. The GPLC model allows the incorporation of more physical aspects related to the RIS, such as contribution of the vertical velocity of the platform to the kinetic energy and the mass of the balls. This mathematical model for the RIS is a tool to predict the motion of the isolation platform. The ability to statistically quantify the expected responses of the RIS is critical in the implementation of earthquake hazard mitigation.

Keywords: earthquake hazard mitigation, earthquake isolation, Gauss’s Principle of Least Constraint, nonlinear dynamics, rolling isolation system

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274 On Space Narrative and American Dream in Martin Eden

Authors: Yangyang Zhang

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Martin Eden tells about the tragedy of the protagonist Martin Eden’s suicide after his disillusion about American dream. The author Jack London presents various spatial routines of Martin Eden and reveals the involvement of space in realizing American dream: on the one hand, the Berkeley and Oakland cities contribute to Martin’s material success, making his American dream practical, and on the other hand, the two cities involve in the oppression of bourgeoisie ideology to Martin, promoting the domestic imperialization of bourgeoisie ideology represented by American dream. Molded by bourgeoisie ideology in the city, Martin constructed the oriental South Sea, revealing the oversea imperialization of bourgeoisie ideology behind American dream. By exploring the social, historical and political aspects of space, Martin Eden tries to demonstrate the mere material success and imperialism represented by American dream, revealing the fact of the involvement of American dreamin ideological oppression. When Jack London wrote Martin Eden, he had become a famous writer and realized his personal "American dream". He integrated his struggle experience into the protagonist Martin Eden, and also put his critique of the nature of "American dream" in the novel. The concept of the "American Dream" made the United States the land of dreams, and it also made many Americans believe that through personal struggle, they could climb the social ladder. Under the context of rapid growth in economy in the late 19 th century, American dream was reduced to the satisfaction on a material level. When material wealth was fulfilled, many people felt shattered for a variety of reasons, and such a phenomenon was reflected in the literature of disillusionment in 19th-century America.Martin Eden is such a work about disillusion, in which the geographical space becomes the witness of the realization and disillusionment of the protagonist Martin's "American dream". By analyzing the spatial narrative in Martin Eden, this paper reveals that the "American dream" only represents material success for individuals and the imperialization of capitalist ideology, and exposes the ideological nature of the "American Dream".

Keywords: Martin Eden, space, American dream, ideology of imperialism

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273 Gendering the Political Crisis in Hong Kong: A Cultural Analysis of Spectatorship on Marvel Superhero Movies in Hong Kong

Authors: Chi S. Lee

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Marvel superhero movies have obtained its unprecedented popularity around the globe. It is a dominant narrative in current scholarship on superhero studies that the political trauma of America, such as attack of September 11, and the masculinity represented in superhero genre are symbolically connected in a way of remasculinization, a standardized plot that before becoming a superhero, a man has to overcome its trauma in his life. Through this standardized plot, American audience finds their pleasure in the spectatorship of equating this plot of remasculinization with the situation of America, rewriting their traumatic memory and resolving around the economic, social, political, and psychological instability of precarity in their own context. Shifting the context to Hong Kong, where Marvel superhero movies have been reaching its dominant status in the local film market, this analysis finds its limitation in explaining the connection between text and context. This article aims to retain this connection through investigation of the Hong Kong audience’s spectatorship. It is argued that the masculinity represented in Marvel superhero movies no longer fits into the stereotypical image of superhero, but presents itself in crisis. This crisis is resolved by the technological excess of the superpower, namely, technological remasculinization. The technological remasculinization offers a sense of futurity through which it is felt that this remasculinization can be achieved in the foreseeable future instead of remaining imaginary and fictional. In this way, the political crisis of Hong Kong is gendered as masculinity in crisis which is worth being remasculinized in the future. This gendering process is a historical product as the symbolic equation between politics and masculinity has for long been encoded in the colonial history of Hong Kong. In short, Marvel superhero’s masculinity offers a sense of masculine hope for the Hong Kong audiences to overcome the political crisis they confront in reality through a postponed identification with the superhero’s masculinity. After the discussion of the Hong Kong audience’s spectatorship on Marvel superhero movies with the insights casted by spectatorship theory, above idea is generated.

Keywords: political crisis in Hong Kong, Marvel superhero movies, spectatorship, technological remasculinization

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272 A History of Taiwan’s Secret Nuclear Program

Authors: Hsiao-ting Lin

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This paper analyzes the history of Taiwan’s secret program to develop its nuclear weapons during the Cold War. In July 1971, US President Richard Nixon shocked the world when he announced that his national security adviser Henry Kissinger had made a secret trip to China and that he himself had accepted an invitation to travel to Beijing. This huge breakthrough in the US-PRC relationship was followed by Taipei’s loss of political legitimacy and international credibility as a result of its UN debacle in the fall that year. Confronted with the Nixon White House’s opening to the PRC, leaders in Taiwan felt being betrayed and abandoned, and they were obliged to take countermeasures for the sake of national interest and regime survival. Taipei’s endeavor to create an effective nuclear program, including the possible development of nuclear weapons capabilities, fully demonstrates the government’s resolution to pursue its own national policy, even if such a policy was guaranteed to undermine its relations with the United States. With hindsight, Taiwan’s attempt to develop its own nuclear weapons did not succeed in sabotaging the warming of US-PRC relations. Worse, it was forced to come to a full stop when, in early 1988, the US government pressured Taipei to close related facilities and programs on the island. However, Taiwan’s abortive attempt to develop its nuclear capability did influence Washington’s and Beijing’s handling of their new relationship. There did develop recognition of a common American and PRC interest in avoiding a nuclearized Taiwan. From this perspective, Beijing’s interests would best be served by allowing the island to remain under loose and relatively benign American influence. As for the top leaders on Taiwan, such a policy choice demonstrated how they perceived the shifting dynamics of international politics in the 1960s and 1970s and how they struggled to break free and pursue their own independent national policy within the rigid framework of the US-Taiwan alliance during the Cold War.

Keywords: taiwan, richard nixon, nuclear program, chiang Kai-shek, chiang ching-kuo

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271 Increasing Sexual Safety Awareness and Capacity for Mental Health Professionals

Authors: Tara Hunter, Kristine Concepcion, Wendy Cheng, Brianna Pike, Jane Estoesta, Anne Stuart

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In 2015, Family Planning NSW was contracted by the NSW Ministry of Health to design and deliver Sexual Safety Policy training (SSPT) to mental health professionals across NSW. The training was based on their current guidelines and developed in consultation with an expert reference group. From October 2015 to April 2017 it was delivered to over 2,400 mental health professionals with a view to supporting implementation of consistent prevention and intervention related to sexual safety in the mental health setting. An evaluation was undertaken to determine the knowledge and confidence of participants related to sexual safety before and after the training, and whether any improvements were translated into changes in practice. Participants were invited to complete a survey prior to the training, upon completion and three to six months thereafter. Telephone interviews were conducted among service managers and mental health champions six months post-training. Prior to training, the majority of mental health professionals reported being slightly to moderately confident in identifying a sexual safety incident. When asked on their understanding of sexual safety, gender sensitive practice and trauma informed care, they reported no confidence, slight confidence and moderate confidence. Immediately after the training, 54.5% reported being very confident and 10.9% extremely confident in identifying a sexual safety incident. More than half felt very confident or extremely confident in their understanding of sexual safety principles. The impact survey (six months later) found that the majority of participants (91%) were highly confident in identifying a sexual safety incident. Telephone interviewees reported a change in workplace culture and increased awareness after the training. Mental health professionals experienced increased knowledge and confidence about sexual safety principles following the training and were able to implement positive changes and concrete actions to better address sexual safety issues in their workplace.

Keywords: sexual safety, mental health professionals, trauma informed care, policy training

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270 Action Research: Visual Dialogue: A Strategy for Managing Emotion of Autistic Students with Intellectual Disabilities

Authors: Tahmina Huq

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Action research equips teachers with the skills needed to work on a particular situation in their classroom. This paper aims to introduce a strategy, visual dialogue between student and teacher, used by the researcher to help autistic students with intellectual disabilities to regulate their immediate emotions to achieve their academic goals. This research has been conducted to determine whether teaching self-regulation strategies can be effective instead of segregating them. The researcher has identified that visual dialogue between the student and teacher is a helpful technique for teaching self-regulation. For this particular research, action research suits the purpose as the findings can be applied immediately in the classroom. Like many autistic students, the teacher had two 15 years old autistic students with intellectual disabilities in class who had difficulty in controlling their emotions and impulses. They expressed their emotions through aggressive behavior, such as shouting, screaming, biting teachers or any adult who was in their sight, and destroying school property. They needed two to four hours to recover from their meltdowns with the help of a psychologist. The students missed the classes as they were often isolated from the classroom and stayed in the calming room until they calmed down. This negatively affected their learning. Therefore, the researcher decided to implement a self-regulation strategy, a visual dialogue between students and teachers, instead of isolating them to recover from the meltdown. The data was collected through personal observations, a log sheet, personal reflections, and pictures. The result shows that the students can regulate their emotions shortly in the classroom (15 to 30 minutes). Through visual dialogue, they can express their feelings and needs in socially appropriate ways. The finding indicates that autistic students can regulate their emotions through visual dialogues and participate in activities by staying in the classroom. Thus it positively impacted their learning and social lives. In this paper, the researcher discussed the findings of exploring how teachers can successfully implement a self-regulation strategy for autistic students in classroom settings. The action research describes the strategy that has been found effective for managing the emotions of autistic students with intellectual disabilities.

Keywords: action research, self-regulation, autism, visual communication

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269 Slave Museums and a Site of Democratic Pedagogy: Engagement, Healing and Tolerance

Authors: Elaine Stavro

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In our present world where acts of incivility, intolerance and anger towards minority communities is on the rise, the ways museum practices cultivate ethical generosity is of interest. Democratic theorists differ as to how they believe respect can be generated through active participation. Allowing minority communities a role in determining what artifacts will be displayed and how they will be displayed has been an important step in generating respect. In addition, the rise of indigenous museums, slave museums and curators who represent these communities, contribute to the communication of their history of oppression. These institutional practices have been supplemented by the handling of objects, recognition stories and multisensory exhibitions. Psychoanalysis, object relations theorists believe that the handling of objects: amenable objects and responsive listeners will trigger the expression of anomie, alienation and traumatizing experiences. Not only memorializing but engaging with one’s lose in a very personal way can facilitate the process of mourning. Manchester Museum (UK) gathered together Somalian refugees, who in the process of handling their own objects and those offered at the museum, began to tell their stories. Democratic theorists (especially affect theorists or vital materialists or Actor Network theorists) believe that things can be social actants- material objects have agentic capacities that humans should align with. In doing so, they challenge social constructivism that attributes power to interpreted things, but like them they assume an openness or responsiveness to Otherness can be cultivated. Rich sensory experiences, corporeal engagement (devices that involve bodily movement or objects that involve handling) auditory experiences (songs) all contribute to improve one’s responsiveness and openness to Others. This paper will focus specifically on slave museums/ and exhibits in the U.K, the USA., South Africa to explore and evaluate their democratic strategies in cultivating tolerant practices via the various democratic avenues outlined above.

Keywords: democratic pedagogy, slave exhibitions, affect/emotion, object handling

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268 Medical/Surgical Skills Day Improves Nurse Competence and Satisfaction

Authors: Betsy Hannam

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Background: Staff nurses felt overwhelmed to learn new skills or complete competencies during their shift. Med/Surg units need to provide dedicated, uninterrupted time to complete training and mandatory competencies and practice skills. Purpose: To improve nurse satisfaction and competence by creating a Skills Day with uninterrupted time to complete competencies, brush up on skills, and evaluate skills learned through pre- and post-tests. Methods: The USL and CNL interviewed nurses to obtain input regarding skills needing reinforcement and included mandatory competencies relevant to Med/Surg to create the Skills Day agenda. Content experts from multiple disciplines were invited to educate staff to help address knowledge gaps. To increase attendance, multiple class days were offered. Results: 2018 Skills Day was held for an inpatient unit with 95% participation (n=35 out of 37RNs). The average pretest score, comprised of content questions from topics discussed, was 57%, and post test scoresaveraged 80%. 94% of test scores improved or remained the same. RNs were given an evaluation at the end of the day, where100% of staff noted Skills Day as beneficial, and 97% requested to repeat next year. Another Med/Surg unit asked to join Skills Day in 2019. In 2019, with 89% participation (n=57 out 64 RNs), the average pretest score was 68%, and the average post test score was 85%. 97% of scores improved or remained the same. 98% reported the class as beneficial, and 96% requested to repeat next year. Skills Day 2020-2022 on hold due to COVID. Looking forward to Skills Day 2023. Conclusion: Skills Day allows nurses to maintain competencies and improve knowledge in areas of interest without the stress of a patient assignment. Having unit leaders organize Skills Day, with the involvement of content experts from multiple disciplines, showed to be a successful and innovative team approach to support professional development.

Keywords: education, competency, skills day, medical/surgical

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267 Health Tourists in Iran and Cultural Prejudices

Authors: Naeemeh Silvari

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The tourism industry is important for different nations in two ways. Apart from economic benefits, it provides a basis for getting acquainted with the culture of different regions of the world. Depending on the capacities and contexts of their geography, countries try to attract more people to their country in different ways. Health tourism has been an important branch of the tourism industry in recent years, and many countries around the world are trying to make progress in this field and attract many tourists from around the world. Iran, like many developing countries in the Middle East and East Asia, is trying to improve and develop tourist attractions in the field of health. Due to the cheapness of providing medical services to tourists, many people have traveled to Iran for medical and health care. However, there is a long way to go before recognizing and reaching the desired position in this field. Due to the direct relationship between tourism and culture, the negative attitude towards the context of Iran has caused foreign travelers not to choose this country as their tourist destination. In this article, we tried to study the change in their attitude towards Iran by using semi-structured interviews of foreign travelers who traveled to Iran for treatment and medical services. The text of the interviews was coded and analyzed by MAX QDA software. Many of the people in the sample were from Middle Eastern and Arabic-speaking countries. Influenced by the media, they felt rejected by the Iranians before the trip. During their stay in Iran and in connection with the health care staff, in the first stage, they pointed out that many of their anxieties about the kind of treatment of Iranians have been allayed. In addition to the satisfaction with the medical services provided, they considered the atmosphere of Iranians' interaction with foreign travelers to be relatively appropriate, and some stated that Iran would be the destination of their leisure trip in the future. At the end of the research, policymakers were suggested that in order to resolve cultural contradictions rooted in values, they should first be recognized and seek to use other opportunities to resolve contradictions and form interactions with other cultures.

Keywords: cultural conflict, health tourism, cultural prejudice, advertising and media

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266 Transitioning Classroom Students to Working Learners: Lived Experiences of Senior High School Work Immersion Students

Authors: Rico Herrero

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The study looked into the different lived experiences of senior high school to work immersion and how they were able to cope up in the transition stage from being classroom students into immersion students in work immersion site. The participants of the study were the ten senior high school students from Punta Integrated School. Using interview guide questions, the researchers motivated the participants to reveal their thoughts, feelings, and experiences in the interviews via video recording. The researchers utilized the qualitative research design, but the approach used was grounded theory. The findings revealed the participants’ lived experiences on how to cope or overcome the transition stage during the work immersion program. They unanimously responded to the interview questions. And based on the themes that emerged from the testimonies of the Senior High School students, the classroom learners benefited a lot from authentic learning opportunity of immersion program. Work immersion provides the students the opportunity to learn and develop their skills/ competencies related to the field of specialization. The hands-on training provides them simulation of work. They realized that theoretical learning in school is not enough to be equipped to work. Immersion program also provides venue for values and standard transformation. Senior High School students felt a high demand of self-confidence at the beginning of their race. Good thing, self-esteem of an individual helps bring out one’s potential at its best. Students find it challenging to get along with people in all ages. But, the endeavour absolutely helps them to grow maturely. Participants also realized that it’s not easy to deal with time pressure. Hence, the immersion program taught them to learn about time management. Part of the best training is to expose the learners to the harsh reality. Despite of the things that the school had taught them, still, students realized that they are not yet ready to deal with the demands of work. Furthermore, they also found out that they need to develop an interpersonal skill to improve their human relationships.

Keywords: grounded theory, lived experiences, senior high school, work immersion

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265 Supply Chain of Energy Resources and Its Alternatives Due to the Arab Spring: The Case of Egyptian Natural Gas Flow to Jordan

Authors: Moh’d Anwer Al-Shboul

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The year 2011 was a challenging year for Jordanian economy, which felt a variety of effects from the Arab Spring which took place in neighboring countries. Since February, 5th 2012, the Arab Gas Supply Pipeline, which carries natural gas from Egypt through the Sinai Peninsula and to Jordan and Israel, has been attacked more than 39 times. Jordan imported about 80 percent of its necessity of natural gas (about 250 million cubic feet of natural gas per day) from Egypt to generate particularly electricity, with the reminder of being produced locally. Jordan has utilized multiple alternatives to address the interruption of available natural gas supply from Egypt. The Jordanian distributed power plants now rely on the use of heavy fuel oil and diesel for electricity generation, in this case, it costs Jordan about four times than natural gas. The substitution of Egyptian natural gas supplies by fuel oil and diesel, coupled with the 32 percent rise in global fuel prices, has increased Jordan’s energy import bill by over 50 percent in 2011, reaching more than 16 percent of the 2011 GDP. The increase in the cost of electricity generation pushed the Jordanian economy to borrow from multiple internal and external resource channels, thus increasing the public debt. The Jordanian government’s short-term solution to the reduced natural gas supply from Egypt was alternatively purchasing the necessary quantities from some Gulf countries such as Qatar and/or Saudi Arabia, which can be imported with two possible methods. The first method is to rent a ship equipped with a liquefied natural gas (LNG) terminal, which is currently operating. The second method requires equipping the Aqaba port with an LNG terminal, which also currently is operating. In the long-term, a viable solution to depending on importing expensive and often unreliable natural gas supplies from surrounding countries is to depend more heavily on renewable supply energy, including solar, wind, and water energy.

Keywords: energy supply resources, Arab spring, liquefied natural gas, pipeline, Jordan

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264 The Strategy for Detection of Catecholamines in Body Fluids: Optical Sensor

Authors: Joanna Cabaj, Sylwia Baluta, Karol Malecha, Kamila Drzozga

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Catecholamines are the principal neurotransmitters that mediate a variety of the central nervous system functions, such as motor control, cognition, emotion, memory processing, and endocrine modulation. Dysfunctions in catecholamine neurotransmission are induced in some neurologic and neuropsychiatric diseases. Changeable neurotransmitters level in biological fluids can be a marker of several neurological disorders. Because of its significance in analytical techniques and diagnostics, sensitive and selective detection of neurotransmitters is increasingly attracting a lot of attention in different areas of bio-analysis or biomedical research. Recently, fluorescent techniques for detection of catecholamines have attracted interests due to their reasonable cost, convenient control, as well as maneuverability in biological environments. Nevertheless, with the observed need for a sensitive and selective catecholamines sensor, the development of a convenient method for this neurotransmitter is still at its basic level. The manipulation of nanostructured materials in conjunction with biological molecules has led to the development of a new class of hybrid modified biosensors in which both enhancement of charge transport and biological activity preservation may be obtained. Immobilization of biomaterials on electrode surfaces is the crucial step in fabricating electrochemical as well as optical biosensors and bioelectronic devices. Continuing systematic investigation in the manufacturing of enzyme–conducting sensitive systems, here is presented a convenient fluorescence sensing strategy for catecholamines detection based on FRET (fluorescence resonance energy transfer) phenomena observed for, i.e., complexes of Fe²⁺ and epinephrine. The biosensor was constructed using low temperature co-fired ceramics technology (LTCC). This sensing system used the catalytical oxidation of catecholamines and quench of the strong luminescence of obtained complexes due to FRET. The detection process was based on the oxidation of substrate in the presence of the enzyme–laccase/tyrosinase.

Keywords: biosensor, conducting polymer, enzyme, FRET, LTCC

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263 The Psychosis Prodrome: Biomarkers of the Glutamatergic System and Their Potential Role in Prediction and Treatment

Authors: Peter David Reiss

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The concept of the psychosis prodrome has allowed for the identification of adolescent and young adult patients who have a significantly elevated risk of developing schizophrenia spectrum disorders. A number of different interventions have been tested in order to prevent or delay progression of symptoms. To date, there has been no consistent meta-analytical evidence to support efficacy of antipsychotic treatment for patients in the prodromal state, and their use remains therefore inconclusive. Although antipsychotics may manage symptoms transiently, they have not been found to prevent or delay onset of psychotic disorders. Furthermore, pharmacological intervention in high-risk individuals remains controversial, because of the antipsychotic side effect profile in a population in which only about 20 to 35 percent will eventually convert to psychosis over a two-year period, with even after two years conversion rates not exceeding 30 to 40 percent. This general estimate is additionally problematic, in that it ignores the fact that there is significant variation in individual risk among clinical high-risk cases. The current lack of reliable tests for at-risk patients makes it difficult to justify individual treatment decisions. Preventive treatment should ideally be dictated by an individual’s risk while minimizing potentially harmful medication exposure. This requires more accurate predictive assessments by using valid and accessible prognostic markers. The following will compare prediction and risk modification potential of behavioral biomarkers such as disturbances of basic sense of self and emotion awareness, neurocognitive biomarkers such as attention, working and declarative memory, and neurophysiological biomarkers such as glutamatergic abnormalities and NMDA receptor dysfunction. Identification of robust biomarkers could therefore not only provide more reliable means of psychosis prediction, but also help test and develop new clinical interventions targeted at the prodromal state.

Keywords: at-risk mental state, biomarkers, glutamatergic system, NMDA receptor, psychosis prodrome, schizophrenia

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262 Impact of COVID-19 on Radiology Training in Australia and New Zealand

Authors: Preet Gill, Danus Ravindran

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These The COVID-19 pandemic resulted in widespread implications for medical specialist training programs worldwide, including radiology. The objective of this study was to investigate the impact of COVID-19 on the Australian and New Zealand radiology trainee experience and well-being, as well as to compare the Australasian experience with that reported by other countries. An anonymised electronic online questionnaire was disseminated to all training members of the Royal Australian and New Zealand College of Radiologists who were radiology trainees during the 2020 – 2022 clinical years. Trainees were questioned about their experience from the beginning of the COVID-19 pandemic in Australasia (March 2020) to the time of survey completion. Participation was voluntary. Questions assessed the impact of the pandemic across multiple domains, including workload (inpatient/outpatient & individual modality volume), teaching, supervision, external learning opportunities, redeployment and trainee wellbeing. Survey responses were collated and compared with other peer reviewed publications. Answer options were primarily in categorical format (nominal and ordinal subtypes, as appropriate). An opportunity to provide free text answers to a minority of questions was provided. While our results mirror that of other countries, which demonstrated reduced case exposure and increased remote teaching and supervision, responses showed variation in the methods utilised by training sites during the height of the pandemic. A significant number of trainees were affected by examination cancellations/postponements and had subspecialty training rotations postponed. The majority of trainees felt that the pandemic had a negative effect on their training. In conclusion, the COVID-19 pandemic has had a significant impact on radiology trainees across Australia and New Zealand. The present study has highlighted the extent of these effects, with most aspects of training impacted. Opportunities exist to utilise this information to create robust workplace strategies to mitigate these negative effects should the need arise in the future.

Keywords: COVID-19, radiology, training, pandemic

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261 A Real Time Set Up for Retrieval of Emotional States from Human Neural Responses

Authors: Rashima Mahajan, Dipali Bansal, Shweta Singh

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Real time non-invasive Brain Computer Interfaces have a significant progressive role in restoring or maintaining a quality life for medically challenged people. This manuscript provides a comprehensive review of emerging research in the field of cognitive/affective computing in context of human neural responses. The perspectives of different emotion assessment modalities like face expressions, speech, text, gestures, and human physiological responses have also been discussed. Focus has been paid to explore the ability of EEG (Electroencephalogram) signals to portray thoughts, feelings, and unspoken words. An automated workflow-based protocol to design an EEG-based real time Brain Computer Interface system for analysis and classification of human emotions elicited by external audio/visual stimuli has been proposed. The front end hardware includes a cost effective and portable Emotive EEG Neuroheadset unit, a personal computer and a set of external stimulators. Primary signal analysis and processing of real time acquired EEG shall be performed using MATLAB based advanced brain mapping toolbox EEGLab/BCILab. This shall be followed by the development of MATLAB based self-defined algorithm to capture and characterize temporal and spectral variations in EEG under emotional stimulations. The extracted hybrid feature set shall be used to classify emotional states using artificial intelligence tools like Artificial Neural Network. The final system would result in an inexpensive, portable and more intuitive Brain Computer Interface in real time scenario to control prosthetic devices by translating different brain states into operative control signals.

Keywords: brain computer interface, electroencephalogram, EEGLab, BCILab, emotive, emotions, interval features, spectral features, artificial neural network, control applications

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260 Shared Decision Making in Oropharyngeal Cancer: The Development of a Decision Aid for Resectable Oropharyngeal Carcinoma, a Mixed Methods Study

Authors: Anne N. Heirman, Lisette van der Molen, Richard Dirven, Gyorgi B. Halmos, Michiel W.M. van den Brekel

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Background: Due to the rising incidence of oropharyngeal squamous cell cancer (OPSCC), many patients are challenged with choosing between transoral(robotic) surgery and radiotherapy, with equal survival and oncological outcomes. Also, functional outcomes are of little difference over the years. With this study, the wants and needs of patients and caregivers are identified to develop a comprehensible patient decision aid (PDA). Methods: The development of this PDA is based on the International Patient Decision Aid Standards criteria. In phase 1, relevant literature was reviewed and compared to current counseling papers. We interviewed ten post-treatment patients and ten doctors from four head and neck centers in the Netherlands, which were transcribed verbatim and analyzed. With these results, the first draft of the PDA was developed. Phase 2 beholds testing the first draft for comprehensibility and usability. Phase 3 beholds testing for feasibility. After this phase, the final version of the PDA was developed. Results: All doctors and patients agreed a PDA was needed. Phase 1 showed that 50% of patients felt well-informed after standard care and 35% missed information about treatment possibilities. Side effects and functional outcomes were rated as the most important for decision-making. With this information, the first version was developed. Doctors and patients stated (phase 2) that they were satisfied with the comprehensibility and usability, but there was too much text. The PDA underwent text reduction revisions and got more graphics. After revisions, all doctors found the PDA feasible and would contribute to regular counseling. Patients were satisfied with the results and wished they would have seen it before their treatment. Conclusion: Decision-making for OPSCC should focus on differences in side-effects and functional outcomes. Patients and doctors found the PDA to be of great value. Future research will explore the benefits of the PDA in clinical practice.

Keywords: head-and-neck oncology, oropharyngeal cancer, patient decision aid, development, shared decision making

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